猪苓（去皮） 茯苓 阿胶 滑石（碎） 泽泻（各一两）
上五味。以水四升。先煮四味。取二升。去滓。内下阿胶。烊消。温服七合。日三服。
成注云。甘甚而反淡。淡味渗泄为阳。猪苓茯苓之甘。以行小便。咸味涌泄为阴。泽泻之咸。以泄伏水。滑利窍。
阿胶滑石之滑以利水道。
琥按上成注云。甘甚而反淡。以二苓之味。虽云甘而实淡故也。猪苓汤专于利水。则是上文云脉浮发热。非关表证
明矣。
后条辩云。猪苓汤之治。与太阳五苓散颇同。在太阳为寒水气化。不避桂术者。从寒也。在阳明为燥金气化。改桂
术为滑石阿胶者。从燥也。同是小便不利。而在太阳则从寒。在阳明则从燥。病机之际。各有气宜。医者可漫焉施。治
乎哉。
或问小便不利。其水亦蓄在膀胱中否。余答云。不然。太阳病小便不利。其水当蓄在膀胱之中。以膀胱为太阳之府
也。五苓散中有桂枝之热以通之。以桂枝为太阳经药也。兹者阳明病。小便不利。其水当积在胃下脘。以胃为阳明之府
也。故猪苓散中有滑石之寒以利之。以滑石为阳明经药也。
或又问云。水既积在胃。成注何以云。热客下焦也。余又答云胃中之水。虽有停积。终当入于小肠。但其水至阑门
分水之处。遂阻绝不行。不能渗入膀胱。以故小便不利。阑门分水之处。谓非下焦主之邪。乃今而知猪苓汤证之小便不
利。为肠胃中之水。不入膀胱而不利。非若五苓散证之小便不利。为膀胱中有水。气化不出而不利也。医者。能达是理。
则用药之道自明。
阳明病。汗出多而渴者。不可与猪苓汤。以汗多。胃中燥。猪苓汤复利其小便故也。（此承上文而言猪苓汤之禁。渴
欲饮水。小便不利者猪苓汤证也。然其证汗必不多。若汗出多。虽小便不利。不可与猪苓汤。何也。汗出既多。则胃中
水液外输。随饮随燥。津液少。以故作渴。复用猪苓汤以利小便。是重亡其津液。故示戒也。）
脉浮而迟。表热里寒。下利清谷者。四逆汤主之。（此条系真寒证。表热是假里寒是真。故与四逆汤主之。正文与注
见中寒论中）
若胃中虚冷。不能食者。饮水则哕。（此亦真寒之证。正文与注见中寒论中）
脉浮发热口干鼻燥。能食者。则衄（脉浮发热。此阳明经有风也。甚至口干鼻燥。经中之热炽矣。能食者。成注云。
里和也。仲景法。阳明病能食者。名中风。风热壅甚于经又不传里。势必致鼻衄也。按此条论。仲景无治法。补亡论常
器之云。可黄芩汤。愚意云。宜犀角地黄汤。）
（重出例）阳明病下之其外有热。（云云至）但头汗出者。栀子豉汤主之。（正文与注已见前）
（附后例）阳明病。发潮热。大便溏。小便自可。胸胁满不去者。小柴胡汤主之。
阳明病胁下硬满不大便而呕。舌上白苔者。可与小柴胡汤。（云云至）身 然而汗出解也。（上二条证。虽云阳明病
实少阳经病居多。故皆与小柴胡汤。正文与注见后第七卷少阳篇中）
阳明中风。脉弦浮大而短气。腹部满。胁下及心痛。（云云至）耳前后肿（云云至）与小柴胡汤。脉但浮。无余证者。
与麻黄汤。若不尿。腹满加哕者。不治。（此条阳明病。亦少阳证居多。至末后脉但浮云云。虽略兼太阳。终非主证。其
主证云。脉弦。胁下痛。耳前后肿。可见少阳经病偏重。故与小柴胡汤。正文与注见后第七卷少阳篇中）
阳明病。自汗出。若发汗小便自利者。此为津液内竭。虽硬不可攻之。当须自欲大便。宜蜜煎导而通之。若土瓜根。
及与大猪胆汁皆可为导（此条乃详言导法。以佐下法之穷也。阳明病自汗出者。不可发汗。若发其汗兼之小便自利者。
此为津液内竭。内指肠胃而言。汗泄于外。溺去于下。皆内耗其津液。故云竭也。津液既竭。则大便硬。不问而可知矣。
大便虽硬成注云。此非结热。不可攻之。当待其自欲大便时。遂因其势而行导之之法。如蜜煎土瓜根大猪胆。皆可用也。
或问小便自利。大便硬。何以不用麻仁丸。余答云麻仁丸治胃热。屎结于回肠以内。兹者胃无热。
证屎已近肛门之上。直肠之中。故云。因其势而导之也。）
猪苓（去皮） 茯苓 阿胶 滑石（捣碎） 泽泻（各一两）
以上五味药。用水四升。先煮前四味药。取二升药液。滤去药渣。加入阿胶。使其溶化。每次温服七合。每日服用三次。
成无己注解说：甘味极浓却反而表现为淡味，淡味具有渗湿泄浊的作用，属于阳。猪苓、茯苓的甘味，用来通利小便。咸味具有涌吐泄下的作用，属于阴。泽泻的咸味，用来排泄体内停滞的水饮。滑石性滑利窍道。
阿胶、滑石的滑利之性，用来通畅水道。
琥按语：对于上述成无己的注解，“甘甚而反淡”，是因为猪苓、茯苓这两味药，虽然味道说是甘，但实际上是淡味。猪苓汤专门用于利水，那么上文所说的“脉浮、发热”，就不是表证，这是很明显的了。
后条辩云：猪苓汤的治疗，与太阳病的五苓散颇为相似。在太阳病中，是由于寒水气化不利，不避忌桂枝、白术，是因为顺应寒邪的性质。在阳明病中，是由于燥金气化不利，将桂枝、白术改为滑石、阿胶，是因为顺应燥邪的性质。同样是小便不利，但在太阳病则从寒论治，在阳明病则从燥论治。在病机变化的关键时候，各有其气化的适宜之处，医生怎么能随意施治呢？
有人问：小便不利，那水饮也是蓄积在膀胱中吗？我回答说：不是这样。太阳病的小便不利，水饮应当蓄积在膀胱之中，因为膀胱是太阳的腑。五苓散中有桂枝的热性来通达它，因为桂枝是太阳经的药。现在阳明病的小便不利，水饮应当积聚在胃的下脘，因为胃是阳明的腑。所以猪苓汤中有滑石的寒性来利导它，因为滑石是阳明经的药。
又有人问：水既然积聚在胃，成无己为什么说是热客于下焦呢？我又回答说：胃中的水饮，虽然有停积，最终应当进入小肠。但是水饮到了阑门分水的地方，就阻绝不行，不能渗入膀胱，因此导致小便不利。阑门分水的地方，不能说不是由下焦主管的邪气，由此才知道猪苓汤证的小便不利，是肠胃中的水饮，不进入膀胱而不通利，不像五苓散证的小便不利，是膀胱中有水，气化不出而不通利。医生如果能通达这个道理，那么用药的道理自然明了。
阳明病，汗出多而且口渴的，不可给予猪苓汤。因为汗出多，胃中干燥，猪苓汤再次利其小便的缘故。（这是承接上文来说明猪苓汤的禁忌。渴欲饮水、小便不利者，是猪苓汤证。然而此证汗出必然不多，如果汗出多，即使小便不利，也不可给予猪苓汤。为什么呢？汗出既多，则胃中的水液向外输布，随饮随燥，津液少，因此作渴。再复用猪苓汤以利小便，这是使津液更加亡失，所以表示警戒。）
脉浮而迟，表热里寒，下利清谷的，用四逆汤主治。（此条是真寒证。表热是假象，里寒是真象。所以给予四逆汤主治。正文与注释见《中寒论》中）
如果胃中虚冷，不能进食的，喝水就会打呃逆。（这也是真寒之证。正文与注释见《中寒论》中）
脉浮发热、口干鼻燥，能进食的，则会流鼻血（脉浮发热，这是阳明经有风邪。甚至出现口干鼻燥，说明经络中的热势炽盛。能进食，成无己注解说：里气调和。仲景的法度，阳明病能进食的，名叫中风。风热壅盛于经络又不传入里，势必导致鼻衄。按此条论述，仲景没有给出治法，《补亡论》常器之说：可用黄芩汤。我的意思是：宜用犀角地黄汤。）
（重出例）阳明病，下之，其外有热。（云云至）但头汗出的，栀子豉汤主治。（正文与注释已见于前）
（附后例）阳明病，发潮热，大便溏，小便正常，胸胁满闷不去的，小柴胡汤主治。
阳明病，胁下硬满，不大便而呕，舌上白苔的，可给予小柴胡汤。（云云至）身濈然汗出而解。（以上两条证候，虽说是阳明病，实际上是少阳经病居多。所以都给予小柴胡汤。正文与注释见后第七卷少阳篇中）
阳明中风，脉弦浮大而短气，腹部胀满，胁下及心痛。（云云至）耳前后肿（云云至）与小柴胡汤。脉只浮，没有其他证候的，与麻黄汤。如果不排尿，腹满加重并出现呃逆的，属不治之症。（此条阳明病，也是少阳证居多。到最后脉只浮云云，虽然略兼太阳，终究不是主证。其主证是：脉弦，胁下痛，耳前后肿，可见少阳经病偏重。所以给予小柴胡汤。正文与注释见后第七卷少阳篇中）
阳明病，自汗出，如果发汗且小便自利的，这是津液内竭。虽然大便硬，不可攻下。应当等待病人自己想排便时，宜用蜜煎导法来通便。或者土瓜根，以及给予大猪胆汁都可以作为导引（此条详细讲述导法，以补充下法的不足。阳明病自汗出的，不可发汗。如果发其汗，兼之小便自利的，这是津液内竭。内指肠胃而言。汗泄于外，溺去于下，都内耗其津液，所以说竭。津液既已枯竭，则大便硬，不问可知。大便虽硬，成无己注解说：这不是结热，不可攻下。应当等待其自己想排便时，于是顺着其势而行导引之法。如蜜煎、土瓜根、大猪胆，都可以使用。或问：小便自利，大便硬，为什么不用麻仁丸？我回答说：麻仁丸治疗胃热，屎结于回肠以内。此时胃无热，证候显示屎已近肛门之上，直肠之中，所以说：因其势而导之也。）
Zhu Ling (Polyporus, with skin removed), Fu Ling (Poria), E Jiao (Donkey-hide Gelatin), Hua Shi (Talcum, crushed), Ze Xie (Alisma, each one tael).
The above five herbs. Use four sheng of water. First decoct the first four herbs, obtain two sheng of liquid, remove the dregs, add E Jiao, and melt it. Take seven ge warm, three times a day.
Cheng Wuji's commentary states: The sweet flavor is intense yet appears faint; the faint flavor promotes seepage and drainage, which belongs to Yang. The sweetness of Zhu Ling and Fu Ling is used to promote urination. The salty flavor induces vomiting and drainage, which belongs to Yin. The saltiness of Ze Xie is used to drain stagnant water. Hua Shi lubricates orifices.
E Jiao and Hua Shi are slippery and facilitate the flow of water passages.
Hu notes on Cheng Wuji's commentary: "Sweetness is intense yet appears faint" refers to the fact that although Zhu Ling and Fu Ling are described as sweet, their actual taste is faint. Zhu Ling Tang is specifically for promoting diuresis; thus, the "floating pulse and fever" mentioned earlier clearly do not relate to exterior syndromes.
The later treatise states: The treatment of Zhu Ling Tang is quite similar to Wu Ling San in Taiyang syndrome. In Taiyang syndrome, due to cold-water qi transformation dysfunction, Gui Zhi (Cinnamon Twig) and Bai Zhu (Atractylodes Macrocephala Rhizome) are not avoided, adhering to the nature of cold. In Yangming syndrome, due to dry-metal qi transformation dysfunction, Gui Zhi and Bai Zhu are replaced by Hua Shi and E Jiao, adhering to the nature of dryness. Both present with difficult urination, but in Taiyang syndrome, treatment follows cold; in Yangming syndrome, treatment follows dryness. At critical junctures of pathogenesis, there are appropriate qi transformations for each. How can physicians treat arbitrarily?
One asks: In difficult urination, is the water also retained in the Bladder? I answer: No. In Taiyang syndrome with difficult urination, water should be retained in the Bladder, as the Bladder is the fu-organ of Taiyang. Wu Ling San contains the heat of Gui Zhi to unblock it, as Gui Zhi is a herb of the Taiyang channel. Now, in Yangming syndrome with difficult urination, water should accumulate in the lower epigastrium of the Stomach, as the Stomach is the fu-organ of Yangming. Therefore, Zhu Ling Tang contains the cold property of Hua Shi to promote drainage, as Hua Shi is a herb of the Yangming channel.
Another asks: If water accumulates in the Stomach, why does Cheng Wuji say "heat lodges in the lower jiao"? I answer again: Water in the Stomach, although stagnant, eventually enters the Small Intestine. However, when water reaches the Lamen (gate where fluids divide), it becomes blocked and cannot flow, failing to seep into the Bladder, thus causing difficult urination. The Lamen area is not solely governed by pathogens of the lower jiao. From this, we understand that difficult urination in Zhu Ling Tang syndrome is due to water in the intestines and stomach not entering the Bladder, unlike Wu Ling San syndrome where difficult urination is due to water in the Bladder failing to undergo qi transformation. If physicians comprehend this principle, the rationale for medication will naturally become clear.
In Yangming syndrome, if there is profuse sweating and thirst, Zhu Ling Tang must not be administered. This is because profuse sweating causes dryness in the Stomach, and Zhu Ling Tang further promotes urination. (This follows the previous text to state the contraindications of Zhu Ling Tang. Thirst with desire to drink water and difficult urination constitute Zhu Ling Tang syndrome. However, in this syndrome, sweating is not profuse. If sweating is profuse, even with difficult urination, Zhu Ling Tang must not be given. Why? Profuse sweating leads to external loss of gastric fluids; drinking water is quickly dried up, resulting in scanty body fluids and thirst. Using Zhu Ling Tang to promote urination would further deplete body fluids, hence the warning.)
With a floating and slow pulse, exterior heat and interior cold, and diarrhea with undigested food, Si Ni Tang (Frigid Four Decoction) is the primary treatment. (This clause describes a true cold syndrome. Exterior heat is false, interior cold is true. Thus, Si Ni Tang is given. The main text and commentary are found in Zhong Han Lun.)
If the Stomach is deficient and cold, unable to accept food, drinking water will cause hiccups. (This is also a true cold syndrome. The main text and commentary are found in Zhong Han Lun.)
With a floating pulse, fever, dry mouth, and dry nose, and the ability to eat, epistaxis (nosebleed) will occur. (Floating pulse and fever indicate wind in the Yangming channel. Severe dry mouth and nose indicate intense heat in the channel. Ability to eat, according to Cheng Wuji, means the interior is harmonious. According to Zhang Zhongjing's method, Yangming syndrome with ability to eat is named Wind Strike. Severe wind-heat stagnating in the channel without transmitting inward will inevitably lead to epistaxis. Regarding this clause, Zhang Zhongjing provides no treatment method. Chang Qizhi in Bu Wang Lun suggests Huang Qin Tang (Scutellaria Decoction). My opinion is Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction).)
(Repeated Example) Yangming syndrome, after purgation, with exterior heat... only head sweating occurs, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment. (Main text and commentary already seen previously.)
(Later Appendix Example) Yangming syndrome, with tidal fever, loose stools, normal urination, and persistent fullness in the chest and hypochondrium, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment.
Yangming syndrome, with hardness and fullness under the hypochondrium, constipation, and vomiting, and a white coating on the tongue, may be treated with Xiao Chai Hu Tang... resolving with generalized sweating. (The above two conditions, though labeled Yangming syndrome, are mostly Shaoyang channel diseases. Hence, Xiao Chai Hu Tang is given. Main text and commentary are found in Volume 7, Shaoyang Chapter.)
Yangming Wind Strike, with wiry, floating, and large pulse, shortness of breath, abdominal fullness, pain in the hypochondrium and heart region... swelling around the ears... give Xiao Chai Hu Tang. If the pulse is only floating without other symptoms, give Ma Huang Tang (Ephedra Decoction). If there is anuria, worsening abdominal fullness, and hiccups, it is incurable. (This Yangming syndrome clause involves mostly Shaoyang symptoms. The final mention of "pulse only floating..." slightly involves Taiyang but is not the main syndrome. The main symptoms are wiry pulse, hypochondriac pain, and periauricular swelling, indicating predominant Shaoyang channel disease. Hence, Xiao Chai Hu Tang is given. Main text and commentary are found in Volume 7, Shaoyang Chapter.)
Yangming syndrome, with spontaneous sweating. If sweating is induced and urination is free, this indicates internal exhaustion of body fluids. Even if stool is hard, it must not be attacked with purgatives. One must wait for the patient's natural urge to defecate and use Mi Jian Dao (Honey Suppository) to guide passage. Alternatively, Tu Gua Gen (Trichosanthes Kirilowii Root) or Da Zhu Dan Jin (Large Pig Gallbladder Juice) can be used as guides. (This clause details guiding methods to supplement the limitations of purgation. Yangming syndrome with spontaneous sweating should not induce sweating. If sweating is induced along with free urination, this indicates internal exhaustion of body fluids, referring to the intestines and stomach. Sweat escapes outward, urine exits downward, both consuming internal fluids, hence "exhaustion." Once body fluids are exhausted, stool becomes hard, which is evident. Although stool is hard, Cheng Wuji notes this is not accumulated heat and must not be purged. Wait for the natural urge to defecate and guide the process顺势. Honey suppositories, Tu Gua Gen, and Large Pig Gallbladder can all be used. One asks: With free urination and hard stool, why not use Ma Ren Wan (Hemp Seed Pill)? I answer: Ma Ren Wan treats Stomach heat with fecal accumulation in the ileum. Here, there is no Stomach heat, and the feces are near the anus in the rectum. Hence, "guide according to the situation.")