见阳明篇
太阳病三日，发汗不解，蒸蒸发热者，属胃也，调胃承气汤主之。
【注】
太阳病三日，发汗后热不解，若仍阵阵发热有汗而不解者，是太阳表证未罢也，则当
以桂枝汤和之。今蒸蒸发热，有汗而不解者，乃属阳明里证不和也，故用调胃承气汤
。
【集注】
程应旄曰：太阳病，三日，经期尚未深也，何以发汗不解便属胃也？盖以胃燥素盛，
故他表症虽罢，而汗与热仍不解也。第征其热，如炊笼蒸蒸而盛，则知其汗必连绵濈
濈而来，此即大便已□之征，故曰属胃也。热虽聚于胃，而未见潮热、□语等证，主
以调胃承气汤者，于下法内从乎中治，以其为日未深故也。
汪琥曰：言太阳病，不可拘以日数，但见属胃之证，即可下也。病方三日，曾经汗矣
，其热自内腾达于外，非表邪不解，乃太阳之邪转属于胃，病热不能解也。
见阳明篇
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。
【注】
太阳病，发汗后，或大汗出，皆令人津液内竭，胃中干，烦躁不得眠，欲得饮水，当
少少与之，以滋胃燥，令胃气和，则可愈也。倘与之饮，胃仍不和，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，津液之府，
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。
【集注】
张兼善曰：白虎治表证已解，邪传里而烦渴者。今脉浮身有微热而渴，乃表邪未得全
解，故用五苓，借桂枝之辛散，和肌表以解微热也。术、泽二苓之淡渗，化水生津以
止燥渴也。
喻昌曰：脉浮当用桂枝，何以变用五苓耶？盖热邪得水，虽不全解，势必衰其大半，
所以热微兼小便不利，证成消渴，则蓄饮证具，故不从单解而从两解也。凡饮水多而
小便少，谓之消渴。里热饮盛，不可单用桂枝解肌，故兼以利水，惟五苓有全功耳！
程应旄曰：微热字，对下条发热字看，彼以发热在表，则知犯本未深，故邪热蓄而拒
水。此曰微热，则表热犯本已深，故热邪结而耗液。所以不惟与水与五苓主治有别，
而前五苓、后五苓主治亦俱有别也。
中风发热，六、七日不解而烦者，有表里证，渴欲饮水，水入则吐者，名曰水逆，五
苓散主之。
【注】
中风发热，六、七日不解而烦者，是有表证也。渴欲饮水，水入则吐者，是有里证也
。若渴欲饮水，水入即消，如前条之胃干，少少与饮，令胃和则愈。今渴欲饮水，水
入不消，上逆而吐，故名曰水逆。原其所以吐之之由，则因邪热入里，与饮相传，三
焦失其蒸化，而不能通调水道，下输膀胱，以致饮热相格于上，水无去路于下，故水
入则吐，小便必不利也，宜五苓散辛甘淡渗之品，外解内利，多服暖水，令其汗出尿
通，则表里两解矣。
【集注】
方有执曰：中风发热，必自汗出，六七日不解而烦者，汗出过多，亡津液，而内燥也
。表以外证未罢言，里以烦渴属府言。欲饮水者，燥甚而渴，希救故也。水入则吐者
，伏饮内作，故外水不得入也。盖饮亦水也，以水得水，涌溢而为格拒，所以谓之水
逆，与五苓散两解表里，汗出而愈也。
喻昌曰：伤风证，原有汗，以其有汗也，延至日久，不行解肌之法，汗出虽多，徒伤
津液，表终不解，转增烦渴，邪入于府，饮水则吐，名曰水逆。乃热邪挟积饮上逆，
故外水格而不入也。服五苓，饮热汤，得汗则表里俱解，是一举而两得也。
See Yangming Chapter.
In Taiyang disease, after three days, if sweating fails to resolve the condition and there is a sensation of heat steaming outward (Zhengzheng Refa), this indicates the pathogen has entered the Stomach (Yangming interior excess). It should be treated with Tiaowei Chengqi Tang (Regulate the Stomach and Inherit Qi Decoction).
[Annotation]
In Taiyang disease, after three days, if sweating fails to resolve the condition, and if there is still intermittent fever with sweating that does not alleviate the heat, this indicates that the Taiyang exterior syndrome has not yet subsided. In such cases, Guizhi Tang (Cinnamon Twig Decoction) should be used to harmonize the Ying and Wei levels. However, in the present case of heat steaming outward with sweating that does not alleviate the heat, it belongs to the disharmony of the Yangming interior syndrome. Therefore, Tiaowei Chengqi Tang (Regulate the Stomach and Inherit Qi Decoction) is used.
[Collected Annotations]
Cheng Yingmao stated: In Taiyang disease, after three days, the course of the disease is still shallow. Why does failure to resolve after sweating indicate involvement of the Stomach? This is because the patient's Stomach dryness and heat are inherently abundant. Thus, although other exterior symptoms have ceased, sweat and heat remain unresolved. By observing the heat sensation, which is vigorous like steam rising from a cooking pot, one knows that the sweating must be continuous. This is a sign that the stool has become dry; hence, it is said to "belong to the Stomach." Although the heat gathers in the Stomach, symptoms such as tidal fever or delirium are absent. The primary use of Tiaowei Chengqi Tang (Regulate the Stomach and Inherit Qi Decoction) employs a milder purgative approach within the purgation method, because the duration of the disease is short.
Wang Hu stated: This refers to Taiyang disease. One should not rigidly adhere to the number of days. As long as signs indicating involvement of the Stomach appear, purgation can be employed. The disease has only lasted three days and has already undergone sweating. The heat rises from the interior to the exterior. This is not due to unresolved exterior pathogens, but rather the Taiyang pathogen transferring to the Stomach, making the pathological heat unresolvable.
See Yangming Chapter.
In Taiyang disease, after sweating, if profuse sweating occurs leading to dryness in the Stomach, restlessness, insomnia, and a desire for water, water should be given in small amounts frequently. When the Stomach Qi becomes harmonious, the patient will recover. If there is floating pulse, difficulty in urination, slight fever, and Xiao Ke (excessive thirst with inability to quench it), Wuling San (Five-Ingredient Powder with Poria) should be administered.
[Annotation]
In Taiyang disease, after sweating, or following profuse sweating, the body's Jin Ye (Body Fluids) may be depleted internally, causing dryness in the Stomach, restlessness, insomnia, and a desire for water. Water should be given in small amounts frequently to moisten Stomach dryness and harmonize Stomach Qi, leading to recovery. If, after giving water, the Stomach remains disharmonious, and symptoms such as floating pulse, difficulty in urination, slight fever, and Xiao Ke (excessive thirst with inability to quench it) appear, this indicates that the Taiyang exterior pathogen has not subsided, and fluid retention in the Bladder has formed. The Classics state: The Bladder is the mansion of Jin Ye (Body Fluids); when Qi transformation functions normally, urine is excreted. Now, pathogenic heat scorching consumes existing Jin Ye (Body Fluids), and ingested water cannot transform into Jin Ye (Body Fluids), cutting off the source of new fluids. With Jin Ye (Body Fluids) exhausted, the body seeks water for self-rescue, so ingested water is quickly consumed, resulting in persistent thirst despite drinking. Wuling San (Five-Ingredient Powder with Poria) is used because it can release exterior heat externally and transport water internally to the Bladder mansion. This restores Qi transformation, generates Jin Ye (Body Fluids), stops heat and thirst, and promotes urination.
[Collected Annotations]
Zhang Jianshan stated: Baihu Tang (White Tiger Decoction) treats cases where the exterior syndrome has resolved, and the pathogen has transmitted to the interior causing irritability and thirst. Here, with a floating pulse, slight body heat, and thirst, the exterior pathogen has not fully resolved. Therefore, Wuling San (Five-Ingredient Powder with Poria) is used. The acrid dispersal of Guizhi (Cinnamon Twig) harmonizes the muscle layer to relieve slight heat. The bland and draining properties of Baizhu (Atractylodis Macrocephalae Rhizoma), Zexie (Alismatis Rhizoma), Fuling (Poria), and Zhuling (Polyporus) transform water and generate Jin Ye (Body Fluids) to stop dryness and thirst.
Yu Chang stated: A floating pulse typically warrants Guizhi Tang (Cinnamon Twig Decoction). Why change to Wuling San (Five-Ingredient Powder with Poria)? Because when heat pathogens encounter water, although not fully resolved, they are significantly weakened by more than half. Thus, there is slight heat accompanied by difficulty in urination. When the syndrome develops into Xiao Ke (excessive thirst with inability to quench it), the signs of fluid retention are complete. Therefore, treatment proceeds from single exterior resolution to simultaneous exterior and interior resolution. Any condition characterized by excessive water intake and scanty urination is called Xiao Ke (excessive thirst with inability to quench it). With intense interior heat and abundant fluid retention, using Guizhi Tang (Cinnamon Twig Decoction) alone to release the muscle layer is insufficient; thus, promoting diuresis is added. Only Wuling San (Five-Ingredient Powder with Poria) can achieve this comprehensive effect!
Cheng Yingmao stated: The term "slight heat" should be compared with "fever" in the subsequent clause. In the latter, fever is at the exterior, indicating the pathogen has not deeply affected the root, so pathogenic heat accumulates and rejects water. Here, "slight heat" indicates that exterior heat has deeply affected the root, so pathogenic heat condenses and consumes Jin Ye (Body Fluids). Therefore, there is a distinction not only between treatment with water versus Wuling San (Five-Ingredient Powder with Poria), but also between the earlier and later uses of Wuling San (Five-Ingredient Powder with Poria).
In Wind-Strike fever, if after six or seven days the condition remains unresolved and irritability occurs, presenting both exterior and interior signs, with thirst desiring water but vomiting immediately after ingestion, this is named Shui Ni (Water Reversal). It should be treated with Wuling San (Five-Ingredient Powder with Poria).
[Annotation]
In Wind-Strike fever, if after six or seven days the condition remains unresolved and irritability occurs, this indicates an exterior syndrome. Thirst desiring water but vomiting immediately after ingestion indicates an interior syndrome. If thirst desiring water results in water being absorbed immediately, as described in the previous clause regarding Stomach dryness, giving water in small amounts frequently to harmonize the Stomach leads to recovery. Now, thirst desiring water results in water not being absorbed, reversing upward and causing vomiting, hence named Shui Ni (Water Reversal). Investigating the cause of vomiting, it is due to pathogenic heat entering the interior and interacting with fluid retention. The San Jiao (Triple Burner) loses its steaming and transforming function, failing to regulate water passages and transmit downward to the Bladder. Consequently, fluid and heat repel each other above, and water has no exit below, causing vomiting upon water ingestion and inevitably difficult urination. Wuling San (Five-Ingredient Powder with Poria), composed of acrid, sweet, bland, and draining herbs, should be used to release the exterior and promote diuresis internally. Drinking warm water in abundance induces sweating and patent urination, thereby resolving both exterior and interior simultaneously.
[Collected Annotations]
Fang Youzhi stated: Wind-Strike fever necessarily involves spontaneous sweating. If after six or seven days the condition remains unresolved and irritability occurs, it is due to excessive sweating depleting Jin Ye (Body Fluids) and causing internal dryness. "Exterior" refers to the persistence of external symptoms; "Interior" refers to irritability and thirst belonging to the Fu organs. Desiring water is due to severe dryness and thirst, seeking relief. Vomiting after water ingestion is due to latent fluid retention acting internally, preventing external water from entering. Since retained fluid is also water, adding water to water causes surging and rejection, hence named Shui Ni (Water Reversal). Wuling San (Five-Ingredient Powder with Poria) resolves both exterior and interior; recovery follows sweating.
Yu Chang stated: Wind-Injury syndromes originally involve sweating. Due to this sweating, if left untreated for a long time without employing methods to release the muscle layer, excessive sweating merely injures Jin Ye (Body Fluids). The exterior never resolves, and irritability and thirst increase. The pathogen enters the Fu organs, causing vomiting upon water ingestion, named Shui Ni (Water Reversal). This is heat pathogens carrying accumulated fluid retention reversing upward, causing external water to be rejected and unable to enter. Taking Wuling San (Five-Ingredient Powder with Poria) and drinking hot soup induces sweating, resolving both exterior and interior simultaneously, achieving two benefits with one action.