桂枝汤原方。加葛根四两。桂枝芍药各减一两。余同。
上六味。以水一斗。先煮葛根减二升。去上沫。纳诸药。煮取三升。去滓。温服一升。
覆取微似汗。不须啜粥。
经云。太阳病。项背强KT KT 。反汗出恶风者。此方主之。按太阳病头项强痛。强不及背
。项
背强KT KT 五字连读。KT 音殊。鸟之短羽者。动则引颈KT KT 然。
形容病患俯仰不能自如之状
。
此属太阳兼阳明之象。汗出恶风。太阳未罢。故仍以桂枝为主方。加葛根者。恐邪气愈转愈
深。亟伐阳明之邪也。
麻黄（三两去节） 桂枝（二两去皮） 甘草（一两炙） 杏仁（七十个汤泡去皮尖）
上四味。以水九升。先煮麻黄。减二升。去上沫。纳诸药。煮取二升半。去滓。温服八
合。覆取微似汗。不须啜粥。余如桂枝法将息。
此太阳伤寒主治之方也。经云。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。同属脉浮头项强痛恶寒之太阳病。发热汗出恶风脉缓者。名为中风。或已发热。或
未发热。恶寒体重呕逆。脉阴阳俱紧者。名曰伤寒。中风头痛。伤寒亦头痛。中风发
热。伤寒亦发热。中风恶风。
伤寒亦恶风。至身疼腰痛。骨节疼痛。乃属体重之征。似与中风不同。然身疼痛。亦有宜桂
枝解表者。然则从何辨其证之的宜麻黄。不宜
桂枝耶。其着眼全在无汗而喘四字。麻黄走卫发汗。杏仁下气定喘。以是为主。而佐以桂枝
入营散寒。甘草和中保液。视桂枝之调和营卫。以取微汗者不同也。
桂枝麻黄。分主太阳病风伤卫寒伤营二证。桂枝汤中不用麻黄。而麻黄汤中何以反用桂
枝。
或谓麻黄发汗太峻。取桂枝以监制之。予则不信也。按桂枝辛热。能入营而助汗。桂枝汤中
。尚取芍药监制桂枝。岂桂枝反能监制麻黄。盖凡病之在太阳者。全要从营卫上讨消息。风
则伤卫。卫气疏则风易入。卫属阳。风为阳邪。两阳相合。则卫强而营反弱。故脉缓而有汗
。卫邪易出。但取主桂枝入营助汗。而无取麻黄过泄卫分之气也。寒则伤营。营气实则寒易
着。营主阴。寒为阴邪。两阴相搏。则寒凝而卫亦闭。故脉紧而无汗。营邪不易出。宜主麻
黄走卫发汗。必兼藉桂枝以散营分之寒也。此本发汗之峻剂。故
更不须啜稀粥以助药力也。不用姜枣者。以姜性升而枣味滞。虑碍杏仁下气定喘之功也。
脉阴阳俱紧者名曰伤寒。则紧固为寒邪之定脉矣。然沉紧者不宜发汗。当以浮字为辨。
故
又曰脉浮者病在表当发汗。宜麻黄汤也。脉之紧者与数不同。紧以象言。有坚凝之义。数以
数言。有迅走之状。伤寒脉数者为欲传也。但浮而数则病尚在表。可乘其半渡而击之。亦宜
以麻黄汤发汗也。
麻黄汤为发汗之重剂。投之不当。变逆非小。即宜发汗之剂。亦须相人之津液。若尺中
迟
者不可发汗。身重心悸者不可发汗。咽喉干燥者不可发汗。淋家不可发汗。疮家不可发汗。
衄家不可发汗。亡血家不可发汗。汗家不可重发汗。俱在麻黄之禁例矣。然当发汗者。或疑
畏而不发。邪气不从表解。转陷入里。其变逆亦不小。总须审系营卫俱实。无汗而喘者。可
放心用之而无疑。此全在平脉辨证工夫。
伤寒有从衄解者。经云。太阳病。脉浮紧。无汗。发热。身疼痛。八九日不解。表证仍
在。
此当发其汗。服药已微除。其人发烦热目瞑。剧者必衄。衄乃解。所以然者。阳气重故也。
麻
黄汤主之。又云。伤寒脉浮紧。不发汗。因致衄者。麻黄汤主之。注家随文衍义。谓衄后当
再用麻黄。以散余邪。按伤寒有衄家不可发汗之禁。而经又言太阳病脉浮紧发热身无汗。自
衄者愈。衄后病解。何以又用麻黄之峻攻。柯韵伯谓麻黄汤主之五字。当属未致衄以前是前
人倒找文法。此言近是。
再按太阳病之主麻黄汤。总以脉浮无汗而喘。为对证之药。其有太阳与阳明合病。喘而
胸满者。邪结上焦。不可妄下。治不从阳明而从太阳。仍宜麻黄汤也。太阳病过
十日以上。脉浮细。嗜卧。设胸胁满痛者。属柴胡证。若脉但浮者。是邪尚恋太阳。治亦从
太阳而不从少阳。仍宜麻黄汤也。
再按柯韵伯谓桂枝麻黄。是通治太阳风寒之药。中风之重者。便是伤寒。伤寒之轻者。
便是中
风。桂枝发汗之轻剂。麻黄发汗之重剂。不必在风寒上细分。只在有汗无汗上着眼。此启后
人淆乱之阶。不可为训。要之麻黄发汗。杏仁定喘。无汗而喘。是伤寒之的证。麻黄汤是伤
寒之的方。用者审之。
桂枝汤原方。加葛根四两。桂枝芍药各减一两。余同。
按照桂枝汤（Cinnamon Twig Decoction，调和营卫的基础方）的原方组成，加入葛根（Puerariae Radix，解肌退热、生津舒筋的药材）四两。将桂枝（Cinnamomi Ramulus，发汗解肌、温通经脉的药材）和芍药（Paeoniae Radix，养血敛阴、柔肝止痛的药材）各减少一两。其余药物及剂量保持不变。
上六味。以水一斗。先煮葛根减二升。去上沫。纳诸药。煮取三升。去滓。温服一升。
将上述六味药，用水一斗（古代容量单位），先单独煎煮葛根，待水量减少二升时，撇去水面上的浮沫。然后加入其他药物，继续煎煮至剩余三升药液。滤去药渣，每次温服一升。
覆取微似汗。不须啜粥。
服药后覆盖衣被，使身体微微出汗即可。不需要喝热粥来辅助发汗。
经云。太阳病。项背强KT KT 。反汗出恶风者。此方主之。按太阳病头项强痛。强不及背
。项
背强KT KT 五字连读。KT 音殊。鸟之短羽者。动则引颈KT KT 然。
形容病患俯仰不能自如之状
。
《伤寒论》原文记载：患有太阳病（Taiyang Disease，外感病初期阶段，主要涉及足太阳膀胱经），出现项背部僵硬不适（强几几，qiáng jǐng jǐng，形容项背拘急不舒的样子），反而伴有出汗、怕风症状的，应当用本方主治。分析认为，太阳病通常表现为头痛、项部僵硬疼痛，但这里的僵硬感不仅限于头部和颈部，还延伸到了背部。“项背强几几”这五个字应连起来读。“几几”读音特殊，像短尾鸟一样，活动时伸长脖子发出“几几”的声音。这里用来形容患者颈部和背部僵硬，低头抬头都不能自如的状态。
此属太阳兼阳明之象。汗出恶风。太阳未罢。故仍以桂枝为主方。加葛根者。恐邪气愈转愈
深。亟伐阳明之邪也。
这种情况属于太阳病兼有阳明病（Yangming Disease，外感病中期或极期，多表现为胃肠实热证）的迹象。因为有汗出、怕风的症状，说明太阳表证尚未解除，所以仍然以桂枝汤作为主方。加入葛根的原因，是担心邪气进一步深入传变，急需清除阳明经的邪气。
麻黄（三两去节） 桂枝（二两去皮） 甘草（一两炙） 杏仁（七十个汤泡去皮尖）
麻黄（Ephedrae Herba，发汗解表、宣肺平喘的药材，三两，去掉节段） 桂枝（Cinnamomi Ramulus，二两，去掉外皮） 甘草（Glycyrrhizae Radix et Rhizoma，一两，蜜炙） 杏仁（Armeniacae Semen Amarum，七十枚，用热水浸泡后去掉皮和尖）。
上四味。以水九升。先煮麻黄。减二升。去上沫。纳诸药。煮取二升半。去滓。温服八
合。覆取微似汗。不须啜粥。余如桂枝法将息。
将上述四味药，用水九升，先单独煎煮麻黄，待水量减少二升时，撇去水面上的浮沫。然后加入其他药物，继续煎煮至剩余二升半药液。滤去药渣，每次温服八合（古代容量单位）。服药后覆盖衣被，使身体微微出汗即可。不需要喝热粥。其余调养方法参照桂枝汤的法度进行。
此太阳伤寒主治之方也。经云。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。同属脉浮头项强痛恶寒之太阳病。发热汗出恶风脉缓者。名为中风。或已发热。或
未发热。恶寒体重呕逆。脉阴阳俱紧者。名曰伤寒。中风头痛。伤寒亦头痛。中风发
热。伤寒亦发热。中风恶风。
伤寒亦恶风。至身疼腰痛。骨节疼痛。乃属体重之征。似与中风不同。然身疼痛。亦有宜桂
枝解表者。然则从何辨其证之的宜麻黄。不宜
桂枝耶。其着眼全在无汗而喘四字。麻黄走卫发汗。杏仁下气定喘。以是为主。而佐以桂枝
入营散寒。甘草和中保液。视桂枝之调和营卫。以取微汗者不同也。
这是治疗太阳伤寒（Taiyang Cold Damage，太阳病中由寒邪引起的一类，特点是无汗、脉紧）的主方。《伤寒论》原文记载：太阳病，出现头痛、发热、全身疼痛、腰痛、骨节疼痛、怕风、无汗且气喘的症状，应当用麻黄汤（Ephedra Decoction，发汗解表、宣肺平喘的方剂）主治。虽然都归属于脉浮、头项强痛、恶寒的太阳病范畴，但发热、出汗、怕风、脉象缓的，称为中风（Wind Strike，太阳病中由风邪引起的一类，特点是汗出、脉缓）；或者已经发热，或者尚未发热，怕冷、身体沉重、恶心呕吐，脉象寸关尺三部都紧的，称为伤寒。中风会头痛，伤寒也会头痛；中风会发热，伤寒也会发热；中风怕风，伤寒也怕风。至于全身疼痛、腰痛、骨节疼痛，这是身体沉重的表现，似乎与中风不同。然而，身体疼痛的情况，也有适合用桂枝汤解表的。那么，如何辨别病症确切应该用麻黄汤而不适用桂枝汤呢？关键在于“无汗而喘”这四个字。麻黄擅长走窜卫分（Wei Division，指体表的防御系统，属阳）以发汗，杏仁擅长降气以平喘，以此为主药。辅以桂枝进入营分（Ying Division，指体内的营养血液系统，属阴）以散寒，甘草调和脾胃、保护津液。这与桂枝汤通过调和营卫来取得微汗的方法是不同的。
桂枝麻黄。分主太阳病风伤卫寒伤营二证。桂枝汤中不用麻黄。而麻黄汤中何以反用桂
枝。
或谓麻黄发汗太峻。取桂枝以监制之。予则不信也。按桂枝辛热。能入营而助汗。桂枝汤中
。尚取芍药监制桂枝。岂桂枝反能监制麻黄。盖凡病之在太阳者。全要从营卫上讨消息。风
则伤卫。卫气疏则风易入。卫属阳。风为阳邪。两阳相合。则卫强而营反弱。故脉缓而有汗
。卫邪易出。但取主桂枝入营助汗。而无取麻黄过泄卫分之气也。寒则伤营。营气实则寒易
着。营主阴。寒为阴邪。两阴相搏。则寒凝而卫亦闭。故脉紧而无汗。营邪不易出。宜主麻
黄走卫发汗。必兼藉桂枝以散营分之寒也。此本发汗之峻剂。故
更不须啜稀粥以助药力也。不用姜枣者。以姜性升而枣味滞。虑碍杏仁下气定喘之功也。
桂枝和麻黄，分别主治太阳病中风伤卫和伤寒伤营两种证候。桂枝汤中不使用麻黄，而麻黄汤中为什么反而使用桂枝？有人说麻黄发汗作用太猛烈，取桂枝来制约它。我不相信这种说法。分析认为，桂枝性味辛热，能进入营分并帮助发汗。在桂枝汤中，尚且取用芍药来制约桂枝，难道桂枝反而能制约麻黄吗？大凡疾病在太阳经的，全都要从营卫的关系上去寻找机理。风邪容易伤害卫气，卫气疏松则风邪容易侵入。卫气属阳，风也是阳邪，两阳相合，则卫气亢盛而营气相对虚弱，所以脉象缓且有汗。卫分的邪气容易排出，只需主用桂枝进入营分帮助发汗，而不需要取用麻黄以免过度耗泄卫分的气。寒邪容易伤害营气，营气充实则寒邪容易附着。营气主阴，寒也是阴邪，两阴相搏结，则寒气凝滞而卫气也闭塞，所以脉象紧且无汗。营分的邪气不容易排出，适宜主用麻黄走窜卫分以发汗，必须借助桂枝来散发营分的寒邪。这本来是发汗的峻猛剂型，所以更不需要喝稀粥来辅助药力。不用生姜和大枣的原因，是因为生姜性升散而大枣味道滋腻，担心妨碍杏仁降气定喘的功效。
脉阴阳俱紧者名曰伤寒。则紧固为寒邪之定脉矣。然沉紧者不宜发汗。当以浮字为辨。
故
又曰脉浮者病在表当发汗。宜麻黄汤也。脉之紧者与数不同。紧以象言。有坚凝之义。数以
数言。有迅走之状。伤寒脉数者为欲传也。但浮而数则病尚在表。可乘其半渡而击之。亦宜
以麻黄汤发汗也。
脉象寸关尺三部都紧的叫做伤寒，那么紧脉确实是寒邪的典型脉象。然而，如果脉象沉而紧，就不适宜发汗，应当以“浮”字来辨别。所以说，脉象浮的，病位在表，应当发汗，适宜用麻黄汤。脉象的“紧”与“数”是不同的。“紧”是从形象上来说的，有坚硬凝滞的含义；“数”是从数量频率上来说的，有迅速运行的状态。伤寒脉数的，是病情将要传变的征兆。但如果脉象浮而数，说明病邪仍在体表，可以趁其半表半里之际攻击它，也适宜用麻黄汤发汗。
麻黄汤为发汗之重剂。投之不当。变逆非小。即宜发汗之剂。亦须相人之津液。若尺中
迟
者不可发汗。身重心悸者不可发汗。咽喉干燥者不可发汗。淋家不可发汗。疮家不可发汗。
衄家不可发汗。亡血家不可发汗。汗家不可重发汗。俱在麻黄之禁例矣。然当发汗者。或疑
畏而不发。邪气不从表解。转陷入里。其变逆亦不小。总须审系营卫俱实。无汗而喘者。可
放心用之而无疑。此全在平脉辨证工夫。
麻黄汤是发汗的重剂，如果使用不当，产生的变证和逆证后果不小。即使是适宜发汗的剂型，也必须观察患者的津液状况。如果尺脉（反映肾气和阴精状况的脉位）迟缓的，不可发汗；身体沉重、心悸的，不可发汗；咽喉干燥的，不可发汗；患淋证（Lin Syndrome，小便频数短涩、滴沥刺痛等症）的人不可发汗；患疮疡的人不可发汗；经常鼻出血的人不可发汗；失血的人不可发汗；平时多汗的人不可再次强力发汗。这些都属于麻黄汤的禁忌症。然而，当需要发汗时，有人因怀疑畏惧而不发汗，导致邪气不从体表解除，转而陷入体内，其产生的变证和逆证也不小。总之，必须审查确属营卫俱实、无汗且气喘的患者，才可以放心使用而无疑虑。这完全依赖于医生平脉和辨证的功夫。
伤寒有从衄解者。经云。太阳病。脉浮紧。无汗。发热。身疼痛。八九日不解。表证仍
在。
此当发其汗。服药已微除。其人发烦热目瞑。剧者必衄。衄乃解。所以然者。阳气重故也。
麻
黄汤主之。又云。伤寒脉浮紧。不发汗。因致衄者。麻黄汤主之。注家随文衍义。谓衄后当
再用麻黄。以散余邪。按伤寒有衄家不可发汗之禁。而经又言太阳病脉浮紧发热身无汗。自
衄者愈。衄后病解。何以又用麻黄之峻攻。柯韵伯谓麻黄汤主之五字。当属未致衄以前是前
人倒找文法。此言近是。
伤寒中有通过鼻出血（Nü, epistaxis）来解除病邪的情况。《伤寒论》原文记载：太阳病，脉象浮紧，无汗，发热，身体疼痛，经过八九天仍未解除，表证仍然存在。这时应当发汗。服药后症状轻微缓解，患者出现心烦发热、眼睛闭合不想睁开等症状，严重的必然会发生鼻出血，鼻出血后病邪得以解除。之所以这样，是因为阳气郁积太重所致。此时仍用麻黄汤主治。又说：伤寒脉象浮紧，没有及时发汗，导致发生鼻出血的，也用麻黄汤主治。注释家顺着文字引申含义，认为鼻出血后应当再用麻黄汤，以发散残余邪气。但是，根据伤寒有鼻出血体质者不可发汗的禁忌，而经文又说太阳病脉浮紧、发热、身体无汗，自然鼻出血后病愈。既然鼻出血后病已解除，为什么又要用麻黄汤这种峻猛的药物去攻伐？清代医家柯韵伯认为，“麻黄汤主之”这五个字，应当属于还没有发生鼻出血之前的情况，这是前人倒置了文章语法。这种说法比较接近真理。
再按太阳病之主麻黄汤。总以脉浮无汗而喘。为对证之药。其有太阳与阳明合病。喘而
胸满者。邪结上焦。不可妄下。治不从阳明而从太阳。仍宜麻黄汤也。太阳病过
十日以上。脉浮细。嗜卧。设胸胁满痛者。属柴胡证。若脉但浮者。是邪尚恋太阳。治亦从
太阳而不从少阳。仍宜麻黄汤也。
再分析，太阳病的主方麻黄汤，总体是以脉浮、无汗、气喘作为对症用药的依据。如果有太阳病与阳明病合病（Combined Diseases of Taiyang and Yangming），出现气喘且胸部胀满的情况，这是邪气结聚在上焦，不可以随意使用泻下法。治疗不从阳明病入手而从太阳病入手，仍然适宜用麻黄汤。太阳病超过十天后，脉象浮而细，喜欢睡觉，如果出现胸胁部胀满疼痛，属于小柴胡汤证（Chaihu Syndrome，少阳病的主要证候）。如果脉象只是浮，说明邪气仍然留恋在太阳经，治疗也从太阳经而不从少阳经，仍然适宜用麻黄汤。
再按柯韵伯谓桂枝麻黄。是通治太阳风寒之药。中风之重者。便是伤寒。伤寒之轻者。
便是中
风。桂枝发汗之轻剂。麻黄发汗之重剂。不必在风寒上细分。只在有汗无汗上着眼。此启后
人淆乱之阶。不可为训。要之麻黄发汗。杏仁定喘。无汗而喘。是伤寒之的证。麻黄汤是伤
寒之的方。用者审之。
再参考柯韵伯的观点，他认为桂枝和麻黄，是通用治疗太阳病风邪和寒邪的药物。中风证重的，就是伤寒；伤寒证轻的，就是中风。桂枝是发汗的轻剂，麻黄是发汗的重剂，不必在风邪和寒邪上进行细致区分，只关注有汗和无汗这一点。这种观点开启了后人混淆混乱的阶梯，不能作为准则。总之，麻黄用于发汗，杏仁用于定喘，无汗且气喘，是伤寒的确切证候，麻黄汤是治疗伤寒的确切方剂。使用者务必仔细审察。
Gui Zhi Tang (Cinnamon Twig Decoction) original formula. Add Ge Gen (Puerariae Radix, Kudzu Root) four liang. Gui Zhi (Cinnamomi Ramulus, Cinnamon Twig) and Bai Shao (Paeoniae Radix, White Peony Root) each reduced by one liang. The rest remains the same.
The above six ingredients. Use one dou (ancient unit of volume) of water. First decoct Ge Gen (Puerariae Radix) until the liquid reduces by two sheng (ancient unit of volume). Remove the foam on the surface. Add the remaining herbs. Decoct to obtain three sheng of liquid. Strain the dregs. Take one sheng warm.
Cover with blankets to induce a slight sweat. There is no need to drink hot porridge.
The classic states: In Taiyang Disease (Taiyang Disease, an early stage of exogenous disease involving the Foot-Taiyang Bladder channel), if there is stiffness and discomfort in the neck and back (Qiang Ji Ji, describing stiffness), accompanied by sweating and aversion to wind, this formula should be used. Analysis indicates that Taiyang Disease typically presents with headache and stiffness/pain in the head and neck, but here the stiffness extends to the back. "Neck and back stiffness Qiāng Jǐ Jǐ" should be read as a continuous phrase. "Ji Ji" has a unique pronunciation, resembling the sound made by a short-winged bird stretching its neck when moving. This describes the patient's inability to freely nod or look up due to stiffness.
This belongs to the pattern of Taiyang Disease combined with Yangming Disease (Yangming Disease, a mid-to-late stage often characterized by gastrointestinal excess-heat). Sweating and aversion to wind indicate that the Taiyang exterior syndrome has not yet resolved, so Gui Zhi Tang (Cinnamon Twig Decoction) remains the primary formula. Ge Gen (Puerariae Radix) is added because there is concern that the pathogenic factor may deepen further, necessitating the urgent expulsion of pathogens from the Yangming channel.
Ma Huang (Ephedrae Herba, Ephedra) three liang, remove joints; Gui Zhi (Cinnamomi Ramulus, Cinnamon Twig) two liang, remove bark; Gan Cao (Glycyrrhizae Radix et Rhizoma, Licorice Root) one liang, honey-fried; Xing Ren (Armeniacae Semen Amarum, Apricot Seed) seventy seeds, soaked in hot water, remove skin and tips.
The above four ingredients. Use nine sheng of water. First decoct Ma Huang (Ephedrae Herba) until the liquid reduces by two sheng. Remove the foam on the surface. Add the remaining herbs. Decoct to obtain two and a half sheng of liquid. Strain the dregs. Take eight he (ancient unit of volume) warm. Cover with blankets to induce a slight sweat. There is no need to drink hot porridge. Rest and care follow the method of Gui Zhi Tang (Cinnamon Twig Decoction).
This is the main formula for treating Taiyang Cold Damage (Taiyang Cold Damage, a type of Taiyang disease caused by cold pathogens, characterized by anhidrosis and tight pulse). The classic states: In Taiyang Disease (Taiyang Disease), if there is headache, fever, body pain, lower back pain, joint pain, aversion to wind, anhidrosis (absence of sweating), and wheezing, Ma Huang Tang (Ephedra Decoction, Ephedra Formula) should be used. Although both belong to Taiyang Disease presenting with floating pulse, headache, neck stiffness/pain, and aversion to cold, those with fever, sweating, aversion to wind, and a slow pulse are named Wind Strike (Wind Strike, a type of Taiyang disease caused by wind pathogens, characterized by sweating and slow pulse). Those who have already developed fever or not yet, with aversion to cold, heavy body, nausea/vomiting, and a tight pulse at all positions (cun, guan, chi) are named Cold Damage (Cold Damage). Wind Strike causes headache; Cold Damage also causes headache. Wind Strike causes fever; Cold Damage also causes fever. Wind Strike causes aversion to wind; Cold Damage also causes aversion to wind. Regarding body pain, lower back pain, and joint pain, these are signs of heaviness of the body, seemingly different from Wind Strike. However, body pain can also be suitable for treatment with Gui Zhi Tang (Cinnamon Twig Decoction) to release the exterior. So, how to distinguish whether the syndrome specifically requires Ma Huang Tang (Ephedra Decoction) and not Gui Zhi Tang (Cinnamon Twig Decoction)? The key lies entirely in the four characters "anhidrosis and wheezing". Ma Huang (Ephedrae Herba) travels through the Wei (Defensive) level to induce sweating; Xing Ren (Armeniacae Semen Amarum) descends qi to calm wheezing. These are the main agents. They are assisted by Gui Zhi (Cinnamomi Ramulus) entering the Ying (Nutritive) level to disperse cold, and Gan Cao (Glycyrrhizae Radix et Rhizoma) harmonizing the middle and preserving fluids. This differs from Gui Zhi Tang (Cinnamon Twig Decoction), which harmonizes Ying and Wei to achieve a slight sweat.
Gui Zhi (Cinnamomi Ramulus) and Ma Huang (Ephedrae Herba) respectively treat the two syndromes of Taiyang Disease: Wind injuring the Wei level and Cold injuring the Ying level. Gui Zhi Tang (Cinnamon Twig Decoction) does not use Ma Huang (Ephedrae Herba), so why does Ma Huang Tang (Ephedra Decoction) use Gui Zhi (Cinnamomi Ramulus)? Some say Ma Huang (Ephedrae Herba) induces sweating too violently, so Gui Zhi (Cinnamomi Ramulus) is taken to restrain it. I do not believe this. Analyzing further, Gui Zhi (Cinnamomi Ramulus) is acrid and hot, capable of entering the Ying level and assisting sweating. In Gui Zhi Tang (Cinnamon Twig Decoction), Bai Shao (Paeoniae Radix) is still used to restrain Gui Zhi (Cinnamomi Ramulus); how could Gui Zhi (Cinnamomi Ramulus) instead restrain Ma Huang (Ephedrae Herba)? Generally, diseases in the Taiyang stage must be understood through the relationship between Ying and Wei. Wind injures the Wei level; if Wei qi is loose, wind enters easily. Wei belongs to Yang, and wind is a Yang pathogen. When two Yangs combine, Wei becomes strong while Ying becomes relatively weak, resulting in a slow pulse and sweating. Pathogens in the Wei level are easy to expel; thus, using Gui Zhi (Cinnamomi Ramulus) to enter the Ying level and assist sweating is sufficient, without needing Ma Huang (Ephedrae Herba) which might excessively deplete Wei qi. Cold injures the Ying level; if Ying qi is substantial, cold adheres easily. Ying governs Yin, and cold is a Yin pathogen. When two Yins contend, cold coagulates and Wei becomes closed, resulting in a tight pulse and anhidrosis. Pathogens in the Ying level are difficult to expel; thus, Ma Huang (Ephedrae Herba) should be the main agent to travel through the Wei level and induce sweating, necessarily relying on Gui Zhi (Cinnamomi Ramulus) to disperse cold in the Ying level. This is inherently a potent diaphoretic agent, so there is even less need to drink thin porridge to assist the medicinal power. Ginger and Jujube are not used because ginger is ascending and dispersing, while jujube is cloying and stagnant, worrying that they would hinder the function of Xing Ren (Armeniacae Semen Amarum) in descending qi and calming wheezing.
A tight pulse at all positions is named Cold Damage; thus, a tight pulse is indeed the definitive pulse for cold pathogens. However, a deep and tight pulse is not suitable for sweating; differentiation relies on the character "floating". Therefore, it is also stated: If the pulse is floating, the disease is in the exterior and should be treated with sweating; Ma Huang Tang (Ephedra Decoction) is appropriate. The "tightness" of the pulse differs from "rapid". "Tight" describes the image, implying firmness and coagulation. "Rapid" describes the frequency, implying swift movement. A rapid pulse in Cold Damage indicates the disease is about to transmit. But if the pulse is floating and rapid, the disease is still in the exterior. One can strike it while it is halfway across; Ma Huang Tang (Ephedra Decoction) for sweating is also appropriate.
Ma Huang Tang (Ephedra Decoction) is a heavy diaphoretic agent. If administered improperly, adverse reactions are significant. Even for agents suitable for sweating, one must assess the patient's body fluids. If the Chi pulse (reflecting Kidney essence and yin) is slow, sweating is contraindicated. If there is heavy body sensation and palpitations, sweating is contraindicated. If the throat is dry, sweating is contraindicated. Patients with Lin Syndrome (Lin Syndrome, disorders characterized by frequent, painful, and scanty urination) cannot sweat. Patients with sores/ulcers cannot sweat. Patients prone to epistaxis (nosebleeds) cannot sweat. Patients with blood loss cannot sweat. Patients prone to spontaneous sweating should not be heavily sweated again. All these are contraindications for Ma Huang (Ephedrae Herba). However, when sweating is indicated, some may hesitate and fail to sweat, causing pathogens to fail to resolve from the exterior and sink inward, leading to significant adverse reactions. Ultimately, one must verify that the patient has robust Ying and Wei, anhidrosis, and wheezing, before confidently using it without doubt. This relies entirely on the skill of pulse taking and syndrome differentiation.
In Cold Damage, resolution can occur via epistaxis (nosebleed). The classic states: Taiyang Disease, floating-tight pulse, anhidrosis, fever, body pain, unresolved after eight or nine days, with exterior symptoms still present. This should be treated with sweating. After taking medicine, symptoms slightly alleviate, but the patient develops irritability, heat, and closes their eyes. In severe cases, epistaxis will occur, and the disease resolves upon bleeding. This happens because Yang qi is overly congested. Ma Huang Tang (Ephedra Decoction) is the main formula. It also states: Cold Damage with floating-tight pulse, if not treated with sweating, leading to epistaxis, Ma Huang Tang (Ephedra Decoction) is the main formula. Commentators expand on the text, suggesting that after epistaxis, Ma Huang Tang (Ephedra Decoction) should be used again to disperse residual pathogens. However, there is a prohibition against sweating in patients prone to epistaxis in Cold Damage, and the classic also says that Taiyang Disease with floating-tight pulse, fever, and anhidrosis resolves spontaneously upon epistaxis. If the disease resolves after epistaxis, why use the harsh attack of Ma Huang Tang (Ephedra Decoction) again? Ke Yunbo stated that the five characters "Ma Huang Tang Zhu Zhi" (Ma Huang Tang is the main formula) likely belong to the period before epistaxis occurs, suggesting previous authors inverted the syntax. This statement is close to the truth.
Furthermore, regarding the main formula for Taiyang Disease, Ma Huang Tang (Ephedra Decoction), it is always indicated for floating pulse, anhidrosis, and wheezing. In cases of combined Taiyang and Yangming Disease, with wheezing and chest fullness, the pathogen is结 (knotted) in the Upper Jiao (Upper Burner). Do not rashly use purgatives. Treatment follows Taiyang rather than Yangming; Ma Huang Tang (Ephedra Decoction) is still appropriate. If Taiyang Disease lasts more than ten days, with a floating-thin pulse and lethargy, if there is chest and hypochondriac fullness/pain, it belongs to Chai Hu Syndrome (Chai Shao Syndrome, the main syndrome of Shaoyang disease). If the pulse is merely floating, the pathogen still lingers in Taiyang. Treatment follows Taiyang rather than Shaoyang; Ma Huang Tang (Ephedra Decoction) is still appropriate.
Regarding Ke Yunbo's view that Gui Zhi (Cinnamomi Ramulus) and Ma Huang (Ephedrae Herba) are general remedies for Wind and Cold in Taiyang Disease: Severe Wind Strike is Cold Damage; mild Cold Damage is Wind Strike. Gui Zhi (Cinnamomi Ramulus) is a light diaphoretic; Ma Huang (Ephedrae Herba) is a heavy diaphoretic. There is no need to finely distinguish between Wind and Cold, only focusing on the presence or absence of sweating. This opens the door for later confusion and should not be set as a standard. In summary, Ma Huang (Ephedrae Herba) induces sweating, Xing Ren (Armeniacae Semen Amarum) calms wheezing. Anhidrosis and wheezing are the definitive syndromes of Cold Damage, and Ma Huang Tang (Ephedra Decoction) is the definitive formula for Cold Damage. Users must examine carefully.