稍轻虽同曰发汗特解肌之药耳故仲景于桂枝证云令半身 微似有汗不可如水淋漓病必不除是知中风不可大发汗汗过
则反动荣血邪气乘虚袭之故病不除也寒伤荣则寒邪入阴血而荣行脉中者也寒邪居脉中非特荣受病邪自内作则并于卫气
犯之久则浸淫及骨是以汗不出而热齿干而烦冤仲景以麻黄发其汗又以桂枝甘草助其发散欲涤除内外之邪荣卫之病耳大
抵二药皆发汗以桂枝则发其卫之邪麻黄并荣与卫治之亦自有浅深也何以验之仲景桂枝第十九证云病常自汗出者此为荣
气和荣气和者外不谐以卫气不共荣气谐和故尔以荣行脉中卫行脉外复发其汗荣卫和则愈宜桂枝汤又四十七证云发热汗
出此为荣弱卫强故使汗出欲救邪风者宜桂枝汤是知中风汗出者荣和而卫不和又第一卷云寸口脉浮而紧浮则为风紧则为
寒风则伤卫寒则伤荣荣卫俱病骨节烦疼当发其汗是知伤寒浮紧者荣卫俱病也麻黄汤中并用桂枝此仲景之意也至于青龙
虽治伤风见寒脉伤寒见风脉之病然仲景又云汗出恶风者不可服之服之厥逆便有筋惕肉 之证故青龙一证尤难用药须是
形证谛当然后可行故王实夫证止用桂枝麻黄各半汤治之盖慎之也
陶 热盛而烦手足自温脉浮而紧此伤风见寒脉也不烦少热四肢微厥脉浮而缓此伤寒见风脉也二者为荣卫俱病法
宜大青龙汤但此汤险峻须风寒俱甚又加烦躁乃可与之否则不如桂枝麻黄各半汤为稳尤不若九味羌活汤加石膏知母枳壳也
温粉方
白术 本 川芎 白芷（各等分）上研为细末每末一两入米粉三两和匀扑周身止汗若汗过多恐亡阳遂厥逆恶风烦
躁不得眠故宜以此粉止之
太阳病项背强KT KT 反汗出恶风者桂枝加葛根汤主之（按诗幽风野狼跋云赤写KT KT 注云KT KT 绚貌绚
谓拘着舄屦头为行戒状如刀衣鼻在屦头言拘者取自拘持使低目不妄顾视按此所以想见项强拘强之状若作鸟羽释则KT
当音殊而于拘强之义反不切矣后证葛根汤者乃桂枝汤中加麻黄葛根也其证无汗故以麻黄发之此证有汗故去麻黄而曰桂
枝加葛根汤也若有麻黄则亦葛根汤矣成氏不当设疑于注以眩后学故辩之
桂枝葛根汤方
葛根（四两） 芍药（二两） 甘草（二两） 生姜（三两切） 桂枝（二两去皮） 大枣（十二枚擘） 上七味
以水一斗煮取三升去滓温服一升
太阳病项背强KT KT 无汗恶风葛根汤主之
葛根汤方
葛根（四两） 麻黄（三两去节） 桂（二两去皮） 芍药（二两切） 甘草（二两炙） 生姜（三两切） 大枣
（十二枚擘） 上七味 咀以水一斗先煮麻黄葛根减二升去沫纳诸药煮取三升去滓温服一升覆取微似汗不须啜粥余如桂
枝法将息及禁忌（本草云轻可去实麻黄葛根之属是也此以中风表实故加二物于桂枝汤中也）
太阳病得之八九日如疟状发热恶寒热多寒少其人不呕清便欲自调一日二三度发脉微缓者为欲愈也脉微而恶寒者此
阴阳俱虚不可更发汗更下更吐也面色反有热色者未欲解也以其不能得小汗出身必痒宜桂枝麻黄各半汤（成 伤寒八九日
则邪传再经又遍三阳欲传二阴之时也传经次第则三日传遍三阳至四日阳去入阴不入阴者为欲解其传阴经第六日传遍三
阴为传经尽而当解其不解传为再经者至九日又遍三阳阳不传阴则解如疟发作有时也寒多者为病进热多者为病退经曰厥
少热多其病为愈寒多热少为病退故为进也今虽发热恶寒而热多寒少为阳气进而邪气少也里不和者呕而利今不呕清便自
调者里和也寒热间日发者邪气深也日一发者邪气复宋本作有常也日再发者邪气浅也日二三发者邪气微也内经曰大则邪
至小则平言邪甚则脉大邪少则脉微今日数多而脉微缓者是邪气微缓也故云欲愈脉缓而恶寒者表里俱虚也阳表也阴里也
脉微为里虚恶寒为表虚以表里俱虚故不可更发汗更下更吐也阴阳俱虚则面色青白反有热色者表未解也热色为赤色也得
小汗则和不得汗则邪气外散皮肤亦为痒也与桂枝麻黄各半汤小发其汗以除表邪 首一节至寒少止为自初至今之证下文
皆拟病防变之辞当分作三截看至欲愈也是不须治至吐也是宜温之至末是小汗之麻黄发桂枝止一发一止则汗不得大出
矣）
桂枝麻黄各半汤方
桂枝（一两十六铢去皮） 芍药 生姜（切） 甘草（炙） 麻黄（去节各一两） 大枣（四枚擘） 杏仁（二十
四枚汤浸去皮尖及双仁者） 上七味以水五升先煮麻黄一二沸去上沫纳诸药煮取一升八合去滓温服六合太阳病发热恶寒
热多寒少脉微弱者此无阳也不可发汗宜桂枝二越婢一汤（前脉微缓面有热色身痒以桂麻各半小汗之者犹未弱也此微而加
弱焉则又虚于前证矣虽小汗亦不宜故云不可发汗决词也然病在太阳表证未罢桂枝发散之药终不可无但不令汗而已）
桂枝二越婢一汤方
桂枝（去皮） 芍药 甘草（各七钱半） 生姜（一两二铢切） 大枣（四枚擘）麻黄（去节七钱半） 石膏（一
两碎绵裹） 上七味 咀以水五升先煮麻黄一二沸去上沫纳诸药煮取二升去滓温服一升本方当裁为越婢汤桂枝汤合饮一
升今合为一方桂枝二越婢一 胃为十二经之主脾治水谷为卑脏若婢内经曰脾主为胃行其津液是汤所以谓之越婢者以发
越婢气通行津液外台方一名越脾汤即此义 凡仲景称太阳病者皆表证发热恶寒头项强痛也若脉浮大则与证相应宜发汗
今见表证而脉反微不与证应故不可发汗但用一二各半汤等和之可也
若太阳中 发热恶寒脉微弱手足逆冷而渴者白虎加人参汤（方论见暑病）
太阳病六七日表证仍在脉微而沉反不结胸其人发狂者以热在下焦少腹当硬满小便自利者下血乃愈所以然者以太阳
随经瘀血在里故也抵当汤主之（方论见蓄血）太阳病身黄脉沉结少腹硬小便不利者为无血也小便自利其人如狂者血证谛
也亦抵当汤主之（详蓄血）凡仲景称太阳证脉沉者皆谓发热恶寒头项强痛而脉反沉也其证兼发狂小腹硬者为蓄血此条抵
当汤是也
兼关节痛小便不利身黄者为湿痹（论见湿）
兼卒口噤反张者为痉若无汗恶寒名刚痉宜葛根汤若有汗不恶寒名柔痉宜栝蒌桂枝汤（详杂病痉门）
病发热头痛脉反沉若不痒身体疼痛当救其里宜四逆汤 少阴病始得之反发热脉沉者麻黄附子细辛汤主之
赵 窃详太阳病发热头痛法当脉浮今反沉少阴脉沉法当无热今反热仲景于此两证各言反者谓反常也盖太阳病脉
似
少阴少阴脉病似太阳所以皆谓之反而治之当异也今究其旨均是脉沉发热以其有头痛故为太阳病阳证当脉浮今反不能浮
者以里虚久寒正气衰微所致又身体疼痛故宜救里使正气内复逼邪出外而干姜生附子亦能出汗而解假使里不虚寒则脉当
见浮而正属太阳麻黄证也均是脉沉发热以其无头痛故名少阴病阴病当无热今反热则寒邪在表未传于里但以皮腠郁闭为
热而在里无热故用麻黄细辛以发表间之热附子以温少阴之经假使寒邪入里则外必无热当见吐利厥逆等证而正属少阴四
逆汤也由此观之表邪浮浅发热之反犹轻正气衰微脉沉之反为重此四逆汤不为不重于麻黄附子细辛汤也又可见熟附配麻
黄发中有补生附配干姜补中有发仲景之旨微矣
麻黄附子细辛汤方
麻黄（二两去节） 细辛（二两） 附子（一枚泡去皮破八片）上三味以水一斗先煮麻黄减二升去上沫纳诸药煮取
三升去滓温服一升日再服
成 内经曰寒淫于内治以甘热佐以苦辛以辛润之麻黄之甘以解少阴之寒细辛附子之辛以温少阴之经
赵 详仲景发汗汤剂各分轻重不同如麻黄桂枝汤青龙各半越婢等汤各有差等至于少阴发汗二汤虽同用麻黄附子
亦
有加减轻重之别故以加细辛为重加甘草为轻辛散甘缓之义也其第一证以少阴本无热今发汗故云反也盖发热为邪在表而
当汗又兼脉沉属阴而当温故以附子温经麻黄散寒而热须汗解故加细辛是汗剂之重者第二证既无里寒之可温又无里热之
可下求其所以用麻黄附子之义则是脉亦沉方可名曰少阴病身亦发热方行发汗药又得之二三日病尚浅比之前证亦稍轻故
不重言脉证而但曰微发汗所以去细辛加甘草是汗剂之轻者 凡仲景称太阳病不恶寒者皆谓发热头项强痛脉浮而反不恶
寒也其证兼渴者为温病兼汗出者为柔痉（方论见温病柔痉）
伤寒六七日发热微恶寒支节烦疼微呕心下支结外证未去者柴胡加桂枝汤主之（成 伤寒六七日邪当传里之时也支散
也呕而心下结者里证也法当攻里发热微恶寒支节烦疼为外证未去不可攻里与柴胡桂枝汤以和解之 按支字训散字未莹
支节支结复不同支节犹云枝节古字通也支结犹云支撑而结当活看不可拘泥文本若调作散则不能结也南阳云外证未解心
下妨闷者非痞也谓之支结）
柴胡加桂枝汤方
桂枝（去皮） 黄芩 人参（各一两半） 甘草（炙一两） 芍药 生姜（切各一两半） 大枣（六枚擘） 柴胡
（四两） 半夏（二合半） 上九味以水七升煮取三升去滓温服 凡仲景称表不解者者谓太阳病发热恶寒头项强痛脉浮
也盖病虽属太阳表证而有里证兼之者则不言太阳病但称表不解也其兼心下支结者此条柴胡桂枝汤是也
兼心下有水气干呕而咳者小青龙也（方论见咳）兼胁痛手足温而渴者小柴胡也 兼心下痞者先用桂枝解表后以泻心
攻痞也（方论见痞）兼下利腹满胀者先以四逆温里后以桂枝攻表也（方论见下利）
太阳病欲解时从已至未解太阳病未解脉阴阳俱停必先振栗汗出而解但阳脉微者先汗出而解阴脉微者下之而解若欲
下之调胃承气汤主之 太阳病脉浮紧发热身无汗自衄者愈
太阳外证未解不可下之下之为逆欲解外者宜桂枝汤主之（经云本发汗而欲下之为逆也若先发汗治不为逆）
海 大小调胃三承气汤必须脉浮头痛恶风恶寒表证尽罢而反发热恶热谵语不大便方可用之若脉浮紧下之必结胸
若脉浮缓下之必痞气
许 常记一亲戚病伤寒身热头痛无汗大便不通已四五日予讯问之医者治大黄朴硝等欲下之予曰子姑少待予为视
之脉浮缓居密室中自称甚恶风予曰表证如此惟大便不通数日腹且不胀别无所苦何遽便下之大抵仲景法须表证尽罢方可下
不尔则邪乘虚而入不为结胸则为热利也予作麻黄桂枝各半汤继以小柴胡 汗出大便亦通而解
仲景云凡伤寒之病多从风寒得之始则表中风寒入里则不消矣拟欲攻之先当解表乃可下之若表已解而内不消大满大
坚实有燥粪者自可除下之虽四五日不能为祸也若不宜下而便攻之内虚热入为挟热自利烦躁之变不可胜数轻者困笃重者
必死矣 原本正文重叠予删正此段其理甚明大抵风寒入里不消必有燥粪或大便坚秘须是脉不浮不恶风表证罢乃可下之
大便虽四五日不通亦无害若罔顾表而下遂为挟热利也 上桂枝麻黄为长沙入手第一方而粗工以之杀人者往往而是故易
水师弟以他药代之不知者谓长沙有遗巧余谓此正易水师弟不及长沙处而婆心切矣中医守之可以万全今具摭为后贤表证
治例及补养兼发散二条于后临病之工宜详玩焉
虽然病情稍轻，但同样称为发汗，实际上只是使用解肌的药物罢了。所以张仲景在论述桂枝汤证时说，服药后应使身体半身高微微似有汗出，不可像水淋那样大汗淋漓，否则病邪必然不能去除。由此可知，中风病不可大发其汗，如果汗出过多，反而会扰动营血，导致邪气乘虚侵袭，因此疾病无法痊愈。寒邪伤及营分，则寒邪进入阴血之中，而营气是运行于脉管之中的。寒邪停留在脉中，不仅营气受邪，而且邪气从内部产生，进而并合卫气侵犯体表，时间久了就会浸淫至骨骼。因此出现无汗、发热、牙齿干燥、心中烦闷痛苦等症状。张仲景用麻黄来发汗，又用桂枝、甘草来辅助发散，目的是涤除内外的邪气，治疗营卫的病变。大致来说，这两类药物都是发汗药，但桂枝主要发散卫分的邪气，麻黄则同时治疗荣（营）与卫的病变，其中自有深浅之别。如何验证这一点呢？张仲景在第十九条桂枝汤证中说：“病人经常自汗出的，这是因为营气平和，营气平和的人，外部不协调，是因为卫气不与营气和谐配合的缘故。因为营气行于脉中，卫气行于脉外，再次发其汗，待营卫调和则痊愈，宜用桂枝汤。”又在第四十七条中说：“发热、汗出，这是因为营弱卫强，所以导致汗出。想要救治这种风邪为患的情况，宜用桂枝汤。”由此可知，中风病见汗出，是营气平和而卫气不和。又在第一卷中说：“寸口脉浮而紧，浮脉主风，紧脉主寒，风邪伤卫，寒邪伤营，营卫都生病，骨节烦痛，应当发汗。”由此可知，伤寒病见浮紧脉，是营卫俱病。麻黄汤中同时使用桂枝，这是张仲景的本意。至于大青龙汤，虽然治疗伤风见寒脉、伤寒见风脉的病证，但张仲景又说：“如果有汗、恶风者，不可服用大青龙汤，服后会出现四肢厥逆、筋惕肉瞤的症状。”所以大青龙汤这一证候用药尤为难处，必须形证确切无误后才能使用。因此王实夫只使用桂枝麻黄各半汤来治疗，这是出于谨慎。
陶华认为：热盛而烦躁，手足自然温暖，脉浮而紧，这是伤风见到寒脉；如果不烦躁，只有轻微发热，四肢微冷，脉浮而缓，这是伤寒见到风脉。这两种情况都属于营卫俱病，治法适宜用大青龙汤。但是此汤剂险峻，必须风寒邪气都很严重，并且加上烦躁症状，才可以给予服用，否则不如桂枝麻黄各半汤稳妥，尤其不如九味羌活汤加石膏、知母、枳壳稳妥。
温粉方：
白术、藁本、川芎、白芷（各等分）。以上药材研为细末，每取药末一两，加入米粉三两，混合均匀，扑洒全身以止汗。如果汗出过多，恐怕亡阳而导致四肢厥逆、恶风、烦躁、不得安眠，所以适宜用此粉来止汗。
太阳病，项背部拘急不舒（KT KT），反而汗出、恶风的，主治用桂枝加葛根汤。（按《诗经·幽风·野狼跋》说“赤写KT KT”，注解说“KT KT”是绚貌，即拘束的样子。“绚”指拘束着鞋头作为行走的警戒，形状像刀衣鼻在鞋头，言拘束是指自我约束使低头不乱看。据此可以想象项部拘强之状。如果解释为鸟羽，则“KT”当读作“殊”，但对于拘强的意义反而不贴切了。后面的葛根汤证乃是桂枝汤中加入麻黄、葛根，其证无汗，所以用麻黄发汗；此证有汗，所以去掉麻黄而称为桂枝加葛根汤。如果有麻黄，那就是葛根汤了。成无己不应在注释中设疑，以此迷惑后学，所以辩明此事。）
桂枝加葛根汤方：
葛根（四两）、芍药（二两）、甘草（二两）、生姜（三两，切片）、桂枝（二两，去皮）、大枣（十二枚，掰开）。以上七味药，用水一斗，煮取三升，去渣，温服一升。
太阳病，项背部拘急不舒（KT KT），无汗、恶风的，主治用葛根汤。
葛根汤方：
葛根（四两）、麻黄（三两，去节）、桂枝（二两，去皮）、芍药（二两，切片）、甘草（二两，炙）、生姜（三两，切片）、大枣（十二枚，掰开）。以上七味药，切碎，用水一斗，先煮麻黄、葛根，减少二升水，撇去浮沫，加入其他药物，煮取三升，去渣，温服一升。服药后覆盖衣被使身体微微似有汗出，不需要喝热粥。其余调养方法及禁忌同桂枝汤法。（《本草》说：“轻可去实，麻黄、葛根之类就是如此。”此处因中风表实证，所以在桂枝汤中加入这两味药。）
太阳病，患病八九日，像疟疾一样发作，发热恶寒，热多寒少。病人不呕吐，大小便基本正常。一天发作两三次，脉象微缓的，是即将痊愈的表现。脉微而恶寒的，这是阴阳俱虚，不可再发汗、攻下或催吐。面色反现红热的，说明病未解除，因为不能得到小汗，身体必定发痒，适宜用桂枝麻黄各半汤。（成无己注：伤寒八九日，邪气传变再经，又遍历三阳，欲传二阴之时。传经次序是三日传遍三阳，至第四日阳气离去进入阴经，不入阴经的是欲解。传遍三阴经是第六日，传遍三阴为传经尽，应当解。如果不解，传为再经，至第九日又遍历三阳，阳不传阴则解。像疟疾发作有时。寒多为病进，热多为病退。经文说：“厥少热多，其病为愈；寒多热少，为病退。”所以说是进。现在虽然发热恶寒，但热多寒少，是阳气进展而邪气减少。里不和者会呕吐腹泻，现在不呕吐，大小便自调，说明里和。寒热间日发，是邪气深；一日一发，是邪气复（宋本作“有常”）；一日再发，是邪气浅；一日二三发，是邪气微。《内经》说：“大则邪至，小则平。”言邪甚则脉大，邪少则脉微。今日数多而脉微缓，是邪气微缓，所以说欲愈。脉缓而恶寒，是表里俱虚。阳主表，阴主里。脉微为里虚，恶寒为表虚。因表里俱虚，故不可再发汗、攻下或催吐。阴阳俱虚则面色青白，反有热色，是表未解。热色为红色。得小汗则和，不得汗则邪气外散，皮肤亦痒。与桂枝麻黄各半汤小发其汗以除表邪。首一节至“寒少”为止，是从初至今的证候；下文皆是推测病情以防变化的言辞，应当分作三段看。至“欲愈”是不须治疗；至“吐”是宜温之；至末尾是小汗之法，麻黄发汗，桂枝止汗，一发一止，则汗不得大出矣。）
桂枝麻黄各半汤方：
桂枝（一两十六铢，去皮）、芍药、生姜（切片）、甘草（炙）、麻黄（去节，各一两）、大枣（四枚，掰开）、杏仁（二十四枚，热水浸泡，去皮尖及双仁者）。以上七味药，用水五升，先煮麻黄一二沸，撇去上沫，加入其他药物，煮取一升八合，去渣，温服六合。
太阳病，发热、恶寒，热多寒少，脉微弱者，这是“无阳”（指阳气虚），不可发汗，适宜用桂枝二越婢一汤。（前证脉微缓，面有热色，身痒，用桂枝麻黄各半汤小汗之，犹未虚弱。此证脉微而更加弱，则又虚于前证。虽需小汗也不宜，所以说不可发汗，这是决断之词。然而病在太阳，表证未罢，桂枝这类发散药终究不可无，只是不让其出汗而已。）
桂枝二越婢一汤方：
桂枝（去皮）、芍药、甘草（各七钱半）、生姜（一两二铢，切片）、大枣（四枚，掰开）、麻黄（去节，七钱半）、石膏（一两，碎，绵裹）。以上七味药，切碎，用水五升，先煮麻黄一二沸，撇去上沫，加入其他药物，煮取二升，去渣，温服一升。本方应当裁减为越婢汤和桂枝汤合饮一升，现在合为一方，名为桂枝二越婢一。胃为十二经之主，脾治水谷，为卑脏，若婢女一般。《内经》说：“脾主为胃行其津液。”此汤之所以称为越婢，是以发越婢气，通行津液。《外台秘要》方名一名越脾汤，即此义。凡是张仲景称太阳病的，都是指表证，发热、恶寒、头项强痛。如果脉浮大，则与证相应，宜发汗。现在见到表证而脉反微，不与证相应，故不可发汗。只用一二各半汤等调和即可。
如果太阳中暍（中暑），发热、恶寒，脉微弱，手足逆冷而渴者，用白虎加人参汤。（方论见暑病章节）
太阳病六七日，表证仍在，脉微而沉，反而不结胸，其人发狂的，是因为热在下焦，少腹应当硬满，小便自利的，下血乃愈。之所以这样，是因为太阳随经，瘀血在里，故也。主治用抵当汤。（方论见蓄血章节）太阳病，身黄，脉沉结，少腹硬，小便不利的，为无血也；小便自利，其人如狂的，是血证确凿无疑，也是抵当汤主治。（详见蓄血章节）凡是张仲景称太阳证脉沉的，都是指发热、恶寒、头项强痛而脉反沉。其证兼发狂、小腹硬的，为蓄血，此条抵当汤即是。
兼突然口噤、角弓反张的为痉病。若无汗、恶寒，名刚痉，宜葛根汤；若有汗、不恶寒，名柔痉，宜栝蒌桂枝汤。（详见杂病痉门）
病发热、头痛，脉反沉，若不痒，身体疼痛，当救其里，宜四逆汤。少阴病始得之，反发热，脉沉者，麻黄附子细辛汤主治。
赵嗣真评述：仔细详察太阳病发热头痛，法当脉浮，今反沉；少阴脉沉，法当无热，今反热。张仲景在此两证各言“反”字，谓反常也。盖太阳病脉似少阴，少阴脉病似太阳，所以皆谓之反，而治之当异。今究其旨，均是脉沉发热。以其有头痛，故为太阳病阳证，当脉浮，今反不能浮者，是以里虚久寒，正气衰微所致。又有身体疼痛，故宜救里，使正气内复，逼邪出外，而干姜、生附子亦能出汗而解。假使里不虚寒，则脉当见浮而正属太阳麻黄证也。均是脉沉发热，以其无头痛，故名少阴病阴病，当无热，今反热，则寒邪在表，未传于里，但以皮腠郁闭为热，而在里无热，故用麻黄、细辛以发表间之热，附子以温少阴之经。假使寒邪入里，则外必无热，当见吐利、厥逆等证，而正属少阴四逆汤也。由此观之，表邪浮浅，发热之反犹轻；正气衰微，脉沉之反为重。此四逆汤不为不重于麻黄附子细辛汤也。又可见熟附配麻黄，发中有补；生附配干姜，补中有发。仲景之意微矣。
麻黄附子细辛汤方：
麻黄（二两，去节）、细辛（二两）、附子（一枚，泡，去皮，破八片）。以上三味药，用水一斗，先煮麻黄，减少二升水，撇去上沫，加入其他药物，煮取三升，去渣，温服一升，日再服。
成无己注：《内经》说：“寒淫于内，治以甘热，佐以苦辛。”以辛润之。麻黄之甘以解少阴之寒，细辛、附子之辛以温少阴之经。
赵嗣真详述：张仲景发汗汤剂各分轻重不同，如麻黄汤、桂枝汤、大青龙汤、各半汤、越婢汤等，各有差等。至于少阴发汗二汤，虽同用麻黄、附子，亦有加减轻重之别。故以加细辛为重，加甘草为轻，这是辛散甘缓之义。其第一证，以少阴本无热，今发汗，故云“反”。盖发热为邪在表而当汗，又兼脉沉属阴而当温，故以附子温经，麻黄散寒，而热须汗解，故加细辛，是汗剂之重者。第二证，既无里寒之可温，又无里热之可下，求其所以用麻黄、附子之义，则是脉亦沉方可名曰少阴病，身亦发热方行发汗药。又得之二三日，病尚浅，比之前证亦稍轻，故不重言脉证，而但曰“微发汗”，所以去细辛加甘草，是汗剂之轻者。凡张仲景称太阳病不恶寒者，皆谓发热、头项强痛、脉浮而反不恶寒也。其证兼渴者为温病，兼汗出者为柔痉。（方论见温病、柔痉章节）
伤寒六七日，发热微恶寒，支节烦疼，微呕，心下支结，外证未去者，柴胡加桂枝汤主治。（成无己注：伤寒六七日，邪当传里之时也。支，散也。呕而心下结者，里证也，法当攻里。发热微恶寒，支节烦疼，为外证未去，不可攻里。与柴胡桂枝汤以和解之。按“支”字训“散”字未莹，“支节”、“支结”复不同。“支节”犹云“枝节”，古字通也。“支结”犹云“支撑而结”，当活看，不可拘泥文本。若调作“散”，则不能结也。南阳云：“外证未解，心下妨闷者，非痞也，谓之支结。”）
柴胡加桂枝汤方：
桂枝（去皮）、黄芩、人参（各一两半）、甘草（炙，一两）、芍药、生姜（切片，各一两半）、大枣（六枚，掰开）、柴胡（四两）、半夏（二合半）。以上九味药，用水七升，煮取三升，去渣，温服。
凡张仲景称表不解者，谓太阳病发热、恶寒、头项强痛、脉浮也。盖病虽属太阳表证，而有里证兼之者，则不言太阳病，但称表不解也。其兼心下支结者，此条柴胡桂枝汤即是。
兼心下有水气，干呕而咳者，用小青龙汤。（方论见咳嗽章节）兼胁痛、手足温而渴者，用小柴胡汤。兼心下痞者，先用桂枝解表，后以泻心汤攻痞也。（方论见痞证章节）兼下利、腹满胀者，先以四逆汤温里，后以桂枝汤攻表也。（方论见下利章节）
太阳病欲解时，从巳至未时解。太阳病未解，脉阴阳俱停，必先振栗，汗出而解。但阳脉微者，先汗出而解；阴脉微者，下之而解。若欲下之，调胃承气汤主治。太阳病，脉浮紧，发热，身无汗，自衄者愈。
太阳外证未解，不可下之。下之为逆。欲解外者，宜桂枝汤主治。（经文说：本发汗而欲下之为逆也。若先发汗，治不为逆。）
海藏评述：大小调胃三承气汤，必须脉浮、头痛、恶风、恶寒等表证尽罢，而反发热、恶热、谵语、不大便，方可用之。若脉浮紧，下之必结胸；若脉浮缓，下之必痞气。
许叔微常记一亲戚病伤寒，身热、头痛、无汗，大便不通，已四五日。予讯问之，医者治大黄、朴硝等欲下之。予曰：“子姑少待，予为视之。”脉浮缓，居密室中自称甚恶风。予曰：“表证如此，惟大便不通数日，腹且不胀，别无所苦，何遽便下之？”大抵仲景法须表证尽罢方可下，不尔则邪乘虚而入，不为结胸，则为热利也。予作麻黄桂枝各半汤，继以小柴胡汤，汗出大便亦通而解。
仲景云：凡伤寒之病，多从风寒得之。始则表中风寒，入里则不消矣。拟欲攻之，先当解表，乃可下之。若表已解而内不消，大满大坚实，有燥粪者，自可除下之。虽四五日，不能为祸也。若不宜下而便攻之，内虚热入，为挟热自利、烦躁之变，不可胜数。轻者困笃，重者必死矣。原本正文重叠，予删正此段，其理甚明。大抵风寒入里不消，必有燥粪或大便坚秘，须是脉不浮、不恶风，表证罢，乃可下之。大便虽四五日不通，亦无害。若罔顾表而下，遂为挟热利也。上桂枝麻黄为长沙（张仲景）入手第一方，而粗工以之杀人者往往而是。故易水师弟以他药代之。不知者谓长沙有遗巧，余谓此正易水师弟不及长沙处，而婆心切矣。中医守之，可以万全。今具摭为后贤表证治例及补养兼发散二条于后，临病之工宜详玩焉。
Although the condition is slightly milder, it is still referred to as inducing sweating (inducing perspiration), but in reality, it merely employs medications that release the muscle layer (release the exterior through the muscle layer). Therefore, Zhang Zhongjing stated regarding Guizhi Tang syndrome: the patient should have a slight perspiration over half of the body, not profuse sweating like pouring water; otherwise, the pathogen will certainly not be eliminated. This indicates that for Wind-stroke (Taiyang Wind Strike), one must not induce excessive sweating. If sweating is excessive, it will disturb Ying Blood (nutritive blood), allowing pathogens to invade due to deficiency, thus failing to cure the disease. Cold damaging Ying (Nutritive level) means cold pathogens enter the Yin blood, and Ying Qi (nutritive qi) circulates within the vessels. When cold pathogens reside within the vessels, not only does Ying suffer from the pathogen, but the pathogen generates internally and merges with Wei Qi (defensive qi) to attack the exterior. Over time, it infiltrates into the bones. Hence, symptoms include absence of sweating, fever, dry teeth, and inner restlessness/oppression. Zhang Zhongjing uses Mahuang (Ephedrae Herba) to induce sweating, and combines it with Guizhi (Cinnamomi Ramulus) and Gancao (Glycyrrhizae Radix et Rhizoma) to assist dispersion, aiming to cleanse internal and external pathogens and treat disorders of Ying and Wei. Generally, both types of herbs induce sweating; however, Guizhi primarily disperses pathogens in the Wei level, while Mahuang treats both Ying and Wei levels, possessing inherent differences in depth. How can this be verified? In Article 19 of the Guizhi Tang conditions, Zhang Zhongjing states: "When a patient constantly sweats spontaneously, it is because Ying Qi is harmonious. In those with harmonious Ying Qi, the exterior is disharmonious because Wei Qi does not coordinate with Ying Qi. Since Ying Qi circulates within the vessels and Wei Qi outside, re-inducing sweating will restore harmony between Ying and Wei, leading to recovery; Guizhi Tang is indicated." In Article 47, he states: "Fever with sweating occurs because Ying is weak and Wei is strong, causing spontaneous sweating. To rescue from evil wind, Guizhi Tang is indicated." Thus, sweating in Wind-stroke indicates harmonious Ying but disharmonious Wei. Furthermore, in Volume 1, it is stated: "The Cun Kou pulse is floating and tight. Floating indicates Wind, tight indicates Cold. Wind damages Wei, Cold damages Ying. When both Ying and Wei are diseased, causing severe joint pain, sweating should be induced." This confirms that a floating-tight pulse in Cold Damage indicates simultaneous disease of Ying and Wei. The inclusion of Guizhi in Mahuang Tang reflects Zhang Zhongjing's intent. Regarding Da Qing Long Tang, although it treats Wind-strike presenting with Cold pulses or Cold damage presenting with Wind pulses, Zhang Zhongjing also warns: "If there is sweating and aversion to wind, it must not be taken; doing so may lead to limb reversal-cold (cold extremities) and twitching muscles." Therefore, the use of Da Qing Long Tang requires precise matching of signs and symptoms. Wang Shifu cautiously used only Gui Zhi Ma Huang Ge Ban Tang (Guizhi and Mahuang Half-Dose Decoction) for treatment.
Tao Hua noted: High heat with irritability and naturally warm hands/feet with a floating-tight pulse indicates Wind-strike showing Cold pulses. Lack of irritability, slight heat, slightly cold limbs, and a floating-slow pulse indicate Cold damage showing Wind pulses. Both represent simultaneous disease of Ying and Wei, ideally treated with Da Qing Long Tang. However, this formula is potent and dangerous; it should only be used when both Wind and Cold pathogens are severe and accompanied by irritability. Otherwise, Gui Zhi Ma Huang Ge Ban Tang is safer, and even better, Jiu Wei Qiang Huo Tang (Nine-Ingredient Notopterygium Decoction) added with Shigao (Gypsum Fibrosum) and Zhimu (Anemarrhenae Rhizoma) and Zhike (Aurantii Fructus).
Wen Fen Fang (Warm Powder Formula): Baizhu (Atractodis Rhizoma), Bencao (Ligustici Chuanxiong Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baizhi (Angelicae Dahuricae Radix) in equal parts. Grind into fine powder. Mix one tael of powder with three taels of rice flour. Apply to the whole body to stop sweating. If sweating is excessive, risking Yang collapse leading to reversal-cold, aversion to wind, irritability, and insomnia, this powder is suitable to arrest sweating.
In Taiyang disease, if there is stiffness and discomfort in the neck and back (KT KT), accompanied by spontaneous sweating and aversion to wind, Guijia Gegen Tang (Guizhi plus Puerariae Radix Decoction) is the primary treatment. (Note: The term KT KT refers to a state of constraint or rigidity, likened to being bound. It describes the rigid sensation in the neck. If interpreted as bird feathers, the pronunciation would differ, making it less accurate for describing rigidity. The subsequent Gegen Tang involves adding Mahuang and Gegen to Guizhi Tang for cases without sweating, using Mahuang to induce sweat. This case has sweating, so Mahuang is omitted, hence Guijia Gegen Tang. Cheng Wuji’s doubt was unnecessary and confusing; thus, this clarification is provided.)
Guijia Gegen Tang Prescription:
Gegen (Puerariae Radix) - 4 liang; Shaoyao (Paeoniae Radix Alba) - 2 liang; Gancao (Glycyrrhizae Radix et Rhizoma) - 2 liang; Shengjiang (Zingiberis Rhizoma Recens) - 3 liang, sliced; Guizhi (Cinnamomi Ramulus) - 2 liang, bark removed; Dazao (Jujubae Fructus) - 12 pieces, split. Boil these seven ingredients in 10 sheng of water to obtain 3 sheng. Strain and take 1 sheng warm.
In Taiyang disease, if there is stiffness and discomfort in the neck and back (KT KT), absence of sweating, and aversion to wind, Gegen Tang (Puerariae Radix Decoction) is the primary treatment.
Gegen Tang Prescription:
Gegen (Puerariae Radix) - 4 liang; Mahuang (Ephedrae Herba) - 3 liang, nodes removed; Guizhi (Cinnamomi Ramulus) - 2 liang, bark removed; Shaoyao (Paeoniae Radix Alba) - 2 liang, sliced; Gancao (Glycyrrhizae Radix et Rhizoma) - 2 liang, honey-fried; Shengjiang (Zingiberis Rhizoma Recens) - 3 liang, sliced; Dazao (Jujubae Fructus) - 12 pieces, split. Coarsely crush these seven ingredients. Boil in 10 sheng of water. First boil Mahuang and Gegen, reduce by 2 sheng, skim off foam, then add remaining herbs. Boil to obtain 3 sheng. Strain and take 1 sheng warm. Cover with blankets to induce slight perspiration. No need to drink hot porridge afterwards. Rest and dietary restrictions follow Guizhi Tang guidelines. (Ben Cao states: "Light substances can remove excess," referring to Mahuang and Gegen. Here, they are added to Guizhi Tang for Wind-strike with exterior excess.)
In Taiyang disease, after eight or nine days, resembling malaria with fever and chills, where heat predominates over cold. If the patient does not vomit and bowel/bladder functions are relatively normal, and symptoms occur two or three times a day with a slightly slow pulse, recovery is imminent. If the pulse is faint and there is aversion to cold, it indicates deficiency of both Yin and Yang; do not induce sweating, purge, or emeticize. If the face appears flushed, the disease has not resolved because slight sweating could not be achieved, leading to itching. Gui Zhi Ma Huang Ge Ban Tang (Guizhi and Mahuang Half-Dose Decoction) is indicated. (Cheng Wuji notes: After eight or nine days, pathogens have circulated through the three Yang meridians and may transmit to the Yin. Transmission order: Day 3 completes Yang transmission; Day 4 enters Yin. If it doesn't enter Yin, it resolves. Day 6 completes Yin transmission. If unresolved, it repeats Yang transmission on Day 9. Malaria-like periodicity occurs. More cold indicates progression; more heat indicates retreat. As per classics: "Less Jue, more heat means cure; more cold, less heat means retreat." Current heat-dominant chills/fever indicates advancing Yang Qi and retreating pathogens. Normal digestion indicates interior harmony. Intermittent fever implies deep pathogens; daily occurrence implies shallow pathogens. A faint, slow pulse amidst frequent symptoms indicates waning pathogens, signaling impending cure. Faint pulse with aversion to cold indicates total deficiency of Yin/Yang and Exterior/Interior. Thus, harsh treatments are contraindicated. Flushed face despite deficiency suggests exterior pathogen remains. Slight sweating resolves it; lack thereof causes skin itching. Gui Zhi Ma Huang Ge Ban Tang induces slight sweating to dispel exterior pathogens. The first section describes current symptoms; the rest predicts complications. Divide into three parts: 'imminent cure' requires no treatment; 'vomiting' requires warming; the end describes slight sweating via alternating Mahuang and Guizhi actions.)
Gui Zhi Ma Huang Ge Ban Tang Prescription:
Guizhi (Cinnamomi Ramulus) - 1 liang 16 zhu, bark removed; Shaoyao (Paeoniae Radix Alba); Shengjiang (Zingiberis Rhizoma Recens), sliced; Gancao (Glycyrrhizae Radix et Rhizoma), honey-fried; Mahuang (Ephedrae Herba), nodes removed (all 1 liang each); Dazao (Jujubae Fructus) - 4 pieces, split; Xingren (Armeniacae Semen Amarum) - 24 kernels, soaked in hot water, skin and tips removed. Boil these seven ingredients in 5 sheng of water. First boil Mahuang for 1-2 boils, skim foam, add other herbs. Boil to obtain 1.8 sheng. Strain and take 0.6 sheng warm.
In Taiyang disease, if there is fever, aversion to cold, heat predominating over cold, and a faint pulse, this indicates "absence of Yang" (Yang deficiency). Do not induce sweating. Gui Zhi Er Yue Bi Yi Tang (Guizhi Double Yuebi One-Tenth Decoction) is indicated. (Previous case had faint-slow pulse, flushed face, itching, treated with slight sweating via Gui Zhi Ma Huang Ge Ban Tang, which was not yet weak. This case is weaker. Although slight sweating is needed, it is contraindicated here due to extreme weakness. However, since Taiyang exterior syndrome persists, some dispersing action is necessary, just not profuse sweating.)
Gui Zhi Er Yue Bi Yi Tang Prescription:
Guizhi (Cinnamomi Ramulus), bark removed; Shaoyao (Paeoniae Radix Alba); Gancao (Glycyrrhizae Radix et Rhizoma) (each 0.75 qian); Shengjiang (Zingiberis Rhizoma Recens) - 1 liang 2 zhu, sliced; Dazao (Jujubae Fructus) - 4 pieces, split; Mahuang (Ephedrae Herba), nodes removed - 0.75 qian; Shigao (Gypsum Fibrosum) - 1 liang, crushed, wrapped in cloth. Coarsely crush these seven ingredients. Boil in 5 sheng of water. First boil Mahuang for 1-2 boils, skim foam, add other herbs. Boil to obtain 2 sheng. Strain and take 1 sheng warm. Originally, this formula was meant to be a combination of Yuebi Tang and Guizhi Tang in a 1:2 ratio, now combined into one prescription. The Stomach is the master of the twelve meridians; the Spleen manages water and grain, acting humbly like a maid. The Neijing states: "The Spleen transports fluids for the Stomach." Hence, it is called Yuebi (Excavating the Maid's Energy) to promote fluid circulation.
Generally, when Zhang Zhongjing mentions Taiyang disease, he refers to exterior syndromes with fever, aversion to cold, head/neck stiffness, and floating pulse. If the pulse is large and floating, it matches the syndrome, and sweating is appropriate. If the exterior syndrome presents with a faint pulse, it mismatches, so sweating is contraindicated. Harmonizing formulas like Ge Ban Tangs should be used instead.
If Taiyang Heatstroke (Zhong Shu) presents with fever, aversion to cold, faint pulse, cold extremities, and thirst, Bai Hu Jia Ren Shen Tang (White Tiger plus Ginseng Decoction) is indicated. (See Heatstroke chapter for formula discussion.)
In Taiyang disease, after six or seven days, if exterior symptoms persist, the pulse becomes faint and sinking, there is no chest binding, but the patient experiences mania, it is because heat resides in the lower jiao. The lower abdomen should be hard and full, and urination is free. Evacuating blood clots will cure it. This is because Taiyang pathogens followed the meridians inward, causing blood stasis in the interior. Didang Tang (Mahuang, Mang Xiao, etc., specifically Di Dang Tang) is indicated. (See Blood Stasis chapter.) In Taiyang disease, if there is yellowing of the body, sinking-knotted pulse, hard lower abdomen, and difficult urination, it is not blood stasis. If urination is free and the patient resembles mania, blood stasis is confirmed. Didang Tang is also indicated. (See Blood Stasis chapter.) Generally, when Zhang Zhongjing mentions a sinking pulse in Taiyang syndrome, it refers to fever, aversion to cold, head/neck stiffness with a paradoxically sinking pulse. Combined with mania and lower abdominal hardness, it indicates blood stasis, treated with Didang Tang.
If accompanied by joint pain, difficult urination, and jaundice, it is Bi Syndrome caused by Dampness. (See Dampness chapter.)
If accompanied by sudden lockjaw and opisthotonos, it is Jing Disease (Spasm). If without sweating and with aversion to cold, it is Gang Jing (Rigid Spasm), treated with Gegen Tang. If with sweating and without aversion to cold, it is Rou Jing (Soft Spasm), treated with Gualou Guizhi Tang. (See Spasm chapter in Miscellaneous Diseases.)
If fever, headache, and a paradoxically sinking pulse occur, without itching but with body pain, the interior must be rescued first with Sini Tang (Four Reversals Decoction). In Shaoyin disease, if initial presentation includes fever and a sinking pulse, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) is indicated.
Zhao Sizhen commented: Carefully examining Taiyang fever and headache, the pulse should be floating, but is now sinking. Shaoyin sinking pulse should present without fever, but now there is fever. Zhang Zhongjing uses "paradoxical" (fan) to denote abnormality. Taiyang pulse resembles Shaoyin; Shaoyin disease resembles Taiyang. Treatments must differ. Analyzing the essence: both have sinking pulse and fever. With headache, it is Taiyang (Yang syndrome), expecting floating pulse. Failure to float indicates interior deficiency and chronic cold, causing Qi decline. Body pain necessitates rescuing the interior to restore Qi and expel pathogens; Ganjiang (Dried Ginger) and Sheng Fuzi (Raw Aconite) can induce sweating. If interior were not deficient/cold, pulse would be floating, fitting Taiyang Mahuang syndrome. Without headache, it is Shaoyin (Yin syndrome), expecting no fever. Fever indicates exterior cold trapped in pores, not yet interior. Use Mahuang/Xixin to release exterior heat, Fuzi to warm Shaoyin channels. If cold entered interior, exterior would lack heat, presenting with vomiting/diarrhea/cold extremities, requiring Sini Tang. Thus, superficial exterior heat paradox is lighter than Qi deficiency sinking pulse paradox. Sini Tang is heavier/more critical than Mahuang Fuzi Xixin Tang. Also, cooked Fuzi with Mahuang provides tonification within dispersion; raw Fuzi with Ganjiang provides dispersion within tonification. Zhang Zhongjing's subtlety is profound.
Mahuang Fuzi Xixin Tang Prescription:
Mahuang (Ephedrae Herba) - 2 liang, nodes removed; Xixin (Asari Radix et Rhizoma) - 2 liang; Fuzi (Aconiti Lateralis Radix Praeparata) - 1 bulb, processed, bark removed, broken into 8 pieces. Boil these three ingredients in 10 sheng of water. First boil Mahuang, reduce by 2 sheng, skim foam, add other herbs. Boil to obtain 3 sheng. Strain and take 1 sheng warm, twice daily.
Cheng Wuji noted: The Neijing states: "For cold invading the interior, treat with sweet-hot, assist with bitter-pungent." Use pungent to moisten. Mahuang's sweetness resolves Shaoyin cold; Xixin and Fuzi's pungency warms Shaoyin channels.
Zhao Sizhen detailed: Zhang Zhongjing's sweating formulas vary in weight. Shaoyin sweating formulas (Mahuang Fuzi Xixin vs. others) use Mahuang/Fuzi but differ in dosage/additions. Adding Xixin increases potency (pungent dispersion); adding Gancao decreases it (sweet moderation). Case 1: Shaoyin normally lacks heat; inducing sweating creates "paradoxical" fever. Fever indicates exterior pathogen needing sweating; sinking pulse indicates Yin needing warming. Fuzi warms, Mahuang disperses, Xixin aids sweating. This is heavy sweating. Case 2: No interior cold to warm, no interior heat to purge. Sinking pulse allows Shaoyin diagnosis; fever allows sweating. Onset 2-3 days implies shallow disease, milder than Case 1. Hence, "slight sweating" is prescribed by removing Xixin and adding Gancao. This is light sweating. Generally, "no aversion to cold" in Taiyang refers to fever, head/neck stiffness, floating pulse without aversion to cold. Thirst indicates Warm Disease; sweating indicates Soft Spasm.
In Cold Damage, after six/seven days, if there is slight fever, mild aversion to cold, joint pain, slight vomiting, epigastric fullness/constraint, and exterior symptoms persist, Chaihu Jia Guizhi Tang (Bupleurum plus Cinnamon Twig Decoction) is indicated. (Cheng Wuji notes: Day 6/7 is when pathogens transmit inward. Vomiting/epigastric constraint are interior signs, suggesting purging. But exterior signs persist, so purging is contraindicated. Use Chaihu Guizhi Tang to harmonize. "Zhi" means scattered/spread. "Zhi jie" refers to branch-like joints; "Zhi jie" in epigastrium means support/constraint. It should be viewed flexibly. Zhang Zhongjing said: "Exterior unresolved, epigastric oppression is not Pi, but Zhi Jie.")
Chaihu Jia Guizhi Tang Prescription:
Guizhi (Cinnamomi Ramulus), bark removed; Huangqin (Scutellariae Radix); Renshen (Ginseng Radix) (each 1.5 liang); Gancao (Glycyrrhizae Radix et Rhizoma), honey-fried (1 liang); Shaoyao (Paeoniae Radix Alba); Shengjiang (Zingiberis Rhizoma Recens), sliced (each 1.5 liang); Dazao (Jujubae Fructus) - 6 pieces, split; Chaihu (Bupleuri Radix) - 4 liang; Banxia (Pinelliae Rhizoma) - 2.5 he. Boil these nine ingredients in 7 sheng of water to obtain 3 sheng. Strain and take warm.
Generally, "exterior unresolved" refers to Taiyang fever, aversion to cold, head/neck stiffness, floating pulse. Even if Taiyang exterior syndrome exists with interior complications, it is termed "exterior unresolved" rather than specifying Taiyang. Epigastric constraint is treated with Chaihu Guizhi Tang.
Epigastric fluid retention with dry heaving and cough is treated with Xiao Qing Long Tang (Minor Blue Dragon Decoction). (See Cough chapter.) Hypochondriac pain, warm hands/feet, and thirst are treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction). Epigastric fullness/stuffiness requires resolving the exterior first with Guizhi Tang, then treating the Pi (stuffiness) with Xi Xin Tang (Draining Heart Decoctions). (See Pi chapter.) Diarrhea with abdominal fullness/bloating requires warming the interior first with Sini Tang, then resolving the exterior with Guizhi Tang. (See Diarrhea chapter.)
Taiyang disease resolves between Si (9-11 AM) and Wei (1-3 PM). If unresolved, and both Yin and Yang pulses cease, the patient will first tremble/shiver, then sweat and resolve. If only the Yang pulse is faint, sweating resolves it. If only the Yin pulse is faint, purging resolves it. If purging is intended, Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction) is indicated. In Taiyang disease, if the pulse is floating-tight, with fever and no sweating, spontaneous nosebleed (xu) leads to resolution.
If Taiyang exterior symptoms are unresolved, do not purge. Purging is an error. To resolve the exterior, use Guizhi Tang. (Classic: Initiating purging before sweating is error; sweating first is correct.)
Hai Zang commented: Da, Xiao, and Tiao Wei Cheng Qi Tangs require complete resolution of exterior symptoms (floating pulse, headache, aversion to wind/cold) before use, followed by recurrence of fever, aversion to heat, delirium, and constipation. If floating-tight pulse, purging causes Chest Binding (Jie Xiong). If floating-slow pulse, purging causes Pi (Stuffiness).
Xu Shimowei recalled a relative with Cold Damage: fever, headache, no sweating, constipation for 4-5 days. The physician wanted to purge with Dahuang (Rhei Radix et Rhizoma) and Pomiao (Natrii Sulfas). Xu examined the patient: floating-slow pulse, severe aversion to wind in a closed room. He advised against purging, noting abdominal distension was absent and no other complaints existed. Following Zhang Zhongjing's principle, exterior symptoms must resolve before purging; otherwise, pathogens invade, causing Chest Binding or Heat Dysentery. Xu prescribed Gui Zhi Ma Huang Ge Ban Tang, followed by Xiao Chai Hu Tang. Sweating occurred, bowels moved, and the patient recovered.
Zhang Zhongjing stated: Cold Damage usually originates from Wind-Cold. Initially at the exterior, if it enters the interior, it does not dissipate. To attack it, resolve the exterior first, then purge. If exterior is resolved but interior excess remains (severe fullness, firmness, dry feces), purging is safe even after several days. If purging is inappropriate, interior deficiency allows heat invasion, causing complicated Heat Dysentery and irritability. Outcomes range from worsening to death. The original text had redundancies, which I corrected. Clearly, Wind-Cold entering the interior without dissipating implies dry feces or constipation. Purging is only safe when the pulse is not floating, there is no aversion to wind, and exterior symptoms have ceased. Constipation for 4-5 days is harmless if these conditions are met. Ignoring the exterior leads to Heat Dysentery. Gui Zhi and Mahuang are Zhang Zhongjing's primary exterior-resolving formulas, yet unskilled practitioners often misuse them fatally. The Yishui School replaced them with other drugs, claiming Zhang left out clever methods. I argue this shows the Yishui School's inadequacy compared to Zhang, albeit well-intentioned. Adhering to Chinese Medicine ensures safety. I present these examples of exterior treatment and combined tonification/dispersion for future scholars to study carefully.