【纲】仲景曰。太阳病。得之八九日。如疟状。发热恶寒。热多寒少。其人不呕。圊便欲自可。
一日二三度发。脉微缓者。为欲愈也。宜桂枝麻黄合半汤。太阳病。发热恶寒。热多寒少。脉微
弱者。此无阳也。不可发汗。宜桂枝二越婢一汤。
【目】朱肱曰。太阳热多寒少。有此二症。其用药皆不同也。二条。以脉微弱。故不可发汗。
若脉浮。虽热多寒少。亦可发汗也。大抵伤寒。寒多易治。热多难愈。伤寒发热者。以寒极则生
热。治法。多用冷药。故令热不去。仲景热多寒少。用桂枝二越婢一汤。不渴。外有微热者。用小
柴胡加桂汤。皆温表之义也。近时多用小柴胡汤。不问阴阳表里。凡伤寒皆令服此药。往往有因服
小柴胡而成阴症者。仲景虽云伤寒中风。有小柴胡症。但见一症便是。不必悉具。此为是少阳症。
当用小柴胡。不必少阳症悉具耳。况本方又有随症加减法。古人方治。审谛如此。
赵嗣真曰。详论中热多寒少。止此二症。其一症。仲景之意盖以得病七八日如疟状。发热恶寒。
热多寒少。十六字。为自初至今之症。以下乃是以后拟议防变之辞。当分三截看。若其人不呕。
圊便欲自可。一日二三度发。脉微缓为欲愈。此一节。乃里和无病而脉微缓者。邪气微缓者。阴阳
同等。脉症皆向安之兆。可不待汗而欲自愈也。若脉微而恶寒者。此阴阳俱虚。不可发汗更吐更下
也。此一节。宜温之。若面色反有热者。未欲解也。以其不能得小汗出。其身必痒。宜各半汤。此
一节。必待汗而后愈也。活人书未详文义。却将其人不呕清便欲自可九字。本是欲愈之症。反以他
症各半汤汗之。又将不可汗吐下及各半汤症语句。并脱略而不言。反将其中欲愈之症。而用彼药汗
其所不当汗。何也。其一症。仲景云。太阳病。发热恶寒。热多寒少。脉微弱者。亡阳也。不可发
汗。宜桂枝二越婢一汤。活人书于脉微弱上添都大二字。岂以仲景论脉为未足。而故加之也乎。
刘完素曰。仲景一书。只有热多寒少之条。无寒多热少之症。
【纲要】张仲景说：太阳病（太阳经受邪所致的病证），患病已经八九天，症状像疟疾一样，发热恶寒，热多寒少。病人没有呕吐，大小便基本正常。一天发作两三次，如果脉象微缓，是病情将要痊愈的征兆，适宜用桂枝麻黄各半汤（Cinnamon Twig and Ephedra Combined Half Decoction）。太阳病，发热恶寒，热多寒少，脉象微弱，这是阳气不足（无阳指阳气虚衰），不可发汗，适宜用桂枝二越婢一汤（Cinnamon Twig Twice and Stone Ginger Decoction One Third）。
【注解】朱肱说：太阳病中热多寒少的情况，有上述两种证候，它们的用药完全不同。这两条中，因为脉象微弱，所以不可发汗。如果脉象浮，虽然热多寒少，也可以发汗。大抵伤寒病中，寒多容易治疗，热多难以痊愈。伤寒发热，是因为寒邪极盛则生热，治疗方法多用寒凉药物，所以导致热势不退。张仲景对于热多寒少，使用桂枝二越婢一汤；如果不口渴，体表有轻微发热，用小柴胡加桂汤（Bupleurum Decoction with Cinnamon Twig），这都是温散表邪的意义。近代人多用小柴胡汤（Bupleurum Decoction），不问阴阳表里，凡是伤寒都让服用此药，往往有人因服用小柴胡汤而转为阴证（Yin Syndrome）。张仲景虽然说伤寒中风有小柴胡汤证，但只要有其中一个症状即可，不必全部具备，这是针对少阳病（Shaoyang Disease）而言，应当用小柴胡汤，不必少阳病的所有症状都具备罢了。况且本方又有随症状加减的方法，古人的方治，审慎细致到了这种地步。
赵嗣真说：详细考察《伤寒论》中热多寒少的内容，只有这两个证候。其中第一个证候，张仲景的意思大概是以“得病七八日如疟状，发热恶寒，热多寒少”这十六个字，作为从发病至今的症状，以下则是为了以后推测和防止变化而说的言辞。应当分三部分来看。如果病人不呕吐，大小便基本正常，一天发作两三次，脉象微缓为欲愈，这一节，是说里气平和无病且脉象微缓，邪气微缓，阴阳平衡，脉症都是趋向安宁的征兆，可以不待发汗而想要自愈。如果脉微且恶寒，这是阴阳俱虚，不可发汗、催吐或攻下，这一节，适宜温补。如果面色反而发红发热，说明病未解除，因为他不能出微小的汗，身体必定发痒，适宜用桂枝麻黄各半汤，这一节，必须等待发汗后才能痊愈。《活人书》没有详细阐明文义，却将“其人不呕，圊便欲自可”九个字，本来是欲愈的症状，反而用其他症状配合桂枝麻黄各半汤来发汗。又将不可汗、吐、下以及桂枝麻黄各半汤的证候语句，一并省略不说，反而将其中欲愈的症状，用那些药物去发本不该发的汗，为什么呢？另一个证候，张仲景说：太阳病，发热恶寒，热多寒少，脉微弱者，是亡阳（Yang Collapse/Deficiency），不可发汗，适宜用桂枝二越婢一汤。《活人书》在脉微弱前面加上“都大”二字，难道认为张仲景论述脉象不够充分，而故意添加的吗？
[General Principle] Zhang Zhongjing stated: In Taiyang disease (disease of the Taiyang channel caused by pathogenic invasion), after eight or nine days, the symptoms resemble malaria, with fever and aversion to cold, where heat is more prominent than cold. The patient does not vomit, and bowel movements are relatively normal. If the condition occurs two or three times a day and the pulse is slightly slow and relaxed, it indicates that recovery is imminent; Guizhi Mahuang Banhe Tang (Cinnamon Twig and Ephedra Combined Half Decoction) is appropriate. In Taiyang disease, if there is fever and aversion to cold with heat predominating over cold, and the pulse is faint and weak, this indicates a deficiency of Yang (absence of sufficient Yang energy); sweating therapy should not be used. Guizhi Er Yuebi Yi Tang (Twice Cinnamon Twig and One-Third Stone Ginger Decoction) is appropriate.
[Commentary] Zhu Gong stated: In Taiyang disease, cases where heat predominates over cold present in these two patterns, and their medication differs significantly. In these two clauses, because the pulse is faint and weak, sweating therapy is contraindicated. However, if the pulse is floating, even if heat predominates over cold, sweating therapy may still be employed. Generally speaking, in Shanghan (Cold Damage) diseases, cases with predominant cold are easier to treat, while those with predominant heat are harder to cure. Fever in Shanghan arises when cold becomes extreme and generates heat; treatment often employs cooling herbs, which can sometimes fail to resolve the heat. For cases where heat predominates over cold, Zhang Zhongjing prescribed Guizhi Er Yuebi Yi Tang. If there is no thirst and slight exterior heat, Xiaochaihu Jia Guizhi Tang (Bupleurum Decoction with Added Cinnamon Twig) is used; both represent the principle of warming and dispersing the exterior. In recent times, many physicians use Xiaochaihu Tang (Bupleurum Decoction) indiscriminately, regardless of Yin-Yang or interior-exterior differentiation, administering it for all Shanghan cases. This often leads to patients developing Yin syndrome (a pattern characterized by cold and deficiency). Although Zhang Zhongjing mentioned that Shanghan or wind-strike may present with Xiaochaihu Tang indications, only one symptom needs to be present, not necessarily all; this refers specifically to Shaoyang disease (disease of the Shaoyang channel), for which Xiaochaihu Tang is indicated, without requiring all Shaoyang symptoms to be present. Moreover, the formula itself allows for modifications based on specific symptoms. Ancient prescriptions were applied with such careful deliberation.
Zhao Sizhen stated: A detailed examination of "heat predominating over cold" in the Treatise reveals only these two patterns. Regarding the first pattern, Zhang Zhongjing's intent seems to be that the sixteen characters—"ill for seven or eight days resembling malaria, fever and aversion to cold, heat predominating over cold"—describe the symptoms from onset to the present moment. The following text consists of speculative remarks aimed at preventing future changes. It should be analyzed in three parts. If the patient does not vomit, bowel movements are normal, episodes occur two or three times daily, and the pulse is slightly slow and relaxed, indicating impending recovery: this section describes a state where the interior is harmonious and free of disease, with a slightly slow and relaxed pulse, mild pathogenic factors, balanced Yin and Yang, and signs pointing toward convalescence. Recovery may occur spontaneously without inducing sweat. If the pulse is faint accompanied by aversion to cold, this indicates a deficiency of both Yin and Yang; sweating, vomiting, or purging therapies are contraindicated. This section requires warming treatment. If the face appears flushed with heat, the disease has not yet resolved because the patient cannot produce a slight sweat, leading to pruritus; Guizhi Mahuang Banhe Tang is appropriate. This section requires sweating therapy for resolution. The *Ren Shu* (*Book of Human Life*) failed to elucidate the textual meaning accurately. It incorrectly treated the nine characters "the patient does not vomit, bowel movements are normal"—which originally indicated impending recovery—as indications for Guizhi Mahuang Banhe Tang. It omitted statements regarding contraindications for sweating, vomiting, and purging, as well as indications for Guizhi Mahuang Banhe Tang. Instead, it applied diaphoretic drugs to symptoms that did not warrant them. Why? Regarding the second pattern, Zhang Zhongjing stated: "Taiyang disease with fever, aversion to cold, heat predominating over cold, and a faint and weak pulse indicates Yang collapse/deficiency; sweating is contraindicated. Guizhi Er Yuebi Yi Tang is appropriate." The *Ren Shu* added the words "du da" (generally/majorly) before "faint and weak pulse." Did it consider Zhang Zhongjing's pulse analysis insufficient and thus arbitrarily add these words?
Liu Wansu stated: In Zhang Zhongjing's work, there are clauses describing heat predominating over cold, but no patterns described as cold predominating over heat.