治中风伤寒脉浮。发热。往来汗出恶风项强。鼻鸣干呕方。
桂枝 芍药（各三两） 甘草（炙） 黄芩（各二两）
上锉。如麻豆大。每服钞五钱匕。水一盏半。枣子一枚。生姜三片。煎至一盏。去滓。取八分。清汁温服。若脉浮
紧。发热无汗者。不可与也。
琥按上论云。桂枝汤。西北二方居人。四时行之。无不应验。此必是极北极西之地。其气寒凉。故宜行此汤尔。余
居东南。地气温暖。虽冬月遇中风证。桂枝汤。亦有不轻用者。况于春末及夏至以后邪。奉议加黄芩知母等药。可为发
仲景未发之义矣。
又云。伤寒热病。药性须凉。不可太温。夏至后。用麻黄汤。须加知母半两。石膏一两。黄芩一分。盖麻黄汤性热。
夏月服之。有发黄斑出之失。惟冬及春。与病患素虚寒者。乃用正方。不在加减。
与仲景原方药味同（分两减半）
琥按上论云。夏至后用麻黄汤。须加知母石膏黄芩。奉议此言。可为深得用药之旨。且也。活人书。取用麻黄汤。
自有通变之法。本方中加苍术。治寒湿。去桂枝。加薏苡仁。治风湿。去桂枝杏仁。加石膏山茵陈苍术。治湿热。皆太
阳经之药也。仲景当日制麻黄汤。后之人。若云。一味不可增损。吾不信矣。
治伤寒一日。至二日。头项及腰脊。拘急疼痛。浑身烦热。恶寒方。
芍药（三两） 豆豉（一合） 干葛（四分） 麻黄（三两去节汤泡一二沸焙干秤）
上锉。如麻豆大。每服四钱。葱白七根。水一盏半。煮至八分。去滓。温服。以浓衣盖覆。如人行四五里间。再服。
良久。如未得汗。更煮葱粥。少少与之热。投以助药力。取汗即愈。
琥按上方。乃仲景葛根汤之变方也。此汤能治太阳病项背强KT KT 无汗恶风者。又能治太阳阳明合病。自下
利者。但仲景葛根汤方后云。不须 粥。此云。如未得汗更煮葱粥。少少与之。热投以助药力。此可见前圣后贤。取汗
之法。各不相同。医者当临证起悟云尔。
许学士云。病患发热恶寒。脉浮而紧者。伤寒之候也。如病患发热头疼。脉浮数而尺中迟弱者。宜先服黄 建中汤。
加当归。以补血。却与麻黄桂枝辈。
治疗中风或伤寒，脉象浮，发热，汗出时作时止，怕风，项部僵硬，鼻鸣，干呕的方剂。
桂枝 芍药（各三两） 甘草（炙） 黄芩（各二两）
以上药材切碎，如麻豆大小。每次服用五钱匕，用水一盏半，大枣一枚，生姜三片，煎煮至一盏，去渣，取八分，温服清汁。如果脉象浮紧，发热无汗者，不可服用此方。
王琥按：上述论述说，桂枝汤在西北地区的居民中，四季使用，无不灵验。这一定是极北和极西之地，气候寒凉，所以适宜使用此汤。我居住在东南，地气温暖，即使是冬季遇到中风证，桂枝汤也不轻易使用，何况是春末及夏至以后呢？奉议先生加入黄芩、知母等药物，可以阐发仲景未曾阐发的义理了。
又说：伤寒热病，药性须清凉，不可太温热。夏至后，使用麻黄汤，须加知母半两，石膏一两，黄芩一分。因为麻黄汤药性热，夏季服用，有导致发黄、出斑疹的过失。只有冬季和春季，以及体质素来虚寒的病人，才使用原方，不在加减之列。
与仲景原方药味相同（分量减半）
王琥按：上述论述说，夏至后使用麻黄汤，须加知母、石膏、黄芩。奉议先生的这番话，可以说是深得用药的宗旨。而且，《活人书》在使用麻黄汤时，自有通变的方法。本方中加入苍术，治疗寒湿；去掉桂枝，加入薏苡仁，治疗风湿；去掉桂枝、杏仁，加入石膏、山茵陈、苍术，治疗湿热，这些都是太阳经的药物。仲景当时制定麻黄汤，后人如果说一味药也不可增减，我不相信。
治疗伤寒一日到二日，头项及腰脊拘急疼痛，浑身烦热，怕冷的方剂。
芍药（三两） 豆豉（一合） 干葛（四分） 麻黄（三两，去节，汤泡一二沸，焙干秤量）
以上药材切碎，如麻豆大小。每次服用四钱，葱白七根，用水一盏半，煮至八分，去渣，温服。用厚衣服覆盖身体，大约人行走四五里的时间，再服药。过了很久，如果仍未出汗，再煮葱粥，少量多次给予，以热饮助药力，出汗即愈。
王琥按：上方，乃是仲景葛根汤的变方。此汤能治疗太阳病项背强直、无汗、怕风的病症，又能治疗太阳阳明合病，自下利的病症。但仲景葛根汤方后注说：“不需啜粥”，这里说：“如果未得汗，再煮葱粥，少量多次给予，以热饮助药力”。由此可见，前圣后贤，发汗的方法各不相同。医者应当临证感悟罢了。
许学士说：病人发热恶寒，脉象浮而紧的，是伤寒的征候。如果病人发热头痛，脉象浮数而尺中迟弱的，宜先服用黄芪建中汤，加入当归，以补血，然后再给予麻黄、桂枝之类的药物。
A formula for treating wind-stroke or cold-injury with a floating pulse, fever, intermittent sweating, aversion to wind, stiffness of the neck and nape, nasal congestion (bi-ming), and dry retching.
Guizhi (Cinnamon Twig) Shaoyao (White Peony Root) [each 3 liang] Gancao (Licorice Root, prepared by roasting) Huangqin (Scutellaria Root) [each 2 liang]
The above herbs are chopped into pieces the size of hemp seeds. Each dose is five qian bi (a small scoop). Add one dan zhen (cup and a half) of water, one jujube (Ziziphus jujuba fruit), and three slices of Shengjiang (Fresh Ginger). Decoct until one cup remains. Remove the dregs, take eight-tenths of the liquid, and drink the clear juice warm. If the pulse is floating and tight, and there is fever without sweating, this formula should not be administered.
Wang Hu notes: The aforementioned discussion states that Guizhi Tang (Cinnamon Twig Decoction) is effective when used in all four seasons by people in the northwest regions. This must be because those extreme northern and western lands have cold climates, making this decoction suitable. I reside in the southeast where the climate is warm; even in winter, when encountering wind-stroke syndromes, Guizhi Tang is not used lightly, let alone in late spring or after the Summer Solstice. Fengyi added herbs such as Huangqin (Scutellaria Root) and Zhimu (Anemarrhena Rhizome), which elucidates principles not fully expounded by Zhang Zhongjing.
It is also stated: For cold-injury and febrile diseases, the nature of medicines should be cooling, not too warming. After the Summer Solstice, when using Mahuang Tang (Ephedra Decoction), one must add Ban liang of Zhimu (Anemarrhena Rhizome), one liang of Shigao (Gypsum Fibrosum), and one fen of Huangqin (Scutellaria Root). This is because Mahuang Tang is hot in nature; taking it in summer may lead to jaundice and macular eruptions. Only in winter and spring, or for patients with inherent deficiency-cold constitutions, should the original formula be used without modifications.
[This formula contains the same herbs as Zhang Zhongjing's original formula, but with halved dosages.]
Wang Hu notes: The aforementioned discussion states that after the Summer Solstice, when using Mahuang Tang (Ephedra Decoction), one must add Zhimu (Anemarrhena Rhizome), Shigao (Gypsum Fibrosum), and Huangqin (Scutellaria Root). Fengyi’s statement deeply grasps the essence of herbal prescription. Furthermore, *Huoren Shu* (Book of Vitality) employs Mahuang Tang (Ephedra Decoction) with flexible variations. Adding Cangzhu (Atractylodis Rhizoma) treats cold-dampness; removing Guizhi (Cinnamon Twig) and adding Yiyiren (Coix Seed) treats wind-dampness; removing Guizhi (Cinnamon Twig) and Xingren (Apricot Seed) and adding Shigao (Gypsum Fibrosum), Shanyinyinchen (Artemisia capillaris), and Cangzhu (Atractylodis Rhizoma) treats damp-heat. All these target the Taiyang Meridian. When Zhang Zhongjing originally formulated Mahuang Tang (Ephedra Decoction), if later generations claimed that not even a single herb could be added or removed, I would not believe it.
A formula for treating cold-injury from day one to two, characterized by stiffness and pain in the head, neck, and lumbar spine, general body irritability and heat, and aversion to cold.
Shaoyao (White Peony Root) [3 liang] Douchi (Prepared Soybean) [1 he] Gegen (Pueraria Root) [4 fen] Mahuang (Ephedra Herba) [3 liang, remove joints, soak in boiling water for one or two boils, then dry and weigh]
The above herbs are chopped into pieces the size of hemp seeds. Each dose is four qian. Add seven stalks of Congbai (Scallion White) and one dan zhen (cup and a half) of water. Decoct until eight-tenths remain. Remove the dregs and drink warm. Cover with thick clothing. Wait approximately the time it takes to walk four or five li, then administer the second dose. If sweating has not occurred after a while, boil Congzhou (Scallion Porridge), give it in small amounts frequently, and use the heat to assist the medicinal power. Recovery occurs upon sweating.
Wang Hu notes: The above formula is a variation of Zhang Zhongjing’s Gegen Tang (Kudzu Decoction). This decoction can treat Taiyang syndrome with stiffness of the neck and back, absence of sweating, and aversion to wind. It can also treat combined Taiyang and Yangming syndromes with spontaneous diarrhea. However, the post-script of Zhang Zhongjing’s Gegen Tang (Kudzu Decoction) states: "No need to consume porridge." Here it says: "If sweating does not occur, boil scallion porridge, give in small amounts frequently, and use heat to assist the medicinal power." This shows that the methods of inducing sweat vary among ancient sages and later worthies. Physicians should gain insight through clinical practice.
Xu Xueshi said: Patients with fever, aversion to cold, and a floating, tight pulse exhibit signs of cold-injury. If patients have fever, headache, and a floating, rapid pulse with a slow and weak chi position, they should first take Huangqi Jianzhong Tang (Astragalus Middle-Warming Decoction) with Danggui (Angelica Sinensis) added to nourish blood, before administering herbs like Mahuang (Ephedra) or Guizhi (Cinnamon Twig).