见阳明篇
发汗已，脉浮数，烦渴者，五苓散主之
【按】
脉浮数之下当有「小便不利」四字，若无此四字，则为阳明内热口燥之烦渴，白虎汤
证也。以其有小便不利烦渴，则为太阳水热瘀结之烦渴，五苓散证也。况无小便不利
证而用五苓散，则犯重竭津液之禁矣。太阳上篇，类此证者数条，唯一条水入即吐，
水不下行，故无小便不利之文，此条应有「小便不利」四字。
【注】
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，是太阳府病，膀胱水畜，五苓证也。故
用五苓散，如法服之，外疏内利，表里均得解矣。
【集注】
方有执曰：已者言发汗毕，非谓表病罢也。烦渴者，膀胱水畜，不化津液，故用四苓
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。
伤寒汗出而渴者，五苓散主之；不渴者，茯苓甘草汤主之。
【注】
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，是荣卫不和也，故主以茯苓甘草汤和表以利水也。
【集注】
郑重光曰：伤寒本无汗，汗因发而出也。上条烦而渴，此条但渴不烦，里证较轻，治
亦不殊；若更不渴，则内无燥，里病少而表证犹多也。故用桂枝汤之三，五苓散之一
，示三表一里之意，易名曰茯苓甘草汤者，乃桂枝五苓之变制也。
See the Yangming Chapter.
After sweating therapy, if the pulse is floating and rapid, accompanied by vexation and thirst, Wuling San (Five-Ling Powder) should be administered.
[Commentary]
Under "pulse floating and rapid," the four characters "difficulty in urination" (xiaobian buli) should be present. Without these four characters, it would be the vexation and thirst due to internal heat and dryness of the mouth in Yangming syndrome, which is a Baizhu Tang (White Tiger Decoction) pattern. Because there is difficulty in urination along with vexation and thirst, it is the vexation and thirst due to water-heat binding in the Taiyang syndrome, which is a Wuling San pattern. Moreover, using Wuling San without the symptom of difficulty in urination violates the prohibition against further depleting body fluids. In the first part of the Taiyang chapter, there are several similar patterns; only one case involves vomiting immediately after drinking water with failure of fluid descent, hence no mention of difficulty in urination. This case should include the four characters "difficulty in urination."
[Annotation]
"After sweating therapy" refers to the fact that sweating therapy has already been performed for Taiyang syndrome. A floating and rapid pulse indicates that the pathogenic factor remains in the exterior. If urination is free but vexation and thirst occur, this indicates the initial entry into Yangming stomach heat, which is a Baizhu Tang pattern. Now, with difficulty in urination and vexation/thirst, this is a Taiyang fu-organ disease, specifically bladder water accumulation, which is a Wuling San pattern. Therefore, Wuling San is used; when taken according to the method, it disperses externally and promotes urination internally, resolving both the exterior and interior.
[Collected Annotations]
Fang Youzhi stated: "Already" means the completion of sweating therapy, not that the exterior disease has ceased. Vexation and thirst result from bladder water accumulation failing to transform into body fluids; thus, Si Ling (Four-Ling) ingredients are used to promote urination. A floating and rapid pulse indicates the exterior has not yet been cleared; therefore, Guizhi (Cinnamon Twig) is relied upon to harmonize the exterior. Hence, it is said that Wuling San can resolve both exterior and interior simultaneously.
In cold damage, if sweating occurs with thirst, Wuling San is indicated; if there is no thirst, Fuling Gancao Tang (Poria and Licorice Decoction) is indicated.
[Annotation]
This supplements the previous clause, distinguishing between cases of thirst without vexation or vexation without thirst, to differentiate treatments. After cold damage sweating therapy, if the pulse is floating and rapid, with sweating, vexation, thirst, and difficulty in urination, Wuling San is indicated (the current text only mentions "sweating" as an abbreviation). Thirst without vexation indicates water retention exceeds heat; thus, Wuling San is also indicated to promote urination and transform fluids. If there is neither vexation nor thirst, it indicates no heat in the interior. Only with a floating and rapid pulse, sweating, and difficulty in urination does it indicate disharmony of Ying and Wei nutrients; thus, Fuling Gancao Tang is indicated to harmonize the exterior and promote urination.
[Collected Annotations]
Zheng Zhongguang stated: Cold damage originally presents without sweating; sweating arises due to diaphoretic treatment. The previous clause involved both vexation and thirst; this clause involves only thirst without vexation, indicating a milder interior condition, so the treatment is not significantly different. If there is additionally no thirst, it indicates no dryness in the interior, with fewer interior diseases and more exterior symptoms. Therefore, three parts of Guizhi Tang (Cinnamon Twig Decoction) and one part of Wuling San are used, demonstrating the principle of treating three parts exterior and one part interior. Renamed as Fuling Gancao Tang, it is actually a modified formulation combining Guizhi Tang and Wuling San.