茯苓半筋 桂枝四两 甘草（炙）一两 大枣（擘）十五枚
右四味，以甘澜水一斗，先煮茯苓，减二升，内诸药，煮取三升，去滓，温服一升，
日三服。作甘澜水法：取水二斗，置大盆内，以杓扬之，水上有珠子五六千颗相逐，
取用之。
【方解】
此方即芩桂术甘汤，去白术加大枣倍茯苓也。彼治心下逆满，气上冲胸，此治脐下悸
，欲作奔豚，盖以水停中焦，故用白术，水停下焦，故倍茯苓。脐下悸，是邪上干心
也，其病由汗后而起，自不外乎桂枝之法。仍以桂枝、甘草补阳气，生心液，倍加茯
苓以君之，专伐肾邪，用大枣以佐之，益培中土，以甘澜水煎，取其不助水邪也。土
强自可制水，阳建则能御阴，欲作奔豚之病，自潜消而默化矣。若已作奔豚，肾阴邪
盛，又非此药所能治，则当从事乎桂枝加桂汤法矣。
服桂枝汤或下之，仍头项强痛，翕翕发热，无汗，心下满，微痛，小便不利者，桂枝
汤去桂加茯苓白术汤主之。
【按】
去桂当是去芍药。此方去桂，将何以治仍头项强痛、发热无汗之表乎？细玩服此汤，
曰余根据桂枝汤法煎服，其意自见。服桂枝汤已，温覆令一时许，通身□□微似有汗，
此服桂枝汤法也。若去桂则是芍药、甘草、茯苓、白术并无辛甘走荣卫之品，而曰余
根据桂枝汤法，无所谓法也。若去桂则是芍药、甘草、茯苓、白术，并无辛甘走荣卫之
品，而曰余根据桂枝汤法，无所谓也。且论中有脉促胸满，汗出恶寒之证，用桂枝去芍
药加附子汤主之，去芍药者、为胸满也。此条证虽稍异，而其满则同，为去芍药可知
矣。
【注】
此条为汗下后表不解，而心下有水气者，立治法也。服桂枝汤或下之，均非其治矣。
仍有头项强痛，翕翕发热，无汗之表证；心下满，微痛，小便不利，停饮之里证。设
未经汗下，则是表不解，而心下有水气，当用小青龙汤汗之；今已经汗下，表里俱虚
，小青龙汤非所宜也。故用桂枝汤去芍药之酸收，避无汗心下之满，加苓术之燥渗，
使表里两解，则内外诸证自愈矣。
【集注】
『外台方议』问曰：心下满微痛，乃是欲成结胸，何缘作停饮治之？答曰：诸证皆似
结胸，但小便不利一证，乃停饮也，故此条仲景只作停饮治之。
喻昌曰：服桂枝汤，病不解而证变，又或下之，则邪势乘虚入里，是益误矣。在表之
邪未除，而在里之饮上逆，故仿五苓两解表里之法也。
张璐曰：此条颇似结胸，所以辨为太阳表证尚在者，全重在翕翕发热无汗上。
林澜曰：头项强痛，经汗下而不解，心下满，微痛，小便不利，此为水饮内蓄，故加
苓术，得小便利，水饮行，腹满减，而表证悉愈矣。如十枣汤证，亦头痛，乃饮热内
蓄，表证已解，故虽头痛，只用逐饮，饮去则病自安也。
Poria (Fuling) half jin, Cinnamon Twig (Guizhi) four liang, Licorice (Zhi/Glazed) one liang, Jujube (Bo/Opened) fifteen pieces.
The above four ingredients: Use one dou of Ganlan Water (Gently Agitated Water). First decoct Poria until the volume reduces by two sheng. Then add the remaining herbs. Decoct to obtain three sheng of liquid. Strain the dregs. Take one sheng warm, three times a day.
Method for preparing Ganlan Water: Take two dou of water, place it in a large basin. Use a ladle to scoop and throw the water repeatedly until five or six thousand pearl-like droplets appear on the surface, chasing each other. Use this water.
[Formula Analysis]
This formula is derived from Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala and Licorice Decoction), by removing Atractylodes Macrocephala (Baizhu), adding Jujube, and doubling the dosage of Poria. The former treats fullness and rebellious Qi rising to the chest; this formula treats palpitations below the umbilicus, indicating the impending onset of Bentun Disease (a condition characterized by a sensation of Qi rushing upward from the lower abdomen). This is because fluid retention in the Middle Jiao warrants the use of Atractylodes Macrocephala, while fluid retention in the Lower Jiao warrants doubling the use of Poria. Palpitations below the umbilicus indicate pathogenic factors interfering with the Heart. The etiology often arises after sweating, generally adhering to the principles of Guizhi Tang (Cinnamon Twig Decoction). It still uses Cinnamon Twig and Licorice to tonify Yang Qi and generate Heart fluids. Poria is doubled and used as the Sovereign herb to specifically expel Kidney pathogens. Jujube is used as an Assistant herb to fortify the Spleen (Middle Earth). Decocting with Ganlan Water is intended to avoid assisting fluid pathogens. When Earth (Spleen) is strong, it can control Water; when Yang is established, it can resist Yin. Thus, the impending Bentun Disease will naturally dissipate. If Bentun Disease has already manifested, with excessive Kidney Yin pathogens, this formula is ineffective, and one should adopt the method of Guizhi Jia Gui Tang (Cinnamon Twig Decoction with Added Cinnamon Twig).
If, after taking Guizhi Tang or undergoing purgation, there remain stiff pain in the head and nape, slight fever (like being covered by feathers), absence of sweat, fullness below the heart, slight pain, and difficulty in urination, the governing formula is Guizhi Qu Gui Jia Fuling Baizhu Tang (Cinnamon Twig Decoction without Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction).
[Commentary]
"Removing Cinnamon Twig" should be "Removing White Peony Root (Shaoyao)". If Cinnamon Twig is removed from this formula, what would treat the persistent stiff pain in the head and nape, fever, and absence of sweat (exterior symptoms)? Careful reading reveals that the text states, "I follow the brewing and administration method of Guizhi Tang." The intent becomes clear. After taking Guizhi Tang, covering warmly for about the time it takes to cook a meal results in a slight, uniform sweat; this is the method of taking Guizhi Tang. If Cinnamon Twig is removed, the remaining White Peony Root, Licorice, Poria, and Atractylodes Macrocephala lack acrid-sweet herbs that circulate in Ying and Wei. To say "I follow the method of Guizhi Tang" would be meaningless. Furthermore, the text mentions cases of rapid pulse, chest fullness, sweating, and aversion to cold, treated with Guizhi Qu Shaoyao Jia Fuzi Tang (Cinnamon Twig Decoction without White Peony Root plus Prepared Aconite Root). White Peony Root is removed due to chest fullness. Although the symptoms here differ slightly, the presence of "fullness" indicates that White Peony Root should indeed be removed.
[Annotation]
This clause addresses the treatment method for exterior patterns unresolved after sweating or purgation, accompanied by fluid accumulation in the epigastrium. Taking Guizhi Tang or undergoing purgation are incorrect treatments. There remain exterior signs: stiff pain in the head and nape, slight fever, and absence of sweat; and interior signs of fluid retention: epigastric fullness, slight pain, and difficulty in urination. Had sweating or purgation not occurred, with unresolved exterior and fluid in the epigastrium, Xiao Qing Long Tang (Minor Blue Dragon Decoction) would be indicated for diaphoresis. However, since sweating and purgation have already occurred, both exterior and interior are deficient, making Xiao Qing Long Tang inappropriate. Therefore, Guizhi Tang is used, removing the astringent nature of White Peony Root to avoid aggravating the absence of sweat and epigastric fullness. Poria and Atractylodes Macrocephala are added for their drying and draining properties, resolving both exterior and interior, thereby curing all internal and external symptoms.
[Collected Notes]
*Waitai Fangyi* asks: Epigastric fullness and slight pain seem indicative of Jie Xiong Syndrome (a condition characterized by painful fullness in the epigastrium), why treat it as fluid retention? The answer is: While symptoms resemble Jie Xiong, the specific sign of difficulty in urination indicates fluid retention. Thus, Zhang Zhongjing treats this case solely as fluid retention.
Yu Chang stated: If the illness does not resolve after taking Guizhi Tang and symptoms change, or if purgation is applied, pathogens enter the interior exploiting deficiency, compounding the error. With exterior pathogens unremoved and interior fluid reversing upward, the method mimics Wu Ling San (Five-Ingredient Powder with Poria) to resolve both exterior and interior.
Zhang Lu stated: This case resembles Jie Xiong Syndrome. The differentiation confirming the persistence of Taiyang exterior signs relies entirely on "slight fever and absence of sweat."
Lin Lan stated: Stiff pain in the head and nape persists despite sweating and purgation; epigastric fullness, slight pain, and difficulty in urination indicate internal fluid accumulation. Hence, Poria and Atractylodes Macrocephala are added. Once urination becomes smooth, fluid moves, abdominal fullness decreases, and exterior signs completely resolve. In Shi Zao Tang (Ten Jujube Decoction) cases, headache also occurs due to internal accumulation of fluid and heat, but with resolved exterior signs. Thus, even with headache, only fluid-draining methods are used; once fluid is expelled, the disease resolves.