鄭論：按脈浮之病，本應汗解，方為合法，醫家不究脈體，而妄以火灸之，大悖經旨。況表陽也，火亦陽也，二陽相合，邪不從外出而從內攻，遂致腰以下必重而痹者，是邪伏於下，阻其太陽寒水流行之氣機故也。名日火逆者，是重在未得汗解，而水滯於下也。
【闡釋】本條係116條中一節，指出浮脈誤灸後的變證。浮脈在表，宜以汗解之，醫以火灸取汗，而不得汗，邪無從出，因火而盛，雖不一定焦骨傷筋，而火阻其邪，陰氣漸竭，下焦乃營血所治，營氣竭而莫運，必重著而為痹。亦即鄭氏所說：“邪不從外出而從內攻，遂致腰以下必重而痹者，是邪伏於下。”則欲治其痹者，宜先治其火矣。
七、脈浮者，〔病在表〕，可發汗，宜麻黃湯。脈浮而數者，可發汗，宜麻黃湯。原文51、52
鄭論：按脈浮、脈數，雖雲可發汗，然有用桂枝湯者，有用麻黃湯者。在營在衛，原有區分，不得以浮、數二字，而斷為麻黃湯的證也。學者務于有汗、無汗、畏風、惡寒處追求，便得用方之實據也。
【闡釋】本條在《傷寒論》為51、52條，鄭氏合併為一條。凡表病皆見浮脈，麻黃湯證之主脈為浮緊，並有頭疼發熱，惡寒無汗等證狀，方可用麻黃湯發汗。脈浮而數者，多是風熱在表的象徵，麻黃湯是不適合的，應該與本篇一條二條互參，如證與之相合，方可用麻黃湯發其汗，則諸證自愈。觀原文不曰以麻黃湯為主之，而皆曰宜麻黃湯，則有商量斟酌之意也。
八、傷寒，發汗〔已〕解，半日許複煩，脈浮數者，可更發汗，宜（用）桂枝湯。原文57
鄭論：大約此證，既經汗解，而邪尚未盡解，故可更汗之，俾邪解盡無遺，庶無後患。
【闡釋】本條為汗解後，表邪猶未盡，因而複煩，脈浮數者，邪氣仍在表之證，故可更發汗，以祛表邪。但已汗複汗，故不宜麻黃湯之峻發，而宜桂枝湯之緩發也。
九、發汗已，脈浮數，煩渴者，五苓散主之。原文72
鄭論：按太陽傷寒，既稱發汗已，想是外邪已去。又見其脈浮數，煩渴，必是外邪已去，而內熱未解，故其脈浮數尚見。至於煩渴者，熱傷津液也，理應清解其熱，熱去則煩渴自解，脈數便平，何得即以五苓散主之？凡用五苓散，必要太陽邪已入腑，口渴而小便不利，原文只據一煩渴，脈數，學者每多不識。
煩渴二字，亦有飲冷、飲熱之分，不可不察（頂批）
【闡釋】此條鄭氏指出用五苓散之不當。凡用五苓散，必要太陽邪已入腑，口渴而小便不利，原文只據一煩渴，脈數，其不當明甚。
十、傷寒汗出而渴者①，五苓散主之；不渴者，茯苓甘草湯主之。原文73
①此處之口渴，不是陽明裏證的口渴，是水氣停在下焦，津液不能上布之口渴。
鄭論：按汗出而渴，是太陽寒水從毛竅而出，不能滋潤腸胃，故見口渴，以五苓散主之，乃使太陽寒水之氣，不從外出，而仍從內出，則汗渴便止。然有不渴者，是津液未大傷，胃中尚可支持，雖見汗出，以茯苓甘草湯主之，亦是化氣行水之妙。此條據餘所見，當時汗出而渴，小便不利者，以五苓散主之；汗出不渴，小便不利者，以茯苓甘草湯主之。加此四字，後學更易於明白了然。
再按汗出而渴，在陽明㈠有白虎之方；汗出而不渴，在少陰有亡陽之概，學者宜知。
㈠大渴飲冷（頂批）。
【闡釋】此條為茯苓甘草湯證與五苓散證之辨證要點，只在渴與不渴之間，則其他證狀，如脈浮數，小便不利，微熱等情況，亦必大致相同。鄭氏釋為加小便不利四字，更加明白了然，是正確的。兩證的主要區別是：一則水蓄於下，口渴而小便不利；一則水停於中，口不渴而小便不利。證情雖有異，但總的原因都屬停飲蓄水為患，所以都治以溫陽化水，不過一則重在溫化膀胱，以利小便，一則重在溫化胃陽而通利三焦，以蠲水飲，所以主治方劑各別。
茯苓四兩桂枝二兩（去皮）甘草一兩（炙）生薑三兩（切）上四味，以水四升，煮取二升，去滓，分溫三服。
【方解及其應用範圍】本方治汗出不渴，其蓄水比五苓散為輕，因而去掉主要的利水藥，僅用茯苓之淡滲，加重桂枝溫陽，生薑溫胃，甘草和中，四味配伍，溫胃散水之功最佳，為治水氣停中焦，不煩不渴，心下悸而四肢厥逆的有效良方。
十一、脈浮緊者，法當身疼痛，宜以汗解之。假令尺中遲者②，不可發汗，〔何以知之？然①，以營氣不足，血少故也。〕原文50
②尺中遲者：尺中的脈搏現遲而澀的現象，所謂“呼吸三至，來去極遲”。遲就是脈搏至數減少。但這裏的遲，是對緊而言。
①然：古人然字，多有作“曰”字解。
十二、〔脈浮數者，法當汗出而愈，若下之，身重心悸者，不可發汗〕，當自汗出乃解。所以然者，尺中脈微，此裏虛，須表裏實②，津液自和，便自汗出愈。原文49
②須：等待的意思。
鄭論：條內指一脈浮緊，身痛之人，法本當汗，假令尺中虛者，不可發汗，是言其陰分本虛，發之深恐亡陽，明是教人留意於發汗之間耳。即有他證，亦俟其津液自和，自汗出愈。蓋慎之深，防之密矣。
【闡釋】按此二條，鄭氏合併來加以注釋，原文錯落較多，其按亦不全面。
茲據《傷寒論》校補其錯落文字，分列兩條之釋文。脈浮緊，身疼痛，此傷寒之脈證，宜麻黃湯以汗之者也，然尺中脈遲，此營氣不足，而不可發汗之虛證也。
至12條表證誤下後，見身重、心悸、尺脈微的，不能再用發汗，可俟其自汗出而愈。但亦可以酌用小建中湯一類方劑，溫養裏氣，使表裏正氣早複，氣血充沛，則津液自和，便能汗出而愈。
十三、咽喉乾燥者，不可發汗。原文83
鄭論：凡咽喉乾燥之人，津液已傷，豈可再行發汗，以重奪其液乎？餘謂咽喉乾燥之人，有因下元坎中真氣衰微，不能啟真水上升而致者，法宜扶陽；有因邪火灼其津液而致者，法宜清潤；有因寒水逆於中，阻其胃中升騰之氣而致者，法宜行水。學者留心察之，若此等證，皆非發汗所能了
【闡釋】本條為汗法禁例之一。咽喉乾燥者，上焦無津液也。鄭氏認為咽喉乾燥之人，有三種不同情況，並提出扶陽、清潤、行水三種治法。筆者認為扶陽可用四逆湯，清潤可用人參白虎湯，行水可用茯苓甘草湯或五苓散。咽喉乾燥，現今多稱為慢性咽炎、喉炎，筆者常先用炮薑甘草湯加桔梗治之，繼加補腎藥調理而愈。
③淋家：是指小便淋瀝不爽，尿時莖中疼痛的病人。
鄭論：凡患淋之人，或熱閉膀胱，或寒閉膀胱，或敗精滯於尿竅，氣化現有不宣，原無發汗之理，若強汗之，則津液外亡，中氣被奪，即不能統束血液，血液流注闌門秘清別濁之處，滲入膀胱，小便下血，於是乎作矣。
【闡釋】本條為汗法禁例之二。歷代醫家注解此條，其原因多由腎陰虛而膀胱有熱，鄭氏所指熱閉膀胱即此，法宜扶腎陰，用四苓滑石阿膠湯治之。繼指出有寒閉膀胱，或敗精滯於尿竅，氣化不宣者。寒閉膀胱者，由下焦陽微，陰寒阻截膀胱之路，陽微無力，不能化之，法宜扶下焦之陽，可用苓桂朮甘湯倍桂加砂仁、白蔻治之。至於敗精滯於尿竅，氣化不宣者，治當清熱利水中，加以化精化氣之品，可選用滋腎丸倍桂，或大劑回陽飲加味治之。淋家雖患外感，亦無強汗之理，若強汗之，陰液愈虛，膀胱之蓄熱愈熾，必致邪熱通血妄行，從小便而為尿血。
①瘡家：患瘡瘍病者，流膿已久，此皆亡失其津血。
②痙（jìng淨）：肌肉收縮，手足抽搐的現象。
鄭論：《內經》雲：諸瘡痛癢，皆屬於火。火盛則血虧，若（在）〔再〕發汗，血液被奪，筋脈失養，痙證必作。然又當察其病情輕重，可汗則汗，不可固執。
【闡釋】本條為汗法禁例之三，瘡家久失膿血，營血勢必不足，若感外邪，雖有身體疼痛等證狀，虛多實少，若以麻黃湯發其汗，則必犯虛虛之戒，故不能發汗。汗出其營血必更加虧耗，筋脈失去濡養，必然強急而為痙矣。
十六、衄③家不可發汗，汗出必（頞）〔額〕上陷，脈急緊，（目）直視不能眴④，不（能）〔得〕眠。原文86
③衄（nǜ）家：常流鼻血的病人。
④不能眴：眴同“瞬”，目轉動。不能眴，就是說目睛不能轉動。
鄭論：申言素患衄血之人，切切不可發汗，汗為血液，血液既傷，若更發汗，則陽從外亡，故現（頞）〔額〕上陷，脈緊急者，陽脫之象也。目直視不能眴者，肝開竅於目，血液已傷，不能灌溉，以致不眴不眠者，皆真陽欲絕，危亡之候也。
【闡釋】本條為汗法禁例之五。常患鼻衄的病人，由於經常失血，則血液素虧，不可任意發汗，更傷其血液，其變證多端，而嚴重的如鄭氏所說有真陽欲脫之危候。
①亡血家：平素有失血（包括吐血大便血、小便血、鼻血及婦人崩漏）疾患的病人。
鄭論：亡血二字，即亡陽之征也。若更發汗，則陽從外越，而內無陽以溫暖，故寒栗而振，此等危候非大劑回陽不可。
【闡釋】經常失血的病者，不但陰血不足，即陽氣亦不充沛，加之發汗亦能傷陽。陰血傷則無以濡養筋脈，陽氣傷則無以衛外為固，所以發生寒栗而振，此陰陽兩虛之危候。如鄭氏所言，非大劑回陽不可，誠屬經驗有得之言。
十八、汗家重發汗②，必恍惚心亂③，小便已陰疼④，與禹餘糧丸。原文88
②汗家：指平常慣會出汗的人，包括盜汗自汗在內。
③恍惚心亂：神迷意惑，慌亂不安，形容精神失常的狀態。
④小便已陰疼：小便後尿道作痛。
鄭論：按汗為心之液，素多汗之人，血液早虧，今重發其汗，汗出過多，則心陽外亡，神無所主，而恍惚生，，小便已陰疼者，血液已虧，不能澤及小便也。原文以禹餘糧丸主之，亦是收納元氣之意也。
【闡釋】本條為汗法禁例之六。平日汗多者，血液早虧，表陽即虛，若重發其汗，則陽從外亡，胸中神魂無主，故心神恍惚。而小便已陰疼者，陽氣大虛，便出則氣愈泄而化源傷，因虛而疼。禹餘糧丸方，原文闕。
發汗後惡寒者，虛故也，不惡寒（反惡）〔但〕熱者，實也，當和胃氣，與調胃承氣湯。原文68、70
鄭論：按發汗病不解，與發汗後惡寒者，皆裏陽不足，因汗而陽更傷也，故見畏寒。原文以芍藥附子甘草湯，使其收納元氣歸根，而惡寒自己。若不惡寒而反惡熱，以調胃承氣湯，是為血虧火旺說法。
餘更有說焉，當其時發汗，有素稟元陽不足，因發汗而有元陽外越者，外大熱而內寒，學者務宜細察。若果血虧，陽明胃熱，必有舌苔幹黃，大渴飲冷，方可與調胃承氣湯。若其人因發汗而元陽外越者，雖周身大熱，舌必潤滑，口必不渴，二便自利，又當以回陽為要，切切不可妄與調胃承氣湯，切記。
【闡釋】本條《傷寒論》分為兩條。“發汗病不解”至“芍藥附子甘草湯主之”為一條；以下又為一條。鄭氏所按，頗為恰當。但其中特提出元陽外越與血虧火旺，陽陰胃熱之區別，則與歷代注家不同，臨證時應特別注意。元陽外越者，可與大劑四逆或白通湯以回陽為要。
芍藥三兩甘草三兩（炙）附子一枚（炮、去皮、破八片）右三味，以水五升，煮取一升五合，去滓，分溫三服。
【方解及其應用範圍】本方芍藥以補陰斂液，附子溫經回陽，佐以甘草，從中調和，使芍、附作用，共同發揮，能夠兼顧氣陰，實屬陰陽雙補、扶正之劑。故用治汗出過多之惡寒屬於陰陽俱虛之證。筆者曾治患風濕疼痛，同時有汗出惡寒證狀，腳攣急，舌質淡，苔白膩，脈沉細，用大劑量芍藥甘草附子湯治之，芍、甘各用60克，附子80克，連服五劑而痊癒。
二十、發汗後，身疼痛，脈沉遲者①，桂枝加芍藥生薑各一兩人參三兩新加湯主之。原文62
①脈沉遲：沉是重按才得，遲是跳動的次數緩慢。
鄭論：據稱發汗後，身疼脈遲，明是裏分有寒也。汗則表陽被奪，而內寒卒起，閉塞經絡，故見身疼。原文以桂枝加芍藥人參新加湯，取姜桂以散陰寒，參芍以養血液，亦屬妥切。
【闡釋】發汗後，身疼痛，脈沉遲，此陽氣虛損，陰液耗竭，亦即氣陰兩傷，營血不足也。鄭氏所論“汗則表陽被奪，而內寒卒起，閉塞經絡，故見身疼”。亦屬確切之論。
桂枝加芍藥生薑各一兩人參三兩新加湯（校補）
桂枝三兩（去皮）芍藥四兩甘草二兩（炙）人參三兩大棗十二枚（劈）生薑四兩上六味，以水一鬥二升，煮取三升去滓，溫服一升。本雲桂枝湯，今加芍藥、生薑、人參。
【郑氏论述】：根据脉象浮，本应使用发汗法解除病邪，这才是合法的治疗。如果医生不探究脉象的本质，而妄用艾灸治疗，这严重违背了经典的本意。况且表阳与火（也是阳）相结合，两阳相合，病邪不从体表外出反而向内攻冲，导致腰部以下必然沉重且麻木痹痛，这是因为邪气潜伏在下焦，阻碍了太阳寒水之气机的正常运行。命名为“火逆”，重点在于未能通过发汗解表，导致水湿停滞于下焦。
【阐释】：本条是第116条中的一节，指出了误用艾灸治疗浮脉后的变证。浮脉主表证，适宜用发汗法解除；医生用火灸取汗，却未能出汗，邪气无从排出，因火势而亢盛，虽然不一定达到焦骨伤筋的程度，但火邪阻滞病邪，阴气逐渐枯竭，下焦是营血所治理的部位，营气枯竭无法运行，必然导致身体沉重而痹痛。这也正如郑氏所说：“邪气不从外出而从内攻，导致腰部以下必然沉重且痹痛，这是邪气潜伏于下。”那么想要治疗这种痹症，应当先治疗火邪引起的病变。
七、脉象浮的，〔病在表〕，可以发汗，适宜用麻黄汤。脉象浮而数的，可以发汗，适宜用麻黄汤。原文第51、52条
【郑氏论述】：根据脉浮、脉数，虽然说可以发汗，然而有用桂枝汤的，也有用麻黄汤的。在营分和卫分之间，原本就有区分，不能仅凭“浮”、“数”两个字，就断定是麻黄汤的适应证。学者务必在有汗、无汗、怕风、恶寒这些方面去探求，就能得到使用方剂的确凿依据。
【阐释】：本条在《伤寒论》中为第51、52条，郑氏将其合并为一条。凡是表病都会出现浮脉，麻黄汤证的主要脉象是浮紧，并且伴有头痛发热、恶寒无汗等症状，才可以使用麻黄汤发汗。脉浮而数的，多是风热在表的象征，麻黄汤是不适合的，应该与本篇第一条、第二条互相参照，如果症状与之相符，才可以用麻黄汤发其汗，这样各种症状自然痊愈。看原文不说“以麻黄汤为主”，而是都说“宜麻黄汤”，这就有商量斟酌的意思。
八、伤寒，发汗〔已经〕解除，半天左右又感到烦闷，脉浮数的，可以再发汗，适宜（用）桂枝汤。原文第57条
【郑氏论述】：大概这个证候，既然经过发汗解除，但邪气尚未完全解除，所以可以再发汗，使邪气彻底解除没有遗留，这样才没有后患。
【阐释】：本条是发汗后，表邪仍然没有完全清除，因而再次出现烦闷，脉浮数的，说明邪气仍在表，所以可以再发汗，以祛除表邪。但是已经发过汗再次发汗，所以不适合用麻黄汤峻猛发汗，而适宜用桂枝汤缓和发汗。
【郑氏论述】：根据太阳伤寒，既然说发汗后，想是外邪已经去除。又见到脉浮数、烦渴，一定是外邪已去，而内热未解，所以脉象仍然浮数。至于烦渴，是热邪损伤津液所致，理应清热解表，热去则烦渴自解，脉数也会平复，怎么能直接用五苓散主治呢？凡是用五苓散，必须是太阳邪气已经传入腑证，口渴且小便不利，原文只根据一个烦渴、脉数，学者们往往不能识别。
“烦渴”二字，也有喜冷饮、喜热饮的区别，不可不仔细考察（顶批）
【阐释】：此条郑氏指出使用五苓散的不当之处。凡是用五苓散，必须是太阳邪气已经传入腑证，口渴且小便不利，原文只根据一个烦渴、脉数，其不当之处非常明显。
十、伤寒汗出而口渴的①，由五苓散主治；不口渴的，由茯苓甘草汤主治。原文第73条
①这里的口渴，不是阳明里证的口渴，是水气停在下焦，津液不能上布导致的口渴。
【郑氏论述】：根据汗出而口渴，是太阳寒水从毛孔而出，不能滋润肠胃，所以见到口渴，用五苓散主治，是让太阳寒水之气，不从体表外出，而仍从体内排出，这样汗出和口渴就会停止。然而有不口渴的，是津液没有大伤，胃中还可以支持，虽然见到汗出，用茯苓甘草汤主治，这也是化气行水的妙法。这一条根据我个人的见解，当时汗出而口渴，小便不利的，用五苓散主治；汗出不口渴，小便不利的，用茯苓甘草汤主治。加上这四个字，后学更容易明白透彻。
再按：汗出而口渴，在阳明病有白虎汤的方子；汗出而不口渴，在少阴病有亡阳的迹象，学者应当知道。
㈠大渴喜冷饮（顶批）。
【阐释】：此条是茯苓甘草汤证与五苓散证的辨证要点，只在口渴与不口渴之间，那么其他症状，如脉浮数、小便不利、微热等情况，也必然大致相同。郑氏解释为加上“小便不利”四个字，更加明白透彻，是正确的。两个证候的主要区别是：一个是水蓄积在下焦，口渴且小便不利；一个是水停在中焦，口不渴且小便不利。病情虽然有异，但总的原因都属于停饮蓄水为患，所以都用温阳化水的方法治疗，不过一个是重在温化膀胱，以利小便，一个是重在温化胃阳而通利三焦，以消除水饮，所以主治方剂各不相同。
茯苓甘草汤方（校补）
茯苓四两 桂枝二两（去皮） 甘草一两（炙） 生姜三两（切） 以上四味，用水四升，煮取二升，去渣，分三次温服。
【方解及其应用范围】：本方治疗汗出不渴，其蓄水比五苓散轻，因此去掉主要的利水药，仅用茯苓的淡渗利湿，加重桂枝温阳，生姜温胃，甘草和中，四味配伍，温胃散水的效果最佳，是治疗水气停在中焦，不烦不渴，心下悸动而四肢厥冷的有效良方。
十一、脉浮紧的，法当身体疼痛，适宜用发汗法解除。假如尺中脉迟的②，不可发汗，〔怎么知道呢？回答说①，因为营气不足，血少缘故。〕原文第50条
②尺中迟者：尺部的脉搏呈现迟而涩的现象，所谓“呼吸三至，来去极迟”。迟就是脉搏至数减少。但这里的迟，是相对于紧脉而言。
①然：古人“然”字，多作“曰”字解释。
十二、〔脉浮数的，法当汗出而愈，如果误用下法，身体沉重心悸的，不可发汗〕，应当自汗出才能解除。之所以这样，是因为尺中脉微，这是里虚，须等待表里正气充实②，津液自然调和，便会自汗出而痊愈。原文第49条
②须：等待的意思。
【郑氏论述】：条文内指出一脉浮紧、身痛的人，法本应当发汗，假如尺中脉虚的，不可发汗，这是说其阴分本来虚弱，发汗深恐亡阳，明显是教导人在发汗时要留意谨慎。即使有其他证候，也要等到其津液自然调和，自汗出而痊愈。真是慎重之极，防范之密啊。
【阐释】：按照这两条，郑氏合并加以注释，原文错乱较多，其按语也不全面。
兹据《伤寒论》校补其错乱文字，分列两条之释文。脉浮紧，身疼痛，这是伤寒的脉证，适宜用麻黄汤发汗。然而尺中脉迟，这是营气不足，属于不可发汗的虚证。
至于第12条表证误用下法后，见身体沉重、心悸、尺脉微的，不能再发汗，可等待其自汗出而痊愈。但也酌情可用小建中汤一类方剂，温养里气，使表里正气早日恢复，气血充沛，则津液自然调和，便能汗出而愈。
【郑氏论述】：凡是咽喉干燥的人，津液已经受伤，岂可再行发汗，以进一步剥夺其津液呢？我认为咽喉干燥的人，有因下元坎中真气温衰微，不能启动真水上承而导致的，法宜扶阳；有因邪火灼烧津液而导致的，法宜清润；有因寒水逆于中焦，阻碍胃中升腾之气而导致的，法宜行水。学者留心察辨，像这类证候，都不是发汗所能解决的。
【阐释】：本条是汗法的禁忌之一。咽喉干燥者，上焦无津液。郑氏认为咽喉干燥的人，有三种不同情况，并提出扶阳、清润、行水三种治法。笔者认为扶阳可用四逆汤，清润可用人参白虎汤，行水可用茯苓甘草汤或五苓散。咽喉干燥，现今多称为慢性咽炎、喉炎，笔者常先用炮姜甘草汤加桔梗治疗，继加补肾药调理而痊愈。
③淋家：是指小便淋沥不爽，尿时茎中疼痛的病人。
【郑氏论述】：凡是患淋证的人，或热闭膀胱，或寒闭膀胱，或败精滞于尿道，气化表现出不宣通，原本就没有发汗的道理，如果强行发汗，则津液外亡，中气被夺，即不能统摄血液，血液流注到阑门泌清别浊的地方，渗入膀胱，小便下血，于是乎发作了。
【阐释】：本条是汗法的禁忌之二。历代医家注解此条，其原因多由肾阴虚而膀胱有热，郑氏所指热闭膀胱即此，法宜扶肾阴，用四苓滑石阿胶汤治疗。接着指出有寒闭膀胱，或败精滞于尿道，气化不宣者。寒闭膀胱者，由下焦阳微，阴寒阻截膀胱之路，阳微无力，不能化之，法宜扶下焦之阳，可用苓桂术甘汤倍桂加砂仁、白蔻治疗。至于败精滞于尿道，气化不宣者，治当清热利水中，加以化精化气之品，可选用滋肾丸倍桂，或大剂回阳饮加味治疗。淋家虽患外感，也无强发其汗的道理，如果强行发汗，阴液更虚，膀胱之蓄热更炽，必致邪热迫血妄行，从小便而出为尿血。
①疮家：患疮疡病者，流脓已久，此皆亡失其津血。
②痉（jìng净）：肌肉收缩，手足抽搐的现象。
【郑氏论述】：《内经》说：诸疮痛痒，皆属于火。火盛则血亏，若再发汗，血液被剥夺，筋脉失养，痉证必然发作。然而又应当察辨其病情轻重，可汗则汗，不可固执己见。
【阐释】：本条是汗法的禁忌之三，疮家久失脓血，营血势必不足，若感受外邪，虽有身体疼痛等症状，虚多实少，若用麻黄汤发其汗，则必犯虚虚之戒，故不能发汗。汗出其营血必更加亏耗，筋脉失去濡养，必然强急而为痉矣。
十六、衄③家不可发汗，汗出必（额）〔额〕上陷，脉急紧，（目）直视不能眴④，不（能）〔得〕眠。原文第86条
③衄（nǜ）家：常流鼻血的病人。
④不能眴：眴同“瞬”，目转动。不能眴，就是说目睛不能转动。
【郑氏论述】：申言素患衄血之人，切切不可发汗，汗为血液，血液既伤，若更发汗，则阳从外亡，故现（额）上陷，脉紧急者，阳脱之象也。目直视不能眴者，肝开窍于目，血液已伤，不能灌溉，以致不眴不眠者，皆真阳欲绝，危亡之候也。
【阐释】：本条是汗法的禁忌之五。常患鼻衄的病人，由于经常失血，则血液素亏，不可任意发汗，更伤其血液，其变证多端，而严重的如郑氏所说有真阳欲脱之危候。
①亡血家：平素有失血（包括吐血大便血、小便血、鼻血及妇人崩漏）疾患的病人。
【郑氏论述】：亡血二字，即亡阳之征也。若更发汗，则阳从外越，而内无阳以温暖，故寒栗而振，此等危候非大剂回阳不可。
【阐释】：经常失血的病者，不但阴血不足，即阳气亦不充沛，加之发汗亦能伤阳。阴血伤则无以濡养筋脉，阳气伤则无以卫外为固，所以发生寒栗而振，此阴阳两虚之危候。如郑氏所言，非大剂回阳不可，诚属经验有得之言。
十八、汗家重发汗②，必恍惚心乱③，小便已阴疼④，与禹余粮丸。原文第88条
②汗家：指平常惯会出汗的人，包括盗汗自汗在内。
③恍惚心乱：神迷意惑，慌乱不安，形容精神失常的状态。
④小便已阴疼：小便后尿道作痛。
【郑氏论述】：按汗为心之液，素多汗之人，血液早亏，今重发其汗，汗出过多，则心阳外亡，神无所主，而恍惚生，小便已阴疼者，血液已亏，不能泽及小便也。原文以禹余粮丸主之，亦是收纳元气之意也。
【阐释】：本条是汗法的禁忌之六。平日汗多者，血液早亏，表阳即虚，若重发其汗，则阳从外亡，胸中神魂无主，故心神恍惚。而小便已阴疼者，阳气大虚，便出则气愈泄而化源伤，因虚而疼。禹余粮丸方，原文缺。
十九、发汗病不解，反恶寒的，是虚的缘故，芍药甘草附子汤主治。
发汗后恶寒的，是虚的缘故，不恶寒（反恶）〔但〕热的，是实的缘故，当和胃气，与调胃承气汤。原文第68、70条
【郑氏论述】：按发汗病不解，与发汗后恶寒者，皆里阳不足，因汗而阳更伤也，故见畏寒。原文以芍药附子甘草汤，使其收纳元气归根，而恶寒自己。若不恶寒而反恶热，以调胃承气汤，是为血亏火旺说法。
我更有话说，当其时发汗，有素禀元阳不足，因发汗而有元阳外越者，外大热而内寒，学者务必细察。如果果真是血亏，阳明胃热，必有舌苔干黄，大渴饮冷，方可与调胃承气汤。如果其人因发汗而元阳外越者，虽周身大热，舌必润滑，口必不渴，二便自利，又当以回阳为要，切切不可妄与调胃承气汤，切记。
【阐释】：本条《伤寒论》分为两条。“发汗病不解”至“芍药附子甘草汤主治”为一条；以下又为一条。郑氏所按，颇为恰当。但其中特提出元阳外越与血亏火旺，阳阴胃热的区别，则与历代注家不同，临证时应特别注意。元阳外越者，可与大剂四逆或白通汤以回阳为要。
芍药甘草附子汤方（校补）
芍药三两 甘草三两（炙） 附子一枚（炮、去皮、破八片） 右三味，用水五升，煮取一升五合，去渣，分三次温服。
【方解及其应用范围】：本方芍药以补阴敛液，附子温经回阳，佐以甘草，从中调和，使芍、附作用，共同发挥，能够兼顾气阴，实属阴阳双补、扶正之剂。故用治汗出过多之恶寒属于阴阳俱虚之证。笔者曾治患风湿疼痛，同时有汗出恶寒症状，脚挛急，舌质淡，苔白腻，脉沉细，用大剂量芍药甘草附子汤治疗，芍、甘各用60克，附子80克，连服五剂而痊愈。
二十、发汗后，身疼痛，脉沉迟者①，桂枝加芍药生姜各一两人参三两新加汤主治。原文第62条
①脉沉迟：沉是重按才得，迟是跳动的次数缓慢。
【郑氏论述】：据称发汗后，身疼脉迟，明是里分有寒也。汗则表阳被夺，而内寒卒起，闭塞经络，故见身疼。原文以桂枝加芍药人参新加汤，取姜桂以散阴寒，参芍以养血液，亦属妥切。
【阐释】：发汗后，身疼痛，脉沉迟，此阳气虚损，阴液耗竭，亦即气阴两伤，营血不足也。郑氏所论“汗则表阳被夺，而内寒卒起，闭塞经络，故见身疼”。亦属确切之论。
桂枝三两（去皮） 芍药四两 甘草二两（炙） 人参三两大枣十二枚（劈） 生姜四两 以上六味，用水一斗二升，煮取三升去渣，温服一升。本云桂枝汤，今加芍药、生姜、人参。
[Zheng's Commentary]: Regarding the condition with a floating pulse, sweating should originally be used to resolve it; this is the correct method. If physicians fail to investigate the nature of the pulse and recklessly apply moxibustion, they grossly violate the principles of the classics. Moreover, since the exterior represents Yang and fire also represents Yang, the combination of two Yangs causes the pathogen not to exit from the exterior but to attack inward, resulting in heaviness and bi-syndrome (obstruction syndrome) below the waist. This is because the pathogen lies latent in the lower jiao, obstructing the qi mechanism of Taiyang cold-water flow. It is named "fire reversal" (huo ni), emphasizing that without resolving via sweating, water stagnates in the lower jiao.
[Explanation]: This section corresponds to part of Article 116, pointing out the complications after misusing moxibustion for a floating pulse. A floating pulse indicates an exterior condition suitable for resolution by sweating. If a physician uses fire moxibustion to induce sweating but fails to do so, the pathogen has no outlet and becomes exacerbated by the fire. Although it may not necessarily scorch bones or injure tendons, the fire blocks the pathogen, gradually depleting Yin qi. The lower jiao is governed by Ying blood; when Ying qi is depleted and unable to circulate, heaviness and bi-syndrome inevitably occur. As Zheng stated: "The pathogen does not exit outward but attacks inward, causing heaviness and bi-syndrome below the waist, indicating the pathogen is latent in the lower jiao." Therefore, to treat this bi-syndrome, one must first address the pathology caused by fire.
Seven. When the pulse is floating [the disease is at the exterior], sweating may be induced, and Mahuang Tang (Ephedra Decoction) is appropriate. When the pulse is floating and rapid, sweating may be induced, and Mahuang Tang (Ephedra Decoction) is appropriate. Original Articles 51, 52.
[Zheng's Commentary]: Although a floating or rapid pulse suggests that sweating may be indicated, both Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang (Ephedra Decoction) have been used. There is a distinction between conditions affecting Ying (Nutritive) and Wei (Defensive) levels. One cannot determine the indication for Mahuang Tang (Ephedra Decoction) solely based on the characters "floating" and "rapid." Scholars must seek solid evidence for prescription usage by investigating the presence or absence of sweating, aversion to wind, and aversion to cold.
[Explanation]: These articles correspond to Articles 51 and 52 in the *Shanghan Lun*, which Zheng combined into one. Any exterior disease presents with a floating pulse. The primary pulse for Mahuang Tang (Ephedra Decoction) syndrome is floating-tight, accompanied by symptoms such as headache, fever, aversion to cold, and absence of sweating. Only under these conditions should Mahuang Tang (Ephedra Decoction) be used to induce sweating. A floating and rapid pulse often symbolizes wind-heat at the exterior, making Mahuang Tang (Ephedra Decoction) unsuitable. One should cross-reference with Articles 1 and 2 of this chapter; if the symptoms match, then Mahuang Tang (Ephedra Decoction) can be used to induce sweating, leading to the resolution of all symptoms. The text states "appropriate for Mahuang Tang (Ephedra Decoction)" rather than "Mahuang Tang (Ephedra Decoction) is the main formula," implying a degree of deliberation.
Eight. In Cold Damage, if sweating has already resolved the condition, but restlessness recurs after half a day, and the pulse is floating and rapid, sweating may be induced again, and Guizhi Tang (Cinnamon Twig Decoction) is appropriate. Original Article 57.
[Zheng's Commentary]: Generally, in this condition, although sweating has resolved the illness, the pathogen has not been completely eliminated. Therefore, sweating may be induced again to ensure the pathogen is entirely expelled, preventing future complications.
[Explanation]: This article describes a situation where, after sweating, the exterior pathogen remains incomplete, causing recurrent restlessness and a floating-rapid pulse, indicating the pathogen is still at the exterior. Thus, sweating may be induced again to dispel the exterior pathogen. However, since sweating has already occurred, harsh sweating agents like Mahuang Tang (Ephedra Decoction) are inappropriate; instead, the mild sweating action of Guizhi Tang (Cinnamon Twig Decoction) is suitable.
Nine. After sweating, if the pulse is floating and rapid, accompanied by irritability and thirst, Wuling San (Five-Ingredient Powder with Poria) should govern the treatment. Original Article 72.
[Zheng's Commentary]: Regarding Taiyang Cold Damage, if it is stated that sweating has been performed, it implies the exterior pathogen has likely been removed. Seeing a floating-rapid pulse, irritability, and thirst indicates that while the exterior pathogen is gone, internal heat remains unresolved, hence the persistent floating-rapid pulse. Irritability and thirst result from heat damaging body fluids. Logically, one should clear and resolve the heat; once the heat is gone, irritability and thirst will resolve, and the rapid pulse will normalize. Why use Wuling San (Five-Ingredient Powder with Poria) directly? Wuling San (Five-Ingredient Powder with Poria) is indicated only when the Taiyang pathogen has entered the Fu organs, presenting with thirst and difficult urination. Relying solely on irritability and a rapid pulse, scholars often fail to recognize the proper indication.
Note: The term "irritability and thirst" distinguishes between preference for cold drinks and hot drinks; this must be carefully observed.
[Explanation]: Zheng points out the inappropriateness of using Wuling San (Five-Ingredient Powder with Poria) here. Wuling San (Five-Ingredient Powder with Poria) is indicated only when the Taiyang pathogen enters the Fu organs, presenting with thirst and difficult urination. Relying solely on irritability and a rapid pulse makes its inappropriateness obvious.
Ten. In Cold Damage, if sweating occurs with thirst, Wuling San (Five-Ingredient Powder with Poria) should govern the treatment; if there is no thirst, Fuling Gancao Tang (Poria and Licorice Decoction) should govern the treatment. Original Article 73.
①Thirst here does not refer to the thirst of Yangming interior syndrome, but to thirst caused by water-qiang stagnating in the lower jiao, preventing body fluids from ascending.
[Zheng's Commentary]: Sweating with thirst indicates that Taiyang cold-water vapor is exiting through the pores and failing to moisten the intestines and stomach, causing thirst. Using Wuling San (Five-Ingredient Powder with Poria) directs the Taiyang cold-water vapor to exit internally rather than externally, stopping both sweating and thirst. However, in cases without thirst, body fluids are not significantly damaged, and the Stomach can still sustain itself. Even with sweating, Fuling Gancao Tang (Poria and Licorice Decoction) is appropriate, demonstrating the efficacy of transforming Qi and moving water. Based on my observations, adding "difficult urination" clarifies the indication: use Wuling San (Five-Ingredient Powder with Poria) for sweating with thirst and difficult urination; use Fuling Gancao Tang (Poria and Licorice Decoction) for sweating without thirst and difficult urination. Adding these four words makes it easier for later learners to understand clearly.
Furthermore, sweating with thirst relates to Baihu Tang (White Tiger Decoction) in Yangming syndrome; sweating without thirst relates to collapse of Yang in Shaoyin syndrome. Scholars should be aware of this.
①Great thirst with preference for cold drinks.
[Explanation]: This article highlights the differential diagnosis between Fuling Gancao Tang (Poria and Licorice Decoction) syndrome and Wuling San (Five-Ingredient Powder with Poria) syndrome, centered on the presence or absence of thirst. Other symptoms such as floating-rapid pulse, difficult urination, and slight fever are likely similar. Zheng’s addition of "difficult urination" clarifies the distinction and is correct. The main difference is: one involves water accumulation in the lower jiao with thirst and difficult urination; the other involves water retention in the middle jiao without thirst but with difficult urination. Although the conditions differ, the root cause is retained fluid and water accumulation, treated by warming Yang and transforming water. One focuses on warming the Bladder to promote urination; the other focuses on warming Stomach Yang and unblocking the Triple Burner to eliminate fluid retention, hence different main formulas.
Fuling Gancao Tang (Poria and Licorice Decoction) Formula (Corrected):
Poria 4 liang, Cinnamon Twig 2 liang (peeled), Licorice 1 liang (honey-fried), Fresh Ginger 3 liang (sliced). Boil the above four ingredients in 4 sheng of water to obtain 2 sheng. Remove dregs and divide into three warm doses.
[Formula Analysis and Application Scope]: This formula treats sweating without thirst. The water accumulation is lighter than in Wuling San (Five-Ingredient Powder with Poria), so the primary diuretic is omitted. Instead, the mild leaching effect of Poria is used, while increasing Cinnamon Twig to warm Yang, Fresh Ginger to warm the Stomach, and Licorice to harmonize the middle. This combination best warms the Stomach and disperses water. It is an effective formula for water-qiang stagnating in the middle jiao, characterized by no irritability or thirst, palpitations in the epigastrium, and cold limbs.
Eleven. When the pulse is floating-tight, body pain is expected, and sweating should be used to resolve it. If the Chi position pulse is slow, sweating is contraindicated. [How do we know this? It is said that Ying Qi is insufficient due to blood deficiency.] Original Article 50.
②Chi slow pulse: The pulse at the Chi position appears slow and choppy, described as "three beats per respiration, extremely slow." Slow refers to reduced pulse frequency. Here, "slow" is contrasted with "tight."
①Ran: In ancient texts, "ran" is often interpreted as "said."
Twelve. [When the pulse is floating and rapid, sweating should normally lead to recovery. If purgatives are incorrectly used, resulting in heavy body and palpitations, sweating is contraindicated.] Recovery occurs when spontaneous sweating happens naturally. This is because the Chi pulse is faint, indicating interior deficiency. One must wait for the exterior and interior to become solid, for body fluids to harmonize naturally, and for spontaneous sweating to occur for recovery. Original Article 49.
②Xu: Means to wait.
[Zheng's Commentary]: The article refers to a person with a floating-tight pulse and body pain, who should normally be treated with sweating. However, if the Chi pulse is deficient, sweating is contraindicated, indicating inherent Yin deficiency. Inducing sweating could severely deplete Yang. This teaches caution regarding sweating therapies. Even if other symptoms exist, one must wait for body fluids to harmonize naturally and for spontaneous sweating to bring recovery. This demonstrates extreme prudence and careful prevention.
[Explanation]: Zheng combines these two articles for commentary, noting the original text is disordered and his commentary is incomplete. Correcting the text according to the *Shanghan Lun*: Floating-tight pulse and body pain indicate Cold Damage, suitable for Mahuang Tang (Ephedra Decoction) to induce sweating. However, a slow Chi pulse indicates Ying Qi deficiency, a deficiency condition where sweating is contraindicated.
Regarding Article 12, after incorrect purgation of an exterior condition, presenting with heavy body, palpitations, and a faint Chi pulse, sweating is contraindicated. Recovery may occur through spontaneous sweating. Alternatively, Xiao Jianzhong Tang (Minor Construct the Middle Decoction) or similar formulas may be used to warm and nourish the interior, restoring exterior and interior Zheng Qi, enriching Qi and Blood, harmonizing body fluids, and inducing spontaneous sweating for recovery.
Thirteen. Throat dryness is a contraindication for sweating. Original Article 83.
[Zheng's Commentary]: In cases of throat dryness, body fluids are already damaged; how can sweating be used to further deprive fluids? I believe throat dryness arises from three situations: 1) Decline of True Qi in the lower Yuan (Kan center), failing to ascend True Water; treatment requires supporting Yang. 2) Pathogenic fire scorching body fluids; treatment requires clearing and moistening. 3) Cold water counterflow in the middle, obstructing the ascending Qi of the Stomach; treatment requires moving water. Scholars must observe carefully, as these conditions cannot be resolved by sweating.
[Explanation]: This is one of the contraindications for sweating therapy. Throat dryness indicates lack of fluids in the Upper Jiao. Zheng identifies three scenarios and proposes supporting Yang, clearing/moistening, and moving water. Supporting Yang may use Sini Tang (Four Reversal Decoction); clearing/moistening may use Renshen Baihu Tang (Ginseng White Tiger Decoction); moving water may use Fuling Gancao Tang (Poria and Licorice Decoction) or Wuling San (Five-Ingredient Powder with Poria). Modern chronic pharyngitis/laryngitis is often treated initially with Paogani Gancao Tang (Roasted Ginger and Licorice Decoction) plus Jiegeng (Platycodon), followed by kidney-tonifying herbs.
Fourteen. Patients with Lin syndrome (strangury) must not undergo sweating; if sweating occurs, hematuria will inevitably follow. Original Article 84.
③Lin patients: Those with dribbling, painful urination.
[Zheng's Commentary]: Patients with Lin syndrome suffer from heat closing the Bladder, cold closing the Bladder, or stagnant seminal essence blocking the urethra, leading to impaired Qi transformation. There is no rationale for sweating. Forcing sweating causes external loss of fluids and depletion of Middle Qi, leading to failure to control blood. Blood flows to the Lanmen (gate separating clear and turbid), infiltrates the Bladder, and causes hematuria.
[Explanation]: This is the second contraindication for sweating. Historically, this is attributed to Kidney Yin deficiency with Bladder heat. Zheng’s "heat closing the Bladder" aligns with this; treatment supports Kidney Yin using Siling Huashi Ejiao Tang (Four Substances, Talcum, and Donkey-Hide Gelatin Decoction). He also notes cold closing the Bladder or stagnant essence impairing Qi transformation. Cold closing the Bladder results from lower Jiao Yang deficiency and Yin-cold obstruction; treatment supports lower Jiao Yang using Linggui Zhugan Tang (Poria, Cinnamon, Atractylodes, and Licorice Decoction) with increased Cinnamon and added Amomum and White Cardamom. For stagnant essence, clear heat and promote urination while adding herbs to transform essence and Qi, such as Zishen Wan (Kidney Nourishing Pill) with increased Cinnamon, or large doses of Huiyang Yin (Return Yang Decoction). Even with exterior pathogens, forcing sweating in Lin patients is wrong; it worsens Yin deficiency and Bladder heat, causing pathogenic heat to force blood to wander, resulting in hematuria.
Fifteen. Patients with sores/chancres, even if experiencing body pain, must not undergo sweating; if sweating occurs, spasms (Jing) will develop. Original Article 85.
①Sore patients: Those with chronic suppurative sores, having lost significant fluids and blood.
②Jing: Muscle contraction, convulsions of hands and feet.
[Zheng's Commentary]: The *Neijing* states: "All sores and itching belong to Fire." Excessive Fire leads to Blood deficiency. If sweating is induced again, Blood is further depleted, tendons and vessels lose nourishment, and spasms will occur. However, severity must be assessed; if sweating is appropriate, it may be done, but rigid adherence is discouraged.
[Explanation]: This is the third contraindication for sweating. Chronic sores lead to Ying Blood deficiency. If exposed to exterior pathogens, despite body pain, deficiency outweighs excess. Using Mahuang Tang (Ephedra Decoction) would commit the error of treating deficiency as excess. Sweating would further deplete Ying Blood, causing tendons to lose nourishment and resulting in spasms.
Sixteen. Patients prone to nosebleeds (Nu) must not undergo sweating; if sweating occurs, depression above the forehead, tight/urgent pulse, fixed gaze inability to blink, and insomnia will result. Original Article 86.
③Nu patients: Those prone to frequent nosebleeds.
④Unable to blink: Blinking refers to eye movement. Inability to blink means eyes cannot move.
[Zheng's Commentary]: Emphasizing that those with chronic nosebleeds must absolutely avoid sweating. Sweat is derived from Blood; if Blood is injured and sweating continues, Yang escapes externally. Depression above the forehead and urgent pulse indicate Yang collapse. Fixed gaze and inability to blink occur because the Liver opens into the eyes; injured Blood cannot irrigate them. Insomnia follows. These are signs of impending True Yang exhaustion and critical danger.
[Explanation]: This is the fifth contraindication for sweating. Frequent nosebleeds imply chronic Blood deficiency. Arbitrary sweating further injures Blood, leading to various complications, including the critical state of True Yang collapse described by Zheng.
Seventeen. Patients with history of blood loss (Wangxue) must not undergo sweating; if sweating occurs, chills and tremors will result. Original Article 87.
①Wangxue patients: Those with chronic bleeding disorders (hematemesis, melena, hematuria, epistaxis, uterine bleeding).
[Zheng's Commentary]: "Blood loss" is a sign of Yang collapse. Further sweating causes Yang to escape externally, leaving the interior without Yang warmth, resulting in chills and tremors. Such critical conditions require large doses of Yang-restoring formulas.
[Explanation]: Chronic blood loss patients suffer not only from Yin Blood deficiency but also insufficient Yang. Sweating further damages Yang. Damaged Yin fails to nourish tendons; damaged Yang fails to defend the exterior. This results in chills and tremors, a critical state of dual Yin-Yang deficiency. Zheng’s assertion that large doses of Yang-restoring formulas are necessary reflects valuable clinical experience.
Eighteen. Patients prone to sweating who undergo heavy sweating will experience mental confusion and anxiety, and pain in the genitals after urination. Yu Yuliang Wan (Hematite Pill) should be given. Original Article 88.
②Sweating-prone patients: Those habitually prone to sweating, including night sweats and spontaneous sweating.
③Mental confusion: Disoriented, panicked, describing mental instability.
④Genital pain after urination: Pain in the urethra after voiding.
[Zheng's Commentary]: Sweat is the fluid of the Heart. Those prone to sweating already have Blood deficiency. Heavy sweating causes excessive loss, leading to external escape of Heart Yang and loss of Shen mastery, resulting in confusion. Genital pain after urination occurs because Blood deficiency fails to moisten the urinary tract. Yu Yuliang Wan (Hematite Pill) is prescribed to gather and secure Yuan Qi.
[Explanation]: This is the sixth contraindication for sweating. Habitual sweaters have Blood deficiency and weak Exterior Yang. Heavy sweating causes Yang escape, leaving the chest/Shen without mastery, resulting in mental confusion. Genital pain after urination occurs because severe Yang deficiency leads to further Qi leakage during voiding, injuring the source of transformation, causing pain due to deficiency. The formula for Yu Yuliang Wan (Hematite Pill) is missing in the original text.
Nineteen. If sweating fails to resolve the illness, and aversion to cold反而 (instead) appears, it is due to deficiency; Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) should govern the treatment.
After sweating, if aversion to cold appears, it is due to deficiency; if there is no aversion to cold but heat appears, it is due to excess; one should harmonize Stomach Qi with Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction). Original Articles 68, 70.
[Zheng's Commentary]: Failure to resolve illness after sweating, or aversion to cold afterward, indicates insufficient Interior Yang, further damaged by sweating, causing aversion to cold. Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) helps gather Yuan Qi and return it to its root, resolving aversion to cold. If there is no aversion to cold but aversion to heat, Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction) addresses Blood deficiency and Fire hyperactivity.
I add further insight: During sweating, some patients with inherent Yuan Yang insufficiency may experience Yuan Yang escaping externally, presenting with external heat and internal cold. Scholars must examine carefully. If truly Blood deficiency with Yangming Stomach Heat, expect dry yellow tongue coating, great thirst with preference for cold drinks, before using Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction). If Yuan Yang escapes externally due to sweating, despite generalized heat, the tongue will be slippery, mouth non-thirsty, and urination/bowel movements normal. In such cases, restoring Yang is paramount; never rashly use Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction). Remember this well.
[Explanation]: The *Shanghan Lun* splits this into two articles. Zheng’s commentary is appropriate. However, his distinction between Yuan Yang escaping externally versus Blood deficiency/Fire hyperactivity and Yangming Stomach Heat differs from traditional commentators and requires special attention in practice. For Yuan Yang escaping externally, large doses of Sini Tang (Four Reversal Decoction) or Baitong Tang (White Through Decoction) should be used to restore Yang.
Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) Formula (Corrected):
Peony 3 liang, Licorice 3 liang (honey-fried), Aconite 1 piece (roasted, peeled, broken into eight pieces). Boil the above three ingredients in 5 sheng of water to obtain 1.5 sheng. Remove dregs and divide into three warm doses.
[Formula Analysis and Application Scope]: Peony nourishes Yin and astringes fluids; Aconite warms channels and restores Yang; Licorice harmonizes the middle. Together, they balance Qi and Yin, serving as a dual Yin-Yang tonic and upright-supporting agent. It treats aversion to cold after excessive sweating, indicative of dual Yin-Yang deficiency. I once treated a patient with rheumatic pain, sweating, aversion to cold, leg cramps, pale tongue, white greasy coating, and deep-thin pulse using a large dose of Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction): Peony and Licorice 60g each, Aconite 80g, taken for five doses, resulting in cure.
Twenty. After sweating, if body pain persists and the pulse is deep and slow, Xinjia Tang (Newly Added Decoction) with Guizhi, increased Peony and Ginger, and Ginseng should govern the treatment. Original Article 62.
①Deep-slow pulse: Deep requires heavy pressure; slow indicates reduced beat frequency.
[Zheng's Commentary]: Post-sweating body pain and slow pulse clearly indicate interior cold. Sweating depletes Exterior Yang, causing sudden interior cold to block collaterals, resulting in body pain. The formula Guizhi Jiashyaoshengjiang Renshen Xinjia Tang (Guizhi Decoction with Added Peony, Ginger, and Ginseng) uses Ginger and Cinnamon to disperse Yin cold, and Ginseng and Peony to nourish Blood, which is appropriate.
[Explanation]: Post-sweating body pain and deep-slow pulse indicate Yang Qi damage and Yin fluid exhaustion, i.e., Qi-Yin dual injury and Ying Blood deficiency. Zheng’s statement that "sweating depletes Exterior Yang, causing sudden interior cold to block collaterals, resulting in body pain" is accurate.
Guizhi Jiashyaoshengjiang Renshen Xinjia Tang (Guizhi Decoction with Added Peony, Ginger, and Ginseng) Formula (Corrected):
Cinnamon Twig 3 liang (peeled), Peony 4 liang, Licorice 2 liang (honey-fried), Ginseng 3 liang, Jujube 12 pieces (split), Fresh Ginger 4 liang. Boil the above six ingredients in 12 sheng of water to obtain 3 sheng. Remove dregs and take 1 sheng warm. Originally Guizhi Tang (Cinnamon Twig Decoction), now with added Peony, Ginger, and Ginseng.