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、
麦冬得酒则良。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。
未持脉时，病患叉手自冒心，师因教试，令咳而不咳者，此必两耳聋无闻也，所以然
者，以重发汗，虚，故如此。
【注】未持脉时，病患叉手自冒其心，师因教试，令咳而不咳者，此必两耳聋无所闻
也。其聋与叉手冒心同见，则非少阳之邪可知，乃重发汗，阳虚，故致此也。
【集注】喻昌曰∶此示人推测阳虚之一端也。阳虚耳聋，宜急固其阳，与少阳传经邪盛之耳聋迥别。
程应旄曰∶诸阳受气于胸中，而精气上通于耳，今以重发汗而虚其阳，阳气所不到
之处，精气亦不复注而通之，故聋。
发汗过多，其人叉手自冒心，心下悸，欲得按者，桂枝甘草汤主之。
【注】此申上条，以详其证而明其治也。发汗过多，外亡其液，内虚其气，气液两虚，
中空无倚，故心下悸，惕惕然不能自主，所以叉手冒心，欲得自按，以护庇而求定也，故
用桂枝甘草汤，以补阳气而生津液，自可愈矣。
【集注】方有执曰∶汗多则伤血，血伤则心虚，心虚则动惕而悸，故叉手自冒，而欲
得人按也。桂枝走表，敛液宅心，能固疏漫之表；甘草和里，补中益气，能调不足之中。
合二物以为方，盖敛阴补阳之法也。
程知曰∶此汗后心虚补阳法也。阳受气于胸中，胸中阳气衰微，故叉手冒心，心悸欲按也。
程应旄曰∶汗为心液，不惟妄汗不同，即当汗而失其分数亦不可。叉手冒心欲得按者，
因阳虚不能自主，而心下悸也。然心悸有心
气虚，有水气乘，水乘先因心虚，今心下悸者，乃阳气虚惕然自恐，欲得按以御之，故
用桂枝甘草，载还上焦之阳，使回旋于胸中也。
魏荔彤曰∶此条乃发汗过多之禁也。风伤卫，固不宜汗出如水流漓矣。即寒伤营，宜
发汗，亦只汗出表解斯已耳！不可听其大汗不止，致有阳虚之变证也。仲景言，其人叉
手自冒心，心下悸欲得按者，乃形容汗多亡阳之象也。
桂枝甘草汤方
桂枝（四两） 甘草（炙，二两）
上二味，以水三升煮取一升，去滓，顿服。
【集解】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，望之而知其为虚矣。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，而未至于亡阳；不须芍药者，以汗已止，而嫌其敛阴也。
发汗后，其人脐下悸者，欲作奔豚，茯苓桂枝甘草大枣汤主之。
【注】发汗后心下悸者，乃虚其心中之阳，本经自病也。今发汗后，脐下悸，欲作奔豚
者，乃心阳虚，而肾水之阴邪，乘虚欲上干于心也。主之以茯苓桂枝甘草大枣汤者，一
以扶阳，一以补土，使水邪不致上干，则脐下之悸可安矣。
【集注】程知曰∶发汗后心下悸者，心液虚而肾气将动也，肾气欲上奔，故脐下先悸
也。谓之豚者，指肾气也。
喻昌曰∶汗本心之液，发汗后脐下悸者，心气虚而肾气发动也。故取茯苓桂枝直趋肾
界，预伐其邪，所谓上兵伐谋也。
汪琥曰∶奔豚者，肾之积名也。发于少腹，上至心下，若豚状，乃肾气发动，有似
乎奔豚之状，非真脐下有积如豚也。
茯苓桂枝甘草大枣汤方
茯苓（半斤） 桂枝（四两） 甘草（炙，一两） 大枣（擘，十五枚）
上四味，以甘澜水一斗，先煮茯苓，减二升，纳诸药，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】此方即苓桂术甘汤，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，并无辛甘走营卫之品，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。
桂枝去桂加茯苓白术汤方
于桂枝汤方内去桂，加茯苓、白术各三两，余根据桂枝汤法煎服。小便利则愈。
【按】去桂去芍之义，详见上条经文下正误文内。
【方解】曰余根据桂枝汤法煎服，谓根据桂枝汤法取汗也。小便利则愈，谓饮病必输水道
始愈也。此方即苓桂术甘汤，而有生姜、大枣，其意专在解肌，利水次之，故用生姜大
枣佐桂枝以通津液取汗也。苓桂术甘汤，不用生姜、大枣，而加茯苓，其意专在利水，扶
阳次之，故倍加茯苓，君桂枝，于利水中扶阳也，所以方后不曰根据服桂枝汤法也。
伤寒若吐若下后，心下逆满，气上冲胸，起则头眩，脉沉紧，发汗则动经，身为振振
摇者，茯苓桂枝白术甘草汤主之。
【注】伤寒若过发汗，则有心下悸，叉手冒心，脐下悸，欲作奔豚等证。今误吐下，则
胸虚邪陷，故心下逆满，气上冲胸也。若脉浮紧，表仍不解，无汗，当用麻黄汤，有汗
当用桂枝汤，一汗而胸满气冲可平矣。今脉沉紧，是其人必素有寒饮相挟而成，若不头
眩，以瓜蒂散吐之，亦自可除。今乃起则头眩，是又为胸中阳气已虚，不惟不可吐，亦
不可汗也。如但以脉之沉紧为实，罔顾头眩之虚，而误发其汗，则是无故而动经表，更
致卫外之阳亦虚，一身失其所倚，故必振振而摇也。主之以苓桂术甘汤者，涤饮与扶阳
并施，调卫与和营共治也。
茯苓桂枝白术甘草汤方
茯苓（四两） 桂枝（三两） 白术（二两） 甘草（炙，二两）
上四味，以水六升，煮取三升，去滓，分温三服。
【方解】身为振振摇者，即战振身摇也；身振振欲擗地者，即战振欲堕于地也。二者
皆为阳虚失其所恃，一用此汤，一用真武者，盖真武救青龙之误汗，其邪已入少阴，故主
以附子，佐以生姜、苓、术，是壮里阳以制水也；此汤救麻黄之误汗，其邪尚在太阳，故
主以桂枝，佐以甘草、苓、术，是扶表阳以涤饮也。至于真武汤用芍药者，里寒阴盛，阳
衰无根据，于大温大散之中，若不佐以酸敛之品，恐阴极格阳，必速其飞越也；此汤不用
芍药者，里寒饮盛，若佐以酸敛之品，恐饮得酸，反凝滞不散也。
发汗，若下之而烦热、胸中窒者，栀子豉汤主之。
【注】发汗表未解，若下之，表邪入里，既不从实化而为结胸气冲，亦不从虚化而为
痞硬下利，但作烦热胸中窒者，以表邪轻，所陷者浅，故只为烦热，胸中不快也。栀子苦
能涌泄，寒能胜热，豆豉轻腐上行，佐栀子使邪热上越于口，庶一吐而胸中舒，烦热解矣。
【集注】方有执曰∶窒者，邪热壅滞而窒塞，未至于痛，较痛为轻也。
程知曰∶下之而阳邪内结，则以陷胸攻之；阴邪内结，则以泻心开之；至虚热上烦，
则以栀豉涌之。未经下而胸中多痰，则以瓜蒂吐之；已经下而胸中虚烦，则以栀豉吐之。
古人于虚实寒热之法，既明且备如此。
林澜曰∶阳受气于胸中，若汗若下，使阳气不足，邪热客于胸中，结而不散，烦热
窒塞，故宜此汤吐胸中之邪。
汪琥曰∶胸中窒者，胸中有物也。下之而不出，以其物在膈上，故宜吐之。
栀子豉汤方
栀子（擘，十四枚） 香豉（绵裹，四合）
上二味，以水四升，先煮栀子，得二升半，纳豉煮取一升半，去滓，分为二服，温
进一服，得吐者，止后服。
下利后更烦，按之心下濡者，为虚烦也，宜栀子豉汤。
【注】此承上条误下下利后，不见诸逆，惟更加烦者而言。然按之心下濡而不痞者，是
虚烦也，故亦宜栀子豉汤。若按之不濡而痞硬，则又为实烦，当用大黄黄连泻心汤矣。
【集注】方有执曰∶更烦本有烦，不为利除而转甚也。
林澜曰∶此利后余热之证也。曰下利后而利止者，必非虚寒之烦，乃热遗于胸中也。
按之心下濡，虽热而非实热，故用此以清其虚烦。
程应旄曰∶热利则烦，若得之利后而心下不硬者，此为虚烦，乃余热乘虚而客于胃中也。
发汗吐下后，虚烦不得眠，若剧者，必反复颠倒，心中懊 ，栀子豉汤主之；若少
气者，栀子甘草豉汤主之；若呕者，栀子生姜豉汤主之。
【注】未经汗吐下之烦多属热，谓之热烦；已经汗吐下之烦多属虚，谓之虚烦。不得眠
者，烦不能卧也。若剧者，较烦尤甚，必反复颠倒心中懊 也。烦，心烦也。躁，身躁
也。身之反复颠倒，则谓之躁无宁时，三阴死证也；心之反复颠倒，则谓之懊 ，三阳
热证也。懊 者，即心中欲吐不吐，烦扰不宁之象也。因汗吐下后，邪热乘虚客于胸中
所致。既无可汗之表，又无可下之里，故用栀子豉汤，顺其势以涌其热，自可愈也。有
前证若更加少气者，是热伤其气也，加甘草以扶之；若呕者，是热迫其饮也，加生姜以散之。
【集注】方有执曰∶虚烦不得眠者，大邪乍退，正气暴虚，余热闷乱，胃中不和也。剧，
极也。反复颠倒，心中懊 者，胸膈壅滞，不得舒快也。所以用栀子豉汤，高者因而越之之法也。
程应旄曰∶发汗若吐若下，或胸中窒，或虚烦不得眠，或反复颠倒，心中懊 ，皆属
三法后，遗热壅遏在上，客于心胸，是以扰乱不宁也。并非汗不出之烦躁，大青龙无所
用，诸法亦无所用，惟宜以栀子豉汤主之。盖栀子气味轻越，合以香豉能化浊为清，但使
涌去客邪，则气升液化，而郁闷得舒矣。
汪琥曰∶虚烦证奚堪再吐，不知虚者正气之虚，烦者邪气之实，邪热郁于胸中，是
为邪实，吐证仍在，理宜更用吐法。所以“虚烦”二字，不可用真虚看，作汗、吐、下后暴虚看。
栀子甘草豉汤方
于栀子豉汤方内，加入甘草二两，余根据前法，得吐，止后服。
栀子生姜豉汤方
于栀子豉汤方内，加生姜五两，余根据前法，得吐，止后服。
伤寒下后，心烦腹满，卧起不安者，栀子浓朴汤主之。
【注】论中下后满而不烦者有二∶一热气入胃之实满，以承气汤下之；一寒气上逆之
虚满，以浓朴生姜甘草半夏人参汤温之。其烦而不满者亦有二∶一热邪入胸之虚烦，以
竹叶石膏汤清之；一懊 欲吐之心烦，以栀子豉汤吐之。今既烦且满，满甚则不能坐，烦
甚则不能卧，故卧起不安也。然既无三阳之证实，又非三阴之虚证，惟热与气结，壅于
胸腹之间，故宜栀子、枳、朴，涌其热气，则胸腹和而烦自去、满自消矣。此亦吐中寓和之意也。
【集注】程应旄曰∶凡邪客胸，便上下不交，此与结胸心下痞相等，虽吐、下和解，各
不同法，其为交通阴阳则一也。
沈明宗曰∶下后微邪内陷，而无痰饮抟结，故无结胸下利。但邪陷胸膈，扰乱于上
The pulse condition can be restored. Using seven sheng of wine and eight sheng of water, extracting only three sheng of the final decoction is because prolonged boiling makes the medicinal action less potent; this is the method for using wine in deficiency cases, and it also indicates that Rehmanniae Radix (Dihuang, 地黄) and Ophiopogonis Radix (Maidong, 麦冬) yield better efficacy when combined with wine. This syndrome should be treated with Ziziphi Spinosae Semen (Suanzaoren, 酸枣仁), while Lung Withered Carbuncle (Fei Fei, 肺痿) may be treated with Cannabis Seed (Huomaren, 火麻仁). If genuine E-Jiao (Donkey-hide Gelatin) is unavailable, Tortoise Plaster (Guiban Jiao, 龟版胶) can be used as a substitute.
Before taking the pulse, the patient crossed their hands over their heart. The physician instructed them to try coughing; if they did not cough, this must indicate bilateral deafness. The reason for this is excessive sweating, which caused deficiency, leading to this condition.
[Annotation] Before taking the pulse, the patient crossed their hands over their heart. The physician instructed them to try coughing; if they did not cough, this must indicate bilateral deafness. Since this deafness occurs simultaneously with crossing hands over the heart, it is evident that this is not Shaoyang pathogenic factor, but rather caused by excessive sweating leading to Yang deficiency.
[Collected Annotations] Yu Chang stated: This illustrates one aspect of inferring Yang deficiency. Deafness due to Yang deficiency requires urgent consolidation of Yang, which is distinctly different from deafness caused by flourishing pathogenic factors transmitting through the Shaoyang channels.
Cheng Yingmao stated: All Yang Qi receives its energy in the chest, and essence-Qi ascends to connect with the ears. Now, due to excessive sweating causing Yang deficiency, in places where Yang Qi cannot reach, essence-Qi no longer flows through and connects, hence the deafness.
After excessive sweating, if the patient crosses their hands over their heart, experiences palpitations in the epigastrium, and desires pressure, Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction) is the primary treatment.
[Annotation] This elaborates on the previous clause, detailing the symptoms and clarifying the treatment. Excessive sweating causes external loss of fluids and internal deficiency of Qi. With both Qi and fluids deficient, there is emptiness and lack of support in the center, resulting in palpitations in the epigastrium, fearfulness, and inability to control oneself. Thus, the patient crosses their hands over the heart and desires self-pressing to seek protection and stability. Therefore, Guizhi Gancao Tang is used to tonify Yang Qi and generate fluids, leading to recovery.
[Collected Annotations] Fang Youzhi stated: Profuse sweating damages Blood; damaged Blood leads to Heart deficiency; Heart deficiency causes agitation and palpitations, hence crossing hands over the heart and desiring manual pressure. Guizhi moves outward to the exterior, consolidating fluids and anchoring the Heart, capable of securing the loose exterior; Gancao harmonizes the interior, tonifying Middle Qi, capable of regulating the deficient center. Combining these two herbs forms a formula that is essentially a method of astringing Yin and tonifying Yang.
Cheng Zhi stated: This is a method for tonifying Yang after sweating-induced Heart deficiency. Yang Qi receives energy in the chest; when chest Yang Qi is weak and micro, the patient crosses hands over the heart, experiencing palpitations and desire for pressure.
Cheng Yingmao stated: Sweat is the fluid of the Heart. Not only is mistaken sweating inadvisable, but even appropriate sweating must be carefully measured. Crossing hands over the heart and desiring pressure occurs because Yang deficiency prevents self-control, leading to epigastric palpitations. However, palpitations can stem from Heart Qi deficiency or Water-Qi encroachment; Water encroachment first arises from Heart deficiency. Current epigastric palpitations result from Yang deficiency causing fearfulness, desiring pressure to resist it. Thus, Guizhi and Gancao are used to carry and return Upper Jiao Yang Qi, allowing it to circulate within the chest.
Wei Litong stated: This clause serves as a warning against excessive sweating. Wind damaging the Wei level should not induce profuse sweating like flowing water. Even if Cold damages the Ying level and sweating is indicated, it should cease once the exterior is resolved. One must not allow continuous profuse sweating, which leads to Yang deficiency complications. Zhang Zhongjing’s description of patients crossing hands over the heart, experiencing palpitations, and desiring pressure describes the phenomenon of sweating-induced Yang collapse.
Guizhi Gancao Tang Formula
Guizhi (Cinnamomi Ramulus, 4 liang) Gancao (Zhi/Roasted, 2 liang)
Crush the above two ingredients. Boil in three sheng of water, reduce to one sheng, remove dregs, and take in one dose.
[Collected Exegesis] Ke Qin stated: Profuse sweating depletes Heart fluids and weakens central Qi, causing palpitations. Crossing hands over the heart provides external protection; receiving pressure provides internal support. Such a vulnerable state clearly indicates deficiency upon observation. Guizhi is originally a Ying-level herb; combined with Mahuang (Ephedrae Herba), it promotes Ying Qi outward to induce sweating (acrid nature); combined with Shaoyao (Paeoniae Radix Alba), it constrains Ying Qi to stop sweating (sour nature); combined with Gancao, it tonifies Middle Qi and nourishes Blood (sweet nature). In this formula, Guizhi is the Sovereign herb, paired solely with Gancao as an Assistant to tonify Yang Qi and generate Heart fluids. The harmony of sweet and warm properties harmonizes Qi and Blood, resolving palpitations naturally. Fuzi (Aconiti Lateralis Radix Praeparata) is unnecessary because, although sweating is profuse, Yang collapse has not yet occurred. Shaoyao is unnecessary because sweating has stopped, and its Yin-astringent property is undesirable.
After sweating, if the patient experiences palpitations below the umbilicus and sensations suggesting impending Ben Tun (Running Piglet), Linggui Zhugan Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) is the primary treatment.
[Annotation] Palpitations in the epigastrium after sweating indicate deficiency of Heart Yang, affecting the channel itself. Now, palpitations below the umbilicus after sweating, suggesting impending Ben Tun, indicate Heart Yang deficiency allowing Kidney Water Yin pathogenic factors to encroach upward due to deficiency. Linggui Zhugan Dazao Tang is prescribed to support Yang and tonify Earth, preventing Water pathogenic factors from encroaching upward, thereby calming sub-umbilical palpitations.
[Collected Annotations] Cheng Zhi stated: Palpitations in the epigastrium after sweating indicate Heart fluid deficiency and stirring of Kidney Qi. As Kidney Qi attempts to surge upward, palpitations begin below the umbilicus. The term "Tun" (Piglet) refers to Kidney Qi.
Yu Chang stated: Sweat is the fluid of the Heart. Sub-umbilical palpitations after sweating indicate Heart Qi deficiency and stirring of Kidney Qi. Therefore, Poria and Cinnamon Twig are used to target the Kidney realm directly, preemptively attacking the pathogen—this is the strategy of "attacking the plan before execution."
Wang Hu stated: Ben Tun is the name of a Kidney accumulation. It originates in the lower abdomen, rises to the epigastrium, resembling a piglet. It is the stirring of Kidney Qi, resembling the shape of Ben Tun, not an actual accumulation like a piglet below the umbilicus.
Linggui Zhugan Dazao Tang Formula
Fuling (Poria, 8 liang) Guizhi (Cinnamomi Ramulus, 4 liang) Gancao (Zhi/Roasted, 1 liang) Dazao (Jujubae Fructus, split, 15 pieces)
Boil the above four ingredients in ten dou of Ganlan Shui (Gentle Wave Water). First boil Fuling until reduced by two sheng, then add the remaining herbs. Boil to obtain three sheng, remove dregs, and take one sheng warm, three times daily.
Method for preparing Ganlan Shui: Take two dou of water, place in a large basin, and ladle it repeatedly until thousands of small bubbles chase each other on the surface. Use this water.
[Formula Analysis] This formula is essentially Ling Gui Zhu Gan Tang, removing Baizhu, increasing Dazao, and doubling Fuling. The former treats epigastric fullness and Qi rushing to the chest (Water stagnation in Middle Jiao, hence Baizhu); this treats sub-umbilical palpitations and impending Ben Tun (Water stagnation in Lower Jiao, hence doubled Fuling). Sub-umbilical palpitations indicate pathogenic factors encroaching on the Heart. Since the disease arises post-sweating, it follows the Guizhi methodology. Guizhi and Gancao continue to tonify Yang and generate Heart fluids; Fuling is doubled as Sovereign to specifically attack Kidney pathogens; Dazao assists in fortifying Middle Earth. Boiling in Ganlan Shui avoids aiding Water pathogens. Strong Earth controls Water; robust Yang resists Yin. The impending Ben Tun pathology will dissolve silently. If Ben Tun has already manifested with flourishing Kidney Yin pathogens, this formula is insufficient, and Guizhi Jia Guizi Tang (Cinnamon Twig Plus Cinnamon Decoction) should be employed.
If, after taking Guizhi Tang or undergoing purgation, the patient still presents with stiffness and pain in the head and neck, mild fever, absence of sweat, epigastric fullness, slight pain, and difficulty urinating, Guizhi Tang Qu Guizi Jia Fuling Baizhu Tang (Cinnamon Twig Decoction minus Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction) is the primary treatment.
[Note] "Removing Guizhi" should likely be "removing Shaoyao." If Guizhi is removed, what treats the persistent headache, neck stiffness, fever, and anhidrosis (exterior syndrome)? Careful reading reveals the instruction "follow Guizhi Tang decoction methods," implying the intent is clear. Taking Guizhi Tang involves warming coverage for about an hour until slight perspiration appears—this is the Guizhi Tang method. Removing Guizhi leaves Shaoyao, Gancao, Fuling, and Baizhu, lacking acrid-sweet herbs that move Ying and Wei. Saying "follow Guizhi Tang method" would be meaningless. Furthermore, the text mentions syndromes of rapid pulse, chest fullness, sweating, and aversion to cold, treated with Guizhi Qu Shaoyao Jia Fuzi Tang. Shaoyao is removed for chest fullness. Although this clause differs slightly, the presence of fullness confirms Shaoyao removal.
[Annotation] This clause establishes treatment for exterior non-resolution following sweating/purgation, accompanied by Water-Qi in the epigastrium. Neither Guizhi Tang nor purgation is correct. Persistent headache, neck stiffness, mild fever, and anhidrosis represent exterior signs; epigastric fullness, slight pain, and dysuria represent interior Water-Qi retention. Had sweating/purgation not occurred, with unresolved exterior and Water-Qi in the epigastrium, Xia Qinglong Tang (Minor Green Dragon Decoction) would be used for sweating. Having undergone sweating/purgation, both exterior and interior are deficient, making Xia Qinglong Tang unsuitable. Thus, Guizhi Tang removes Shaoyao’s sour astringency to avoid worsening anhidrosis and epigastric fullness, adding Fuling and Baizhu for drying and leaching, achieving simultaneous resolution of exterior and interior, healing all symptoms.
[Collected Annotations] *Waitai Fangyi* asks: Epigastric fullness and slight pain suggest impending Jie Xiong (Chest Binding); why treat as Water-Qi retention? Answer: Symptoms resemble Jie Xiong, but dysuria indicates Water-Qi retention; thus, Zhang Zhongjing treats it as Water-Qi retention.
Yu Chang stated: If Guizhi Tang fails to resolve the disease and symptoms change, or if purgation is applied, pathogenic factors enter the interior due to deficiency, compounding the error. Exterior pathogens remain, while interior Water-Qi rebels upward. Hence, mimicking Wu Ling San (Five Ingredient Powder with Poria), both exterior and interior are addressed.
Zhang Lu stated: This clause resembles Jie Xiong, but distinguishing it as persisting Taiyang exterior syndrome relies entirely on mild fever and anhidrosis.
Lin Lan stated: Headache and neck stiffness persisting after sweating/purgation, epigastric fullness, slight pain, and dysuria indicate internal Water-Qi accumulation. Adding Fuling and Baizhu promotes urination; as Water-Qi moves and abdominal fullness subsides, exterior symptoms resolve. In Shizao Tang (Ten Jujubes Decoction) syndrome, headache exists due to internal Water-Heat accumulation with resolved exterior; thus, only Water expulsion is needed, and illness resolves when Water is gone.
Guizhi Tang Qu Guizi Jia Fuling Baizhu Tang Formula
In Guizhi Tang formula, remove Guizhi, add Fuling and Baizhu (3 liang each). Follow Guizhi Tang decoction methods. Urination promoting indicates cure.
[Note] The rationale for removing Guizhi/Shao Yao is detailed in the correction text under the previous clause.
[Formula Analysis] "Follow Guizhi Tang decoction methods" means inducing sweating via Guizhi Tang protocol. "Urination promoting indicates cure" means Water-Qi diseases require urinary drainage for resolution. This formula is Ling Gui Zhu Gan Tang with Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger) and Dazao. Its intent is primarily releasing the muscle layer, with diuresis secondary; thus, Shengjiang and Dazao assist Guizhi in unblocking Jin Ye (Body Fluids) to induce sweating. Ling Gui Zhu Gan Tang lacks Shengjiang/Dazao but adds Fuling; its intent is primarily diuresis, supporting Yang secondarily; thus, Fuling is doubled, Guizhi is Sovereign, supporting Yang within diuresis. Hence, it does not state "follow Guizhi Tang method."
If Cold Damage is followed by emesis or purgation, presenting with epigastric rebellious fullness, Qi rushing to the chest, dizziness upon standing, deep-tight pulse, and subsequent shaking/trembling of the body after sweating (indicating channel disturbance), Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction) is the primary treatment.
[Annotation] Over-sweating in Cold Damage causes palpitations, hand-over-heart posture, sub-umbilical palpitations, and impending Ben Tun. Mistaken emesis/purgation causes empty Chest allowing pathogenic factors to sink, resulting in epigastric rebellious fullness and Qi rushing to the chest. If the pulse were floating-tight with unresolved exterior and anhidrosis, Mahuang Tang (Ephedra Decoction) would be used; with sweating, Guizhi Tang would be used; one sweating episode would calm chest fullness and Qi rushing. Now, with a deep-tight pulse, the patient likely has chronic Cold-Water-Qi retention. Without dizziness, Gouti San (Melon Dispersant Powder) could be used for emesis. However, dizziness upon standing indicates depleted Chest Yang; neither emesis nor sweating is appropriate. Mistaking deep-tight pulse for excess and ignoring dizziness (deficiency) by inducing sweating disturbs the exterior channels, depleting Defensive Yang further, causing loss of bodily support and trembling. Ling Gui Zhu Gan Tang is used to combine draining Water-Qi with supporting Yang, harmonizing Wei and Ying.
Ling Gui Zhu Gan Tang Formula
Fuling (Poria, 4 liang) Guizhi (Cinnamomi Ramulus, 3 liang) Baizhu (Atractylodis Macrocephalae Rhizoma, 2 liang) Gancao (Zhi/Roasted, 2 liang)
Boil the above four ingredients in six sheng of water, reduce to three sheng, remove dregs, and take warm in three divided doses.
[Formula Analysis] "Shaking/trembling" refers to shivering tremors; "wanting to fall to the ground" refers to trembling weakness. Both result from Yang deficiency losing support. Zhen Wu Tang (True Warrior Decoction) corrects mistaken sweating from Xiao Qing Long Tang; pathogen entered Shaoyin, so Fuzi is Sovereign, assisted by Shengjiang, Fuling, Baizhu, strengthening Interior Yang to control Water. This formula corrects mistaken sweating from Mahuang Tang; pathogen remains in Taiyang, so Guizhi is Sovereign, assisted by Gancao, Fuling, Baizhu, supporting Exterior Yang to drain Water-Qi. Zhen Wu Tang uses Shaoyao because Interior Cold/Yin Flourishing with Yang deficiency risks extreme Yin repelling Yang; sour astringents prevent Yang flight during strong warming/dispersing. This formula excludes Shaoyao because Interior Cold/Water-Qi Flourishing; sour astringents might cause Water-Qi to coagulate and stagnate.
After sweating or purgation, if heat irritability and chest oppression occur, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment.
[Annotation] If exterior syndrome is unresolved after sweating and purgation is applied, exterior pathogens enter the interior. They do not transform into excess Jie Xiong/Qi Rushing, nor deficiency Pi Ying/Downward Flowing. Instead, they present as heat irritability and chest oppression because the exterior pathogen was light and shallowly sunk, causing only heat irritability and chest discomfort. Zhizi is bitter (promotes vomiting/draining) and cold (overcomes heat); Chidou Chi (Fermented Soybean) is light and ascending, assisting Zhizi to push pathogenic heat upward via vomiting, relieving chest oppression and heat irritability.
[Collected Annotations] Fang Youzhi stated: Oppression implies pathogenic heat stagnation without reaching pain level, lighter than pain.
Cheng Zhi stated: Post-purgation Yang excess knotting requires Tan Xiong Tang (Chest Expelling Decoction); Yin excess knotting requires Xie Xin Tang (Drain the Epigastrium Decoction); deficiency heat upper irritability requires Zhizi Chi Tang for vomiting. Pre-purgation phlegm in chest requires Gouti San; post-purgation deficiency irritability requires Zhizi Chi Tang. Ancient methods for deficiency/excess and cold/heat are thus clear and comprehensive.
Lin Lan stated: Yang Qi receives energy in the chest. Sweating/purgation depletes Yang, allowing pathogenic heat to lodge in the chest, knotting and not dispersing, causing irritability and oppression. This decoction vomits chest pathogens.
Wang Hu stated: Chest oppression indicates material presence in the chest. Post-purgation failure to expel it suggests location above the diaphragm, requiring emesis.
Zhizi Chi Tang Formula
Zhizi (Gardeniae Fructus, split, 14 pieces) Chidou Chi (Sojae Semens Praeparatum, wrapped in silk, 4 he)
Boil Zhizi in four sheng of water to obtain two and a half sheng, add Chidou Chi, boil to obtain one and a half sheng, remove dregs, divide into two doses. Take warm; if vomiting occurs, stop subsequent doses.
After diarrhea, if irritability increases and the epigastrium is soft upon palpation, it is deficiency irritability, suitable for Zhizi Chi Tang.
[Annotation] This follows the previous clause regarding post-mistaken-purgation diarrhea. Absence of adverse reactions, only increased irritability, and soft epigastrium upon palpation (without piying) indicate deficiency irritability, suitable for Zhizi Chi Tang. If hard/piying upon palpation, it is excess irritability, requiring Dahuang Huanglian Xiexin Tang (Rhubarb, Coptis, and Pinellia Decoction).
[Collected Annotations] Fang Youzhi stated: Increased irritability implies pre-existing irritability worsened despite diarrhea cessation.
Lin Lan stated: This is residual heat post-diarrhea. Diarrhea cessation indicates not deficiency-cold irritability, but heat lingering in the chest. Soft epigastrium indicates heat but not excess heat; this formula clears deficiency irritability.
Cheng Yingmao stated: Heat diarrhea causes irritability. Post-diarrhea soft epigastrium indicates deficiency irritability, residual heat lodging in Stomach due to deficiency.
After sweating, emesis, or purgation, if deficiency irritability prevents sleep, or severely causes tossing and turning and mental restlessness (Ao Nao), Zhizi Chi Tang is primary. If Qi deficiency exists, Zhizi Gancao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction) is primary. If vomiting occurs, Zhizi Shengjiang Chi Tang (Gardenia, Fresh Ginger, and Fermented Soybean Decoction) is primary.
[Annotation] Irritability prior to sweating/emesis/purgation is usually heat (Heat Irritability); post-procedure irritability is usually deficiency (Deficiency Irritability). Insomnia results from irritability preventing lying down. Severe cases involve tossing/turning and Ao Nao. "Fan" (Irritability) is Heart irritability; "Zao" (Restlessness) is Body restlessness. Tossing/turning of the body is Zao (endless restlessness), a Three-Yin death sign; tossing/turning of the Heart is Ao Nao, a Three-Yang heat sign. Ao Nao describes the sensation of wanting to vomit but unable, with mental unrest. Caused by pathogenic heat lodging in the chest post-procedures. With no exterior to sweat and no interior to purge, Zhizi Chi Tang follows the pathogen's trend to涌 (urge/vomit) out the heat. If Qi deficiency accompanies these symptoms, heat damaged Qi; add Gancao to support. If vomiting occurs, heat forced Water-Qi; add Shengjiang to disperse.
[Collected Annotations] Fang Youzhi stated: Deficiency irritability insomnia occurs when major pathogens retreat, Zheng Qi suddenly deficiences, residual heat causes confusion, and Stomach is disharmonious. "Ju" means extreme. Tossing/turning and Ao Nao indicate chest-diaphragm stagnation lacking relief. Zhizi Chi Tang employs the method "high pathogens are expelled via vomiting."
Cheng Yingmao stated: Post-sweating/emesis/purgation, whether chest oppression, insomnia, tossing/turning, or Ao Nao, all result from residual heat stuck upper, lodging in Heart/Chest, causing unrest. This is not irritability from inhibited sweating (where Da Qing Long Tang applies); these methods are useless here. Only Zhizi Chi Tang applies. Zhizi’s light aroma combines with Chidou to transform turbidity to clarity, urging out lodged pathogens, raising Qi, transforming fluids, and relieving depression.
Wang Hu stated: How can deficiency irritability withstand further vomiting? Understand that "deficiency" refers to Zheng Qi deficiency, while "irritability" refers to Pathogen excess. Pathogenic heat郁 (stagnates) in the chest, constituting pathogen excess. Vomiting indication persists; thus, vomiting method is appropriate. "Deficiency Irritability" should not be viewed as true deficiency, but as sudden deficiency post-sweating/emesis/purgation.
Zhizi Gancao Chi Tang Formula
Add Gancao (2 liang) to Zhizi Chi Tang. Follow previous method. Stop after vomiting.
Zhizi Shengjiang Chi Tang Formula
Add Shengjiang (5 liang) to Zhizi Chi Tang. Follow previous method. Stop after vomiting.
After Cold Damage purgation, if irritability, abdominal fullness, and restless sleeping/waking occur, Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction) is the primary treatment.
[Annotation] Post-purgation fullness without irritability includes: 1. Excess fullness from Heat entering Stomach, treated with Chengqi Tang (Descending Qi Decoction); 2. Deficiency fullness from Cold Qi rebelling upward, treated with Houpo Shengjiang Gancao Banxia Renshen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction). Irritability without fullness includes: 1. Deficiency irritability from Heat entering Chest, treated with Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction); 2. Ao Nao/desire-to-vomit irritability, treated with Zhizi Chi Tang. Now, both irritability and fullness exist; severe fullness prevents sitting, severe irritability prevents lying, causing restlessness. Lacking Three-Yang excess confirmation or Three-Yin deficiency signs, it is Heat and Qi knotting in Chest/Abdomen. Zhizi, Zhishi (Immature Bitter Orange), and Houpo (Magnolia Bark) urge out Heat, harmonizing Chest/Abdomen, resolving irritability/fullness. This embodies harmony within vomiting.
[Collected Annotations] Cheng Yingmao stated: When pathogens lodge in Chest, Upper/Lower communication fails. This equals Jie Xiong/Pi in epigastrium. Though vomiting/purgation/harmonizing methods differ, facilitating Yin-Yang communication is identical.
Shen Mingzong stated: Post-purgation, minor pathogens sink internally without Phlegm-Water knotting, thus no Jie Xiong/downward flow. But pathogens sink in Chest-Diaphragm, disturbing above...