桂枝汤
桂枝为仲景群方之冠，乃滋阴和阳，解肌发汗，调和营卫之
总方也。凡中风、伤寒、杂证，脉浮弱，汗自出，而表不解者，咸得而主之。先辈言无汗不得用桂枝者，正以
汤中有芍药能止汗也。芍药之功在于止烦，烦止，汗亦止。故反烦、更烦与心悸而烦者，咸赖之。若倍加芍药，
即建中之剂，非复发汗之剂矣。是方也，用桂枝发汗，即用芍药止汗！生姜之辛，佐桂枝以解肌；大枣之甘，
佐芍药以和里。桂、芍之相须，姜、枣之相得，阳表阴里，并行不悖，是刚柔相济以为和也。甘草甘平，有安
内攘外之能，用以调和气血者，即以调和表里，且以调和诸药矣。而精义又在啜稀热粥，以助药力，盖谷气内
充，则邪不复入，而啜粥以继药之后，则余邪不复留，复方之妙用又如此。要知此方专治表虚，能解肌以发营
中之汗，而不能开皮毛之窍以出卫分之邪。故汗不出者是麻黄证，脉浮紧者是麻黄脉，即不得与桂枝汤矣。○桂
枝不足以胜风，先刺风池、风府，复与桂枝以祛风。烧针不足以散寒，先灸其核，与桂枝加桂以散寒。皆内外
夹攻法。又先治其外，后治其内之理也。桂枝加芍药治阳邪下陷，桂枝更加桂治阴邪上攻，只在一味中加分两，
不于本方外求他味，不即不离之妙如此。○服桂枝汤后，大汗出，而大烦渴，是阳陷于里，急当滋阴，故用白
虎加参以和之。用麻黄汤后，汗漏不止，是阳亡于外，急当扶阳，故用桂枝加附以固之。要知发汗之剂，用桂
枝太过，则阳陷于里；用麻黄太过，则阳亡于外。因桂枝汤有芍药而无麻黄，故虽大汗出而元府仍能自闭，但
能使阳盛，不致亡阳也。○凡寒中人，不在营卫，即入腠理。仲景制桂枝汤调和营卫，制柴胡汤调和腠理，观
六经证外，仲景独出桂枝证、柴胡证之称，见二方任重，不可拘于经也。惟太阳统诸阳之气，六经表证，咸属
于太阳，故柴胡得与桂枝对待于太阳之部。桂枝本为太阳风寒设，凡六经初感之邪，未离营卫者悉宜之。柴胡
本为少阳半表设，凡三阳半表之邪，逗留腠理者悉宜之。仲景最重二方，所以自为桂枝证注释之，为柴胡证注
释之。桂枝有疑似证，柴胡
亦有疑似证。桂枝有坏病，柴胡亦有坏病。桂枝证罢，桂枝不中与，而随证治法，仍不离桂枝方加减。柴胡证
罢，柴胡不中与，而设法救逆，仍不出柴胡方加减。（柯韵伯）
麻黄汤
麻黄一方，与桂枝各半，则小发汗；加石膏、姜、枣，即于发表中清火而除烦躁；去桂枝之辛热，加石膏
之辛寒，则于发表中清火而定喘；君以文蛤，即于发表中祛内外之湿热；加连翘等之苦寒，即于发表中清火而
治黄；加附子、细辛之大辛热，加附子、甘草之辛甘，亦因少阴表里之微甚，并非为严寒之时拘。医咸谓麻黄
不可轻用，安知仲景之神化哉？○先辈言麻黄汤主治伤寒，不治中风，似非确论。盖麻黄汤、大青龙汤，治中
风之重剂；桂枝汤、葛根汤，治中风之轻剂。伤寒可通用之，非主治伤寒之剂也。○麻黄汤证，发热骨节疼，
即是风寒两伤，营卫俱病。先辈何故以大青龙治营卫两伤，麻黄汤治寒伤营而不伤卫，桂枝散治风伤卫而不伤
营，曷不以桂枝证之恶寒，麻黄证之恶风，一反勘耶？要之，冬月风寒本同一体，故中风、伤寒皆恶风、恶寒，
营病卫必病。中风之重者，便是伤寒；伤寒之浅者，便是中风。不必在风寒上细分，须当在有汗、无汗上着眼
耳。（柯韵伯）
仲景治伤寒，无汗用麻黄，有汗用桂枝。历代名医未有究其精微。尝绎思之，似有一得。云津液为汗，汗
即血也。在营则为血，在卫则为汗。夫寒伤营，营血内涩，不能外通于卫，卫气闭固，津液不行，故无汗发热
而憎寒。夫风伤卫，卫气外泄，不能内护于营，营气虚弱，津液不固，故有汗发热而恶风。然风寒之邪，皆由
于皮毛而入，皮毛者，肺之合也。肺主卫气，包罗一身，天之象也。是证虽属乎太阳，而肺实受邪气，证兼面
赤怫郁咳嗽，以及痰喘胸满者，非肺病乎？盖皮毛外闭，则邪热内攻，而肺气 郁。故用麻黄、甘草，同桂枝
引出营分之邪，达之肌表，佐以杏仁泄肺而利气。是则麻黄汤虽太阳发汗重剂，实为发散肺
经火郁之药也。（李时珍）
葛根汤
葛根为阳明经药，惟表实里虚者宜之，而胃家实，非所宜也。故仲景于阳明经中，反不用葛根。若谓其能
亡津液而不用，则与本草生津之义背矣。若谓其能大开肌肉，何反加于汗出恶风之合病乎？有汗、无汗，下利、
不下利，俱得以葛根主之。是葛根与桂枝，同为解肌和中之剂，与麻黄之专于发表者不同。○仲景于阳明经中
不用葛根，东垣定为阳明经药，易老云∶未入阳明者不可便服。岂二老未读仲景书乎？（柯韵伯）
大青龙汤
大青龙证之不明于世者，许叔微始之作俑也。其言曰∶桂枝治中风，麻黄治伤寒，大青龙治中风见寒脉、
伤寒见风脉。三者如鼎立，此三大纲所由来也。愚谓先以脉论∶夫中风脉浮紧，伤寒脉浮缓，是仲景互文见意
处。言中风脉多缓，然亦有脉紧者；伤寒脉当紧，然亦有脉缓者。盖中风、伤寒，各有浅深，或因人之强弱而
异，或因地之高下、时之乖和而殊。证固不可拘，脉亦不可执。如阳明中风而脉浮紧，太阳伤寒而脉浮缓，不
可谓脉紧必伤寒，脉缓必中风也。按∶《内经》脉滑曰风，则风脉原无定象；又盛而紧曰胀，则紧脉不专属伤
寒；又缓而滑曰热中，则缓脉又不专指中风矣。且阳明中风有脉浮紧者，又有脉浮大者，必欲以脉浮缓为中风，
则二条将属何证耶？今人但以太阳之脉缓自汗，脉紧无汗，以分风寒别营卫，并不知他经皆有中风，即阳明之中
风，无人谈及矣。请以太阳言之，太阳篇言中风之脉证有二∶一曰太阳中风，阳浮而阴弱，阳浮者热自发，阴
弱者汗自出，啬啬恶寒，淅淅恶风，翕翕发热，鼻鸣干呕者，桂枝汤主之。一曰太阳中风，脉浮紧，发热恶寒，
身疼痛，不汗出而烦躁者，大青龙汤主之。以二证相较∶阳浮见寒之轻，浮紧见寒之重；汗出见寒之轻，不汗
出见寒之重；啬啬、淅淅见风寒之轻，翕翕见发热
之轻，发热恶寒觉寒热之俱重；鼻鸣见风之轻，身疼见风之重；自汗干呕见烦之轻，不汗烦躁见烦之重也。
言伤寒之脉证有二∶一曰太阳病，或未发热，或已发热，必恶寒、体痛、呕逆，脉阴阳俱紧者，名曰伤寒。一
曰伤寒脉浮，自汗出，小便数，心烦，微恶寒，脚挛急。以二证相较∶微恶寒见必恶寒之重，体痛觉挛急之轻；
自汗出、小便数、心烦，见伤寒之轻；或未发热，见发热之难；必先呕逆，见伤寒之重；脉浮见寒之轻，阴阳
俱紧见寒之重。中风伤寒，各有轻重如此。今人必以伤寒为重，中风为轻，但知分风寒之中伤，而不辨风寒之
轻重，于是有伤寒见风、中风见寒之遁辞矣。合观之，则不得以脉缓自汗为中风定局，更不得以脉紧无汗为伤
寒而非中风矣。要知仲景凭脉辨证，只审虚实。不论中风、伤寒，脉之紧、缓，但于指下有力者为实，脉弱
无力者为虚；不出汗而烦躁者为实，汗出多而烦躁者为虚；证在太阳而烦躁者为实，证在少阴而烦躁者为虚。
实者可服大青龙；虚者便不可服。此最易晓也。要知仲景立方，因证而设，不专因脉而设。大青龙汤，为风寒
在表而兼热中者设，不专为无汗而设。故中风而烦躁者可用，伤寒而烦躁者亦可用。盖风寒本是一气，故汤剂
可以互投。论中有中风、伤寒互称者，如大青龙是也；有中风、伤寒并提者，如小柴胡是也。仲景细审脉证而
施治，何尝拘拘于中风、伤寒之名是别乎？○大青龙诸证，全是麻黄，有喘与烦躁之别。喘者，是寒郁其气，升
降不得自如，故多用杏仁之苦以降气；烦躁是热伤其气，无津不能作汗，故特加石膏之甘以生津。○麻黄证，热
全在表。桂枝之自汗，大青龙之烦躁，皆兼乎里热。仲景于表剂中，便用寒药以清里。自汗是烦之兆，烦是躁
之征。汗出，则烦得外泄，故不躁，宜用微寒酸苦之味以和之；汗不出，则烦不得泄，故躁，宜用大寒坚重之
品以清之。夫芍药、石膏，是里药入表剂中。今人不审表中有里，因生疑畏，当用不用，至热并阳明，而斑黄
狂乱发矣。仲景于太阳经中，用石
膏以清胃火，是预保阳明之先着；加姜、枣以培中土，又虑夫转属太阴矣。○两青龙，俱两解表里法。大青龙治
里热，小青龙治里寒。故发表之药同，而治里之药殊也。○大青龙之点睛，在“无汗烦躁，无少阴证”二句。○
大青龙名重剂，不特少阴伤寒不可用，即太阳中风亦不可轻用也。脉浮紧、汗不出，是麻黄证，不可与桂枝汤，
以中有芍药能止汗也。脉浮弱、自汗出，是桂枝证，不可与大青龙，以中有麻黄、石膏故也。（柯韵伯）
小青龙汤
小青龙，小柴胡，俱是两解表里之剂。小青龙重在里证；小柴胡重在表证。故青龙加减，麻黄可去；柴
胡加减，柴胡独存。盖小青龙重在半里之水，小柴胡重在半表之热也。○小青龙与小柴胡，俱为枢机之剂，
故皆设或然证，因各立加减法。盖表证既去其半，则病机偏于向里。故二方之证多属里，仲景多用里药，少用
表药。未离于表，故为解表之小方。然小青龙主太阳之半表里，尚用麻黄、桂枝，还重视其表；小柴胡主少阳
之半表里，只用柴胡、生姜，但微解其表而已。此缘太、少之阳气不同，故用表药之轻重亦异。○小青龙设或然
五证，加减法内即备五方。小柴胡设或然七证，即具加减七方。此仲景法中之法，方外之方。○小青龙与五苓，
同为治表不解而心下有水气在。五苓治水之蓄而不行，故大利其水，而微发其汗，是为水郁折之也；小青龙治
水之动而不居，故备举辛温以散水，并用酸苦以安肺，培其化源也。（柯韵伯）
十枣汤
同是心下有水气，干呕咳喘，一用小青龙汤主之，一用十枣汤主之。何也？盖小青龙发散表邪，使水气
自毛窍而出，乃《内经》所谓开鬼门法也；十枣汤驱逐里邪，使水气自大小便而泄，乃《内经》所谓洁净府、
去陈 法也。○昔杜任问孙兆曰∶十枣汤究竟治甚病？孙曰∶治太阳中风，表解里未和也。杜曰∶何以
知里未和？孙曰∶头痛，心下痞满，胁下痛，干呕，汗出，此知里未和也。杜曰∶公但言病证，而所以里未和
之故，要紧处总未言也。孙曰∶某尝于此未决，愿听开谕。杜曰∶里未和者，盖痰与水气壅于中焦，故头痛，
干呕，短气，汗出，是痰膈也。非十枣不治。但此汤不宜轻用，恐损人于倏忽，用者慎之！（喻嘉言）
五苓散
伤寒之用五苓，允为太阳寒邪犯本，热在膀胱，故以五苓利水泻热。然用桂枝者，所以宣邪，而仍治太阳
也。杂证之用五苓，特以膀胱之虚，寒水为壅，故用肉桂之浓以君之，而虚寒之气，始得营运宣泄。二证之用
稍异，不可不辨。（罗东逸）
欲用五苓发表，则热饮走表，桂枝得令也；欲利小便，则冷冻饮料达下，泽泻得令也。欲吐则温服，复饮热汤
探之，猪苓得令也。一方之中，无穷妙用如此。（《慎斋三书》）
五苓原是治水，不是治渴。用以散所饮之水，而非治烦渴、消渴之水也。且五苓重在内烦外热，用桂枝是
逐水以除烦，不是热因热用。是少发汗以解表，不是助四苓以利水。其用四苓，是行积水留垢，不是疏通水道。
（柯韵伯）
五苓兼表治法，猪苓专里治法。欲邪透表，则五苓上消也，所谓开鬼门；欲邪下渗，则猪苓下消也，所谓
洁净府。（魏荔彤）
诸泻心汤
《内经》曰∶腰以上为阳。故三阳俱有心胸之病，仲景立泻心汤以分治三阳。在太阳以生姜为君者，以未
经误下，而心下成痞，虽汗出表解，水气犹未散，故微寓解肌之义也；在阳明用甘草为君者，以两番妄下，胃
中空虚，其痞益甚，故倍甘草以建中，而缓客邪之上逆，是亦从乎中治之法也；在少阳用半夏为君者，以误下
而成痞，邪已去半表，则柴胡汤不中与之，又未全入里，则黄芩汤亦不中与之矣。治心下痞，按之濡，其脉关
上浮者，用大黄黄连泻心汤；心下痞，而复恶寒汗出者，用附子泻心汤。此
皆攻实之剂，与前三方名虽同，而法不同矣。○仲景泻心无定法，正气夺，则为虚痞，杂用甘补、辛散、苦泄、
寒温之品以和之；邪气盛，则为实痞，用大寒、大热、大苦、大辛之味以下之。和有轻重之分，下有寒热之别。
同名泻心，而命剂不同如此。然五方中，诸药味数分两，各有进退加减，独黄连定而不移者，以其苦先入心，
中空外连，能疏通诸药之寒热，故为泻心之主剂也。（柯韵伯）
泻心本名理中黄连人参汤，盖泻心疗痞，正是理中处。当知仲景用理中有寒热两法∶一以扶阳，一以益阴
也。（林亿）
中虚不能化气，则阴逆于下，阳格于上，此亦邪居半表里之间。变小柴胡汤为半夏泻心汤，彼和解于表里
桂枝汤是张仲景众多方剂中的首领，它是滋阴和阳、解肌发汗、调和营卫的总括性方剂。凡是中风、伤寒或杂病，出现脉象浮而弱、自汗出且表证未解的情况，都可用此方主治。前辈医家说无汗者不能用桂枝汤，正是因为汤中含有芍药能止汗的缘故。芍药的功效在于消除烦闷，烦闷消除了，汗也就止住了。所以对于那些出现反常烦闷、更加烦闷以及心悸伴烦闷的症状，都依赖芍药来治疗。如果加倍使用芍药，就变成了建中类的方剂，而不是再次发汗的方剂了。这个方子，用桂枝来发汗，同时用芍药来止汗！生姜的辛味，辅助桂枝来解肌；大枣的甘味，辅助芍药来调和里气。桂枝与芍药的相互协同，生姜与大枣的相互配合，阳主表阴主里，并行不悖，这是刚柔相济以达到和谐。甘草味甘性平，具有安定内部、抵御外邪的能力，用它来调和气血，也就是用来调和表里，并且用来调和诸药。而这个方子的精妙之处又在于喝热稀粥，以助长药力，因为谷气在体内充实，邪气就不容易再侵入，而在服药后喝粥，余留的邪气就不会残留，复方奥妙的运用又是如此。要知道此方专门治疗表虚证，能解肌发出营分中的汗，但不能打开皮毛的毛孔以排出卫分分的邪气。所以无汗的是麻黄汤证，脉象浮紧的是麻黄汤脉，就不能给患者服用桂枝汤了。○桂枝不足以战胜风邪时，先针刺风池穴、风府穴，然后再给予桂枝汤以祛除风邪。烧针不足以散寒时，先在针孔处艾灸，然后给予加量的桂枝汤（桂枝加桂汤）以散寒。这都是内外夹攻的方法。也是先治外部、后治内部的道理。桂枝加芍药用于治疗阳邪下陷，桂枝再加桂用于治疗阴邪上攻，仅仅在一味药中增加分量，不在本方之外寻求其他药物，这种不即不离的奥妙就是这样。○服用桂枝汤后，大汗出，并且出现大烦渴，这是阳气陷入内部，急需滋阴，所以用白虎加人参汤来调和它。使用麻黄汤后，汗漏不止，这是阳气亡失于外部，急需扶阳，所以用桂枝加附子汤来固护它。要知道发汗的药剂，如果使用桂枝太过，则阳气会陷入内部；使用麻黄太过，则阳气会亡失于外部。因为桂枝汤中有芍药而没有麻黄，所以即使大汗出，玄府（汗孔）仍然能够自行闭合，只能使阳气旺盛，不至于导致亡阳。○凡是寒气中人，如果不进入营卫，就会进入腠理。张仲景制定桂枝汤来调和营卫，制定柴胡汤来调和腠理，观察六经证候之外，张仲景唯独提出桂枝证、柴胡证的称呼，可见这两个方子责任重大，不能拘泥于经络。只有太阳统摄诸阳之气，六经的表证都属于太阳，所以柴胡汤能与桂枝汤在太阳部形成对应。桂枝汤本是针对太阳风寒设立的，凡是六经初感之邪，未离开营卫的都适宜使用。柴胡汤本是针对少阳半表半里设立的，凡是三阳半表之邪，逗留于腠理的都适宜使用。张仲景最重视这两个方子，所以专门为桂枝证作注释，为柴胡证作注释。桂枝汤有疑似证，柴胡汤也有疑似证。桂枝汤证有坏病，柴胡汤证也有坏病。桂枝证罢去，不再适合用桂枝汤，而随证治法，仍然不离桂枝汤加减。柴胡证罢去，不再适合用柴胡汤，而设法救逆，仍然不出柴胡汤加减的范围。（柯韵伯）
麻黄一方，与桂枝各半，就能小发汗；加入石膏、生姜、大枣，就能在发表的同时清火并消除烦躁；去掉桂枝的辛热，加入石膏的辛寒，就能在发表的同时清火并平息喘逆；以文蛤为君药，就能在发表的同时祛除内外的湿热；加入连翘等苦寒药物，就能在发表的同时清火并治疗黄疸；加入附子、细辛的大辛热，或者加入附子、甘草的辛甘，也是根据少阴表里的轻重程度而定，并不是为了严寒时节所拘束。医生们都认为麻黄不可轻用，哪里知道张仲景的神妙变化呢？○前辈医家说麻黄汤主治伤寒，不治中风，似乎不是确切的论断。其实麻黄汤、大青龙汤，是治疗中风的重剂；桂枝汤、葛根汤，是治疗中风的轻剂。伤寒可以通用这些方剂，它们并非专门主治伤寒的方剂。○麻黄汤证，发热骨节疼痛，就是风寒两伤，营卫俱病。前辈医家为什么认为大青龙汤治营卫两伤，麻黄汤治寒伤营而不伤卫，桂枝散治风伤卫而不伤营，为什么不参照桂枝证的恶寒、麻黄证的恶风来反向验证呢？总之，冬季的风寒本是一体，所以中风、伤寒都会恶风、恶寒，营病则卫必病。中风重的，就是伤寒；伤寒浅的，就是中风。不必在风寒上细分，应当在有汗、无汗上着眼罢了。（柯韵伯）
张仲景治疗伤寒，无汗用麻黄汤，有汗用桂枝汤。历代名医没有探究其精微之处。我曾经推究思考，似乎有一点心得。云津（注：此处指代某种观点或前人言论来源，原文语境似指代一种理论阐述者）说津液化为汗，汗即是血。在营分则为血，在卫分则为汗。寒邪伤营，营血内部涩滞，不能向外通达于卫，卫气闭固，津液不行，所以无汗、发热且憎寒。风邪伤卫，卫气外泄，不能向内护卫于营，营气虚弱，津液不固，所以有汗、发热且恶风。然而风寒之邪，都是从皮毛而入，皮毛是肺的外合。肺主卫气，包罗一身，像天的形象一样。这个证候虽然属于太阳，但肺实际上受了邪气，证候兼见面色红赤、郁结咳嗽，以及痰喘胸满的，不是肺病吗？大概皮毛外部闭塞，则邪热内攻，导致肺气郁结。所以用麻黄、甘草，配合桂枝引出营分的邪气，达之于肌表，佐以杏仁泄肺利气。这样看来，麻黄汤虽然是太阳发汗的重剂，实际上是发散肺经火郁的药物。（李时珍）
葛根是阳明经的药物，只有表实里虚的才适宜使用，而胃家实证，是不适宜的。所以张仲景在阳明经中，反而不用葛根。如果说因为它能亡失津液而不用它，那就违背了本草书中生津的意义。如果说它能大开肌肉，为什么反而加在汗出恶风的合病中呢？有汗、无汗，下利、不下利，都可以用葛根为主治。这说明葛根与桂枝，同为解肌和中的方剂，与麻黄专于发表不同。○张仲景在阳明经中不用葛根，李东垣定为阳明经药，易老（王好古）说：“未入阳明者不可便服”。难道这两位老先生没读过张仲景的书吗？（柯韵伯）
大青龙汤证之所以不被世人明白，是从许叔微开始肇始的。他说：桂枝汤治中风，麻黄汤治伤寒，大青龙汤治中风见寒脉、伤寒见风脉。这三者如鼎足而立，这是三大纲领的来源。我认为先以脉象论述：中风脉浮紧，伤寒脉浮缓，这是张仲景互文见意的地方。意思是说中风脉多缓，但也有脉紧的；伤寒脉当紧，但也有脉缓的。大概中风、伤寒，各有深浅，或者因人的强弱而异，或者因地的高下、时令的乖和而不同。证候固然不可拘泥，脉象也不可执着。比如阳明中风而脉浮紧，太阳伤寒而脉脉浮缓，不能说脉紧必定是伤寒，脉缓必定是中风。按：《内经》说脉滑曰风，那么风脉原本没有固定形象；又说盛而紧曰胀，那么紧脉不专属伤寒；又说缓而滑曰热中，那么缓脉又不专指中风了。况且阳明中风有脉浮紧的，又有脉浮大的，一定要以脉浮缓为中风，那么这两条将属于什么证候呢？现在的人只以太阳脉缓自汗、脉紧无汗，来区分风寒辨别营卫，并不知道其他经络都有中风，就连阳明中风，也没人谈及了。请以太阳经来说，太阳篇讲中风脉证有二：一是太阳中风，阳浮而阴弱，阳浮者热自发，阴弱者汗自出，啬啬恶寒，淅淅恶风，翕翕发热，鼻鸣干呕的，用桂枝汤主治。二是太阳中风，脉浮紧，发热恶寒，身疼痛，不汗出而烦躁的，用大青龙汤主治。比较这两个证候：阳浮显示寒邪轻，浮紧显示寒邪重；汗出显示寒邪轻，不汗出显示寒邪重；啬啬、淅淅显示风寒轻，翕翕显示发热轻，发热恶寒觉寒热俱重；鼻鸣显示风轻，身疼显示风重；自汗干呕显示烦轻，不汗烦躁显示烦重。讲伤寒的脉证有二：一是太阳病，或未发热，或已发热，必恶寒、体痛、呕逆，脉阴阳俱紧的，名叫伤寒。二是伤寒脉浮，自汗出，小便数，心烦，微恶寒，脚挛急。比较这两个证候：微恶寒显示必恶寒重，体痛觉挛急轻；自汗出、小便数、心烦，显示伤寒轻；或未发热，显示发热难；必先呕逆，显示伤寒重；脉浮显示寒轻，阴阳俱紧显示寒重。中风伤寒，各有轻重如此。现在的人一定认为伤寒为重，中风为轻，只知道区分风寒的中伤，而不分辨风寒的轻重，于是就有了“伤寒见风、中风见寒”的遁辞了。综合来看，就不能以脉缓自汗作为中风的定局，更不能以脉紧无汗作为伤寒而非中风了。要知道张仲景凭脉辨证，只审虚实。不论中风、伤寒，脉的紧、缓，只要指下有力者为实，脉弱无力者为虚；不出汗而烦躁者为实，汗出多而烦躁者为虚；证在太阳而烦躁者为实，证在少阴而烦躁者为虚。实者可服大青龙汤；虚者便不可服。这最容易明白。要知道张仲景立方，是因证而设，不专因脉而设。大青龙汤，是为风寒在表而兼热中者设立，不专为无汗而设。所以中风而烦躁的可用，伤寒而烦躁的也可用。大概风寒本是一气，所以汤剂可以互相投用。论中有中风、伤寒互称的，比如大青龙汤；有中风、伤寒并提的，比如小柴胡汤。张仲景仔细审察脉证而施治，何曾拘泥于中风、伤寒的名称区别呢？○大青龙汤的各种证候，全是麻黄汤为基础，有喘与烦躁的区别。喘，是寒郁其气，升降不得自如，所以多用杏仁的苦味以降气；烦躁是热伤其气，无津不能作汗，所以特加石膏的甘味以生津。○麻黄汤证，热全在表。桂枝汤的自汗，大青龙汤的烦躁，都兼有里热。张仲景在表剂中，就用寒药以清里。自汗是烦的征兆，烦是躁的征象。汗出，则烦得以外泄，所以不躁，宜用微寒酸苦的味道来调和；汗不出，则烦不得泄，所以躁，宜用大寒坚重的物品来清解。夫芍药、石膏，是里药放入表剂中。现在的人不审察表中有里，因而产生疑畏，该用的不用，直到热并入阳明，而出现斑黄狂乱发作。张仲景在太阳经中，用石膏以清胃火，是预先保护阳明的先着；加姜、枣以培补中土，又担心转属太阴了。○两个青龙汤，都是两解表里的方法。大青龙汤治里热，小青龙汤治里寒。所以发表的药物相同，而治里的药物不同。○大青龙汤的点睛之笔，在于“无汗烦躁，无少阴证”两句。○大青龙汤名为重剂，不仅少阴伤寒不可用，就是太阳中风也不可以轻用。脉浮紧、汗不出，是麻黄汤证，不可给桂枝汤，因为其中有芍药能止汗。脉浮弱、自汗出，是桂枝汤证，不可给大青龙汤，因为其中有麻黄、石膏的缘故。（柯韵伯）
小青龙汤、小柴胡汤，都是两解表里的方剂。小青龙汤重在里证；小柴胡汤重在表证。所以小青龙汤加减，麻黄可以去掉；小柴胡汤加减，柴胡独存。大概小青龙汤重在半里之水，小柴胡汤重在半表之热。○小青龙汤与小柴胡汤，都是枢机之剂，所以都设有或然证，各自设立加减法。大概表证既去其半，则病机偏于向里。所以这两个方的证候多属里，张仲景多用里药，少用表药。尚未完全离于表，所以称为解表的小方。然而小青龙汤主治太阳的半表里，还用麻黄、桂枝，还重视其表；小柴胡汤主治少阳的半表里，只用柴胡、生姜，只是轻微解其表而已。这是因为太、少二经的阳气不同，所以用表药的轻重也异。○小青龙汤设有或然五证，加减法内就备有五方。小柴胡汤设有或然七证，就具备加减七方。这是张仲景法中之法，方外之方。○小青龙汤与五苓散，同为治表不解而心下有水气。五苓散治水之蓄积而不行，所以大利其水，而微发其汗，这是《内经》所谓的水郁折之；小青龙汤治水之动而不居，所以备举辛温以散水，并用酸苦以安肺，培补其化源。（柯韵伯）
同样是心下有水气，干呕咳喘，一个用小青龙汤主治，一个用十枣汤主治。为什么呢？大概小青龙汤发散表邪，使水气从毛窍而出，这是《内经》所谓的开鬼门法；十枣汤驱逐里邪，使水气从大小便而泄，这是《内经》所谓的洁净府、去陈莝法。○从前杜任问孙兆说：十枣汤究竟治什么病？孙兆说：治太阳中风，表解里未和。杜任说：怎么知道里未和？孙兆说：头痛，心下痞满，胁下痛，干呕，汗出，由此知道里未和。杜任说：您只说了病证，而所以里未和的原因，关键的地方都没说。孙兆说：我对此也未决断，愿听您的开导。杜任说：里未和，大概是痰与水气壅塞于中焦，所以头痛，干呕，短气，汗出，这是痰膈证。非十枣汤不能治。但是这个汤不宜轻用，恐怕瞬间损伤人体，使用者要谨慎！（喻嘉言）
伤寒使用五苓散，确实是太阳寒邪侵犯本经，热在膀胱，所以用五苓散利水泻热。然而用桂枝的原因，是为了宣通邪气，而仍治太阳。杂病使用五苓散，特别因为膀胱之虚，寒水壅滞，所以用肉桂的浓烈来作为君药，而虚寒之气，才得以营运宣泄。这两种证候的使用稍有差异，不可不辨别。（罗东逸）
想要用五苓散发表，则热饮走表，桂枝得令；想要利小便，则冷冻饮料达下，泽泻得令。想要吐则温服，再饮热汤探之，猪苓得令。一方之中，无穷妙用如此。（《慎斋三书》）
五苓散原本是治水，不是治渴。用以散发所饮之水，而不是治烦渴、消渴之水。而且五苓散重在內烦外热，用桂枝是逐水以除烦，不是热因热用。是少发汗以解表，不是助四苓以利水。其用四苓，是行积水留垢，不是疏通水道。（柯韵伯）
五苓散兼有表治法，猪苓散专于里治法。想要邪气透表，则五苓散从上消解，所谓开鬼门；想要邪气下渗，则猪苓散从下消解，所谓洁净府。（魏荔彤）
诸泻心汤
《内经》说：腰以上为阳。所以三阳经都有心胸的病，张仲景立泻心汤来分别治疗三阳。在太阳经以生姜为君药，是因为未经误下，而心下成痞，虽然汗出表解，水气仍未散，所以微寓解肌之义；在阳明经用甘草为君药，是因为两次妄下，胃中空虚，其痞益甚，所以倍用甘草以建中，而缓客邪之上逆，这也是从乎中治的方法；在少阳经用半夏为君药，是因为误下而成痞，邪已去半表，则柴胡汤不适合再用，又未全入里，则黄芩汤也不适合再用了。治心下痞，按之濡软，其脉关上浮的，用大黄黄连泻心汤；心下痞，而又恶寒汗出的，用附子泻心汤。这些都是攻实的方剂，与前三方名称虽同，而方法不同。○张仲景的泻心法没有定法，正气夺，则为虚痞，杂用甘补、辛散、苦泄、寒温的物品来调和它；邪气盛，则为实痞，用大寒、大热、大苦、大辛的味道以下之。和有轻重之分，下有寒热之别。同名泻心，而命方不同如此。然而五方中，诸药味数分量，各有进退加减，唯独黄连固定不移的，因为其苦先入心，中空外连，能疏通诸药的寒热，所以为泻心之主剂。（柯韵伯）
Guizhi Tang (Cinnamon Twig Decoction)
Guizhi Tang is the premier formula among Zhang Zhongjing's numerous prescriptions. It is the comprehensive formula for nourishing yin and harmonizing yang, releasing the muscle layer to induce sweating, and harmonizing Ying (Nutritive Qi) and Wei (Defensive Qi). For conditions such as Wind Strike (Zhong Feng), Cold Damage (Shang Han), or miscellaneous diseases presenting with a floating and weak pulse, spontaneous sweating, and unresolved exterior syndrome, this formula serves as the primary treatment. Predecessors stated that Guizhi Tang should not be used when there is no sweat, precisely because the decoction contains Shaoyao (Paeoniae Radix Alba), which can stop sweating. The function of Shaoyao lies in relieving irritability; once irritability is resolved, sweating also ceases. Therefore, for symptoms such as paradoxical irritability, worsening irritability, and palpitations accompanied by irritability, reliance is placed on Shaoyao. If the dosage of Shaoyao is doubled, it transforms into a Jianzhong (Establish the Middle) type formula, rather than a formula for inducing sweating again. In this formula, Guizhi (Cinnamomi Ramulus) is used to induce sweating, while simultaneously Shaoyao is used to stop sweating! The pungency of Shengjiang (Zingiberis Rhizoma) assists Guizhi in releasing the muscle layer; the sweetness of Dazao (Jujubae Fructus) assists Shaoyao in harmonizing the interior. The mutual synergy of Guizhi and Shaoyao, and the proper combination of Shengjiang and Dazao, allow the exterior (Yang) and interior (Yin) to proceed without contradiction. This represents the harmonization achieved through the mutual supplementation of rigidity and softness. Gancao (Glycyrrhizae Radix et Rhizoma) is sweet and neutral, possessing the ability to stabilize the interior and repel external pathogens. It is used to harmonize Qi and Blood, thereby harmonizing the exterior and interior, and also to harmonize the various herbs in the prescription. The profound essence of this formula further lies in drinking hot thin porridge to assist the medicinal power. When grain Qi is充盈 (full) within, pathogens cannot re-enter. Drinking porridge after taking the medicine ensures that residual pathogens do not remain. Thus, the subtle application of compound formulas is demonstrated here. It must be understood that this formula specifically treats Exterior Deficiency Syndrome, capable of releasing the muscle layer to induce sweat from the Ying level, but it cannot open the pores of the skin to expel pathogens from the Wei level. Therefore, absence of sweating indicates a Mahuang Tang (Ephedra Decoction) syndrome, and a floating-tight pulse indicates a Mahuang Tang pulse; in such cases, Guizhi Tang should not be administered. ○ When Guizhi alone is insufficient to overcome wind pathogens, one should first puncture Fengchi (GB20) and Fengfu (GV16), then administer Guizhi Tang to dispel wind. When burning needle therapy is insufficient to disperse cold, one should first moxa the needle sites, then administer Guizhi Jia Gui Tang (Guizhi Decoction with Added Cinnamon Twig) to disperse cold. These are methods of attacking from both inside and outside, illustrating the principle of treating the exterior first and the interior subsequently. Adding Shaoyao to Guizhi Tang treats the sinking of Yang pathogens, while adding more Guizhi to Guizhi Tang treats the attacking upward of Yin pathogens. The subtlety lies in adjusting the dosage of a single herb within the formula, without seeking other ingredients outside the base formula, demonstrating a method that is neither too close nor too distant. ○ After taking Guizhi Tang, if profuse sweating occurs accompanied by severe irritability and thirst, this indicates Yang sinking into the interior. Immediate nourishment of Yin is required, so Baihu Jia Renshen Tang (White Tiger Decoction with Added Ginseng) is used to harmonize it. After using Mahuang Tang, if sweating continues unceasingly, this indicates Yang collapsing at the exterior. Immediate support of Yang is required, so Guizhi Jia Fuzi Tang (Guizhi Decoction with Added Aconite Root) is used to consolidate it. It must be known that in diaphoretic agents, excessive use of Guizhi causes Yang to sink into the interior, while excessive use of Mahuang causes Yang to collapse at the exterior. Because Guizhi Tang contains Shaoyao but lacks Mahuang, even with profuse sweating, the Yuan Fu (pores/sweat gates) can still close themselves, ensuring Yang remains abundant without leading to Yang collapse. ○ Whenever cold pathogens invade the body, if they do not enter Ying and Wei, they enter the Cou Li (interstices). Zhang Zhongjing formulated Guizhi Tang to harmonize Ying and Wei, and Chaihu Tang (Bupleuri Decoction) to harmonize the Cou Li. Observing the Six Meridian syndromes, Zhang Zhongjing uniquely designated "Guizhi Syndrome" and "Chaihu Syndrome," indicating that these two formulas bear significant responsibility and cannot be confined strictly to meridians. Only Taiyang governs the Qi of all Yang meridians, and all exterior syndromes of the Six Meridians belong to Taiyang. Therefore, Chaihu Tang stands in correspondence with Guizhi Tang within the Taiyang sector. Guizhi Tang was originally established for Taiyang Wind-Cold; for any pathogen initially affecting the Six Meridians that has not yet left Ying and Wei, it is suitable. Chaihu Tang was originally established for Shaoyang Half-Exterior/Half-Interior; for any pathogen of the Three Yang meridians lingering in the Cou Li, it is suitable. Zhang Zhongjing valued these two formulas most highly, hence he provided annotations specifically for Guizhi Syndrome and Chaihu Syndrome. Guizhi Tang has ambiguous syndromes, and Chaihu Tang also has ambiguous syndromes. Guizhi Tang syndromes can deteriorate (Hua Bing), and Chaihu Tang syndromes can also deteriorate. When the Guizhi Syndrome resolves and Guizhi Tang is no longer indicated, treatment follows the syndrome, yet still relies on modifications of the Guizhi Tang formula. When the Chaihu Syndrome resolves and Chaihu Tang is no longer indicated, methods to rescue adverse transformations are employed, yet still remain within the scope of modifications of the Chaihu Tang formula. (Ke Yunbo)
Mahuang Tang (Ephedra Decoction)
The Mahuang formula, combined with half the dosage of Guizhi, induces slight sweating; adding Shigao (Gypsum Fibrosum), Shengjiang, and Dazao clears fire and relieves irritability while releasing the exterior; removing the pungent heat of Guizhi and adding the pungent coolness of Shigao clears fire and calms wheezing while releasing the exterior; using Wen Ge (Clam Shell) as the sovereign herb dispels internal and external damp-heat while releasing the exterior; adding bitter-cold herbs like Lianqiao (Forsythiae Fructus) clears fire and treats jaundice while releasing the exterior; adding the great pungent-hot properties of Fuzi (Aconiti Lateralis Radix Praeparata) and Xixin (Asari Radix et Rhizoma), or the pungent-sweet nature of Fuzi and Gancao, depends on the severity of the Shaoyin interior-exterior condition, and is not restricted merely to times of severe cold. Physicians generally assert that Mahuang should not be used lightly, failing to appreciate the divine transformation of Zhang Zhongjing. ○ Predecessors stated that Mahuang Tang primarily treats Shang Han (Cold Damage) and does not treat Zhong Feng (Wind Strike), which seems an inaccurate conclusion. In fact, Mahuang Tang and Da Qing Long Tang (Great Azure Dragon Decoction) are heavy-dose formulas for treating Zhong Feng; Guizhi Tang and Gegen Tang (Kudzu Decoction) are light-dose formulas for treating Zhong Feng. These can be commonly used for Shang Han, but they are not exclusively formulas for treating Shang Han. ○ The Mahuang Tang syndrome, characterized by fever and bone/joint pain, indicates injury by both Wind and Cold, affecting both Ying and Wei. Why did predecessors argue that Da Qing Long Tang treats simultaneous Ying-Wei injury, Mahuang Tang treats Cold injuring Ying without injuring Wei, and Guizhi San treats Wind injuring Wei without injuring Ying? Why not cross-reference the aversion to cold in Guizhi syndrome with the aversion to wind in Mahuang syndrome? Essentially, Wind and Cold in winter share the same origin; thus, both Zhong Feng and Shang Han present with aversion to wind and cold. If Ying is diseased, Wei must also be diseased. Severe Zhong Feng is equivalent to Shang Han; mild Shang Han is equivalent to Zhong Feng. There is no need to distinguish finely between Wind and Cold; one must focus on the presence or absence of sweating. (Ke Yunbo)
Zhang Zhongjing treated Shang Han by using Mahuang Tang for absence of sweat and Guizhi Tang for presence of sweat. Famous physicians of subsequent generations failed to investigate its subtleties. I have pondered this and seem to have gained some insight. It is said that Body Fluids transform into sweat, and sweat is essentially blood. Within Ying, it is called blood; within Wei, it is called sweat. When Cold injures Ying, Ying-Blood becomes stagnant internally and cannot communicate externally with Wei. Wei-Qi closes and secures, Body Fluids fail to circulate, resulting in absence of sweat, fever, and aversion to cold. When Wind injures Wei, Wei-Qi leaks externally and cannot protect Ying internally. Ying-Qi becomes deficient, Body Fluids fail to secure, resulting in presence of sweat, fever, and aversion to wind. However, Wind and Cold pathogens enter via the skin and hair, which are the exterior correspondences of the Lung. The Lung governs Wei-Qi and envelops the entire body, resembling the image of Heaven. Although this syndrome belongs to Taiyang, the Lung actually receives the pathogenic qi. Symptoms including flushed face, depression, cough, phlegm-wheezing, and chest fullness indicate Lung disease. Generally, when the exterior skin and hair close, pathogenic heat attacks internally, causing Lung Qi stagnation. Therefore, Mahuang and Gancao, assisted by Guizhi, draw out pathogens from the Ying level to the muscle surface, assisted by Xingren (Armeniacae Semen Amarum) to drain the Lung and promote Qi flow. Thus, although Mahuang Tang is a heavy diaphoretic agent for Taiyang, it is essentially a medication for dispersing Fire Stagnation in the Lung Meridian. (Li Shizhen)
Gegen Tang (Kudzu Decoction)
Gegen (Puerariae Lobatae Radix) is a herb of the Yangming Meridian. It is suitable only for Exterior Excess and Interior Deficiency, and is not suitable for Yangming Organ Excess (Stomach Excess). Therefore, Zhang Zhongjing rarely uses Gegen in Yangming meridian treatments. If one argues it is avoided because it consumes Body Fluids, this contradicts the materia medica description of Gegen generating fluids. If one argues it greatly opens the muscles, why is it added to combinations involving sweating and aversion to wind? Whether there is sweat or not, whether there is diarrhea or not, Gegen can serve as the principal treatment. This shows that Gegen and Guizhi are both formulas for releasing the muscle layer and harmonizing the middle, differing from Mahuang which specializes in releasing the exterior. ○ Zhang Zhongjing did not use Gegen in Yangming treatments, yet Li Dongyuan classified it as a Yangming herb, and Yi Lao (Wang Haogu) stated: "Do not take it before entering Yangming." Did these two masters not read Zhang Zhongjing's books? (Ke Yunbo)
Da Qing Long Tang (Great Azure Dragon Decoction)
The syndrome of Da Qing Long Tang has remained unclear to the world since Xu Shuwei initiated the misunderstanding. He stated: Guizhi Tang treats Zhong Feng, Mahuang Tang treats Shang Han, and Da Qing Long Tang treats Zhong Feng presenting with Cold pulses, or Shang Han presenting with Wind pulses. These three stand like a tripod, forming the source of these three major outlines. I propose analyzing by pulse first: Zhong Feng pulse floating-tight, Shang Han pulse floating-slow—this is Zhang Zhongjing’s use of parallel prose to imply meaning. It means Zhong Feng pulses are mostly slow, but can be tight; Shang Han pulses should be tight, but can be slow. Generally, Zhong Feng and Shang Han have varying depths, differing due to individual strength, geographical altitude, or seasonal harmony/disorder. Syndromes cannot be rigidly fixed, nor can pulses be dogmatically interpreted. For example, Yangming Zhong Feng may present with a floating-tight pulse, and Taiyang Shang Han may present with a floating-slow pulse; one cannot claim tight pulse necessarily means Shang Han, or slow pulse necessarily means Zhong Feng. According to: *Neijing* states slippery pulse indicates Wind, so Wind pulse has no fixed image; strong and tight indicates distension, so tight pulse does not exclusively indicate Shang Han; slow and slippery indicates Heat in the Middle, so slow pulse does not exclusively indicate Zhong Feng. Moreover, Yangming Zhong Feng presents with floating-tight or floating-large pulses. If one insists floating-slow pulse defines Zhong Feng, what would those two cases be? Current practitioners only differentiate Wind and Cold, Ying and Wei based on Taiyang slow pulse with spontaneous sweat versus tight pulse without sweat, ignoring that all meridians can have Zhong Feng, including Yangming Zhong Feng, which is rarely discussed. Let us speak of Taiyang: The Taiyang chapter describes two Zhong Feng pulse-syndromes: 1) Taiyang Zhong Feng, floating Yang and weak Yin, Yang floating means heat spontaneously arises, Yin weak means sweat spontaneously exits, shivering aversion to cold, chilly aversion to wind, mild fever, nasal congestion, dry vomiting—treated with Guizhi Tang. 2) Taiyang Zhong Feng, floating-tight pulse, fever, aversion to cold, body pain, no sweat, irritability—treated with Da Qing Long Tang. Comparing these two: Floating Yang indicates mild cold, floating-tight indicates severe cold; sweating indicates mild cold, no sweat indicates severe cold; shivering/chilly indicates mild Wind-Cold, mild fever indicates mild heat; nasal congestion indicates mild Wind, body pain indicates severe Wind; spontaneous sweat/dry vomiting indicates mild irritability, no sweat/irritability indicates severe irritability. Regarding Shang Han pulse-syndromes: 1) Taiyang Disease, either no fever or already fever, must have aversion to cold, body pain, vomiting/reversal, pulse tight at both Yin and Yang positions—named Shang Han. 2) Shang Han, floating pulse, spontaneous sweat, frequent urination, irritability, slight aversion to cold, foot cramping. Comparing these two: Slight aversion to cold indicates severe aversion to cold; body pain indicates mild cramping; spontaneous sweat/frequent urination/irritability indicates mild Shang Han; no fever indicates difficulty in fever onset; vomiting/reversal indicates severe Shang Han; floating pulse indicates mild cold, tight Yin-Yang pulse indicates severe cold. Thus, Zhong Feng and Shang Han have varying degrees of severity. Current practitioners insist Shang Han is severe and Zhong Feng is mild, knowing only to distinguish Wind/Cold invasion but not their severity, leading to excuses like "Shang Han showing Wind signs, Zhong Feng showing Cold signs." Synthesizing this, one cannot define Zhong Feng solely by slow pulse and sweat, nor define Shang Han solely by tight pulse and no sweat. It must be known that Zhang Zhongjing diagnoses based on pulse and syndrome, focusing only on Deficiency and Excess. Regardless of Zhong Feng or Shang Han, if the pulse is tight or slow but forceful under the fingers, it is Excess; if weak and powerless, it is Deficiency; no sweat with irritability is Excess; profuse sweat with irritability is Deficiency; irritability in Taiyang is Excess; irritability in Shaoyin is Deficiency. Excess patterns can take Da Qing Long Tang; Deficiency patterns must not. This is easy to understand. It must be known that Zhang Zhongjing formulates based on syndrome, not solely on pulse. Da Qing Long Tang is established for Wind-Cold at the exterior combined with internal Heat, not solely for absence of sweat. Therefore, it can be used for Zhong Feng with irritability, and for Shang Han with irritability. Since Wind and Cold share the same origin, the decoctions can be interchangeable. The text mentions Zhong Feng and Shang Han interchangeably, as seen in Da Qing Long Tang; and together, as seen in Xiao Chai Hu Tang. Zhang Zhongjing carefully examines pulse and syndrome to apply treatment; how could he be constrained by the names Zhong Feng and Shang Han? ○ The various syndromes of Da Qing Long Tang are based on Mahuang, distinguished by wheezing versus irritability. Wheezing results from Cold stagnating Qi, disrupting ascending and descending functions, hence Xingren’s bitter property is used to descend Qi. Irritability results from Heat damaging Qi and lack of fluids preventing sweat, hence Gypsum’s sweet property is specifically added to generate fluids. ○ In Mahuang Tang syndrome, Heat is entirely at the exterior. Spontaneous sweat in Guizhi Tang syndrome, and irritability in Da Qing Long Tang syndrome, both involve interior Heat. Zhang Zhongjing uses cold medicines within exterior-releasing formulas to clear the interior. Spontaneous sweat is a sign of irritability; irritability is a sign of restlessness. With sweat, irritability can vent outward, so there is no restlessness; mild cold, sour, and bitter flavors are used to harmonize. Without sweat, irritability cannot vent, so restlessness occurs; great cold and heavy substances are used to clear. Shaoyao and Shigao are interior herbs placed in exterior formulas. Modern practitioners, failing to recognize interior involvement in exterior conditions, hesitate and fail to use them when needed, until Heat merges into Yangming, causing macules, jaundice, mania, and confusion. Zhang Zhongjing uses Shigao in Taiyang to clear Stomach Fire, a preemptive move to protect Yangming; adding Jiang and Zao to fortify the Middle Earth prevents transmission to Taiyin. ○ Both Qing Long formulas are methods of resolving both exterior and interior. Da Qing Long Tang treats interior Heat; Xiao Qing Long Tang treats interior Cold. Thus, exterior-releasing herbs are the same, but interior-treating herbs differ. ○ The key point of Da Qing Long Tang lies in the phrases "no sweat, irritability, and no Shaoyin syndrome." ○ Da Qing Long Tang is named a heavy formula; it is not only contraindicated in Shaoyin Shang Han but should also not be used lightly in Taiyang Zhong Feng. Floating-tight pulse with no sweat is a Mahuang Tang syndrome, contraindicated for Guizhi Tang because Shaoyao stops sweat. Floating-weak pulse with spontaneous sweat is a Guizhi Tang syndrome, contraindicated for Da Qing Long Tang because it contains Mahuang and Shigao. (Ke Yunbo)
Xiao Qing Long Tang (Minor Azure Dragon Decoction)
Xiao Qing Long Tang and Xiao Chai Hu Tang are both formulas that resolve both exterior and interior. Xiao Qing Long Tang focuses on interior syndromes; Xiao Chai Hu Tang focuses on exterior syndromes. Therefore, in modifications of Xiao Qing Long Tang, Mahuang can be removed; in modifications of Xiao Chai Hu Tang, Chaihu (Bupleuri Radix) remains unique. This is because Xiao Qing Long Tang focuses on Water-Dampness in the semi-interior, while Xiao Chai Hu Tang focuses on Heat in the semi-exterior. ○ Both Xiao Qing Long Tang and Xiao Chai Hu Tang are pivot mechanisms; thus, both include "possible syndromes" (Huo Ran Zheng) and respective modification methods. Once half the exterior syndrome is resolved, the disease mechanism tends inward. Therefore, the syndromes of these two formulas mostly belong to the interior, and Zhang Zhongjing uses more interior herbs and fewer exterior herbs. Since they have not completely left the exterior, they are called small exterior-resolving formulas. However, Xiao Qing Long Tang governs the semi-exterior/semi-interior of Taiyang and still uses Mahuang and Guizhi, valuing the exterior; Xiao Chai Hu Tang governs the semi-exterior/semi-interior of Shaoyang and uses only Chaihu and Shengjiang, slightly resolving the exterior. This is because the Yang Qi of Taiyang and Shaoyin differs, so the weight of exterior herbs varies. ○ Xiao Qing Long Tang sets five possible syndromes, containing five formulas within its modifications. Xiao Chai Hu Tang sets seven possible syndromes, containing seven formulas within its modifications. This is the method within Zhang Zhongjing’s methods, the formula beyond formulas. ○ Xiao Qing Long Tang and Wu Ling San (Five-Ingredient Powder with Poria) both treat unresolved exterior with Water-Qi under the heart. Wu Ling San treats Water accumulation and stagnation, promoting diuresis and slight sweating, following the *Neijing* principle of "breaking water stagnation"; Xiao Qing Long Tang treats Water movement and instability, employing pungent-warm herbs to scatter Water and sour-bitter herbs to calm the Lung, cultivating the source of transformation. (Ke Yunbo)
Shi Zao Tang (Ten Date Decoction)
Both present with Water-Qi under the heart, dry retching, coughing, and wheezing; one is treated with Xiao Qing Long Tang, the other with Shi Zao Tang. Why? Xiao Qing Long Tang disperses exterior pathogens, allowing Water-Qi to exit via the pores, following the *Neijing* method of "opening the ghost gate" (diaphoresis); Shi Zao Tang drives out interior pathogens, allowing Water-Qi to drain via urination and defecation, following the *Neijing* method of "cleaning the residence" (diuresis/catharsis). ○ Previously, Du Ren asked Sun Zhao: "What disease does Shi Zao Tang ultimately treat?" Sun replied: "It treats Taiyang Zhong Feng where the exterior is resolved but the interior is not harmonized." Du asked: "How do you know the interior is not harmonized?" Sun said: "Headache, epigastric fullness/stuffiness, hypochondriac pain, dry retching, sweating—these indicate the interior is not harmonized." Du said: "You only mentioned the syndrome, but not the crucial reason why the interior is not harmonized." Sun said: "I have been undecided on this; I wish to hear your enlightenment." Du said: "The interior is not harmonized because Phlegm and Water-Qi are congested in the Middle Jiao, causing headache, dry retching, shortness of breath, and sweating. This is Phlegm Obstruction. Only Shi Zao Tang can treat it. But this decoction should not be used lightly, as it may harm the patient suddenly. Users must be cautious!" (Yu Jiayan)
Wu Ling San (Five-Ingredient Powder with Poria)
In Shang Han, Wu Ling San is appropriately used when Taiyang Cold Pathogen invades the root, with Heat in the Bladder; thus, it promotes water drainage and dissipates Heat. The use of Guizhi here is to disseminate pathogens and continue treating Taiyang. In miscellaneous diseases, Wu Ling San is used specifically for Bladder Deficiency with Cold-Water congestion; thus, Rougui (Cinnamomi Cortex) is used as the sovereign herb to enable the circulation and discharge of Deficient-Cold Qi. The usage for these two conditions differs slightly and must be distinguished. (Luo Dongyi)
If one wishes to use Wu Ling San to release the exterior, hot drink travels to the exterior, and Guizhi takes command; if one wishes to promote urination, cold drink reaches the lower part, and Zexie (Alismatis Rhizoma) takes command. If one wishes to induce vomiting, warm administration followed by hot water probing allows Zhu Ling (Polypori Mycelium) to take command. Such infinite subtle applications exist within one formula. (*Shen Zhai San Shu*)
Wu Ling San originally treats Water, not Thirst. It is used to dissipate ingested Water, not to treat Irritable Thirst or Wasting-Thirst (Xiao Ke). Moreover, Wu Ling San focuses on Internal Irritability and External Heat; using Guizhi is to drive out Water to relieve irritability, not "treating heat with heat." It induces slight sweating to resolve the exterior, not assisting Si Ling (the four draining herbs) to promote urination. Its use of Si Ling is to move accumulated water and retained turbidity, not merely to unblock water pathways. (Ke Yunbo)
Wu Ling San combines exterior treatment methods; Zhu Ling San specializes in interior treatment methods. If one desires pathogens to penetrate the exterior, Wu Ling San resolves from above, known as "opening the ghost gate"; if one desires pathogens to渗 (seep) downward, Zhu Ling San resolves from below, known as "cleaning the residence." (Wei Litong)
Zhu Xi Xin Tang (Various Heart-Draining Decoctions)
*Neijing* states: Above the waist is Yang. Therefore, the Three Yang meridians all have Heart and Chest diseases. Zhang Zhongjing established Xi Xin Tang to treat the Three Yang separately. In Taiyang, using Shengjiang as sovereign is because there was no erroneous purgation, yet Pi (Glomus/Stuffiness) formed under the heart; although sweat occurred and exterior resolved, Water-Qi had not dispersed, so it subtly incorporates the meaning of releasing the muscle layer. In Yangming, using Gancao as sovereign is because of double erroneous purgation leaving the Stomach empty, making Pi worse; thus, doubling Gancao establishes the Middle and slows the counterflow of guest pathogens, also a method of treating from the center. In Shaoyang, using Banxia (Pinelliae Rhizoma) as sovereign is because erroneous purgation caused Pi, pathogens have left the semi-exterior (so Chai Hu Tang is no longer suitable), and have not fully entered the interior (so Huang Qin Tang is no longer suitable). To treat Pi under the heart, soft upon pressure, with pulse floating at the Guan position, use Da Huang Huang Lian Xi Xin Tang (Rhubarb and Coptis Heart-Draining Decoction); for Pi under the heart accompanied by aversion to cold and sweating, use Fu Zi Xi Xin Tang (Aconite Heart-Draining Decoction). These are all excess-draining agents. Although sharing the name with the previous three formulas, their methods differ. ○ Zhang Zhongjing’s method for Xi Xin has no fixed rule. If Righteous Qi is depleted, it becomes Deficient Pi, treated with a mix of Sweet-Nourishing, Pungent-Dispersing, Bitter-Draining, and Cold-Warming items to harmonize. If Pathogenic Qi is abundant, it becomes Excess Pi, treated with Great Cold, Great Hot, Great Bitter, and Great Pungent flavors to drain. Harmonizing has degrees of lightness/heaviness; draining has distinctions of cold/warmth. Named similarly as Heart-Draining, but the prescribed formulas differ thus. However, among the five formulas, the number and dosage of herbs vary in each, except Huanglian (Coptidis Rhizoma) which remains fixed. This is because its bitterness enters the Heart first; hollow inside and connected outside, it can unblock the cold and heat of other herbs, making it the main agent for Heart-Draining. (Ke Yunbo)
Xi Xin was originally named Lizhong Huanglian Renshen Tang (Regulate the Middle, Coptis, and Ginseng Decoction). Treating Pi with Xi Xin is precisely the process of Regulating the Middle. One must know Zhang Zhongjing uses two methods in Lizhong: one to Support Yang, one to Benefit Yin. (Lin Yi)
Middle Deficiency fails to transform Qi, causing Yin to rebel downward and Yang to block upward. This is also Pathogen residing in the semi-exterior/semi-interior. Transforming Xiao Chai Hu Tang into Banxia Xi Xin Tang... [Text cuts off]