伤寒本论曰。夫以为疾病至急。仓卒寻按。要者难得。故重集诸
可与不可方治。比之三阴三阳篇中。此易见也。又时有不止是三阴
三阳。出在诸可与不可中也。
仲景曰。少阴病。脉细沉数。病为在里。不可发汗。
又曰。太阳病。脉浮紧者。法当身疼痛。宜以汗解之。假令尺中
迟者。不可发汗。何以知之。以营气不足。血少故也。庞氏云。前阳明
病脉迟。汗出多。微恶寒。宜桂枝汤。不责营不足。盖尺脉长大而迟。
此必软紧而迟。不可汗。宜小建中汤。雍曰。桂枝本为解肌。不动经。
故前阳明证中用之。麻黄则发汗动经也。常氏云。可小柴胡汤。雍
曰。伤寒阳脉涩。阴脉弦。法当腹中急痛。先与小建中汤。不瘥。与小
柴胡汤。二药可相须用也。故庞氏又曰。凡脉紧病。必无汗。唯濡而
紧。必有汗。勿误行桂枝。宜建中汤也。
又曰。少阴病脉微。不可发汗。亡阳故也。（一作濡而微弱）庞氏
曰。汗则厥而烦躁不得眠。常氏云。可附子汤。
又曰。脉濡而弱。弱反在关。濡反在巅。微反在上。涩反在下。微
则阳气不足。涩则无血。阳气反微。中风汗出而反躁烦。涩则无血。
厥而且寒。阳微发汗。躁不得眠。雍曰。宜与小建中汤。
又曰。动气在右。不可发汗。发汗则衄而渴。心苦烦。饮则吐水。
庞氏曰。动气者。谓心腹中虚气动。若误汗者。先服五苓散一服。次
服竹叶汤。朱氏曰。凡脉濡弱。不可发汗。诸动气在心腹上下左右。
不可发汗。诸脉动数微弱。不可发汗。皆宜小建中汤。烦躁者。宜竹
叶汤。雍曰。诸动气不可发汗者。皆宜茯苓桂枝甘草大枣汤。
又曰。动气在左。不可发汗。发汗则头眩。汗不止。筋惕肉 。庞
氏曰。此为逆。难治。先服茯苓白术散。汗止。续与小建中汤。朱氏
同。雍曰。汗不止。筋惕肉 者。皆亡失津液证。不可茯苓汤也。
又曰。动气在上。不可发汗。发汗则气上卫。正在心端。庞氏云。
李根汤主之。朱氏同。常氏云。可奔豚汤。
又曰。动气在下。不可发汗。发汗则无汗。心中大烦。骨节苦疼。
目运恶寒。食则反吐。谷不得前。（一云谷不消化）庞氏云。先服大橘
皮汤。得吐止。服小建中汤。朱氏同。常氏云。可柴胡桂枝汤、茯苓汤、
小半夏汤。雍曰。大橘皮汤、茯苓汤、小半夏汤。皆可用以止吐。吐止
而心中烦。骨节疼。恶寒证不去者。服柴胡桂枝汤。后服小建中汤。
又曰。咽中闭塞。不可发汗。发汗则吐血。气欲绝。手足厥冷。欲
得蜷卧。不能自温。庞氏云。甘草干姜汤主之。常氏曰。咽中闭塞。可
小柴胡汤。设经发汗吐血者。柏叶艾叶汤。（金匮方）气微厥逆蜷卧
者。可当归四逆汤。
又曰。诸脉得数动微弱者。不可发汗。发汗则大便难。腹中干。
（一云大便难胞中干）胃燥而烦。其形相象。根本异源。雍曰。宜小建
中汤。
又曰。脉濡而弱。弱反在关。濡反在巅。弦反在上。微反在下。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 不能自还。常氏云。可当归四逆汤。
又曰。咳者则剧。数吐涎沫。咽中必干。小便不利。心中饥烦。
时而发。其形似疟。有寒无热。虚而寒 。咳而发汗。蜷而苦满。腹中
复坚。（一作蜷而心痛）常氏云。可柴胡干姜桂枝汤、小青龙汤、理
中丸。雍曰。脉经以上二证合而为一。雍谓自咳者之下。为咳者剧
证。咳者之上。为不咳未剧之证。二证之脉。皆濡而弱也。咳证里寒
多。宜小建中汤、理中丸、附子汤微温之。
又曰。厥脉紧。不可发汗。发汗则声乱咽嘶。舌萎。声不得前。雍
曰。厥阴经紧。则引舌与卵。故舌卷而囊缩。若缓。则舌萎声不得前。
故厥脉紧者。不可发汗。恐其脉缓也。厥脉紧者。宜四逆汤。缓者。宜
小建中汤。或言宜白虎、小柴胡。皆不可用。
又曰。诸逆发汗。病微者难瘥。剧者言乱。目眩者死。（一云谵语
目眩精乱者死）命将难全。
又曰。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。不可更发汗也。常氏云。可小柴胡汤。雍曰。亦宜
先服小建中汤。
又曰。太阳病。发热恶寒。热多寒少。（千金翼云寒多热少）脉微
弱者。此无阳也。不可发汗。常氏云。可小柴胡汤。雍曰。亦宜甘草干
姜汤。
又曰。咽喉干燥者。不可发汗。常氏云。可小柴胡汤。
又曰。亡血家。不可发汗。发汗则寒 而振。常氏云。可小柴胡
加芍药地黄汤。
又曰。衄家不可发汗。汗出必额上陷。脉紧急。目直视。不能 。
不得眠。常氏云。可犀角地黄汤。
又曰。汗家重发汗。必恍惚心乱。小便已。阴疼。宜禹余粮丸。
（本阙方）常氏云。只取一味禹余粮石。火 末服之亦可。雍曰。禹余
粮不用石壳。此火 末服则是壳也。
又曰。淋家不可发汗。发汗必便血。常氏云。可猪苓汤、芍药地
黄汤。
又曰。疮家虽身疼痛。不可发汗。汗出则 。常氏云。可小柴胡
汤。 者。葛根桂枝汤。雍曰。更详治 门中。
又曰。下利清谷。不可发汗。汗出必胀满。雍曰。宜温其里。后随
证治之。
又曰。咳而小便利。若失小便者。不可发汗。汗出则四肢厥而
逆。雍曰。设误发汗。宜甘草干姜汤、当归四逆汤。
又曰。伤寒一二日至四五日厥者。必发热。前厥者后必热。厥深
者热亦深。厥微者热亦微。厥应下之。而反发汗。必口伤烂赤。雍曰。
已见厥阴卷中厥论并问。
又曰。伤寒脉弦细。头痛发热者。属少阳。少阳不可发汗。常氏
云。可小柴胡汤。
又曰。伤寒头痛。翕翕发热。形象中风。常微汗出。自呕者。下之
益烦。心中懊 如饥。发汗则致 。身强难以屈伸。熏之则发黄。不
得小便。灸则发咳唾。常氏云。可小柴胡汤、桂枝加葛根汤、茵陈蒿
汤、小青龙汤。雍曰。各随证用之。头痛发热汗出。即小柴胡汤。心烦
喜呕。亦柴胡。 而身强。用桂枝加葛根汤。不得小便而咳唾。则小
青龙汤。熏之发黄。则茵陈蒿汤也。
又曰。太阳与少阳并病。头项强痛。或眩冒。时如结胸。心下痞
硬者。不可发汗。当刺大椎第一间肺俞肝俞。发汗则谵语脉弦。五六
日语不止。当刺期门。
又曰。太阳发汗。因致 。雍曰。前本病云。太阳病发汗太多。因
致。
又曰。少阴病。咳而下利。谵语者。此被火气劫故也。小便必难。
以强责少阴汗也。常氏云。可桂枝去芍药加蜀漆牡蛎龙骨救逆汤。
小便难者。五苓散。
又曰。少阴病。但厥无汗。而强发之。必动其血。未知从何道出。
或从口鼻。或从目出者。是名下厥上竭。为难治。常氏云。可芍药地
黄汤。雍曰。仍灸三阴交涌泉二穴。三阴交难取。涌泉尤奇。
王叔和曰。冬时发其汗。必吐利。口中烂。生疮。（千金翼同）
又曰。汗出多热。发其汗亦坚。雍曰。坚字宜作 。前有云。发汗
太多。因致 也。
又曰。病患脉数。数为热。当消谷引食而反吐者。以医发其汗。
令阳气微。膈气虚。脉乃数也。数为客热。不能消谷。胃中虚冷。故令
吐也。常氏云。可与小半夏汤、温中汤。
又曰。伤寒四五日。其脉沉。烦而喘满。脉沉者。病为在里。不可
发汗。津液越出。大便为难。表虚里实。久则谵语。常氏云。可麻黄杏
仁甘草石膏汤。脉沉里实谵语者。调胃承气汤。
又曰。伤寒有五。皆热病之类也。同病异名。同脉异经。虽俱伤
于风。其人自有痼疾。则不得同法。其人素伤于风。因复伤于热。风
热相搏。则发风温。四肢不收。头痛身热。常汗出不解。治在少阴。厥
阴不可发汗。汗出谵语。独语内烦。躁扰不得卧。善惊。目乱无精。治
之复发其汗。如此死者。医杀之耳。（出医律）朱氏曰。风温不可发
汗。宜葳蕤汤。雍曰。仲景以风温湿温为伤寒四种坏病。难经以湿温
为五种伤寒。皆属伤寒也。余见风温本门。
又曰。伤寒湿温。其人常伤于湿。因而中 。湿热相搏。则发湿
温。病苦两胫逆冷。腹满叉胸。头目痛苦。妄言。治在足太阴。不可发
汗。汗出必不能言。耳聋。不知痛所在。身青。面色变。名曰重 。如
此死者。医杀之耳。（出医律）朱氏曰。白虎加苍术汤。
又曰。湿温多汗。其脉阳濡而弱。阴小而热。
庞氏曰。不当汗而强汗之。则津液枯槁而死。
《伤寒论》本论中说：认为疾病发作急迫，仓促之间寻找治疗方法，关键之处难以获得。所以重新汇集各种可以治疗与不可治疗的方治方法，比起三阴三阳篇中，这里更容易见到。而且有时情况不止局限于三阴三阳，而出现在各种“可与”、“不可与”的条目中。
张仲景说：少阴病（少阴经受邪所致的病证），脉象细、沉、数，病位在里，不可发汗。
又说：太阳病（太阳经受邪所致的病证），脉象浮紧的，按照法度应当身体疼痛，适宜用发汗法解除。假如尺部脉搏迟缓的，不可发汗。怎么知道呢？因为营气不足，血少的缘故。庞氏说：前文阳明病脉迟，汗出多，微恶寒，适宜用桂枝汤（Cinnamon Twig Decoction）。不责备营气不足，大概是尺脉长大而迟，这必定是软紧而迟，不可发汗，适宜用小建中汤（Minor Construct the Middle Decoction）。郭雍说：桂枝汤本来是用来解肌表的，不扰动经脉，所以在前文阳明证中使用它。麻黄汤则是发汗且扰动经脉的。常氏说：可以用小柴胡汤（Minor Chaihu Decoction）。郭雍说：伤寒症见阳脉涩、阴脉弦，按照法度应当腹中急痛，先给予小建中汤，如果不痊愈，再给予小柴胡汤。这两种药可以相互辅助使用。所以庞氏又说：凡是脉紧的病，必定无汗，只有脉濡而紧的，必定有汗，不要误用桂枝汤，适宜用建中汤。
又说：少阴病脉微，不可发汗，因为会亡阳的缘故。（另一种说法是脉濡而微弱）庞氏说：如果发汗则会导致四肢厥冷、烦躁不得睡眠。常氏说：可以用附子汤（Aconite Decoction）。
又说：脉象濡而弱，弱脉反而出现在关部，濡脉反而出现在巅部（指寸部），微脉反而出现在上部，涩脉反而出现在下部。微脉表示阳气不足，涩脉表示无血。阳气反而微弱，中风后汗出反而躁烦；涩脉表示无血，导致四肢厥冷且寒。阳气微弱而发汗，会导致躁动不得睡眠。郭雍说：适宜给予小建中汤。
又说：动气在右胁下，不可发汗。发汗则会导致鼻衄（鼻出血）且口渴，心中苦于烦闷，饮水则呕吐清水。庞氏说：动气，是指心腹部虚寒气机逆乱。如果误用发汗，先服用五苓散（Poria Decoction）一服，接着服用竹叶汤（Bamboo Leaf Decoction）。朱氏说：凡是脉象濡弱的，不可发汗；各种心腹上下左右部位的动气，不可发汗；各种脉象动数微弱，不可发汗，都适宜用小建中汤。烦躁的，适宜用竹叶汤。郭雍说：各种动气不可发汗的，都适宜用茯苓桂枝甘草大枣汤（Poria, Cinnamon Twig, Licorice and Jujube Decoction）。
又说：动气在左胁下，不可发汗。发汗则会导致头晕目眩，汗出不止，筋惕肉瞤（肌肉跳动）。庞氏说：这是逆证，难治。先服用茯苓白术散（Poria and Atractylodes Macrocephala Powder），汗止后，继续给予小建中汤。朱氏观点相同。郭雍说：汗不止、筋惕肉瞤的，都是津液亡失的证候，不可用茯苓汤。
又说：动气在上焦，不可发汗。发汗则气上冲卫分，正在心端。庞氏说：李根汤主治之。朱氏观点相同。常氏说：可以用奔豚汤（Roving Pig Decoction）。
又说：动气在下焦，不可发汗。发汗则无汗，心中大烦，骨节痛苦疼痛，眼花眩晕，恶寒，进食则反而呕吐，食物无法下行。（另一种说法是食物不消化）庞氏说：先服用大橘皮汤（Large Tangerine Peel Decoction），吐止后，服用小建中汤。朱氏观点相同。常氏说：可以用柴胡桂枝汤（Chaihu and Cinnamon Twig Decoction）、茯苓汤、小半夏汤（Minor Banxia Decoction）。郭雍说：大橘皮汤、茯苓汤、小半夏汤，都可以用来止吐。吐止之后，如果心中烦、骨节疼、恶寒的证候未去，服用柴胡桂枝汤，随后服用小建中汤。
又说：咽中闭塞，不可发汗。发汗则会导致吐血，气息欲绝，手足厥冷，想要蜷缩卧倒，不能自我温暖。庞氏说：甘草干姜汤主治之。常氏说：咽中闭塞，可以用小柴胡汤。如果经过发汗导致吐血的，用柏叶艾叶汤（（出自《金匮要略》方剂））。气息微弱、四肢厥冷、蜷卧的，可以用当归四逆汤（Angelica Sinensis and Cinnamon Twig Decoction）。
又说：各种脉象出现数、动、微、弱的，不可发汗。发汗则会导致大便困难，腹中干燥。（另一种说法是大便难、胞中干燥）胃燥而烦，其外形相似，但根本来源不同。郭雍说：适宜用小建中汤。
又说：脉象濡而弱，弱脉反而在关部，濡脉反而在巅部，弦脉反而在上部，微脉反而在下部。弦脉代表阳气运行异常，微脉代表阴寒。上实下虚，意念想要温热。微弦为虚，不可发汗。发汗则会导致寒冷僵硬，不能自行恢复。常氏说：可以用当归四逆汤。
又说：咳嗽严重的，频繁吐出涎沫，咽喉必定干燥，小便不利，心中饥烦，时而发作，外形似疟疾，只有寒战没有发热，体虚而寒战。咳嗽而发汗，会导致蜷缩而苦于胀满，腹中再次坚硬。（另一种说法是蜷缩而心痛）常氏说：可以用柴胡干姜桂枝汤、小青龙汤（Minor Blue Dragon Decoction）、理中丸（Regulate the Middle Pill）。郭雍说：《脉经》将以上两个证候合并为一个。我认为从“咳者之下”开始，是咳嗽严重的证候；“咳者之上”，是不咳或尚未严重的证候。这两个证候的脉象，都是濡而弱的。咳嗽证候里寒较多，适宜用小建中汤、理中丸、附子汤微微温补。
又说：厥阴病的脉紧，不可发汗。发汗则会导致声音混乱、咽喉嘶哑、舌头萎软、声音发不出。郭雍说：厥阴经脉紧，则会牵引舌头和睾丸，所以舌卷缩而囊缩。如果脉缓，则舌头萎软、声音发不出。所以厥脉紧的，不可发汗，恐怕其脉转为缓。厥脉紧的，适宜用四逆汤（Four Reversal Decoction）；脉缓的，适宜用小建中汤。有人说适宜用白虎汤或小柴胡汤，都不可用。
又说：各种逆证误用发汗，病情轻微的难以痊愈，病情严重的会出现言语错乱，眼睛昏眩的会死亡。（另一种说法是谵语、眼睛昏眩、精气紊乱的会死亡）生命将难以保全。
又说：太阳病得病八九日，像疟疾的样子，发热恶寒，热多寒少，这个人没有呕吐，大小便基本正常，一天发作两三次，脉象微缓的，是快要痊愈了。脉微而恶寒的，这是阴阳俱虚，不可再次发汗。常氏说：可以用小柴胡汤。郭雍说：也适宜先服用小建中汤。
又说：太阳病，发热恶寒，热多寒少。（《千金翼方》说是寒多热少）脉微弱的，这是无阳，不可发汗。常氏说：可以用小柴胡汤。郭雍说：也适宜用甘草干姜汤（Licorice and Dried Ginger Decoction）。
又说：亡血家（平素失血的人），不可发汗。发汗则会导致寒战而振摇。常氏说：可以用小柴胡加芍药地黄汤（Minor Chaihu with Peony and Rehmannia Decoction）。
又说：衄家（平素鼻出血的人），不可发汗。发汗必然导致额上动脉凹陷，脉紧急，眼睛直视，不能转动，不得睡眠。常氏说：可以用犀角地黄汤（Rhinoceros Horn and Rehmannia Decoction）。
又说：汗家（平素多汗的人）再次发汗，必然导致恍惚心乱，小便结束后，阴部疼痛，适宜用禹余粮丸（Hematitum Pill）。（原书缺此方）常氏说：只取一味禹余粮石，火煅成末服用也可以。郭雍说：禹余粮不用石壳，这里说火煅成末服用，那就是用了石壳。
又说：淋家（平素患淋证的人），不可发汗。发汗必然导致便血。常氏说：可以用猪苓汤（Polyporus Decoction）、芍药地黄汤。
又说：疮家（平素有疮疡的人）虽然身体疼痛，不可发汗。发汗则会导致痉病（筋脉拘急抽搐）。常氏说：可以用小柴胡汤。痉病，用葛根桂枝汤（Kudzu and Cinnamon Twig Decoction）。郭雍说：更详细地参考治疗痉病的章节。
又说：下利清谷（腹泻排出未消化的食物），不可发汗。发汗必然导致腹胀满。郭雍说：适宜温补其里，随后根据证候治疗。
又说：咳嗽而小便通利，或者小便失禁的，不可发汗。发汗则会导致四肢厥冷且逆。郭雍说：如果误用发汗，适宜用甘草干姜汤、当归四逆汤。
又说：伤寒一二天到四天五天出现厥冷的，必定发热，先前厥冷的后来必定发热，厥冷深的发热也深，厥冷轻的发热也轻。厥冷应当用攻下法，却反而发汗，必然导致口腔糜烂发红。郭雍说：已在厥阴卷中的厥论及问答中见过。
又说：伤寒脉弦细，头痛发热的，属于少阳病（少阳经受邪所致的病证）。少阳病不可发汗。常氏说：可以用小柴胡汤。
又说：伤寒头痛，翕翕发热（形容发热如羽毛覆盖般温和），形象像中风，常常微汗出，自己呕吐的，如果用下法会更烦闷，心中懊恼如饥饿感，如果发汗则会导致痉病，身体强直难以屈伸，如果用熏法则会发黄，导致小便不通，如果用灸法则会引发咳嗽吐唾沫。常氏说：可以用小柴胡汤、桂枝加葛根汤（Cinnamon Twig plus Kudzu Decoction）、茵陈蒿汤（Artemisiae Scopariae Decoction）、小青龙汤。郭雍说：各自根据证候使用。头痛发热汗出，即用小柴胡汤；心烦喜呕，也是用小柴胡汤；出现痉病而身体强直，用桂枝加葛根汤；小便不通而咳嗽吐唾沫，则用小青龙汤；熏之发黄，则用茵陈蒿汤。
又说：太阳与少阳并病，头项强痛，有时头晕目眩，有时像结胸证，心下痞硬的，不可发汗。应当针刺大椎第一间、肺俞、肝俞。如果发汗则会出现谵语、脉弦，五六天言语不停，应当刺期门穴。
又说：太阳病发汗，因此导致痉病。郭雍说：前文本病中说：太阳病发汗太多，因此导致痉病。
又说：少阴病，咳嗽而下利，出现谵语的，这是因为被火气劫夺的缘故。小便必定困难，因为强行索取少阴汗的缘故。常氏说：可以用桂枝去芍药加蜀漆牡蛎龙骨救逆汤（Cinnamon Twig Decoction minus Peony plus Chinese Tallow Tree Bark, Oyster Shell and Fossilized Bones for Saving from Peril Decoction）。小便困难的，用五苓散。
又说：少阴病，只是厥冷无汗，而强行发汗，必然会扰动血液，不知道从哪个通道流出，或者从口鼻，或者从眼睛流出，这叫做下厥上竭，为难治。常氏说：可以用芍药地黄汤。郭雍说：仍然艾灸三阴交、涌泉两个穴位。三阴交难取，涌泉尤其奇特。
王叔和说：冬天时候发其汗，必然导致呕吐腹泻，口中腐烂，生疮。（《千金翼方》相同）
又说：汗出多且有热，发其汗也会导致痉病。郭雍说：“坚”字应该作“痉”。前文说过：发汗太多，因此导致痉病。
又说：病患脉数，数为热，应当消谷引食却反而呕吐的，是因为医生发其汗，令阳气微弱，膈气虚弱，脉才呈现数象。数是客热，不能消谷，胃中虚冷，所以导致呕吐。常氏说：可以与小半夏汤、温中汤。
又说：伤寒四五日，其脉沉，烦闷而喘满，脉沉的，病在里，不可发汗。津液越出，大便为难，表虚里实，久了则会谵语。常氏说：可以用麻黄杏仁甘草石膏汤（Ephedra, Apricot Kernel, Licorice and Gypsum Decoction）。脉沉里实谵语的，用调胃承气汤（Stomach-Regulating Cathartic Decoction）。
又说：伤寒有五类，都属于热病一类。同病异名，同脉异经，虽然都伤于风，但人自有痼疾，则不能用同样的方法。人平素伤于风，又复伤于热，风热相搏，则发风温（Wind-Warmth disease），四肢不收，头痛身热，常常汗出不解。治疗在少阴、厥阴，不可发汗。发汗则谵语，独语内烦，躁扰不得卧，善惊，目乱无精。治疗如果再发其汗，如此死亡的，是医生杀死了他。（出自《医律》）朱氏说：风温不可发汗，适宜用葳蕤汤（Jade Bamboo Decoction）。郭雍说：张仲景以风温、湿温为伤寒四种坏病，《难经》以湿温为五种伤寒，都属于伤寒。其余详见风温本门。
又说：伤寒湿温，其人常伤于湿，因而中湿。湿热相搏，则发湿温（Damp-Warmth disease）。病人苦于两小腿逆冷，腹满叉胸，头目痛苦，妄言。治疗在足太阴，不可发汗。发汗必然不能说话，耳聋，不知痛所在，身体青紫，面色改变，叫做重暝（Zhong Ming, a severe state of unconsciousness）。如此死亡的，是医生杀死了他。（出自《医律》）朱氏说：白虎加苍术汤（White Tiger plus Atractylodes Lancea Decoction）。
又说：湿温多汗，其脉阳部濡而弱，阴部小而热。
The original treatise of *Shanghan Lun* states: "Considering that diseases arise urgently, it is difficult to find key treatments in haste. Therefore, I have recompiled various methods regarding what can and cannot be treated. Compared to the chapters on the Three Yin and Three Yang meridians, these are easier to understand. Moreover, sometimes conditions extend beyond just the Three Yin and Three Yang, appearing in the sections on 'what may be given' and 'what may not be given'."
Zhang Zhongjing said: "In Shaoyin disease (disease of the Shaoyin meridian), if the pulse is fine, deep, and rapid, the pathology is interior; sweating should not be induced."
He also said: "In Taiyang disease (disease of the Taiyang meridian), if the pulse is floating and tight, according to the method, there should be body pain, and sweating should be induced to resolve it. However, if the cunian (尺) pulse is slow, sweating should not be induced. How do we know this? Because Ying Qi (defensive-nutritive qi) is insufficient and blood is scant." Pang Shi said: "Regarding the previous Yangming disease where the pulse was slow, with profuse sweating and slight aversion to cold, Guizhi Tang (Cinnamon Twig Decoction) is appropriate. We do not blame insufficiency of Ying Qi here; rather, the chi pulse being large and slow indicates it must be soft, tight, and slow, so sweating is contraindicated, and Xiaojianzhong Tang (Minor Construct the Middle Decoction) is appropriate." Guo Yong said: "Guizhi Tang is originally for resolving the muscle layer without disturbing the meridians, hence it was used in the previous Yangming syndrome. Mahuang (Ephedrae Herba) induces sweating and disturbs the meridians." Chang Shi said: "Xiaochaihu Tang (Minor Chaihu Decoction) can be used." Guo Yong said: "In Shanghan, if the yang pulse is choppy and the yin pulse is wiry, according to the method, there should be acute abdominal pain. First give Xiaojianzhong Tang; if not cured, then give Xiaochaihu Tang. These two medicines can be used synergistically." Thus, Pang Shi further stated: "For any disease with a tight pulse, there must be no sweat; only when the pulse is soggy and tight is there sweat. Do not mistakenly use Guizhi Tang; Jianzhong Tang is appropriate."
He also said: "In Shaoyin disease, if the pulse is faint, sweating should not be induced because it leads to the loss of Yang Qi. (Another version reads: soggy and weak.)" Pang Shi said: "If sweating is induced, it will lead to cold limbs, irritability, and inability to sleep." Chang Shi said: "Fuzi Tang (Aconite Decoction) can be used."
He also said: "If the pulse is soggy and weak, with the weak position reversed at the guan (middle) section, the soggy position reversed at the dian (top/cun) section, the faint position reversed at the upper part, and the choppy position reversed at the lower part: Faint indicates insufficiency of Yang Qi; choppy indicates lack of blood. If Yang Qi is faint, wind-stroke with sweating leads to contrary irritability; choppy indicates lack of blood, leading to cold limbs and chill. Inducing sweating when Yang Qi is faint causes irritability and insomnia." Guo Yong said: "Xiaojianzhong Tang is appropriate."
He also said: "If there is moving Qi in the right side, sweating should not be induced. Inducing sweating leads to epistaxis (nosebleed) and thirst, bitter vexation in the heart, and vomiting water upon drinking." Pang Shi said: "'Moving Qi' refers to deficiency and rebellious Qi movement in the heart and abdomen. If sweating is mistakenly induced, first administer Wuling San (Poria Decoction), followed by Zhuye Tang (Bamboo Leaf Decoction)." Zhu Shi said: "Whenever the pulse is soggy and weak, sweating is contraindicated; whenever there is moving Qi in the heart, abdomen, above, below, left, or right, sweating is contraindicated; whenever the pulse is active, rapid, faint, or weak, sweating is contraindicated. All such cases are suitable for Xiaojianzhong Tang. For those with irritability, Zhuye Tang is appropriate." Guo Yong said: "For all cases of moving Qi where sweating is contraindicated, Linggui Zhigan Dazao Tang (Poria, Cinnamon Twig, Licorice and Jujube Decoction) is appropriate."
He also said: "If there is moving Qi in the left side, sweating should not be induced. Inducing sweating leads to dizziness, continuous sweating, and twitching of muscles (jin ti rou tiao)." Pang Shi said: "This is a counter-indication and difficult to treat. First take Fuling Baizhu San (Poria and Atractylodes Macrocephala Powder); once sweating stops, continue with Xiaojianzhong Tang." Zhu Shi agrees. Guo Yong said: "Continuous sweating and muscle twitching are signs of fluid exhaustion; Fuling Tang is not appropriate."
He also said: "If there is moving Qi in the upper jiao, sweating should not be induced. Inducing sweating causes Qi to rush upward to the Wei level, centering at the heart." Pang Shi said: "Ligen Tang (Li Root Decoction) governs this." Zhu Shi agrees. Chang Shi said: "Ben Tun Tang (Roving Pig Decoction) can be used."
He also said: "If there is moving Qi in the lower jiao, sweating should not be induced. Inducing sweating leads to anhidrosis, severe mental restlessness, painful bone joints, vertigo, aversion to cold, vomiting after eating, and food failing to pass forward. (One version says food fails to digest.)" Pang Shi said: "First take Daju Pi Tang (Large Tangerine Peel Decoction); once vomiting stops, take Xiaojianzhong Tang." Zhu Shi agrees. Chang Shi said: "Chaihu Guizhi Tang (Chaihu and Cinnamon Twig Decoction), Fuling Tang, or Xiaobanxia Tang (Minor Banxia Decoction) can be used." Guo Yong said: "Daju Pi Tang, Fuling Tang, and Xiaobanxia Tang can all be used to stop vomiting. After vomiting stops, if mental restlessness, bone joint pain, and aversion to cold persist, take Chaihu Guizhi Tang, followed by Xiaojianzhong Tang."
He also said: "If the throat feels closed, sweating should not be induced. Inducing sweating leads to hematemesis (vomiting blood), impending collapse of Qi, cold hands and feet, a desire to curl up, and inability to self-warm." Pang Shi said: "Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) governs this." Chang Shi said: "For throat closure, Xiaochaihu Tang can be used. If hematemesis occurs after sweating, Baiye Yiye Tang (Mugwort and Bloodwort Decoction, from *Jinkui Yaolue*) is indicated. For faint Qi, cold limbs, and curled posture, Danggui Sini Tang (Angelica Sinensis and Cinnamon Twig Decoction) can be used."
He also said: "For any pulse presenting as rapid, active, faint, or weak, sweating should not be induced. Inducing sweating leads to difficult defecation and dryness in the abdomen. (One version adds: difficult defecation and dryness in the bladder cavity.) The stomach becomes dry and irritable. Although the appearance is similar, the root source is different." Guo Yong said: "Xiaojianzhong Tang is appropriate."
He also said: "If the pulse is soggy and weak, with weakness reversed at the guan section, soggy reversed at the dian section, wiry reversed at the upper part, and faint reversed at the lower part: Wiry represents abnormal Yang movement; faint represents Yin cold. Upper excess and lower deficiency indicate a desire for warmth. Faint and wiry indicate deficiency; sweating is contraindicated. Inducing sweating leads to cold stiffness that cannot recover spontaneously." Chang Shi said: "Danggui Sini Tang can be used."
He also said: "If coughing is severe, with frequent expectoration of saliva and foam, the throat will surely be dry, urination will be difficult, and there will be hunger-like vexation in the heart. It occurs intermittently, resembling malaria but with chills only and no fever. In deficiency with chills, inducing sweating while coughing leads to curling up with fullness and hardness in the abdomen. (One version says: curling up with heart pain.)" Chang Shi said: "Chaihu Ganjiang Guizhi Tang, Xiao Qinglong Tang (Minor Blue Dragon Decoction), or Lizhong Wan (Regulate the Middle Pill) can be used." Guo Yong said: "*Mai Jing* combines the above two syndromes into one. I believe that starting from 'severe coughing' describes the severe cough syndrome, while above 'severe coughing' describes the non-coughing or non-severe syndrome. The pulses for both syndromes are soggy and weak. Cough syndromes often involve interior cold; Xiaojianzhong Tang, Lizhong Wan, or Fuzi Tang should be used to gently warm."
He also said: "If the pulse in Jueyin is tight, sweating should not be induced. Inducing sweating leads to chaotic voice, hoarse throat, flaccid tongue, and inability to speak." Guo Yong said: "Tightness in the Jueyin meridian draws the tongue and testicles, causing tongue retraction and scrotal contraction. If the pulse is slow, the tongue becomes flaccid and speech is impaired. Therefore, for a tight Jueyin pulse, sweating is contraindicated, fearing the pulse may become slow. For a tight Jueyin pulse, Sini Tang (Four Reversal Decoction) is appropriate; for a slow pulse, Xiaojianzhong Tang is appropriate. Some suggest Baihu Tang or Xiaochaihu Tang, which are all inappropriate."
He also said: "For various counter-indications, inducing sweating makes mild conditions difficult to cure and severe conditions result in delirium. Those with dizziness die. (One version says: delirium, dizziness, and chaos of essence lead to death.) Life will be hard to preserve."
He also said: "In Taiyang disease, after eight or nine days, resembling malaria, with fever and aversion to cold, more heat than cold, no vomiting, normal bowel and bladder function, occurring two or three times a day: if the pulse is slightly slow and smooth, recovery is imminent. If the pulse is faint with aversion to cold, this indicates deficiency of both Yin and Yang; sweating should not be induced again." Chang Shi said: "Xiaochaihu Tang can be used." Guo Yong said: "It is also appropriate to first take Xiaojianzhong Tang."
He also said: "In Taiyang disease, with fever, aversion to cold, and more heat than cold. (*Qianjin Yifang* says more cold than heat): if the pulse is faint and weak, this indicates absence of Yang; sweating is contraindicated." Chang Shi said: "Xiaochaihu Tang can be used." Guo Yong said: "Gancao Ganjiang Tang is also appropriate."
He also said: "Those with dry throats should not be sweated." Chang Shi said: "Xiaochaihu Tang can be used."
He also said: "Patients who have lost blood should not be sweated. Inducing sweating leads to chills and tremors." Chang Shi said: "Xiaochaihu Tang plus Shaoyao and Dihuang (Peony and Rehmannia) can be used."
He also said: "Patients prone to nosebleeds should not be sweated. Sweating will cause depression of the arteries above the forehead, urgent pulse, fixed staring eyes, inability to move them, and insomnia." Chang Shi said: "Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) can be used."
He also said: "Profuse sweaters subjected to heavy sweating will suffer from恍惚 (mental confusion) and heart disorder. After urination, there will be pain in the genitalia. Yuyuliang Wan (Hematitum Pill) is appropriate. (The formula is missing in the original text.)" Chang Shi said: "Simply taking Yuyuliang stone, calcined and powdered, is also acceptable." Guo Yong said: "Yuyuliang should not use the shell; saying 'calcined powder' implies using the shell."
He also said: "Patients with strangury should not be sweated. Sweating will certainly lead to hematuria." Chang Shi said: "Zhuling Tang (Polyporus Decoction) or Shaoyao Dihuang Tang can be used."
He also said: "Patients with sores/ulcers, even if they have body pain, should not be sweated. Sweating will lead to spasms (Jing). Chang Shi said: "Xiaochaihu Tang can be used. For spasms, Gegen Guizhi Tang (Kudzu and Cinnamon Twig Decoction) is used." Guo Yong said: "Refer more closely to the chapter on treating spasms."
He also said: "Diarrhea with undigested food should not be sweated. Sweating will certainly lead to abdominal distension." Guo Yong said: "Warm the interior first, then treat according to the syndrome."
He also said: "Coughing with free urination, or incontinence, should not be sweated. Sweating will lead to cold extremities and reversal." Guo Yong said: "If sweating is mistakenly induced, Gancao Ganjiang Tang or Danggui Sini Tang is appropriate."
He also said: "In Shanghan, from one or two days to four or five days, if there is cold reversal (Jue), there will definitely be fever. Previous cold reversal will later turn to heat; deeper cold reversal means deeper heat, shallower cold reversal means shallower heat. Cold reversal should be treated with purgation, but if sweating is mistakenly induced, it will certainly cause oral ulceration and redness." Guo Yong said: "This has been seen in the discussion and questions on cold reversal in the Jueyin volume."
He also said: "In Shanghan, if the pulse is wiry and fine, with headache and fever, it belongs to Shaoyang. Shaoyang disease should not be sweated." Chang Shi said: "Xiaochaihu Tang can be used."
He also said: "In Shanghan, with headache, mild fever (like feathers covering), resembling wind-stroke, with slight spontaneous sweating and spontaneous vomiting: purging increases vexation and mental discomfort like hunger; inducing sweating leads to spasms, stiff body difficult to flex and extend; moxibustion leads to jaundice and inability to urinate; cauterization leads to coughing and spitting phlegm." Chang Shi said: "Xiaochaihu Tang, Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Decoction), Yinchen Hao Tang (Artemisiae Scopariae Decoction), or Xiao Qinglong Tang can be used." Guo Yong said: "Use each according to the syndrome. Headache, fever, and sweating: Xiaochaihu Tang. Mental vexation and frequent vomiting: also Xiaochaihu Tang. Spasms and stiff body: Guizhi Jia Gegen Tang. Inability to urinate with coughing/phlegm: Xiao Qinglong Tang. Jaundice from moxibustion: Yinchen Hao Tang."
He also said: "When Taiyang and Shaoyang diseases occur together, with stiffness and pain in the head and neck, occasional dizziness or vertigo, occasional sensation of chest binding, and fullness/hardness below the heart: sweating is contraindicated. One should needle the first interspace of Dazhui, Feishu, and Ganshu. Inducing sweating leads to delirium and wiry pulse. If delirium persists for five or six days, needle Qimen."
He also said: "Taiyang disease treated with sweating leads to spasms." Guo Yong said: "The original text states: Taiyang disease with excessive sweating leads to spasms."
He also said: "In Shaoyin disease, with coughing, diarrhea, and delirium, this is due to coercion by fire Qi. Urination will certainly be difficult, caused by forcing sweat from Shaoyin." Chang Shi said: "Guizhi Qu Shaoyao Jia Shuji Muli Longgu Jiunv Tang (Cinnamon Twig Decoction minus Peony plus Chinese Tallow Tree Bark, Oyster Shell and Fossilized Bones for Saving from Peril Decoction) can be used. For difficult urination, Wuling San."
He also said: "In Shaoyin disease, with cold reversal but no sweat, forcing sweating will disturb the blood. It is unknown from which channel it exits; it may exit from the mouth/nose or eyes. This is called 'Lower Cold and Upper Exhaustion,' which is difficult to treat." Chang Shi said: "Shaoyao Dihuang Tang can be used." Guo Yong said: "Moxibustion should still be applied to Sanyinjiao and Yongquan acupoints. Sanyinjiao is difficult to locate; Yongquan is particularly effective."
Wang Shuhe said: "Inducing sweating in winter will certainly lead to vomiting and diarrhea, rotting of the mouth, and sores. (*Qianjin Yifang* agrees)."
He also said: "Profuse sweating with heat, inducing sweating also leads to spasms." Guo Yong said: "The character 'jian' (firm) should be read as 'jing' (spasm). As stated before: excessive sweating leads to spasms."
He also said: "If a patient's pulse is rapid, indicating heat, they should digest food well, yet they vomit instead. This is because the physician induced sweating, making Yang Qi faint and Diaphragm Qi deficient, resulting in a rapid pulse. Rapid pulse indicates guest heat, which cannot digest food; the stomach is deficient and cold, causing vomiting." Chang Shi said: "Xiaobanxia Tang or Wenzhong Tang can be given."
He also said: "In Shanghan, after four or five days, if the pulse is deep, with vexation, wheezing, and fullness: a deep pulse indicates interior pathology; sweating is contraindicated. Fluids escape outward, leading to difficult defecation. Exterior deficiency and interior excess, prolonged, lead to delirium." Chang Shi said: "Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice and Gypsum Decoction) can be used. For deep pulse, interior excess, and delirium, Tiaowei Chengqi Tang (Stomach-Regulating Cathartic Decoction) is appropriate."
He also said: "Shanghan has five types, all belonging to heat diseases. Same disease, different names; same pulse, different meridians. Although all are injured by wind, individuals have chronic diseases, so the same method cannot be used. If a person is chronically injured by wind and then re-injured by heat, wind and heat clash, leading to Fengwen (Wind-Warmth disease): limbs fail to receive commands, headache, body heat, constant sweating without resolution. Treatment focuses on Shaoyin and Jueyin; sweating is contraindicated. Sweating leads to delirium, muttering, internal vexation, restlessness preventing sleep, fearfulness, chaotic vision, and lack of spirit. If treatment involves re-inducing sweating, death results; this is killing the patient by the physician. (From *Yi Lü*)" Zhu Shi said: "Fengwen should not be sweated; Weihui Tang (Jade Bamboo Decoction) is appropriate." Guo Yong said: "Zhang Zhongjing considers Fengwen and Shiwen as bad outcomes of the four types of Shanghan. *Nanjing* considers Shiwen as one of the five types of Shanghan; both belong to Shanghan. See the Fengwen section for details."
He also said: "Shanghan Shiwen (Damp-Warmth): the person is chronically injured by dampness, leading to damp accumulation. Damp and heat clash, leading to Shiwen. The patient suffers from reverse cold in both calves, abdominal fullness, chest compression, head and eye pain, and delirium. Treatment focuses on Foot-Taiyin; sweating is contraindicated. Sweating leads to inability to speak, deafness, unawareness of pain location, bluish body, and changed complexion. This is called 'Zhong Ming' (Heavy Obscuration). Death results; this is killing the patient by the physician. (From *Yi Lü*)" Zhu Shi said: "Baihu Jia Cangzhu Tang (White Tiger plus Atractylodes Lancea Decoction)."
He also said: "Shiwen often presents with profuse sweating; the pulse is soggy and weak in the Yang position, and small and hot in the Yin position."
Pang Shi said: "Sweating when it should not be done leads to desiccation of fluids and death."