欲止汗。宜此法。活人书。去零陵香。直为温粉方。录大青龙汤后。尔后本事方。三因方。明理论等。皆以辟
温粉。为温粉。不知川芎白芷 本苍术。能止汗否。吴氏医方考。有扑粉方。龙骨。牡蛎。糯米。各等分为末。
服发汗药。出汗过多者。以此粉扑之。此方予常用有验。又伤寒类方曰。此外治之法。论中无温粉方。后人用
牡蛎。麻黄根。铅粉。龙骨。亦可。又孝慈备览。扑身止汗法。麸皮。糯米粉。二合。牡蛎。龙骨。二两。上
共为极细末。以疏绢包裹。周身扑之。其汗自止。免致亡阳而死。亦良法也。产宝。粳米散。疗产后汗不止。
牡蛎三两。附子一两。炮。白粳米粉三升。上为散。搅令匀。汗出敷之。案此亦扑粉之一方也。
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。（玉函。千金翼。者下。有可与二
字。程本。张本。作小青龙汤发之。）
〔柯〕寒有重轻。伤之重者。脉阴阳俱紧而身疼。伤之轻者。脉浮缓而身重。亦有初时脉紧渐缓。初时身疼。
继而不疼者。诊者勿执一以拘也。然脉浮紧者。必身疼。脉浮缓者。身不疼。中风伤寒皆然。又可谓之定脉定
证矣。脉浮缓下。当有发热恶寒无汗。烦躁等证。盖脉浮缓身不疼。见表症同轻。且身重乍有轻时。见表症将
罢。以无汗烦躁。故合用大青龙。无少阴证。仲景正为不汗出而烦躁之证。因少阴亦有发热恶热。无汗烦躁之
证。与大青龙同。法当温补。若反与麻黄之散。石膏之寒。真阳立亡矣。必细审其所不用。然后不失其所当用
也。〔鉴〕身轻。邪在阳也。身重。邪在阴也。乍有轻时。谓身重而有时轻也。若但欲寐。身重无轻时。是少
阴证也。今无但欲寐。身虽重乍有轻时。则非少阴证。
〔魏〕发字诸家多置议。然不过发汗之义耳。不必深言之。反晦也。
舒氏曰。案发热恶寒。无汗烦躁。乃大青龙汤之主证也。有其主证。虽脉浮缓身不疼。但重乍有轻时。
即可用大青龙汤。然必辨其无少阴证方可用。否则不可用也。
案程氏曰。小青龙汤。坊本。俱作大青龙。余幼读古本。实是小青龙。观条中脉证。总非大青龙病。宜
世人有伤风兼寒之说。张氏缵论。亦改作小青龙汤。然无明据。不可从也。且程氏所谓古本。不知何等本。恐
是根据托之言也。
伤寒类方曰。案此条必有误。脉浮缓。邪轻易散。身不疼。外邪已退。乍有轻时。病未入阴。又别无少
阴等症。此病之最轻者。何以投以青龙险峻之剂。此必别有主方。而误以大青龙当之者也。
伤寒表不解。心下有水气。干呕发热而咳。或渴。或利。或噎。或小便不利。少腹满。或喘者。小青龙
汤主之。（不解。千金。作未解。干呕发热而咳。玉函。千金翼。作咳而发热。玉函。脉经。千金。少腹。作
小腹。喘上。有微字。程本。噎。作噫。）
〔成〕伤寒表不解。心下有水饮。则水寒相搏。肺寒气逆。故干呕发热而咳。针经曰。形寒饮冷则伤肺。
以其两寒相感。中外皆伤。故气逆而上行。此之谓也。与小青龙汤。发汗散水。水气内渍。则所传不一。故有
或为之证。随证增损。以解化之。〔钱〕伤寒表不解。谓头痛项强。发热体痛。无汗之证。未得汗解也。心下。
心之下。胃脘之分也。水气。水饮之属也。干呕发热。太阳表证也。喘咳。水寒伤肺而气逆也。以肺主皮毛。
寒邪在表。水气停蓄。故伤肺气也。或利者。水溜于肠。而下流也。或噎者。水气寒邪。窒碍胃中。气不通行
也。或渴。或小便不利者。水寒固闭于中焦。则下焦之
阳气。不得上腾而为津液。故渴。上焦之清气。不得下降而为渗利。其升降之气化不行。故小便不利。而少腹
满也。或者。或有或无。非必诸证皆见也。前以风寒郁热之邪。不得外泄而烦躁。故以大青龙汤。汗泄凉解之。
此条以寒邪未解。水饮停蓄。肺脏伤而喘咳。并见中气寒而气滞不行。宜温宜散。可发可收。故以小青龙汤主
之。〔周〕素常有饮之人。一感外邪。伤皮毛而蔽肺气。则便停于心下。而上下之气不利焉。于是喘满咳呕。相
因而见。尔时竟一汗之。外邪未解。里证转增。何也。为水气所持。不能宣越故也。况水饮停蓄者。中州必不
健运。才兼外感。遂令上逆。尚可徒以风药上升作患乎。
案噎字。成注。KT 同。乃引辨脉水得寒气。冷必相搏。其人即KT 。为证。方氏亦云。噎。与KT 咽
同。水寒窒气也 即是膈噎之噎。又作 。钱氏云。噎者。呃逆也。徐大椿云。内经无噎字。疑即呃逆之轻者。
皆臆解也。程氏作噫者。亦未知何据也。
小青龙汤方
麻黄（去节） 芍药 细辛 干姜 甘草（炙） 桂枝（各三两去皮） 五味子（半升） 半夏（半升
洗○成本。作汤洗）
上八味。以水一斗。先煮麻黄。减二升。去上沫。纳诸药。煮取三升。去滓。温服一升。若渴。去半夏。
加栝蒌根三两。若微利。去麻黄。加荛花如一鸡子。熬令赤色。若噎者。去麻黄。加附子一枚炮。若小便不利。
少腹满者。去麻黄。加茯苓四两。若喘。去麻黄。加杏仁半升去皮尖。且荛花不治利。麻黄主喘。今此语反之。
疑非仲景意。（【原注】臣亿等谨案小青龙汤。大要治水。又案本草。荛花。下十二水。若水去利则止也。又
案千金。形肿者。应纳麻黄。乃纳杏仁者。以麻黄发其阳故也。以此证之。岂非仲景意也。○千金。
荛花。作芫花。总病论同。若噎者。外台。作若食饮噎者。总病论。作咽字。玉函。无且字。主喘。作定喘。
无此语二字。反之下。有者字。外台同。成本。无且荛花以下二十字。）
〔鉴〕表实无汗。故合麻桂二方以解外。去大枣者。以其性滞也。去杏仁者。以其无喘也。有喘者仍加之。
去生姜者。以有干姜也。若呕者。仍用之。佐干姜细辛。极温极散。使寒与水俱得从汗而解。佐半夏逐痰饮。
以清不尽之饮。佐五味收肺气。以敛耗伤之气。若渴者。去半夏。加花粉。避燥以生津也。若微利与噎。小便
不利。少腹满。俱去麻黄。远表而就里也。加附子以散寒。则噎可止。加茯苓以利水。则微利止。（案金鉴。
以荛花如鸡子大熬令赤色。为传写之误。改作加茯苓四两）少腹满可除矣。〔柯〕两青龙。俱治有表里证。皆用
两解法。大青龙是里热。小青龙是里寒。故发表之药相同。而治里之药则殊也。此与五苓。同为治表不解而心
下有水气。然五苓治水之蓄而不行。故专渗泻以利水。而微发其汗。使水从下而去也。此方。治水之动而不
居。故备举辛温以散水。而大发其汗。使水从外而出也。仲景发表利水诸法。精义入神矣。〔钱〕详推后加减
法。凡原文中。每具诸或有之证者。皆有之。如小青龙汤。小柴胡汤。真武汤。通脉四逆汤。四逆散。皆是也。
愚窃揆之以理。恐未必皆出于仲景也。
案且荛花以下二十字。盖是叔和语。大柴胡方后云。不加大黄。恐不为大柴胡汤。许氏本事方。引为叔和
语。此段语气。亦与彼条相类。可以证也。且玉函外台。并有此语。可见不出于后人手。
吴恕活人指掌云。荛花。如无。以生桃花代。
柯氏曰。此方。又主水寒在胃。久咳肺虚。○案金匮要略。本方。治溢饮。又加石膏。治肺胀咳而上气。
烦躁而喘。
脉浮者。心下有水气。又本方。治咳逆倚息不得卧。外台秘要古今录验沃雪汤。即本方。去芍药甘草。治上气
不得息。喉中如水鸡声。凡局方温肺汤。杏子汤之类。从此方增损者颇多。
御药院方。细辛五味子汤。治肺气不利。咳嗽喘满。胸膈烦闷。痰涎多。喉中有声。鼻塞清涕。头痛目眩。
肢体倦怠。咽嗌不利。呕逆恶心。（即本方）
医学六要。香港脚上气喘促。初起有表邪者。小青龙加槟榔。
伤寒心下有水气。咳而微喘。发热不渴。服汤已渴者。此寒去欲解也。小青龙汤主之。（已下。玉函。脉
经。千金翼。有而字。此下。玉函。千金翼。有为字。）
〔成〕咳而微喘者。水寒射肺也。发热不渴者。表证未罢也。与小青龙汤。发表散水。服汤已渴者。里气
温。水气散。为欲解也。〔钱〕与上文同义。发热不渴者。因心下有水气。故虽发热。亦不渴也。服汤。谓服
小青龙汤也。服汤已而渴。则知心下之水气已消。胃中之寒湿已去。但以发热之后。温解之余。上焦之津液尚
少。所以反渴也。前以有水气。故发热不渴。今服汤已而渴。故知寒水去而欲解也。小青龙汤主之句。当在发
热不渴句下。今作末句者。是补出前所服之汤。非谓寒去欲解之后。更当以小青龙汤主之也。此与发烦目瞑衄
乃解之后。及不发汗因致衄者。皆以麻黄汤主之之义相同。〔张〕虽渴而不必复药。但当静俟津回可也。〔周〕
小青龙汤主之句。是缴结上文之词。况服汤二字。明明指定。他书曾易经文。今仍古本读。
伤寒类方曰。小青龙汤主之。此倒笔法。即指服汤已三字。非谓欲解之后。更服小青龙汤也。○案汪氏
引补亡论。
小青龙汤主之六字。移在发热不渴字下。张璐志聪金鉴。皆从其说。不知仲景章法。固有如此者。盖未考耳。
太阳病外证未解。脉浮弱者。当以汗解。宜桂枝汤。（玉函。脉上。有其字。汤下。有主之三字。）
〔张〕外证未解。曾服过发汗药可知。〔方〕外证未解。谓头痛项强恶寒等犹在也。浮弱。即阳浮而阴弱。
此言太阳中风。凡在未传变者。仍当从于解肌。盖严不得下早之意。〔柯〕如但浮不弱。或浮而紧者。便是麻
黄症。要知本方。只主外症之虚者。
案原本每篇重出各方。今一从成本删之。
太阳病。下之微喘者。表未解故也。桂枝加浓朴杏子汤主之。（杏子。成本。玉函。千金。作杏仁。千金
翼。作桂枝汤。注。一云。麻黄汤。）
〔成〕下后大喘。则为里气大虚。邪气传里。正气将脱也。下后微喘。则为里气上逆。邪不能传里。犹在表
也。与桂枝汤以解外。加浓朴杏仁。以下逆气。〔程〕喘之一证。有里有表。不可不辨。下后汗出而喘者。其喘
必盛。属里热壅逆。火炎故也。下后微喘者。汗必不大出。属表邪遏闭。气逆故也。表未解。仍宜从表治。于
桂枝解表内。加浓朴杏子。以下逆气。不可误用葛根连芩汤。使表邪淆入里分。寒从热治。变证更深也。〔志〕
燕氏曰。此与喘家作桂枝汤加浓朴杏子。同一义也。
桂枝加浓朴杏子汤方
桂枝（三两去皮） 甘草（二两炙） 生姜（三两切） 芍药（三两） 大枣（十二枚擘） 浓朴（二两
炙去皮） 杏仁（五十枚去皮尖）
上七味。以水七升。微火煮取三升。去滓。温服一升。覆取微似汗。（成本。不载此方。第十卷曰。于桂
枝汤方内。加浓朴。二两。杏仁。五十个。去皮尖。根据前法）
伤寒类方曰。别录。浓朴。主消痰下气。本经。杏仁主咳逆上气。
本事方曰。戊申正月。有一武臣。为寇所执。置舟中 板下。数日得脱。乘饥恣食。良久解衣扪虱。次日
遂作伤寒。自汗而鬲不利。一医利伤食而下之。一医作解衣中邪而汗之。杂治数日。渐觉昏困。上喘急高。医
者怆惶失措。予诊之曰。太阳病下之。表未解。微喘者。桂枝加浓朴杏仁汤。此仲景之法也。命令医者急治药。
一啜喘定。再啜 微汗。至晚身凉。而脉已和矣。医曰。某平生未曾用仲景方。不知其神捷如是。予曰。仲
景之法。岂诳后人也哉。人自寡学。无以发明耳。
太阳病。外证未解。不可下也。下之为逆。欲解外者。宜桂枝汤。（成本。玉函。解不间。有者字。汤下。
有主之二字。玉函。千金翼。无欲字。）
〔钱〕太阳中风。其头痛项强。发热恶寒自汗等表证未除。理宜汗解。慎不可下。下之则于理为不顺。于
法为逆。逆则变生。而邪气乘虚内陷。结胸痞硬。下利喘汗。脉促胸满等证作矣。故必先解外邪。欲解外者。
宜以桂枝汤主之。无他法也。〔鉴〕凡表证未解。无论已汗未汗。虽有可下之证。而非在急下之例者。均不可下。
〔王〕但有一毫头痛恶寒。即为表证未解也。〔张〕下之为逆。不独指变结胸等证而言。即三阴坏病。多由误下
所致也。〔柯〕外证初起。有麻黄桂枝之分。如当解未解时。惟桂枝汤可用。故桂枝汤。为伤寒中风杂病解外之
总方。凡脉浮弱汗自出。而表不解者。咸得而主之也。即阳明病脉迟。汗出多者宜之。太阴病脉浮者亦宜之。
则知诸经外证之虚者。咸得同太阳未解之治法。又可见桂枝汤不专为太阳用矣。
伤寒选录。张氏曰。予观仲景周旋去就之妙。穷至事理之极。尤且未肯放乎。尚言欲解外。宜桂枝汤。一
其欲字。权衡犹未放乎。更有踌躇详审不尽之意。后之学人。当反复斟酌。别其所宜。庶无差失之患。此乃临
证审决之意也。卷内凡言宜者。即同此理也。
太阳病。先发汗不解。而复下之。脉浮者不愈。浮为在外。而反下之。故令不愈。今脉浮故在外。当须解
想要止住汗。适宜用这种方法。《活人书》中去掉了零陵香，直接作为温粉方。记录在大青龙汤之后。后来的《本事方》、《三因方》、《明理论》等，都把辟（避）温粉当作温粉，不知道川芎、白芷、苍术能否止汗。吴氏的《医方考》中有扑粉方：龙骨、牡蛎、糯米，各等分研为末。服用发汗药后，出汗过多的人，用这种粉扑在身上。这个方子我常用且有效。又，《伤寒类方》说：这是外治的方法，《伤寒论》中没有温粉方。后人用牡蛎、麻黄根、铅粉、龙骨也可以。又，《孝慈备览》中有扑身止汗法：麸皮、糯米粉各二合，牡蛎、龙骨各二两，一起研成极细末，用疏绢包裹，扑遍全身，汗自然停止，避免亡阳而死。这也是好方法。《产宝》中的粳米散，治疗产后汗不止：牡蛎三两，附子一两（炮制），白粳米粉三升，一起研为散剂，搅匀，出汗时敷在身上。按语：这也是扑粉的一个方子。
伤寒脉象浮缓，身体不疼痛，只是沉重，偶尔有减轻的时候，没有少阴病证候的，用大青龙汤发汗。（《玉函经》、《千金翼方》在“者”字下有“可与”二字。程本、张本作小青龙汤发汗。）
〔柯琴〕寒邪有重有轻。伤得重的，脉象阴阳俱紧而且身体疼痛；伤得轻的，脉象浮缓而身体沉重。也有起初脉紧后来变缓，起初身体疼痛后来不疼的。诊察者不要固执一端来拘泥。然而脉浮紧的，一定身体疼痛；脉浮缓的，身体不疼痛。中风和伤寒都是这样。这又可以称为定脉定证了。在“脉浮缓”之下，应当有发热恶寒、无汗、烦躁等症状。因为脉浮缓身体不疼痛，表明表症较轻，而且身体沉重偶尔有减轻，表明表症将要解除。因为有无汗、烦躁，所以合用大青龙汤。没有少阴病证，正是仲景针对不出汗而烦躁的证候。因为少阴也有发热恶寒、无汗、烦躁的证候，与大青龙汤证相同，但治法应当温补。如果反而用麻黄的发散、石膏的寒凉，真阳立刻就会亡失。必须仔细审察那些不适用的情况，然后才不会失误于适用的情况。
〔尤怡〕身体轻，说明邪气在阳分。身体重，说明邪气在阴分。偶尔有减轻的时候，是说身体沉重但有时减轻。如果是但欲寐（总是想睡觉）、身体沉重且没有减轻的时候，就是少阴病证。现在没有但欲寐，身体虽然沉重但偶尔有减轻，就不是少阴病证。
〔魏荔彤〕“发”字各家多有议论。但这不过是发汗的意思罢了，不必深究，否则反而晦涩。
舒驰远说：案发热恶寒、无汗、烦躁，是大青龙汤的主要证候。有了主要证候，即使脉浮缓、身体不疼痛、只是沉重且偶尔有减轻，也可以用大青龙汤。但是必须辨别没有少阴病证才可以应用，否则不可用。
按语：程知说：小青龙汤，坊间刻本都作大青龙。我小时候读古本，确实是小青龙。看条文中的脉证，总不是大青龙的病。应该是因为世人说有伤风兼寒的说法，张璐的《缵论》也改为小青龙汤。但是没有明确依据，不能听从。而且程氏所说的古本，不知道是什么版本，恐怕是根据托辞而言。
《伤寒类方》说：按此条必有错误。脉浮缓，邪气轻浅容易消散，身体不疼痛，外邪已退，偶尔有减轻，病未入阴，又没有其他少阴等症，这是最轻的病，为什么投以青龙这样险峻的药剂？这必定另有主方，而误以大青龙汤当之。
伤寒表证未解，心下有水气，干呕、发热而咳嗽，或者口渴，或者腹泻，或者噎塞，或者小便不利、少腹胀满，或者气喘的，用小青龙汤主治。（“不解”，《千金方》作“未解”。“干呕发热而咳”，《玉函经》、《千金翼方》作“咳而发热”。《玉函经》、《脉经》、《千金方》中，“少腹”作“小腹”。在“喘”字上有“微”字。程本中，“噎”作“噫”。）
〔成无己〕伤寒表证未解，心下有水饮，则水寒相互搏结，肺寒气逆，所以干呕、发热而咳嗽。《针经》说：形体受寒、饮食生冷就会伤肺。因为内外两寒相感，中外都受伤，所以气逆而上行。说的就是这个意思。给予小青龙汤，发汗散水。水气内渍，传变不一，所以有或然的证候。随证增减，以化解它。
〔钱潢〕伤寒表证未解，是指头痛项强、发热体痛、无汗的证候，没有得到汗解。心下，是心之下，胃脘的部位。水气，是水饮之类。干呕发热，是太阳表证。喘咳，是水寒伤肺导致气逆。因为肺主皮毛，寒邪在表，水气停蓄，所以伤及肺气。或者腹泻，是水流入肠，向下流。或者噎塞，是水气和寒邪，阻碍胃中，气不通行。或者口渴，或者小便不利，是水寒固闭于中焦，那么下焦的阳气，不能上腾化为津液，所以口渴；上焦的清气，不能下降化为渗利，其升降的气化不行，所以小便不利，而少腹胀满。所谓“或”，是有或者没有，不一定所有证候都出现。前文以风寒郁热之邪，不得外泄而烦躁，所以用大青龙汤，通过发汗宣泄凉解。此条以寒邪未解，水饮停蓄，肺脏受伤而喘咳，并见中气寒而气滞不行，宜温宜散，可发可收，所以用小青龙汤主治。
〔周扬俊〕平素常有痰饮的人，一旦感受外邪，损伤皮毛而闭塞肺气，水饮就停在心下，上下之气就不利了。于是喘满咳呕，相继出现。此时如果单纯发汗，外邪未解，里证反而增加，为什么呢？因为被水气所束缚，不能宣通发散。况且水饮停蓄的人，中州脾胃必然不健运，才兼外感，就令气机上逆，还可以仅仅用风药上升致病吗？
按语：“噎”字，成无己注认为与“KT”（此处疑为古籍异体字或OCR识别问题，指“嗌”或类似字）同，乃引用《辨脉》篇“水得寒气，冷必相搏，其人即KT”为证。方有执也说：“噎”与“KT”（咽）同，是水寒阻滞气机，即是膈噎的噎。又写作某字。钱潢说：“噎”是呃逆。徐大椿说：《内经》无“噎”字，怀疑是呃逆的轻者。这些都是臆测的解释。程知作“噫”，也不知道有什么依据。
小青龙汤方
麻黄（去节） 芍药 细辛 干姜 甘草（炙） 桂枝（各三两去皮） 五味子（半升） 半夏（半升洗○成本作汤洗）
以上八味药，用水一斗，先煮麻黄，减少二升，去掉上面的沫，加入其余药物，煮取三升，去渣，温服一升。如果口渴，去掉半夏，加栝蒌根三两。如果轻微腹泻，去掉麻黄，加荛花如一鸡子大，熬至赤色。如果噎塞，去掉麻黄，加附子一枚（炮）。如果小便不利，少腹胀满，去掉麻黄，加茯苓四两。如果气喘，去掉麻黄，加杏仁半升（去皮尖）。况且荛花不治腹泻，麻黄主治气喘，现在这里的话相反，怀疑不是仲景的本意。（【原注】臣亿等谨慎地考察：小青龙汤，大要在于治水。又案《本草》，荛花能下十二水，如果水去则腹泻自止。又案《千金方》，形肿者，应纳入麻黄，却纳入了杏仁，是因为麻黄会发越阳气。以此证之，难道不是仲景的本意吗？○《千金方》中，荛花作芫花，《总病论》同。若噎者，《外台秘要》作若食饮噎者，《总病论》作咽字。《玉函经》无“且”字，主喘作定喘，无此语二字。反之下，有“者”字，《外台》同。成本无“且荛花以下二十字”。）
〔尤怡〕表实无汗，所以合用麻黄、桂枝两个方子以解表。去掉大枣，是因为它的性质滞腻。去掉杏仁，是因为没有气喘。如果有气喘仍然加上。去掉生姜，是因为有干姜。如果呕吐，仍然使用。佐以干姜、细辛，极温极散，使寒与水都能从汗而解。佐半夏驱逐痰饮，以清除未尽的水饮。佐五味子收敛肺气，以敛耗伤之气。如果口渴，去掉半夏，加花粉，避开燥性以生津。如果轻微腹泻、噎塞、小便不利、少腹胀满，都去掉麻黄，远离表证而治里。加附子以散寒，则噎可止。加茯苓以利水，则轻微腹泻止。（按语：《金鉴》认为，以荛花如鸡子大熬令赤色，是传写错误，改为加茯苓四两）少腹胀满可以消除了。
〔柯琴〕两个青龙汤，都治疗有表里证的病，都用两解法。大青龙汤是里热，小青龙汤是里寒。所以发表的药物相同，而治里的药物则不同。此方与五苓散，同为治疗表不解而心下有水气。然而五苓散治疗水的蓄积而不行，所以专门渗泻以利水，而微微发汗，使水从下面排出。此方，治疗水的流动而不居，所以备举辛温以散水，而大发其汗，使水从外面排出。仲景发表利水诸法，精义入神了。
〔钱潢〕详细推求后面的加减法，凡是原文中，每具备诸或有之证的，都有这些证。如小青龙汤、小柴胡汤、真武汤、通脉四逆汤、四逆散，都是如此。我私下揣度其理，恐怕未必都出于仲景之手。
按语：且荛花以下二十字，大概是王叔和的话。《大柴胡汤》方后云：不加大黄，恐不为大柴胡汤。许叔皮的《本事方》引为叔和语。这段语气，也与彼条相似，可以证明。而且《玉函经》、《外台秘要》都有此语，可见不出于后人手笔。
吴恕《活人指掌》说：荛花，如果没有，可以用生桃花代替。
柯琴说：此方，又主治水寒在胃，久咳肺虚。○按《金匮要略》，本方治疗溢饮。又加石膏，治疗肺胀咳而上气，烦躁而喘。
脉浮者，心下有水气。又本方，治疗咳逆倚息不得卧。《外台秘要》古今录验沃雪汤，即本方，去掉芍药、甘草，治疗上气不得息，喉中如水鸡声。凡局方温肺汤、杏子汤之类，从此方增减的很多。
《御药院方》细辛五味子汤，治疗肺气不利，咳嗽喘满，胸膈烦闷，痰涎多，喉中有声，鼻塞清涕，头痛目眩，肢体倦怠，咽嗌不利，呕逆恶心。（即本方）
《医学六要》香港脚上气喘促，初起有表邪者，小青龙加槟榔。
伤寒心下有水气，咳而微喘，发热不渴，服药后感到口渴的，这是寒邪去除、病欲解除的表现。用小青龙汤主治。（以下，《玉函经》、《脉经》、《千金翼方》有“而”字。此下，《玉函经》、《千金翼方》有“为”字。）
〔成无己〕咳而微喘，是水寒射肺。发热不渴，是表证未罢。给予小青龙汤，发表散水。服药后感到口渴，是里气温，水气散，为欲解也。
〔钱潢〕与上文同义。发热不渴，是因为心下有水气，所以虽然发热，也不渴。服汤，指服用小青龙汤。服药后而渴，则知心下的水气已消，胃中的寒湿已去，但因为发热之后，温解之余，上焦的津液尚少，所以反而渴。前文因为有水气，所以发热不渴。现在服药后而渴，所以知道寒水去而欲解。小青龙汤主治之句，应当在发热不渴句下。现在作末句的，是补出前面所服的汤，不是说寒去欲解之后，更应当用小青龙汤主治。这与发烦目瞑衄乃解之后，以及不发汗因致衄者，皆以麻黄汤主治的意义相同。
〔张路玉〕虽然渴但不必再服药，只要静待津液回复即可。
〔周扬俊〕小青龙汤主治之句，是总结上文之词。况且“服汤”二字，明明指定。其他书籍曾更改经文，现在仍按古本阅读。
《伤寒类方》说：小青龙汤主治之，这是倒笔法。即指“服汤已”三字，不是说欲解之后，更服小青龙汤。○按汪氏引《补亡论》，将“小青龙汤主治之”六字，移在“发热不渴”字下。张璐、志聪《金鉴》，都听从这个说法。不知道仲景章法，固有如此者，大概没有考证罢了。
太阳病，外证未解，脉浮弱的，应当以汗解，宜用桂枝汤。（《玉函经》在“脉”上有“其”字。在“汤”下有“主之”三字。）
〔张路玉〕外证未解，可知曾经服用过发汗药。
〔方有执〕外证未解，是指头痛项强、恶寒等还在。浮弱，即阳浮而阴弱。这是说太阳中风，凡是在未传变者，仍应当从于解肌。这是严格告诫不得过早攻下的意思。
〔柯琴〕如果只浮不弱，或者浮而紧的，就是麻黄症。要知道本方，只主治外症之虚者。
按语：原本每篇重复出现的各方，现在一律从成本删去。
太阳病，下之微喘者，表未解故也。桂枝加厚朴杏子汤主治。（杏子，成本、《玉函经》、《千金方》作杏仁。《千金翼方》作桂枝汤，注：一说麻黄汤。）
〔成无己〕下后大喘，则为里气大虚，邪气传里，正气将脱也。下后微喘，则为里气上逆，邪不能传里，犹在表也。给予桂枝汤以解外，加厚朴、杏仁，以降逆气。
〔程知〕喘这一证候，有里有表，不可不辨。下后汗出而喘的，其喘一定严重，属里热壅逆，火炎所致。下后微喘的，汗一定不大出，属表邪遏闭，气逆所致。表未解，仍应从表治，在桂枝解表内，加厚朴、杏仁，以降逆气。不可误用葛根黄连黄芩汤，使表邪混淆入里分，寒从热治，变证更深。
〔志〕燕氏说：此与喘家作桂枝汤加厚朴杏子，同一义也。
桂枝加厚朴杏子汤方
桂枝（三两去皮） 甘草（二两炙） 生姜（三两切） 芍药（三两） 大枣（十二枚擘） 厚朴（二两炙去皮） 杏仁（五十枚去皮尖）
以上七味药，用水七升，微火煮取三升，去渣，温服一升，覆盖取微似汗。（成本不载此方，第十卷曰：于桂枝汤方内，加厚朴二两，杏仁五十个，去皮尖，根据前法）
《伤寒类方》说：《别录》记载，厚朴主治消痰下气。《本经》记载，杏仁主治咳逆上气。
《本事方》说：戊申正月，有一位武官，被贼寇抓获，放在舟中板下，几天后逃脱。乘着饥饿恣意进食，很久后脱衣捉虱。第二天就得了伤寒，自汗且膈部不利。一个医生认为是伤食而下之，一个医生认为是解衣中邪而汗之。杂治数日，渐渐觉得昏困，上喘急高。医者惊慌失措。我诊察他说：太阳病下之，表未解，微喘者，桂枝加厚朴杏仁汤。这是仲景的法度。命令医者急治药，一喝喘定，再喝微汗，到晚上身凉，而脉已和了。医生说：我平生未曾用过仲景方，不知道其神捷如是。我说：仲景之法，岂欺骗后人哉？是人自己学识浅薄，无以发明罢了。
太阳病，外证未解，不可下也。下之为逆。欲解外者，宜桂枝汤。（成本、《玉函经》中，“解”后有“不间”二字，有“者”字。在“汤”下有“主之”二字。《玉函经》、《千金翼方》无“欲”字。）
〔钱潢〕太阳中风，其头痛项强、发热恶寒、自汗等表证未除，理应汗解，慎不可下。下之则于理为不顺，于法为逆。逆则变生，而邪气乘虚内陷，结胸痞硬、下利喘汗、脉促胸满等证作矣。所以必须先解外邪。欲解外者，宜以桂枝汤主治。无他法也。
〔尤怡〕凡表证未解，无论已汗未汗，虽有可下之证，而非在急下之例者，均不可下。
〔王肯堂〕但只要有一毫头痛恶寒，即为表证未解。
〔张路玉〕下之为逆，不独指变结胸等证而言，即三阴坏病，多由误下所致也。
〔柯琴〕外证初起，有麻黄桂枝之分。如当解未解时，惟桂枝汤可用。故桂枝汤，为伤寒中风杂病解外之总方。凡脉浮弱汗自出，而表不解者，咸得而主之也。即阳明病脉迟、汗出多者宜之。太阴病脉浮者亦宜之。则知诸经外证之虚者，咸得同太阳未解之治法。又可见桂枝汤不专为太阳用矣。
《伤寒选录》张氏说：我看仲景周旋去就之妙，穷至事理之极，尤其不肯放乎。尚言欲解外，宜桂枝汤。一个“欲”字，权衡犹未放乎。更有踌躇详审不尽之意。后之学人，当反复斟酌，别其所宜，庶无差失之患。此乃临证审决之意也。卷内凡言“宜”者，即同此理也。
太阳病，先发汗不解，而复下之，脉浮者不愈。浮为在外，而反下之，故令不愈。今脉浮故在外，当须解
To stop sweating, this method is suitable. The *Huoren Shu* (Book of Vitality) removes Lingling Xiang (Ligusticum linglingii), directly forming the Wenfen Fang (Warm Powder Prescription). It is recorded after the Daqinglong Tang (Major Blue Green Dragon Decoction). Later texts such as the *Benshi Fang* (Prescriptions from Personal Experience), *Sanyin Fang* (Three Causes Prescriptions), and *Mingli Lun* (Treatise on Clear Principles) all treat "Bi Wenfen" (Avoiding Warmth Powder) as "Wenfen" (Warm Powder), not knowing whether Chuanxiong Baizhi Ben Congzhu (Ligusticum chuanxiong, Angelica dahurica, and Atractylodes lancea) can stop sweating. Wu's *Yifang Kao* (Study of Medical Prescriptions) contains a Pufen Fang (Dusting Powder Prescription): Longgu (Fossil Bones), Muli (Oyster Shell), Nuomi (Glutinous Rice), ground into powder in equal parts. For those who sweat excessively after taking diaphoretic medicines, dust this powder on the body. I often use this prescription with verified efficacy. Furthermore, the *Shanghan Leifang* (Classified Formulas for Cold Damage) states: This is an external treatment method; the *Shanghan Lun* does not contain a Wenfen Fang. Later practitioners used Muli (Oyster Shell), Mahuanggen (Ephedra Root), Qianfen (Lead Powder), and Longgu (Fossil Bones), which is also acceptable. Additionally, the *Xiaoci Beilan* (Comprehensive Guide to Filial Piety and Kindness) describes a method for stopping sweating by dusting the body: Bran and Nuomi Fen (Glutinous Rice Powder), two he; Muli (Oyster Shell) and Longgu (Fossil Bones), two liang. Grind all into an extremely fine powder, wrap in a coarse silk bag, and dust over the entire body. The sweating will naturally cease, preventing death from Yang collapse. This is also a good method. The *Chanbao* (Treasures for Childbirth) contains Jingmi San (Rice Powder): Muli (Oyster Shell), three liang; Fuzi (Aconite Lateral Root), one liang (processed); Baijingmi Fen (White Rice Flour), three sheng. Grind into a powder, mix well, and apply when sweating occurs. Note: This is also a type of dusting powder prescription.
In cold damage, if the pulse is floating and slow, the body does not ache but feels heavy, occasionally feeling lighter at times, and there are no Shaoyin syndrome signs, Daqinglong Tang (Major Blue Green Dragon Decoction) should be used to induce sweating. (*Yuhan Jing* [Golden Jar Classic] and *Qianjin Yi Fang* [Supplements to the Thousand Golden Prescriptions] add "ke yu" [may be given] after "zhe" [one]. Cheng's edition and Zhang's edition read "Xiao Qinglong Tang" [Minor Blue Green Dragon Decoction]).
[Ke Qin] Cold pathogens vary in severity. Severe injury results in a tight pulse in both Yin and Yang positions and body pain. Mild injury results in a floating, slow pulse and body heaviness. There are cases where the pulse is initially tight and becomes slow, or body pain is initially present and later disappears. Practitioners should not be rigid in diagnosis. However, a floating, tight pulse must accompany body pain; a floating, slow pulse means no body pain. This applies to both wind-stroke and cold damage. This can be termed fixed pulse and fixed syndrome. Below "floating, slow pulse," symptoms such as fever, aversion to cold, absence of sweating, and irritability should be present. Because the pulse is floating and slow with no body pain, the exterior syndrome is mild. Moreover, the occasional relief of body heaviness indicates the exterior syndrome is about to resolve. Due to the absence of sweating and irritability, Daqinglong Tang (Major Blue Green Dragon Decoction) is combined. The absence of Shaoyin syndrome refers precisely to Zhongjing's indication for non-sweating with irritability. Since Shaoyin disease also presents with fever, aversion to cold, absence of sweating, and irritability—similar to Daqinglong Tang—it requires warming and tonification. If one mistakenly uses the dispersing nature of Mahuang (Ephedra) and the cooling nature of Shigao (Gypsum), True Yang will perish immediately. One must carefully examine what is contraindicated to avoid errors in application.
[You Yi] Lightness of the body indicates the pathogen is in the Yang aspect. Heaviness indicates the pathogen is in the Yin aspect. "Occasionally lighter" means the heaviness sometimes alleviates. If there is lethargy ("Dan Yu Mei") and constant heaviness without relief, it is a Shaoyin syndrome. Currently, there is no lethargy, and although the body is heavy, it occasionally lightens; thus, it is not a Shaoyin syndrome.
[Wei Litong] Scholars have debated the character "Fa" (Induce/Release). However, it simply means inducing sweating. Over-interpreting it only obscures the meaning.
Shu Chiyuan states: Fever, aversion to cold, absence of sweating, and irritability are the main indications for Daqinglong Tang (Major Blue Green Dragon Decoction). With these main indications, even if the pulse is floating and slow, the body does not ache, feels heavy, and occasionally lightens, Daqinglong Tang may still be used. However, one must confirm the absence of Shaoyin syndrome before using it; otherwise, it is contraindicated.
Note: Cheng Zhi states that坊间 editions (market editions) of Xiao Qinglong Tang (Minor Blue Green Dragon Decoction) all read Da Qinglong Tang. In my youth, reading ancient editions, it was indeed Xiao Qinglong Tang. Observing the pulse and symptoms in this clause, they do not match Da Qinglong Tang. This is likely due to the popular notion of "wind-stroke combined with cold." Zhang Lu's *Zuanlun* also changed it to Xiao Qinglong Tang. However, lacking clear evidence, this change should not be followed. Furthermore, the "ancient edition" mentioned by Cheng is unknown, possibly a fabricated claim.
*Shanghan Leifang* (Classified Formulas for Cold Damage) notes: This clause must contain an error. A floating, slow pulse suggests a mild pathogen that easily dissipates. No body pain indicates the exterior pathogen has retreated. Occasional relief suggests the disease has not entered the Yin level. Without other Shaoyin symptoms, this is the mildest form of illness. Why administer the potent and hazardous Qinglong formulas? There must be another primary formula, mistakenly substituted here with Da Qinglong Tang.
When the exterior of cold damage is unresolved, and there is fluid retention in the epigastrium, presenting with dry retching, fever, and cough, or thirst, or diarrhea, or choking sensation, or dysuria with hypogastric fullness, or wheezing, Xiao Qinglong Tang (Minor Blue Green Dragon Decoction) is the principal treatment. ("Unresolved" reads "Wei Jie" [Not yet resolved] in *Qianjin Fang*. "Dry retching, fever, and cough" reads "Cough then fever" in *Yuhan Jing* and *Qianjin Yi Fang*. *Yuhan Jing*, *Maijing*, and *Qianjin Fang* read "Xiao Fu" [Lower Abdomen] instead of "Shao Fu" [Hypogastrium]. The character "Wei" [Mild] appears before "Chuan" [Wheeze]. Cheng's edition reads "Ye" [Belch] instead of "Ye" [Choking].)
[Cheng Wuji] When the exterior of cold damage is unresolved and there is fluid retention in the epigastrium, water and cold contend. Lung Qi becomes cold and rebels upward, causing dry retching, fever, and cough. The *Zhen Jing* (Needle Classic) states: "Exposure to cold and consumption of cold drinks injure the lungs." Because internal and external colds interact, both the interior and exterior are injured, causing Qi to rebel upward. This is the meaning. Xiao Qinglong Tang (Minor Blue Green Dragon Decoction) is given to induce sweating and disperse water. As water retention permeates internally, transmission varies, leading to various potential symptoms. Modifications are made according to symptoms to resolve them.
[Qian Huang] "Exterior unresolved" refers to headache, stiff neck, fever, body ache, and absence of sweating, indicating the condition has not been resolved by sweating. "Epigastrium" is below the heart, in the region of the stomach. "Fluid Qi" refers to fluid retention. Dry retching and fever are Taiyang exterior signs. Wheezing and cough result from water-cold injuring the lung and rebelling Qi. Since the lung governs skin and hair, cold pathogens in the exterior and stagnant fluid Qi injure Lung Qi. Diarrhea occurs when water flows into the intestines. Choking occurs when fluid Qi and cold pathogens obstruct the stomach, blocking Qi flow. Thirst or dysuria occur because cold-water stagnation in the Middle Jiao prevents Lower Jiao Yang Qi from ascending to transform into fluids (causing thirst) and prevents Upper Jiao Clear Qi from descending for excretion (causing dysuria and hypogastric fullness). "Or" implies presence or absence; not all symptoms need appear simultaneously. Previously, wind-cold with郁 heat caused irritability due to inability to vent externally, treated with Da Qinglong Tang to vent and cool via sweating. Here, unresoved cold pathogens and stagnant fluid Qi injure the lung, causing wheezing and cough, accompanied by Middle Qi cold and stagnation. Warming and dispersing, releasing and collecting are needed; thus, Xiao Qinglong Tang is used.
[Zhou Yangjun] Individuals with chronic phlegm-fluids who contract external pathogens suffer from exterior obstruction affecting Lung Qi, causing fluids to stagnate in the epigastrium and disrupting upper-lower Qi movement. Consequently, wheezing, fullness, cough, and retching occur sequentially. At this time, simple sweating fails to resolve the exterior and worsens interior symptoms because the fluid pathogens restrain Qi dispersion. Moreover, stagnant fluids indicate weak Spleen transport. External contraction causes Qi to rebel upward; relying solely on acrid-warm dispersants is insufficient.
Note: Regarding "Ye" (Choking), Cheng Wuji equates it with a specific character, citing *Bian Mai* regarding water-cold contention causing this symptom. Fang Youzhi also equates it with "Yan" (Throat), meaning water-cold blocking Qi, i.e., chest choking. Qian Huang defines it as hiccups. Xu Dachun notes the *Neijing* lacks "Ye," suspecting it is mild hiccups. These are speculative. Cheng Zhi reads it as "Yi" (Belch), also lacking basis.
**Xiao Qinglong Tang Formula**
Mahuang (Ephedrae Herba, removed nodes), Shaoyao (Paeoniae Radix Alba), Xixin (Asari Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried), Guizhi (Cinnamomi Ramulus, each 3 liang, bark removed), Wuweizi (Schisandrae Fructus, half sheng), Banxia (Pinelliae Tuber, half sheng, washed [Cheng's edition specifies boiling water wash]).
Grind the above eight ingredients. Use one dou of water. First boil Mahuang, reduce by two sheng, skim off the foam. Add remaining herbs. Boil to obtain three sheng. Strain. Take one sheng warm. If thirsty, remove Banxia, add Gualougen (Trichosanthis Radix, 3 liang). If mild diarrhea, remove Mahuang, add Raohua (Adenophorae Radix, size of a chicken egg, fried until red). If choking, remove Mahuang, add Fuzi (Aconiti Lateralis Radix Praeparata, one piece, processed). If dysuria with hypogastric fullness, remove Mahuang, add Fuling (Poria, 4 liang). If wheezing, remove Mahuang, add Xingren (Armeniacae Semen Amarum, half sheng, skin and tips removed). Note: Raohua does not treat diarrhea; Mahuang treats wheezing. The current text contradicts this, suggesting it may not be Zhongjing's original intent. ([Original Note: Ministers Yi et al. cautiously note: Xiao Qinglong Tang primarily treats water retention. Also, *Bencao* states Raohua drains water from twelve areas; if water drains, diarrhea stops. Also, *Qianjin Fang* states that for edema, Mahuang should be added, but Xingren is added instead because Mahuang disperses Yang. By this reasoning, is this not Zhongjing's intent? ○ *Qianjin Fang* reads Yuanhua (Genkwa Flos) instead of Raohua; *Zongbing Lun* agrees. *Waitai Miyao* reads "If food/drink causes choking." *Zongbing Lun* reads "Yan" (Swallow). *Yuhan Jing* lacks "Qie" (Moreover). "Zhu Chuan" reads "Ding Chuan" (Definitively treats wheezing). Lacks "Ci Yu Er Zi" (These two words). Below "Fan," adds "Zhe" (One). *Waitai* agrees. Cheng's edition lacks the twenty characters from "Qie Raohua" onwards.])
[You Yi] Exterior excess with no sweating necessitates combining Mahuang and Guizhi formulas to release the exterior. Dazao (Jujubae Fructus) is removed for its cloying nature. Xingren is removed due to absence of wheezing; add if wheezing exists. Shengjiang (Zingiberis Rhizoma Recens) is removed because Ganjiang is present; add if vomiting occurs. Ganjiang and Xixin provide extreme warmth and dispersion, allowing cold and water to exit via sweat. Banxia drives out phlegm-fluids to clear residual retention. Wuweizi astringes Lung Qi to conserve depleted Qi. For thirst, remove Banxia, add Huafen (Trichosanthis Radix) to avoid dryness and generate fluids. For mild diarrhea, choking, dysuria, and hypogastric fullness, remove Mahuang to shift focus from exterior to interior. Add Fuzi to dispel cold (stopping choking); add Fuling to promote urination (stopping mild diarrhea). [Note: *Jinjian* considers "Raohua... fried until red" a transcription error, changing it to "Add Fuling 4 liang."] Hypogastric fullness can be eliminated.
[Ke Qin] Both Qinglong formulas treat exterior-interior syndromes using dual resolution. Da Qinglong Tang addresses Interior Heat; Xiao Qinglong Tang addresses Interior Cold. Thus, exterior-releasing herbs are similar, but interior-treating herbs differ. Like Wuling San (Five-Ingredient Powder with Poria), this treats unresolved exterior with fluid retention in the epigastrium. However, Wuling San treats stagnant, immobile water, focusing on leaching and draining with mild sweating to expel water downward. This formula treats mobile, unsettled water, utilizing acrid-warm herbs to disperse water and induce strong sweating to expel water outward. Zhongjing's methods for releasing the exterior and promoting urination are profound and divine.
[Qian Huang] Detailed analysis of the modification rules shows that whenever "potential" symptoms are listed, they are all present. Examples include Xiao Qinglong Tang, Xiaochaihu Tang, Zhenwu Tang, Tongmai Sini Tang, and Sini San. I speculate based on reason that these may not all originate from Zhongjing.
Note: The twenty characters from "Qie Raohua" onwards are likely Wang Shuhe's commentary. The post-prescription note for Daxiehu Tang says: "Without Dahuang, it is not Daxiehu Tang." Xu Shupi's *Benshi Fang* cites this as Shuhe's words. The tone matches that clause, providing proof. *Yuhan Jing* and *Waitai Miyao* also contain this, confirming it is not a later addition.
Wu Shu's *Huoren Zhizhang* states: If Raohua is unavailable, substitute with fresh Taohua (Peach Flower).
Ke Qin states: This formula also treats Water-Cold in the Stomach causing chronic cough and Lung deficiency. ○ According to *Jinkui Yaolue*, this formula treats Yi Yin (Overflowing Drink). Adding Shigao treats Fei Zhang (Lung Distension) with cough, Qi rebellion, irritability, and wheezing.
Floating pulse with fluid retention in the epigastrium. This formula also treats cough with Qi rebellion preventing lying flat. *Waitai Miyao*'s Gujin Lu Yan Wo Xue Tang (Ancient and Modern Record Snow-Melting Decoction) is this formula minus Shaoyao and Gancao, treating upper Qi obstruction, breathing difficulty, and a frog-like sound in the throat. Many formulas from Ju Fang, such as Wenfei Tang and Xingzi Tang, are derived from modifications of this formula.
*Yuyao Yuan Fang* Xixin Wuweizi Tang (Asari and Schisandra Decoction) treats dysfunctional Lung Qi, cough, wheezing, chest oppression, excessive phlegm, throat sounds, nasal congestion with clear discharge, headache, dizziness, limb fatigue, throat discomfort, and nausea/vomiting. (This is essentially this formula.)
*Yixue Liuyao* (Six Essentials of Medicine) recommends adding Binglang (Arecae Semen) to Xiao Qinglong Tang for Hongjiao (Beriberi) with upper Qi wheezing and shortness of breath, if exterior pathogens are present initially.
In cold damage, fluid retention in the epigastrium causes cough with mild wheezing, fever, and no thirst. If thirst develops after taking the medicine, it indicates the cold is departing and the disease is resolving. Xiao Qinglong Tang is the principal treatment. (Below, *Yuhan Jing*, *Maijing*, and *Qianjin Yi Fang* add "Er" [And]. Below this, *Yuhan Jing* and *Qianjin Yi Fang* add "Wei" [Is].)
[Cheng Wuji] Cough with mild wheezing indicates water-cold projecting to the lung. Fever without thirst indicates the exterior syndrome has not ceased. Xiao Qinglong Tang releases the exterior and disperses water. Thirst after taking the medicine indicates interior warmth and dispersion of water, signifying resolution.
[Qian Huang] Same meaning as above. Fever without thirst is due to fluid retention in the epigastrium; thus, despite fever, there is no thirst. "Taking medicine" refers to taking Xiao Qinglong Tang. Thirst after taking it confirms fluid retention has dissipated and stomach cold-dampness has cleared. However, post-fever and post-warming resolution, Upper Jiao fluids are still scarce, hence the thirst. Previously, fluid retention caused fever without thirst. Now, thirst after medication confirms cold-water departure and impending resolution. The phrase "Xiao Qinglong Tang is the principal treatment" should follow "fever without thirst." Placing it at the end supplements the information about the previously taken medicine; it does not mean administering Xiao Qinglong Tang again after resolution. This parallels the principle of using Mahuang Tang after nosebleeds resolve irritability or after spontaneous nosebleeds due to lack of sweating.
[Zhang Luzhou] Even with thirst, further medication is unnecessary; simply wait for fluids to return.
[Zhou Yangjun] "Xiao Qinglong Tang is the principal treatment" concludes the preceding text. Moreover, "taking medicine" clearly specifies the action. Other texts altered the scripture; we adhere to the ancient edition.
*Shanghan Leifang* states: "Xiao Qinglong Tang is the principal treatment" is an inverted syntax, referring to "after taking medicine." It does not mean administering the decoction again after resolution. ○ Note: Wang cites *Buwang Lun*, moving the six characters "Xiao Qinglong Tang is the principal treatment" below "fever without thirst." Zhang Lu and *Jinjian* follow this view. They fail to recognize Zhongjing's structural style, likely due to lack of research.
In Taiyang disease, if exterior signs remain unresolved and the pulse is floating and weak, sweating should be induced using Guizhi Tang (Cinnamon Twig Decoction). (*Yuhan Jing* adds "Qi" [Its] before "Mai" [Pulse]. Adds "Zhu Zhi" [Main Treats] after "Tang".)
[Zhang Luzhou] Unresolved exterior signs imply previous administration of diaphoretics.
[Fang Youzhi] Unresolved exterior signs refer to persistent headache, stiff neck, and aversion to cold. Floating and weak corresponds to "Yang floating and Yin weak." This describes Taiyang Wind-Strike. For cases not yet transmitted, muscle-release is still indicated. This strictly warns against premature purgation.
[Ke Qin] If the pulse is merely floating without weakness, or is floating and tight, it is a Mahuang syndrome. Know that this formula only treats deficient exterior signs.
Note: Originally, repeated formulas in each chapter were deleted uniformly based on Cheng's edition.
In Taiyang disease, if purgation leads to mild wheezing, it is because the exterior remains unresolved. Guizhi Jia Houpo Xingzi Tang (Guizhi Decoction plus Magnolia Bark and Apricot Kernel) is the principal treatment. (Xingzi reads "Xingren" [Apricot Kernel] in Cheng's edition, *Yuhan Jing*, and *Qianjin Fang*. *Qianjin Yi Fang* reads "Guizhi Tang" with a note: alternatively Mahuang Tang.)
[Cheng Wuji] Profuse wheezing after purgation indicates severe interior deficiency, pathogen transmission to the interior, and impending collapse of righteous Qi. Mild wheezing after purgation indicates rebellious interior Qi, inability of the pathogen to transmit inward, and persistence in the exterior. Guizhi Tang releases the exterior; adding Houpo (Magnoliae Officinalis Cortex) and Xingren (Armeniacae Semen Amarum) directs rebellious Qi downward.
[Cheng Zhi] Wheezing can be interior or exterior; differentiation is essential. Wheezing with sweating after purgation is severe, indicating interior heat congestion and rebellion due to fire flaring. Mild wheezing after purgation involves minimal sweating, indicating exterior pathogen constriction and Qi rebellion. With unresolved exterior, treatment must target the exterior. Add Houpo and Xingren to Guizhi Tang to direct Qi downward. Do not mistakenly use Gegen Linqin Tang (Kudzu, Coptis, and Scutellaria Decoction), which would confuse the exterior pathogen into the interior, treating cold with heat, deepening complications.
[Zhi] Yan Shi states: This shares the same principle as "For asthmatics, prepare Guizhi Tang and add Houpo and Xingzi."
**Guizhi Jia Houpo Xingzi Tang Formula**
Guizhi (Cinnamomi Ramulus, 3 liang, bark removed), Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang, honey-fried), Shengjiang (Zingiberis Rhizoma Recens, 3 liang, sliced), Shaoyao (Paeoniae Radix Alba, 3 liang), Dazao (Jujubae Fructus, 12 pieces, split), Houpo (Magnoliae Officinalis Cortex, 2 liang, honey-fried and bark removed), Xingren (Armeniacae Semen Amarum, 50 pieces, skin and tips removed).
Boil the above seven ingredients in seven sheng of water over low heat to obtain three sheng. Strain. Take one sheng warm. Cover to induce slight sweating. (Cheng's edition does not record this formula; Volume 10 states: Add Houpo 2 liang and Xingren 50 pieces (skin/tips removed) to Guizhi Tang formula, following previous methods.)
*Shanghan Leifang* notes: *Bielu* states Houpo treats phlegm elimination and Qi descent. *Benjing* states Xingren treats cough, wheezing, and Qi rebellion.
*Benshi Fang* records: In the first month of Wushen year, a military officer was captured by bandits and confined under a boat plank for several days before escaping. Starving, he ate greedily. Later, undressing to catch lice, he developed cold damage the next day, with spontaneous sweating and diaphragmatic obstruction. One physician treated it as food stagnation with purgatives; another treated it as pathogen from undressing with diaphoretics. After days of mixed treatments, he became increasingly lethargic with high-pitched wheezing. Physicians were panicked. I diagnosed: Taiyang disease treated with purgation, exterior unresolved, mild wheezing. This is Guizhi Jia Houpo Xingzi Tang, Zhongjing's method. Ordered urgent preparation. One dose stopped wheezing; second dose induced slight sweating. By evening, body cooled, pulse harmonized. Physician said: "I never used Zhongjing's formulas; did not know their efficacy was so miraculous." I replied: "Zhongjing's methods do not deceive posterity. People lack learning to elucidate them."
In Taiyang disease, if exterior signs remain unresolved, purgation is contraindicated. Purgation is adverse. To resolve the exterior, Guizhi Tang is suitable. (Cheng's edition and *Yuhan Jing*: "Jie" has "Bu Jian" [Not separated], "Zhe" [One]. Adds "Zhu Zhi" [Main Treats] after "Tang". *Yuhan Jing* and *Qianjin Yi Fang* lack "Yu" [Desire/Wish].)
[Qian Huang] In Taiyang Wind-Strike, if headache, stiff neck, fever, aversion to cold, and spontaneous sweating persist, sweating is indicated. Purging is forbidden. Purging violates principles and methods, causing complications: pathogen sinking into deficiency, resulting in Jie Xiong (Chest Binding), Pi Ying (Stagnant Hardness), diarrhea, wheezing, sweating, Cu Mai (Knotted Pulse), and Chest Fullness. Therefore, exterior pathogens must be resolved first. To resolve the exterior, Guizhi Tang is the only option.
[You Yi] Whenever exterior signs are unresolved, regardless of prior sweating, if purgation is indicated but not an emergency purge, it is contraindicated.
[Wang Ken-tang] Any trace of headache or aversion to cold indicates unresolved exterior.
[Zhang Luzhou] "Purgation is adverse" refers not only to Jie Xiong complications but also to damaged diseases of the Three Yin, often caused by erroneous purgation.
[Ke Qin] At the onset of exterior signs, distinction between Mahuang and Guizhi is necessary. If resolution is delayed, only Guizhi Tang is applicable. Thus, Guizhi Tang is the general formula for releasing the exterior in cold damage, wind-stroke, and miscellaneous diseases. For floating, weak pulse with spontaneous sweating and unresolved exterior, it is appropriate. It suits Yangming disease with slow pulse and profuse sweating, and Taiyin disease with floating pulse. Thus, deficient exterior signs of all meridians share the Taiyang unresolved treatment. Guizhi Tang is not exclusive to Taiyang.
*Shanghan Xuanlu* (Selected Records of Cold Damage) by Zhang states: I observe Zhongjing's skillful maneuvering, reaching the pinnacle of logic, yet hesitating. Saying "To resolve the exterior, suit Guizhi Tang," the word "Suit" (Yi) shows restraint. It implies deliberation and careful consideration. Future students must ponder this to avoid errors. This reflects clinical judgment. All instances of "Yi" (Suit/Appropriate) in the volume carry this meaning.
In Taiyang disease, if initial sweating fails to resolve the condition, and purgation is subsequently applied, and the pulse remains floating, the disease is not cured. Floating indicates the pathogen is still exterior. Erroneous purgation prevents cure. Since the pulse is currently floating, the pathogen is exterior. Resolution is required.