太阳症，自汗出，发热不解，恶风，脉浮缓，此风伤卫，宜解肌。仲景用桂枝汤，家秘用羌
活防风汤。若太阳发热，自汗口渴，小便不利，此热结膀胱，仲景用五苓散，家秘用羌活木
通汤。若太阳表邪已解，自汗发热，口渴不恶寒，此阳明里热自汗，宜用凉膈散、三黄石膏
汤、导赤各半汤。若大便不通，腹胀多汗，脉沉而数，此乃下症自汗也，宜用三承气汤。仲
景下法，独详自汗条内者，以下法最怕表症不散，今自汗则表邪多解。以上论冬令伤寒，然
亦可参治四时者。外有汗自出，身仍发热之冬温；有自汗出发热不恶寒而渴之温病；有发汗
已，身灼热之风温；有汗出身热，口燥渴之暑病；有自汗出身灼热，烦闷口渴，长幼相似之
温疫。此皆四时有汗之寒热病，而非冬月伤寒自汗症也。伤寒初起，里未郁热，用辛温散
表。若三时寒热病，里先有热，后感风寒在表者，用麻、桂则碍里热，故化立辛凉散表、和
解表里两法。发散太阳，羌独败毒散；和解太阳，羌活冲和汤；发散阳明，升麻干葛汤；和
解阳明，干葛石膏汤；发散少阳，柴胡防风汤；和解少阳；小柴胡汤。若表散里热，仍照伤
寒清里之法。
太阳病欲解时，从巳至未止。
此言太阳时候也。巳午主太阳，故太阳病多发辰巳时。太阳病欲解，必过辰巳午时至未方解也。
欲自解者，必当先烦，乃有汗而解。何以知之？脉浮，故知汗出解也。
此明太阳病欲解，当必其脉浮先烦，知其汗出而解。
太阳病，发热汗出，恶风脉浮者，名为中风。
此条言发热汗出，脉浮缓，乃是风伤卫之中风症。以无汗有汗，分别中风伤寒。
太阳中风，阳浮而阴弱。阳浮者，热自发；阴弱者，汗自出。啬啬恶寒，淅淅恶风，翕翕发
热，鼻鸣干呕者，桂枝汤主之。
申明太阳中风，因卫之阳分有邪，故脉浮缓；营之阴分无邪，故不紧而弱。卫阳有邪，则
发热；营弱无邪，则不闭郁而汗自出。言翕翕发热，形容表邪拘紧之象。鼻鸣喘逆，表邪
气粗也。干呕者，表邪呕恶也。故用桂枝汤，急解风邪。
太阳病，头痛发热，汗出恶风者，桂枝汤主之。
此申明头痛发热自汗之中风，宜桂枝汤者。
病患脏无他病，时发热自汗出而不愈者，此为卫气不和也，先其时发汗则愈。宜桂枝汤主之。
脏无他病，言无里症，但时有发热自汗表症，此卫气有病，当未发作时，先服桂枝汤发汗，则愈。
病尝自汗出者，此为营气和。营气和者，外不谐，以卫气不共营气和谐故耳。以营行脉中，
卫行脉外，复发其汗，营卫和则愈。
此重明自汗出之病。营分本无病，因卫外之卫气，不谐和于营气，服桂枝汤，以和谐营气则病愈。
发汗后，不可更行桂枝汤。汗出而喘，无大热者，可与麻黄杏仁甘草石膏汤主之。发汗后，
饮水多者必喘，以水灌之亦喘。
大凡汗出而喘，似太阳中风桂枝汤症，深恐误用桂枝，故曰若发汗后，不可更行桂枝。即
自汗喘热之表症，若身无大热，但可用麻黄杏仁甘草石膏汤。盖麻黄与石膏同用，化辛温
而为辛凉。麻黄同石膏，不惟散表，兼能清肺定喘。石膏得麻黄杏仁，不惟清肺，兼能散
表。又云发汗后，饮水多，必水寒射肺而喘。若水灌之，则外闭毛窍，亦必喘。
下后不可更行桂枝汤，汗出而喘，无大热者，可与麻黄杏仁甘草石膏汤。
前条发汗后，汗出而喘，无大热，不可更用桂枝。此条下后汗出而喘，无大热，亦不可更
行桂枝，亦可与麻黄杏仁甘草石膏汤。两条汗下不同，然汗出而喘无大热则同。
伤寒发热，汗出不解，心下痞硬，呕吐而下利者，大柴胡汤主之。
发热汗出不解，心下痞硬，下利，此邪走肠胃，宜用下法。然发热呕吐，尚非承气症，故用大柴胡汤。
阳明病，脉迟，出汗多，微恶寒者，表未解也，可发汗，宜桂枝汤。
此申明阳明病，亦有自汗发热恶风寒中风者，但以脉迟不浮缓，别阳明也。
阳明病，脉浮，无汗而喘者，发汗则愈，宜麻黄汤。
此申明阳明病，亦有无汗寒伤营症，但脉不紧，别阳明也。非教人必服麻、桂，当比例用方可也。
问曰∶阳明病外症云何，答云∶身热自汗出，不恶寒，反恶热也。
此申明阳明病里热外症形象，身热自汗出，不恶寒反恶热者。
阳明病，脉迟，虽汗出不恶寒者，其身必重，短气腹满而喘；有潮热者，此外欲解，可攻里
也，手足 然而汗，此大便已硬也，大承气汤；若腹大满不通者，可与小承气汤，微和胃
气，勿令大泄。
此申明上章。自汗出，不恶寒反恶热，脉象症形，分详里症之大下未可下，微和胃气之次第轻重。
阳明病汗出多而渴者，不可与猪苓汤，以汗多胃中燥，猪苓汤复利其小便故也。
此言汗多而渴，宜生津退热，不可用猪苓汤。
病患烦热，汗出则解，又如疟状，日晡所发热者，属阳明也。脉实者，宜下之；脉浮虚者，
宜发汗。下之与大承气汤；发汗宜桂枝汤。
此一日一发似疟之症。言病患烦热汗出而解，至明日日晡，又见先寒后热，此阳明经似
疟，脉实多汗，便结腹胀，宜承气汤下之。如尚有头痛恶寒发热表症，而见浮缓虚脉，尚
宜桂枝汤汗之。
伤寒发热无汗，呕而不能食，而反汗出 然者，是转属阳明也。伤寒转系阳明者，其人
微汗出也。
发热无汗太阳症，今有汗出而至 然者，转属阳明矣。故转属阳明，必 常有微汗出而
不干。然虽属阳明，未见热结在里，故不用下法。
太阳病三日，发汗不解，蒸蒸发热者，属胃也，调胃承气汤主之。
汗出热不解，蒸蒸常有汗者，属胃家里热，故与调胃承气汤。上条但 微汗不干，此条
蒸蒸时汗外达，邪已入里，故立调胃承气汤，以示微下之意。
阳明病，其人多汗，汗以液外出，胃中燥，大便必硬，硬则谵语，小承气汤主之。若一服谵
语止，更莫复服。
较上章多谵语大便硬二症，故用小承气汤，但清胃热，谵语一止，莫再服。不服恐热气不
清，多服恐无燥粪。
汗出谵语者，以有燥粪在胃中，此为风也，须下之。过经乃可下，若下之太早，语言必乱。
以表虚里实故也，下之则愈，宜大承气汤。
上章多汗亡津，肠中干结，内热谵语，未必燥屎，故用小承气汤。此章汗出谵语，且有燥
屎在肠胃之中，乃是阳明风热，消津结硬，蒸其胃汁，外腾阴血阳津有立尽之势，则须下
之。以表虚无邪，里实有热，下之则愈，宜大承气汤。然立大下之法，又恐后人下早，故
先戒曰∶过经表散，乃可下之。若下之太早，则表邪内攻，语言必乱而死矣。前四句，立
大下法门；中三句，关防下早变症；末三句，缴前应下方法。失下恐津液立尽，早下恐变
症不测。仲景岂以未过经而下早，变出内乱神明危恶之症，反轻言下之则愈，复立大承气
大下危法于后。
阳明病，发热汗多者，急下之，宜大承气汤。
言阳明病，则无太阳少阳表症。言汗多，则阳明表邪尽解。仍发热，乃是里热，蒸汗尽
出，故用急下。前条言 蒸蒸汗出，初入阳明里症，用调胃承气，清胃热；中条言汗
多，津液竭，大便硬，可用小承气微下；后条言谵语，有燥屎，当用大承气大下；此条总
结上文，发热汗多，表解谵语，大便硬，有燥屎，已过经下症，当用急下、大下之法。
太阳病，项背强KT KT ，反汗出恶风者，桂枝葛根汤。
太阳病项，背强KT KT ，无汗恶寒，当用麻黄汤。太阳病，项背强KT KT ，反汗出恶风，当用
桂枝汤。今用桂枝葛根汤，必汗出恶风，又兼见阳明症。
三阳合病，脉浮，大上关上，但欲眠睡，目合则汗。
三阳合病，脉浮，大表脉也。上关上，少阳也。肝胆主目，合目则汗，盗汗也。虽不立方、
然宜用小柴胡症。
三阳合病，腹满身重，难以转侧，口不仁而面垢，谵语遗屎。发汗则谵语，下之则额生汗，手
足逆冷，若自汗出者，白虎汤主之。
前条三阳合病，发明脉浮大，上关上，目合则汗，以示少阳和解主治。此条三阳合病，发
明腹满身重，口不仁，面垢谵语遗屎之里症，以示阳明清里主治。非表症，故发汗则谵
语。非下症，故下之则额生汗。因手足冷，复戒之曰∶自汗出者，可用白虎汤。
桂枝汤 见恶寒。
羌活防风汤 见项强。
凉膈散 见发狂。
三黄石膏汤
黄连 黄芩 黄柏 石膏
上焦肺胃有热，蒸汗外出，用前方凉膈散。若二焦皆热，则用此方，兼治三焦。
导赤各半汤 见腹满痛。
败毒散 见发狂。
羌活冲和汤 见发热。
升麻干葛汤 干葛石膏汤 俱见寒热。
柴胡防风汤
柴胡 防风 荆芥 前胡
少阳自汗，亦有表里二条。若少阳表症多，宜散少阳表邪，当用此方。
小柴胡汤 见寒热头眩。
少阳表里皆热而自汗，不可单解表，宜用此方，以柴胡散少阳之表，黄芩清少阳之里。
知母石膏汤
知母 石膏 麦门冬 粳米
阳明纯表邪症，则用升麻干葛汤。表有邪，里有热，则用干葛石膏汤。若表邪已解，里热
自汗，则以此方单清里热。
三黄解毒汤 见发狂。
三乙承气汤 见便结。
葛根黄连黄芩汤
葛根 黄连 黄芩 甘草
阳明里有燥热而自汗，用干葛石膏汤。阳明里有温热而自汗下利，则用葛根黄连汤。阳明
受热，肺受火制，则用干葛芩连汤，兼清肺胃。然又有热在气分而多汗，则用干葛知母石
膏汤。热在血分而多汗，又用升麻清胃汤。
十枣汤 见结胸。
麻黄杏仁甘草石膏汤
麻黄 杏仁 甘草 石膏
汗出而喘，身无大热，且见于汗下后，乃是肺家内有积热，外冒寒邪。内有积热，外攻皮
毛，故汗出；外有表邪，故发喘。此方妙在杏仁利肺气，借麻黄以散外寒，借石膏以清内
热，从越婢汤中化出辛温变辛凉之法，并开后人双解肺经表里之法也。
大柴胡汤 见潮热。
甘草附子汤 见身痛。
甘草干姜汤 见烦躁。
芍药甘草汤 见烦躁。
桂枝葛根汤
桂枝 葛根 白芍药 甘草 大枣
太阳发热，项背强KT KT ，反汗出恶风者，当用桂枝汤。今加入干葛者，以项强自汗兼见阳明耳。
【自汗】
太阳病，出现自汗出、发热不退、怕风、脉象浮缓的症状，这是风邪伤及卫气，应当采用解肌的方法治疗。张仲景使用桂枝汤，我（作者）的秘方使用羌活防风汤。如果太阳病表现为发热、自汗、口渴、小便不利，这是热邪结聚在膀胱，张仲景使用五苓散，我的秘方使用羌活木通汤。如果太阳表的邪气已经解除，仍然有自汗、发热、口渴但不怕冷，这是阳明经里热导致的自汗，适宜使用凉膈散、三黄石膏汤、导赤各半汤。如果大便不通、腹部胀满、多汗、脉象沉而数，这是下焦实证导致的自汗，适宜使用三承气汤（调胃承气汤、小承气汤、大承气汤）。张仲景在下法中特别详细地论述自汗症状的原因，是因为下法最怕表证未解，现在既然有自汗，说明表邪大多已解。以上讨论的是冬季感受寒邪的情况，但也可以参考用于治疗四季的疾病。此外还有：外感出汗且身体仍发热的冬温病；自汗出发热不怕冷而口渴的温病；发汗后身体灼热的风温病；出汗后身热、口燥渴的暑病；自汗出身热、烦闷口渴、老少相似的温疫病。这些都是四季中有汗的寒热病，而不是冬季伤寒的自汗症。伤寒初起，体内没有郁积的热邪，使用辛温药物发散表邪。如果是春夏秋三季的寒热病，体内先有热邪，后感风寒在表，使用麻黄、桂枝会妨碍里热，因此创立了辛凉发散和解表里两种方法。发散太阳经邪气用羌独败毒散；和解太阳经用羌活冲和汤；发散阳明经邪气用升麻干葛汤；和解阳明经用干葛石膏汤；发散少阳经邪气用柴胡防风汤；和解少阳经用小柴胡汤。如果要发散表邪并清解里热，则按照伤寒清里的方法处理。
太阳病想要缓解的时间，从巳时到未时结束。
这是在说明太阳经对应的时间。巳时和午时主司太阳经，所以太阳病多在辰时和巳时发作。太阳病想要缓解，必须经过辰、巳、午时，到了未时才可能缓解。
如果想要自行缓解，病人必定先感到心烦，然后才有汗出而病解。怎么知道呢？因为脉象浮，所以知道是汗出而解。
这是在阐明太阳病想要缓解，必定是先脉浮、先心烦，从而知道它是通过汗出而解除的。
太阳病，发热、汗出、怕风、脉浮的，称为中风。
这一条说发热汗出、脉浮缓，是风邪伤及卫气的中风症。以无汗和有汗来区分中风和伤寒。
太阳中风，脉象阳部浮而阴部弱。阳部浮，说明热自发；阴部弱，说明汗自出。病人啬啬恶寒，淅淅恶风，翕翕发热，鼻鸣干呕的，用桂枝汤主治。
这是申述太阳中风，因为卫分的阳气有邪气，所以脉浮缓；营分的阴气没有邪气，所以不紧而弱。卫阳有邪气，则发热；营阴弱而无邪气，则不闭郁而汗自出。“翕翕发热”形容表邪拘紧的样子。鼻鸣喘逆，是表邪气粗的表现。干呕，是表邪导致胃气上逆。所以用桂枝汤，急解风邪。
太阳病，头痛、发热、汗出、怕风的，用桂枝汤主治。
这是申述头痛发热自汗的中风症，适宜用桂枝汤。
病人脏腑没有其他疾病，只是时常发热、自汗出而不能痊愈的，这是卫气不和，应当在发作前发汗才能痊愈，适宜用桂枝汤主治。
“脏无他病”，是说没有里证，只有时有发热自汗的表证，这是卫气有病，应当在未发作时，先服用桂枝汤发汗，就能痊愈。
病人经常自汗出的，这是营气调和。营气调和，说明外部不协调，是因为卫气不能与营气和谐所致。营气行于脉中，卫气行于脉外，再发其汗，营卫和谐则病愈。
这是再次阐明自汗出的病症。营分本来没有病，是因为体外的卫气，不与营气和谐，服用桂枝汤，以调和营卫之气则病愈。
发汗后，不可再用桂枝汤。如果汗出而喘，身上没有大热的，可以给予麻黄杏仁甘草石膏汤主治。发汗后，饮水过多的必定气喘，用水浇洗身体也会气喘。
大凡汗出而喘，看似太阳中风桂枝汤证，深恐误用桂枝汤，所以说如果发汗后，不可再用桂枝汤。即使是自汗喘热的表证，如果身上没有大热，只可用麻黄杏仁甘草石膏汤。因为麻黄与石膏同用，将辛温化为辛凉。麻黄配合石膏，不仅能发散表邪，兼能清肺定喘。石膏得到麻黄杏仁，不仅能清肺，兼能发散表邪。又说发汗后，饮水过多，必然导致水寒射肺而气喘。如果用冷水浇洗，则外闭毛孔，也必然气喘。
攻下后不可再用桂枝汤，如果汗出而喘，身上没有大热的，可以给予麻黄杏仁甘草石膏汤主治。
前一条说发汗后，汗出而喘，无大热，不可再用桂枝汤。这一条说攻下后汗出而喘，无大热，也不可行桂枝汤，也可给予麻黄杏仁甘草石膏汤。两条虽然汗法和下法不同，但汗出而喘无大热是一样的。
伤寒发热，汗出不解，心下痞硬，呕吐而下利的，用大柴胡汤主治。
发热汗出不解，心下痞硬，下利，这是邪气走窜肠胃，适宜用下法。但是发热呕吐，还不是承气汤证，所以用大柴胡汤。
阳明病，脉迟，出汗多，微恶寒的，是表证未解，可以发汗，适宜用桂枝汤。
这是申述阳明病，也有自汗发热恶风寒的中风症，但以脉迟不浮缓，来区别阳明病。
阳明病，脉浮，无汗而喘的，发汗则愈，适宜用麻黄汤。
这是申述阳明病，也有无汗寒伤营的症候，但脉不紧，以此区别阳明病。不是教人一定要服麻黄、桂枝，应当按比例使用才可以。
问曰：阳明病的表证是什么？答曰：身热、自汗出、不恶寒、反恶热。
这是申述阳明病里热外证的形象，身热自汗出，不恶寒反恶热。
阳明病，脉迟，虽然汗出但不恶寒的，身体必定沉重，短气、腹满而喘；如果有潮热的，这是表证将要解除，可以攻里了，手足濈然汗出，这说明大便已经硬结，用大承气汤；如果腹部大满不通的，可以给予小承气汤，轻微调和胃气，不要让它剧烈泄下。
这是申述上一章。自汗出，不恶寒反恶热，脉象症状，详细分辨里证的大下不可下，以及轻微调和胃气的次第轻重。
阳明病汗出多而口渴的，不可给猪苓汤，因为汗多胃中干燥，猪苓汤又会利其小便的缘故。
这是说汗多而渴，适宜生津退热，不可用猪苓汤。
病人烦热，汗出则缓解，又像疟疾一样，每天下午日晡时发热的，属于阳明病。脉实的，适宜用下法；脉浮虚的，适宜用发汗法。下法用大承气汤；发汗宜用桂枝汤。
这是一天一发似疟的症候。说病人烦热汗出而解，到第二天日晡时，又见先寒后热，这是阳明经似疟，脉实多汗，便结腹胀，适宜承气汤下之。如果还有头痛恶寒发热等表证，而见浮缓虚脉，尚适宜桂枝汤汗之。
伤寒发热无汗，呕吐不能进食，反而汗出濈然的，是转属阳明病。伤寒转系阳明的，其人微汗出。
发热无汗是太阳症，现在有汗出而至濈然者，是转属阳明了。所以转属阳明，必定常常有微汗出而不干燥。虽然属阳明，但未见到热结在里，所以不用下法。
太阳病三天，发汗后热不解，蒸蒸发热的，属于胃家实，用调胃承气汤主治。
汗出热不解，蒸蒸常有汗出的，属于胃家里热，所以给调胃承气汤。上一条只是微汗不干，这一条蒸蒸时汗外达，邪气已入里，所以立调胃承气汤，以示轻微攻下的意思。
阳明病，病人多汗，汗液外出，胃中干燥，大便必硬，硬则谵语，用小承气汤主治。如果一服后谵语停止，不要再服。
较上一章多了谵语和大便硬两个症状，所以用小承气汤，只是清胃热，谵语一止，不要再服。不服恐热气不清，多服恐无燥粪。
汗出谵语的，因为有燥屎在胃中，这是风邪，须用下法。必须过了经界才可下，如果下得太早，语言必定错乱。因为表虚里实，下之则愈，适宜大承气汤。
上一章是多汗亡津，肠中干结，内热谵语，未必有燥屎，所以用小承气汤。这一章汗出谵语，且有燥屎在肠胃之中，乃是阳明风热，消耗津液结硬，蒸腾胃汁，外腾阴血阳津有立即耗尽的趋势，则须下之。因为表虚无邪，里实有热，下之则愈，适宜大承气汤。然而设立大下之法，又恐后人下之过早，所以先告诫说：过了经界表散之后，才可下之。如果下之太早，则表邪内攻，语言必定错乱而死。前四句，设立大下法门；中间三句，防范下早变症；最后三句，回应前面应下方法。失下恐津液立即耗尽，早下恐变症不可测。张仲景难道是用未过经而下早，变出内乱神明危恶之症，反而轻言下之则愈，再在大承气大下危法之后立此法吗？
阳明病，发热汗多的，急下之，适宜大承气汤。
说阳明病，就没有太阳少阳表证。说汗多，则阳明表邪尽解。仍发热，乃是里热，蒸汗尽出，所以用急下。前条说蒸蒸汗出，初入阳明里症，用调胃承气，清胃热；中条说汗多，津液竭，大便硬，可用小承气微下；后条说谵语，有燥屎，当用大承气大下；这一条总结上文，发热汗多，表解谵语，大便硬，有燥屎，已过经下症，当用急下、大下之法。
太阳病，项背强几几，反汗出恶风的，用桂枝加葛根汤。
太阳病项背强几几，无汗恶寒，当用麻黄汤。太阳病，项背强几几，反汗出恶风，当用桂枝汤。现在用桂枝加葛根汤，必定是汗出恶风，又兼见阳明症。
三阳合病，脉浮，大上关上，只想睡觉，闭上眼睛就出汗。
三阳合病，脉浮，是大表脉。上关上，是少阳。肝胆主目，合目则汗，是盗汗。虽然没有立方，但适宜用小柴胡症的处理方法。
三阳合病，腹满身重，难以转侧，口不仁而面垢，谵语遗屎。发汗则谵语，下之则额生汗，手足逆冷，如果自汗出的，白虎汤主治。
前条三阳合病，发明脉浮大，上关上，目合则汗，以示少阳和解主治。此条三阳合病，发明腹满身重，口不仁，面垢谵语遗屎的里症，以示阳明清里主治。不是表证，所以发汗则谵语。不是下证，所以下之则额生汗。因为手足冷，又告诫说：自汗出的，可用白虎汤。
桂枝汤 见恶寒。
羌活防风汤 见项强。
凉膈散 见发狂。
三黄石膏汤
黄连 黄芩 黄柏 石膏
上焦肺胃有热，蒸汗外出，用前方凉膈散。如果二焦皆热，则用此方，兼治三焦。
导赤各半汤 见腹满痛。
败毒散 见发狂。
羌活冲和汤 见发热。
升麻干葛汤 干葛石膏汤 俱见寒热。
柴胡防风汤
柴胡 防风 荆芥 前胡
少阳自汗，也有表里两条。如果少阳表症多，宜散少阳表邪，当用此方。
小柴胡汤 见寒热头眩。
少阳表里皆热而自汗，不可单解表，宜用此方，以柴胡散少阳之表，黄芩清少阳之里。
知母石膏汤
知母 石膏 麦门冬 粳米
阳明纯表邪症，则用升麻干葛汤。表有邪，里有热，则用干葛石膏汤。如果表邪已解，里热自汗，则以此方单清里热。
三黄解毒汤 见发狂。
三乙承气汤 见便结。
葛根黄连黄芩汤
葛根 黄连 黄芩 甘草
阳明里有燥热而自汗，用干葛石膏汤。阳明里有温热而自汗下利，则用葛根黄连汤。阳明受热，肺受火制，则用干葛芩连汤，兼清肺胃。然而又有热在气分而多汗，则用干葛知母石膏汤。热在血分而多汗，又用升麻清胃汤。
十枣汤 见结胸。
麻黄杏仁甘草石膏汤
麻黄 杏仁 甘草 石膏
汗出而喘，身无大热，且见于汗下后，乃是肺家内有积热，外冒寒邪。内有积热，外攻皮毛，故汗出；外有表邪，故发喘。此方妙在杏仁利肺气，借麻黄以散外寒，借石膏以清内热，从越婢汤中化出辛温变辛凉之法，并开后人双解肺经表里之法也。
大柴胡汤 见潮热。
甘草附子汤 见身痛。
甘草干姜汤 见烦躁。
芍药甘草汤 见烦躁。
桂枝加葛根汤
桂枝 葛根 白芍药 甘草 大枣
太阳发热，项背强几几，反汗出恶风的，当用桂枝汤。现在加入干葛的，是因为项强自汗兼见阳明耳。
[Spontaneous Sweating]
Taiyang disease presents with spontaneous sweating, persistent fever, aversion to wind, and a floating, moderate pulse. This indicates wind pathogen injuring the Wei (Defensive) Qi, and the appropriate treatment is to resolve the muscle layer. Zhang Zhongjing uses Guizhi Tang (Cinnamon Twig Decoction), while my secret formula uses Qianghuo Fangfeng Tang (Notopterygium and Saposhnikovia Decoction). If Taiyang disease manifests as fever, spontaneous sweating, thirst, and dysuria, this indicates heat binding in the Bladder. Zhang Zhongjing uses Wuling San (Five-Ingredient Powder with Poria), while my secret formula uses Qianghuo Mutong Tang (Notopterygium and Akebia Decoction). If the exterior pathogen of Taiyang has been resolved, yet there remains spontaneous sweating, fever, and thirst without aversion to cold, this is spontaneous sweating due to interior heat in the Yangming channel. It is suitable to use Liangge San (Cooling the Diaphragm Powder), Sanhuang Shigao Tang (Three-Yellow and Gypsum Decoction), or Daochi Banjie Tang (Half-Solution for Guiding Redness Decoction). If there is constipation, abdominal distension, profuse sweating, and a deep, rapid pulse, this is spontaneous sweating caused by interior excess syndromes requiring purgation. It is suitable to use the Three Chengqi Decoctions (Tiaowei Chengqi Tang, Xiaochengqi Tang, Dachengqi Tang). Zhang Zhongjing details the purgative method specifically within the section on spontaneous sweating because the purgative method is most feared when the exterior syndrome has not resolved; now, since there is spontaneous sweating, it indicates that the exterior pathogen has mostly resolved. The above discusses cold damage occurring in winter, but these principles can also be referenced for treating diseases in all four seasons. Additionally, there are: Dongwen (Winter Warmth) characterized by external sweating with persistent body heat; Wenbing (Warm Disease) characterized by spontaneous sweating, fever, no aversion to cold, and thirst; Fengwen (Wind Warmth) characterized by burning heat after sweating; Shubing (Summerheat Disease) characterized by sweating, body heat, dry mouth, and thirst; and Wenyi (Warm Epidemic) characterized by spontaneous sweating, burning heat, irritability, thirst, and similarity among young and old. These are all cold-heat diseases with sweating occurring in the four seasons, distinct from the spontaneous sweating syndrome of winter cold damage. At the onset of cold damage, when there is no interior郁 (stagnant) heat, acrid-warm herbs should be used to disperse the exterior. However, for cold-heat diseases in the other three seasons, where interior heat exists prior to contracting wind-cold on the exterior, using Mahuang (Ephedra) and Guizhi (Cinnamon Twig) would hinder the interior heat. Therefore, methods of acrid-cool dispersion and harmonizing the exterior and interior were established. To disperse Taiyang pathogen, use Qiangdu Baidu San (Notopterygium, Angelica, and Detoxification Powder); to harmonize Taiyang, use Qianghuo Chonghe Tang (Notopterygium and Harmony Decoction); to disperse Yangming pathogen, use Shengma Gan Ge Tang (Burdock Root and Kudzu Decoction); to harmonize Yangming, use Gan Ge Shigao Tang (Kudzu and Gypsum Decoction); to disperse Shaoyang pathogen, use Chaihu Fangfeng Tang (Bupleurum and Saposhnikovia Decoction); to harmonize Shaoyang, use Xiao Chaihu Tang (Minor Bupleurum Decoction). If dispersing the exterior and clearing the interior is required, follow the methods for clearing interior heat in cold damage.
The time when Taiyang disease desires to resolve is from Si hour to Wei hour.
This explains the timing associated with the Taiyang channel. Si and Wu hours govern the Taiyang channel, so Taiyang disease often occurs during Chen and Si hours. For Taiyang disease to resolve, it must pass through Chen, Si, and Wu hours, only resolving at Wei hour.
If the disease is to resolve spontaneously, the patient will first experience vexation, followed by sweating and resolution. How do we know this? Because the pulse is floating, we know it resolves through sweating.
This clarifies that for Taiyang disease to resolve, there must first be a floating pulse and vexation, indicating resolution through sweating.
In Taiyang disease, if there is fever, sweating, aversion to wind, and a floating pulse, it is named Wind Strike (Zhong Feng).
This clause states that fever, sweating, and a floating-moderate pulse constitute Wind Strike caused by wind injuring the Wei Qi. The distinction between Wind Strike and Cold Damage is made based on the presence or absence of sweating.
In Taiyang Wind Strike, the Yang portion of the pulse is floating and the Yin portion is weak. Floating Yang indicates spontaneous heat generation; weak Yin indicates spontaneous sweating. With symptoms of shivering aversion to cold, chilly aversion to wind, mild fever, nasal congestion with roaring sounds, and dry retching, Guizhi Tang (Cinnamon Twig Decoction) is the primary treatment.
This elaborates on Taiyang Wind Strike: because there is pathogen in the Yang aspect of the Wei Qi, the pulse is floating and moderate; because there is no pathogen in the Yin aspect of the Ying (Nutritive) Qi, the pulse is not tight but weak. Pathogen in the Wei Yang causes fever; weak Ying Yin without pathogen does not cause closure/stagnation, leading to spontaneous sweating. "Mild fever" describes the sensation of exterior pathogen constraint. Nasal roaring and wheezing indicate coarse exterior pathogen qi. Dry retching indicates stomach rebellion due to exterior pathogen. Thus, Guizhi Tang is used to urgently resolve the wind pathogen.
In Taiyang disease, if there is headache, fever, sweating, and aversion to wind, Guizhi Tang (Cinnamon Twig Decoction) is the primary treatment.
This reiterates that for Wind Strike presenting with headache, fever, spontaneous sweating, and aversion to wind, Guizhi Tang is appropriate.
If a patient's internal organs have no other pathology, but they experience periodic fever and spontaneous sweating that does not heal, this is disharmony of the Wei Qi. Sweating should be induced before the onset of symptoms to achieve cure. Guizhi Tang (Cinnamon Twig Decoction) is the primary treatment.
"No other pathology in the internal organs" means there are no interior syndromes, only periodic exterior syndromes of fever and spontaneous sweating due to diseased Wei Qi. One should administer Guizhi Tang to induce sweating before the attack begins to achieve cure.
If a patient frequently experiences spontaneous sweating, this indicates that the Ying Qi is harmonious. Since the Ying Qi is harmonious, the disharmony lies externally, specifically because the Wei Qi does not harmonize with the Ying Qi. Ying Qi circulates within the vessels, while Wei Qi circulates outside the vessels. Inducing sweating again will restore harmony between Ying and Wei, leading to recovery.
This further elucidates the pathology of spontaneous sweating. The Ying division itself is not diseased; rather, the exterior Wei Qi is not in harmony with the Ying Qi. Administering Guizhi Tang harmonizes the Ying and Wei Qi, curing the disease.
After inducing sweating, Guizhi Tang (Cinnamon Twig Decoction) should not be administered again. If there is sweating accompanied by wheezing and no significant high fever, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be given. After inducing sweating, excessive water intake will inevitably cause wheezing; bathing with cold water will also cause wheezing.
Generally, sweating with wheezing resembles the Taiyang Wind Strike syndrome treated with Guizhi Tang. Deeply fearing misapplication of Guizhi Tang, it is stated that after sweating, Guizhi Tang should not be used again. Even if there are exterior symptoms of spontaneous sweating, wheezing, and heat, if there is no significant high fever, Mahuang Xingren Gancao Shigao Tang is applicable. The combination of Mahuang (Ephedra Herba) and Shigao (Gypsum Fibrosum) transforms acrid-warm properties into acrid-cool ones. Mahuang combined with Shigao not only disperses the exterior but also clears the Lung and stabilizes wheezing. Shigao combined with Mahuang and Xingren (Apricot Kernel) not only clears the Lung but also disperses the exterior. Furthermore, after sweating, excessive water intake leads to cold-water attacking the Lung, causing wheezing. Bathing with cold water closes the pores externally, also causing wheezing.
After purgation, Guizhi Tang (Cinnamon Twig Decoction) should not be administered again. If there is sweating accompanied by wheezing and no significant high fever, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be given.
The previous clause stated that after sweating, with sweating, wheezing, and no significant heat, Guizhi Tang should not be used. This clause states that after purgation, with sweating, wheezing, and no significant heat, Guizhi Tang should also not be used; instead, Mahuang Xingren Gancao Shigao Tang may be given. Although the methods (sweating vs. purgation) differ, the presentation of sweating, wheezing, and lack of significant heat is identical.
In cold damage, if there is fever, sweating that does not resolve, epigastric fullness and hardness, vomiting, and diarrhea, Da Chaihu Tang (Major Bupleurum Decoction) is the primary treatment.
Fever and unresolved sweating, epigastric fullness/hardness, and diarrhea indicate the pathogen has moved to the intestines and stomach, requiring purgation. However, fever and vomiting are not yet indications for the Chengqi formulas, hence Da Chaihu Tang is used.
In Yangming disease, if the pulse is slow, there is profuse sweating, and slight aversion to cold, the exterior syndrome has not resolved. Sweating may be induced, and Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
This reiterates that Yangming disease can also present with spontaneous sweating, fever, and aversion to wind/cold resembling Wind Strike. It is distinguished from Taiyang by the slow pulse rather than a floating-moderate one.
In Yangming disease, if the pulse is floating, there is no sweating, and wheezing, inducing sweating leads to recovery, and Mahuang Tang (Ephedra Decoction) is appropriate.
This reiterates that Yangming disease can also present with no sweating and cold injuring the Ying Qi. It is distinguished from Taiyang by the pulse not being tight. This does not instruct that Mahuang and Guizhi must always be used, but rather applied proportionally according to pattern differentiation.
Question: What are the exterior symptoms of Yangming disease? Answer: Body heat, spontaneous sweating, no aversion to cold, and aversion to heat.
This elaborates on the exterior manifestation of interior heat in Yangming disease: body heat, spontaneous sweating, no aversion to cold, and aversion to heat.
In Yangming disease, if the pulse is slow, and although there is sweating, there is no aversion to cold, the body will feel heavy, there will be shortness of breath, abdominal fullness, and wheezing. If there is tidal fever, the exterior is about to resolve, and the interior may be attacked. If the hands and feet sweat continuously, the stool has hardened. Use Dachengqi Tang (Major Order the Qi Decoction). If the abdomen is severely distended and obstructed, Xiaochengqi Tang (Minor Order the Qi Decoction) may be given to gently harmonize the Stomach Qi, avoiding severe purgation.
This elaborates on the previous chapter. Spontaneous sweating, no aversion to cold but aversion to heat, pulse characteristics, and symptom forms detail the interior syndromes, distinguishing between cases where major purgation is contraindicated and those requiring gentle harmonization of Stomach Qi.
In Yangming disease, if there is profuse sweating and thirst, Zhu Ling Tang (Polyporus Decoction) should not be given. Because profuse sweating dries the Stomach, and Zhu Ling Tang promotes urination, which would further deplete fluids.
This states that for profuse sweating and thirst, generating fluids and reducing heat is appropriate; Zhu Ling Tang should not be used.
If a patient feels vexed and hot, relief comes with sweating, but symptoms resemble malaria with fever occurring at dusk (You hour), this belongs to Yangming. If the pulse is solid, purgation is appropriate; if the pulse is floating and deficient, sweating is appropriate. Purgation uses Dachengqi Tang (Major Order the Qi Decoction); sweating uses Guizhi Tang (Cinnamon Twig Decoction).
This describes a daily episode resembling malaria. The patient feels vexed and hot, relieved by sweating. By the next day at dusk, chills precede fever. This is a malaria-like presentation in the Yangming channel. With a solid pulse, profuse sweating, constipation, and abdominal distension, Chengqi Decoction is used for purgation. If headache, aversion to cold, and fever (exterior symptoms) persist alongside a floating-moderate-deficient pulse, Guizhi Tang is still appropriate for sweating.
In cold damage, if there is fever, no sweating, vomiting, inability to eat, but suddenly continuous sweating occurs, the condition has transferred to Yangming. In cold damage transferring to Yangming, the patient exhibits slight sweating.
Fever and no sweating are Taiyang symptoms. Now, with continuous sweating, it has transferred to Yangming. Transfer to Yangming is characterized by constant slight sweating that is not dry. Although it belongs to Yangming, there is no evidence of heat binding in the interior, so purgation is not used.
After three days of Taiyang disease, if sweating fails to resolve the fever and there is steaming heat, it belongs to the Stomach (Yangming interior excess). Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) is the primary treatment.
Sweating does not resolve the heat; steaming heat with continuous sweating indicates interior heat in the Stomach. Hence, Tiaowei Chengqi Tang is given. The previous case had only slight non-drying sweating; this case has steaming heat with outward sweating, indicating the pathogen has entered the interior. Thus, Tiaowei Chengqi Tang is established to indicate mild purgation.
In Yangming disease, if the patient sweats profusely, fluid loss dries the Stomach, and the stool becomes hard, leading to delirium, Xiaochengqi Tang (Minor Order the Qi Decoction) is the primary treatment. If delirium stops after one dose, do not administer more.
Compared to the previous chapter, this adds delirium and hard stool, warranting Xiaochengqi Tang to clear Stomach heat. Once delirium ceases, stop administration. Not administering risks uncontrolled heat; over-administering risks purging non-existent dry feces.
Spontaneous sweating with delirium indicates dry feces in the Stomach/Intestines, caused by wind pathogen. Purging is necessary. One must wait until the pathogen has passed through the meridians before purging. If purged too early, speech will become confused. This is due to exterior deficiency and interior excess. Purging will lead to recovery, and Dachengqi Tang (Major Order the Qi Decoction) is appropriate.
The previous chapter involved fluid loss from sweating, intestinal dryness, and internal heat-induced delirium, possibly without dry feces, hence Xiaochengqi Tang. This chapter involves spontaneous sweating with delirium and actual dry feces in the intestines, caused by Yangming wind-heat consuming fluids and hardening them, steaming Stomach juices, threatening immediate exhaustion of Yin blood and Yang fluids. Purging is necessary. With no exterior pathogen (exterior deficiency) and interior excess heat, purging cures the disease, using Dachengqi Tang. However, establishing a major purgation method requires warning against premature purging. It is warned: only purge after the meridian stage has passed and the exterior is dispersed. Premature purging allows exterior pathogen to invade inward, causing confusion of speech and death. The first four sentences establish the major purgation protocol; the middle three warn against complications of premature purging; the last three summarize the correct method. Failure to purge risks immediate fluid exhaustion; premature purging risks unpredictable complications. Did Zhang Zhongjing propose premature purging leading to chaotic spirit and critical illness, only to later suggest Dachengqi Tang as a dangerous method? No.
In Yangming disease, if there is fever and profuse sweating, urgent purgation is required, and Dachengqi Tang (Major Order the Qi Decoction) is appropriate.
Yangming disease implies no Taiyang or Shaoyang exterior syndromes. Profuse sweating implies Yangming exterior pathogen has fully resolved. Persistent fever indicates interior heat steaming out sweat. Hence, urgent purgation is used. The previous case of steaming sweating indicated initial entry into Yangming interior, treated with Tiaowei Chengqi Tang to clear Stomach heat. The middle case of profuse sweating with fluid exhaustion and hard stool could use Xiaochengqi Tang for mild purgation. The delirium case with dry feces required Dachengqi Tang for major purgation. This final case summarizes: fever, profuse sweating, resolved exterior, delirium, hard stool, dry feces, and passage of the meridian stage require urgent and major purgation.
In Taiyang disease, if there is stiffness and tension in the neck and back, but paradoxically with sweating and aversion to wind, Guizhi Jia Ge Gen Tang (Cinnamon Twig Decoction plus Kudzu Root) is used.
For Taiyang disease with neck/back stiffness, no sweating, and aversion to cold, Mahuang Tang (Ephedra Decoction) is used. For Taiyang disease with neck/back stiffness, sweating, and aversion to wind, Guizhi Tang (Cinnamon Twig Decoction) is used. Now, Guizhi Jia Ge Gen Tang is used, indicating sweating and aversion to wind co-occurring with Yangming symptoms.
In Combined Disease of the Three Yang channels, the pulse is floating, large and rising to the Guan position. The patient desires sleep, and sweats when closing the eyes.
Combined Disease of the Three Yang channels with a floating, large pulse indicates an exterior syndrome. Rising to the Guan position indicates Shaoyang. Liver and Gallbladder govern the eyes; sweating upon closing the eyes is night sweating. Although no formula is prescribed here, the approach of Xiao Chaihu Tang (Minor Bupleurum Decoction) for harmonization is implied.
In Combined Disease of the Three Yang channels, there is abdominal fullness, heaviness of the body, difficulty turning over, insensitivity in the mouth, greasy facial complexion, delirium, and involuntary defecation. Inducing sweating leads to delirium; purging leads to sweating on the forehead and cold extremities. If there is spontaneous sweating, Baihu Tang (White Tiger Decoction) is the primary treatment.
The previous clause on Combined Disease of the Three Yang channels explained the floating-large pulse, Guan position, and eye-closing sweating to indicate Shaoyang harmonization as the main treatment. This clause explains the interior syndromes of abdominal fullness, body heaviness, oral insensitivity, greasy face, delirium, and incontinence to indicate Yangming interior clearing as the main treatment. It is not an exterior syndrome, so sweating causes delirium. It is not a purgation syndrome, so purging causes forehead sweating. Due to cold extremities, it is further warned: if there is spontaneous sweating, Baihu Tang (White Tiger Decoction) may be used.
Guizhi Tang (Cinnamon Twig Decoction) - See Aversion to Cold.
Qianghuo Fangfeng Tang (Notopterygium and Saposhnikovia Decoction) - See Neck Stiffness.
Liangge San (Cooling the Diaphragm Powder) - See Mania.
Sanhuang Shigao Tang (Three-Yellow and Gypsum Decoction)
Huanglian (Coptis Rhizome), Huangqin (Scutellaria Root), Huangbai (Phellodendron Bark), Shigao (Gypsum Fibrosum).
Heat in the Upper Jiao (Lung and Stomach) steams sweat outward; use the preceding Liangge San. If Heat exists in both Upper and Middle Jiao, use this formula to treat all three Jiao.
Daochi Banjie Tang (Half-Solution for Guiding Redness Decoction) - See Abdominal Fullness and Pain.
Baidu San (Detoxification Powder) - See Mania.
Qianghuo Chonghe Tang (Notopterygium and Harmony Decoction) - See Fever.
Shengma Gan Ge Tang (Burdock Root and Kudzu Decoction) and Gan Ge Shigao Tang (Kudzu and Gypsum Decoction) - See Cold and Heat.
Chaihu Fangfeng Tang (Bupleurum and Saposhnikovia Decoction)
Chaihu (Bupleurum Root), Fangfeng (Saposhnikovia Root), Jingjie (Schizonepeta Spike), Qianhu (Peucedanum Root).
Shaoyang spontaneous sweating has both exterior and interior aspects. If Shaoyang exterior symptoms predominate, disperse Shaoyang exterior pathogen using this formula.
Xiao Chaihu Tang (Minor Bupleurum Decoction) - See Cold/Heat and Vertigo.
For Shaoyang with both exterior and interior heat causing spontaneous sweating, do not solely resolve the exterior. Use this formula: Chaihu disperses Shaoyang exterior, Huangqin clears Shaoyang interior.
Zhimu Shigao Tang (Anemarrhena and Gypsum Decoction)
Zhimu (Anemarrhena Rhizome), Shigao (Gypsum Fibrosum), Maidong (Ophiopogon Tuber), Jingmi (Rice Grain).
For pure Yangming exterior pathogen, use Shengma Gan Ge Tang. For exterior pathogen with interior heat, use Gan Ge Shigao Tang. If exterior pathogen is resolved and interior heat causes spontaneous sweating, use this formula to solely clear interior heat.
Sanhuang Jiedu Tang (Three-Yellow Detoxification Decoction) - See Mania.
San Yi Chengqi Tang (Three-Evil Order the Qi Decoction) - See Constipation.
Ge Gen Huang Lian Huang Qin Tang (Kudzu, Coptis, and Scutellaria Decoction)
Ge Gen (Pueraria Root), Huang Lian (Coptis Rhizome), Huang Qin (Scutellaria Root), Gan Cao (Licorice Root).
For Yangming interior dry-heat with spontaneous sweating, use Gan Ge Shigao Tang. For Yangming interior warm-heat with spontaneous sweating and diarrhea, use Ge Gen Huang Lian Tang. If Yangming receives heat and Lung is constrained by fire, use Gan Ge Qin Lian Tang to clear Lung and Stomach. Furthermore, for heat in the Qi level with profuse sweating, use Gan Ge Zhi Mu Shi Gao Tang. For heat in the Blood level with profuse sweating, use Shengma Qing Wei Tang.
Shi Zao Tang (Ten Date Decoction) - See Chest Binding.
Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction)
Mahuang (Ephedra Herba), Xingren (Apricot Kernel), Gan Cao (Licorice Root), Shigao (Gypsum Fibrosum).
Sweating with wheezing and no significant high fever, appearing after sweating or purgation, indicates accumulated heat in the Lung invading from external cold. Internal accumulated heat attacks the skin/hair, causing sweating; external exterior pathogen causes wheezing. This formula is ingenious: Xingren benefits Lung Qi, Mahuang disperses external cold, Shigao clears internal heat. It evolves from Yebibo Tang (Yarbipore Decoction), transforming acrid-warm to acrid-cool, opening the method for later generations to simultaneously resolve Lung channel exterior and interior.
Da Chaihu Tang (Major Bupleurum Decoction) - See Tidal Fever.
Gancao Fuzi Tang (Licorice and Aconite Decoction) - See Body Pain.
Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) - See Vexation.
Shaoyao Gancao Tang (Peony and Licorice Decoction) - See Vexation.
Guizhi Jia Ge Gen Tang (Cinnamon Twig Decoction plus Kudzu Root)
Guizhi (Cinnamon Twig), Ge Gen (Pueraria Root), Baishao (White Peony Root), Gan Cao (Licorice Root), Dazao (Jujube Fruit).
For Taiyang fever, neck/back stiffness, and paradoxical sweating with aversion to wind, Guizhi Tang is used. Adding Ge Gen (Kudzu Root) is because neck stiffness and spontaneous sweating co-occur with Yangming symptoms.