凡三十八条方十八
中风者。单只卫中于风而病也。伤寒者。单只荣伤于寒而病也。若风寒俱有而中伤。则荣卫
皆受而俱病。故以荣卫俱中伤风寒而病者为下编。盖寒虽专令乎冬。而风则无时不有。所以或则
单中单伤。或则俱有而中伤也。单中单伤而为病者已云难治矣。然则俱中伤而病者。其治不尤难乎。
何也。寒须发汗。风则解肌。欲并行而不悖。其为两难也。何如哉。故能发两难发之汗者名曰青
龙。能解两难解之热者名曰白虎。能救无两难。而误服大青龙之逆者则曰真武焉。夫所谓青
龙白虎真武者。言其灵应不难于其所难。妙效验于不可测度。有如此其神。神汤之谓也。神其神。
礼记曰唯圣者能之。其斯之谓乎。学人能明诸此。始可与言医也已。
（一）太阳中风。脉浮紧。发热。恶寒。身疼痛。不汗出而烦躁者。大青龙汤主之。若脉浮
弱。汗出。恶风者。不可服。服之则厥逆。筋惕肉 。此为逆也。以真武汤救之。
末后六字。旧本大青龙汤主之。黄氏正之如此。盖既曰不可服。服之为逆。则安得又复有大
青龙汤主之之文。传写之误甚明。黄氏正之甚是。当从之。后人又因其更改致疑。并六字皆删之。
删之则上编第二十五条无证书据。故存朱以备通考。然此与下条互相发明而同一治。故合二说并
见于下。
（二）伤寒脉浮缓。身不疼但重。乍有轻时。无少阴证者。大青龙汤发之。
大青龙汤方
麻黄（六两去节） 桂枝（二两去皮） 甘草（二两炙） 杏仁（四十枚去皮尖） 生姜
（三两切） 大枣（十二枚擘） 石膏如鸡子大（绵裹碎）
上七味。以水九升。先煮麻黄减二升。去上沫。内诸药。煮取三升。去滓。温服一升。取微
似汗。汗出多者温粉扑之。一服汗者。停后服。汗多亡阳。遂虚。恶风烦躁不得眠也。
上条太阳中风者。言有上编第三条之证也。病属太阳则脉浮。然浮以候风。紧以候寒。发热者。
中风热即发也。恶寒身疼痛。不汗出。皆寒也。风为烦。寒则躁。盖谓风寒俱有而中伤。风多寒少
之证。犹指言此风之中有寒之谓也。此条伤寒者。言有中篇首条之证也。缓者风之诊。身不疼亦
风也。但重。寒也。乍有轻时。亦为有风而然也。无少阴证者。言若是但欲寐。则涉于少阴之疑似矣。
今是但重。故曰无少阴证。亦谓风寒两中伤。荣卫俱受病。寒多风少之证。犹指言此寒之
中有风之谓也。盖风寒二者。大率多相因而少相离。有寒时。不皆无风。有风时。不皆无寒。所
以单中单伤者。固尝自是。相兼而中伤者。亦尝多有。此大青龙之所以作也。二条者互文而互相
发明。以为此篇之小总。太阳分病之纪。上编一。中篇二。此其三焉。三者。太阳一经吃紧太三辨也。
以下凡似此云云以为称首者。皆风寒俱有而中伤之证。其例则又皆统乎此也。夫风寒二治。大法
不外乎桂枝麻黄之二汤。然桂枝汤中忌麻黄。而麻黄汤中反用桂枝。此中有极深奥义。非言国文
字可以形容暴白者。要在人之心领神会耳。大青龙者。桂枝麻黄二汤合剂之变制也。故为并中风
寒之主治。校之桂枝麻黄各半汤。与桂枝二麻黄一汤。则少芍药而多石膏。去芍药者。不欲其收也。
以其无芍药而观之。即
麻黄汤方加石膏姜枣也。姜枣本桂枝汤中所有。其制则重在石膏。按本草。石膏辛甘大寒。辛以
散风。甘以散寒。寒以除热。故为并中风寒发热之用。然青龙以桂枝麻黄得石膏之辛甘而有青龙
之名。其白虎亦以知母粳米得石膏之辛寒而有白虎之名。一物二用。得君而成其功名于异世。神
变于时者也。夫所谓青龙白虎者。青乃木色。龙乃木神。木主春。春热而烦躁。雷雨解而致和焉。
人之汗。以天地之雨名之。龙兴云雨至。发烦躁之汗而荣卫以和。龙之所以为汤。神汤之谓也。
白乃金色。虎乃金神。金主秋。秋热而燥渴。金风解而荐凉焉。人之气以天地之疾风名之。虎啸
谷风生。解燥渴之热而表里以凉。虎之所以为汤。神汤之谓也。然均是龙也而一则曰主之。一则
曰发之。何也。主之者。以烦躁之急疾属动而言。发之者。以但重之沉默属静而言之也。上条末
节。脉微弱汗出恶风。盖指上编阳浮而阴弱中风之证而言。中风误服大青龙则为逆。其第二十五
条是也。与此参看。其义自合。夫以中风之用桂枝汤。伤寒用麻黄汤。风寒俱中伤而用大青龙汤。
向使认病亲切于克始。用汤的对于及时。则三法行之之下。风寒尚有余治乎。然则三百九十七一
百一十三者。医药注误之所致十八九。病病传变之所致无二三。由此观之。司命君子可能不惕惕
于心乎。是故。仲景氏之所以若然者。岂得已哉。惟其不得已。故谆谆然曰。知犯何逆。随证治之。
知犯何逆。以法治之。斯言也。岂非深忧天下后世而自致其不能尽其所欲言之意耶。呜呼。以仲
景氏方法之多如许。而犹自致其不能尽其所欲言之意如此。则后之以截江。杀车。活人。类证。
纂要。自谓能尽伤寒之治。而胶柱以待天下后世者。吾不知其是诚何心也。
（三）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。其人发烦目瞑。剧者必衄。衄乃解。所以然者阳气重故也。麻黄汤主之。
太阳病。脉浮紧无汗发热身疼痛。皆与首条同。而无恶寒烦躁。则是较轻于首条。亦风寒俱
有而中伤之证也。微除。言虽未全罢亦已减轻也。发烦风壅而气昏也。目瞑。寒郁而血滞也。剧。
作衄之兆也。衄。鼻出血也。鼻为肺之窍。肺为阳中之阴而主气。阳邪上盛。所以气载血上妄行
而逆出于鼻也。阳气。以风而言也。风为阳而由气道。所以得随衄散解。故曰阳气重故也。用麻
黄汤者。以寒属阴。性沉滞而难解。所以须发之也。方见中篇。下同。
（四）太阳病。脉浮紧。发热身无汗。自衄者愈。
此承上条复以其更较轻者言。以见证亦有不治自愈之变。所以晓人勿妄治以致误之意。太阳
病脉浮紧。发热身无汗与上条同。而无疼痛。既无疼痛。则比之上条又更较轻于首条可知矣。所以
不待攻治。得衄则亦自愈。得衄自愈者。汗本血之液。北人谓衄为红汗。达此义也。
（五）伤寒。脉浮紧。不发汗。因致衄者。麻黄汤主之。
以伤寒为首称而承之以脉浮紧者。寒多风少之谓也。上二条皆风多寒少。前条以服药已微除。
汗发不对而致衄。上条以较轻得自衄。此以寒多不发汗而致衄。三条之所以辨差分也。盖寒多则于
法当发汗。当发而失于不发。热郁血乱。所以衄也。衄则阳邪之风散。麻黄汤者。发其尚未散之寒也。
（六）脉浮紧者法当身疼痛。宜以汗解之。假令尺中迟者。不可发汗。何以知之。然以荣气
不足。血少故也。
令。平声。此总上三条而着其不可汗之脉。所以严致戒慎之意也。盖尺以候阴。迟为不足。
血。阴也。荣主血。汗者。血之
液。尺迟不可发汗者。嫌夺血也。
（七）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。
桂枝麻黄各半汤方
杏仁（二十四个去皮尖） 桂枝（一两十六铢去皮） 芍药（一两） 生姜（一两切） 甘草
（一两炙） 麻黄（一两去节） 大枣（四枚擘）
上七味。以水五升。先煮麻黄一二沸。去上沫。内诸药。煮取一升八合。去滓。温服六合。
八九日。约言久也。如疟状。谓有往来寒热而无作辍之常也。发热恶寒热多寒少者。风寒俱有而
寒少风多也。不呕不渴清便欲自可。邪之往来。出者未彻表。入亦未及里也。一日二三度发。乃
邪居浅近。则往来易及而频数。故脉亦微缓而谓为欲愈也。脉微而恶寒已下。重以不得解者言而
出其治也。阴言后。阳言前。俱虚。故禁攻也。更。再也。不可汗。已过表也。不可吐下。未见
有里也。热色。阳浮外薄也。然阳虽外薄。以阴寒持之而不能散。所以小汗亦不能得出。气郁而
痒也。桂枝麻黄各半汤者。总风寒而两解之之谓也。此与第十四篇第二十章互看。
（八）太阳病。发热。恶寒。热多寒少。脉微弱者。此无阳也。不可更汗。宜桂枝二越婢一汤。
桂枝二越婢一汤方
桂枝（十八铢去皮） 芍药（十八铢） 甘草（十八铢炙） 生姜（一两三钱切） 大枣
（四枚擘） 麻黄（十八铢去节） 石膏（二十四铢碎绵裹）
上七味。 咀。以水五升。煮麻黄一二沸。去上沫。内诸药。煮取二升。去滓。温服一升。
本方当裁为越婢汤桂枝汤合饮一升。今合为一方桂枝二越婢一。
发热恶寒。热多寒少。与上条同。上条以脉微而恶寒为阴阳俱虚。此以脉微弱为无阳。两皆
不可更汗亦同。然风为阳。病属太阳。而曰无阳。诚不可晓。阙疑可也。或曰。无阳者。谓有疾
在阴而无在阳也。审药识病。即越婢观之可知矣。越。逾也过也。婢。女子之卑者也。女子。阴也。
卑。少也。言其人本来虚弱。有宿疾在少阴。少阴之脉本微弱而有不可发汗之义。所以但责其难
发汗之过在于少阴。法则谓之无阳。方则谓之越婢。且是汤也。名虽越婢之辅桂枝。实则桂枝麻
黄之合济。乃大青龙以芍药易杏仁之变制耳。去杏仁者。恶其从阳而主气也。用芍药者。以其走
阴而酸收也。以此易彼而曰桂枝二。则主之以不发汗可知。而越婢一者。乃麻黄石膏之二物。则
是寓微发于不发之中亦可识也。寓微发者。寒少也。主之以不发者。风多而宿疾在少阴也。又况
首条末节不可服大青龙以发汗。亦由脉微弱。首条末节者。以太阳中风言也。此与上二条者。
皆以风多寒少言也。合而观之。则无阳之阳义不微矣乎。说者如此。未知是否。
（九）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。
桂枝二麻黄一汤方
桂枝（一两十七铢去皮） 芍药（一两六铢） 麻黄（十六铢去节） 生姜（一两六铢切）
杏仁（十六个去皮尖） 甘草（一两二铢炙） 大枣（五枚擘）
上七味。以水五升。先煮麻黄一二沸。去上沫。内诸药。煮取二升。去滓。温服一升。日再服。
服桂枝汤。证转大汗出。脉转洪大者。风多寒少。风邪欲散而寒持之。两皆不得解而热反甚也。
与桂枝汤如前法者。重赜之也。形如疟日再发者。邪居浅而外向。终为微寒所持。故曰汗出必解。
言须发之也。桂枝二麻黄一汤者。重解风而轻于散寒也。
（十）服桂枝汤。大汗出后。大烦渴不解。脉洪大者。白虎加人参汤主之。
此与上条同而多大烦渴。盖比上条汗更出过多。亡津液而表里燥热更甚。所以用白虎两解表
里之热。加人参润其燥而消其渴也。（方见下。）
（十一）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
汤去桂加茯苓白术汤主之。
桂枝去桂加茯苓白术汤方
于桂枝汤方内。去桂枝。加茯苓白术各三两。余根据桂枝汤法煎服。小便利则愈。
服桂枝汤病不解而证变者。不独中风而且有寒也。又或下之。益误也。仍头项强痛翕翕发热
无汗者。风寒之表皆在而未除也。心下满微痛者。误下而证入里也。小便不利。下后亡津液而水
饮停也。去桂枝用芍药甘草者。收重伤之阴而益里伤之虚也。姜枣健脾胃而和中。下后用之更宜。
故二物仍其旧也。茯苓淡渗以利窍。术能益土以胜水。本其有
停饮之故。所以加之。以为拯前治之误也。脉经术上无白字。
（十二）伤寒不大便六七日。头痛有热者。与承气汤。其小便清者。知不在里仍在表也。当
须发汗。若头痛者。必衄。宜桂枝汤。
有热则不大便为里实明矣。故虽头痛亦宜承气汤下之。小便清则里无热可知。故曰仍在表宜
发汗。然小便清而头痛。阳邪上盛也。故衄可必。而宜桂枝汤解之。承气汤有四方。此不明言。
要当随证辨用耳。桂枝汤方见上编。
（十三）伤寒脉浮滑。此表有热里有寒。白虎汤主之。
白虎汤方
知母（六两） 石膏（一斤碎绵裹） 甘草（二两炙） 粳米（六合）
上四味。以水一斗。煮米熟汤成。去滓。温服一升。日三服。
伤寒见中篇首条。其脉不浮。浮者。风也。言不独伤于寒而亦有风则然也。滑为里热。以滑
且浮。知热不独在里也。故指言此表有热。盖表里俱热之谓也。里有寒者。里字非对表而称。以
热之里言。盖伤寒之热本寒因也。故谓热里有寒。指热之所以然者言也。夫寒与风俱中伤。表与
里既皆热。欲两皆而解之。诚哉极其难也。譬如夏秋两届之间。燥热酷甚。非金风之荐凉。则暑
毒不解也。是故白虎者。西方之金神。司秋之阴兽。虎啸谷风冷。凉生酷暑消。神于解秋。莫如
凡是三十八条，涉及十八个方剂。
中风病，是指卫气单独被风邪侵袭而发病。伤寒病，是指营气单独被寒邪损伤而发病。如果风寒同时存在并侵袭人体，那么营气和卫气都会受到损害而共同发病。因此，将营卫同时遭受风寒侵袭而发病的情况列为下编。虽然寒冷主要主宰冬季，但风邪却无时无刻不存在。所以有时是单独受风或单独受寒，有时则是风寒俱有而共同侵袭。单独受风或单独受寒而发病的情况已经难以治疗了，那么同时遭受风寒侵袭而发病的情况，治疗岂不是更加困难吗？为什么呢？因为寒邪需要用发汗的方法治疗，风邪则需要用解肌的方法治疗。想要这两种方法并行而不冲突，确实非常两难。怎样才能做到呢？能够发出这种两难之证的汗的方剂，称为青龙汤；能够解除这种两难之热的方剂，称为白虎汤；能够挽救因误服大青龙汤而导致逆证（无两难之证却误治）的方剂，则称为真武汤。所谓青龙、白虎、真武，是说它们能在困难之处显得灵验，在不可测度的地方显现出奇妙的疗效，像这样神奇，这就是所谓的“神汤”。《礼记》说只有圣人才能做到这一点，说的就是这种情况吧。学习的人如果能明白这些道理，才可以与他谈论医学了。
（一）太阳中风证，出现脉浮紧，发热，恶寒，身体疼痛，无汗且烦躁的症状，以大青龙汤为主治方剂。如果脉象浮弱，有汗出，恶风，则不可服用大青龙汤。如果误服，会导致四肢厥冷，筋肉跳动，肌肉瞤动，这是误治导致的逆证。此时应用真武汤来救治。
最后六个字“此为逆也。以真武汤救之”，旧本中在大青龙汤主之之后。黄氏将其校正为如此位置。既然说了不可服用，误服即为逆证，怎么还会有接着说“大青龙汤主之”的文字呢？这显然是传抄过程中的错误。黄氏的校正是非常正确的，应当遵从。后人又因为他的更改而产生怀疑，甚至将这六个字都删除了。如果删除了，那么上编第二十五条就失去了佐证依据。所以保留朱熹版本的文字以备通考。然而这一条与下一条互相阐发且治疗方法相同，所以将两种说法合并见于下文。
（二）伤寒病，脉象浮缓，身体不疼只觉沉重，偶尔有减轻的时候，如果没有少阴病的症状，可用大青龙汤发散。
大青龙汤方
麻黄（六两，去节） 桂枝（二两，去皮） 甘草（二两，炙） 杏仁（四十枚，去皮尖） 生姜（三两，切） 大枣（十二枚，掰开） 石膏（如鸡蛋大小，用绵布包裹捣碎）
以上七味药，用水九升，先煮麻黄，减少二升水，去掉水面上的浮沫，加入其他药物，煮取三升药液，去渣。温服一升。服药后取微似汗出的效果。如果汗出过多，用温粉扑身止汗。服一次药若已出汗，停服后面的药。如果汗出过多导致亡阳，身体虚弱，会出现恶风、烦躁、不能安眠的症状。
上一条所说的太阳中风，是指具备上编第三条所述的症状。病属太阳经，所以脉浮。然而浮脉候风，紧脉候寒。发热，是中风热邪即发的表现。恶寒、身体疼痛、无汗，都是寒邪的表现。风邪引起烦，寒邪引起躁。这里说的是风寒同时存在并侵袭，风多寒少的证候。仍然指明这种风中包含寒邪的意思。这一条所说的伤寒，是指具备中篇首条所述的症状。缓脉是风的诊象，身体不疼也是风邪的表现。只是沉重，是寒邪的表现。偶尔有减轻的时候，也是因为风邪的作用。没有少阴病的症状，是说如果是嗜睡欲寐，那就涉及少阴病的疑似情况了。现在是仅仅身体沉重，所以说没有少阴病。这也是指风寒两伤，营卫俱病，寒多风少的证候。仍然指明这种寒中包含风邪的意思。大概风寒二者，大多相互伴随而很少分离。有寒的时候，不一定没有风；有风的时候，不一定没有寒。所以单独受风或受寒的，固然各自有其特点；相互兼夹而共同侵袭的，也常常有很多。这就是大青龙汤产生的原因。这两条条文互为文义，互相阐发，作为本篇的小总纲，太阳分病的纲领。上编一条，中篇两条，这是第三条。这三条，是太阳一经最关键的辨治要点。以下凡是类似这样开头的，都是风寒同时存在并侵袭的证候，其体例也都统摄于此。对于风寒两种病邪的治疗，大法不外乎桂枝汤和麻黄汤这两个方剂。然而桂枝汤中忌讳使用麻黄，而麻黄汤中反而使用桂枝，这其中有着极深奥的道理，不是语言文字可以轻易形容清楚的，关键在于人们的心领神会。大青龙汤，是桂枝汤和麻黄汤两个方剂合剂的变制方。所以它是治疗同时感受风寒的主方。与桂枝麻黄各半汤、桂枝二麻黄一汤相比，它少了芍药而多了石膏。去掉芍药，是不希望它收敛。从没有芍药这一点来看，它就是麻黄汤加上石膏、生姜、大枣。生姜和大枣本来就是桂枝汤中的成分。这个方子的重点在于石膏。根据本草记载，石膏性辛、甘、大寒。辛能散风，甘能散寒，寒能除热。所以它是用来治疗同时感受风寒引起的发热的。然而青龙汤之所以得名，是因为桂枝和麻黄得到石膏的辛甘而有了青龙的名称。白虎汤也是如此，知母和粳米得到石膏的辛寒而有了白虎的名称。一味药有两种用途，凭借君药的地位在不同的时代成就其功名，在时变中展现神奇的变化。所谓青龙、白虎，青色是木的颜色，龙是木的神灵，木主宰春季，春天温热而烦躁，雷雨降临而达到和谐。人的汗，可以用天地的雨来比喻。龙兴起云雨到来，发出烦躁之汗而使营卫调和。这就是龙之所以成为汤剂的原因，称之为神汤。白色是金的颜色，虎是金的神灵，金主宰秋季，秋天燥热而口渴，金风吹拂而带来凉爽。人的气，可以用天地的疾风来比喻。虎啸叫而谷风生起，解除燥渴之热而使表里清凉。这就是虎之所以成为汤剂的原因，称之为神汤。然而同样是龙，一条说“主之”，一条说“发之”，为什么呢？“主之”，是因为烦躁急迫属于动态而言；“发之”，是因为仅仅身体沉重的沉默状态属于静态而言。上一条末尾提到的脉微弱、汗出、恶风，是指向上编阳浮而阴弱的中风证而言。中风误服大青龙汤就会造成逆证，就是第二十五条的内容。与此条参看，意义自然吻合。用桂枝汤治疗中风，用麻黄汤治疗伤寒，风寒同时侵袭用大青龙汤。假如一开始就能准确认识病情，用药及时对症，那么这三种方法施行下去，风寒还有剩余的治疗方法吗？然而三百九十七法、一百一十三方中，医药失误造成的占十分之八九，疾病传变造成的占不到十分之二三。由此看来，掌管生命的大夫怎么能不警惕在心呢？因此，张仲景先生之所以这样做，难道是出于无奈吗？正因为不得已，所以他谆谆告诫说：“知道犯了什么逆证，随着证候进行治疗。”“知道犯了什么逆证，按照法治疗。”这些话，难道不是深深忧虑天下后世，而自己表达出不能完全尽述心意的意思吗？唉！以张仲景先生的方法如此之多，却还自我表达出不能完全尽述心意的意思像这样，那么后来那些自称能穷尽伤寒治疗，拿着死板的方法对待天下后世的人，我不知道他们究竟是何居心。
（三）太阳病，脉浮紧，无汗，发热，身体疼痛，经过八九天没有解除，表证仍然存在，这应当发汗。服药后，症状稍微缓解。病人出现心烦，眼睛闭合不想睁开，严重的必定流鼻血，鼻血流出后病才解除。之所以这样，是因为阳气郁重所致。主治方剂为麻黄汤。
太阳病，脉浮紧，无汗，发热，身体疼痛，都与第一条相同，但没有恶寒和烦躁，说明比第一条轻，这也是风寒同时存在并侵袭的证候。“微除”，意思是虽然没有完全停止，但也已经减轻了。“发烦”，是风邪壅滞导致气机昏蒙。“目瞑”，是寒邪郁结导致血液停滞。“剧”，是即将发生鼻血的征兆。“衄”，即鼻出血。鼻子是肺的窍道，肺是阳中之阴脏，主管气。阳邪在上部盛实，所以气推动血液向上妄行，逆而出于鼻腔。这里的“阳气”，是从风的角度来说的。风属于阳，由气道运行，所以能随着鼻血散发解除。所以说“阳气重故也”。使用麻黄汤，是因为寒属于阴，性质沉滞难以解散，所以需要发汗来解除。方剂见中篇，下同。
（四）太阳病，脉浮紧，发热，身体无汗，自己流鼻血的，病会痊愈。
这是承接上一条，进一步用更轻的情况来说明。因为见证也有不治疗而自愈的变化，以此告知人们不要妄加治疗以致误治。太阳病脉浮紧，发热，身体无汗，与上一条相同，但没有疼痛。既然没有疼痛，那么比起上一条又比第一条更轻，这是显而易见的。所以不需要攻治，得到鼻血也就自愈了。得衄自愈的道理是：汗本是血的液体，北方人称鼻血为“红汗”，通达了这个含义。
（五）伤寒病，脉浮紧，没有发汗，因而导致流鼻血的，主治方剂为麻黄汤。
以伤寒为首称并承接脉浮紧，是说寒多风少。上面两条都是风多寒少。前一条因为服药后症状稍减，发汗不对症而导致鼻血。上一条因为病情较轻而自发性鼻血。这一条因为寒多没有发汗而导致鼻血。这三条之所以要辨别区分。大概寒多则依法应当发汗。应当发汗而失于不发，热郁血乱，所以导致鼻血。鼻血流出则阳邪之风散失。麻黄汤，是发散那尚未散失的寒邪。
（六）脉浮紧者，依法应当身体疼痛，适宜用发汗法解除。假如尺中脉迟者，不可发汗。为什么知道是这样？因为营气不足，血少的原因。
“令”，读平声。这是总结上面三条，指出不可发汗的脉象，以此来严格警示谨慎的意思。尺脉候阴，迟脉表示不足。血，属于阴。营气主营血。汗，是血的液体。尺脉迟不可发汗，是担心夺血。
（七）太阳病，得了八九天，像疟疾的样子，发热，恶寒，热多寒少。病人不呕吐，大小便基本正常。一天发作两三次，脉象微缓的，是快要痊愈了。脉微，并且恶寒的，这是阴阳俱虚，不可以再发汗、再泻下、再催吐。面色反而有热色的，病还没有解除。因为不能得到小汗出，身体必定发痒，适宜用桂枝麻黄各半汤。
桂枝麻黄各半汤方
杏仁（二十四个，去皮尖） 桂枝（一两十六铢，去皮） 芍药（一两） 生姜（一两，切） 甘草（一两，炙） 麻黄（一两，去节） 大枣（四枚，掰开）
以上七味药，用水五升，先煮麻黄一二沸，去掉水面上的浮沫，加入其他药物，煮取一升八合药液，去渣。温服六合。
“八九日”，是概言时间久。“如疟状”，是说有往来寒热但没有固定的发作规律。发热恶寒，热多寒少，是风寒俱有而寒少风多。不呕吐，不渴，大小便基本正常，说明邪气往来，出来未彻表，进去也未及里。一天发作两三次，乃是因为邪气停留浅近，所以往来容易且频繁。因此脉象也微缓，说是快要痊愈了。脉微而恶寒以下，是重新论述未能解除的情况并给出治法。阴在后，阳在前。俱虚，所以禁止攻伐。更，是再次的意思。不可发汗，是因为表证已过。不可吐下，是因为未见里有证。热色，是阳气浮越于外。然而阳气虽外浮，因为有阴寒牵制而不能散失，所以即使小汗也不能得出。气机郁结而发痒。桂枝麻黄各半汤，是说总括风寒而两解之意。这与第十四篇第二十章互相对照观看。
（八）太阳病，发热，恶寒，热多寒少，脉微弱者，这是无阳，不可再发汗，适宜用桂枝二越婢一汤。
桂枝二越婢一汤方
桂枝（十八铢，去皮） 芍药（十八铢） 甘草（十八铢，炙） 生姜（一两三钱，切） 大枣（四枚，掰开） 麻黄（十八铢，去节） 石膏（二十四铢，碎，绵裹）
以上七味药，切碎，用水五升，煮麻黄一二沸，去掉水面上的浮沫，加入其他药物，煮取二升药液，去渣。温服一升。
本方应当裁减为越婢汤和桂枝汤合饮一升，现在合为一个方子，名为桂枝二越婢一。
发热恶寒，热多寒少，与上一条相同。上一条因为脉微而恶寒诊断为阴阳俱虚，这一条因为脉微弱诊断为无阳。两者都不可再发汗也是相同的。然而风为阳，病属太阳，却说无阳，实在令人不解。存疑即可。有人说，无阳，是指有病在阴而无在阳。仔细审视药物识别病证，从越婢汤就可以知道了。越，是逾越、超过的意思。婢，是地位低下的女子。女子，属阴。卑，是少、小的意思。说这个人本来虚弱，有宿疾在少阴。少阴的脉本微弱，而有不可发汗的含义。所以只责怪难发汗的过错在于少阴，法则称之为无阳，方剂则称之为越婢。况且这个汤剂，名义上是越婢辅助桂枝，实际上是桂枝和麻黄的合济，是大青龙汤以芍药替换杏仁的变制方。去掉杏仁，是厌恶它从阳而主气。使用芍药，是因为它走阴而酸收。用这个替换那个而称为桂枝二，则主治不发汗可知。而越婢一，乃是麻黄和石膏两味药，则可以识得其中寓含微发汗于不发汗之中。寓微发，是因为寒少。主之以不发，是因为风多且宿疾在少阴。更何况第一条末尾说不可服大青龙汤发汗，也是由于脉微弱。第一条末尾是指太阳中风而言。这一条与上面两条，都是以风多寒少而言。合起来看，那么无阳的阳的意义不是很微妙了吗？解说的人这样说，不知道是否正确。
（九）服用桂枝汤后，大汗出，脉洪大的，给予桂枝汤按前面的方法服用。如果像疟疾一样一天发作两次的，出汗后必解，适宜用桂枝二麻黄一汤。
桂枝二麻黄一汤方
桂枝（一两十七铢，去皮） 芍药（一两六铢） 麻黄（十六铢，去节） 生姜（一两六铢，切） 杏仁（十六个，去皮尖） 甘草（一两二铢，炙） 大枣（五枚，掰开）
以上七味药，用水五升，先煮麻黄一二沸，去掉水面上的浮沫，加入其他药物，煮取二升药液，去渣。温服一升，一天服两次。
服用桂枝汤，证候转为大汗出，脉转为洪大，是风多寒少，风邪欲散而寒邪持留，两者都不能解除而热反而加重。给予桂枝汤按前面方法服用，是为了慎重复杂的情况。像疟疾一样一天发作两次，是邪气停留浅表而向外，终究被微寒所束缚，所以说出汗后必解。意思是必须发汗。桂枝二麻黄一汤，是重在解风而轻于散寒。
（十）服用桂枝汤后，大汗出之后，出现大烦渴不解，脉洪大的，主治方剂为白虎加人参汤。
这一条与上一条相同但多了大烦渴。大概比上一条汗出更多，亡失津液而表里燥热更甚。所以用白虎汤两解表里之热，加人参滋润其燥而消除其渴。（方剂见下文。）
（十一）服用桂枝汤，或者经过泻下治疗后，仍然头项强痛，翕翕发热，无汗，心下满，微痛，小便不利者，主治方剂为桂枝汤去桂加茯苓白术汤。
桂枝去桂加茯苓白术汤方
在桂枝汤方内，去掉桂枝，加茯苓、白术各三两。其余依照桂枝汤法煎服。小便利则愈。
服用桂枝汤病未解而证候变化的，不只是中风而且有寒。又或者经过泻下，更是误治。仍然头项强痛，翕翕发热，无汗，是风寒表证都在而未除。心下满微痛，是误下后证候入里。小便不利，是下后亡津液而水饮停聚。去掉桂枝用芍药甘草，是为了收敛重伤的阴气而补益里伤的虚损。姜枣健脾胃而和中，下后使用更为适宜。所以这两味药仍用旧的。茯苓淡渗以利窍，术能益土以胜水。基于有停饮的缘故，所以加上它们，用来补救之前的治疗错误。《脉经》中术上没有“白”字。
（十二）伤寒不大便六七天，头痛有热的，给予承气汤。如果小便清亮的，知道病不在里仍在表，应当须发汗。如果头痛的，必定流鼻血，适宜用桂枝汤。
有热则不大便是里实证明了。所以即使头痛也适宜用承气汤下之。小便清亮则里无热可知。所以说仍在表宜发汗。然而小便清而头痛，是阳邪上盛。所以鼻血必然发生，而适宜用桂枝汤解之。承气汤有四方，这里不明确说明，应当随证辨别使用。桂枝汤方见上编。
白虎汤方
知母（六两） 石膏（一斤，碎，绵裹） 甘草（二两，炙） 粳米（六合）
以上四味药，用水一斗，煮米熟汤成，去渣。温服一升，一天三次。
伤寒见中篇首条，其脉不浮。浮，是风邪。说不独伤于寒而有风才会这样。滑为里热。以滑且浮，知道热不独在里。所以指明此表有热，是说表里俱热。里有寒者，“里”字不是对表而言，而是从热的内部来说。大概伤寒的热本源于寒。所以谓热里有寒，是指热之所以产生的原因。风寒同时侵袭，表与里既皆热，想要两者都解除，确实极其困难。譬如夏秋两季之间，燥热酷甚，如果不是金风带来凉爽，则暑毒不能解除。因此白虎者，是西方的金神，司掌秋季的阴兽。虎啸谷风冷，凉生酷暑消。在解除秋热方面，没有比...
There are thirty-eight clauses in total, involving eighteen formulas.
Wind-stroke (Zhongfeng) refers to a disease where only the Wei Qi (Defensive Qi) is invaded by Wind pathogen. Cold damage (Shanghan) refers to a disease where only the Ying Qi (Nutritive Qi) is injured by Cold pathogen. If both Wind and Cold exist simultaneously and invade the body, both Ying and Wei will be damaged and suffer together. Therefore, cases where Ying and Wei are simultaneously injured by Wind and Cold are classified under the Lower Section. Although Cold primarily governs Winter, Wind exists at all times. Thus, sometimes one is solely affected by Wind or solely injured by Cold, and other times both coexist and jointly invade. Cases of sole Wind invasion or sole Cold injury are already difficult to treat; therefore, cases of simultaneous Wind and Cold invasion must be even more difficult to treat. Why? Because Cold requires sweating to resolve, while Wind requires releasing the muscle layer. To apply both methods without conflict is indeed a dilemma. How can this be achieved? The formula capable of inducing sweat for this dual difficulty is named Qinglong Tang (Azure Dragon Decoction); the formula capable of resolving this dual heat is named Baihu Tang (White Tiger Decoction); and the formula capable of saving those who suffered adverse reactions from mistakenly taking Da Qinglong Tang (when there was no dual difficulty) is called Zhenwu Tang (True Warrior Decoction). The terms Azure Dragon, White Tiger, and True Warrior imply that these formulas show their efficacy precisely where difficulties arise, revealing miraculous effects beyond measure. Such divinity justifies calling them "Divine Formulas" (Shen Tang). As stated in the *Book of Rites*, only sages can achieve this—this is what is meant. Only when students understand these principles can they discuss medicine.
(1) In Taiyang Wind-stroke, if the pulse is floating and tight, accompanied by fever, aversion to cold, body pain, anhidrosis (no sweat), and irritability, Da Qinglong Tang (Major Azure Dragon Decoction) is the primary treatment. However, if the pulse is floating and weak, with spontaneous sweating and aversion to wind, Da Qinglong Tang must not be administered. If mistakenly taken, it leads to cold extremities (Jue Ni), twitching of tendons, and fasciculation of muscles. This constitutes an adverse reaction (Ni). In such cases, Zhenwu Tang should be used to rescue the patient.
The last six characters ("This constitutes an adverse reaction. Use Zhenwu Tang to rescue") were originally placed after "Da Qinglong Tang is the primary treatment" in older editions. Huang corrected their position. Since it states that the formula must not be taken and mistaken use causes an adverse reaction, it makes no sense to follow it with "Da Qinglong Tang is the primary treatment." This is clearly a transcription error. Huang's correction is correct and should be followed. Later scholars, doubting his changes, deleted these six characters entirely. Deleting them removes evidence for Clause 25 in the Upper Section. Therefore, Zhu Xi's version retains them for comprehensive study. However, since this clause and the next mutually elucidate each other and share the same treatment, both views are presented together below.
(2) In Cold damage, if the pulse is floating and slow, the body feels heavy but not painful, with occasional relief, and there are no Shaoyin syndrome signs, Da Qinglong Tang should be used to disperse the pathogen.
Formula: Da Qinglong Tang (Major Azure Dragon Decoction)
Ephedrae Herba (Mahuang, 麻黄) - 6 liang, remove nodes
Cinnamomi Ramulus (Guizhi, 桂枝) - 2 liang, remove bark
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 2 liang, honey-fried
Prunus Armeniaca Semen (Xingren, 杏仁) - 40 seeds, remove skin and尖
Zingiberis Rhizoma Recens (Shengjiang, 生姜) - 3 liang, sliced
Jujubae Fructus (Dazao, 大枣) - 12 pieces, torn open
Receptacum Nelumbinis (Shigao, 石膏) - size of a chicken egg, wrapped in silk and crushed
Take seven ingredients. Add nine sheng of water. First boil Ephedrae Herba until reduced by two sheng, discard the foam on the surface. Add remaining herbs. Boil to obtain three sheng of decoction. Strain. Take one sheng warm. Aim for slight perspiration. If sweating is excessive, dust the body with warm powder to stop sweat. If one dose induces sweat, stop taking the remainder. Excessive sweating leads to Yang collapse, resulting in deficiency, aversion to wind, irritability, and insomnia.
The previous clause regarding Taiyang Wind-stroke refers to symptoms described in Clause 3 of the Upper Section. Disease belonging to Taiyang presents with a floating pulse. Floating indicates Wind, while tight indicates Cold. Fever indicates the immediate manifestation of Wind-heat. Aversion to cold, body pain, and anhidrosis are signs of Cold. Wind causes irritability (Fan), while Cold causes restlessness (Zao). This describes a condition where both Wind and Cold are present, with Wind predominating over Cold. It implies that within the Wind invasion, there is also Cold. This clause regarding Cold damage refers to symptoms in the first clause of the Middle Section. Slow pulse is a diagnostic sign of Wind; lack of body pain also indicates Wind. Heaviness indicates Cold. Occasional relief is due to the presence of Wind. "No Shaoyin signs" means that if the patient were lethargic and desirous of sleeping, it would resemble Shaoyin disease. Here, there is only heaviness, so it is stated as no Shaoyin signs. This also refers to a condition where both Wind and Cold injure Ying and Wei, with Cold predominating over Wind. It implies that within the Cold invasion, there is also Wind. Generally, Wind and Cold accompany each other and rarely separate. Where there is Cold, there is often Wind; where there is Wind, there is often Cold. Thus, sole invasions have their specific characteristics, but combined invasions are common. This is why Da Qinglong Tang was created. These two clauses are complementary, serving as a mini-summary for this chapter and the outline of Taiyang differentiated diseases. One clause in the Upper Section, two in the Middle Section, and this is the third. These three are the critical differentiations for the Taiyang channel. All subsequent clauses starting similarly refer to simultaneous Wind and Cold invasion, following this principle. The general principles for treating Wind and Cold do not exceed Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang (Ephedra Decoction). However, Mahuang is contraindicated in Guizhi Tang, yet Guizhi is used in Mahuang Tang. This contains profound meaning, not easily explained by words, requiring intuitive understanding. Da Qinglong Tang is a modified combination of Guizhi Tang and Mahuang Tang. Thus, it is the main treatment for simultaneous Wind and Cold. Compared to Guizhi Mahuang Ban Tang (Half-Guizhi Half-Mahuang Decoction) and Guizhi Er Mahuang Yi Tang (Two-Parts Guizhi One-Part Mahuang Decoction), it lacks Shaoyao (Paeoniae Radix Alba) and contains more Shigao (Gypsum Fibrosum). Removing Shaoyao avoids astringency. Viewed without Shaoyao, it is essentially Mahuang Tang plus Shigao, Shengjiang, and Dazao. Shengjiang and Dazao are original components of Guizhi Tang. The key ingredient here is Shigao. According to Materia Medica, Shigao is acrid, sweet, and very cold. Acrid disperses Wind, sweet disperses Cold, and cold clears Heat. Thus, it treats fever caused by simultaneous Wind and Cold. The name "Qinglong" (Azure Dragon) comes from Guizhi and Mahuang gaining the acrid-sweet properties from Shigao. Similarly, "Baihu" (White Tiger) comes from Zhimu (Anemarrhenae Rhizoma) and Jingmi (Oryza Sativa) gaining the acrid-cold properties from Shigao. One herb serves two purposes, achieving fame through its sovereign role in different eras, demonstrating divine transformation. "Qinglong" (Azure Dragon): Green is the color of Wood; Dragon is the spirit of Wood; Wood governs Spring. Spring is warm and prone to irritability; thunderstorms bring harmony. Human sweat is likened to heavenly rain. When the Dragon rises, clouds and rain arrive, inducing sweat to relieve irritability and harmonize Ying and Wei. Hence, it is called a Divine Formula. "Baihu" (White Tiger): White is the color of Metal; Tiger is the spirit of Metal; Metal governs Autumn. Autumn is dry and hot with thirst; metal winds bring coolness. Human Qi is likened to swift winds. When the Tiger roars, valley winds arise, relieving dry heat and cooling the interior and exterior. Hence, it is called a Divine Formula. However, why does one clause say "governs" (zhu zhi) and another says "disperse" (fa zhi)? "Governs" refers to the urgency of irritability, which is dynamic. "Disperse" refers to the silence of mere heaviness, which is static. The end of the previous clause mentions weak pulse, sweating, and aversion to wind, referring to the Wind-stroke syndrome of floating Yang and weak Yin from the Upper Section. Mistakenly using Da Qinglong Tang for Wind-stroke causes adverse reactions, as seen in Clause 25. Comparing this clarifies the meaning. Using Guizhi Tang for Wind-stroke, Mahuang Tang for Cold damage, and Da Qinglong Tang for simultaneous invasion: if one accurately diagnoses early and applies the correct formula promptly, are there any remaining treatments needed for Wind and Cold after these three methods? Yet, among the 397 methods and 113 formulas, 80-90% result from medical errors, and less than 20% from disease transmission. From this, physicians responsible for life must remain vigilant. Thus, Zhang Zhongjing’s approach was not out of choice but necessity. Hence he earnestly said, "Know what error occurred, and treat according to the syndrome." "Know what error occurred, and apply the appropriate method." Do these words not express deep concern for future generations and the inability to fully articulate his intent? Alas! With so many methods from Zhang Zhongjing, yet still expressing incomplete intent, how can later authors claiming to exhaustively treat Cold Damage, relying on rigid interpretations, justify their mindset?
(3) In Taiyang disease, if the pulse is floating and tight, with anhidrosis, fever, and body pain, persisting for eight or nine days without resolution, and exterior signs remain, sweating should be induced. After medication, symptoms may slightly alleviate. The patient may experience irritability and closed eyes. Severe cases will likely suffer epistaxis (nosebleed), which resolves the disease. This occurs because Yang Qi is heavily constrained. Mahuang Tang is the primary treatment.
Taiyang disease with floating-tight pulse, anhidrosis, fever, and body pain matches the first clause, but lacks aversion to cold and irritability, indicating a milder case of simultaneous Wind and Cold invasion. "Slightly alleviated" means symptoms have reduced but not ceased. "Irritability" results from Wind obstruction causing Qi stagnation. "Closed eyes" results from Cold constraint causing Blood stasis. "Severe" indicates impending epistaxis. "Epistaxis" is nosebleed. The nose is the orifice of the Lung, which governs Qi and is Yin within Yang. Excess Yang pathogen forces Qi and Blood upward, causing bleeding from the nose. "Yang Qi" here refers to Wind. Wind is Yang and travels via Qi channels, thus dissipating with epistaxis. Hence, "because Yang Qi is heavy." Mahuang Tang is used because Cold is Yin, sinking and stagnant, requiring sweating to resolve. See Middle Section for formula.
(4) In Taiyang disease, if the pulse is floating and tight, with fever and anhidrosis, spontaneous epistaxis leads to recovery.
This continues the previous clause, describing an even milder variation where self-healing occurs without intervention, warning against unnecessary treatment. Taiyang disease with floating-tight pulse, fever, and anhidrosis matches the previous clause, but lacks pain. Lack of pain makes it milder than the previous clause, and thus milder than the first clause. No aggressive treatment is needed; epistaxis leads to self-healing. Sweat is the fluid of Blood; northerners call epistaxis "red sweat," reflecting this concept.
(5) In Cold damage, if the pulse is floating and tight, and failure to induce sweating leads to epistaxis, Mahuang Tang is the primary treatment.
Starting with "Cold damage" and "floating-tight pulse" indicates Cold predominates over Wind. The previous two clauses involved Wind predominating. The first resulted in epistaxis due to mismatched sweating; the second due to mildness causing spontaneous epistaxis. This one results from Cold predominance and failure to sweat. These three clauses distinguish these differences. Generally, excess Cold requires sweating. Failure to sweat when indicated causes Heat constraint and Blood chaos, leading to epistaxis. Epistaxis dissipates Yang Wind pathogen. Mahuang Tang disperses the remaining Cold.
(6) Floating-tight pulses typically indicate body pain and should be treated with sweating. However, if the Chi position pulse is slow, sweating is contraindicated. Why? Because Ying Qi is deficient and Blood is scant.
"Ling" is pronounced level tone. This summarizes the previous three clauses, highlighting pulses contraindicating sweating to emphasize caution. Chi pulse inspects Yin; slow pulse indicates deficiency. Blood is Yin. Ying governs Blood. Sweat is the fluid of Blood. Slow Chi pulse contraindicates sweating to avoid depleting Blood.
(7) In Taiyang disease, after eight or nine days, resembling malaria with fever, aversion to cold, more heat than cold, no vomiting, normal bowel movements, occurring two or three times a day, if the pulse is slightly slow and relaxed, recovery is imminent. If the pulse is faint and accompanied by aversion to cold, this indicates deficiency of both Yin and Yang; sweating, purging, and vomiting are all contraindicated. If the face shows redness, the disease has not resolved. Due to inability to produce slight sweat, the body will itch. Guizhi Mahuang Ban Tang is suitable.
Formula: Guizhi Mahuang Ban Tang (Half-Guizhi Half-Mahuang Decoction)
Prunus Armeniaca Semen (Xingren, 杏仁) - 24 seeds, remove skin and尖
Cinnamomi Ramulus (Guizhi, 桂枝) - 1 liang 16 zhu, remove bark
Paeoniae Radix Alba (Shaoyao, 芍药) - 1 liang
Zingiberis Rhizoma Recens (Shengjiang, 生姜) - 1 liang, sliced
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 1 liang, honey-fried
Ephedrae Herba (Mahuang, 麻黄) - 1 liang, remove nodes
Jujubae Fructus (Dazao, 大枣) - 4 pieces, torn open
Take seven ingredients. Add five sheng of water. First boil Ephedrae Herba for one or two boils, discard foam. Add remaining herbs. Boil to obtain 1.8 sheng. Strain. Take 0.6 sheng warm.
"Eight or nine days" implies a long duration. "Resembling malaria" means alternating chills and fever without regularity. More heat than cold indicates Wind predominates over Cold. No vomiting or thirst, normal bowels, means pathogen is neither fully exterior nor interior. Occurring multiple times daily indicates shallow pathogen location, allowing easy fluctuation, hence the slightly relaxed pulse suggests recovery. Faint pulse with aversion to cold indicates Yin-Yang deficiency, prohibiting attack. "Geng" means again. Contraindication of sweating means exterior is passed. Contraindication of purging/vomiting means no interior signs. Red face indicates Yang floating outward. Although Yang floats, Yin-Cold prevents dispersion, preventing even slight sweat. Qi constraint causes itching. Guizhi Mahuang Ban Tang resolves both Wind and Cold. Compare with Chapter 14, Clause 20.
(8) In Taiyang disease, with fever, aversion to cold, more heat than cold, and faint pulse, this indicates "No Yang." Sweating is contraindicated. Guizhi Er Yuebi Yi Tang is suitable.
Formula: Guizhi Er Yuebi Yi Tang (Two-Parts Guizhi One-Part Yuebi Decoction)
Cinnamomi Ramulus (Guizhi, 桂枝) - 18 zhu, remove bark
Paeoniae Radix Alba (Shaoyao, 芍药) - 18 zhu
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 18 zhu, honey-fried
Zingiberis Rhizoma Recens (Shengjiang, 生姜) - 1 liang 3 qian, sliced
Jujubae Fructus (Dazao, 大枣) - 4 pieces, torn open
Ephedrae Herba (Mahuang, 麻黄) - 18 zhu, remove nodes
Receptacum Nelumbinis (Shigao, 石膏) - 24 zhu, crushed, wrapped in silk
Chop seven ingredients. Add five sheng of water. Boil Ephedrae Herba for one or two boils, discard foam. Add remaining herbs. Boil to obtain 2 sheng. Strain. Take 1 sheng warm.
Originally, this formula was calculated as one part Yuebi Tang and two parts Guizhi Tang mixed to make one sheng. Now combined into one formula named Guizhi Er Yuebi Yi.
Fever, aversion to cold, more heat than cold matches the previous clause. Previous clause diagnosed Yin-Yang deficiency due to faint pulse and aversion to cold; this diagnoses "No Yang" due to faint pulse. Both contraindicate sweating. Wind is Yang, and disease is Taiyang, yet "No Yang" is confusing. Leave as doubt. Some say "No Yang" means disease is in Yin, not Yang. Examining the formula reveals this. "Yue" means surpass/exceed. "Bi" means low-status woman. Woman is Yin. Low means little. The patient is inherently weak with chronic disease in Shaoyin. Shaoyin pulse is naturally faint, contraindicating sweating. Blame the difficulty on Shaoyin. Hence termed "No Yang" in principle and "Yuebi" in formula. This formula, though nominally Yuebi assisting Guizhi, is actually a combination of Guizhi and Mahuang, a variant of Da Qinglong Tang replacing Xingren with Shaoyao. Removing Xingren avoids its Qi-moving nature. Using Shaoyao utilizes its Yin-entering astringent property. Replacing Xingren with Shaoyao makes it "Guizhi Two," indicating non-sweating focus. "Yuebi One" consists of Mahuang and Shigao, implying slight sweating within non-sweating strategy. Slight sweating addresses minor Cold. Non-sweating addresses predominant Wind and Shaoyin chronic disease. Note Clause 1 end warns against Da Qinglong Tang due to faint pulse. That clause refers to Wind-stroke. This and previous clauses refer to Wind predominating. Combined, the meaning of "No Yang" becomes subtle. Whether this interpretation is correct remains unknown.
(9) After taking Guizhi Tang, if profuse sweating occurs and pulse becomes surging-large, administer Guizhi Tang as before. If symptoms resemble malaria occurring twice daily, sweating will resolve it. Guizhi Er Mahuang Yi Tang is suitable.
Formula: Guizhi Er Mahuang Yi Tang (Two-Parts Guizhi One-Part Mahuang Decoction)
Cinnamomi Ramulus (Guizhi, 桂枝) - 1 liang 17 zhu, remove bark
Paeoniae Radix Alba (Shaoyao, 芍药) - 1 liang 6 zhu
Ephedrae Herba (Mahuang, 麻黄) - 16 zhu, remove nodes
Zingiberis Rhizoma Recens (Shengjiang, 生姜) - 1 liang 6 zhu, sliced
Prunus Armeniaca Semen (Xingren, 杏仁) - 16 seeds, remove skin and尖
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 1 liang 2 zhu, honey-fried
Jujubae Fructus (Dazao, 大枣) - 5 pieces, torn open
Take seven ingredients. Add five sheng of water. First boil Ephedrae Herba for one or two boils, discard foam. Add remaining herbs. Boil to obtain 2 sheng. Strain. Take 1 sheng warm, twice daily.
Profuse sweating and surging-large pulse after Guizhi Tang indicate Wind predominating, Wind pathogen attempting to scatter but held by Cold, causing intensified heat. Re-administering Guizhi Tang emphasizes caution. Resembling malaria twice daily indicates shallow pathogen facing outward but held by slight Cold, requiring sweating for resolution. Guizhi Er Mahuang Yi Tang focuses on resolving Wind rather than dispersing Cold.
(10) After taking Guizhi Tang, if profuse sweating leads to severe irritability and unquenchable thirst with surging-large pulse, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is the primary treatment.
Similar to the previous clause but with severe irritability and thirst. Likely due to excessive sweating damaging fluids, intensifying interior-exterior dry-heat. Baihu Tang clears interior-exterior heat; Ginseng moistens dryness and quenches thirst. (See formula below.)
(11) After taking Guizhi Tang, or after purging, if head/neck stiffness, mild fever, anhidrosis, fullness in epigastrium, slight pain, and dysuria persist, Guizhi Qu Guijia Fuling Baizhu Tang (Guizhi Tang minus Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction) is the primary treatment.
Formula: Guizhi Qu Guijia Fuling Baizhu Tang
In Guizhi Tang formula, remove Cinnamomi Ramulus (Guizhi), add Poria (Fuling) and Atractylodes Macrocephala Rhizome (Baizhu), each 3 liang. Prepare and administer according to Guizhi Tang method. Recovery occurs when urination improves.
Failure to resolve after Guizhi Tang indicates not only Wind-stroke but also Cold. Purging was an additional error. Persistent head/neck stiffness, mild fever, anhidrosis indicate lingering exterior Wind-Cold. Epigastric fullness and slight pain indicate interior shift due to purging. Dysuria indicates fluid retention due to fluid loss from purging. Removing Guizhi and using Shaoyao/Gancao conserves injured Yin and tonifies interior deficiency. Shengjiang/Dazao strengthen Spleen/Stomach and harmonize middle, suitable post-purging. Fuling promotes diuresis; Baizhu strengthens Earth to control Water. Added to address fluid retention and correct previous errors. Note: *Mai Jing* omits "Bai" before Baizhu.
(12) In Cold damage, if constipation persists for six-seven days with headache and fever, administer Chengqi Tang. If urine is clear, the disease is not in the interior but remains in the exterior; sweating is required. If headache occurs, epistaxis is likely; Guizhi Tang is suitable.
Fever with constipation indicates interior excess. Thus, even with headache, Chengqi Tang is appropriate for purging. Clear urine indicates no interior heat, confirming exterior location requiring sweating. Clear urine with headache indicates excess Yang pathogen ascending, making epistaxis certain. Guizhi Tang resolves this. There are four Chengqi Tang formulas; choose based on syndrome. Guizhi Tang see Upper Section.
(13) In Cold damage, if pulse is floating and slippery, this indicates Heat in Exterior and Cold in Interior. Baihu Tang is the primary treatment.
Formula: Baihu Tang (White Tiger Decoction)
Anemarrhenae Rhizoma (Zhimu, 知母) - 6 liang
Receptacum Nelumbinis (Shigao, 石膏) - 1 jin, crushed, wrapped in silk
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 2 liang, honey-fried
Oryza Sativa (Jingmi, 粳米) - 6 he
Take four ingredients. Add ten dou of water. Cook until rice is ripe and soup is ready. Strain. Take 1 sheng warm, three times daily.
Cold damage in Middle Section first clause has non-floating pulse. Floating indicates Wind. This implies injury is not solely by Cold but involves Wind. Slippery indicates interior Heat. Floating and slippery indicate Heat is not solely interior. Thus, "Heat in Exterior" means interior-exterior Heat. "Cold in Interior": "Interior" here does not contrast with Exterior, but refers to the origin of Heat. Cold-damage Heat originates from Cold. Thus, "Heat in Interior [has] Cold" refers to the cause of Heat. Simultaneous Wind-Cold invasion causing interior-exterior Heat is extremely difficult to resolve. Like late Summer/early Autumn, intense dry-heat requires autumn winds to cool. Thus, Baihu (Western Metal Spirit, Autumn Beast) brings coolness when roaring, dispelling summer heat. Regarding resolving Autumn heat, nothing is more...