甘草（二两炙） 附子（二枚炮去皮破八片） 白术（二两） 桂枝（四两去皮）
上四味。以水六升。煮取三升。去滓温服一升。日三服。初服。得微汗则解能食。汗止。复烦者。服五合。恐
一升多者。宜服六七合为妙。
成注云。桂枝甘草之辛甘。发散风邪而和卫。附子白术之辛甘。解湿气而温经。○愚以上方乃热补兼发散之药
也。
内台方议云。风则伤卫。湿流关节。风湿相搏。两邪乱经。故见骨节烦疼等证。上方用附子为君除湿祛风。温
经散寒。桂枝为臣。祛风固卫。白术去湿为使。甘草为佐而辅诸药。乃疏风去寒湿之禁方也。○愚按上议。实发明
成注之意。
后条辩云。桂枝附子汤。桂枝附子去桂加白术汤。甘草附子汤。三方俱用附子者。以风伤卫而表阳已虚。加寒
湿而里阴更胜。凡所见证。皆阳气不充。故经络关节得着湿。而卫阳愈虚耳○愚以此言实发仲景奥义。
上三条证（见原论中第四卷太阳病脉证并治法下第七）
阳明病。不能食。攻其热。必哕。所以然者。胃中虚冷故也。以其人本虚。故攻其热。必哕。（哕于月切。○
此言阳明中寒也。阳明中寒。有胸已前受寒气者。有口食冷物而得者。今者。阳明病不能食。是胃中无物。医人以
不能食。为胃家实。而以苦寒之药。误攻其热必作哕。哕者。哕逆。俗云冷呃是也。其所以然者。为胃中虚冷之故。
以其人胃气本虚。不能食。又攻其热。则胃中寒极而成冷。胃中之气。既虚且冷。乃真火之气欲脱。反上逆而作哕
也。○按此条论。仲景无治法。补亡论常器之云。可温中汤。下注云金匮方。及考金匮无此方。愚谓宜用附子理中
汤。）
脉浮而迟。表热里寒。下利清谷者。四逆汤主之。（阳明胃脉本和缓。若经病热。脉当洪长。今则但浮。此在
表之热微也。腑病热。脉当洪数。今则过迟。此在里之寒甚也。武陵陈氏云。阳明气血俱盛。邪客之。表里俱热。
病机之常。然亦有表热里寒者。由其人胃气本弱。寒邪乘虚入里。其留于表者变热。而骤入于里者。不及变热。故
见下利清谷一证。清。洁也。其所利之谷食。色不变。气不臭。即完谷不化也。此为里寒已极故与四逆汤。以温里
散寒。）
若胃中虚冷。不能食者。饮水则哕。（此承上文里寒而言。兹则胃中不但寒。而竟成虚冷矣。夫胃中虚。宜能
食。今者既虚且冷。故不能食。即经云。食不得入。是无火也。庸工不知。见其表热。认以为胃中实热证。且下利
之后。亡津液而思水。遂饮之以水。水寒相搏。气逆而亦为哕也。武陵陈氏云。法当大温。上节已用四逆。故不更
言治法。○愚按补亡论常器之云。宜温中汤。然不若用茯苓四逆汤。即四逆汤中。加人参以补虚。茯苓以利水也。
方已见上太阳治法中。）
食谷欲呕者。属阳明也。吴茱萸汤主之。得汤反剧者。属上焦也。止条亦胃中虚冷之证。食谷欲呕者。胃既
无火。不能消下也。曰属阳明者。后条辩云。此别其与少阳喜呕之半表证。又太阳干呕不能食之表证不同。宜温中
补虚。降逆气。方用吴茱萸汤主之无疑矣。其有得汤呕反剧者。此寒不在中焦。而属上焦。吴茱萸气味苦辛重浊。
与上焦之清气。不相和协故也。○愚按成注云。以治上焦法治之。而无其方。准绳云。葛根半夏汤误矣。尚论篇云。
仍属太阳热邪。而非胃寒。条辩云。上焦以膈言。戒下之意。此又泥于伤寒呕多。虽有阳明证不可攻之。皆大谬之
极。窃思先贤用药。岂如今医之鲁莽。误以胃家虚寒为实热证。但虚寒在膈以上。不与胃腑之中。溷同一治。上条
证。治以吴茱萸汤。寒热虚实。原无误也。其有得汤反剧者补亡论常器之云。宜橘皮汤。注云。类要方。用橘皮二
两。甘草一两。生姜四两。人参三两。水煎服。斯言庶得之矣。
Gancao (Radix Glycyrrhizae Preparata, two liang, honey-fried) Fuzi (Radix Aconiti Lateralis Preparata, two pieces, processed, peeled, broken into eight slices) Baizhu (Rhizoma Atractylodis Macrocephalae, two liang) Guizhi (Ramulus Cinnamomi, four liang, bark removed)
The above four herbs. Add six sheng of water. Boil until three sheng of liquid remain. Strain the dregs and take one sheng warm. Take three times a day. After the first dose, if slight sweating occurs, the disease resolves and appetite returns; if restlessness recurs after sweating stops, take five ge. If one sheng is feared to be too much, taking six or seven ge is optimal.
Cheng Wuji commented: The pungent-sweet nature of Guizhi and Gancao disperses wind pathogens and harmonizes Wei Qi (Defensive Qi). The pungent-sweet nature of Fuzi and Baizhu resolves dampness and warms the meridians. ○ I consider the above formula to be a combination of heat-tonifying and dispersing herbs.
Neitai Fangyi commented: Wind injures Wei Qi, dampness flows into the joints. When wind and dampness contend, both pathogens disrupt the collaterals, thus presenting symptoms such as bone-joint vexation and pain. In the above formula, Fuzi is used as the Sovereign herb to resolve dampness, dispel wind, warm the meridians, and scatter cold. Guizhi serves as the Minister herb to dispel wind and secure Wei Qi. Baizhu acts as the Guide herb to remove dampness. Gancao serves as the Assistant herb to support the other herbs. This is a precious formula for dispersing wind and eliminating cold-dampness. ○ My commentary notes that the above discussion actually elucidates the intent behind Cheng Wuji's annotation.
Shanghan Lun Tiaobian commented: Guizhi Fuzi Tang, Qugui Jiabai Zhu Tang, and Gancao Fuzi Tang all use Fuzi because wind injuring Wei Qi has already depleted the Exterior Yang, and the addition of cold-dampness makes the Interior Yin even stronger. All manifested syndromes indicate insufficient Yang Qi, causing the collaterals and joints to be susceptible to dampness attachment, while Wei Yang becomes increasingly deficient. ○ I believe this statement truly expounds Zhang Zhongjing's profound principles.
The above three syndromes (see Original Treatise, Volume 4, "Sunyang Disease Pulse, Syndrome, and Treatment Methods Part II", Section 7):
Yangming Disease characterized by inability to eat. If treated with heat-clearing methods, it will inevitably cause hiccups (Yue). The reason for this is deficiency-cold in the Stomach. Because the person is originally deficient, attacking the heat will inevitably cause hiccups. ("Yue" is pronounced yuè. ○ This discusses Yangming Cold Invasion. Yangming Cold Invasion can result from cold air affecting the chest and diaphragm, or from consuming cold food. Now, the inability to eat in Yangming Disease indicates emptiness in the Stomach. Physicians mistake the inability to eat for Excess in the Stomach House and mistakenly attack the heat with bitter-cold medicines, inevitably causing hiccups. Yue refers to hiccupping, commonly known as cold eructation. The reason lies in the deficiency-cold of the Stomach. Since the person's Stomach Qi is originally weak and unable to eat, further attacking the heat leads to extreme cold in the Stomach. With Stomach Qi being both deficient and cold, the True Fire Qi is about to escape, reversing upward to cause hiccups. ○ Regarding this passage, Zhang Zhongjing provides no treatment method. Bu Wang Lun states Chang Qizhi suggested Wenzhong Tang. The footnote mentions it is from Jin Gui Fang, but examination of Jin Gui Yao Lue reveals no such formula. I suggest using Fuzi Lizhong Tang.)
Pulse floating and slow, exterior heat and interior cold, with diarrhea passing undigested food: Sini Tang is the primary treatment. (The Yangming Stomach pulse should naturally be moderate. If channel heat exists, the pulse should be surging and long. Now it is merely floating, indicating mild heat at the exterior. If organ heat exists, the pulse should be surging and rapid. Now it is excessively slow, indicating severe cold at the interior. Chen of Wuling stated: Yangming Qi and Blood are abundant; when pathogens invade, exterior and interior heat are the norm. However, there are cases of exterior heat and interior cold due to original weakness of Stomach Qi, allowing cold pathogens to enter the interior upon deficiency. Pathogens remaining at the exterior transform into heat, while those entering the interior rapidly do not have time to transform into heat, thus presenting diarrhea with undigested food. "Qing" means clean. The discharged food retains its color and lacks odor, i.e., undigested food. This indicates extreme interior cold, hence Sini Tang is given to warm the interior and scatter cold.)
If the Stomach is deficient and cold, unable to eat, drinking water causes hiccups. (This continues the discussion on interior cold. Here, the Stomach is not only cold but also deficient-cold. Deficiency in the Stomach usually allows eating. Now, being both deficient and cold, it cannot eat. As the Classic states: "Food cannot enter, meaning there is no fire." Unskilled physicians, unaware of this, see exterior heat and diagnose Stomach Excess-Heat. Furthermore, after diarrhea, fluids are lost, leading to thirst for water. Drinking water causes water and cold to contend, Qi reverses upward, and hiccups occur. Chen of Wuling stated: The method should be strong warming. Since Sini Tang was used in the previous section, the treatment method is not reiterated. ○ My commentary notes that Bu Wang Lun states Chang Qizhi suggested Wenzhong Tang, but Fuling Sini Tang is preferable. This is Sini Tang plus Renshen to tonify deficiency and Fuling to promote urination. This formula appears in the Sunyang treatment section above.)
Desire to vomit after eating belongs to Yangming. Wuzhuyu Tang is the primary treatment. If symptoms worsen after taking the decoction, it belongs to the Upper Jiao. This clause also describes a Stomach deficiency-cold syndrome. Desire to vomit after eating occurs because the Stomum lacks Fire and cannot digest and descend. It is said to belong to Yangming. Shanghan Lun Tiaobian comments: This distinguishes it from Shaoyang's preference for vomiting (half-exterior syndrome) and Taiyang's dry retching and inability to eat (exterior syndrome). It is appropriate to warm the middle, tonify deficiency, and direct rebellious Qi downward. Using Wuzhuyu Tang is undoubtedly correct. For those whose vomiting worsens after taking the decoction, the cold is not in the Middle Jiao but in the Upper Jiao. Wuzhuyu has a pungent-bitter and heavy-turbid flavor, which does not harmonize with the clear Qi of the Upper Jiao. ○ My commentary notes Cheng Wuji said: "Treat it according to Upper Jiao methods," but provided no formula. Zhunsheng suggested Gegen Banxia Tang, which is incorrect. Shanglun Pian stated it still belongs to Taiyang Heat Pathogen, not Stomach Cold. Tiaobian stated Upper Jiao refers to the diaphragm, implying a prohibition against purgatives. These interpretations cling to "in cold damage, frequent vomiting, even with Yangming signs, purgatives are forbidden," which are extremely erroneous. I privately ponder: Did ancient sages prescribe medicines as recklessly as modern physicians? Mistaking Stomach deficiency-cold for Excess-Heat. If deficiency-cold is above the diaphragm, it should not be treated identically to the Stomach organ. The previous syndrome was treated with Wuzhuyu Tang, where cold/heat and excess/deficiency were correctly identified. For those worsening after the decoction, Bu Wang Lun states Chang Qizhi suggested Jupi Tang. The note cites Lei Yao Fang: Jupi two liang, Gancao one liang, Shengjiang four liang, Renshen three liang, decocted in water. This statement is likely correct.