茯苓（二两） 桂枝（二两去皮） 生姜（三两切） 甘草（一两炙）
上四味。以水四升。煮取三升。去滓。分温三服。
琥按成注云。茯苓甘草之甘。益津液而和卫。桂枝生姜之辛。助阳气而解表。彼以姜桂味辛走表。能助阳气。注甚
明切。若茯苓味甘而淡。乃泄水之物。何以能益津液。盖膀胱之邪水利。则气化得以流通。津液即由此而回复。所以五
苓散。散邪消水。为最燥之药。成注反云润燥者。亦此义也。至其云。和卫。乃甘草之力。与茯苓何与焉。成氏以上病。
止汗出而不渴。为邪气不传里。但在表而表虚。故以上汤为解表和卫之剂。从不云茯苓之主里。此为论与方两失其义。
琥又按五苓散。茯苓甘草汤。二方皆太阳标本齐病。表里兼主之剂。何谓标太阳之经是也。何谓本。膀胱府是也。
经在表。本在里。五苓散证。邪已入府。表证实微。故方中止用桂枝一味以主表。其余四味。皆主里之药也。茯苓甘草
汤证。邪犹在经。里证尚少。故方中止用茯苓一味。以主里。其余三味。皆主表之药也。学人能于仲景书反复玩索。其
中意味自见。
（重出例）中风发热六七日不解（云云至）名曰水逆五苓散主之（已见前）
未持脉时。病患手叉自冒心。师因教试令咳。而不咳者。此必两耳聋无闻也。所以然者。以重发汗虚故如此。（此仲
景示人以诊病法也。医师诊病。必先持脉。今者未持脉时。是师欲持其手切脉也。而病患反以手叉自冒其心。其时病者。
精神不与医师相对。师因行教试法也。手叉叉手义同。注已见前。教令咳而不咳者。耳聋也。所以然者。以发汗过多。
阳亡。胸中之气馁而不充。故手叉自冒心。重复发汗精气更虚。不得上通于耳。故耳聋无闻也。尚论篇云。此耳聋。与
少阳传经邪盛之耳聋迥别。按成注云。阳气虚。精气不足。夫阳气精气。非二物也。人身之阳为气。气积久而成精。气
为精之母精为气之子。气者肺主之。心胸即其分也。精者肾主之。两耳其开窍也。又按此条病。仲景无治法。补亡论常
器之云。素无热人。可与芍药附子汤。素有热人。可与黄 建中汤。愚以重发汗而致虚。黄 建中汤。固宜用也。夫精
气虚。非火虚。芍药附子汤。不宜用也。至于病患之平素有热无热。此常氏诊病最可笑之法。）
发汗后。饮水多。必喘。以水灌之亦喘（喘。肺病也。经曰。形寒饮冷则伤肺。发汗后。其人亡津液而燥渴。内饮
水多。水气上逆。必作喘。外以水灌。冷气侵肤。与内邪相搏。亦作喘也。按此条论。仲景无治法。补亡论常器之云。
可与麻黄杏子甘草石膏汤主之。愚以发汗后。以水灌之。其人汗孔。仍受水寒所闭。上汤固宜用也。然不若仍用麻黄汤
以发之。若发汗后。饮水多。其人汗孔或疏。上汤不宜用也。宜改用茯苓桂枝生姜甘草汤。喘甚者。加浓朴杏子人。）
发汗后。水药不得入口。为逆。若更发汗。必吐下不止。（发汗后。水药不得入口者。此是过服麻黄汤以发其汗。汗
多亡阳。胃中元气虚。不能消水。此治之之逆。谓治不以理也。医人不知用药之过。更服前汤以发其汗。则胃中元气大
虚。所入之药。不惟吐出。而且下利不止。是为大逆。此仲景所以深致谨戒之意。按此条论。仲景无救逆之法。补亡论
常器之云。可与半夏茯苓汤。）
发汗吐下后。虚烦。不得眠。若剧者。必反复颠倒。心中懊 。栀子豉汤主之。（发汗吐下后者。谓虽经汗吐且下。
而伤寒之邪热。犹未解也。邪热未解。必乘其人之虚。而客于胸中。胸中郁热。因生烦躁。阳气扰乱。不得眠也。剧者。
烦极也。烦极。则知其人郁热愈甚。故不惟不眠。而且反复颠倒而不安。心中懊 。郁郁然不舒畅而愦闷也。成注引内
经曰。其高者因而越之。与栀子豉汤。以吐胸中之邪。按成注云。心恶热。热甚。必神昏。是以反复颠倒。殊不知反复
颠倒。非神昏也。乃心胸中郁热烦闷。懊懊 。欲作吐之状耳。所以内台方议云。此非结胸痞证之比。而可下。当用
栀子豉汤。吐而散之也。或问云。虚烦证。奚堪再吐。余答云。虚者正气之虚。烦者。邪气之实。邪热郁于胸中。是为
吐证仍在。理宜更用吐法。犹之汗下之证仍在。可再行汗下法也。愚以虚烦二字。不可作真虚看。）
茯苓（二两） 桂枝（二两，去皮） 生姜（三两，切片） 甘草（一两，炙用）
以上四味药。用水四升。煎煮至三升。滤去药渣。分三次温服。
琥按：成无己注解说：“茯苓、甘草的甘味，能益生津液并调和卫气；桂枝、生姜的辛味，能助长阳气并解除表邪。”那些认为姜、桂味辛走表，能助阳气的注解，非常明白贴切。至于茯苓味甘且淡，本是利水之物，怎么能益生津液呢？这是因为膀胱的水湿之邪得以排泄，气化功能就能流通，津液自然由此恢复。所以五苓散（Wuling San, Five-Ingredient Powder with Poria），作为祛邪消水的燥烈药物，成注反而说它润燥，也是这个意思。至于他说“和卫”，那是甘草的功效，与茯苓有什么关系呢？成氏因为患者有汗出而不口渴的症状，认为邪气没有传入里，只在表而且表虚，所以将上方（指茯苓甘草汤）作为解表和卫的方剂，从未提到茯苓主治里证，这是对于经文和方义的双重误解。
琥又按：五苓散、茯苓甘草汤，这两个方子都是治疗太阳病标本同病的方剂，兼顾表里。什么是标？就是太阳经。什么是本？就是膀胱腑。经在表，本在里。五苓散的证候，邪气已经入腑，表证实证轻微，所以方中只用桂枝一味来主表，其余四味药，都是主治里的药物。茯苓甘草汤的证候，邪气还在经，里证还少，所以方中只用茯苓一味来主里，其余三味药，都是主治表的药物。学医的人如果能反复研读张仲景的著作，其中的意味自然显现。
（重出例：中风发热六七日不解……名为水逆，五苓散主之。（前文已见））
诊脉之前，病人双手交叉护住心口。医生于是教他试着咳嗽，如果不咳，这一定是双耳失聪听不见声音。为什么会这样呢？因为过度发汗导致正气虚弱所以如此。（这是张仲景展示给人看的诊病方法。医师诊病，必须先切脉。现在还没切脉时，是医生想要切他的手腕脉搏，而病人却反手交叉捂住心口。此时病人的精神不与医生相对接应。医生于是采用试探的方法。手叉叉，即两手交叉的意思。注释已见于前文。教令咳嗽却不咳，是因为耳聋。之所以这样，是因为发汗过多，阳气亡失，胸中的宗气衰败而不能充盈，所以双手交叉捂住心口。再次发汗使精气更加虚弱，不能上通于耳，所以耳聋听不见。《尚论篇》说：这种耳聋，与少阳病传经邪盛导致的耳聋截然不同。按成无己注解说：阳气虚，精气不足。其实阳气、精气并非两种东西。人身之阳即为气，气积聚久了成为精，气是精的母亲，精是气的儿子。气由肺所主，心胸即是其分部。精由肾所主，两耳是其开窍之处。又按此条病症，张仲景没有给出治法，《补亡论》常器之说：平素无热的人，可用芍药附子汤。平素有热的人，可用黄芪建中汤。我认为因过度发汗导致虚损，黄芪建中汤固然适宜使用。但精气虚并非火虚，芍药附子汤不宜使用。至于病人平素是否有热，这是常氏诊病最可笑的方法。）
发汗后，饮水过多，必定气喘。用水冲洗身体也会气喘。（气喘，是肺的病。经文说：形体受寒、饮食生冷会伤肺。发汗后，人体津液亡失而干燥口渴，内饮入过多的水，水气上逆，必定引发气喘。外部用水冲洗，冷气侵袭肌肤，与内部邪气相搏结，也会引发气喘。按此条论述，张仲景没有给出治法，《补亡论》常器之说：可用麻黄杏仁甘草石膏汤主治。我认为发汗后，用水冲洗，人的汗孔仍然受到水寒的闭塞，上方固然适宜使用。然而不如仍用麻黄汤来发汗。如果发汗后，饮水过多，人的汗孔或许疏松，上方就不宜使用了。宜改用茯苓桂枝生姜甘草汤。气喘严重的，加厚朴、杏仁。）
发汗后，水药无法入口，这是逆证。如果再次发汗，必定呕吐下利不止。（发汗后，水药无法入口，这是过服麻黄汤发汗，汗多亡阳，胃中元气虚弱，不能消化水液，这是治疗上的逆乱，指治疗不合道理。医生不知道用药有过错，再次服用前方以发汗，则胃中元气大虚，进入的药液，不仅吐出，而且下利不止，这是大逆。这是张仲景所以深加谨慎告诫的意思。按此条论述，张仲景没有给出救逆之法，《补亡论》常器之说：可用半夏茯苓汤。）
发汗、催吐、泻下之后，出现虚烦，无法入睡。如果病情严重，必定翻来覆去，心中懊恼，栀子豉汤主之。（发汗、催吐、泻下之后，指虽然经过汗、吐、下法，但伤寒的邪热仍未解除。邪热未解，必定乘人之虚，客居于胸中。胸中郁热，因而产生烦躁，阳气扰乱，无法入睡。所谓剧者，是烦躁到了极点。烦躁到极点，说明胸中郁热更甚，所以不仅不眠，而且翻来覆去不安宁，心中懊恼，郁郁然不舒畅而感到烦闷。成无己引用《内经》说：病位高的，因势利导使其涌吐。给予栀子豉汤，以涌吐胸中之邪。按成无己注解说：心恶热，热甚必然神志昏乱，所以翻来覆去。殊不知翻来覆去，并非神志昏乱，而是心胸中郁热烦闷，懊恼，有想呕吐的样子。所以《内台方议》说：这不是结胸痞证的同类，不可攻下，应当用栀子豉汤，通过涌吐来消散邪气。有人问：虚烦证，怎能承受再次涌吐？我回答说：虚，是指正气的虚；烦，是指邪气的实。邪热郁于胸中，仍是涌吐证的适应证，理应再用涌吐法。就像汗、下法的适应证仍在，可以再次行汗、下法一样。我认为“虚烦”二字，不可当作真正的虚证来看待。）
Poria (Liang Er), Cinnamon Twig (Liang Er, peeled), Fresh Ginger (San Liang, sliced), Licorice Root (Liang Yi, honey-fried)
The above four ingredients. Boil in four sheng of water. Reduce to three sheng. Remove the dregs. Divide into three warm doses.
Hu notes: Cheng Wuji's commentary states: "The sweetness of Poria and Licorice tonifies body fluids and harmonizes Wei Qi; the pungency of Cinnamon Twig and Fresh Ginger assists Yang Qi and releases the exterior." The annotation that ginger and cinnamon, being pungent and traveling to the exterior, can assist Yang Qi is very clear and pertinent. As for Poria, which is sweet and bland, it is a substance that drains dampness; how can it tonify body fluids? This is because when the water-damp pathogen in the Bladder is excreted, Qi transformation flows freely, and body fluids are thereby restored. Therefore, Wuling San (Five-Ingredient Powder with Poria), despite being a drying medicine for dispelling pathogens and eliminating water, was described by Cheng as moistening dryness; this is also based on this principle. Regarding his statement "harmonizing Wei," that is the power of Licorice, what does it have to do with Poria? Cheng, observing symptoms of sweating without thirst, concluded that the pathogen had not transmitted to the interior but remained at the exterior with deficiency. Thus, he regarded the above formula (Fuling Gancao Tang) as a formula to release the exterior and harmonize Wei, never mentioning that Poria treats the interior. This is a loss of meaning in both the text and the formula.
Hu further notes: Both Wuling San and Fuling Gancao Tang are formulas treating simultaneous disease of the Biao (Exterior/Channel) and Ben (Interior/Organ) of Taiyang. What is Biao? It is the Taiyang Channel. What is Ben? It is the Bladder Fu organ. The Channel is at the exterior, the Fu is at the interior. In Wuling San syndrome, the pathogen has entered the Fu, and the exterior excess is slight; thus, only one ingredient, Cinnamon Twig, is used to treat the exterior, while the other four ingredients all treat the interior. In Fuling Gancao Tang syndrome, the pathogen remains in the Channel, and interior symptoms are few; thus, only one ingredient, Poria, is used to treat the interior, while the other three ingredients all treat the exterior. If students repeatedly study Zhang Zhongjing's works, their profound meanings will naturally become apparent.
(Repeated Case: Wind-stroke with fever for six or seven days unresolved... named Water Reversal, treated with Wuling San. (Seen previously))
Before taking the pulse, the patient crosses hands over the heart. The physician then instructs them to try to cough. If they do not cough, this must be bilateral deafness. Why is this so? Because excessive sweating has caused deficiency. (This is Zhang Zhongjing demonstrating diagnostic methods. Physicians must take the pulse first. Here, before taking the pulse, the physician intends to palpate the wrist, but the patient crosses hands over the heart. At this time, the patient's spirit is not engaged with the physician. The physician uses a test method. 'Hand crossing' means hands interlaced. The annotation is seen previously. Being instructed to cough but not doing so indicates deafness. The reason is that excessive sweating causes Yang collapse, leading to depletion of Zong Qi in the chest, unable to fill, hence hands cross over the heart. Repeated sweating makes Jing-Qi more deficient, unable to ascend to the ears, hence deafness. *Shanglun Pian* states: This deafness is distinctly different from deafness due to excess pathogen in Shaoyang transmission. Cheng Wuji comments: Yang Qi is deficient, Jing-Qi is insufficient. Actually, Yang Qi and Jing-Qi are not two separate entities. Yang Qi in the body is Qi; accumulated Qi becomes Jing. Qi is the mother of Jing, Jing is the child of Qi. Qi is governed by the Lung, and the chest-heart is its domain. Jing is governed by the Kidney, and the two ears are its orifices. Also, regarding this condition, Zhang Zhongjing provides no treatment method. *Buwang Lun* by Chang Qizhi says: For those without prior heat, Shaoyao Fuzi Tang may be used. For those with prior heat, Huangqi Jianzhong Tang may be used. I believe that since deficiency results from excessive sweating, Huangqi Jianzhong Tang is indeed appropriate. However, Jing-Qi deficiency is not Fire deficiency; Shaoyao Fuzi Tang is inappropriate. As for whether the patient had prior heat, this is the most laughable diagnostic method of Chang.)
After sweating, drinking too much water inevitably causes wheezing. Washing the body with water also causes wheezing. (Wheezing is a lung disease. The classic states: Cold affecting the form and cold drinks injure the lungs. After sweating, body fluids are lost causing dryness and thirst. Drinking excessive water internally leads to rebellious Qi of water, inevitably causing wheezing. Externally washing with water allows cold air to invade the skin, combusting with internal pathogens, also causing wheezing. Regarding this clause, Zhang Zhongjing provides no treatment. *Buwang Lun* by Chang Qizhi says: Mahuang Xingzi Gancao Shigao Tang may be used. I believe that after sweating, washing with water closes the sweat pores with cold-water, making the above formula appropriate. However, it is better to still use Mahuang Tang to induce sweating. If after sweating, excessive water is drunk and sweat pores are likely loose, the above formula is not suitable. Instead, Fuling Guizhi Shengjiang Gancao Tang should be used. For severe wheezing, add Houpo and Xingren.)
After sweating, if water and medicine cannot enter the mouth, it is a reversal pattern. If sweating is induced again, vomiting and diarrhea will certainly not cease. (After sweating, inability to take food and water indicates excessive use of Mahuang Tang to sweat, leading to Yang collapse from profuse sweating. Yuan Qi in the Stomach is deficient and cannot transform water. This is therapeutic reversal, meaning improper treatment. The physician, unaware of the medication error, administers the previous formula again to sweat, causing severe deficiency of Yuan Qi in the Stomach. The ingested medicine is not only vomited but also causes incessant diarrhea. This is great reversal. This is why Zhang Zhongjing deeply emphasizes caution. Regarding this clause, Zhang Zhongjing provides no rescue method. *Buwang Lun* by Chang Qizhi says: Banxia Fuling Tang may be used.)
After sweating, vomiting, or purging, deficiency vexation occurs, preventing sleep. If severe, the patient tosses and turns, feeling stifled in the heart, treated with Zhizi Chi Tang. (After sweating, vomiting, or purging refers to cases where, despite these treatments, the pathogenic heat of Shanghan remains unresolved. Unresolved pathogenic heat takes advantage of deficiency to lodge in the chest. Heat stagnating in the chest generates vexation, disturbing Yang Qi and preventing sleep. 'Severe' means extreme vexation. Extreme vexation indicates more severe stagnated heat in the chest, causing not only insomnia but also tossing and turning restlessly, with stifling sensations in the heart. Cheng Wuji cites the *Neijing*: "Where the pathology is high, promote emesis." Zhizi Chi Tang is given to emetic pathogens in the chest. Cheng comments: The Heart dislikes heat; extreme heat causes mental confusion, hence tossing and turning. He fails to realize that tossing and turning is not mental confusion, but rather stifling and vexation due to stagnated heat in the chest, resembling the urge to vomit. *Neitai Fangyi* states: This is not comparable to Jie Xiong or Pi syndromes; it should not be purged but treated with Zhizi Chi Tang to emetic and dissipate. A question arises: Can deficiency vexation tolerate repeated emesis? My answer: 'Deficiency' refers to righteous Qi deficiency; 'Vexation' refers to pathogenic excess. Pathogenic heat stagnating in the chest remains an indication for emesis, warranting repeated emetic therapy, just as indications for sweating or purging remain allow for repeated sweating or purging. I believe 'deficiency vexation' should not be viewed as true deficiency.)