甘草（四两炙） 干姜（二两炮）
上 咀。以水三升。煮取一升五合。去滓。分温再服。
成注引内经曰。辛甘发散为阳。甘草干姜相合。以复阳气。
琥按上方。实非发散药。条辩云。甘草益气。干姜助阳。复其阳者。充其气之谓也。愚以气充。则津液生。而
咽中不干。膈寒解。吐逆自止也。
白芍药（四两） 甘草（四两炙）
上二味。 咀。以水三升。煮取一升五合。去滓。分温再服。
成注云。芍药白补而赤泻白收而赤散也。酸以收之。甘以缓之。酸甘相合。用补阴血。
琥按上方。用于阳气既复之后。但阴血未和。故用白芍药为君以补营血。炙甘草为臣以和阴气。阴血和补而脚
自伸矣。
（见伤寒辩注第六卷阳明篇中）
琥按上方。治伤寒胃腑实热药也。今取以治中寒者。以前证误与桂枝汤。复与甘草干姜汤。姜桂辛热。耗胃中
津液。因而谵语。原方后云。少少温服。此不过暂假之。以和胃气而止谵语。故尚论篇云。倘多与之。则为下而非
和。岂不大误。
（正解见中卷少阴病中）
琥按上汤。治上条证。若重发其汗。复加烧针者夫重发汗。则阳亡而气欲脱。故用干姜附子。以回阳助气。加
烧针。则阴受伤而血不流。故用炙甘草。以和其血。兼扶其阴。此亦借用之方。非若少阴病。脉沉厥逆。此方为正
治之药也。
或问重发汗为亡阳。阳气虚而用四逆。固矣。加烧针。不无火逆之患。何以仍用四逆汤。余答云。热病阳气有
余。加烧针。则为火逆。寒病阴寒用事。加烧针。徒耗其阳。兼损其阴。气血受伤。寒气反入。后条辩所云治之一
误。寒即中于治法中矣。医者可不慎之。
问曰。证象阳旦。按法治之而增剧厥逆。咽中干。两胫拘急而谵语。师曰言夜半手足当温。两脚当伸。后如师
言。何以知此。答曰。寸口脉浮而大。浮则为风。大则为虚。风则生微热。虚则两胫挛。病证象桂枝。因加附子参
其间。增桂。令汗出。附子温经。亡阳故也。厥逆。咽中干。烦躁。阳明内结。谵语烦乱。更饮甘草干姜汤。夜半
阳气还。两足当热。胫尚微拘急。重与芍药甘草汤。尔乃胫伸。以承气汤。微溏。则止其谵语。故知病可愈。（此
条问答。补亡论郭白云云。此重解释前段。误用桂枝汤证。阳旦者。即桂枝汤中加黄芩之别名也。阳旦汤本治阳证。
以前条脉浮自汗出之阴证相似。遂按阳旦汤法治之。其增剧者。盖前此误用桂枝。此则更加黄芩。误之误矣。厥逆。
咽中干。两胫拘急而谵语者。此病增剧之形也。病既剧矣。师能决其向愈之时。卒如其言者。何也。师盖诊其脉。
验其证。而知其为风虚之候微热是假。虚寒是真。故见两胫挛也。据师之意。以前证象桂枝矣。还宜加附子。参入
乎其间为正治。乃用桂枝加附子汤主之。更增桂。能令汗出。以散其风邪。参用炮附子。为能温经而补虚。以上证
亡阳。无热可发故也。今者。见证不明。而以阳旦汤治之。以致前厥逆咽干等证。须改用甘草干姜等汤一如前条法
救之。夜半者。阴极而阳气当回之时也。故其病可愈。条辩云。末后不复言重发汗已下等文者。以其或然或不然也。
○按阳旦汤。见活人书第十八卷杂方中。即桂枝汤加黄芩二两。治中风伤寒。脉浮发热。往来汗出恶风者。尚论篇
纽合阴旦汤。极闸人问答示奇。大失仲景立论之旨。）
上四条证。（见原论中第二卷太阳病治法上第五）
下之后复发汗昼日烦躁不得眠。夜而安静。不呕不渴。无表证。脉沉微。身无大热者。干姜附子汤主之。（此
条系中寒证。汗下颠倒所至。夫阴证可下。原有调胃承气汤。少与微溏之例。阴证发汗。原有麻黄附子细辛汤。微
汗之法。医者不明其理。竟过与承气汤下之后。虚阳外走。必有微热。复与麻黄等汤以发之。成注云。表里俱虚也。
昼日主阳。阳虚欲复。与阴寒之邪交争。故烦躁不得眠。乃虚烦虚躁也。夜主阴。纯阴用事。阳气太虚。不能与邪
相争。故主安静。不呕不渴者。里无热也。身无大热者。表无热也。脉沉为寒邪胜。微为阳气虚。故与干姜附子汤。
以退阴复阳。）
甘草（四两，炙） 干姜（二两，炮制）
以上药材切碎。用水三升，煮取一升五合药液。滤去药渣。分两次温服。
成无己注引《内经》说：辛味和甘味的药物配合能发散阳气。甘草与干姜相合，用以恢复阳气。
丹波琥按上述方剂，实际上并非发散类药物。条辩云：甘草补益元气，干姜助长阳气。所谓“复其阳”，是指充实元气的意思。我认为元气充足，则津液生成，咽喉干燥自解，膈间寒邪消散，呕吐逆气自然停止。
白芍药（四两） 甘草（四两，炙）
以上两味药，切碎。用水三升，煮取一升五合药液。滤去药渣。分两次温服。
成无己注说：白芍药性白属补，赤芍药性赤属泻；白芍收敛，赤芍发散。酸味以收敛，甘味以缓和。酸甘相合，用于补益阴血。
丹波琥按上述方剂，用于阳气已经恢复之后，但阴血尚未调和，所以用白芍药为君药以补益营血，炙甘草为臣药以调和阴气。阴血得到调和补益，脚部痉挛自然舒展。
（见《伤寒辩注》第六卷阳明篇中）
丹波琥按上述方剂，是治疗伤寒胃腑实热的药物。现在取来治疗中寒证，是因为之前的病症误用了桂枝汤，又用了甘草干姜汤。生姜、桂枝辛热，耗伤了胃中的津液，因而出现谵语。原方后注说：少量温服。这不过是暂时借用此方，以调和胃气而止住谵语。所以《尚论篇》说：如果多给服用，就变成了攻下而非调和，岂不大大错误。
（正解见中卷少阴病中）
丹波琥按上述汤剂，治疗上一条所述证候。如果重发其汗，又加用烧针法。重发汗，则阳气亡失而气欲脱散，所以用干姜、附子，以回阳助气。加用烧针，则阴液受伤而血液运行不畅，所以用炙甘草，以调和血液，兼扶护阴液。这也是借用的方剂，不像少阴病脉沉厥逆那样，此方才是正治之药。
有人问：重发汗导致亡阳，阳气虚损而使用四逆汤，这是确定的了。加用烧针，难道没有火逆的祸患吗？为什么仍然使用四逆汤？我回答说：热病阳气有余，加用烧针，就会造成火逆；寒病阴寒当令，加用烧针，徒然耗伤阳气，兼损阴液。气血受伤，寒气反而内入。后文条辩所说的治疗失误，寒邪即因治疗方法不当而侵入体内。医者能不谨慎吗？
问曰：证候表现像阳旦汤证，按照阳旦汤法治之却病情加重，出现四肢厥冷，咽喉干燥，两小腿拘急挛缩且谵语。老师说半夜手足应当转温，两脚应当舒展。后来果然如老师所言，凭什么知道这一点？回答说：寸口脉浮而大，浮主风邪，大主虚证。风邪则生微热，虚证则两小腿挛急。病证象桂枝汤证，因此加入附子在其中，增加桂枝用量，令其出汗。附子温通经脉，是因为阳气亡失的缘故。出现四肢厥冷，咽喉干燥，烦躁，阳明内结，谵语烦乱。再饮甘草干姜汤，夜半阳气回复，两足应当发热，小腿尚轻微拘急挛缩。再次给予芍药甘草汤，然后小腿才能舒展。再用承气汤，大便微溏，则止住谵语。所以知道病可痊愈。（此条问答，《补亡论》郭白云说：这是对前段的重新解释，误用桂枝汤证。阳旦汤，即是桂枝汤中加入黄芩的别名。阳旦汤本用于治疗阳证，因为与前一条脉浮自汗出的阴证相似，于是按阳旦汤法治之。病情增剧的原因，大概是此前误用桂枝，此处又加上黄芩，错上加错。四肢厥冷，咽喉干燥，两小腿拘急挛缩且谵语，这是病情加剧的表现。病既已严重，老师能断定其向愈的时间，最终应验，为什么呢？老师大概诊察了其脉象，验证了其证候，而知其为风虚之候，微热是假象，虚寒是真象，所以见到两小腿挛急。据老师的意图，以前证象桂枝汤证，还宜加入附子，参入其中为正治，乃用桂枝加附子汤主治。更增加桂枝，能令出汗，以疏散风邪。参用炮附子，是为了温经而补虚。以上证候阳气亡失，无热可发。如今，证候不明，而以阳旦汤治之，以致出现前述厥逆咽干等证，须改用甘草干姜等汤，一如前条之法救之。夜半，是阴极而阳气应当回复之时，所以病可痊愈。条辩说：最后不再重复说重发汗以下等文字，是因为情况可能如此也可能不如此。○按阳旦汤，见《活人书》第十八卷杂方中，即桂枝汤加黄芩二两，治疗中风伤寒，脉浮发热，往来汗出恶风者。《尚论篇》将阴旦汤纽合在一起，极尽问答示奇之能事，大大失去了张仲景立论的本旨。）
以上四条证候。（见原论中第二卷太阳病治法上第五）
误用下法后又复发汗，白天烦躁不能入睡，夜间却安静，不呕不渴，无表证，脉沉微，身体没有大热的，用干姜附子汤主治。（此条属于中寒证，是汗下颠倒所致。阴证可下，原有调胃承气汤少量服用致微溏的先例；阴证发汗，原有麻黄附子细辛汤微汗的方法。医者不明其理，竟过量给予承气汤进行攻下，导致虚阳外越，必有微热。又给予麻黄等汤剂发汗。成无己注说：表里俱虚。白天主阳，阳气虚欲回复，与阴寒之邪交争，所以烦躁不得眠，这是虚烦虚躁。夜间主阴，纯阴当令，阳气太虚，不能与邪气相争，所以表现为安静。不呕不渴，说明里没有热。身无大热，说明表里没有热。脉沉为寒邪胜，脉微为阳气虚，所以给予干姜附子汤，以退阴寒而复阳气。）
Gancao (Licorizae Radix et Rhizoma, four liang, honey-fried) Ganjiang (Zingiberis Rhizoma, two liang, processed)
Crush the above ingredients. Boil in three sheng of water to obtain one sheng and five he of decoction. Strain off the dregs. Divide into two doses and take warm.
Cheng Wuji's commentary cites the *Neijing*: "Pungent and sweet flavors disperse and generate Yang." The combination of Gancao and Ganjiang serves to restore Yang Qi.
Danbo Hu notes: The above formula is actually not a dispersing agent. The *Tiaobian* states: "Gancao tonifies Yuan Qi, Ganjiang assists Yang." What is meant by "restoring Yang" is filling the Yuan Qi. I believe that when Yuan Qi is sufficient, body fluids are generated, throat dryness resolves, cold in the diaphragm dissipates, and vomiting and counterflow qi cease naturally.
Baishao (Paeoniae Radix Alba, four liang) Gancao (Licorizae Radix et Rhizoma, four liang, honey-fried)
Crush the above two ingredients. Boil in three sheng of water to obtain one sheng and five he of decoction. Strain off the dregs. Divide into two doses and take warm.
Cheng Wuji's commentary says: "White Shaoyao is white and tonifying; red Shaoyao is red and draining. White Shaoyao astringes; red Shaoyao disperses. Sour flavor astringes; sweet flavor moderates. The combination of sour and sweet is used to tonify Yin blood."
Danbo Hu notes: The above formula is used after Yang Qi has been restored, but Yin blood is not yet harmonized. Therefore, Baishao is used as the sovereign herb to tonify Ying blood, and honey-fried Gancao is used as the minister herb to harmonize Yin Qi. When Yin blood is harmonized and tonified, leg cramps will naturally extend.
(See *Shanghan Bianzhu*, Volume 6, Yangming Chapter)
Danbo Hu notes: The above formula is for treating excess heat in the stomach fu organ in Shanghan. It is now taken to treat Zhonghan (Cold Strike) because the previous condition was mistakenly treated with Guizhi Tang, followed by Gancao Ganjiang Tang. Shengjiang and Guizhi are pungent and hot, consuming stomach fluids, leading to delirium. The post-formula note says: "Take small amounts warm." This is merely a temporary borrowing to harmonize stomach qi and stop delirium. Thus, *Shanglun Pian* states: If given in large quantities, it becomes purgation rather than harmonization, which would be a great error.
(Correct explanation see Middle Volume, Shaoyin Disease Chapter)
Danbo Hu notes: The above decoction treats the syndrome described in the preceding clause. If heavy sweating is induced again, and burning needle therapy is added: Heavy sweating causes Yang collapse and Qi depletion, so Ganjiang and Fuzi are used to return Yang and assist Qi. Burning needle therapy injures Yin and impedes blood flow, so honey-fried Gancao is used to harmonize blood and support Yin. This is also an borrowed formula, unlike Shaoyin disease with deep pulse and cold limbs, where this formula is the correct treatment.
A question arises: Heavy sweating leads to Yang collapse; using Sini Tang for deficient Yang is established. Adding burning needles, does it not risk Fire Adverse Reaction? Why still use Sini Tang? My answer: In heat diseases, Yang Qi is excessive; adding burning needles causes Fire Adverse Reaction. In cold diseases, Yin Cold dominates; adding burning needles merely consumes Yang and damages Yin. Qi and Blood are injured, and Cold pathogen enters inward. As stated in the later *Tiaobian*, the treatment error allows Cold to invade via the treatment method itself. Can physicians not be cautious?
Question: The syndrome resembles Yangdan Tang pattern. Following Yangdan Tang treatment worsens the condition, causing cold limbs, dry throat, calf cramping, and delirium. The Master said, "By midnight, hands and feet will warm, legs will extend." Later it happened as predicted. How did he know? Answer: Cun Kou pulse is floating and large. Floating indicates Wind; Large indicates Deficiency. Wind generates slight heat; Deficiency causes calf cramping. The syndrome resembles Guizhi Tang pattern, so Fuzi was added, and Guizhi increased to induce sweating. Fuzi warms the meridians due to Yang collapse. Cold limbs, dry throat, irritability, Yangming internal binding, delirious confusion follow. Drink Gancao Ganjiang Tang again. By midnight, Yang Qi returns, feet warm, calves slightly cramped. Administer Shaoyao Gancao Tang again, then calves extend. Use Chengqi Tang, slight stool softening stops delirium. Thus, recovery is known. (This Q&A from *Buwang Lun* by Guo Baiyun explains the previous misused Guizhi Tang case. Yangdan Tang is Guizhi Tang plus Huangqin. Yangdan Tang treats Yang patterns. Since it resembled the Yin pattern of floating pulse and spontaneous sweating, Yangdan Tang was used incorrectly. Worsening occurred due to prior Guizhi misuse and current Huangqin addition—error upon error. Cold limbs, dry throat, calf cramping, delirium indicate severe worsening. The Master predicted recovery time accurately by diagnosing pulse and verifying symptoms, identifying Wind-Deficiency where slight heat is false and deficiency-cold is true. Seeing calf cramping, the Master intended to add Fuzi to Guizhi pattern as correct treatment, using Guizhi Jia Fuzi Tang. Increasing Guizhi induces sweat to disperse Wind; Pao Fuzi warms meridians and tonifies deficiency. With Yang collapse, no heat can be released. Now, unclear symptoms treated with Yangdan Tang caused cold limbs and dry throat. Must switch to Gancao Ganjiang Tang etc., as before. Midnight is Yin extreme and Yang returning time, hence recovery. *Tiaobian* says omitting "heavy sweating" text implies uncertainty. ○ Note: Yangdan Tang appears in *Huo Ren Shu* Vol 18, misc formulas: Guizhi Tang plus two liang Huangqin, treating Wind-Strike/Shanghan with floating pulse, fever, alternating sweating, aversion to wind. *Shanglun Pian* combines Yindan Tang, making Q&A overly clever, losing Zhang Zhongjing's original intent.)
The above four syndromes. (See Original Treatise, Volume 2, Taiyang Disease Treatment Methods Part 1, Section 5)
After mistaken purgation and subsequent sweating: Restlessness during day, unable to sleep; quiet at night; no vomiting, no thirst; no exterior syndrome; deep and faint pulse; no significant body heat. Treat with Ganjiang Fuzi Tang. (This clause belongs to Zhonghan, caused by inverted sweating and purging. Yin patterns may be purged, e.g., Tiaowei Chengqi Tang in small doses for slight stool softening; Yin patterns may be sweated, e.g., Mahuang Fuzi Xixin Tang for mild sweating. Physicians ignorant of principles overuse Chengqi Tang for purging, causing deficient Yang to float outward, resulting in slight heat. Then administering Mahuang-type decoctions for sweating. Cheng Wuji notes: Exterior and Interior both deficient. Day governs Yang; deficient Yang attempts to recover and struggles with Yin-Cold, causing restlessness and insomnia—this is empty irritability. Night governs Yin; Pure Yin dominates, Yang is too deficient to struggle with pathogens, hence quiet. No vomiting/thirst means no interior heat. No significant body heat means no exterior heat. Deep pulse indicates Cold dominance; faint pulse indicates Yang deficiency. Hence, Ganjiang Fuzi Tang is given to dispel Yin and restore Yang.)