凡病患身轻自能转侧者易治若身体沉重不能转侧者难治盖阴证则身重必足冷而蜷卧恶寒常好向壁卧闭目不欲向明
懒见人也又阴毒身如被杖之疼身重如山而不能转侧也又中湿风湿皆主身重疼痛不可转侧要当辨之大抵阳证身轻而手足
和暖开目而欲见人者可治若头重视身此天柱骨倒而元气败也凡伤寒传变循衣摸床两手撮空此神去而魂乱也总之病患皮
肤润泽者生而枯燥者死经曰脉浮而洪身汗如油喘而不休形体不仁乍静乍乱此为命绝也
(发热 恶寒 恶风 头痛 项强 身体痛)
黄 经曰太阳之为病头项强痛而恶风寒不传经者固有之然而传者多矣如经言伤寒一日太阳受之脉若静者为不传
颇欲吐
及烦躁脉数急者为传也又曰伤寒二三日阳明少阳证不见者为不传也太阳经治法有汗吐下温和解调并刺俱有之盖太阳所
感非一传变多端故也虽发汗解肌一法证有轻重脉有浮沉用药必宜随脉证用之庶造仲景之深意如发热恶寒脉浮紧麻黄汤
自汗恶风脉浮缓桂枝汤此脉证相应之定法也又如项背强八八反汗出恶风桂枝加葛根脉微而恶寒桂枝麻黄各半汤发热恶
寒热多寒少脉微弱者桂枝二越婢一汤脉浮紧自汗出小便数心烦微恶寒脚挛急桂枝加附子汤又如汗后复宜汗者发汗遂漏
不止恶风小便难四肢微急难以屈伸桂枝加附子汤服桂枝大汗出脉洪大者与桂枝如前法若如疟状日再发宜桂枝二麻黄一
汤仲景汗剂二十七汤所治五十九证大宜精别如何而用青龙汤如何而用五苓散如何而用茯苓甘草汤之类盖病有轻重治有
急缓故也清碧杜先生曰伤寒阳热之证传经之邪变态不一辨之不精则汗吐下三法之治一差死生反掌矣非比阴寒之邪中在
一经不复传变易于治也不过随寒邪轻重用温药治之一定之法耳今之庸工好用热剂而不知凉药之妙且难也
汗 桂枝汤 桂枝加葛根汤 桂枝加浓朴杏子汤 桂枝加附子汤 桂枝去芍药汤 桂枝去芍药加附子汤 桂枝麻
黄各半汤 桂枝二越婢一汤 桂枝二麻黄一汤 桂枝去桂加茯苓白术汤 葛根汤 葛根加半夏汤 葛根黄连黄芩汤
麻黄汤 大青龙汤 小青龙汤 桂枝加芍药人参新加汤 麻黄杏仁甘草石膏汤 五苓散 桂枝去芍药加蜀漆龙骨牡蛎
救逆汤 桂枝加桂汤 桂枝甘草龙骨牡蛎汤 桂枝附子汤 茯苓甘草汤 文蛤散 去桂加白术汤 甘草附子汤
吐 栀子豉汤 栀子甘草豉汤 栀子生姜豉汤 栀子浓朴汤 栀子干姜汤 瓜蒂散
下 调胃承气汤 大柴胡汤 承气汤 柴胡加芒硝汤 桃仁承气汤 抵当丸 大陷胸汤 抵当汤 大陷胸丸 白
散十枣汤 大黄黄连泻心汤 附子泻心汤
温 甘草干姜汤 芍药甘草汤 四逆汤 干姜附子汤 茯苓桂枝甘草大枣汤 浓朴生姜甘草半夏人参汤 茯苓桂
枝白术甘草汤 芍药甘草附子汤 茯苓四逆汤 桂枝甘草汤 真武汤 小建中汤 炙甘草汤
和解 小柴胡汤 柴胡加龙骨牡蛎汤 小陷胸汤 柴胡桂枝干姜汤 半夏泻心汤 生姜泻心汤 甘草泻心汤 柴
胡桂枝汤 桂枝人参汤 白虎汤 白虎加人参汤 黄芩汤 黄芩加半夏生姜汤
调 赤石脂禹余粮汤 旋复代赭石汤 黄连汤
刺 纵横刺期门 服桂枝刺风池风府 太少并病刺期门 热入血室刺期门 太少并病刺大椎肺俞
太阳之为病脉浮头项强痛而恶寒(成 经曰尺寸俱浮者太阳受病太阳主表为诸阳主气脉浮头项强痛而恶寒者太阳表
病也 但有一毫头痛即为在表)太阳病发热汗出恶风脉缓者名为中风(太阳病上条所揭云云者是也后皆仿此 成 风阳
也寒阴也风则伤卫发热汗出恶风者卫中风也荣病则发热无汗不恶风而恶寒卫病则发热汗出不恶寒而恶风以卫为阳卫外
者也病则不能卫固其外而皮腠疏故汗出而恶风也伤寒脉紧伤风脉缓者寒性劲急而风性解缓故也)太阳病头痛发热汗出恶
风者桂枝汤主之 太阳病发热汗出者此为荣弱卫强故使汗出欲救邪风者宜桂枝汤(成 太阳中风风并于卫则卫实而荣虚
荣者阴也卫者阳也发热汗出阴弱阳强也内经曰阴虚者阳必凑之故少气时热而汗出与桂枝汤解散风邪调和荣卫)太阳中风
阳浮而阴弱阳浮者热自发阴弱者汗自出瑟瑟恶寒淅淅恶风翕翕发热鼻鸣干呕者桂枝汤主之(成 阳以候卫阴以候荣阳脉
浮者卫中风也阴脉弱者荣气弱也风并于卫则卫实而荣虚故发热汗自出也经曰太阳病发热汗出者此为荣弱卫强者是也瑟
瑟者不足也恶寒之貌也淅淅者潇淅也恶风之貌也卫虚则恶风荣虚则恶寒荣弱卫强恶寒复恶风者以自汗出则皮肤缓腠理
疏是亦恶风也翕翕者 然而热也若合羽所覆言热在表也鼻鸣干呕者风拥而气逆也与桂枝汤和荣卫而散风邪也)病患脏
无他病时发热自汗出而不愈者此卫气不和也先其时发汗则愈宜桂枝汤主之(时发热自汗出谓有时而发热自汗出有时而止
惟其时作时止故病留连而不愈也当其发热自汗之时不可与药当先其时作候其时止而后与之故曰先其时也素问曰当其盛
而必毁因其衰也事必大昌其是之谓欤
桂枝汤方
桂枝(三两去皮) 芍药(三两) 甘草(二两炙) 生姜(三两切) 大枣(十二枚擘)上五味 咀以水七升微
火煮取三升去滓适寒温服一升服已须臾 热稀粥一升余以助药力温覆令一时许遍身 微似有汗者益佳不可令如水淋
漓病必不除若一服汗出病瘥停后服不必尽剂若不汗更服根据前法又不汗后服小促其间半日许令三服尽若病重者一日一夜
服周时观之服一剂尽病证犹在者更作服若汗不出乃服至二三剂禁生冷粘滑肉面五辛酒酪臭恶等物(小促宋板作少从容)
成 经云桂枝本为解肌若脉浮紧发热汗不出者不可与之常须识此勿令误也盖桂枝汤本专主太阳中风必也皮肤疏
凑
又自汗风邪干于卫气者乃可投之也仲景以解肌为轻以发汗为重故发汗吐下后身疼不休者津液内耗也虽有表邪而止可解
肌故须桂枝汤少和之也桂味辛热用之为君桂犹圭也宣导诸药为之先聘是谓辛甘发散为阳之意盖发散风邪必以辛为主内
经所谓风淫所胜平以辛佐以苦以甘缓之以酸收之是以芍药为臣而甘草为佐也内经曰风淫于内以甘缓之以辛散之生姜味
辛温大枣味甘温是用以为使而此又不特专于发散以脾主为胃行其津液姜枣之用专行脾之津液而和荣卫者也麻黄汤不用
姜枣者谓专于发汗不待行化而津液得通矣
庞 凡桂枝汤病证者常自汗出小便不数手足温和或手足指稍露之则微冷覆之则温浑身热微烦而又憎寒始可行之
若
病者无汗小便数或手足逆身冷不恶寒反恶热或饮酒后慎不可行桂枝汤也脉紧必无汗设有汗不可误作桂枝证
许 有人病发热恶寒自汗脉微弱而浮三服汤而愈此方在仲景一百十三方内独冠其首今人全不用何也仲景云太阳
中
风阳浮而阳弱阳浮者云云至翕翕发热宜桂枝汤此脉与证仲景说得甚明后人看不透所以不敢用也 假令寸口脉微名曰阳
不足阴气上入阳中则洒淅恶寒也尺脉弱名曰阴不足阳气下陷入阴中则发汗也此谓元气受病而然也又曰阳微则恶寒阴微
则发热医既汗之使阳气微又大下之令阴气弱此谓医所使也大抵阴不足阳往从之故内陷而发热阳不足阴往乘之故阴上入
阳中则恶寒举此二端明白易晓何惮而不用桂枝汤哉
垣 仲景治表虚制此汤桂枝味辛热发散助阳体轻本乎天者亲上故桂枝为君芍药甘草佐之如阳脉涩阴脉弦法当腹
中
急痛乃制小建中汤以芍药为君桂枝甘草佐之一则治其表虚一则治其里虚故各有主用也后学当触类而长之 以桂枝易肉
桂治寒腹痛神品药也如夏中热腹疼少加黄芩去桂痛立止桂于春夏二时为禁药
陶 桂枝麻黄汤为当时伤寒设与过时之温暑者何预焉若以此二汤通治春温夏 之病则误之甚矣
太阳病或已发热或未发热必恶寒体痛呕逆脉阴阳俱紧者名曰伤寒 (成 经曰凡伤于寒则为病热为寒气客于经中阳
经怫结而成热也中风即发热者风为阳也及伤寒云或已发热或未发热以寒为阴邪不能即热郁而方变热也风则伤卫寒则伤
荣卫虚者恶风荣虚者恶寒荣伤寒者必恶寒也气病者则麻血病者则痛风令气缓寒令气逆体痛呕逆者荣中寒也经曰脉盛身
寒得之伤寒脉阴阳俱紧者知其伤寒也 但见恶寒即为在表此是要诀)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(成 寒则伤荣头痛身疼腰痛以至牵连骨节疼痛者太阳经荣血不利也内经曰风寒客于人使人毫毛毕直皮肤闭
而为热者寒在表也风并于卫卫气而荣虚者自汗出而恶风寒也寒并于荣荣实而卫虚者无汗而恶风也以荣强卫弱故气逆而
喘与麻黄汤以发其汗)
麻黄汤方
麻黄(三两去节) 桂枝(二两去皮) 甘草(一两炙) 杏仁(七十个泡去皮尖)上四味以水九升先煮麻黄减二
升去上沫内诸药煮取二升半去滓温服八合覆取微汗不须啜粥余如桂枝法(凡用麻黄去节先滚醋汤略浸片时捞起以备后用
庶免大发如冬月严寒腠理致密当生用)一用麻黄后汗出不止者将病患发披水盆中足露出外用炒糯米一升龙骨牡蛎 本防
风各一两研为细末周身扑之随后秘方用药免至亡阳而死此良法也
吴 或云发汗必用麻黄亦有禁用者何也凡伤寒发于天令寒冷之时且其寒邪在表闭其腠理身疼拘急恶寒而无汗者
须
用麻黄辛苦之药为能开发腠理逐寒邪汗出而解也惟夏月炎暑之时为禁用之药故宜辛凉之剂以发之乃葛根葱白豆豉之类
是也若麻黄加凉剂在内亦可用如通解散是也
成 本草言轻可去实即麻黄葛根之属实谓寒邪在表汗不出而腠密邪气胜而表实轻剂所以扬之麻黄味甘苦用以为
君
者以麻黄为轻剂而专主发散也风邪在表而肤理疏者必以桂枝解其肌今寒邪在经表实而腠密非桂枝所能独散必专麻黄以
发汗而桂枝所以为臣也内经曰寒淫于内治以甘热佐以辛苦者兹是类欤内经曰肝苦急急食甘以缓之肝者荣之主也伤寒荣
胜卫固血脉不流必用味甘之物以缓之故以甘草味甘平杏仁味苦温为之佐使且桂枝汤主中风风则伤卫风邪并于卫则卫实
而荣弱仲景所谓汗出恶风者此为荣弱卫强故桂枝汤佐以芍药用和荣也麻黄汤主伤寒寒则伤荣邪并于荣则荣实而卫虚
内经所谓气之所并为血虚血之所并为气虚者是也故麻黄汤佐以杏仁用利气也
太阳中风脉浮紧发热恶寒身疼痛汗不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(成 此中风见寒脉也浮则为风风则伤卫紧则为寒寒则伤荣荣卫俱病故发热恶寒身疼痛也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则荣卫俱实故不汗出而烦躁也与大青龙汤发汗以除荣卫风寒若脉微弱汗出恶风者为
荣卫俱虚反服青龙汤则必亡阳故生厥逆筋惕肉 此治之逆也)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
(成 此伤寒见风脉也伤寒者身疼此以风胜故身不疼中风者身重此以兼风故乍有轻时不发厥吐利无少阴里证者为风寒
外甚也与大青龙汤以发散表中风寒)
大青龙汤方
麻黄(六两去节) 桂枝(二两去皮) 甘草(二两炙) 杏仁(四十枚去皮尖) 生姜(三两切)大枣(十二枚
擘) 石膏(鸡子大碎)上七味以水九升先煮麻黄减一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(一作逆)虚恶风烦躁不得眠也
成 青龙东方甲乙木神也应春而主肝专发生之令为敷荣之主万物出甲开则有两岐肝有两叶以应之谓之青龙者以
发
散荣卫两伤之邪是应肝木之体耳桂枝汤主中风麻黄汤主伤寒中风脉浮紧为中风见寒脉伤寒脉浮缓为伤寒见风脉是风寒
两伤也风兼寒寒兼风虽欲与桂枝汤解肌以祛风而不能已其寒或欲以麻黄汤发汗以散寒而不能去其风兹仲景所以特处青
龙汤而两解也麻黄味甘温桂枝味辛热寒则伤荣必以甘缓之风则伤卫必以辛散之此风寒两伤荣卫俱病故以甘辛相合而为
发散之剂表虚肤腠疏则以桂枝为主此为表实腠理密者则以麻黄为主是先麻黄为君后桂枝为臣也甘草味甘平杏仁味甘苦
苦甘为助佐麻黄以发表大枣甘温生姜味辛温辛甘相合佐桂枝以解肌风阳邪寒阴邪风则伤阳寒则伤阴荣卫阴阳为风寒两
伤则非轻剂可独除散也必须轻重之剂以同散之乃得阴阳之邪俱已荣卫之气俱和是以石膏味苦辛微寒质重而又专达肌表
为使也大青龙发汗之重剂用之稍过则有亡阳之失经曰若脉微弱汗出恶风者不可服服之则厥逆筋惕肉 此为逆也又曰一
服汗者停后服若再服汗多亡阳遂致恶风烦躁不得眠也用者宜详审之
吴 大青龙汤仲景治伤寒发热恶寒烦躁者则用之夫伤寒邪气在表不得汗出其人烦躁不安身心无如之奈何如脉浮
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
岂胜言哉若脉不浮紧而数无恶风恶寒身疼者亦不可用之也如误用之其害亦复不浅所以脉证不明者多不敢用也
许 仲景治伤寒一则桂枝二则麻黄三则青龙桂枝治中风麻黄治伤寒青龙治中风见寒脉伤寒见风脉三者如鼎立人
皆
凡是病人身体轻便,能够自行翻转侧卧的,容易治疗;若是身体沉重,不能翻转侧卧的,则难治。这是因为阴证的身重,必定伴有脚冷、蜷缩而卧、恶寒,常常喜欢面向墙壁躺卧,闭着眼睛不想见光亮,懒得见人。另外,阴毒病(一种严重的阴寒证)的身体疼痛如同被棍棒打过一样,身体沉重如山而不能转侧。还有中湿和风湿病,也都以身体沉重疼痛、不可转侧为主症,必须加以辨别。大抵阳证身轻,手足和暖,睁眼想见人的,可以治疗;若是头垂视下、身体僵直,这是天柱骨倒(指颈部支撑无力)、元气败绝的表现。凡是伤寒传变过程中,出现循衣摸床(手指无意识地抓摸衣被或床沿)、两手撮空(手在空中虚抓)的症状,这是神气离去、魂志混乱的表现。总之,病人皮肤润泽的能生,皮肤枯燥的死。医经说:脉象浮而洪大,身体出汗如油,喘息不止,形体麻木不仁,时而安静时而乱语,这是命绝之兆。
(发热 恶寒 恶风 头痛 项强 身体痛)
医经说:太阳病的典型症状是头项强痛且恶风寒。不传经的情况固然存在,但传变的也很多。如医经所言:伤寒第一天,太阳经受邪,如果脉象平静(没有数急变化),说明没有传经;如果病人颇欲吐(经常想呕吐)以及烦躁,脉象数急,说明已经传经。又说:伤寒二三天后,如果没有出现阳明病或少阳病的症状,说明没有传经。太阳经的治疗方法包括汗法、吐法、下法、温法、和解法、调理法和针刺法,这些都具备。因为太阳经受感的外邪不止一种,传变多端,所以如此。虽然发汗解肌是一种方法,但证候有轻重,脉象有浮沉,用药必须根据脉证来决定,这样才能符合张仲景的深意。例如:发热、恶寒、脉浮紧的,用麻黄汤;自汗、恶风、脉浮缓的,用桂枝汤。这是脉证相应的定法。又如:项背强几几(拘紧不舒),反而出汗、恶风的,用桂枝加葛根汤;脉微而恶寒的,用桂枝麻黄各半汤;发热、恶寒、热多寒少、脉微弱的,用桂枝二越婢一汤;脉浮紧、自汗出、小便频数、心烦、微恶寒、脚挛急的,用桂枝加附子汤。又如:发汗后,应当再发汗的,结果发汗导致汗漏不止、恶风、小便困难、四肢轻微拘急、难以屈伸的,用桂枝加附子汤。服用桂枝汤后大汗出,脉象洪大的,给予桂枝汤按前法服用;如果像疟疾一样,一天发作两次的,宜用桂枝二麻黄一汤。张仲景的汗剂有二十七方,所治疗的有五十九种证候,非常精妙区别,如何应用青龙汤?如何应用五苓散?如何应用茯苓甘草汤等等?这是因为病情有轻重,治疗有急缓的缘故。清碧杜先生说:伤寒阳热之证,传经之邪,变态不一,如果不仔细辨别,那么汗、吐、下三种治疗方法一旦出错,生死就在反掌之间了。这不像阴寒之邪,只中在一经,不再传变,容易治疗,也不过是根据寒邪的轻重,用温药治疗的一定法则罢了。现在的庸医好用热剂,却不知道凉药的奥妙和难处。
【汗法】
桂枝汤、桂枝加葛根汤、桂枝加浓朴杏子汤、桂枝加附子汤、桂枝去芍药汤、桂枝去芍药加附子汤、桂枝麻黄各半汤、桂枝二越婢一汤、桂枝二麻黄一汤、桂枝去桂加茯苓白术汤、葛根汤、葛根加半夏汤、葛根黄连黄芩汤、麻黄汤、大青龙汤、小青龙汤、桂枝加芍药人参新加汤、麻黄杏仁甘草石膏汤、五苓散、桂枝去芍药加蜀漆龙骨牡蛎救逆汤、桂枝加桂汤、桂枝甘草龙骨牡蛎汤、桂枝附子汤、茯苓甘草汤、文蛤散、去桂加白术汤、甘草附子汤。
【吐法】
栀子豉汤、栀子甘草豉汤、栀子生姜豉汤、栀子浓朴汤、栀子干姜汤、瓜蒂散。
【下法】
调胃承气汤、大柴胡汤、承气汤、柴胡加芒硝汤、桃仁承气汤、抵当丸、大陷胸汤、抵当汤、大陷胸丸、白散、十枣汤、大黄黄连泻心汤、附子泻心汤。
【温法】
甘草干姜汤、芍药甘草汤、四逆汤、干姜附子汤、茯苓桂枝甘草大枣汤、浓朴生姜甘草半夏人参汤、茯苓桂枝白术甘草汤、芍药甘草附子汤、茯苓四逆汤、桂枝甘草汤、真武汤、小建中汤、炙甘草汤。
【和解法】
小柴胡汤、柴胡加龙骨牡蛎汤、小陷胸汤、柴胡桂枝干姜汤、半夏泻心汤、生姜泻心汤、甘草泻心汤、柴胡桂枝汤、桂枝人参汤、白虎汤、白虎加人参汤、黄芩汤、黄芩加半夏生姜汤。
【针刺法】
纵横刺期门穴、服用桂枝汤同时针刺风池和风府穴、太少并病刺期门穴、热入血室刺期门穴、太少并病刺大椎穴和肺俞穴。
太阳病,脉浮,头项强痛而恶寒。(成无己注:医经说尺寸脉俱浮的,是太阳受病。太阳主表,为诸阳主气。脉浮、头项强痛而恶寒,是太阳表病。只要有一点点头痛,就是在表。)
太阳病,发热,汗出,恶风,脉缓的,叫做中风。(太阳病上条所揭示的症状就是这样,后面都仿照这个格式。成无己注:风属阳,寒属阴。风伤卫分,表现为发热、汗出、恶风;营分生病则发热、无汗、不恶风而恶寒。卫分生病则发热、汗出、不恶寒而恶风。因为卫气属阳,护卫体表,生病则不能固护外表,导致腠理疏松,所以汗出而恶风。伤寒脉紧,伤风脉缓,是因为寒性劲急而风性舒缓。)
太阳病,头痛,发热,汗出,恶风的,用桂枝汤主治。(太阳病,发热,汗出的,这是因为营弱卫强,所以使汗出。想要救治这种邪风,适宜用桂枝汤。成无己注:太阳中风,风邪并入卫分,则卫实而营虚。营属阴,卫属阳。发热汗出,是阴弱阳强。内经说:阴虚者阳必凑之,所以少气、时热而汗出。给予桂枝汤解散风邪,调和营卫。)
太阳中风,阳脉浮而阴脉弱。阳浮者热自发,阴弱者汗自出,瑟瑟恶寒,淅淅恶风,翕翕发热,鼻鸣,干呕的,桂枝汤主之。(成无己注:阳脉候卫,阴脉候营。阳脉浮,是卫中风;阴脉弱,是营气弱。风邪并入卫分,则卫实而营虚,所以发热、汗自出。经说:太阳病发热汗出,这是营弱卫强。瑟瑟,是不足的样子,恶寒的形态;淅淅,是潇淅的样子,恶风的形态。卫虚则恶风,营虚则恶寒。营弱卫强,既恶寒又恶风,是因为自汗出,皮肤松弛,腠理疏松,这也是恶风的表现。翕翕,是温热貌,像羽毛覆盖在身上那样感觉热,表示热在表。鼻鸣、干呕,是风拥塞导致气逆。给予桂枝汤调和营卫而散风邪。)
病人脏腑没有其他疾病,只是有时发热、自汗出而不愈的,这是卫气不和。在发热自汗之前发汗则痊愈,适宜用桂枝汤主治。(时发热、自汗出,是指有时发热自汗出,有时停止。正因为时作时止,所以病留连不愈。应当在发热自汗之时不给药,先等待其时,候其时止后再给药,所以说“先其时”。素问说:当其盛势时必然毁坏,因其衰势时做事必然大昌,说的就是这个道理。)
桂枝汤方
桂枝(三两,去皮)、芍药(三两)、甘草(二两,炙)、生姜(三两,切)、大枣(十二枚,擘)。以上五味药,切碎,用水七升,微火煮取三升,去渣滓。适寒温服一升。服完后须臾,喝热稀粥一升多,以助药力。温覆衣服,约一时许,全身微微似有汗出的最好,不可令汗出如水淋漓,否则病必不除。如果一服药汗出病愈,停后服,不必尽剂。如果不汗出,再按前法服用;又不汗出,后服药稍微缩短间隔时间,半日左右让三服药服完。如果病重的,一日一夜服,周时观察。服完一剂,病证还在的,再制作服用。如果汗不出,就服到二三剂。禁忌生冷、粘滑、肉面、五辛、酒酪、臭恶等食物。(小促,宋板作少从容)
成无己注:医经云桂枝本为解肌,如果脉浮紧、发热、汗不出者,不可与之。常须记住这一点,不要弄错。盖桂枝汤本来专门主治太阳中风,必须是皮肤疏凑,又自汗,风邪干扰卫气的,才可以投用。张仲景以解肌为轻,以发汗为重,所以发汗、吐、下后,身疼不休的,是津液内耗。虽然有表邪,但只可解肌,所以须用桂枝汤少量调和。桂味辛热,用之为君。桂犹圭也,宣导诸药为之先导,这是谓辛甘发散为阳的意思。盖发散风邪必以辛为主,内经所谓风淫所胜,平以辛,佐以苦,以甘缓之,以酸收之。所以用芍药为臣,甘草为佐。内经曰:风淫于内,以甘缓之,以辛散之。生姜味辛温,大枣味甘温,是用以为使。而且此方不特专于发散,因为脾主为胃行其津液,姜枣之用专行脾之津液而和营卫。麻黄汤不用姜枣,是因为专于发汗,不待行化而津液得通矣。
庞安时注:凡是桂枝汤的病证,病人常自汗出,小便不数,手足温和,或者手足指稍露之则微冷,覆之则温,浑身热微烦而又憎寒,始可行之。如果病人无汗,小便数,或者手足逆冷,不恶寒反恶热,或者饮酒后,慎不可行桂枝汤。脉紧必无汗,设有汗不可误作桂枝证。
许叔微注:有人病发热恶寒,自汗,脉微弱而浮,三服药而愈。此方在张仲景一百十三方内独冠其首,今人全不用,为什么?张仲景云:太阳中风,阳浮而阴弱,阳浮者……至翕翕发热,宜桂枝汤。此脉与证张仲景说得甚明,后人看不透,所以不敢用。假令寸口脉微,名曰阳不足,阴气上入阳中,则洒淅恶寒也;尺脉弱,名曰阴不足,阳气下陷入阴中,则发汗也。此谓元气受病而然也。又说:阳微则恶寒,阴微则发热。医既汗之,使阳气微,又大下之,令阴气弱,此谓医所使也。大抵阴不足,阳往从之,故内陷而发热;阳不足,阴往乘之,故阴上入阳中则恶寒。举此二端,明白易晓,何惮而不用桂枝汤哉!
李东垣注:张仲景治表虚制此汤。桂枝味辛热,发散助阳,体轻本乎天者亲上,故桂枝为君。芍药、甘草佐之。如阳脉涩、阴脉弦,法当腹中急痛,乃制小建中汤,以芍药为君,桂枝、甘草佐之。一则治其表虚,一则治其里虚,故各有主用也。后学当触类而长之。以桂枝易肉桂,治寒腹痛,是神品药也。如夏中热腹疼,少加黄芩,去桂,痛立止。桂于春夏二时为禁药。
陶华注:桂枝麻黄汤为当时伤寒设,与过时之温暑者何预焉?若以此二汤通治春温夏热之病,则误之甚矣。
太阳病,或已发热,或未发热,必恶寒,体痛,呕逆,脉阴阳俱紧的,名曰伤寒。(成无己注:医经说凡伤于寒则为病热。为寒气客于经中,阳经怫结而成热也。中风即发热者,风为阳也。及伤寒云或已发热或未发热,以寒为阴邪,不能即热,郁而方变热也。风则伤卫,寒则伤荣。卫虚者恶风,荣虚者恶寒。荣伤寒者必恶寒也。气病者则麻,血病者则痛风。令气缓,寒令气逆。体痛、呕逆者,荣中寒也。经曰:脉盛身寒,得之伤寒。脉阴阳俱紧者,知其伤寒也。但见恶寒即为在表,这是要诀。)
太阳病,头痛,发热,身疼,腰痛,骨节疼痛,恶风,无汗而喘的,麻黄汤主之。(成无己注:寒则伤荣。头痛、身疼、腰痛,以至牵连骨节疼痛者,是太阳经荣血不利也。内经曰:风寒客于人,使人毫毛毕直,皮肤闭而为热者,寒在表也。风并于卫,卫气而荣虚者,自汗出而恶风寒也。寒并于荣,荣实而卫虚者,无汗而恶风也。以荣强卫弱,故气逆而喘。与麻黄汤以发其汗。)
麻黄汤方
麻黄(三两,去节)、桂枝(二两,去皮)、甘草(一两,炙)、杏仁(七十个,泡,去皮尖)。以上四味,用水九升,先煮麻黄,减二升,去上沫,内诸药,煮取二升半,去渣滓。温服八合,覆取微汗,不须啜粥。其余如桂枝法。(凡用麻黄去节,先滚醋汤略浸片时捞起以备后用,庶免大发。如冬月严寒,腠理致密,当生用。)一用麻黄后汗出不止者,将病患发披水盆中,足露出,外用炒糯米一升、龙骨、牡蛎、防风各一两,研为细末,周身扑之。随后秘方用药,免至亡阳而死,此良法也。
吴谦注:有人说发汗必用麻黄,也有禁用者,为什么?凡是伤寒发于天令寒冷之时,且其寒邪在表,闭其腠理,身疼拘急,恶寒而无汗者,须用麻黄辛苦之药,为能开发腠理,逐寒邪,汗出而解也。惟夏月炎暑之时,为禁用之药,故宜辛凉之剂以发之,乃葛根、葱白、豆豉之类是也。若麻黄加凉剂在内,亦可用,如通解散是也。
成无己注:本草言轻可去实,即麻黄、葛根之属实,谓寒邪在表,汗不出而腠密,邪气胜而表实,轻剂所以扬之。麻黄味甘苦,用以为君者,以麻黄为轻剂而专主发散也。风邪在表而肤理疏者,必以桂枝解其肌。今寒邪在经,表实而腠密,非桂枝所能独散,必专麻黄以发汗,而桂枝所以为臣也。内经曰:寒淫于内,治以甘热,佐以辛苦者,兹是类欤?内经曰:肝苦急,急食甘以缓之。肝者,荣之主也。伤寒荣胜卫固,血脉不流,必用味甘之物以缓之,故以甘草味甘平、杏仁味苦温为之佐使。且桂枝汤主中风,风则伤卫,风邪并于卫,则卫实而荣弱,仲景所谓汗出恶风者,此为荣弱卫强,故桂枝汤佐以芍药用和荣也。麻黄汤主伤寒,寒则伤荣,邪并于荣,则荣实而卫虚,内经所谓气之所并为血虚,血之所并为气虚者是也,故麻黄汤佐以杏仁用利气也。
太阳中风,脉浮紧,发热,恶寒,身疼痛,汗不出而烦躁的,大青龙汤主之。若脉微弱,汗出恶风的,不可服。服之则厥逆,筋惕肉瞤,此为逆也。(成无己注:此中风见寒脉也。浮则为风,风则伤卫;紧则为寒,寒则伤荣。荣卫俱病,故发热、恶寒、身疼痛也。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,则荣卫俱实,故不汗出而烦躁也。与大青龙汤发汗以除荣卫风寒。若脉微弱、汗出恶风者为荣卫俱虚,反服青龙汤,则必亡阳,故生厥逆、筋惕肉瞤,此为治之逆也。)
伤寒,脉浮缓,身不疼但重,乍有轻时,无少阴证的,大青龙汤发之。(成无己注:此伤寒见风脉也。伤寒者身疼,此以风胜故身不疼;中风者身重,此以兼风故乍有轻时。不发厥、吐利,无少阴里证者,为风寒外甚,也与大青龙汤以发散表中风寒。)
大青龙汤方
麻黄(六两,去节)、桂枝(二两,去皮)、甘草(二两,炙)、杏仁(四十枚,去皮尖)、生姜(三两,切)、大枣(十二枚,擘)、石膏(鸡子大,碎)。以上七味,用水九升,先煮麻黄,减一升,去上沫,纳诸药,煮取三升,去渣滓。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(一作逆)虚,恶风,烦躁,不得眠也。
成无己注:青龙,东方甲乙木神也,应春而主肝,专发生之令,为敷荣之主。万物出甲开,则有两岐,肝有两叶以应之,谓之青龙者,以发散荣卫两伤之邪,是应肝木之体耳。桂枝汤主中风,麻黄汤主伤寒。中风脉浮紧为中风见寒脉,伤寒脉浮缓为伤寒见风脉,是风寒两伤也。风兼寒,寒兼风,虽欲与桂枝汤解肌以祛风,而不能已其寒;或欲以麻黄汤发汗以散寒,而不能去其风。兹仲景所以特处青龙汤而两解也。麻黄味甘温,桂枝味辛热。寒则伤荣,必以甘缓之;风则伤卫,必以辛散之。此风寒两伤,荣卫俱病,故以甘辛相合而为发散之剂。表虚肤腠疏则以桂枝为主,此为表实腠理密者则以麻黄为主,是先麻黄为君,后桂枝为臣也。甘草味甘平,杏仁味甘苦,苦甘为助,佐麻黄以发表;大枣甘温,生姜味辛温,辛甘相合,佐桂枝以解肌。风阳邪,寒阴邪,风则伤阳,寒则伤阴。荣卫阴阳为风寒两伤,则非轻剂可独除散,也必须轻重之剂以同散之,乃得阴阳之邪俱已,荣卫之气俱和。是以石膏味苦辛微寒,质重而又专达肌表为使也。大青龙发汗之重剂,用之稍过则有亡阳之失。经曰:若脉微弱、汗出恶风者,不可服。服之则厥逆、筋惕肉瞤,此为逆也。又说:一服汗者,停后服。若再服,汗多亡阳,遂致恶风、烦躁、不得眠也。用者宜详审之。
吴谦注:大青龙汤,张仲景治伤寒发热、恶寒、烦躁者则用之。夫伤寒邪气在表,不得汗出,其人烦躁不安,身心无如之奈何。如脉浮紧或浮数者,急用此汤发汗则愈,乃张仲景之妙法也。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,其害岂胜言哉!若脉不浮紧而数,无恶风、恶寒、身疼者,亦不可用之也。如误用之,其害亦复不浅,所以脉证不明者多不敢用也。
许叔微注:张仲景治伤寒,一则桂枝,二则麻黄,三则青龙。桂枝治中风,麻黄治伤寒,青龙治中风见寒脉、伤寒见风脉。三者如鼎立,人皆
In general, if a patient's body is light and they can turn over independently, the condition is easy to treat; however, if the body feels heavy and turning over is difficult, it is hard to treat. This is because in Yin syndromes (syndromes characterized by deficiency of Yang or excess of Yin), heaviness of the body is invariably accompanied by cold feet, curling up while lying down, aversion to cold, a preference for lying facing the wall with eyes closed avoiding light, and reluctance to see people. Additionally, in Yin toxicity (a severe Yin-cold syndrome), pain feels as if beaten by a club, the body is as heavy as a mountain and unable to turn. Furthermore, dampness obstruction (obstruction caused by pathogenic dampness) and wind-dampness bi-syndrome both present with heavy, painful bodies unable to turn, which must be differentiated. Generally speaking, in Yang syndromes (syndromes characterized by excess of Yang or deficiency of Yin), the body is light, hands and feet are warm, eyes are open and the patient wishes to see people, indicating a treatable condition. If the head droops and the body is rigid, this indicates collapse of the Tianzhu bone (loss of neck support) and failure of Yuan Qi (Original Qi). In the progression of Shanghan (Cold Damage), symptoms such as picking at clothes and bedrails, and grasping at empty air indicate the departure of Shen (Spirit) and chaos of Hun (Ethereal Soul). In summary, patients with moist and lustrous skin will survive, while those with dry and rough skin will die. The Classic states: "If the pulse is floating and surging, sweat oozes like oil, panting does not cease, the body is insensible, alternating between quietness and confusion, this is a sign of impending death."
(Fever, Aversion to Cold, Aversion to Wind, Headache, Stiffness and Pain of the Neck and Occiput, Body Pain)
The Classic states: The hallmark of Taiyang disease (disease of the Taiyang channel) is stiffness and pain of the neck and occiput with aversion to wind and cold. While non-transmission occurs, transmission is common. As stated in the Classic: On the first day of Shanghan, when the Taiyang channel is affected, if the pulse remains calm (without rapid changes), it indicates no transmission; however, if the patient frequently desires to vomit and experiences irritability with a rapid and urgent pulse, transmission has occurred. It also states: If two or three days after Shanghan begin, there are no signs of Yangming disease (disease of the Yangming channel) or Shaoyang disease (disease of the Shaoyang channel), it indicates no transmission. Treatment methods for the Taiyang channel include sweating (diaphoresis), vomiting (emesis), purging (catharsis), warming, harmonizing, regulating, and acupuncture. These are all applicable because the pathogenic factors affecting the Taiyang channel vary, leading to diverse transmissions. Although releasing the muscle layer and inducing sweating is one method, syndromes vary in severity and pulses in depth and superficiality; medication must be tailored to the pulse and syndrome to align with Zhang Zhongjing's profound intent. For instance: Fever, aversion to cold, and a floating-tight pulse indicate the use of Mahuang Tang (Ephedra Decoction); spontaneous sweating, aversion to wind, and a floating-slow pulse indicate the use of Guizhi Tang (Cinnamon Twig Decoction). These are fixed methods corresponding to pulse and syndrome. For example: Stiffness and tension in the neck and back with paradoxical sweating and aversion to wind indicate Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Pueraria Decoction); a faint pulse with aversion to cold indicates Guizhi Mahuang Ban Ge Tang (Half-Cinnamon Twig and Half-Ephedra Decoction); fever, aversion to cold, more heat than cold, and a weak pulse indicate Guizhi Er Yuebi Yi Tang (Two-Parts Cinnamon Twig and One-Part Jade Breather Decoction); a floating-tight pulse with spontaneous sweating, frequent urination, irritability, slight aversion to cold, and leg cramps indicate Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite Decoction). Furthermore: After sweating, if sweating continues uncontrollably with aversion to wind, difficulty in urination, slight stiffness in the four limbs making flexion and extension difficult, Guizhi Jia Fuzi Tang should be used. After taking Guizhi Tang, if profuse sweating leads to a surging pulse, administer Guizhi Tang again according to previous instructions; if symptoms resemble malaria occurring twice daily, Guizhi Er Mahuang Yi Tang (Two-Parts Cinnamon Twig and One-Part Ephedra Decoction) is appropriate. Zhang Zhongjing’s twenty-seven sweating formulas treat fifty-nine syndromes with great precision. How to apply Qinglong Tang (Azure Dragon Decoction)? How to apply Wuling San (Five-Ling Powder)? How to apply Fuling Gancao Jiang Tang (Poria, Licorice, and Ginger Decoction)? This depends on the severity of the illness and the urgency of treatment. Mr. Qingbi Du stated: For Yang-heat syndromes in Shanghan, where transmitted pathogens manifest variably, imprecise differentiation can lead to fatal errors in sweating, vomiting, or purging treatments instantly. This differs from Yin-cold pathogens confined to one channel without transmission, which are easier to treat using fixed warming methods based on cold severity. Modern incompetent physicians often prefer hot remedies, unaware of the subtleties and difficulties of cooling medicines.
[Sweating Methods]
Guizhi Tang (Cinnamon Twig Decoction), Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Pueraria Decoction), Guizhi Jia Nongpo Xingzi Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Kernel Decoction), Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite Decoction), Guizhi Qu Shaoyao Tang (Cinnamon Twig Decoction minus Peony Decoction), Guizhi Qu Shaoyao Jia Fuzi Tang (Cinnamon Twig Decoction minus Peony plus Aconite Decoction), Guizhi Mahuang Ban Ge Tang (Half-Cinnamon Twig and Half-Ephedra Decoction), Guizhi Er Yuebi Yi Tang (Two-Parts Cinnamon Twig and One-Part Jade Breather Decoction), Guizhi Er Mahuang Yi Tang (Two-Parts Cinnamon Twig and One-Part Ephedra Decoction), Guizhi Qu Gui Jia Fuling Baizhu Tang (Cinnamon Twig Decoction minus Cinnamon plus Poria and Atractylodes Macrocephala Decoction), Gegen Tang (Pueraria Decoction), Gegen Jia Banxia Tang (Pueraria Decoction plus Pinellia Decoction), Gegen Huanglian Huangqin Tang (Pueraria, Coptis, and Scutellaria Decoction), Mahuang Tang (Ephedra Decoction), Da Qinglong Tang (Major Azure Dragon Decoction), Xiao Qinglong Tang (Minor Azure Dragon Decoction), Guizhi Jia Shaoyao Renshen Xinjia Tang (Cinnamon Twig Decoction plus Peony and Ginseng New Formula Decoction), Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction), Wuling San (Five-Ling Powder), Guizhi Qu Shaoyao Jia Shuke Longgu Muli Jiuni Tang (Cinnamon Twig Decoction minus Peony plus Coelia, Dragon Bone, and Oyster Shell Rescue Decoction), Guizhi Jia Gui Tang (Cinnamon Twig Decoction plus Extra Cinnamon Decoction), Guizhi Gancao Longgu Muli Tang (Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction), Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction), Fuling Gancao Jiang Tang (Poria, Licorice, and Ginger Decoction), Wenli San (Clam Shell Powder), Qu Gui Jia Baizhu Tang (Remove Cinnamon Add Atractylodes Macrocephala Decoction), Gancao Fuzi Tang (Licorice and Aconite Decoction).
[Vomiting Methods]
Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction), Zhizi Gancao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction), Zhizi Shengjiang Chi Tang (Gardenia, Ginger, and Fermented Soybean Decoction), Zhizi Nongpo Tang (Gardenia and Magnolia Bark Decoction), Zhizi Ganjiang Tang (Gardenia and Dried Ginger Decoction), Gouti San (Melon Seed Powder).
[Purging Methods]
Tiaowei Chengqi Tang (Regulating the Stomach and Directing Downward Decoction), Da Chaihu Tang (Major Bupleurum Decoction), Chengqi Tang (Directing Downward Decoction), Chaihu Jia Mangxiao Tang (Bupleurum plus Mirabilite Decoction), Tao Ren Chengqi Tang (Apricot Kernel Directing Downward Decoction), Didang Wan (Defending Against Pill), Da Jianxiong Tang (Major Constraining Chest Decoction), Didang Tang (Defending Against Decoction), Da Jianxiong Wan (Major Constraining Chest Pill), Baisan (White Powder), Shizao Tang (Ten Jujubes Decoction), Dahuang Huanglian Xiexin Tang (Rhubarb, Coptis, and Heart-Draining Decoction), Fuzi Xiexin Tang (Aconite Heart-Draining Decoction).
[Warming Methods]
Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction), Shaoyao Gancao Tang (Peony and Licorice Decoction), Sini Tang (Reverse-Recovery Decoction), Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction), Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction), Nongpo Shengjiang Gancao Banxia Renshen Tang (Magnolia Bark, Ginger, Licorice, Pinellia, and Ginseng Decoction), Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction), Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction), Fuling Sini Tang (Poria Reverse-Recovery Decoction), Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction), Zhenwu Tang (True Warrior Decoction), Xiao Jianzhong Tang (Minor Constructing the Middle Decoction), Zhigancao Tang (Roasted Licorice Decoction).
[Harmonizing Methods]
Xiao Chaihu Tang (Minor Bupleurum Decoction), Chaihu Jia Longgu Muli Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction), Xiao Xiantong Tang (Minor Obstructed Chest Clearing Decoction), Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction), Banxia Xiexin Tang (Pinellia Heart-Draining Decoction), Shengjiang Xiexin Tang (Ginger Heart-Draining Decoction), Gancao Xiexin Tang (Licorice Heart-Draining Decoction), Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction), Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction), Baihu Tang (White Tiger Decoction), Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction), Huangqin Tang (Scutellaria Decoction), Huangqin Jia Banxia Shengjiang Tang (Scutellaria plus Pinellia and Ginger Decoction).
[Regulating Methods]
Chishizhi Yuyuliang Tang (Red Halloysite and Yuliang Stone Decoction), Xuanshu Zheishi Tang (Inula and Magnetite Decoction), Huanglian Tang (Coptis Decoction).
[Acupuncture Methods]
Longitudinal and transverse needling of Qimen (LR14); administering Guizhi Tang combined with needling Fengchi (GB20) and Fengfu (GV16); needling Qimen (LR14) for simultaneous Taiyang and Shaoyang disease; needling Qimen (LR14) for Heat entering the Blood Chamber; needling Dazhui (GV14) and Feishu (BL13) for simultaneous Taiyang and Shaoyang disease.
Taiyang disease presents with a floating pulse, stiffness and pain of the neck and occiput, and aversion to cold. (Cheng Wuji notes: The Classic states that floating pulses at both cun and chi positions indicate Taiyang involvement. Taiyang governs the exterior and is the master of all Yang channels. Floating pulse, neck/occipital stiffness/pain, and aversion to cold signify Taiyang exterior disease. Any headache indicates an exterior location.)
Taiyang disease presenting with fever, spontaneous sweating, aversion to wind, and a slow pulse is named Wind Strike (Zhongfeng). (As described in the preceding Taiyang disease条目. Cheng Wuji notes: Wind is Yang, Cold is Yin. Wind injures Wei (Defensive Qi), causing fever, sweating, and aversion to wind. Ying (Nutritive Qi) disease causes fever, no sweating, aversion to cold but not wind. Wei disease causes fever, sweating, aversion to wind but not cold. Since Wei is Yang and protects the exterior, its dysfunction leads to loose pores, sweating, and aversion to wind. Shanghan pulses are tight, while wind injury pulses are slow, due to the taut nature of cold and the lax nature of wind.)
Taiyang disease with headache, fever, spontaneous sweating, and aversion to wind is primarily treated with Guizhi Tang (Cinnamon Twig Decoction). (Fever and sweating in Taiyang disease result from weak Ying and strong Wei. To rescue from pathogenic wind, Guizhi Tang is appropriate. Cheng Wuji notes: In Taiyang Wind Strike, wind merges with Wei, making Wei solid and Ying deficient. Ying is Yin, Wei is Yang. Fever and sweating indicate Yin weakness and Yang excess. The Inner Canon states: When Yin is deficient, Yang invades, causing shortness of breath, intermittent fever, and sweating. Guizhi Tang disperses wind and harmonizes Ying and Wei.)
Taiyang Wind Strike with a floating Yang pulse and weak Yin pulse: Spontaneous heat arises from floating Yang; spontaneous sweating occurs from weak Yin. Shivering aversion to cold, rustling aversion to wind, mild fever, nasal congestion, and dry retching are primarily treated with Guizhi Tang. (Cheng Wuji notes: Yang pulse reflects Wei, Yin pulse reflects Ying. Floating Yang pulse indicates Wind injuring Wei; weak Yin pulse indicates weak Ying Qi. Wind merging with Wei makes Wei solid and Ying weak, causing fever and spontaneous sweating. The Classic states: Fever and sweating in Taiyang disease indicate weak Ying and strong Wei. 'Shivering' describes the sensation of cold; 'rustling' describes the sensation of wind. Weak Wei causes aversion to wind; weak Ying causes aversion to cold. Both aversions occur due to sweating, loose skin, and open pores. 'Mild fever' resembles warmth under feathers, indicating exterior heat. Nasal congestion and dry retching result from wind obstructing and reversing Qi. Guizhi Tang harmonizes Ying and Wei and disperses wind.)
When internal organs are healthy but the patient experiences periodic fever and spontaneous sweating without resolution, this is disharmony of Wei Qi. Sweating before the onset of symptoms cures the condition; Guizhi Tang is indicated. (Periodic fever and sweating imply intermittent episodes. Because they come and go, the disease lingers. Medication should be given just before the episode starts, after it subsides. The Suwen states: Act when the pathogen is declining to ensure success.)
Guizhi Tang (Cinnamon Twig Decoction) Formula
Guizhi (Cinnamomi Ramulus, 3 liang, bark removed), Shaoyao (Paeoniae Radix Alba, 3 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang, honey-fried), Shengjiang (Zingiberis Rhizoma Recens, 3 liang, sliced), Dazao (Jujubae Fructus, 12 pieces, crushed). Five ingredients. Crushed, boiled in 7 sheng of water with mild fire to yield 3 sheng. Strain. Drink 1 sheng at a comfortable temperature. Shortly after ingestion, drink hot thin porridge (1 sheng) to assist medicinal power. Cover warmly for about one hour until slight perspiration is achieved throughout the body. Profuse sweating is undesirable as it fails to resolve the disease. If one dose resolves the condition, stop subsequent doses; do not finish the decoction. If no sweating occurs, repeat administration. If still no sweating, shorten the interval, aiming to complete three doses within half a day. For severe cases, administer over 24 hours. If symptoms persist after one dose, prepare another. If no sweating, continue to two or three doses. Avoid cold, sticky, slippery, meat, flour, five pungent spices, alcohol, dairy, and foul-smelling foods. (Song edition reads 'shao cong rong' instead of 'xiao cu').
Cheng Wuji notes: The Classic says Guizhi Tang primarily releases the muscle layer. It is contraindicated for floating-tight pulses, fever, and absence of sweating. Guizhi Tang is specific for Taiyang Wind Strike with loose pores, spontaneous sweating, and Wind invading Wei Qi. Zhang Zhongjing considers releasing the muscle layer lighter than inducing sweating. After sweating, vomiting, or purging, persistent body pain indicates internal depletion of fluids. Even with exterior pathogens, only muscle-layer release is needed, hence small amounts of Guizhi Tang to harmonize. Guizhi is acrid and hot, serving as the Sovereign herb. Its name implies guiding other herbs. Acrid and sweet disperse Yang. Dispersing wind requires acridity; the Inner Canon states wind excess is treated with acrid, assisted by bitter, relaxed by sweet, and gathered with sour. Thus, Shaoyao is Minister, Gancao is Assistant. The Inner Canon states internal wind is relaxed by sweet and dispersed by acrid. Shengjiang is acrid-warm, Dazao is sweet-warm, serving as Envoys. Ginger and Daze promote Spleen fluid transformation to harmonize Ying and Wei. Mahuang Tang omits ginger and jujube because it focuses purely on sweating, allowing fluid passage without digestion assistance.
Pang Anshi notes: Indications for Guizhi Tang include spontaneous sweating, normal urination frequency, warm extremities (slightly cool if exposed, warm if covered), mild whole-body heat, slight irritability, and aversion to cold. Contraindications include absence of sweating, frequent urination, cold extremities, aversion to heat rather than cold, or recent alcohol consumption. Tight pulses indicate no sweating; sweating with tight pulses is not Guizhi Tang syndrome.
Xu Shimicro notes: A case of fever, aversion to cold, spontaneous sweating, and weak-floating pulse cured in three doses illustrates Guizhi Tang's primacy among Zhang Zhongjing's 113 formulas. Modern neglect stems from misunderstanding Zhang's description of Yang floating and Yin weak pulses. Micro pulse at Cun indicates insufficient Yang, allowing Yin to invade Yang causing chills. Weak pulse at Chi indicates insufficient Yin, allowing Yang to sink into Yin causing sweating. This reflects Yuan Qi pathology. Yang deficiency leads to Yin invasion (chills); Yin deficiency leads to Yang invasion (fever). These clear principles justify Guizhi Tang usage.
Li Dongyuan notes: Zhang Zhongjing formulated this for Exterior Deficiency. Guizhi is acrid-hot, dispersing and assisting Yang, light in nature. Shaoyao and Gancao assist. For abdominal pain with涩 (choppy) Yang and string-taut Yin pulses, Xiao Jianzhong Tang (Minor Constructing the Middle Decoction) uses Shaoyao as Sovereign with Guizhi and Gancao. One treats exterior deficiency, the other interior deficiency. Replace Guizhi with Rougui (Cortex Cinnamomi) for cold-induced abdominal pain. In summer heat with abdominal pain, add Huangqin and remove Guizhi. Guizhi is contraindicated in Spring and Summer.
Tao Hua notes: Guizhi and Mahuang Tangs were designed for contemporary Shanghan, not later Warm Diseases or Summerheat. Using them for Spring Warmth or Summer Heat is a grave error.
Taiyang disease, whether fever has appeared or not, invariably presents with aversion to cold, body pain, vomiting, and tight pulses at both Yin and Yang positions, named Shanghan. (Cheng Wuji notes: Cold injury generates heat due to Yang channel stagnation. Wind causes immediate fever as it is Yang; Cold is Yin and takes time to generate heat. Wind injures Wei, Cold injures Ying. Wei deficiency causes aversion to wind; Ying deficiency causes aversion to cold. Ying Cold causes definite aversion to cold. Qi pathology involves numbness; Blood pathology involves pain. Cold causes Qi reversal. Body pain and vomiting indicate Cold in Ying. Tight pulses confirm Shanghan. Aversion to cold confirms exterior location.)
Taiyang disease with headache, fever, body pain, lower back pain, joint pain, aversion to wind, absence of sweating, and wheezing is primarily treated with Mahuang Tang (Ephedra Decoction). (Cheng Wuji notes: Cold injures Ying. Pain radiating to joints indicates impaired Ying blood in Taiyang. The Inner Canon states cold closes pores, trapping heat. Wind merging with Wei causes sweating and aversion to wind/cold. Cold merging with Ying causes no sweating and aversion to wind. Strong Ying and weak Wei cause Qi reversal and wheezing. Mahuang Tang induces sweating.)
Mahuang Tang (Ephedra Decoction) Formula
Mahuang (Ephedrae Herba, 3 liang, nodes removed), Guizhi (Cinnamomi Ramulus, 2 liang, bark removed), Gancao (Glycyrrhizae Radix et Rhizoma, 1 liang, honey-fried), Xingren (Armeniacae Semen Amarum, 70 seeds, soaked, skin and tips removed). Four ingredients. Boil Mahuang in 9 sheng water, reduce by 2 sheng, skim foam. Add remaining herbs, boil to 2.5 sheng. Strain. Drink 8 ge warm. Cover for slight sweating. No porridge required. Follow Guizhi Tang precautions. (Soak Mahuang in vinegar briefly to prevent excessive sweating. Use raw in deep winter when pores are tight.) If sweating persists after Mahuang, immerse patient's hair in water basin, expose feet, and dust body with roasted glutinous rice, Longgu (Dragon Bone), Muli (Oyster Shell), and Fangfeng (Saposhnikoviae Radix) powder to prevent Yang collapse.
Wu Qian notes: Mahuang is essential for sweating in cold weather Shanghan with closed pores, body pain, rigidity, aversion to cold, and no sweating. It opens pores and expels cold. Contraindicated in summer heat; use acrid-cool agents like Gegen (Puerariae Radix), Congbai (Allii Fistulosi Bulbus), and Chidou Chi (Sojae Semen Praeparatum). Mahuang can be combined with cooling agents, e.g., Tongjie San.
Cheng Wuji notes: Light herbs remove excess, referring to Mahuang and Gegen for exterior excess with closed pores. Mahuang is acrid-bitter, Sovereign for dispersing. For loose pores with Wind, Guizhi releases the muscle layer. For tight pores with Cold, Mahuang is necessary with Guizhi as Minister. The Inner Canon states cold excess is treated with acrid-hot, assisted by acrid-bitter. Liver suffers from urgency, treated with sweet to relax. Mahuang Tang uses Gancao (sweet-flat) and Xingren (bitter-warm) to assist. Guizhi Tang uses Shaoyao to harmonize Ying; Mahuang Tang uses Xingren to benefit Qi.
Taiyang Wind Strike with floating-tight pulse, fever, aversion to cold, body pain, no sweating, and irritability is primarily treated with Da Qinglong Tang (Major Azure Dragon Decoction). If pulse is weak, with sweating and aversion to wind, do not administer. Doing so causes cold limbs, twitching muscles, and palpitations, constituting a therapeutic error. (Cheng Wuji notes: Wind Strike showing Cold pulse. Floating indicates Wind injuring Wei; tight indicates Cold injuring Ying. Both injured causes fever, aversion to cold, pain. Wind/Cold dual injury makes Ying and Wei solid, causing no sweating and irritability. Da Qinglong Tang disperses both. Weak pulse with sweating indicates Ying/Wei deficiency; administering Qinglong Tang causes Yang collapse.)
Shanghan with floating-slow pulse, body heaviness without pain, fluctuating severity, and no Shaoyin syndrome is treated with Da Qinglong Tang. (Cheng Wuji notes: Shanghan showing Wind pulse. Wind dominance prevents pain; Wind inclusion causes heaviness. Absence of Shaoyin symptoms allows Da Qinglong Tang to disperse exterior Wind-Cold.)
Da Qinglong Tang (Major Azure Dragon Decoction) Formula
Mahuang (Ephedrae Herba, 6 liang, nodes removed), Guizhi (Cinnamomi Ramulus, 2 liang, bark removed), Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang, honey-fried), Xingren (Armeniacae Semen Amarum, 40 seeds, skin/tips removed), Shengjiang (Zingiberis Rhizoma Recens, 3 liang, sliced), Dazao (Jujubae Fructus, 12 pieces, crushed), Shigao (Gypsi Fibrosus, size of chicken egg, crushed). Seven ingredients. Boil Mahuang in 9 sheng water, reduce by 1 sheng, skim foam. Add others, boil to 3 sheng. Strain. Drink 1 sheng warm. Aim for slight sweating. If sweating is excessive, dust with warm powder. Stop after one dose if sweating occurs. Overdose causes Yang collapse, aversion to wind, irritability, and insomnia.
Cheng Wuji notes: Azure Dragon corresponds to Wood/Liver/Spring, governing growth. It disperses dual Ying-Wei injury. Guizhi Tang treats Wind Strike; Mahuang Tang treats Shanghan. Floating-tight in Wind Strike and floating-slow in Shanghan indicate mixed Wind-Cold. Neither Guizhi nor Mahuang alone suffices; Da Qinglong Tang addresses both. Mahuang (sweet-warm) relaxes Ying; Guizhi (acrid-hot) disperses Wei. Sweet-acrid combination disperses dual injury. For loose pores, Guizhi dominates; for tight pores, Mahuang dominates. Gancao and Xingren assist Mahuang; Dazao and Shengjiang assist Guizhi. Wind injures Yang, Cold injures Yin. Heavy/light herbs combine to resolve Yin-Yang pathogens. Shigao (bitter-pungent, slightly cold, heavy) reaches the muscle layer. Da Qinglong Tang is a heavy sweating formula; overdose risks Yang collapse. Use with caution.
Wu Qian notes: Da Qinglong Tang treats Shanghan with fever, aversion to cold, and irritability due to trapped exterior pathogens. With floating-tight or floating-rapid pulses, urgent use induces sweating and cure. It is akin to rain cooling extreme heat. Misusing cooling herbs for irritability is harmful. Do not use if pulses are not floating-tight/rapid or if aversion to cold/body pain are absent. Misuse causes significant harm.
Xu Shimicro notes: Zhang Zhongjing's three primary formulas: Guizhi for Wind Strike, Mahuang for Shanghan, Qinglong for Wind Strike with Cold pulse or Shanghan with Wind pulse. They stand together like a tripod.