甘草（四两炙） 干姜（二两炮）
上 咀。以水三升。煮取一升五合。去滓。分温再服。
成注引内经曰。辛甘发散为阳。甘草干姜相合。以复阳气。
琥按上方。实非发散药。条辩云。甘草益气。干姜助阳。复其阳者。充其气之谓也。愚以气充。则津液生。而
咽中不干。膈寒解。吐逆自止也。
白芍药（四两） 甘草（四两炙）
上二味。 咀。以水三升。煮取一升五合。去滓。分温再服。
成注云。芍药白补而赤泻白收而赤散也。酸以收之。甘以缓之。酸甘相合。用补阴血。
琥按上方。用于阳气既复之后。但阴血未和。故用白芍药为君以补营血。炙甘草为臣以和阴气。阴血和补而脚
自伸矣。
（见伤寒辩注第六卷阳明篇中）
琥按上方。治伤寒胃腑实热药也。今取以治中寒者。以前证误与桂枝汤。复与甘草干姜汤。姜桂辛热。耗胃中
津液。因而谵语。原方后云。少少温服。此不过暂假之。以和胃气而止谵语。故尚论篇云。倘多与之。则为下而非
和。岂不大误。
（正解见中卷少阴病中）
琥按上汤。治上条证。若重发其汗。复加烧针者夫重发汗。则阳亡而气欲脱。故用干姜附子。以回阳助气。加
烧针。则阴受伤而血不流。故用炙甘草。以和其血。兼扶其阴。此亦借用之方。非若少阴病。脉沉厥逆。此方为正
治之药也。
或问重发汗为亡阳。阳气虚而用四逆。固矣。加烧针。不无火逆之患。何以仍用四逆汤。余答云。热病阳气有
余。加烧针。则为火逆。寒病阴寒用事。加烧针。徒耗其阳。兼损其阴。气血受伤。寒气反入。后条辩所云治之一
误。寒即中于治法中矣。医者可不慎之。
问曰。证象阳旦。按法治之而增剧厥逆。咽中干。两胫拘急而谵语。师曰言夜半手足当温。两脚当伸。后如师
言。何以知此。答曰。寸口脉浮而大。浮则为风。大则为虚。风则生微热。虚则两胫挛。病证象桂枝。因加附子参
其间。增桂。令汗出。附子温经。亡阳故也。厥逆。咽中干。烦躁。阳明内结。谵语烦乱。更饮甘草干姜汤。夜半
阳气还。两足当热。胫尚微拘急。重与芍药甘草汤。尔乃胫伸。以承气汤。微溏。则止其谵语。故知病可愈。（此
条问答。补亡论郭白云云。此重解释前段。误用桂枝汤证。阳旦者。即桂枝汤中加黄芩之别名也。阳旦汤本治阳证。
以前条脉浮自汗出之阴证相似。遂按阳旦汤法治之。其增剧者。盖前此误用桂枝。此则更加黄芩。误之误矣。厥逆。
咽中干。两胫拘急而谵语者。此病增剧之形也。病既剧矣。师能决其向愈之时。卒如其言者。何也。师盖诊其脉。
验其证。而知其为风虚之候微热是假。虚寒是真。故见两胫挛也。据师之意。以前证象桂枝矣。还宜加附子。参入
乎其间为正治。乃用桂枝加附子汤主之。更增桂。能令汗出。以散其风邪。参用炮附子。为能温经而补虚。以上证
亡阳。无热可发故也。今者。见证不明。而以阳旦汤治之。以致前厥逆咽干等证。须改用甘草干姜等汤一如前条法
救之。夜半者。阴极而阳气当回之时也。故其病可愈。条辩云。末后不复言重发汗已下等文者。以其或然或不然也。
○按阳旦汤。见活人书第十八卷杂方中。即桂枝汤加黄芩二两。治中风伤寒。脉浮发热。往来汗出恶风者。尚论篇
纽合阴旦汤。极闸人问答示奇。大失仲景立论之旨。）
上四条证。（见原论中第二卷太阳病治法上第五）
下之后复发汗昼日烦躁不得眠。夜而安静。不呕不渴。无表证。脉沉微。身无大热者。干姜附子汤主之。（此
条系中寒证。汗下颠倒所至。夫阴证可下。原有调胃承气汤。少与微溏之例。阴证发汗。原有麻黄附子细辛汤。微
汗之法。医者不明其理。竟过与承气汤下之后。虚阳外走。必有微热。复与麻黄等汤以发之。成注云。表里俱虚也。
昼日主阳。阳虚欲复。与阴寒之邪交争。故烦躁不得眠。乃虚烦虚躁也。夜主阴。纯阴用事。阳气太虚。不能与邪
相争。故主安静。不呕不渴者。里无热也。身无大热者。表无热也。脉沉为寒邪胜。微为阳气虚。故与干姜附子汤。
以退阴复阳。）
Gancao (Licorizae Radix et Rhizoma, four liang, honey-fried) Ganjiang (Zingiberis Rhizoma, two liang, processed)
Crush the above ingredients. Boil in three sheng of water to obtain one sheng and five he of decoction. Strain off the dregs. Divide into two doses and take warm.
Cheng Wuji's commentary cites the *Neijing*: "Pungent and sweet flavors disperse and generate Yang." The combination of Gancao and Ganjiang serves to restore Yang Qi.
Danbo Hu notes: The above formula is actually not a dispersing agent. The *Tiaobian* states: "Gancao tonifies Yuan Qi, Ganjiang assists Yang." What is meant by "restoring Yang" is filling the Yuan Qi. I believe that when Yuan Qi is sufficient, body fluids are generated, throat dryness resolves, cold in the diaphragm dissipates, and vomiting and counterflow qi cease naturally.
Baishao (Paeoniae Radix Alba, four liang) Gancao (Licorizae Radix et Rhizoma, four liang, honey-fried)
Crush the above two ingredients. Boil in three sheng of water to obtain one sheng and five he of decoction. Strain off the dregs. Divide into two doses and take warm.
Cheng Wuji's commentary says: "White Shaoyao is white and tonifying; red Shaoyao is red and draining. White Shaoyao astringes; red Shaoyao disperses. Sour flavor astringes; sweet flavor moderates. The combination of sour and sweet is used to tonify Yin blood."
Danbo Hu notes: The above formula is used after Yang Qi has been restored, but Yin blood is not yet harmonized. Therefore, Baishao is used as the sovereign herb to tonify Ying blood, and honey-fried Gancao is used as the minister herb to harmonize Yin Qi. When Yin blood is harmonized and tonified, leg cramps will naturally extend.
(See *Shanghan Bianzhu*, Volume 6, Yangming Chapter)
Danbo Hu notes: The above formula is for treating excess heat in the stomach fu organ in Shanghan. It is now taken to treat Zhonghan (Cold Strike) because the previous condition was mistakenly treated with Guizhi Tang, followed by Gancao Ganjiang Tang. Shengjiang and Guizhi are pungent and hot, consuming stomach fluids, leading to delirium. The post-formula note says: "Take small amounts warm." This is merely a temporary borrowing to harmonize stomach qi and stop delirium. Thus, *Shanglun Pian* states: If given in large quantities, it becomes purgation rather than harmonization, which would be a great error.
(Correct explanation see Middle Volume, Shaoyin Disease Chapter)
Danbo Hu notes: The above decoction treats the syndrome described in the preceding clause. If heavy sweating is induced again, and burning needle therapy is added: Heavy sweating causes Yang collapse and Qi depletion, so Ganjiang and Fuzi are used to return Yang and assist Qi. Burning needle therapy injures Yin and impedes blood flow, so honey-fried Gancao is used to harmonize blood and support Yin. This is also an borrowed formula, unlike Shaoyin disease with deep pulse and cold limbs, where this formula is the correct treatment.
A question arises: Heavy sweating leads to Yang collapse; using Sini Tang for deficient Yang is established. Adding burning needles, does it not risk Fire Adverse Reaction? Why still use Sini Tang? My answer: In heat diseases, Yang Qi is excessive; adding burning needles causes Fire Adverse Reaction. In cold diseases, Yin Cold dominates; adding burning needles merely consumes Yang and damages Yin. Qi and Blood are injured, and Cold pathogen enters inward. As stated in the later *Tiaobian*, the treatment error allows Cold to invade via the treatment method itself. Can physicians not be cautious?
Question: The syndrome resembles Yangdan Tang pattern. Following Yangdan Tang treatment worsens the condition, causing cold limbs, dry throat, calf cramping, and delirium. The Master said, "By midnight, hands and feet will warm, legs will extend." Later it happened as predicted. How did he know? Answer: Cun Kou pulse is floating and large. Floating indicates Wind; Large indicates Deficiency. Wind generates slight heat; Deficiency causes calf cramping. The syndrome resembles Guizhi Tang pattern, so Fuzi was added, and Guizhi increased to induce sweating. Fuzi warms the meridians due to Yang collapse. Cold limbs, dry throat, irritability, Yangming internal binding, delirious confusion follow. Drink Gancao Ganjiang Tang again. By midnight, Yang Qi returns, feet warm, calves slightly cramped. Administer Shaoyao Gancao Tang again, then calves extend. Use Chengqi Tang, slight stool softening stops delirium. Thus, recovery is known. (This Q&A from *Buwang Lun* by Guo Baiyun explains the previous misused Guizhi Tang case. Yangdan Tang is Guizhi Tang plus Huangqin. Yangdan Tang treats Yang patterns. Since it resembled the Yin pattern of floating pulse and spontaneous sweating, Yangdan Tang was used incorrectly. Worsening occurred due to prior Guizhi misuse and current Huangqin addition—error upon error. Cold limbs, dry throat, calf cramping, delirium indicate severe worsening. The Master predicted recovery time accurately by diagnosing pulse and verifying symptoms, identifying Wind-Deficiency where slight heat is false and deficiency-cold is true. Seeing calf cramping, the Master intended to add Fuzi to Guizhi pattern as correct treatment, using Guizhi Jia Fuzi Tang. Increasing Guizhi induces sweat to disperse Wind; Pao Fuzi warms meridians and tonifies deficiency. With Yang collapse, no heat can be released. Now, unclear symptoms treated with Yangdan Tang caused cold limbs and dry throat. Must switch to Gancao Ganjiang Tang etc., as before. Midnight is Yin extreme and Yang returning time, hence recovery. *Tiaobian* says omitting "heavy sweating" text implies uncertainty. ○ Note: Yangdan Tang appears in *Huo Ren Shu* Vol 18, misc formulas: Guizhi Tang plus two liang Huangqin, treating Wind-Strike/Shanghan with floating pulse, fever, alternating sweating, aversion to wind. *Shanglun Pian* combines Yindan Tang, making Q&A overly clever, losing Zhang Zhongjing's original intent.)
The above four syndromes. (See Original Treatise, Volume 2, Taiyang Disease Treatment Methods Part 1, Section 5)
After mistaken purgation and subsequent sweating: Restlessness during day, unable to sleep; quiet at night; no vomiting, no thirst; no exterior syndrome; deep and faint pulse; no significant body heat. Treat with Ganjiang Fuzi Tang. (This clause belongs to Zhonghan, caused by inverted sweating and purging. Yin patterns may be purged, e.g., Tiaowei Chengqi Tang in small doses for slight stool softening; Yin patterns may be sweated, e.g., Mahuang Fuzi Xixin Tang for mild sweating. Physicians ignorant of principles overuse Chengqi Tang for purging, causing deficient Yang to float outward, resulting in slight heat. Then administering Mahuang-type decoctions for sweating. Cheng Wuji notes: Exterior and Interior both deficient. Day governs Yang; deficient Yang attempts to recover and struggles with Yin-Cold, causing restlessness and insomnia—this is empty irritability. Night governs Yin; Pure Yin dominates, Yang is too deficient to struggle with pathogens, hence quiet. No vomiting/thirst means no interior heat. No significant body heat means no exterior heat. Deep pulse indicates Cold dominance; faint pulse indicates Yang deficiency. Hence, Ganjiang Fuzi Tang is given to dispel Yin and restore Yang.)