甘草（二两炙） 附子（二枚炮去皮破八片） 白术（二两） 桂枝（四两去皮）
上四味。以水六升。煮取三升。去滓温服一升。日三服。初服。得微汗则解能食。汗止。复烦者。服五合。恐
一升多者。宜服六七合为妙。
成注云。桂枝甘草之辛甘。发散风邪而和卫。附子白术之辛甘。解湿气而温经。○愚以上方乃热补兼发散之药
也。
内台方议云。风则伤卫。湿流关节。风湿相搏。两邪乱经。故见骨节烦疼等证。上方用附子为君除湿祛风。温
经散寒。桂枝为臣。祛风固卫。白术去湿为使。甘草为佐而辅诸药。乃疏风去寒湿之禁方也。○愚按上议。实发明
成注之意。
后条辩云。桂枝附子汤。桂枝附子去桂加白术汤。甘草附子汤。三方俱用附子者。以风伤卫而表阳已虚。加寒
湿而里阴更胜。凡所见证。皆阳气不充。故经络关节得着湿。而卫阳愈虚耳○愚以此言实发仲景奥义。
上三条证（见原论中第四卷太阳病脉证并治法下第七）
阳明病。不能食。攻其热。必哕。所以然者。胃中虚冷故也。以其人本虚。故攻其热。必哕。（哕于月切。○
此言阳明中寒也。阳明中寒。有胸已前受寒气者。有口食冷物而得者。今者。阳明病不能食。是胃中无物。医人以
不能食。为胃家实。而以苦寒之药。误攻其热必作哕。哕者。哕逆。俗云冷呃是也。其所以然者。为胃中虚冷之故。
以其人胃气本虚。不能食。又攻其热。则胃中寒极而成冷。胃中之气。既虚且冷。乃真火之气欲脱。反上逆而作哕
也。○按此条论。仲景无治法。补亡论常器之云。可温中汤。下注云金匮方。及考金匮无此方。愚谓宜用附子理中
汤。）
脉浮而迟。表热里寒。下利清谷者。四逆汤主之。（阳明胃脉本和缓。若经病热。脉当洪长。今则但浮。此在
表之热微也。腑病热。脉当洪数。今则过迟。此在里之寒甚也。武陵陈氏云。阳明气血俱盛。邪客之。表里俱热。
病机之常。然亦有表热里寒者。由其人胃气本弱。寒邪乘虚入里。其留于表者变热。而骤入于里者。不及变热。故
见下利清谷一证。清。洁也。其所利之谷食。色不变。气不臭。即完谷不化也。此为里寒已极故与四逆汤。以温里
散寒。）
若胃中虚冷。不能食者。饮水则哕。（此承上文里寒而言。兹则胃中不但寒。而竟成虚冷矣。夫胃中虚。宜能
食。今者既虚且冷。故不能食。即经云。食不得入。是无火也。庸工不知。见其表热。认以为胃中实热证。且下利
之后。亡津液而思水。遂饮之以水。水寒相搏。气逆而亦为哕也。武陵陈氏云。法当大温。上节已用四逆。故不更
言治法。○愚按补亡论常器之云。宜温中汤。然不若用茯苓四逆汤。即四逆汤中。加人参以补虚。茯苓以利水也。
方已见上太阳治法中。）
食谷欲呕者。属阳明也。吴茱萸汤主之。得汤反剧者。属上焦也。止条亦胃中虚冷之证。食谷欲呕者。胃既
无火。不能消下也。曰属阳明者。后条辩云。此别其与少阳喜呕之半表证。又太阳干呕不能食之表证不同。宜温中
补虚。降逆气。方用吴茱萸汤主之无疑矣。其有得汤呕反剧者。此寒不在中焦。而属上焦。吴茱萸气味苦辛重浊。
与上焦之清气。不相和协故也。○愚按成注云。以治上焦法治之。而无其方。准绳云。葛根半夏汤误矣。尚论篇云。
仍属太阳热邪。而非胃寒。条辩云。上焦以膈言。戒下之意。此又泥于伤寒呕多。虽有阳明证不可攻之。皆大谬之
极。窃思先贤用药。岂如今医之鲁莽。误以胃家虚寒为实热证。但虚寒在膈以上。不与胃腑之中。溷同一治。上条
证。治以吴茱萸汤。寒热虚实。原无误也。其有得汤反剧者补亡论常器之云。宜橘皮汤。注云。类要方。用橘皮二
两。甘草一两。生姜四两。人参三两。水煎服。斯言庶得之矣。
甘草（二两，经蜜炙处理） 附子（两枚，炮制后去皮并破开成八片） 白术（二两） 桂枝（四两，去皮）
以上四味药。加入六升水。煮至剩余三升药液。滤去药渣，温服一升。每日服用三次。初次服药后，若出现微微出汗则病愈，食欲恢复；若汗止后再次出现烦闷症状，则改为服用五合。如果担心一升药量过多，适宜服用六七合最为巧妙。
成无己注解说：桂枝和甘草的辛甘之性，能发散风邪并调和卫气。附子和白术的辛甘之性，能解除湿气并温暖经脉。○我认为上方是热补兼有发散作用的药物。
《内台方议》评论说：风邪伤害卫气，湿邪流注关节，风湿相互搏结，两种邪气扰乱经络，所以出现骨节烦痛等症状。上方用附子作为君药以除湿祛风、温暖经脉、散寒；桂枝作为臣药，祛风固护卫气；白术作为使药去除湿气；甘草作为佐药辅助诸药。这是疏风散寒湿的禁方（珍贵有效的方剂）。○我按语认为上述评论，实际上阐发了成无己注解的本意。
《伤寒论条辩》评论说：桂枝附子汤、去桂加白术汤、甘草附子汤，这三方都使用附子，是因为风邪伤及卫气导致表阳已虚，加上寒湿侵袭使得里阴更盛。凡是所见证候，都是阳气不充盈，所以经络关节容易受湿邪着留，而卫阳更加虚弱。○我认为这番话确实阐发了张仲景的深奥义理。
以上三条证候（见原论第四卷《太阳病脉证并治法下》第七节）
阳明病，不能进食。如果用清热法攻治，必然发生呃逆（哕）。之所以这样，是因为胃中虚冷。因为患者本身体质虚弱，所以用清热法攻治，必然导致呃逆。（“哕”音yuè。○这里论述的是阳明中寒证。阳明中寒，有的是胸膈以前受寒气所致，有的是因吃冷物而得。现在阳明病不能进食，说明胃中空虚无物。医生把不能进食当作胃家实证，而用苦寒药物误攻其热，必然引起呃逆。哕，即呃逆，俗称冷呃。之所以这样，是因为胃中虚冷的缘故。因为患者胃气本来虚弱，不能进食，又用清热法攻治，导致胃中寒冷至极而成冷。胃中之气，既虚弱又寒冷，真火之气欲脱，反而上逆产生呃逆。○按此条论述，张仲景没有给出治疗方法，《补亡论》常器之说可用温中汤。下方注释说是金匮方的内容，但考证《金匮要略》并无此方。我认为适宜使用附子理中汤。）
脉象浮而迟，表热里寒，腹泻且排出未消化食物者，用四逆汤主治。（阳明胃脉本应和缓，若经病发热，脉应当洪大长实。现在只是浮，说明在表的热轻微。腑病发热，脉应当洪数。现在却过于迟慢，说明在里的寒很严重。武陵陈氏说：阳明气血俱盛，邪气客犯它，表里俱热，这是病机的常态。然而也有表热里寒的情况，这是因为患者胃气本来虚弱，寒邪乘虚入里。停留在表部的邪气变为热，而骤然入里的邪气来不及变热，所以出现腹泻完谷不化的证候。“清”，意为洁净。所泻出的谷物食物，颜色不变，气味不臭，就是完谷不化。这是因为里寒已到极点，所以给予四逆汤，以温暖里气、散发寒气。）
如果胃中虚冷，不能进食，喝水就会引发呃逆。（这是承接上文里寒而言。此时胃中不仅寒，而且竟成了虚冷。胃中虚，按理应该能进食。现在既虚又冷，所以不能进食。正如经文所说：“食不得入，是无火也。”庸医不知晓这一点，见到表热，就认作胃中实热证。且在腹泻之后，津液耗伤而想喝水，于是给水喝。水与寒相互搏结，气机上逆，也产生呃逆。武陵陈氏说：治法应当大温。上一节已经用了四逆汤，所以不再言明治法。○我按语认为《补亡论》常器之说适宜用温中汤，然而不如使用茯苓四逆汤，即在四逆汤中加入人参以补虚，茯苓以利水。该方已在上面太阳病治法中出现过。）
进食后想要呕吐的，属于阳明病。用吴茱萸汤主治。喝了药汤反而病情加剧的，属于上焦病。这一条也是胃中虚冷的证候。进食后想要呕吐，是因为胃中没有火，不能消化下行。说属于阳明病，《伤寒论条辩》评论说：这是为了区别它与少阳病喜欢呕吐的半表证，以及太阳病干呕不能食的表证不同。适宜温中补虚，降逆气，方用吴茱萸汤主治无疑。那些喝了药汤呕吐反而加剧的，这是因为寒不在中焦，而属于上焦。吴茱萸气味苦辛重浊，与上焦的清气不相和谐。○我按语认为成无己注解说：“用治疗上焦的方法治疗它”，但没有给出方剂。《准绳》说是葛根半夏汤，这是错误的。《尚论篇》说仍属于太阳热邪，而非胃寒。《条辩》说上焦指膈膜，意在禁止攻下。这些都是拘泥于“伤寒呕多，虽有阳明证不可攻”的说法，都是极其荒谬的。我私下思考先贤用药，难道像如今医生那样鲁莽？误将胃家虚寒当作实热证。只要虚寒在膈以上，不与胃腑之中混同治疗。上一条证候，用吴茱萸汤治疗，寒热虚实原本没有错误。那些喝了药汤反而加剧的，《补亡论》常器之说适宜用橘皮汤。注释说是《类要方》，用橘皮二两，甘草一两，生姜四两，人参三两，水煎服。这话才差不多正确了。
Gancao (Radix Glycyrrhizae Preparata, two liang, honey-fried) Fuzi (Radix Aconiti Lateralis Preparata, two pieces, processed, peeled, broken into eight slices) Baizhu (Rhizoma Atractylodis Macrocephalae, two liang) Guizhi (Ramulus Cinnamomi, four liang, bark removed)
The above four herbs. Add six sheng of water. Boil until three sheng of liquid remain. Strain the dregs and take one sheng warm. Take three times a day. After the first dose, if slight sweating occurs, the disease resolves and appetite returns; if restlessness recurs after sweating stops, take five ge. If one sheng is feared to be too much, taking six or seven ge is optimal.
Cheng Wuji commented: The pungent-sweet nature of Guizhi and Gancao disperses wind pathogens and harmonizes Wei Qi (Defensive Qi). The pungent-sweet nature of Fuzi and Baizhu resolves dampness and warms the meridians. ○ I consider the above formula to be a combination of heat-tonifying and dispersing herbs.
Neitai Fangyi commented: Wind injures Wei Qi, dampness flows into the joints. When wind and dampness contend, both pathogens disrupt the collaterals, thus presenting symptoms such as bone-joint vexation and pain. In the above formula, Fuzi is used as the Sovereign herb to resolve dampness, dispel wind, warm the meridians, and scatter cold. Guizhi serves as the Minister herb to dispel wind and secure Wei Qi. Baizhu acts as the Guide herb to remove dampness. Gancao serves as the Assistant herb to support the other herbs. This is a precious formula for dispersing wind and eliminating cold-dampness. ○ My commentary notes that the above discussion actually elucidates the intent behind Cheng Wuji's annotation.
Shanghan Lun Tiaobian commented: Guizhi Fuzi Tang, Qugui Jiabai Zhu Tang, and Gancao Fuzi Tang all use Fuzi because wind injuring Wei Qi has already depleted the Exterior Yang, and the addition of cold-dampness makes the Interior Yin even stronger. All manifested syndromes indicate insufficient Yang Qi, causing the collaterals and joints to be susceptible to dampness attachment, while Wei Yang becomes increasingly deficient. ○ I believe this statement truly expounds Zhang Zhongjing's profound principles.
The above three syndromes (see Original Treatise, Volume 4, "Sunyang Disease Pulse, Syndrome, and Treatment Methods Part II", Section 7):
Yangming Disease characterized by inability to eat. If treated with heat-clearing methods, it will inevitably cause hiccups (Yue). The reason for this is deficiency-cold in the Stomach. Because the person is originally deficient, attacking the heat will inevitably cause hiccups. ("Yue" is pronounced yuè. ○ This discusses Yangming Cold Invasion. Yangming Cold Invasion can result from cold air affecting the chest and diaphragm, or from consuming cold food. Now, the inability to eat in Yangming Disease indicates emptiness in the Stomach. Physicians mistake the inability to eat for Excess in the Stomach House and mistakenly attack the heat with bitter-cold medicines, inevitably causing hiccups. Yue refers to hiccupping, commonly known as cold eructation. The reason lies in the deficiency-cold of the Stomach. Since the person's Stomach Qi is originally weak and unable to eat, further attacking the heat leads to extreme cold in the Stomach. With Stomach Qi being both deficient and cold, the True Fire Qi is about to escape, reversing upward to cause hiccups. ○ Regarding this passage, Zhang Zhongjing provides no treatment method. Bu Wang Lun states Chang Qizhi suggested Wenzhong Tang. The footnote mentions it is from Jin Gui Fang, but examination of Jin Gui Yao Lue reveals no such formula. I suggest using Fuzi Lizhong Tang.)
Pulse floating and slow, exterior heat and interior cold, with diarrhea passing undigested food: Sini Tang is the primary treatment. (The Yangming Stomach pulse should naturally be moderate. If channel heat exists, the pulse should be surging and long. Now it is merely floating, indicating mild heat at the exterior. If organ heat exists, the pulse should be surging and rapid. Now it is excessively slow, indicating severe cold at the interior. Chen of Wuling stated: Yangming Qi and Blood are abundant; when pathogens invade, exterior and interior heat are the norm. However, there are cases of exterior heat and interior cold due to original weakness of Stomach Qi, allowing cold pathogens to enter the interior upon deficiency. Pathogens remaining at the exterior transform into heat, while those entering the interior rapidly do not have time to transform into heat, thus presenting diarrhea with undigested food. "Qing" means clean. The discharged food retains its color and lacks odor, i.e., undigested food. This indicates extreme interior cold, hence Sini Tang is given to warm the interior and scatter cold.)
If the Stomach is deficient and cold, unable to eat, drinking water causes hiccups. (This continues the discussion on interior cold. Here, the Stomach is not only cold but also deficient-cold. Deficiency in the Stomach usually allows eating. Now, being both deficient and cold, it cannot eat. As the Classic states: "Food cannot enter, meaning there is no fire." Unskilled physicians, unaware of this, see exterior heat and diagnose Stomach Excess-Heat. Furthermore, after diarrhea, fluids are lost, leading to thirst for water. Drinking water causes water and cold to contend, Qi reverses upward, and hiccups occur. Chen of Wuling stated: The method should be strong warming. Since Sini Tang was used in the previous section, the treatment method is not reiterated. ○ My commentary notes that Bu Wang Lun states Chang Qizhi suggested Wenzhong Tang, but Fuling Sini Tang is preferable. This is Sini Tang plus Renshen to tonify deficiency and Fuling to promote urination. This formula appears in the Sunyang treatment section above.)
Desire to vomit after eating belongs to Yangming. Wuzhuyu Tang is the primary treatment. If symptoms worsen after taking the decoction, it belongs to the Upper Jiao. This clause also describes a Stomach deficiency-cold syndrome. Desire to vomit after eating occurs because the Stomum lacks Fire and cannot digest and descend. It is said to belong to Yangming. Shanghan Lun Tiaobian comments: This distinguishes it from Shaoyang's preference for vomiting (half-exterior syndrome) and Taiyang's dry retching and inability to eat (exterior syndrome). It is appropriate to warm the middle, tonify deficiency, and direct rebellious Qi downward. Using Wuzhuyu Tang is undoubtedly correct. For those whose vomiting worsens after taking the decoction, the cold is not in the Middle Jiao but in the Upper Jiao. Wuzhuyu has a pungent-bitter and heavy-turbid flavor, which does not harmonize with the clear Qi of the Upper Jiao. ○ My commentary notes Cheng Wuji said: "Treat it according to Upper Jiao methods," but provided no formula. Zhunsheng suggested Gegen Banxia Tang, which is incorrect. Shanglun Pian stated it still belongs to Taiyang Heat Pathogen, not Stomach Cold. Tiaobian stated Upper Jiao refers to the diaphragm, implying a prohibition against purgatives. These interpretations cling to "in cold damage, frequent vomiting, even with Yangming signs, purgatives are forbidden," which are extremely erroneous. I privately ponder: Did ancient sages prescribe medicines as recklessly as modern physicians? Mistaking Stomach deficiency-cold for Excess-Heat. If deficiency-cold is above the diaphragm, it should not be treated identically to the Stomach organ. The previous syndrome was treated with Wuzhuyu Tang, where cold/heat and excess/deficiency were correctly identified. For those worsening after the decoction, Bu Wang Lun states Chang Qizhi suggested Jupi Tang. The note cites Lei Yao Fang: Jupi two liang, Gancao one liang, Shengjiang four liang, Renshen three liang, decocted in water. This statement is likely correct.