（此系仲景原文）
太阳病项背强KT KT 无汗恶风。葛根汤主之。（太阳病项背强。KT KT 前于反汗出条下已注明。今则无汗恶
风。此原系太阳中风表实之证。欲传入阳明也。内台方议云。项背强。KT KT 然恶风。乃有风在表而不得散。只因无
汗是兼有寒邪。故于桂枝加葛根汤方中。更加麻黄。而改名曰葛根汤方也。）
葛根（四两） 麻黄（三两去节） 桂枝（二两去皮） 芍药（二两切） 甘草（二两炙） 生姜（三两切） 大
枣（十二枚擘）
上七味。 咀。以水一斗。先煮麻黄葛根。减二升。去沫。内诸药。煮取三升。去滓。温服一升。覆取微似汗。不
须粥。余如桂枝法将息及禁忌。
（成注云。本草言轻可去实。麻黄葛根之属是也。此以中风表实。故加二物于桂枝汤中也。愚谓伤风恶风。此亦太
阳伤风证。因无汗故加麻黄。因KT KT 然拘强。故用葛根为君。）
或问予仲景法太阳病无汗者。为伤寒表实。何以不竟用麻黄汤。愚谓伤寒表实。必恶寒而喘。此则不喘。知非麻黄
证。故汤中不用杏人。且仲景云。KT KT 无汗恶风。明系是中风表实证。故于桂枝汤中加麻黄葛根也。
或又问云。同是太阳无汗。何以别其为中风表实。且伤寒亦有恶风者。不必拘拘于伤风始恶风也。愚意以伤寒表实。
是绝无汗。故恶寒发热而加喘。中风表实是欲汗出而不得。故项背强KT KT 然而恶风。以是而别。其为中风表实也。
太阳与阳明合病者。必自下利。葛根汤主之。（伤寒有合病。有并病。成注云。本太阳病不解。并于阳明者。谓之并
病。其合病者。喻氏尚论篇云。两经之证。各见一半。如日月之合朔。故云。合也。太阳与阳明合病者。太阳恶寒发热
头项强痛等证。与阳明热渴目疼鼻干等证。同时均发。无有先后也。阳邪之气交合。而病甚于表。表邪既甚。则里气决
不相和。太阳之里为膀胱。其腑主水。阳明之里为胃。其腑主谷。二腑之气不和。则水谷虽运化而不厘清。所以必自下
利也。治法与葛根汤。以发散二经中合病之表邪。而利自止。按成注云。里气不和。下而不上者。当病利。仲景法。用
葛根汤者。乃发中有升举之义。又按成注云。寒邪气甚。客于二阳。二阳方外实而不主里。则里气虚。故必下利。愚以
里气虚即为不和。不可作真虚看。内台方议云。此条病用此方。乃内外均解之剂。葛根性甘平。能祛风。行于阳明之经。
用之为君。麻黄为臣。辅之发汗。解太阳之表。桂枝芍药为佐。通行于营卫之间。甘草大枣之甘。生姜之辛。以通脾胃
之津液。为使。是为内外均解。愚以芍药。虽为今医治下利之药。得桂枝既外行于营。甘草虽能和中。姜枣虽健脾胃。
行津液。要之于此汤中用之。不过是辛甘发散之剂。初非治下利之药也。或问成注云。寒邪气甚。客于二阳。内台方又
云葛根性甘平。能祛风行于阳明之经。究竟此条合病。是风是寒。愚以此条病。系风寒两伤之证。尚论篇以此条病主寒。
下条病主风。且以上葛根汤。即桂枝汤内加葛根。不用麻黄者。是为大失仲景之旨。内台方疑问云。经云。下利不可发
汗发汗则胀满。今此下利。又发汗者。何也。答曰。少阴病下利清谷者。为里虚。若更发汗。则脾虚而胀。今此太阳证
未罢。或有头痛恶风寒。证尚在表。其脉尚带浮。便传入阳明。有口渴身热等证。必自下利也。必须此方微发汗而散表
邪。中有葛根。以除阳明之邪也。若是诸证发热。兼有里而脉浮者。此方最善。愚按上云传入阳明。此与并病无异。内
台为合病作解。其言亦误。）
太阳与阳明合病。不下利。但呕者。葛根加半夏汤主之。（此条合病。亦风寒两伤之证。风寒之邪交合。而病甚于表。
表病。则里气亦不和。成注云。里气上逆而不下者。但呕而不下利。愚以其人胸中必有停饮故也。仲景法。与葛根汤。
以发散二经之邪。加半夏以下气散饮。按条辩云。此条病以见太阳阳明中风之不同。与上条伤寒下利之证。互相发明。
寒为阴。阴气主下降。故下利。风为阳阳气主上逆。故作呕殊不知伤寒之证。郁热于里。胸中兀兀欲吐而作呕者甚多。
非比中寒之证而云必自下利也。又中风之证。木来侮土。胃气下注。肠鸣而作利者亦不少。未必皆风气上壅。而作呕逆
也。盖上条乃病患肠中有食积。故下利其不治。下利者以风寒方甚于表也。此条乃病患胸中有停饮。故作呕其兼治作呕
者。以半夏同一辛散。且无碍于风寒。故加之也。）
（这是张仲景的原文）
太阳病，出现项背部僵硬拘急不适，且无汗、怕风。应当用葛根汤主治。（关于“太阳病项背强”这一症状，在之前“反汗出”的条文下已经注明过。现在这里是无汗且怕风，这原本属于太阳中风兼表实的证候。病情有向阳明经传变的趋势。《内台方议》认为：项背部僵硬拘急且怕风，是因为风邪在体表而不能发散。只因为无汗，所以是兼有寒邪。因此，在桂枝加葛根汤的基础上，再加麻黄，并改名为葛根汤。）
葛根（四两） 麻黄（三两，去节） 桂枝（二两，去皮） 芍药（二两，切碎） 甘草（二两，炙烤） 生姜（三两，切碎） 大枣（十二枚，掰开）
以上七味药。捣碎。用水一斗，先煮麻黄和葛根，减少二升水量，撇去浮沫，加入其余药物，煮取三升药液，滤去药渣。温服一升，服药后覆盖衣被使身体微微出汗。不需要喝热粥助汗。其余调养方法和禁忌事项，参照桂枝汤的方法执行。
（成无己注解说：本草书说轻清之品可以去实邪，麻黄、葛根这类药物就是如此。此证属于中风兼表实，所以在桂枝汤中加入这两味药。我认为伤风怕风，这也属于太阳伤风证，因为无汗所以加麻黄，因为项背部僵硬拘急，所以用葛根作为君药。）
有人问我：按照张仲景的法度，太阳病无汗的，属于伤寒表实证，为什么不全用麻黄汤？我认为伤寒表实证，必定伴有怕冷和气喘。此证没有气喘，知道不是麻黄汤证，所以汤剂中不用杏仁。而且张仲景说：“项背强且无汗怕风”，明确属于中风表实证。因此在桂枝汤中加入麻黄和葛根。
又有人问：同样是太阳病无汗，如何区别它是中风表实？况且伤寒也有怕风的，不必拘泥于只有伤风才怕风。我的意思是，伤寒表实是完全不出汗，所以怕冷、发热且伴有气喘；中风表实是想出汗却出不来，所以项背部僵硬拘急且怕风。据此来区分，这就是中风表实证。
太阳经与阳明经合病，必然出现自发性腹泻。应当用葛根汤主治。（伤寒中有合病，有并病。成无己注解说：原本是太阳病未解，传入阳明的，称为并病。对于合病，《尚论篇》喻嘉言说：两经的症状各现一半，就像日月相合朔望之时，所以叫合病。太阳与阳明合病时，太阳病的恶寒、发热、头项强痛等症状，与阳明病的口渴、目痛、鼻干等症状，同时发生，没有先后之分。阳邪之气交合，导致表证加重。表邪既然严重，里气必然不和。太阳的里脏是膀胱，其腑主司水液代谢；阳明的里脏是胃，其腑主司谷物消化。两腑之气不和，虽然水谷能够运化，但不能分清别浊，所以必然出现自发性腹泻。治疗方法用葛根汤，以发散两经合病的表邪，腹泻自然停止。按成无己注解说：里气不和，气机下行而不上升的，应当患腹泻。张仲景的法度使用葛根汤，其中含有发汗兼升举阳气的意思。另外按成无己注解说：寒邪气盛，客居于太阳、阳明二经，二经此时外部充实而不顾护内部，导致里气虚弱，所以必然腹泻。我认为里气虚弱即为不和，不能当作真正的虚损来看待。《内台方议》说：此条病症使用此方，是内外同治的方剂。葛根性味甘平，能祛风，行于阳明经，用作君药。麻黄为臣药，辅助发汗，解除太阳表邪。桂枝、芍药为佐药，通行于营卫之间。甘草、大枣的甘味，生姜的辛味，用来通达脾胃的津液，为使药。这是内外同解之法。我认为芍药虽然是现代医生治疗腹泻的药物，但配合桂枝就能向外运行于营分；甘草虽能调和脾胃，姜枣虽能健运脾胃、通行津液，总之在此汤中使用它们，不过是辛甘发散之剂，起初并不是治疗腹泻的药物。有人问：成无己说寒邪气盛，客居二阳；《内台方议》又说葛根性甘平，能祛风行于阳明经。究竟此条合病，是风邪还是寒邪？我认为此条病症，属于风寒两伤的证候。《尚论篇》认为此条病主寒，下一条病主风，并且认为上面的葛根汤就是在桂枝汤内加葛根而不用麻黄的，这是大大违背了张仲景的本意。《内台方疑问》说：经文讲“腹泻不可发汗，发汗则会导致胀满”，现在这个腹泻，又要发汗，为什么呢？回答说：少阴病腹泻完谷不化的，属于里虚，如果再发汗，就会脾虚而腹胀。现在此证太阳表证未罢，或许有头痛、恶风寒，证候仍在表，脉象还带浮象，便传入阳明，出现口渴、身热等症状，必然伴随腹泻。必须用此方微发汗以解散表邪，方中含有葛根，以清除阳明之邪。如果是各种发热症状，兼有里证而脉浮的，此方最为适宜。我按语：上面说的传入阳明，这与并病没有区别。《内台方议》对合病的解释，其说法也是错误的。）
太阳与阳明合病，不下利，只是呕吐的，用葛根加半夏汤主治。（此条合病，也属于风寒两伤的证候。风寒之邪交合，导致表证加重。表病，则里气也不和。成无己注解说：里气上逆而不下降的，只是呕吐而没有腹泻。我认为这是因为患者胸中必有停饮的缘故。张仲景的法度，给予葛根汤，以发散两经之邪，加入半夏以降气散饮。按《条辩》说：此条病症是为了显示太阳、阳明中风的不同，与上一条伤寒下利的证候，互相阐明。寒为阴，阴气主下降，所以下利；风为阳，阳气主上逆，所以作呕。殊不知伤寒的证候，郁热在里，胸中懊恼欲吐而作呕的情况很多，并不像中寒之证那样必然腹泻。另外中风的证候，木气侮土，胃气下注，肠鸣而作泻的情况也不少，未必都是风气上壅而导致呕吐。上一条乃是因为患者肠中有食积，所以腹泻难以治愈，之所以腹泻，是因为风寒邪气正盛于体表。此条乃是因为患者胸中有停饮，所以作呕。之所以兼治呕吐，是因为半夏同样具有辛散之功，且不妨碍祛除风寒，所以加入它。）
(This is the original text by Zhang Zhongjing)
Taiyang disease (disease of the Taiyang channel, characterized by exterior syndrome) presents with stiffness and tension in the neck and back (Xiangbei Qiang), absence of sweating, and aversion to wind. Ge Gen Tang (Kudzu Root Decoction) is indicated. (Regarding "stiffness and tension in the neck and back" in Taiyang disease, this was noted previously under the clause regarding spontaneous sweating. Here, there is no sweating and aversion to wind. This originally belongs to a Taiyang Wind-stroke syndrome with exterior excess. The condition is prone to transmitting to the Yangming channel. *Neitai Fangyi* states: Stiffness and tension in the neck and back with aversion to wind indicates wind pathogen in the exterior unable to disperse. Because there is no sweating, it implies the concurrent presence of cold pathogen. Therefore, Mahuang (Ephedrae Herba) is added to Guizhi Jia Ge Gen Tang (Cinnamon Twig plus Kudzu Root Decoction), and the formula is renamed Ge Gen Tang.)
Ge Gen (Puerariae Lobatae Radix, 4 liang) Mahuang (Ephedrae Herba, 3 liang, removed nodes) Guizhi (Cinnamomi Ramulus, 2 liang, removed bark) Shaoyao (Paeoniae Radix, 2 liang, sliced) Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang, honey-fried) Shengjiang (Zingiberis Rhizoma Recens, 3 liang, sliced) Dazao (Ziziphi Jujubae Fructus, 12 pieces, split)
The above seven ingredients. Crushed. Boiled in one dou of water. First boil Mahuang and Ge Gen, reduce by two sheng, skim off the foam. Add the remaining herbs. Boil until three sheng remain. Strain. Take one sheng warm. Cover with blankets to induce slight sweating. No hot porridge is required. Rest and dietary precautions follow the method of Guizhi Tang.
(Cheng Wuji's commentary notes: Materia Medica states that light substances can remove excess; Mahuang and Ge Gen are examples of such. Since this is Wind-stroke with exterior excess, these two herbs are added to Guizhi Tang. I believe that aversion to wind in wind-strike also belongs to Taiyang Wind-strike syndrome. Mahuang is added due to the absence of sweating. Ge Gen is used as the sovereign herb due to the stiffness and tension in the neck and back.)
Someone asked me: According to Zhang Zhongjing's principles, Taiyang disease without sweating constitutes Cold damage with exterior excess. Why not use Mahuang Tang (Ephedra Decoction) exclusively? I believe that Cold damage with exterior excess must present with aversion to cold and wheezing. This case lacks wheezing, indicating it is not a Mahuang Tang pattern. Therefore, Xingren (Armeniacae Semen Amarum) is not included in the decoction. Moreover, Zhang Zhongjing stated: "Stiffness in the neck and back with no sweating and aversion to wind" clearly indicates Wind-stroke with exterior excess. Thus, Mahuang and Ge Gen are added to Guizhi Tang.
Another question arises: Both present with Taiyang disease and no sweating. How to distinguish Wind-stroke with exterior excess? Furthermore, Cold damage can also present with aversion to wind; one should not rigidly assume that only Wind-strike causes aversion to wind. My view is that Cold damage with exterior excess involves complete absence of sweating, leading to aversion to cold, fever, and wheezing. Wind-stroke with exterior excess involves an attempt to sweat but failure to do so, resulting in stiffness and tension in the neck and back with aversion to wind. This distinction identifies it as Wind-stroke with exterior excess.
When Taiyang and Yangming channels are affected simultaneously (He Bing, combined disease), spontaneous diarrhea will inevitably occur. Ge Gen Tang is indicated. (In Shanghan, there is He Bing [combined disease] and Bing Bing [concurrent disease]. Cheng Wuji notes: When Taiyang disease fails to resolve and transmits to Yangming, it is called Bing Bing. Yu Jia Yan in *Shanglun Pian* describes He Bing as symptoms of both channels appearing simultaneously, like the conjunction of sun and moon. In Tai-Yang Yangming He Bing, Taiyang symptoms such as aversion to cold, fever, headache, and stiff neck occur simultaneously with Yangming symptoms such as thirst, eye pain, and dry nose, without sequence. The interaction of yang pathogens intensifies the exterior syndrome. Severe exterior pathogens cause interior disharmony. The interior of Taiyang is the Bladder, which governs water metabolism; the interior of Yangming is the Stomach, which governs grain digestion. Disharmony between these two fu organs leads to improper separation of clear and turbid fluids during digestion, causing spontaneous diarrhea. Treatment with Ge Gen Tang disperses the exterior pathogens of both channels, stopping the diarrhea. Cheng Wuji notes: Interior disharmony with qi descending rather than ascending leads to diarrhea. Zhang Zhongjing's use of Ge Gen Tang embodies the principle of releasing the exterior while lifting qi. Additionally, Cheng Wuji states: Severe cold pathogens lodging in the two yang channels cause the exterior to be full while the interior becomes deficient, leading to diarrhea. I consider interior deficiency as disharmony, not true deficiency. *Neitai Fangyi* states: This formula treats both interior and exterior. Ge Gen is sweet and neutral, dispels wind, and enters the Yangming channel, serving as the sovereign herb. Mahuang is the minister herb, assisting in sweating and releasing the Taiyang exterior. Guizhi and Shaoyao are assistant herbs, circulating within Ying and Wei. Gancao and Dazao provide sweetness, and Shengjiang provides pungency, to unblock Stomach and Spleen fluids, acting as guides. This achieves simultaneous resolution of interior and exterior. Although modern physicians use Shaoyao for diarrhea, combined with Guizhi it acts outwardly on Ying. Gancao harmonizes, and Ginger and Jujube strengthen the Spleen/Stomach and move fluids. Ultimately, in this formula, they function merely as pungent-sweet dispersants, not primarily as anti-diarrheal agents. Someone asks: Cheng Wuji mentions severe cold pathogens in the two yang channels; *Neitai Fangyi* says Ge Gen dispels wind in Yangming. Is this He Bing caused by wind or cold? I believe this case involves both wind and cold pathogens. *Shanglun Pian* attributes this case to cold and the next to wind, claiming Ge Gen Tang is simply Guizhi Tang plus Ge Gen without Mahuang, which greatly misinterprets Zhang Zhongjing. *Neitai Fangyiwen* asks: The classic states "diarrhea should not be treated with sweating, as it causes distension." Why sweat for this diarrhea? Answer: Shaoyin diarrhea with undigested food indicates interior deficiency; sweating would cause spleen deficiency and distension. Here, Taiyang exterior signs persist (headache, aversion to cold/wind, floating pulse), transmitting to Yangming with thirst and fever, causing diarrhea. Mild sweating with this formula releases exterior pathogens, while Ge Gen clears Yangming pathogens. For fever with interior signs and floating pulse, this formula is optimal. Note: Transmission to Yangming here is akin to Bing Bing. *Neitai Fangyi*'s explanation of He Bing is erroneous.)
When Taiyang and Yangming channels are affected simultaneously, without diarrhea but with vomiting only, Ge Gen Jia Ban Xia Tang (Kudzu Root plus Pinellia Decoction) is indicated. (This He Bing also involves both wind and cold pathogens. Their interaction intensifies the exterior, causing interior disharmony. Cheng Wuji notes: Interior qi rebels upward instead of descending, causing vomiting without diarrhea. I attribute this to retained fluid-phlegm in the chest. Zhang Zhongjing uses Ge Gen Tang to release pathogens from both channels, adding Ban Xia (Pinelliae Rhizoma) to direct qi downward and dissipate fluid retention. *Tiaobian* explains: This clause distinguishes Taiyang/Yangming Wind-strike from the previous Cold damage diarrhea. Cold is yin, governing descent, hence diarrhea. Wind is yang, governing rebellion, hence vomiting. However, in Cold damage, latent heat in the chest often causes retching and vomiting, not just in Cold injury cases. Similarly, in Wind-strike, Wood insulting Earth can cause stomach qi to descend, leading to intestinal rumbling and diarrhea, not just wind obstruction causing vomiting. The previous case involved food stagnation in the intestines causing difficult-to-treat diarrhea due to strong exterior pathogens. This case involves retained fluid in the chest causing vomiting. Ban Xia is added because its pungent dispersion aids in resolving wind-cold without hindering the process.)