秦子曰∶余着《伤寒大白》书，内立二十七总论，七十二症治，并详解仲景原文汇聚于
各症之下，详且悉矣。今着大方杂症，又何必多赘。但仲景《伤寒论》中，中寒伤寒，同卷
立名，虽已注明直中阴经者为阴症，传入阴经者为阳症。后人不知，往往于阴经之阳症，混
以阴症名之，误投热剂，都致不救。余今以直中阴经之寒症，名曰中寒，另立一条。寒伤阳
经之热症，名曰伤寒，亦另立一条，使展卷了然，而无阴阳误治之弊矣。
【伤寒之症】头痛身疼，腰脊强直，恶寒发热，此太阳经表症也；目痛，鼻干不眠，眼
眶痛，或口干，或呕吐
，此阳明经表症也；寒热往来，口苦胁痛，耳聋而呕，此少阳经半表半里症也。以上皆三阳
经表症也。若阳经热邪不解，传入于里，恶寒身痛未除，又加小便不利，此太阳经里症也；
若恶寒身痛头疼悉除，脉沉数不浮，皮肤不热，口渴唇焦，引饮消水，小便赤，大便结，潮
热谵语，手足多汗，此阳明之里症也；若口干咽燥，渴而消水，或自利纯清水，心下硬痛胀
满，不大便，此阳邪传入少阴里症也；若手足自温，或发身黄，或腹满实痛者，此阳邪传入
太阴里症也；烦满囊缩，下利谵语，腹中痛，失气，或厥而有热，此阳邪传入厥阴里症也。
以上皆三阳经之热邪，传入阴经而为里症者，经虽属阴，症则阳症。若初起两经见症，或三
经皆病，名曰合病；若是一经先病未罢，而又见一经者，名曰并病；凡此皆伤寒症也。
【伤寒之因】其人腠理空疏，偶值时令之寒，入于肌表，郁而发热，此冬月伤寒致病
之因也。若热令之人，内有积热，又因非时之暴寒，外束皮毛，亦令人头疼身痛，恶寒发热，此
即三时之寒热病也。
【伤寒之脉】浮大为表，沉数为里。左关浮紧，寒伤太阳。右关洪长，病在阳明。左
关弦数，病在少阳。沉数实大，阳明里症。沉数细疾，三阴里热。
【伤寒之治】头疼腰痛，脉浮紧，无汗恶寒，太阳经寒伤营也，仲景冬月麻黄汤，家秘
用
恶寒身痛发热，又加小便不利，此热结膀胱，乃太阳经里症也，仲景冬月用五苓散，家秘用
羌活木通汤。目痛鼻干不眠，脉弦长，阳明经表症也，宜汗之，冬葛根汤，余月葱白葛根汤
。口渴消水，昼夜皆热，六脉洪数而长，阳明经半表半里症也，宜清之，干葛石膏汤。口燥
舌苔黄，脉沉数而长，阳明之腑，里症也，未见腹痛便结等下症者，凉膈散清之；若下症悉
具者，三承气汤选用。若寒热未除，口苦耳聋，或呕吐胸满，尚在少阳经，未入里也，小柴
胡汤。若阳经不解，传入三阴，乃是阴经之阳症，口燥咽干而渴，腹不胀，便不结，宜清里
热；若腹胀不大便，或自利纯清水，心下硬痛，此热传于少阴也，有下症者，大小承气汤选
用。夫阳邪传入少阴，直至口燥咽干，内水将竭，不得不急下之，以存津液也；若手足自温
，发热身黄，腹满大实痛者，此热邪传于太阴也，仲景不设承气汤下法，而立桂枝大黄汤下
之，以太阴脾经为纯阴之脏，且太阳之邪，传入太阴，故用桂枝太阳之药，协大黄之功，即
散太阳之表邪，复清太阴之里热。烦满囊缩，脉数而厥，先热后厥，此热深厥亦深，热邪入
于厥阴经也，仲景不用大下；盖先见发热，后乃发厥，手足既已厥冷，不合大下之法，故立
小承气汤，以示轻下之意，待其手足自温，然后再议清热之药，庶为缓转得宜。按伤寒里症
有四经，一曰阳明，一曰少阴，一曰太阴，一曰厥阴。在阳明者，阳经之热病也；在三阴者
，乃阴经之热病也，故三阴之下药，稍轻于阳明也。若热邪虽已内传，然未有下症，即热在
阴经，但可清之，未可下也。如手少阴热极，神昏不语，如醉如痴，不用承气，止用导赤各
半汤、泻心等汤。是以下法，必要确见腹胀痛，大便结，时下矢气，欲便而不得便，手见自
汗时出，皮肤不热，面无赤色，舌上有黄黑干胎，方可用下；若见一些头疼身痛。恶寒发热
，手足未见自汗 ，即为表邪未尽，不可下也。总令腹胀便结，不得不下。亦止
用大柴胡汤，不可用承气，即用小承气，亦加柴胡、干葛、羌活，仍治三阳各经见症之表药
，庶里热得清，而表邪有升散之药，不致内陷。此用下法而不碍表邪，似下法，实和解之法
也。此章伤寒，别明阴症阳症两条，故略注大纲条目，若细细治法，另注《伤寒大白》书中
麻黄汤
麻黄 桂枝 杏仁 甘草
陶氏加川芎、防风、羌活。
桂枝汤
桂枝 白芍药 麻黄 甘草
陶氏以葛根易去麻黄。
按∶以上二方 仲景治西北方冬令伤寒之方；南方三时不宜用者。
羌活败毒散 此方治无汗发热，代麻黄汤者。
羌活 独活 柴胡 前胡 防风 荆芥 甘草 川芎
口干渴，去川芎、易干葛，兼清阳明。
羌活冲和汤
羌活 黄芩 防风 苍术 川芎 生地 细辛 白芷 甘草
唇干口渴，去川芎、细辛，以干葛易白芷。胸前饱闷，去生地，加枳壳。
家秘冲和汤 此方治自汗发热，代桂枝汤。
羌活 黄芩 防风 生地 白芷 白芍药 甘草
寒热，加柴胡；眼眶目痛口渴，加葛根，去白芷；小便赤，加木通；渴而有痰，加天花
粉；渴而消水，加石膏；吐呕，加半夏；痞满，加枳、连。
以上三方，其败毒散，治太阳经纯是表邪之症也；其冲和汤，治太阳经表有邪，里有热
，用此和解者也；其家秘冲和汤，治太阳经汗出，热不减之方也。
羌活木通汤
羌活 木通
二味同煎。
干葛汤
干葛 桂枝 麻黄 白芍药 甘草
陶氏以升麻易麻黄；里有热，加石膏；时寒时热，加柴胡；恶寒身痛，加羌活；头痛，
加川芎。前方去麻桂，加荆芥、葱白，名葱白干葛汤。
干葛石膏汤
干葛 知母 石膏 甘草
心烦躁，加麦冬、竹叶；呕而多痰，加半夏；烦渴痰多，加花粉；小便涩，加木通、灯
小柴胡汤
柴胡 黄芩 广皮 半夏 甘草 人参
胸热痞满，去人参，加川连、枳壳；渴，去半夏，加花粉。
凉膈散
山栀 黄芩 川连 天花粉 连翘 薄荷 桔梗 甘草
大承气汤
大黄 芒硝 枳实 浓朴
去芒硝，即小承气汤。
调胃承气汤
大黄 芒硝 甘草
家秘加广皮。
桂枝大黄汤
桂枝 大黄 白芍药 甘草
导赤各半汤 见中风。
外感风寒，从毛窍而入，必要从毛窍而出，故伤寒发热症，首重发表解肌。太阳篇曰，
初起病时，发汗不彻，则转属阳明而病不解，但坐，以汗出不彻之故，再当发汗则愈。以身
表发热，未有不出汗而能凉者，若汗虽出而仍干，到底出汗不彻，而热不退，必得时时有汗
，邪热方解。若不分方宜，概以北方麻黄桂枝汤，治南方温热之症，则犯火闭无汗，而热愈
甚。又有表邪烦热，失用解表，误用寒凉，则胃阳抑遏，不能敷布作汗。又有外冒表邪，
内有痰饮食滞，误用寒凉，凝结胃阳，岂能作汗外解。夫发汗以治发热，人人知之；然发之
不效，以其未知发汗之真诀在何处，前书未有发明，后人愦愦到老。谁知《伤寒论》首条用
麻黄汤，治无汗发热，气逆喘满，独加杏仁，以理肺气，默示肺气壅遏，则皮毛闭郁，不能
作汗，此开发肺主皮毛，润肺气为发汗之真诀。又以桂枝汤，治有汗之发热，方下注明服
药后，食稀粥以助药力，此默示发热之症，必胃气空松，方能敷布作汗；若汗出而邪不散，
以桂枝汤解肌散邪，助以稀粥，则胃阳敷布，汗出而邪亦散。可见有汗之症，胃无凝滞，可
食稀粥；无汗之症，胃家必有壅滞凝结，决不食稀粥，此开发胃主肌肉，疏利胃气，升发胃
阳，为发汗之真诀。然此暗度金针，非精思不觉者。至于头汗条中，则明言但头有汗，遍身
无汗，皆系水饮瘀热，凝结中焦，胃阳不能通达，隔绝周身升降之道路，故遍身不得出汗，
治以宣发胃气，疏通经络，余今化立败毒散中加枳桔桑皮，宣通肺气，治风寒壅肺，喘逆
发热无汗之症；此从麻黄杏仁理肺发汗中，化出治法。又常以败毒散中加枳朴半夏广皮，疏
散胃滞，宣扬胃气，以治痰涎食滞，凝塞中焦，腹满发热无汗之症，此从头汗条中，及太阳
表症，心下有水饮，用小青龙汤，化出辛散水饮，宣发胃阳，敷布作汗之真诀，一名理肺
发表汤，一名平胃发表汤。
秦子说：我撰写了《伤寒大白》一书，其中设立了二十七篇总论、七十二种病症的治疗方案，并将张仲景的原文详细解释后汇聚于各病症之下，内容详尽完备。如今我又编写关于大方杂症的内容，又何必再多此一举呢？只是张仲景的《伤寒论》中，“中寒”与“伤寒”在同一卷中命名，虽然已经注明直中阴经的为阴证，传入阴经的为阳证。但后人不知晓这一点，往往将阴经中的阳证混同为阴证来称呼，误用热性药物投治，导致无法挽救。我现在将直中阴经的寒证命名为“中寒”，单独设立一条；将寒邪伤及阳经的热证命名为“伤寒”，也单独设立一条，使翻开书卷就能一目了然，从而避免阴阳误治的弊端。
【伤寒的症状】头痛身体疼痛，腰脊僵硬挺直，怕冷发热，这是太阳经表证；眼睛疼痛，鼻子干燥失眠，眼眶痛，或者口干，或者呕吐，这是阳明经表证；忽冷忽热，口苦胁肋疼痛，耳聋且呕吐，这是少阳经半表半里证。以上都是三阳经的表证。如果阳经的热邪不解，传入体内（里），怕冷身体疼痛未除，又加上小便不利，这是太阳经里证；如果怕冷身体疼痛头痛全部消失，脉象沉数而不浮，皮肤不热，口渴嘴唇焦裂，大量饮水以解渴，小便颜色红赤，大便干结，定时发热说胡话，手脚多汗，这是阳明经的里证；如果口干咽燥，口渴想喝水，或者自行腹泻排出纯清水，心窝处硬痛胀满，不大便，这是阳邪传入少阴经的里证；如果手脚自然温暖，或者出现全身发黄，或者腹部胀满结实疼痛，这是阳邪传入太阴经的里证；烦躁胀满，生殖器收缩，腹泻说胡话，腹中疼痛，排气，或者四肢厥冷却伴有发热，这是阳邪传入厥阴经的里证。以上都是三阳经的热邪，传入阴经而成为里证的情况，经络虽然属于阴，症状却表现为阳证。如果初起时两经同时出现症状，或者三经都发病，称为“合病”；如果是一经先发病未愈，而又出现另一经的症状，称为“并病”。凡是这些都属于伤寒的症状。
【伤寒的病因】人的腠理（皮肤纹理及毛孔）空虚疏松，偶然遇到时令的寒气，侵入肌表，郁结而发热，这是冬季患伤寒致病的成因。如果是炎热季节的人，体内有积热，又因为非时节的突然寒冷，外束皮毛，也会让人头疼身痛，怕冷发热，这就是其他三个季节的寒热病。
【伤寒的脉象】脉浮大表示在表，脉沉数表示在里。左关脉浮紧，是寒邪伤了太阳经。右关脉洪长，病在阳明经。左关脉弦数，病在少阳经。脉沉数实大，是阳明经里证。脉沉数细疾，是三阴经里热。
【伤寒的治疗】头疼腰痛，脉浮紧，无汗怕冷，这是太阳经寒邪伤了营分，张仲景在冬季使用麻黄汤，家传秘方使用[此处原文缺失方名，根据上下文推测可能指代某种变方或省略]。如果恶寒身痛发热，又加上小便不利，这是热结膀胱，乃太阳经里证，张仲景在冬季使用五苓散，家传秘方使用羌活木通汤。眼睛疼痛鼻子干燥失眠，脉弦长，这是阳明经表证，应当发汗，冬季用葛根汤，其余月份用葱白葛根汤。口渴想喝水，昼夜都发热，六脉洪数而长，这是阳明经半表半里证，应当清热，用干葛石膏汤。口燥舌苔黄，脉沉数而长，这是阳明腑证，里证，如果没有见到腹痛大便干结等可以使用下法的症状，用凉膈散清热；如果下法的症状全都具备，选用三承气汤。如果寒热未除，口苦耳聋，或者呕吐胸满，病还在少阳经，未入里，用小柴胡汤。如果阳经病不解，传入三阴，乃是阴经的阳证，口燥咽干而渴，腹部不胀，大便不干结，应当清里热；如果腹胀不大便，或者自行腹泻排出纯清水，心窝处硬痛，这是热邪传于少阴，有下法适应症的，选用大小承气汤。阳邪传入少阴，直到口燥咽干，体内津液即将枯竭，不得不紧急使用下法，以保存津液；如果手脚自然温暖，发热身黄，腹部胀满大实痛，这是热邪传于太阴，张仲景不设承气汤的下法，而立桂枝大黄汤来下之，因为太阴脾经是纯阴之脏，而且太阳的邪气传入太阴，所以用桂枝这味太阳经的药物，配合大黄的功效，既疏散太阳的表邪，又清除太阴的里热。烦躁胀满，生殖器收缩，脉数而四肢厥冷，先发热后厥冷，这是热深厥亦深，热邪进入厥阴经，张仲景不使用峻下法；因为先见发热，后来才发厥，手脚既然已经厥冷，不合峻下之法，所以立小承气汤，以示轻下之意，等待其手脚自然温暖，然后再议清热药，这样才算是缓转得当。按：伤寒里证涉及四经，一是阳明，一是少阴，一是太阴，一是厥阴。在阳明者，是阳经的热病；在三阴者，是阴经的热病，所以三阴经使用下药，比阳明经稍微轻一些。如果热邪虽然已经内传，然而没有下法的适应症，即使热在阴经，只可清热，不可攻下。如手少阴热极，神志昏迷不说话，像喝醉又像痴呆，不用承气汤，只用导赤各半汤、泻心汤等。所以下法，必须确切见到腹胀痛，大便干结，时常排气，想大便却排不出，手脚自然出汗，皮肤不热，面色不红，舌上有黄黑色干燥苔垢，才可以攻下；如果见到一点头疼身痛，怕冷发热，手脚未见自然出汗，就是表邪未尽，不可攻下。总之即使腹胀大便干结，不得不攻下，也只可用大柴胡汤，不可用承气汤，即使用小承气汤，也要加柴胡、干葛、羌活，仍然保留治疗三阳各经表证的药物，这样里热得以清除，而表邪有升散的药物，不至于内陷。这是使用下法而不碍表邪，看似下法，实则是和解的方法。这一章关于伤寒，特别阐明阴证和阳证两条，所以略注大纲条目，如果详细的治法，另注在《伤寒大白》书中。
桂枝汤
桂枝 白芍药 麻黄 甘草
陶氏用葛根替换去掉麻黄。
按：以上两个方子是张仲景治疗西北方冬季伤寒的方子；南方三个季节不宜使用。
羌活败毒散 此方治疗无汗发热，代替麻黄汤。
羌活 独活 柴胡 前胡 防风 荆芥 甘草 川芎
口干渴，去掉川芎，改用干葛，兼清阳明经。
羌活冲和汤
羌活 黄芩 防风 苍术 川芎 生地 细辛 白芷 甘草
唇干口渴，去掉川芎、细辛，用干葛替换白芷。胸前饱闷，去掉生地，加枳壳。
家秘冲和汤 此方治疗自汗发热，代替桂枝汤。
羌活 黄芩 防风 生地 白芷 白芍药 甘草
寒热，加柴胡；眼眶目痛口渴，加葛根，去白芷；小便赤，加木通；渴而有痰，加天花粉；渴而消水，加石膏；吐呕，加半夏；痞满，加枳实、黄连。
以上三方，其败毒散，治疗太阳经纯是表邪的症状；其冲和汤，治疗太阳经表有邪，里有热，用此方和解；其家秘冲和汤，治疗太阳经汗出，热不减的方子。
干葛汤
干葛 桂枝 麻黄 白芍药 甘草
陶氏用升麻替换麻黄；里有热，加石膏；时寒时热，加柴胡；恶寒身痛，加羌活；头痛，加川芎。前方去掉麻黄、桂枝，加荆芥、葱白，名为葱白干葛汤。
干葛石膏汤
干葛 知母 石膏 甘草
心烦躁，加麦冬、竹叶；呕而多痰，加半夏；烦渴痰多，加花粉；小便涩，加木通、灯心草。
小柴胡汤
柴胡 黄芩 广皮 半夏 甘草 人参
胸热痞满，去人参，加川连、枳壳；渴，去半夏，加花粉。
外感风寒，从毛窍而入，必要从毛窍而出，所以伤寒发热症，首要重视发表解肌。太阳篇说，初起病时，发汗不彻底，则转属阳明而病不解，只是由于汗出不彻底的缘故，再当发汗则痊愈。因为身体表面发热，没有不出汗而能凉的，如果汗虽然出了但仍然干燥，到底出汗不彻底，而热不退，必须得时时有汗，邪热才能解除。如果不分情况适宜与否，一概用北方的麻黄桂枝汤，治疗南方的温热病症，就会犯火闭无汗的错误，而热更严重。又有表邪烦热，失用解表，误用寒凉，则胃阳被抑制遏止，不能敷布作汗。又有外冒表邪，内有痰饮食滞，误用寒凉，凝结胃阳，怎么能作汗外解呢？发汗以治发热，人人知道；然而发汗不效，是因为不知道发汗的真诀在哪里，前书没有发明，后人糊涂到老。谁知道《伤寒论》首条用麻黄汤，治疗无汗发热，气逆喘满，独加杏仁，以调理肺气，暗示肺气壅遏，则皮毛闭郁，不能作汗，这是开发肺主皮毛，润肺气为发汗的真诀。又以桂枝汤，治疗有汗的发热，方下注明服药后，吃稀粥以助药力，这是暗示发热的症状，必须胃气空松，方能敷布作汗；如果汗出而邪不散，用桂枝汤解肌散邪，助以稀粥，则胃阳敷布，汗出而邪亦散。可见有汗的症状，胃无凝滞，可以吃稀粥；无汗的症状，胃家必有壅滞凝结，决不吃稀粥，这是开发胃主肌肉，疏利胃气，升发胃阳，为发汗的真诀。然而这是暗度金针，不是精心思考察觉不到的。至于头汗条中，则明言只有头部有汗，遍身无汗，都是水饮瘀热，凝结中焦，胃阳不能通达，隔绝周身升降的道路，所以遍身不得出汗，治疗以宣发胃气，疏通经络，我现在化裁创立败毒散中加枳壳桔梗桑白皮，宣通肺气，治疗风寒壅肺，喘逆发热无汗的症状；这是从麻黄杏仁理肺发汗中，化出的治法。又常用败毒散中加枳实厚朴半夏广皮，疏散胃滞，宣扬胃气，以治疗痰涎食滞，凝塞中焦，腹满发热无汗的症状，这是从头汗条中，及太阳表症，心下有水饮，用小青龙汤，化出的辛散水饮，宣发胃阳，敷布作汗的真诀，一名理肺发表汤，一名平胃发表汤。
Qin Zi said: I wrote the book *Shanghan Dabai* (Great Clarity on Cold Damage), establishing twenty-seven general discussions and seventy-two symptom treatments within it. I also provided detailed explanations of Zhang Zhongjing's original texts, gathering them under each respective symptom section; the content is detailed and exhaustive. Now that I am writing about miscellaneous diseases in large prescriptions, why add more redundancy? However, in Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage), "Zhonghan" (Direct Invasion of Cold) and "Shanghan" (Cold Damage) are named in the same volume. Although it has been noted that direct invasion into the Yin meridians constitutes a Yin syndrome, and transmission into the Yin meridians constitutes a Yang syndrome, later generations were unaware of this. They often confused Yang syndromes occurring in Yin meridians with Yin syndromes, mistakenly administering hot-natured agents, which led to untreatable conditions. I now name the cold syndrome directly invading the Yin meridians as "Zhonghan" (Direct Invasion of Cold), establishing it as a separate category. I name the heat syndrome caused by cold damaging the Yang meridians as "Shanghan" (Cold Damage), also establishing it as a separate category. This ensures clarity upon opening the book and prevents the error of misdiagnosing Yin and Yang.
[Symptoms of Shanghan] Headache, body pain, stiffness and rigidity of the waist and spine, aversion to cold, and fever are exterior syndromes of the Taiyang Meridian (Taiyang Channel). Eye pain, nasal dryness, insomnia, orbital pain, or dry mouth, or vomiting are exterior syndromes of the Yangming Meridian (Yangming Channel). Alternating chills and fever, bitter taste in the mouth, hypochondriac pain, deafness, and vomiting are half-exterior, half-interior syndromes of the Shaoyang Meridian (Shaoyang Channel). The above are all exterior syndromes of the Three Yang Meridians. If the heat pathogen in the Yang meridians does not resolve and transmits inward (to the interior), if aversion to cold and body pain remain but are accompanied by difficult urination, this is an interior syndrome of the Taiyang Meridian. If aversion to cold, body pain, and headache have completely resolved, the pulse is deep and rapid rather than floating, the skin is not hot, there is thirst with cracked lips, excessive water intake, red urine, and constipation, accompanied by tidal fever and delirious speech, and profuse sweating on the hands and feet, this is an interior syndrome of the Yangming Meridian. If there is dry mouth and throat, thirst with excessive water intake, or spontaneous diarrhea of pure clear water, hardness, pain, and fullness in the epigastrium, and constipation, this is an interior syndrome where the Yang pathogen has transmitted to the Shaoyin Meridian (Shaoyin Channel). If the hands and feet are naturally warm, or there is generalized jaundice, or abdominal fullness and solid pain, this is an interior syndrome where the Yang pathogen has transmitted to the Taiyin Meridian (Taiyin Channel). Restlessness and fullness, contraction of the genitals, diarrhea with delirium, abdominal pain, flatus, or cold extremities accompanied by fever, this is an interior syndrome where the Yang pathogen has transmitted to the Jueyin Meridian (Jueyin Channel). The above are all cases where heat pathogens from the Three Yang Meridians transmit to the Yin meridians to become interior syndromes. Although the meridians belong to Yin, the symptoms manifest as Yang syndromes. If symptoms appear simultaneously in two meridians at the onset, or all three meridians are affected, it is called "Hebing" (Combined Disease). If one meridian is diseased first and remains unresolved before another meridian shows symptoms, it is called "Bingbing" (Concurrent Disease). All these are symptoms of Shanghan.
[Etiology of Shanghan] When a person's couli (pores and interstices) are loose and sparse, and they accidentally encounter seasonal cold, which enters the muscle and surface, stagnates, and generates fever, this is the cause of Shanghan disease in winter. For individuals in hot seasons who have accumulated heat internally, if they are subjected to sudden unseasonal cold externally binding the skin and hair, it will also cause headache, body pain, aversion to cold, and fever. This is the cold-heat disease of the other three seasons.
[Pulse of Shanghan] Floating and large pulses indicate exterior conditions; deep and rapid pulses indicate interior conditions. A floating and tight pulse at the left Guan position indicates cold damaging the Taiyang Meridian. A surging and long pulse at the right Guan position indicates disease in the Yangming Meridian. A wiry and rapid pulse at the left Guan position indicates disease in the Shaoyang Meridian. A deep, rapid, solid, and large pulse indicates an interior syndrome of the Yangming Meridian. A deep, rapid, fine, and hurried pulse indicates interior heat of the Three Yin Meridians.
[Treatment of Shanghan] Headache, lower back pain, floating and tight pulse, no sweat, and aversion to cold indicate that cold has damaged the Ying (Nutritive) level of the Taiyang Meridian. Zhang Zhongjing used Mahuang Tang (Ephedra Decoction) in winter; my family secret formula uses [formula omitted in source]. If there is aversion to cold, body pain, fever, plus difficult urination, this indicates heat binding in the Bladder, an interior syndrome of the Taiyang Meridian. Zhang Zhongjing used Wuling San (Five-Ling Powder) in winter; my family secret formula uses Qianghuo Mutong Tang (Notopterygium and Akebia Decoction). Eye pain, nasal dryness, insomnia, and a wiry-long pulse indicate an exterior syndrome of the Yangming Meridian; diaphoresis should be induced. Ge Gen Tang (Kudzu Decoction) is used in winter, and Congbai Ge Gen Tang (Scallion Stem and Kudzu Decoction) in other months. Thirst with excessive water intake, fever day and night, and surging-rapid-long pulses in all six positions indicate a half-exterior, half-interior syndrome of the Yangming Meridian; clearing heat is indicated using Gange Shigao Tang (Kudzu and Gypsum Decoction). Dry mouth, yellow tongue coating, and deep-rapid-long pulses indicate a Fu-organ interior syndrome of the Yangming Meridian. If symptoms requiring purgation such as abdominal pain and constipation are absent, Liangge San (Cooling the Diaphragm Powder) is used to clear heat. If all purgative indications are present, one of the Three Chengqi Decoctions is selected. If chills and fever persist, along with bitter taste, deafness, vomiting, and chest fullness, the disease remains in the Shaoyang Meridian and has not entered the interior; Xiao Chaihu Tang (Minor Bupleurum Decoction) is used. If the Yang meridians do not resolve and transmit to the Three Yin meridians, it becomes a Yang syndrome in the Yin meridians. With dry mouth, throat, and thirst, but without abdominal distension or constipation, clearing interior heat is indicated. If there is abdominal distension and constipation, or spontaneous diarrhea of pure clear water, and hardness/pain in the epigastrium, heat has transmitted to Shaoyin. If purgative indications exist, Da Chengqi Tang (Major Order the Qi Decoction) or Xiao Chengqi Tang (Minor Order the Qi Decoction) is selected. When Yang pathogen transmits to Shaoyin, causing extreme dry mouth and throat with depletion of internal fluids, urgent purgation is necessary to preserve Jin-Ye (Body Fluids). If hands and feet are naturally warm, with fever, jaundice, and severe abdominal fullness/pain, heat has transmitted to Taiyin. Zhang Zhongjing did not use Chengqi formulas for this but established Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction). Since the Spleen of Taiyin is a purely Yin organ, and Taiyang pathogen transmits to Taiyin, Guizhi (Cinnamon Twig) treats the Taiyang exterior while Dahuang (Rhubarb) clears Taiyin interior heat. Restlessness, fullness, genital contraction, rapid pulse with cold extremities, initial fever followed by coldness, indicates "deep heat leads to deep coldness," with pathogen entering Jueyin. Zhang Zhongjing did not use strong purgation because initial fever followed by cold extremities contraindicates harsh purgation; thus, Xiao Chengqi Tang was established to indicate mild purgation. Wait for hands and feet to warm up before considering heat-clearing herbs. Note: Interior syndromes of Shanghan involve four meridians: Yangming, Shaoyin, Taiyin, and Jueyin. In Yangming, it is a Yang-meridian heat disease; in the Three Yin, it is a Yin-meridian heat disease. Therefore, purgatives for the Three Yin are slightly milder than for Yangming. If heat has transmitted internally but lacks purgative indications, even if heat is in a Yin meridian, only clearing is allowed, not purgation. For example, extreme heat in Hand-Shaoyin causing coma, muteness, drunkenness-like state, does not use Chengqi Tang but Daochi Banjie Tang (Half-Half Guide Outward Decoction) or Xiexin Tang (Drain Epigastrium Decoction). Thus, purgation requires definite signs: abdominal pain/distension, constipation, frequent flatus, inability to defecate despite urge, spontaneous sweating on hands/feet, non-hot skin, non-red face, and yellow-black dry tongue coating. If any headache, body pain, aversion to cold, fever, or lack of spontaneous sweating on extremities exists, exterior pathogen is not exhausted, and purgation is forbidden. Even if abdominal distension and constipation necessitate purgation, use Dachaihu Tang (Major Bupleurum Decoction) instead of Chengqi Tang. If Xiao Chengqi Tang is used, add Chaihu (Bupleurum), Genge (Kudzu), and Qianghuo (Notopterygium) to treat residual exterior symptoms of the Three Yang meridians. This clears interior heat while allowing exterior pathogen to ascend and disperse, preventing internal collapse. This method of purgation does not hinder the exterior pathogen; it appears to be purgation but is actually a harmonizing method. This chapter clarifies Yin and Yang syndromes separately, so only outlines are noted here; detailed treatments are in *Shanghan Dabai*.
Mahuang Tang (Ephedra Decoction): Ephedrae Herba (Mahuang), Cinnamomi Ramulus (Guizhi), Armeniacae Semen Amarum (Xingren), Glycyrrhizae Radix et Rhizoma (Gancao). Tao’s addition: Chuanxiong Rhizoma (Chuanxiong), Saposhnikoviae Radix (Fangfeng), Notopterygii Rhizoma et Radix (Qianghuo).
Guizhi Tang (Cinnamon Twig Decoction): Cinnamomi Ramulus (Guizhi), Paeoniae Radix Alba (Baishao), Ephedrae Herba (Mahuang), Glycyrrhizae Radix et Rhizoma (Gancao). Tao replaced Mahuang with Puerariae Radix (Ge Gen).
Note: These two formulas are for treating winter Shanghan in Northwest China; unsuitable for the three seasons in the South.
Qianghuo Baidu San (Notopterygium Resolving Toxin Powder): Treats fever without sweat, replacing Mahuang Tang. Ingredients: Notopterygii Rhizoma et Radix (Qianghuo), Angelicae Dahuricae Radix (Duhuo - *Note: Text says Du Huo*), Bupleuri Radix (Chaihu), Peucedani Radix (Qianhu), Saposhnikoviae Radix (Fangfeng), Schizonepetae Spica (Jingjie), Glycyrrhizae Radix et Rhizoma (Gancao), Chuanxiong Rhizoma (Chuanxiong). For dry mouth/thirst, remove Chuanxiong, substitute with Puerariae Radix (Ge Gen) to clear Yangming.
Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction): Notopterygii Rhizoma et Radix (Qianghuo), Scutellariae Radix (Huangqin), Saposhnikoviae Radix (Fangfeng), Atractylodis Rhizoma (Cangzhu), Chuanxiong Rhizoma (Chuanxiong), Rehmanniae Radix Preparata (Shengdi), Asari Radix et Rhizoma (Xixin), Angelicae Dahuricae Radix (Baizhi), Glycyrrhizae Radix et Rhizoma (Gancao). For dry lips/thirst, remove Chuanxiong and Xixin, replace Baizhi with Ge Gen. For chest fullness, remove Shengdi, add Aurantii Fructus (Zhiqiao).
Jiami Chonghe Tang (Family Secret Harmonizing Decoction): Treats spontaneous sweating with fever, replacing Guizhi Tang. Ingredients: Notopterygii Rhizoma et Radix (Qianghuo), Scutellariae Radix (Huangqin), Saposhnikoviae Radix (Fangfeng), Rehmanniae Radix Preparata (Shengdi), Angelicae Dahuricae Radix (Baizhi), Paeoniae Radix Alba (Baishao), Glycyrrhizae Radix et Rhizoma (Gancao). Add Chaihu for chills/fever; add Ge Gen and remove Baizhi for eye/orbital pain/thirst; add Akebiae Caulis (Mutong) for red urine; add Trichosanthis Radix (Tianhuafen) for thirst with phlegm; add Gypsum Fibrosum (Shigao) for thirst with excessive water intake; add Pinelliae Rhizoma Preparatum (Banxia) for vomiting; add Zhiqiao and Huanglian for stuffiness/fullness.
Among these three, Baidu San treats pure exterior pathogen in Taiyang; Chonghe Tang treats exterior pathogen with interior heat in Taiyang (harmonizing); Jiami Chonghe Tang treats Taiyang with sweating and persistent fever.
Qianghuo Mutong Tang: Notopterygii Rhizoma et Radix (Qianghuo), Akebiae Caulis (Mutong). Decoct together.
Gegen Tang (Kudzu Decoction): Puerariae Radix (Gegen), Cinnamomi Ramulus (Guizhi), Ephedrae Herba (Mahuang), Paeoniae Radix Alba (Baishao), Glycyrrhizae Radix et Rhizoma (Gancao). Tao replaces Mahuang with Cimicifugae Rhizoma (Shengma). Add Shigao for interior heat; add Chaihu for alternating chills/fever; add Qianghuo for aversion to cold/body pain; add Chuanxiong for headache. Removing Mahuang and Guizhi, adding Jingjie and Congbai creates Congbai Gegen Tang (Scallion Stem and Kudzu Decoction).
Gegen Shigao Tang (Kudzu and Gypsum Decoction): Puerariae Radix (Gegen), Anemarrhenae Rhizoma (Zhimu), Gypsum Fibrosum (Shigao), Glycyrrhizae Radix et Rhizoma (Gancao). Add Ophiopogonis Radix (Maidong) and Lophatheri Herba (Zhuye) for restlessness; add Banxia for vomiting with phlegm; add Tianhuafen for烦渴 (restless thirst) with phlegm; add Mutong and Dengcaoxin (Lampwick Grass Tip) for astringent urination.
Xiao Chaihu Tang (Minor Bupleurum Decoction): Bupleuri Radix (Chaihu), Scutellariae Radix (Huangqin), Citri Reticulatae Pericarpium (Guangpi), Pinelliae Rhizoma Preparatum (Banxia), Glycyrrhizae Radix et Rhizoma (Gancao), Ginseng Radix (Renshen). Remove Renshen and add Coptidis Rhizoma (Chuanlian) and Zhiqiao for chest heat/stuffiness; remove Banxia and add Tianhuafen for thirst.
Liangge San (Cooling the Diaphragm Powder): Gardeniae Fructus (Shanzhi), Scutellariae Radix (Huangqin), Coptidis Rhizoma (Chuanlian), Trichosanthis Radix (Tianhuafen), Forsythiae Fructus (Lianqiao), Menthae Haplocalycis Herba (Bohe), Platycodonis Radix (Jiegeng), Glycyrrhizae Radix et Rhizoma (Gancao).
Da Chengqi Tang (Major Order the Qi Decoction): Rheii Radix et Rhizoma (Dahuang), Natrii Sulfas (Mangxiao), Immaturus Trilobitae Citri Fructus (Zhishi), Magnoliae Officinalis Cortex (N Houpo). Removing Mangxiao yields Xiao Chengqi Tang.
Tiaowei Chengqi Tang (Regulate Stomach Order the Qi Decoction): Dahuang, Mangxiao, Gancao. Family secret adds Guangpi.
Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction): Cinnamomi Ramulus (Guizhi), Dahuang, Baishao, Gancao.
Daochi Banjie Tang (Guide Outward Half-Half Decoction): See Stroke section.
Exogenous Wind-Cold enters via pores and must exit via pores. Therefore, treating fever in Shanghan prioritizes releasing the exterior and resolving the muscles. The Taiyang Chapter states: If diaphoresis is incomplete at onset, the condition may transfer to Yangming and remain unresolved due to insufficient sweating; re-inducing diaphoresis will cure it. Body surface fever cannot subside without sweating. If sweat occurs but skin remains dry, sweating is incomplete, and fever persists. Continuous sweating is required for heat resolution. Applying Northern Mahuang/Guizhi formulas indiscriminately to Southern warm-heat diseases causes fire-closure and no sweat, worsening heat. If exterior pathogen causes irritability/heat and cooling herbs are mistakenly used, Stomach Yang is suppressed, preventing sweat distribution. If exterior pathogen coexists with internal phlegm/food stagnation, cooling herbs congeal Stomach Yang, preventing sweat. Everyone knows diaphoresis treats fever, but failure stems from ignorance of the true principle. Zhang Zhongjing’s first line uses Mahuang Tang for fever without sweat, wheezing, and qi reversal, adding Xingren to regulate Lung Qi. This implies that Lung Qi obstruction causes pore closure, preventing sweat; moistening Lung Qi is the key to diaphoresis. Guizhi Tang treats fever with sweat. Post-medication rice gruel aids efficacy, implying that empty/loose Stomach Qi facilitates sweat distribution. If sweat fails to dispel pathogen, Guizhi Tang resolves muscles and disperses pathogen; rice gruel assists Stomach Yang to distribute sweat and disperse pathogen. Thus, sweating syndromes allow rice gruel (no Stomach stagnation); non-sweating syndromes imply Stomach congestion (no rice gruel). Developing Stomach Qi and ascending Stomach Yang is the true key to diaphoresis. Regarding head-sweat: isolated head sweating with no body sweat indicates fluid retention and stasis-heat congealing in the Middle Jiao, blocking Stomach Yang and circulation. Treatment involves promoting Stomach Qi and unblocking collaterals. I modified Baidu San by adding Zhiqiao, Jiegeng, and Sangbaipi to promote Lung Qi, treating Wind-Cold congesting the Lung with wheezing, fever, and no sweat. This derives from Mahuang/Xingren Lung-regulating diaphoresis. Also, adding Zhishi, Houpo, Banxia, and Guangpi to Baidu San disperses Stomach stagnation and promotes Stomach Qi to treat phlegm/food stagnation in the Middle Jiao causing abdominal fullness, fever, and no sweat. This derives from the head-sweat section and Taiyang exterior syndrome with fluid retention under the heart, modified from Xiao Qinglong Tang. This reveals the true principle of acrid-dispelling fluid retention, promoting Stomach Yang, and distributing sweat, named Lipu Fabiao Tang (Lung-Regulating Exterior-Releasing Decoction) or Pingwei Fabiao Tang (Stomach-Pacifying Exterior-Releasing Decoction).