伤寒发汗已。热邪解矣何由反蒸身目为黄。所以然者。寒湿搏聚适在躯壳之里。故尔发黄也。里者在内之通称非谓
寒湿深入在里。盖身目正属躯壳。与脏腑无关也。于寒湿中求之即下文三法也。
伤寒瘀热在里。身必发黄麻黄连翘赤小豆汤主之。而伤寒之邪得湿而不行。所以热瘀身中而发黄。故用外解之法设
泥里字。岂有邪在里而反治其表之理哉。
伤寒身黄发热者。栀子柏皮汤主之。
热已发出于外。自与内瘀不同。正当随热势清解其黄。使不留于肌表之间。前条热瘀在里故用麻黄发之。此条发热
在表反不用麻黄者。盖寒湿之证难于得热。热则其势外出而不内入矣。所谓于寒湿中求之。不可泥伤寒之定法也。
伤寒七八日。身黄如橘子色。小便不利腹微满者。茵陈蒿汤主之小盒饭利尿如皂角汁状色正赤一宿腹减黄从小便出
也。
色黄鲜明其为三阳之热无疑小便不利腹微满乃湿家之本证。不得因此指为伤寒之里证也。方中用大黄者。取佐茵陈
栀子。建驱湿除邪之功。以利小便非用下也。然二便有兼阻者。有因前窍不利。而后窍并为不通者。如阳明证不更衣十
日无苦渴者。与五苓散一条。非湿热挟津液下渗膀胱而致大便枯燥不通耶。此因湿热搏聚。小便不利致腹微满。故少与
大黄同水道药开泄下窍则二便俱得通利。而湿热势杀得以分解矣。○或问仲景既云寒湿而用药。又忌祛湿热之味。其故
何耶。盖始本寒湿袭入躯壳。久之阳气渐复。则郁发而为热矣。若泥寒字。全失移寒化热之义。
下之后复发汗。必振寒脉微细所以然者。以内外俱虚故也。
误汗亡阳。误下亡阴。故内外俱虚。虽不出方。其用附子回阳。人参益阴。已有成法不必赘也。
下之后复发汗。昼日烦躁不得眠。夜而安静不呕。不渴无表证。脉沉微身无大热者。干姜甘草汤主之。
日烦躁扰夜间安静。则阴不病而阳病可知矣无表证而脉沉微。则太阳之邪已尽以下后复发汗复扰其虚阳故用附子干
姜以温补其阳不用四逆者。恐甘草恋胃故也。即自汗小便数。咽干烦躁吐逆。用干姜甘草以温胃复阳不用四逆者。恐附
子峻下故也。
发汗病不解。反恶寒者。虚故也。芍药甘草附子汤主之。
未汗而恶寒。邪盛而表实。已汗而恶寒。邪退而表虚。阳虚则恶寒。宜用附子固矣。然既发汗不解可知其热犹在也。
热在而别无他证。自是阴虚之热。又当用芍药以收阴。此营胃阴虚之救法也。
发汗后恶寒者。虚故也。不恶寒但热者实也。当和胃气与调胃承气汤。
恶寒者汗出营卫新虚。故用法以收阴固阳而和其营卫。不恶寒者。汗出表气未虚反加恶热则津干。胃实可知故用法
以泄实而和平。然曰与似大有酌量。其不当径行攻下。重虚津液从可知矣。
伤寒医下之续得下利清谷不止身疼痛者。急当救里。后身疼痛。清便自调者。急当救表。救里宜四逆汤。救表宜桂
枝汤。
下利清谷。阳气内微也。身体疼痛。表邪外盛也。法当急救其在里之微阳。俟其清便调和。则在里之阳已复而身痛
不止明。是营卫不和所致又当急救其表。使外邪仍从外解矣。救里与攻里天渊。若攻里。必须先表后里。惟在里之阴寒
极盛恐阳气暴脱。不得不急救其里也。厥阴篇下利腹胀。身体疼痛者。先温其里乃攻其表。是互此意。
病发热头痛脉反沉。若不瘥身体疼痛。当救其里。宜四逆汤。
病发热头痛者。太阳伤寒脉反沉者。其人本虚。或病后阳气弱也。虽脉沉体虚。以其有头痛表证而用解肌药病不瘥
反加身疼者。此阳虚阴盛可知。宜与四逆汤回阳散寒不解表而表解矣。盖太阳膀胱为肾之腑。肾中阳虚阴盛。势必传出
于腑。故宜四逆以消阴复阳。倘服四逆后脉变浮数。仍身疼头痛。热不止者。此里得药助驱邪外散之候。仍少用桂枝汤
佐其作汗更不待言。
以上寒伤营坏证。
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。不可更发汗更下更吐也面色反有热色者。未欲解也以其不能得小汗出身必痒。宜桂枝麻黄各半汤。
太阳病得之八九日。如疟状发热恶寒。热多寒少为自初至今之证。下文乃是。以后拟病防变之辞。分作一节。看其
人不呕清便欲自可。一日二三度发。脉微缓者为欲愈。此一节。乃表和无病。而脉微者邪气微缓也。阴阳相等。脉证皆
同。向安之兆。可不待汗而欲愈。若脉微而恶寒者。此阴阳俱虚。不可更汗更下更吐也。此一节宜温之。面上反有赤色
者。未欲解也。以不能得小汗出。其身必痒。桂枝麻黄各半汤。此一节必待汗而解也。○首节颇似小柴胡证故以不呕清
便自调证之次节虽脉微恶寒。止宜小建中。加黄 以温分肉司开阖。原非温经之谓。后节面色反有热色。言表邪未尽。
故宜各半。不可与面合赤色。比类而观也。
太阳病发热恶寒。热多寒少脉微弱者。此无阳也不可复发汗。宜桂枝二越脾一汤。
无阳乃无津液之通称。盖津为阳。血为阴也。无阳为脾胃衰。故不可更发汗非汗。则风寒终不解惟取桂枝之二。以
治风邪。越脾之一。以治郁热。越脾者石膏之辛凉以化胃之郁热。则热化津生而脾气发越得以行其胃液也。世本作越婢
言脾为小姑比之女婢。若此则越字何义。二字便不贯矣今从外台方正之。
服桂枝汤大汗出。脉洪大者。与桂枝汤如前法。若形如疟。日再发者。汗出必解。宜桂枝二麻黄一汤。
此风多寒少之证。服桂枝汤。治风而遗其寒。汗又大出。脉反洪大。似乎风邪再袭。故重以桂枝汤。探之。若果风
邪之故立解矣。若形如疟日再发。此邪本欲解。终为微寒所持。故略兼治寒。而汗出必愈也。○此条前半。与温热病篇
白虎证。第七条但少大烦渴一句。盖大烦渴。明热能消水。故为伏气非略欲饮一二口即止也。○详此方与各半药品不殊。
惟铁分稍异而证治攸分。可见仲景于差多差少之间。分毫不苟也。
服桂枝汤。或下之。仍头项强痛。翕翕发热无汗。心下满微痛。小便不利者。桂枝去桂。加茯苓白术汤主之。
治风而遗其寒。所以不解。而证变。则在表之风寒未除。而在里之水饮上逆。故变五苓而用白术茯苓为主治。去桂
枝者。已误不可复用也。○张卿子曰。逐饮何不用橘皮半夏。可见。此停饮而胃虚。故无汗耳。○此条颇似结胸。所以
辨为太阳之表证尚在。全重在翕翕发热上。
发汗若下之。病仍不解。烦躁者。茯苓四逆汤主之。
此大青龙证误施汗下。而转增烦躁也误汗。则亡阳而表虚误下。则亡阴而里虚。阴阳俱虚。邪独不解。故生烦躁。
用此汤以救之。盖烦为心烦。躁为肾躁。故用干姜附子入肾以解躁茯苓人参入心以解烦也。○夫不汗出之烦躁与发汗后
之烦躁毫厘千里。不汗出之烦躁。不辨脉而投大青龙。尚有亡阳之变。是则发汗后之烦躁。即不误用药已误在汗矣。
伤寒若吐若下后。心下逆满。气上冲胸。起则头眩。脉沉紧发汗。则动经身为振振摇者。茯苓桂枝白术甘草汤主之。
此小青龙证误施吐下而成也。心下逆满。气上冲胸。风邪搏饮。壅塞于膈。所以起其头眩因吐下后邪气乘虚入内。
连动其饮也。脉见沉紧。明系寒邪留结于中。若但发汗。以强解其外。外虽解而津液尽竭反足伤动经脉。有身为振摇之
患矣。遇此等证必兼涤饮散邪。乃克有济。小青龙本证。全是此意但始病重在风寒两受。不得不重在表。此吐下后复汗。
外邪已散。止存饮中之邪故以桂枝加入制饮药内。使饮中之邪。尽散。津液得以四布而滋养其经脉也。至若吐下。后重
发汗太过。亡阳厥逆烦躁。或仍发热心悸。头眩身 动振振欲擗地者。又属真武汤证非此汤可能治也。
伤寒吐下后发汗。虚烦脉甚微八九日心下痞硬胁下痛。气上冲咽喉。眩冒经脉动惕者。久而成痿。
此即上条之证。而明其增重者。必致废也。曰虚烦曰脉甚微。则津液内亡。求上条之脉沉紧为不可得矣。曰心下痞
硬。曰胁下痛。较上条之心下逆满更甚矣。曰气上冲咽喉。较上条之冲胸更高矣。此皆痰饮上逆之故。逆而不已。上冲
头目。因而眩冒日加。则不但身为振摇。其颈项间。且阳虚而阴凑之矣。阴气上入高巅。则愈重。而益振摇矣。上盛下
虚。两足必先痿废。此仲景于心下逆满。气上冲胸之日。茯苓桂枝白术甘草汤早已用力矣。
伤寒八九日。风湿相搏身体烦疼。不能自转侧。不呕不渴脉浮虚而涩者。与桂枝附子汤主之。若其人大便硬小便自
利者。去桂枝加白术汤主之。（即白术附子汤）
风湿相搏。止是流入关节。身疼极重而无头疼呕渴等证。见卑湿之邪难犯高巅脏腑之界也。不呕者。上无表邪也。
不渴者。内无热炽也。加以脉浮虚而涩。则为风湿搏于躯壳无疑。故用桂枝附子。疾驰经络水道以桂枝散表之风。附子
逐经之湿。迅扫而分竭之也。其小便利大便坚。为津液不足。故去桂枝之辛散而加白术以助津液也。
风湿相搏。骨节烦疼掣痛不得屈伸。近之则痛剧。汗出短气。小便不利。恶风不欲去衣。或身微肿者甘草附子汤主
之。
风则上先受之。湿则下先受之。逮至两相搏聚注经络流关节渗骨体躯壳之间。无处不到。则无处不痛矣。于中短气
一证。乃汗多亡阳。阳气大伤之征。故用甘草附子白术桂枝为剂。以复阳而分解内外之邪也。
伤寒脉浮自汗出。小便数。心烦微恶寒脚挛急。反与桂枝汤欲攻其表。此误也得之便厥咽中干。烦躁吐逆者。作甘
草干姜汤与之。以复其阳。若厥愈足温者。更作芍药甘草汤与之。其脚即伸。若胃气不和谵语者。少与调胃承气汤。若
重发汗。复加烧针者四逆汤主之。
此阳虚营卫俱伤误用桂枝。治风遗寒。治表遗里之变证也。脉浮自汗。固为在表之风邪而小便数心烦则邪又在里。
加以微恶寒则在里为寒邪更加脚挛急。则寒邪颇重矣。乃用桂枝独治其表。则阳愈虚阴愈无制故得之便厥也。桂枝误矣。
麻黄青龙更可知也阴寒内凝总无攻表之理甘草干姜汤复其阳者。即所以散其寒也。厥愈足温不但不必治。寒且虑前之辛
热有伤其阴而足挛转锢故随用芍药甘草以和阴而伸其脚设胃气不和而谵语则胃中津液为热所耗。故少与调胃承气汤以和
胃而止其谵语多与则为下而非和矣。若不知此证之不可汗。而重发其汗。复加烧针则阳之虚者必造于亡阴之无制者。必
致犯上无等此则用四逆汤以回其阳。尚恐不胜况可兼阴为治乎。○此证始终只是夹。阴虽脉浮自汗为阳证。而脚挛急不
温。乃属平素下虚至于心烦小便数。不独真阳素虚而真阴亦亏。所以才用阳且遂变厥逆也。
问曰证象阳旦按法治之而增剧厥逆咽中干。两胫拘急而谵语。师言夜半手足当温两脚当伸。后如师言何以知此答曰
寸口脉浮而大浮则为风。大则为虚风则生微热。虚则两胫挛。病证象桂枝。因加附子参其间。增桂令汗出附子温经亡阳
故也。厥逆咽中干烦燥阳明内结谵语烦乱。更饮干姜甘草汤夜半阳气还两足当热胫尚微拘急重与芍药甘草汤尔乃胫伸。
以乘气汤微溏则止其谵语。故知病可愈。
阳旦者桂枝加黄芩之制本治冬温之的方也。以其心烦小便数有似冬温而误与之。因其人阳气素衰所以得汤便厥也。
若重发汗。或烧针者。误上加误非四逆汤不能回其阳矣。此证既象阳旦又云按法治之即是按冬温之法也。所以病患得之
便厥明明误在黄芩助其阴寒。若单服桂枝何致是耶。故仲景即行阴旦之法以救其失观增桂令汗出一语岂不昭昭耶。阴旦
不足更加附子温经即咽中干阳明内结。谵语烦乱浑不为意。且重饮甘草干姜汤。以俟夜半阳回足热后果如言岂非先有所
试乎为黄芩入口而便厥。未几即以桂附干姜尾其后。固知其厥必不久。所以可断夜半手足当温况谵语咽干热证相错其非
重阴冱寒可知。故才得足温。即便以和阴为务。何其审哉。
以上营卫俱伤坏证。
太阳中风。以火劫发汗。邪风被火热。血气流溢。失其常度。两阳相薰灼其身。发黄阳盛则欲衄。阴虚则小便难。
阴阳相虚竭。身体则枯燥。但头汗出剂颈而还腹满微喘。口干咽烂。或不大便久则谵语。甚者至哕。手足躁扰捻衣抹床。
小便利者。其人可治。
风阳也。火亦阳也。邪风更被火热助之。则血气沸腾所以失其常度。蒸身为黄。然阳邪盛于阳位者。尚或可以从衄
解。可从汗解。至于阳邪深入阴分势必劫。尽津液所以剂颈以下。不能得汗。口干咽烂。肺焦喘促。身体枯燥。小便难。
大便秘。手足扰动。谵妄哕逆。乃火邪内炽。真阴立尽之象。非药力所能胜者。必其人小便尚利。阴未尽伤。肺气不逆。
膀胱气化。肾水不枯。始得行驱阳救阴之法。注家泥于阴阳俱虚竭一语。遂谓小便利者。阴未尽虚。则阳犹可回。是认
可治为回阳。大失经旨。不知此证急救其阳。以存阴之一线。尚恐不得。况可回阳以更劫其阴乎。且头汗乃阳邪上壅。
伤寒经过发汗治疗后，热邪应当已经解除。为什么反而出现身体蒸热、面目发黄的症状呢？之所以这样，是因为寒湿之邪搏结聚集在躯壳之内。所以导致发黄。所谓“里”，在这里是体内的通称，并不是说寒湿深入到了脏腑内部。因为身体和面目都属于躯壳范围，与脏腑没有直接关系。应当在寒湿的病机中寻找原因，也就是下文提到的三种治法。
伤寒瘀滞的热邪在体内，身体一定会发黄，应用麻黄连翘赤小豆汤主治。伤寒的邪气遇到湿气就会阻滞不行，所以热邪郁滞在身体中而发黄。因此使用外解的方法。如果拘泥于“里”字，怎么会有邪气在里却反而治疗其表部的道理呢？
伤寒身体发黄且伴有发热者，应用栀子柏皮汤主治。
热邪已经发散到体表，自然与热邪郁结在内部不同。正当顺着热势清解其黄，使黄色不留存在肌肤表层之间。前一条提到热瘀在里，所以用麻黄发散；这一条提到发热在表，反而不用麻黄的原因，是因为寒湿的证候难以得到热邪，一旦有热，其趋势就是向外发散而不向内侵入。这就是所说的在寒湿中求治，不可拘泥于伤寒的固定法则。
伤寒七八天，身体黄得像橘子色，小便不通利，腹部轻微胀满者，应用茵陈蒿汤主治。（服药后）小便应该像皂角汁一样颜色深红，过一夜腹部胀满减轻，黄色从小便排出。
黄色鲜明，这无疑是三阳经的热证。小便不利、腹部轻微胀满是湿病患者的本证，不能因此就指为伤寒的里证。方中使用大黄，是取它辅助茵陈、栀子，建立驱除湿邪的功效，是利用利尿的作用，而不是用泻下的方法。然而大小便都有阻滞的情况，有的是因为前窍（尿道）不利，导致后窍（肛门）也不通的。比如阳明证十天不大便但没有痛苦口渴的，以及五苓散那条条文所述，难道不是湿热挟带津液下渗膀胱而导致大便干燥不通吗？这里是因为湿热搏结聚集，小便不利导致腹部轻微胀满，所以少量配合大黄同水道药一起开泄下窍，使得大小便都能通利，而湿热的势头减弱得以分解。○有人问：张仲景既然说是寒湿，用药却又忌讳祛除湿热的味道，这是什么缘故呢？大概开始本是寒湿侵袭入躯壳，时间久了阳气逐渐恢复，则郁积而化热。如果拘泥于“寒”字，就完全失去了移寒化热的意义。
误用下法后又发汗，必定出现怕冷、脉象微细。之所以这样，是因为内外都虚损的缘故。
误汗导致亡阳，误下导致亡阴，所以内外都虚损。虽然原文没有出方，但使用附子回阳、人参益阴，已有成法，不必赘述。
误用下法后又发汗，白天烦躁不能入睡，夜间安静，不呕吐，不口渴，没有表证，脉象沉微，身体没有大热的，应用干姜甘草汤主治。
白天烦躁扰攘，夜间安静，说明阴分没有病而阳分有病。没有表证而脉象沉微，说明太阳的邪气已经完全通过下法去除了。又因为下法之后再次发汗，反复扰动虚弱的阳气，所以用附子、干姜来温补阳气。不用四逆汤，是恐怕甘草留恋胃气（此处意指四逆汤中附子干姜配伍更峻烈，或此处特指不用附子以防过于峻猛，原文逻辑稍显隐晦，通常解释为不用附子之峻，或保留甘草以守中）。如果是自汗、小便频数、咽干烦躁、吐逆，用干姜甘草汤温胃复阳，不用四逆汤，是恐怕附子峻烈伤正。
发汗后病没有解除，反而怕冷的，这是虚证。应用芍药甘草附子汤主治。
没有发汗时怕冷，是邪气盛而表实；已经发汗后怕冷，是邪气退而表虚。阳虚就会怕冷，适宜用附子固护阳气。但是既然发汗后病不解，可知热邪还在。热邪存在而没有其他症状，自然是阴虚之热，又应当用芍药来收敛阴液。这是救治营卫阴虚的方法。
发汗后怕冷的，是虚证；不怕冷只发热的，是实证。应当调和胃气，给予调胃承气汤。
怕冷是因为汗出导致营卫新近虚损，所以用法以收敛阴液、固护阳气，调和营卫。不怕冷的人，汗出后表气未虚，反而加重怕热，那么津液干枯，胃实可知，所以用法以泄实而平和。然而说“给予”，似乎大有斟酌之意，其不应当直接进行攻下，严重损伤津液，从这一点就可以知道了。
伤寒医生误用下法，接着出现下利完谷不化不止，身体疼痛的，应当紧急救里。后来身体疼痛，大便小便正常的，应当紧急救表。救里适宜用四逆汤，救表适宜用桂枝汤。
下利完谷不化，是阳气内里微弱。身体疼痛，是表邪外盛。法当急救在里的微弱阳气，等到二便调和，那么在里的阳气已经恢复，而身体疼痛不止，明显是营卫不和所致，又应当急救其表，使外邪仍然从外表解除。救里与攻里有天壤之别。如果是攻里，必须先解表后攻里。只有在里的阴寒极盛，恐怕阳气暴脱，不得不急救其里。厥阴篇中提到下利腹胀、身体疼痛的，先温其里再攻其表，是与此处意思互见。
病发热头痛，脉象反而沉，如果不痊愈，身体疼痛的，应当救其里，适宜用四逆汤。
病发热头痛，是太阳伤寒，脉象反而沉的，其人本来体虚，或者是病后阳气虚弱。虽然脉沉体虚，因为有头痛表证而用解肌药，病不痊愈反而加重身体疼痛的，这是阳虚阴盛可知。适宜给予四逆汤回阳散寒，不解表而表自解了。因为太阳膀胱是肾的腑，肾中阳虚阴盛，势必传变出到腑，所以适宜用四逆汤消除阴寒恢复阳气。如果服用四逆汤后脉象变为浮数，仍然身体疼痛头痛，热不止的，这是里气得药力帮助驱邪外散的征候，仍少量用桂枝汤辅助其作汗，更不用说别的了。
以上是寒伤营导致的坏证。
太阳病得病八九天，像疟疾的样子，发热恶寒，热多寒少，病人不呕吐，大小便正常，一天发作两三次，脉象微缓的是将要痊愈。脉象微而恶寒的，这是阴阳俱虚，不可以再发汗、再下、再吐。面色反而有热色的，还没有解除，因为他不能得到小汗出，身体一定会痒，适宜用桂枝麻黄各半汤。
太阳病得病八九天，像疟疾样子，发热恶寒，热多寒少，是从初起到现在的证候。下文是以后推测病情防止变化的言辞，分为一节看。看病人不呕吐，大小便想当然地正常，一天发作两三次，脉象微缓的是将要痊愈。这一节，是表和无病，而脉微是邪气微缓。阴阳相等，脉证皆同，是趋向安定的征兆，可以不待发汗而欲愈。如果脉微而恶寒的，这是阴阳俱虚，不可以再发汗、再下、再吐。这一节适宜温补。面上反而有赤色的，还没有解除。因为不能得到小汗出，身体一定痒。桂枝麻黄各半汤。这一节必须待发汗而解。○首节很像小柴胡证，所以用不呕吐、大小便自调来验证。次节虽然脉微恶寒，只适宜用小建中汤加黄芪以温分肉司开阖，原本不是温经的意思。后节面色反有热色，说表邪未尽，所以适宜各半汤，不可与面合赤色类比来看。
太阳病发热恶寒，热多寒少，脉象微弱的，这是无阳，不可以再发汗。适宜用桂枝二越婢一汤。
无阳是津液不足的通称。盖津为阳，血为阴。无阳是因为脾胃衰弱，所以不可以再发汗。如果不是发汗，那么风寒终究不能解除。只取桂枝的二份，以治风邪；越婢的一份，以治郁热。越婢是石膏的辛凉以化解胃中的郁热，那么热化津生而脾气发越，能够运行胃液。世传本作越婢，说脾是小姑比的女婢，如果这样，越字是什么意思？两个字就不连贯了。现在从《外台秘要》方正之。
服用桂枝汤大汗出，脉象洪大的，给予桂枝汤按以前的方法服用。如果像疟疾一样，一天发作两次的，汗出必定解除，适宜用桂枝二麻黄一汤。
这是风多寒少的证候。服用桂枝汤，治风而遗漏了寒，汗又大出，脉象反而洪大，似乎是风邪再次袭击，所以重新用桂枝汤试探。如果确实是风邪的缘故，立刻解除了。如果像疟疾一样一天发作两次，这是邪气本想解除，终究被微寒所持留，所以略兼治寒，而汗出必定痊愈。○此条前半部分，与温热病篇白虎证第七条但缺少“大烦渴”一句。盖大烦渴，明确热能消水，所以是伏气，不是稍微想喝一两口就停止。○详细看此方与各半汤药品不殊，只是铁分（疑为剂量或比例之误，或指药性侧重）稍有差异而证治区分明显，可见张仲景在差多差少之间，分毫不苟。
服用桂枝汤，或者用下法，仍然头项强痛，翕翕发热无汗，心下满微痛，小便不利的，应用桂枝去桂加茯苓白术汤主治。
治风而遗漏了寒，所以不解，而证候变化。则在表的风寒未除，而在里的水饮上逆。所以改变五苓散而用白术茯苓为主治。去掉桂枝，是因为已经误治不可再用。○张卿子说：逐饮为什么不用橘皮半夏？由此可见，这是停饮而胃虚，所以无汗。○此条很像结胸，所以辨为太阳的表证尚在，全重在翕翕发热上。
发汗或者用下法，病仍然不解，烦躁的，应用茯苓四逆汤主治。
这是大青龙证误施汗下，而转增烦躁。误汗，则亡阳而表虚；误下，则亡阴而里虚。阴阳俱虚，邪气独不解，所以生烦躁。用此汤来救治。盖烦是心烦，躁是肾躁，所以用干姜附子入肾以解躁，茯苓人参入心以解烦。○夫不出汗的烦躁与发汗后的烦躁毫厘千里。不出汗的烦躁，不辨脉而投大青龙，尚有亡阳的变故，那么发汗后的烦躁，即使不误用药，也已经误在发汗了。
伤寒如果用吐法或者下法后，心下逆满，气上冲胸，站起来头晕目眩，脉象沉紧，发汗，则动经，身体震颤摇动的，应用茯苓桂枝白术甘草汤主治。
这是小青龙证误施吐下而成的。心下逆满，气上冲胸，风邪搏结水饮，壅塞于膈，所以引起头晕。因为吐下后邪气乘虚入内，连动其水饮。脉见沉紧，明系寒邪留结于中。如果只发汗，以强行解除其外，外虽解而津液尽竭，反而足以伤动经脉，有身体震颤摇晃的祸患。遇到这种证候必须兼涤除水饮消散邪气，才能有效。小青龙本证，全是这个意思，但始病重在风寒两受，不得不重在表。这里是吐下后再次发汗，外邪已散，只存留饮中之邪，所以以桂枝加入制饮药内，使饮中之邪尽散，津液得以四布而滋养其经脉。至于若吐下后重发汗太过，亡阳厥逆烦躁，或仍发热心悸，头晕身体动摇振振欲倒地者，又属于真武汤证，不是此汤能治疗的。
伤寒吐下后发汗，虚烦脉象甚微，八九天后心下痞硬，胁下痛，气上冲咽喉，眩晕冒昧，经脉跳动惕惧的，时间久了会形成痿证。
这就是上一条的证候，而说明其增重的，必定导致废用。曰虚烦、曰脉甚微，则津液内亡，求上一条的脉沉紧是不可能得到的。曰心下痞硬、曰胁下痛，比上一条的心下逆满更严重了。曰气上冲咽喉，比上一条的冲胸更高了。这都是痰饮上逆的缘故。逆而不已，上冲头目，因而眩晕冒昧日益加重，则不但身体震颤摇晃，其颈项间，而且阳虚而阴凑之。阴气上入高巅，则愈重而益震颤摇晃。上盛下虚，两足必先痿废。这是张仲景在心下逆满、气上冲胸之日，茯苓桂枝白术甘草汤早已用力了。
伤寒八九天，风湿相搏，身体烦疼，不能自己转侧，不呕吐不渴，脉象浮虚而涩的，给予桂枝附子汤主治。如果其人大便硬、小便自利的，去掉桂枝加白术汤主治。（即白术附子汤）
风湿相搏，只是流入关节，身疼极重而没有头疼呕渴等证，见卑湿之邪难犯高巅脏腑之界。不呕吐，是上无表邪。不渴，是内无热炽。加上脉浮虚而涩，则为风湿搏于躯壳无疑。所以用桂枝附子，疾驰经络水道，以桂枝散表之风，附子逐经之湿，迅扫而分竭之。其小便利大便坚，为津液不足，所以去掉桂枝的辛散而加白术以助津液。
风湿相搏，骨节烦疼掣痛不得屈伸，靠近则痛剧，汗出短气，小便不利，恶风不欲去衣，或者身体微肿的，应用甘草附子汤主治。
风则上先受之，湿则下先受之。等到两者相搏聚注经络流关节渗骨体躯壳之间，无处不到，则无处不痛。其中短气一证，乃是汗多亡阳，阳气大伤的征象。所以用甘草附子白术桂枝为剂，以复阳而分解内外之邪。
伤寒脉浮自汗出，小便数，心烦微恶寒，脚挛急，反与桂枝汤想要攻其表，这是误治。得了这个误治的反应就出现四肢厥冷，咽中干，烦躁吐逆的，作成甘草干姜汤给予它，以恢复其阳气。如果厥冷愈、足温的，再作成芍药甘草汤给予它，其脚就伸直了。如果胃气不和谵语的，少量给予调胃承气汤。如果重发汗，再加烧针的，应用四逆汤主治。
这是阳虚营卫俱伤，误用桂枝，治风遗寒，治表遗里的变证。脉浮自汗，固为在表的风邪，而小便数心烦则邪又在里，加以微恶寒则在里为寒邪，更加脚挛急，则寒邪颇重了。乃用桂枝独治其表，则阳愈虚阴愈无制，所以得了就厥冷。桂枝误矣，麻黄青龙更可知也。阴寒内凝，总无攻表的道理。甘草干姜汤复其阳，就是所以散其寒。厥愈足温，不但不必治寒，且虑前面的辛热有伤其阴而足挛转锢，所以随即用芍药甘草以和阴而伸其脚。设胃气不和而谵语，则胃中津液为热所耗，故少量给予调胃承气汤以和胃而止其谵语，多与则为下而非和了。如果不知道此证不可汗，而重发其汗，复加烧针，则阳之虚者必造于亡，阴之无制者，必致犯上无等。此则用四逆汤以回其阳，尚恐不胜，况可兼阴为治乎。○此证始终只是夹阴。虽脉浮自汗为阳证，而脚挛急不温，乃属平素下虚。至于心烦小便数，不独真阳素虚而真阴亦亏，所以才用阳且遂变厥逆。
问曰：证象阳旦，按法治之而增剧，厥逆咽中干，两胫拘急而谵语。师言夜半手足当温，两脚当伸，后如师言，何以知此？答曰：寸口脉浮而大，浮则为风，大则为虚。风则生微热，虚则两胫挛。病证象桂枝，因加附子参其间，增桂令汗出，附子温经，亡阳故也。厥逆咽中干，烦躁阳明内结，谵语烦乱，更饮干姜甘草汤，夜半阳气还，两足当热，胫尚微拘急，重与芍药甘草汤，尔乃胫伸。以承气汤微溏，则止其谵语。故知病可愈。
阳旦者是桂枝加黄芩的制度，本是治疗冬温的确切方剂。因为其心烦小便数有似冬温而误与之。因其人阳气素衰，所以得汤就厥冷。如果重发汗，或烧针者，误上加误，非四逆汤不能回其阳。此证既象阳旦，又云按法治之，即是按冬温之法。所以病患得了就厥冷，明明误在黄芩助其阴寒。若单服桂枝何致是这样？故仲景即行阴旦之法以救其失，观增桂令汗出一语，岂不昭昭耶。阴旦不足，更加附子温经，即咽中干、阳明内结、谵语烦乱浑不为意，且重饮甘草干姜汤，以俟夜半阳回足热，后果如言，岂非先有所试乎？为黄芩入口而便厥，未几即以桂附干姜尾其后，固知其厥必不久，所以可断夜半手足当温。况谵语咽干热证相错，其非重阴冱寒可知。故才得足温，即便以和阴为务，何其审哉。
以上是营卫俱伤坏证。
太阳中风，用火劫发汗，邪风被火热，血气流溢，失去常度，两阳相薰灼，其身发黄。阳盛则欲衄，阴虚则小便难。阴阳相虚竭，身体则枯燥。但头汗出，齐颈而还，腹满微喘，口干咽烂，或不大便，久则谵语，甚者至哕，手足躁扰，捻衣抹床。小便利的，其人可治。
风是阳，火也是阳。邪风更被火热助之，则血气沸腾，所以失去常度。蒸身为黄。然阳邪盛于阳位者，尚或可以从衄解，可从汗解。至于阳邪深入阴分，势必劫尽津液，所以齐颈以下，不能得汗。口干咽烂，肺焦喘促，身体枯燥，小便难，大便秘，手足扰动，谵妄哕逆，乃火邪内炽，真阴立尽之象，非药力所能胜者。必其人小便尚利，阴未尽伤，肺气不逆，膀胱气化，肾水不枯，始得行驱阳救阴之法。注家泥于阴阳俱虚竭一语，遂谓小便利者，阴未尽虚，则阳犹可回，是认可治为回阳，大失经旨。不知此证急救其阳，以存阴之一线，尚恐不得，况可回阳以更劫其阴乎。且头汗乃阳邪上壅。
After the treatment of sweating for cold damage, the pathogenic heat should have been resolved. Why does it instead present with steaming body heat and yellowing of the face and eyes? The reason for this is that the pathogenic cold-dampness has clumped together inside the exterior shell (body surface). Therefore, jaundice occurs. Here, "interior" is a general term for the inside of the body, not implying that the cold-dampness has deeply penetrated into the zang-fu organs. Since the body and face belong to the exterior shell, they are unrelated to the zang-fu organs. One should seek the cause within the cold-dampness, which refers to the three methods mentioned below.
In cold damage, if stagnant heat is retained in the interior, the body will certainly turn yellow; Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Red Bean Decoction) is the primary formula. When the pathogen of cold damage encounters dampness, it becomes obstructed and fails to move, causing heat to stagnate in the body and result in jaundice. Therefore, an external resolving method is used. If one rigidly adheres to the concept of "interior," how could there be logic in treating the exterior when the pathogen is in the interior?
For cold damage presenting with jaundice and fever, Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Bark Decoction) is the primary formula.
The heat has already emerged to the exterior, which is naturally different from heat stagnating internally. One should clear and resolve the jaundice following the trend of the heat, preventing it from remaining between the skin and muscles. In the previous clause, because heat was stagnant in the interior, Ma Huang (Ephedra) was used to disperse it. In this clause, because fever is at the exterior, Ma Huang is not used. The reason is that in cold-dampness patterns, it is difficult to obtain heat; once heat is present, its tendency is to move outward rather than inward. This is what is meant by seeking the cause within cold-dampness; one must not rigidly adhere to fixed rules for cold damage.
After seven or eight days of cold damage, if the body is yellow like an orange peel, urination is difficult, and the abdomen is slightly full, Yin Chen Hao Tang (Artemisia Capillaris Decoction) is the primary formula. (After taking the medicine), urine should resemble the juice of soap pods with a deep red color. After one night, abdominal fullness decreases, and the yellow color exits via urination.
Bright yellow color undoubtedly indicates heat in the Three Yang channels. Urinary difficulty and slight abdominal fullness are the fundamental signs of dampness diseases; one should not therefore identify them as interior syndromes of cold damage. The use of Da Huang (Rhubarb Root and Rhizome) in the formula is to assist Yin Chen (Artemisiae Scopariae Herba) and Zhi Zi (Gardeniae Fructus) in driving out dampness and eliminating pathogens through diuresis, not for purgation. However, there are cases where both bowel and bladder movements are obstructed: some due to urinary difficulty leading to constipation. For example, in Yangming syndrome, ten days without stool but no discomfort or thirst, or in the case of Wu Ling San (Five-Ingredient Powder with Poria), is this not caused by damp-heat carrying fluids downward into the Bladder, resulting in dry and obstructed stools? Here, due to the clumping of damp-heat and urinary difficulty causing slight abdominal fullness, a small amount of Da Huang is combined with water-draining herbs to open the lower orifice, allowing both bowel and bladder movements to become unobstructed, thereby reducing the intensity of damp-heat and facilitating its separation. ○ A question arises: Since Zhang Zhongjing mentions cold-dampness, why are herbs that dispel damp-heat avoided? The answer is that initially, cold-dampness invades the exterior shell. Over time, Yang Qi gradually recovers, becoming depressed and transforming into heat. If one rigidly sticks to the character "cold," one completely misses the meaning of transforming cold into heat.
After erroneous purgation followed by sweating, chills and a faint, thin pulse occur. The reason is deficiency in both the interior and exterior.
Erroneous sweating leads to loss of Yang Qi; erroneous purgation leads to loss of Yin fluids, resulting in deficiency in both interior and exterior. Although no formula is explicitly given, the established methods of using Fu Zi (Aconiti Lateralis Radix Preparata) to restore Yang and Ren Shen (Ginseng Radix) to benefit Yin are sufficient, requiring no further elaboration.
After erroneous purgation followed by sweating, if there is restlessness during the day preventing sleep, but quietness at night, without vomiting, thirst, or exterior signs, and with a deep, faint pulse and no significant fever, Gan Jiang Zhi Gan Cao Tang (Dried Ginger and Licorice Decoction) is the primary formula.
Restlessness during the day and quietness at night indicate that the Yin aspect is unaffected while the Yang aspect is diseased. Without exterior signs but with a deep, faint pulse, the Taiyang pathogen has been exhausted by purgation. Furthermore, repeated sweating after purgation disturbs the deficient Yang; thus, Fu Zi (Aconiti Lateralis Radix Preparata) and Gan Jiang (Zingiberis Rhizoma) are used to warm and tonify Yang. Si Ni Tang (Frigid Extremities Decoction) is not used to avoid the potential retention in the stomach caused by Gan Cao (Licorice Root) in combination with other strong warming agents, or specifically to avoid the harshness of Fu Zi in this specific context of restoring middle Jiao Yang. Similarly, for spontaneous sweating, frequent urination, dry throat, restlessness, and vomiting, Gan Jiang Zhi Gan Cao Tang is used to warm the Stomach and restore Yang; Si Ni Tang is avoided to prevent the harsh descending action of Fu Zi.
If sweating fails to resolve the disease and chills appear instead, it is due to deficiency. Shao Yao Gan Cao Fu Zi Tang (Peony, Licorice, and Aconite Decoction) is the primary formula.
Chills before sweating indicate excess pathogen and exterior excess; chills after sweating indicate the pathogen has retreated and the exterior is deficient. Yang deficiency causes chills, warranting the use of Fu Zi (Aconiti Lateralis Radix Preparata) to secure Yang. However, since the disease persists after sweating, heat remains. With heat present and no other symptoms, this is Yin deficiency heat. Shao Yao (Paeoniae Radix Alba) should be used to collect Yin. This is the rescue method for Ying and Wei Yin deficiency.
If chills appear after sweating, it is deficiency; if there are no chills but only fever, it is excess. One should harmonize the Stomach Qi with Tiao Wei Cheng Qi Tang (Modulate the Stomach and Direct the Flow Decoction).
Chills indicate recent deficiency of Ying and Wei due to sweating; thus, the method is to collect Yin, secure Yang, and harmonize Ying and Wei. Absence of chills indicates that although the exterior Qi is not yet deficient, increased aversion to heat suggests dried fluids and Stomach excess. Thus, the method is to drain excess and bring about peace. The phrase "give" implies careful consideration; direct purgation should be avoided to prevent severe depletion of fluids.
In cold damage, if the physician erroneously uses purgation, leading to continuous diarrhea with undigested food and body pain, one must urgently rescue the interior. Later, if body pain persists but bowel and bladder functions are normal, one must urgently rescue the exterior. Rescue of the interior requires Si Ni Tang (Frigid Extremities Decoction); rescue of the exterior requires Gui Zhi Tang (Cinnamon Twig Decoction).
Diarrhea with undigested food indicates weak interior Yang. Body pain indicates strong exterior pathogen. The method dictates urgent rescue of the weak interior Yang. Wait until bowel and bladder functions harmonize; then, if body pain persists, it is clearly due to disharmony of Ying and Wei, requiring urgent rescue of the exterior to allow the exterior pathogen to resolve from the outside. Rescuing the interior is vastly different from attacking the interior. Attacking the interior requires resolving the exterior first. Only when interior cold-dampness is extremely severe, fearing sudden collapse of Yang Qi, is urgent interior rescue necessary. In the Jueyin chapter, diarrhea with abdominal fullness and body pain requires warming the interior first, then attacking the exterior, illustrating the same principle.
If a disease presents with fever, headache, and a surprisingly deep pulse, and if it does not improve with body pain, one must rescue the interior, preferably with Si Ni Tang (Frigid Extremities Decoction).
Fever and headache suggest Taiyang cold damage; a surprisingly deep pulse indicates inherent deficiency or post-illness weak Yang Qi. Even with a deep pulse and deficiency, if exterior signs like headache persist, exterior-resolving medicines are used. If the disease does not improve and body pain worsens, this indicates Yang deficiency and Yin excess. Si Ni Tang (Frigid Extremities Decoction) should be given to restore Yang and scatter cold; the exterior resolves without direct intervention. The Taiyang Bladder is the fu organ of the Kidney. Kidney Yang deficiency and Yin excess inevitably transmit to the fu organ. Thus, Si Ni Tang is suitable to eliminate Yin and restore Yang. If after taking Si Ni Tang, the pulse becomes floating and rapid, and headache/body pain/fever persist, this indicates the interior Qi is assisting the expulsion of pathogens outward. A small amount of Gui Zhi Tang (Cinnamon Twig Decoction) can be used to assist sweating.
These are defective syndromes caused by Cold damaging the Ying level.
Taiyang disease lasting eight or nine days, resembling malaria with fever and chills, more heat than cold, no vomiting, normal bowel and bladder function, occurring two or three times a day, with a slightly slow pulse indicates impending recovery. A faint pulse with chills indicates dual deficiency of Yin and Yang; do not sweat, purge, or vomit again. If the face appears flushed with heat, resolution is not yet achieved; inability to produce slight sweating causes itching. Gui Zhi Ma Huang Ge Ban Tang (Half-Gui Zhi Half-Ma Huang Decoction) is appropriate.
Taiyang disease lasting eight or nine days, resembling malaria with fever and chills, more heat than cold, describes the condition from onset to now. The following text discusses future changes. Observing no vomiting and normal bowel/bladder function, occurring two or three times daily, with a slightly slow pulse indicates impending recovery. This section shows harmonious exterior with no disease, and a faint pulse indicates mild pathogen retreat. Yin and Yang are balanced, pulse and signs are consistent, signaling approaching peace; recovery may occur without sweating. If the pulse is faint with chills, this is dual deficiency of Yin and Yang; do not sweat, purge, or vomit again. This section requires warming. A reddish face indicates unresolved condition; inability to sweat slightly causes itching. Gui Zhi Ma Huang Ge Ban Tang (Half-Gui Zhi Half-Ma Huang Decoction) is needed; resolution requires sweating. The first section resembles Xiao Chai Hu Tang (Minor Bupleurum Decoction) syndrome, verified by no vomiting and normal bowels/bladder. The second section, despite faint pulse and chills, suits Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) plus Huang Qi (Astragali Radix) to warm the flesh and regulate opening/closing, not primarily for warming meridians. The third section, reddish face, indicates residual exterior pathogen, hence the half-half decoction, distinct from facial flushing in other contexts.
Taiyang disease with fever, chills, more heat than cold, and a weak pulse indicates "No Yang"; do not sweat again. Gui Zhi Er Yue Bi Yi Tang (Two Parts Gui Zhi, One Part Yue Bi Decoction) is appropriate.
"No Yang" generally refers to lack of Jin Ye (Body Fluids). Jin is Yang, Blood is Yin. Lack of Yang stems from Spleen/Stomach weakness, precluding further sweating. To resolve wind-cold, take two parts Gui Zhi Tang (Cinnamon Twig Decoction) to treat wind, and one part Yue Bi (which contains Shi Gao/Gypsum) to treat stagnant heat. Shi Gao's acrid-cool nature transforms Stomach stagnant heat, generating fluids and allowing Spleen Qi to ascend and distribute Stomach fluids. The transmitted text says "Yue Bi," claiming Pi (Spleen) is a maid to the younger sister-in-law; this makes the character "Yue" meaningless and disjointed. We follow the correct version from *Waitai Miyao*.
After taking Gui Zhi Tang (Cinnamon Twig Decoction), heavy sweating occurs, and the pulse is flooding and large. Give Gui Zhi Tang (Cinnamon Twig Decoction) as before. If the pattern resembles malaria, occurring twice a day, sweating will resolve it. Gui Zhi Er Ma Huang Yi Tang (Two Parts Gui Zhi, One Part Ma Huang Decoction) is appropriate.
This is a pattern of much wind and little cold. Taking Gui Zhi Tang treats wind but leaves cold; heavy sweating results in a flooding pulse, suggesting renewed wind attack. Re-administering Gui Zhi Tang tests this. If purely wind, it resolves immediately. If resembling malaria twice daily, the pathogen intends to resolve but is held by slight cold; thus, slightly treating cold allows sweating to cure. The first half of this clause resembles Bai Hu Tang (White Tiger Decoction) syndrome in Warm Diseases, lacking "severe irritability and thirst." Severe irritability/thirst indicates heat consuming water, characteristic of latent qi, not just wanting a sip. This formula differs from Ge Ban Tang mainly in dosage/proportion, showing Zhang Zhongjing's precision.
After taking Gui Zhi Tang (Cinnamon Twig Decoction) or purging, if head/neck stiffness,翕翕 (mild) fever, no sweat, epigastric fullness with slight pain, and urinary difficulty persist, Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Tang (Gui Zhi Decoction minus Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction) is primary.
Treating wind while neglecting cold causes non-resolution and transformation. Exterior wind-cold remains, while interior fluid retention rises. Thus, modify Wu Ling San (Five-Ingredient Powder with Poria) to use Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Fu Ling (Poria) as main treatments. Gui Zhi (Cinnamon Twig) is removed because it was previously misused. Zhang Qingzi asks why not use Chen Pi (Citri Reticulatae Pericarpium) and Ban Xia (Pinelliae Rhizoma)? This indicates fluid retention with Stomach deficiency, causing no sweat. This resembles Jie Xiong (Chest Binding) but distinguishes itself by persistent Taiyang exterior signs, focusing on翕翕 fever.
After sweating or purging, if the disease persists with irritability, Fu Ling Si Ni Tang (Poria and Frigid Extremities Decoction) is primary.
This results from erroneous sweating/purgation in Da Qing Long Tang (Major Blue Green Dragon Decoction) syndrome, worsening irritability. Erroneous sweating loses Yang/exterior deficiency; erroneous purging loses Yin/interior deficiency. Dual deficiency with unresolved pathogen causes irritability. This formula rescues it. Fan (restlessness) is Heart irritability; Zao (fidgeting) is Kidney fidgeting. Gan Jiang (Zingiberis Rhizoma) and Fu Zi (Aconiti Lateralis Radix Preparata) enter the Kidney to resolve Zao; Fu Ling (Poria) and Ren Shen (Ginseng Radix) enter the Heart to resolve Fan. Irritability without sweating vs. after sweating differs greatly. Giving Da Qing Long Tang without pulse differentiation risks Yang collapse; thus, post-sweating irritability is already an error of sweating.
After cold damage treated with vomiting or purging, if epigastric reverse fullness, Qi rushing to the chest, dizziness upon standing, and deep-tight pulse occur, and sweating causes meridian disturbance with body tremors, Fu Ling Gui Zhi Bai Zhu Gan Cao Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction) is primary.
This results from erroneous vomiting/purgation in Xiao Qing Long Tang (Minor Blue Green Dragon Decoction) syndrome. Epigastric reverse fullness and Qi rushing to the chest result from wind-clumping with fluid, blocking the diaphragm, causing dizziness. Post-vomit/purge, pathogen enters deficiency, moving fluid. Deep-tight pulse indicates cold-pathogen binding in the middle. Sweating alone exhausts fluids, damaging meridians, causing tremors. One must clear fluid and scatter pathogen. Xiao Qing Long Tang focuses on exterior wind-cold; here, post-vomit/purge, exterior pathogen is scattered, leaving fluid pathogen. Adding Gui Zhi (Cinnamon Twig) to fluid-resolving herbs disperses fluid pathogen, allowing fluids to nourish meridians. If excessive sweating post-vomit/purge causes Yang collapse, cold extremities, irritability, palpitations, or desire to fall, this is Zhen Wu Tang (True Warrior Decoction) syndrome, not treatable by this formula.
After cold damage treated with vomiting, purging, and sweating, if empty irritability, very faint pulse, epigastric痞硬 (stuffiness/hardness), hypochondriac pain, Qi rushing to the throat, dizziness, and meridian twitching occur over eight-nine days, prolonged suffering leads to Wei (flaccidity) syndrome.
This is the previous syndrome worsening, leading to disability. Empty irritability and faint pulse indicate internal fluid loss; deep-tight pulse is absent. Epigastric stuffiness/hardness and hypochondriac pain are worse than previous epigastric reverse fullness. Qi rushing to the throat is higher than rushing to the chest. All stem from phlegm-fluid rising. Unchecked rising to head/eyes causes worsening dizziness and tremors. Yang deficiency allows Yin to gather at the high peak, increasing tremors. Upper excess and lower deficiency lead to leg flaccidity. Zhang Zhongjing addressed this early with Fu Ling Gui Zhi Bai Zhu Gan Cao Tang.
After eight-nine days of cold damage, if Wind-Dampness clumps, causing severe body pain, inability to turn, no vomiting/thirst, and floating-deficient-choppy pulse, Gui Zhi Fu Zi Tang (Cinnamon Twig and Aconite Decoction) is primary. If stool is hard and urination normal, remove Gui Zhi and add Bai Zhu (Bai Zhu Fu Zi Tang / Atractylodes Macrocephala and Aconite Decoction).
Wind-Dampness clumping in joints causes severe pain without headache/vomiting/thirst, showing dampness rarely attacks high peaks/zang-fu. No vomiting means no upper exterior pathogen; no thirst means no interior heat. Floating-deficient-choppy pulse confirms Wind-Dampness in the exterior shell. Gui Zhi (Cinnamon Twig) scatters exterior wind; Fu Zi (Aconiti Lateralis Radix Preparata) drives meridian dampness. Normal urination and hard stool indicate fluid deficiency; thus, remove acrid-dispersing Gui Zhi and add Bai Zhu (Atractylodis Macrocephalae Rhizoma) to aid fluids.
If Wind-Dampness clumps, causing joint pain, pulling pain, inability to flex/extend, severe pain on touch, sweating, shortness of breath, urinary difficulty, aversion to wind preferring clothes, or slight swelling, Gan Cao Fu Zi Tang (Licorice and Aconite Decoction) is primary.
Wind affects the upper first; Dampness affects the lower first. Clumping in meridians/joints/bones causes universal pain. Shortness of breath indicates sweating-induced Yang loss and major Yang injury. Gan Cao (Licorice Root), Fu Zi (Aconiti Lateralis Radix Preparata), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Gui Zhi (Cinnamon Twig) restore Yang and resolve interior/exterior pathogens.
In cold damage, if floating pulse, spontaneous sweating, frequent urination, heart irritability, slight chills, and foot cramping occur, and Gui Zhi Tang (Cinnamon Twig Decoction) is wrongly given to attack the exterior, this is an error. Resulting in cold extremities, dry throat, irritability, and vomiting, make Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) to restore Yang. If extremities warm, make Shao Yao Gan Cao Tang (Peony and Licorice Decoction) to extend the feet. If Stomach disharmony causes delirium, give small amounts of Tiao Wei Cheng Qi Tang (Modulate the Stomach and Direct the Flow Decoction). If heavily sweated and moxa-burned, Si Ni Tang (Frigid Extremities Decoction) is primary.
This is Yang deficiency with Ying/Wei injury, wrongly treated with Gui Zhi Tang, neglecting cold and interior. Floating pulse/spontaneous sweating suggest exterior wind; frequent uritation/heart irritability suggest interior pathogen. Slight chills and foot cramping indicate severe interior cold. Using Gui Zhi Tang solely for exterior worsens Yang deficiency and Yin unconstraint, causing cold extremities. Gui Zhi Tang is wrong; Ma Huang Tang (Ephedra Decoction) and Da Qing Long Tang (Major Blue Green Dragon Decoction) are even more inappropriate. Interior Yin-cold precludes exterior attack. Gan Cao Gan Jiang Tang restores Yang, scattering cold. Once extremities warm, fear prior acrid-hot herbs damaged Yin and tightened cramps; thus, Shao Yao Gan Cao Tang harmonizes Yin to extend feet. If Stomach disharmony causes delirium, fluids are consumed by heat; small amounts of Tiao Wei Cheng Qi Tang harmonize Stomach and stop delirium. Too much constitutes purgation, not harmony. If unaware of non-sweating indication and heavily sweated/moxa-burned, Yang collapse and Yin unconstraint ensue. Si Ni Tang (Frigid Extremities Decoction) restores Yang; adding Yin-nourishing herbs is contraindicated. This syndrome involves hidden Yin deficiency. Though floating pulse/spontaneous sweating seem Yang-excess, foot cramping/coldness indicates chronic lower deficiency. Heart irritability/frequent urination show both True Yang and True Yin deficiency. Using Yang-restoring herbs led to cold extremities.
Question: Syndrome resembles Yang Dan, treated according to method but worsens with cold extremities, dry throat, calf cramping, and delirium. Master said hands/feet would warm and legs extend at midnight, which happened. How did you know? Answer: Cun Kou pulse floating and large. Floating indicates wind; Large indicates deficiency. Wind generates slight heat; deficiency causes calf cramping. Syndrome resembles Gui Zhi Tang, so Fu Zi (Aconiti Lateralis Radix Preparata) was added, and Gui Zhi (Cinnamon Twig) increased to induce sweating. Fu Zi warms meridians; Yang loss occurred. Cold extremities, dry throat, irritability, Yangming internal binding, delirious confusion. Drink Gan Jiang Gan Cao Tang again. At midnight, Yang returns, feet warm. Calves still slightly cramped; re-give Shao Yao Gan Cao Tang to extend calves. Use Cheng Qi Tang slightly to soften stool and stop delirium. Hence, recovery is known.
Yang Dan is Gui Zhi Tang plus Huang Qin (Scutellariae Radix), the correct formula for Winter-Warmth. Given wrongly due to heart irritability/frequent urination resembling Winter-Warmth. Patient's inherent weak Yang caused immediate cold extremities. Heavy sweating or moxa-burning adds error; only Si Ni Tang (Frigid Extremities Decoction) can restore Yang. Treating as Winter-Warmth method explains immediate cold extremities, clearly due to Huang Qin aiding Yin-cold. Single Gui Zhi Tang would not cause this. Thus, Zhang Zhongjing used Yin Dan method to correct error. Increasing Gui Zhi to sweat and adding Fu Zi to warm meridians ignores dry throat/Yangming delirium, prioritizing Gan Jiang Gan Cao Tang to wait for midnight Yang return. Testing confirmed prediction. Huang Qin induced cold extremities quickly; Gui/Fu/Gan Jiang followed. Recovery was certain. Delirium/dry throat mixed with heat signs rule out severe Yin-cold. Once feet warmed, focus shifted to harmonizing Yin. How prudent!
These are defective syndromes of dual Ying/Wei injury.
Taiyang Wind Strike treated with fire-induced sweating: Pathogenic wind meets fire, blood/qi overflow, losing normal rhythm. Two Yangs scorch the body, causing jaundice. Yang excess leads to nosebleed; Yin deficiency leads to difficult urination. Dual Yin/Yang exhaustion causes dry body. Only head sweats up to neck. Abdominal fullness, slight wheezing, dry mouth, rotten throat, or constipation. Long-term delirium, severe retching, hand/foot restlessness, picking at clothes/bed. If urination is free, treatable.
Wind is Yang; Fire is Yang. Pathogenic wind aided by fire boils blood/qi, losing rhythm. Steaming causes jaundice. Yang pathogen in Yang positions may resolve via nosebleed or sweat. But Yang pathogen entering Yin positions consumes all fluids. Sweat stops below neck. Dry mouth/throat, scorched lungs, wheezing, dry body, difficult urination, constipation, restlessness, delirium, retching indicate fierce fire-pathogen and imminent death of True Yin, beyond medicinal power. Treatable only if urination is free, indicating Yin not fully injured, Lung Qi not reversed, Bladder Qi transformation active, Kidney Water not dry. Then, driving Yang and saving Yin is possible. Commentators cling to "dual Yin/Yang exhaustion," thinking free urination means Yin not deficient and Yang recoverable, mistaking "treatable" for "Yang restoration." This misses the classic intent. Urgent Yang rescue preserves a thread of Yin; even this is doubtful, let alone restoring Yang to further consume Yin. Head sweat is Yang pathogen congesting upward.