此条病不解之烦躁。乃汗下后之烦躁属虚。然脉之浮紧沉微。自当别之。恐其误也。故谆谆言之也。
案此汤症。阳症俱备。而不然者。身虽烦热。而手足指尖。微有厥冷。虽有烦渴引饮。亦自喜热而恶冷。
舌苔白滑。或假生燥苔。脉虽洪大。或散而数。或弦大浮疾而空虚。无力无底。总之取脉不取症。庶几无失真的矣。
茯苓四逆汤方
茯苓（四两○成本。作六两。） 人参（一两） 附子（一枚。生用。去皮。破八片） 甘草（二两炙）
干姜（一两半）
上五味。以水五升。煮取三升。去滓。温服七合。日二服。（玉函。味下。有 咀二字。三升。作一升二
合。去滓以下。作分温再服日三。千金翼。三升。作二升。）
〔成〕四逆汤。以补阳。加茯苓人参。以益阴。〔柯〕先汗后下。于法为顺。而表仍不解。是妄下亡阴。阴
阳俱虚。而烦躁也。故制茯苓四逆。固阴以收阳。先下后汗。于法为逆。而表症反解。内不呕渴。似于阴阳自
和。而实妄汗亡阳。所以虚阳扰于阳分。昼则烦躁也。故专用干姜附子。固阳以配阴。二方皆从四逆加减。而
有救阳救阴之异。此比四逆为缓。固里宜缓也。姜附者。阳中之阳也。用生附而去甘草。则势力更猛。比四逆
为峻。回阳当急也。一去甘草。一加茯苓。而缓急自别。加减之妙。见用方之神乎。
案千金方。妇人产后。淡竹茹汤方后云。若有人参。入一两。若无。纳茯苓一两半。亦佳。盖人参茯苓。
皆治心烦闷。及心虚惊悸。安定精神。
圣济总录。治霍乱脐上筑悸。平胃汤。（即本方）
发汗后恶寒者。虚故也。不恶寒但热者。实也。当和胃气。与调胃承气汤。（【原注】玉函云。与小承
气汤。○玉函。脉经。千金翼。故也下。有芍药甘草附子汤主之九字。乃合前条。为一则耳。又调胃承气汤。
作小承气汤。千金翼注。一云。调胃承气汤。程。喻。钱。及王肯堂校千金翼。热上。有恶字。）
〔成〕汗出而恶寒者。表虚也。汗出而不恶寒。但热者。里实也。经曰。汗出不恶寒者。此表解里未和。
（见下编十枣汤条。）与调胃承气汤和胃气。〔程〕汗后不恶寒反恶热。其人大便必实。由发汗后。亡津液所
致。病不在营卫。而在胃矣。法当和胃气。〔钱〕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。〔柯〕虚实俱指胃言。汗后正气夺则胃虚。故用附子
芍药。邪气盛则胃实。故用大黄芒硝。此自用甘草。是和胃之意。此见调胃承气。是和剂而非下剂也。
案阳明篇。太阳病三日。发汗不解。蒸蒸发热者。属胃也。调胃承气汤主之。正与此条发矣。
太阳病发汗后。大汗出。胃中干。烦躁不得眠。欲得饮水者。少少与饮之。令胃气和则愈。若脉浮。小
便不利。微热消渴者。五苓散主之。（【原注】即猪苓散是○脉经。后。作若。干字。作燥。无烦躁之躁字。
欲得饮水。玉函。作其人欲引水。玉函。脉经。少少与。作当稍二字。胃气。作胃中。五苓上。成本。玉函。
并有与字。非也。）
〔汪〕此条论当作两截看。太阳病发汗后云云。至胃气和则愈。此系胃中干。烦躁作渴。止须饮水以和胃
气。非五苓散证也。若脉浮。小便不利。微热消渴。此系水热结于膀胱而渴。乃为五苓散证。太阳病。乃合中
风伤寒。而言之也。方喻列入中风。何其执也。〔魏〕大汗出。所谓如水流漓也。于是胃中津液。受伤而干。
因干而燥。因燥而烦。因烦躁而不得眠。此一串而至者。惟恐人误认为传里之燥烦。误下也。
于是标出欲饮水者一证。〔志〕不可恣其所欲。须少少与饮之。〔鉴〕若脉浮。小便不利。微热消渴者。则是太
阳表邪未罢。膀胱里饮已成也。经曰。膀胱者。津液之腑。气化则能出矣。今邪热熏灼。燥其现有之津。饮水
不化。绝其未生之液。津液告匮。求水自救。所以水入即消渴而不止也。用五苓散者。以其能外解表热。内输
水府。则气化津生。热渴止而小便利矣。〔方〕消。言饮水而小便又不利。则其水有似乎内自消也。渴。言能饮
且能多也〔锡〕案大汗出。胃中干者。乃胃无津液而烦躁。故与水以润之。小便不利消渴者。乃脾不转输。水
津不布而消渴。故用五苓以散之。若胃中干者。复与五苓散。利其小便。则愈干矣。故阳明篇云。汗出多而渴
者。不可与猪苓汤。以汗多胃中燥。猪苓汤复利其小便故也。
伤寒准绳。张兼善曰。烦渴用白虎汤。宜也。其用五苓散渗津液。何哉。曰白虎。乃表证已解。邪传里
而烦渴者用之。今脉尚浮。身有微热而渴。乃表邪未全解。故用桂枝之辛和肌表。白术茯苓之甘淡。以润虚燥也。
五苓散方
猪苓（十八铢去皮） 泽泻（一两六铢○成本。铢下。有半字。） 白术（十八铢） 茯苓（十八铢）
桂枝（半两去皮○成本。玉函。无枝字。后人故生议。考成氏本注。并明理论。俱作桂枝。知其脱误也。）
上五味捣为散。以白饮和。服方寸匕。日三服。多饮暖水汗出愈。如法将息。（捣为散。金匮。成本。玉
函。作为末二字。千金翼。作各为散。更于臼中治之。外台夭行病。作为散水服。千金。亦作水服。多饮暖水。
千金。无暖字。外台。温病。作多饮暖水。以助药势。成本。无如法将息四字。）
〔锡〕散者。取四散之意也。茯苓泽泻猪苓。淡味而渗泄者也。白术助脾气以转输。桂枝从肌达表。外窍
通而内窍利矣。故曰多饮暖水汗出愈也。〔汪〕方中用术。昔贤如孙真人
朱奉议许学士等。皆用白术。近医方中行喻嘉言。改用苍术。然苍术过于燥烈。不若白术之甘平滋腻。能补津
液而润燥。纵使仲景时无白术。于今业已有之。在医人亦可权宜取用。方后云。多服暖水。令汗出愈。此即桂
枝汤方下。 热稀粥一升余。以助药力之义。建安许氏云。五苓散。乃汗后一解表药。于此可见。〔魏〕五苓
必为散。以白饮调服。方能多服暖水。而汗出始愈。设煎法而服。则内外迎拒。药且不下。故必服药如法。然
后可效。
案明理论曰。苓。令也。号令之令矣。通行津液。克伐肾邪。专为号令者。苓之功也。五苓之中。茯苓为
主。故曰五苓散。马永卿懒真子录云。关中名医骆耕道曰。五苓散五味。而以木猪苓为主。故曰五苓。庄子之
言曰。药也其实堇也。桔梗也。鸡壅也。豕零也。是时为帝者也。疏云。药无贵贱。愈病则良。去水则豕零为
君。豕零。木猪苓也。二说未知何是。姑两存焉。
案白饮。诸家无注。医垒元戎。作白米饮。始为明晰。活人书作白汤。恐非也。
千金方。五苓散。主时行热病。但狂言烦躁不安。精采言语。不与人相主当者。
和剂局方。辰砂五苓散。治伤寒表里未解。头痛发热。心胸郁闷。唇口干焦。神志昏沉。狂言谵语。如见
鬼神。及治瘴疟烦闷不省者。即本方加辰砂。如中暑发渴小便赤涩。用新汲水调下。小儿五心烦热。焦躁多哭。
切牙上撺。欲为惊状。每服半钱。温热水下。
三因方曰。己未年。京师大疫。汗之死。下之死。服五苓散遂愈。此无佗。温疫也。（案医说。引信效方。）
又五苓散。治伏暑饮热。暑气流入经络。壅溢发衄。或
胃气虚。血渗入胃。停留不散。吐出一二升许。
伤寒百问经络图。五苓散。又治瘴气温疟。不伏水土。黄胆或泻。又治中酒恶心。或呕吐痰水。水入便
吐。心下痞闷。又治黄胆。如黄橘色。心中烦急。眼睛如金。小便赤涩。或大便自利。若治黄胆。煎山茵陈汤
下。日三服。
济生。加味五苓散。治伏暑热二气。及冒湿泄泻注下。或烦。或小便不利。
于本方。加车前子。
直指。五苓散。治湿症小便不利。经云。治湿之法。不利小便。非其治也。又治伤暑烦渴。引饮过多。
小便赤涩。心下水气。又流行水饮。每二钱。沸汤调下。小便更不利。加防己佐之。又治尿血。内加辰砂少许。
用灯心一握。新水煎汤调下。又治便毒。疏利小便。以泄败精。用葱二茎。煎汤调下。
发汗已。脉浮数。烦渴者。五苓散主之。（玉函。已。作后。浮下。有而字。脉经。千金翼。烦上。有复字。）
〔方〕已者。言发汗毕。非谓表病罢也。烦渴者。膀胱水蓄。不化津液。故用四苓以利之。浮数者。外表未
除。故凭一桂以和之。所以谓五苓能两解表里也。（案方注。系金鉴改订。故与原书。有异同焉。）〔鉴〕发汗
已。为太阳病已发过汗也。脉浮数。知邪仍在表也。若小便利而烦渴者。是初入阳明胃热。白虎汤证也。今小
便不利而烦渴。是太阳腑病。膀胱水蓄。五苓证也。故用五苓散。如法服之。外疏内利。表里均得解矣。
案表邪未解。则阳气盛于外。而津液亦走于外。下焦蓄水。则升腾之气液失其常。是以胃中燥而烦渴。
故主以五苓。外发表邪。内利蓄水也。成注。为亡津液。而胃燥之解。恐非是也。
伤寒汗出而渴者。五苓散主之。不渴者。茯苓甘草汤主之。
〔鉴〕此申上条或渴而不烦。或烦而不渴者。以别其治也。伤寒发汗后。脉浮数。汗出烦渴。小便不利者。
五苓散主之。今惟曰汗出者。省文也。渴而不烦。是饮盛于热。故亦以五苓散主之。利水以化津也。若不烦且
不渴者。是里无热也。惟脉浮数汗出。小便不利。是营卫不和也。故主以茯苓甘草汤。和表以利水也。
案柯氏汗出下。补心下悸三字。其说难凭。盖因厥阴篇。伤寒厥而心下悸者。宜先治水。当服茯苓甘草汤。
却治其厥。不尔水渍入胃。必作利也一条。而生此说耳。
茯苓甘草汤方
茯苓（二两○玉函。作三两。） 桂枝（二两去皮） 甘草（一两炙） 生姜（三两切）
上四味。以水四升。煮取二升。去滓。分温三服。
〔鉴〕有脉浮数汗出之表。故主以桂枝。去大枣芍药者。因有小便不利之里。恐滞敛而有碍于癃闭也。五苓
去术泽猪苓者。因不渴不烦。里饮无多。惟小便一利可愈。恐过于燥渗伤阴也。
伤寒类方曰。此方之义。从未有能诠释者。汗出之后。而渴不止。与五苓。人所易知也。乃汗出之后。
并无渴证。又未指明别有何症。忽无端而与茯苓甘草汤。此意何居。要知此处汗出二字。乃发汗后汗出不止也。
汗出不止。则亡阳在。即当与以真武汤。其稍轻者。当与以茯苓桂枝白术甘草汤。更轻者。则与以此汤。何以
知之。以三方同用茯苓知之。盖汗大泄。必引肾水上泛。非茯苓不能镇之。故真武则佐以附子回阳。此二方则
以桂枝甘草敛汗。而茯苓则皆以为主药。此方之义。不了然乎。观厥阴篇心悸治法益明。
虚实辨疑曰。水停心下而悸者。茯苓甘草汤。加芫花主
之。金匮要略云。食少饮多。水停心下。甚则发悸。是以悸当治其饮也。
中风发热。六七日不解而烦。有表里证。渴欲饮水。水入则吐者。名曰水逆。五苓散主之。（名曰。玉
函。及千金翼。外台。作此为。喻本。程本。柯本。张本。主之下。有多服暖水汗出愈七字。）
〔魏〕表里证。里证何。即所谓烦渴饮水。水入即吐。是也。表证何。即前条所谓头项强痛。而恶寒发热
汗出。是也。于是用桂枝以驱表邪。佐以术苓泽泻。以固土逐水。加以多饮暖水。使汗出而表解。水既不逆。
小便利而里解。而病有不愈者乎。〔柯〕是其人。心下有水气。膻中之火用不宣。邪水凝结于内。水饮拒绝于外。
既不能外输于玄府。又不能上输于口舌。亦不能下输于膀胱。此水逆所由名也。〔方〕伏饮内作。故外者不得
入也。盖饮亦水也。以水得水。涌溢而为格拒。所以谓之曰水逆也。
吴遵程方论曰。五苓散。逐内外水饮之首剂。金匮。治心下支饮眩冒。用泽泻汤治呕吐思水。用猪苓散。
止用二三味。总不出是方为祖剂云。凡太阳表里未解。头痛发热。口燥咽干。烦渴饮水。或水入即吐。或小便
不利者。宜服之。又治霍乱吐利。燥渴引饮。及瘦人脐下有动悸。吐涎沫而颠眩者。咸属水饮停蓄。津液固结。
便宜取用。但须增损合宜耳。若津液损伤。阴血亏损之人。作渴而小便不利者。再用五苓利水劫阴之药。则祸
不旋踵矣。
张景医说曰。春夏之交。人病如伤寒。其人汗自出。肢体重痛。转仄难。小便不利。此名风湿。非伤寒也。
阴雨之后卑湿。或引饮过多。多有此证。但多服五苓散。小便通利。湿去则愈。切忌转泻发汗。小误必不可救。
初虞世云。医者不识。作伤风治之。发汗死。下之死。己未年。京师大疫正
为此。予自得其说。救人甚多。壬辰年。予守官洪州。一同官妻。有此证。因劝其速服五苓散。不信。医投发
汗药。一夕而毙。不可不谨也。大抵五苓散。能导水去湿耳。胸中有停痰。及小儿吐 。欲作痫。服五苓散。
最效。初君之说详矣。予因广此说。以信诸人。出信效方。博闻类纂曰。春夏之交。或夏秋之交。霖雨乍歇。
This clause describes irritability and restlessness (Fan Zao) resulting from unresolved disease, which belongs to deficiency after sweating or purging. However, the floating-tight pulse versus the deep-micro pulse naturally allow for differentiation to prevent misdiagnosis; hence, it is repeatedly emphasized.
Commentary: The symptoms corresponding to this decoction present with complete Yang syndrome manifestations, but it is not that simple. Although the body feels irritable and hot, the tips of the hands and feet are slightly cold. Although there is irritability and thirst desiring water intake, the patient prefers hot drinks and dislikes cold ones. The tongue coating is white and slippery, or falsely appears dry. The pulse may be surging-large, or scattered and rapid, or string-taut, large, floating, and rapid yet empty, powerless, and rootless. In summary, diagnosis should rely on the pulse rather than solely on symptoms, thereby avoiding inaccuracy.
Fuling Sini Decoction Formula
Fuling (Poria) (4 liang ○ Cheng's edition makes it 6 liang.) Renshen (Ginseng Radix et Rhizoma) (1 liang) Fuzi (Aconiti Lateralis Radix Praeparata) (1 piece, used raw, skin removed, broken into eight pieces.) Gancao (Licorice Root) (2 liang, honey-fried)
Ganjiang (Dried Ginger) (1.5 liang)
The above five herbs are boiled in 5 sheng of water until 3 sheng remain. Strain. Take 7 ge warm, twice daily. (In *Yuhan Jing*, the character "ju" [chew] appears after "wei". 3 sheng becomes 1 sheng 2 ge. After straining, it says "take warm in two doses daily three times". In *Qianjin Yifang*, 3 sheng becomes 2 sheng.)
[Cheng Wuji] Sini Decoction tonifies Yang; adding Fuling and Renshen benefits Yin. [Ke Qin] Sweating first then purging follows the correct method, yet the exterior syndrome remains unresolved, indicating wrongful purging leading to loss of Yin fluid, causing both Yin and Yang deficiency and resulting in irritability and restlessness. Thus, Fuling Sini Decoction was formulated to secure Yin to gather Yang. Purging first then sweating is contrary to proper method, yet the exterior syndrome resolves, and internally there is no vomiting or thirst, seemingly indicating self-harmonization of Yin and Yang, but actually it is wrongful sweating leading to loss of Yang. Hence, deficient Yang disturbs the Yang aspect, causing daytime irritability. Therefore, Ganjiang and Fuzi are used specifically to secure Yang to match Yin. Both formulas are modified from Sini Decoction but differ in rescuing Yang versus rescuing Yin. This formula is milder than Sini Decoction because securing the interior requires a gentle approach. Ginger and Aconite are Yang within Yang; using raw Aconite and removing Licorice makes the power more intense and harsher than Sini Decoction, as rescuing Yang requires urgency. Removing Licorice and adding Fuling distinguishes mildness from urgency. The subtlety of modification reveals the divine skill in prescription.
Commentary: In *Qianjin Fang*, under the formula for Danzhuru Tang for postpartum women, it states: If Ginseng is available, add 1 liang; if not, add 1.5 liang of Poria, which is also good. Generally, Ginseng and Poria treat mental irritability and palpitations due to Heart deficiency, calming the spirit.
*Shengji Zonglu* treats abdominal pounding and palpitation in Huoluan with Pingwei Tang (which is this formula).
After sweating, chills indicate deficiency; absence of chills with only heat indicates excess. One should harmonize Stomach Qi by administering Tiaowei Chengqi Decoction. ([Original Note] *Yuhan Jing* says: administer Xiao Chengqi Decoction. ○ *Yuhan Jing*, *Maijing*, *Qianjin Yifang* have nine characters "Shaoyao Gancao Fuzi Tang Zhu Zhi" after "gu ye", merging the previous clause into one. Also, *Qianjin Yifang* note changes Tiaowei Chengqi Decoction to Xiao Chengqi Decothesis. Cheng, Yu, Qian, and Wang Kentang's collation of *Qianjin Yifang* add the character "e" [aversion] after "re" [heat].)
[Cheng Wuji] Sweating with chills indicates exterior deficiency. Sweating without chills, only heat, indicates interior excess. The Classic states: Sweating without chills means the exterior is resolved but the interior is not harmonized. (See Ten-Zao Decoction clause in lower volume.) Administer Tiaowei Chengqi Decoction to harmonize Stomach Qi. [Cheng Zhi] After sweating, aversion to cold turns to aversion to heat; the person's stool must be solid, caused by loss of fluids after sweating. The disease is no longer in Ying and Wei but in the Stomach. The method is to harmonize Stomach Qi. [Qian Huang] After sweating, Yang Qi is already deficient; drastic purging is unsuitable. Thus, one should administer Tiaowei Chengqi Decoction, as mentioned in the Yangming chapter: "administer Xiao Chengqi Decoction to mildly harmonize Stomach Qi, do not cause drastic purgation." This is correct. [Ke Qin] Excess and deficiency refer to the Stomach. After sweating, if healthy Qi is depleted, the Stomach is deficient, so use Aconite and Peony. If pathogenic Qi is abundant, the Stomach is excess, so use Rhubarb and Mirabilite. The natural use of Licorice here indicates harmonizing the Stomach. This shows Tiaowei Chengqi Decoction is a harmonizing agent, not a purgative.
Commentary: The Yangming chapter states: Sun-Yang disease for three days, unresolved after sweating, with steaming fever, belongs to the Stomach, treated with Tiaowei Chengqi Decoction. This precisely illustrates the principle of this clause.
Sun-Yang disease after sweating, with profuse sweating, dryness in the Stomach, irritability and restlessness preventing sleep, desiring water: give small amounts of water frequently. When Stomach Qi harmonizes, the patient recovers. If the pulse is floating, urination is difficult, with slight fever and excessive thirst, Wuling San is indicated. ([Original Note] It is Zhuling San. ○ *Maijing*: "hou" [after] reads "ruo" [if]. "Gan" [dry] reads "zao" [dry/arid]. No "zao" in "fan zao". *Yuhan Jing*: "yu de yin shui" reads "qi ren yu yin shui". *Yuhan Jing*, *Maijing*: "shao shao yu" reads "dang shao". "Wei qi" reads "wei zhong". Above Wuling San, *Cheng Ben* and *Yuhan Jing* both have the character "yu" [give], which is incorrect.]
[Wang Hu] This clause should be read in two parts. From "Sun-Yang disease after sweating..." to "...when Stomach Qi harmonizes, the patient recovers," this relates to dryness in the Stomach causing irritability and thirst, requiring only water to harmonize Stomach Qi, not Wuling San. If the pulse is floating, urination is difficult, with slight fever and excessive thirst, this relates to water-heat binding in the Bladder causing thirst, which is the indication for Wuling San. Sun-Yang disease encompasses Wind-Medium and Cold-Injury. Fang Youzhi classifying it under Wind-Medium is too rigid. [Wei Litong] Profuse sweating, described as flowing like water, injures Stomach fluids causing dryness. Due to dryness comes aridity, due to aridity comes irritability, due to irritability comes inability to sleep. This is a continuous sequence. One must fear mistaking it for interior transmission dryness-irritability and wrongly purging. Thus, the sign "desiring water" is highlighted. [You Yujing] Do not indulge desires; give water in small amounts frequently. [Shen Mingzong] If pulse is floating, urination is difficult, slight fever, and excessive thirst, it means Sun-Yang exterior pathogen has not ceased, and interior fluid retention in the Bladder has formed. The Classic says: The Bladder is the mansion of fluids; only through Qi transformation can they exit. Now, pathogenic heat scorches existing fluids; drinking water does not transform, cutting off newly generated fluids. Fluids are exhausted, seeking water for self-rescue, so water enters but thirst persists. Wuling San is used because it releases exterior heat externally and transports water internally, allowing Qi transformation and fluid generation, stopping heat-thirst and promoting urination. [Fang Youzhi] "Xiao" [consume] means drinking water but urination remains difficult, making it seem as if water consumes itself internally. "Ke" [thirst] means able to drink and drink much. [Wu Qian] Commentary: Profuse sweating and Stomach dryness mean lack of fluids causing irritability, so water is given to moisten. Urinary difficulty and excessive thirst mean Spleen fails to transport, fluids do not distribute, causing excessive thirst, so Wuling San is used to disperse. If Stomach dryness is treated with Wuling San to promote urination, dryness increases. Hence, the Yangming chapter says: Those with profuse sweating and thirst cannot take Zhuling Tang, because profuse sweating causes Stomach dryness, and Zhuling Tang further promotes urination.
*Shanghan Zhunsheng* Zhang Jianshan said: For irritability-thirst, Baihu Tang is appropriate. Why use Wuling San to seep fluids? Answer: Baihu Tang is for when exterior syndrome is resolved, pathogen transmits to interior causing irritability-thirst. Now pulse is still floating, slight fever and thirst exist, meaning exterior pathogen is not fully resolved. Thus, Cinnamon Twig's pungency harmonizes muscle-surface; Atractylodes and Poria's sweet-bland nature moistens deficiency-aridity.
Wuling San Formula
Zhuling (Polyporus) (18 zhu, skin removed) Zexie (Alisma Rhizome) (1 liang 6 zhu ○ Cheng Ben adds "ban" [half] after zhu.) Baizhu (Atractylodes Macrocephala Rhizome) (18 zhu) Fuling (Poria) (18 zhu)
Guizhi (Cinnamon Twig) (0.5 liang, skin removed ○ Cheng Ben, *Yuhan Jing* omit "zhi" [twig]; later scholars debated. Checking Cheng's notes and *Ming Lilun*, both write Guizhi, proving omission/error.)
The above five herbs are pounded into powder. Mix with white liquid (bai yin), take one fang cun bi (square-inch spoonful) three times daily. Drink plenty of warm water to induce sweating for recovery. Regulate according to method. (Pounded into powder: *Jinkui Yaolue*, Cheng Ben, *Yuhan Jing* say "as powder". *Qianjin Yifang* says pound each separately, then grind in mortar. *Waitai Mi Yao* epidemic disease says make into powder taken with water. *Qianjin Fang* also says taken with water. Drink plenty of warm water: *Qianjin Fang* omits "warm". *Waitai Mi Yao* warm disease says "drink plenty of warm water to assist drug potency". Cheng Ben omits "ru fa jiang xi" [regulate according to method].)
[Wu Qian] Powder implies dispersing four directions. Poria, Alisma, Polyporus are bland and draining. Atractylodes assists Spleen Qi transport; Cinnamon Twig reaches from muscle to surface. Exterior pores open, interior pores benefit. Hence, "drink plenty of warm water, sweat out, recover." [Wang Hu] Using Atractylodes in the formula: ancient sages like Sun Simiao, Zhu Fengyi, Xu Xueshi all used Baizhu. Recent physicians Fang Zhongxing, Yu Jiayan changed to Cangzhu. However, Cangzhu is too drying and acrid, unlike Baizhu's sweet-ping and moistening nature, which supplements fluids and moistens dryness. Even if Baizhu did not exist in Zhang Zhongjing's time, it exists now, so physicians may use it flexibly. The formula note says: "Drink plenty of warm water to induce sweating." This aligns with Guizhi Tang's instruction: "drink hot millet porridge to assist drug power." Xu Jian'an said: Wuling San is an exterior-releasing drug after sweating, evident here. [Wei Litong] Wuling must be powder, mixed with white liquid, to allow drinking plenty of warm water and inducing sweat for recovery. If decocted, internal and external resistance occurs, drug won't go down. Thus, taking medicine according to method is essential for efficacy.
Commentary: *Ming Lilun* says: Ling [Poria] sounds like Ling [Order/Command]. It commands fluid circulation and suppresses Kidney evil. Its merit lies in commanding. Among Wuling, Fuling is primary, hence named Wuling San. Ma Yongqing's *Lanzhen Zilu* records: Famous doctor Luo Gengdao of Guanzhong said: Of the five ingredients in Wuling San, Mu Zhuling (Wood Polyporus) is primary, hence named Wuling. *Zhuangzi* says: Herbs include Jin, Jiegeng, Jiyong, Shiling; whichever is timely becomes Emperor. Annotation: Herbs have no high or low value; healing disease is good. To remove water, Shiling (King). Shiling is Mu Zhuling. Uncertain which is correct, keep both.
Commentary: Baiyin [white liquid]: No commentary by various schools. *Yilei Yuanrong* defines it as white rice drink, clarifying it. *Huo Ren Shu* calls it white soup, likely incorrect.
*Qianjin Fang*: Wuling San treats seasonal febrile diseases with manic speech, irritability, restlessness, coherent speech but inappropriate interaction.
*Heji Jufang*: Chen Sha Wuling San treats Shanghan with unresolved exterior-interior, headache, fever, chest oppression, dry lips/mouth, dull consciousness, manic speech, delirium, seeing ghosts/spirits. Also treats malaria with irritability and unconsciousness. Add realgar to this formula. For summerheat thirst with red/scanty urine, mix with fresh well water. For children with five-center heat, irritability, crying, grinding teeth, convulsive signs, take half qian, warm water.
*Sanyin Fang*: In Jiwei year, capital epidemic: sweating caused death, purging caused death; taking Wuling San led to recovery. This was simply warm plague. (Note: *Yishuo* cites *Xinxiao Fang*.)
Also, Wuling San treats latent summerheat and drinking heat. Summerheat qi flows into meridians, obstructs and overflows causing epistaxis, or Stomach Qi deficiency, blood seeps into Stomach, stays undigested, vomiting 1-2 sheng.
*Shanghan Baiwen Jingluo Tu*: Wuling San also treats miasma warm malaria,不适应水土 (unaccustomed to local conditions), jaundice or diarrhea. Also treats alcohol intoxication nausea, or vomiting phlegm-water, water vomited immediately upon entering, epigastric fullness. Also treats jaundice, orange-yellow color, mental irritability, eyes like gold, red/scanty urine, or spontaneous loose stools. For treating jaundice, decoct Yinchen Tang to wash down, three times daily.
*Jisheng Fang*: Modified Wuling San treats latent summerheat and damp-heat, or dampness-induced diarrhea/dysentery. Or irritability, or urinary difficulty. Add Cheqianzi to this formula.
*Zhizhi Fang*: Wuling San treats dampness syndrome with urinary difficulty. Classic says: Method for treating dampness is not promoting urination, is not its treatment. Also treats summerheat injury with irritability-thirst, excessive drinking, red/scanty urine, water-Qi below Heart. Also circulating fluid retention, take 2 qian, boil water to mix. If urination still difficult, add Fangji as assistant. Also treats hematuria, add little Chen Sha, decoct Dengxin with new water to mix. Also treats perineal abscess, promote urination to drain stale essence, decoct Cong (Scallion) stems to mix.
After sweating, if pulse is floating-rapid, with irritability-thirst, Wuling San is indicated. (*Yuhan Jing*: "yi" [finished] reads "hou" [after]. "Fu" [floating] has "er" [and]. *Maijing*, *Qianjin Yifang*: "fan" [irritability] has "fu" [again].)
[Fang Youzhi] "Yi" means sweating is finished, not that exterior disease has ceased. Irritability-thirst means Bladder water accumulation fails to transform fluids, so use four Ling herbs to drain. Floating-rapid means exterior remains, so rely on Gui [Cinnamon] to harmonize. Thus, Wuling San resolves both exterior and interior. (Note: Fang's annotation is revised from *Jinjian*, differing from original text.) [Wu Qian] "Sweating finished" means Sun-Yang disease has been sweated. Floating-rapid pulse knows pathogen remains at exterior. If urination is free with irritability-thirst, it is early Yangming Stomach heat, Baihu Tang syndrome. Now urination is difficult with irritability-thirst, it is Sun-Yang Fu disease, Bladder water accumulation, Wuling syndrome. Thus, use Wuling San, take according to method, releasing exterior and draining interior, resolving both.
Commentary: If exterior pathogen is unresolved, Yang Qi is abundant externally, and fluids move externally. Lower-jiao water accumulation causes ascending Qi-fluid to lose normal function, leading to Stomach dryness and irritability-thirst. Thus, Wuling San is indicated to release exterior pathogen and drain interior water accumulation. Cheng's note attributing it to fluid loss and Stomach dryness is likely incorrect.
Shanghan with sweating and thirst: Wuling San is indicated. Without thirst: Fuling Ganjiang Tang is indicated.
[Wu Qian] This elaborates on the previous clause distinguishing cases of thirst without irritability, or irritability without thirst, to differentiate treatment. After Shanghan sweating, if pulse is floating-rapid, sweating, irritability-thirst, urinary difficulty, Wuling San is indicated. Here only "sweating" is mentioned as abbreviated text. Thirst without irritability means fluid abundance exceeds heat, so Wuling San is also indicated to drain water and transform fluids. If no irritability and no thirst, interior has no heat. Only floating-rapid pulse, sweating, urinary difficulty indicates Ying-Wei disharmony. Thus, Fuling Ganjiang Tang is indicated to harmonize exterior and drain water.
Commentary: Ke Qin added "xina ji" [palpitations below heart] after "sweating"; his theory is unreliable. Likely derived from Jueyin chapter: "Shanghan with cold extremities and palpitations below heart should first treat water, take Fuling Ganjiang Tang, then treat cold extremities; otherwise water infiltrates Stomach, causing diarrhea."
Fuling Ganjiang Tang Formula
Fuling (Poria) (2 liang ○ *Yuhan Jing* makes it 3 liang.) Guizhi (Cinnamon Twig) (2 liang, skin removed) Gancao (Licorice Root) (1 liang, honey-fried) Shengjiang (Fresh Ginger) (3 liang, sliced)
The above four herbs are boiled in 4 sheng of water until 2 sheng remain. Strain. Divide into three warm doses.
[Wu Qian] With floating-rapid pulse and sweating (exterior), Gui [Cinnamon] is primary. Removing Dazao [Jujube] and Shaoyao [Peony] is due to interior urinary difficulty, fearing their astringent nature hinders urination. Removing Baizhu, Zexie, Zhuling from Wuling San is because without thirst/irritability, interior fluid retention is minimal, only needing urination to resolve, fearing excessive drying/draining damages Yin.
*Shanghan Leifang* says: The meaning of this formula has never been interpreted. Post-sweating thirst continuing, giving Wuling San is easily understood. But post-sweating, no thirst sign, nor other specified signs, suddenly giving Fuling Ganjiang Tang, what is the intent? Know that "sweating" here means sweating continues after induced sweating. Continuous sweating means Yang loss exists; thus, Zhenwu Tang should be given. Milder case: Fuling Guizhi Baizhu Gancao Tang. Lightest case: this formula. How do we know? Because all three use Fuling. Profuse sweating draws Kidney water upward; only Fuling can calm it. Thus, Zhenwu uses Fuzi to rescue Yang; these two use Guizhi-Gancao to arrest sweating, with Fuling as main drug. The meaning is clear. Observing Jueyin chapter palpitation treatment clarifies it further.
*Xushi Bianyi* says: Water stagnating below Heart causing palpitations: Fuling Ganjiang Tang with Yuanhua is indicated. *Jinkui Yaolue* says: Eating little, drinking much, water stagnates below Heart, severe cases cause palpitations. Thus, palpitations should be treated by addressing fluid retention.
Wind-Medium with fever, unresolved for six-seven days with irritability, having exterior-interior signs, desiring water to drink, vomiting after drinking: named Shui Ni [Water Reversal]. Wuling San is indicated. ("Ming yue" [named]: *Yuhan Jing*, *Qianjin Yifang*, *Waitai* read "ci wei" [this is]. Yu Ben, Cheng Ben, Ke Ben, Zhang Ben: after "zhu zhi" [indicated], seven characters "duo fu nuan shui han chu yu" [drink plenty of warm water, sweat out, recover] appear.)
[Wei Litong] Exterior-interior signs: What is interior sign? It is irritability-thirst, drinking water then vomiting. What is exterior sign? It is previous clause's head-neck stiffness, aversion to cold, fever, sweating. Thus, use Guizhi to expel exterior pathogen, assist with Baizhu, Fuling, Zexie to strengthen Earth and drive water, plus drink plenty of warm water to induce sweating and resolve exterior. Water will not reverse, urination will flow, interior resolves, how could disease not heal? [Ke Qin] The person has water-Qi below Heart, Zangmid fire function not unblocked, pathogenic water condenses internally, fluid rejection externally. Cannot transmit externally to pores, cannot ascend to mouth/tongue, cannot descend to Bladder. This is why it is named Water Reversal. [Fang Youzhi] Latent fluid acts internally, so exterior cannot enter. Fluid is water; adding water to water, surging causes blockage, hence named Water Reversal.
Wu Zuncheng *Fanglun* says: Wuling San is the premier formula for driving internal-external fluid retention. *Jinkui* treats Heart-side fluid retention with dizziness using Zexie Tang; treats vomiting desiring water using Zhuling San. Using only 2-3 herbs, all trace back to this formula as ancestor. For any Sun-Yang unresolved exterior-interior, headache, fever, dry mouth/throat, irritability-thirst, or vomiting after drinking, or urinary difficulty, it is suitable. Also treats Huoluan vomiting/diarrhea, dry-thirst desiring water, and thin people with pulsation below umbilicus, vomiting saliva-drool, dizziness. All belong to fluid retention and congealed fluids, suitable for use. Must adjust appropriately. If fluid damage, Yin-blood deficiency persons with thirst and urinary difficulty, using Wuling's fluid-draining Yin-depleting drugs brings disaster swiftly.
Zhang Jing *Yishuo* says: Spring-Summer transition, people sick like Shanghan. Spontaneous sweating, heavy painful limbs, difficult turning, urinary difficulty. Named Fengshi [Wind-Damp], not Shanghan. After rainy low-dampness, or excessive drinking, many have this syndrome. Just take plenty of Wuling San, urination becomes free, dampness leaves, recovery. Strictly avoid purging/sweating; small error is incurable.
Chu Yushi said: Doctors don't recognize it, treat as Wind-Cold, sweating causes death, purging causes death. Jiwei year capital epidemic was exactly this. I learned this theory, saved many. Renchen year, I governed Hongzhou, colleague's wife had this syndrome. Advised quick Wuling San, refused, doctor gave sweating drug, died overnight. Must be cautious. Generally, Wuling San guides water and removes dampness. Phlegm-stagnation in Chest, and infants vomiting wanting epilepsy, taking Wuling San is most effective. Chu Jun's theory is detailed; I expand it to confirm to others. Out of *Xinxiao Fang*.
*Bowen Leizuan* says: Spring-Summer transition, or Summer-Autumn transition, rain suddenly stops.