于桂枝汤方内。去桂枝。加茯苓白术各三两。余根据前法煎服。小便利则愈。
王宇泰云。或问头项强痛。此邪气仍在表也。虽经汗下而未解。何故去桂加茯苓白
术。是无意于表也。曰、此非桂枝证。乃属饮家也。夫头项强痛。既经汗下而
不解。心下满而微痛。小便不利。此为水饮内蓄。邪不在表。故去桂枝。加茯苓白术。
若得小便利。水饮行。腹满减而热自除。则头项强痛悉愈矣。且如十枣汤证。头亦痛。
乃邪热内蓄而有伏饮。故头痛。其饮水头痛。不须攻表。但宜逐饮。饮尽、则病安矣。
张卿子云。逐饮何不用橘皮半夏。可见此停饮。以胃虚。故无汗耳。与五苓散近似。
伤寒脉浮。自汗出。小便数。心烦、微恶寒。脚挛急。反与桂枝汤。欲攻其表。此
误也。得之便厥咽中干。烦燥。吐逆者。作甘草干姜汤与之。以复其阳。若厥愈足温者。
更作芍药甘草汤与之。其脚即伸。若胃气不和。谵语者。少与调胃承气汤。若重发汗。复
加烧针者。四逆汤主之。
脉浮。自汗出。小便数而恶寒者。阳气不足也。心烦、脚挛急者。阴气不足也。阴阳
血气俱虚。则不可发汗。若与桂枝汤攻表。则又损阳气。故为误也。得之便厥。咽中干。
烦燥。吐逆者。先作甘草干姜汤复其阳气。得厥愈足温。乃与芍药甘草汤。益其阴血。
则脚 得伸。阴阳虽复。其有胃燥谵语。少与谓胃承气汤。微溏以和
其胃。重发汗为亡阳。加烧针则损阴。内经曰。荣气微者。加烧针。则血不流行。重发
汗。复烧针。是阴阳之气大虚。四逆汤以复阴阳之气。
在桂枝汤的方剂组成中，去掉桂枝，加入茯苓和白术各三两。其余按照之前的方法煎煮并服用。小便通畅后病就好了。
王宇泰说：有人问，头项强痛，说明邪气仍在体表。虽然经过发汗和攻下治疗但病未解除，为什么还要去掉桂枝而加入茯苓、白术？这岂不是对表证置之不理吗？回答说：这不是桂枝汤证，而是属于有水饮内停的患者。头项强痛，既然经过发汗和攻下治疗后仍未解除，且伴有心下痞满微痛、小便不利，这是水饮内蓄所致，邪气并不在体表，所以去掉桂枝，加入茯苓和白术。如果小便利通，水饮得以运行，腹部胀满减轻，热邪自然消除，那么头项强痛也就全部痊愈了。就像十枣汤证一样，头部也会疼痛，那是邪热内蓄且有伏饮，所以导致头痛。这种因饮水引起的头痛，不需要解表，只应当逐除水饮。水饮排尽，病就能安愈了。
张卿子说：逐除水饮为什么不使用橘皮和半夏呢？可以看出此处的停饮是因为胃气虚弱，所以无汗。这与五苓散的情况近似。
伤寒脉浮，自汗出，小便频数，心烦，轻微恶寒，脚部拘挛急迫，反而给予桂枝汤，想要攻治其表证，这是错误的。服药后出现四肢厥冷、咽喉干燥、烦躁、呕吐逆气的症状，应制作甘草干姜汤给患者服用，以恢复其阳气。如果四肢厥冷痊愈、足部变温，再制作芍药甘草汤给患者服用，其脚部就能伸展。如果胃气不和，出现谵语（胡言乱语），少量给予调胃承气汤。如果再次发汗，又加上烧针疗法，应以四逆汤主治。
脉浮，自汗出，小便频数且恶寒，这是阳气不足的表现。心烦、脚部拘挛急迫，这是阴气不足的表现。阴阳气血都虚弱，则不可发汗。如果给予桂枝汤攻治表证，就会进一步损伤阳气，所以这是错误的治疗。服药后出现四肢厥冷、咽喉干燥、烦躁、呕吐逆气，应先制作甘草干姜汤来恢复其阳气。等到四肢厥冷痊愈、足部变温，再给予芍药甘草汤，以补益其阴血，这样脚部就能伸展。虽然阴阳得以恢复，但如果仍有胃燥导致的谵语，少量给予调胃承气汤，使大便微溏以调和胃气。过度发汗会导致亡阳，加用烧针则会损伤阴气。《内经》说：营气微弱的人，如果加用烧针，血液就不能正常运行。过度发汗后又加用烧针，这是阴阳之气严重虚弱，应用四逆汤来恢复阴阳之气。
Within the formula of Guizhi Tang (Cinnamon Twig Decoction), remove Guizhi (Cinnamon Twig) and add Fuling (Poria) and Baizhu (Atractylodes Macrocephala Rhizome), each three liang. Prepare and administer the remaining ingredients according to the previous method. The patient will recover when urination becomes smooth.
Wang Yutai stated: One might ask, "Head stiffness and pain indicate that the pathogenic factor remains in the exterior. Although sweating and purging therapies have been applied without resolution, why remove Guizhi and add Fuling and Baizhu? Does this imply neglecting the exterior syndrome?" The response is: This is not a Guizhi Tang syndrome but belongs to patients with retained fluid retention. Head stiffness and pain, which persist despite prior sweating and purging, accompanied by fullness and slight pain in the epigastrium and difficulty in urination, indicate internal accumulation of water-fluids; the pathogen is not in the exterior. Therefore, Guizhi is removed, and Fuling and Baizhu are added. If urination becomes unobstructed, the water-fluids move, abdominal fullness subsides, and heat naturally dissipates, thereby resolving the head stiffness and pain completely. Consider the Shizao Tang (Ten Date Decoction) syndrome, where headache also occurs due to internal accumulation of pathogenic heat and latent fluids causing the headache. In cases of headache caused by drinking water, exterior-releasing therapy is unnecessary; instead, one should only expel the fluids. Once the fluids are eliminated, the disease resolves.
Zhang Qingzi remarked: Why not use Jupi (Tangerine Peel) and Banxia (Pinellia Tuber) to expel fluids? It can be seen that this retention of fluids is due to deficiency of Stomach Qi, resulting in anhidrosis (absence of sweating). This condition is similar to Wuling San (Five-Ingredient Powder with Poria).
In Shanghan (Cold Damage), if the pulse is floating, there is spontaneous sweating, frequent urination, irritability, slight aversion to cold, and cramping of the legs, administering Guizhi Tang to attack the exterior is an error. Following this mistake, the patient may develop cold limbs (Jue), dryness in the throat, irritability, and vomiting or regurgitation. In such cases, prepare Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) for the patient to restore Yang Qi. If the cold limbs resolve and the feet become warm, subsequently prepare Shaoyao Gancao Tang (Peony and Licorice Decoction) for the patient, allowing the legs to extend. If there is disharmony of Stomach Qi manifesting as delirious speech (Shanyu), administer a small amount of Xiaochengqi Tang or Tiaowei Chengqi Tang (Regulate the Stomach and Purge the Yang Decoction variant). If excessive sweating is induced again, combined with the application of burning needles (Shaozhen), Sini Tang (Frigid Extremities Decoction) should be used as the primary treatment.
Floating pulse, spontaneous sweating, frequent urination, and aversion to cold indicate insufficiency of Yang Qi. Irritability and leg cramps indicate insufficiency of Yin Qi. When both Yin and Yang, as well as Blood and Qi, are deficient, sweating therapy must not be employed. Administering Guizhi Tang to attack the exterior would further damage Yang Qi, constituting an error. Upon developing cold limbs, dry throat, irritability, and vomiting, first prepare Gancao Ganjiang Tang to restore Yang Qi. Once the cold limbs resolve and the feet warm up, then administer Shaoyao Gancao Tang to nourish Yin and Blood, enabling the legs to extend. Although Yin and Yang are restored, if gastric dryness causes delirium, a small amount of Tiaowei Chengqi Tang should be given to slightly loosen the bowels and harmonize the Stomach. Excessive sweating leads to loss of Yang, while burning needles damage Yin. The Neijing (Inner Canon) states: "In cases of faint Ying Qi (Nutritive Qi), applying burning needles causes blood circulation to stagnate." Excessive sweating followed by burning needles results in severe deficiency of both Yin and Yang Qi; Sini Tang is used to restore Yin and Yang Qi.