太阳中风者，风伤于卫也；伤寒者，寒伤于荣也。其说已详上、中二篇。兹以风寒两
伤，荣卫俱病者，疏为下篇。盖风寒二气，多相因而少相离，有寒时不皆无风，有风
时不皆无寒。风寒并发，邪中于人，则荣卫兼病，惟其证均无汗，皆谓之实邪，故立
大青龙清两解之法，发其寒邪并发，邪中于人，则荣卫兼病，惟其证均无汗，皆谓之
实邪，故立大青龙汤两解之法，发其寒邪外闭，风邪内郁，不汗出而烦燥之汗也。然
必审其人脉不微弱，无少阴证者，乃可与之。若误施之，则大汗淋漓，厥逆筋惕肉□
，必致亡阳之变，故又立真武一汤，以救青龙之误。夫表寒里热者，大青龙固所宜也
。若表里俱热，则又非大青龙之所胜任，爰立白虎一汤，以辅青龙之不逮。至于寒热
轻微者，则更出桂枝二越婢一汤、麻黄桂枝各半汤、桂枝二麻黄一汤，皆两解荣卫法
也。合上、中二篇而熟读之，则三法了然，以之施治，庶不紊耳。
@@@
太阳中风，脉浮紧，发热恶寒，身疼痛，不汗出而烦躁者，大青龙汤主之。若脉微弱
，汗出恶风者，不可服，服之则厥逆，筋惕肉□，此为逆也。
【注】
太阳中风，脉当浮缓，今脉浮紧，是中风之病而兼伤寒之脉也。中风当身不痛，汗自
出，今身疼痛，不汗出，是中风之病而兼伤寒之证也。不汗出而烦躁者，太阳郁蒸之
所致也。风、阳邪也，寒、阴邪也。阴寒郁于外则无汗，阳热蒸于内则烦躁，此风寒
两伤，荣卫同病，故合麻桂二汤加石膏，制为大青龙汤，用以解荣卫同病之实邪也。
若脉微弱，汗出恶风者，即有烦躁，乃少阴之烦躁，非太阳之烦躁也。禁不可服。服
之则厥逆，筋惕肉□之患生，而速其亡阳之变矣。故曰：此为逆也。
【集注】
成无己曰：风并于卫者，为荣弱卫强；寒并于荣者，为荣强卫弱。今风寒两伤，故为
荣卫俱实，所宜大青龙汤主之也。
喻昌曰：大青龙汤为太阳无汗而设，与麻黄汤证何异，因有烦躁一证兼见，则非此法
不解。
程应旄曰：此汤非为烦躁设，为不汗出之烦躁设。若脉微弱，汗出恶风者，虽有烦躁
证，乃少阴亡阳之象，全非汗不出而郁蒸者比也。
@@@
伤寒脉浮缓，身不疼，但重，乍有轻时，无少阴证者，大青龙汤发之。
【注】
伤寒脉当浮紧，今脉浮缓，是伤寒之病而兼中风之脉也。伤寒当身疼，今身不疼，是
伤寒之病而兼中风之证也。身轻，邪在阳也；身重，邪在阴也；乍有轻时，谓身重而
有时轻也。若但欲寐，身重无轻时，是少阴证也。今无但欲寐，身虽重，乍有轻时，
则非少阴证，乃荣卫兼病之太阳证也。脉虽浮缓，证则无汗，属实邪也，故亦以大青
龙汤发之。前条以脉微汗出示禁，此条以无少阴证发明，盖详审慎重之至也。此二条
，承上篇首条、次条，中篇首条、次条，再揭太阳风寒两伤，以为下篇荣卫兼病之提
纲。后凡称太阳中风伤寒，涉于荣卫同病者，皆指此二条而言也。
【集注】
方有执曰：大青龙汤，一则曰主之，一则曰发之，何也？主之者，以烦躁之急疾，属
动而言；发之者，以但重之沉默，属静而言也。
喻昌曰：无少阴证，「但重乍有轻时」，六字，早已指明。言但身重而无少阴之欲寐
，其为寒因可审，况乍有轻时，不似少阴之昼夜俱重，又兼风因可审，所以力驱其在
表之风寒而无疑也。若脉微弱，身重欲寐，则内顾少阴且不遑矣，敢发之乎？又曰：
细玩二条文义，伤风脉本浮缓，反见浮紧；伤寒脉本浮紧，反见浮缓，是为伤风见寒
，伤寒见风，两无疑矣。又当辨无少阴证相杂，则用青龙，万举万当矣。故脉见微弱
，即不可用大青龙汤，以少阴病脉必微细也。方氏注：泥弱字牵入中风之脉，阳浮阴
弱为解。不思中风之脉，以及误汗等证，太阳上篇已悉，此处但归重分别少阴，以太
阳膀胱经与少阴肾经合为表里，其在阴虚之人，表邪不俟传经，早从膀胱袭入肾藏者
有之。况两感夹阴等证，临病犹当细察，设少阴不亏，表邪安能飞渡而见身重欲寐等
证耶！故有少阴证者，不得已而行表散，自有温经散邪，两相绾照之法，岂可径用青
龙之猛剂，立铲孤阳之根乎！
魏荔彤曰：身重一证，必须辨明，但欲寐而常重，则属少阴。误发其汗，变上厥下竭
者，少阴热也；变筋惕肉□者，少阴寒也。其犯误汗之忌一也。
太阳中风证，是风邪损伤卫气；伤寒证，是寒邪损伤营血。这些说法在上篇和中篇中已经详细论述了。现在针对风寒同时致病、营卫两经都受病的状况，整理为下篇。大概风寒二气，往往相互伴随而很少分离，有寒冷的时候不一定没有风，有风的时候不一定没有寒。风寒并发，邪气侵入人体，就会使营卫同时患病，只要症状都是无汗，都称为实邪，所以制定大青龙汤这一表里双解的方法，以发散其外闭的寒邪和内郁的风邪，治疗因无汗而导致烦躁的症状。然而必须仔细审查患者的脉象不微弱，且没有少阴病证候，才可以给予服用。如果误用此药，就会导致大汗淋漓，四肢厥冷，筋肉跳动，必然导致亡阳的变证，所以又制定真武汤一方，来补救误用大青龙汤的错误。对于表寒里热的情况，大青龙汤确实是适宜的。如果表里都热，那就不是大青龙汤所能胜任的了，于是制定白虎汤一方，来弥补大青龙汤的不足。至于寒热症状轻微的情况，则另外提出桂枝二越婢一汤、麻黄桂枝各半汤、桂枝二麻黄一汤，这些都是营卫双解的方法。结合上篇和中篇熟读，那么这三种治法就清晰明了，用来施治，大概就不会混乱了。
@@@
太阳中风证，出现脉浮紧，发热恶寒，身体疼痛，无汗且烦躁的，以大青龙汤主治。如果脉象微弱，出汗且怕风的，不可服用，服后会导致四肢厥冷，筋肉跳动，这是治疗错误。
【注】
太阳中风证，脉象应当是浮缓的，现在脉象浮紧，这是中风病兼有伤寒的脉象。中风证应当身体不痛，自然出汗，现在身体疼痛，无汗，这是中风病兼有伤寒的症状。无汗且烦躁，是太阳经郁热蒸腾所致。风，属于阳邪；寒，属于阴邪。阴寒郁结在体表则无汗，阳热蒸腾于体内则烦躁，这是风寒两伤，营卫同病，所以合并麻黄汤和桂枝汤并加入石膏，制成大青龙汤，用以解除营卫同病的实邪。如果脉象微弱，出汗且怕风，即使有烦躁症状，也是少阴病的烦躁，而不是太阳病的烦躁。严禁服用。服用后就会产生四肢厥冷、筋肉跳动的祸患，从而加速亡阳的变证发生。所以说：这是治疗错误。
【集注】
成无己说：风邪偏并于卫分的，是营弱卫强；寒邪偏并于荣分的，是荣强卫弱。现在风寒两伤，所以是营卫俱实，适宜用大青龙汤主治。
喻昌说：大青龙汤是为太阳病无汗而设立的，与麻黄汤证有什么不同呢？因为兼见烦躁这一症状，就不是其他方法所能解决的。
程应旄说：这个方剂不是为了烦躁设立的，而是为了无汗导致的烦躁设立的。如果脉象微弱，出汗且怕风，虽然有烦躁症状，那是少阴病亡阳的现象，完全不同于无汗而郁热蒸腾的情况。
@@@
伤寒证，脉象浮缓，身体不疼，只是沉重，偶尔有减轻的时候，且没有少阴病证候的，用大青龙汤发汗治疗。
【注】
伤寒证脉象应当是浮紧的，现在脉象浮缓，这是伤寒病兼有中风证的脉象。伤寒证应当身体疼痛，现在身体不疼，这是伤寒病兼有中风证的症状。身体轻快，说明邪气在阳分；身体沉重，说明邪气在阴分；偶尔有减轻的时候，是指身体沉重但有时减轻。如果只是嗜睡，身体沉重且没有减轻的时候，就是少阴病证。现在没有嗜睡，身体虽然沉重，但偶尔有减轻的时候，那就不是少阴病证，而是营卫兼病的太阳病证。脉象虽然是浮缓，但症状是无汗，属于实邪，所以也用大青龙汤发汗。前一条通过脉微汗出禁止使用，这一条通过无少阴病证加以阐明，可以说是详尽审慎到了极点。这两条，承接上篇首条、次条，中篇首条、次条，再次揭示太阳病风寒两伤，作为下篇营卫兼病的提纲。后来凡是提到太阳中风伤寒，涉及营卫同病的，都指这两条而言。
【集注】
方有执说：大青龙汤，一条说“主之”，一条说“发之”，为什么呢？“主之”是因为烦躁急迫，属于动症；“发之”是因为仅身体沉重沉默，属于静症。
喻昌说：“无少阴证”、“但重乍有轻时”这六个字，早已指明。意思是只身体沉重而没有少阴病的嗜睡，可以断定是寒邪，况且偶尔有减轻的时候，不像少阴病昼夜都沉重，又兼有风邪，可以断定，所以有力驱散在表的风寒而无疑。如果脉象微弱，身体沉重想睡觉，那顾护少阴还来不及呢，敢发汗吗？又说：仔细玩味两条文义，伤风脉本应浮缓，反而见浮紧；伤寒脉本应浮紧，反而见浮缓，这是伤风见寒，伤寒见风，毫无疑问了。还应当辨别没有少阴病证夹杂，才用青龙汤，万无一失。所以脉见微弱，就不可用大青龙汤，因为少阴病脉必微细。方氏注：拘泥于“弱”字牵入中风之脉，解释为阳浮阴弱。没考虑到中风脉象，以及误汗等证候，在太阳上篇已经详尽，这里只着重区分少阴病，因为太阳膀胱经与少阴肾经互为表里，在阴虚之人身上，表邪不必等待传经，早就从膀胱袭入肾脏的有这种情况。何况两感夹阴等证，临证时还应当仔细考察，假设少阴不虚，表邪怎么能飞渡而见到身重欲睡等症状呢！所以有少阴病证的，不得已而行表散，自有温经散邪、内外兼顾的方法，岂可径用大青龙汤这种猛剂，立刻铲断孤阳的根本呢！
魏荔彤说：身体沉重这一症状，必须辨明，如果嗜睡且常觉沉重，则属少阴。误用发汗，变成上厥下竭的，是少阴热证；变成筋肉跳动的，是少阴寒证。它们犯下误汗禁忌是一样的。
Taiyang Wind-Strike (Taiyang Zhongfeng, a syndrome caused by wind pathogen attacking the Wei level) is when wind damages the Wei Qi (Defensive Qi); Cold Damage (Shanghan, a syndrome caused by cold pathogen attacking the Ying level) is when cold damages the Ying Blood (Nutritive Blood). These explanations have been detailed in the Upper and Middle Chapters. Here, we address cases where both Wind and Cold simultaneously injure the body, causing disease in both Ying and Wei levels, organizing them into the Lower Chapter. Generally, the two energies of Wind and Cold often accompany each other and rarely separate; when there is cold, there is not necessarily no wind, and when there is wind, there is not necessarily no cold. When Wind and Cold occur together, pathogens invade the human body, causing simultaneous disease in Ying and Wei. As long as the symptoms present with anhidrosis (absence of sweating), they are all classified as Excess Pathogens (Excess syndromes characterized by strong pathogenic factors). Therefore, the method of Dual Resolution (treating both exterior and interior or multiple pathogenic factors simultaneously) using Da Qing Long Tang (Major Blue Dragon Decoction) is established to release the externally closed Cold pathogen and the internally stagnant Wind pathogen, treating the restlessness and irritability caused by anhidrosis. However, one must carefully examine that the patient's pulse is not weak or thready, and that there are no Shaoyin disease patterns, before administering it. If mistakenly used, it will cause profuse sweating, cold limbs (Jue Ni), twitching of tendons and muscles, inevitably leading to the collapse of Yang (Wang Yang). Therefore, Zhen Wu Tang (True Warrior Decoction) is established to remedy the errors caused by Da Qing Long Tang. For conditions with Exterior Cold and Interior Heat, Da Qing Long Tang is indeed appropriate. If both Exterior and Interior are hot, then Da Qing Long Tang is insufficient, so Bai Hu Tang (White Tiger Decoction) is established to supplement the inadequacy of Da Qing Long Tang. As for mild Cold and Heat symptoms, Gui Zhi Er Yue Bi Yi Tang (Cinnamon Twig Twice and Minor Yellow Dragon Once Decoction), Ma Huang Gui Zhi Ban Tang (Ephedra and Cinnamon Twig Half-Decoction), and Gui Zhi Er Ma Huang Yi Tang (Cinnamon Twig Twice and Ephedra Once Decoction) are proposed; these are all methods of dual resolution for Ying and Wei. By studying the Upper and Middle Chapters thoroughly, these three methods will become clear, and their application in treatment will likely prevent confusion.
@@@
In Taiyang Wind-Strike, if the pulse is Floating-Tight, accompanied by fever, aversion to cold, body pain, anhidrosis, and restlessness/irritability, Da Qing Long Tang (Major Blue Dragon Decoction) should be administered. If the pulse is Weak-Thready, with sweating and aversion to wind, it must not be taken; taking it will result in cold limbs and twitching of tendons and muscles, which constitutes a therapeutic error.
[Annotation]
In Taiyang Wind-Strike, the pulse should be Floating-Slow. The current Floating-Tight pulse indicates that the Wind-Strike disease is combined with the pulse pattern of Cold Damage. Wind-Strike typically presents without body pain and with spontaneous sweating; the current body pain and anhidrosis indicate that the Wind-Strike disease is combined with the symptoms of Cold Damage. Anhidrosis with restlessness/irrigability is caused by the steaming of heat due to stagnation in the Taiyang channel. Wind is a Yang pathogen; Cold is a Yin pathogen. Yin-Cold stagnating on the exterior causes anhidrosis, while Yang-Heat steaming internally causes restlessness/irritability. This is a case of simultaneous injury by Wind and Cold, affecting both Ying and Wei. Therefore, Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) are combined with Shigao (Gypsum Fibrosum) to formulate Da Qing Long Tang (Major Blue Dragon Decoction), used to resolve the Excess Pathogen affecting both Ying and Wei. If the pulse is Weak-Thready, with sweating and aversion to wind, even if restlessness/irritability is present, it is the restlessness of Shaoyin, not Taiyang. It is strictly forbidden to administer. Doing so will lead to cold limbs and twitching of tendons and muscles, accelerating the collapse of Yang. Thus, it is said: this is a therapeutic error.
[Collected Annotations]
Cheng Wuji stated: When Wind predominates in the Wei level, it results in weak Ying and strong Wei; when Cold predominates in the Ying level, it results in strong Ying and weak Wei. Now, since both Wind and Cold injure the body, Ying and Wei are both Excess, making Da Qing Long Tang (Major Blue Dragon Decoction) appropriate.
Yu Chang stated: Da Qing Long Tang (Major Blue Dragon Decoction) is prescribed for Taiyang anhidrosis. How does it differ from Mahuang Tang (Ephedra Decoction)? Because the accompanying symptom of restlessness/irritability makes this method necessary for resolution.
Cheng Yingmao stated: This decoction is not prescribed merely for restlessness/irritability, but specifically for restlessness/irritability caused by anhidrosis. If the pulse is Weak-Thready, with sweating and aversion to wind, even if restlessness/irritability exists, it is a sign of Yang collapse in Shaoyin, completely different from the steaming caused by anhidrosis.
@@@
In Cold Damage, if the pulse is Floating-Slow, the body does not ache but feels heavy, occasionally feeling lighter at times, and there are no Shaoyin disease patterns, Da Qing Long Tang (Major Blue Dragon Decoction) should be used to induce sweating.
[Annotation]
In Cold Damage, the pulse should be Floating-Tight. The current Floating-Slow pulse indicates that the Cold Damage disease is combined with the pulse pattern of Wind-Strike. Cold Damage typically involves body ache; the current absence of body ache indicates that the Cold Damage disease is combined with the symptoms of Wind-Strike. Lightness of the body indicates the pathogen is in the Yang level; heaviness indicates the pathogen is in the Yin level; "occasionally feeling lighter" means that although the body feels heavy, it sometimes alleviates. If there is only drowsiness and constant heaviness without relief, it is a Shaoyin disease pattern. Currently, there is no drowsiness; although the body is heavy, it occasionally feels lighter, so it is not a Shaoyin disease pattern, but rather a Taiyang disease pattern involving both Ying and Wei. Although the pulse is Floating-Slow, the symptom is anhidrosis, classifying it as an Excess Pathogen; therefore, Da Qing Long Tang (Major Blue Dragon Decoction) is also used to induce sweating. The previous clause prohibited use based on weak pulse and sweating; this clause clarifies by excluding Shaoyin patterns, demonstrating extreme caution and thoroughness. These two clauses follow the first and second clauses of the Upper Chapter and the Middle Chapter, reiterating Taiyang simultaneous injury by Wind and Cold, serving as the outline for Ying-Wei simultaneous disease in the Lower Chapter. Henceforth, whenever Taiyang Wind-Strike and Cold Damage are mentioned involving simultaneous Ying-Wei disease, they refer to these two clauses.
[Collected Annotations]
Fang Youzhi stated: Da Qing Long Tang (Major Blue Dragon Decoction) uses "should be administered" in one instance and "should be used to induce sweating" in another. Why? "Should be administered" refers to the urgency of restlessness/irritability, associated with movement; "should be used to induce sweating" refers to the silence of mere heaviness, associated with stillness.
Yu Chang stated: The six characters "no Shaoyin pattern," "only heaviness, occasionally lighter," already point this out clearly. It means that if there is only body heaviness without Shaoyin drowsiness, the presence of Cold can be determined; furthermore, since it occasionally feels lighter, unlike Shaoyin where heaviness persists day and night, the presence of Wind can also be determined. Thus, there is no doubt about forcefully driving out the Wind and Cold on the exterior. If the pulse is Weak-Thready, body is heavy, and there is drowsiness, attending to the internal Shaoyin deficiency would be urgent enough; how could one dare to induce sweating? He further stated: Carefully examining the text of these two clauses, Wind-Strike pulse is originally Floating-Slow, yet here appears Floating-Tight; Cold Damage pulse is originally Floating-Tight, yet here appears Floating-Slow. This is Wind-Strike showing signs of Cold, and Cold Damage showing signs of Wind, beyond doubt. One must also distinguish the absence of mixed Shaoyin patterns before using Qing Long [Tang]; then, ten thousand applications will be successful. Therefore, if the pulse is Weak-Thready, Da Qing Long Tang (Major Blue Dragon Decoction) cannot be used, because Shaoyin disease pulses are invariably micro-thready. Fang's annotation: Clinging to the character "weak" to explain it as the Wind-Strike pulse, interpreting it as Yang floating and Yin weak. This fails to consider that Wind-Strike pulses and mis-sweating syndromes were fully detailed in the Upper Taiyang Chapter; here, the emphasis is solely on distinguishing Shaoyin. Since the Taiyang Bladder Channel and Shaoyin Kidney Channel are exterior-interior pairs, in individuals with Yin deficiency, exterior pathogens may invade the Kidney organ from the Bladder without waiting for transmission. Moreover, in complex cases like simultaneous contraction or Yin-clasping, careful observation is required during clinical practice. If Shaoyin is not deficient, how could exterior pathogens cross over to produce symptoms like heaviness and drowsiness! Therefore, if Shaoyin patterns exist, and exterior dispersion is不得已 (unavoidable), there are methods to warm the channels and scatter pathogens while balancing both aspects. How can one rashly use the potent agent Qing Long [Tang] to instantly uproot solitary Yang!
Wei Litong stated: The symptom of body heaviness must be clearly distinguished. If drowsiness accompanies constant heaviness, it belongs to Shaoyin. Mistakenly inducing sweating leads to upper Jue and lower exhaustion in Shaoyin Heat patterns, or twitching of tendons and muscles in Shaoyin Cold patterns. Both commit the same error of violating the prohibition against mistaken sweating.