上二句。是承上文语。所以起下文者也。言前条云发汗后恶寒者。以汗后阳虚故也。若发汗之后。不恶寒而反恶热
者。非虚证也。乃汗后太阳已罢。邪转阳明。为胃实之证。当和其胃气则愈矣。然既汗之后。阳气已虚。不宜大
下。故当与调胃承气汤。即阳明篇所谓与小承气汤。微和胃气。勿令大泄下是也。
发汗后。饮水多者必喘。以水灌之亦喘。
发汗之后。卫外之阳气已疏。胃中之真阳已损。若津液竭而渴欲饮水。当如太阳上编中风发汗后。欲得饮水者。少
少与之可也。若饮水过多。则胃虚不运。水冷难消。必至停蓄不渗。水寒侵肺。呼吸不利。故肺胀胸满。气逆而喘急也。
若以冷水灌濯。则营卫先已空疏。使寒邪入腠。水气侵肤。肺本主乎皮毛。故内通于脏而亦为喘也。肺热而喘者。故
用麻黄杏仁甘草石膏汤。此以汗后水寒而喘。则去麻黄加葶苈之小青龙汤。或可酌用也。
发汗若下之。病仍不解烦躁者。茯苓四逆汤主之。
既发其汗。则表邪当解。若又下之。里邪亦当解矣。乃仍不解而烦躁者。此非郁热不解。大青龙之烦躁也。盖因汗
之
太过。亡其卫外之阳。下之太甚。又损其胃脘之阳。致无阳而阴独故也。烦躁者。阴盛迫阳。虚阳搅扰则作烦。阴邪纵
肆则发躁。补虚复阳。乃其治也。故以茯苓四逆汤主之。然大青龙之烦躁。因热邪不得发越所致。乃实邪也。故用汗
泄凉解之剂。茯苓四逆之烦躁。因阴盛阳虚所致。乃虚邪也。故当用收复温补之药。尚论引入青龙项中。
良有以也。
茯苓四逆汤方
茯苓（六两） 人参（一两） 甘草（二两炙） 干姜（一两） 附子（一枚去皮破八片）
上五味。以水五升。煮取三升。去滓温服七合。日三服。
茯苓虚无淡渗而降下。导无形之火以入坎水之源。故以为君。人参补汗下之虚。而益胃中之津液。干姜辛热。
守中而暖胃。附子温经。直达下焦。导龙火以归源也。
These two sentences serve as a transition from the preceding text to introduce the following content. They explain that the previous clause mentions aversion to cold after sweating, which is due to yang deficiency caused by sweating. If, after sweating, there is no aversion to cold but rather an aversion to heat, this is not a deficiency syndrome. Instead, it indicates that the pathogen in the Taiyang (Greater Yang) channel has resolved, and the pathogen has transferred to the Yangming (Yang Brightness) channel, resulting in a Stomach Excess syndrome (accumulation of dry-heat in the gastrointestinal tract). In this case, harmonizing the Stomach Qi will lead to recovery. However, since sweating has already occurred and yang qi is deficient, drastic purgation should not be used. Therefore, Tiaowei Chengqi Tang (Regulating the Stomach Decoction) should be administered. This corresponds to what is mentioned in the Yangming chapter of the *Shanghan Lun*: "administer Xiao Chengqi Tang" to slightly harmonize the Stomach Qi without causing severe diarrhea.
After sweating, if one drinks too much water, wheezing will inevitably occur; similarly, washing the body with cold water will also cause wheezing.
After sweating, the defensive yang qi on the exterior is dispersed, and the true yang qi in the Stomach is damaged. If fluids are depleted and thirst prompts the desire to drink water, one should follow the principle described in the Upper Section of the Taiyang chapter regarding wind-strike after sweating: provide water in small amounts repeatedly. If too much water is consumed, the weak Stomach cannot transport it, and the cold water is difficult to dissipate. This leads to fluid retention without percolation. The cold-water pathogen invades the Lung, impairing respiration, resulting in lung distension, chest fullness, rebellious Qi, and急促 wheezing. If cold water is poured over the body, the Ying (Nutrient) and Wei (Defensive) qi are already sparse, allowing cold pathogens to enter the interstices and water qi to invade the skin. Since the Lung governs the skin and hair and connects internally with the zang organs, this also induces wheezing. For wheezing caused by Lung heat, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) is used. In this case, where wheezing is caused by cold-water pathogen after sweating, a modified Qinglong Tang (Azure Dragon Decoction) with Mahuang removed and Tingli (Lepidii Semen) added might be considered for use.
If, after sweating or purging, the disease remains unresolved and irritability and restlessness (Fan Zao) appear, Fuling Sini Tang (Poria and Aconite Decoction) is the primary treatment.
Having induced sweating, the exterior pathogen should have resolved; having then purged, the interior pathogen should also have resolved. Yet, if the disease remains unresolved accompanied by irritability and restlessness, this is not the irritability and restlessness of the Da Qinglong Tang (Major Azure Dragon Decoction) syndrome caused by trapped heat. Rather, it results from excessive sweating damaging the defensive yang qi, and excessive purging damaging the stomach yang qi, leading to a state where yang is exhausted and yin stands alone. Irritability arises because excess yin forces the floating yang, causing disturbance; restlessness occurs because yin pathogens run rampant. Tonifying deficiency and restoring yang is the correct treatment. Thus, Fuling Sini Tang is used. However, the irritability and restlessness in the Da Qinglong Tang syndrome is caused by heat pathogens failing to disperse, representing an excess condition treated with diaphoretic, purgative, and cooling agents. The irritability and restlessness in the Fuling Sini Tang syndrome is caused by yin excess and yang deficiency, representing a deficiency condition treated with warming and tonifying herbs. Shanglun's classification of this into the Qinglong Tang category is well-founded.
Fuling Sini Tang Formula
Fuling (Poria, 6 liang), Renshen (Ginseng Radix et Rhizoma, 1 liang), Gancao (Licorice Root, 2 liang, honey-fried), Ganjiang (Dried Ginger, 1 liang), Fuzi (Aconiti Lateralis Radix Praeparata, 1 piece, peeled and broken into eight slices).
The above five ingredients are boiled in five sheng of water until three sheng remain. The dregs are removed, and the liquid is taken warm, seven ge at a time, three times daily.
Fuling, being void and lightly penetrating, descends effectively, guiding formless fire back to its source in Kan Water (Kidney/Yin); thus, it serves as the sovereign herb. Renshen tonifies the deficiency caused by sweating and purging and replenishes Stomach fluids. Ganjiang is acrid and hot, stabilizing the middle jiao and warming the Stomach. Fuzi warms the meridians, reaching directly to the lower jiao, guiding the "dragon fire" (deficient fire) back to its origin.