【纲】仲景曰。太阳病。外症未解。脉浮弱者。当以汗解。宜桂枝汤。
【目】许叔微曰。太阳表症者。恶寒是也。问。三阴有可汗者乎。答曰。阴病不当发汗。发汗则动经。然太阴脉浮。
少阴发热。亦须微微取汗。但不正发汗耳。大抵风寒中人。与营卫俱薄而发热。又未曾行诸汗药。虽无阳症。须少汗解
逐
之。王叔和云。表中风寒。入里则不消。故知初病脉沉细数。虽里不消。本表中风寒。须温覆少
汗而解。
柯琴曰。此条是桂枝本脉。伤寒中风杂病。皆有外症。太阳主表。表脉咸统于太阳。然必脉浮
弱。可用此解外。如但浮不弱。及浮而紧。便是麻黄症。要知本方只是外症之虚者。
【纲】仲景曰。伤寒发汗。解半日许。复烦。脉浮数者。可更发汗。宜桂枝汤。
【目】王肯堂曰。凡发汗。欲令手足俱周。 然一时间许。益佳。不可令如水流漓。若病不
解。当重发汗。汗多者必亡阳。阳虚。不得重发汗也。凡服汤发汗。中病即止。不必尽剂也。仲景
论。凡云可发汗。无汤者。丸散亦可用。要以汗出为解。然不如汤随症良验。
柯琴曰。此条因余热。卫解而营未解。故用桂枝更汗也。凡曰桂枝汤主之者。定法也。服桂枝
不解。仍与桂枝汗。解后复烦。更用桂枝者。活法也。麻黄脉症。但可用桂枝更汗。不可先用桂枝
发汗。且服麻黄复烦。可更用桂枝。用桂枝复烦。不得更用麻黄。又活法中定法也。
【纲】仲景曰。太阳病。先发汗。不解。而复下之。浮脉者不愈。浮为在外。当须解外。则愈。
宜桂枝汤。
【目】张元素曰。仲景凡为汗症关防。无所不备。且如太阳中风。桂枝汤主之。加喘者。桂枝
加浓朴杏子汤。有汗恶风
者。桂枝加葛根汤。形如疟。且二三度发。桂麻合半汤。日再发者。桂枝二麻黄一汤。脉微弱者。
不可汗。桂枝二越婢一汤。至于伤风。KT KT 无汗恶风者。葛根汤。恶风无汗而喘者。麻黄汤。复加
烦躁者。大青龙汤。随其所感轻重。用众理以应之。可见汗症中间。其周详整密。无所不至矣。
张兼善曰。误下后脉仍浮。可知表症未解。阳邪未陷。只宜桂枝解外。勿以脉浮而用麻黄。下
后仍可用桂枝。乃见桂枝方之力量。
【纲】仲景曰。伤寒不大便六七日。头痛有热者。与承气汤。其大便圊者。知不在里。仍在表
也。当须发汗。若头痛者。必衄。宜桂枝汤。
【目】朱震亨曰。伤寒前三日。法当汗。可用双解散。连进数服。必愈。
李 曰。服药而不得汗。当用蒸法。陶氏再造散主之。
柯琴曰。此辨太阳阳明之法。太阳主表。头痛为主。阳明主里。不大便为主。阳明亦有头痛。
浊气上冲也。太阳亦有不大便。阳气太重也。七日不大便。病在里。则头痛身热属阳明。外不解由
内不通也。若下之。大便去。则头痛身热。病仍在表。仍是太阳。宜桂枝汗之也。
本条当有汗出症。故合用桂枝承气。
【纲】仲景曰。脉浮者。病在表。可发汗。麻黄汤。脉浮而数者。可发汗。宜麻黄汤。
【目】李 曰。太阳病。脉浮紧者。宜汗。汗之不解者。再汗之。若失其汗。则寒邪传经。当
看传过何经。变出何病。若因汗而反下渗。表邪乘虚内陷。则热蓄于里。变为瘀血懊 痞气结胸等
症。
鳌按。脉言浮。浮而有力者。言数。是由于发热者。故为热在表。故可发汗。
【纲】仲景曰。太阳病。脉浮紧。无汗。发热。身疼痛。八九日不解。表症仍在。此当发其汗。
麻黄汤主之。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。
【目】张介宾曰。各经表症。凡有汗出不彻者。皆未足言汗。盖邪未尽去。其人必身热不退。
而仍觉躁烦。或四肢酸疼。坐卧不安者。以汗出不彻故也。何从知之。但诊其脉紧不退。及热时干
躁无汗者。即其症也。仍宜汗之。如果汗透而热仍不退。或汗后身热愈甚者。是即所谓阴阳交。魂
魄离。大凶之兆。凡汗之不彻者。其故有三。如邪在经络筋骨。而汗出皮毛者。此邪深汗浅。卫解
而营不解。一也。或以十分之邪。而出五分之汗。此邪重汗轻。二也。或寒邪方去。犹未清楚。遽
起露风。因虚复感。此新旧相踵。三也。凡遇此当详辨。而因微甚以再汗也。取汗之法。当取于自
然。不宜急暴。但服以汤剂。盖令温暖。使得津津微汗。令稍久之。则手足俱周。遍身通达。邪无
不散矣。若一时逼之。如淋如洗。则急遽间。卫气已达。而营气未周。反有不到之处。且恐大伤元
气。非良法之。
【纲】仲景曰。太阳病。不解。热结膀胱。其人如狂。血自下。下者愈。其外不解者。尚未可
攻。当先解外。外解已。但少腹急结者。乃可攻之。宜桃仁承气汤。
【目】柯琴曰。此阳气太重。标本俱病者。然病自外来者。当先审表热之重轻。以治其表。继
攻其里之结血。此以尚未可攻。知其为未下症。（读书之法）
【纲】张仲景说：太阳病（太阳经受邪所致的病证），表证未解，脉象浮而弱的，应当用发汗法解除，适宜使用桂枝汤（Cinnamon Twig Decoction）。
【目】许叔微说：太阳表的病症，恶寒（怕冷）是主要表现。问：三阴经有可以发汗的吗？回答说：阴病不应当发汗，发汗就会扰动经络。然而太阴脉浮，少阴发热，也须微微取汗，只是不采用正规的强力发汗方法罢了。大抵风寒侵入人体，与营卫之气俱薄而发热，又未曾服用各种发汗药，虽然无阳证，也须少量发汗以驱除病邪。王叔和说：表中的风寒，入里则不能消散。所以知道初病时脉沉细数，虽然里有邪气未消，但根本原因是表受风寒，须温覆身体少量发汗而解。
柯琴说：这一条是桂枝汤的本脉。伤寒、中风及杂病，都有外证。太阳主表，表脉都统属于太阳。然而必须脉浮弱，才可用此方解表。如果仅浮而不弱，以及浮而紧的，便是麻黄汤证。要知道本方只适用于外证的虚者。
【纲】张仲景说：伤寒发汗后，过了半天左右，又出现烦热，脉浮数的，可以再发汗，适宜使用桂枝汤。
【目】王肯堂说：凡是发汗，希望让手足周身都出汗，持续约一顿饭的时间，这样更好。不可让汗出如水流漓。如果病不解，应当再次发汗。汗出过多的人必定亡阳（阳气耗竭），阳虚，不得再次发汗。凡是服汤药发汗，中病即止，不必喝完全部药剂。张仲景论述中，凡是说可发汗的，没有汤药的话，丸散也可以使用，要以汗出为愈，然而不如汤药随症良验。
柯琴说：这一条是因为余热，卫气已解而营气未解，所以用桂枝汤再次发汗。凡是说“桂枝汤主之”的，是定法。服桂枝汤不解，仍给桂枝汤发汗；解后复烦，更用桂枝汤的，是活法。麻黄汤的脉症，只可用桂枝汤再次发汗，不可先用桂枝汤发汗。且服麻黄汤后复烦，可更用桂枝汤；用桂枝汤后复烦，不得更用麻黄汤。这也是活法中的定法。
【纲】张仲景说：太阳病，先发汗，病不解，而又用下法，脉仍浮的，病不愈。浮脉表示病邪在外，应当先解表，则病愈，适宜使用桂枝汤。
【目】张元素说：张仲景对于发汗症的禁忌，无所不备。比如太阳中风，桂枝汤主治。兼喘的，桂枝加厚朴杏子汤。有汗恶风的，桂枝加葛根汤。症状像疟疾，一天发作两三次，桂枝麻黄各半汤。一天发作两次的，桂枝二麻黄一汤。脉微弱的，不可发汗，用桂枝二越婢一汤。至于伤风，无汗恶风的，葛根汤。恶风无汗而喘的，麻黄汤。再兼烦躁的，大青龙汤。根据感受邪气的轻重，用多种理法来应对。可见发汗症中间，其周详整密，无所不至。
张兼善说：误用下法后脉仍浮，可知表证未解，阳邪未陷入里，只宜桂枝汤解表，不要因为脉浮就用麻黄汤。下法之后仍可用桂枝汤，这体现了桂枝汤方的力量。
【纲】张仲景说：伤寒不大便六七天，头痛且有热的，给予承气汤。如果大便正常（圊，指排便），知道病不在里，仍在表，应当发汗。如果头痛，必会鼻衄（流鼻血），适宜使用桂枝汤。
【目】朱震亨说：伤寒前三天，法当发汗，可用双解散，连进数服，必愈。
柯琴说：这是辨别太阳阳明病的方法。太阳主表，头痛为主症；阳明主里，不大便为主症。阳明也有头痛，是浊气上冲所致。太阳也有不大便，是阳气太重所致。七日不大便，病在里，则头痛身热属阳明，外不解由内不通引起。如果下之，大便去，则头痛身热，病仍在表，仍是太阳，宜桂枝汤发汗。本条应当有汗出的症状，故合用桂枝承气。
【纲】张仲景说：脉浮的，病在表，可发汗，用麻黄汤。脉浮而数的，可发汗，适宜用麻黄汤。
【目】李梴说：太阳病，脉浮紧的，宜发汗。发汗不解的，再发汗。如果失于发汗，则寒邪传经，应当看传过何经，变出何病。如果因发汗反而导致下利渗泄，表邪乘虚内陷，则热蓄于里，变为瘀血、懊憹、痞气、结胸等症。
沈金鳌按：脉言浮，浮而有力者，言数，是由于发热者，故为热在表，故可发汗。
【纲】张仲景说：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，麻黄汤主治。服药后，症状稍减，其人发烦，目瞑（闭眼欲睡），剧者必衄，衄乃解。所以然者，阳气重故也。
【目】张介宾说：各经表证，凡有汗出不彻底的，都算不上真正的发汗。因为邪气未尽去，其人必身热不退，而仍觉躁烦，或四肢酸疼，坐卧不安的，是因为汗出不彻底。怎么知道呢？只要诊其脉紧不退，及热时干燥无汗的，就是其症。仍宜发汗。如果确实汗透而热仍不退，或汗后身热愈甚的，是即所谓阴阳交，魂魄离，大凶之兆。凡是汗之不彻底的，其原因有三。如邪在经络筋骨，而汗出皮毛的，此邪深汗浅，卫气解而营气未解，这是一。或以十分之邪，而出五分之汗，此邪重汗轻，这是二。或寒邪方去，犹未清楚，遽起露风，因虚复感，此新旧相踵，这是三。凡遇此当详辨，而因微甚以再汗也。取汗之法，当取于自然，不宜急暴。但服以汤剂，盖令温暖，使得津津微汗，令稍久之，则手足俱周，遍身通达，邪无不散矣。若一时逼之，如淋如洗，则急遽间，卫气已达，而营气未周，反有不到之处。且恐大伤元气，非良法。
【纲】张仲景说：太阳病，不解，热结膀胱，其人如狂，血自下，下者愈。其外不解者，尚未可攻，当先解外。外解已，但少腹急结者，乃可攻之，适宜桃仁承气汤。
【目】柯琴说：这是阳气太重，标本俱病的情况。然而病自外来者，当先审表热之重轻，以治其表，继攻其里之结血。此以“尚未可攻”，知其为未下症。（读书之法）
[General Principle] Zhang Zhongjing said: In Taiyang disease (disease of the Taiyang channel), if the exterior syndrome is unresolved and the pulse is floating and weak, it should be resolved by sweating. Guizhi Tang (Cinnamon Twig Decoction) is suitable.
[Commentary] Xu Shuwei said: The exterior syndrome of Taiyang is characterized by aversion to cold (fear of cold). Question: Are there cases in the Three Yin channels that can be treated with sweating? Answer: Yin diseases should not be treated with sweating; doing so will disturb the meridians. However, if the Taoyin pulse is floating, or Shaoyin presents with fever, slight sweating may be required, but not standard vigorous sweating. Generally, when wind-cold invades the body, causing heat due to thinning of Ying and Wei Qi, and no diaphoretic medicines have been taken yet, even without Yang syndromes, mild sweating is necessary to expel the pathogen. Wang Shuhe said: Wind-cold in the exterior, if entering the interior, cannot dissipate. Therefore, knowing that an initial deep, fine, and rapid pulse indicates internal retention despite the root cause being exterior wind-cold, one must cover warmly to induce slight sweating for resolution.
Ke Qin said: This clause describes the primary pulse for Guizhi Tang. Cold damage, wind strike, and miscellaneous diseases all present with exterior syndromes. Taiyang governs the exterior, and all exterior pulses are unified under Taiyang. However, only when the pulse is floating and weak can this formula be used to resolve the exterior. If the pulse is merely floating without weakness, or floating and tight, it is a Mahuang Tang syndrome. One must understand that this formula is only applicable to deficiency-type exterior syndromes.
[General Principle] Zhang Zhongjing said: After inducing sweating for cold damage, if restlessness returns after about half a day and the pulse is floating and rapid, sweating may be induced again. Guizhi Tang is suitable.
[Commentary] Wang Kentang said: When inducing sweating, one should aim for uniform sweating over the hands and feet, lasting about the time it takes to cook a meal, which is ideal. Sweating should not be profuse like flowing water. If the disease does not resolve, sweating may be repeated. Excessive sweating leads to Yang collapse (depletion of Yang Qi); thus, in cases of Yang deficiency, repeated sweating is contraindicated. When taking decoctions to induce sweating, stop once the illness is addressed; there is no need to finish the entire dose. In Zhang Zhongjing’s discussions, whenever sweating is indicated but no decoction is available, pills or powders may be used. Resolution is confirmed by sweating, although decoctions offer better efficacy tailored to symptoms.
Ke Qin said: This clause addresses residual heat where Wei Qi has resolved but Ying Qi remains unresoved, hence Guizhi Tang is used to induce sweating again. "Guizhi Tang Zhu Zhi" (Guizhi Tang is the main prescription) denotes a fixed method. Using Guizhi Tang again if the first dose fails, or using it again if restlessness recurs after resolution, represents flexible application. For Mahuang Tang syndromes, Guizhi Tang may be used for subsequent sweating but should not be used initially. Conversely, if restlessness occurs after Mahuang Tang, Guizhi Tang may follow; but if restlessness occurs after Guizhi Tang, Mahuang Tang must not be used. This is also a fixed rule within flexible applications.
[General Principle] Zhang Zhongjing said: In Taiyang disease, if initial sweating fails to resolve the condition and purgation is subsequently applied, but the pulse remains floating, the disease persists. A floating pulse indicates the pathogen is still at the exterior; therefore, the exterior must be resolved first for recovery. Guizhi Tang is suitable.
[Commentary] Zhang Yuansu said: Zhang Zhongjing’s precautions regarding sweating therapies are comprehensive. For example, Taiyang wind strike is primarily treated with Guizhi Tang. If accompanied by wheezing, Guizhi Jia Houpo Xingzi Tang is used. For those with sweating and aversion to wind, Guizhi Jia Gegen Tang is indicated. If symptoms resemble malaria, occurring two or three times a day, Guizhi Mahuang Ban Tang is used. If occurring twice a day, Guizhi Er Mahuang Yi Tang is appropriate. If the pulse is faint and weak, sweating is contraindicated, and Guizhi Er Yubi Yi Tang is used. For wind strike without sweating and aversion to wind, Gegen Tang is used. For aversion to wind, no sweating, and wheezing, Mahuang Tang is used. If irritability is added, Da Qinglong Tang is indicated. According to the severity of the pathogenic factor, various principles are applied. Thus, the management of sweating syndromes is thorough and meticulous.
Zhang Jianshan said: If the pulse remains floating after erroneous purgation, it indicates the exterior syndrome is unresolved and Yang pathogens have not sunk inward. Only Guizhi Tang should be used to resolve the exterior; do not use Mahuang Tang simply because the pulse is floating. The fact that Guizhi Tang can still be used after purgation demonstrates its potency.
[General Principle] Zhang Zhongjing said: In cold damage, if there is constipation for six or seven days accompanied by headache and fever, Chengqi Tang should be administered. If bowel movements are normal, it indicates the pathology is not in the interior but remains at the exterior, requiring sweating. If headache is present, epistaxis (nosebleed) is likely; Guizhi Tang is suitable.
[Commentary] Zhu Zhenheng said: In the first three days of cold damage, the method dictates sweating. Shuangjie San can be taken continuously for several doses until cure.
Li Chen said: If sweating does not occur after medication, steaming therapy should be employed, primarily using Tao Shi Zaizao San.
Ke Qin said: This distinguishes between Taiyang and Yangming diseases. Taiyang governs the exterior, with headache as the primary symptom; Yangming governs the interior, with constipation as the primary symptom. Yangming may also present with headache due to turbid Qi rising. Taiyang may present with constipation due to excessive Yang Qi. Constipation for seven days indicates interior pathology; headache and fever then belong to Yangming, where exterior unresolved status results from interior blockage. If purged and stool passes, but headache and fever persist, the disease remains at the exterior, classified as Taiyang, and should be treated with Guizhi Tang to induce sweating. This clause implies the presence of sweating symptoms, justifying the combination of Guizhi and Chengqi approaches.
[General Principle] Zhang Zhongjing said: A floating pulse indicates disease at the exterior; sweating may be induced using Mahuang Tang. A floating and rapid pulse also permits sweating, preferably with Mahuang Tang.
[Commentary] Li Chen said: In Taiyang disease, a floating and tight pulse indicates the need for sweating. If sweating fails to resolve the condition, repeat sweating. Failure to sweat allows cold pathogens to transmit through channels; one must identify the affected channel and resulting pathology. If sweating leads to unintended purgation/diarrhea, exterior pathogens may sink inward due to deficiency, causing heat accumulation in the interior, leading to blood stasis, profound discomfort (Ao Nao), fullness, or chest binding syndromes.
Shen Jin'ao noted: A floating pulse suggests exterior location. If forceful and rapid, indicating fever, it confirms heat at the exterior, warranting sweating.
[General Principle] Zhang Zhongjing said: In Taiyang disease, with a floating-tight pulse, absence of sweating, fever, and body pain persisting for eight or nine days without resolution, the exterior syndrome remains. Sweating should be induced using Mahuang Tang. After ingestion, symptoms may slightly subside, but the patient may experience restlessness and desire to close eyes. In severe cases, epistaxis occurs, leading to resolution. This is because Yang Qi is excessive.
[Commentary] Zhang Jiebin said: For exterior syndromes in all channels, incomplete sweating does not constitute true resolution. Since pathogens remain, the patient continues to have fever, restlessness, limb soreness, and restlessness due to incomplete sweating. How to diagnose? A persistent tight pulse and dry skin without sweating during fever confirm this. Sweating should still be induced. If fever persists despite thorough sweating, or worsens post-sweating, it indicates Yin-Yang intersection and separation of soul and spirit, a dire omen. Causes of incomplete sweating include: 1) Pathogens deep in meridians/bones/muscles while sweat emerges only from skin (deep pathogen, shallow sweat; Wei resolved, Ying unresolved); 2) Heavy pathogens met with light sweating (heavy pathogen, light sweat); 3) Residual cold pathogens not fully cleared, followed by exposure to wind due to deficiency, causing new and old pathogens to accumulate. Careful differentiation is needed to determine the degree of sweating. Sweating methods should be natural, not abrupt. Warm decoctions should induce gentle, continuous sweating. Over time, sweating spreads to hands, feet, and whole body, dispersing pathogens. Forced, profuse sweating causes Wei Qi to reach extremities before Ying Qi, leaving gaps and damaging Yuan Qi, which is not a good method.
[General Principle] Zhang Zhongjing said: In Taiyang disease, if unresolved, heat binds to the Bladder, causing manic behavior. If bleeding occurs spontaneously, the patient recovers. If exterior symptoms remain unresolved, attack is premature; resolve the exterior first. Once the exterior is resolved, if only lower abdominal urgency and knotting persist, attack may proceed using Taoren Chengqi Tang.
[Commentary] Ke Qin said: This involves excessive Yang Qi affecting both root and branch. Since the disease originates externally, one must first assess the severity of exterior heat and treat the exterior, then attack the interior blood stasis. The phrase "attack is premature" indicates it is not yet a purgation case. (Method of reading texts)