太阳中风者，风伤于卫也；伤寒者，寒伤于荣也。其说已详上、中二篇。兹以风寒
两伤，荣卫俱病者，疏为下编。盖风寒二气，多相因而少相离，有寒时不皆无风，有风时
不皆无寒。风寒并发，邪中于人，则荣卫兼病，惟其证均无汗，皆谓之实邪，故立大青
龙汤两解之法，发其寒邪外闭，风邪内郁，不汗出而烦躁之汗也。然必审其人脉不微弱，无
少阴证者，乃可与之。若误施之，则大汗淋漓，厥逆筋惕肉 ，必致亡阳之变，故又
立真武一汤，以救青龙之误。夫表寒里热者，大青龙固所宜也。若表里俱热，则又非大青
龙之所胜任，爰立白虎一汤，以辅青龙之不逮。至于寒热轻微者，则更出桂枝二越婢一
汤、麻黄桂枝各半汤、桂枝二麻黄一汤，皆两解荣卫法也。合上、中二篇而熟读之，则
三法了然，以之施治，庶不紊耳。
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。若脉微弱，
汗出恶风者，不可服，服之则厥逆，筋惕肉 ，此为逆也。
【注】太阳中风，脉当浮缓，今脉浮紧，是中风之病而兼伤寒之脉也。中风当身不痛，
汗自出，今身疼痛，不汗出，是中风之病而兼伤寒之证也。不汗出而烦躁者，太阳郁蒸
之所致也。风，阳邪也，寒，阴邪也。阴寒郁于外则无汗，阳热蒸于内则烦躁，此风寒
两伤，营卫同病，故合麻、桂二汤中石膏，制为大青龙汤，用以解荣卫同病之实邪也。若
脉微弱，汗出恶风者，即有烦躁，乃少阴之烦躁，非太阳之烦躁也。禁不可服，服之则
厥逆、筋惕肉 之患生，而速其亡阳之变矣。故曰∶此为逆也。
【集注】成无己曰∶风并于卫者，为荣弱卫强，寒并于荣者，为荣强卫弱。今风寒两
伤，故为荣卫俱实，所以宜大青龙汤主之也。
喻昌曰∶大青龙汤为太阳无汗而设，与麻黄汤证何异？因有烦躁一证兼见，则非此法不解。
程应旄曰∶此汤非为烦躁设，为不汗出之烦躁设。若脉微弱，汗出恶风者，虽有烦
躁证，乃少阴亡阳之象，全非汗不出而郁蒸者比也。
伤寒，脉浮缓，身不疼，但重，乍有轻时，无少阴证者，大青龙汤发之。
【注】伤寒脉当浮紧，今脉浮缓，是伤寒之病兼中风之脉也。伤寒当身疼，今身不疼，
是伤寒之病而兼中风之证也。身轻，邪在阳也；身重，邪在阴也；乍有轻时，谓身重而
有时轻也。若但欲寐，身重无轻时，是少阴证也。今无但欲寐，身虽重，乍有轻时，则
非少阴证，乃荣卫兼病之太阳证也。脉虽浮缓，证则无汗，属实邪也，故亦以大青龙汤
发之。前条以脉微汗出示禁，此条以无少阴证发明，盖详审慎重之至也。此二条，承上
篇首条、次条，中篇首条、次条，再揭太阳风寒两伤，以为下编荣卫兼病之提纲。后凡
称太阳中风、伤寒，涉于荣卫同病者，皆指此二条而言也。
【集注】方有执曰∶大青龙汤，一则曰主之，一则曰发之，何也？主之者，以烦躁之
急疾，属动而言；发之者，以但重之沉默，属静而言也。
喻昌曰∶无少阴证，“但重乍有轻时”六字早已指明。言但身重而无少阴之欲寐，其
为寒因可审，况乍有轻时，不似少阴之昼夜俱重。又兼风因可审，所以力驱其在表之风
寒而无疑也。若脉微弱，身重欲寐，则内顾少阴且不遑矣，敢发之乎？又曰∶细玩二条
文义，伤风脉本浮缓，反见浮紧；伤寒脉本浮紧，反见浮缓，是为伤风见寒，伤寒见风，
两无疑矣。又当辨无少阴证相杂，则用青龙，万举万当矣。故脉见微弱，即不可用大青龙，
以少阴病脉必微细也。方氏注泥“弱”字，牵入中风之脉，阳浮阴弱为解。不思中风之脉，
以及误汗等证，太阳上编已悉，此处但归重分别少阴，以太阳膀胱经与少阴肾经合为表
里，其在阴虚之人，表邪不俟传经，早从膀胱袭入肾脏者有之。况两感夹阴等证，临病
犹当细察，设少阴不亏，表邪安能飞渡而见身重欲寐等证耶！故有少阴证者，不得已而
行表散，自有温经散邪，两相绾照之法，岂可径用青龙之猛剂，立铲孤阳之根乎！
魏荔彤曰∶身重一证，必须辨明，但欲寐而常重，则属少阴。误发其汗，变上厥下
竭者，少阴热也；变筋惕肉 者，少阴寒也。其犯误汗之忌一也。
大青龙汤方
麻黄（去节，六两） 桂枝（二两） 甘草（炙，二两） 杏仁（去皮尖，四十枚） 生姜（切，三两）
大枣（擘，十二枚） 石膏（碎，绵裹，如鸡子大）
上七味，以水九升，先煮麻黄，减二升，去上沫，纳诸药，煮取三升，去滓，温服一
升，取微似汗，汗出多者，温粉扑之。一服汗者，停后服。若复服，汗多亡阳，遂虚恶
风，烦躁不得眠也。
【方解】名大青龙者，取龙兴云雨之义也。治风不外乎桂枝，治寒不外乎麻黄，合桂枝、
麻黄二汤以成剂，故为兼风寒中伤者之主剂也。二证俱无汗，故减芍药，不欲其收也；二
证俱烦躁，故加石膏以解其热也。设无烦躁，则又当从事于麻黄桂枝各半汤矣。仲景于表
剂中加大寒辛甘之品，则知麻黄证之发热，热全在表；大青龙证之烦躁，热兼肌里矣。初
病太阳即用石膏者，以其辛能解肌热，寒能清胃火，甘能生津液，是预保阳明存津液之
先着也。粗工疑而畏之，当用不用，必致热结阳明，斑黄狂冒，纷然变出矣。观此，则
可知石膏乃中风、伤寒之要药，故得麻、桂而有青龙之名，得知、草而有白虎之号也。服
后取微汗，汗出多者，温粉扑之。一服得汗，停其后服，盖戒人即当汗之证，亦不可过汗
也。所以仲景桂枝汤中不用麻黄者，是欲其不大发汗也；麻黄汤中用桂枝者，恐其过汗
无制也。若不慎守其法，汗多亡阳，变生诸逆，表遂空虚，而不任风，阴盛格阳，而更烦躁不得眠也。
【集解】许叔微曰∶仲景治伤寒，一则桂枝，二则麻黄，三则青龙。桂枝治风，麻黄
治寒，青龙兼治风寒，不拘时候，施与脉证相对者，无不应手而愈。今人皆能言之，而
未晓前人处方用药之意，多不敢用，无足怪也。
吴绶曰∶大青龙汤，治伤寒发热，恶寒不得汗出，烦躁不安，脉浮紧或浮数者，急
用此汤发汗则愈，乃仲景之妙法也。譬若亢热已极，一雨而凉，其理可见也。若不晓此
理，见其躁热，投以寒凉之药，其害可胜言哉！若脉微弱汗出恶风者，不可用也；如误
用之，其害亦不浅。所以脉证不明者，多不敢用也。
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
发其汗而不可下也。
【注】此发明风寒两伤，荣卫俱病之义也。
浮，风邪脉也；风，阳也；卫，阳也。紧，寒邪脉也。寒，阴也；荣，阴也。各从其类而
伤之。荣卫俱病，骨节烦疼，是大青龙发汗之脉证，虽发热烦躁，其热在肌而不在胃，不可下也。
太阳病发汗，汗出不解，其人仍发热，心下悸，头眩身 动，振振欲擗地者，真武汤主之。
【注】此申首条，示人以救逆之法也。首条言误汗，此条言过汗，互文以明其义也。盖
二证皆属亡阳，故均当以真武汤主之，扶阳抑阴以救其逆也。大汗出，仍热不解者，阳
亡于上也；心下悸筑筑然动，阳虚不能内守也；头眩者，头晕眼黑，阳微气不能升也；身
动者，蠕蠕然 动，阳虚液涸，失养于经也。振，耸动也。振振欲擗地者，耸动不已，
不能兴起，欲堕于地，阳虚气力不能支也。
【集注】张璐曰∶此为误用大青龙因而致变者立法也。汗出虽多而热不退，则邪未尽
而正已大伤，况里虚为悸，上虚为眩，经虚为 ，身振振摇，无往而非亡阳之象，所以
用真武，把守关口坐镇之法也。
汪琥曰∶或问治不在表，何以方中尚用生姜？盖病自过汗而来，虽无郁热可发，其
内外寒邪犹在，用生姜者，乃温中有发也。
真武汤方（见少阴篇）
太阳病二日，反躁，反熨其背，而大汗出，大热入胃，胃中水竭，躁烦，必发谵语，
十余日，振栗自下利者，此为欲解也。故其汗从腰以下不得汗，欲小便不得，反呕欲失
溲，足下恶风，大便硬，小盒饭数而反不数，及多大便已，头卓然而痛，其人足心必热，谷气下流故也。
【注】太阳病中风、伤寒，二日不躁，今反躁者，是不得汗出而躁，大青龙汤证也。不
以青龙汤发汗，反以火劫熨背，逼汗大出，火邪入胃，胃热水竭，则烦躁谵语所必发也。十
有余日，邪正相持，持久必争，争必振栗作解，然解非汗出及下利，邪无从解也。若自
下利，此为欲从里解也；若自汗出，此为欲从表解也。今十余日不自下利，而有欲小便不
得，反呕欲失溲者，是里不解也；不自汗出，而下体无汗，足下恶风者，是表不解也。里
不解者，大便必硬，小盒饭数而反不数，则知水留胃中，久必肠润，其久积之大便自应
多下而解也。及多大便已，虽小便不得，诸病不解，其头卓然而痛，是里解表未悉解也。
表未悉解者，是因火逼汗出，而从腰以下不得汗，乃上解而下未解也。故有小便不得，诸
在下之病。今虽里解，而其人头卓然而痛者，是表之余邪上逆也。足心必热者，里之余热
下流也。谷气者，即胃气也，言胃中热气随大便而下流也。此病皆由妄行火劫致变，难
以拘定成规，当诊犯何逆，随证治之可也。
服桂枝汤，大汗出，脉洪大者，与桂枝汤如前法。若形似疟，一日再发者，汗出必
解，宜桂枝二麻黄一汤。
【注】服桂枝汤，大汗出，病不解，脉洪大，若烦渴者，则为表邪已入阳明，是白虎
汤证也。今脉虽洪大而不烦渴，则为表邪仍在太阳，当更与桂枝汤如前法也。服汤不解，
若形如疟，日再发者，虽属轻邪，然终是为风寒所持，非汗出必不得解，故宜桂枝二麻
黄一汤，小发荣卫之汗。其不用麻黄桂枝各半汤者，盖因大汗已出也。
【集注】方有执曰∶服桂枝汤，证转大汗出，脉转洪大者，乃风多寒少，风邪欲散而
以微寒持之，两者皆不得解，而寒热如疟也。桂枝二麻黄一汤者，重解风而轻于散寒也。
桂枝二麻黄一汤方
桂枝（一两十七株） 芍药（一两六铢） 麻黄（去节，十六铢） 甘草（一两二铢） 杏仁
（去皮尖，十六枚） 生姜（切，一两六铢） 大枣（擘，五枚）
上七味，以水五升，先煮麻黄一二沸，去
上沫，纳诸药，煮取二升，去滓，温服一升，日再服。
【集解】张璐曰∶详此方药品，与各半不殊，惟铢分稍异，而证治攸分，可见仲景于
差多差少之间，分毫不苟也。
太阳病，得之八九日，如疟状，发热恶寒，热多寒少，其人不呕，清便欲自可，一
日二三度发，脉微缓者，为欲愈也；脉微而恶寒者，此阴阳俱虚，不可更发汗，更下更
吐也；面色反有热色者，未欲解也，以其不能得小汗出，身必痒，宜桂枝麻黄各半汤。
【注】太阳荣卫两伤，风多寒少之病，得之八九日，有如疟状之寒热，热多寒少，其
人不呕，小便清白者，此里和不受邪，虽为欲愈，然必审其人。如疟状之寒热，一日二
三度，轻轻而发，诊其脉微且缓，则知邪已衰，正欲复，表里将和，始为欲愈也。若脉
微不缓，是正犹未复，恶寒是邪犹未衰，尚不能自愈，但已为前之汗、吐、下，虚其表
里，不可更发汗、更下、更吐也。脉微恶寒，表里俱虚，则面色当白，今色反赤，犹有余
邪怫郁于表，不能得小汗出，宣发阳气，故面赤身痒，未欲解也，宜桂枝麻黄各半汤，小
小汗之，以和荣卫，自可愈也。
【集注】吴人驹曰∶此不专事桂枝，而兼合乎麻黄者，谓其面热身痒，邪在轻虚浮浅
之处，惟麻黄能达也。
桂枝麻黄各半汤方
桂枝（一两十六铢） 芍药（一两） 生姜（一两） 甘草（炙，一两） 麻黄（去节，一两） 大枣（擘，
四枚） 杏仁（去皮，尖，二十四枚）
上七味，以水五升，先煮麻黄一二沸，去上沫，纳诸药，煮取一升八合，去滓，温服六合。
脉浮而迟，面热赤而战惕者，六七日当汗出而解，反发热者瘥迟，迟为无阳，不能
作汗，其身必痒也。
【注】此承上条，发明面赤身痒之义也。表阳气虚，故脉浮迟，邪气怫郁，故面热赤，
正虚邪盛相争，故战惕也。至六七日，则邪当衰，应汗出而解，若反发热，是邪未衰，故
瘥迟也。迟者，正不胜邪也。阳微怫郁，其身必痒，以无阳气，不能宣发作汗故也。
【集注】程知曰∶此言阳虚不能作汗之脉也。浮则邪在肌表；迟则阳虚；气怫郁而不
得越，则面热赤；正与邪争而不得出，则身战惕。至六七日传经尽，当汗解之时，乃不
得汗，反发热者，其差必迟。盖阳虚不能领汗外出，其热邪浮于肌肤，必作身痒也。
太阳病，发热恶寒，热多寒少，脉微弱者，此无阳也，不可发汗，宜桂枝二越婢一汤。
【注】太阳病发热恶寒，热多寒少，此为荣卫兼病，风邪多而寒邪少也。若脉浮紧，或
脉浮数，是表有阳邪郁蒸，则为无汗热多之实邪，以大青龙汤汗之可也。今脉阳微阴弱，
太阳中风，是风邪伤及卫气；伤寒，是寒邪伤及营血。这一说法在上、中两篇中已经详细论述了。现在针对风寒同时侵袭，导致营卫都发病的情况，梳理为下编。大概风寒二气，多相互伴随而少分离，有寒的时候不一定没有风，有风的时候不一定没有寒。风寒并发，邪气侵入人体，则营卫同时患病，只要证候都是无汗的，都称为实邪，所以设立大青龙汤双解的方法，发散其被寒邪外闭、风邪内郁，以及因无汗而出烦躁的症状。然而必须仔细审查患者脉象不微弱，且没有少阴病证候的，才可以给予服用。如果误用，则会导致大汗淋漓，四肢厥冷，筋肉跳动，必然导致亡阳的变证，所以又设立真武汤一剂，来补救误用大青龙汤的错误。如果是表寒里热的情况，大青龙汤确实是适宜的。如果表里俱热，那么大青龙汤就不能胜任了，于是设立白虎汤一剂，以弥补大青龙汤的不足。至于寒热症状轻微的，则另外列出桂枝二越婢一汤、麻黄桂枝各半汤、桂枝二麻黄一汤，这些都是双解营卫的方法。结合上、中两篇熟读，那么这三种方法就清晰明了，用来施治，大致就不会混乱了。
太阳中风，脉象浮紧，发热恶寒，身体疼痛，无汗且烦躁的，以大青龙汤主治。如果脉象微弱，出汗且怕风的，不可服用，服用了就会四肢厥冷，筋肉跳动，这是逆治。
【注】太阳中风，脉象应当是浮缓的，现在脉象浮紧，这是中风病兼有伤寒的脉象。中风应当身体不痛，自然出汗，现在身体疼痛，无汗，这是中风病兼有伤寒的证候。无汗且烦躁，是太阳经郁蒸所致。风，是阳邪；寒，是阴邪。阴寒郁结于外则无汗，阳热蒸腾于内则烦躁，这是风寒两伤，营卫同病，所以合用麻黄汤和桂枝汤并加入石膏，制成大青龙汤，用以解除营卫同病的实邪。如果脉象微弱，出汗且怕风的，即使有烦躁，也是少阴病的烦躁，不是太阳病的烦躁。禁止服用，服用了就会产生四肢厥冷、筋肉跳动的祸患，从而加速亡阳的变证。所以说：这是逆治。
【集注】成无己说：风邪偏并于卫气的，是营弱卫强；寒邪偏并于营血的，是营强卫弱。现在风寒两伤，所以是营卫俱实，因此适宜用大青龙汤主治。
喻昌说：大青龙汤是为太阳病无汗而设立的，与麻黄汤证有什么不同？因为兼见烦躁这一证候，就不是这种方法不能解除。
程应旄说：此汤不是为了烦躁设立的，是为了无汗导致的烦躁设立的。如果脉象微弱，出汗且怕风的，虽然有烦躁证候，那是少阴病亡阳的现象，完全不同于无汗而郁蒸的情况。
伤寒，脉象浮缓，身体不痛，只是沉重，偶尔有减轻的时候，没有少阴病证候的，用大青龙汤发汗。
【注】伤寒脉象应当是浮紧的，现在脉象浮缓，这是伤寒病兼有中风的脉象。伤寒应当身体疼痛，现在身体不痛，这是伤寒病兼有中风的证候。身体轻，说明邪在阳分；身体重，说明邪在阴分；偶尔有减轻的时候，是说身体重但有时减轻。如果只想睡觉，身体重且没有减轻的时候，就是少阴病证候。现在没有只想睡觉，身体虽然重，但偶尔有减轻的时候，那就不是少阴病证候，而是营卫兼病的太阳病证候。脉象虽然浮缓，但证候是无汗，属于实邪，所以也用大青龙汤发汗。前一条以脉微、汗出作为禁忌，这一条以无少阴病证候来阐明，可以说是详尽审慎到了极点。这两条，承接上篇首条、次条，中篇首条、次条，再次揭示太阳风寒两伤，作为下编营卫兼病的提纲。后来凡是提到太阳中风、伤寒，涉及营卫同病的，都指这两条而言。
【集注】方有执说：大青龙汤，一次说“主之”，一次说“发之”，为什么呢？“主之”，是因为烦躁的急疾，属于动而言；“发之”，是因为只有沉重的沉默，属于静而言。
喻昌说：“无少阴病证候”、“只是沉重偶尔有减轻”这六个字早已指明。意思是只是身体重而没有少阴病的想睡觉，其为寒邪可以审察清楚，况且偶尔有减轻，不像少阴病那样昼夜都重。又兼有风邪也可以审察清楚，所以极力驱散在表的风寒而毫无疑问。如果脉象微弱，身体重且想睡觉，那顾护少阴还来不及呢，敢发汗吗？又说：细玩味两条文义，伤风脉本应是浮缓，反而见到浮紧；伤寒脉本应是浮紧，反而见到浮缓，这是伤风见寒，伤寒见风，毫无疑问了。还应当辨别没有少阴病证候夹杂，那么使用青龙汤，万举万当。所以脉象见微弱，就不可用大青龙汤，因为少阴病脉象必定微细。方氏注解拘泥于“弱”字，牵入中风的脉象，以阳浮阴弱来解释。不考虑中风的脉象，以及误汗等证候，在太阳上编已经详尽，这里只着重分别少阴病，因为太阳膀胱经与少阴肾经互为表里，对于阴虚之人，表邪不必等到传经，早就从膀胱袭入肾脏的情况是有的。何况两感夹阴等证候，临病时还应当仔细察看，假设少阴不虚，表邪怎么能飞渡而见到身体重、想睡觉等证候呢！所以有少阴病证候的，不得已而行表散，自有温经散邪，两者兼顾的方法，岂可径自使用青龙汤这种猛剂，立刻铲断孤阳的根本呢！
魏荔彤说：身体重这一证候，必须辨明，只想睡觉且常感重的，属于少阴。误用发汗，变为上厥下竭的，是少阴热证；变为筋肉跳动的，是少阴寒证。它们触犯误汗的禁忌是一样的。
大青龙汤方
麻黄（去节，六两） 桂枝（二两） 甘草（炙，二两） 杏仁（去皮尖，四十枚） 生姜（切，三两）
大枣（擘，十二枚） 石膏（碎，绵裹，如鸡子大）
以上七味药，用水九升，先煮麻黄，减少二升，去掉上面的沫，加入其他药物，煮取三升，去渣，温服一升，取微微似出汗的样子，如果汗出多的，用温粉扑身。服一次药出汗的，停服后面的药。如果再次服药，汗多亡阳，遂致虚弱怕风，烦躁不得眠。
【方解】名叫大青龙，是取龙兴云雨的意思。治疗风邪不外乎桂枝，治疗寒邪不外乎麻黄，合用桂枝汤、麻黄汤两方成为一剂，所以是兼治风寒中伤的主方。两个证候都无汗，所以减去芍药，不想让它收敛；两个证候都有烦躁，所以加入石膏以解其热。如果没有烦躁，那么就应当从事于麻黄桂枝各半汤了。仲景在表剂中加入大寒辛甘的药物，就知道麻黄证的发热，热全在体表；大青龙证的烦躁，热兼有肌理了。初病太阳就用石膏，是因为它能辛能解肌热，寒能清胃火，甘能生津液，这是预先保护阳明、保存津液的第一步。粗工怀疑而畏惧它，该用不用，必然导致热结阳明，出现斑黄狂冒，纷然变证百出。看这一点，就可以知道石膏是中风、伤寒的要药，所以得到麻黄、桂枝就有青龙的名字，得到知母、甘草就有白虎的称号。服药后取微汗，汗出多的，用温粉扑身。服一次得汗，停服后面的药，这是告诫人们即使是应当发汗的证候，也不可过汗。所以仲景在桂枝汤中不用麻黄，是想要它不大发汗；在麻黄汤中使用桂枝，是恐怕它过汗没有节制。如果不谨慎遵守这些法则，汗多亡阳，变生各种逆证，表气遂空虚，而不能耐受风邪，阴盛格阳，反而更加烦躁不得眠。
【集解】许叔微说：仲景治疗伤寒，一是桂枝汤，二是麻黄汤，三是青龙汤。桂枝汤治风，麻黄汤治寒，青龙汤兼治风寒，不拘时候，施用于脉证相对的，没有不手到病愈的。现在的人都能说，但不明白前人处方用药的意思，大多不敢用，这没什么可怪的。
吴绶说：大青龙汤，治疗伤寒发热，恶寒不得汗出，烦躁不安，脉象浮紧或浮数的，急用此汤发汗则痊愈，这是仲景的妙法。譬如亢热已极，一场雨后就凉快，这个道理可见。如果不晓悟这个理，见到躁热，投以寒凉的药物，其害能说尽吗？如果脉象微弱汗出怕风的，不可用；如果误用，其害也不浅。所以脉证不明的，大多不敢用。
脉象浮而紧，浮则为风，紧则为寒，风则伤卫，寒则伤营。营卫都病了，骨节烦疼，应当发汗而不可攻下。
【注】这是阐明风寒两伤，营卫俱病的意义。
浮，是风邪的脉象；风，属阳；卫，属阳。紧，是寒邪的脉象。寒，属阴；营，属阴。各自从其类而受伤。营卫俱病，骨节烦疼，是大青龙汤发汗的脉证，虽然发热烦躁，其热在肌表而不在胃，不可攻下。
太阳病发汗，汗出不解，那人仍然发热，心下悸动，头晕目眩，身体颤动，振振欲倒地者，用真武汤主治。
【注】这是申述首条，告诉人们救逆的方法。首条讲误汗，这条讲过汗，互文见义以阐明道理。大概这两个证候都属于亡阳，所以都应当用真武汤主治，扶阳抑阴以救其逆。大汗出，仍然热不解，是阳亡于上；心下悸筑筑然动，是阳虚不能内守；头眩，是头晕眼黑，阳气微弱气不能上升；身动，是蠕蠕然颤动，阳虚液涸，失养于经脉。振，是耸动。振振欲擗地，是耸动不已，不能兴起，欲堕于地，阳虚气力不能支撑。
【集注】张璐说：这是为误用大青龙因而致变的情况立法。汗出虽多而热不退，则邪未尽而正气已大伤，况且里虚导致悸，上虚导致眩，经虚导致颤动，身体振振摇，无处不是亡阳的征象，所以用真武汤，把守关口坐镇的方法。
汪琥说：有人问治疗不在表，为什么方中还用生姜？大概病从过汗而来，虽然没有郁热可发，但其内外寒邪犹在，用生姜，是在温中有发汗之意。
真武汤方（见少阴篇）
太阳病第二天，反而烦躁，反而熨背，而大汗出，大热入胃，胃中水液枯竭，躁烦，必然发谵语，十余日后，振栗自下利的，这是将要解除了。所以他的汗从腰以下不得出，想小便却不得，反而呕吐想失禁，脚底怕风，大便硬，小便频数反而次数不多，以及大便已通，头突然疼痛，那人脚心必然热，这是因为谷气下流的关系。
【注】太阳病中风、伤寒，第二天不烦躁，现在反而烦躁的，是不得汗出而躁，是大青龙汤证。不用青龙汤发汗，反而用火劫熨背，逼汗大出，火邪入胃，胃热水竭，则烦躁谵语必然发生。十几天，邪正相持，持久必争，争必振栗作解，然而解非汗出及下利，邪无从解。如果自下利，这是想要从里解；如果自汗出，这是想要从表解。现在十几天不自下利，而有想小便不得，反而呕吐想失禁的，是里不解；不自汗出，而下体无汗，脚底怕风的，是表不解。里不解者，大便必硬，小便频数反而次数不多，则知水留胃中，久必肠润，那些久积的大便自然应当多下而解。等到大部分大便已通，虽然小便不得，诸病不解，头突然疼痛，是里解表未悉解。表未悉解者，是因为火逼汗出，而从腰以下不得汗，乃上解而下未解。所以有小便不得，诸在下之病。现在虽然里解，而其人头突然疼痛的，是表之余邪上逆。脚心必热者，是里之余热下流。谷气，即胃气，言胃中热气随大便而下流。这些病都是由妄行火劫导致变证，难以拘定成规，应当诊察犯了什么逆，随证治之即可。
服桂枝汤，大汗出，脉洪大的，给桂枝汤按前面的方法服用。如果像疟疾一样，一天发作两次的，汗出必解，适宜用桂枝二麻黄一汤。
【注】服桂枝汤，大汗出，病不解，脉洪大，如果烦渴的，则是表邪已入阳明，是白虎汤证。现在脉虽洪大而不烦渴，则是表邪仍在太阳，应当再给桂枝汤按前面的方法服用。服汤不解，如果像疟疾，一天发作两次，虽然属于轻邪，但最终是为风寒所持，非汗出必不得解，所以适宜用桂枝二麻黄一汤，小发营卫之汗。之所以不用麻黄桂枝各半汤，是因为已经大汗出了。
【集注】方有执说：服桂枝汤，证转大汗出，脉转洪大的，乃是风多寒少，风邪欲散而以微寒持之，两者皆不得解，而寒热如疟也。桂枝二麻黄一汤，是重解风而轻于散寒。
桂枝二麻黄一汤方
桂枝（一两十七株） 芍药（一两六铢） 麻黄（去节，十六铢） 甘草（一两二铢） 杏仁
（去皮尖，十六枚） 生姜（切，一两六铢） 大枣（擘，五枚）
以上七味药，用水五升，先煮麻黄一二沸，去掉上面的沫，加入其他药物，煮取二升，去渣，温服一升，每天服两次。
【集解】张璐说：详查此方的药品，与各半汤没有不同，只是分量稍异，而证治由此区分，可见仲景在差多差少之间，分毫不苟。
太阳病，得之八九日，像疟疾一样，发热恶寒，热多寒少，那人不呕，大小便基本正常，一天发作两三次，脉微缓的，是快要好了；脉微而恶寒的，这是阴阳俱虚，不可再发汗，再攻下再催吐了；面色反而有热色的，是未解除，因为他不能得小汗出，身体必然痒，适宜用桂枝麻黄各半汤。
【注】太阳营卫两伤，风多寒少的病，得之八九日，有如疟疾一样的寒热，热多寒少，那人不呕，小便清白的，这是里和不受邪，虽然是欲愈，然而必须审察其人。像疟疾一样的寒热，一天两三次，轻轻而发，诊其脉微且缓，则知邪已衰，正气欲复，表里将和，始为欲愈。如果脉微不缓，是正气犹未复，恶寒是邪气犹未衰，尚不能自愈，但已经经过之前的汗、吐、下，虚其表里，不可再发汗、再攻下、再催吐。脉微恶寒，表里俱虚，则面色应当白，现在色反赤，犹有余邪怫郁于表，不能得小汗出，宣发阳气，故面赤身痒，未欲解，适宜用桂枝麻黄各半汤，小小汗之，以和营卫，自然可愈。
【集注】吴人驹说：这不专事桂枝，而兼合乎麻黄的，是说其面热身痒，邪在轻虚浮浅之处，只有麻黄能达。
桂枝麻黄各半汤方
桂枝（一两十六铢） 芍药（一两） 生姜（一两） 甘草（炙，一两） 麻黄（去节，一两） 大枣（擘，
四枚） 杏仁（去皮，尖，二十四枚）
以上七味药，用水五升，先煮麻黄一二沸，去掉上面的沫，加入其他药物，煮取一升八合，去渣，温服六合。
脉浮而迟，面部热赤而战惕的，六七天应当汗出而解，反而发热的，痊愈迟缓，迟为无阳，不能作汗，其身必然痒。
【注】这是承接上条，阐明面赤身痒的意义。表阳气虚，故脉浮迟，邪气怫郁，故面热赤，正虚邪盛相争，故战惕。至六七天，则邪当衰，应汗出而解，若反发热，是邪未衰，故痊愈迟缓。迟者，正不胜邪。阳微怫郁，其身必然痒，因为没有阳气，不能宣发作汗的缘故。
【集注】程知说：这是说阳虚不能作汗的脉象。浮则邪在肌表；迟则阳虚；气怫郁而不得越，则面热赤；正与邪争而不得出，则身战惕。至六七天传经尽，当汗解之时，乃不得汗，反发热者，其差必迟。盖阳虚不能领汗外出，其热邪浮于肌肤，必然作身痒。
太阳病，发热恶寒，热多寒少，脉微弱的，这是无阳，不可发汗，适宜用桂枝二越婢一汤。
【注】太阳病发热恶寒，热多寒少，这是营卫兼病，风邪多而寒邪少。如果脉浮紧，或脉浮数，是表有阳邪郁蒸，则为无汗热多之实邪，用大青龙汤发汗即可。现在脉阳微阴弱，
Taiyang wind-stroke is when wind pathogen injures the Wei (Defensive) Qi; cold injury is when cold pathogen injures the Ying (Nutritive) Blood. This explanation has been detailed in the upper and middle chapters. Here, we address the condition where both wind and cold simultaneously invade, causing disease in both Ying and Wei, organizing it into the lower chapter. Generally, wind and cold qi often accompany each other and rarely separate; when there is cold, there is not necessarily no wind, and when there is wind, there is not necessarily no cold. When wind and cold occur together, pathogens enter the human body, causing simultaneous disease in Ying and Wei. As long as the symptoms present with anhidrosis (absence of sweating), they are all classified as excess pathogens. Therefore, Da Qing Long Tang (Major Blue Dragon Decoction) is established to resolve both, dispersing the cold pathogen externally closed and the wind pathogen internally constrained, specifically addressing the restlessness caused by anhidrosis. However, one must carefully examine that the patient's pulse is not weak or thready, and there are no Shaoyin syndrome manifestations, before administering it. If mistakenly used, it will cause profuse sweating, cold extremities, muscle twitching, inevitably leading to Yang collapse. Thus, Zhen Wu Tang (True Warrior Decoction) is established to remedy the error of using Da Qing Long Tang. For cases of exterior cold and interior heat, Da Qing Long Tang is indeed appropriate. However, if both exterior and interior are hot, Da Qing Long Tang cannot handle it; therefore, Bai Hu Tang (White Tiger Decoction) is established to supplement the limitations of Da Qing Long Tang. For mild cold and heat symptoms, Gui Zhi Er Yue Bi Yi Tang (Cinnamon Twig Twice, Bitter Ginger One Third Decoction), Ma Huang Gui Zhi Ge Ban Tang (Ephedra and Cinnamon Twig Half-and-Half Decoction), and Gui Zhi Er Ma Huang Yi Tang (Cinnamon Twig Twice, Ephedra One Third Decoction) are presented, all of which are methods to simultaneously resolve Ying and Wei. Reading these thoroughly along with the upper and middle chapters will make the three methods clear, ensuring treatment is not chaotic.
In Taiyang wind-stroke, if the pulse is floating and tight, accompanied by fever, aversion to cold, body pain, anhidrosis, and restlessness, Da Qing Long Tang (Major Blue Dragon Decoction) should be administered. If the pulse is weak or thready, with sweating and aversion to wind, it must not be taken; taking it will result in cold extremities and muscle twitching, which is a therapeutic error.
[Annotation] In Taiyang wind-stroke, the pulse should be floating and relaxed (slow); a floating and tight pulse indicates wind-stroke complicated by cold-injury patterns. Wind-stroke typically presents without body pain and with spontaneous sweating; body pain and anhidrosis indicate wind-stroke complicated by cold-injury symptoms. Anhidrosis with restlessness is caused by stagnation and steaming in the Taiyang channel. Wind is a Yang pathogen; cold is a Yin pathogen. Yin-cold stagnating externally causes anhidrosis, while Yang-heat steaming internally causes restlessness. This represents simultaneous injury by wind and cold, affecting both Ying and Wei. Therefore, combining Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) with Shigao (Gypsum Fibrosum) creates Da Qing Long Tang (Major Blue Dragon Decoction) to resolve the excess pathogen affecting both Ying and Wei. If the pulse is weak or thready, with sweating and aversion to wind, even if restlessness is present, it is Shaoyin restlessness, not Taiyang restlessness. It is forbidden to take this formula; doing so will cause cold extremities and muscle twitching, accelerating Yang collapse. Hence, it is stated: "This is a therapeutic error."
[Collected Annotations] Cheng Wuji states: When wind predominates in Wei, it results in weak Ying and strong Wei; when cold predominates in Ying, it results in strong Ying and weak Wei. Now, with both wind and cold injuring, Ying and Wei are both excess, hence Da Qing Long Tang (Major Blue Dragon Decoction) is suitable.
Yu Chang states: Da Qing Long Tang (Major Blue Dragon Decoction) is prescribed for Taiyang anhidrosis. How does it differ from Mahuang Tang (Ephedra Decoction)? Because restlessness is concurrently present, only this method can resolve it.
Cheng Yingmao states: This decoction is not prescribed for restlessness per se, but for restlessness caused by anhidrosis. If the pulse is weak or thready, with sweating and aversion to wind, even with restlessness, it is a sign of Yang collapse in Shaoyin, completely different from stagnation due to anhidrosis.
In cold injury, if the pulse is floating and relaxed, the body is not painful but heavy, occasionally feeling lighter, and there are no Shaoyin syndrome manifestations, Da Qing Long Tang (Major Blue Dragon Decoction) should be used to induce sweating.
[Annotation] In cold injury, the pulse should be floating and tight; a floating and relaxed pulse indicates cold injury complicated by wind-stroke patterns. Cold injury typically involves body pain; absence of pain indicates cold injury complicated by wind-stroke symptoms. Lightness of the body indicates pathogen in Yang; heaviness indicates pathogen in Yin; "occasionally lighter" means heaviness that sometimes alleviates. If there is desire to sleep and constant heaviness without alleviation, it is a Shaoyin syndrome. Now, without desire to sleep, and although heavy, occasionally lighter, it is not Shaoyin syndrome, but a Taiyang syndrome involving both Ying and Wei. Although the pulse is floating and relaxed, the symptom is anhidrosis, belonging to excess pathogen, so Da Qing Long Tang (Major Blue Dragon Decoction) is also used to induce sweating. The previous clause prohibited use based on weak pulse and sweating; this clause clarifies based on the absence of Shaoyin syndrome, showing extreme caution. These two clauses follow the first and second clauses of the upper and middle chapters, reiterating Taiyang dual injury by wind and cold as the outline for Ying-Wei dual disease in the lower chapter. Subsequent mentions of Taiyang wind-stroke or cold injury involving Ying-Wei dual disease refer to these two clauses.
[Collected Annotations] Fang Youzhi states: Da Qing Long Tang (Major Blue Dragon Decoction) uses "prescribed for" once and "induce sweating" once. Why? "Prescribed for" refers to the urgency of restlessness (movement); "induce sweating" refers to the silence of heaviness (stillness).
Yu Chang states: "No Shaoyin syndrome" and "only heavy, occasionally lighter" clarify the point. It means only body heaviness without Shaoyin desire to sleep allows confirmation of cold pathogen. Moreover, occasional lightness differs from Shaoyin's constant day-and-night heaviness. Combined with wind pathogen confirmation, vigorously driving out exterior wind-cold is unquestionable. If pulse is weak/thready, body heavy, desire to sleep, attending to Shaoyin internal deficiency would be urgent enough; how could one dare to induce sweating? Furthermore, examining the text, wind-stroke pulse is naturally floating/relaxed but shows floating/tight; cold injury pulse is naturally floating/tight but shows floating/relaxed. This confirms wind-stroke with cold, cold injury with wind. One must distinguish the absence of Shaoyin syndrome to use Qinglong safely. Weak pulse contraindicates Da Qing Long Tang because Shaoyin pulse is micro-thready. Fang's annotation clings to "weak," linking it to wind-stroke pulse (floating Yang, weak Yin). Ignoring that wind-stroke pulses and mis-sweating signs were detailed in the upper Taiyang chapter, here the focus is distinguishing Shaoyin. Since Taiyang Bladder and Shaoyin Kidney are exterior-interior pairs, in Yin-deficient individuals, exterior pathogens may enter the Kidney via Bladder without transmission. Even more so in complex cases like concurrent cold/heat with Yin involvement. If Shaoyin is not deficient, how could exterior pathogens bypass to cause heaviness and desire to sleep? Thus, with Shaoyin syndrome, if exterior release is unavoidable, warming meridians and dispersing pathogens is required. Using the potent Qinglong directly would destroy the root of solitary Yang.
Wei Litong states: Body heaviness must be distinguished. Desire to sleep with constant heaviness belongs to Shaoyin. Misusing sweating leads to upper cold/lower exhaustion (Shaoyin Heat) or muscle twitching (Shaoyin Cold). Both violate the prohibition against mis-sweating.
Da Qing Long Tang (Major Blue Dragon Decoction) Formula:
Mahuang (Ephedrae Herba, stems removed, 6 liang), Guizhi (Cinnamomi Ramulus, 2 liang), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 2 liang), Xingren (Armeniacae Semen Amarum, skin and tip removed, 40 pieces), Shengjiang (Zingiberis Rhizoma Recens, sliced, 3 liang), Dazao (Ziziphi Jujubae Fructus, broken, 12 pieces), Shigao (Gypsum Fibrosum, crushed, wrapped in silk, size of a chicken egg).
Take seven ingredients, add 9 sheng of water, first boil Mahuang (Ephedrae Herba), reduce by 2 sheng, remove foam, add remaining herbs, boil to obtain 3 sheng, strain, warm and take 1 sheng. Aim for slight perspiration. If sweat is excessive, apply warm powder. If one dose induces sweat, stop subsequent doses. Repeated dosing causes excessive sweating and Yang collapse, leading to deficiency, aversion to wind, restlessness, and insomnia.
[Formula Analysis] Named "Major Blue Dragon," referencing the dragon raising clouds and rain. Treating wind relies on Guizhi Tang (Cinnamon Twig Decoction); treating cold relies on Mahuang Tang (Ephedra Decoction). Combining these forms the primary formula for dual wind-cold injury. Both syndromes lack sweat, so Shaoyao (Paeoniae Radix Alba) is reduced to avoid astringency. Both have restlessness, so Shigao (Gypsum Fibrosum) is added to clear heat. Without restlessness, Ma Huang Gui Zhi Ge Ban Tang (Ephedra and Cinnamon Twig Half-and-Half Decoction) would be appropriate. Zhang Zhongjing adds cold-natured acrid-sweet herbs to exterior-releasing formulas, indicating Mahuang Tang fever is purely exterior, while Da Qing Long Tang restlessness involves heat in the muscle layer. Using Shigao (Gypsum Fibrosum) early in Taiyang disease clears muscle heat, stomach fire, and generates fluids, protecting Yangming and preserving fluids. Unskilled physicians fear it; failure to use it leads to Yangming heat binding, macules, jaundice, mania, and various complications. Thus, Shigao (Gypsum Fibrosum) is essential for wind-stroke and cold injury. With Mahuang and Guizhi, it earns the name "Qinglong"; with Zhimu and Gancao, it becomes "Baihu." Post-administration requires slight sweat; excessive sweat is managed with warm powder. Stopping after one dose warns against over-sweating. Guizhi Tang omits Mahuang to prevent excessive sweating; Mahuang Tang includes Guizhi to prevent uncontrolled sweating. Failure to follow these rules leads to Yang collapse, reverse conditions, exterior emptiness, inability to withstand wind, Yin excess repelling Yang, and worsened restlessness/insomnia.
[Collected Exegesis] Xu Shuwei states: Zhang Zhongjing treats cold injury with three main approaches: Guizhi Tang (Cinnamon Twig Decoction), Mahuang Tang (Ephedra Decoction), and Qinglong Tang. Guizhi treats wind, Mahuang treats cold, Qinglong treats both. Applied correctly to matching pulse/symptoms, cures are immediate. People know this but misunderstand the rationale, fearing use.
Wu Shou states: Da Qing Long Tang (Major Blue Dragon Decoction) treats cold injury with fever, aversion to cold, anhidrosis, restlessness, and floating-tight or floating-rapid pulse. Urgent sweating cures it. Like extreme heat cooling with rain. Misunderstanding this and using cold-cooling herbs for restlessness is harmful. Contraindicated in weak pulse, sweating, aversion to wind. Misuse causes harm. Unclear pulse/symptoms lead to hesitation.
Floating and tight pulse: Floating indicates wind, tight indicates cold. Wind injures Wei, cold injures Ying. Ying and Wei disease causes bone/joint vexing pain. Induce sweating; do not purge.
[Annotation] This explains dual wind-cold injury affecting Ying and Wei. Floating is wind-pulse; wind is Yang; Wei is Yang. Tight is cold-pulse; cold is Yin; Ying is Yin. Injury follows their nature. Ying-Wei disease with bone/joint pain indicates Da Qing Long Tang (Major Blue Dragon Decoction) for sweating. Despite fever/restlessness, heat is in muscles, not stomach; purging is contraindicated.
If Taiyang disease sweating fails to resolve symptoms, with persistent fever, epigastric palpitations, dizziness, body tremors, and feeling as if falling to the ground, Zhen Wu Tang (True Warrior Decoction) is indicated.
[Annotation] This elaborates on the first clause, showing rescue methods. First clause discusses mis-sweating; this discusses over-sweating. Both involve Yang collapse, treated with Zhen Yu Tang (True Warrior Decoction) to support Yang and suppress Yin. Profuse sweating with unresolved fever indicates Yang loss upward. Epigastric palpitations indicate Yang deficiency failing to hold inward. Dizziness indicates weak Yang failing to rise. Body tremors indicate Yin fluid depletion and meridian malnutrition due to Yang deficiency. "Zhenzhen yu pixi di" describes uncontrollable trembling and inability to rise.
[Collected Annotations] Zhang Lu states: This addresses complications from misusing Da Qing Long Tang (Major Blue Dragon Decoction). Persistent fever despite sweating shows incomplete pathogen and damaged Zheng Qi. Epigastric palpitations (interior deficiency), dizziness (upper deficiency), tremors (meridian deficiency) all signal Yang collapse. Zhen Wu Tang (True Warrior Decoction) secures the foundation.
Wang Hu states: Why include Shengjiang (Zingiberis Rhizoma Recens) if treatment is not exterior? Pathogen arises from over-sweating; though no stagnation heat exists, interior/exterior cold remains. Shengjiang warms and gently releases.
Zhen Wu Tang (True Warrior Decoction) Formula (See Shaoyin Chapter).
In Taiyang disease on the second day, unexpected restlessness, followed by back moxibustion/ironing causing profuse sweating, intense heat entering the Stomach, drying Stomach fluids, leading to restlessness/vexation and delirium. After ten+ days, chills and spontaneous diarrhea indicate impending resolution. Sweat below waist is absent; urge to urinate is blocked; vomiting and urinary incontinence occur; feet are cold/averted to wind; stool is hard; frequent small bowel movements occur but volume is low. Eventually, large stool passage brings sudden head pain, and sole warmth occurs due to Grain Qi flowing downward.
[Annotation] Taiyang wind-stroke/cold injury without restlessness on day two, now restless, indicates anhidrosis-related restlessness (Da Qing Long Tang syndrome). Instead of sweating with Qinglong, fire therapy forced sweat. Fire pathogen enters Stomach, drying fluids, causing delirium. After ten days, pathogen/Zheng struggle leads to chills/resolution. Resolution comes via sweat or diarrhea. Spontaneous diarrhea suggests interior resolution; spontaneous sweat suggests exterior resolution. Lack of diarrhea and presence of urinary issues/vomiting indicate unresolved interior. Lack of sweat and lower-body cold/aversion indicate unresolved exterior. Interior unresolved implies hard stool. Frequent small stools suggest water retention in Stomach eventually moistening intestines, resolving accumulated stool. After large stool passage, if urine remains blocked and other symptoms persist, sudden head pain indicates residual exterior pathogen rising. Foot warmth indicates residual interior heat flowing down. Grain Qi is Stomach Qi; heat flows down with stool. These changes result from improper fire therapy; rigid rules don't apply. Diagnose the error and treat accordingly.
After taking Guizhi Tang (Cinnamon Twig Decoction), profuse sweating occurs, pulse becomes flooding. Administer Guizhi Tang (Cinnamon Twig Decoction) again as before. If symptoms resemble malaria, occurring twice daily, sweating will resolve it; Gui Zhi Er Ma Huang Yi Tang (Cinnamon Twig Twice, Ephedra One Third Decoction) is suitable.
[Annotation] After Guizhi Tang (Cinnamon Twig Decoction), profuse sweating without cure and flooding pulse, if accompanied by vexation/thirst, indicates pathogen entered Yangming (Bai Hu Tang syndrome). Here, flooding pulse without vexation/thirst means pathogen remains in Taiyang; repeat Guizhi Tang (Cinnamon Twig Decoction). If unresolved and resembling malaria (twice daily), though mild, pathogen is still held by wind-cold. Sweating is necessary. Gui Zhi Er Ma Huang Yi Tang (Cinnamon Twig Twice, Ephedra One Third Decoction) mildly releases Ying-Wei sweat. Ma Huang Gui Zhi Ge Ban Tang (Ephedra and Cinnamon Twig Half-and-Half Decoction) is avoided due to prior profuse sweating.
[Collected Annotations] Fang Youzhi states: Post-Guizhi Tang profuse sweating and flooding pulse indicate more wind than cold. Wind wants to scatter, but slight cold holds it. Neither resolves, causing malaria-like chills/fever. Gui Zhi Er Ma Huang Yi Tang (Cinnamon Twig Twice, Ephedra One Third Decoction) emphasizes resolving wind over dispersing cold.
Gui Zhi Er Ma Huang Yi Tang (Cinnamon Twig Twice, Ephedra One Third Decoction) Formula:
Guizhi (Cinnamomi Ramulus, 1 liang 17 zhu), Shaoyao (Paeoniae Radix Alba, 1 liang 6 zhu), Mahuang (Ephedrae Herba, stems removed, 16 zhu), Gancao (Glycyrrhizae Radix et Rhizoma, 1 liang 2 zhu), Xingren (Armeniacae Semen Amarum, skin/tip removed, 16 pieces), Shengjiang (Zingiberis Rhizoma Recens, sliced, 1 liang 6 zhu), Dazao (Ziziphi Jujubae Fructus, broken, 5 pieces).
Take seven ingredients, add 5 sheng water, first boil Mahuang (Ephedrae Herba) for 1-2 boils, remove foam, add others, boil to 2 sheng, strain, warm and take 1 sheng, twice daily.
[Collected Exegesis] Zhang Lu states: Ingredients are similar to Ge Ban Tang, differing only slightly in dosage. This distinction highlights Zhang Zhongjing's precision in minor adjustments.
In Taiyang disease, after 8-9 days, malaria-like symptoms, fever/aversion to cold, more heat than cold, no vomiting, normal bowel/bladder function, occurring 2-3 times daily. Pulse micro-relaxed indicates recovery. Pulse micro with aversion to cold indicates dual Yin-Yang deficiency; no further sweating, purging, or vomiting. Face flushed red indicates unresolved pathogen due to inability to produce slight sweat, causing body itching. Gui Zhi Ma Huang Ge Ban Tang (Cinnamon Twig and Ephedra Half-and-Half Decoction) is suitable.
[Annotation] Taiyang Ying-Wei dual injury, more wind than cold, after 8-9 days, malaria-like chills/fever, more heat than cold, no vomiting, clear urine indicates interior harmony. Recovery depends on pulse. Malaria-like episodes 2-3 times daily, gentle onset, micro-relaxed pulse indicates declining pathogen and recovering Zheng, signaling impending harmony/recovery. Micro pulse without relaxation, plus aversion to cold, indicates unrecovered Zheng and undeclined pathogen; cannot self-resolve. Prior sweating/purging/vomiting depleted interior/exterior; no further harsh treatments. Micro pulse/aversion to cold indicates dual deficiency; face should be pale. Red face indicates residual pathogen stagnating exterior, blocking slight sweat and Yang dispersion, causing red face/body itch. Gui Zhi Ma Huang Ge Ban Tang (Cinnamon Twig and Ephedra Half-and-Half Decoction) mildly induces sweat to harmonize Ying-Wei.
[Collected Annotations] Wu Renju states: Not solely relying on Guizhi but combining Mahuang addresses red face/itchy body, where pathogen is light/shallow. Only Mahuang can reach this level.
Gui Zhi Ma Huang Ge Ban Tang (Cinnamon Twig and Ephedra Half-and-Half Decoction) Formula:
Guizhi (Cinnamomi Ramulus, 1 liang 16 zhu), Shaoyao (Paeoniae Radix Alba, 1 liang), Shengjiang (Zingiberis Rhizoma Recens, 1 liang), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 1 liang), Mahuang (Ephedrae Herba, stems removed, 1 liang), Dazao (Ziziphi Jujubae Fructus, broken, 4 pieces), Xingren (Armeniacae Semen Amarum, skin/tip removed, 24 pieces).
Take seven ingredients, add 5 sheng water, first boil Mahuang (Ephedrae Herba) for 1-2 boils, remove foam, add others, boil to 1.8 sheng, strain, warm and take 0.6 sheng.
Floating and slow pulse, facial heat/redness with trembling/chills: Resolution via sweating expected in 6-7 days. Persistent fever indicates delayed recovery. Slow pulse indicates lack of Yang, inability to sweat, resulting in body itching.
[Annotation] Elaborates on red face/itchy body. Exterior Yang deficiency causes floating/slow pulse. Pathogen stagnation causes facial heat/redness. Deficiency vs. Excess struggle causes trembling. By day 6-7, pathogen should decline, allowing sweat/resolution. Persistent fever means pathogen hasn't declined, delaying recovery. Slow pulse means Zheng cannot overcome pathogen. Weak Yang stagnation causes itching due to inability to disperse sweat.
[Collected Annotations] Cheng Zhi states: Describes pulse of Yang deficiency unable to induce sweat. Floating indicates exterior pathogen; slow indicates Yang deficiency. Stagnant Qi causes facial redness; struggle prevents exit, causing trembling. By day 6-7 (end of transmission cycle), sweating should occur. Failure to sweat with fever delays recovery. Yang deficiency fails to guide sweat out; heat floats in skin/muscles, causing itching.
In Taiyang disease, fever/aversion to cold, more heat than cold, weak pulse indicates "no Yang"; do not induce sweating. Gui Zhi Yue Bi Yi Tang (Cinnamon Twig Twice, Bitter Ginger One Third Decoction) is suitable.
[Annotation] Taiyang fever/aversion to cold, more heat than cold, indicates Ying-Wei dual disease, more wind than cold. If pulse is floating-tight or floating-rapid, exterior Yang stagnation causes anhidrosis/excess heat; Da Qing Long Tang (Major Blue Dragon Decoction) induces sweating. Here, pulse is Yang-micro/Yin-weak,