中风发热，六七日不解而烦，有表里症，渴欲饮水，水入则吐者，名曰水逆，五苓散主之。多服暖水，汗出
愈。
表热不解，内复烦渴者，因于发汗过多。反不受水者，是其人心下有水气。因离中之真水不足，则膻中之火用
不宣。邪水凝结于内，水饮拒绝于外，既不能外输于玄府，又不能上输于口舌，亦不能下输于膀胱，此水逆所由
名也。势必藉四苓辈味之淡者，以渗泄其水。然水气或降，而烦渴未必除，表热未必散。故必藉桂枝之辛温，入心
而化液；更仗暖水之多服，推陈而致新。斯水精四布而烦渴解，输精皮毛而汗自出，一汗而表里顿除，又大变乎
麻黄、桂枝、葛根、青龙等法也。暖水可多服，则逆者是冷水，热淫于内故不受寒。反与桂枝、暖水，是热因热用
法。五苓因水气不舒而设，是小发汗，不是生津液，是逐水气，不是利水道。
发汗已，脉浮数烦渴者，五苓散主之。
上条有表里之症，此条有表里之脉，互相发明五苓双解之义。虽经发汗而表未尽除，水气内结，故用五苓。
若无表症，当用白虎加人参汤矣。伤寒发汗解、复烦而脉浮数者，热在表未传里也，故用桂枝。此更加渴，则热
已在里，而表邪未罢，故用五苓。脉浮而数者，可发汗。病在表之表，宜麻黄汤；病在表之里，宜桂枝汤；病在
里之表，宜五苓散。若病里之里，当用猪苓汤但利其水，不可用五苓散兼发其汗矣。要知五苓是太阳半表半里之剂，
归重又在半表。
太阳病，发汗后，大汗出，胃中干，烦躁不得眠，欲得饮水者，少少与饮之，令胃气和则愈。若脉浮小便不
利微热消渴者，五苓散主之。
妄发其汗，津液大泄，故胃中干。汗为心液，汗多则离中水亏，无以济火，故烦。肾中水衰，不能制火，故躁。
精气不能游溢以上输于脾，脾不能为胃行其津液，胃不和，故不得眠。内水不足，须外水以相济，故欲饮水。此便是
转属阳明症。水能制火而润土，水土合和，则胃家不实，故病愈。但勿令恣饮，使水气为患而致悸喘等症也。所以然
者，其人内热尚少，饮不能多，勿多与耳。如饮水数升而不解者，又当与人参白虎汤矣。若发汗后，脉仍浮，而微
热犹在，表未尽除也。虽不烦而渴特甚，饮多即消。小便反不利，水气未散也。伤寒者，伤于冬时寒水之气。太阳卫外
之阳微，不足以御邪，故寒水得以内侵，所以心下有水气。胸中之阳又不足以散水气，故烦渴而小便不利耳。小便
由于气化。肺气不化，金不生水，不能下输膀胱；心气不化，离中水虚，不能下交于坎。必上焦得通，津液得下。桂枝
色赤入丙，四苓色白归辛，丙辛合为水运，用之为散，散于胸中。必先上焦如雾，然后下焦如渎，何有烦渴癃闭之患
哉？要知五苓，重在脉浮微热，不重在小便不利。
太阳病，其人发热汗出、不恶寒而渴者，此转属阳明也。渴欲饮水者，少少与之，但以法救之，宜五苓散。
此与前上半条同义。前条在大汗后，此在未汗前，即是太阳温病。要知太阳温病，即是阳明来路，其径最捷。不
若伤寒中风，止从亡津液而后转属也。饮水是治温大法，庶不犯汗、吐、下、温之误。夫五苓
散又是治饮多之法。夫曰转属，是他经戾及。其人平日未必胃实，故预立此法，以防胃家虚耳。仲景治太阳不特
先为胃家惜津液，而且为胃家虑及痼瘕、谷瘅等症矣。全条见阳明篇，此节文以备五苓症。
发汗后，饮水多者必喘，以水灌之亦喘。
未发汗，因风寒而喘者，是麻黄症。下后微喘者，桂枝加浓朴杏仁症。喘而汗出者，葛根黄连黄芩症。此汗
后津液不足，饮水多而喘者，是五苓症。以水灌之亦喘者，形寒饮冷，皆能伤肺，气迫上行，是以喘也。汉时治
病，有火攻、水攻之法，故仲景言及之。
太阳病，饮水多，小便利者，必心下悸，小便少者，必苦里急也。
此望问法。《内经》所云∶“一者因得之”，审其上下得一之情者是也。见其饮水，即问其小便。小便利则
水结上焦，不能如雾，故心下悸可必；小便少则水蓄下焦，不能如渎，故里急可必。火用不宣，致水停心下而悸；
水用不宣，致水结膀胱而里急也。
伤寒汗出而心下悸，渴者，五苓散主之，不渴者，茯苓甘草汤主之。
汗出下当有心下悸三字，看后条可知。不然汗出而渴，是白虎汤症；汗后不渴而无他症，是病已瘥，可勿药
矣。二方皆因心下有水气而设。渴者是津液已亡，故少用桂枝，多服暖水，微发其汗；不渴者津液未亡，故仍用桂
加减，更发其汗。上条言症而不及治。此条言方而症不详，当互文以会意也。
本以下之，故心下痞，与泻心汤。痞不解，其人渴而口燥烦小便不利者，五苓散主之。
与泻心汤，而痞不除，必心下有水气故耳。其症必兼燥烦而小便不利，用五苓散入心而逐水气，则痞自除矣。
大下之后，复发汗，小便不利者，亡津液故也。勿治之，得小便利，必自愈。
凡病，若发汗、若吐、若下、若亡血、亡津液，阴阳自和者，必自愈。
前条用五苓者，以心下有水气，是逐水非利小便也。若心下无水气，则发汗后津液既亡，小便不利者，亦将
何所利乎？勿治之，是禁其勿得利小便，非待其自愈之谓也。然以亡津液之人，勿生其津液，焉得小便利？欲小便
利，治在益其津液也。其人亡血亡津液，阴阳安能自和？欲其阴阳自和，必先调其阴阳之所自。阴自亡血，阳自
亡津，益血生津，阴阳自和矣。要知不益津液，小便必不得利；不益血生津，阴阳必不自和。凡看仲景书，当于
无方处索方，不治处求治，才知仲景无死方，仲景无死法。
五苓散∶
猪苓（去皮） 白术 茯苓（各十八铢） 泽泻（一两六钱） 桂枝（半两）
上五味，捣为末，以白饮和服方寸匕。
猪苓色黑入肾，泽泻味咸入肾，具水之体。茯苓味甘入脾，色白入肺，清水之源。桂枝色赤入心，通经发
汗，为水之用。合而为散，散于胸中则水精四布，上滋心肺，外溢皮毛，通调水道，一汗而解矣。本方治汗后表
里俱热、燥渴、烦躁、不眠等症，全同白虎。所异者，在表热未解，及水逆与饮水多之变症耳。若谓此方是利水
而设，不识仲景之旨矣。若谓用此以生津液，则非渗泄之味所长也。
伤寒厥而心下悸者，宜先治水，当用茯苓甘草汤却治其厥。不尔，水渍入胃，必作利也。
心下悸是有水气。今乘其未及渍胃时先治之，不致厥利相连，此治法有次第也。
茯苓甘草汤∶
茯苓 桂枝（各一两） 甘草（一两，炙） 生姜（三两）
上四味，以水四升，煮取二升，去滓，分温三服。
此方从桂枝加减。水停而悸，故去大枣；不烦而厥，故去芍药；水宜渗泄，故加茯苓；既云治水，仍任姜、
桂以发汗。不用猪、泽以利小
便者，防水渍入胃故耳。与五苓治烦渴者不同法。
【中风发热，六七日不解而烦，有表里症，渴欲饮水，水入则吐者，名曰水逆，五苓散主之。多服暖水，汗出愈。】
中风（外感风邪）导致发热，经过六七天病情没有缓解并且出现烦躁，既有表证又有里证，口渴想喝水，但水喝进去就吐出来，这种情况叫做“水逆”，用五苓散主治。服用较多温开水后，通过出汗即可痊愈。
【表热不解，内复烦渴者，因于发汗过多。反不受水者，是其人心下有水气。因离中之真水不足，则膻中之火用不宣。邪水凝结于内，水饮拒绝于外，既不能外输于玄府，又不能上输于口舌，亦不能下输于膀胱，此水逆所由名也。势必藉四苓辈味之淡者，以渗泄其水。然水气或降，而烦渴未必除，表热未必散。故必藉桂枝之辛温，入心而化液；更仗暖水之多服，推陈而致新。斯水精四布而烦渴解，输精皮毛而汗自出，一汗而表里顿除，又大变乎麻黄、桂枝、葛根、青龙等法也。暖水可多服，则逆者是冷水，热淫于内故不受寒。反与桂枝、暖水，是热因热用法。五苓因水气不舒而设，是小发汗，不是生津液，是逐水气，不是利水道。】
表部的热邪未解，体内又出现烦躁和口渴，这是因为发汗过多造成的。反而不能接受饮水，是因为患者心下部有水气停留。因为心中（离卦象征心脏/火）的真阴之水不足，导致胸中（膻中）的火气功能无法宣通。邪气与水湿凝结在体内，水饮排斥在体外，既不能向外输送到毛孔（玄府），也不能向上输送到口舌，更不能向下输送到膀胱，这就是“水逆”这一名称的由来。必然要借助猪苓、茯苓、泽泻、白术这四种药性淡薄的药物，来渗透排泄体内的水湿。然而，即使水气下降，烦躁和口渴未必能消除，表部的热邪也未必能消散。所以必须借助桂枝的辛温特性，进入心脏促进津液化生；更要依靠多喝温开水，推动新陈代谢。这样水液精华就能四处布散，从而解除烦躁和口渴，精气输送到皮毛，自然就会出汗，一次发汗就能使表里症状同时去除，这与麻黄汤、桂枝汤、葛根汤、大/小青龙汤等方法有了巨大的变化。可以大量饮用温水，说明呕吐是因为胃中有冷水，内部热邪盛行所以不接受寒凉。反而给予桂枝和温水，这是“热因热用”的治疗方法。五苓散是因为水气不畅而设立的，属于轻微的发汗法，目的不是生津液，而是驱逐水气，不是单纯通利水道。
【上条有表里之症，此条有表里之脉，互相发明五苓双解之义。虽经发汗而表未尽除，水气内结，故用五苓。若无表症，当用白虎加人参汤矣。伤寒发汗解、复烦而脉浮数者，热在表未传里也，故用桂枝。此更加渴，则热已在里，而表邪未罢，故用五苓。脉浮而数者，可发汗。病在表之表，宜麻黄汤；病在表之里，宜桂枝汤；病在里之表，宜五苓散。若病里之里，当用猪苓汤但利其水，不可用五苓散兼发其汗矣。要知五苓是太阳半表半里之剂，归重又在半表。】
上一条提到了表里症状，这一条提到了表里脉象，两者互相印证阐明了五苓散表里双解的含义。虽然经过发汗但表证未完全解除，水气在体内凝结，所以使用五苓散。如果没有表证，应当使用白虎加人参汤了。伤寒发汗后表证已解，但又出现烦躁且脉搏浮快的，说明热邪仍在表部未传入里，所以用桂枝汤。这里如果再加上口渴，说明热邪已经在里，而表邪仍未停止，所以用五苓散。脉搏浮且快的，可以采用发汗法。病邪在表的表层，适宜用麻黄汤；病邪在表的深层，适宜用桂枝汤；病邪在里的表层（半表半里），适宜用五苓散。如果病邪在里的深层，应当使用猪苓汤仅利其水，不可用五苓散兼以发汗。要知道五苓散是治疗太阳病半表半里的方剂，重点侧重于半表。
【太阳病，发汗后，大汗出，胃中干，烦躁不得眠，欲得饮水者，少少与饮之，令胃气和则愈。若脉浮小便不利微热消渴者，五苓散主之。】
太阳病，发汗后，大汗淋漓，导致胃中干燥，烦躁无法入睡，想要喝水的，少量多次地给予饮水，让胃气调和就能痊愈。如果脉搏浮、小便不通畅、有轻微发热且极度口渴的，用五苓散主治。
【妄发其汗，津液大泄，故胃中干。汗为心液，汗多则离中水亏，无以济火，故烦。肾中水衰，不能制火，故躁。精气不能游溢以上输于脾，脾不能为胃行其津液，胃不和，故不得眠。内水不足，须外水以相济，故欲饮水。此便是转属阳明症。水能制火而润土，水土合和，则胃家不实，故病愈。但勿令恣饮，使水气为患而致悸喘等症也。所以然者，其人内热尚少，饮不能多，勿多与耳。如饮水数升而不解者，又当与人参白虎汤矣。若发汗后，脉仍浮，而微热犹在，表未尽除也。虽不烦而渴特甚，饮多即消。小便反不利，水气未散也。伤寒者，伤于冬时寒水之气。太阳卫外之阳微，不足以御邪，故寒水得以内侵，所以心下有水气。胸中之阳又不足以散水气，故烦渴而小便不利耳。小便由于气化。肺气不化，金不生水，不能下输膀胱；心气不化，离中水虚，不能下交于坎。必上焦得通，津液得下。桂枝色赤入丙，四苓色白归辛，丙辛合为水运，用之为散，散于胸中。必先上焦如雾，然后下焦如渎，何有烦渴癃闭之患哉？要知五苓，重在脉浮微热，不重在小便不利。】
错误地发汗，导致津液大量流失，所以胃中干燥。汗是心的液体，出汗过多则心中（离卦）阴水亏损，无法制约心火，所以烦躁。肾中阴水衰弱，不能制约心火，所以躁动不安。精气不能流动溢出向上输送给脾脏，脾脏不能为胃传输津液，胃气不和，所以无法入睡。体内阴水不足，需要外部的水来补充，所以想要喝水。这就是病证转化为阳明病的表现。水能制约火并滋润土（脾胃），水土和谐，则胃腑不会燥实，所以病愈。但不要让人肆意豪饮，以免水气成为祸害而导致心悸、气喘等症状。之所以这样，是因为此人内部热邪尚少，饮水不能太多，不要给太多水。如果喝了几升水病情仍未缓解的，又应当给人参白虎汤了。如果发汗后，脉搏仍然浮，且轻微发热依然存在，说明表证未完全解除。虽然不烦躁但口渴特别严重，喝下去的水很快就被消耗掉。小便反而不通畅，说明水气尚未消散。伤寒，是受到冬季寒水之气的伤害。太阳经护卫体表的阳气微弱，不足以抵御邪气，所以寒水得以侵入体内，因此心下部有水气。胸中的阳气又不足以发散水气，所以出现烦躁、口渴和小便不利。小便的通利依赖于气化作用。肺气不能正常气化，肺（金）不能生水，不能向下输送到膀胱；心气不能正常气化，心中（离卦）阴水虚弱，不能向下交接于肾（坎卦）。必须上焦通畅，津液才能下行。桂枝颜色赤红入心（丙火），猪苓、茯苓、泽泻、白术颜色偏白入肺（辛金），丙辛相合化为水运，将其制成散剂，散布于胸中。必须先让上焦像雾露一样滋润，然后下焦像沟渠一样流通，哪里还会有烦躁、口渴、小便闭塞的祸患呢？要知道五苓散的重点在于脉搏浮和轻微发热，不在于小便不利。
【太阳病，其人发热汗出、不恶寒而渴者，此转属阳明也。渴欲饮水者，少少与之，但以法救之，宜五苓散。】
太阳病，患者发热、出汗、不恶寒而且口渴的，这是病证转属阳明病。口渴想喝水的，少量多次给予饮水，只要按照法则救治，适宜用五苓散。
【此与前上半条同义。前条在大汗后，此在未汗前，即是太阳温病。要知太阳温病，即是阳明来路，其径最捷。不若伤寒中风，止从亡津液而后转属也。饮水是治温大法，庶不犯汗、吐、下、温之误。夫五苓散又是治饮多之法。夫曰转属，是他经戾及。其人平日未必胃实，故预立此法，以防胃家虚耳。仲景治太阳不特先为胃家惜津液，而且为胃家虑及痼瘕、谷瘅等症矣。全条见阳明篇，此节文以备五苓症。】
这条与前文的上半段意思相同。前一条是在大汗之后，这一条是在未发汗之前，这属于太阳温病。要知道太阳温病，就是通向阳明病的途径，路径最为快捷。不像伤寒或中风，只是从津液耗损后才转属阳明。饮水是治疗温病的大法，这样可以避免误用汗、吐、下、温等疗法。五苓散也是治疗饮水过多导致停水的办法。所谓“转属”，是指病邪从他经波及而来。这个人平时未必胃腑实证，所以预先设立这个法则，以防止胃气虚弱。张仲景治疗太阳病，不仅事先为胃腑爱惜津液，而且为胃腑考虑到痼瘕、谷瘅等疾病。完整条文见于阳明病篇，这里摘录这段文字是为了备录五苓散的适应症。
【未发汗，因风寒而喘者，是麻黄症。下后微喘者，桂枝加浓朴杏仁症。喘而汗出者，葛根黄连黄芩症。此汗后津液不足，饮水多而喘者，是五苓症。以水灌之亦喘者，形寒饮冷，皆能伤肺，气迫上行，是以喘也。汉时治病，有火攻、水攻之法，故仲景言及之。】
未发汗时，因为风寒引起气喘的，是麻黄汤证。泻下后出现轻微气喘的，是桂枝加厚朴杏子汤证。气喘且出汗的，是葛根黄芩黄连汤证。这里是发汗后津液不足，因饮水过多而气喘的，是五苓散证。用冷水浇洗身体也气喘的，形体受寒和饮用冷物，都能损伤肺脏，气机被迫向上逆行，所以发生气喘。汉代治病，有火攻和水攻的方法，所以张仲景在书中提及了这些情况。
【太阳病，饮水多，小便利者，必心下悸，小便少者，必苦里急也。】
太阳病，饮水过多，小便通畅的，必定会出现心下部悸动；小便少的，必定会感到腹部拘急痛苦。
【此望问法。《内经》所云∶“一者因得之”，审其上下得一之情者是也。见其饮水，即问其小便。小便利则水结上焦，不能如雾，故心下悸可必；小便少则水蓄下焦，不能如渎，故里急可必。火用不宣，致水停心下而悸；水用不宣，致水结膀胱而里急也。】
这是望诊和问诊的方法。《黄帝内经》所说：“一种病因是由于饮食不当获得的”，审查其上下部位得到统一病情的道理就是这样。看到他在饮水，就问他的排尿情况。小便通畅说明水湿结聚在上焦，不能像雾露一样布散，所以心下部悸动是可以确定的；小便少说明水湿蓄积在下焦，不能像沟渠一样流通，所以腹部拘急痛苦是可以确定的。心火功能不能宣通，导致水湿停在心下部而引起悸动；肾水功能不能宣通，导致水湿结聚在膀胱而引起腹部拘急痛苦。
【伤寒汗出而心下悸，渴者，五苓散主之，不渴者，茯苓甘草汤主之。】
伤寒出汗且心下部悸动，口渴的，用五苓散主治；不口渴的，用茯苓甘草汤主治。
【汗出下当有心下悸三字，看后条可知。不然汗出而渴，是白虎汤症；汗后不渴而无他症，是病已瘥，可勿药矣。二方皆因心下有水气而设。渴者是津液已亡，故少用桂枝，多服暖水，微发其汗；不渴者津液未亡，故仍用桂加减，更发其汗。上条言症而不及治。此条言方而症不详，当互文以会意也。】
“汗出”下面应当有“心下悸”三个字，看后面的条文就可以知道。否则，出汗且口渴，是白虎汤证；发汗后不口渴且没有其他症状，是病已经痊愈，可以不用药了。这两个方子都是因为心下部有水气而设立的。口渴的是津液已经耗亡，所以少用桂枝，多服温水，微微发汗；不口渴的是津液未耗亡，所以仍然用桂枝汤加减，进一步发汗。上一条只讲症状而未涉及治法。这一条只讲方剂而症状描述不详，应当通过互文见义的方法来理解。
【本以下之，故心下痞，与泻心汤。痞不解，其人渴而口燥烦小便不利者，五苓散主之。】
本来是因为误用泻下法，导致心下部痞满，给予泻心汤治疗。痞满不缓解，患者口渴、口干燥、烦躁且小便不通利的，用五苓散主治。
【与泻心汤，而痞不除，必心下有水气故耳。其症必兼燥烦而小便不利，用五苓散入心而逐水气，则痞自除矣。】
给予泻心汤治疗后，痞满不消除，一定是因为心下部有水气停留。其症状必定兼有口燥烦躁和小便不利，使用五苓散进入心脏区域驱逐水气，痞满自然就会消除。
【大下之后，复发汗，小便不利者，亡津液故也。勿治之，得小便利，必自愈。】
大规模泻下之后，再次发汗，导致小便不通利的，是因为津液耗亡的缘故。不要强行治疗，等到小便通利，必定会自愈。
【凡病，若发汗、若吐、若下、若亡血、亡津液，阴阳自和者，必自愈。】
凡是疾病，无论是发汗、催吐、泻下，还是失血、津液耗亡，只要阴阳能够自我调和，必定会自愈。
【前条用五苓者，以心下有水气，是逐水非利小便也。若心下无水气，则发汗后津液既亡，小便不利者，亦将何所利乎？勿治之，是禁其勿得利小便，非待其自愈之谓也。然以亡津液之人，勿生其津液，焉得小便利？欲小便利，治在益其津液也。其人亡血亡津液，阴阳安能自和？欲其阴阳自和，必先调其阴阳之所自。阴自亡血，阳自亡津，益血生津，阴阳自和矣。要知不益津液，小便必不得利；不益血生津，阴阳必不自和。凡看仲景书，当于无方处索方，不治处求治，才知仲景无死方，仲景无死法。】
前一条使用五苓散，是因为心下部有水气，目的是驱逐水湿而非单纯通利小便。如果心下部没有水气，那么发汗后津液既然已经耗亡，小便不通利，又能通利什么呢？“不要治疗”，是禁止使用通利小便的药物，并非等待它自愈的意思。然而对于津液耗亡的人，如果不补充津液，怎么能使得小便通利呢？想要小便通利，治疗关键在于补充津液。这个人失血且津液耗亡，阴阳怎么能自我调和呢？想要阴阳自我调和，必须先调理产生阴阳的根本。阴源于血液，阳源于津液，补充血液和津液，阴阳就能自我调和了。要知道不补充津液，小便必定不能通利；不补血生津，阴阳必定不能自我调和。凡是阅读张仲景的书籍，应当在看似没有方子的地方寻找方子，在不治疗的地方寻求治疗原则，才知道张仲景没有僵死的方子，张仲景没有僵死的方法。
【五苓散：猪苓（去皮） 白术 茯苓（各十八铢） 泽泻（一两六钱） 桂枝（半两）上五味，捣为末，以白饮和服方寸匕。】
五苓散配方：猪苓（去掉外皮）、白术、茯苓（各十八铢）、泽泻（一两六钱）、桂枝（半两）。以上五味药，捣碎成粉末，用米汤调和，每次服用一方寸匕的量。
【猪苓色黑入肾，泽泻味咸入肾，具水之体。茯苓味甘入脾，色白入肺，清水之源。桂枝色赤入心，通经发汗，为水之用。合而为散，散于胸中则水精四布，上滋心肺，外溢皮毛，通调水道，一汗而解矣。本方治汗后表里俱热、燥渴、烦躁、不眠等症，全同白虎。所异者，在表热未解，及水逆与饮水多之变症耳。若谓此方是利水而设，不识仲景之旨矣。若谓用此以生津液，则非渗泄之味所长也。】
猪苓颜色黑入肾脏，泽泻味道咸入肾脏，具备水的形体。茯苓味道甘入脾脏，颜色白入肺脏，是清理水源的关键。桂枝颜色赤红入心脏，通达经络并发汗，发挥水液代谢的功能。合起来制成散剂，散布于胸中则水液精华四处布散，向上滋润心肺，向外充盈皮毛，通调水道，一次发汗即可痊愈。本方治疗发汗后面部和身体都发热、燥渴、烦躁、失眠等症状，完全与白虎汤相同。不同的是，在于表热未解，以及水逆和饮水过多引起的变症罢了。如果说这个方子是专门为了利水而设立的，那就没认识张仲景的本意了。如果说用它来生津液，那也不是渗泄类药物所擅长的。
【伤寒厥而心下悸者，宜先治水，当用茯苓甘草汤却治其厥。不尔，水渍入胃，必作利也。】
伤寒出现四肢厥冷且心下部悸动的，应当先治疗水气，当用茯苓甘草汤，然后再治疗四肢厥冷。不这样的话，水气浸渍进入胃中，必定会导致腹泻。
【心下悸是有水气。今乘其未及渍胃时先治之，不致厥利相连，此治法有次第也。】
心下部悸动是因为有水气。现在趁着水气还没有浸渍到胃的时候先治疗它，不至于让四肢厥冷和腹泻接连发生，这是治疗方法有先后次序。
【茯苓甘草汤：茯苓 桂枝（各一两） 甘草（一两，炙） 生姜（三两）上四味，以水四升，煮取二升，去滓，分温三服。】
茯苓甘草汤配方：茯苓、桂枝（各一两）、甘草（一两，炙过）、生姜（三两）。以上四味药，用水四升，煮取二升药液，去掉药渣，分三次温服。
【此方从桂枝加减。水停而悸，故去大枣；不烦而厥，故去芍药；水宜渗泄，故加茯苓；既云治水，仍任姜、桂以发汗。不用猪、泽以利小便者，防水渍入胃故耳。与五苓治烦渴者不同法。】
这个方子是从桂枝汤加减变化而来。水湿停滞引起悸动，所以去掉大枣；没有烦躁但有四肢厥冷，所以去掉芍药；水湿适宜渗泄，所以加入茯苓；既然说是治疗水气，仍然任用生姜、桂枝来发汗。不用猪苓、泽泻来利小便，是为了防止水气浸渍进入胃中。这与五苓散治疗烦躁口渴的方法不同。
[Wind-stroke (Exogenous Wind Syndrome) with fever, persisting for six or seven days without resolution accompanied by irritability, presenting both exterior and interior symptoms: thirst with desire to drink water, but vomiting immediately after ingestion is termed "Water Reversal" (Shui Ni). Wuling San (Five-Ingredient Powder with Cinnamon Twig) is the primary prescription. Drinking more warm water induces sweating, leading to recovery.]
When wind-strike syndrome causes fever, and after six or seven days the condition remains unresolved with irritability, presenting both exterior and interior signs, where the patient feels thirsty and desires to drink water but vomits it immediately upon ingestion, this condition is named "Water Reversal" (Shui Ni). It should be treated primarily with Wuling San (Five-Ingredient Powder with Cinnamon Twig). By consuming a larger amount of warm water, sweating will occur, resulting in recovery.
[The exterior heat remains unresolved, and internally there is irritability and thirst due to excessive sweating. The inability to accept water indicates the presence of fluid retention below the heart. Due to insufficient true yin water in the Heart (Li), the fire function in the Chest (Dan Zhong) cannot circulate freely. Pathogenic water condenses internally, while normal fluids are rejected externally; they cannot be transported outward to the pores (Xuan Fu), upward to the mouth and tongue, or downward to the Bladder. This explains the name "Water Reversal." It is necessary to rely on the bland-tasting herbs among the Four Poria group (Si Ling) to渗泄 (osmose and drain) the water. However, even if the fluid qi descends, the irritability and thirst may not resolve, nor will the exterior heat necessarily dissipate. Therefore, one must rely on the acrid-warm nature of Guizhi (Cinnamon Twig) to enter the Heart and transform fluids; furthermore, relying on the consumption of warm water promotes renewal. Thus, water essence distributes throughout the body, resolving irritability and thirst, and essence is transported to the skin and hair, causing natural sweating. One sweat clears both exterior and interior instantly, greatly differing from methods like Mahuang Tang, Guizhi Tang, Gegen Tang, and Qinglong Decoctions. Warm water can be taken in large quantities because the vomiting is caused by cold water in the stomach; internal heat excess rejects cold. Giving Guizhi and warm water exemplifies the method of "treating heat with heat." Wuling San is established for stagnant fluid qi; it is a mild diaphoretic, not a fluid-generating formula; it expels fluid qi rather than merely promoting urination.]
If exterior heat persists and internal irritability and thirst arise, it is due to excessive sweating. The inability to tolerate drinking water indicates fluid retention below the heart. Because the true yin water within the Heart (symbolized by Li) is insufficient, the fire function in the Chest (Dan Zhong) fails to circulate smoothly. Pathogenic water and dampness condense inside, while physiological fluids are repelled outside; they cannot be transported outward to the pores (Xuan Fu), upward to the oral cavity, or downward to the Bladder. This is the origin of the term "Water Reversal." It is imperative to utilize the bland-tasting herbs of the Si Ling group (Zhu Ling, Ze Xie, Fu Ling, Bai Zhu) to osmose and drain the retained water. Nevertheless, even if the fluid qi descends, the irritability and thirst might not cease, nor will the exterior heat necessarily disperse. Hence, reliance is placed on the acrid-warm properties of Guizhi (Cinnamon Twig) to enter the Heart and facilitate fluid transformation; additionally, copious intake of warm water aids in eliminating the old and generating the new. Consequently, water essence distributes evenly, relieving irritability and thirst, and essence reaches the skin and hair, inducing spontaneous sweating. A single episode of sweating resolves both exterior and interior conditions simultaneously, marking a significant departure from the methodologies of Mahuang Tang, Guizhi Tang, Gegen Tang, and Qinglong Decoctions. Since warm water can be consumed in abundance, it implies that the vomiting stems from cold water in the stomach, which rejects cold due to internal heat hyperactivity. Administering Guizhi and warm water constitutes the therapeutic principle of "using heat to treat heat." Wuling San is formulated for stagnant fluid qi; it acts as a mild diaphoretic, not for generating fluids, nor does it solely focus on promoting urination.
[After sweating, if the pulse is floating and rapid with irritability and thirst, Wuling San is indicated.]
Following diaphoresis, if the pulse becomes floating and rapid, accompanied by irritability and thirst, Wuling San (Five-Ingredient Powder with Cinnamon Twig) is the indicated treatment.
[The preceding clause mentions exterior and interior symptoms; this clause mentions exterior and interior pulses, mutually illuminating the dual-resolving meaning of Wuling San. Although sweating has occurred, the exterior pathogen is not fully eliminated, and fluid retention is internal; thus, Wuling San is used. If there were no exterior symptoms, Baibu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) would be appropriate. In Shanghan, if sweating resolves the exterior but irritability returns with a floating-rapid pulse, the heat remains in the exterior and has not transmitted inward, so Guizhi Tang is used. Here, with added thirst, the heat has entered the interior while the exterior pathogen persists, hence Wuling San is employed. A floating and rapid pulse suggests diaphoresis is suitable. For disease in the outer layer of the exterior, Mahuang Tang is preferred; for the inner layer of the exterior, Guizhi Tang is preferred; for the outer layer of the interior (half-exterior half-interior), Wuling San is preferred. If the disease is in the deep interior, Zhuling Tang should be used to drain water only, and Wuling San should not be used as it also induces sweating. It must be understood that Wuling San is a formula for the Taiyang half-exterior half-interior stage, with emphasis on the half-exterior.]
The previous passage describes exterior and interior symptoms, while this passage describes exterior and interior pulse patterns, together elucidating the dual-resolution mechanism of Wuling San. Although diaphoresis has been performed, the exterior syndrome is not entirely resolved, and fluid qi is constrained internally; therefore, Wuling San is administered. If there were no exterior signs, Baibu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) would have been indicated. In Cold Damage, if sweating resolves the exterior but irritability recurs with a floating and rapid pulse, the heat remains in the exterior and has not yet transmitted inward, warranting Guizhi Tang. In this case, the addition of thirst indicates that heat has reached the interior while the exterior pathogen has not subsided, necessitating Wuling San. A floating and rapid pulse indicates that diaphoresis is applicable. When the pathology is at the superficial level of the exterior, Mahuang Tang is suitable; when it is at the deeper level of the exterior, Guizhi Tang is suitable; when it is at the superficial level of the interior (the half-exterior/half-interior zone), Wuling San is suitable. If the pathology lies in the deep interior, Zhuling Tang should be used to promote urination alone, and Wuling San should be avoided as it combines water-draining with diaphoresis. It is crucial to recognize that Wuling San is a formula for the Taiyang half-exterior half-interior stage, with its primary focus on the half-exterior aspect.
[Taiyang disease, after sweating, with profuse sweating, dryness in the Stomach, irritability, insomnia, and desire to drink water: give small amounts of water frequently to harmonize the Stomach Qi, leading to recovery. If the pulse is floating, urination is difficult, there is slight fever, and extreme thirst, Wuling San is indicated.]
In Taiyang disease, after diaphoresis, if profuse sweating occurs causing dryness in the Stomach, irritability, insomnia, and a desire to drink water, administer small amounts of water frequently. Harmonizing the Stomach Qi will lead to recovery. However, if the pulse is floating, urination is impaired, there is slight fever, and extreme thirst (xiaoke), Wuling San (Five-Ingredient Powder with Cinnamon Twig) is the primary prescription.
[Indiscriminate sweating causes massive loss of body fluids, leading to Stomach dryness. Sweat is the fluid of the Heart; excessive sweating depletes Yin water in the Heart (Li), failing to control Fire, causing irritability. Decline of Kidney water fails to restrain Fire, causing restlessness. Essence cannot overflow upward to nourish the Spleen; the Spleen cannot transport fluids to the Stomach; Stomach disharmony causes insomnia. Internal water deficiency requires external water supplementation, hence the desire to drink. This represents a transition to Yangming syndrome. Water controls Fire and moistens Earth (Spleen/Stomach); when Water and Earth harmonize, the Stomach does not become dry-excess, and the disease heals. However, avoid excessive drinking to prevent fluid retention causing palpitations or asthma. This is because internal heat is still minimal, so intake should be limited. If drinking several liters fails to relieve symptoms, Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) should be given. If after sweating, the pulse remains floating and slight fever persists, the exterior is not fully cleared. Even without irritability, if thirst is severe and drinks are quickly consumed, but urination is poor, fluid qi has not dispersed. Shanghan results from winter cold-water qi. Weak defensive Yang of Taiyang fails to resist pathogens, allowing cold-water to invade, causing fluid retention below the heart. Insufficient chest Yang fails to disperse fluid, causing irritability, thirst, and dysuria. Urination depends on Qi transformation. Lung Qi failure means Metal does not generate Water, preventing downward transmission to the Bladder. Heart Qi failure means Heart Yin deficiency prevents connection with Kidney (Kan). Upper Jiao must open for fluids to descend. Guizhi (red, enters Bing/Fire) and Si Ling herbs (white, enter Xin/Metal) combine to form Water circulation. As a powder, it disperses in the chest. Once the Upper Jiao is like mist, the Lower Jiao flows like a ditch, avoiding irritability, thirst, and urinary obstruction. Note that Wuling San focuses on floating pulse and slight fever, not merely dysuria.]
Erroneous diaphoresis leads to massive fluid loss, resulting in Stomach dryness. Sweat is considered the fluid of the Heart; excessive sweating depletes the Yin water within the Heart (represented by the Li trigram), leaving it unable to moderate Fire, thus causing irritability. Deficiency of Kidney water fails to control Fire, leading to restlessness. Vital essence cannot flow upward to nourish the Spleen, and the Spleen fails to distribute fluids to the Stomach; Stomach disharmony results in insomnia. Internal fluid insufficiency necessitates external fluid replenishment, hence the desire to drink. This signifies a transformation into Yangming syndrome. Water controls Fire and moistens Earth (Spleen and Stomach); when Water and Earth are in harmony, the Stomach does not become dry and excess, and the disease resolves. However, one must avoid unrestricted drinking to prevent fluid retention from causing palpitations or wheezing. This is because the internal heat is still slight, so fluid intake should be moderated. If drinking several liters provides no relief, Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) should be administered. If, after sweating, the pulse remains floating and slight fever persists, the exterior pathogen has not been completely expelled. Although there is no irritability, if thirst is extreme and fluids are consumed rapidly, yet urination is inadequate, it indicates that fluid qi has not dissipated. Shanghan (Cold Damage) is contracted from the cold-water qi of winter. The defensive Yang of Taiyang is weak and insufficient to resist pathogens, allowing cold-water to invade internally, resulting in fluid retention below the heart. Furthermore, chest Yang is insufficient to disperse this fluid, leading to irritability, thirst, and difficulty in urination. Urination relies on Qi transformation. If Lung Qi fails to transform, Metal does not generate Water, preventing downward transmission to the Bladder. If Heart Qi fails to transform, Heart Yin deficiency prevents downward communication with the Kidney (Kan). The Upper Jiao must be unobstructed for fluids to descend. Guizhi (Cinnamon Twig), being red, enters the Heart (Bing Fire); the four Poria herbs, being white, enter the Lung (Xin Metal). Bing and Xin combine to facilitate Water circulation. Prepared as a powder and dispersed in the chest, it ensures the Upper Jiao becomes like mist and the Lower Jiao flows like a ditch, thereby preventing irritability, thirst, and urinary retention. It is essential to understand that Wuling San emphasizes the floating pulse and slight fever, rather than focusing solely on dysuria.
[Taiyang disease with fever, sweating, aversion to cold absent, and thirst indicates transition to Yangming. For thirst with desire to drink, give small amounts of water and treat according to principles; Wuling San is suitable.]
In Taiyang disease, if the patient presents with fever, sweating, absence of aversion to cold, and thirst, this indicates a transition to Yangming syndrome. For those with thirst and desire to drink, provide small amounts of water and treat according to proper principles; Wuling San (Five-Ingredient Powder with Cinnamon Twig) is appropriate.
[This shares the same meaning as the first half of the previous clause. The previous clause refers to post-profuse sweating; this refers to pre-sweating, constituting Taiyang Warm Disease. Taiyang Warm Disease is the direct pathway to Yangming, the most expedient route. Unlike Shanghan or Wind-stroke, which transition only after fluid depletion, drinking water is the major method for treating Warm Disease, avoiding errors of sweating, purging, or warming. Wuling San is also a method for treating excessive fluid intake. "Transition" implies pathogenic influence from other meridians. The patient may not normally have Stomach excess, so this method is preemptively established to protect against Stomach deficiency. Zhang Zhongjing, in treating Taiyang, not only preserves Stomach fluids but also anticipates complications like masses or grain jaundice. The full text appears in the Yangming chapter; this excerpt is included to illustrate Wuling San indications.]
This passage aligns with the first half of the preceding clause. The previous clause addresses the state after profuse sweating, whereas this clause addresses the state before sweating, characterizing it as Taiyang Warm Disease. It is important to note that Taiyang Warm Disease represents the most direct pathway to Yangming syndrome. This differs from Shanghan (Cold Damage) or Wind-stroke syndromes, which typically transition only after significant fluid depletion. Administering water is a fundamental method for treating Warm Disease, thereby avoiding the errors associated with inappropriate sweating, emesis, purgation, or warming therapies. Wuling San also serves as a remedy for conditions arising from excessive fluid intake. The term "transition" implies that the pathology has spread from other meridians. The patient may not inherently possess Stomach excess; thus, this method is prescribed proactively to prevent Stomach deficiency. Zhang Zhongjing, in managing Taiyang diseases, not only prioritizes preserving Stomach fluids but also anticipates potential complications such as fixed masses or grain-related jaundice. The complete context is found in the Yangming Chapter; this segment is cited here to document indications for Wuling San.
[After sweating, excessive water intake inevitably causes asthma/wheezing; washing with cold water also causes wheezing.]
After diaphoresis, excessive consumption of water will inevitably induce wheezing; similarly, bathing with cold water will also cause wheezing.
[Pre-sweating wheezing due to wind-cold is Mahuang syndrome. Post-purgation mild wheezing is Guizhi Houpo Xiren syndrome. Wheezing with sweating is Gegen Huanglian Huangqin syndrome. Post-sweat wheezing due to fluid deficiency and excessive drinking is Wuling syndrome. Cold water bathing causing wheezing indicates that external cold and internal cold drinks damage the Lungs, forcing Qi upward. Han dynasty treatments included fire and water attacks, hence mentioned by Zhongjing.]
Wheezing occurring prior to sweating due to wind-cold invasion corresponds to the Mahuang Tang syndrome. Mild wheezing following purgation corresponds to the Guizhi Houpo Xiren Tang (Guizhi Plus Magnolia Bark and Apricot Kernel Decoction) syndrome. Wheezing accompanied by sweating corresponds to the Gegen Huanglian Huangqin Tang (Pueraria, Coptis, and Scutellaria Decoction) syndrome. Wheezing after sweating due to fluid deficiency and excessive water intake corresponds to the Wuling San syndrome. Wheezing induced by washing with cold water indicates that both external cold exposure and consumption of cold beverages can injure the Lungs, forcing Qi to rush upward, resulting in wheezing. During the Han Dynasty, medical treatments included "fire attack" and "water attack" methods, which is why Zhang Zhongjing references them.
[Taiyang disease with excessive water intake: if urination is free, palpitations below the heart are certain; if urination is scanty, abdominal urgency is certain.]
In Taiyang disease, if water intake is excessive: if urination is free and abundant, palpitations below the heart are inevitable; if urination is scanty, abdominal urgency and discomfort are inevitable.
[This illustrates inspection and inquiry methods. As stated in Neijing: "One cause is dietary," examining the upper and lower aspects confirms this. Seeing the patient drink, inquire about urination. Free urination indicates water stagnation in the Upper Jiao, unable to act like mist, causing palpitations. Scanty urination indicates water accumulation in the Lower Jiao, unable to flow like a ditch, causing abdominal urgency. Fire dysfunction causes water stagnation below the heart (palpitations); Water dysfunction causes water knotting in the Bladder (abdominal urgency).]
This section illustrates the diagnostic methods of inspection and inquiry. As stated in the *Neijing* (Inner Canon): "One etiology is derived from diet," referring to assessing the consistency between upper and lower bodily functions. Upon observing the patient drinking, one should inquire about their urination status. If urination is free, it indicates water stagnation in the Upper Jiao, failing to disperse like mist, which inevitably leads to palpitations below the heart. If urination is scanty, it indicates water accumulation in the Lower Jiao, failing to drain like a ditch, which inevitably leads to abdominal urgency. Dysfunction of Fire (Heart) causes water to stagnate below the heart, resulting in palpitations; dysfunction of Water (Kidney) causes water to knot in the Bladder, resulting in abdominal urgency.
[Shanghan with sweating, palpitations below the heart, and thirst: Wuling San. Without thirst: Fuling Gancao Tang.]
In Shanghan, if sweating is accompanied by palpitations below the heart and thirst, Wuling San (Five-Ingredient Powder with Cinnamon Twig) is indicated. If there is no thirst, Fuling Gancao Tang (Poria and Licorice Decoction) is indicated.
["Palpitations below the heart" should follow "sweating"; see later clauses. Otherwise, sweating with thirst is Baibu Tang syndrome; post-sweat no thirst/no other symptoms means recovery. Both formulas address fluid below the heart. Thirst indicates fluid loss; use less Guizhi, more warm water, mild sweating. No thirst indicates fluid intact; use Guizhi modification, further sweating. Previous clause discusses symptoms; this discusses formulas; read mutually for meaning.]
The phrase "palpitations below the heart" should logically follow "sweating," as evidenced in subsequent clauses. Otherwise, sweating accompanied by thirst indicates the Baibu Tang (White Tiger Decoction) syndrome. Post-sweat absence of thirst and other symptoms implies the disease has resolved, requiring no medication. Both formulas are established for fluid retention below the heart. In cases with thirst, body fluids have been depleted; thus, a smaller dose of Guizhi is used, combined with copious warm water to induce mild sweating. In cases without thirst, fluids remain intact; thus, a modified Guizhi Tang is used to induce further sweating. The preceding clause describes symptoms without specifying treatment; this clause specifies formulas without detailed symptoms; they should be interpreted mutually to grasp the underlying intent.
[Originally treated with purgatives, causing epigastric fullness; given Xiexin Tang. Fullness persists, with thirst, dry mouth, irritability, and dysuria: Wuling San.]
Initially, improper purgation led to epigastric fullness (Pi), for which Xiexin Tang (Drain the Epigastrium Decoction) was administered. If the fullness persists, accompanied by thirst, dry mouth, irritability, and dysuria, Wuling San (Five-Ingredient Powder with Cinnamon Twig) is indicated.
[If Xiexin Tang fails to resolve fullness, it is due to fluid below the heart. Symptoms include dryness, irritability, and dysuria. Wuling San enters the Heart to expel fluid, resolving fullness.]
If Xiexin Tang (Drain the Epigastrium Decoction) fails to alleviate the epigastric fullness, it is necessarily due to fluid retention below the heart. The symptoms will necessarily include dryness, irritability, and dysuria. Administering Wuling San allows the formula to enter the Heart region and expel the fluid, thereby resolving the fullness.
[After severe purgation and subsequent sweating, dysuria results from fluid depletion. Do not treat directly; wait for natural urination recovery.]
Following severe purgation and subsequent diaphoresis, if dysuria occurs, it is due to the depletion of body fluids. Do not intervene directly; allow the body to recover naturally until urination resumes.
[For any disease, whether due to sweating, vomiting, purging, blood loss, or fluid depletion, if Yin and Yang self-harmonize, recovery is certain.]
In any disease, whether caused by diaphoresis, emesis, purgation, blood loss, or fluid depletion, if the Yin and Yang phases achieve self-harmony, spontaneous recovery is guaranteed.
[Previous Wuling usage was for fluid below the heart, expelling water, not just promoting urination. Without fluid, post-sweat dysuria is due to fluid loss; what is there to drain? "Do not treat" prohibits diuretics, not waiting for cure. But for fluid-depleted patients, how can urine flow without replenishing fluids? Treatment must focus on generating fluids. Blood/fluid loss prevents Yin-Yang harmony; harmony requires regulating the source. Blood generates Yin, fluids generate Yang; replenishing blood and fluids restores harmony. Not replenishing fluids prevents urination; not replenishing blood/fluids prevents harmony. Read Zhongjing's works to find prescriptions where none seem to exist, and treatment where none seems applied. Zhongjing has no rigid formulas or methods.]
The previous instance of using Wuling San was because fluid retention existed below the heart; the goal was to expel water, not merely to promote urination. If there is no fluid retention below the heart, then post-sweat dysuria is due to fluid depletion; in such a case, what is there to drain? The instruction "do not treat" prohibits the use of diuretic agents, rather than implying passive waiting for recovery. However, in a patient depleted of fluids, how can urination resume without replenishing fluids? To restore urination, the treatment must focus on generating fluids. If a patient has lost blood and fluids, how can Yin and Yang self-harmonize? To achieve Yin-Yang harmony, one must first regulate their sources. Blood constitutes Yin, and fluids constitute Yang; replenishing blood and generating fluids restores Yin-Yang harmony. It is crucial to understand that without replenishing fluids, urination cannot be restored; without replenishing blood and fluids, Yin-Yang cannot self-harmonize. When studying Zhang Zhongjing’s works, one should seek prescriptions in passages where none appear to be offered, and find therapeutic principles in sections that seem to advocate non-intervention. Only then will one realize that Zhang Zhongjing possesses no rigid or dead-end formulas, nor does he adhere to inflexible methods.
[Wuling San: Zhu Ling (peeled), Bai Zhu, Fu Ling (each 18 zhu), Ze Xie (1 liang 6 qian), Guizhi (0.5 liang). Pound into powder, mix with rice water, take 1 fangcun bi.]
**Wuling San (Five-Ingredient Powder with Cinnamon Twig):**
* Zhu Ling (Polyporus Umbellatus, peeled)
* Bai Zhu (Atractylodis Macrocephalae Rhizoma)
* Fu Ling (Poria, each 18 zhu)
* Ze Xie (Alismatis Rhizoma, 1 liang 6 qian)
* Guizhi (Cinnamomi Ramulus, 0.5 liang)
Pound these five ingredients into a fine powder. Mix with rice water (bai yin) and administer one *fangcun bi* (a square-inch measure) per dose.
[Zhu Ling (black, Kidney) and Ze Xie (salty, Kidney) represent water substance. Fu Ling (sweet, Spleen; white, Lung) clears the water source. Guizhi (red, Heart) unblocks channels and induces sweating, representing water function. Combined as powder, dispersed in chest, water essence distributes, nourishing Heart/Lung, overflowing to skin, unblocking water pathways, resolving via sweat. Treats post-sweat exterior-interior heat, thirst, irritability, insomnia, similar to Baibu. Difference: exterior heat unresolved, water reversal, excessive drinking. Not merely for diuresis; not for generating fluids.]"
Zhu Ling (Polyporus), being black, enters the Kidney; Ze Xie (Alisma), being salty, enters the Kidney; together they embody the substance of water. Fu Ling (Poria), being sweet and entering the Spleen, and white in color entering the Lung, serves to clarify the source of water. Guizhi (Cinnamon Twig), being red and entering the Heart, unblocks the meridians and induces sweating, representing the functional aspect of water metabolism. Combined into a powder and dispersed in the chest, the water essence distributes throughout the body, nourishing the Heart and Lungs upwards, overflowing to the skin and hair externally, and unblocking the water pathways, leading to resolution through sweating. This formula treats post-sweat conditions involving both exterior and interior heat, dryness-thirst, irritability, and insomnia, which are identical to the indications for Baibu Tang (White Tiger Decoction). The difference lies in the unresolved exterior heat and the specific variations of water reversal and excessive fluid intake. To claim this formula is designed solely for diuresis demonstrates a misunderstanding of Zhang Zhongjing’s intent. To claim it generates fluids is incorrect, as osmotic-draining herbs are not suited for this purpose.
[Shanghan with cold extremities and palpitations below the heart: treat water first with Fuling Gancao Tang, then treat cold extremities. Otherwise, water invades Stomach, causing diarrhea.]
In Shanghan, if cold extremities (Jue) are accompanied by palpitations below the heart, water retention should be treated first using Fuling Gancao Tang (Poria and Licorice Decoction), followed by treatment of the cold extremities. If this order is not followed, water will infiltrate the Stomach, inevitably causing diarrhea.
[Palpitations indicate fluid. Treating before it invades Stomach prevents connected Jue and diarrhea. This shows sequential treatment.]
Palpitations below the heart indicate the presence of fluid retention. By treating this now, before the fluid infiltrates the Stomach, one prevents the progression of cold extremities and diarrhea. This illustrates the importance of sequential treatment protocols.
[Fuling Gancao Tang: Fu Ling, Guizhi (each 1 liang), Gancao (1 liang, roasted), Sheng Jiang (3 liang). Boil 4 sheng water to 2 sheng, strain, divide into 3 warm doses.]
**Fuling Gancao Tang (Poria and Licorice Decoction):**
* Fu Ling (Poria)
* Guizhi (Cinnamomi Ramulus, each 1 liang)
* Gancao (Glycyrrhizae Radix Et Rhizoma, 1 liang, roasted)
* Sheng Jiang (Zingiberis Rhizoma Recens, 3 liang)
Boil these four ingredients in 4 sheng of water until reduced to 2 sheng. Strain the dregs and divide into three warm doses.
[Modified from Guizhi Tang. Remove Dazao for fluid/stagnation; remove Shaoyao for no irritability/cold limbs; add Fu Ling for draining; keep Jiang/Gui for sweating. Avoid Zhu/Ze to prevent water invading Stomach. Different from Wuling for thirst/irritability.]
This formula is a modification of Guizhi Tang. Da Zao (Jujube) is removed because fluid stagnation causes palpitation; Shao Yao (Peony) is removed because there is no irritability, only cold extremities; Fu Ling (Poria) is added to promote osmotic drainage; since the aim is to treat water, Sheng Jiang (Fresh Ginger) and Guizhi (Cinnamon Twig) are retained to induce sweating. Zhu Ling (Polyporus) and Ze Xie (Alisma) are omitted to prevent water from infiltrating the Stomach. This approach differs from Wuling San, which is used for treating irritability and thirst.