寒者。知邪已不在太阳之表。且汗出而不恶热。知邪亦不在阳明之里。是邪独在肺中。肺气满而喘矣。故不可
更行桂枝汤。〔兼〕予观景仲常言发汗后。乃表邪悉解。止余一证而已。故言不可更行桂枝汤。今汗出而喘。
无大热。乃上焦余邪未解。当用麻黄杏仁甘草石膏汤。以散之。桂枝加浓朴杏仁汤。乃桂枝证悉具。而加喘者
用之。〔钱〕因邪热在肺。或时有微热。未可知也。然非若表里有邪之热。故曰无大热也。
案柯氏无大热。删无字。云。无字。旧本讹在大热上。前辈因循不改。随文衍义。为后学之迷途。此说不可从。
麻黄杏仁甘草石膏汤方。（○千金。名四物甘草汤。）
麻黄（四两去节） 杏仁（五十个去皮尖○玉函。作杏子五十枚。） 甘草（二两炙○玉函。作一两）
石膏（半斤碎绵裹）
上四味。以水七升。煮麻黄减二升。去上沫。纳诸药。煮取二升。去滓。温服一升。本云黄耳 。（成
本。玉函。千金翼。升煮间。有先字。玉函。无本云黄耳 五字。千金翼。 。作杯。汪云。黄耳 。想系置
水器也。）
〔钱〕李时珍云。麻黄乃肺经专药。虽为太阳发汗之重剂。实发散肺经火郁之药也。杏仁利气。而能泄
肺。石膏寒凉。能肃西方金气。乃泻肺肃肺之剂。非麻黄汤。及大青龙之汗剂也。世俗不晓。惑于活人书及陶
节庵之说。但见一味麻黄。即以为汗剂。畏而避之。不知麻黄汤之制。欲用麻黄以泄营分之汗。必先以桂枝。
开解卫分之邪。则汗出而邪去矣。所以麻黄不与桂枝同用。止能泄肺邪。而不至大汗泄也。观后贤之麻黄定喘
汤。皆因之以立法也。
千金方。贝母汤。治上气咽喉窒塞。短气不得卧。腰背痛胸满不得食。面色萎黄。
于本方。加贝母。桂心。半夏。生姜。
三因方。惺惺散。治伤寒发热。头疼脑痛。
于本方。去杏仁。加茶葱煎服。
仁斋直指附遗。五虎汤。治喘急痰气。
于本方。加细茶。万病回春。有桑白皮。生姜。葱白。
张氏医通。冬月咳嗽。寒痰结于咽喉。语声不出者。此寒气客于会厌。故卒然而喑也。麻杏甘石汤。
发汗过多。其人叉手自冒心。心下悸欲得按者。桂枝甘草汤主之。
〔成〕发汗过多。亡阳也。阳受气于胸中。胸中阳气不足。故病叉手自冒心。心下悸欲得按者。与桂枝甘草汤。以
调不
足之气。〔钱〕阳本受气于胸中。故膻中为气之海。上通于肺而为呼吸。位处心胸之间。发汗过多。则阳气散
亡。气海空虚。所以叉手自冒覆其心胸。而心下觉惕惕然悸动也。凡病之实者皆不可按。按之则或满或痛。而
不欲也。此以误汗亡阳。心胸真气空虚而悸动。故欲得按也。〔柯〕叉手冒心。则外有所卫。得按则内有所根据。
如是不堪之状。望之而知其虚矣。〔汪〕冒字。作覆字解。
案悸。说文云。心动也。今云心下悸。脐下悸。活人书云。悸气者。动气也。乃知悸假为动气之总称。活
人指掌云。悸。即怔忪之别名。未允。
桂枝甘草汤方
桂枝（四两去皮） 甘草（二两炙○成本。并脱两数。）
上二味。以水三升。煮取一升。去滓顿服。
〔柯〕此用桂枝为君。独任甘草为佐。以补心之阳。则汗出多者。不至于亡阳矣。姜之辛散。枣之泥滞。
固非所宜。并不用芍药者。不欲其苦泄也。甘温相得。气和而悸自平。与心中悸而烦。心下有水气而悸者。迥别。
伤寒类方曰。此以一剂为一服者。二味扶阳补中。此乃阳虚之轻者。甚而振振欲擗地。则用真武汤矣。一
症而轻重不同。用方迥异。
案此方。与甘草干姜汤。芍药甘草汤。立方之妙。在于单捷。钱氏则云。如参芍之补敛。恐不可少。仲景
立方。谅不止此。或有脱落。未可知也。此乃后人之见耳。
证治大还。桂枝汤。治生产不快。或死腹中。桂枝一握。甘草三钱。水煎服。
发汗后。其人脐下悸者。欲作奔豚。茯苓桂枝甘草大枣汤主之。（奔。玉函。脉经。作贲。）
〔魏〕此条。乃申明发汗后阳虚之变证也。汗出过多。阳浮于上。阴阳二者。相维而不相离。阳既上浮。
阴即下动。其脐下悸者。阴气欲上乘而作奔豚。容不急温中固阳以御之乎。阳盛于中。阴自安于下。斯奔豚欲
作。而终不能作也乎。〔柯〕脐下悸时。水气尚在下焦。欲作奔豚之兆。而未发也。〔方〕欲作。待作未作之谓。
〔汪〕奔豚。难经云。肾之积名。此言奔豚。乃肾气发动。如欲作奔豚之状。非真脐下有积如豚也。
茯苓桂枝甘草大枣汤方
茯苓（半斤） 桂枝（四两去皮） 甘草（二两炙） 大枣（十五枚擘）
上四味。以甘烂水一斗。先煮茯苓。减二升。纳诸药煮取三升。去滓。温服一升。日三服。作甘烂水法。
取水二斗。置大盆内。以杓扬之。水上有珠子五六千颗相逐。取用之。（烂。玉函。作澜。方氏诸家同。千金
翼。作水一斗。不用甘烂水）
〔鉴〕此方。即苓桂术甘汤。去白术。加大枣。倍茯苓也。彼治心下逆满。气上冲胸。此治脐下悸欲作奔
豚。盖以水停中焦。故用白术。水停下焦。故倍茯苓。其病由汗后而起。自不外乎桂枝之法也。若已作奔豚。
又非此药所能治。则当从事乎桂枝加桂汤法矣。〔吴〕汗后余邪。挟下焦邪水为患。故取桂枝汤中之三以和表。
五苓散中之二以利水。
总病论曰。甘烂水。郎肝切。熟也。不击则生。击之则熟。水之味本咸。击熟之则归土性矣。然土之味本
甘故也。暴崖之水。击之而成沫。干而成土。水归土性。故谓之甘烂水。○案甘烂水。诸说不一。成氏云。扬
之有力。取不助肾邪也。徐氏云。甘而轻。取其不助肾邪。而益脾土也。柯氏云。甘烂水状似奔豚。而性则柔
弱。故又名劳水。钱氏云。动则其性属阳。扬则其势下走故也。张锡驹云。扬之无力。
以其不助水气也。徐大椿云。大约取其动极思静之意。数说未知孰是。姑举于斯。
伤寒类方曰。先煮茯苓者。凡方中专重之药。法必先煮。
发汗后。腹胀满者。浓朴生姜半夏甘草人参汤主之。
〔成〕吐后腹胀。与下后腹满。皆为实。言邪气乘虚。入里为实。发汗后。外已解也。腹胀满。知非里实。
由脾胃津液不足。气涩不通。壅而为满。与此汤。和脾胃而降气。〔程〕胃为津液之主。发汗亡阳。则胃气虚。
而不能敷布诸气。故壅滞而为胀满。是当实其所虚。自能虚其所实矣。虚气留滞之胀满。较实者。自不坚痛。
伤寒准绳。张兼善曰。凡言发汗后者。以外无表证。里无别术。止有腹胀一事而已。除此之外。即获全安。
浓朴生姜半夏甘草人参汤（○千金。名浓朴汤。分两稍异。）
浓朴（半斤炙去皮） 生姜（半斤切） 半夏（半升洗○玉函。作半斤） 人参（一两） 甘草（二两
○成本。千金翼。有炙字。）
上五味。以水一斗。煮取三升。去滓。温服一升。日三服。（玉函。五味下。有 咀二字。）
〔钱〕此虽阳气已伤。因未经误下。故虚中有实。以胃气未平。故以浓朴为君。生姜宣通阳气。半夏蠲饮
利膈。故以为臣。参甘补中和胃。所以益汗后之虚耳。〔喻〕移此治泄后腹胀果验。
证治大还曰。孙召治一女子。心腹胀满。色不变。经曰。三焦胀者。气满皮肤。 然石坚。遂以仲景
浓朴生姜半夏人参甘草汤。下保和丸。渐愈。
张氏医通曰。石顽治总戎陈孟庸。泻利腹胀作痛。服黄芩白芍之类。胀急愈甚。其脉洪盛而数。按之则
濡。气口大三倍于人迎。此湿热伤脾胃之气也。与浓朴生姜甘草半夏人
参汤二剂。痛止胀减。而泻利未已。与干姜黄芩黄连人参汤二剂。泻利止。而饮食不思。与半夏泻心汤二剂而安。
伤寒若吐若下后。心下逆满。气上冲胸。起则头眩。脉沉紧。发汗则动经。身为振振摇者。茯苓桂枝白术
甘草汤主之。（玉函。若下下。有若发汗三字。脉上。有其字。脉经。千金翼。作伤寒吐下发汗后。少一振字。
脉经。无白字。）
〔成〕吐下后里虚。气上逆者。心下逆满。气上冲胸。表虚阳不足。起则头眩。脉浮紧。为邪在表。当
发汗。脉沉紧为邪在里。则不可发汗。发汗则外动经络。损伤阳气。阳气外虚。则不能主持诸脉。身为振振摇
也。与此汤以和经益阳。〔钱〕伤寒本当以麻黄汤汗解。若吐下之。则治之为逆。心下者。胃脘之间也。逆满。
气逆中满也。〔汪〕里虚气逆。心下作满。且上冲于胸膈之间。更上逆于头。起则作眩。〔鉴〕脉沉紧。是其
人必素有寒饮。相挟而成。若不头眩。以瓜蒂散吐之。亦自可除。今乃起则头眩。是又为胸中阳气已虚。不惟
不可吐。亦不可汗也。〔张〕至若吐下后。重发汗太过。亡阳。厥逆烦躁。或仍发热心悸。头眩身 动。振振
欲擗地者。又属真武汤证。非此汤可能治也。
伤寒准绳曰。凡伤寒头眩者。莫不因汗吐下虚其上焦元气之所致也。眩者。目无常主。头眩者。俗谓头
旋眼花。是也。针经曰。上虚则眩。下虚则厥。
案逆满者。上虚而气逆不降。以为中满。气上冲胸者。时时气撞抢于胸胁间也。二证递别。
茯苓桂枝白术甘草汤方（○千金。名茯苓汤。）
茯苓（四两） 桂枝（三两去皮） 白术（○金匮。及玉函。作三两。） 甘草（各二两炙）
上四味。以水六升。煮取三升。去滓。分温三服。（玉函。
三服下。有小便即利四字。）
〔鉴〕身为振振摇者。即战振身摇也。身振振欲擗地者。即战振欲堕于地也。二者皆为阳虚失其所恃。一
用此汤。一用真武者。盖真武救青龙之误汗。其邪已入少阴。故主以附子。佐以生姜苓术。是壮里阳。以制水
也。此汤。救麻黄之误汗。其邪尚在太阳。故主以桂枝。佐以甘草苓术。是扶表阳。以涤饮也。至真武汤。用
芍药者。里寒阴盛。阳衰无根据。于大温大散之中。若不佐以酸敛之品。恐阴极格阳。必速其飞越也。此汤不用
芍药者。里寒饮盛。若佐以酸敛之品。恐饮得酸。反凝滞不散也。
案金匮要略痰饮篇曰。心下有痰饮。胸胁支满。目眩。苓桂术甘汤主之。乃知此条。心下逆满。气上冲
胸。起则头眩者。阳虚淡饮所致也。
伤寒类方曰。此亦阳虚。而动肾水之症。即真武症之轻者。故其法亦仿真武之意。
发汗病不解。反恶寒者。虚故也。芍药甘草附子汤主之。（玉函。脉经。千金翼。发汗病不解。作发其
汗不解而。）
〔成〕发汗病解。则不恶寒。发汗病不解。表实者。亦不恶寒。今发汗病且不解。又反恶寒者。营卫俱
虚也。汗出则营虚。恶寒则卫虚。与芍药甘草附子汤。以补营卫。〔徐〕汗后而表不解。是证仍如故。而恶寒
独曰反。比前有加也。〔钱〕或曰。既云发汗病不解。安知非表邪未尽乎。曰。若伤寒汗出不解。则当仍有头痛
发热。脉浮紧之辨矣。而仲景非唯不言发热且毫不更用解表。而毅然断之。曰虚故也。则知所谓虚者阳气也。
其脉必微弱。或虚大虚数。而见汗出但恶寒之证如附子泻心证。及用桂枝加附子汤。桂枝去芍药加附子汤之类。
故曰虚故也。
芍药甘草附子汤方
芍药 甘草（各三两炙○玉函。作各一两。） 附子（一枚。炮。去皮破八片）
上三味。以水五升。煮取一升五合。去滓。分温三服。疑非仲景方。（玉函。千金翼。五升。作三升。
无疑非仲景方五字。五合。玉函。作三合。千金翼。作二合。成本。无三服之三字。方作意。）
〔周〕汗多为阳虚。而阴则素弱。补阴当用芍药。回阳当用附子。势不得不芍附兼资。然又惧一阴一阳两不
相和也。于是以甘草和之。庶几阴阳谐。而能事毕矣。〔柯〕脚挛急。与芍药甘草汤。本治阴虚。此阴阳俱虚。
故加附子。皆仲景治里不治表之义。〔汪〕叔和认为伤寒病发汗不解而恶寒。乃表邪未尽。仍宜发汗。因疑此方。
为非仲景意。似不可用。故内台方议亦云。若非大汗出。又反恶寒。其脉沉微。及无热证者。不可服也。明乎
此。而此方之用。可无疑矣。
柯氏曰案少阴亡阳之证。未曾立方。本方恰与此症相合。芍药止汗。收肌表之余津。甘草和中。除咽痛
而止吐利。附子固少阴。而招失散之阳。温经络而缓脉中之紧。此又仲景隐而未发之旨欤。
案此方。于芍药甘草汤中。加附子。于四逆汤中。去干姜。代芍药。阴阳双救之意。可自知也。
发汗若下之。病仍不解烦躁者。茯苓四逆汤主之。（脉经。千金翼。作发汗吐下以后不解烦躁。）
〔成〕发汗若下。病宜解也。若病仍不解。则发汗外虚阳气。下之内虚阴气。阴阳俱虚。邪独不解。故
生烦躁。与茯苓四逆汤。以复阴阳之气。〔程〕发汗下后。病仍不解。而烦躁者。此时既有未解之外寒。复有
内热之烦躁。大青龙之证备具矣。不为所误者。几何。不知得之汗下后。则阳虚为阴所凌。故外亡而作烦躁。
必须温补兼施。〔徐〕此证惑人。在
病仍不解四字。〔汪〕此虚烦虚躁。乃假热之象也。〔鉴〕大青龙证。不汗出之烦躁。乃未经汗下之须躁属实。
寒邪。说明病邪已经不在太阳经的表证阶段。并且患者出汗却不恶热，说明病邪也不在阳明经的里证阶段。因此，病邪独自在肺中，肺气壅满而引发喘息。所以不能再使用桂枝汤。〔兼〕观察柯氏常引用仲景的话说：“发汗后，表邪完全解除，仅剩下一个症状而已。”所以说“不可更行桂枝汤”。现在患者出汗且喘息，没有大热，这是上焦残余的病邪未解，应当使用麻黄杏仁甘草石膏汤来发散它。桂枝加浓朴杏仁汤，是用于桂枝汤证全部具备，但增加了喘息症状时使用的。〔钱〕因为邪热在肺，或许偶尔有轻微发热，这还不确定。然而这并不是像表里都有邪气那样的热，所以说“无大热”。
案：柯氏认为“无大热”中的“无”字被删除了，他说：“‘无’字，旧本错误地放在‘大热’之上。前辈沿袭不改，顺文生义，成为后学者的迷途。这种说法不可采纳。”
麻黄杏仁甘草石膏汤方。（○《千金方》名为四物甘草汤。）
麻黄（四两，去节） 杏仁（五十个，去皮尖○《玉函经》作杏子五十枚。） 甘草（二两，炙○《玉函经》作一两）
石膏（半斤，碎，用绵布包裹）
以上四味药，用水七升，先煮麻黄，减少二升水，去掉上面的浮沫，加入其他药物，煮取二升药液，去掉药渣，温服一升。原本说是黄耳杯。（成无己注：《成本》、《玉函经》、《千金翼方》在“升”和“煮”之间有个“先”字。《玉函经》没有“本云黄耳”这五个字。《千金翼方》把“杯”写作“ ”。汪昂说：“黄耳 ”大概是放置水的器具。）
〔钱〕李时珍说：麻黄是肺经的专药，虽然它是太阳经发汗的重剂，但实际上是发散肺经火郁的药。杏仁利气，能泄肺；石膏寒凉，能肃清西方金气（肺），这是泻肺肃肺的方剂，不是麻黄汤及大青龙汤那样的发汗剂。世俗之人不懂，受《活人书》及陶节庵观点的影响，只要见到一味麻黄，就认为是发汗剂，畏惧而避开它。他们不知道麻黄汤的制法，是想用麻黄来泄营分之汗，必须先以桂枝开解卫分之邪，这样汗出而邪气就去除了。所以麻黄不与桂枝同用时，只能泄肺邪，而不至于大汗淋漓。看后世医家的麻黄定喘汤，都是依据这个原理立法的。
《千金方》贝母汤，治疗上气咽喉窒塞，短气不能卧，腰背痛胸满不能食，面色萎黄。
在本方基础上，加贝母、桂心、半夏、生姜。
《三因方》惺惺散，治疗伤寒发热，头疼脑痛。
在本方基础上，去杏仁，加茶、葱煎服。
《仁斋直指附遗》五虎汤，治疗喘急痰气。
在本方基础上，加细茶。《万病回春》中有桑白皮、生姜、葱白。
《张氏医通》冬季咳嗽，寒痰结于咽喉，说话声音出不来的，这是寒气客居在会厌，所以突然失音。用麻杏甘石汤。
发汗过多，其人双手交叉按在心口，心下悸动，喜欢按压的，用桂枝甘草汤主治。
〔成〕发汗过多，导致亡阳。阳气受气于胸中，胸中阳气不足，所以出现双手交叉按在心口，心下悸动喜欢按压的症状。给予桂枝甘草汤，以调补不足之气。〔钱〕阳气本来受气于胸中，所以膻中为气之海，上通于肺而为呼吸，位置处于心胸之间。发汗过多，则阳气散失，气海空虚，所以双手交叉覆盖其心胸，而心下觉得惕惕然悸动。凡是实证都不可按压，按压则会感到胀或痛，而不想让人按。这里是因为误汗亡阳，心胸真气空虚而悸动，所以喜欢按压。〔柯〕双手交叉冒心，则是外在有所护卫，得到按压则内在有所依托。像这样不堪忍受的状态，望诊即可知其虚。〔汪〕“冒”字，解释为“覆”字。
案：悸，《说文解字》说：心动也。现在说心下悸，脐下悸。《活人书》说：悸气者，动气也。由此可知，“悸”假借为动气的总称。《活人指掌》说：悸，即怔忪的别名。这种说法不恰当。
桂枝甘草汤方
桂枝（四两，去皮） 甘草（二两，炙○《成本》脱漏了两数。）
以上两味药，用水三升，煮取一升，去掉药渣，一次性服用。
〔柯〕这里用桂枝为君药，独任甘草为佐药，以补心之阳，那么出汗多的人，就不会导致亡阳了。姜的辛散，枣的泥滞，固然是不适宜的。不用芍药的原因，是不希望它苦泄。甘温相得，气和而悸自然平息。这与心中悸而烦，心下有水气而悸的情况，截然不同。
《伤寒类方》说：此方是一剂作为一次服用的。这两味药扶阳补中，这是阳虚较轻的情况。严重到振振欲擗地（身体颤抖想要倒地）时，就用真武汤了。同一个症状轻重不同，用药迥异。
案：此方与甘草干姜汤、芍药甘草汤，立方之妙在于单捷。钱氏则说：如参、芍的补敛作用，恐怕不可少。仲景立法，谅必不止于此。或许有脱落之处，也未可知。这是后人的见解罢了。
《证治大还》：桂枝汤，治疗生产不顺，或胎儿死在腹中。桂枝一握，甘草三钱，水煎服。
发汗后，其人脐下悸动的，想要发作奔豚证，用茯苓桂枝甘草大枣汤主治。（奔，《玉函经》、《脉经》作贲。）
〔魏〕这一条，是申明发汗后阳虚的变证。汗出过多，阳浮于上，阴阳二者，相互维系而不分离。阳既上浮，阴即下动。其脐下悸动，是阴气想要上乘而发作奔豚。难道不急温中固阳以抵御它吗？阳盛于中，阴自安于下。这样奔豚欲作，而终究不能发作。〔柯〕脐下悸动时，水气尚在下焦，是欲作奔豚的征兆，而未发作。〔方〕“欲作”，指等待发作尚未发作的时候。〔汪〕奔豚，《难经》说：肾之积名。这里说的奔豚，乃是肾气发动，像是要发作奔豚的样子，并非真的脐下有积聚像小猪一样。
茯苓桂枝甘草大枣汤方
茯苓（半斤） 桂枝（四两，去皮） 甘草（二两，炙） 大枣（十五枚，掰开）
以上四味药，用甘烂水一斗，先煮茯苓，减少二升水，加入其他药物，煮取三升，去掉药渣，温服一升，每日三次。制作甘烂水的方法：取水二斗，放入大盆内，用勺子扬水，水上有珠子五六千颗互相追逐，取用这些水。（烂，《玉函经》作澜，方氏诸家相同。《千金翼方》作水一斗，不用甘烂水）
〔鉴〕此方，就是苓桂术甘汤，去掉白术，加大枣，加倍茯苓。彼方治疗心下逆满，气上冲胸，此方治疗脐下悸欲作奔豚。大概是因为水停在中焦，所以用白术；水停下焦，所以倍用茯苓。其病由发汗后引起，自然离不开桂枝汤的法度。如果已经发作奔豚，又不是此药所能治疗的，那就应当从事于桂枝加桂汤的方法了。〔吴〕发汗后的余邪，挟带下焦邪水为患，所以取桂枝汤中的三味药以和解表邪，五苓散中的两味药以利水。
《总病论》说：甘烂水，郎肝切，熟也。不击则生，击之则熟。水的味道本是咸的，击打煮熟之后则归土性了。然而土的味道本是甘的。暴崖之水，击打而成沫，晒干而成土，水归土性，所以称为甘烂水。○案：甘烂水，各种说法不一。成无己说：扬之有力，取之不助肾邪。徐氏说：甘而轻，取其不助肾邪，而益脾土。柯氏说：甘烂水状似奔豚，而性则柔弱，故又名劳水。钱氏说：动则其性属阳，扬则其势下走。张锡驹说：扬之无力，以其不助水气。徐大椿说：大约取其动极思静之意。几种说法不知哪个正确，姑且列举于此。
《伤寒类方》说：先煮茯苓，凡是方中专重之药，法度上必须先煮。
发汗后，腹胀满的，用浓朴生姜半夏甘草人参汤主治。
〔成〕吐后腹胀，与下后腹满，皆为实证，是说邪气乘虚入里为实。发汗后，外证已解。腹胀满，知道不是里实。是由于脾胃津液不足，气涩不通，壅滞而为满。给予此汤，调和脾胃而降气。〔程〕胃为津液之主，发汗亡阳，则胃气虚，而不能敷布诸气，故壅滞而为胀满。这是应当实其所虚，自然能虚其所实。虚气留滞之胀满，较之实证，自然不坚硬疼痛。
《伤寒准绳》张兼善说：凡言发汗后的，以外无表证，里无别症，只有腹胀一事而已。除此之外，即获全安。
浓朴生姜半夏甘草人参汤（○《千金方》名为浓朴汤，分两稍异。）
浓朴（半斤，炙，去皮） 生姜（半斤，切） 半夏（半升，洗○《玉函经》作半斤） 人参（一两） 甘草（二两○《成本》、《千金翼方》有炙字。）
以上五味药，用水一斗，煮取三升，去掉药渣，温服一升，每日三次。（《玉函经》在五味之下，有“咀”二字。）
〔钱〕这里虽然阳气已伤，但因为未经误下，所以虚中有实。因为胃气未平，所以以浓朴为君药。生姜宣通阳气，半夏蠲饮利膈，所以作为臣药。参、甘补中和胃，以此来补益发汗后的虚弱。〔喻〕将此方用于治疗泄后腹胀果然有效。
《证治大还》说：孙召治疗一女子，心腹胀满，颜色不变。《内经》说：三焦胀者，气满皮肤， 然石坚。于是用仲景的浓朴生姜半夏人参甘草汤，配合保和丸，逐渐痊愈。
《张氏医通》说：石顽治疗总戎陈孟庸，泻利腹胀作痛，服用黄芩、白芍之类，胀急更加严重。其脉洪盛而数，按之则濡，气口大三倍于人迎。这是湿热损伤脾胃之气。给予浓朴生姜甘草半夏人参汤两剂，痛止胀减，而泻利未止。给予干姜黄芩黄连人参汤两剂，泻利止，而饮食不思。给予半夏泻心汤两剂而安。
伤寒若吐若下后，心下逆满，气上冲胸，起则头眩，脉沉紧，发汗则动经，身为振振摇者，用茯苓桂枝白术甘草汤主治。（《玉函经》在“若下”下有“若发汗”三字。“脉”上，有“其”字。《脉经》、《千金翼方》作“伤寒吐下发汗后”，少一个“振”字。《脉经》无“白”字。）
〔成〕吐下后里虚，气上逆者，心下逆满，气上冲胸。表虚阳不足，起则头眩。脉浮紧，为邪在表，当发汗。脉沉紧为邪在里，则不可发汗。发汗则外动经络，损伤阳气。阳气外虚，则不能主持诸脉，身为振振摇。与此汤以和经益阳。〔钱〕伤寒本当以麻黄汤汗解，若吐下之，则治之为逆。心下者，胃脘之间也。逆满，气逆中满也。〔汪〕里虚气逆，心下作满，且上冲于胸膈之间，更上逆于头，起则作眩。〔鉴〕脉沉紧，是其人必素有寒饮，相挟而成。若不头眩，以瓜蒂散吐之，亦自可除。今乃起则头眩，是又为胸中阳气已虚，不惟不可吐，亦不可汗也。〔张〕至若吐下后，重发汗太过，亡阳，厥逆烦躁，或仍发热心悸，头眩身动，振振欲擗地者，又属真武汤证，非此汤可能治也。
《伤寒准绳》说：凡伤寒头眩者，莫不因汗吐下虚其上焦元气之所致也。眩者，目无常主。头眩者，俗谓头旋眼花，是也。《针经》说：上虚则眩，下虚则厥。
案：逆满者，上虚而气逆不降，以为中满。气上冲胸者，时时气撞抢于胸胁间也。二证递别。
茯苓桂枝白术甘草汤方（○《千金方》名为茯苓汤。）
茯苓（四两） 桂枝（三两，去皮） 白术（○《金匮要略》及《玉函经》作三两。） 甘草（各二两，炙）
以上四味药，用水六升，煮取三升，去掉药渣，分三次温服。（《玉函经》在“三服”下，有“小便即利”四字。）
〔鉴〕身为振振摇者，即战振身摇也。身振振欲擗地者，即战振欲堕于地也。二者皆为阳虚失其所恃。一用此汤，一用真武者，盖真武救青龙之误汗，其邪已入少阴，故主以附子，佐以生姜苓术，是壮里阳，以制水也。此汤救麻黄之误汗，其邪尚在太阳，故主以桂枝，佐以甘草苓术，是扶表阳，以涤饮也。至于真武汤，用芍药者，里寒阴盛，阳衰无根据，于大温大散之中，若不佐以酸敛之品，恐阴极格阳，必速其飞越也。此汤不用芍药者，里寒饮盛，若佐以酸敛之品，恐饮得酸，反凝滞不散也。
案：《金匮要略·痰饮篇》说：心下有痰饮，胸胁支满，目眩，苓桂术甘汤主之。由此可知此条，心下逆满，气上冲胸，起则头眩者，是阳虚淡饮所致。
《伤寒类方》说：这也是阳虚，而动肾水之症，即真武症的轻者，故其法亦仿真武之意。
发汗病不解，反恶寒者，虚故也。用芍药甘草附子汤主治。（《玉函经》、《脉经》、《千金翼方》，“发汗病不解”作“发其汗不解而”。）
〔成〕发汗病解，则不恶寒。发汗病不解，表实者，亦不恶寒。今发汗病且不解，又反恶寒者，营卫俱虚也。汗出则营虚，恶寒则卫虚。与芍药甘草附子汤，以补营卫。〔徐〕汗后而表不解，是证仍如故，而恶寒独曰反，比前有加也。〔钱〕或曰：既云发汗病不解，安知非表邪未尽乎？曰：若伤寒汗出不解，则当仍有头痛发热，脉浮紧之辨矣。而仲景非唯不言发热，且毫不更用解表，而毅然断之，曰虚故也。则知所谓虚者阳气也。其脉必微弱，或虚大虚数，而见汗出但恶寒之证如附子泻心证，及用桂枝加附子汤、桂枝去芍药加附子汤之类。故曰虚故也。
芍药甘草附子汤方
芍药 甘草（各三两，炙○《玉函经》作各一两。） 附子（一枚，炮，去皮破八片）
以上三味药，用水五升，煮取一升五合，去掉药渣，分三次温服。疑非仲景方。（《玉函经》、《千金翼方》，“五升”作“三升”。“疑非仲景方”五字。《玉函经》，“五合”作“三合”。《千金翼方》作“二合”。《成本》无“三服”之“三”字。方作意。）
〔周〕汗多为阳虚，而阴则素弱。补阴当用芍药，回阳当用附子，势不得不芍附兼资。然又惧一阴一阳两不相和也。于是以甘草和之，庶几阴阳谐，而能事毕矣。〔柯〕脚挛急，与芍药甘草汤，本治阴虚。此阴阳俱虚，故加附子。皆仲景治里不治表之义。〔汪〕叔和认为伤寒病发汗不解而恶寒，乃表邪未尽，仍宜发汗，因疑此方为非仲景意，似不可用。故《内台方议》亦云：若非大汗出，又反恶寒，其脉沉微，及无热证者，不可服也。明乎此，而此方之用，可无疑矣。
柯氏说：案少阴亡阳之证，未曾立方。本方恰与此症相合。芍药止汗，收肌表之余津。甘草和中，除咽痛而止吐利。附子固少阴，而招失散之阳，温经络而缓脉中之紧。这又是仲景隐而未发之旨欤？
案：此方，于芍药甘草汤中加附子，于四逆汤中去干姜，代芍药，阴阳双救之意，可自知也。
发汗若下之，病仍不解烦躁者，用茯苓四逆汤主治。（《脉经》、《千金翼方》作“发汗吐下以后不解烦躁”。）
〔成〕发汗若下，病宜解也。若病仍不解，则发汗外虚阳气，下之内虚阴气。阴阳俱虚，邪独不解，故生烦躁。与茯苓四逆汤，以复阴阳之气。〔程〕发汗下后，病仍不解，而烦躁者，此时既有未解之外寒，复有内热之烦躁，大青龙之证备具矣。不为所误者，几何。不知得之汗下后，则阳虚为阴所凌，故外亡而作烦躁。必须温补兼施。〔徐〕此证惑人，在“病仍不解”四字。〔汪〕此虚烦虚躁，乃假热之象也。〔鉴〕大青龙证，不汗出之烦躁，乃未经汗下之须躁属实。
Cold pathogen. This indicates that the pathogenic factor is no longer in the exterior stage of the Taiyang (Greater Yang) channel. Furthermore, the patient sweats but does not dislike heat, indicating that the pathogenic factor is also not in the interior stage of the Yangming (Yang Brightness) organ. Therefore, the pathogenic factor resides solely in the Lung. The Lung Qi is full and causes wheezing. Thus, it is contraindicated to use Guizhi Tang (Cinnamon Twig Decoction) again. [Jian] Observing Ke's commentary, Zhongjing often stated: "After inducing sweating, the exterior pathogenic factors are completely resolved, leaving only one symptom." Hence, it says "do not use Guizhi Tang again." Now, the patient sweats and wheezes without significant fever; this is due to residual pathogenic factors in the Upper Jiao (Upper Burner) not yet resolved. One should use Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) to disperse them. Guizhi Jia Houpo Xingren Tang (Guizhi Decoction with Magnolia Bark and Apricot Kernel) is used when all symptoms of the Guizhi Tang syndrome are present, accompanied by wheezing. [Qian] Because the pathogenic heat is in the Lung, there might occasionally be slight fever, which is uncertain. However, this is not the heat associated with pathogenic factors in both the exterior and interior, hence it is described as "no significant fever."
Note: Ke deleted the character "Wu" (No/Without) from "Wu Da Re" (No Significant Fever). He stated: "The character 'Wu' was erroneously placed before 'Da Re' in old editions. Predecessors followed suit without correction, deriving meaning from the text contextually, leading later students astray. This interpretation should not be followed."
Mahuang Xingren Gancao Shigao Tang Formula. (○ *Qianjin Fang* names it Siwu Gancao Tang.)
Mahuang (Ephedrae Herba, four liang, remove joints) Xingren (Armeniacae Semen Amarum, fifty kernels, remove skin and tips ○ *Yuhan Jing* makes it fifty apricot seeds.) Gancao (Glycyrrhizae Radix et Rhizoma, two liang, honey-fried ○ *Yuhan Jing* makes it one liang)
Shigao (Gypsi Fibrosus, half jin, crushed, wrapped in silk gauze)
Take the above four ingredients. Boil in seven sheng of water. First boil Mahuang until reduced by two sheng, skim off the foam on top. Add the remaining herbs. Boil until two sheng remain. Strain. Take one sheng warm. Originally said to be measured in a yellow ear cup. (Cheng Wuji notes: *Cheng Ben*, *Yuhan Jing*, and *Qianjin Yi Fang* have the character "Xian" (First) between "sheng" and "zhu". *Yuhan Jing* lacks the five characters "Ben Yun Huang Er Bei". *Qianjin Yi Fang* writes the cup character as " ". Wang Ang says: "Huang Er Bei" likely refers to a vessel for holding water.)
[Qian] Li Shizhen said: Mahuang is a specific herb for the Lung channel. Although it is a heavy agent for inducing sweating in the Taiyang channel, it is actually an herb that disperses fire stagnation in the Lung channel. Xingren promotes Qi movement and can drain the Lung. Shigao is cold and cool, capable of肃清 (clearing/purifying) the Metal Qi of the West (Lung). This is a formula that drains and purifies the Lung, not a sweating agent like Mahuang Tang or Da Qing Long Tang. Laypeople do not understand this; influenced by *Huoren Shu* and Tao Jian'an's theories, they see just one ingredient of Mahuang and assume it is a sweating agent, fearing and avoiding it. They do not know the formulation principle of Mahuang Tang: to use Mahuang to sweat out Ying-level pathogens, one must first use Guizhi to resolve Wei-level pathogens, so that sweating occurs and the pathogen leaves. Therefore, when Mahuang is not used with Guizhi, it can only drain Lung pathogens without causing profuse sweating. Later physicians' Mahuang Dingchuan Tang (Ephedra Asthma-Calming Decoction) all established their formulas based on this principle.
*Qianjin Fang* Beimu Tang treats upper Qi obstruction in the throat and windpipe, shortness of breath preventing lying down, lower back pain, chest fullness preventing eating, and sallow complexion.
Add Beimu (Fritillariae Bulbus), Guixin (Cinnamomi Ramulus), Banxia (Pinelliae Rhizoma), and Shengjiang (Zingiberis Rhizoma Recens) to this base formula.
*Sanyin Fang* Xingxing San treats typhoid fever with headache and brain pain.
Remove Xingren from this base formula, add tea and scallion white, decoct and take.
*Renzhi Zhizhi Fuyi* Wuhu Tang treats urgent wheezing and phlegm-Qi.
Add fine tea to this base formula. *Wanbing Huichun* includes Sangbaipi (Morus Cortex), Shengjiang, and Congbai.
*Zhangshi Yitong*: Winter cough, cold-phlegm knotting in the throat, inability to speak. This is cold pathogen lodging in the Huiyan (epiglottis), causing sudden aphonia. Use Mahuang Xingren Gancao Shigao Tang.
After excessive sweating, if the person crosses their hands over the heart region, feels palpitations in the epigastrium, and desires pressure, treat with Guizhi Gancao Tang.
[Cheng] Excessive sweating leads to Yang collapse. Yang receives Qi in the Chest Middle (Zhongjiao/Chest area). Insufficiency of Yang Qi in the chest causes the symptom of crossing hands over the heart and desiring pressure for palpitations. Administer Guizhi Gancao Tang to regulate the insufficient Qi. [Qian] Yang originally receives Qi in the chest; thus, Danzhong (Conception Vessel CV17) is the Sea of Qi, connecting upward to the Lung for respiration, located between the heart and chest. Excessive sweating causes Yang Qi to dissipate, emptying the Sea of Qi. Hence, hands cross to cover the chest, and palpitations are felt in the epigastrium. In general, excess conditions cannot be pressed; pressing causes distension or pain, and the patient dislikes it. Here, because erroneous sweating caused Yang collapse, the true Qi of the heart and chest is empty, causing palpitations, hence the desire for pressure. [Ke] Crossing hands over the heart provides external protection; receiving pressure provides internal support. Such unbearable states indicate deficiency upon observation alone. [Wang] The character "Mao" means "cover".
Note: Ji (*Palpitation*), according to *Shuowen Jiezi*, means heart movement. Now we say epigastric ji or umbilical ji. *Huoren Shu* states: Ji Qi refers to moving Qi. Thus, "Ji" is used as a general term for moving Qi. *Huoren Zhizhang* states: Ji is another name for Zhengzhong (palpitation). This is not appropriate.
Guizhi Gancao Tang Formula
Guizhi (Cinnamon Twig, four liang, remove bark) Gancao (Licorice Root, two liang, honey-fried ○ *Cheng Ben* omits the weight.)
Take the above two ingredients. Boil in three sheng of water until one sheng remains. Strain. Take in one dose.
[Ke] Here, Guizhi is the Sovereign herb, and Gancao alone serves as the Assistant to tonify Heart Yang. Thus, those who sweat excessively will not suffer Yang collapse. The pungent dispersion of Ginger and the cloying nature of Jujube are indeed unsuitable. The reason Shaoyao is not used is to avoid its bitter-draining action. Sweet and warm harmonize, Qi becomes balanced, and palpitations subside naturally. This is distinctly different from palpitations with irritability in the heart, or palpitations due to Water-Qi in the epigastrium.
*Shanghan Leifang* states: This formula is taken as one dose per administration. These two herbs support Yang and tonify the Middle. This represents mild Yang deficiency. If severe, shaking and wanting to fall to the ground, then Zhenwu Tang is used. The same symptom varies in severity, requiring vastly different formulas.
Note: The ingenuity of this formula, along with Gancao Ganjiang Tang and Shaoyao Gancao Tang, lies in their simplicity and efficacy. Qian stated: Tonifying and astringent herbs like Renshen and Shaoyao are probably indispensable. Zhongjing's formulations were surely not limited to this. There may be omissions. This is merely the view of later generations.
*Zhengzhi Dahuan*: Guizhi Tang treats difficult labor or fetal death in the womb. One handful of Guizhi, three qian of Gancao, decoct in water and take.
After sweating, if the person experiences palpitations below the navel, indicating impending Ben Tun (Running Piglet) syndrome, treat with Fuling Guizhi Gancao Dazao Tang. (Ben, in *Yuhan Jing* and *Mai Jing*, is written as Ben.)
[Wei] This clause clarifies the post-sweating complication of Yang deficiency. Excessive sweating causes Yang to float upward. Yin and Yang are interconnected and inseparable. If Yang floats up, Yin moves downward. Palpitations below the navel indicate Yin Qi attempting to ascend, precipitating Ben Tun. Is it not urgent to warm the Middle and secure Yang to resist this? If Yang is abundant in the Middle, Yin remains stable below. Thus, Ben Tun may arise but ultimately fail to manifest. [Ke] When palpitations occur below the navel, Water-Qi is still in the Lower Jiao. This is a sign of impending Ben Tun, not yet manifested. [Fang] "Yu Zuo" means waiting to manifest but not yet manifested. [Wang] Ben Tun, according to *Nan Jing*, is named the accumulation of the Kidney. Here, Ben Tun refers to Kidney Qi activating, resembling the state of impending Ben Tun, not literally an accumulation under the navel shaped like a pig.
Fuling Guizhi Gancao Dazao Tang Formula
Fuling (Poria, half jin) Guizhi (Cinnamon Twig, four liang, remove bark) Gancao (Licorice Root, two liang, honey-fried) Dazao (Jujube, fifteen fruits, split open)
Take the above four ingredients. Use one dou of Ganlan Shui (Sweet Rotated Water). First boil Fuling until reduced by two sheng. Add other herbs. Boil until three sheng remain. Strain. Take one sheng warm, three times daily. Method for preparing Ganlan Shui: Take two dou of water, place in a large basin. Scoop and throw the water repeatedly until 5,000-6,000 pearl-like bubbles chase each other on the surface. Use this water. (Lan, in *Yuhan Jing*, is written as Lan. Fang Shi and others agree. *Qianjin Yi Fang* uses one dou of water, omitting Ganlan Shui.)
[Jian] This formula is Ling Gui Zhu Gan Tang, removing Baizhu, adding Dazao, and doubling Fuling. That formula treats rebellious fullness below the heart and Qi rushing to the chest. This formula treats palpitations below the navel indicating impending Ben Tun. Generally, Water retention in the Middle Jiao requires Baizhu; Water retention in the Lower Jiao requires doubled Fuling. Since the disease arises after sweating, it naturally follows the principles of Guizhi Tang. If Ben Tun has already manifested, this medicine cannot treat it; one should employ the method of Guizhi Jia Gui Tang. [Wu] Residual pathogens after sweating, combined with pathological Water in the Lower Jiao, cause harm. Thus, three herbs from Guizhi Tang are used to harmonize the exterior, and two from Wuling San are used to promote urination.
*Zong Bing Lun* states: Ganlan Shui (Sweet Rotated Water). Lang gan cut, cooked. Not beaten, it is raw; beaten, it is cooked. Water tastes salty originally; beating it cooks it, returning it to Earth nature. Earth tastes sweet originally. Water from violent cliffs, when beaten into foam and dried into earth, returns to Earth nature, hence called Ganlan Shui. ○ Note: Various explanations exist for Ganlan Shui. Cheng Wuji says: Vigorous scooping prevents aiding Kidney pathogens. Xu says: Sweet and light, preventing aid to Kidney pathogens while benefiting Spleen Earth. Ke says: Ganlan Shui resembles Ben Tun in shape but is soft and weak in nature, hence also called Lao Shui. Qian says: Movement implies Yang nature; scooping directs its force downward. Zhang Xiju says: Weak scooping avoids aiding Water Qi. Xu Dachun says: It roughly captures the meaning of extreme movement seeking stillness. It is unknown which is correct; listed here for reference.
*Shanghan Leifang* states: Boiling Fuling first applies to any herb given primary importance in a formula; such herbs must be boiled first according to method.
After sweating, if abdominal fullness occurs, treat with Houpo Shengjiang Banxia Gancao Renshen Tang.
[Cheng] Abdominal fullness after vomiting or purgation are both excess conditions, meaning pathogens enter the interior due to deficiency. After sweating, the exterior is resolved. Abdominal fullness indicates it is not interior excess. It results from insufficiency of Spleen and Stomach fluids, Qi stagnation and blockage, leading to fullness. Give this formula to harmonize Spleen and Stomach and descend Qi. [Cheng] The Stomach is the master of fluids. Sweating causes Yang loss, making Stomach Qi deficient and unable to distribute Qi, leading to stagnation and fullness. One must tonify the deficiency to resolve the excess. Fullness due to stagnant deficient Qi is not hard or painful like excess fullness.
*Shanghan Zhunshe* Zhang Jianshan states: Whenever "after sweating" is mentioned, there is no exterior syndrome, no other interior syndrome, only abdominal fullness. Aside from this, the patient recovers fully.
Houpo Shengjiang Banxia Gancao Renshen Tang (○ *Qianjin Fang* names it Houpo Tang, weights slightly differ.)
Houpo (Magnolia Bark, half jin, honey-fried, remove bark) Shengjiang (Fresh Ginger, half jin, sliced) Banxia (Pinellia Tuber, half sheng, washed ○ *Yuhan Jing* makes it half jin) Renshen (Ginseng Radix, one liang) Gancao (Licorice Root, two liang ○ *Cheng Ben*, *Qianjin Yi Fang* include "honey-fried".)
Take the above five ingredients. Boil in one dou of water until three sheng remain. Strain. Take one sheng warm, three times daily. (*Yuhan Jing* adds the character "Ju" (chew/crush) after the five ingredients.)
[Qian] Although Yang Qi is injured, because there was no erroneous purgation, there is deficiency within excess. Because Stomach Qi is not平和 (harmonious), Houpo is used as Sovereign. Shengjiang disseminates and unblocks Yang Qi; Banxia eliminates fluid retention and benefits the diaphragm, serving as Assistant. Renshen and Gancao tonify and harmonize the Middle, thereby benefiting the deficiency after sweating. [Yu] Using this for abdominal fullness after diarrhea is indeed effective.
*Zhengzhi Dahuan* states: Sun Zhao treated a woman with heart and abdominal fullness, color unchanged. *Neijing* states: San Jiao fullness means Qi fills the skin, firm like stone. Thus, he used Zhongjing's Houpo Shengjiang Banxia Renshen Gancao Tang combined with Baohe Wan, resulting in gradual recovery.
*Zhangshi Yitong* states: Shi Wen treated Commander Chen Mengyong, who had diarrhea, abdominal fullness, and pain. Taking Huangqin and Shaoyao worsened the urgency and fullness. Pulse was surging, full, and rapid, but soft upon pressure. Qi Kou pulse was three times larger than Ren Ying pulse. This is damp-heat injuring Spleen and Stomach Qi. Given Houpo Shengjiang Gancao Banxia Renshen Tang for two doses; pain stopped, fullness decreased, but diarrhea persisted. Given Ganjiang Huangqin Huanglian Renshen Tang for two doses; diarrhea stopped, but appetite remained poor. Given Banxia Xiexin Tang for two doses; condition stabilized.
If Typhoid is treated with emesis or purgation, and subsequently rebellious fullness below the heart, Qi rushing to the chest, dizziness upon rising, deep-tight pulse, and sweating induces meridian disturbance causing body tremors, treat with Fuling Guizhi Baizhu Gancao Tang. (*Yuhan Jing* adds "Ruo Fa Han" (if sweating) after "Ruo Xia". Adds "Qi" (its) before "Mai" (pulse). *Mai Jing*, *Qianjin Yi Fang* read "Typhoid after vomiting, purgation, and sweating", missing one "Zhen" character. *Mai Jing* omits "Bai".)
[Cheng] After vomiting and purgation, interior deficiency leads to rebellious Qi, causing rebellious fullness below the heart and Qi rushing to the chest. Exterior deficiency and Yang insufficiency cause dizziness upon rising. Floating-tight pulse indicates exterior pathogens, requiring sweating. Deep-tight pulse indicates interior pathogens, prohibiting sweating. Sweating disturbs the exterior meridians and injures Yang Qi. Exterior Yang deficiency fails to govern the pulses, causing body tremors. Give this formula to harmonize meridians and benefit Yang. [Qian] Typhoid should normally be resolved by sweating with Mahuang Tang. Vomiting and purgation are contrary treatments. Below the heart is the epigastrium. Rebellious fullness is Qi rebellion and middle fullness. [Wang] Interior deficiency and rebellious Qi cause fullness below the heart, rushing to the chest, and further rebelling to the head, causing dizziness upon rising. [Jian] Deep-tight pulse indicates chronic Cold-Phlegm. If there were no dizziness, Phlegm could be expelled via Cathartic powder (Gua Di San). Now, dizziness upon rising indicates deficiency of Upper Jiao Yang. Not only is emesis contraindicated, but sweating is also prohibited. [Zhang] If, after vomiting and purgation, excessive sweating causes Yang collapse, cold limbs, irritability, or lingering fever, palpitations, dizziness, body movement, and trembling wanting to fall to the ground, this belongs to Zhenwu Tang syndrome, not treatable by this formula.
*Shanghan Zhunshe* states: All cases of dizziness in Typhoid result from deficiency of Upper Jiao Yuan Qi due to sweating, emesis, or purgation. Xuan means eyes lack focus. Tou Xuan (head dizziness) is commonly known as spinning vision. *Needle Classic* states: Upper deficiency causes dizziness; Lower deficiency causes syncope/fainting.
Note: Rebellious fullness is Upper deficiency with rebellious Qi failing to descend, creating middle fullness. Qi rushing to the chest is Qi striking the chest and hypochondrium intermittently. These two syndromes are distinct.
Fuling Guizhi Baizhu Gancao Tang Formula (○ *Qianjin Fang* names it Fuling Tang.)
Fuling (Poria, four liang) Guizhi (Cinnamon Twig, three liang, remove bark) Baizhu (Atractylodis Macrocephalae Rhizoma ○ *Jinkui Yaolue* and *Yuhan Jing* make it three liang.) Gancao (Licorice Root, two liang each, honey-fried)
Take the above four ingredients. Boil in six sheng of water until three sheng remain. Strain. Divide into three warm doses. (*Yuhan Jing* adds "Xiao Bian Ji Li" (urine will flow freely) after "three doses".)
[Jian] Body trembling ("Zhen Zhen Yao") is shaking and swaying. Wanting to fall to the ground ("Yu Pi Di") is shaking and wanting to collapse. Both result from Yang deficiency losing support. One uses this formula; the other uses Zhenwu Tang. Zhenwu Tang rescues errors from Qing Long Tang sweating; the pathogen has entered Shaoyin, so Fuzi is Sovereign, assisted by Shengjiang, Fuling, Baizhu to strengthen Interior Yang and control Water. This formula rescues errors from Mahuang Tang sweating; the pathogen remains in Taiyang, so Guizhi is Sovereign, assisted by Gancao, Fuling, Baizhu to support Exterior Yang and wash away Phlegm-Fluid. Regarding Zhenwu Tang using Shaoyao: Interior Cold and Yin Excess with Yang deficiency lacking foundation. Within strong warming and dispersing, without sour-astringent herbs, Extreme Yin repelling Yang would accelerate Yang's flight. This formula does not use Shaoyao: Interior Cold and Fluid Excess. Adding sour-astringent herbs might cause Fluids to coagulate and not disperse due to the sour taste.
Note: *Jinkui Yaolue · Tan Yin Chapter* states: Phlegm-Fluid in the Heart, hypochondriac distension and fullness, dizziness of eyes. Ling Gui Zhu Gan Tang treats this. Thus, rebellious fullness below the heart, Qi rushing to the chest, and dizziness upon rising in this clause are caused by Yang deficiency and mild Fluid retention.
*Shanghan Leifang* states: This is also a symptom of Yang deficiency moving Kidney Water, i.e., a mild form of Zhenwu syndrome. Hence, its method imitates the intent of Zhenwu Tang.
After sweating, if the disease is unresolved and the patient instead dislikes cold, it is due to deficiency. Treat with Shaoyao Gancao Fuzi Tang. (*Yuhan Jing*, *Mai Jing*, *Qianjin Yi Fang*: "Fa Han Bing Bu Jie" reads "Fa Qi Han Bu Jie Er".)
[Cheng] If sweating resolves the disease, there is no aversion to cold. If sweating does not resolve the disease and it is Exterior Excess, there is also no aversion to cold. Now, sweating does not resolve the disease, and there is aversion to cold; this indicates both Ying and Wei are deficient. Sweating depletes Ying; aversion to cold depletes Wei. Give Shaoyao Gancao Fuzi Tang to tonify Ying and Wei. [Xu] After sweating, if the exterior is unresolved, the syndrome remains as before, but aversion to cold is specifically termed "fan" (instead/reversely), indicating worsening compared to before. [Qian] One might ask: Since it says disease is unresolved after sweating, how do we know it is not residual exterior pathogens? Answer: If Typhoid sweating is unresolved, there should still be differentiation of headache, fever, and floating-tight pulse. Zhongjing not only omits mention of fever but also entirely avoids exterior-resolving methods, decisively stating "due to deficiency." Thus, the "deficiency" refers to Yang Qi. The pulse must be weak, or vacuous-large/vacuuous-rapid, presenting symptoms like sweating with only aversion to cold, similar to Fuzi Xixin Tang syndrome, or using Guizhi Jia Fuzi Tang, Guizhi Qu Shaoyao Jia Fuzi Tang, etc. Hence, it says "due to deficiency."
Shaoyao Gancao Fuzi Tang Formula
Shaoyao (Paeoniae Radix) Gancao (Licorice Root, three liang each, honey-fried ○ *Yuhan Jing* makes it one liang each.) Fuzi (Aconiti Lateralis Radix Praeparata, one piece, roasted, remove skin, broken into eight pieces)
Take the above three ingredients. Boil in five sheng of water until one sheng and five he remain. Strain. Divide into three warm doses. Suspected not to be Zhongjing's formula. (*Yuhan Jing*, *Qianjin Yi Fang*: "Five sheng" makes "Three sheng". The five characters "Suspected not Zhongjing's formula". *Yuhan Jing*: "Five he" makes "Three he". *Qianjin Yi Fang* makes "Two he". *Cheng Ben* omits the character "San" (three) in "three doses". Formula intention.)
[Zhou] Profuse sweating indicates Yang deficiency, while Yin is inherently weak. To tonify Yin, use Shaoyao; to restore Yang, use Fuzi. It is inevitable to use both. However, fearing that Yin and Yang may not harmonize, Gancao is added to mediate, ensuring Yin-Yang harmony and completing the treatment. [Ke] Leg cramping is treated with Shaoyao Gancao Tang, originally for Yin deficiency. Here, both Yin and Yang are deficient, so Fuzi is added. This embodies Zhongjing's principle of treating the interior rather than the exterior. [Wang] He Su believed that Typhoid unresolved after sweating with aversion to cold indicated residual exterior pathogens, still requiring sweating. Suspecting this formula was not Zhongjing's intent, he deemed it unusable. Thus, *Neitai Fangyi* also states: If not profuse sweating, plus aversion to cold, deep-micro pulse, and absence of heat signs, it cannot be taken. Understanding this, the use of this formula is beyond doubt.
Ke states: Note: No formula was provided for Shaoyin Yang Collapse. This formula fits this syndrome perfectly. Shaoyao stops sweating, collecting residual fluids from the muscle layer. Gancao harmonizes the Middle, relieves sore throat, and stops vomiting/diarrhea. Fuzi secures Shaoyin and attracts scattered Yang, warms meridians, and relaxes tightness in the pulses. This is perhaps Zhongjing's hidden, unexpressed principle?
Note: This formula adds Fuzi to Shaoyao Gancao Tang, and removes Ganjiang replacing it with Shaoyao in Sini Tang. The intent of dual rescue of Yin and Yang is self-evident.
If sweating or purgation is performed, and the disease remains unresolved with irritability, treat with Fuling Sini Tang. (*Mai Jing*, *Qianjin Yi Fang*: "Fa Han Tu Xia Yi Hou Bu Jie Fan Zao".)
[Cheng] Sweating or purgation should resolve the disease. If unresolved, sweating causes exterior Yang deficiency, and purgation causes interior Yin deficiency. With both Yin and Yang deficient, the pathogen remains unresolved, generating irritability. Give Fuling Sini Tang to restore Yin and Yang Qi. [Cheng] After sweating and purgation, if the disease remains unresolved with irritability, at this time there is both unresolved exterior Cold and interior Heat irritability. The syndrome of Da Qing Long Tang is complete. How many are not misled by this? Unaware that after sweating and purgation, Yang deficiency allows Yin to oppress, causing exterior loss and irritability. Warmtonification must be combined. [Xu] This case is confusing due to the four characters "disease remains unresolved". [Wang] This false irritability is a manifestation of false heat. [Jian] Da Qing Long Tang syndrome involves irritability without sweating, which is excess requiring agitation before sweating and purgation.