《伤寒论》原文∶太阳与阳明合病，喘而胸满者不可下，宜麻黄汤主之。
太阳与阳明合病，是太阳表证未罢，而又兼阳明之热也。其喘者风寒由皮毛袭肺也。其胸满者胸中大
气因营卫闭塞，不能宣通而生 胀也。其言不可下者，因阳明仍连太阳，下之则成结胸，且其胸本发满，成
结胸尤易，矧其阳明之热，仅在于经，亦断无可下之理，故谆谆以不可下示戒也。仍治以麻黄汤，是开其
太阳而使阳明初生之热随汗而解也。
证兼阳明，而仍用麻黄汤主治，在古人禀赋敦浓，淡泊寡欲，服之可以有效。今人则禀赋薄弱，嗜
好日多，强半阴亏，若遇此等证时，宜以薄荷代方中桂枝。若其热稍剧，而大便实者，又宜
酌加生石膏（宜生用不可 用理详白虎汤下）数钱，方能有效。
至于温病，在上古时，原与中风、伤寒统名之为伤寒，是以
秦越人《难经》有伤寒有五之说。至仲景着《伤寒论》，知温病初
得之治法，原与中风、伤寒皆不同，故于太阳篇首即明分为三项，
而于温病复详细论之，此仲景之医学，较上古有进步之处也。
《伤寒论》原文∶太阳病，发热而渴，不恶寒者，为温病。若发汗已，身灼热者，名曰风温。风温
为病，脉阴阳俱浮，自汗出，身重，多眠睡，息必鼾，语言难出。
论温病之开端，亦冠以太阳病三字者，因温病亦必自太阳（此是足太阳非手太阳，彼谓温病入手经
不入足经者，果何所据也）入也。然其化热最速，不过数小时即侵入阳明，是以不觉恶寒转发热而渴也。治
之者不知其为温病，而误以热药发之，竟至汗出不解而转增其灼热，则即此不受热药之发表，可确定其名为风温
矣。其脉阴阳俱浮者象风之飘扬也，自汗出者热随浮脉外透也，身重者身体经热酸软也，多眠睡者精
神经热昏沉也，语言难出者，上焦有热而舌肿胀也。
风温之外，又有湿温病与伏气化热温病，而提纲中止论风温
者，因湿温及伏气化热之温，其病之起点亦恒为风所激发，故皆可以风温统之也。
提纲中论风温之病状详矣，而提纲之后未列治法，后世以为憾事。及反复详细推之，乃知《伤寒论》
中原有治温病之方，特因全书散佚，后经叔和编辑而错简在后耳。尝观《伤寒论》第六十二节云∶“发汗后，
不可更行桂枝汤，汗出而喘，无大热者，可与麻黄杏仁甘草生石膏汤。”今取此节与温病提纲对观，则此
节之所谓发汗后，即提纲之所谓若发汗也，此节之所谓喘，即提纲之所谓息必鼾也，由口息而喘者，由鼻息即
鼾矣，此节之所谓无大热，即提纲之所谓身灼热也，盖其灼热犹在外表，心中仍无大热也，
将此节之文与温病提纲一一比较，皆若合符节。
夫中风、伤寒、温病特立三大提纲，已并列于篇首，至其后则于治中风治伤寒之方首仍加提纲，以
彼例此，确知此节之文原为温病之方，另加提纲无疑，即麻杏甘石汤为治温病之方无疑
也。盖当仲景时，人之治温病者，犹混温病于中风、伤寒之中，于病初得时，未细审其发热不恶寒，而以
温热之药发之，是以汗后不解。或见其发热不恶寒，误认为病已传里，而竟以药下之，是以百六十三节，
又有下后不可更行桂枝汤云云。所稍异者，一在汗后，一在下后，仲景恐人见其汗出再误认为桂枝证，故
切戒其不可更行桂枝汤，而宜治以麻杏甘石汤。盖伤寒定例，凡各经病证误服他药后，其原病犹在者，仍
可投以正治之原方，是以百零三节云，凡柴胡汤病证而下之，若柴胡证不罢者复与小柴胡汤。以此例彼，知
麻杏甘石汤为救温病误治之方，实即治温病初得之主方，而欲用此方于今日，须将古方之分量稍有变通。
【麻黄杏仁甘草石膏汤原方】 麻黄四两去节，杏仁五十个去皮尖，甘草二两，石膏八两碎绵裹。
上四味以水七升，先煮麻黄减二升去上沫，纳诸药煮取二升，去渣温服一升。
方中之义，用麻黄协杏仁以定喘，伍以石膏以退热，热退其汗自止也。复加甘草者，取其甘缓之性，能
调和麻黄、石膏，使其凉热之力溶和无间以相助成功，是以奏效甚捷也。
此方原治温病之汗出无大热者，若其证非汗出且热稍重者，用此方时，原宜因证为之变通，是以愚
用此方时，石膏之分量恒为麻黄之十倍，或麻黄一钱、石膏一两，或麻黄钱半、石膏两半。遇有不出汗者，
恐麻黄少用不致汗，服药后可服西药阿斯匹林瓦许以助其汗。若遇热重者，石膏又可多用。曾治白喉证及烂
喉痧证（烂喉痧证必兼温病、白喉证，亦多微兼外感），麻黄用一钱，石膏恒重至二两，喉
证最忌麻黄，而能多用石膏以辅弼之，则不惟不忌，转能借麻黄之力立见奇功也。
至于肺病之起点，恒有因感受风温，其风邪稽留肺中化热铄
肺，有时肺中作痒，即连连喘嗽者，亦宜投以此汤，清其久蕴之
风邪，连服数剂其肺中不作痒，嗽喘自能减轻，再徐治以润肺清火利痰之剂，而肺病可除矣。盖此麻杏甘
石汤之用处甚广，凡新受外感作喘嗽，及头疼、齿疼、两腮肿疼，其病因由于外感风热
者皆可用之，惟方中药品之分量，宜因证变通耳。
【附记】林××，年近五旬，因受风温，虽经医治愈，而肺中余热未清，致肺阴铄耗，酿成肺病，屡经
医治无效。其脉一息五至，浮沉皆有力，自言喉连肺际，若觉痒则咳嗽顿发，剧时连嗽数十声，周身汗出，
必吐出若干稠痰其嗽始止。问其心中常觉发热，大便燥甚，四五日一行。因悟其肺际作痒，即顿发咳嗽
者，必其从前病时风邪由皮毛袭入肺中者，至今犹未尽除也。因其肺中风热相助为虐，宜以麻黄祛其风，
石膏清其热，遂为开麻杏甘石汤方，麻黄用钱半，生石膏用两半，杏仁三钱，甘草二钱，煎服一剂，咳嗽顿
愈。诊其脉仍有力，又为开善后之方，用生山药一两，北沙参、天花粉、天冬各五钱，川贝、射干、苏
子、甘草各二钱，嘱其多服数剂，肺病可从此除根。后阅旬日，林××又求诊视，言先生去后，余服所开善
后方，肺痒咳嗽仍然反复，遂仍服第一次方，至今已连服十剂，心中热已退，仍分毫不觉药凉，肺痒咳嗽皆
愈，且饮食增加，大便亦不甚干燥。闻其所言，诚出愚意料之外也。再诊其脉已不数，仍似有力，遂将方
中麻黄改用一钱，石膏改用一两，杏仁改用二钱，又加生怀山药六钱，俾煎汤接续服之，若服之稍觉凉时，即
速停止，后连服七八剂似稍觉凉，遂停服，肺病从此竟愈。
按:治肺劳投以麻黄杏仁甘草石膏汤，且用至二十余剂，竟将肺劳治愈，未免令阅者生疑，然此中固
有精细之理由在也。盖肺病之所以难愈者，为治之者但治其目前所现之证，而不深究其病因也。如此证原
以外感受风成肺劳，且其肺中作痒，犹有风邪存留肺中，且为日既久则为锢闭难出之风邪，非麻黄不能开发其
锢闭之深，惟其性偏于热，于肺中蕴有实热者不宜，而重用生石膏以辅弼之，既可解麻黄之热，更可清肺中
久蕴之热，以治肺热有风劳嗽者，原为正治之方，故服之立时见功。至于此药，必久服始能拔除病根，且
久服麻黄、石膏而无流弊者，此中又有理由在，盖深入久锢之风邪，非屡次发之不能透，而伍以多量之石
膏以为之反佐，俾麻黄之力惟旋转于肺脏之中，不至直达于表而为汗，此麻黄久服无弊之原因也。至石膏性
虽寒凉，然其质重气轻，煎入汤剂毫无汁浆（无汁浆即是无质），其轻而且凉之气，尽随麻黄发表之
力外出，不复留中而伤脾胃，此石膏久服无弊之原因也。所遇之证，非如此治法不愈，用药即不得不如此也。
《伤寒论》原文：太阳病与阳明病同时发病，出现气喘且胸部胀满的症状，此时不可使用泻下法，适宜用麻黄汤来主治。
太阳病与阳明病同时发病，是指太阳表的证候尚未解除，同时又兼有阳明的热邪。其中的气喘，是因为风寒之邪从皮毛侵袭肺脏所致。其中的胸部胀满，是因为胸中的大气因为营卫之气闭塞不通，无法宣散通畅而产生胀闷感。文中说“不可下”，是因为阳明经仍然与太阳经相连属，如果误用泻下法，就会形成结胸证；而且患者原本就有胸部胀满，一旦形成结胸证更是极易发生。况且阳明的热邪仅仅停留在经络层面，也绝对没有可以使用泻下法的道理，所以反复告诫人们不可使用泻下法。仍然使用麻黄汤治疗，是为了开通太阳经的表邪，使阳明初生的热邪随着汗液排出而解散。
病症虽然兼有阳明，但仍然用麻黄汤作为主方，这是因为古人体质敦厚浓厚，生活淡泊、欲望少，服用此方能够见效。现代人则体质薄弱，嗜好日益增多，大半属于阴精亏损之人，如果遇到这类证候，适宜用薄荷代替方中的桂枝。如果热邪稍微剧烈，并且大便干结的，又适宜酌情加入生石膏（应当生用，不可用煅制，详细道理见白虎汤条下）数钱，才能见效。
至于温病，在上古时期，原本与中风、伤寒统称为伤寒，所以秦越人的《难经》中有“伤寒有五”的说法。到了张仲景撰写《伤寒论》时，知道温病初起的治疗方法，原本就与中风、伤寒都不同，所以在太阳篇开头就明确分为三项，并且对温病进行了详细论述，这是张仲景的医学比上古时期进步的地方。
《伤寒论》原文：太阳病，发热并且口渴，不恶寒的，称为温病。如果发汗之后，身体灼热的，称为风温。风温这种病，脉象寸关尺三部都浮，自汗出，身体沉重，嗜睡，呼吸一定伴有鼾声，说话困难。
论述温病的开端，也冠以“太阳病”三个字，是因为温病也必须从太阳经开始（这里指的是足太阳膀胱经，而不是手太阳小肠经，那些认为温病只入手经不入足经的人，究竟有什么依据呢？）。然而温病化热速度最快，不过几个小时就会侵入阳明经，所以感觉不到恶寒，直接转为发热和口渴。治疗的人不知道这是温病，而错误地用热药来发汗，竟然导致出汗后病不解，反而增加了身体的灼热感，那么仅凭这一点——即不接受热药的发表治疗——就可以确定其名称为风温了。所谓脉象阴阳俱浮，是像风一样飘扬的样子；自汗出，是因为热邪随着浮脉向外透发；身体沉重，是因为身体被热邪熏蒸而感到酸软；多眠睡，是因为精神神经被热邪熏蒸而昏沉；语言难出，是因为上焦有热导致舌头肿胀。
除了风温之外，还有湿温病和伏气化热引起的温病，而在提纲中只论述风温，是因为湿温和伏气化热的温病，其疾病的起点也常常由风邪激发，所以都可以用风温来统括。
提纲中详细论述了风温的病状，但在提纲之后没有列出治疗方法，后世的人对此感到遗憾。等到反复详细推敲之后，才知道《伤寒论》中原有治疗温病的方子，只是因为全书曾经散佚，后来经过王叔和编辑整理，导致条文顺序错乱而排在后面罢了。我曾经看到《伤寒论》第六十二节说：“发汗之后，不可以再用桂枝汤，如果汗出且气喘，体表没有大热的，可以与麻黄杏仁甘草生石膏汤。”现在拿这一节与温病提纲对照来看，这一节所说的“发汗后”，就是提纲所说的“若发汗”；这一节所说的“喘”，就是提纲所说的“息必鼾”；由口呼吸而喘的，由鼻呼吸就是打鼾了；这一节所说的“无大热”，就是提纲所说的“身灼热”，大概是因为那种灼热感还在外表，心中仍然没有大热。将这一节的文字与温病提纲一一比较，全都像符节相合一样吻合。
中风、伤寒、温病特别设立三大提纲，已经并列在篇首，到了后面则在治疗中风、治疗伤寒的方子标题下仍然加上提纲，以此类推，可以确切知道这一节的文字原本是治疗温病的方子，另外加上提纲毫无疑问，即麻杏甘石汤是治疗温病的方子毫无疑问。大概在张仲景那个时代，治疗温病的人，还将温病混同于中风、伤寒之中，在病初起时，没有仔细审察其发热且不恶寒的特点，而用温热性质的药物来发汗，所以发汗后病不解。或者见到其发热不恶寒，错误地认为病邪已经传入里部，而竟然用下药攻下，所以在第一百六十三节，又有“下后不可再用桂枝汤”等说法。所不同的地方在于，一个是在发汗之后，一个是在攻下之后。张仲景恐怕人们见到出汗，再次错误地认为是桂枝汤证，所以严厉告诫不可再用桂枝汤，而适宜用麻杏甘石汤治疗。按照伤寒的定例，凡是各经病证误服其他药物后，原来的病证还在的，仍然可以投用正治的原方，所以在第一百零三节说，凡是柴胡汤病证被误用下法后，如果柴胡证没有罢除的，再给予小柴胡汤。以此类推，可知麻杏甘石汤是救治温病误治的方子，实际上也就是治疗温病初起的主方。如果想要在今天使用这个方子，必须将古方的分量稍有变通。
【麻黄杏仁甘草石膏汤原方】麻黄四两（去节），杏仁五十个（去皮尖），甘草二两，石膏八两（碎，绵裹）。
以上四味药，用水七升，先煮麻黄，减少二升水，去掉上面的浮沫，放入其他药物，煮取二升药液，去掉药渣，温服一升。
方子的意义，是用麻黄配合杏仁来平定气喘，配伍石膏来退热，热退了汗自然就会停止。再加上甘草，是取其甘缓的性质，能够调和麻黄和石膏，使它们凉性和热性的力量融合无间，互相协助取得成功，所以奏效非常迅速。
这个方子原本治疗温病汗出且体表没有大热的情况，如果病症不是汗出且热势稍重的，使用此方时，原本就应该根据病情进行变通，所以我使用此方时，石膏的分量通常是麻黄的十倍，或者是麻黄一钱、石膏一两，或者麻黄一钱半、石膏一两半。遇到不出汗的患者，担心麻黄用量少了不能发汗，服药后可以服用西药阿斯匹林少许以帮助发汗。如果遇到热势重的，石膏又可以多用。曾经治疗白喉证及烂喉痧证（烂喉痧证必定兼有温病，白喉证也多微兼外感），麻黄用一钱，石膏重用至二两，喉科疾病最忌讳用麻黄，但是能多用石膏来辅助制约它，那么不仅不忌讳，反而能借助麻黄的力量立刻见到奇效。
至于肺病的起点，常常有因为感受风温，风邪稽留在肺中化热灼伤肺脏的，有时肺中作痒，就会连续不断地咳嗽气喘，也适宜投用此汤，清除久蕴的风邪，连服几剂后肺中不再作痒，咳嗽气喘自然能减轻，然后再慢慢用润肺、清火、利痰的药物调理，肺病就可以消除了。大概这个麻杏甘石汤的应用范围很广，凡是新近感受外感引起咳嗽气喘，以及头疼、牙疼、两腮肿痛，病因是由于外感风热的，都可以使用，只是方中药品的分量，应当根据病情变通而已。
【附记】林某某，年龄接近五十岁，因为感受风温，虽然经过医生治愈，但肺中余热未清，导致肺阴被灼烧消耗，酿成肺病，多次医治无效。他的脉搏一息五至，浮取沉取都有力，自己说喉咙连接到肺际，如果觉得痒就会突然发作咳嗽，严重时连续咳嗽几十声，全身出汗，必须吐出一些稠痰咳嗽才会停止。问他心里常觉得发热，大便干燥得很，四五天才排一次便。我领悟到他的肺际作痒从而突然发作咳嗽，一定是他从前生病时风邪从皮毛侵入肺中，到现在还没有完全清除。因为肺中风热相互勾结为害，适宜用麻黄祛除风邪，石膏清解热邪，于是为他开具麻杏甘石汤方，麻黄用钱半，生石膏用两半，杏仁三钱，甘草二钱，煎服一剂，咳嗽立刻痊愈。诊察他的脉象仍然有力，又为他开具善后调理的方子，用生山药一两，北沙参、天花粉、天冬各五钱，川贝母、射干、苏子、甘草各二钱，嘱咐他多服几剂，肺病可以从这里除根。过了十天，林某某又来求诊，说先生离开后，我服用所开的善后方，肺痒咳嗽仍然反复，于是又服第一次的方子，到现在已经连续服了十剂，心中的热已经退去，丝毫不觉得药性凉，肺痒咳嗽都好了，而且饮食增加，大便也不怎么干燥了。听到他说的话，确实出乎我的意料之外。再次诊察他的脉象已经不数（快），仍然似乎有力，于是将方中的麻黄改用一钱，石膏改用一两，杏仁改用二钱，又加生怀山药六钱，让他煎汤接续服用，如果服用后稍微觉得凉，就立即停止，后来连续服了七八剂，似乎稍微觉得凉，于是停服，肺病从此竟然痊愈。
按语：治疗肺劳（肺结核类疾病）投以麻黄杏仁甘草石膏汤，并且用到二十多剂，竟然将肺劳治愈，未免让读者产生怀疑，但这中间固然有精细的理由存在。大概肺病之所以难以治愈，是因为治疗者只治疗目前显现的症状，而不深入探究病因。像这个病例，原本是因为外感风邪而成肺劳，而且肺中作痒，说明还有风邪存留肺中，并且因为日子久了，成为锢闭难出的风邪，非麻黄不能开发其锢闭的深度，只是麻黄性偏热，对于肺中蕴有实热的人不宜单独使用，而重用生石膏来辅助制约它，既可以解除麻黄的热性，更可以清解肺中久蕴的热邪，用来治疗肺热有风邪导致的劳嗽，原本是正治的方子，所以服用后立刻见效。至于这个药，必须久服才能拔除病根，而且久服麻黄、石膏而没有流弊的原因，这中间又有理由存在，大概深入且久锢的风邪，非屡次发散不能透达，而配伍大量的石膏作为反佐，使得麻黄的力量只在肺脏中旋转，不至于直达体表变成汗液，这是麻黄久服没有弊端的原因。至于石膏性质虽然寒凉，但是它质地重而气味轻，煎入汤剂完全没有汁浆（没有汁浆就是没有实质），它轻而且凉的气，全部随着麻黄发表的力量外出，不再停留在中焦损伤脾胃，这是石膏久服没有弊端的原因。所遇到的病症，不是这样治疗就不会痊愈，用药就不得不这样。
Original text of *Shanghan Lun*: When Taiyang disease and Yangming disease occur simultaneously, with symptoms of wheezing and chest fullness, purgation (downward draining) is contraindicated; it is appropriate to treat primarily with Mahuang Tang (Ephedra Decoction).
Simultaneous occurrence of Taiyang and Yangming diseases refers to the fact that the exterior syndrome of Taiyang has not yet resolved, while simultaneously accompanied by heat in Yangming. The wheezing is caused by wind-cold pathogens invading the Lung from the skin and hair. The chest fullness arises because the Great Qi in the chest cannot circulate freely due to the blockage of Ying (Nutritive) and Wei (Defensive) Qi, resulting in a sensation of distension. The statement "do not use purgation" exists because the Yangming channel is still connected to Taiyang; if purgation is mistakenly used, it will lead to Jie Xiong (Chest Binding/Clumping). Moreover, since the patient already suffers from chest fullness, developing Jie Xiong becomes even more likely. Furthermore, the heat in Yangming is merely located in the channels, so there is absolutely no rationale for using purgation. Therefore, repeated warnings are given against its use. Treating with Mahuang Tang again serves to open the Taiyang exterior, allowing the nascent heat of Yangming to dissipate through sweating.
Although the syndrome involves Yangming, Mahuang Tang is still used as the primary formula because ancient people had robust constitutions, lived simply, and had few desires, making them responsive to this prescription. Modern people, however, have weaker constitutions, increasing indulgences, and most suffer from Yin deficiency. In such cases, Bohe (Menthae Haplocalycis Herba, Mint) should be used to replace Guizhi (Cinnamomi Ramulus, Cinnamon Twig) in the formula. If the heat is slightly severe and the stool is dry, raw Shigao (Gypsum Fibrosum, Gypsum) should be added in doses of several qian to be effective.
Regarding Wenbing (Warm Diseases), in ancient times, they were collectively referred to as Shanghan (Cold Damage), which is why Qin Yueren's *Nanjing* (Classic of Difficult Issues) mentions that "Shanghan comprises five types." When Zhang Zhongjing wrote *Shanghan Lun*, he recognized that the treatment for early-stage Wenbing differed fundamentally from Fengzhong (Wind Strike) and Shanghan. Thus, at the beginning of the Taiyang chapter, he clearly divided them into three categories and discussed Wenbing in detail. This represents an advancement in Zhang Zhongjing’s medicine compared to ancient times.
Original text of *Shanghan Lun*: In Taiyang disease, if there is fever and thirst without aversion to cold, it is called Wenbing. If after sweating, the body feels burning hot, it is named Fengwen (Wind-Warmth). In Fengwen disease, the pulse is floating at both the Yin (Cun/Rencheng) and Yang (Chi/Yongquan) positions, there is spontaneous sweating, heaviness of the body, excessive sleepiness, snoring during respiration, and difficulty speaking.
The reason the opening of the discussion on Wenbing is headed with "Taiyang Disease" is that Wenbing must also originate from the Taiyang channel (specifically the Foot-Taiyang Bladder Channel; those who claim Wenbing enters only the Hand-Taiyang Small Intestine Channel and not the Foot channels—on what basis do they stand?). However, Wenbing transforms into heat extremely rapidly, invading the Yangming channel within hours, so one does not feel aversion to cold but directly experiences fever and thirst. If the practitioner fails to recognize this as Wenbing and mistakenly uses hot herbs to induce sweating, the illness will not resolve with sweat, and the burning heat will increase. Based solely on this rejection of hot exterior-releasing drugs, the name can be determined as Fengwen. The floating pulse at both Yin and Yang positions resembles the fluttering of wind; spontaneous sweating indicates heat penetrating outward along the floating pulse; body heaviness results from the body feeling sore and weak due to heat; excessive sleepiness reflects mental and neural dullness caused by heat; and difficulty speaking is due to swelling of the tongue caused by upper Jiao heat.
Besides Fengwen, there are Shiwen (Damp-Warmth) and Wenbing caused by latent pathogen transforming into heat. The outline discusses only Fengwen because the onset of Shiwen and latent-heat Wenbing is often triggered by wind pathogens, so they can all be categorized under Fengwen.
Although the outline details the symptoms of Fengwen, it lacks treatment methods afterward, which later generations regretted. Upon careful re-examination, it becomes clear that *Shanghan Lun* originally contained formulas for treating Wenbing, but due to the loss and subsequent disordered compilation by Wang Shuhe, these sections were misplaced. I once observed Article 62 of *Shanghan Lun*: "After sweating, Guizhi Tang should not be administered again. If there is sweating and wheezing without significant internal heat, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) may be given." Comparing this article with the Wenbing outline: "After sweating" corresponds to "if sweating"; "wheezing" corresponds to "snoring"; mouth breathing leading to wheezing equates to nose breathing leading to snoring; "no significant heat" corresponds to "burning body heat," implying the heat remains superficial while the interior remains relatively cool. A one-to-one comparison confirms their perfect alignment.
Fengzhong, Shanghan, and Wenbing are established as three major outlines at the beginning of the chapter. Later, when discussing treatments for Fengzhong and Shanghan, the outlines are reiterated. By analogy, it is certain that this section originally belonged to the treatment of Wenbing, and Mahuang Xingren Gancao Shigao Tang is undoubtedly the primary formula for Wenbing. During Zhang Zhongjing's time, practitioners often confused Wenbing with Fengzhong and Shanghan. At the onset, failing to distinguish fever without aversion to cold, they used warm herbs to induce sweating, leading to unresolved illness post-sweating. Alternatively, mistaking fever without aversion to cold for interior transmission, they used purgatives, as noted in Article 163 regarding post-purgation contraindications. The distinction lies in whether the error occurred post-sweating or post-purgation. Zhang Zhongjing warned against misdiagnosing post-sweating sweating as a Guizhi Tang syndrome, strictly advising Mahuang Xingren Gancao Shigao Tang instead. According to the standard protocol of Shanghan, if the original syndrome persists after erroneous medication, the correct original formula should be used (e.g., Article 103 advises Xiao Chaihu Tang if Chaihu syndrome persists after purgation). By analogy, Mahuang Xingren Gancao Shigao Tang is the rescue formula for mistreated Wenbing and effectively the primary formula for early-stage Wenbing. To use this formula today, dosages must be adjusted.
[Original Formula: Mahuang Xingren Gancao Shigao Tang]
Mahuang (Ephedrae Herba, Ephedra) 4 liang (removed joints), Xingren (Prunus Armeniaca Semen, Apricot Seed) 50 pieces (skin and tips removed), Gancao (Glycyrrhizae Radix et Rhizoma, Licorice Root) 2 liang, Shigao (Gypsum Fibrosum, Gypsum) 8 liang (crushed, wrapped in cloth).
Take the above four ingredients, add 7 sheng of water, first boil Mahuang until reduced by 2 sheng, remove the foam on top, then add the remaining herbs. Boil to obtain 2 sheng, strain, and take 1 sheng warm.
The rationale of the formula: Mahuang combined with Xingren stabilizes wheezing; paired with Shigao to reduce heat; once heat subsides, sweating stops naturally. Gancao is added for its sweet and緩 (moderating) nature to harmonize Mahuang and Shigao, blending their cooling and warming properties seamlessly to enhance efficacy, resulting in rapid action.
This formula originally treated Wenbing with sweating and no significant internal heat. If the case involves no sweating and heavier heat, dosage adjustments are necessary. In my practice, the dosage of Shigao is usually ten times that of Mahuang, e.g., Mahuang 1 qian with Shigao 1 liang, or Mahuang 1.5 qian with Shigao 1.5 liang. For patients without sweating, fearing insufficient Mahuang dosage may fail to induce sweat, Aspirin may be taken after administration to assist sweating. For severe heat, Shigao dosage can be increased. I once treated Baihou (Diphtheria) and Lanhou Sha (Scarlet Fever-like throat condition) [Lanhou Sha invariably involves Wenbing; Baihou often involves slight exterior contraction]. Using Mahuang 1 qian and Shigao up to 2 liang, although throat conditions generally contraindicate Mahuang, the copious use of Shigao counteracts its heat, allowing Mahuang to exert miraculous effects.
Regarding lung diseases originating from Wind-Warmth invasion, where wind pathogens linger in the Lung, transform into heat, and scorch the Lung tissue, sometimes causing itching in the Lung leading to continuous coughing and wheezing, this decoction should also be administered to clear long-standing wind pathogens. After several doses, when Lung itching ceases, coughing and wheezing will naturally subside, followed by moistening-Lung, clearing-fire, and resolving-phlegm therapies to cure the disease. Mahuang Xingren Gancao Shigao Tang has broad applications: it is suitable for new exterior contractions causing cough/wheeze, headache, toothache, or bilateral cheek swelling due to exterior wind-heat, provided dosages are adjusted according to the syndrome.
[Appendix] Patient Lin XX, nearly fifty years old, suffered from Wind-Warmth. Although cured by previous doctors, residual heat remained in the Lung, consuming Lung Yin and resulting in chronic Lung disease unresponsive to multiple treatments. Pulse was 5 beats per breath, forceful at both superficial and deep levels. He reported that itching extending from the throat to the Lung interface triggered immediate coughing fits, lasting dozens of bouts with profuse sweating and expectoration of thick phlegm before relief. He felt constant internal heat and severe constipation (bowel movement every 4-5 days). I deduced that the Lung itching triggering cough indicated residual wind pathogens from the initial exterior invasion that had entered the Lung via skin/hair and remained uncleared. Since wind-heat in the Lung were exacerbating each other, I prescribed Mahuang Xingren Gancao Shigao Tang: Mahuang 1.5 qian, Raw Shigao 1.5 liang, Xingren 3 qian, Gancao 2 qian. One dose resulted in immediate cessation of coughing. The pulse remained forceful, so I prescribed a follow-up formula: Shanyao (Dioscoreae Rhizoma, Yam) 1 liang, Beishashen (Glehniae Radix, Glehnia Root), Tianhuafen (Trichosanthis Radix, Trichosanthes Root), Tiandong (Asparagi Radix, Asparagus Root) each 5 qian, Chuanbei (Fritillariae Cirrhosae Bulbus, Fritillaria Bulb), Shegan (Belamcandae Rhizoma, Belamcanda Rhizome), Suzi (Perillae Fructus, Perilla Fruit), Gancao each 2 qian. He was advised to take several doses to eradicate the disease. Ten days later, he returned, stating that after taking the follow-up formula, Lung itching and coughing recurred. Resuming the first formula for ten doses, internal heat subsided, no cold sensation was felt from the medicine, and Lung itching/coughing resolved. Appetite increased, and bowel movements normalized. This outcome surprised me. Re-pulse diagnosis showed a non-rapid but still forceful pulse. I adjusted the formula: Mahuang 1 qian, Shigao 1 liang, Xingren 2 qian, plus Raw Huai Shanyao 6 qian. He was instructed to continue drinking the decoction and stop immediately if it felt too cold. After 7-8 doses, a slight cold sensation prompted cessation, and the Lung disease was finally cured.
Commentary: Treating Feilao (Lung Consumption/TB) with Mahuang Xingren Gancao Shigao Tang for over twenty doses and achieving a cure may seem doubtful to readers, but there are precise reasons. Lung disease is difficult to cure because practitioners often treat only current symptoms without investigating the root cause. This case originated from exterior wind contracting into Feilao. The persistent Lung itching indicates lingering wind pathogens, now entrenched due to duration. Only Mahuang can penetrate this deep entrapment, but its hot nature is unsuitable for Lung excess-heat. Heavy use of Raw Shigao counters Mahuang's heat and clears long-standing Lung heat, making it the correct treatment for wind-heat Feilao cough, hence the immediate effect. Long-term use is required to eradicate the root. The safety of long-term Mahuang and Shigao use lies in the following: entrenched wind pathogens require repeated dispersal to exit; Shigao acts as a counter-agent (fan zuo), confining Mahuang's action to the Lung rather than forcing it to the surface as sweat, preventing adverse effects from prolonged Mahuang use. Although Shigao is cold, its heavy texture and light aroma mean it contains no viscous fluid ("no fluid implies no substance"). Its light, cool qi exits with Mahuang's exterior-releasing power, avoiding retention in the Middle Jiao to damage the Spleen/Stomach, explaining the safety of prolonged Shigao use. Such cases require this specific method and medication.