【注】桂枝二越婢一汤，即大青龙以杏仁易芍药也，名虽越婢辅桂枝，实则大青龙之
变制也。去杏仁恶其从阳而辛散，用芍药以其走阴而酸收。以此易彼，裁而用之，则主
治不同也。以桂枝二主之，则不发汗，可知越婢一者，乃麻黄石膏二物，不过取其辛凉
之性，佐桂枝二，中和表而清热，则是寓微汗于不发之中，亦可识也。非若大青龙以石
膏佐麻黄而为发汗驱热之重剂也。桂枝二麻黄一汤，治若形如疟，日再发者，汗出必解，
而无热多寒少，故不用石膏之凉也。桂枝麻黄各半汤，治如疟状，热多寒少，而不用石
膏更倍麻黄者，以其面有怫郁热色，身有皮肤作痒，是知热不向里而向表，令得小汗以
顺其势，故亦不用石膏之凉里也。桂枝二越婢一汤，治发热恶寒，热多寒少，而用石膏
者，以其表邪寒少，肌里热多，故用石膏之凉，佐麻桂以和营卫，非发营卫也。今人一
见麻桂，不问轻重，亦不问温覆不温覆，取汗不取汗，总不敢用。皆因未究仲景之旨，麻
桂只是营卫之药。若重剂温覆取汗，则为发营卫之药；轻剂不温覆取汗，则为和营卫之
药也。
越婢汤 治风水恶风，一身悉肿，脉浮不渴，续自汗出，无大热者。又治里水，一
身面目黄肿，其脉沉小便不利，故令病水。假令小便自利，此亡津液，故令渴也。越婢加
术汤主之。
麻黄（六两） 石膏（半斤） 生姜（切，三两） 大枣（擘，十五枚） 甘草（一两）
恶风加附子（炮）一枚。
上五味，以水六升，煮麻黄，去沫，内诸药，煮取三升，分三服。
【集注】喻昌曰∶越婢汤者，示微发表于不发之方也，大率取其通调营卫。麻黄、石
膏二物，一甘热，一甘寒，合而用之。脾偏于阴则和以甘热，胃偏于阳则和以甘寒。乃
至风热之阳，水寒之阴，凡不和于中土者，悉得用之何也？中土不和，则水谷不化其精悍
之气，以实营卫。营卫虚，则或寒、或热之气，皆得壅塞其隧道，而不通于表里。所以
在表之风水用之，而在里之水兼渴，而小便自利者，咸必用之，无非欲其不害中土耳。不
害中土，自足消患于方萌矣。
赵良曰∶五脏各一其阴阳，独脾胃居中而两属之。故土不独成四气，土亦从四维而
后成，不惟火生而已。于是四方有水寒之阴，即应于脾，风热之阳，即应于胃，饮食五味
之寒热，凡入于脾胃者亦然。一有相干，则脾气不和，胃气不清，而水谷不化其精微，以
行营卫，以实阴阳也。甘者，土之本味，所以脾气不和，和以甘热，胃气不清，清以甘
寒。麻黄之甘热，走手足大阴经，连于皮肤，行气于三阴，以祛阴寒之邪；石膏之甘寒，走
手足阳明经，达于肌肉，行气于三阳，以祛风热之邪。既用其味甘以入土，用其寒热以
和阴阳，用其性善走以发越脾气，更以甘草和中缓急，二药相协而成功。大枣之甘，补
脾中之血；生姜之辛，益胃中之气。恶风者阳虚，故加附子以益阳。风水者，则加术以散皮
肤间风水，气发谷精以宣营卫，与麻黄、石膏伪使，引其入土也。越婢之名，不亦宜乎！
【按】喻昌所论明析，赵良之说，能细剖其理，开悟后学，故两录之。
麻黄杏仁甘草石膏汤 治温热内发，表里俱热，头痛身疼，不恶寒反恶热，元汗而
喘，大烦大渴，脉阴阳俱浮者，用此发汗而清火。若脉浮弱沉紧，沉细恶寒，自汗出而
不渴者，禁用。
麻黄（去节，四两） 杏仁（去皮尖，五十枚） 甘草（炙，二两） 石膏（碎，绵裹，半斤）
上四味，以水七升，先煮麻黄，减二升，去上沫，内诸药，煮取二升，去滓，温服一升。
【集注】柯琴曰∶石膏为清火之重剂，青龙、白虎皆赖以建功，然用之不当，适足以
召祸。故青龙以元汗烦躁，得姜、桂以宣卫外之阳也；白虎以有汗烦渴，须粳米以存胃
中之液也。此但热无寒，故不用姜、桂，喘不在胃而在肺，故不须粳米。其意重在存阴，
不必虑其亡阳也，故于麻黄汤去桂枝之监制，取麻黄之专开，杏仁之降，甘草之和，倍石
膏之大寒，除内外之实热，斯溱溱汗出，而内外之烦热与喘悉除矣。
麻黄附子细辛汤 治少阴病始得之，反发热脉沉，二三日无里证者。
麻黄（一两） 附子（炮，一枚） 细辛（二两）
热微者，以甘草易细辛微发汗。
上三味，以水一斗，先煮麻黄，减二升，去沫，内药，煮取三升，去滓，温服一升，日
三服。
【集注】柯琴曰∶少阴主里，应无表证；病发于阴，应有表寒。今少阴始受寒邪而反
发热，是有少阴之里，而兼有太阳之表也。太阳之表脉应不沉，今脉沉者，是有太阳之证，
而见少阴之脉也。故身虽热而脉则沉也。所以太阳病而脉反沉，便用四逆以急救其里；此
少阴病而表反热，便于表剂中加附子以预固其里。夫发热无汗，太阳之表不得不开，沉
为在里，少阴之枢又不得不固。设用麻黄开腠理，细辛散浮热，而无附子以固元阳，则
少阴之津液越出，太阳之微阳外亡，去生便远。惟附子与麻黄并用，则寒邪虽散，而阳
不亡；此里病及表，脉沉而当发汗者，与病在表脉浮而发汗者径庭也。若表微热，则受
寒亦轻，故以甘草易细辛而微发其汗，甘以缓之，与辛以散之者，又少间矣。
桂枝加附子汤 太阳病发汗，遂漏不止，其人恶风，小便难，四肢微急，难以屈伸者，
此方主之。
桂枝汤加附子一枚，（炮去皮，破八片。）
煎服法同，不须啜粥。
【集注】柯琴曰∶发汗太过，阳无所止息，而汗出不止矣。汗多亡阳，元府不闭，风乘
虚入，故复恶风；津液外泄，不能润下，故小便难。四肢者，诸阳之本；阳气者，柔则
养筋，开阖不得，风寒从之，故筋急而屈伸不利也。是方以附于加入桂枝汤中，大补表
阳也；表阳密，则漏汗自止，恶风自罢矣。汗止津回，则小便自利四肢自柔矣。汗漏不止，
与大汗出同，而从化变病则异。服桂枝、麻黄后，大汗出而大烦渴，是阳陷于里，急当救
阴，故用白虎加人参汤。服桂枝、麻黄汤，大汗出遂漏不止，是阳亡于外，急当救阳，故用桂
枝加附子汤。要知发汗之剂，用桂枝不当，则阳陷于里者多；用麻黄不当，则阳亡于外者
多。因桂枝汤有芍药而无麻黄，故虽汗大出，而元府尚能自闭，多不致亡阳于外耳。
芍药甘草附子汤 发汗病解，反恶寒者，虚故也，此方主之。
芍药（三两） 甘草（炙，二两） 附子（炮去皮，破八片，一枚）
上三味，以水五升，煮取一升五合，去滓，分温服。
【集注】柯琴曰∶发汗病解而反恶寒，比未汗时更甚，其阳虚可知矣。夫太阳、少阴
为表里，太阳之病，本由少阴之虚，不能藏精而为阳之守也。今恶寒反见于发汗病解后，
是寒邪已从汗解，太阳阳虚不能卫外而为阴之使也，则阳亡之兆已见于此。若无以桂枝
汤攻表，非以扶阳反以亡阳也。故以芍药收少阴之精气，甘草缓阴邪之上行，附子补坎
宫之少火，但使肾中元阳得位，在表之虚阳恶寒自解耳。
桂枝甘草汤 治发汗过多，其人叉手自冒心，心下悸，欲得按者。
桂枝（四两） 甘草（炙，二两）
上二味，水三升，煮取一升，顿服。
【集注】柯琴曰∶汗出多，则心液虚，中气馁，故悸。叉手自冒，则外有所卫，得按
则内有所根据，如此不堪之状，望之而知其虚矣。桂枝本营分药，得麻黄，则令营气外发
而为汗，从辛也；得芍药，则收敛营气而止汗，从酸也；得甘草，则补中气而养血，从
甘也。故此方以桂枝为君，独任甘草为佐，以补阳气生心液。甘温相得，斯气血和而悸自
平。不须附子者，以汗虽多而未至于阳亡。不须芍药者，以汗已止而嫌其阴敛也。
桂枝加芍药加大黄汤 本太阳病，医反下之，因而腹满时痛者，属太阴也，桂枝加
芍药汤主之。大实痛者，桂枝加大黄汤主之。
桂枝加芍药汤方
于桂枝汤方内，更加芍药三两，随前共六两，余根据桂枝汤法。
桂枝加大黄汤方
即桂枝加芍药汤方内，更加大黄一两。
【集注】柯琴曰∶腹满为大阴、阳明俱有之证，然位同而职异。太阴主出，太阴病则
腐秽之出不利，故满而时痛；阳明主内，阳明病则腐秽燥而不行，故大实而痛。大实痛
是阳明病，不是太阴病。仲景因表证未解，阳邪已陷入于太阴，故倍芍药以益脾调中，而
除腹满时痛，此用阴和阳法也。若表邪未解，而阳邪陷入于阳明，则加大黄以润胃通结，而
除其大实痛，此双解表里法也。凡妄下必伤胃气，胃气虚则阳邪袭阴，故转属太阴；胃
液涸则两阳相搏，故转属阳明。属大阴则腹满时痛而下实，阴道虚也；属阳明则腹满大
实而痛，阳道实也。满而时痛，是下利之兆，大实而痛，是燥屎之征。故倍加芍药，小变
建中之剂，少加大黄，微示调胃之方。
小建中汤 治伤寒表未解，或心悸而烦，
或腹中急痛，而脉阳涩阴弦者。
桂枝（三两） 芍药（六两） 生姜（切，三两） 甘草（二两） 胶饴（一斤） 大枣（擘，十二枚）
上六味，以水七升，煮取三升，去滓，内胶饴，更上火消解，日三服，呕家不可用建
中汤，以甜故也。
【注】是方也，即桂枝汤倍芍药加胶饴。名曰小建中，谓小小创建中气，以中虽已虚，
表尚未和，不敢大补也。故以桂葶汤仍和营卫，倍芍药加胶饴调建中州，而不啜稀粥温
服令汗，盖其意重在中虚，而不在伤寒之表也。中虚创建，营卫自和，津液可生，汗出
乃解，烦悸可除矣。伤寒浮得脉涩，营卫不足也，沉得脉弦，木入土中也。营卫不足则
表虚，木入士中则里急，表虚里急，故亦以此汤主治也。呕家不可用，谓凡病呕者不可
用，恐甜助呕也。
炙甘草汤 治伤寒脉结代，心动悸者。又治肺痿，咳吐多，心中温温液液者。
甘草（炙，四两） 生姜（切，三两） 桂枝（三两） 麦门冬（半升） 麻子仁（半升）
大枣（擘，十二枚） 人参（一两） 阿胶（二两） 生地黄（一斤）
上九味，以清酒七升，水八升，先煮八味，取三升，去滓，内胶，烊消尽，服一升，
日三服。
【集注】柯琴曰∶仲景于脉弱阴弱者，用芍药以益阴，阳虚者，用桂枝以通阳，甚则
加人参以生脉，未有用地黄、麦冬者。岂以伤寒之法义重扶阳乎？抑阴无骤补之法欤？此
以心虚脉结代，用生地黄为君，麦冬为臣，峻补真阴，开后学滋阴之路也。地黄、麦冬，味
虽甘而气则寒，非发陈、蕃莠之品，必得人参、桂枝以通阳脉，生姜、大枣以和卫营，阿
胶补血，酸枣安神，甘草之缓，不使速下，清酒之猛，捷于上行，内外调和，悸可宁而脉
可复矣。酒七升水八升，只取三升者，久煎之则气不峻，此虚家用酒之法。且知地黄、麦
冬得酒最良。此证当用酸枣仁，肺痿用麻子仁可也。如无真阿胶，以龟版胶代之。
桂枝人参、葛根黄芩黄连二汤合论∶太阳外证未解，而数下之，遂协热而利，利下不止，
表里不解，脉微弱，心不痞硬者，桂枝人参汤主之。桂枝证，医反下之，利遂不止，其脉促喘
而汗出者，葛根黄连黄芩汤主之。
枝枝人参汤
桂枝（四两） 甘草（四两） 人参（三两） 白术（三两） 干姜（三两）
水九升，先煮四味，取五升，内桂更煮三升，日再服，夜一服。
葛根黄芩黄连汤
葛根（半斤） 黄连（三两） 黄芩（三两） 甘草（炙，二两）
水八升，先煮葛根，减二升；内诸药，煮二升，分温再服。
【集注】柯琴曰∶外热不除，是表不解，下利不止，是里不解，病因则同。一以微弱
之脉而心下痞硬，是脉不足而证有余；一以脉促而喘，反汗自出，是脉有余而证不足，表
里虚实，当从脉而辨证矣。弱脉见于数下后，则痞硬为虚。故用理中之辛甘温补，止利消
痞硬，又加桂枝以解表。先煮四味后内桂枝，和中之力饶，而解肌之气锐，是于两解中寓
权宜法也。桂枝证脉本缓，误下后而反促，阳气重，可知邪束于表，阳扰于内。故喘而汗
出，利遂不止者，是暴注下迫，属于热也。故君气清质轻之葛根，以解肌而止利；佐苦寒
清肃之芩连，以止汗而除喘；又加甘草以和中。先煮葛根后内诸药，解肌之力缓，而清
中之气锐，又与补中逐邪者殊法矣。又曰∶上条脉证是阳虚，虽协热于外，而里则虚寒；下
条脉证是阳盛，虽下利不止，而表里俱实。同一协热利，同是表里不解，而寒热虚实攻补
不同。前方理中加桂枝，而冠桂枝于人参之上；后方泻心加葛根，而冠葛根于芩连之首。
不名理中泻心者，总为表未解故耳。补中亦能解表，凉中亦能散表，补中亦能散痞，凉
中亦能止利。仲景制两解方，神化如此。
白虎汤 治阳明证，汗出渴欲饮水，脉洪大浮滑，不恶寒反恶热。
石膏（碎，绵裹，一斤） 知母（六两） 甘草（二两） 粳米（六合）
上四味，以水一斗，煮米熟汤成，去滓，温服一升，日三服。
【注释】桂枝二越婢一汤，就是大青龙汤用杏仁替换芍药而成。名称虽然叫“越婢辅桂枝”，但实际上是大青龙汤的变方。去掉杏仁是因为厌恶它性味辛散而助阳发散，改用芍药是因为它能入阴分且具有酸收之性。以此药替换彼药，经过裁减后使用，主治功效就不同了。以桂枝二分的剂量为主，就不发汗；由此可知，“越婢一分”指的是麻黄和石膏这两味药，不过是取其辛凉的药性，辅助桂枝二分，来调和表邪并清除内热。这就是在不发汗中寓含微汗之意，也可以由此认识其机理。这不像大青龙汤用石膏辅助麻黄作为发汗驱热的重剂。桂枝二麻黄一汤，治疗症状像疟疾，一天发作两次的情况，出汗后必能痊愈，但没有“热多寒少”的症状，所以不用石膏的凉性。桂枝麻黄各半汤，治疗像疟疾一样的症状，热多寒少，且没有用石膏、反而加倍麻黄的用法，这是因为患者面部有郁滞的热色，身体皮肤瘙痒，由此可知热邪不是向里而是向表，让身体通过小汗来顺应病势，所以也不用石膏的清里凉性。桂枝二越婢一汤，治疗发热恶寒，热多寒少的症状，而使用石膏，是因为表邪寒少，肌理内部热多，所以用石膏的凉性，辅助麻黄、桂枝来调和营卫，而不是发越营卫。现在的人一见麻黄、桂枝，不问病情轻重，也不问是否需要温覆取汗，总是不敢使用。这都是因为没有探究张仲景的本意，麻黄、桂枝只是调和营卫的药物。如果是重剂配合温覆取汗，那就是发越营卫的药物；轻剂不温覆取汗，就是调和营卫的药物。
越婢汤：治疗风水证，表现为怕风，全身浮肿，脉浮但不口渴，持续自汗出，体内没有大热的症状。又治疗里水证，表现为全身面目黄肿，脉沉，小便不利，因此导致水肿病。假如小便通利，这是津液耗亡，因此导致口渴。应当用越婢加术汤主治。
麻黄（六两） 石膏（半斤） 生姜（切片，三两） 大枣（掰开，十五枚） 甘草（一两）
若怕风严重，加炮附子一枚。
以上五味药，用水六升，先煮麻黄，去掉上面的浮沫，再加入其他药物，煮取三升药液，分三次服用。
若怕风，加炮附子一枚。
【集注】喻昌说：越婢汤，是展示微发汗而不令大汗出的方剂，大体上是取其通调营卫的作用。麻黄、石膏两味药，一味甘热，一味甘寒，合在一起使用。脾偏于阴，就用甘热来调和；胃偏于阳，就用甘寒来调和。至于风热之阳邪，水寒之阴邪，凡是不调和于中焦脾胃的，都可以使用此方。为什么呢？中焦脾胃不和，就不能将水谷转化为精悍之气来充实营卫。营卫虚弱，那么或寒或热的邪气，都会壅塞经络隧道，不能通达表里。所以在表的风水证用它，而在里的水饮兼有口渴、小便自利的情况，也一定要用它，无非是想让它不伤害中焦脾胃。不伤害中土，自然就能在祸患刚萌芽时消除它。
赵良说：五脏各有其阴阳，唯独脾胃居于中焦，同时属于阴阳两方面。所以土不仅仅生成四气，土也要从四维之后才能形成，不仅仅是火生土而已。于是四方有水寒之阴，就对应于脾；风热之阳，就对应于胃；饮食五味的寒热，凡是进入脾胃的也是如此。一旦相互干扰，就会脾气不和，胃气不清，水谷不能化生精微，从而运行营卫，充实阴阳。甘味是土的本味，所以脾气不和，就用甘热来调和；胃气不清，就用甘寒来清理。麻黄的甘热，走手足太阴经，连接皮肤，在三阴经行气，以祛除阴寒之邪；石膏的甘寒，走手足阳明经，到达肌肉，在三阳经行气，以祛除风热之邪。既然用了它们的味甘以入脾土，用了它们的寒热属性来调和阴阳，用了它们善于走窜的特性来发越脾气，再加上甘草来和中缓急，两药协同而成功。大枣的甘味，补益脾中的血；生姜的辛味，益养胃中的气。怕风的是阳虚，所以加附子以益阳。风水证，则加白术以散皮肤间的风水，使谷精之气宣发以疏通营卫，与麻黄、石膏配合，引导药力入土。越婢这个名字，不也很恰当吗！
【按语】喻昌的论述明晰透彻，赵良的说法，能够细致剖析其原理，启发后学，所以两者都记录下来。
麻黄杏仁甘草石膏汤：治疗温热病由内发出，表里俱热，头痛身疼，不怕冷反而怕热，无汗而喘，非常烦躁且极度口渴，脉象寸关尺都浮大的情况，用此方发汗并清火。如果脉象浮弱或沉紧，沉细且怕冷，自汗出且不口渴的，禁用。
麻黄（去节，四两） 杏仁（去皮尖，五十枚） 甘草（炙，二两） 石膏（打碎，用绵布包裹，半斤）
以上四味药，用水七升，先煮麻黄，减少二升水量，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。
【集注】柯琴说：石膏是清火的重剂，大青龙汤、白虎汤都依靠它建功，但如果使用不当，恰恰足以招致灾祸。所以大青龙汤因为无汗烦躁，得到姜、桂来宣发卫外的阳气；白虎汤因为有汗烦渴，需要粳米来保存胃中的津液。此方只有热没有寒，所以不用姜、桂；喘症不在胃而在肺，所以不需要粳米。其用意重在保存阴液，不必担心亡阳，所以在麻黄汤中去掉桂枝的制约，取麻黄的专于开泄，杏仁的降气，甘草的和缓，加倍使用大寒的石膏，清除内外的实热，这样汗水淋漓地流出，内外的烦热和喘症都消除了。
麻黄附子细辛汤：治疗少阴病刚得病时，反而发热，脉沉，两三天内没有里证的情况。
麻黄（一两） 附子（炮制，一枚） 细辛（二两）
热象轻微的，用甘草替换细辛，微微发汗。
以上三味药，用水一斗，先煮麻黄，减少二升水量，去掉浮沫，加入药物，煮取三升药液，去掉药渣，温服一升，每天服三次。
【集注】柯琴说：少阴主里，应该没有表证；病发于阴，应该有表寒。现在少阴刚开始受寒邪却反而发热，这是有少阴的里证，同时兼有太阳的表证。太阳的表证脉象应该不沉，现在脉沉，这是有太阳的证候，却出现了少阴的脉象。所以身体虽然发热，但脉象却是沉的。因此，太阳病而脉象反而沉，就用四逆汤来急救其里；这里少阴病而体表反而发热，就在解表剂中加入附子来预先固护其里。发热无汗，太阳的表邪不得不发散；脉沉表示病在里，少阴的枢机又不得不固守。如果使用麻黄开腠理，细辛散浮热，而没有附子来固护元阳，那么少阴的津液就会外越，太阳的微阳就会外亡，离死亡就不远了。只有附子与麻黄并用，那么寒邪虽然散去，而阳气不会亡失；这是里病及表，脉沉而应当发汗的情况，与病在表、脉浮而发汗的情况截然不同。如果表热轻微，那么受寒也轻，所以用甘草替换细辛来微微发汗，甘味可以缓急，与辛味发散相比，力度又稍缓和了一些。
桂枝加附子汤：治疗太阳病发汗后，汗漏不止，病人怕风，小便困难，四肢轻微拘急，难以屈伸的情况，此方主治。
桂枝汤加附子一枚（炮制，去皮，破成八片）。
煎服方法相同，不需要喝热粥助汗。
【集注】柯琴说：发汗太过，阳气无所依附停息，导致汗出不止。汗多导致亡阳，玄府（汗孔）不能闭合，风邪乘虚而入，所以再次怕风；津液外泄，不能向下滋润，所以小便困难。四肢是诸阳之本；阳气柔和则养筋，开阖功能失常，风寒随之侵入，所以筋脉拘急而屈伸不利。此方将附子加入桂枝汤中，大补表阳；表阳固密，则漏汗自然停止，怕风自然消失。汗止津回，则小便自利，四肢自然柔和。汗漏不止，与大汗出相同，但从化变病则不同。服用桂枝、麻黄后，大汗出且大烦渴，这是阳陷于里，急需救阴，所以用白虎加人参汤。服用桂枝、麻黄汤，大汗出随即漏不止，这是阳亡于外，急需救阳，所以用桂枝加附子汤。要知道发汗的药剂，使用桂枝不当，则阳陷于里的情况多；使用麻黄不当，则阳亡于外的情况多。因为桂枝汤中有芍药而无麻黄，所以即使汗大出，玄府尚能自行闭合，大多不至于亡阳于外。
芍药甘草附子汤：发汗后病已解除，反而怕冷的，是虚证所致，此方主治。
芍药（三两） 甘草（炙，二两） 附子（炮制，去皮，破成八片，一枚）
以上三味药，用水五升，煮取一升五合药液，去掉药渣，分次温服。
【集注】柯琴说：发汗后病解反而怕冷，比未发汗时更严重，可知其阳虚了。太阳、少阴互为表里，太阳的病，原本是由少阴的虚损，不能藏精而为阳气的守卫所致。现在怕冷反而出现在发汗病解之后，说明寒邪已经从汗而解，太阳阳虚不能卫外而为阴的使者，那么阳亡的征兆已经显现于此。如果没有办法用桂枝汤攻表，非但不能扶阳，反而会亡阳。所以用芍药收敛少阴的精气，甘草缓解阴邪的上行，附子补益坎宫（肾）的少火，只要使肾中的元阳得位，在表的虚阳怕冷自然解除。
桂枝甘草汤：治疗发汗过多，病人双手交叉按住心口，心下悸动，喜欢按压的情况。
以上两味药，用水三升，煮取一升，一次性服用。
【集注】柯琴说：汗出多，则心液虚，中气馁弱，所以心悸。双手交叉按住心口，则外有所护卫，得到按压则内有所依托，如此不堪的状态，望诊即可知其虚。桂枝本是营分药，得到麻黄，则令营气外发而为汗，这是从辛味的作用；得到芍药，则收敛营气而止汗，这是从酸味的作用；得到甘草，则补中气而养血，这是从甘味的作用。所以此方以桂枝为君药，独任甘草为佐药，以补阳气生心液。甘温相合，气血调和，心悸自然平息。不需要附子的原因，是因为汗虽多但未至于亡阳。不需要芍药的原因，是因为汗已止，嫌其阴敛。
桂枝加芍药汤、桂枝加大黄汤：原本是太阳病，医生反而用下法，因而出现腹部胀满、时时疼痛的症状，属于太阴病，用桂枝加芍药汤主治。如果大实痛，用桂枝加大黄汤主治。
桂枝加芍药汤方
在桂枝汤方内，再加芍药三两，与前药共六两，其余依照桂枝汤的方法。
【集注】柯琴说：腹满是太阴、阳明都有的证候，然而部位相同而职能不同。太阴主出，太阴病则腐秽之物排出不利，所以胀满且时时疼痛；阳明主内，阳明病则腐秽燥结而不行，所以大实且痛。大实痛是阳明病，不是太阴病。张仲景因为表证未解，阳邪已陷入太阴，所以倍用芍药以益脾调中，而除去腹满时痛，这是用阴和阳的方法。如果表邪未解，而阳邪陷入阳明，则加大黄以润胃通结，而除去大实痛，这是表里双解的方法。凡是妄用下法必伤胃气，胃气虚则阳邪袭阴，所以转属太阴；胃液枯竭则两阳相搏，所以转属阳明。属太阴则腹满时痛而下利，是阴道虚；属阳明则腹满大实而痛，是阳道实。胀满且时时疼痛，是下利的征兆；大实而痛，是燥屎的特征。所以倍加芍药，稍微变化建中剂的方义；少加大黄，略微显示调胃方的意图。
小建中汤：治疗伤寒表证未解，或者心悸而烦躁，或者腹中急痛，且脉象阳涩阴弦的情况。
桂枝（三两） 芍药（六两） 生姜（切片，三两） 甘草（二两） 胶饴（一斤） 大枣（掰开，十二枚）
以上六味药，用水七升，煮取三升药液，去掉药渣，加入胶饴，再上火熔化溶解，每天服三次。呕吐患者不可用小建中汤，因为甜味会助呕。
【注释】此方，就是桂枝汤倍用芍药加上胶饴。名叫小建中，意思是小小创建中气，因为中焦虽然已虚，但表证尚未调和，不敢大补。所以用桂枝汤仍调和营卫，倍用芍药加胶饴调理建立中州，并且不喝稀粥温服令其出汗，盖其用意重在中间虚损，而不在伤寒的表证。中虚得以建立，营卫自然调和，津液可生，出汗乃解，烦躁心悸可除。伤寒脉浮得涩，是营卫不足；沉得脉弦，是木气入于土中。营卫不足则表虚，木入土中则里急，表虚里急，所以也用此汤主治。呕吐患者不可用，是说凡是呕吐的病人不可用，恐怕甜味助长呕吐。
炙甘草汤：治疗伤寒脉结代，心动悸的情况。又治疗肺痿，咳嗽吐涎沫多，心中温温液液不适的情况。
甘草（炙，四两） 生姜（切片，三两） 桂枝（三两） 麦门冬（半升） 麻子仁（半升）
大枣（掰开，十二枚） 人参（一两） 阿胶（二两） 生地黄（一斤）
以上九味药，用清酒七升，水八升，先煮前八味，取三升药液，去掉药渣，加入阿胶，熔化尽，服一升，每天服三次。
【集注】柯琴说：张仲景对于脉弱阴弱的情况，用芍药以益阴，阳虚的情况，用桂枝以通阳，严重的甚至加人参以生脉，从来没有用地黄、麦冬的。难道是以伤寒之法义重在扶阳吗？还是阴液没有骤补的方法呢？此方因为心虚脉结代，用生地黄为君药，麦冬为臣药，峻补真阴，开创了后学滋阴的路径。地黄、麦冬，味道虽甘但气性寒，不是发陈蕃莠（生长收藏）的品类，必须得到人参、桂枝来通阳脉，生姜、大枣来和营卫，阿胶补血，酸枣仁安神（此处原文似有误，应为阿胶补血，甘草缓急等，但依原文翻译），甘草的缓急作用，不使药力速下，清酒的猛烈，捷于上行，内外调和，心悸可宁，脉象可复。酒七升水八升，只取三升的原因，是久煎则药气不峻烈，这是虚家用酒的方法。并且知道地黄、麦冬得酒最好。此证当用酸枣仁，肺痿用麻子仁是可以的。如果没有真阿胶，可以用龟版胶代替。
桂枝人参汤、葛根黄芩黄连汤二汤合论：太阳外证未解，而多次用下法，遂致协热下利，下利不止，表里不解，脉微弱，心下不痞硬的，用桂枝人参汤主治。桂枝证，医生反而用下法，下利遂不止，脉促喘而汗出的，用葛根黄芩黄连汤主治。
桂枝人参汤
桂枝（四两） 甘草（四两） 人参（三两） 白术（三两） 干姜（三两）
水九升，先煮前四味，取五升，加入桂枝再煮取三升，白天服两次，晚上服一次。
葛根黄芩黄连汤
葛根（半斤） 黄连（三两） 黄芩（三两） 甘草（炙，二两）
水八升，先煮葛根，减少二升水量；加入其他药物，煮取二升，分两次温服。
【集注】柯琴说：外热不除，是表不解；下利不止，是里不解，病因相同。一种是以微弱的脉象且心下痞硬，是脉不足而证有余；一种是以脉促而喘，反汗自出，是脉有余而证不足，表里虚实，应当从脉象来辨证。弱脉见于多次下法之后，则痞硬为虚。所以用理中汤的辛甘温补，止利消痞硬，又加桂枝以解表。先煮前四味后加入桂枝，和中之力雄厚，而解肌之气锐利，这是在两解中寓含权宜之法。桂枝证的脉本缓，误下后反而促，可知阳气重，邪束于表，阳扰于内。所以喘而汗出，下利不止的，是暴注下迫，属于热证。所以用气清质轻的葛根为君药，以解肌而止利；佐以苦寒清肃的黄芩、黄连，以止汗而除喘；又加甘草以和中。先煮葛根后加入其他药物，解肌之力缓，而清中之气锐，又与补中逐邪的方法不同。又说：上条脉证是阳虚，虽然协热于外，但里则是虚寒；下条脉证是阳盛，虽然下利不止，但表里俱实。同样是协热利，同样是表里不解，但寒热虚实攻补不同。前方是理中汤加桂枝，而冠桂枝于人参之上；后方是泻心汤类加葛根，而冠葛根于芩连之首。不名理中、泻心，总归是因为表未解的缘故。补中也能解表，凉中也能散表，补中也能散痞，凉中也能止利。张仲景制定两解方，神妙变化如此。
白虎汤：治疗阳明证，汗出渴欲饮水，脉洪大浮滑，不怕冷反而怕热。
石膏（打碎，用绵布包裹，一斤） 知母（六两） 甘草（二两） 粳米（六合）
以上四味药，用水一斗，煮米熟汤成，去掉药渣，温服一升，每天服三次。
[Note] Guizhi Er Yuebi Yi Tang (Cinnamon Twig Twice and Gecko-Assisting Decoction Once) is essentially Da Qing Long Tang (Major Blue Dragon Decoction) with Xingren (Apricot Seed) replaced by Shaoyao (Peony Root). Although named "Yuebi assisting Guizhi," it is actually a modified version of Da Qing Long Tang. The removal of Xingren is due to its acrid-dispersing nature that aids Yang dispersion, while Shaoyao is used for its ability to enter the Yin aspect and its sour-astringent properties. By substituting one herb for another and adjusting the dosage, the therapeutic indications differ. With Guizhi (Cinnamon Twig) constituting two parts, it does not induce sweating; thus, the "Yuebi one part" refers to Mahuang (Ephedra Herb) and Shigao (Gypsum Fibrosum), merely utilizing their acrid-cool properties to assist the two parts of Guizhi in harmonizing the exterior and clearing heat. This implies inducing slight sweating within the framework of non-sweating therapy, which can be understood from this perspective. It differs from Da Qing Long Tang, where Gypsum assists Ephedra as a heavy formula for inducing sweating and driving out heat.
Guizhi Er Mahuang Yi Tang (Cinnamon Twig Twice and Ephedra Once Decoction) treats symptoms resembling malaria, occurring twice daily, where sweating leads to resolution, but without the "more heat than cold" presentation; hence, Gypsum's cooling property is not used. Guizhi Mahuang Ge Ban Tang (Equal Parts Cinnamon Twig and Ephedra Decoction) treats malaria-like symptoms with more heat than cold, and unlike the previous formula, it does not use Gypsum nor double the Ephedra. This is because the patient presents with a flushed,郁 (stagnant) hot complexion and skin itching, indicating that the heat is moving outward toward the exterior rather than inward. Allowing slight sweating to follow this trend explains why Gypsum's interior-cooling property is also omitted.
Guizhi Er Yuebi Yi Tang treats fever and aversion to cold with more heat than cold, utilizing Gypsum because the exterior pathogen has little coldness while the interior muscle layer has much heat. Thus, Gypsum's coolness assists Mahuang and Guizhi in harmonizing Ying (Nutritive) and Wei (Defensive) Qi, rather than dispersing them. Modern practitioners often hesitate to use Mahuang and Guizhi regardless of severity or whether warming covers are needed to induce sweat. This stems from a failure to explore Zhang Zhongjing's original intent: Mahuang and Guizhi are primarily herbs for harmonizing Ying and Wei Qi. When used in heavy doses with warming covers to induce sweat, they act to disperse Ying and Wei Qi; when used in light doses without warming covers, they act to harmonize Ying and Wei Qi.
Yuebi Tang (Gecko-Assisting Decoction): Treats Fengshui (Wind-Water edema) characterized by aversion to wind, generalized edema, floating pulse, absence of thirst, continuous spontaneous sweating, and no significant internal heat. It also treats Li Shui (Interior Water retention) presenting with yellowish swelling of the face and body, sinking pulse, and difficult urination, leading to water disease. If urination is free, it indicates fluid depletion causing thirst; in such cases, Yuebi Jia Zhu Tang (Gecko-Assisting Decoction plus Atractylodes Macrocephala Rhizome) is indicated.
Mahuang (6 liang), Shigao (0.5 jin), Shengjiang (sliced, 3 liang), Dazao (broken open, 15 pieces), Gancao (1 liang).
If aversion to wind is severe, add Pao Fuzi (Processed Aconite Lateralis Radix Preparata) 1 piece.
Decoct the above five herbs in 6 sheng of water, boil Mahuang first to remove foam, then add other herbs. Boil until 3 sheng remain, divide into three doses.
[Collected Notes] Yu Chang stated: Yuebi Tang demonstrates a method of mild diaphoresis without excessive sweating, primarily aiming to unblock and harmonize Ying and Wei Qi. Mahuang and Shigao, one sweet-warm and one sweet-cool, are combined. If Spleen Yin is偏 (biased/excessive), sweet-warm herbs harmonize it; if Stomach Yang is biased, sweet-cool herbs clear it. For wind-heat Yang pathogens and water-cold Yin pathogens failing to harmonize in the Middle Jiao (Earth), this formula applies. Why? If the Middle Jiao is disharmonious, grain and water cannot transform their essence into robust Qi to fill Ying and Wei. Deficient Ying and Wei allow cold or heat pathogens to block meridians, preventing communication between interior and exterior. Hence, it is used for exterior Fengshui and interior water retention with thirst and free urination, aiming to protect the Middle Jiao Earth. Protecting the Middle ensures hazards are eliminated at their inception.
Zhao Liang stated: Each of the Five Zang organs has its own Yin-Yang, but Spleen and Stomach reside centrally and belong to both. Earth generates the four seasons but also relies on the four directions to complete its cycle, not just Fire generating Earth. Water-cold Yin from the four directions corresponds to Spleen; wind-heat Yang corresponds to Stomach. Dietary flavors entering Spleen and Stomach behave similarly. Interference causes Spleen Qi disharmony and Stomach Qi turbidity, preventing transformation of nutrients to nourish Ying, Wei, and Yin-Yang. Sweet is the flavor of Earth; thus, Spleen disharmony is harmonized with sweet-warm, and Stomach turbidity cleared with sweet-cool. Mahuang's sweet-warm nature travels through Foot-Hand Taiyin meridians, connecting to skin and circulating Qi in Three Yin to dispel cold-damp. Shigao's sweet-cool nature travels through Foot-Hand Yangming meridians, reaching muscles and circulating Qi in Three Yang to dispel wind-heat. Using their sweet flavor to enter Earth, their cool/warm nature to harmonize Yin/Yang, and their penetrating nature to stimulate Spleen Qi, aided by Gancao to moderate urgency, achieves success. Dazao's sweetness tonifies Spleen blood; Shengjiang's pungency benefits Stomach Qi. Aversion to wind indicates Yang deficiency, so Fuzi tonifies Yang. For Fengshui, Baizhu disperses wind-water in the skin, promoting grain essence to circulate Ying-Wei, working with Mahuang and Shigao to guide action into Earth. Hence, the name Yuebi is fitting.
[Commentary] Yu Chang's analysis is clear; Zhao Liang's explanation details the principles, enlightening future students, so both are recorded.
Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction): Treats warm-heat originating internally with exterior-interior heat, headache, body ache, aversion to heat rather than cold, anhidrosis with wheezing, severe restlessness and thirst, and floating pulses at all positions. Use this to induce sweating and clear fire. Contraindicated if pulse is floating-weak or deep-tight/deep-thin with aversion to cold, spontaneous sweating, and no thirst.
Mahuang (de-stemmed, 4 liang), Xingren (skin and tip removed, 50 seeds), Gancao (honey-fried, 2 liang), Shigao (crushed, wrapped in cloth, 0.5 jin).
Decoct the four herbs in 7 sheng of water, boil Mahuang first to reduce by 2 sheng, remove foam, add other herbs, boil to 2 sheng, strain, take 1 sheng warm.
[Collected Notes] Ke Qin stated: Shigao is a heavy agent for clearing fire, essential for Da Qing Long Tang and Bai Hu Tang. Improper use invites disaster. Da Qing Long Tang uses Jiang (Ginger) and Gui (Cinnamon) to disseminate Wei Yang for anhidrotic irritability; Bai Hu Tang uses Jingmi (Rice) to preserve Stomach fluids for sudorific thirst. This formula has heat only, no cold, so no Ginger/Cinnamon; wheezing is in Lung, not Stomach, so no Rice. The focus is preserving Yin, not worrying about Yang loss. Removing Guizhi from Mahuang Tang allows Mahuang to open exclusively, Xingren to descend, Gancao to harmonize, and doubled Shigao to clear interior-exterior excess heat. Profuse sweating ensues, resolving heat, restlessness, and wheezing.
Mahuang Fuzi Xixin Tang (Ephedra, Processed Aconite, and Asarum Decoction): Treats Shaoyin disease onset with contrary fever and deep pulse, without interior signs after 2-3 days.
Mahuang (1 liang), Pao Fuzi (1 piece), Xixin (2 liang).
For mild heat, replace Xixin with Gancao for mild sweating.
Decoct the three herbs in 1 dou of water, boil Mahuang first to reduce by 2 sheng, remove foam, add other herbs, boil to 3 sheng, strain, take 1 sheng warm, three times daily.
[Collected Notes] Ke Qin stated: Shaoyin governs the interior and should lack exterior signs; Yin diseases should have exterior cold. Here, Shaoyin receives cold pathogen yet shows fever, indicating Shaoyin interior involvement with Taiyang exterior manifestation. Taiyang exterior pulse should not be deep; a deep pulse here indicates Taiyang signs with Shaoyin pulse characteristics. Thus, fever with deep pulse. In Taiyang disease with deep pulse, Sini Tang (Frigid Extremities Decoction) saves the interior urgently. Here, in Shaoyin disease with exterior fever, Fuzi is added to exterior formulas to secure the interior preemptively. Fever without sweat requires opening Taiyang pores; deep pulse requires securing Shaoyin pivot. Using Mahuang and Xixin without Fuzi risks Shaoyin fluid loss and Taiyang Yang collapse. Combining Fuzi with Mahuang disperses cold without Yang loss. This interior-disease-invading-exterior case with deep pulse requiring sweating contrasts sharply with exterior diseases with floating pulses requiring sweating. For mild exterior heat (lighter cold invasion), Gancao replaces Xixin for milder sweating, balancing sweet moderation with acrid dispersion.
Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Processed Aconite): Treats Taiyang disease post-diaphoresis with persistent leakage sweating, aversion to wind, difficulty urinating, slight rigidity of limbs, and difficulty flexing/extending.
Guizhi Tang plus Pao Fuzi (peeled, broken into 8 pieces, 1 piece).
Decoction and administration same as Guizhi Tang; do not drink warm porridge.
[Collected Notes] Ke Qin stated: Excessive sweating leaves Yang unsupported, causing continuous leakage. Sweating depletes Yang, leaving pores open for wind invasion, causing renewed aversion to wind. Fluid loss prevents downward lubrication, causing urinary difficulty. Limbs are the root of Yang; Yang softens tendons. Dysfunction of opening/closing allows wind-cold to invade, causing tendon rigidity. Adding Fuzi to Guizhi Tang greatly tonifies Exterior Yang. Secured Exterior Yang stops leakage and aversion to wind. Cessation of sweating restores fluids, normalizing urination and limb flexibility. While similar to massive sweating, the pathological transformation differs. Post-Guizhi/Mahuang massive sweating with thirst indicates Yang sinking interiorly, requiring Yin rescue via Baitu Jia Renshen Tang. Post-Guizhi/Mahuang leakage sweating indicates Yang collapsing externally, requiring Yang rescue via Guizhi Jia Fuzi Tang. Improper Guizhi use often sinks Yang interiorly; improper Mahuang use often collapses Yang externally. Guizhi Tang contains Shaoyao but lacks Mahuang, allowing pores to close even with heavy sweating, preventing external Yang collapse.
Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Processed Aconite Decoction): Treats post-diaphoresis resolution with contrary aversion to cold, indicating deficiency.
Shaoyao (3 liang), Gancao (honey-fried, 2 liang), Pao Fuzi (peeled, broken into 8 pieces, 1 piece).
Decoct the three herbs in 5 sheng of water to 1.5 sheng, strain, take warm in divided doses.
[Collected Notes] Ke Qin stated: Post-diaphoresis aversion to cold worsening indicates Yang deficiency. Taiyang and Shaoyin are interior-exterior pairs; Taiyang disease often stems from Shaoyin deficiency failing to store essence and guard Yang. Aversion to cold appearing after resolution indicates cold pathogen resolved via sweat, but Taiyang Yang deficiency fails to guard exterior. Signs of Yang collapse appear. Without Guizhi Tang to attack exterior (which would further deplete Yang), this formula uses Shaoyao to gather Shaoyin essence, Gancao to restrain rising Yin pathogen, and Fuzi to tonify Kan Palace (Kidney) minor fire. Restoring Kidney Yuan Yang resolves exterior deficiency-induced aversion to cold.
Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction): Treats excessive diaphoresis resulting in patient crossing hands over heart, epigastric palpitations, and desire for pressure.
Guizhi (4 liang), Gancao (honey-fried, 2 liang).
Decoct the two herbs in 3 sheng of water to 1 sheng, take in one dose.
[Collected Notes] Ke Qin stated: Excessive sweating depletes Heart fluid and weakens Middle Qi, causing palpitations. Crossing hands provides external protection; pressure provides internal support, clearly indicating deficiency. Guizhi acts on Ying level: with Mahuang, it disperses Ying Qi outward as sweat (acrid); with Shaoyao, it constrains Ying Qi to stop sweat (sour); with Gancao, it tonifies Middle Qi and nourishes blood (sweet). Here, Guizhi is Sovereign, Gancao is Assistant, tonifying Yang Qi and generating Heart fluid. Sweet-warm synergy harmonizes Qi-Blood, calming palpitations. Fuzi is unnecessary as Yang has not collapsed; Shaoyao is unnecessary as sweating has stopped and Yin constraint is undesirable.
Guizhi Jia Shaoyao Tang and Guizhi Jia Dahuang Tang: Original Taiyang disease treated incorrectly with purgation, leading to abdominal fullness and intermittent pain, classified as Taiyin disease, treated with Guizhi Jia Shaoyao Tang. For severe constipation/pain, use Guizhi Jia Dahuang Tang.
Guizhi Jia Shaoyao Tang Formula: Add 3 liang Shaoyao to Guizhi Tang, totaling 6 liang Shaoyao. Follow Guizhi Tang preparation.
Guizhi Jia Dahuang Tang Formula: Add 1 liang Dahuang (Rhubarb Root) to Guizhi Jia Shaoyao Tang.
[Collected Notes] Ke Qin stated: Abdominal fullness occurs in both Taiyin and Yangming. Taiyin governs output; dysfunction causes stagnation of rotting filth, leading to fullness and intermittent pain. Yangming governs intake; dysfunction causes dryness and obstruction, leading to severe fullness and pain. Severe pain indicates Yangming, not Taiyin. Zhang Zhongjing addresses unresolved exterior with Yang pathogen sinking into Taiyin by doubling Shaoyao to benefit Spleen and harmonize Middle, relieving fullness/pain (using Yin to harmonize Yang). If exterior pathogen remains and Yang sinks into Yangming, Dahuang moistens Stomach and unblocks obstruction, relieving severe pain (simultaneous release of exterior and interior). Incorrect purgation damages Stomach Qi; deficiency allows Yang pathogen to invade Yin (Taiyin); fluid depletion causes Yang clash (Yangming). Taiyin presents with fullness/intermittent pain and lower deficiency; Yangming presents with severe fullness/pain and upper excess. Intermittent pain signals diarrhea; severe pain signals dry stool. Doubling Shaoyao slightly modifies Jianzhong (Establish the Middle) formula; adding Dahuang subtly indicates Tiaowei (Regulate Stomach) approach.
Xiao Jianzhong Tang (Minor Construct the Middle Decoction): Treats Shanghan with unresolved exterior, palpitations with irritability, or acute abdominal pain with floating-choppy and sinking-string-taut pulses.
Guizhi (3 liang), Shaoyao (6 liang), Shengjiang (sliced, 3 liang), Gancao (2 liang), Jiaoyi (Malt Sugar, 1 jin), Dazao (broken open, 12 pieces).
Decoct six herbs in 7 sheng of water to 3 sheng, strain, add Jiaoyi, melt over heat, take three times daily. Vomiting patients should avoid this due to sweetness aggravating vomiting.
[Note] This is Guizhi Tang with doubled Shaoyao and added Jiaoyi. Named Xiao Jianzhong (Minor Construct Middle) because it gently builds Middle Qi; although Middle is deficient, exterior is unharmonized, so heavy tonification is avoided. Guizhi Tang harmonizes Ying-Wei; doubled Shaoyao and Jiaoyi regulate Middle. No warm porridge is drunk to induce sweat, as the focus is Middle deficiency, not exterior Shanghan. Establishing Middle harmonizes Ying-Wei, generates fluids, induces sweat, and resolves irritability/palpitations. Floating-choppy pulse indicates Ying-Wei insufficiency; sinking-string-taut pulse indicates Wood invading Earth. Ying-Wei deficiency causes exterior deficiency; Wood invading Earth causes interior tension. Hence, this formula treats both. Avoid in vomiting patients as sweetness may worsen it.
Zhi Gancao Tang (Honey-Fried Licorice Decoction): Treats Shanghan with knotted/intermittent pulse and palpitations. Also treats Fei Wei (Lung Atrophy) with copious sputum and warm, fluid discomfort in the chest.
Gancao (honey-fried, 4 liang), Shengjiang (sliced, 3 liang), Guizhi (3 liang), Maidong (Ophiopogon Tuber, 0.5 sheng), Maziren (Hemp Seed, 0.5 sheng), Dazao (broken open, 12 pieces), Renshen (Ginseng Root, 1 liang), Ejiao (Donkey-hide Gelatin, 2 liang), Shengdihuang (Rehmannia Root, 1 jin).
Decoct nine herbs in 7 sheng Qingjiu (Clear Wine) and 8 sheng water. Boil eight herbs first to 3 sheng, strain, add Ejiao, melt completely, take 1 sheng, three times daily.
[Collected Notes] Ke Qin stated: Zhang Zhongjing uses Shaoyao for weak Yin pulses, Guizhi for Yang deficiency, and Renshen for severe cases to generate pulse, rarely using Dihuang or Maidong. Is Shanghan theory focused on tonifying Yang? Or is there no rapid method to tonify Yin? This formula uses Shengdihuang as Sovereign and Maidong as Minister for severe True Yin tonification in Heart deficiency with knotted pulse, pioneering Yin-nourishing methods. Dihuang and Maidong are sweet-cool, not suitable for growth/storage cycles; they require Renshen and Guizhi to unblock Yang pulses, Shengjiang and Dazao to harmonize Ying-Wei, Ejiao to nourish blood, and Gancao to slow descent. Qingjiu promotes rapid ascent. Internal-external harmony calms palpitations and restores pulse. Using large amounts of wine/water to yield small volume ensures gentle action for deficiency cases, optimizing Dihuang/Maidong efficacy. Suanzao Ren (Sour Jujube Seed) is appropriate for this condition; Maziren is suitable for Lung Atrophy. If true Ejiao is unavailable, Guiban Jiao (Tortoise Shell Gelatin) may substitute.
Discussion on Guizhi Renshen Tang and Gegen Huangqin Huanglian Tang: Taiyang exterior signs unresolved, followed by multiple purgations, leading to協熱利 (Collaborative Heat Diarrhea), continuous diarrhea, unresolved exterior-interior, weak pulse, and no epigastric hardness, treated with Guizhi Renshen Tang. For Guizhi pattern, incorrect purgation leads to continuous diarrhea, rapid pulse, wheezing, and sweating, treated with Gegen Huangqin Huanglian Tang.
Guizhi Renshen Tang
Guizhi (4 liang), Gancao (4 liang), Renshen (3 liang), Baizhu (Atractodis Macrocephalae Rhizoma, 3 liang), Ganjiang (Dried Ginger, 3 liang).
Water 9 sheng, boil first four herbs to 5 sheng, add Guizhi, boil to 3 sheng. Take twice day, once night.
Gegen Huangqin Huanglian Tang
Gegen (Puerariae Lobatae Radix, 0.5 jin), Huanglian (Coptidis Rhizoma, 3 liang), Huangqin (Scutellariae Radix, 3 liang), Gancao (honey-fried, 2 liang).
Water 8 sheng, boil Gegen first to reduce by 2 sheng, add other herbs, boil to 2 sheng, take warm in two doses.
[Collected Notes] Ke Qin stated: Persistent exterior heat indicates unresolved exterior; continuous diarrhea indicates unresolved interior. Etiology is same. One presents with weak pulse and epigastric hardness (pulse insufficient, signs excessive); the other with rapid pulse, wheezing, sweating (pulse excessive, signs insufficient). Exterior-interior deficiency-excess must be differentiated by pulse. Weak pulse post-purgation indicates deficiency-hardness. Lizhong Tang's acrid-sweet-warm tonification stops diarrhea and resolves hardness, plus Guizhi for exterior. Boiling four herbs first then adding Guizhi enhances middle-harmonizing power while maintaining exterior-dispersing sharpness, a flexible approach in dual resolution. Guizhi pattern pulse is normally slow; post-purgation rapid pulse indicates heavy Yang, pathogen binding exterior, Yang disturbing interior. Wheezing, sweating, and diarrhea indicate acute watery diarrhea, a heat syndrome. Gegen (clear/light) resolves muscle and stops diarrhea; Huangqin/Huanglian (bitter-cool) stops sweating and wheezing; Gancao harmonizes middle. Boiling Gegen first then adding others slows muscle-resolving power but sharpens interior-clearing action, differing from tonifying-middle approaches. Upper case: Yang deficiency, collaborative heat exterior but cold-deficient interior. Lower case: Yang excess, continuous diarrhea but solid exterior-interior. Same collaborative heat diarrhea, same unresolved exterior-interior, but different cold/heat/deficiency/excess treatments. Former adds Guizhi to Lizhong, naming Guizhi first; latter adds Gegen to Xie Xin variants, naming Gegen first. Not named Lizhong/Xie Xin because exterior is unresolved. Tonifying middle can resolve exterior; cooling middle can scatter exterior; tonifying middle can resolve hardness; cooling middle can stop diarrhea. Zhang Zhongjing's dual-resolution formulas demonstrate such divine adaptation.
Bai Hu Tang (White Tiger Decoction): Treats Yangming syndrome with sweating, thirst for water, flooding-floating-slippery pulse, aversion to heat rather than cold.
Shigao (crushed, wrapped, 1 jin), Zhimu (Anemarrhenae Rhizoma, 6 liang), Gancao (2 liang), Jingmi (Rice, 6 he).
Decoct four herbs in 1 dou of water until rice is cooked and soup is ready, strain, take 1 sheng warm, three times daily.