桂枝汤 治风寒在表，脉浮弱，自汗出，头痛发热，恶风恶寒，鼻鸣干呕等证，及杂
证自汗、盗汗、虚损、虚疟亦可用。若脉浮紧，汗不出者，酒客病风寒而汗出者，禁用。
桂枝（三两） 芍药（三两） 生姜（三两） 甘草（炙，二两） 大枣（十二枚）
上五味，以水七升，煮取三升，服一升，覆令微汗，不可令如水流漓，病必不除。若
服一升，汗出病痊，不必尽剂。服已，更啜稀粥一盏，以助药力。
【注】凡风寒在表，脉浮弱自汗出者，皆属表虚，宜桂枝汤主之。名曰桂枝汤者，君
以桂枝也。桂枝辛温，辛能散邪，温从阳而扶卫。芍药酸寒，酸能敛汗，寒走阴而益营。
桂枝君芍药，是于发散中寓敛汗之意；芍药臣桂枝，是于固表中有微汗之道焉。生姜之
辛，佐桂枝以解肌表；大枣之甘，佐芍药以和营里。甘草甘平，有安内攘外之能，用以
调和中气，即以调和表里，且以调和诸药矣。以桂、芍之相须，姜、枣之相得，借甘草之
调和阳表阴里，气卫血营，并行而不悖，是刚柔相济以为和也，而精义在服后须臾啜热
稀粥以助药力，盖谷气内充，不但易为酿汗，更使已人之邪不能少留，将来之邪不得复入
也。又妙在温服令一时许， 微似有汗，是授人以微汗之法。不可令如水流漓，病必不
除，禁人以不可过汗之意也。此方为仲景群方之冠，乃解肌、发汗、调和营卫之第一方
也。凡中风、伤寒，脉浮弱汗自出而表不解者，皆得而主之。其他但见一、二证即是，不
必悉具。故麻、葛、青龙发汗诸剂，咸用之也。若汗不出麻黄证也，脉浮紧者麻黄脉也，
固不可与桂枝汤，然初起无汗，当用麻黄发汗，如汗解后复烦，脉浮数者，与下后脉仍
浮、气上冲者，及下后下利止而身痛不休者，皆用此以解外。何也？盖此时表虽不解，腠
理已疏，邪不在皮毛而在肌肉，且经汗下，津液已伤，故脉证虽同麻黄，而主治当属桂枝
矣。粗工妄谓桂枝汤专治中风，不治伤寒，使人疑而不用；又谓专发肌表不治他病。不知
此汤倍芍药、生姜加人参，名桂枝新加汤，用以治营表虚寒，肢体疼痛；倍芍药加饴糖，名
小建中汤，用以治里虚心悸，腹中急痛；再加黄 ，名黄 建中汤，用以治虚损虚热，自
汗盗汗。因知仲景之方，可通治百病也。
麻黄汤 治太阳风寒在表，头项强痛发热，身疼，腰痛，骨节痛，恶风寒无汗，胸
满面喘，其脉浮紧或浮数者，用此发汗，虽有是证，若脉浮而弱，汗自出，或尺中脉微
与迟者，俱不可用。风、寒、湿成痹，肺经壅塞，昏乱不语，冷风哮吼最宜。
麻黄（去节，三两） 桂枝（二两） 甘草（炙，一两） 杏仁（去皮尖，六十枚）
上四味，以水九升，先煮麻黄，减二升，去上沫，内诸药，煮取二升半，去滓，温服
八合。温覆取微汗，不须啜粥。一服汗出，停后服。汗出多者，温粉扑之。
【注】凡风寒在表，脉浮紧数无汗者，皆表实也，宜麻黄汤主之。名曰麻黄汤者，君
以麻黄也。麻黄性温，味辛而苦，其用在迅升，桂枝性温，味辛而甘，其能在固表。证
属有余，故主以麻黄必胜之算也。监以桂枝制节之妙也。杏仁之苦温佐麻黄逐邪而降逆；
甘草之甘平，佐桂枝和内而拒外。饮入于胃，行气于元府，输精于皮毛，斯毛脉合精，溱
溱汗出，在表之邪必尽去而不留，痛止喘平，寒热顿解。不须啜粥而藉汗于谷也。其不用
姜、枣者，以生姜之性横散于肌，碍麻黄之迅升，大枣之性泥滞于膈，碍杏仁之速降，此
欲急于直达，稍缓则不迅，横散则不升矣。然则为纯阳之剂，过于发散，如单刀直入之将，
用之若当，一战成功，不当则不戢而召祸。故可一而不可再，如汗后不解，盒饭以桂枝代
之。此方为仲景开表逐邪发汗第一峻药也。庸工不知其制在温覆取汗，若不温覆取汗，则
不峻也。世谓麻黄专能发表，不治他病。不知此汤合桂枝汤，名麻桂各半汤，用以和太
阳留连未尽之寒热。去杏仁加石膏合桂枝汤，名桂枝二越婢一汤，用以解太阳热多寒少之
寒热。若阳盛于内而无汗者，又有麻黄杏仁甘草石膏汤，以散太阴肺之邪。若阴盛于内
而无汗者，又有麻黄附子细辛甘草汤，以温散少阴肾家之寒。《金匮要略》以此方去桂枝，
《千金方》以此方桂枝易桂，皆名还魂汤，用以治邪在太阴，卒中暴厥，口噤气绝，下咽
奏效，而皆不温覆取汗。是知麻黄汤之峻与不峻，而温覆与不温覆。此仲景用方之心法，
岂常人所能得而窥耶！
大青龙汤 治太阳风寒两伤，营卫同病。伤寒之脉而见中风之证，中风之脉而见伤寒
之证，二证俱不出汗而烦躁者，用此两解发汗。虽有是证，若脉微弱，自汗出者，不可
服之，服必亡阳。
麻黄（去节，六两） 桂枝（二两） 杏仁（去皮尖，四十个） 甘草（炙，二两） 生姜（切，
三两） 大枣（擘，十二枚） 石膏（碎，绵囊，如鸡子大）
上七味，以水九升，先煮麻黄，减二升，去上沫，内诸药，煮取三升，去滓，温服一
升，取微汗。汗出多者，温粉扑之。一服汗者，停后服。汗多亡阳，遂虚，恶风烦躁不
得眠也。
【注】何以知风寒两伤、营卫同病、以伤寒之脉而见中风之证，中风之脉而见伤寒之
证也。名大青龙汤者，取龙兴云雨之义也。治风不外乎桂枝，治寒不外乎麻黄，合桂枝麻
黄二汤以成剂，故为兼风寒中伤者主之也。二证俱无汗，故减芍药、不欲其收也。二证俱
烦躁，故加石膏以解其热也。设无烦躁，则又当从事于麻黄桂枝各半汤也。仲景于表剂
中加大寒辛甘之品，则知麻黄证之发热，热全在表；大青龙证之烦躁，兼肌里矣。初病
太阳即用石膏者，以其辛能解肌热，寒能清胃火，甘能生津液，是预保阳存津液之先着
也。粗工疑而畏之，当用不用，必致热结阳明，斑黄狂冒，纷然变出矣。观此则可知石
膏乃中风伤寒之要药，得麻、桂而有青龙之名，得知草而有白虎之号也。服后取微汗，汗
出多者，温粉扑之。一服得汗，停其后服，盖戒人即当汗之证，亦不可过汗也。所以仲景
桂枝汤中不用麻黄者，是欲其不大发汗也；麻黄汤中用桂枝者，恐其过汗无制也。若不慎
守其法，汗多亡阳，变生诸逆，表遂空虚而不任风，阴盛格阳而更烦躁不得眠也。
小青龙汤 治伤寒表不解，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。及杂病肤胀、水肿证，用此发汗而利水。
麻黄（去节，三两） 芍药（三两） 五味子（半升） 甘草（炙，三两） 干姜（二两） 半夏（洗，
半升） 桂枝（三两） 细辛（三两）
上八味，以水一斗，先煮麻黄，减二升，去上沫，内诸药，煮取三升，去滓，温服一升。
若渴者，去半夏加括姜根三两，若噎者，去麻黄加附子（炮）一枚。若小便不利少腹
满者，去麻黄加茯苓四两。若喘者，去麻黄加杏仁（去皮尖）半升。若微利者，去麻黄
加荛花如鸡子（熬令赤色）。
【按】“加荛花如鸡子，熬令赤色”，此必
传写之讹。盖《本草》芜花即芫花类也，用之攻水，其力甚峻，五分可令人卞行数十次，
岂有治停饮之微利，而用鸡子大之荛花者乎？当改加茯苓四两。
【注】太阳停饮有二∶一中风，表虚有汗，五苓散证也；一伤寒，表实无汗，小青龙汤
证也。表实无汗，故合麻桂二方以解外。去大枣者，以其性泥也。去杏仁者，以其无喘
也，有喘者加之。去生姜者，以有干姜也，若呕者仍用。佐干姜、细辛，极温极散，使寒
与水俱从汗而解。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
以就里也。加附子以去噎散寒，则噎可止。加茯苓以利水，则微利少腹满可除矣。此方与
越婢汤同治水饮溢于表，而为肤胀、水肿，宜发汗外解者，元不随手而消。越婢治有热者，
故方中君以石膏以散阳水也。小青龙治有寒者，故方中佐以姜、桂以消阴水也。
葛根汤治太阳、阳明两经合病，头项强痛，背亦牵强，脉浮元汗恶风者，及表不
解，下利而呕者，并宜服此发汗。
葛根（四两） 麻黄（去节，三两） 桂枝（二两） 芍药（二两） 甘草（炙，二两） 生姜（切，二两）
大枣（擘，十二枚）
上七味，以水一斗，先煮麻黄、葛根，减二升，去沫，内诸药，煮取三升，温服一升。
覆取微似汗，不须啜粥。余如桂枝法将息及禁忌。
【注】是方也，即桂枝汤加麻黄、葛根。麻黄佐桂枝发太阳营卫之汗，葛根君桂枝解
阳明肌表之邪。不曰桂枝汤加麻黄、葛根，而以葛根命名者，其意重在阳明，以呕利属阳
明多也。二阳表急，非温服覆而取汗，其表未易解也。或呕或利，里已失和，虽啜粥而
胃亦不能输精于皮毛，故不须啜粥也。柯琴曰∶此证身不疼、腰不疼、骨节不疼、不恶
寒，是骨不受寒矣。头项强痛，下连于背，牵动不宁，是筋伤于风矣。不喘不烦躁，不干
呕，是里不病，元汗恶风，病只在表。若表病而兼下利，则是表实里虚矣。比麻黄、青
龙二证较轻，然项强连背拘强，更甚于项强无汗，不失为表。但脉浮不紧，故不从乎麻
黄，而于桂枝方加麻黄倍葛根以去实，小变麻桂之法也。盖葛根为阳明主药，凡太阳有
阳明者，则佐入太阳药中；凡少阳有阳明者，则佐入少阳药中，无不可也。李杲定为阳明
经药。张洁古云∶未入阳明者、不可便服。岂二人未读仲景书乎？要知葛根、桂枝，俱是
解肌和里之药，故有汗、无汗，下利、不下利，俱可用，与麻黄之专于发表者不同也。
《金匮》治太阳病无汗，小便反少，气上冲胸，口噤不得语，欲作刚痉。
【集注】喻昌曰∶伤寒项背KT KT ，无汗恶风者，用葛根汤。此证亦用之者，以其邪在
太阳、阳明两经之界。两经之热并于胸中，必伤肺金清肃之气，故水道不行，小便少，津
液不布而无汗。阳明之筋内结胃口，外行胸中，过人迎环口，热并阳明，斯筋脉牵引，口
噤不得语。然刚痉无汗，必从汗解，况湿邪内郁，必以汗出如故而止。故用此汤合解两
经之湿热，与风寒之表，法无害其同也。
桂枝麻黄各半汤 太阳病，得之八九日，如疟状，发热恶寒，热多寒少，其人不呕，清
便欲自可，一日二三度发，脉微缓者，为欲愈也。脉微而恶寒者，此阴阳俱虚，不可更
发汗更下更吐也。面色反有热色者，未欲解也，以其不能得小汗出，身必痒，宜桂枝麻
黄各半汤。
桂枝（一两六铢） 芍药（一两） 麻黄（去节，一两） 生姜（一两） 甘草（炙，一两） 大枣（擘，四枚）
杏仁（去皮尖，二十四个）
上七味，以水五升，先煮麻黄一二沸，去上沫，内诸药，煮取一升八合，去滓，温服
六。
【注】太阳病，得之八九日，有如疟状之寒热。热多寒少者，其人不呕，小便清白，此
里和不受邪，虽为欲自愈；然必审其如疟状寒热，一日二、三度，轻轻而发，诊其脉微
而且缓，则知邪衰正复，表里将和，始为欲愈也。若脉微不缓，正未复也，更恶寒者，邪
未衰也，虽不能自愈，但已为前之汗、吐、下虚其表里，故不可更发汗、更吐、更下也。脉
微恶寒，表里俱虚，面色当白，今色反赤，是犹有表邪怫郁，不能得小汗出宣发阳气，故
面赤身痒，未欲解也，宜桂枝麻黄各半汤，小小汗之以和营卫，自可愈也。
桂枝二麻黄一汤 服桂枝汤，大汗出，脉洪大者，与桂枝汤如前法。若形如疟，日再
发者，汗出必解，宜桂枝二麻黄一汤。
桂枝（一两十六铢） 芍药（一两六铢） 麻黄（去节，十六铢） 甘草（一两二铢）
杏仁（去皮尖，十六个） 生姜（一两六铢） 大枣（擘，五枚）
上七味，以水五升，先煮麻黄一二沸，去上沫，内诸药，煮取二升，去滓，温服一升，日再服。
【注】服桂枝汤大汗出，脉洪大不解，若烦渴者，则表邪已入阳明，白虎汤证也。今
脉虽洪大而不烦渴，则为表邪无在太阳，故与桂枝汤如前法也。若脉不洪大，壮热亦减，
惟寒热如疟，日再发者，虽属轻邪，然终为微寒所持，非汗出必不解也，宜桂枝二麻黄
一汤，小发营卫之汗。不用麻黄桂枝各半汤者，盖因已大汗出，不欲其发营卫汗，欲其
和营卫汗也。
桂枝二越婢一汤 太阳病，发热恶寒，热多寒少。脉微弱者，此无阳也，不可更汗。宜
桂枝二越婢一汤。
桂枝（一两六铢） 芍药（一两） 甘草（炙，一两三铢） 石膏（二十四铢）
麻黄（十六铢） 大枣（擘，五枚） 生姜（切，一两六铢）
上七味，以水五升，煮麻黄一二沸，去上沫，内诸药，煮取二升，去滓，温服一升，
日再服。本方当裁为越婢汤、桂枝汤，各饮一升，今合为一方，桂枝二越婢一汤。
桂枝汤：治疗风寒邪气在体表，脉象浮而弱，自汗出，头痛发热，怕风怕冷，鼻鸣干呕等症状，以及杂病中的自汗、盗汗、虚损、虚性疟疾也都可以使用。如果脉象浮紧，无汗出的；或者嗜酒之人患风寒而有汗出的，禁止使用。
桂枝（三两） 芍药（三两） 生姜（三两） 甘草（炙，二两） 大枣（十二枚）
以上五味药，用水七升，煮取三升药液，每次服用一升，服药后覆盖衣被使身体微微出汗，不可让汗水像水流一样淋漓不止，否则病必不能去除。如果服用一升后，出汗且病愈，就不必服完剩余的药剂。服药后，再喝一碗稀粥，以助药力。
【注】凡是风寒在体表，脉浮弱且自汗出的，都属于表虚证，适宜用桂枝汤主治。命名为桂枝汤，是因为以桂枝为君药。桂枝味辛性温，辛能发散邪气，温性从阳分而扶助卫气。芍药味酸性寒，酸能收敛汗液，寒性走阴分而滋养营血。桂枝为君，芍药为臣，这是在发散之中蕴含收敛汗液的意思；芍药辅助桂枝，这是在固护体表中留有微微发汗的途径。生姜的辛味，辅助桂枝来解除肌表之邪；大枣的甘味，辅助芍药来调和营血与里气。甘草味甘平，具有安定内部、攘除外邪的能力，用来调和中气，进而调和表里，并且调和诸药。凭借桂枝与芍药的相互协同，生姜与大枣的相互配合，借助甘草的调和作用，协调阳表与阴里，气分卫气与血分营血，并行而不违背，这是刚柔相济以达到和谐。其精妙之处在于服药后须臾之间喝热稀粥以助药力，因为谷气在内充实，不仅容易酿成汗液，更使已经进入体内的邪气无法稍作停留，将来的邪气也不能再次进入。又巧妙在于温服并保持约一顿饭的时间，微微似有汗出，这是传授给人微汗的方法。不可让汗水像水流一样淋漓，是告诫人们不可过汗的意思。此方是张仲景众多方剂中的冠首，是解肌、发汗、调和营卫的第一方。凡是中风、伤寒，脉浮弱、自汗出而表证未解的，都可用它为主治。其他情况只要见到一两个症状即可，不必全部具备。所以麻黄汤、葛根汤、大青龙汤等发汗的方剂，都常配合使用它。如果无汗，那是麻黄汤证；脉浮紧，那是麻黄的脉象，固然不能用桂枝汤。但是初起无汗，应当用麻黄汤发汗；如发汗后再次出现烦热，脉浮数的；或者经过攻下后脉仍浮、气上冲的；以及攻下后腹泻停止但身体疼痛不休的，都用此方来解除表邪。为什么呢？因为此时虽然表证未解，但腠理已疏松，邪气不在皮毛而在肌肉，且经过发汗和攻下，津液已经受伤，所以脉证虽然类似麻黄汤证，但主治应当归属桂枝汤了。粗疏的医生错误地认为桂枝汤专门治疗中风，不治疗伤寒，使人怀疑而不敢使用；又认为它专门发散肌表，不治疗其他疾病。他们不知道此汤将芍药、生姜加倍并加入人参，名为桂枝新加汤，用来治疗营卫表虚寒引起的肢体疼痛；将芍药加倍并加入饴糖，名为小建中汤，用来治疗里虚引起的心悸、腹中急痛；再加黄芪，名为黄芪建中汤，用来治疗虚损虚热、自汗盗汗。由此可知张仲景的方剂可以通治百病。
麻黄汤：治疗太阳经风寒在体表，头项强痛发热，身体疼痛，腰痛，骨节疼痛，怕风怕冷无汗，胸闷面赤气喘，脉象浮紧或浮数的，用此方发汗。虽然有这些症状，但如果脉浮而弱，自汗出，或者尺中脉微迟的，都不可使用。风、寒、湿邪导致痹症，肺经壅塞，神志昏乱不语，冷风哮吼，最为适宜。
麻黄（去节，三两） 桂枝（二两） 甘草（炙，一两） 杏仁（去皮尖，六十枚）
以上四味药，用水九升，先煮麻黄，减少二升水，去掉水面上的浮沫，加入其他药物，煮取二升半药液，滤去药渣，温服八合。温覆衣被取微汗，不需要喝粥。服用一次若出汗，停服后续药物。如果出汗过多，用温粉扑身止汗。
【注】凡是风寒在体表，脉浮紧数且无汗的，都属于表实证，适宜用麻黄汤主治。命名为麻黄汤，是因为以麻黄为君药。麻黄性温，味辛而苦，作用在于迅速上升；桂枝性温，味辛而甘，能力在于固护体表。证候属于有余（实证），所以主以麻黄作为必胜的策略。辅以桂枝起到监制节制的作用。杏仁的苦温辅助麻黄驱逐邪气并降逆气；甘草的甘平辅助桂枝调和内部并抵御外邪。药液进入胃中，元气府的气机运行，精气输布到皮毛，这样毛脉精气相合，溱溱然汗出，在表的邪气必定全部去除而不留，疼痛停止喘息平息，寒热顿时解除。不需要喝粥而依靠汗出于谷物之气。不用姜、枣的原因，是因为生姜的性质横散于肌表，妨碍麻黄的迅速上升；大枣的性质黏滞于膈膜，妨碍杏仁的快速下降。这是想要急于直达病所，稍微缓慢就不能迅速，横散就不能上升了。然而这是纯阳的方剂，过于发散，如同单刀直入的将领，使用得当，一战成功；使用不当，则不收敛而招致祸患。所以只能使用一次而不可再用，如发汗后病不解，应当用桂枝汤代替。此方是张仲景开表逐邪发汗的第一峻猛药物。庸医不知道它的制约在于温覆取汗，如果不温覆取汗，就不算峻猛。世人说麻黄专门能发表，不治疗其他疾病。他们不知道此汤合桂枝汤，名为麻桂各半汤，用来调和太阳经留恋未尽的寒热。去掉杏仁加入石膏合桂枝汤，名为桂枝二越婢一汤，用来解除太阳经热多寒少的寒热。如果阳气盛于内而无汗的，又有麻黄杏仁甘草石膏汤，以疏散太阴肺经的邪气。如果阴气盛于内而无汗的，又有麻黄附子细辛甘草汤，以温散少阴肾家的寒邪。《金匮要略》将此方去掉桂枝，《千金方》将此方的桂枝换成桂心，都名为还魂汤，用来治疗邪气在太阴，突然中风口噤气绝，药下咽即奏效，而且都不需要温覆取汗。由此可知麻黄汤的峻猛与否，关键在于是否温覆取汗。这是张仲景用药的心法，岂是一般常人所能窥探的呢！
大青龙汤：治疗太阳经风寒两伤，营卫同时发病。伤寒的脉象却出现中风的症状，中风的脉象却出现伤寒的症状，两种证候都没有汗出且烦躁的，用此方两解发汗。虽然有这些症状，但如果脉微弱，自汗出的，不可服用，服用必然导致亡阳。
麻黄（去节，六两） 桂枝（二两） 杏仁（去皮尖，四十个） 甘草（炙，二两） 生姜（切，三两） 大枣（擘，十二枚） 石膏（碎，绵囊包裹，如鸡蛋大小）
以上七味药，用水九升，先煮麻黄，减少二升水，去掉水面上的浮沫，加入其他药物，煮取三升药液，滤去药渣，温服一升，取微汗。如果出汗过多，用温粉扑身止汗。服用一次若出汗，停服后续药物。如果出汗过多导致亡阳，身体遂虚，怕风、烦躁、不得安眠。
【注】怎么知道是风寒两伤、营卫同病，以伤寒的脉象出现中风的症状，中风的脉象出现伤寒的症状呢？命名大青龙汤，是取龙兴云雨的意义。治疗风邪不外乎桂枝，治疗寒邪不外乎麻黄，合桂枝汤和麻黄汤两方成为一剂，所以作为兼受风寒伤害的主治方剂。两种证候都无汗，所以减去芍药，不希望它收敛。两种证候都烦躁，所以加入石膏以解热。如果没有烦躁，则应当从事于麻黄桂枝各半汤。张仲景在表剂中加入大寒辛甘的药物，就知道麻黄证的发热，热全在体表；大青龙证的烦躁，兼及肌理了。初病太阳就使用石膏，是因为它能辛散解肌热，寒凉清胃火，甘味生津液，这是预先保护阳气、保存津液的第一步。粗疏的医生怀疑并畏惧它，当用时不用，必然导致热结阳明，出现斑疹发黄、狂躁冒昧等纷至沓来的变证。看这一点就可以知道石膏是中风伤寒的要药，得到麻黄、桂枝就有青龙的名称，得到甘草就有白虎的称号。服药后取微汗，出汗多的用温粉扑身。服用一次得汗，停服后面的药，这是告诫人们即使是应当发汗的证候，也不可以过汗。所以张仲景在桂枝汤中不用麻黄，是希望它不要大发汗；在麻黄汤中使用桂枝，是担心它过汗没有制约。如果不谨慎遵守这种方法，出汗过多导致亡阳，变生各种逆证，体表遂空虚而不能耐受风邪，阴盛格阳而更加烦躁不得安眠。
小青龙汤：治疗伤寒表证未解，心下有痰饮水气，干呕发热而咳嗽。或者口渴、或者腹泻、或者咽喉噎塞感、或者小便不利、少腹部胀满、或者喘息的。以及杂病中的肤胀、水肿证，用此方发汗并利水。
麻黄（去节，三两） 芍药（三两） 五味子（半升） 甘草（炙，三两） 干姜（二两） 半夏（洗，半升） 桂枝（三两） 细辛（三两）
以上八味药，用水一斗，先煮麻黄，减少二升水，去掉水面上的浮沫，加入其他药物，煮取三升药液，滤去药渣，温服一升。如果口渴的，去掉半夏加入栝楼根三两；如果咽喉噎塞感的，去掉麻黄加入炮附子一枚。如果小便不利、少腹胀满的，去掉麻黄加入茯苓四两。如果喘息的，去掉麻黄加入杏仁（去皮尖）半升。如果轻微腹泻的，去掉麻黄加入荛花如鸡蛋大小（熬至红色）。
【按语】“加荛花如鸡蛋大小，熬至红色”，这一定是传抄的错误。因为《本草》中芜花即芫花之类，用它攻逐水饮，力量非常峻猛，五分就能让人下行数十次，哪有治疗停饮导致的轻微腹泻，而使用鸡蛋大小的荛花的道理呢？应当改为加入茯苓四两。
【注】太阳经停饮有两种：一种是中风，表虚有汗，是五苓散证；一种是伤寒，表实无汗，是小青龙汤证。表实无汗，所以合用麻黄汤和桂枝汤两方以解表。去掉大枣，是因为它的性质黏滞。去掉杏仁，是因为没有喘息，如果有喘息则加上。去掉生姜，是因为有干姜，如果有呕吐仍然使用。辅助干姜、细辛，极温极散，使寒邪与水饮都从汗而解。辅助半夏驱逐痰饮，以清除未尽的水饮。辅助五味子收敛肺气，以敛耗伤之气。如果口渴的，去掉半夏加入花粉，避开燥性以生津液。如果轻微腹泻、噎塞感、小便不利、少腹胀满，都去掉麻黄，远离表证而趋向里证。加入附子以消除噎塞散寒，则噎塞可止。加入茯苓以利水，则轻微腹泻和少腹胀满可除。此方与越婢汤同治水饮溢于体表，导致肤胀、水肿，适宜发汗外解的，元不随手而消。越婢汤治疗有热的，所以方中以石膏为君以散阳水。小青龙汤治疗有寒的，所以方中辅助姜、桂以消阴水。
葛根汤：治疗太阳、阳明两经合病，头项强痛，背部也牵强，脉浮无汗恶风的，以及表证未解，腹泻且呕吐的，都适宜服用此方发汗。
葛根（四两） 麻黄（去节，三两） 桂枝（二两） 芍药（二两） 甘草（炙，二两） 生姜（切，二两） 大枣（擘，十二枚）
以上七味药，用水一斗，先煮麻黄、葛根，减少二升水，去掉浮沫，加入其他药物，煮取三升药液，温服一升。覆盖衣被取微微似有汗出，不需要喝粥。其余按照桂枝汤的方法调养及禁忌。
【注】这个方子，就是桂枝汤加上麻黄、葛根。麻黄辅助桂枝发太阳营卫之汗，葛根辅助桂枝解阳明肌表之邪。不叫桂枝汤加麻黄、葛根，而以葛根命名，其意图重在阳明，因为呕吐和腹泻属于阳明病较多。二阳表证紧急，如果不是温服覆盖取汗，表证不容易解除。或者呕吐或者腹泻，里气已经不和，虽然喝粥但胃也不能输布精气到皮毛，所以不需要喝粥。柯琴说：此证身体不疼、腰不疼、骨节不疼、不怕冷，是骨头没有受寒。头项强痛，向下连到背部，牵动不安宁，是筋受到风邪伤害。不喘不烦躁，不干呕，是里部没有病，无汗恶风，病只在表。如果表病兼有腹泻，那就是表实里虚。比麻黄汤、青龙汤二证较轻，但是项强连背拘挛强硬，比项强无汗更严重，不失为表证。但脉浮而不紧，所以不归属于麻黄汤，而在桂枝方中加入麻黄并倍用葛根以去除实邪，稍微变化了麻黄桂枝的方法。大概葛根是阳明经的主药，凡是太阳经有阳明病的，就佐入太阳药中；凡是少阳经有阳明病的，就佐入少阳药中，没有不可以的。李杲定为阳明经药。张洁古说：邪气未入阳明的，不可以立即服用。难道这两个人没读过张仲景的书吗？要知道葛根、桂枝，都是解肌和里的药物，所以有汗、无汗，腹泻、不腹泻，都可以使用，与麻黄专门发表不同。《金匮要略》治疗太阳病无汗，小便反而少，气上冲胸，口噤不能说话，将要发作刚痉。
【集注】喻昌说：伤寒项背强几几，无汗恶风的，用葛根汤。此证也用它的，是因为邪气在太阳、阳明两经的交界。两经的热邪并聚于胸中，必然损伤肺金清肃之气，所以水道不通，小便少，津液不布而无汗。阳明经的筋内结胃口，外行胸中，过人迎环口，热邪并入阳明，于是筋脉牵引，口噤不能说话。然而刚痉无汗，必须从汗解，何况湿邪内郁，必须以汗出如初而止。所以用此汤合解两经的湿热，与风寒之表，方法没有害处相同。
桂枝麻黄各半汤：太阳病，得了八九天，像疟疾的样子，发热恶寒，热多寒少，病人不呕吐，大小便基本正常，一天发作两三次，脉象微缓的，是快要痊愈了。脉微而恶寒的，这是阴阳俱虚，不可以再发汗、攻下、催吐。面色反而有热色的，是病未解，因为他不能得到微小的汗出，身体必定发痒，适宜用桂枝麻黄各半汤。
桂枝（一两六铢） 芍药（一两） 麻黄（去节，一两） 生姜（一两） 甘草（炙，一两） 大枣（擘，四枚） 杏仁（去皮尖，二十四个）
以上七味药，用水五升，先煮麻黄一二沸，去掉水面上的浮沫，加入其他药物，煮取一升八合药液，滤去药渣，温服六合。
【注】太阳病，得了八九天，有如疟疾一样的寒热。热多寒少，病人不呕吐，小便清白，这是里气和顺不受邪气，虽然是想要自愈；但是必须审察那如疟疾一样的寒热，一天二、三次，轻轻发作，诊察他的脉微而且缓，就知道邪气衰退正气恢复，表里将要调和，这才算是想要痊愈。如果脉微不缓，正气未恢复，更恶寒的，邪气未衰退，虽然不能自愈，但已经因为之前的发汗、催吐、攻下使其表里虚弱，所以不可以再发汗、催吐、攻下。脉微恶寒，表里俱虚，面色应当白，现在色反赤，是还有表邪郁结，不能得到微小汗出宣发阳气，所以面赤身痒，病未解，适宜用桂枝麻黄各半汤，小小发汗以调和营卫，自然可以痊愈。
桂枝二麻黄一汤：服用桂枝汤后，大汗出，脉洪大的，给予桂枝汤按照前面的方法。如果形体像疟疾，一天发作两次的，出汗必定解除，适宜用桂枝二麻黄一汤。
桂枝（一两十六铢） 芍药（一两六铢） 麻黄（去节，十六铢） 甘草（一两二铢） 杏仁（去皮尖，十六个） 生姜（一两六铢） 大枣（擘，五枚）
以上七味药，用水五升，先煮麻黄一二沸，去掉水面上的浮沫，加入其他药物，煮取二升药液，滤去药渣，温服一升，一天服用两次。
【注】服用桂枝汤大汗出，脉洪大病不解，如果烦渴的，那么表邪已经入阳明，是白虎汤证。现在脉虽洪大但不烦渴，则为表邪无在太阳，所以给予桂枝汤按照前面的方法。如果脉不洪大，壮热也减轻，只有寒热像疟疾，一天发作两次的，虽然属于轻邪，但最终被微寒所持，不是出汗必定不解，适宜用桂枝二麻黄一汤，小发营卫之汗。不用麻黄桂枝各半汤的原因，是因为已经大汗出，不希望它大发营卫之汗，希望它调和营卫之汗。
桂枝二越婢一汤：太阳病，发热恶寒，热多寒少。脉微弱的，这是无阳，不可以再发汗。适宜用桂枝二越婢一汤。
桂枝（一两六铢） 芍药（一两） 甘草（炙，一两三铢） 石膏（二十四铢） 麻黄（十六铢） 大枣（擘，五枚） 生姜（切，一两六铢）
以上七味药，用水五升，煮麻黄一二沸，去掉水面上的浮沫，加入其他药物，煮取二升药液，滤去药渣，温服一升，一天服用两次。本方应当裁减为越婢汤、桂枝汤，各饮用一升，现在合为一一方，名为桂枝二越婢一汤。
Guizhi Tang (Cinnamon Twig Decoction): Treats conditions where wind-cold pathogens are at the exterior, with a floating and weak pulse, spontaneous sweating, headache, fever, aversion to wind and cold, nasal congestion with humming sound, and dry retching. It is also applicable for miscellaneous diseases involving spontaneous sweating, night sweats, deficiency exhaustion, and deficient malaria. It is contraindicated if the pulse is floating and tight with no sweat, or in habitual drinkers who have wind-cold with sweating.
Ingredients: Guizhi (Cinnamomi Ramulus) (3 liang), Shaoyao (Paeoniae Radix Alba) (3 liang), Shengjiang (Zingiberis Rhizoma Recens) (3 liang), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (2 liang), Dazao (Jujubae Fructus) (12 pieces).
Process: Take the above five herbs, add seven sheng of water, decoct to obtain three sheng of liquid. Take one sheng per dose. After taking the medicine, cover with blankets to induce slight perspiration. Do not allow profuse sweating like flowing water, otherwise the disease will not be resolved. If after taking one sheng, sweating occurs and the disease resolves, there is no need to finish the remaining decoction. After taking the medicine, drink a bowl of thin porridge to assist the medicinal power.
[Commentary]: Whenever wind-cold is at the exterior with a floating-weak pulse and spontaneous sweating, it belongs to Exterior Deficiency syndrome, and Guizhi Tang is indicated. Named Guizhi Tang because Guizhi is the Sovereign herb. Guizhi is acrid and warm; acridity disperses pathogens, and warmth supports Wei Qi (Defensive Qi) from the Yang aspect. Shaoyao is sour and cold; sourness consolidates sweat, and cold nourishes Ying Qi (Nutritive Blood) in the Yin aspect. Guizhi as Sovereign and Shaoyao as Minister implies containing the intent of consolidating sweat within dispersion; Shaoyao assisting Guizhi implies leaving a pathway for slight sweating within surface consolidation. The acridity of Shengjiang assists Guizhi in resolving the muscle and exterior; the sweetness of Dazao assists Shaoyao in harmonizing Ying Qi and the interior. Gancao is sweet and neutral, possessing the ability to stabilize the interior and repel the exterior; it is used to harmonize Middle Jiao Qi, thereby harmonizing the exterior and interior, and harmonizing all herbs. Relying on the mutual assistance of Guizhi and Shaoyao, and the harmony of Shengjiang and Dazao, aided by Gancao’s harmonizing action to coordinate Yang-exterior and Yin-interior, Qi-Wei and Blood-Ying, proceeding together without conflict, this achieves harmony through the combination of rigid and soft. The essence lies in drinking hot thin porridge shortly after administration to boost medicinal power. Since grain Qi fills the interior, it not only facilitates the brewing of sweat but also prevents pathogens already entered from lingering slightly and future pathogens from re-entering. Another subtlety lies in taking the medicine warm and maintaining this for about an hour, resulting in slight apparent sweating; this teaches the method of inducing slight sweating. Profuse sweating like flowing water is prohibited, warning against excessive sweating. This formula is the crown among Zhang Zhongjing’s formulas, being the primary formula for resolving the muscle layer, inducing sweating, and harmonizing Ying and Wei. For Wind Strike or Cold Damage with floating-weak pulse and spontaneous sweating where the exterior is not resolved, it serves as the main treatment. In other cases, seeing one or two symptoms is sufficient; all symptoms need not be present. Therefore, sweating agents like Mahuang Tang, Gegen Tang, and Da Qinglong Tang often incorporate it. If there is no sweat, it is a Mahuang Tang pattern; a floating-tight pulse indicates Mahuang’s indication, so Guizhi Tang is naturally contraindicated. However, in early stages with no sweat, Mahuang Tang should be used for sweating; if restlessness recurs after sweating with a floating-rapid pulse; or if the pulse remains floating and Qi rushes upward after purgation; or if diarrhea stops after purgation but body pain persists, this formula is used to resolve the exterior. Why? Although the exterior is unresolved, the couli (pores) are loose, pathogens are in the muscle layer rather than the skin/hair, and fluids are damaged due to prior sweating and purging. Thus, although the pulse and symptoms resemble Mahuang Tang, the treatment belongs to Guizhi Tang. Unskilled doctors erroneously claim Guizhi Tang treats only Wind Strike and not Cold Damage, causing hesitation; or that it only disperses the muscle layer and treats no other diseases. They do not know that doubling Shaoyao and Shengjiang and adding Renshen creates Guizhi Xinjia Tang (Newly Added Cinnamon Twig Decoction) for Ying-Exterior deficiency-cold with limb pain; doubling Shaoyao and adding Yitang creates Xiaojianzhong Tang (Minor Construct the Middle Decoction) for Interior deficiency palpitations and abdominal urgency/pain; adding Huangqi creates Huangqi Jianzhong Tang for deficiency exhaustion, deficient heat, spontaneous and night sweats. Thus, Zhang Zhongjing’s formulas can treat hundred diseases.
Mahuang Tang (Ephedra Decoction): Treats Taiyang wind-cold at the exterior, with stiffness and pain in the head and neck, fever, body ache, lower back pain, bone and joint pain, aversion to wind and cold, no sweat, chest fullness, facial redness, and wheezing. The pulse may be floating-tight or floating-rapid. Use this to induce sweating. However, even with these symptoms, if the pulse is floating-weak with spontaneous sweating, or if the Chi position pulse is faint and slow, it is contraindicated. It is most suitable for Bi syndrome caused by wind-cold-dampness, lung meridian obstruction with confusion and muteness, and cold-wind asthma.
Ingredients: Mahuang (Ephedrae Herba) (de-stemmed, 3 liang), Guizhi (Cinnamomi Ramulus) (2 liang), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (roasted, 1 liang), Xingren (Armeniacae Semen Amarum) (skin and tip removed, 60 pieces).
Process: Take the above four herbs, add nine sheng of water. First decoct Mahuang, reducing by two sheng, remove the foam on top. Add the other herbs, decoct to obtain two and a half sheng. Strain and take eight ge warm. Cover warmly to induce slight sweating; no porridge is needed. If sweating occurs after one dose, stop subsequent doses. If sweating is excessive, apply warm powder to the body.
[Commentary]: Whenever wind-cold is at the exterior with a floating-tight-rapid pulse and no sweat, it belongs to Exterior Excess syndrome, and Mahuang Tang is indicated. Named Mahuang Tang because Mahuang is the Sovereign herb. Mahuang is warm, acrid and bitter, its action being rapid ascent. Guizhi is warm, acrid and sweet, its capacity being surface consolidation. Since the syndrome is Excess, Mahuang is used as the decisive strategy. Guizhi acts as a monitor to regulate it. Xingren’s bitter-warmness assists Mahuang in expelling pathogens and descending rebellious Qi; Gancao’s sweet-neutrality assists Guizhi in harmonizing the interior and resisting the exterior. Upon entering the stomach, Qi moves in the Yuan Fu (Qi Gates), essence is transported to the skin and hair. Thus, hair and vessel essence combine, and sweat pours forth. Pathogens at the exterior are completely expelled, pain ceases, wheezing flattens, and cold/heat resolve instantly. No porridge is needed as sweat relies on grain Qi. Ginger and Jujube are omitted because Shengjiang’s nature spreads horizontally in the muscle, hindering Mahuang’s rapid ascent; Dazao’s nature is sticky in the diaphragm, hindering Xingren’s rapid descent. This aims for direct and swift action; any delay hinders speed, horizontal spreading hinders ascent. As a pure Yang formula, it is overly dispersing, like a general charging straight in. Used correctly, victory is won in one battle; incorrectly, failure brings disaster. Thus, it can be used once but not twice. If unresolved after sweating, substitute with Guizhi Tang. This is Zhang Zhongjing’s first harsh/decocting formula for opening the exterior and expelling pathogens. Ignorant practitioners do not know its harshness depends on warming covers to induce sweat; without this, it is not harsh. The world says Mahuang only releases the exterior and treats no other diseases. They do not know combining this with Guizhi Tang creates Magui Ge Ban Tang (Half-Half Cinnamon and Ephedra Decoction) to harmonize lingering cold-heat in Taiyang. Removing Xingren and adding Shigao combined with Guizhi Tang creates Guizhi Er Yuebi Yi Tang (Two Parts Cinnamon Twig, One Part Yuebi Decoction) to resolve Taiyang heat-dominant/cold-minor cold-heat. If Yang is excess internally with no sweat, there is Mahuang Xingren Gancao Shigao Tang to disperse Taiyin Lung pathogens. If Yin is excess internally with no sweat, there is Mahuang Fuzi Xixin Gancao Tang to warm-disperse Shaoyin Kidney cold. *Jingui Yaolue* removes Guizhi from this formula; *Qianjin Fang* replaces Guizhi with Guixin, both named Huanhun Tang (Return Soul Decoction) for Taiyin pathogens causing sudden syncope, jaw lock, and breath cessation, effective upon swallowing, without requiring warm covers for sweating. Thus, the harshness of Mahuang Tang depends on warm covers. This is Zhang Zhongjing’s secret method of using formulas, inaccessible to ordinary people!
Da Qinglong Tang (Great Blue Dragon Decoction): Treats Taiyang suffering from both wind and cold, with simultaneous Ying and Wei pathology. A Taiyin Cold-Damage pulse showing Wind-Strike symptoms, or a Wind-Strike pulse showing Cold-Damage symptoms, where neither presents with sweat but both show irritability, use this to resolve both via sweating. Contraindicated if the pulse is faint-weak with spontaneous sweating; ingestion will cause Yang collapse.
Ingredients: Mahuang (Ephedrae Herba) (de-stemmed, 6 liang), Guizhi (Cinnamomi Ramulus) (2 liang), Xingren (Armeniacae Semen Amarum) (skin and tip removed, 40 pieces), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (roasted, 2 liang), Shengjiang (Zingiberis Rhizoma Recens) (sliced, 3 liang), Dazao (Jujubae Fructus) (split, 12 pieces), Shigao (Gypsum Fibrosum) (crushed, wrapped in silk bag, size of a chicken egg).
Process: Take the above seven herbs, add nine sheng of water. First decoct Mahuang, reducing by two sheng, remove foam. Add other herbs, decoct to obtain three sheng. Strain and take one sheng warm to induce slight sweating. If sweating is excessive, apply warm powder. If one dose induces sweating, stop subsequent doses. Excessive sweating causes Yang collapse, leading to deficiency, aversion to wind, irritability, and inability to sleep.
[Commentary]: How do we know it is wind-cold dual injury and Ying-Wei simultaneous pathology, with Cold-Damage pulse showing Wind-Strike symptoms, etc.? Named Da Qinglong Tang, taking the meaning of dragon raising clouds and rain. Treating wind relies on Guizhi; treating cold relies on Mahuang. Combining Guizhi Tang and Mahuang Tang forms this agent, hence it is the main treatment for combined wind-cold injury. Both syndromes lack sweat, so Shaoyao is reduced to avoid astringency. Both syndromes show irritability, so Shigao is added to clear heat. If no irritability, one should resort to Magui Ge Ban Tang. Zhang Zhongjing adds large-cold, acrid-sweet herbs to exterior formulas, indicating Mahuang syndrome fever is entirely at the exterior; Da Qinglong syndrome irritability involves the muscle interior. Using Shigao early in Taiyang illness works because it is acrid to resolve muscle heat, cold to clear Stomach fire, and sweet to generate fluids—this is the preemptive move to protect Yang and preserve fluids. Unskilled doctors doubt and fear it, failing to use it when needed, inevitably leading to Heat binding in Yangming, macules, jaundice, mania, and various transformations. From this, we see Shigao is a key herb for Wind Strike and Cold Damage; with Mahuang and Guizhi it earns the name Qinglong; with Gancao it earns the name Baihu. Post-administration requires slight sweating; excessive sweating is treated with warm powder. One dose inducing sweat means stopping further doses, warning that even appropriate sweating cases must not be over-treated. Hence, Zhang Zhongjing omits Mahuang in Guizhi Tang to avoid excessive sweating; he includes Guizhi in Mahuang Tang to prevent uncontrolled sweating. Failure to observe these methods leads to excessive sweating and Yang collapse, generating reverse syndromes. The exterior becomes empty and unable to withstand wind; Yin excess repels Yang, causing worse irritability and insomnia.
Xiao Qinglong Tang (Minor Blue Dragon Decoction): Treats Cold-Damage exterior unresolved, with fluid retention in the epigastrium, dry retching, fever, and cough. Or thirst, or diarrhea, or throat obstruction, or urinary difficulty with lower abdominal fullness, or wheezing. Also applicable for miscellaneous diseases presenting with skin distension and edema, using this to induce sweating and promote urination.
Ingredients: Mahuang (Ephedrae Herba) (de-stemmed, 3 liang), Shaoyao (Paeoniae Radix Alba) (3 liang), Wuweizi (Schisandrae Fructus) (half sheng), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (roasted, 3 liang), Ganjiang (Zingiberis Rhizoma) (2 liang), Banxia (Pinelliae Rhizoma Praeparatum) (washed, half sheng), Guizhi (Cinnamomi Ramulus) (3 liang), Xixin (Asari Radix et Rhizoma) (3 liang).
Process: Take the above eight herbs, add ten sheng of water. First decoct Mahuang, reducing by two sheng, remove foam. Add other herbs, decoct to obtain three sheng. Strain and take one sheng warm. Modifications: If thirsty, remove Banxia and add Gualougen (Trichosanthis Radix) 3 liang. If throat obstruction, remove Mahuang and add Pao Fuzi (Aconiti Lateralis Radix Praeparata) 1 piece. If urinary difficulty/lower abdominal fullness, remove Mahuang and add Fuling (Poria) 4 liang. If wheezing, remove Mahuang and add Xingren (Armeniacae Semen Amarum) (skin/tip removed) half sheng. If mild diarrhea, remove Mahuang and add Raohua (Edwardsiae Radix) size of a chicken egg (roasted until red).
[Note]: "Add Raohua size of a chicken egg, roasted until red" is likely a transcription error. Bencao states Wuhua is similar to Yuanhua (Genkwa Flos), which is very harsh for draining water; 5 fen can cause dozens of bowel movements. It is unlikely that for mild diarrhea from fluid retention, one would use a chicken-egg-sized dose of Raohua. It should be changed to adding Fuling 4 liang.
[Commentary]: There are two types of fluid retention in Taiyang: one is Wind-Strike, exterior deficiency with sweat, indicated by Wuling San; the other is Cold-Damage, exterior excess without sweat, indicated by Xiao Qinglong Tang. Exterior excess without sweat necessitates combining Mahuang and Guizhi formulas to resolve the exterior. Dazao is removed due to its stickiness. Xingren is removed because there is no wheezing (add if present). Shengjiang is removed because Ganjiang is present (use Shengjiang if vomiting occurs). Assisted by Ganjiang and Xixin, extremely warm and dispersing, allowing cold and water to resolve via sweat. Banxia assists in driving out phlegm-fluids to clear residual fluid. Wuweizi assists in收敛 (astringing) Lung Qi to conserve consumed Qi. If thirsty, remove Banxia and add Huafen (Trichosanthis Radix) to avoid dryness and generate fluids. For mild diarrhea, throat obstruction, urinary difficulty, and lower abdominal fullness, remove Mahuang to move from exterior to interior. Add Fuzi to stop obstruction and dispel cold. Add Fuling to promote urination, resolving mild diarrhea and lower abdominal fullness. This formula, along with Yuebi Tang, treats water-fluid overflowing to the exterior causing skin distension and edema, suitable for resolution via sweating. Yuebi Tang treats heat, using Shigao as Sovereign to disperse Yang-water. Xiao Qinglong Tang treats cold, assisted by Jiang and Gui to dissipate Yin-water.
Gegen Tang (Kudzu Decoction): Treats concurrent disease of Taiyang and Yangming meridians, with stiffness and pain in the head and neck, pulling stiffness in the back, floating pulse, no sweat, and aversion to wind. Also applicable when the exterior is unresolved accompanied by diarrhea and vomiting. Indicated for inducing sweating.
Ingredients: Gegen (Puerariae Lobatae Radix) (4 liang), Mahuang (Ephedrae Herba) (de-stemmed, 3 liang), Guizhi (Cinnamomi Ramulus) (2 liang), Shaoyao (Paeoniae Radix Alba) (2 liang), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (roasted, 2 liang), Shengjiang (Zingiberis Rhizoma Recens) (sliced, 2 liang), Dazao (Jujubae Fructus) (split, 12 pieces).
Process: Take the above seven herbs, add ten sheng of water. First decoct Mahuang and Gegen, reducing by two sheng, remove foam. Add other herbs, decoct to obtain three sheng. Take one sheng warm. Cover to induce slight apparent sweating; no porridge is needed. Rest follow Guizhi Tang care instructions and contraindications.
[Commentary]: This formula is Guizhi Tang plus Mahuang and Gegen. Mahuang assists Guizhi to sweat Taiyang Ying-Wei; Gegen assists Guizhi to resolve Yangming muscle-exterior pathogens. It is not named Guizhi Tang plus Mahuang/Gegen, but Gegen Tang, emphasizing Yangming, as vomiting and diarrhea belong more to Yangming. When both Yang meridians’ exterior is urgent, without warm intake and covering to induce sweat, the exterior is hard to resolve. Vomiting or diarrhea indicates Interior disharmony; even with porridge, the Stomach cannot transport essence to skin/hair, hence no porridge is needed. Ke Qin said: This syndrome lacks body/back/joint pain and aversion to cold, indicating bones are not affected by cold. Head/neck stiffness extending to the back with restless pulling indicates tendons injured by wind. No wheezing, irritability, or dry retching indicates the Interior is unaffected. No sweat and aversion to wind indicate the disease is solely at the Exterior. If Exterior disease accompanies diarrhea, it is Exterior Excess and Interior Deficiency. It is milder than Mahuang and Qinglong patterns, but neck/back stiffness is more severe than simple neck stiffness without sweat, still retaining Exterior characteristics. However, the pulse is floating not tight, so it does not follow Mahuang Tang. Instead, it modifies Guizhi Tang by adding Mahuang and doubling Gegen to remove Excess, slightly altering the Mahuang-Guizhi method. Gegen is the Sovereign herb of Yangming. Whenever Taiyang involves Yangming, it is added to Taiyang herbs; whenever Shaoyang involves Yangming, it is added to Shaoyang herbs—there is no case where it cannot be used. Li Gao designated it as a Yangming Meridian herb. Zhang Jiegu said: Do not administer if pathogens have not entered Yangming. Did these two not read Zhang Zhongjing’s books? One must know Gegen and Guizhi are both muscle-resolving and Interior-harmonizing herbs. Thus, they are usable with or without sweat, with or without diarrhea, differing from Mahuang which specializes in releasing the Exterior. *Jingui Yaolue* treats Taiyang disease with no sweat, urine unexpectedly scant, Qi rushing to the chest, jaw lock and inability to speak, impending Gang Jing (Stiff Spasm).
[Collected Commentary]: Yu Chang said: For Cold-Damage with stiff neck/back, no sweat, and aversion to wind, Gegen Tang is used. This syndrome uses it too, because the pathogen is at the boundary of Taiyang and Yangming. Heat from both meridians converges in the chest, damaging Lung Metal’s clearing/descending Qi, causing water pathways to fail, scant urine, fluid distribution failure, and no sweat. Yangming tendons knot internally at the stomach gate, run externally through the chest, pass Yingling and around the mouth. Heat merging into Yangming causes tendon/muscle traction, jaw lock, and inability to speak. However, Gang Jing with no sweat must resolve via sweating. Moreover, damp-heat constrained internally must cease when sweat returns to normal. Thus, this decoction resolves damp-heat in both meridians and wind-cold at the exterior; the method has no harm in similarity.
Guizhi Mahuang Ge Ban Tang (Half-Half Cinnamon Twig and Ephedra Decoction): Taiyang disease, after eight or nine days, resembling malaria with fever and aversion to cold, heat dominant over cold, patient does not vomit, stool and urine are relatively normal, occurring two or three times a day. If the pulse is faint and slow, recovery is imminent. If the pulse is faint with aversion to cold, this indicates simultaneous Yin and Yang deficiency; do not use sweating, purging, or vomiting again. If the face shows abnormal redness, the disease is not resolved because small amounts of sweat cannot be released, causing body itching. Use Guizhi Mahuang Ge Ban Tang.
Ingredients: Guizhi (Cinnamomi Ramulus) (1 liang 6 zhu), Shaoyao (Paeoniae Radix Alba) (1 liang), Mahuang (Ephedrae Herba) (de-stemmed, 1 liang), Shengjiang (Zingiberis Rhizoma Recens) (1 liang), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (roasted, 1 liang), Dazao (Jujubae Fructus) (split, 4 pieces), Xingren (Armeniacae Semen Amarum) (skin/tip removed, 24 pieces).
Process: Take the above seven herbs, add five sheng of water. First decoct Mahuang for one or two boils, remove foam. Add other herbs, decoct to obtain one sheng eight he. Strain and take six ge warm.
[Commentary]: Taiyang disease after eight or nine days presents with malaria-like chills and fever. Heat dominant over cold, no vomiting, clear urine/stool indicates Interior harmony and resistance to pathogens; although self-healing is possible, one must examine if the malaria-like chills/fever occur lightly two or three times daily. If the pulse is faint and slow, it indicates pathogen decline and Zheng Qi recovery, suggesting Exterior-Interior harmony and imminent recovery. If the pulse is faint but not slow, Zheng Qi has not recovered; with increased aversion to cold, the pathogen has not declined. Although self-healing is impossible, previous sweating/vomiting/purging has weakened the Exterior-Interior, so do not use sweating/vomiting/purging again. Faint pulse and aversion to cold indicate Exterior-Interior deficiency; the face should be pale, but now it is red, indicating lingering Exterior pathogen constraint preventing slight sweat release to vent Yang Qi. Thus, red face and body itch indicate unresolved disease. Use Guizhi Mahuang Ge Ban Tang to induce slight sweating and harmonize Ying-Wei, ensuring recovery.
Guizhi Er Mahuang Yi Tang (Two Parts Cinnamon Twig, One Part Ephedra Decoction): After taking Guizhi Tang, profuse sweating occurs with a洪大 (Surging-Large) pulse. Give Guizhi Tang as before. If the condition resembles malaria, occurring twice a day, sweating will resolve it. Use Guizhi Er Mahuang Yi Tang.
Ingredients: Guizhi (Cinnamomi Ramulus) (1 liang 16 zhu), Shaoyao (Paeoniae Radix Alba) (1 liang 6 zhu), Mahuang (Ephedrae Herba) (de-stemmed, 16 zhu), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (1 liang 2 zhu), Xingren (Armeniacae Semen Amarum) (skin/tip removed, 16 pieces), Shengjiang (Zingiberis Rhizoma Recens) (1 liang 6 zhu), Dazao (Jujubae Fructus) (split, 5 pieces).
Process: Take the above seven herbs, add five sheng of water. First decoct Mahuang for one or two boils, remove foam. Add other herbs, decoct to obtain two sheng. Strain and take one sheng warm, twice daily.
[Commentary]: After Guizhi Tang, profuse sweating with Surging-Large pulse without resolution: if accompanied by irritability and thirst, the Exterior pathogen has entered Yangming, indicating Baihu Tang syndrome. Now, although the pulse is Surging-Large, there is no irritability/thirst, so the pathogen remains in Taiyang. Give Guizhi Tang as before. If the pulse is not Surging-Large, high fever subsides, leaving only malaria-like chills/fever occurring twice daily: although this is a light pathogen, it is held by minor cold and will not resolve without sweating. Use Guizhi Er Mahuang Yi Tang to slightly sweat Ying-Wei. Magui Ge Ban Tang is not used because profuse sweating has already occurred; we do not want to excessively sweat Ying-Wei, but rather harmonize Ying-Wei sweat.
Guizhi Er Yuebi Yi Tang (Two Parts Cinnamon Twig, One Part Yuebi Decoction): Taiyang disease with fever, aversion to cold, heat dominant over cold. If the pulse is faint-weak, this indicates "No Yang"; do not sweat again. Use Guizhi Er Yuebi Yi Tang.
Ingredients: Guizhi (Cinnamomi Ramulus) (1 liang 6 zhu), Shaoyao (Paeoniae Radix Alba) (1 liang), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (roasted, 1 liang 3 zhu), Shigao (Gypsum Fibrosum) (24 zhu), Mahuang (Ephedrae Herba) (16 zhu), Dazao (Jujubae Fructus) (split, 5 pieces), Shengjiang (Zingiberis Rhizoma Recens) (sliced, 1 liang 6 zhu).
Process: Take the above seven herbs, add five sheng of water. Boil Mahuang for one or two boils, remove foam. Add other herbs, decoct to obtain two sheng. Strain and take one sheng warm, twice daily. This formula should ideally be prepared as separate Yuebi Tang and Guizhi Tang, each drinking one sheng. Now combined into one formula, named Guizhi Er Yuebi Yi Tang.