葛根（半斤） 黄连（三两） 黄芩（二两） 甘草（二两炙）
上四味。以水八升。先煮葛根。减二升。纳诸药。煮取二升。去滓。分温再服。
此桂枝证误下救逆之法。非葛根汤之变制也。经云。太阳病。桂枝证。医反下之。利遂
不止。
脉促者表未解也。喘而汗出者。此汤主之。夫误下致利。亦有阳盛阳虚之别。但下利脉不应
促而反促者。此属表未解之诊也。邪束于表。阳扰于内。喘而汗出。乃表里俱热之象。则治
表不宜用桂枝。而当改葛根以解表。治里不宜用理中。而反取芩连以清里矣。
按此当与前条桂枝人参证参看。柯韵伯曰。上条脉证是阳虚。此条脉证是阳盛。上条表
热里
寒。此条表里俱热。上条表里俱虚。此条表里俱实。同一协热利。同是表里不解。而寒热虚
实。攻补不同。补中亦能解表。亦能除痞。寒中亦能解表。亦能止利。神化极矣。
于桂枝汤方内去芍药。余根据前法。
此当与上条葛根黄连黄芩汤证参看。经云。太阳病。下之后。脉促胸满者。桂枝去芍药
汤主
之。按下后脉促。同属表未解之诊。而促脉中又有阳盛阳虚之别。误下脉促。虽与上条同。
然既无下利不止之证。又无喘而汗出之证。但见胸满。而又非结胸硬痛者比。则
胸满非下后阳邪之内陷。实因下后阴邪之上搏。但当扶阳逐邪。不宜再益阴气。故治法仍主
桂枝。而方中芍药。自在急删之列也。
Ge Gen (Radix Puerariae, half jin) Huang Lian (Rhizoma Coptidis, three liang) Huang Qin (Radix Scutellariae, two liang) Gan Cao (Radix Glycyrrhizae, two liang, honey-fried)
The above four herbs. Use eight sheng of water. First decoct Ge Gen until the volume decreases by two sheng. Then add the remaining herbs. Decoct to obtain two sheng of liquid. Remove the dregs. Divide into two doses and take warm.
This is a method to correct errors after mistakenly using purgation for a Guizhi syndrome (syndrome characterized by fever, aversion to wind, sweating, and floating-slow pulse). It is not a modified version of Gegen Tang (Kudzu Decoction). The classics state: In Taiyang disease (disease pattern caused by pathogenic invasion of the Taiyang channel), if it presents as Guizhi syndrome, and the physician mistakenly uses purgation, diarrhea will persist incessantly.
If the pulse is rapid and forceful (Cu mai, 促脉), it indicates that the exterior syndrome has not yet resolved. If there is panting and sweating, this formula (Gegen Huanglian Huangqin Tang, Kudzu, Coptidis, and Scutellaria Decoction) should be used. Diarrhea caused by mistaken purgation can be distinguished between excess heat (Yang excess) and deficiency cold (Yang deficiency). However, when diarrhea occurs, the pulse should not be rapid; if it is unexpectedly rapid, this is a diagnostic sign of unresolved exterior syndrome. Pathogens are constrained at the exterior, while Yang qi is disturbed internally. Panting and sweating are manifestations of heat in both the interior and exterior. Therefore, treating the exterior is inappropriate with Guizhi (Cinnamon Twig); instead, Gegen (Kudzu Root) should be used to release the exterior. Treating the interior is inappropriate with Lizhong Tang (Regulate the Middle Decoction); rather, Huang Qin (Scutellaria Root) and Huang Lian (Coptis Rhizome) should be taken to clear interior heat.
Note: This should be read in conjunction with the previous clause regarding Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction). Ke Yunbo said: The pulse and symptoms in the previous clause indicate Yang deficiency; here, they indicate Yang excess. The previous clause shows exterior heat and interior cold; this clause shows heat in both interior and exterior. The previous clause shows deficiency in both interior and exterior; this clause shows excess in both interior and exterior. Both present as Xiere Li (diarrhea with accompanying exterior heat) and involve simultaneous unresolved exterior and interior conditions. Yet, their cold/heat and deficiency/excess patterns differ, requiring different attacking and tonifying methods. Tonifying the middle can also release the exterior and eliminate fullness; purging the middle can also release the exterior and stop diarrhea. The transformation is extremely subtle.
Remove Shaoyao (Paeonia Root) from the Guizhi Tang formula. Follow the previous decoction and administration methods otherwise.
This should be read in conjunction with the previous clause on Gegen Huanglian Huangqin Tang. The classics state: After Taiyang disease is treated with purgation, if the pulse is rapid and forceful and there is chest fullness, Guizhi Qushaoyao Tang (Cinnamon Twig Decoction without Paeonia) should be used. Analysis: A rapid and forceful pulse after purgation similarly indicates an unresolved exterior syndrome. However, within the Cu pulse, there is a distinction between Yang excess and Yang deficiency. Although a rapid pulse after mistaken purgation is similar to the previous clause, since there are no symptoms of incessant diarrhea or panting with sweating, but only chest fullness, and it is not the hard and painful condition of Jie Xiong (chest binding syndrome), the chest fullness is not due to the internal sinking of Yang pathogens after purgation. Rather, it is truly due to Yin pathogens rising and clashing after purgation. One should only support Yang and expel pathogens, and it is inappropriate to further nourish Yin. Therefore, the treatment method still centers on Guizhi Tang, and Shaoyao in the formula naturally falls into the category of urgent removal.