桂枝（二两去皮） 大黄（一两） 芍药（六两） 生姜（二两切） 甘草（一两炙） 大枣（十
二枚）
上六味。以水七升。煮取三升。去滓。温服一升。日三服。
按此条之大实痛。则非腹满时痛之比矣。腹满时痛。是脾阴为虚阳所扰。大实痛则脾气
与阳
气俱实。大实大满。似宜亟下。但阳邪究从太阳陷入太阴。与阳明胃实不同。仍宜桂枝领出
阳邪。但加大黄微导其滞。则表里两邪。各有去路。程郊倩曰。二证虽属太阴。然来路实从
太阳。则脉必尚有浮者存。
再按柯韵伯谓腹满时痛。是太阳太阴并病。若大实痛。是太阳阳明并病。满而时痛。下
利之
兆。大实而痛。燥屎之征。桂枝加芍药。小试建中之剂。桂枝加大黄。微示调胃之功。王晋
三亦沿此论。然经文大实痛三字直接上文。并无转属阳明之说。而仲景于太阴病。亦有当行
大黄芍药之条。若果阳明胃实。则大实痛正承气亟攻之证。而桂枝加大黄。究属和解之法。
并非下夺之剂。恐柯氏所云。未免失之穿凿。
桂枝（三两去皮） 甘草（二两炙） 生姜（三两切） 大枣（十二枚擘） 蜀漆（二两洗去脚）
龙骨（四两） 牡蛎（五两熬）
上为末。以水一斗二升。先煮蜀漆。减二升。纳诸药。煮取三升。去滓。温服一升。经
云。伤寒脉浮。医以火迫劫之亡阳。必惊狂。卧起不安者。此方主之。按亡阳有二义。发
汗过多。厥逆筋惕肉 而亡阳者。乃亡阴中之阳。故用真武辈以救之。此以火劫致变。惊狂
卧起不安而亡阳者。乃亡阳中之阳。故无藉于芍药敛阴。而当加重镇入心之品。以急挽飞越
之阳神也。此证稍缓须臾。神丹莫挽。故重加救逆二字。喻嘉言曰。桂枝汤除去芍药。非恶
其酸收也。盖阳神散乱。当求之于阳桂枝汤。阳药也。然必去芍药之阴重。始得疾趋以达于
阳位。既达阳位矣。其神之惊狂者。漫难安定。更加蜀漆为之主统。则神可赖之以安矣。缘
蜀漆之性最急。丹溪谓其能飞补是也。更加龙骨牡蛎。有形之骨属。为之舟楫。以载神而反
其
宅。亦于重以镇怯。涩以固脱之外。行其妙用。如是而后天君复辟。聿追晋重耳越勾践返国
之良图矣。
桂枝（二两，去皮） 大黄（一两） 芍药（六两） 生姜（二两，切片） 甘草（一两，炙烤） 大枣（十二枚）
以上六味药。用水七升。煮取三升药液。滤去药渣。温服一升。每日服用三次。
按语：此条文中提到的“大实痛”，就不是“腹满时痛”所能比拟的了。“腹满时痛”，是脾阴被虚阳所扰乱所致；而“大实痛”则是脾气与阳气都处于实证状态。面对大实大满的情况，似乎应当紧急攻下。但是，阳邪终究是从太阳经陷入太阴经的，这与阳明胃腑的实证不同。因此，仍然适宜用桂枝汤引领出在表的阳邪，只是加大黄轻微疏导其积滞，这样表邪和里邪各有出路。程郊倩说：这两种证候虽然属于太阴病，但其来路确实是从太阳经传入的，所以脉象必然还有浮象存在。
再按语：柯韵伯认为，“腹满时痛”是太阳病与太阴病并病；如果是“大实痛”，则是太阳病与阳明病并病。腹部胀满且时而疼痛，是下利的征兆；大实且疼痛，是燥屎内结的迹象。桂枝加芍药汤，是小试建中汤的功效；桂枝加大黄汤，是微示调胃承气汤的作用。王晋三也沿袭这一观点。然而，经文中的“大实痛”三字直接承接上文，并没有转属阳明的说法。而且张仲景在太阴病的论述中，也有应当使用大黄、芍药的条文。如果果真是阳明胃腑实证，那么“大实痛”正是承气汤急需攻下的证候。而桂枝加大黄汤，究其本质仍属于和解之法，并非峻下夺实的方剂。恐怕柯氏所说的，未免有些牵强附会。
桂枝（三两，去皮） 甘草（二两，炙烤） 生姜（三两，切片） 大枣（十二枚，掰开） 蜀漆（二两，水洗去脚根泥土） 龙骨（四两） 牡蛎（五两，熬制）
以上药物研为粗末。用水一斗二升，先煮蜀漆，减少二升水量后，加入其余药物，煮取三升药液。滤去药渣。温服一升。经云：伤寒脉浮，医生用火法强迫发汗导致亡阳，必定出现惊狂、卧起不安的症状，此方主治。按语：“亡阳”有两种含义。因发汗过多，出现四肢厥逆、筋惕肉瞤而亡阳的，这是亡失阴中之阳，所以用真武汤之类来救治。此证是因火劫导致变证，出现惊狂、卧起不安而亡阳的，这是亡失阳中之阳，所以不需要借助芍药收敛阴液，而应当加重镇入心的药物，以急挽飞越的阳神。此证如果稍微迟缓片刻，即使是神丹也无法挽回，所以加上“救逆”二字。喻嘉言说：桂枝汤除去芍药，并不是厌恶它的酸收作用。而是因为阳神散乱，应当从阳分寻求解决。桂枝汤是阳药，但必须去掉芍药的阴重之性，才能迅速到达阳位。既然到达了阳位，那些因神志惊狂难以安定的情况，再加上蜀漆作为主统药物，那么神志就可以依赖它而安定。因为蜀漆的药性最急，丹溪说它能“飞补”。再加上龙骨、牡蛎，这些有形的骨属药物，作为舟楫，承载神志使其返回宅舍，也是在重镇怯症、涩以固脱之外，发挥其妙用。如此之后，心神得以恢复，就像追赶晋文公重耳、越王勾践返国的良策一样。
Cinnamon Twig (Guizhi, 2 liang, bark removed) Rhubarb (Dahuang, 1 liang) Peony Root (Shaoyao, 6 liang) Fresh Ginger (Shengjiang, 2 liang, sliced) Prepared Licorice Root (Gancao, 1 liang, honey-fried) Jujube (Dazao, 12 pieces)
These six ingredients. Decoct with seven sheng of water. Boil to obtain three sheng of liquid. Strain off the dregs. Take one sheng warm. Administer three times daily.
Commentary: The "severe real pain" (Da Shi Tong) mentioned in this clause is not comparable to "abdominal fullness and intermittent pain" (Fu Man Shi Tong). "Abdominal fullness and intermittent pain" arises from spleen yin being disturbed by deficient yang; whereas "severe real pain" indicates that both spleen qi and yang qi are in a state of excess. In cases of severe excess and fullness, it might seem appropriate to urgently purge. However, the pathogenic yang ultimately descended from the Taiyang channel into the Taiyin channel, which differs from the excess condition of the Yangming stomach. Therefore, it is still suitable to use Guizhi Tang (Cinnamon Twig Decoction) to lead out the exterior pathogenic yang, merely adding Dahuang (Rhubarb) to slightly guide away the stagnation. Thus, both exterior and interior pathogens have their respective paths of exit. Cheng Jiaoqian stated: Although these two conditions belong to Taiyin disease, their origin indeed comes from the Taiyang channel; therefore, the pulse must still retain a floating quality.
Further Commentary: Ke Yunbo asserted that "abdominal fullness and intermittent pain" represents a concurrent disease of Taiyang and Taiyin; if it is "severe real pain," it represents a concurrent disease of Taiyang and Yangming. Abdominal fullness with intermittent pain is a sign of impending diarrhea; severe real pain with pain is a sign of dry stool accumulation. Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony Root) is a trial of the Jianzhong (Establish the Middle) formula's efficacy; Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rhubarb) subtly demonstrates the function of Tiaowei (Regulate the Stomach) [Chengqi] action. Wang Jinthree also followed this theory. However, the phrase "severe real pain" in the classic text directly follows the preceding context without any mention of transmission to Yangming. Moreover, Zhang Zhongjing included clauses in the Taiyin disease section where Dahuang and Shaoyao should be used. If it were truly a Yangming stomach excess, "severe real pain" would be an indication for urgent attack by Chengqi Tang (Major Order the Qi Decoction). Guizhi Jia Dahuang Tang, essentially, belongs to harmonizing methods, not to drastic purgative agents. It is feared that Ke's statement is somewhat forced and far-fetched.
Cinnamon Twig (Guizhi, 3 liang, bark removed) Prepared Licorice Root (Gancao, 2 liang, honey-fried) Fresh Ginger (Shengjiang, 3 liang, sliced) Jujube (Dazao, 12 pieces, broken open) Pyrite Fern Rhizome (Shuqi, 2 liang, washed to remove root base) Dragon Bone (Longgu, 4 liang) Oyster Shell (Muli, 5 liang, calcined)
Grind the above ingredients into coarse powder. Use twelve dou of water. First decoct Shuqi (Pyrite Fern Rhizome), reducing the volume by two dou. Then add the remaining herbs. Decoct to obtain three sheng of liquid. Strain off the dregs. Take one sheng warm. The Classic states: In cold damage, if the pulse is floating, and the physician uses fire methods to force sweating leading to loss of yang, there will inevitably be fright, mania, restlessness lying down and rising up. This formula governs such cases. Commentary: "Loss of yang" has two meanings. When excessive sweating leads to cold limbs, twitching of tendons and flesh, resulting in loss of yang, this is the loss of yang within yin; thus, Zhenwu Tang (True Warrior Decoction) or similar formulas are used to rescue it. In this case, changes caused by fire coercion leading to fright, mania, restlessness, and loss of yang represent the loss of yang within yang. Therefore, there is no need to rely on Shaoyao (Peony Root) to astringe yin; instead, heavy sedatives entering the Heart should be added in greater dosage to urgently retrieve the flying away yang spirit. If this condition lingers even for a moment, even divine pills cannot save it; hence the addition of the characters "Rescue from Peril." Yu Jiayan said: Removing Shaoyao from Guizhi Tang is not due to aversion to its sour astringent nature. Rather, because the yang spirit is scattered, one must seek resolution through yang. Guizhi Tang is a yang formula, but one must remove the heavy yin nature of Shaoyao to allow rapid arrival at the yang position. Once reaching the yang position, the fright and mania of the spirit are difficult to stabilize. Adding Shuqi as the primary unifying agent allows the spirit to rely on it for stability. This is because Shuqi has the most urgent nature; Danxi stated it can "fly and tonify." Additionally, Longgu (Dragon Bone) and Muli (Oyster Shell), being tangible bone substances, serve as vessels to carry the spirit back to its residence. Beyond heavy sedation for fearfulness and astringency for collapse prevention, they exert their subtle effects. Only in this way can the Heavenly Lord (Heart/Mind) be restored, akin to the good strategy of chasing Duke Chong'er of Jin and King Goujian of Yue to return to their states.