躁在汗下之后也。按二方之证，兼有外热而利，故虽脉微不加人参。四逆加人参汤，恶寒脉
微而身不热，故加之。夫利止脉不出者加人参，仲圣固明明言之。是其加参为脉微，非为利
止亡血。至茯苓四逆汤，乃少阴阳虚，上扰其心，故烦躁。以四逆扶阳而平躁，茯苓入肾而
抑阴，人参入心而去烦，各味俱有实义，何得以颟顸了之。二家之论方辨药，大率类是。又
不独二家为然。语有之，儒学医，菜作 。噫，岂易言哉！（集中人参未言治烦，故补论之。
）
邹氏云∶石膏体质最重，光明润泽，乃随击即解，纷纷星散，而丝丝纵列，无一缕横陈
，故其性主解横溢之热邪，此正石膏解肌之所以然。至其气味辛甘，亦兼具解肌之长；质重
而大寒，则不足于发汗。乃别录于杏仁曰解肌，于大戟曰发汗，石膏则以解肌发汗连称。岂
以仲圣尝用于发汗耶。不知石膏治伤寒阳明病之自汗，不治太阳病之无汗。若太阳表实而兼
阳明热郁，则以麻黄发汗，石膏泄热，无舍麻黄而专用石膏者。白虎汤治无表证之自汗，且
戒人以无汗勿与。即后世发表经验之方，亦从无用石膏者，所谓发表不远热也。然则解肌非
欤？夫白虎证至表里俱热，虽尚未入血成腑实，而阳明气分之热，已势成连衡，非得辛甘寒
解
非所以出汗。他如竹叶石膏汤、白虎加桂枝汤，非不用于无汗，而其证则非发表之证，学人
勿过泥别录可耳。
又王海藏谓石膏发汗，朱丹溪谓石膏出汗，皆以空文附和，未能实申其义。窃思方书石
膏主治，如时气肌肉壮热、烦渴、喘逆、中风、眩晕、阳毒发斑等证，无一可以发汗而愈者
。病之倚重石膏，莫如热疫。余师愚清瘟败毒散，一剂用至六两、八两，而其所着疫证一得
，则谆谆以发表致戒。顾松园以白虎汤治汪缵功阳明热证，每剂石膏用至三两，两服热顿减
，而遍身冷汗，肢冷发呃。群医哗然，阻勿再进。顾引仲圣热深厥深及喻氏阳证忽变阴厥万
中无一之说与辩。勿听。迨投参附回阳之剂，而汗益多，体益冷。复求顾诊。顾仍以前法用
石膏三两，而二服后即汗止身温。（见陆定圃冷庐医话）此尤可为石膏解肌不发汗之明证。
要
之顾
本经中风寒热四字，刘潜江、邹润安皆作两项看，甚是。惟邹以下文∶心下逆气惊喘口
干舌焦不能息，为即中风与寒热之候，强为牵合，殊不切当。刘谓∶阳不足而阴有余者，风
之虚也；阴不足而阳有余者，风之淫也。兹味之阴有余，正对待阳有余之证，而治其风淫。
讲石膏治中风极真，讲寒热则以五蒸汤内三焦之乍寒乍热用石膏释之，而五蒸汤却不仅恃石
膏除寒热也。窃思中风用石膏，如金匮风引汤、古今录验续命汤皆是；寒热用石膏，当以外
台石膏一味，治阳邪入里，传为骨蒸，令人先寒后热，渐成羸瘦，有汗而脉长者为切。又白
虎加人参汤，治太阳中热汗出恶寒身热而渴，亦可为石膏治寒热之据。然此二证，与阳虚之
寒，阴虚之热，伤寒有表证之恶寒，皆迥乎不同，未可漫施而不细辨也。
石膏甘淡入胃，辛入肺，体重易碎，亦升亦降，则入三焦。以清肃之寒，涤蒸郁之热，
只在三经气分而不入于血，其为胃药非脾药亦由于是。然则腹中坚痛，必苦寒入血如大黄，
方克胜任，即枳朴芍药，亦只堪用为臣使，石膏断不能攻坚而止痛。本经腹中坚痛四字，必
是后
仲圣方石膏麻黄并用，与大黄协附子变其性为温药相似。更设多方以增损而轩轾之，觉
变幻纷纭，令人目眩。然只认定麻黄散寒发汗，石膏泄热止汗，相为制还相为用。推此以求
，何方不可解，何方不可通。大青龙汤，咸以为发汗之猛剂矣。窃谓发汗之猛，当推麻黄汤
，不当推大青龙。麻黄汤中桂枝杏仁，皆堪为麻黄发汗效力，而无石膏以制麻黄。大青龙麻
黄受
，则曰脉浮缓，身不疼，但重。中风自较伤寒为轻。身不疼但重，自非但取解表。柯韵伯谓
∶大青龙方后之“汗出多者，温粉扑之，一服汗者，停后服，汗多亡阳，遂虚恶风，烦躁不
得眠也”宜移列麻黄汤后。盖从温服八合，并汗后烦躁与未汗烦躁悟出，可谓读书得间。诸
家震于青龙之名，念有汗多亡阳之戒，遂以麻黄得石膏，譬龙之兴云致雨。其于白虎非驱风
之方，小青龙无石膏亦名青龙，越婢麻膏之多如大青龙而不言取汗，皆有所难通，则罔顾也。
然则名大小青龙何哉？盖龙者屈伸飞潜不可方物，能召阳而化阴者也。麻黄能由至阴以达至
阳，而性味轻扬，得石膏芍药则屈而入里，得桂枝杏仁则伸而出表，石膏寒重之质，复辛甘
津润而解肌，并堪为麻黄策应，故名之曰大青龙。小青龙心下有水气，以石膏寒重而去之，
麻黄可任其发矣，而麻黄三两，芍药亦三两，麻黄虽发亦绌，其辛夏诸味，又皆消水下行，
盖龙之潜者，故名之曰小青龙。越婢汤之麻黄，亦制于石膏者，而故制之而故多之，则越婢
之证使然也。风水恶风，一身悉肿，脉浮不渴，种种皆麻黄证。惟里热之续自汗出，则不能
无石膏。有石膏故用麻黄至六两，石膏因有麻黄，故虽无大热而用至半斤。其不以石膏倍麻
黄者，化阴尤要于退阳也。或问越婢以汗出用石膏，大青龙以烦躁用石膏（别有说详麻黄），
无阳明热邪者，宜不得而用矣。乃伤寒脉浮缓、身不疼但重、乍有轻时，大青龙汤发之。徐
洄溪谓∶此条必有误。其信然乎？曰∶此正合青龙屈伸飞潜之义也。尤在泾云∶经谓脉缓者
多热，伤寒邪在表则身疼，邪入里则身重。寒已变热而脉缓，经脉不为拘急，故身不疼而但
重。而其脉犹浮，则邪气在或进或退之时，故身体有乍重乍轻之候也。不曰主之而曰发之者，
谓邪欲入里，而以药发之使从表出也。诠解之精，诸家不及。夫邪欲入里而以药发之，非麻
黄得石膏寒重之质，如青龙出而复入，入而复出，何能如是。若视石膏为汗药，麻黄不因石
膏而加多（诸家多作此误），则此条真大可疑矣。越婢石膏多于麻黄止二两，即不以龙名，
不以汗多示禁。大青龙石膏断不至如鸡子大一块。（别有说详麻黄）且石膏多则不能发汗，
又有可证者，麻杏甘膏汤之石膏倍麻黄是也。麻黄四两，虽不及大青龙之六两，而较麻黄汤
之三两，尚多一两。即杏仁少于麻黄汤二十枚，而麻黄一两，则非杏仁二十枚可比。此汤何
不用于无汗之证，而反用于汗出应止之证，则以石膏制麻黄，更甚于越婢耳。（方解别详麻
黄）石膏止阳明热炽之汗，亦止肺经热壅之喘。既有麻黄，原可不加杏仁，因麻黄受制力微，
故辅以杏仁解表间余邪。无大热而用石膏至半斤，其义与越婢正同。乃柯氏不察，改汗出而
喘无大热，为无汗而喘、大热，反谓前辈因循不改。不知用石膏正为汗出，若无汗而喘，乃
麻黄汤证，与此悬绝矣。更证之桂枝二越婢一汤，大青龙谓脉微弱，汗出恶风者，不可服，
此云脉微弱此无阳也，不可更汗，岂犹以麻黄发之，石膏寒之。夫不可更汗，必先已发汗，
或本有自汗。观其用桂枝汤全方而不去芍药可见。至又加以麻膏，则非与桂枝麻黄各半汤互
参不明。按桂枝麻黄各半汤，发热恶寒，热多寒少，与此同。而彼如疟状，脉微缓，有邪退
欲愈之象；若脉微非缓而恶寒，面反有热色，则以桂枝麻黄各半汤微汗之。此脉微弱而恶寒，
阳微之体，亦无自愈之理。桂枝汤所以和阳，协麻黄则散余寒而解表邪，法已备矣。加石膏
何为者，为热多耶？乃热多不过较多于寒。若脉非微弱，亦将如桂枝麻黄各半汤之欲愈，而
何热之足虑。然则加石膏者，专为阳虚不任麻黄之发，而以石膏制之，化峻厉为和平也。药
止七味，皆伤寒重证之选，而各大减其分数，遂为治余邪之妙法。用石膏而不以泄热，如大
黄之用以泻心，用以利小便，同一巧也。生姜多于他味者，以能辅桂甘生阳，又为石膏防弊
也。
烦躁出现在发汗或攻下治疗之后。考察这两个方剂的证候，都兼有体表发热且伴有腹泻，所以虽然脉象微弱也不加用人参。四逆加人参汤证，表现为恶寒、脉微而身体不发热，所以才加入人参。对于腹泻停止但脉搏摸不到的情况要加用人参，张仲景确实明确说过。这说明他加用人参是因为脉微，而不是因为腹泻停止导致的亡血。至于茯苓四逆汤，是由于少阴阳气虚衰，虚阳上扰心神，所以出现烦躁。用四逆汤扶助阳气以平息躁动，茯苓入肾以抑制阴邪，人参入心以去除烦闷，每一味药都有确切的含义，怎么能含糊了事呢。这两家对方剂和药物的辨析，大体都是如此。又不只是这两家如此。俗话说：“儒者学医，如同把蔬菜当作肉吃（意指隔靴搔痒，不得要领）。”唉，这哪里是容易说清楚的呢！（本集中人参未提及治疗烦躁，故在此补充论述。）
邹氏说：石膏质地最重，光泽润泽，敲击即碎，纷纷散落，且丝缕纵向排列，没有一缕横向陈列的，所以它的药性主要解除横溢的热邪，这正是石膏能“解肌”的原因所在。至于它的气味辛甘，也兼具解肌的功效；质地沉重且大寒，则不足以发汗。然而《名医别录》在杏仁条下说“解肌”，在大戟条下说“发汗”，对石膏却将“解肌”和“发汗”连称。难道是因为张仲景曾经用它来发汗吗？不知道石膏治疗的是伤寒阳明病的自汗，而不治疗太阳病的无汗。如果是太阳表实证兼有阳明热郁，就用麻黄发汗，石膏泄热，没有舍弃麻黄而专用石膏的道理。白虎汤治疗没有表证的自汗，并且告诫人们无汗时不要给予。即使是后世发表的经验方，也没有使用石膏的，这就是所谓的“发表不远热”。那么，难道说石膏不解肌吗？白虎汤证发展到表里俱热，虽然尚未入血分形成腑实，但阳明气分的热势已经形成内外呼应之势，非得用辛甘寒的药物来解肌，并不是为了出汗。其他如竹叶石膏汤、白虎加桂枝汤，并非不用于无汗的情况，但其证候并非需要发表的类型，学习的人不要过分拘泥于《名医别录》的说法。
另外，王海藏说石膏发汗，朱丹溪说石膏出汗，都是以空泛的文字附和，未能切实阐明其义。我思考方书中石膏的主治，如时行气温病肌肉壮热、烦渴、喘逆、中风、眩晕、阳毒发斑等证候，没有一个可以通过发汗而痊愈的。病情倚重石膏的，莫过于热疫。余师愚的清瘟败毒散，一剂用到六两、八两，而他著的《疫证一得》中，谆谆告诫不要发表。顾松园用白虎汤治疗汪缵功的阳明热证，每剂石膏用到三两，服两剂后热势顿减，但遍身冷汗，四肢冰冷，打呃。众医哗然，阻止不再进药。顾松园引用张仲景“热深厥深”及喻嘉言“阳证忽变阴厥万中无一”的说法进行辩解。众人不听。等到投用参附回阳的药剂，汗出更多，身体更冷。再次请求顾松园诊治。顾松园仍用前法，服用石膏三两，服两剂后汗止身温。（见陆定圃《冷庐医话》）这更是石膏解肌不发汗的明证。
总之，《本经》中提到的“中风、寒、热”三个字，刘潜江、邹润安都将其分为两项来看待，非常正确。只有邹氏以下文：“心下逆气惊喘口干舌焦不能息”，强行牵合为即是中风与寒热的证候，殊不恰当。刘潜江说：“阳气不足而阴气有余的，是风之虚证；阴气不足而阳气有余的，是风之淫证。”此药（石膏）的阴气有余，正是针对阳气有余的证候，从而治疗风淫之邪。讲石膏治疗中风极为真切，讲寒热则以五蒸汤内三焦的乍寒乍热用石膏来解释，但五蒸汤并不仅仅依靠石膏来除寒热。我认为中风用石膏，如《金匮要略》的风引汤、《古今录验》的续命汤都是；寒热用石膏，应当以外台秘要的石膏一味，治疗阳邪入里，传变为骨蒸，使人先寒后热，逐渐消瘦，有汗且脉长者为切当。另外，白虎加人参汤，治疗太阳中热症，汗出恶寒、身热而渴，也可以作为石膏治疗寒热的依据。然而这两种证候，与阳虚的寒、阴虚的热、伤寒有表证的恶寒，都截然不同，不可随意施用而不仔细辨别。
石膏味甘淡入胃，味辛入肺，体重易碎，既升又降，所以入三焦。以其清肃之寒，涤荡蒸郁之热，只在三经的气分而不进入血分，它是胃药而非脾药也是由此决定。那么腹中坚痛，必须用苦寒入血的药物如大黄，才能胜任，即使枳实、厚朴、芍药，也只堪用作臣使药，石膏绝对不能攻坚止痛。《本经》中“腹中坚痛”四字，必定是后人添加的。
张仲景的方剂中石膏与麻黄并用，与大黄协同附子改变其性质成为温药相似。再设立多方以增加或减少比较，觉得变幻纷纭，令人目眩。然而只要认定麻黄散寒发汗，石膏泄热止汗，二者相互制约又相互为用。推究这个原理，哪个方子不能理解，哪个方子不能通晓。大青龙汤，大家都认为是发汗的猛剂。我认为发汗之猛，应当推麻黄汤，不当推大青龙汤。麻黄汤中的桂枝、杏仁，都能为麻黄发汗效力，而没有石膏来制约麻黄。大青龙汤中麻黄受……（此处原文似有缺漏或语意未完，依上下文推断意为麻黄受到石膏制约），所以说脉浮缓，身体不疼，只觉沉重。中风自然比伤寒轻。身体不疼只觉沉重，自然不是单纯取解表。柯韵伯说：大青龙方后的“汗出多者，温粉扑之，一服汗者，停后服，汗多亡阳，遂虚恶风，烦躁不得眠也”宜移列在麻黄汤后。大概是从温服八合，以及汗后烦躁与未汗烦躁悟出的道理，可谓读书得间。诸家震惊于青龙之名，念及有汗多亡阳的戒律，于是认为麻黄得石膏，譬若龙之兴云致雨。这对于白虎汤非驱风之方、小青龙无石膏亦名青龙、越婢汤麻膏之多如大青龙而不言取汗等情况，都有所难通，则是罔顾事实。
那么为什么命名大小青龙呢？大概龙是屈伸飞潜不可比拟的，能召唤阳气而化生阴液的东西。麻黄能从至阴达至阳，且性味轻扬，得到石膏、芍药则屈而入里，得到桂枝、杏仁则伸而出表，石膏寒重之质，又具辛甘津润而解肌的特点，并能为麻黄策应，所以命名为大青龙。小青龙心下有 water qi（水气），用石膏寒重之性去之，麻黄可任其发汗，但麻黄三两，芍药亦三两，麻黄虽发亦显不足，其中的辛夏诸味，又都是消水下行，盖龙之潜藏者，所以命名为小青龙。越婢汤中的麻黄，也是被石膏所制约的，但故意制约而又故意多用，这是越婢汤的证候所致。风水恶风，一身悉肿，脉浮不渴，种种皆是麻黄证。唯独里有热而继续自汗出，则不能没有石膏。因为有石膏，所以用麻黄至六两；石膏因为有麻黄，所以虽无大热也用至半斤。不用石膏倍于麻黄的原因，在于化阴尤为重要于退阳。有人问：越婢汤因汗出用石膏，大青龙汤因烦躁用石膏（另有说法详见麻黄篇），如果没有阳明热邪，应该不得而用了吧？然而伤寒脉浮缓、身不疼但重、乍有轻时，用大青龙汤发之。徐洄溪说：这条必有错误。真的吗？我说：这正符合青龙屈伸飞潜的意义。尤在泾说：经文说脉缓者多热，伤寒邪在表则身疼，邪入里则身重。寒已变热而脉缓，经脉不为拘急，所以身不疼而但重。而其脉犹浮，则邪气在或进或退之时，所以身体有乍重乍轻的征候。不说“主之”而说“发之”，是说邪欲入里，而以药发之使其从表出。诠释之精妙，诸家不及。邪欲入里而以药发之，如果不是麻黄得到石膏寒重之质，如青龙出而复入，入而复出，怎么能做到这样。如果把石膏看作发汗药，麻黄不因石膏而加多（诸家多犯此误），那么这一条真的大可疑了。越婢汤石膏多于麻黄仅二两，即不以龙为名，不以汗多示禁。大青龙汤石膏断不至如鸡子大一块。（另有说法详见麻黄篇）而且石膏多则不能发汗，又有可证明的，麻杏甘膏汤中石膏倍于麻黄就是。麻黄四两，虽不及大青龙汤的六两，但较麻黄汤的三两，尚多一两。即杏仁少于麻黄汤二十枚，但麻黄一两，则非杏仁二十枚可比。此汤为何不用于无汗之证，反而用于汗出应止之证，是因为石膏制约麻黄，比越婢汤更甚罢了。（方解另详麻黄篇）石膏止住阳明热炽之汗，也止住肺经热壅之喘。既然有麻黄，原可不加杏仁，因麻黄受制力微，故辅以杏仁解表间余邪。无大热而用石膏至半斤，其义与越婢汤正相同。然而柯氏不察，将“汗出而喘无大热”改为“无汗而喘、大热”，反而谓前辈因循不改。不知道用石膏正是因为汗出，若无汗而喘，乃是麻黄汤证，与此截然相反。再佐证以桂枝二越婢一汤，大青龙汤谓脉微弱、汗出恶风者，不可服，此云脉微弱此为无阳也，不可更汗，岂还是用麻黄发之，石膏寒之。所谓不可更汗，必先已发汗，或本有自汗。观其用桂枝汤全方而不去芍药可见。至于又加以麻黄、石膏，则不与桂枝麻黄各半汤互参就不明白。按桂枝麻黄各半汤，发热恶寒，热多寒少，与此相同。而彼如疟状，脉微缓，有邪退欲愈之象；若脉微非缓而恶寒，面反有热色，则以桂枝麻黄各半汤微汗之。此脉微弱而恶寒，属阳微之体，也无自愈之理。桂枝汤所以和阳，协麻黄则散余寒而解表邪，法已备矣。加石膏做什么呢？是为热多吗？乃热多不过较多于寒。若脉非微弱，也将如桂枝麻黄各半汤之欲愈，那有什么热足虑。然而加石膏者，专为阳虚不任麻黄之发，而以石膏制之，化峻厉为和平也。药止七味，皆伤寒重证之选，而各大减其分数，遂为治余邪之妙法。用石膏而不以泄热，如大黄之用以泻心，用以利小便，同一巧也。生姜多于他味者，以能辅桂甘生阳，又为石膏防弊也。
Restlessness occurs after sweating or purging therapies. Examining the syndromes of these two formulas, both present with exterior heat accompanied by diarrhea; therefore, although the pulse is faint, Ginseng Radix et Rhizoma (Renshen) is not added. In Si Ni Jia Ren Shen Tang (Four Reversals plus Ginseng Decoction), the patient presents with aversion to cold and a faint pulse but no body heat, hence Ginseng is added. Regarding the addition of Ginseng when diarrhea stops but the pulse does not emerge, Zhang Zhongjing indeed stated this clearly. This indicates that his addition of Ginseng was due to the faint pulse, not because of blood loss following the cessation of diarrhea. As for Fu Ling Si Ni Tang (Poria Four Reversals Decoction), it arises from Shaoyin Yang deficiency, where deficient Yang disturbs the Heart, causing restlessness. Si Ni Tang supports Yang to calm restlessness; Poria (Fuling) enters the Kidney to suppress Yin; Ginseng enters the Heart to remove vexation. Each herb has a specific purpose; how can one dismiss it vaguely? The discussions on formulas and herbs by these two scholars are generally like this. It is not just these two scholars who do so. As the saying goes, "A Confucian scholar learning medicine is like treating vegetables as meat" (implying a superficial understanding). Alas, how difficult it is to speak of! (In the original collection, Ginseng's ability to treat vexation was not mentioned, hence this supplementary discussion.)
Zou stated: Gypsum Fibrosum (Shigao) is extremely heavy in texture, bright and lustrous. When struck, it shatters instantly, scattering in fragments with fibers arranged longitudinally, without any transverse strands. Thus, its nature primarily resolves heat pathogens overflowing horizontally. This is precisely why Gypsum can "release the muscle layer." Its acrid and sweet flavor also contributes to releasing the muscle layer; however, its heavy texture and extreme coldness make it insufficient for inducing sweating. Yet, *Ben Cao Jing Ji Zhu* (Supplement to the Materia Medica) states under Almond Seed (Xingren) that it "releases the muscle layer," and under Giant Knotweed Root (Daji) that it "induces sweating," while linking "releasing the muscle layer" and "inducing sweating" together for Gypsum. Is it because Zhang Zhongjing once used it to induce sweating? One should know that Gypsum treats spontaneous sweating in Yangming disease of Shanghan, not absence of sweating in Taiyang disease. If there is Taiyang exterior excess combined with Yangming heat stagnation, Ephedra Herb (Mahuang) is used to induce sweating, and Gypsum to clear heat; there is no case of discarding Mahuang to use only Shigao. Bai Hu Tang (White Tiger Decoction) treats spontaneous sweating without exterior syndrome, and explicitly warns against using it when there is no sweating. Even later empirical formulas for releasing the exterior never use Gypsum, which aligns with the principle that "releasing the exterior does not distance itself from hot-natured drugs." Then, does Gypsum not release the muscle layer? In Bai Hu syndrome, heat exists in both interior and exterior. Although it has not yet entered the Blood level to form Fu-organ excess, the heat in the Qi level of the Yangming channel has formed a balanced force. It requires Acrid-Sweet-Cold herbs to release the muscle layer, not to induce sweating. Other formulas like Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) and Bai Hu Jia Gui Zhi Tang (White Tiger plus Cinnamon Twig Decoction) are not unused for absence of sweating, but their syndromes are not those requiring exterior release. Students should not overly adhere to *Ben Cao Jing Ji Zhu*.
Furthermore, Wang Haicang stated that Gypsum induces sweating, and Zhu Danxi stated that Gypsum causes sweating. Both merely echoed empty texts without substantiating their meaning. I ponder that in medical formularies, Gypsum's indications include epidemic febrile diseases with high fever in muscles, vexation and thirst, wheezing and counterflow, wind-stroke, vertigo, Yang toxicity with macules, etc. None of these conditions can be cured by inducing sweating. The disease most reliant on Gypsum is heat plague. Yu Shiyu's Qing Wen Bai Du San (Clear Plague and Resolve Toxin Powder) uses up to six or eight taels per dose, yet in his work *Yi Zheng Yi De*, he earnestly warns against exterior-releasing therapies. Gu Songyuan treated Wang Zuangong's Yangming heat syndrome with Bai Hu Tang, using three taels of Gypsum per dose. After two doses, the fever subsided suddenly, but the patient broke out in cold sweat all over, with cold limbs and hiccups. The physicians clamored, stopping further administration. Gu cited Zhang Zhongjing's "deep heat leads to deep cold extremities" and Yu Jia Yan's "one in ten thousand cases where Yang syndrome suddenly changes to Yin cold extremities" to argue. They did not listen. When they administered Shen Fu Hui Yang agents (Ginseng and Aconite to restore Yang), the sweating increased, and the body became colder. They sought Gu again. Gu continued the previous method, using three taels of Gypsum. After two doses, the sweating stopped, and the body warmed. (See Lu Dingpu's *Leng Lu Yi Hua*). This is even more definitive proof that Gypsum releases the muscle layer and does not induce sweating.
In summary, the terms "wind-stroke, cold, heat" in *Shen Nong Ben Cao Jing* were viewed by Liu Qianjiang and Zou Run'an as two separate categories, which is very correct. Only Zou forcibly linked the subsequent text: "adverse Qi in the epigastrium, frightful panting, dry mouth, scorched tongue, inability to breathe" as symptoms of wind-stroke and cold/heat, which is inappropriate. Liu said: "When Yang is insufficient and Yin is excessive, it is deficiency-wind; when Yin is insufficient and Yang is excessive, it is excess-wind." The excessive Yin nature of this herb [Gypsum] precisely counters the syndrome of excessive Yang, thereby treating wind-excess. Discussing Gypsum for wind-stroke is very accurate; discussing it for cold/heat, one might explain it via the alternating chills and fever of the Triple Burner in Wu Zheng Tang (Five Steaming Decoction), using Gypsum to interpret it. However, Wu Zheng Tang does not rely solely on Gypsum to remove cold/heat. I believe that for wind-stroke, Gypsum is used in Feng Yin Tang (Wind Pulling Decoction) from *Jin Gui Yao Lue* and Xu Ming Tang (Continuing Life Decoction) from *Gu Jin Lu Yan*; for cold/heat, Gypsum should be used as described in *Wai Tai Mi Yao*: single herb Gypsum treating Yang pathogen entering the interior, transforming into bone-steaming consumption, causing initial chills followed by fever, gradually leading to emaciation, with sweating and a long pulse. Additionally, Bai Hu Jia Ren Shen Tang treats Taiyang heatstroke with sweating, aversion to cold, body heat, and thirst, which can serve as evidence for Gypsum treating cold/heat. However, these two syndromes are completely different from Yang-deficiency cold, Yin-deficiency heat, and the aversion to cold seen in Shanghan with exterior syndrome. They must not be treated indiscriminately without careful differentiation.
Gypsum is sweet and bland, entering the Stomach; acrid, entering the Lung. It is heavy, brittle, rising and descending, thus entering the Triple Burner. With its clearing and肃 (solemn/clearing) coldness, it washes away steaming and stagnant heat. It acts only on the Qi level of the three channels and does not enter the Blood level. Being a Stomach herb rather than a Spleen herb stems from this. Therefore, for hardness and pain in the abdomen, bitter-cold herbs entering the Blood level, such as Rhubarb (Dahuang), are required to be effective. Even Magnolia Bark (Zhipohuang) and Immature Bitter Orange (Zhishi) or Peony Root (Shaoyao) can only serve as assistant or guide herbs. Gypsum absolutely cannot attack hardness or relieve pain. The four characters "hardness and pain in the abdomen" in *Ben Cao Jing* must be a later addition.
Zhang Zhongjing's formulas combining Gypsum and Ephedra are similar to combining Rhubarb and Aconite to alter their nature into warm herbs. Setting up various methods to increase or decrease them creates confusion. However, if one recognizes that Ephedra disperses cold and induces sweating, while Gypsum clears heat and stops sweating, and that they mutually constrain and utilize each other, then any formula can be understood and mastered. Da Qing Long Tang (Major Blue Dragon Decoction) is widely considered a potent sweating agent. I believe the most potent sweating agent is Ma Huang Tang (Ephedra Decoction), not Da Qing Long Tang. In Ma Huang Tang, Cinnamon Twig (Guizhi) and Almond Seed (Xingren) enhance Ephedra's sweating efficacy, without Gypsum to restrain it. In Da Qing Long Tang, Ephedra is restrained... [text implies restraint by Gypsum], hence the pulse is floating and slow, the body does not ache, but feels heavy. Wind-stroke is naturally milder than cold damage. Body heaviness without pain indicates it is not merely for releasing the exterior. Ke Yunbo stated: The post-formula instructions of Da Qing Long Tang—"If sweating is profuse, apply warm powder; if one dose induces sweating, stop the next dose; profuse sweating leads to Yang collapse, resulting in deficiency, aversion to wind, restlessness, and insomnia"—should be moved to after Ma Huang Tang. This insight likely came from observing warm intake of 8 liang and distinguishing between post-sweating vexation and pre-sweating vexation. Scholars, awed by the name "Blue Dragon" and mindful of the warning against profuse sweating causing Yang collapse, liken Ephedra with Gypsum to a dragon raising clouds and rain. This explanation fails to account for why Bai Hu Tang is not a wind-dispelling formula, why Xiao Qing Long Tang bears the name "Dragon" despite lacking Gypsum, and why Yue Bi Tang uses large amounts of Ephedra and Gypsum without mentioning sweating induction. These are oversights.
So why name them Major and Minor Blue Dragons? The dragon symbolizes unclassifiable flexibility, rising, sinking, flying, and hiding, capable of summoning Yang to transform Yin. Ephedra can reach extreme Yang from extreme Yin, but its nature is light and ascending. With Gypsum and Peony, it bends inward; with Cinnamon Twig and Almond, it extends outward. Gypsum, being heavy and cold, yet possessing acrid-sweet moisture to release the muscle layer, can support Ephedra, hence named Major Blue Dragon. Xiao Qing Long Tang involves Water Qi in the epigastrium. Gypsum's heavy coldness dispels it, allowing Ephedra to induce sweating. However, with equal amounts of Ephedra and Peony (3 liang each), Ephedra's action is checked. The acrid and warm herbs promote water metabolism downward. Like a hidden dragon, it is named Minor Blue Dragon. In Yue Bi Tang, Ephedra is also restrained by Gypsum, but deliberately restrained yet heavily dosed due to the syndrome. Wind-water syndrome features aversion to wind, generalized edema, floating pulse, and no thirst—all Ephedra indications. However, continuous spontaneous sweating due to interior heat necessitates Gypsum. Because of Gypsum, Ephedra is used up to 6 liang; because of Ephedra, Gypsum is used up to half a jin even without severe heat. Gypsum is not doubled relative to Ephedra because transforming Yin is more critical than reducing Yang. Someone asked: Yue Bi Tang uses Gypsum for sweating; Da Qing Long Tang uses it for vexation. Without Yangming heat, it shouldn't be used. Yet, for Shanghan with floating-slow pulse, body heaviness without pain, and intermittent lightness, Da Qing Long Tang is used to "release" it. Xu Huixi claimed this clause must be erroneous. Is it true? I say: This perfectly fits the meaning of the dragon's flexing and hiding. You Saijing said: The classic states slow pulses often indicate heat. When Shanghan pathogen is in the exterior, the body aches; when it enters the interior, the body feels heavy. Cold transforming to heat results in a slow pulse, meridians are not cramped, so no pain, only heaviness. The pulse remains floating, indicating the pathogen is advancing or retreating, causing intermittent heaviness/lightness. It says "release" instead of "treat" because the pathogen desires to enter the interior, and the medicine releases it to exit via the exterior. His interpretation is superior to others. Releasing a pathogen desiring to enter the interior requires Ephedra aided by Gypsum's heavy coldness, like a dragon exiting and re-entering. If Gypsum were viewed as a sweating drug, and Ephedra not increased due to Gypsum (a common error), this clause would indeed be suspicious. In Yue Bi Tang, Gypsum exceeds Ephedra by only 2 liang, and it is not named Dragon, nor does it forbid sweating. Da Qing Long Tang's Gypsum certainly does not amount to a piece the size of a chicken egg. Moreover, excessive Gypsum prevents sweating, proven by Ma Xing Gan Shi Tang where Gypsum doubles Ephedra. Ephedra is 4 liang, less than Da Qing Long Tang's 6 liang but more than Ma Huang Tang's 3 liang. Almonds are fewer than in Ma Huang Tang by 20 pieces, but 1 liang of Ephedra is not comparable to 20 almonds. Why is this formula used for sweating syndromes instead of non-sweating ones? Because Gypsum restrains Ephedra even more strongly than in Yue Bi Tang. Gypsum stops sweating caused by Yangming heat blazing and wheezing caused by Lung heat congestion. With Ephedra, Almond might seem unnecessary, but since Ephedra's power is weakened by restraint, Almond assists in resolving residual exterior pathogens. Using half a jin of Gypsum without significant heat shares the same logic as Yue Bi Tang. Ke failed to observe this, changing "sweating, wheezing, no great heat" to "no sweating, wheezing, great heat," accusing predecessors of blind adherence. Not knowing that Gypsum is used precisely for sweating; if there were no sweating and wheezing, it would be a Ma Huang Tang syndrome, completely different. Further evidence comes from Gui Zhi Er Yue Bi Yi Tang. Da Qing Long Tang warns against use in patients with faint pulse, sweating, and aversion to wind. Here, faint pulse means "no Yang," and sweating is forbidden. How can one still use Ephedra to release and Gypsum to cool? Forbidding further sweating implies prior sweating or spontaneous sweating. The use of full Gui Zhi Tang without removing Peony confirms this. Adding Ephedra and Gypsum requires comparison with Gui Zhi Ma Huang Ge Ban Tang (Gui Zhi and Ephedra Half-Dose Decoction). That decoction presents fever, aversion to cold, more heat than cold, similar to this. But that one resembles malaria with a faint-slow pulse, showing pathogen retreat and recovery. If the pulse is faint but not slow, with aversion to cold and facial heat color, Gui Zhi Ma Huang Ge Ban Tang induces slight sweating. Here, faint pulse with aversion to cold indicates Yang deficiency, with no likelihood of self-recovery. Gui Zhi Tang harmonizes Yang; combined with Ephedra, it disperses residual cold and releases exterior pathogens. The method is complete. Why add Gypsum? For heat? Heat is only slightly greater than cold. If the pulse were not faint, it would recover like the Half-Dose Decoction, leaving little heat to worry about. Thus, Gypsum is added specifically because Yang deficiency cannot withstand Ephedra's releasing power; Gypsum restrains it, turning harshness into peace. The seven herbs are selected from severe Shanghan cases, but doses are greatly reduced, making it an excellent method for treating residual pathogens. Using Gypsum not to clear heat, but like Rhubarb used to drain the Heart or promote urination, is equally skillful. Ginger is used in larger quantities than other herbs to assist Cinnamon and Licorice in generating Yang, and to prevent adverse effects of Gypsum.