【注】桂枝二越婢一汤，即大青龙以杏仁易芍药也，名虽越婢辅桂枝，实则大青龙之
变制也。去杏仁恶其从阳而辛散，用芍药以其走阴而酸收。以此易彼，裁而用之，则主
治不同也。以桂枝二主之，则不发汗，可知越婢一者，乃麻黄石膏二物，不过取其辛凉
之性，佐桂枝二，中和表而清热，则是寓微汗于不发之中，亦可识也。非若大青龙以石
膏佐麻黄而为发汗驱热之重剂也。桂枝二麻黄一汤，治若形如疟，日再发者，汗出必解，
而无热多寒少，故不用石膏之凉也。桂枝麻黄各半汤，治如疟状，热多寒少，而不用石
膏更倍麻黄者，以其面有怫郁热色，身有皮肤作痒，是知热不向里而向表，令得小汗以
顺其势，故亦不用石膏之凉里也。桂枝二越婢一汤，治发热恶寒，热多寒少，而用石膏
者，以其表邪寒少，肌里热多，故用石膏之凉，佐麻桂以和营卫，非发营卫也。今人一
见麻桂，不问轻重，亦不问温覆不温覆，取汗不取汗，总不敢用。皆因未究仲景之旨，麻
桂只是营卫之药。若重剂温覆取汗，则为发营卫之药；轻剂不温覆取汗，则为和营卫之
药也。
越婢汤 治风水恶风，一身悉肿，脉浮不渴，续自汗出，无大热者。又治里水，一
身面目黄肿，其脉沉小便不利，故令病水。假令小便自利，此亡津液，故令渴也。越婢加
术汤主之。
麻黄（六两） 石膏（半斤） 生姜（切，三两） 大枣（擘，十五枚） 甘草（一两）
恶风加附子（炮）一枚。
上五味，以水六升，煮麻黄，去沫，内诸药，煮取三升，分三服。
【集注】喻昌曰∶越婢汤者，示微发表于不发之方也，大率取其通调营卫。麻黄、石
膏二物，一甘热，一甘寒，合而用之。脾偏于阴则和以甘热，胃偏于阳则和以甘寒。乃
至风热之阳，水寒之阴，凡不和于中土者，悉得用之何也？中土不和，则水谷不化其精悍
之气，以实营卫。营卫虚，则或寒、或热之气，皆得壅塞其隧道，而不通于表里。所以
在表之风水用之，而在里之水兼渴，而小便自利者，咸必用之，无非欲其不害中土耳。不
害中土，自足消患于方萌矣。
赵良曰∶五脏各一其阴阳，独脾胃居中而两属之。故土不独成四气，土亦从四维而
后成，不惟火生而已。于是四方有水寒之阴，即应于脾，风热之阳，即应于胃，饮食五味
之寒热，凡入于脾胃者亦然。一有相干，则脾气不和，胃气不清，而水谷不化其精微，以
行营卫，以实阴阳也。甘者，土之本味，所以脾气不和，和以甘热，胃气不清，清以甘
寒。麻黄之甘热，走手足大阴经，连于皮肤，行气于三阴，以祛阴寒之邪；石膏之甘寒，走
手足阳明经，达于肌肉，行气于三阳，以祛风热之邪。既用其味甘以入土，用其寒热以
和阴阳，用其性善走以发越脾气，更以甘草和中缓急，二药相协而成功。大枣之甘，补
脾中之血；生姜之辛，益胃中之气。恶风者阳虚，故加附子以益阳。风水者，则加术以散皮
肤间风水，气发谷精以宣营卫，与麻黄、石膏伪使，引其入土也。越婢之名，不亦宜乎！
【按】喻昌所论明析，赵良之说，能细剖其理，开悟后学，故两录之。
麻黄杏仁甘草石膏汤 治温热内发，表里俱热，头痛身疼，不恶寒反恶热，元汗而
喘，大烦大渴，脉阴阳俱浮者，用此发汗而清火。若脉浮弱沉紧，沉细恶寒，自汗出而
不渴者，禁用。
麻黄（去节，四两） 杏仁（去皮尖，五十枚） 甘草（炙，二两） 石膏（碎，绵裹，半斤）
上四味，以水七升，先煮麻黄，减二升，去上沫，内诸药，煮取二升，去滓，温服一升。
【集注】柯琴曰∶石膏为清火之重剂，青龙、白虎皆赖以建功，然用之不当，适足以
召祸。故青龙以元汗烦躁，得姜、桂以宣卫外之阳也；白虎以有汗烦渴，须粳米以存胃
中之液也。此但热无寒，故不用姜、桂，喘不在胃而在肺，故不须粳米。其意重在存阴，
不必虑其亡阳也，故于麻黄汤去桂枝之监制，取麻黄之专开，杏仁之降，甘草之和，倍石
膏之大寒，除内外之实热，斯溱溱汗出，而内外之烦热与喘悉除矣。
麻黄附子细辛汤 治少阴病始得之，反发热脉沉，二三日无里证者。
麻黄（一两） 附子（炮，一枚） 细辛（二两）
热微者，以甘草易细辛微发汗。
上三味，以水一斗，先煮麻黄，减二升，去沫，内药，煮取三升，去滓，温服一升，日
三服。
【集注】柯琴曰∶少阴主里，应无表证；病发于阴，应有表寒。今少阴始受寒邪而反
发热，是有少阴之里，而兼有太阳之表也。太阳之表脉应不沉，今脉沉者，是有太阳之证，
而见少阴之脉也。故身虽热而脉则沉也。所以太阳病而脉反沉，便用四逆以急救其里；此
少阴病而表反热，便于表剂中加附子以预固其里。夫发热无汗，太阳之表不得不开，沉
为在里，少阴之枢又不得不固。设用麻黄开腠理，细辛散浮热，而无附子以固元阳，则
少阴之津液越出，太阳之微阳外亡，去生便远。惟附子与麻黄并用，则寒邪虽散，而阳
不亡；此里病及表，脉沉而当发汗者，与病在表脉浮而发汗者径庭也。若表微热，则受
寒亦轻，故以甘草易细辛而微发其汗，甘以缓之，与辛以散之者，又少间矣。
桂枝加附子汤 太阳病发汗，遂漏不止，其人恶风，小便难，四肢微急，难以屈伸者，
此方主之。
桂枝汤加附子一枚，（炮去皮，破八片。）
煎服法同，不须啜粥。
【集注】柯琴曰∶发汗太过，阳无所止息，而汗出不止矣。汗多亡阳，元府不闭，风乘
虚入，故复恶风；津液外泄，不能润下，故小便难。四肢者，诸阳之本；阳气者，柔则
养筋，开阖不得，风寒从之，故筋急而屈伸不利也。是方以附于加入桂枝汤中，大补表
阳也；表阳密，则漏汗自止，恶风自罢矣。汗止津回，则小便自利四肢自柔矣。汗漏不止，
与大汗出同，而从化变病则异。服桂枝、麻黄后，大汗出而大烦渴，是阳陷于里，急当救
阴，故用白虎加人参汤。服桂枝、麻黄汤，大汗出遂漏不止，是阳亡于外，急当救阳，故用桂
枝加附子汤。要知发汗之剂，用桂枝不当，则阳陷于里者多；用麻黄不当，则阳亡于外者
多。因桂枝汤有芍药而无麻黄，故虽汗大出，而元府尚能自闭，多不致亡阳于外耳。
芍药甘草附子汤 发汗病解，反恶寒者，虚故也，此方主之。
芍药（三两） 甘草（炙，二两） 附子（炮去皮，破八片，一枚）
上三味，以水五升，煮取一升五合，去滓，分温服。
【集注】柯琴曰∶发汗病解而反恶寒，比未汗时更甚，其阳虚可知矣。夫太阳、少阴
为表里，太阳之病，本由少阴之虚，不能藏精而为阳之守也。今恶寒反见于发汗病解后，
是寒邪已从汗解，太阳阳虚不能卫外而为阴之使也，则阳亡之兆已见于此。若无以桂枝
汤攻表，非以扶阳反以亡阳也。故以芍药收少阴之精气，甘草缓阴邪之上行，附子补坎
宫之少火，但使肾中元阳得位，在表之虚阳恶寒自解耳。
桂枝甘草汤 治发汗过多，其人叉手自冒心，心下悸，欲得按者。
桂枝（四两） 甘草（炙，二两）
上二味，水三升，煮取一升，顿服。
【集注】柯琴曰∶汗出多，则心液虚，中气馁，故悸。叉手自冒，则外有所卫，得按
则内有所根据，如此不堪之状，望之而知其虚矣。桂枝本营分药，得麻黄，则令营气外发
而为汗，从辛也；得芍药，则收敛营气而止汗，从酸也；得甘草，则补中气而养血，从
甘也。故此方以桂枝为君，独任甘草为佐，以补阳气生心液。甘温相得，斯气血和而悸自
平。不须附子者，以汗虽多而未至于阳亡。不须芍药者，以汗已止而嫌其阴敛也。
桂枝加芍药加大黄汤 本太阳病，医反下之，因而腹满时痛者，属太阴也，桂枝加
芍药汤主之。大实痛者，桂枝加大黄汤主之。
桂枝加芍药汤方
于桂枝汤方内，更加芍药三两，随前共六两，余根据桂枝汤法。
桂枝加大黄汤方
即桂枝加芍药汤方内，更加大黄一两。
【集注】柯琴曰∶腹满为大阴、阳明俱有之证，然位同而职异。太阴主出，太阴病则
腐秽之出不利，故满而时痛；阳明主内，阳明病则腐秽燥而不行，故大实而痛。大实痛
是阳明病，不是太阴病。仲景因表证未解，阳邪已陷入于太阴，故倍芍药以益脾调中，而
除腹满时痛，此用阴和阳法也。若表邪未解，而阳邪陷入于阳明，则加大黄以润胃通结，而
除其大实痛，此双解表里法也。凡妄下必伤胃气，胃气虚则阳邪袭阴，故转属太阴；胃
液涸则两阳相搏，故转属阳明。属大阴则腹满时痛而下实，阴道虚也；属阳明则腹满大
实而痛，阳道实也。满而时痛，是下利之兆，大实而痛，是燥屎之征。故倍加芍药，小变
建中之剂，少加大黄，微示调胃之方。
小建中汤 治伤寒表未解，或心悸而烦，
或腹中急痛，而脉阳涩阴弦者。
桂枝（三两） 芍药（六两） 生姜（切，三两） 甘草（二两） 胶饴（一斤） 大枣（擘，十二枚）
上六味，以水七升，煮取三升，去滓，内胶饴，更上火消解，日三服，呕家不可用建
中汤，以甜故也。
【注】是方也，即桂枝汤倍芍药加胶饴。名曰小建中，谓小小创建中气，以中虽已虚，
表尚未和，不敢大补也。故以桂葶汤仍和营卫，倍芍药加胶饴调建中州，而不啜稀粥温
服令汗，盖其意重在中虚，而不在伤寒之表也。中虚创建，营卫自和，津液可生，汗出
乃解，烦悸可除矣。伤寒浮得脉涩，营卫不足也，沉得脉弦，木入土中也。营卫不足则
表虚，木入士中则里急，表虚里急，故亦以此汤主治也。呕家不可用，谓凡病呕者不可
用，恐甜助呕也。
炙甘草汤 治伤寒脉结代，心动悸者。又治肺痿，咳吐多，心中温温液液者。
甘草（炙，四两） 生姜（切，三两） 桂枝（三两） 麦门冬（半升） 麻子仁（半升）
大枣（擘，十二枚） 人参（一两） 阿胶（二两） 生地黄（一斤）
上九味，以清酒七升，水八升，先煮八味，取三升，去滓，内胶，烊消尽，服一升，
日三服。
【集注】柯琴曰∶仲景于脉弱阴弱者，用芍药以益阴，阳虚者，用桂枝以通阳，甚则
加人参以生脉，未有用地黄、麦冬者。岂以伤寒之法义重扶阳乎？抑阴无骤补之法欤？此
以心虚脉结代，用生地黄为君，麦冬为臣，峻补真阴，开后学滋阴之路也。地黄、麦冬，味
虽甘而气则寒，非发陈、蕃莠之品，必得人参、桂枝以通阳脉，生姜、大枣以和卫营，阿
胶补血，酸枣安神，甘草之缓，不使速下，清酒之猛，捷于上行，内外调和，悸可宁而脉
可复矣。酒七升水八升，只取三升者，久煎之则气不峻，此虚家用酒之法。且知地黄、麦
冬得酒最良。此证当用酸枣仁，肺痿用麻子仁可也。如无真阿胶，以龟版胶代之。
桂枝人参、葛根黄芩黄连二汤合论∶太阳外证未解，而数下之，遂协热而利，利下不止，
表里不解，脉微弱，心不痞硬者，桂枝人参汤主之。桂枝证，医反下之，利遂不止，其脉促喘
而汗出者，葛根黄连黄芩汤主之。
枝枝人参汤
桂枝（四两） 甘草（四两） 人参（三两） 白术（三两） 干姜（三两）
水九升，先煮四味，取五升，内桂更煮三升，日再服，夜一服。
葛根黄芩黄连汤
葛根（半斤） 黄连（三两） 黄芩（三两） 甘草（炙，二两）
水八升，先煮葛根，减二升；内诸药，煮二升，分温再服。
【集注】柯琴曰∶外热不除，是表不解，下利不止，是里不解，病因则同。一以微弱
之脉而心下痞硬，是脉不足而证有余；一以脉促而喘，反汗自出，是脉有余而证不足，表
里虚实，当从脉而辨证矣。弱脉见于数下后，则痞硬为虚。故用理中之辛甘温补，止利消
痞硬，又加桂枝以解表。先煮四味后内桂枝，和中之力饶，而解肌之气锐，是于两解中寓
权宜法也。桂枝证脉本缓，误下后而反促，阳气重，可知邪束于表，阳扰于内。故喘而汗
出，利遂不止者，是暴注下迫，属于热也。故君气清质轻之葛根，以解肌而止利；佐苦寒
清肃之芩连，以止汗而除喘；又加甘草以和中。先煮葛根后内诸药，解肌之力缓，而清
中之气锐，又与补中逐邪者殊法矣。又曰∶上条脉证是阳虚，虽协热于外，而里则虚寒；下
条脉证是阳盛，虽下利不止，而表里俱实。同一协热利，同是表里不解，而寒热虚实攻补
不同。前方理中加桂枝，而冠桂枝于人参之上；后方泻心加葛根，而冠葛根于芩连之首。
不名理中泻心者，总为表未解故耳。补中亦能解表，凉中亦能散表，补中亦能散痞，凉
中亦能止利。仲景制两解方，神化如此。
白虎汤 治阳明证，汗出渴欲饮水，脉洪大浮滑，不恶寒反恶热。
石膏（碎，绵裹，一斤） 知母（六两） 甘草（二两） 粳米（六合）
上四味，以水一斗，煮米熟汤成，去滓，温服一升，日三服。
[Note] Guizhi Er Yuebi Yi Tang (Cinnamon Twig Twice and Gecko-Assisting Decoction Once) is essentially Da Qing Long Tang (Major Blue Dragon Decoction) with Xingren (Apricot Seed) replaced by Shaoyao (Peony Root). Although named "Yuebi assisting Guizhi," it is actually a modified version of Da Qing Long Tang. The removal of Xingren is due to its acrid-dispersing nature that aids Yang dispersion, while Shaoyao is used for its ability to enter the Yin aspect and its sour-astringent properties. By substituting one herb for another and adjusting the dosage, the therapeutic indications differ. With Guizhi (Cinnamon Twig) constituting two parts, it does not induce sweating; thus, the "Yuebi one part" refers to Mahuang (Ephedra Herb) and Shigao (Gypsum Fibrosum), merely utilizing their acrid-cool properties to assist the two parts of Guizhi in harmonizing the exterior and clearing heat. This implies inducing slight sweating within the framework of non-sweating therapy, which can be understood from this perspective. It differs from Da Qing Long Tang, where Gypsum assists Ephedra as a heavy formula for inducing sweating and driving out heat.
Guizhi Er Mahuang Yi Tang (Cinnamon Twig Twice and Ephedra Once Decoction) treats symptoms resembling malaria, occurring twice daily, where sweating leads to resolution, but without the "more heat than cold" presentation; hence, Gypsum's cooling property is not used. Guizhi Mahuang Ge Ban Tang (Equal Parts Cinnamon Twig and Ephedra Decoction) treats malaria-like symptoms with more heat than cold, and unlike the previous formula, it does not use Gypsum nor double the Ephedra. This is because the patient presents with a flushed,郁 (stagnant) hot complexion and skin itching, indicating that the heat is moving outward toward the exterior rather than inward. Allowing slight sweating to follow this trend explains why Gypsum's interior-cooling property is also omitted.
Guizhi Er Yuebi Yi Tang treats fever and aversion to cold with more heat than cold, utilizing Gypsum because the exterior pathogen has little coldness while the interior muscle layer has much heat. Thus, Gypsum's coolness assists Mahuang and Guizhi in harmonizing Ying (Nutritive) and Wei (Defensive) Qi, rather than dispersing them. Modern practitioners often hesitate to use Mahuang and Guizhi regardless of severity or whether warming covers are needed to induce sweat. This stems from a failure to explore Zhang Zhongjing's original intent: Mahuang and Guizhi are primarily herbs for harmonizing Ying and Wei Qi. When used in heavy doses with warming covers to induce sweat, they act to disperse Ying and Wei Qi; when used in light doses without warming covers, they act to harmonize Ying and Wei Qi.
Yuebi Tang (Gecko-Assisting Decoction): Treats Fengshui (Wind-Water edema) characterized by aversion to wind, generalized edema, floating pulse, absence of thirst, continuous spontaneous sweating, and no significant internal heat. It also treats Li Shui (Interior Water retention) presenting with yellowish swelling of the face and body, sinking pulse, and difficult urination, leading to water disease. If urination is free, it indicates fluid depletion causing thirst; in such cases, Yuebi Jia Zhu Tang (Gecko-Assisting Decoction plus Atractylodes Macrocephala Rhizome) is indicated.
Mahuang (6 liang), Shigao (0.5 jin), Shengjiang (sliced, 3 liang), Dazao (broken open, 15 pieces), Gancao (1 liang).
If aversion to wind is severe, add Pao Fuzi (Processed Aconite Lateralis Radix Preparata) 1 piece.
Decoct the above five herbs in 6 sheng of water, boil Mahuang first to remove foam, then add other herbs. Boil until 3 sheng remain, divide into three doses.
[Collected Notes] Yu Chang stated: Yuebi Tang demonstrates a method of mild diaphoresis without excessive sweating, primarily aiming to unblock and harmonize Ying and Wei Qi. Mahuang and Shigao, one sweet-warm and one sweet-cool, are combined. If Spleen Yin is偏 (biased/excessive), sweet-warm herbs harmonize it; if Stomach Yang is biased, sweet-cool herbs clear it. For wind-heat Yang pathogens and water-cold Yin pathogens failing to harmonize in the Middle Jiao (Earth), this formula applies. Why? If the Middle Jiao is disharmonious, grain and water cannot transform their essence into robust Qi to fill Ying and Wei. Deficient Ying and Wei allow cold or heat pathogens to block meridians, preventing communication between interior and exterior. Hence, it is used for exterior Fengshui and interior water retention with thirst and free urination, aiming to protect the Middle Jiao Earth. Protecting the Middle ensures hazards are eliminated at their inception.
Zhao Liang stated: Each of the Five Zang organs has its own Yin-Yang, but Spleen and Stomach reside centrally and belong to both. Earth generates the four seasons but also relies on the four directions to complete its cycle, not just Fire generating Earth. Water-cold Yin from the four directions corresponds to Spleen; wind-heat Yang corresponds to Stomach. Dietary flavors entering Spleen and Stomach behave similarly. Interference causes Spleen Qi disharmony and Stomach Qi turbidity, preventing transformation of nutrients to nourish Ying, Wei, and Yin-Yang. Sweet is the flavor of Earth; thus, Spleen disharmony is harmonized with sweet-warm, and Stomach turbidity cleared with sweet-cool. Mahuang's sweet-warm nature travels through Foot-Hand Taiyin meridians, connecting to skin and circulating Qi in Three Yin to dispel cold-damp. Shigao's sweet-cool nature travels through Foot-Hand Yangming meridians, reaching muscles and circulating Qi in Three Yang to dispel wind-heat. Using their sweet flavor to enter Earth, their cool/warm nature to harmonize Yin/Yang, and their penetrating nature to stimulate Spleen Qi, aided by Gancao to moderate urgency, achieves success. Dazao's sweetness tonifies Spleen blood; Shengjiang's pungency benefits Stomach Qi. Aversion to wind indicates Yang deficiency, so Fuzi tonifies Yang. For Fengshui, Baizhu disperses wind-water in the skin, promoting grain essence to circulate Ying-Wei, working with Mahuang and Shigao to guide action into Earth. Hence, the name Yuebi is fitting.
[Commentary] Yu Chang's analysis is clear; Zhao Liang's explanation details the principles, enlightening future students, so both are recorded.
Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction): Treats warm-heat originating internally with exterior-interior heat, headache, body ache, aversion to heat rather than cold, anhidrosis with wheezing, severe restlessness and thirst, and floating pulses at all positions. Use this to induce sweating and clear fire. Contraindicated if pulse is floating-weak or deep-tight/deep-thin with aversion to cold, spontaneous sweating, and no thirst.
Mahuang (de-stemmed, 4 liang), Xingren (skin and tip removed, 50 seeds), Gancao (honey-fried, 2 liang), Shigao (crushed, wrapped in cloth, 0.5 jin).
Decoct the four herbs in 7 sheng of water, boil Mahuang first to reduce by 2 sheng, remove foam, add other herbs, boil to 2 sheng, strain, take 1 sheng warm.
[Collected Notes] Ke Qin stated: Shigao is a heavy agent for clearing fire, essential for Da Qing Long Tang and Bai Hu Tang. Improper use invites disaster. Da Qing Long Tang uses Jiang (Ginger) and Gui (Cinnamon) to disseminate Wei Yang for anhidrotic irritability; Bai Hu Tang uses Jingmi (Rice) to preserve Stomach fluids for sudorific thirst. This formula has heat only, no cold, so no Ginger/Cinnamon; wheezing is in Lung, not Stomach, so no Rice. The focus is preserving Yin, not worrying about Yang loss. Removing Guizhi from Mahuang Tang allows Mahuang to open exclusively, Xingren to descend, Gancao to harmonize, and doubled Shigao to clear interior-exterior excess heat. Profuse sweating ensues, resolving heat, restlessness, and wheezing.
Mahuang Fuzi Xixin Tang (Ephedra, Processed Aconite, and Asarum Decoction): Treats Shaoyin disease onset with contrary fever and deep pulse, without interior signs after 2-3 days.
Mahuang (1 liang), Pao Fuzi (1 piece), Xixin (2 liang).
For mild heat, replace Xixin with Gancao for mild sweating.
Decoct the three herbs in 1 dou of water, boil Mahuang first to reduce by 2 sheng, remove foam, add other herbs, boil to 3 sheng, strain, take 1 sheng warm, three times daily.
[Collected Notes] Ke Qin stated: Shaoyin governs the interior and should lack exterior signs; Yin diseases should have exterior cold. Here, Shaoyin receives cold pathogen yet shows fever, indicating Shaoyin interior involvement with Taiyang exterior manifestation. Taiyang exterior pulse should not be deep; a deep pulse here indicates Taiyang signs with Shaoyin pulse characteristics. Thus, fever with deep pulse. In Taiyang disease with deep pulse, Sini Tang (Frigid Extremities Decoction) saves the interior urgently. Here, in Shaoyin disease with exterior fever, Fuzi is added to exterior formulas to secure the interior preemptively. Fever without sweat requires opening Taiyang pores; deep pulse requires securing Shaoyin pivot. Using Mahuang and Xixin without Fuzi risks Shaoyin fluid loss and Taiyang Yang collapse. Combining Fuzi with Mahuang disperses cold without Yang loss. This interior-disease-invading-exterior case with deep pulse requiring sweating contrasts sharply with exterior diseases with floating pulses requiring sweating. For mild exterior heat (lighter cold invasion), Gancao replaces Xixin for milder sweating, balancing sweet moderation with acrid dispersion.
Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Processed Aconite): Treats Taiyang disease post-diaphoresis with persistent leakage sweating, aversion to wind, difficulty urinating, slight rigidity of limbs, and difficulty flexing/extending.
Guizhi Tang plus Pao Fuzi (peeled, broken into 8 pieces, 1 piece).
Decoction and administration same as Guizhi Tang; do not drink warm porridge.
[Collected Notes] Ke Qin stated: Excessive sweating leaves Yang unsupported, causing continuous leakage. Sweating depletes Yang, leaving pores open for wind invasion, causing renewed aversion to wind. Fluid loss prevents downward lubrication, causing urinary difficulty. Limbs are the root of Yang; Yang softens tendons. Dysfunction of opening/closing allows wind-cold to invade, causing tendon rigidity. Adding Fuzi to Guizhi Tang greatly tonifies Exterior Yang. Secured Exterior Yang stops leakage and aversion to wind. Cessation of sweating restores fluids, normalizing urination and limb flexibility. While similar to massive sweating, the pathological transformation differs. Post-Guizhi/Mahuang massive sweating with thirst indicates Yang sinking interiorly, requiring Yin rescue via Baitu Jia Renshen Tang. Post-Guizhi/Mahuang leakage sweating indicates Yang collapsing externally, requiring Yang rescue via Guizhi Jia Fuzi Tang. Improper Guizhi use often sinks Yang interiorly; improper Mahuang use often collapses Yang externally. Guizhi Tang contains Shaoyao but lacks Mahuang, allowing pores to close even with heavy sweating, preventing external Yang collapse.
Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Processed Aconite Decoction): Treats post-diaphoresis resolution with contrary aversion to cold, indicating deficiency.
Shaoyao (3 liang), Gancao (honey-fried, 2 liang), Pao Fuzi (peeled, broken into 8 pieces, 1 piece).
Decoct the three herbs in 5 sheng of water to 1.5 sheng, strain, take warm in divided doses.
[Collected Notes] Ke Qin stated: Post-diaphoresis aversion to cold worsening indicates Yang deficiency. Taiyang and Shaoyin are interior-exterior pairs; Taiyang disease often stems from Shaoyin deficiency failing to store essence and guard Yang. Aversion to cold appearing after resolution indicates cold pathogen resolved via sweat, but Taiyang Yang deficiency fails to guard exterior. Signs of Yang collapse appear. Without Guizhi Tang to attack exterior (which would further deplete Yang), this formula uses Shaoyao to gather Shaoyin essence, Gancao to restrain rising Yin pathogen, and Fuzi to tonify Kan Palace (Kidney) minor fire. Restoring Kidney Yuan Yang resolves exterior deficiency-induced aversion to cold.
Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction): Treats excessive diaphoresis resulting in patient crossing hands over heart, epigastric palpitations, and desire for pressure.
Guizhi (4 liang), Gancao (honey-fried, 2 liang).
Decoct the two herbs in 3 sheng of water to 1 sheng, take in one dose.
[Collected Notes] Ke Qin stated: Excessive sweating depletes Heart fluid and weakens Middle Qi, causing palpitations. Crossing hands provides external protection; pressure provides internal support, clearly indicating deficiency. Guizhi acts on Ying level: with Mahuang, it disperses Ying Qi outward as sweat (acrid); with Shaoyao, it constrains Ying Qi to stop sweat (sour); with Gancao, it tonifies Middle Qi and nourishes blood (sweet). Here, Guizhi is Sovereign, Gancao is Assistant, tonifying Yang Qi and generating Heart fluid. Sweet-warm synergy harmonizes Qi-Blood, calming palpitations. Fuzi is unnecessary as Yang has not collapsed; Shaoyao is unnecessary as sweating has stopped and Yin constraint is undesirable.
Guizhi Jia Shaoyao Tang and Guizhi Jia Dahuang Tang: Original Taiyang disease treated incorrectly with purgation, leading to abdominal fullness and intermittent pain, classified as Taiyin disease, treated with Guizhi Jia Shaoyao Tang. For severe constipation/pain, use Guizhi Jia Dahuang Tang.
Guizhi Jia Shaoyao Tang Formula: Add 3 liang Shaoyao to Guizhi Tang, totaling 6 liang Shaoyao. Follow Guizhi Tang preparation.
Guizhi Jia Dahuang Tang Formula: Add 1 liang Dahuang (Rhubarb Root) to Guizhi Jia Shaoyao Tang.
[Collected Notes] Ke Qin stated: Abdominal fullness occurs in both Taiyin and Yangming. Taiyin governs output; dysfunction causes stagnation of rotting filth, leading to fullness and intermittent pain. Yangming governs intake; dysfunction causes dryness and obstruction, leading to severe fullness and pain. Severe pain indicates Yangming, not Taiyin. Zhang Zhongjing addresses unresolved exterior with Yang pathogen sinking into Taiyin by doubling Shaoyao to benefit Spleen and harmonize Middle, relieving fullness/pain (using Yin to harmonize Yang). If exterior pathogen remains and Yang sinks into Yangming, Dahuang moistens Stomach and unblocks obstruction, relieving severe pain (simultaneous release of exterior and interior). Incorrect purgation damages Stomach Qi; deficiency allows Yang pathogen to invade Yin (Taiyin); fluid depletion causes Yang clash (Yangming). Taiyin presents with fullness/intermittent pain and lower deficiency; Yangming presents with severe fullness/pain and upper excess. Intermittent pain signals diarrhea; severe pain signals dry stool. Doubling Shaoyao slightly modifies Jianzhong (Establish the Middle) formula; adding Dahuang subtly indicates Tiaowei (Regulate Stomach) approach.
Xiao Jianzhong Tang (Minor Construct the Middle Decoction): Treats Shanghan with unresolved exterior, palpitations with irritability, or acute abdominal pain with floating-choppy and sinking-string-taut pulses.
Guizhi (3 liang), Shaoyao (6 liang), Shengjiang (sliced, 3 liang), Gancao (2 liang), Jiaoyi (Malt Sugar, 1 jin), Dazao (broken open, 12 pieces).
Decoct six herbs in 7 sheng of water to 3 sheng, strain, add Jiaoyi, melt over heat, take three times daily. Vomiting patients should avoid this due to sweetness aggravating vomiting.
[Note] This is Guizhi Tang with doubled Shaoyao and added Jiaoyi. Named Xiao Jianzhong (Minor Construct Middle) because it gently builds Middle Qi; although Middle is deficient, exterior is unharmonized, so heavy tonification is avoided. Guizhi Tang harmonizes Ying-Wei; doubled Shaoyao and Jiaoyi regulate Middle. No warm porridge is drunk to induce sweat, as the focus is Middle deficiency, not exterior Shanghan. Establishing Middle harmonizes Ying-Wei, generates fluids, induces sweat, and resolves irritability/palpitations. Floating-choppy pulse indicates Ying-Wei insufficiency; sinking-string-taut pulse indicates Wood invading Earth. Ying-Wei deficiency causes exterior deficiency; Wood invading Earth causes interior tension. Hence, this formula treats both. Avoid in vomiting patients as sweetness may worsen it.
Zhi Gancao Tang (Honey-Fried Licorice Decoction): Treats Shanghan with knotted/intermittent pulse and palpitations. Also treats Fei Wei (Lung Atrophy) with copious sputum and warm, fluid discomfort in the chest.
Gancao (honey-fried, 4 liang), Shengjiang (sliced, 3 liang), Guizhi (3 liang), Maidong (Ophiopogon Tuber, 0.5 sheng), Maziren (Hemp Seed, 0.5 sheng), Dazao (broken open, 12 pieces), Renshen (Ginseng Root, 1 liang), Ejiao (Donkey-hide Gelatin, 2 liang), Shengdihuang (Rehmannia Root, 1 jin).
Decoct nine herbs in 7 sheng Qingjiu (Clear Wine) and 8 sheng water. Boil eight herbs first to 3 sheng, strain, add Ejiao, melt completely, take 1 sheng, three times daily.
[Collected Notes] Ke Qin stated: Zhang Zhongjing uses Shaoyao for weak Yin pulses, Guizhi for Yang deficiency, and Renshen for severe cases to generate pulse, rarely using Dihuang or Maidong. Is Shanghan theory focused on tonifying Yang? Or is there no rapid method to tonify Yin? This formula uses Shengdihuang as Sovereign and Maidong as Minister for severe True Yin tonification in Heart deficiency with knotted pulse, pioneering Yin-nourishing methods. Dihuang and Maidong are sweet-cool, not suitable for growth/storage cycles; they require Renshen and Guizhi to unblock Yang pulses, Shengjiang and Dazao to harmonize Ying-Wei, Ejiao to nourish blood, and Gancao to slow descent. Qingjiu promotes rapid ascent. Internal-external harmony calms palpitations and restores pulse. Using large amounts of wine/water to yield small volume ensures gentle action for deficiency cases, optimizing Dihuang/Maidong efficacy. Suanzao Ren (Sour Jujube Seed) is appropriate for this condition; Maziren is suitable for Lung Atrophy. If true Ejiao is unavailable, Guiban Jiao (Tortoise Shell Gelatin) may substitute.
Discussion on Guizhi Renshen Tang and Gegen Huangqin Huanglian Tang: Taiyang exterior signs unresolved, followed by multiple purgations, leading to協熱利 (Collaborative Heat Diarrhea), continuous diarrhea, unresolved exterior-interior, weak pulse, and no epigastric hardness, treated with Guizhi Renshen Tang. For Guizhi pattern, incorrect purgation leads to continuous diarrhea, rapid pulse, wheezing, and sweating, treated with Gegen Huangqin Huanglian Tang.
Guizhi Renshen Tang
Guizhi (4 liang), Gancao (4 liang), Renshen (3 liang), Baizhu (Atractodis Macrocephalae Rhizoma, 3 liang), Ganjiang (Dried Ginger, 3 liang).
Water 9 sheng, boil first four herbs to 5 sheng, add Guizhi, boil to 3 sheng. Take twice day, once night.
Gegen Huangqin Huanglian Tang
Gegen (Puerariae Lobatae Radix, 0.5 jin), Huanglian (Coptidis Rhizoma, 3 liang), Huangqin (Scutellariae Radix, 3 liang), Gancao (honey-fried, 2 liang).
Water 8 sheng, boil Gegen first to reduce by 2 sheng, add other herbs, boil to 2 sheng, take warm in two doses.
[Collected Notes] Ke Qin stated: Persistent exterior heat indicates unresolved exterior; continuous diarrhea indicates unresolved interior. Etiology is same. One presents with weak pulse and epigastric hardness (pulse insufficient, signs excessive); the other with rapid pulse, wheezing, sweating (pulse excessive, signs insufficient). Exterior-interior deficiency-excess must be differentiated by pulse. Weak pulse post-purgation indicates deficiency-hardness. Lizhong Tang's acrid-sweet-warm tonification stops diarrhea and resolves hardness, plus Guizhi for exterior. Boiling four herbs first then adding Guizhi enhances middle-harmonizing power while maintaining exterior-dispersing sharpness, a flexible approach in dual resolution. Guizhi pattern pulse is normally slow; post-purgation rapid pulse indicates heavy Yang, pathogen binding exterior, Yang disturbing interior. Wheezing, sweating, and diarrhea indicate acute watery diarrhea, a heat syndrome. Gegen (clear/light) resolves muscle and stops diarrhea; Huangqin/Huanglian (bitter-cool) stops sweating and wheezing; Gancao harmonizes middle. Boiling Gegen first then adding others slows muscle-resolving power but sharpens interior-clearing action, differing from tonifying-middle approaches. Upper case: Yang deficiency, collaborative heat exterior but cold-deficient interior. Lower case: Yang excess, continuous diarrhea but solid exterior-interior. Same collaborative heat diarrhea, same unresolved exterior-interior, but different cold/heat/deficiency/excess treatments. Former adds Guizhi to Lizhong, naming Guizhi first; latter adds Gegen to Xie Xin variants, naming Gegen first. Not named Lizhong/Xie Xin because exterior is unresolved. Tonifying middle can resolve exterior; cooling middle can scatter exterior; tonifying middle can resolve hardness; cooling middle can stop diarrhea. Zhang Zhongjing's dual-resolution formulas demonstrate such divine adaptation.
Bai Hu Tang (White Tiger Decoction): Treats Yangming syndrome with sweating, thirst for water, flooding-floating-slippery pulse, aversion to heat rather than cold.
Shigao (crushed, wrapped, 1 jin), Zhimu (Anemarrhenae Rhizoma, 6 liang), Gancao (2 liang), Jingmi (Rice, 6 he).
Decoct four herbs in 1 dou of water until rice is cooked and soup is ready, strain, take 1 sheng warm, three times daily.