伤寒条下。而谓邪气欲传未传之时。恐其内虚。故创建中气。令邪不易入。即入亦足以御之。如此议论。则此方
仅足以暂阻邪气而已。岂仲景立方。犹不足以疗病欤。余不得已。移置太阳下编。以俟有识者订之。
小建中汤方
桂枝（三两） 芍药（六两） 甘草（二两炙） 生姜（三两） 胶饴（一升） 大枣（十二枚擘）
上六味。以水七升。煮取三升。去滓。内胶饴。更上微火消化。温服一升。日三服。呕家不可用建中汤。以甜
故也。
建中者。创建中焦之脾土也。盖土为五行之主。脾为四脏之本。即洪范建中立极之义也。中气虚馁。脾弱不运。
胃气不行。致心中悸动。故以创建中气为急也。谓之小建中者。以风邪未解。未可以参术补中。止加胶饴。倍芍药于
桂枝全汤。和卫解邪之中。以稍裨中土。故谓之小建中汤。芍药性虽酸收。既无寒邪。在所不计。李时珍谓其益脾。
能于土中泻木。故倍用之饴糖为米 之上品。能和润中州。经所云脾欲缓。急食甘以缓之是也。中气既和。阳邪得解。
则心中之悸烦自止矣。
太阳伤寒者。加温针必惊也。
温针。即前烧针也。太阳伤寒。当以麻黄汤发汗。乃为正治。若以温针取汗。虽欲以热攻寒。而邪受火迫。
不得外泄而反内走。必致火邪内犯阳神。故震惊摇动也。寒邪被火。尚致惊惕。况中风之阳邪被火乎。
伤寒脉浮。医以火迫劫之。亡阳必惊狂起卧不安者。桂枝去芍药。加蜀漆龙骨牡蛎救逆汤主之。
伤寒。以发热无汗言也。脉但浮而不紧。兼中风邪也。火迫者。或熏或熨。或烧针皆是也。劫者。要挟逼胁之称也。
言风寒两伤营卫之症。以火劫之而强逼其汗。阳气随汗而泄。致卫阳丧亡而真阳飞越矣。前已云太阳伤寒者。加温针
必惊。此又以兼有阳邪之证。以火劫迫之。阳邪兼并于上。真阳欲亡于下。虚阳挟饮而上奔。使神魂飞越。君主孤危。
故必惊骇癫狂。起卧不安也。以桂枝去芍药。加蜀漆牡蛎龙骨。方可救其变逆也。
桂枝去芍药加蜀漆龙骨牡蛎救逆汤方
桂枝（三两） 甘草（二两） 牡蛎（五两熬） 龙骨（四两） 生姜（三两切） 大枣（十二枚擘） 蜀漆（一
两洗去脚）
上为末。以水一斗二升。先煮蜀漆减二升。内诸药煮取三升。去滓。温服一升。
中风当用桂枝汤者。以风邪在卫也。伤寒忌用桂枝汤。以寒邪在营也。此方用桂枝者。所以解卫分之风邪也。去芍
药者。
恐其敛营分之寒邪也。伤寒不忌桂枝之温散。故麻黄汤中用之。但忌芍药之酸收。故此方去之。旧说谓心神浮越。故惊
狂起卧不安。
若论火邪迫劫。自应心神散乱。然蜀漆之加。又不止于心神散乱矣。考之本草。蜀漆乃常山之苗。味辛有毒。与常山功
用相
同。但有劫痰截疟之功。并无敛散收补之用。且老人久病之所忌。谅非补益之品。仲景用之。不过因痰随气逆。饮逐火
升。故使
人迷乱惊狂耳。尚论引丹溪谓其能飞补。神可赖以攸宁。岂其然乎。仲景虽未明言痰饮。观其蜀漆之用。已晓然无疑矣。
况人
身之津液。皆随气以流行。有形之痰饮。犹水湿之就下。水性无常。激之可使过颡。痰虽重浊。随气可以逆行。盖气即
是火。
火即是气。当火劫亡阳之候。下焦之虚阳失守。厥逆上奔。挟痰涎而骤升。遂使阳神飞越。痰气迷漫而惊狂不安也。故
亦以蜀
漆劫截之药。邀而夺之。破其痰饮。又以龙骨牡蛎之重。所以镇而摄之也。李时珍云。龙乃东方之神。其骨与角齿。皆
主肝病。
许叔微云。肝藏魂。魂游不定者以此治
之。牡蛎亦咸涩镇重。能平治肝邪。此以神魂不定。肝主惊骇。故以此急救其火劫亡阳之逆变也。前中风误汗。
俱以补虚复阳为治。而此症独不用者。前以亡阳则真阳丧失。阴邪独盛。此则阳邪兼并。阳气独厥。所以不同也。
火逆下之。因烧针烦躁者。桂枝甘草龙骨牡蛎汤主之。
以火劫变逆之证。而又下之。此一误再误矣。又因烧针而致烦躁者。盖因外邪未尽而阳烦。真阳欲亡而阴躁也。
虽经屡误。但见烦躁而不至惊狂。则亦未若挟痰迷乱之甚。故不须蜀漆。止用去芍药姜枣之桂枝汤。以解其外。
龙骨牡蛎以镇摄其内而已。此经所谓大小轻重。制方之法也。前误汗条中。因发汗而又下之。病仍不解而烦躁。
以茯苓四逆汤主之者。以汗下两亡其阳。故用温经复阳之治。此虽汗下而未经误汗。且挟火邪而表犹未解。故止宜
解肌镇坠之法也。
桂枝甘草龙骨牡蛎汤方
桂枝（一两） 甘草（二两） 龙骨（二两） 牡蛎（二两）
上为末。以水五升。煮取二升半。去滓。温服八合。日三服。（义见前条方论及注中）
Below the clauses of Shanghan (Cold Damage), it is argued that when pathogenic factors are about to transmit but have not yet done so, fearing internal deficiency, [the author] established methods to strengthen the Middle Jiao (Middle Burner/Spleen-Stomach system) so that pathogens cannot easily enter; even if they do enter, there is sufficient resistance. If this reasoning were adopted, this formula would only be sufficient to temporarily block the pathogen. Would Zhang Zhongjing's creation of formulas truly be insufficient to treat diseases? Reluctantly, I have relocated this section to the end of the Taiyang (Greater Yang) chapter, awaiting correction by those with insight.
Xiao Jianzhong Tang (Minor Construct the Middle Decoction)
Guizhi (Cinnamon Twig, 3 liang) Shaoyao (White Peony Root, 6 liang) Gancao (Licorice Root, 2 liang, honey-fried) Shengjiang (Fresh Ginger, 3 liang) Jiaoyi (Malt Sugar, 1 sheng) Dazao (Jujube, 12 pieces, split)
Take the above six ingredients, add seven sheng of water, and decoct to obtain three sheng. Remove the dregs, add the Jiaoyi (Malt Sugar), and heat gently over a low fire until dissolved. Take one sheng warm, three times daily. Patients prone to vomiting should not use Jianzhong Tang due to its sweetness.
"Jianzhong" refers to establishing the Spleen Earth of the Middle Jiao. Earth is the master of the Five Elements, and the Spleen is the root of the four Zang organs, corresponding to the principle of "establishing the center and setting the pole" in the Hongfan. When Middle Qi is weak and deficient, the Spleen fails to transport and the Stomach fails to descend, leading to palpitations in the heart. Therefore, strengthening the Middle Qi is urgent. It is called "Minor" Jianzhong Tang because the Wind pathogen has not yet resolved, and tonifying herbs like Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala Rhizome) for the Middle Jiao are contraindicated. Instead, Jiaoyi is added, and the dosage of Shaoyao is doubled relative to the Guizhi Tang (Cinnamon Twig Decoction). This harmonizes the Ying (Nutritive) and Wei (Defensive) levels to resolve the pathogen while slightly supporting the Middle Earth, hence "Minor." Although Shaoyao is sour and astringent, since there is no Cold pathogen, this is disregarded. Li Shizhen stated that it benefits the Spleen and drains Wood from within Earth; thus, it is used in double dosage. Jiaoyi, being a superior grain product, harmonizes and moistens the Middle Jiao, as the Classic states: "The Spleen desires relaxation; urgently feed sweet flavors to relax it." Once the Middle Qi is harmonized and the Yang pathogen resolved, the palpitations and irritability in the heart will naturally cease.
In Taiyang Shanghan (Cold Damage), the application of Warm Needle therapy will inevitably cause fright.
Warm Needle refers to the previously mentioned Burning Needle. For Taiyang Shanghan, Ma Huang Tang (Ephedra Decoction) for sweating is the correct treatment. If Warm Needle is used to induce sweating, although intending to use heat to attack cold, the pathogen is forced by the fire, cannot exit outward, but moves inward. This inevitably causes Fire Pathogens to invade the Yang Spirit, resulting in shock and agitation. Even Cold pathogens provoked by fire cause fright; how much more so for the Yang pathogens of Wind Strike provoked by fire?
In Shanghan with floating pulse, if the physician uses fire methods to coerce sweating, leading to Loss of Yang, symptoms such as fright, mania, restlessness, and inability to lie still or sit up will occur. Gui Zhi Qu Shao Yao Jia Shu Ku Long Gu Mu Li Jiu Ni Tang (Cinnamon Twig Decoction without White Peony plus Chinese Honeysuckle Bud, Dragon Bone, and Oyster Shell to Rescue Deviation) is the primary treatment.
Shanghan here refers to fever without sweat. The pulse is floating but not tight, indicating a combination with Wind pathogen. "Fire coercion" includes fumigation, moxibustion/ironing, and burning needles. "Coerce" means to force or threaten. This describes symptoms where Wind and Cold damage both Ying and Wei levels; using fire to coerce and forcibly induce sweating causes Yang Qi to leak out with the sweat, leading to the loss of Defensive Yang and the flight of True Yang. Previously, it was stated that Taiyang Shanghan with Warm Needle causes fright. Here, for syndromes combined with Yang pathogens, fire coercion causes Yang pathogens to merge upward, while True Yang attempts to perish downward. Deficient Yang carries Phlegm-Fluids upward, causing the Soul and Spirit to fly away, leaving the Heart (Monarch) isolated and endangered. Thus, fright, madness, restlessness, and inability to lie still or sit up occur. Gui Zhi Qu Shao Yao Jia Shu Ku Long Gu Mu Li can rescue this deviation.
Gui Zhi Qu Shao Yao Jia Shu Ku Long Gu Mu Li Jiu Ni Tang (Cinnamon Twig Decoction without White Peony plus Chinese Honeysuckle Bud, Dragon Bone, and Oyster Shell to Rescue Deviation)
Guizhi (Cinnamon Twig, 3 liang) Gancao (Licorice Root, 2 liang) Muli (Oyster Shell, 5 liang, calcined) Longgu (Dragon Bone, 4 liang) Shengjiang (Fresh Ginger, 3 liang, sliced) Dazao (Jujube, 12 pieces, split) Shuku (Chinese Honeysuckle Bud, 1 liang, washed to remove soil)
Grind into powder. Add 12 sheng of water, first decoct Shuku until reduced by 2 sheng, then add other herbs and decoct to obtain 3 sheng. Remove dregs. Take 1 sheng warm.
For Wind Strike, Guizhi Tang is indicated because the Wind pathogen is at the Wei (Defensive) level. Shanghan contraindicates Guizhi Tang because the Cold pathogen is at the Ying (Nutritive) level. This formula uses Guizhi to resolve Wind pathogens at the Wei level. It removes Shaoyao to avoid astringing Cold pathogens at the Ying level. Shanghan does not contraindicate the warming and dispersing nature of Guizhi (used in Ma Huang Tang), but contraindicates the sour astringency of Shaoyao; hence, it is removed. Old theories suggest that floating Yang Spirit causes fright, mania, and restlessness. Regarding fire coercion causing mental scattering, adding Shuku addresses more than just mental scattering. According to Materia Medica, Shuku is the sprout of Changshan (Dichroa Root), pungent and toxic, with similar functions to Changshan but specifically for coercing Phlegm and arresting malaria, lacking astringent or tonifying properties. It is contraindicated for the elderly and chronically ill, clearly not a tonic. Zhang Zhongjing used it likely because Phlegm follows rebellious Qi and Fluids rise with Fire, causing confusion and mania. Shanglun cites Danxi saying it can "fly and tonify," allowing the Spirit to find peace—is this true? Although Zhang Zhongjing did not explicitly mention Phlegm-Fluids, his use of Shuku makes this clear. Body fluids circulate with Qi.有形 (有形 - tangible) Phlegm-Fluids, like water, tend to flow downward. Water’s nature is variable; agitation can make it splash over the forehead. Though Phlegm is heavy and turbid, it can move upward with Qi. Qi is Fire; Fire is Qi. During Fire coercion leading to Yang loss, deficient Yang in the Lower Jiao loses control, reverses upward, carrying Phlegm-Saliva suddenly rising, causing Yang Spirit to fly away and Phlegm-Qi to obscure, resulting in mania and restlessness. Therefore, Shuku, a herb that coerces and intercepts, is used to intercept and drain it, breaking the Phlegm-Fluids. Longgu and Muli, being heavy, are used to suppress and gather. Li Shizhen said: Dragon is the God of the East; its bone, horn, and teeth govern Liver disease. Xu Shuwei said: The Liver stores the Hun (Ethereal Soul); for restless Hun, this treats it. Muli is also salty, astringent, and heavy, capable of pacifying Liver pathogens. Since the Hun is unsettled and the Liver governs fright, these are used to urgently rescue the deviation of Yang loss caused by Fire. Previous cases of Wind Strike with erroneous sweating were treated by tonifying deficiency and restoring Yang. This case differs because previous cases involved loss of True Yang with excess Yin pathogens; this involves merging Yang pathogens with isolated Yang reversal.
If Fire Deviation is treated with purgation, and Irritability results from Burning Needles, Gui Zhi Gan Cao Long Gu Mu Li Tang (Cinnamon Twig and Licorice Decoction with Dragon Bone and Oyster Shell) is the primary treatment.
Treating Fire Deviation deviations with purgation is a second error after the first. Irritability caused by burning needles arises because external pathogens remain (causing Yang irritability) and True Yang attempts to perish (causing Yin restlessness). Although multiple errors occurred, if irritability exists without reaching mania, it is not as severe as Phlegm-induced confusion. Thus, Shuku is unnecessary. Only Gui Zhi Tang without Shaoyao, Jiang, and Zao is used to resolve the exterior, while Longgu and Muli suppress the interior. This illustrates the Classic’s principle of adjusting formula composition based on severity. In previous clauses regarding erroneous sweating, if purgation follows sweating and irritability persists, Fuling Sini Tang (Poria and Aconite Decoction) is used because sweating and purgation both cause Yang loss, requiring warming meridians and restoring Yang. Here, although sweating and purgation occurred, there was no erroneous sweating initially, and Fire pathogens remain with unresolved exterior symptoms; thus, resolving the muscle layer and suppressing/descending is appropriate.
Gui Zhi Gan Cao Long Gu Mu Li Tang (Cinnamon Twig and Licorice Decoction with Dragon Bone and Oyster Shell)
Guizhi (Cinnamon Twig, 1 liang) Gancao (Licorice Root, 2 liang) Longgu (Dragon Bone, 2 liang) Muli (Oyster Shell, 2 liang)
Grind into powder. Add 5 sheng of water, decoct to obtain 2.5 sheng. Remove dregs. Take 8 ge warm, three times daily. (See previous clause commentary for rationale.)