治伤寒有汗。
桂枝尖（三钱） 生杭芍（三钱） 甘草（钱半） 生姜（三钱） 大枣（三枚，掰开） 生黄 （三钱）
知母（三钱） 防风（二钱）
煎汤一茶盅，温服复被，令一时许，遍身 微似有汗者益佳。不可如水流漓，病必不除。禁生冷、粘滑、
肉面、五辛、酒酪及臭恶等物。
桂枝汤为治伤风有汗之方。释者谓风伤营则有汗，又或谓营分虚损，即与外邪相感召。斯说也，愚尝疑之。
人之营卫，皆为周身之外廓。卫譬则郭也，营譬则城也，有卫以为营之外围，外感之邪，何能越卫而伤营乎？
盖人之胸中大气，息息与卫气相关，大气充满于胸中，则饶有吸力，将卫气吸紧，以密护于周身，捍御外感，
使不得着体，即或着体，亦止中于卫，而不中于营，此理固显然也。有时胸中大气虚损，不能吸摄卫气，卫气
散漫，不能捍御外邪，则外邪之来，直可透卫而入营矣。且愚临证实验以来，凡胸中大气虚损，或更下陷者，
其人恒大汗淋漓，拙拟升陷汤下，载有数案，可参观也。是知凡桂枝汤证，皆因大气
虚损，其汗先有外越之机，而外邪之来，又乘卫气之虚，直透营分，扰其营中津液，外泄而为汗也。究之，风
寒原不相离，即系伤风，其中原挟有寒气，若但中于卫则亦能闭汗矣。故所用桂枝汤中，不但以祛风为务，而
兼有散寒之功也。
陈古愚曰∶“桂枝辛温，阳也。芍药苦平，阴也。桂枝又得生姜之辛，同气相求，可恃之调周身之阳气。
芍药而得大枣、甘草之甘苦化合，可恃之以滋周身之阴液。既取大补阴阳之品，养其汗源，为胜邪之本，又啜
粥以助之，取水谷之津以为汗，汗后毫不受伤，所谓立身于不败之地，以图万全也。”按∶此解甚超妙，而于啜
粥之精义，犹欠发挥。如谓取水谷之津，以为汗，而人无伤损，他发汗药，何以皆不啜粥？盖桂枝汤所主之证，
乃外感兼虚之证，所虚者何？胸中大气是也。《内经》曰∶“谷始入于胃，其精微者，先出于胃之两焦，以溉
五脏，别出两行营卫之道，其大气之抟而不行者，积于胸中，命曰气海。”由斯观之，大气虽本于先天，实赖
后天水谷之气培养而成。桂枝汤证，既因大气虚损，致卫气漫散，邪得越卫而侵营，故于服药之后，即啜热粥，
能补助胸中大气以胜邪，兼能宣通姜、桂以逐邪，此诚战则必胜之良方也。乃后世医者忽不加察，虽用其方，
多不啜粥，致令服后无效，病转深陷，故王清任《医林改错》深诋桂枝汤无用，非无用也，不啜粥故也。是以
愚用此方时，加黄 升补大气，以代粥补益之力，防风宣通营卫，以代粥发表之力，服后啜粥固佳，即不啜粥，
亦可奏效。而又恐黄 温补之性，服后易至生热，故又加知母，以预为之防也。
按∶凡服桂枝汤原方，欲其出汗者，非啜粥不效。赵晴初曰∶族侄柏堂，二十一岁时，酒后寐中受风，遍
身肌肤麻痹，搔之不知疼痒，饮食如常。时淮阴吴鞠通适寓伊芳家，投以桂枝汤，桂枝五钱、白芍四钱、甘草三
钱、生姜三片、大枣两枚，水三
杯，煎二杯，先服一杯，得汗止后服，不汗再服。并嘱弗夜膳，临睡腹觉饥，服药一杯，须臾啜热稀粥一碗，
复被取汗。柏堂如其法，只一服，便由头面至足，遍身 得微汗，汗到处，一手搔之，辄知疼痒，次日病若
失。观此医案，知欲用桂枝汤原方发汗者，必须啜粥，若不啜粥，即能发汗，恐亦无此功效。
或问∶桂枝汤证，其原因既为大气虚损，宜其阳脉现微弱之象，何以其脉转阳浮而阴弱乎？答曰∶人之
一身，皆气之所撑悬也。此气在下焦为元气，在中焦为中气，在上焦为大气，区域虽分，而实一气贯注。故一
身之中，无论何处气虚，脉之三部，皆现弱象。今其关前之脉，因风而浮，转若不见其弱，而其关后之脉，仍
然微弱，故曰阳浮而阴弱也。如谓阴弱为下焦阴虚，则其脉宜兼数象。而愚生平所遇此等证，其脉多迟缓，不
及四至，其为气分虚损，而非阴分虚损可知。即所谓啬啬恶寒、淅淅恶风，翕翕发热，亦皆气分怯弱之形状也。
桂枝尖（三钱） 生杭芍（三钱） 甘草（一钱半） 生姜（三钱） 大枣（三枚，掰开） 生黄芪（三钱） 知母（三钱） 防风（二钱）
煎煮成一杯茶盅量的药汤，温服后覆盖衣被，约一小时左右，以全身微微似有汗出为最佳。不可让汗出如水流漓，否则病邪必然不能去除。禁食生冷、粘滑、肉类面食、五辛、酒酪及气味臭恶等食物。
桂枝汤是治疗伤风表虚有汗的方剂。解释者认为，风邪伤及营分则会有汗出；又有人说是营分虚损，从而与外邪相互感召。这种说法，我曾对此表示怀疑。
人的营气和卫气，都是周身的外围屏障。卫气好比城墙外的郭城，营气好比内城，有了卫气作为营气的外围保护，外感邪气，怎么能越过卫气而伤害营气呢？
大概是因为人的胸中大气，每一息都与卫气密切相关。当胸中大气充满时，便具有强大的吸力，将卫气紧紧吸附，以严密地护卫周身，抵御外感邪气，使邪气不得附着于体表；即使邪气附着于体表，也只会侵犯卫气，而不会侵犯营气，这个道理显然是显而易见的。有时胸中大气虚损，不能吸附固摄卫气，导致卫气散漫，无法抵御外邪，那么外邪来袭时，就能直接穿透卫气而入侵营分了。况且我临证实验以来，凡是胸中大气虚损，或者进一步下陷的患者，其人往往大汗淋漓，我在《升陷汤》下方记载了几个医案，可以参考。由此可知，凡是桂枝汤证，都是因为胸中大气虚损，其汗先有向外越出的趋势，而外邪来袭时，又乘卫气之虚，直接透入营分，扰乱营中的津液，使其外泄而为汗。究其根本，风寒原是不分离的，即使是伤风，其中原本就挟带有寒气，如果仅仅侵犯卫气，也能闭塞汗孔导致无汗。所以所用的桂枝汤中，不仅以祛风为主要任务，而且兼有散寒的功效。
陈古愚说：“桂枝味辛性温，属阳。芍药味苦性平，属阴。桂枝又得到生姜的辛味相助，同气相求，可以依靠它来调和周身的阳气。芍药得到大枣、甘草的甘苦化合，可以依靠它来滋养周身的阴液。既然选取大补阴阳的药物，养护汗源，作为战胜邪气的根本，又喝热粥来辅助它，利用水谷的精微津液化为汗，出汗后身体丝毫不受损伤，这就是所谓立于不败之地，以求万全。”按：这个解释非常精妙，但对于喝热粥的精义，还有欠缺发挥的地方。如果说利用水谷津液化为汗，而人不受伤，为什么其他发汗药都不需要喝粥呢？原来桂枝汤所主治的病证，乃是外感兼有内虚的病证，所虚的是什么？就是胸中大气。《内经》说：“谷物刚进入胃中，它的精微物质，先从胃的两焦分出，以灌溉五脏，另外分出两条途径，即营和卫的运行之道，其中聚结而不运行的大气，积聚在胸中，命名为气海。”由此看来，大气虽然本源于先天，但实际上依赖后天水谷之气培养而成。桂枝汤证，既因大气虚损，导致卫气散漫，邪气得以越过卫气而侵入营分，所以在服药之后，立即喝热粥，能够补助胸中大气以战胜邪气，同时又能宣通姜、桂的药力以驱逐邪气，这确实是战则必胜的好方子。然而后世医生疏忽不加考察，虽然使用这个方子，大多不喝热粥，导致服药后无效，病情反而深陷，所以王清任在《医林改错》中深深诋毁桂枝汤无用，并非桂枝汤无用，而是因为不喝热粥的缘故。因此，我使用此方时，加入黄芪升补大气，以代替喝粥的补益力量；加入防风宣通营卫，以代替喝粥的发散力量，服药后喝热粥固然好，即使不喝热粥，也可以奏效。而又担心黄芪温补的性质，服药后容易生热，所以又加入知母，以预先防止这种情况发生。
按：凡是服用桂枝汤原方，想要让它出汗的，如果不喝热粥就没有效果。赵晴初说：我的族侄柏堂，二十一岁时，酒后睡觉时受风，全身肌肤麻痹，搔抓也不知道疼痒，饮食正常。当时淮阴人吴鞠通恰好寓居在他家，投予桂枝汤，桂枝五钱、白芍四钱、甘草三钱、生姜三片、大枣两枚，水三杯，煎取两杯，先喝一杯，出汗后停止服用，不出汗再喝。并嘱咐不要吃夜饭，临睡前肚子觉得饿，喝下一杯药，一会儿喝一碗热稀粥，盖好被子取汗。柏堂按照这个方法，只服了一次，就从头面到脚，全身得到微微汗出，汗出的地方，用手一搔，就知道疼痒了，第二天病就好了。看这个医案，知道想要用桂枝汤原方发汗的，必须喝热粥，如果不喝热粥，即使能出汗，恐怕也没有这样的功效。
有人问：桂枝汤证，其原因既然是大气虚损，按理其阳脉应该呈现微弱之象，为什么它的脉象反而是阳浮而阴弱呢？回答说：人的全身，都是由气来支撑悬挂的。这股气在下焦称为元气，在中焦称为中气，在上焦称为大气，区域虽然分开，但实际是一气贯通的。所以一身之中，无论哪里气虚，脉的寸关尺三部，都会呈现虚弱之象。现在他关前（寸部）的脉，因为风邪而浮起，看起来似乎看不出虚弱，而他关后（尺部）的脉，仍然微弱，所以说阳浮而阴弱。如果说阴弱是指下焦阴虚，那么脉象应该兼见数象。而我平生遇到的这类证候，脉多迟缓，不足四至，这明显是气分虚损，而不是阴分虚损。至于所说的怕冷像瑟缩一样，怕风像淋雨一样，发热像羽毛覆盖一样，也都是气分怯弱的表现形状。
Treatment for Taiyang disease (Taiyang syndrome) with sweating.
Guizhi Jian (Cinnamon Twig Tip, 3 qian), Sheng Hangshao (Raw Paeoniae Radix Alba, 3 qian), Gancao (Licorice Root, 1.5 qian), Shengjiang (Fresh Ginger, 3 qian), Dazao (Jujube Fruit, 3 pieces, split open), Sheng Huangqi (Raw Astragali Radix, 3 qian), Zhimu (Anemarrhenae Rhizoma, 3 qian), Fangfeng (Saposhnikoviae Radix, 2 qian).
Decoct in water to obtain one teacupful of decoction. Take warm and cover with blankets. After about one hour, slight general sweating is ideal. Do not allow profuse sweating like flowing water, otherwise the pathogenic factor will certainly not be eliminated. Avoid raw/cold foods, sticky/slippery foods, meat/noodles, five pungent spices, wine/dairy products, and foul-smelling substances.
Guizhi Tang (Cinnamon Twig Decoction) is a formula for treating Shangfeng (Wind-stroke) with sweating. Commentators state that when Wind damages Ying (Nutrient level), sweating occurs; others suggest that deficiency in Ying allows it to resonate with external pathogens. I have always doubted this theory.
Ying (Nutrient level) and Wei (Defensive level) constitute the outer barriers of the body. Wei is like the outer wall, while Ying is like the inner city. With Wei protecting Ying from the outside, how can external pathogens bypass Wei to damage Ying?
The Daqi (Pivotal Qi) in the chest is intimately related to Wei at every breath. When Daqi fills the chest, it possesses suction power, drawing Wei tightly to protect the body densely, defending against external pathogens, preventing them from attaching to the body. Even if they attach, they only affect Wei, not Ying. This principle is obvious. However, when Daqi in the chest is deficient and cannot hold Wei, Wei becomes scattered and unable to defend against external pathogens. Consequently, external pathogens can penetrate Wei directly into Ying. In my clinical experience, patients with deficient or sinking Daqi often suffer from profuse sweating. Several cases are recorded under Shengxian Tang (Ascending the Sinking Decoction) for reference. Thus, all Guizhi Tang patterns result from Daqi deficiency. The sweating indicates a tendency for fluids to escape outward, and the external pathogen, taking advantage of Wei's weakness, penetrates Ying, disturbing Ying fluids which then leak out as sweat. Fundamentally, Wind and Cold are inseparable; even in Wind-strike, Cold is present. If only Wei were affected, it could close the pores and prevent sweating. Therefore, Guizhi Tang not only dispels Wind but also scatters Cold.
Chen Guyu stated: "Guizhi is acrid and warm, Yang. Shaoyao is bitter and neutral, Yin. Guizhi combined with the acridity of Shengjiang seeks its kind, regulating Yang Qi throughout the body. Shaoyao combined with the sweet/bitter nature of Dazao and Gancao nourishes Yin fluids throughout the body. By using herbs that greatly tonify Yin and Yang to nourish the source of sweat, serving as the foundation for overcoming pathogens, and drinking hot congee to assist, utilizing Jingwei (Essence and Wei) fluids to form sweat without damaging the body, one stands on unassailable ground for perfection." While this explanation is profound, it fails to fully elaborate on the essence of drinking congee. If consuming grain fluids forms sweat without injury, why do other diaphoretic formulas not require congee? The pattern treated by Guizhi Tang is an exterior excess with interior deficiency. What is deficient? The Daqi in the chest. The *Neijing* states: "When food enters the stomach, its refined essence first emerges from the two Jiao of the stomach to irrigate the Zang-fu organs, separating into two pathways for Ying and Wei. The Daqi that gathers and does not circulate accumulates in the chest, named Qi Hai (Sea of Qi)." Thus, although Daqi originates from congenital essence, it relies on postnatal Qi from food and drink for cultivation. In Guizhi Tang patterns, Daqi deficiency causes Wei to scatter, allowing pathogens to bypass Wei and invade Ying. Drinking hot congee after medication supplements Daqi to overcome pathogens and aids Jiang/Gui in dispersing pathogens. This is indeed a winning formula. Later physicians neglected this, often omitting congee, leading to treatment failure and deepening illness. Wang Qingren criticized Guizhi Tang as useless in *Yilin Gaicuo*, but it is not useless; it is ineffective due to the omission of congee. Therefore, I add Huangqi to ascend and tonify Daqi, replacing the tonic effect of congee, and Fangfeng to circulate Ying and Wei, replacing the dispersing effect of congee. Drinking congee is beneficial, but effective even without it. To prevent heat generation from Huangqi's warming nature, I add Zhimu as a precaution.
Note: For the original Guizhi Tang to induce sweating, drinking congee is essential. Zhao Qingchu reported: His nephew Botang, aged 21, caught wind while sleeping after drinking alcohol. His skin was numb and insensitive to pain/itch, though appetite was normal. Wu Jutong, staying nearby, prescribed Guizhi Tang: Guizhi 5 qian, Baishao 4 qian, Gancao 3 qian, Shengjiang 3 slices, Dazao 2 pieces. Water 3 cups, decocted to 2 cups. Drink one cup; stop if sweating occurs, continue if not. Advised against dinner; take medicine when hungry before sleep, followed immediately by a bowl of hot thin congee, then cover to induce sweat. Botang followed this method. After one dose, he sweated slightly from head to toe. Wherever he sweated, scratching induced sensation. The next day, the illness vanished. This case confirms that to use Guizhi Tang for sweating, congee is mandatory. Without it, even if sweating occurs, the efficacy is lacking.
Question: Since Guizhi Tang patterns stem from Daqi deficiency, shouldn't the Yang pulse appear weak? Why is it floating on the Yang position (Cun) and weak on the Yin position (Chi)? Answer: The entire body is supported by Qi. This Qi is Yuanqi (Original Qi) in the Lower Jiao, Zhongqi (Middle Qi) in the Middle Jiao, and Daqi in the Upper Jiao. Though regions differ, Qi is continuous. Thus, Qi deficiency anywhere manifests as weakness in all three pulse positions (Cun, Guan, Chi). Here, the Cun pulse floats due to Wind, masking the weakness, while the Chi pulse remains weak, hence "Yang floating and Yin weak." If Yin weakness indicated Lower Jiao Yin deficiency, the pulse would likely be rapid. However, such cases typically present with slow pulses (less than four beats per breath), indicating Qi deficiency rather than Yin deficiency. Symptoms like aversion to cold (se se), aversion to wind (xi xi), and fever (xi xi) are manifestations of Qi deficiency and timidity.