茯苓（六两） 人参（一两） 附子（一枚生用去皮破八片） 甘草（二两炙） 干姜（一两半）
上五味。以水五升。煮取三升。去滓。温服七合。日三服。
成注云。四逆汤以补阳。加茯苓人参以益阴。
琥按上方。用茯苓人参甘草。补中而生阴血也。附子干姜除寒而回阳气也。此可见不汗出之。烦躁。用大青龙
汤。与既汗下之烦躁用此汤。不大相径庭邪。
或问发汗。若下之。病仍不解。烦躁焉知非实热证。余答云。实热证至烦躁。邪在表者。必不汗出。邪在里者。
必不大便五六日。绕脐痛矣。伤寒中寒。揆之脉证。两者判然。可无疑也。
太阳病发汗。汗出不解其人仍发热。心下悸。头眩。身 动。振振欲擗地者。真武汤主之。（此条病。乃太阳
真寒证。与前第一条太阳病同。真阳素虚之人。卒中风寒。先宜补里固表。然后可用温解之法。今者暂见太阳病。
即强发其汗。汗出者。谓汗已大出也。若汗出不彻。仍发热。为阳邪之气未解。此则汗已大出而不解。乃病剧而邪
不在表矣。汗多亡阳。真气内虚。阴中之火。离其本根而游走于外。故仍发热。心下悸云云者。心阳不安则悸。阳
虚于上则头眩。且也。阳虚则周身经脉。总无主持。故身 动。振振欲擗地。擗者。两手开拓也。身欲倒地。则两
手开拓。诸家注。或云以手拊心。或云思欲辟地而处其内。何穿凿之甚邪。此不过形容阳亡里虚。经脉无以主持之
状。方用真武汤者。并非行水导湿。乃补其虚而复其阳也。○方喻二氏议此条证。皆以为误服大青龙汤而致逆。遂
以真武汤为救逆之法。此泥于太阳中风脉浮紧。大青龙汤证云。若脉微弱。汗出畏风者。服之。则厥逆筋惕肉 为
逆。黄仲理以真武汤救之。遂以此为比例。殊不知古人之汗法甚多。岂得限一大青龙汤。为发汗之药乎。后之人各
执己见以立异。是为大失仲景之旨。）
茯苓（六两） 人参（一两） 附子（一枚，生用，去皮，破成八片） 甘草（二两，炙） 干姜（一两半）
以上五味药。用水五升。煮取三升药液。滤去药渣。温服七合。每日服用三次。
成无己注解说：四逆汤（Sini Tang, Four Reversal Decoction）用于补益阳气，加入茯苓和人参以增益阴液。
琥按上述方剂，使用茯苓、人参、甘草，旨在补益中焦并化生阴血。使用附子、干姜，旨在祛除寒邪并回阳救逆。由此可见，对于无汗出的烦躁症状，使用大青龙汤（Daqinglong Tang, Major Green Dragon Decoction），与对于已经经过发汗或攻下治疗后出现的烦躁症状使用此方（指茯苓四逆汤），二者在病机辨析上并没有太大的差异。
有人问：经过发汗或攻下治疗后，病证仍未解除，出现烦躁，怎么知道这不是实热证呢？我回答说：实热证发展到烦躁阶段，若邪气在表，必定无汗；若邪气在里，必定有大便不通五六日且绕脐疼痛的症状。伤寒和中寒（Zhonghan, Cold Damage and Middle Cold），通过脉象和证候来衡量，两者截然不同，可以毫无疑问地加以区分。
太阳病（Taiyang Disease, Taiyang Syndrome）发汗后，汗出而病不解，患者仍然发热，心下悸动（Palpitations in the epigastrium），头晕目眩，身体肌肉跳动，震颤欲倒仆于地者，主治以真武汤（Zhenwu Tang, True Warrior Decoction）。（本条病证，属于太阳经真寒证，与前文第一条太阳病相同。乃因真阳素虚之人，突然感受风寒，应先宜补益里气、固护肌表，然后才可用温散解表之法。如今暂时见到太阳病症状，就强行发其汗。所谓“汗出”，是指汗已大量排出。如果汗出不彻底，仍发热，那是阳邪之气未解。此处则是汗已大量排出而病不解，说明病情加重且邪气已不在表。汗多导致亡阳（Wang Yang, Loss of Yang Qi），真气内虚，阴中之火（命门之火/肾阳）脱离其根本而游走于外，所以仍然发热。“心下悸”等描述，是因为心阳不安则悸动，阳气虚于上则头晕目眩。况且，阳气虚则周身经脉失去主持，所以身体肌肉跳动，震颤欲倒仆于地。“擗”字，意为两手向两侧开拓。身体欲倒地时，则双手向两侧开拓。各家注解，有的说用手抚摸胸口，有的说想避开地面而处于室内，为何如此穿凿附会呢？这不过是形容阳气亡失、里气虚弱、经脉失去主持的状态罢了。使用真武汤的目的，并非行水导湿，而是补益虚损并恢复阳气。○方有执、喻嘉言两位医家议论此条证候，都认为是误服大青龙汤而导致变证，于是将真武汤视为救逆之法。这是拘泥于“太阳中风脉浮紧”以及大青龙汤证中提到的“若脉微弱，汗出畏风者，服之，则厥逆筋惕肉瞤为逆”，黄仲理用真武汤救治，遂以此为比例推断。殊不知古人的发汗法有很多，岂能限定只有大青龙汤是发汗药呢？后世之人各执己见以标新立异，这是大大违背了张仲景的本意。）
Fuling (Poria, 6 liang) Renshen (Ginseng Radix, 1 liang) Fuzi (Aconiti Lateralis Radix Praeparata, 1 piece, raw, peeled, broken into eight pieces) Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang, honey-fried) Ganjiang (Zingiberis Rhizoma, 1.5 liang).
The above five herbs. Boil with five sheng of water. Reduce to three sheng of decoction. Remove the dregs. Take seven ge of warm decoction orally. Three times a day.
Cheng Wuji's commentary states: Sini Tang (Four Reversal Decoction) is used to tonify Yang Qi; adding Fuling and Renshen benefits Yin fluids.
Hu notes that in the above formula, Fuling, Renshen, and Gancao are used to tonify the Middle Jiao and generate Yin Blood. Fuzi and Ganjiang are used to dispel Cold and restore Yang Qi. This demonstrates that for irritability without sweating, Daqinglong Tang (Major Green Dragon Decoction) is used, whereas for irritability after sweating or purging, this formula (Fuling Sini Tang) is used; there is not much difference between the two in terms of pathogenesis analysis.
One asks: After sweating or purging, if the disease remains unresolved and irritability occurs, how do we know it is not an Excess-Heat syndrome? I reply: When Excess-Heat progresses to irritability, if the pathogen is in the Exterior, there must be no sweating; if the pathogen is in the Interior, there must be constipation for five to six days and pain around the umbilicus. Shanghan (Cold Damage) and Zhonghan (Middle Cold), when evaluated by pulse and symptoms, are clearly distinct, leaving no room for doubt.
In Taiyang Disease (Taiyang Syndrome), after sweating, if the disease does not resolve despite sweating, and the patient still has fever, palpitations in the epigastrium, dizziness, muscle twitching, and tremors with a desire to fall to the ground, Zhenwu Tang (True Warrior Decoction) should be administered. (This condition belongs to the True Cold syndrome of the Taiyang channel, similar to the first Taiyang disease mentioned earlier. It occurs in individuals with inherent deficiency of True Yang who suddenly contract Wind-Cold. Initially, one should tonify the Interior and secure the Exterior before employing warming and resolving methods. Here, seeing only temporary Taiyang symptoms, one forcibly induces sweating. "Sweating" here refers to profuse sweating. If sweating is incomplete and fever persists, it indicates that Yang-pathogenic Qi has not resolved. In this case, however, profuse sweating fails to resolve the disease, indicating that the illness has worsened and the pathogen is no longer in the Exterior. Profuse sweating leads to Wang Yang (Loss of Yang Qi), causing internal deficiency of True Qi. The Fire within Yin (Mingmen Fire/Kidney Yang) detaches from its root and wanders externally, hence the persistent fever. The description of "palpitations," etc., arises because unsettled Heart Yang causes palpitations, and deficient Yang in the Upper Jiao causes dizziness. Moreover, Yang deficiency means the meridians throughout the body lose their governance, resulting in muscle twitching and tremors with a desire to collapse. The character "Pi" means extending both hands outward. When the body desires to fall, the hands extend outward. Various commentators interpret this as stroking the heart or wanting to avoid the ground and stay indoors; why such forced interpretations? This merely describes the state of Yang loss, Interior deficiency, and lack of meridian governance. The use of Zhenwu Tang is not for promoting urination and draining dampness, but for tonifying deficiency and restoring Yang Qi. ○ Fang Youzhi and Yu Jiayan both argued that this condition resulted from mistakenly administering Daqinglong Tang, leading to adverse reactions, thus viewing Zhenwu Tang as a method to rescue from these reversals. This stems from rigid adherence to the statement in Taiyang Wind-Stroke regarding floating-tight pulse, and the Daqinglong Tang indication stating that if the pulse is weak, sweating occurs, and aversion to wind, administration leads to cold limbs, muscle twitching, and tremors as adverse effects. Huang Zhongli used Zhenwu Tang to rescue such cases, drawing parallels. However, ancient sweating methods were diverse; how can one limit Daqinglong Tang as the sole sweating agent? Later generations, each holding their own views to innovate, have greatly deviated from Zhang Zhongjing's original intent.)