病名伤寒，而太阳篇之开端，实中风、伤寒、风温并列，盖寒气多随风至，是中风者伤寒之诱起也。无论
中风、伤寒，入阳明后皆化为温，是温病者伤寒之归宿也。惟其初得之时，中风、伤寒、温病，当分三种治
法耳。为中风为伤寒之诱起，是以太阳篇开始之第一方为桂枝汤，其方原为治中风而设也。
《伤寒论》原文∶太阳病，发热，汗出，恶风，脉缓者（缓脉与迟脉不同，脉搏以一息四至为准，脉迟者
不足四至，若缓脉则至数不改似有懒动之意），名为中风。
《伤寒论》原文∶太阳中风，阳浮而阴弱（脉法关前为阳，关后为阴，其浮脉见于关前，弱脉见于关后，浮者
着手即得，弱者不任重按）。阳浮者热自发，阴弱者汗自出，啬啬恶寒。
（单弱不胜寒之意），淅淅恶风（为风所伤恒畏风声之意），翕翕发热（其热蕴而不散之意），鼻鸣干
呕者，桂枝汤主之。
【桂枝汤方】桂枝三两去皮，芍药三两，炙甘草二两，生姜三两，大枣十二枚擘。上五味 咀，以水
七升微火煮取三升，去滓，适寒温，服一升。服须臾，啜热稀粥一升余以助药力，温复令一时许，遍体 微
似有汗者益佳，不可令如水流漓，病必不除。若一服汗出病瘥（愈也），停后服，不必尽剂；若不汗，更服
根据前法；又不汗，后服小促其间，半日许，令三服尽；若病重者，一日一夜服，周时观之；服一剂尽，病
证犹在者，更作服；若汗不出者乃服至二三剂。禁生冷、粘滑、肉面、五辛、酒酪、臭恶等物。
人之营卫皆在太阳部位，卫主皮毛，皮毛之内有白膜一层名为腠理，腠理之内遍布微丝血管即营也。其
人若卫气充盛，可为周身之外围，即受风不能深入（此受风，不可名为中风），其人恒多汗闭不出，
迨其卫气流通，其风自去，原可不药而愈也。至桂枝汤所主之证，乃卫气虚弱，不能护卫其营分，外感之风
直透卫而入营，其营为风邪所伤，又乏卫之保护，是以易于出汗。其发热者，因营分中之微丝血管原有自心传
来之热，而有风以扰之，则更激发其热也。其恶风者，因卫虚无御风之力，而病之起点又由于风也。推原其
卫气不能卫护之故，实由于胸中大气之虚损。《灵枢》五味篇曰∶“谷始入于胃，其精微者，先出于胃之
两焦，以溉五脏，别出两行营卫之道，其大气之抟而不行者，积于胸中，命曰气海。”由斯观之，营卫原与
胸中大气息息相通，而大气实为营卫内部之大都会，愚临证实验以来，见有大气虚者，其营卫即不能护卫于
外而汗出淋漓，夫大气原赖水谷之气时时培养，观服桂枝汤者当啜热粥以助药力，此不惟助其速于出汗，
实兼欲助胸中大气以固营卫之本源也。
或问∶桂枝汤提纲中原谓阴弱者汗自出，未尝言阳弱者汗自
出也。夫关后为阴主血，关前为阳主气，桂枝汤证，其弱脉惟见于关后，至关前之脉则见有浮象，未见其弱，
而先生竟谓桂枝汤证之出汗，实由于胸中大气之弱，不显与提纲中之言相背乎？答曰∶凡受风之脉多见于关
前，提纲中所谓阳浮者，其关前之脉因受风而浮也，所谓阴弱者，知其未病之先其脉原弱，至病后而仍
不改其弱也，由斯而论，其未病之先，不但关后之脉弱，即关前之脉亦弱，既病之后，其关前脉之弱者转为
浮脉所掩，而不见其弱耳。然其脉虽浮，必不任重按，是浮中仍有弱也，特古人立言尚简，未尝细细明言耳。
是以愚用桂枝汤时，恒加黄 以补其胸中大气，加薄荷以助其速于出汗，不至若方后所云，恒服药多次
始汗也。又宜加天花粉助芍药以退热（但用芍药退热之力恒不足），即以防黄 服后能助热也（黄 天花粉等
分并用，其凉热之力相敌，若兼用之助芍药清热，分量又宜多用）。若遇干呕过甚者，又宜加半夏以治其
呕，惟此时药局所鬻之半夏，多制以矾（虽清半夏亦有矾），若用以止呕，必须用微温之水淘净矾味，用之方效。
愚治桂枝汤证，又有屡用屡效之便方，较用桂枝汤殊为省事，方用生怀山药细末两半或一两，凉水调和
煮成稀粥一碗，加白糖令适口，以之送服西药阿斯匹林一瓦，得汗即愈。
桂枝汤证之出汗，不过间有出汗之时，非时时皆出汗也，故必用药再发其汗，始能将外感之风邪逐出。然
风邪去后，又虑其自汗之病不愈，故方中山药与阿斯匹林并用，一发汗、一止汗也，至于发汗与止汗之药并
用而药力两不相妨者，此中原有深义，盖药性之入人脏腑，其流行之迟速原迥异，阿斯匹林之性其发汗最速，而
山药止汗之力则奏效稍迟，是以二药虽一时并用，而其药力之行则一先一后，分毫不相妨碍也。
病名虽称为伤寒，但《伤寒论》太阳篇的开端，实际上将中风、伤寒、风温并列提出。这是因为寒气多伴随风邪而至，所以中风往往是伤寒的诱因。无论是中风还是伤寒，一旦传入阳明经后都会转化为温病，因此温病是伤寒的最终转归。只是在疾病初起之时，对于中风、伤寒、温病这三种情况，应当分别采用三种不同的治疗方法。正因为中风是伤寒的诱因，所以太阳篇开始的第一张方剂是桂枝汤，这张方子原本就是为治疗中风而设立的。
《伤寒论》原文：太阳病，出现发热、出汗、怕风、脉搏缓弱的症状（缓脉与迟脉不同，脉搏以医生一呼一吸间跳动四次为标准，迟脉则不足四次；若为缓脉，则至数不变，但感觉似有懒动之意），这被称为中风。
《伤寒论》原文：太阳中风，表现为阳脉浮而阴脉弱（脉法中，关前为阳，关后为阴；浮脉出现在关前，弱脉出现在关后；浮脉轻按即得，弱脉重按无力）。阳脉浮说明热自发于内，阴脉弱说明汗自出于外，患者感到畏寒怯冷（单弱不能抵御寒冷之意），淅淅恶风（因受风伤而常畏惧风声之意），翕翕发热（热蕴积体内而不散之意），伴有鼻鸣和干呕的，用桂枝汤主治。
【桂枝汤方】桂枝三两（去皮），芍药三两，炙甘草二两，生姜三两，大枣十二枚（掰开）。以上五味药切碎，用水七升，微火煮取三升，去渣，待温度适宜时，服用一升。服药片刻后，喝热稀粥一升多以助药力，覆盖衣被约一顿饭的时间，使全身微微似有汗出为佳，不可让汗出如水流漓，否则病必不除。如果服一次药后汗出病愈，就停止后续服药，不必喝完剩余的药液；如果没有出汗，再按前面的方法服药；如果仍不出汗，缩短后两次服药的间隔时间，在半日左右让三次药服完；如果病情较重，可以一天一夜连续服药，观察二十四小时；如果服完一剂药，病症仍在，就重新煎服；如果仍然不出汗，就服用到两三剂为止。禁忌食用生冷、粘滑、肉类、面食、五辛、酒酪、腐臭等食物。
人的营气和卫气都分布在太阳部位，卫气主管皮毛，皮毛之内有一层白膜名为腠理，腠理之内遍布微丝血管，这就是营气。如果一个人的卫气充盛，可以作为周身的外围防御，即使受到风邪侵袭也不能深入（这种受风，不能称为中风），此人往往多表现为汗闭不出，等到卫气流通，风邪自然去除，原本可以不药而愈。至于桂枝汤所主治的证候，乃是卫气虚弱，不能护卫其营分，外感的风邪直接穿透卫气而入营分，营分受到风邪伤害，又缺乏卫气的保护，所以容易出汗。发热的缘故，是因为营分中的微丝血管原有从心脏传来的热，又有风邪来扰动，从而更加激发其热。恶风的缘故，是因为卫气虚无抵御风邪的力量，而且疾病的起点又是由于风邪引起的。推究其卫气不能护卫的原因，实际上是由于胸中大气（宗气）的虚损。《灵枢·五味》篇说：“谷物刚进入胃中，其中的精微物质，先出于胃的两焦，用来灌溉五脏，另外分出两条运行营卫的道路，其中聚集而不运行的那部分大气，积聚在胸中，叫做气海。”由此看来，营卫原本与胸中大气息息相通，而大气实际上是营卫内部的大都会。我临证实验以来，见到有大气虚的人，其营卫就不能护卫于外而汗出淋漓。大气原本依赖水谷之气时时培养，看服用桂枝汤时要喝热粥以助药力，这不仅是为了帮助快速出汗，实在是为了帮助胸中大气以巩固营卫的本源。
有人问：桂枝汤提纲中原来说“阴弱者汗自出”，并没有说“阳弱者汗自出”啊。关后为阴主血，关前为阳主气，桂枝汤证，其弱脉只见于关后，至关前的脉则见有浮象，未见其弱，而先生竟说桂枝汤证的出汗，实际是由于胸中大气的虚弱，这不明显与提纲中的说法相违背吗？回答说：凡是受风邪的脉象多见于关前，提纲中所谓“阳浮者”，是指关前的脉因为受风而浮；所谓“阴弱者”，是知道其在未病之前脉原已弱，到了生病后仍然不改其弱。由此而论，其在未病之前，不但关后的脉弱，就连关前的脉也弱；既病之后，其关前脉的弱被浮脉所掩盖，而不显现其弱罢了。然而其脉虽然浮，必定不能承受重按，这说明浮中仍有弱，只是古人立言崇尚简略，未曾细细明言罢了。所以我使用桂枝汤时，常常加入黄芪以补益其胸中大气，加入薄荷以帮助其快速出汗，不至于像方后所说，经常需要多次服药才出汗。又适宜加入天花粉辅助芍药以退热（但单用芍药退热之力往往不足），以此来防止黄芪服药后能助热（黄芪、天花粉等分并用，其凉热之力相互抵消，如果兼用之辅助芍药清热，分量又宜多用）。如果遇到干呕特别严重的，又适宜加入半夏来治疗呕吐，只是此时药店出售的半夏，大多用矾制过（即使是清半夏也有矾），如果用来止呕，必须用微温水淘洗干净矾味，使用才有效。
我治疗桂枝汤证，还有一个屡用屡效的简便方子，比使用桂枝汤省事得多。方用生怀山药细末一两半或一两，凉水调和煮成稀粥一碗，加白糖使其适口，用它送服西药阿斯匹林一瓦，得到汗出即痊愈。
桂枝汤证的出汗，不过是偶尔有出汗的时候，并非时时都在出汗，所以必须用药再次发汗，才能将外感的风邪驱逐出去。然而风邪去除后，又担心其自汗的病不愈，所以方中山药与阿斯匹林并用，一个是发汗，一个是止汗。至于发汗与止汗的药并用而药力互不相妨，这其中原有深义，大概药物性质进入人脏腑，其流行的快慢原本迥然不同。阿斯匹林的性质发汗最快，而山药止汗的力量奏效稍慢，所以这两种药虽然同时并用，但其药力的运行则是一先一后，分毫不相妨碍。
Although the disease name is "Shanghan" (Cold Damage), the opening of the Taiyang Chapter in *Shanghan Lun* actually lists Zhongfeng (Wind Strike), Shanghan, and Fengwen (Wind-Warmth) together. This is because cold qi often arrives accompanied by wind; thus, Zhongfeng serves as the inducement for Shanghan. Whether it is Zhongfeng or Shanghan, once transmitted to the Yangming channel, both transform into Wenbing (Warm Disease); therefore, Wenbing represents the ultimate outcome of Shanghan. However, at the initial stage of onset, three distinct treatment methods should be applied to Zhongfeng, Shanghan, and Wenbing respectively. Because Zhongfeng is the inducement for Shanghan, the first formula presented at the beginning of the Taiyang Chapter is Guizhi Tang (Cinnamon Twig Decoction), which was originally established for treating Zhongfeng.
*Shanghan Lun* original text: In a Taiyang disease, if there is fever, sweating, aversion to wind, and a slow pulse (the Huan Mai [Slow/Relaxed Pulse] differs from Chi Mai [Delayed Pulse]; the standard is four beats per respiration cycle of the physician; Chi Mai has fewer than four beats, whereas Huan Mai maintains the same frequency but feels sluggish), this is named Zhongfeng.
*Shanghan Lun* original text: In Taiyang Zhongfeng, the Yang pulse is floating and the Yin pulse is weak (in pulse diagnosis, the area anterior to the Guan position is Yang, and posterior is Yin; the Floating pulse appears anteriorly, while the Weak pulse appears posteriorly; the Floating pulse is palpable with light pressure, while the Weak pulse cannot withstand heavy pressure). A Yang-floating pulse indicates spontaneous heat generation; a Yin-weak pulse indicates spontaneous sweating. The patient experiences Se-se aversion to cold (meaning weakness unable to resist cold), Xi-xi aversion to wind (meaning fear of wind sounds due to wind injury), Xi-xi fever (meaning heat accumulating internally without dispersing), along with nasal congestion and dry retching; these are treated with Guizhi Tang (Cinnamon Twig Decoction).
[Guizhi Tang Formula]: Guizhi (Cinnamomi Ramulus, 3 liang, bark removed), Shaoyao (Paeoniae Radix Alba, 3 liang), Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma, 2 liang), Shengjiang (Zingiberis Rhizoma Recens, 3 liang), Dazao (Jujubae Fructus, 12 pieces, split). The above five herbs are crushed. Boil in 7 sheng of water with mild fire until 3 sheng remain. Strain. Take 1 sheng when warm. Shortly after ingestion, drink more than 1 sheng of hot thin porridge to assist the medicinal power. Cover with blankets for about an hour until the whole body shows slight perspiration; this is optimal. Do not allow profuse sweating like flowing water, otherwise the disease will not be resolved. If after one dose sweating occurs and the illness resolves, stop subsequent doses; do not finish the remaining decoction. If no sweating occurs, administer again according to the previous method. If still no sweating, shorten the interval between subsequent doses, completing three doses within half a day. For severe cases, administer continuously over a day and night, observing for 24 hours. If symptoms persist after finishing one prescription, prepare another. If sweating does not occur, continue up to two or three prescriptions. Avoid raw/cold foods, sticky/slippery foods, meat, wheat products, Five Pungent Spices, dairy/wine, and foul-smelling substances.
Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi) are distributed in the Taiyang region. Wei Qi governs the skin and hair. Inside the skin and hair lies a white membrane called Cili (interstitial spaces/pores). Within the Cili are distributed microscopic blood vessels, which constitute Ying Qi. If a person's Wei Qi is robust, it acts as an external defense for the body; even if exposed to wind, it cannot penetrate deeply (this type of wind exposure cannot be termed Zhongfeng). Such individuals often present with closed pores and no sweating. Once Wei Qi circulation restores, the wind dissipates naturally, and recovery can occur without medication. The syndrome indicated by Guizhi Tang (Cinnamon Twig Decoction), however, involves deficient Wei Qi that fails to protect the Ying Fen (Nutritive Level). External wind pathogens penetrate directly through the Wei level into the Ying level. The Ying level is injured by wind pathogens and lacks Wei protection, leading to easy sweating. Fever arises because the microscopic blood vessels in the Ying level possess inherent heat transmitted from the Heart; wind disturbance further excites this heat. Aversion to wind occurs because deficient Wei Qi lacks the strength to repel wind, and the disease originated from wind. Tracing the root cause of Wei Qi's failure to protect, it is actually due to deficiency of the Da Qi (Great Qi/Zong Qi) in the chest. The *Ling Shu · Wu Wei* chapter states: "When grain enters the stomach, its refined essence first emerges from the two Jiao of the stomach to nourish the five Zang organs. It separately gives rise to two pathways for Ying and Wei Qi. The portion of Great Qi that gathers and does not circulate accumulates in the chest, designated as the Sea of Qi." From this, we see that Ying and Wei Qi are intimately connected with the Great Qi in the chest, and the Great Qi serves as the central hub for Ying and Wei. In my clinical experience, I have observed that those with deficient Great Qi fail to guard the exterior with Ying and Wei, resulting in profuse sweating. Great Qi relies on continuous nourishment from food and drink essence. Note that patients taking Guizhi Tang (Cinnamon Twig Decoction) are instructed to drink hot porridge to assist the medicine. This not only aids rapid sweating but also aims to support the Great Qi in the chest to consolidate the source of Ying and Wei.
A questioner asks: The outline of Guizhi Tang (Cinnamon Twig Decoction) states "Yin weakness leads to sweating," but never mentions "Yang weakness leads to sweating." The posterior Guan position corresponds to Yin and governs Blood; the anterior Guan corresponds to Yang and governs Qi. In Guizhi Tang syndrome, the weak pulse is seen only at the posterior Guan, while the anterior Guan shows a floating image, not weakness. How can you claim that sweating in Guizhi Tang syndrome is actually due to weakness of the Great Qi in the chest? Does this not contradict the outline? I reply: Pulses indicating wind invasion are commonly seen at the anterior Guan. The "Yang floating" mentioned in the outline refers to the anterior Guan pulse becoming floating due to wind. The "Yin weak" means that prior to illness, the pulse was already weak, and it remains weak after onset. Therefore, prior to illness, not only was the posterior Guan pulse weak, but the anterior Guan pulse was also weak. After onset, the weakness of the anterior Guan pulse is masked by the floating pulse, making the weakness invisible. However, although the pulse floats, it cannot withstand heavy pressure, indicating that weakness exists within the floating quality. Ancient texts were concise and did not explain this in detail. Thus, when I use Guizhi Tang (Cinnamon Twig Decoction), I often add Huangqi (Astragali Radix) to tonify the Great Qi in the chest, and Bohe (Menthae Haplocalycis Herba) to facilitate rapid sweating, avoiding the need for multiple doses as described in the post-prescription notes. I also add Tianhuafen (Trichosanthis Radix) to assist Shaoyao (Paeoniae Radix Alba) in reducing fever (as Shaoyao alone is often insufficient for clearing heat), thereby preventing Huangqi (Astragali Radix) from generating heat after ingestion (when using Huangqi and Tianhuafen in equal parts, their cooling and warming effects neutralize each other; if used together to assist Shaoyao in clearing heat, the dosage should be increased). If dry retching is severe, I add Banxia (Pinelliae Rhizoma) to treat vomiting. However, Banxia sold in pharmacies is often processed with Mingfan (Alumen). Even Qing Banxia (Processed Pinelliae Rhizoma) may contain alum residues. To stop vomiting effectively, it must be rinsed with slightly warm water to remove the alum taste before use.
I have a frequently effective simple prescription for treating Guizhi Tang (Cinnamon Twig Decoction) syndrome, which is much more convenient than using Guizhi Tang itself. The formula consists of 1.5 liang or 1 liang of fine powder of Sheng Huai Shanyao (Dioscoreae Hypoglaucae Rhizoma), mixed with cold water and boiled into a bowl of thin porridge. Add white sugar to taste. Use this to swallow 1 grain of Aspirin. Recovery follows upon sweating.
Sweating in Guizhi Tang (Cinnamon Twig Decoction) syndrome occurs intermittently, not constantly. Therefore, medication is required to induce sweating again to expel the external wind pathogen. However, after the wind pathogen is expelled, there is concern that spontaneous sweating may persist. Hence, the combination of Shanyao (Dioscoreae Rhizoma) and Aspirin in this prescription serves one to induce sweating and one to stop sweating. The reason why inducing and stopping sweating agents can be used together without interfering with each other lies in the profound principle that drugs enter the Zang-Fu organs with different speeds of circulation. Aspirin induces sweating most rapidly, while Shanyao's effect in stopping sweating takes slightly longer. Thus, although administered simultaneously, their actions occur sequentially—one first, one later—without hindering each other.