之风邪。所以桂枝与芍药同行。一以汗解其卫邪而卫气和。一以救其营弱而汗液收矣。若必以为桂枝止汗。岂不
见麻黄汤中亦有桂枝乎。岂有用麻黄而欲发其汗。又以桂枝收之乎。唯此义未明。所以方氏于麻黄汤论中。有用
麻黄而监之以桂枝。为节制之妙。此皆相沿相习之惑也。盖麻黄为肺经之专药。杏仁所以助麻黄而利肺气。开皮
毛而定喘者也。皆为发泄魄汗之要药。其所以亦用桂枝者。既欲泄脉中营内之寒邪。有不先开脉外一层之卫气
乎。此皆仲景制方之妙。深得内经客者除之。结者散之。开之发之之意也。尚论不知桂枝汤义。亦但云使寒邪漫无
出路。贻患无穷。岂亦仍方氏之旧说欤。
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。
下后不可更行桂枝汤。若汗出而喘。无大热者。可与麻黄杏仁甘草石膏汤。
此二条。所以辨既非伤寒。亦非中风也。然证同而治亦同。又以一汗一下为言者。盖示人以病不在表。
徒汗无益。病不在里。徒下亦无益。又不可更疑其邪在表。而更行桂枝汤以致误也。汗出而喘者。肺主
皮毛。邪热但在肺脏也。无大热者。言表里皆无邪也。邪在表。则发翕翕之热。邪在里。则发蒸蒸之热。
此不言不热。又不言微热。而曰无大热者。盖肺主皮毛。因邪热在肺。或时有微热。未可知也。然非
若表里有邪之热也。既汗既下。仍然汗出而喘。足见邪不在表里。治非其治矣。不可更行桂枝汤者。恐
助热而敛邪也。言肺为人身之天气。所以通呼吸。主皮毛而司开阖者也。热邪实于肺中。则肺气满而喘
矣。肺病而清肃不行。失其治节。皮毛不密。开阖失司。是以汗出也。若疑似之间。误认为太阳中风之汗自
出。则桂枝之辛温。能不助肺家之热。芍药之酸收。宁不敛肺分之邪乎。故曰不可更行桂枝汤。可与
麻黄杏仁甘草石膏汤也。
麻黄杏仁甘草石膏汤
麻黄（四两去节） 杏仁（五十个去皮尖研） 甘草（二两） 石膏（半斤研）
上四味。以水七升。先煮麻黄减二升。去上沫。内诸药。煮取二升。去滓。温服一升。
辨误 成氏之说。固为背谬。方氏谓不当用桂枝固卫。故用麻黄以发之。喻氏亦谓误用桂枝固卫。
寒不得泄。故变青龙之制。允为的对。不思若邪果在太阳而汗出。可复用麻黄以发之耶。汗出而加之
以喘。岂犹未知为肺病乎。此所谓麻黄杏仁甘草石膏汤者。所以解肺家之邪热。非所以发太阳之汗也。若仍
用麻黄以发之。则不必另立一名。
当命之曰麻黄去桂枝加石膏汤。不然则又当曰青龙去桂枝芍药汤矣。何必另立名义乎。其别立一名者。
所以别乎其非青龙麻黄之汗剂耳。李时珍云。麻黄乃肺经专药。虽为太阳发汗之重剂。实发散肺经火郁之药也。杏仁
利气而能泄肺。石膏寒凉。能肃西方金气。乃泻肺肃肺之剂。非麻黄汤。及大青龙之汗剂也。世俗不晓。
惑于活人书。
及陶节庵之说。但见一味麻黄。即以为汗剂。畏而避之。唯恐不及。不知麻黄汤之制。欲用麻黄以泄营
分之汗。必先以桂枝。开解卫分之邪。则汗出而邪去矣。何也。卫在营外。营居卫中。欲泄其内。必先开其
外也。前人每谓桂枝能固卫止汗者。误甚。若果能固卫止汗。何仲景又以此解太阳中风之邪。使 似汗。
而又警人以如水流漓之戒。且又云一服汗出病瘥。止后服。若不汗更服。若汗不出者。服至二三剂。其第四条曰。
外证未解。脉浮弱者。当以汗解。宜桂枝汤。非其明训乎。所以麻黄不与桂枝同用。止能泄肺邪而不至
大汗泄也。况服麻黄汤法。原令微似汗而未许人大汗出也。观后贤之麻黄定喘汤。皆因之以立法也。若夫大
青龙之制。则以寒温并感。故以麻黄全汤。合桂枝去芍药汤以两解之。又以热郁烦躁之温邪。更入之以
白虎之半。以解其烦热耳。注家俱不知其义。又乌足以窥仲景哉。以上十四条。皆太阳中风之脉证。及应用桂枝
汤之情形方法禁例也。正治之法。已尽于此。其误治失治之变。逐门条列于后。即坏病条中之已发汗。若吐若
下若温针之误治而仍不解者之变也。观其脉证。知犯何逆。随证治之之法也。从来正治误治。杂乱不分。混淆于
一篇之中。不知误汗吐下。即坏病也。误汗吐下之治。即坏病治法也。又另立坏病一门。而谓仲景坏病治法。
失而不传。遂为千古恨事。今读之者眩目惑心。用之者茫然无措。谓非从前编次之失。何可得欤。余为分其绪端
各立条目。使正治误治之法。井井不紊。庶可为将来之助云。
风邪侵袭人体，因此桂枝与芍药配合使用。一方面通过发汗解除卫分的邪气，使卫气调和；另一方面救助营血的虚弱，从而收敛汗液。如果一定认为桂枝的作用是止汗，难道没看见麻黄汤中也含有桂枝吗？哪里有使用麻黄想要发汗，却又用桂枝来收敛的道理呢？正是因为这一层道理没有阐明，所以方有执在论述麻黄汤时，认为有用麻黄而用桂枝来制约它，这是节制用药的妙处。这都是沿袭相习造成的迷惑。大概麻黄是肺经的专用药物，杏仁是用来辅助麻黄疏通肺气、开启皮毛以平喘的。它们都是发泄腠理汗出的重要药物。其中之所以也用到桂枝，是因为既然想要泄出脉中营分内的寒邪，难道不需要先开通脉外一层的卫气吗？这些都是张仲景制方的精妙之处，深得《内经》“客者除之，结者散之，开之发之”的宗旨。尚论（指方有执）不明白桂枝汤的真义，也只是说这样会使寒邪漫无出路，留下无穷后患，难道也是沿用方氏的旧说吗？
经过发汗治疗后，不可再用桂枝汤。如果出现汗出且气喘，身体没有明显大热的症状，可以给予麻黄杏仁甘草石膏汤主治。
经过泻下治疗后，不可再用桂枝汤。如果出现汗出且气喘，身体没有明显大热的症状，可以给予麻黄杏仁甘草石膏汤。
这两条条文，是为了辨别这既不是伤寒，也不是中风。然而证候相同，治疗方法也相同。之所以特别提及一次发汗、一次泻下，是为了告诉人们：病不在表，单纯发汗没有益处；病不在里，单纯泻下也没有益处。同时也不应再怀疑邪气在表，从而误用桂枝汤导致错误。汗出且气喘，是因为肺主皮毛，邪热仅在肺脏。所谓“无大热”，是指表里都没有明显的邪热。邪气在表，会发出像羽毛覆盖般的翕翕发热；邪气在里，会发出蒸蒸而出的内热。这里不说“不热”，也不说“微热”，而说“无大热”，是因为肺主皮毛，因邪热在肺，或许偶尔会有轻微发热，这也是可能的。但这不同于表里有邪所致的发热。既然已经发汗又泻下，仍然出现汗出气喘，足以证明邪气不在表里，之前的治疗不对症。不可再用桂枝汤，是担心桂枝助热并收敛邪气。肺被称为人身之天气，主管呼吸，主司皮毛的开阖。热邪实于肺中，导致肺气壅满而气喘。肺病导致清肃功能不行，失去治节能力，皮毛不致密，开阖失司，因此出现汗出。如果在疑似之间，误认为是太阳中风的自汗，那么桂枝的辛温怎能不助长肺家的热邪？芍药的酸收怎能不收敛肺分的邪气？所以说不可再用桂枝汤，而应给予麻黄杏仁甘草石膏汤。
麻黄杏仁甘草石膏汤
麻黄（四两，去节） 杏仁（五十个，去皮尖，研碎） 甘草（二两） 石膏（半斤，研碎）
以上四味药，用水七升，先煮麻黄，减少二升水，去掉上面的浮沫，加入其他药物，煮取二升药液，去渣，温服一升。
辨误：成无己的说法，固然违背谬误。方有执认为不应当用桂枝固护卫气，所以用麻黄来发散。喻嘉言也认为误用桂枝固卫，导致寒邪不得宣泄，所以改变了小青龙汤的配方，确实说得对。但他不曾思考，如果邪气果然在太阳经且伴有汗出，还可以再次复用麻黄来发汗吗？汗出再加上气喘，难道还不知道这是肺的病证吗？这个所谓的麻黄杏仁甘草石膏汤，是用来解除肺家邪热的，并不是用来发太阳经汗液的。如果还是用麻黄来发汗，那就不必另外立一个方名。应当命名为“麻黄去桂枝加石膏汤”。否则又应当叫“青龙去桂枝芍药汤”了。何必另立名义呢？之所以另立一名，是为了区别于小青龙和麻黄汤这类发汗剂。李时珍说：麻黄是肺经的专用药，虽然作为太阳经发汗的重剂，实际上是发散肺经火郁的药物。杏仁利气并能泄肺，石膏性寒凉，能肃降西方金气，这是泻肺肃肺的方剂，不是麻黄汤及大青龙汤那样的发汗剂。世俗之人不懂，被《活人书》及陶节庵的说法所迷惑，只要见到一味麻黄，就以为是发汗剂，畏惧并避开它，唯恐不及。他们不知道麻黄汤的配制，是想用麻黄来泄营分之汗，但必须先以桂枝开解卫分之邪，这样汗出而邪去。为什么呢？因为卫气在营分之外，营血居于卫气之中，想要泄出内部的邪气，必须先开通外部的卫气。前人常说桂枝能固卫止汗，这是很大的错误。如果真能固卫止汗，为什么张仲景又用它来解太阳中风的邪气，使其微微似有汗出，并且警告人们不要像水流漓那样大汗淋漓？而且又说：“一服药后汗出病愈，停服后面的药；如果不汗出，继续服用；如果仍不出汗，服用到二三剂。”其第四条还说：“外证未解，脉浮弱的，应当以汗解，宜用桂枝汤。”这不是明确的训诫吗？所以麻黄不与桂枝同用时，只能泄肺邪而不至于大汗淋漓。况且服用麻黄汤的方法，原本就是要求微微似有汗出，而不允许人大量出汗。看后世的麻黄定喘汤，都是依据这个原理立法的。至于大青龙汤的配方，是因为寒温同时感受，所以用麻黄全汤，合上桂枝去芍药汤来两解表里，又因为热郁烦躁的温邪，再加入白虎汤的一半，来解除烦热。注家都不明白其中的意义，又怎么能够窥探张仲景的本意呢？以上十四条，都是关于太阳中风的脉证，以及应用桂枝汤的情形、方法和禁忌。正治的方法，已经全部在这里了。误治和失治产生的变证，将在后续各门类中逐条列出，即坏病条文中提到的已发汗、若吐、若下、若温针等误治而仍然不解的变证。观察其脉证，知道犯了什么逆乱，随证治疗的方法。从来正治和误治混杂不分，混淆在一篇之中，不知道误汗、吐、下就是坏病。误汗、吐、下的治疗，就是坏病的治疗方法。又另立坏病一门，声称张仲景的坏病治法失传，成为千古恨事。现在读的人眼花缭乱，用心困惑，用的人茫然无措，如果说不是从前编排次序的失误，怎么可能这样呢？我将其头绪分开，各自设立条目，使正治和误治的方法井井有条，希望能为将来提供帮助。
Wind pathogenic factors invade the body, therefore *Guizhi* (Cinnamon Twig) and *Shaoyao* (Peony Root) are used together. On one hand, sweating is induced to resolve the pathogenic factors in the Wei (Defensive) level, harmonizing the Wei Qi; on the other hand, it aids the deficiency of Ying (Nutritive) blood, thereby consolidating and stopping sweat. If one insists that the function of *Guizhi* is to stop sweating, have you not seen that *Mahuang Tang* (Ephedra Decoction) also contains *Guizhi*? How could there be a situation where *Mahuang* (Ephedra) is used to induce sweating, yet *Guizhi* is used to consolidate it? Precisely because this principle was not clarified, Fang Youzhi, in his discussion of *Mahuang Tang*, argued that using *Guizhi* to restrain *Mahuang* represents the subtlety of regulating dosage. These are all confusions arising from blind adherence to tradition. Generally, *Mahuang* is the specific herb for the Lung Meridian, and *Xingren* (Apricot Seed) assists *Mahuang* in unblocking Lung Qi, opening the skin and hair pores, and relieving asthma. Both are essential herbs for venting sweat from the Cou Li (interstices). The reason *Guizhi* is also used here is that since one wishes to vent the cold pathogenic factors within the Ying level inside the vessels, is it not necessary to first open the Wei Qi layer outside the vessels? These are all the profound aspects of Zhang Zhongjing’s formula construction, deeply embodying the principles of *Neijing*: "Eliminate those who intrude, disperse those who knot, open and vent." Shanglun (referring to Fang Youzhi) did not understand the true meaning of *Guizhi Tang* (Cinnamon Twig Decoction), merely stating that this would leave cold pathogenic factors with no outlet, causing endless trouble. Was he still adhering to Fang’s old theory?
After sweating therapy, *Guizhi Tang* should not be administered again. If there is sweating accompanied by asthma and no significant high fever, *Mahuang Xingren Gancao Shigao Tang* (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) may be given as the primary treatment.
After purgative therapy, *Guizhi Tang* should not be administered again. If there is sweating accompanied by asthma and no significant high fever, *Mahuang Xingren Gancao Shigao Tang* may be given.
These two clauses serve to distinguish conditions that are neither Cold Damage (Shanghan) nor Wind Strike (Zhongfeng). However, since the symptoms are identical, the treatment is also identical. The mention of prior sweating and purgation serves to instruct people: if the disease is not in the Exterior, simple sweating is of no benefit; if the disease is not in the Interior, simple purgation is of no benefit. Furthermore, one must not suspect that the pathogen remains in the Exterior and thus mistakenly administer *Guizhi Tang*. Sweating with asthma indicates that the Lung governs the skin and hair pores, and the pathogenic heat is confined to the Lung organ. "No significant high fever" means there is no obvious pathogenic heat in either the Exterior or the Interior. When pathogens are in the Exterior, there is a slight, covering heat (Xi Xi Re); when pathogens are in the Interior, there is a steaming internal heat. Here, it does not say "no heat" nor "slight heat," but "no significant high fever," because the Lung governs the skin and hair pores; due to pathogenic heat in the Lung, occasional slight fever might occur. However, this differs from the heat caused by pathogens in both Exterior and Interior. Since both sweating and purgation have been performed, yet sweating and asthma persist, it proves that the pathogen is not in the Exterior or Interior, and the previous treatments were inappropriate. One must not administer *Guizhi Tang* again, lest it assist heat and consolidate pathogens. The Lung is regarded as the Heavenly Qi of the human body, governing respiration and controlling the opening and closing of the skin and hair pores. When pathogenic heat accumulates in the Lung, Lung Qi becomes full, leading to asthma. Lung disease causes the failure of clear descending functions and loss of regulatory control; the skin and hair pores become loose, and the opening and closing mechanisms fail, resulting in sweating. If, amidst doubt, one mistakes this for the spontaneous sweating of Taiyang Wind Strike, how can the acrid-warm nature of *Guizhi* fail to assist the heat in the Lung family? How can the sour-astringent nature of *Shaoyao* fail to consolidate the pathogens in the Lung branch? Therefore, it is stated that *Guizhi Tang* should not be administered again; instead, *Mahuang Xingren Gancao Shigao Tang* should be given.
**Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction)**
*Mahuang* (4 liang, remove joints), *Xingren* (50 seeds, remove skin and tips, crush), *Gancao* (2 liang), *Shigao* (0.5 jin, crush).
Take the above four ingredients, add seven sheng of water, first boil *Mahuang* until reduced by two sheng, remove the foam on top, then add the remaining herbs. Boil until two sheng remain, strain, and take one sheng warm.
**Discussion on Errors:**
Cheng Wuji’s interpretation is indeed erroneous. Fang Youzhi asserted that *Guizhi* should not be used to secure the Wei level, hence *Mahuang* was used to vent it. Yu Jiayan also argued that misusing *Guizhi* to secure the Wei level prevented the expulsion of cold, leading to a modification of the *Xiao Qinglong Tang* (Minor Blue Dragon Decoction) formula, which is quite accurate. However, he failed to consider: if the pathogen were truly in the Taiyang channel with sweating, could *Mahuang* be reused to induce sweating? Sweating combined with asthma—does one still not recognize this as a Lung disease? This so-called *Mahuang Xingren Gancao Shigao Tang* is intended to resolve pathogenic heat in the Lung, not to induce sweating from the Taiyang channel. If it were still used to induce sweating, there would be no need for a new name. It should be called "Mahuang without Guizhi plus Gypsum Decoction." Otherwise, it should be named "Qinglong Decoction without Guizhi and Shaoyao." Why establish a new name? The reason for establishing a separate name is to distinguish it from the diaphoretic formulas like *Qinglong* and *Mahuang Tang*. Li Shizhen stated: "*Mahuang* is the specific herb for the Lung Meridian. Although it is a heavy agent for inducing sweating in the Taiyang channel, it is actually an herb for dispersing fire stagnation in the Lung Meridian." *Xingren* promotes Qi flow and vents the Lung; *Shigao* (Gypsum) is cold and cool, capable of肃降 (descending and purifying) the Metal Qi of the West. This is a formula to purge and purify the Lung, not a diaphoretic formula like *Mahuang Tang* or *Da Qinglong Tang* (Major Blue Dragon Decoction). Laypeople do not understand and are confused by the *Huoren Shu* (Book of Vitality) and Tao Jian’an’s theories. Seeing only *Mahuang*, they assume it is a diaphoretic agent, fearing and avoiding it excessively. They do not know that in the formulation of *Mahuang Tang*, the intention to use *Mahuang* to vent Ying-level sweat requires first using *Guizhi* to resolve Wei-level pathogens, so that sweat emerges and pathogens depart. Why? Because Wei Qi is outside Ying Blood, and Ying Blood resides within Wei Qi. To vent what is inside, one must first open what is outside. Previous scholars often claimed that *Guizhi* can secure the Wei level and stop sweating, which is a great error. If it truly could secure the Wei level and stop sweating, why would Zhang Zhongjing use it to resolve Taiyang Wind Strike pathogens, causing only slight perspiration, while warning against profuse sweating like flowing water? Moreover, he stated: "After one dose, if sweating occurs and the illness resolves, stop taking the remaining medicine; if no sweating, continue taking it; if still no sweating, take up to two or three doses." Clause 4 also states: "If exterior symptoms remain unresolved and the pulse is floating and weak, resolve with sweating, preferably using *Guizhi Tang*." Is this not a clear instruction? Thus, when *Mahuang* is not used with *Guizhi*, it can only vent Lung pathogens without causing profuse sweating. Furthermore, the method for taking *Mahuang Tang* originally required only slight perspiration, not allowing for profuse sweating. Observing later generations' *Mahuang Dingchuan Tang* (Ephedra Asthma-Relieving Decoction), all laws were established based on this principle. As for the formulation of *Da Qinglong Tang*, it addresses simultaneous contraction of cold and warmth; thus, the complete *Mahuang Tang* is combined with *Guizhi Tang* minus *Shaoyao* to resolve both sides, and half of *Baihu Tang* (White Tiger Decoction) is added to address the irritability and heat caused by warm pathogens stagnating with heat. Commentators do not understand these meanings; how can they fathom Zhang Zhongjing’s intent? The above fourteen clauses cover the pulses and symptoms of Taiyang Wind Strike, as well as the circumstances, methods, and contraindications for applying *Guizhi Tang*. The correct treatment methods are fully presented here. The variations resulting from incorrect or missed treatments will be listed item by item in subsequent sections, specifically referring to the variations in Huabing (Ruined Disease) clauses where prior sweating, vomiting, purgation, or moxibustion failed to resolve the condition. Observe the pulses and symptoms, determine what deviation occurred, and treat according to the current presentation. Historically, correct treatments and errors have been mixed indistinguishably within single chapters. People fail to realize that incorrect sweating, vomiting, or purgation constitutes Huabing, and the treatment for such errors is the treatment for Huabing. Yet another section on Huabing was created, claiming that Zhang Zhongjing’s treatment methods for Huabing were lost, becoming a regret for millennia. Readers today are dazzled and confused; practitioners are at a loss. If this is not due to errors in previous compilation and arrangement, how could it be so? I have separated the threads and established independent entries, ensuring that correct and incorrect treatment methods are orderly and unconfused, hoping to provide assistance for the future.