【按】病者服此方后，绝不汗出。阅者或疑余作诳言，安有服麻桂各五钱，而无反响者乎？非也，有其故在。缘病者未进药之先，自以为大便不通，误用泻盐下之。及其中气内陷，其脉即由浮紧转为微细，故虽服麻黄汤，而汗勿出。二诊，师加附子以振心阳，救逆而差，此不汗出之因于误治者也。余更目覩师治史惠甫君之弟，发热，恶寒，无汗，用麻桂各三钱，一剂，亦绝不汗出。二剂加量，方得微似汗解。其故安在？盖史君弟执业于鸿昌造船厂，厂址临江，江风飒飒，史弟平日督理工场之间，固曾饱尝风露者，此不汗出之因于地土者也。又余在广益医院治一人，衣冠楚楚，发热，恶寒，无汗，头痛，与麻桂各三钱，余药称是。
次日二诊，谓服药后，了无交化。嘱再服原方。三诊又然。予疑院中药量不足，嘱改从药铺购服。四诊，依然未汗出，予万思不得其故。及细询其业，曰：予包车夫也。至是，予方恍然。盖若是之人，平日惯伍风寒，本不易受风寒之侵袭。若果受其侵袭，则其邪必较常人为重，此不汗出之因于职业者也。然凡此诸例，其不汗出，犹可理解。余又曾治一妊妇肿病，面日手足悉肿。一时意想所至：径予麻黄汤加味。次日覆诊，肿退其半。问曾汗出否？曰，否。问小便较多否？又曰，否。然余未之信也，予原方加减。三日，肿将退净，仍问其汗与小便各如何？则又绝口否认。倘其言果属真切，则若不曰：水化为气，无形外泄，而承认生理学上之所谓潜汗，直无理足以释之。嘻，病情万变，固有不可以常理格之者，惟亲历者能信是言。
曹颖甫曰：发热恶寒无汗，而两脉浮紧者，投以麻黄汤，无不应手奏效。辛未六月，有乡人子因事居舍弟裔伯家，卒然觏病，发热恶寒，拥被而卧。寒战不已。长女昭华为疏麻黄汤。服后，汗出神昏，裔伯大恐。不谕时，沈沈睡去，日幕始醒，病若失。大约天时炎热，药剂太重，以致神昏，非有他也。今年阴历十一月初一日，予在陕西渭南县，交通银行行长曹某之弟志松病，发热无汗脉浮紧，予用麻黄三钱，桂枝四钱，生草三钱，杏仁五钱，服后，微汗出，脉微，嗜卧，热退，身凉，不待再诊，病已愈矣。又记昔在丁甘仁先生家，课其孙济华昆季，门人裴德炎因病求诊于济万，方治为荆防等味，四日，病无增减，亦不出汗。乃招予往诊，予仅用麻黄二钱，桂枝一钱半，杏仁三钱，生草一钱。明日，德炎不至，亦不求再诊，予甚疑之。越日，德炎欣然而来曰，愈矣。予按伤寒始病脉之所以浮紧者，以邪正交争于皮毛肌腠间，相持而不下也。一汗之后，则皮毛肌腠已开，而邪正之交争者解矣。世人相传麻黄多用亡阳，而悬为厉禁，然则病太阳伤寒者，将何自而愈乎？
葛根汤证其一
封姓缝匠，病恶寒，遍身无汗，循背脊之筋骨疼痛不能转侧，脉浮紧。余诊之曰：此外邪袭于皮毛，故恶寒无汗，况脉浮紧，证属麻黄，而项背强痛，因邪气已侵及背输经络，比之麻黄证更进一层，宜治以葛根汤。
葛根五钱麻黄三钱桂枝二钱白芍三钱甘草二钱生姜四片红枣四枚方意系借葛根之升提，达水液至皮肤，更佐麻黄之力，推运至毛孔之外。两解肌表，虽与桂枝二麻黄一汤同意，而用却不同。服后顷刻，觉背内微热，再服，背汗遂出，次及周身，安睡一宵，病遂告差。
【按】葛根汤主治温病者也。学者当知今人所谓温病，非仲圣所谓温病。仲圣所谓温病，非今人所谓温病。吾人先具今人温病之概观，乃读《伤寒论》温病之条文，无怪格不相入。我姑仿狭义伤寒，广义伤寒之例，当日仲圣所谓温病乃狭义温病，今人所谓温病乃广义温病。虽然，我但愿学者心知此意，我却不愿杜撰名辞，转滋纠纷。今为求名正言顺计，不妨称仲圣之所谓温病为太阳温病，如是，即可别于今人之所谓温病。称仲圣之所谓伤寒，与温病对称者，为太阳伤寒，如是，即可别于《伤寒论》广义之伤寒。称仲圣之所谓中风，与伤寒对称者，为太阳中风，如是，即可别于杂病中之中风。命名既定，乃论大旨。
然则太阳温病之异于太阳中风太阳伤寒者何在乎？余斗胆，敢揭一旨。曰：太阳中风太阳伤寒是皆太阳病之津液未伤者也。若其人先自伤津，续得太阳病，是即太阳温病。是故伤津二字，实为太阳温病之内蕴，此乃绝无可疑者。惟其内津已伤，不能上承口舌，故作渴。故仲圣曰：太阳病，发热，而渴，……者，为温病。且将渴字特置于而字之下，以彰其首要。惟其内津已伤，不能注输背脊，故非但头痛项强，且进而为背部亦强几几矣。故仲圣曰：太阳病，项背强几几，……葛根汤主之。是故渴与项背强几几同是伤津之外证，实一而二，二而一者也。
学者既已知渴与项背强几几同为太阳温病葛根汤证之主证，更可由此左右推求，自得逢源之乐。例如由太阳温病之渴，可以推知太阳中风太阳伤寒之不渴。
故恽铁樵先生教学子谓：桂枝汤麻黄汤当同以口中和为主证云云。学子遵此施治，不啻指南良针。实则口中和即不渴之易辞，不渴即由太阳温病之渴字悟来。仲圣待人以智，故遂不自觉其言之约耳。更例如由太阳温病之项背强几几，可以推知太阳痉病之背反张,身体强几几然者，乃疾病之传变也。诚以项背强几几尚为津伤邪袭之轻者，若治不如法，更汗下伤其津，势必背反张,身体强几几然，而为进一层之痉病矣。此《伤寒》《金匮》之可以通释者也。
阅者必将发问曰：然则《伤寒论》温病条下之若发汗已，身灼热者，名曰风温又作如何解说？答曰：此乃仲圣后人之注语，非仲圣原文也。虽然，彼为仲圣之后人，犹为吾侪之前贤，故其言非无理致。彼之意若曰：假使逢太阳温病之葛根汤症，医者误认为太阳伤寒之麻黄汤证，径予麻黄汤以发其汗，则汗虽出，表虽解，必将引起全身之灼热，必不克一剂而竟全功，若是者，其初病非为伤寒，实为温病。但嫌温病之病字与太阳病之病字重，故不若改称风温，因葛根汤原有麻桂以治风，葛根以治温也。由是观之，风温即是温病之别名，初不必另眼视之。又此风温与近日温热家所说之风温亦异，为免除混淆计，宁削而不论。抑尤有进者，学者当知发汗已，身灼热，并非绝对坏病之渭，不过由太阳转入阳明。此时但随其证，或用白虎以清之，或用麻杏甘石以开之，或用葛根芩连以折之，其病即得全差，初不必过事张皇。惟经方家之治病，其可以一剂愈者，不当用二剂，即其可以用葛根汤一剂全愈者，不当用麻黄汤使人阳明，以致二剂而愈。
阅者又将问曰：然则《伤寒论》原文风温为病，脉阴旧俱浮，自汗出，身重，多眠睡，鼻息必鼾，语言难出，若被下者，小便大利，直视，失溲，若被火者，微发黄色，剧则如惊癎，时瘈疭，若火熏之，一逆尚引日，再逆促命期。
又作如何解说？答曰：此亦仲圣后人之言也。注家有视此为错误，任意颠倒改易，以求曲符己意者矣。是乃窃所不取。细按此条大意，重在申明二禁，一禁被下，二禁被火。何以禁下？盖下为阳明正治，今温病病在太阳，未到阳明，故不可下，下之将更伤其津。何以禁火？盖温病津液既已内伤，安堪更以火灼烁之？如此治之，是为一逆再逆。逆之重者，促命期。逆之轻者，或语言难出，或直视，或惊癎，或瘈疭，合考种种证状，无一不由津液内竭，神经失其濡养所致。或小便不利，则伤津之重者，几无余液足以外泄。或微发黄色，则津竭血溶，血液变色，尤为显明之病理。夫下与被火未始合于太阳中风太阳伤寒之治，今独在温病条下剀切告诫者，抑亦何哉？无非中风伤寒者津液未伤，虽误下误火，逆犹不甚，今温病者津液已伤，实未许毫厘误治故也。呜呼，前贤之旨微矣！
葛根汤证其二
葛根汤方治取效之速，与麻黄汤略同。且此证兼有渴饮者。予近日在陕州治夏姓一妇见之。其证太阳穴剧痛，微恶寒，脉浮紧，口燥，予用：葛根六钱麻黄二钱桂枝三钱白芍三钱生草一钱天花粉四钱枣七枚按诊病时已在南归之前晚，亦未暇问其效否。及明日，其夫送至车站，谓夜得微汗，证已全愈矣。予盖因其燥渴，参用括萎桂枝汤意。吾愿读经方者，皆当临证化裁也。
【按】本案为吾师所亲撰。夏姓妇所病者即太阳温病也。向使吾师用葛根汤原方，未始不可优治之。今又以花粉易生姜，则更为恰切。
虽然，读者于此，有不能释疑者在焉。曰：温病条言不恶寒，葛根汤条言恶风，风寒本属互称，如是得毋自相矛盾？答曰：此正仲圣之互文见意处，可以深长思者也。夫曰风寒为互称，此言不谬。但当知寒为重，风为轻，恶寒为重，恶风为轻。故温病及葛根汤二条合一之后，即成恶风不恶寒。其意犹曰微恶风寒，节言之，即本案吾师所谓微恶寒是也。为其尚不能尽脱恶寒本色，而合于太阳首条提纲之旨，故仲圣称此为太阳病。又为其兼口渴津伤，易于化热，故仲圣称此为太阳温病。
历来伤寒注家有一绝大错误，贤贤相承，莫能自觉者，即以温病为阳明病是也。佐景觉之，不容缄默；夫依吾说，温病为太阳病之一纲，判然异于阳明病，固矣，然窃以为尚有辨证之法在。大论曰：问曰：阳明病，外证云何？答曰：……反恶热也。然则恶热者方为阳明病，其但渴而不恶热之温病得称阳明病乎？然则恶热者当用膏知硝黄，其俱渴而不恶热者得用辛温发散之麻桂，仲圣于此又岂非暗暗点明乎？余之旨，盖在于此。今试排列太阳阳明之主证如下：
太阳伤寒 或已发热或未发热 恶风恶寒
太阳中风 发热 恶风
太阳温病 发热而渴 恶风不恶寒
阳明 发热谵语 不恶寒反恶热
阅者试察上表，其中层次何等分明。太阳伤寒当或未发热恶寒之时，完全为寒象，且不但曰恶风，兼曰恶寒，显见其恶风寒之重。至太阳中风，即但曰发热，显无或未发热之时，且但曰恶风，不兼曰恶寒，显见其恶风寒之轻。至太阳温病，不但曰发热,且加渴以示其津液之伤，曰恶风，又曰不恶寒，显见其恶风寒之微。至阳明，其甚者曰谵语，以示其津竭之后，神经且受热灼矣，又曰反恶热，至此完全为热象，与太阳伤寒之完全为寒象者适相反。由是吾人可得外感疾病传变之第一原则，曰由寒化热是也。此原则实为吾人依经探讨之收获，而温病之不得称为阳明病，又其余事也矣！
葛根汤证其三
予昔在西门内中医专校授课，无暇为人治病，故出诊之日常少。光华眼镜公司有袁姓少年，其岁八月，卧病四五日，昏不知人。其兄欲送之归，延予诊视以决之。余往诊，日将暮。病者卧榻在楼上，悄无声息。余就病榻询之，形无寒热，项背痛，不能自转侧。诊其脉，右三部弦紧而浮，左三部不见浮象，按之则紧，心虽知为太阳伤寒，而左脉不类。时其兄赴楼下取火，少顷至。予曰：乃弟沈溺于酒色者乎？其兄曰：否，惟春间在汕头一月，闻颇荒唐，宿某妓家，挥金且甚巨。予曰：此其是矣。今按其左脉不浮，是阴分不足，不能外应太阳也。然其舌苔必抽心，视之，果然。予用：葛根二钱桂技一钱麻黄八分白芍二钱炙草一钱红枣五枚生姜三片予微语其兄曰：服后，微汗出，则愈。若不汗，则非予所敢知也。
临行，予又恐其阴液不足，不能达汗于表，令其药中加粳米一酒杯，遂返寓。明早，其兄来，求复诊。予往应之，六脉俱和。询之，病者曰：五日不曾熟睡，昨服药得微汗，不觉睡去。比醒时，体甚舒展，亦不知病于何时去也。随请开调理方。予曰：不须也，静养二三日足矣。闻其人七日后，即往汉口经商云。
【按】《素问·金匮真言论》曰：夫精者，身之本也。故藏于精者，春不病温。《生气通天论》曰：冬伤于寒，春必病温。此数语也，凡习中医者类能道之。然而议论纷纷，每悖经旨。佐景不敏，请以本案袁姓少年病为《内经》之注释可也。简言之，袁姓少年宿妓荒唐，不藏于精，故生温病。治之以葛根汤，应手而起者，以葛根汤为温病之主方故也。夫精者，津之聚于一处者也。津者，精之散于周身者也。故精与津原属一而二，二而一之物。其人平日既不藏精，即是津液先伤，及其外受邪风之侵，乃不为太阳中风，亦不为太阳伤寒，而独为太阳温病，乃不宜乎桂枝汤，亦不宜乎麻黄汤，而独宜乎葛根汤。此《内经》《伤寒》之可以通释者也。
抑尤有当知者，藏精之要，初不必限于冬时，然尤以冬时为甚。故《伤寒例》曰：冬时严寒，万类深藏。君子固密，则不伤于寒。触冒之者，乃名伤寒耳。温病之成，初不必限于春日，观袁姓少年之呻吟于仲秋可知，然尤以春日为甚。盖春继冬来，于时为迩，冬不闭藏，使扰乎阳，则春不发陈，无能随天地万物以俱生荣也。精之泄，初不必限于男女之间，凡志勤而多欲，心怵而常惧，形劳而致倦，高下必相慕，嗜欲伤目，淫邪惑心者，是皆不藏于精之类也，然尤以直耗肾精为甚。故吾人可作结论曰：冬不藏精，春必病温。必，犹言多也。此经旨之所当达观者也。
【按语】患者服用此方后，完全没有出汗。读者或许怀疑我在说假话，难道服用了各五钱的麻黄和桂枝，竟然没有反应吗？不是这样的，其中另有原因。因为患者在服药之前，自认为大便不通，误用了泻盐进行攻下。等到中气内陷之后，脉象就由浮紧转为微细，所以虽然服用了麻黄汤，但汗液无法排出。第二次诊治时，老师加入附子以振奋心阳，挽救逆证而痊愈，这是不汗出由于误治造成的。我又亲眼目睹老师治疗史惠甫先生的弟弟，症状为发热、恶寒、无汗，使用麻黄和桂枝各三钱，一剂药后，也完全没有出汗。服用两剂并增加剂量后，才得到微微似有汗出的解表效果。这是什么原因呢？原来史先生的弟弟在鸿昌造船厂工作，厂址临江，江风飒飒，史先生弟弟平日在工地督工，确实饱尝过风露，这是不汗出由于地理环境造成的。另外，我在广益医院治疗一个人，衣着光鲜，症状为发热、恶寒、无汗、头痛，给予麻黄和桂枝各三钱，其他药物分量相当。
第二天复诊，他说服药后，身体没有任何变化。嘱咐再服用原方。第三次诊治依然如此。我怀疑医院里的药量不足，嘱咐他改从药店购买服用。第四次诊治，依然没有出汗，我绞尽脑汁也想不出原因。等到详细询问他的职业，他说：我是包车夫。到了这时，我才恍然大悟。像这样的人，平日习惯于与风寒打交道，本来就不容易受到风寒的侵袭。如果果然受到风寒侵袭，那么邪气一定比常人更重，这是不汗出由于职业造成的。然而以上这些例子，其不汗出还可以理解。我又曾治疗一个孕妇水肿病，面部和手足全部肿胀。一时灵机一动：直接给予加味的麻黄汤。第二天复诊，肿胀消退了一半。问他是否出汗了？他说：没有。问小便是否增多？他又说：没有。但我当时并不相信，于是给予原方加减。三天后，肿胀即将退净，再次询问他的汗和小便情况如何？他却坚决否认。如果他的话属实，那么如果不说是“水化为气，无形外泄”，而要承认生理学上所谓的潜汗，简直没有道理可以解释。唉，病情千变万化，本来就有不能用常理来衡量的，只有亲身经历的人才能相信这句话。
曹颖甫说：发热、恶寒、无汗，且两手脉象浮紧的，投用麻黄汤，没有不立刻见效的。辛未年六月，有个同乡人的孩子因事住在我弟弟裔伯家，突然生病，发热、恶寒，裹着被子躺着。寒战不止。长女昭华为他开了麻黄汤。服用后，出汗且神志昏迷，裔伯非常惊恐。不到半天时间，沉沉睡去，直到日落才醒来，病好像消失了。大约是因为天气炎热，药剂太重，导致神志昏迷，没有其他问题。今年农历十一月初一，我在陕西渭南县，交通银行行长曹某的弟弟志松生病，发热、无汗、脉浮紧，我使用麻黄三钱、桂枝四钱、生甘草三钱、杏仁五钱，服用后，微微出汗，脉象微弱，嗜睡，热退，身凉，不需要再诊，病已经好了。又记得以前在丁甘仁先生家，教他的孙子济华兄弟，门人裴德炎因病求诊于济万，方剂治疗用的是荆芥、防风等药，四天，病情没有增减，也没有出汗。于是邀请我去诊治，我只用了麻黄二钱、桂枝一钱半、杏仁三钱、生甘草一钱。第二天，德炎没来，也不要求再诊，我很疑惑。过了几天，德炎高兴地来了，说：病好了。我分析伤寒初起脉象之所以浮紧，是因为邪正交争于皮毛肌腠之间，相持不下。一次发汗之后，皮毛肌腠已开，邪正交争也就解除了。世人相传麻黄多用会导致亡阳，并将其列为严厉禁忌，那么患太阳伤寒病的人，将从何途径痊愈呢？
葛根汤证其一
姓封的裁缝，患病表现为恶寒，全身无汗，沿着背脊的筋骨疼痛不能转身，脉象浮紧。我诊断说：这是外邪侵袭皮毛，所以恶寒无汗，况且脉象浮紧，证候属于麻黄汤证，但项背部僵硬疼痛，是因为邪气已经侵入背部的输注经络，比麻黄汤证更进一步，适宜用葛根汤治疗。
葛根五钱 麻黄三钱 桂枝二钱 白芍三钱 甘草二钱 生姜四片 红枣四枚 方义是借助葛根的升提作用，将水液输送到皮肤，再辅助麻黄的力量，推运至毛孔之外。两解肌表，虽然与桂枝二麻黄一汤的意思相同，但用法却不同。服用后片刻，感觉背部内部微微发热，再服用，背部出汗，接着遍及全身，安稳睡了一夜，病就好了。
【按语】葛根汤主治的是温病。学者应当知道，今人所说的温病，不是仲景所说的温病；仲景所说的温病，也不是今人所说的温病。我们先具备今人温病的概观，再去读《伤寒论》中关于温病的条文，就不会觉得格格不入。我姑且模仿狭义伤寒、广义伤寒的例子，称仲景所说的温病为狭义温病，今人所说的温病为广义温病。虽然这样，我希望学者心里明白这个意思，我却不愿意杜撰名词，反而增添纠纷。现在为了追求名正言顺，不妨称仲景所说的温病为太阳温病，这样，就可以区别于今人所说的温病。称仲景所说的伤寒，与温病对称的，称为太阳伤寒，这样，就可以区别于《伤寒论》广义的伤寒。称仲景所说的中风，与伤寒对称的，称为太阳中风，这样，就可以区别于杂病中的中风。命名确定之后，再论述大意。
那么太阳温病与太阳中风、太阳伤寒的不同在哪里呢？我斗胆，敢揭示一个主旨。说：太阳中风、太阳伤寒都是太阳病中津液未受损的情况。如果这个人先损伤了津液，随后得了太阳病，这就是太阳温病。因此，“伤津”二字，实际上是太阳温病的内在本质，这是绝对没有疑问的。正因为体内津液已伤，不能上承口舌，所以感到口渴。所以仲景说：太阳病，发热，而且渴，……的，称为温病。并且特意将“渴”字放在“而”字之下，以彰显其首要地位。正因为体内津液已伤，不能注输背脊，所以不仅头痛项强，进而发展到背部也僵硬不适（几几然）。所以仲景说：太阳病，项背强几几，……葛根汤主之。因此，口渴和项背强几几同样是伤津的外在表现，实质上是同一事物的两个方面。
学者既然已经知道口渴和项背强几几同为太阳温病葛根汤证的主要症状，更可以由此左右推求，自然能得到融会贯通的乐趣。例如由太阳温病的口渴，可以推知太阳中风、太阳伤寒的不口渴。
所以恽铁樵先生教导学生说：桂枝汤、麻黄汤应当都以“口中和”为主证云云。学生遵照此法施治，无异于指南针。实际上，“口中和”就是不口渴的另一种说法，不口渴就是从太阳温病的“渴”字悟出来的。仲景待人以智慧，所以不知不觉言语简约罢了。再例如由太阳温病的项背强几几，可以推知太阳痉病的背反张、身体强几几然，那是疾病的传变。诚然，项背强几几尚且只是津伤邪袭较轻的情况，如果治疗不合法度，再次发汗或攻下损伤津液，势必导致背反张、身体强几几然，成为进一层的痉病。这是《伤寒》《金匮》可以通释的地方。
读者必将发问说：那么《伤寒论》温病条下的“若发汗已，身灼热者，名曰风温”又作如何解说？回答说：这是仲景后人的注语，不是仲景原文。虽然如此，他是仲景的后人，也是我们的前贤，所以他的话并非没有道理。他的意思是说：假如遇到太阳温病的葛根汤症，医生误认为是太阳伤寒的麻黄汤证，直接用麻黄汤发汗，那么汗虽然出了，表证虽然解了，必定会引起全身的灼热，不可能一剂药就完全治愈，像这种情况，起初的病不是伤寒，其实是温病。只是嫌“温病”的“病”字与“太阳病”的“病”字重复，所以不如改称“风温”，因为葛根汤原有麻黄、桂枝来治风，葛根来治温。由此看来，风温就是温病的别名，起初不必另眼看待。另外，这个风温与近日温热家所说的风温也不同，为了避免混淆，宁可删去不论。更有进一层的意思是，学者应当知道“发汗已，身灼热”，并不是绝对的坏病，不过是由太阳转入阳明。此时只要根据证候，或用白虎汤清之，或用麻杏甘石汤开之，或用葛根芩连汤折之，病就能完全痊愈，起初不必过分惊慌。只是经方家治病，如果可以一剂痊愈的，不应当用两剂，即用葛根汤一剂能全愈的，不应当用麻黄汤使人转入阳明，以致用两剂才痊愈。
读者又将问说：那么《伤寒论》原文风温为病，“脉阴阳俱浮，自汗出，身重，多眠睡，鼻息必鼾，语言难出，若被下者，小便大利，直视，失溲，若被火者，微发黄色，剧则如惊痫，时瘈疭，若火熏之，一逆尚引日，再逆促命期。”又作如何解说？回答说：这也是仲景后人的话。注家有认为这是错误，任意颠倒改易，以求曲意符合自己观点的。这是我私下所不取的。仔细分析这条大意的重点，在于申明两个禁忌，一是禁止攻下，二是禁止火疗。为什么禁止攻下？因为攻下是阳明的正治法，现在温病病在太阳，未到阳明，所以不可攻下，攻下将进一步损伤津液。为什么禁止火疗？因为温病津液既已内伤，怎么经得起再用火灼烧呢？这样治疗，就是一逆再逆。逆得重的，缩短寿命；逆得轻的，或者语言难出，或者直视，或者惊痫，或者抽搐，综合考察各种症状，无一不是由于津液内竭，神经失去濡养所致。或者小便不利，则是伤津严重的，几乎没有剩余液体可以外泄。或者微发黄色，则是津竭血溶，血液变色，尤为明显的病理表现。攻下和火疗原本不符合太阳中风、太阳伤寒的治疗原则，现在唯独在温病条下恳切告诫，又是为什么呢？无非是因为中风、伤寒者津液未伤，即使误下误火，逆乱还不严重；现在温病者津液已伤，实在不允许丝毫误治啊。唉，前贤的宗旨真是精微啊！
葛根汤证其二
葛根汤方治疗效果迅速，与麻黄汤大致相同。而且此证兼有口渴饮水的症状。我最近在陕州治疗夏姓一位妇女看到了这种情况。她的症状是太阳穴剧烈疼痛，轻微恶寒，脉象浮紧，口燥，我使用：葛根六钱、麻黄二钱、桂枝三钱、白芍三钱、生甘草一钱、天花粉四钱、枣七枚。按诊时病情已在南归的前一晚，也没来得及问她的疗效。到了第二天，她的丈夫送到车站，说夜里得了微微出汗，症状已经完全痊愈了。我大概是考虑到她的燥渴，参考了括萎桂枝汤的意思。我希望研读经方的医者，都应当在临证时灵活变通。
【按语】本案是我的老师亲自撰写的。夏姓妇女所患的就是太阳温病。假如我的老师用葛根汤原方，未始不可以很好地治疗它。现在又以花粉代替生姜，则更为恰当。
虽然如此，读者在这里有不能释疑的地方。说：温病条说不恶寒，葛根汤条说恶风，风寒本属互称，这样岂不是自相矛盾？回答说：这正是仲景运用互文见意的手法，可以深思的。说风寒为互称，这话不错。但应当知道寒为重，风为轻；恶寒为重，恶风为轻。所以温病及葛根汤两条合一之后，即成恶风不恶寒。其意思犹如说微恶风寒，节略言之，就是本案我老师所说的微恶寒。因为其尚不能完全脱离恶寒的本色，而合于太阳首条提纲的主旨，所以仲景称此为太阳病。又因为其兼有口渴津伤，易于化热，所以仲景称此为太阳温病。
历来伤寒注家有一个巨大的错误，贤者代代相传，不能自觉，就是把温病当作阳明病。佐景察觉到了，不容沉默；依我的说法，温病是太阳病的一纲，显然不同于阳明病，这固然确定了，但我私下认为还有辨证的方法。大论说：问曰：阳明病，外证是什么？回答说：……反恶热也。那么恶热的才是阳明病，那些只口渴而不恶热的温病能称为阳明病吗？那么恶热的当用石膏、知母、芒硝、大黄，那些都口渴而不恶热的能用辛温发散的麻黄、桂枝吗？仲景在这里岂不是暗暗点明吗？我的主旨，大概就在这里。现在试着排列太阳、阳明的主要症状如下：
太阳伤寒 或已发热或未发热 恶风恶寒
太阳中风 发热 恶风
太阳温病 发热而渴 恶风不恶寒
阳明 发热谵语 不恶寒反恶热
读者试察上表，其中层次何等分明。太阳伤寒当在未发热恶寒之时，完全为寒象，且不但说恶风，兼说恶寒，显见其恶风寒之重。至于太阳中风，就说发热，显见没有未发热的时候，且只说恶风，不说恶寒，显见其恶风寒之轻。至于太阳温病，不但说发热，且加渴以示其津液之伤，说恶风，又说不恶寒，显见其恶风寒之微。至于阳明，严重的说谵语，以示其津竭之后，神经受热灼烧了，又说反恶热，至此完全为热象，与太阳伤寒的完全为寒象恰好相反。由此我们可以得出外感疾病传变的第一原则，说由寒化热是也。这一原则实际上是我们依据经典探讨的收获，而温病不得称为阳明病，又是其余的事了！
葛根汤证其三
我以前在西门内中医专校授课，无暇为人治病，所以出诊的日子常常很少。光华眼镜公司有袁姓少年，那年八月，卧病四五日，昏不知人。他的哥哥想送他回家，请我去诊治以决定方案。我去诊治时，天快黑了。病人躺在楼上的床上，悄无声息。我靠近病床询问，形体没有寒热表现，项背痛，不能自行转身。诊其脉，右三部弦紧而浮，左三部不见浮象，按之则紧，心中虽知为太阳伤寒，但左脉不像。当时他的哥哥下楼取火，一会儿回来。我说：你弟弟沉溺于酒色吗？他哥哥说：不是，只是春天在汕头一个月，听说颇为荒唐，宿在某妓院，挥霍金钱甚巨。我说：这就是了。现在按其左脉不浮，是阴分不足，不能外应太阳。但他的舌苔必然抽心（指舌苔剥落或异常），一看，果然。我使用：葛根二钱、桂枝一钱、麻黄八分、白芍二钱、炙甘草一钱、红枣五枚、生姜三片。我悄悄对他哥哥说：服用后，微微出汗，就好了。如果不汗出，那就不是我敢保证的了。
临走时，我又担心他阴液不足，不能达汗于表，令他在药中加入粳米一杯，于是返回寓所。第二天早上，他哥哥来，请求复诊。我去应答，六脉调和。询问他，病人说：五天不曾熟睡，昨天服药得微微出汗，不知不觉睡去了。等到醒来时，身体很舒展，也不知道病是什么时候好的。随即请开调理方。我说：不需要，静养两三天就够了。听说那人七天后，就去汉口经商了。
【按语】《素问·金匮真言论》说：夫精者，身之本也。故藏于精者，春不病温。《生气通天论》说：冬伤于寒，春必病温。这几句话，凡是学习中医的人都能说出来。然而议论纷纷，往往违背经旨。佐景不敏，请以本案袁姓少年的病作为《内经》的注释即可。简而言之，袁姓少年宿妓荒唐，不藏于精，所以生温病。用葛根汤治疗，应手而起者，是因为葛根汤是温病的主方。所谓精，是津液聚集在一处的表现。所谓津，是精散于周身的表现。所以精与津原本是一而二、二而一的东西。这个人平日既不藏精，即是津液先伤，等到外受邪风侵袭，就不是太阳中风，也不是太阳伤寒，而是独为太阳温病，就不适宜桂枝汤，也不适宜麻黄汤，而独适宜葛根汤。这是《内经》《伤寒》可以通释的地方。
更有应当知道的，藏精的要领，起初不一定限于冬季，但尤其以冬季为甚。所以《伤寒例》说：冬时严寒，万类深藏。君子固密，则不伤于寒。触冒之者，乃名伤寒耳。温病的形成，起初不一定限于春季，看袁姓少年在仲秋呻吟可知，但尤其以春季为甚。因为春继冬来，于时为近，冬不闭藏，使阳气受扰，则春不发陈，无能随天地万物一起生长繁荣。精的泄漏，起初不一定限于男女之间，凡是志向勤勉而欲望多，内心恐惧而常忧惧，形体劳累而致疲倦，高下必相慕，嗜欲伤目，淫邪惑心的，都是不藏于精之类，但尤其以直耗肾精为甚。所以我们可作结论说：冬不藏精，春必病温。“必”，犹言“多”也。这是经旨所应当通达的观点。
[Note] After the patient took this prescription, there was absolutely no sweating. Readers might suspect I am telling lies; how could taking five qian of both Mahuang (Ephedrae Herba) and Guizhi (Cinnamon Twig) produce no reaction? No, there is a reason. Before taking the medicine, the patient mistakenly used Epsom salts to purge himself, believing his stool was blocked. Once his Middle Qi sank inward, his pulse changed from floating-tight to minute-fine. Therefore, even though he took Mahuang Tang (Ephedra Decoction), sweat did not come out. At the second consultation, the Master added Fuzi (Aconiti Lateralis Radix Preparata) to invigorate Heart Yang and rescue the counterflow condition, resulting in recovery. This non-sweating was due to mismanagement. I also witnessed the Master treating Mr. Shi Huifu's younger brother, who presented with fever, aversion to cold, and anhidrosis. He was prescribed three qian each of Mahuang and Guizhi. After one dose, there was absolutely no sweating. Only after two doses with increased dosages did he achieve a slight resolution through mild sweating. What is the reason? Mr. Shi's brother worked at the Hongchang Shipyard, located by the river where the wind was brisk. As he supervised the construction site daily, he had indeed been exposed to wind and dew. This non-sweating was due to the geographical environment. Additionally, while treating a patient at Guangyi Hospital, who was well-dressed and presented with fever, aversion to cold, anhidrosis, and headache, I prescribed three qian each of Mahuang and Guizhi, with other herbs in equivalent amounts.
At the next day's follow-up, he reported no physiological changes after taking the medicine. I instructed him to take the original prescription again. The third consultation yielded the same result. Suspecting the hospital's herbal dosage was insufficient, I advised him to purchase herbs from a pharmacy instead. At the fourth consultation, there was still no sweating. I racked my brains but could find no cause. Upon detailed inquiry into his occupation, he said, "I am a rickshaw puller." At that moment, it dawned on me. Such individuals are accustomed to dealing with wind and cold daily and are naturally less susceptible to invasion. If they do contract wind-cold, the pathogenic factor is likely heavier than in ordinary people. This non-sweating was due to his occupation. However, these examples are understandable. I once treated a pregnant woman with edema, presenting with swelling of the face, hands, and feet. Acting on a sudden inspiration, I directly prescribed modified Mahuang Tang. At the next day's follow-up, the swelling had reduced by half. I asked if he had sweated; he said no. I asked if urination had increased; he said no. I did not believe this initially and prescribed modifications of the original formula. Three days later, as the swelling was nearly gone, I asked again about his sweating and urination, but he firmly denied any changes. If his statement were true, then unless we say "water transformed into Qi and leaked out invisibly," admitting the physiological concept of insensible perspiration would be the only explanation, yet it seems unreasonable. Alas, disease conditions change infinitely; there are indeed cases that cannot be judged by common sense, which can only be believed by those who have experienced them personally.
Cao Yingfu stated: For patients presenting with fever, aversion to cold, anhidrosis, and floating-tight pulses bilaterally, administering Mahuang Tang should yield immediate results. In the sixth month of the Xinwei year, a villager's son stayed at my younger brother Yibo's house and suddenly fell ill with fever, aversion to cold, lying wrapped in blankets, and uncontrollable chills. My eldest daughter, Zhaohua, prescribed Mahuang Tang for him. After ingestion, he sweated and became comatose, causing great fear in Yibo. Within half a day, he fell into a deep sleep and woke up at dusk, appearing cured. It was likely due to the hot weather and heavy medication causing coma, nothing else. On the first day of the eleventh lunar month this year, in Weinan County, Shaanxi, Cao, the younger brother of the branch manager of the Bank of Communications, suffered from fever, anhidrosis, and a floating-tight pulse. I prescribed Mahuang (3 qian), Guizhi (4 qian), Sheng Gancao (Raw Licorice Root, 3 qian), and Xingren (Apricot Seed, 5 qian). After taking it, he sweated slightly, his pulse became minute, he felt drowsy, his fever subsided, and his body cooled. Without needing further consultation, he was cured. I also recall teaching the grandsons of Mr. Ding Garen previously. A disciple, Pei Deyan, sought diagnosis from Jiwan for illness. The treatment involved Jingjie (Schizonepetae Spica) and Fangfeng (Saposhnikoviae Radix). After four days, there was no improvement or sweating. I was invited to diagnose. I prescribed only Mahuang (2 qian), Guizhi (1.5 qian), Xingren (3 qian), and Sheng Gancao (1 qian). The next day, Deyan did not appear nor request further consultation, which puzzled me. A few days later, Deyan came happily and said, "I am cured." I analyzed that in the initial stage of Shanghan, the pulse is floating-tight because pathogenic factors and healthy Qi contend between the skin-hair and muscle-cou-li, holding stalemate. After one episode of sweating, the skin-hair and cou-li open, resolving the contention. People claim excessive use of Mahuang causes Yang collapse and strictly forbid it; otherwise, how can patients with Taiyang Shanghan recover?
Ge Gen Tang Syndrome Case One
A tailor surnamed Feng suffered from aversion to cold, generalized anhidrosis, pain along the spinal bones preventing turning, and a floating-tight pulse. I diagnosed: "This is external pathogens invading the skin-hair, causing aversion to cold and anhidrosis. Moreover, the floating-tight pulse indicates a Mahuang Tang syndrome. However, the stiffness and pain in the neck and back indicate the pathogen has invaded the Bladder meridians on the back, progressing one step beyond the Mahuang Tang syndrome. Ge Gen Tang (Kudzu Decoction) is appropriate."
Formula: Ge Gen (Puerariae Lobatae Radix) 5 qian, Mahuang 3 qian, Guizhi 2 qian, Baishao (Paeoniae Radix Alba) 3 qian, Gancao (Glycyrrhizae Radix) 2 qian, Shengjiang (Zingiberis Rhizoma Recens) 4 slices, Hongzao (Jujubae Fructus) 4 pieces. The rationale relies on Ge Gen's ascending property to transport fluids to the skin, assisted by Mahuang to push them out through the pores. Both actions resolve the muscle layer and exterior. Although similar in intent to Guizhi Er Mahuang Yi Tang (Cinnamon Twig Twice Ephedra Once Decoction), the usage differs. Shortly after taking it, he felt slight heat inside the back. After the second dose, sweat appeared on the back, then spread to the whole body. He slept peacefully, and the illness resolved.
[Note] Ge Gen Tang treats Wenbing (Warm Diseases). Scholars must know that what modern people call Wenbing is not what Zhongjing called Wenbing, and vice versa. One must first understand the modern concept of Wenbing before reading the Wenbing clauses in *Shanghan Lun* to avoid confusion. Mimicking the distinction between narrow and broad Shanghan, I propose calling Zhongjing's Wenbing "Narrow Wenbing" and modern Wenbing "Broad Wenbing." However, I hope scholars understand this internally without creating new terms that cause disputes. To ensure proper nomenclature, let us call Zhongjing's Wenbing "Taiyang Wenbing" to distinguish it from modern Wenbing. Call Zhongjing's Shanghan, symmetric to Wenbing, "Taiyang Shanghan" to distinguish it from the broad Shanghan in *Shanghan Lun*. Call Zhongjing's Zhongfeng, symmetric to Shanghan, "Taiyang Zhongfeng" to distinguish it from stroke in miscellaneous diseases. With names established, let us discuss the main principles.
What distinguishes Taiyang Wenbing from Taiyang Zhongfeng and Taiyang Shanghan? I dare to reveal a principle: Taiyang Zhongfeng and Taiyang Shanghan involve Taiyang diseases where Body Fluids (Jinye) are not damaged. If a person first damages their Jinye and subsequently contracts a Taiyang disease, it is Taiyang Wenbing. Thus, "damaged Jinye" is the internal essence of Taiyang Wenbing, unquestionably. Because internal Jinye is damaged and cannot ascend to moisten the mouth and tongue, thirst occurs. Hence, Zhongjing states: "Taiyang disease, fever, and thirst... is called Wenbing." Placing "thirst" under "and" highlights its primary importance. Because internal Jinye is damaged and cannot irrigate the back, besides headache and neck stiffness, the back also becomes stiff ("jijiran"). Hence, Zhongjing states: "Taiyang disease, neck and back stiffness jijiran... Ge Gen Tang governs it." Therefore, thirst and neck/back stiffness are both external signs of Jinye damage, essentially one entity manifesting in two ways.
Knowing that thirst and neck/back stiffness are chief symptoms of Taiyang Wenbing Ge Gen Tang syndrome, scholars can deduce related aspects. For instance, from Taiyang Wenbing thirst, one can deduce that Taiyang Zhongfeng and Taiyang Shanghan do not present with thirst.
Thus, Mr. Yun Tieqiao taught students: "Guizhi Tang and Mahuang Tang should both take 'mouth feeling neutral' as a chief symptom." Students following this guidance treat effectively. Actually, "mouth feeling neutral" is synonymous with "no thirst," derived from understanding the "thirst" in Taiyang Wenbing. Zhongjing trusted human intelligence, hence his concise language. Similarly, from Taiyang Wenbing neck/back stiffness, one can deduce the progression of Taiyang Jingbing (Spasm Disease) with opisthotonos and body stiffness. Neck/back stiffness represents mild Jinye damage and pathogen invasion; improper treatment leading to further sweating or purging damages Jinye, inevitably progressing to opisthotonos and stiffness, a deeper stage of Jingbing. This explains connections between *Shanghan* and *Jingui Yaolue*.
Readers may ask: How to interpret "If sweating has occurred and the body burns with heat, it is named Fengwen" in the Wenbing clause? Answer: This is a note by Zhongjing's descendants, not original text. Nevertheless, as our predecessors, their words have merit. Their meaning: If a doctor mistakes Taiyang Wenbing (Ge Gen Tang syndrome) for Taiyang Shanghan (Mahuang Tang syndrome) and uses Mahuang Tang to induce sweating, although sweat comes out and the exterior resolves, it will likely cause generalized burning heat, failing to cure in one dose. Thus, the initial illness was not Shanghan but Wenbing. To avoid repeating the character "bing" (disease) in "Wenbing bing" and "Taiyang bing," they changed it to "Fengwen." Since Ge Gen Tang contains Mahuang and Guizhi to treat Wind, and Ge Gen to treat Warmth, Fengwen is an alias for Wenbing. Furthermore, this Fengwen differs from the Fengwen discussed by recent Warm Pathogen theorists; to avoid confusion, I omit discussion. Importantly, "sweating followed by burning heat" is not an absolute critical condition but a transition from Taiyang to Yangming. At this stage, treat according to symptoms: use Baihu Tang (White Tiger Decoction) to clear, Maxing Shigan Tang (Ephedra, Apricot Kernel, Glycyrrhiza, and Gypsum Decoction) to open, or Gegen Qinlian Tang (Kudzu, Coptis, and Pinellia Decoction) to reduce. The disease will resolve without panic. Jingfang practitioners aim for cure in one dose; if Ge Gen Tang cures in one dose, do not use Mahuang Tang to drive the pathogen into Yangming, requiring two doses.
Readers will ask again: How to interpret the original text regarding Fengwen: "Pulse Yin and Yang both floating, spontaneous sweating, heavy body, excessive sleepiness, snoring nasal breathing, difficulty speaking; if purged, excessive urination, fixed gaze, incontinence; if fire therapy applied, slight yellow discoloration; severe cases like convulsions/clonic spasms, resembling smoke staining; one error prolongs the disease, two errors shorten life." Answer: Also a descendant's note. Some annotators consider it erroneous and alter it arbitrarily, which I reject. Analyzing the main point, it emphasizes two prohibitions: purging and fire therapy. Why prohibit purging? Purging is the correct treatment for Yangming; since Wenbing is in Taiyang and has not reached Yangming, purging is forbidden as it further damages Jinye. Why prohibit fire therapy? Since Wenbing Jinye is already internally damaged, fire therapy would scorch it further. Such treatment constitutes error upon error. Severe errors shorten life; mild errors cause speech difficulties, fixed gaze, convulsions, or spasms. All symptoms result from internal exhaustion of Jinye and lack of nourishment to nerves. If urination is difficult, severe Jinye damage leaves no fluid to excrete. Slight yellow discoloration indicates blood stasis due to Jinye exhaustion. While purging and fire therapy are inappropriate for Taiyang Zhongfeng/Shanghan, why emphasize them here? Because Zhongfeng/Shanghan have undamaged Jinye, so errors are less severe; Wenbing has damaged Jinye, allowing no margin for error. Alas, the wisdom of predecessors is profound!
Ge Gen Tang Syndrome Case Two
Ge Gen Tang acts quickly, similar to Mahuang Tang. This syndrome often includes thirst. Recently in Shanzhou, I treated a Mrs. Xia. Symptoms: severe temporal headache, slight aversion to cold, floating-tight pulse, dry mouth. Prescription: Ge Gen (6 qian), Mahuang (2 qian), Guizhi (3 qian), Baishao (3 qian), Sheng Gancao (1 qian), Tianhuafen (Trichosanthis Radix, 4 qian), Hongzao (7 pieces). I examined her the night before leaving for the south and didn't ask for the outcome. The next day, her husband brought her to the station, saying she sweated slightly overnight and recovered completely. I likely incorporated ideas from Gua Lou Gui Zhi Tang (Trichosanthes and Cinnamon Twig Decoction) due to her dryness/thirst. I wish Jingfang readers would adapt prescriptions clinically.
[Note] This case was written by my Master. Mrs. Xia suffered from Taiyang Wenbing. Had my Master used the original Ge Gen Tang, it would have been effective. Replacing Shengjiang with Tianhuafen makes it more appropriate.
However, readers may doubt: The Wenbing clause says "no aversion to cold," while the Ge Gen Tang clause says "aversion to wind." Wind and Cold are interchangeable terms; isn't this contradictory? Answer: This is Zhongjing's use of mutual literary implication, worthy of deep thought. Wind and Cold are interchangeable, but Cold is heavy, Wind is light; aversion to Cold is heavy, aversion to Wind is light. Combining the two clauses results in "aversion to wind, no aversion to cold," implying "slight aversion to wind and cold." This matches my Master's description of "slight aversion to cold." Because it retains some aversion to cold, fitting the Taiyang提纲 (outline), Zhongjing calls it Taiyang disease. Because it involves thirst and Jinye damage prone to heat transformation, he calls it Taiyang Wenbing.
Historical Shanghan commentators made a major error, passed down unconsciously: treating Wenbing as Yangming disease. I cannot remain silent. According to my view, Wenbing is a category of Taiyang disease, distinct from Yangming. There is a method for differentiation. The Great Treatise asks: "What are the external signs of Yangming disease?" Answer: "...aversion to heat." Therefore, only those with aversion to heat are Yangming disease. Can those with thirst but no aversion to heat (Wenbing) be called Yangming? Those with aversion to heat use Shigao (Gypsum), Zhimu (Anemarrhenae Rhizoma), Xiaoshi (Natrii Sulfas), and Dahuang (Rhei Radix et Rhizoma); those with thirst but no aversion to heat use acrid-warm dispersants like Mahuang and Guizhi. Did Zhongjing not hint at this? My point lies here. Listing chief symptoms of Taiyang and Yangming:
Taiyang Shanghan: Fever or no fever yet, aversion to wind/cold.
Taiyang Zhongfeng: Fever, aversion to wind.
Taiyang Wenbing: Fever with thirst, aversion to wind, no aversion to cold.
Yangming: Fever with delirium, no aversion to cold, aversion to heat.
Observe the clarity. Taiyang Shanghan during pre-fever/aversion to cold is entirely cold-like, emphasizing severe wind-cold aversion. Taiyang Zhongfeng presents with fever and only wind aversion, indicating milder wind-cold aversion. Taiyang Wenbing presents with fever and thirst (indicating Jinye damage), and wind aversion without cold aversion, indicating minimal wind-cold aversion. Yangming severe cases show delirium (nerve irritation from heat exhaustion) and aversion to heat, entirely heat-like, opposite to Taiyang Shanghan's cold nature. Thus, the first principle of external disease progression is "transforming from cold to heat." This principle, derived from classics, confirms Wenbing is not Yangming.
Ge Gen Tang Syndrome Case Three
Previously teaching at Ximen Ne TCM College, I rarely saw outpatients. A young man surnamed Yuan from Guanghua Glasses Company fell ill in August, bedridden for 4-5 days, unconscious. His brother sought my diagnosis. Arriving at dusk, he lay silently upstairs. Examining him, no obvious cold/heat signs, neck/back pain, inability to turn. Pulse: Right three positions string-tight-floating; Left three positions not floating, tight on pressure. Though I suspected Taiyang Shanghan, the left pulse was atypical. His brother returned from fetching firewood. I asked: "Does your brother indulge in alcohol and sex?" Brother: "No, but in spring in Shantou for a month, he was quite reckless, staying at a brothel, spending heavily." I said: "That explains it. Left pulse not floating indicates deficiency of Yin aspect, unable to respond externally to Taiyang." Tongue coating confirmed abnormality. Prescription: Ge Gen (2 qian), Guizhi (1 qian), Mahuang (8 fen), Baishao (2 qian), Zhi Gancao (Prepared Licorice Root, 1 qian), Hongzao (5 pieces), Shengjiang (3 slices). I whispered to the brother: "After taking, slight sweating means cure. If no sweat, I cannot guarantee."
Before leaving, fearing insufficient Yin fluids for sweating, I instructed adding a cup of Jingmi (Oryza Sativa Grain) to the decoction. Next morning, the brother requested follow-up. Pulse harmonious. Patient reported: "Five days without deep sleep. Yesterday, slight sweating after medicine, then slept. Woke up feeling relaxed, unaware when illness left." Asked for conditioning formula. I said: "None needed, rest 2-3 days." Heard he went to Hankou for business seven days later.
[Note] *Suwen · Jingui Zhenyan Lun* states: "Essence is the root of the body. Those who store essence will not suffer warm diseases in spring." *Shengqi Tongtian Lun* states: "Winter injury to cold leads to warm disease in spring." These lines are known to all TCM students, yet interpretations often deviate. I offer this Yuan case as an annotation of *Neijing*. Briefly, Yuan indulged in sexual recklessness, failing to store essence, thus contracting Wenbing. Treating with Ge Gen Tang worked immediately because Ge Gen Tang is the principal formula for Wenbing. Essence is concentrated Jinye; Jinye is dispersed essence. They are one entity. Chronic essence leakage implies prior Jinye damage. External wind invasion then results not in Zhongfeng or Shanghan, but uniquely Taiyang Wenbing, unsuitable for Guizhi Tang or Mahuang Tang, but ideal for Ge Gen Tang. This reconciles *Neijing* and *Shanghan*.
Furthermore, storing essence is not limited to winter, but most critical then. *Shanghan Li* states: "In winter severe cold, all things hide deeply. Gentlemen secure themselves, avoiding cold injury. Those exposed are named Shanghan." Wenbing formation is not limited to spring, as seen in Yuan's autumn illness, but most common in spring. Spring follows winter; if winter storage fails, disturbing Yang, spring sprouting fails, hindering growth with heaven and earth. Essence leakage is not limited to sexual activity; excessive desire, fear, fatigue, envy, sensory overload, and mental confusion also deplete essence, especially direct Kidney Essence consumption. Conclusion: "Winter failure to store essence leads to frequent warm disease in spring." "Bi" (must) here means "often/frequently." This is the broad understanding required by classic principles.