【闡釋】此條原文係《傷寒論》76條之一段。此證胃陽素虛，夙有寒飲，發汗則傷其上焦之陽氣，故水藥不得入口，此為逆也。若更發汗，又傷其中、下焦之陽氣，中焦傷而吐不止，下焦傷而利不止。如鄭氏所言：“明係發汗過多，以致亡陽……若更汗之，則中氣愈虛，而吐下更甚也。法宜扶陽、宣中、降逆為主。”筆者在臨證中，常用附子理中湯加半夏、吳茱萸治之。
十二、太陽病，頭痛、發熱、汗出、惡風，桂枝湯主之。原文13
鄭論：此即太陽風傷衛證之候，桂枝〔湯〕的方，茲不贅。
【闡釋】太陽經脈之循行，起於目內眥，上額、交巔，從巔入絡腦，循項背而下。此節首提出頭痛二字，知外邪客太陽最高之處，故太陽頭痛，每在正中與頭後部，與陽明、少陽頭痛之部位不同。次言發熱、汗出、惡風等證，乃太陽中風的候，此經病由上而下，故先言頭痛，而次及項背也。其脈當為浮弱，舌苔當為薄白，桂枝湯乃適當之方也，
十三、太陽病，外證未解①，脈浮弱者，當以汗解，宜桂枝湯。原文42
①外證：指表證而言，表證所指者狹，外證所指者廣，實際並沒有大的區別。
鄭論：此條既外證未解，可以再汗，但脈浮弱，其正必虛，故不能助藥力以祛邪外出，余意當于桂枝湯內，或加飴糖，或加附子，方為妥當。
【闡釋】此條乃脈象浮弱，外證未解之治法也。若脈浮緊是為傷寒外證未解，又當用麻黃湯也。鄭氏指出其正必虛，于桂枝湯內，或加飴糖，或加附子，以助藥力祛邪外出，為其經驗之總結。筆者對於體虛之人，或產婦漏汗不止，外感風寒之邪，皆用桂枝湯加附子以助藥力，祛邪外出而愈。
十四、太陽病，發熱汗出者，此為營弱衛強，故使汗出，欲救邪風者②，宜桂枝湯（主之）。原文95
②救：驅散的意思。邪風：內經所謂：虛邪賊風。這裏指作風邪解。
鄭論：此條明是太陽為風邪所傷，衛分邪實，營分正虛耳。
【闡釋】營衛在正常時，是相互協調的。太陽為風邪所傷，衛分邪實，故有汗；營分正虛，故無汗。弱言正氣虛，強謂邪氣實，即肌理不開，皮毛獨疏之謂。惟其營弱，故里汗閉而不出，惟其衛強，故表汗獨出也。故宜用桂枝湯救邪風之所傷，邪風去則衛氣和，汗出止則營自複。
十五、病人髒無他病①，時發熱自汗出②，而不愈者，此（為）衛氣不和也。先其時發汗則愈，宜桂枝湯。原文54
①髒無他病：指病不在裏之義。
鄭論：此條定是失于解表，不然，何得雲先其時發汗則愈，宜桂枝湯耶？
【闡釋】時發熱，自汗出，頗似陽明，故曰髒無他病，以明其為表證也。《外台》雲：“裏和表病，汗之則愈”。本條先其時發汗則愈，係迎其氣機而導之之意也。
十六、病常自汗出者，此為榮氣和③，榮氣和者，外不諧④，以衛氣不共榮氣諧和故（所）〔爾〕⑤；以榮行脈中，衛行脈外，復發其汗，榮衛和則愈，宜桂枝湯（則愈）。原文53
②時發熱自汗出：指間歇性發熱，自汗出。
③榮氣和：榮不病也。
④外不諧：外是“衛”的代稱，即衛失調。
⑤諧和故爾：指衛氣與榮氣不協調。
鄭論：按病常自汗，似不專主太陽榮衛不和，如果屬太陽榮衛不和，亦必有惡風、畏寒足征。茲雲自汗出，其中有素稟陽虛，或多言，或過用心，或稍勞動，而即自汗出者，皆在不足之例，尚敢輕用桂枝湯乎？此條大抵專主榮衛不和說法也，學者宜細求之。
【闡釋】本條榮衛不和，不是由於外受風寒所致，而是由於榮衛本身不能互相協調的自汗出，不論是衛強榮弱或衛弱榮強，仍宜桂枝湯治療。但鄭氏深一層指出有素稟陽虛，或多言，或過用心，或稍勞動，而即自汗出者，皆在不足之例，不能用桂枝湯治療，值得我們臨證時審慎。然則如何治之，筆者認為鄭氏所訂之補坎益離丹為合拍之方。
十七、太陽病，初服桂枝湯，反煩不解者，先刺風池風府⑥，卻與桂枝湯〔則〕愈。原文24
⑥風池：穴名，在腦後（腦空穴外）發際中，在枕骨斜方凹陷中，足少陽膽經穴。風府：穴名，在項後入發際一寸，在枕骨與第一頸惟之間，是督脈經的穴位。
鄭論：此條明言解表未透，邪未遽出，故見煩，刺風池風府穴者，泄其邪熱，仍以桂枝湯，俾邪盡出無遺，故自愈也。
【闡釋】太陽中風證，治以桂枝湯，病不解而反煩者，此藥力未達，煩者，為正邪相爭之現象。經雲：大風頸項痛，刺風池。又曰：風從外入，令人振寒，汗出頭痛，身重惡寒，刺在風府。此刺法之所本也。刺法所以泄其邪勢，然後再服桂枝湯，俾邪盡出無遺而愈也。
十八、風家表解①，而不了了者②，十二日愈，原文10
①風家：凡“家”字俱皆指宿病而言，此處應作太陽中風傷寒看。
②不了了：就是不清楚、不爽快之意。
鄭論：既稱表解，邪已去矣，應當清爽如常，此則不了了者，是邪去而正未複也。延至十二日者，侯正氣漸漸複還也。
【闡釋】表解還有不爽快的感覺，一是餘邪還未全清，一是正氣尚未全複，而預計十二日愈者，經盡之時，餘邪盡，自然愈矣。亦有教人不必服藥，當心靜養就可漸漸痊癒的意思。本論中的日數，多是約略之詞，必須靈活的領會其精神實質。
十九、中風發熱，六七日不解而煩，有表裏證③，渴欲飲水，水入則吐者，名曰水逆④，五苓散主之（多服暖水，汗出愈）。原文74
③有表裏證：表證指發熱、惡風、汗出、脈浮等；裏證指煩渴欲飲水，小便不利、水入即吐等。
④水逆：胃有停水，水氣不化，渴欲飲水，水入即吐的意思。
鄭論：此條既稱六七日不解而煩，有表裏證，應有表裏證形足征，方為確論。況病形所見，全是太陽腑證，觀於用五苓散方，是獨重在太陽腑分一面，並未道及表證一面，原文何得稱有表裏證也。裏證即太陽腑證也，即言外邪入腑，何等直切。況此刻病現飲水入口即吐，是因太陽之氣化不宣，中宮之轉輸失職，氣機升多降少，以致上逆而吐，用五苓散多服㈠，俾太陽之氣化行，水道通，氣機下降，自然逆者不逆，而吐者不吐也。學者宜細繹之。
㈠多服二字，定教人不可見其吐而遂不與之服也。
【闡釋】本條中風發熱，六七日經盡不解，此即表證；渴欲飲水，邪傳裏也，此即裏證。鄭注何得謂病形所見，全是太陽腑證？至鄭氏所言太陽之氣化不宣，中宮之轉輸失職，氣機升多降少，以致上逆而吐，五苓散和表裏，散停飲，故治之而愈，這是正確的。又原文五苓散主之後有“多服暖水，汗出愈。”舒本亦有此七字。但《傷寒論》原文無此七字，此係五苓散方後所載，舒、鄭二氏竟移于原文之後，不識何故？
二十、太陽病，發汗後，大汗出，胃中幹，煩（燥）〔躁〕不得眠，欲得飲水者，（少與之）〔少少與飲之〕，〔令〕胃氣和則愈。若脈浮，小便不利，微熱消渴者①，五苓散主之。原文71
①消渴：形容渴飲不止的意思。《金匱》上的消渴是飲多少，小便多少，屬於一種病名。本條之消渴是形容口渴甚，是一種症狀，二者不可混同。
鄭論：按太陽既發汗後，複見大汗出，汗為血液，血液過傷，胃中失養，故胃幹，津液不能上下交通，故煩（燥）〔躁〕不得眠，欲得水飲者，少與之，令胃和則愈。蓋水亦陰也，土燥得水以潤之，自然燥者不燥，而病自見其愈也。若見小便不利，微渴者，是血液亡於外，而氣化失於內也，主以五苓化太陽之氣，氣化一宣，則水道通，裏氣暢，升降不乖，病焉有不愈者乎？
【闡釋】此節乃發汗傷津，胃與膀胱之救治不同也。鄭氏謂：“汗為血液，血液過傷，胃中失養，故胃幹。”此處稱汗為血液，不能是一般所指之血液，而為一種不能養榮之津液。胃中津液受損不足者，以致煩躁作渴，只須飲水以和胃氣則愈，非五苓散證也。若脈浮，小便不利，微熱消渴者，此膀胱氣化不行也。
膀胱為太陽之腑，脈浮微熱，太陽之表邪未盡，故用五苓散兩解表裏，小便利則水去渴止。用散而不用湯者，取藥性直達於下也。
五苓散方（校補）
豬苓十八株（去皮）澤瀉一兩六銖白朮十八銖茯苓十八銖桂枝半兩（去皮）上五味，搗為散②以白飲和服方寸匕③，日三服，多飲暖水，汗出愈，如法將息。
②散：將藥製成粉末，叫做散。
③白飲：即米湯。方寸匕：是古代食具之一，曲柄淺鬥，狀如今之羹匙。《名醫別錄》雲：“方寸匕者，作匕正方一寸，抄散不落為度。”
【方解及其應用範圍】本方功專利水，乃化氣行水之劑。《傷寒論》太陽腑分之主方也。茯苓甘溫，助陽益脾，淡滲利竅，除濕，色白入肺，瀉熱而下通膀胱。豬苓甘淡，入肺而通膀胱，利便行水與茯苓同。澤瀉甘淡微鹹，入膀胱，利小便，功專祛濕行水。三者皆有導水下行，通行小便之功。益土所以制水，故以白朮健脾去濕。最妙在桂枝一味，化膀胱氣機，使膀胱津液得以通調，外則輸津於皮毛，內則通行于上下，自然小便利，口渴除。觀方後雲：“多飲暖水，汗出愈”，則本方不但有利水之功，且有發汗作用；要知如五苓散者，也可為太陽經腑兩解之方也。本方現多改作湯劑。至於本方之應用，《傷寒論》列為太陽腑證之主方，治療口渴、小便不利、膀胱蓄水、表裏上下同病。鄭氏在《醫法圓通》中更用以：（l）治大便瀉水，而小便全無者；（2）治頭暈、咳嗽、嘔吐、腹脹、小便短；（3）治霍亂吐瀉，思飲冷水者。以上三症，本非此方所治之病，因其有無小便及小便短的證狀，故能治之而愈，可謂善於運用成方。筆者曾用此方治腹水脹滿。患者腹部脹滿，食欲不振，食後脹滿更甚，雖口幹而不思飲水，小便短少，人困無神，舌苔白膩，脈沉數而滑。此脾失健運，氣化不行，水濕阻滯，用五苓倍桂、朮，再加上桂以化膀胱之氣，氣行水即行，加椒目專行水道以消水脹，而腹脹之症即愈。又傷濕咳嗽之症，肌肉隱黃，頭眩，痰涎及泡沫痰特多，脘中不暢，有時嘔吐清水，身體倦怠，小便不利，口中津液多，雖渴不欲飲水，舌苔白膩，脈沉細而滑。係因膀胱氣機不利，濕邪反上幹清道而咳，則須以滲利為主，五苓散加味治之。痰飲咳嗽其根本由於水飲所致，祛其水飲則咳嗽自愈，如中腹脹滿，上氣喘逆，二便不利，或四肢俱腫者，此為痰水壅滯，五苓散能上下分消其痰水，治之而愈。近人加減推廣應用本方，凡屬津液運行失調的病症，均可以用此加減施治而獲效。
二十一、太陽病發汗，汗出不解，〔其〕人仍發熱，心下悸①，頭眩身瞤〔動〕②，振振欲擗地者③，真武湯主之。原文82
①心下悸：即心下築築跳動。
②身瞤（shùn順）動：即全身筋肉跳動之意。
③振振欲擗（pǐ匹）地：就是站立不穩，搖搖欲墜的樣子。
鄭論：按發汗原是解表，表解自然熱退，乃不易之理，今汗出而熱仍然，所現種種病形，非表邪未透之征，卻是亡陽之候，必是因發汗過度，傷及腎陽。太陽底面，即是少陰，此際發熱者，陽越於外也，心下悸，頭眩身瞤者，陽氣外亡而群陰僭上也。振振欲擗地者，陽欲藏而不得也。夫先天之真陽，喜藏而不喜露，藏則命根永固，露則危亡立生，主以真武湯，是重藏陽之意也。
【闡釋】鄭氏所按，大有卓見，與成無己、張隱菴、陳修圓等之注“仍發熱”為邪氣未解也，太陽之病不解也等不同。鄭氏說：“所現種種病形，非表邪未透之征，卻是亡陽之候，必是因發汗過度，傷及腎陽。太陽底面，即是少陰，此際發熱者，陽越於外也，心下悸、頭眩、身瞤者，陽氣外亡，而群陰僭上也；振振欲擗地者，陽欲藏而不得也。”實即發汗過度，損及腎陽，主以真武湯，是溫經複陽之意，使陰氣不上逆為病也。（真武湯方，載少陰篇）
二十二、太陽病，〔發汗〕，遂漏不止①，其人惡風，小便難②，四肢微急③，難以屈伸者，桂枝加附子湯〔主〕之。原文20
①漏：滲泄不止的意思，在這裏形容汗多。
②難：不通暢的意思。
③急：拘急，即屈伸運動不自如。
鄭論：按發汗而至漏不止，其傷及腎陽也明甚。太陽底面，即是少陰，其人惡風者，外體疏也，小便難者，汗為水液，氣化行於外，而不行於內也。四肢微急，難以屈伸者，血液外亡，而筋脈失養也。
此際理應以扶陽為是，原文取桂枝加附子湯，意在用附子，取內以固其根蒂，得桂枝，外以祛其未盡之邪，內外兼備，斯無大害，庶不失立方之妙也。
【闡釋】太陽病的治法，雖然以發汗為主，但以漐漐汁出為佳。今發汗太過，遂漏不止，乃傷及腎陽，腎與膀胱為表裏，腎陽衰則膀胱寒結，故小便難。四肢為諸陽之本，不得陽氣以養之，故微急，且至難以屈伸者。鄭氏謂：“用附子內以固其根蒂，得桂枝外以祛其未盡之邪，內外兼備。”此乃發汗太過，導致陽虛液脫救逆之法也。
桂枝加附子湯方（校補）
桂枝三兩（去皮）芍藥三兩甘草三兩（炙）生薑三兩（切）大棗十二枚（擘）附子一枚（炮、去皮、破八片）上六味，以水七升，煮取三升，去滓，溫服一升。本雲桂枝湯，今加附子，將息如前法。
【阐释】这一条原文是《伤寒论》第76条的一部分。此证患者胃阳素来虚弱，体内素有寒饮，发汗会损伤上焦的阳气，导致水药无法入口，这是误治（逆证）。如果再次发汗，又会损伤中、下焦的阳气；中焦受损则呕吐不止，下焦受损则腹泻不止。正如郑氏所言：“这明显是发汗过多，导致亡阳……如果再发汗，中气会更加虚弱，呕吐和腹泻会更严重。治疗法则应以扶阳、宣通中气、降逆为主。”我在临床实践中，常用附子理中汤加半夏、吴茱萸来治疗。
十二、太阳病，出现头痛、发热、出汗、怕风的症状，用桂枝汤主治。原文13
郑氏评论：这就是太阳中风伤及卫分的证候，桂枝汤是对证的方剂，这里不再赘述。
【阐释】太阳经脉的循行路线，起于目内眦，向上至额部，交会于头顶，从头顶入络于脑，沿项背向下。本节首先提出“头痛”二字，可知外邪客居于太阳经最高之处，所以太阳病的头痛，多在正中及头后部，这与阳明病、少阳病头痛的部位不同。接着说发热、出汗、怕风等症状，这是太阳中风的证候。此经的病由上而下发展，所以先说头痛，然后涉及项背。其脉象应当是浮弱，舌苔应当是薄白，桂枝汤是恰当的方剂。
十三、太阳病，表证未解，脉象浮弱的，应当用发汗法解除，适宜用桂枝汤。原文42
①外证：指表证而言，表证所指的范围较窄，外证所指的范围较广，实际上没有大的区别。
郑氏评论：这一条既然表证未解，可以再发汗，但脉象浮弱，说明正气必然虚弱，因此不能依靠药物力量强行祛邪外出。我的意见是在桂枝汤内，或者加饴糖，或者加附子，才为妥当。
【阐释】这一条讲的是脉象浮弱、表证未解的治疗方法。如果脉象浮紧，那是伤寒表证未解，又当用麻黄汤了。郑氏指出正气必然虚弱，在桂枝汤内加饴糖或附子，以助药力祛邪外出，这是他的经验总结。对于体质虚弱的人，或者产妇漏汗不止，感受风寒之邪者，我都用桂枝汤加附子以助药力，祛邪外出而痊愈。
十四、太阳病，发热出汗的，这叫营弱卫强，所以导致出汗，想要驱散风邪的，适宜用桂枝汤（主治）。原文95
②救：驱散的意思。邪风：《内经》所谓“虚邪贼风”。这里指风邪。
郑氏评论：这一条明确是太阳被风邪所伤，卫分邪气实，营分正气虚。
【阐释】营卫在正常状态下，是相互协调的。太阳被风邪所伤，卫分邪气实，所以有汗；营分正气虚，所以无汗（注：此处原文逻辑似有矛盾，通常卫强营弱致汗出，卫强指邪气盛，营弱指津液亏，故汗出。原文解释称“营分正虚，故无汗”与上下文“故使汗出”冲突，依中医理论及下文“里汗闭而不出...表汗独出”，应理解为营阴不足不能内守，卫阳浮越不能固密，故汗出。此处忠实翻译原文表述，但需注意中医常理）。“弱”指正气虚，“强”谓邪气实，即肌理不开，唯独皮毛疏松。正因为营弱，所以体内的汗液闭塞而出不来；正因为卫强，所以体表的汗液独自流出。因此适宜用桂枝汤来救治风邪的伤害，风邪去除则卫气调和，汗止则营阴自然恢复。
十五、病人脏腑没有其他疾病，时常发热自汗出，却不痊愈的，这是卫气不和。在发作前发汗则能痊愈，适宜用桂枝汤。原文54
①脏无他病：指病不在里的意思。
郑氏评论：这一条肯定是失于解表，否则，怎么能说在发作前发汗就能痊愈，适宜用桂枝汤呢？
【阐释】时常发热，自汗出，很像阳明病，所以说“脏腑没有其他疾病”，以明确这是表证。《外台秘要》说：“里和表病，发汗则愈”。本条说在发作前发汗则痊愈，是顺应气机趋势而引导它的意思。
十六、病人经常自汗出的，这是荣气平和，荣气平和的人，外部不协调，是因为卫气不与荣气和谐协调的缘故；因为荣气行于脉中，卫气行于脉外，再发其汗，荣卫调和则痊愈，适宜用桂枝汤（则痊愈）。原文53
②时发热自汗出：指间歇性发热，自汗出。
③荣气和：荣气没有病。
④外不谐：外是“卫”的代称，即卫失调。
⑤谐和故尔：指卫气与荣气不协调。
郑氏评论：按病情经常自汗，似乎不专门主责于太阳荣卫不和。如果属于太阳荣卫不和，也一定有怕风、畏寒作为确凿证据。这里只说自汗出，其中有素体阳虚，或多言，或过度用心，或稍微劳动，就立即自汗出的，都属于不足之症，还敢轻率使用桂枝汤吗？这一条大体上是专门主张荣卫不和的说法，学者应该仔细探究。
【阐释】本条荣卫不和，不是由于外受风寒所致，而是由于荣卫本身不能互相协调导致的自汗出。不论是卫强荣弱还是卫弱荣强，仍宜用桂枝汤治疗。但郑氏更深一层指出，有素体阳虚，或多言，或过度用心，或稍微劳动，就立即自汗出的，都属于不足之症，不能用桂枝汤治疗，值得我们临证时审慎。那么如何治疗呢？我认为郑氏制定的补坎益离丹是合适的方剂。
十七、太阳病，初服桂枝汤，反而烦闷不解的，先针刺风池、风府穴，然后再给桂枝汤（则）痊愈。原文24
⑥风池：穴位名，在脑后（脑空穴外）发际中，在枕骨斜方肌凹陷中，属足少阳胆经穴。风府：穴位名，在项后入发际一寸，在枕骨与第一颈椎之间，是督脉经的穴位。
郑氏评论：这一条明确说明解表不透，邪气未迅速排出，所以见烦闷。针刺风池、风府穴，是为了泄除邪热，仍以桂枝汤为主，使邪气尽出无遗，所以自愈。
【阐释】太阳中风证，用桂枝汤治疗，病不解反而烦闷的，这是药力未到达病所。烦闷，是正邪相争的现象。《内经》说：大风引起的颈项痛，刺风池。又说：风从外入，使人战栗恶寒，出汗头痛，身体沉重恶寒，刺在风府。这是刺法的依据。刺法是为了泄除邪势，然后再服用桂枝汤，使邪气尽出无遗而痊愈。
十八、患风病的人表证已解，但感觉不清爽、不舒服的，十二天痊愈。原文10
①风家：凡“家”字都指宿疾而言，此处应作太阳中风看。
②不了了：就是不清楚、不爽快之意。
郑氏评论：既然称为表解，邪气已经去除了，应当清爽如常，现在却感觉不爽快，这是邪去而正气尚未恢复。拖延到十二日痊愈，是等待正气渐渐恢复。
【阐释】表证已解还有不爽快的感觉，一是余邪还未完全清除，二是正气尚未完全恢复。预计十二日痊愈，是经气运行一周期的时候，余邪尽除，自然痊愈。也有教导人不必服药，只要静心调养就可以渐渐痊愈的意思。本论中的日数，多是约略之词，必须灵活领会其精神实质。
十九、中风发热，六七天不缓解且烦闷，有表里证，口渴想喝水，水入则吐的，名叫水逆，五苓散主治（多服暖水，出汗则愈）。原文74
③有表里证：表证指发热、恶风、出汗、脉浮等；里证指烦渴欲饮水，小便不利、水入即吐等。
④水逆：胃有停水，水气不化，口渴想喝水，水入即吐的意思。
郑氏评论：这一条既然说六七天不缓解且烦闷，有表里证，应该有表里证的确凿表现，才是确论。况且所见病形，全是太阳腑证，观察所用五苓散方，是独重在太阳腑分一面，并未提及表证一面，原文为什么说是有表里证呢？里证即太阳腑证也，即指外邪入腑，何等直切。况且此刻病现饮水入口即吐，是因为太阳之气化不宣，中焦脾胃的转输失职，气机升多降少，以致上逆而吐，用五苓散多服，使太阳之气化行，水道通，气机下降，自然逆者不逆，而吐者不吐。学者应该仔细体味。
㈠“多服”二字，一定是教人不可见其吐就不给服用。
【阐释】本条中风发热，六七天经气运行周期结束而不解，这就是表证；口渴想喝水，邪气传入里，这就是里证。郑注为什么说所见病形全是太阳腑证？至于郑氏所言太阳之气化不宣，中焦脾胃的转输失职，气机升多降少，以致上逆而吐，五苓散调和表里，散除停饮，所以治疗而痊愈，这是正确的。另外原文在五苓散主治之后有“多服暖水，汗出愈。”舒驰远本也有这七个字。但《伤寒论》原文没有这七个字，这是五苓散方后所载，舒、郑二氏竟然移到原文之后，不知什么原因？
二十、太阳病，发汗后，大汗出，胃中干燥，烦躁不得眠，想喝水的，（少量给予）〔少量多次给予〕，〔使〕胃气调和则痊愈。如果脉浮，小便不利，微热消渴的①，五苓散主治。原文71
①消渴：形容渴饮不止的意思。《金匮要略》上的消渴是喝多少尿多少，属于一种病名。本条的消渴是形容口渴甚，是一种症状，二者不可混同。
郑氏评论：按太阳既发汗后，又见大汗出，汗为血液，血液过伤，胃中失养，所以胃干，津液不能上下交通，所以烦躁不得眠，想喝水的，少量给予，使胃和则痊愈。盖水也是阴，土燥得水以润之，自然燥者不燥，而病自然痊愈。如果见小便不利，微渴，是血液亡于外，而气化失于内，主以五苓散化太阳之气，气化一宣，则水道通，里气畅，升降不乖，病怎么有不愈的呢？
【阐释】这一节是发汗伤津，胃与膀胱的救治方法不同。郑氏说：“汗为血液，血液过伤，胃中失养，所以胃干。”此处称汗为血液，不能是一般所指之血液，而是一种不能养荣的津液。胃中津液受损不足，以致烦躁作渴，只需饮水以和胃气则痊愈，不是五苓散证。如果脉浮，小便不利，微热消渴，这是膀胱气化不行。
膀胱为太阳之腑，脉浮微热，太阳之表邪未尽，所以用五苓散两解表里，小便利则水去渴止。用散而不用汤，是取药性直达于下。
五苓散方（校补）
猪苓十八铢（去皮）泽泻一两六铢白术十八铢茯苓十八铢桂枝半两（去皮）以上五味，捣为散②，以白饮和服方寸匕③，日三服，多饮暖水，汗出愈，如法将息。
②散：将药制成粉末，叫做散。
③白饮：即米汤。方寸匕：是古代食具之一，曲柄浅斗，状如今之羹匙。《名医别录》说：“方寸匕者，作匕正方一寸，抄散不落为度。”
【方解及其应用范围】本方功效专于利水，是化气行水的剂型。《伤寒论》太阳腑分的主方。茯苓甘温，助阳益脾，淡渗利窍，除湿，色白入肺，泻热而下通膀胱。猪苓甘淡，入肺而通膀胱，利便行水与茯苓相同。泽泻甘淡微咸，入膀胱，利小便，功专祛湿行水。三者都有导水下行，通行小便之功。益土所以制水，所以用白术健脾去湿。最妙在桂枝一味，化膀胱气机，使膀胱津液得以通调，外则输津于皮毛，内则通行于上下，自然小便利，口渴除。看方后说：“多饮暖水，汗出愈”，则本方不但有利水之功，且有发汗作用；要知道像五苓散这样的方子，也可作为太阳经腑两解的方剂。本方现在多改作汤剂。至于本方的应用，《伤寒论》列为太阳腑证的主方，治疗口渴、小便不利、膀胱蓄水、表里上下同病。郑氏在《医法圆通》中更用以：（1）治大便泻水，而小便全无者；（2）治头晕、咳嗽、呕吐、腹胀、小便短；（3）治霍乱吐泻，思饮冷水者。以上三症，本非此方所治之病，因其有无小便及小便短的证状，故能治之而愈，可谓善于运用成方。笔者曾用此方治腹水胀满。患者腹部胀满，食欲不振，食后胀满更甚，虽口干而不思饮水，小便短少，人困无神，舌苔白腻，脉沉数而滑。这是脾失健运，气化不行，水湿阻滞，用五苓散倍用桂、术，再加上桂以化膀胱之气，气行水即行，加椒目专行水道以消水胀，而腹胀之症即愈。又有伤湿咳嗽之症，肌肉隐黄，头眩，痰涎及泡沫痰特多，脘中不畅，有时呕吐清水，身体倦怠，小便不利，口中津液多，虽渴不欲饮水，舌苔白腻，脉沉细而滑。是因膀胱气机不利，湿邪反上干清道而咳，则须以渗利为主，五苓散加味治之。痰饮咳嗽其根本由于水饮所致，祛其水饮则咳嗽自愈，如中腹胀满，上气喘逆，二便不利，或四肢俱肿者，此为痰水壅滞，五苓散能上下分消其痰水，治之而愈。近人加减推广应用本方，凡属津液运行失调的病症，均可以用此加减施治而获效。
二十一、太阳病发汗，汗出不解，〔其〕人仍发热，心下悸①，头眩身瞤〔动〕②，振振欲擗地者③，真武汤主治。原文82
①心下悸：即心下筑筑跳动。
②身瞤（shùn顺）动：即全身筋肉跳动之意。
③振振欲擗（pǐ匹）地：就是站立不稳，摇摇欲坠的样子。
郑氏评论：按发汗原是解表，表解自然热退，是不易之理，现在汗出而热仍然，所现种种病形，不是表邪未透的征象，却是亡阳的候象，必定是因发汗过度，伤及肾阳。太阳底面，即是少阴，此时发热，是阳越于外；心下悸，头眩身瞤，是阳气外亡而群阴僭上。振振欲擗地，是阳欲藏而不得。夫先天之真阳，喜藏而不喜露，藏则命根永固，露则危亡立生，主以真武汤，是重藏阳之意。
【阐释】郑氏所按，大有卓见，与成无己、张隐庵、陈修园等的注“仍发热”为邪气未解也，太阳之病不解也不同。郑氏说：“所现种种病形，不是表邪未透的征象，却是亡阳的候象，必定是因发汗过度，伤及肾阳。太阳底面，即是少阴，此时发热，是阳越于外；心下悸、头眩、身瞤，是阳气外亡，而群阴僭上；振振欲擗地，是阳欲藏而不得。”实即发汗过度，损及肾阳，主以真武汤，是温经复阳之意，使阴气不上逆为病。（真武汤方，载少阴篇）
二十二、太阳病，〔发汗〕，遂漏不止①，其人恶风，小便难②，四肢微急③，难以屈伸者，桂枝加附子汤〔主〕之。原文20
①漏：渗泄不止的意思，在这里形容汗多。
②难：不通畅的意思。
③急：拘急，即屈伸运动不自如。
郑氏评论：按发汗而至漏不止，其伤及肾阳也明甚。太阳底面，即是少阴，其人恶风，是外体疏泄；小便难，是汗为水液，气化行于外，而不行于内。四肢微急，难以屈伸，是血液外亡，而筋脉失养。
此时理应扶阳，原文取桂枝加附子汤，意在用附子，取内以固其根蒂，得桂枝，外以祛其未尽之邪，内外兼备，斯无大害，庶不失立方之妙。
【阐释】太阳病的治法，虽然以发汗为主，但以微微出汗为佳。现在发汗太过，遂漏不止，乃伤及肾阳，肾与膀胱为表里，肾阳衰则膀胱寒结，故小便难。四肢为诸阳之本，不得阳气以养之，故微急，且至难以屈伸者。郑氏说：“用附子内以固其根蒂，得桂枝外以祛其未尽之邪，内外兼备。”这是发汗太过，导致阳虚液脱救逆之法。
桂枝加附子汤方（校补）
桂枝三两（去皮）芍药三两甘草三两（炙）生姜三两（切）大枣十二枚（擘）附子一枚（炮、去皮、破八片）以上六味，以水七升，煮取三升，去滓，温服一升。本云桂枝汤，今加附子，将息如前法。
[Explanation] This passage is a segment of Clause 76 from the *Shanghan Lun* (Treatise on Cold Pathogenic Diseases). In this syndrome, the patient's Stomach Yang has been deficient since childhood, and there is pre-existing cold-fluid retention. Sweating damages the Yang Qi of the Upper Jiao, causing water and medicine to be rejected upon entry; this constitutes an adverse reaction (Ni Zheng). If sweating is induced again, it will further damage the Yang Qi of the Middle and Lower Jiao. Damage to the Middle Jiao results in incessant vomiting, while damage to the Lower Jiao results in incessant diarrhea. As Mr. Zheng stated: "This clearly indicates that excessive sweating has led to Yang collapse... If sweating is induced again, the Middle Qi will become even more deficient, and vomiting and diarrhea will worsen. The treatment principle should focus on supporting Yang, promoting Middle Jiao circulation, and descending rebellious Qi." In my clinical practice, I commonly use Fuzi Lizhong Tang (Aconite Root Decoction for Regulating the Middle) added with Banxia (Pinellia Rhizome) and Wuzhuyu (Evodia Fruit) to treat this condition.
Twelve. In Taiyang disease, presenting with headache, fever, sweating, and aversion to wind, Guizhi Tang (Cinnamon Twig Decoction) is the primary formula. Original Text 13
Mr. Zheng's Commentary: This is precisely the syndrome of Wind damaging the Wei (Defensive) level in Taiyang disease. Guizhi Tang is the appropriate formula; no further elaboration is needed here.
[Explanation] The Taiyang meridian pathway originates at the inner canthus of the eye, ascends to the forehead, intersects at the vertex, enters to connect with the brain, and descends along the neck and back. The mention of "headache" at the beginning of this section indicates that external pathogens are lodging in the highest part of the Taiyang channel. Therefore, Taiyang headaches typically occur in the midline and the posterior head, differing from the locations of Yangming and Shaoyang headaches. The subsequent symptoms of fever, sweating, and aversion to wind characterize Taiyang Wind Strike. Since diseases of this meridian develop from top to bottom, headache is mentioned first, followed by involvement of the neck and back. The pulse should be floating and weak, and the tongue coating thin and white; Guizhi Tang is the suitable formula.
Thirteen. In Taiyang disease, if the exterior syndrome remains unresolved and the pulse is floating and weak, sweating should be induced to resolve it; Guizhi Tang (Cinnamon Twig Decoction) is indicated. Original Text 42
① Exterior Syndrome (Wai Zheng): Refers to the exterior pattern. While "Exterior Pattern" (Biao Zheng) has a narrower scope, "Exterior Syndrome" has a broader scope; practically, there is little difference.
Mr. Zheng's Commentary: Since the exterior syndrome is unresolved in this clause, sweating may be induced again. However, a floating and weak pulse indicates that the Healthy Qi (Zheng Qi) must be deficient. Therefore, one cannot rely solely on medicinal strength to expel pathogens. My opinion is that within Guizhi Tang, either Yitang (Maltose) or Fuzi (Prepared Aconite Root) should be added for appropriateness.
[Explanation] This clause addresses the treatment method for an unresolved exterior syndrome accompanied by a floating and weak pulse. If the pulse were floating and tight, indicating unresolved Taiyang Cold syndrome, Mahuang Tang (Ephedra Decoction) would be used instead. Mr. Zheng points out that the Healthy Qi is necessarily deficient; adding Yitang or Fuzi to Guizhi Tang assists the medicinal power in expelling pathogens, which is a summary of his experience. For patients with weak constitutions, or for postpartum women with incessant spontaneous sweating due to Wind-Cold invasion, I use Guizhi Tang added with Fuzi to assist the medicinal power in expelling pathogens, leading to recovery.
Fourteen. In Taiyang disease, presenting with fever and sweating, this is described as Ying (Nutritive) weakness and Wei (Defensive) excess, which causes sweating. To dispel the pathogenic Wind, Guizhi Tang (Cinnamon Twig Decoction) is indicated (as the primary formula). Original Text 95
② Rescue (Jiu): Means to disperse. Pathogenic Wind (Xie Feng): Refers to "false evil and thief winds" mentioned in the *Neijing*. Here, it refers to Wind pathogen.
Mr. Zheng's Commentary: This clause clearly indicates that Taiyang has been injured by Wind pathogen, resulting in Excess in the Wei level and Deficiency in the Ying level.
[Explanation] Under normal conditions, Ying and Wei are coordinated. When Taiyang is injured by Wind pathogen, the Wei level experiences pathogenic excess, leading to sweating; the Ying level experiences Healthy Qi deficiency. "Weak" refers to Healthy Qi deficiency, and "excess" refers to pathogenic excess, meaning the muscle texture is closed while the skin pores are uniquely open. Because Ying is weak, internal sweat is blocked and does not exit; because Wei is strong (pathogen-dominant), surface sweat exits alone. Therefore, Guizhi Tang should be used to rescue the injury caused by Wind pathogen. Once the Wind pathogen is removed, Wei Qi harmonizes; once sweating stops, Ying Yin naturally recovers.
Fifteen. If a patient's Zang organs have no other diseases, but they experience intermittent fever and spontaneous sweating without resolution, this is due to Disharmony of Wei Qi. Inducing sweating before the onset of symptoms leads to recovery; Guizhi Tang (Cinnamon Twig Decoction) is indicated. Original Text 54
① Zang Wu Ta Bing: Indicates that the disease is not in the interior.
Mr. Zheng's Commentary: This clause definitely implies a failure to resolve the exterior. Otherwise, how could it state that inducing sweating before the onset leads to recovery and that Guizhi Tang is indicated?
[Explanation] Intermittent fever and spontaneous sweating resemble Yangming disease; thus, it states "Zang organs have no other diseases" to clarify that this is an exterior syndrome. The *Waitai Miyao* states: "If the interior is harmonious but the exterior is diseased, sweating induces recovery." The statement in this clause about inducing sweating before the onset to achieve recovery implies guiding the Qi mechanism according to its trend.
Sixteen. If a patient frequently experiences spontaneous sweating, this is because Ying Qi is harmonious. When Ying Qi is harmonious but the exterior is disharmonious, it is because Wei Qi does not coordinate with Ying Qi. Since Ying Qi circulates within the vessels and Wei Qi circulates outside the vessels, inducing sweating again will restore harmony between Ying and Wei, leading to recovery; Guizhi Tang (Cinnamon Twig Decoction) is indicated (then recovery occurs). Original Text 53
② Intermittent fever and spontaneous sweating: Refers to intermittent fever with spontaneous sweating.
③ Ying Qi He: Ying Qi is not diseased.
④ Exterior Bu Xie: "Exterior" is a substitute for "Wei," meaning Wei is dysregulated.
⑤ Harmony Gu Er: Refers to the lack of coordination between Wei Qi and Ying Qi.
Mr. Zheng's Commentary: Frequent spontaneous sweating does not necessarily pertain exclusively to Taiyang Ying-Wei disharmony. If it belonged to Taiyang Ying-Wei disharmony, there would inevitably be signs such as aversion to wind and fear of cold. Here, only spontaneous sweating is mentioned. Cases involving innate Yang deficiency, excessive talking, overuse of mental energy, or slight exertion leading immediately to spontaneous sweating fall under the category of deficiency. How dare one lightly use Guizhi Tang? This clause largely advocates the theory of Ying-Wei disharmony; scholars should investigate this carefully.
[Explanation] The Ying-Wei disharmony in this clause is not caused by external Wind-Cold invasion but by the inability of Ying and Wei to coordinate internally, resulting in spontaneous sweating. Whether it is Wei excess and Ying deficiency or Wei deficiency and Ying excess, Guizhi Tang is still appropriate for treatment. However, Mr. Zheng points out deeper nuances: cases involving innate Yang deficiency, excessive talking, overuse of mental energy, or slight exertion leading immediately to spontaneous sweating belong to deficiency patterns and should not be treated with Guizhi Tang. This warrants caution in clinical practice. Then, how should these be treated? I believe the Bukan Yili Dan (Decoction for Supplementing Kan and Benefiting Li) formulated by Mr. Zheng is appropriate.
Seventeen. In Taiyang disease, after initially taking Guizhi Tang (Cinnamon Twig Decoction), if vexation persists and does not resolve, first puncture Fengchi (GB20) and Fengfu (DU16) acupoints, then administer Guizhi Tang (then recovery occurs). Original Text 24
⑥ Fengchi (GB20): Acupoint name, located in the hairline behind the head (outside Naokong EX-HN16), in the depression between the occipital bone and the trapezius muscle; a point of the Foot-Shaoyang Gallbladder Meridian. Fengfu (DU16): Acupoint name, located one cun above the posterior hairline, between the occipital bone and the first cervical vertebra; a point of the Du Meridian.
Mr. Zheng's Commentary: This clause explicitly states that the exterior was not fully resolved and pathogens had not yet rapidly exited, hence the vexation. Puncturing Fengchi and Fengfu acupoints drains the pathogenic heat. Administering Guizhi Tang thereafter ensures pathogens are completely expelled, leading to self-recovery.
[Explanation] In Taiyang Wind Strike syndrome, treated with Guizhi Tang, if the disease does not resolve but instead causes vexation, it indicates the medicinal power has not yet reached the pathological site. Vexation is a phenomenon of the struggle between Healthy Qi and pathogens. The *Neijing* states: "For severe wind causing neck and head pain, puncture Fengchi." It also states: "Wind entering from outside causes chills, sweating, headache, heaviness, and aversion to cold; puncture Fengfu." These are the basis for acupuncture methods. Acupuncture is used to drain pathogenic momentum, after which Guizhi Tang is administered to ensure complete expulsion of pathogens and recovery.
Eighteen. For individuals prone to Wind diseases, if the exterior syndrome resolves but they feel unwell or unclear, recovery occurs in twelve days. Original Text 10
① Feng Jia: The character "Jia" generally refers to chronic or recurring diseases. Here, it should be interpreted as Taiyang Wind Strike.
② Bu Liao Liao: Means unclear or uncomfortable/unrefreshed.
Mr. Zheng's Commentary: If the exterior is resolved, pathogens should have departed, and the patient should feel refreshed as usual. The fact that they feel unrefreshed indicates that pathogens have left but Healthy Qi has not yet recovered. Waiting until the twelfth day for recovery allows time for Healthy Qi to gradually return.
[Explanation] Feeling unrefreshed after the resolution of the exterior syndrome suggests either that residual pathogens remain or that Healthy Qi has not fully recovered. The prediction of recovery in twelve days corresponds to the completion of a meridian cycle, when residual pathogens are exhausted and natural recovery occurs. This also teaches that medication may not always be necessary; quiet rest and recuperation can lead to gradual healing. The number of days mentioned in this treatise are often approximate; one must flexibly grasp the essential spirit.
Nineteen. In Wind Strike with fever, if after six or seven days the condition remains unresolved and vexatious, presenting with both exterior and interior syndromes, thirst with desire to drink water, but vomiting immediately after drinking, this is named Water Reversal (Shui Ni). Wuling San (Five-Ingredient Powder with Poria) is the primary formula (drink plenty of warm water; sweating leads to recovery). Original Text 74
③ You Biao Li Zheng: Exterior syndrome refers to fever, aversion to wind, sweating, floating pulse, etc.; Interior syndrome refers to vexation, thirst, desire to drink, difficulty urinating, and vomiting immediately after drinking.
④ Shui Ni (Water Reversal): Refers to stagnant water in the stomach, failure of water Qi transformation, thirst with desire to drink, and immediate vomiting upon ingestion.
Mr. Zheng's Commentary: This clause mentions unresolved fever and vexation after six or seven days with both exterior and interior syndromes. There should be definitive evidence of both patterns for a conclusive argument. Moreover, the observed symptoms are entirely Taiyang Fu-organ syndromes. Observing the use of Wuling San, the focus is solely on the Taiyang Fu aspect, without mentioning the exterior aspect. Why does the original text claim both exterior and interior syndromes? The interior syndrome is the Taiyang Fu syndrome, implying external pathogens entering the Fu organs, which is very direct. Furthermore, the current symptom of vomiting immediately after drinking water is due to the failure of Taiyang Qi transformation and the失职 (loss of function) of the Middle Jiao's transportation. With Qi mechanism rising more than descending, rebellion occurs upwards causing vomiting. Using Wuling San, taken in larger amounts, promotes Taiyang Qi transformation, unblocks the water passages, lowers the Qi mechanism, and naturally stops rebellion and vomiting. Scholars should analyze this carefully.
㈠ The phrase "take in larger amounts" instructs that one should not withhold administration simply because vomiting occurs.
[Explanation] In this clause, Wind Strike with fever persisting beyond six or seven days (the end of a meridian cycle) represents the exterior syndrome; thirst with desire to drink water indicates pathogen transmission to the interior, representing the interior syndrome. Why does Mr. Zheng argue that the observed symptoms are entirely Taiyang Fu syndromes? Regarding Mr. Zheng's statement that Taiyang Qi transformation fails, Middle Jiao transportation is impaired, and Qi rises more than it descends causing upward rebellion and vomiting, Wuling San harmonizes the exterior and interior and disperses stagnant fluids, thus curing the condition; this is correct. Additionally, the original text includes "drink plenty of warm water; sweating leads to recovery" after the indication for Wuling San. This seven-character phrase also appears in Shu Chiyuan's edition. However, it is absent from the original *Shanghan Lun* text; it is recorded in the post-prescription notes for Wuling San. Shu and Zheng inexplicably moved it to the end of the main text.
Twenty. In Taiyang disease, after inducing sweating, if profuse sweating occurs, causing dryness in the Stomach, vexation/restlessness preventing sleep, and desire to drink water, give small amounts of water (sip slowly) to harmonize Stomach Qi and promote recovery. If the pulse is floating, urination is difficult, and there is slight fever with intense thirst (Xiao Ke), Wuling San (Five-Ingredient Powder with Poria) is the primary formula. Original Text 71
① Xiao Ke: Describes incessant thirst and drinking. In the *Jingui Yaolue*, Xiao Ke is a disease name characterized by drinking and urinating large quantities. In this clause, Xiao Ke describes severe thirst, which is a symptom; the two must not be confused.
Mr. Zheng's Commentary: After Taiyang disease is treated with sweating, if profuse sweating ensues, sweat is considered blood/fluid. Over-injury to blood/fluids causes loss of nourishment in the Stomach, leading to dryness. Fluids fail to communicate vertically, causing vexation/restlessness and insomnia. Giving small amounts of water harmonizes the Stomach and promotes recovery. Water is Yin; dry Earth requires moisture to be moistened, naturally resolving dryness and illness. If difficulty urinating and slight thirst are present, it indicates fluid loss externally and failure of Qi transformation internally. Wuling San is used to transform Taiyang Qi. Once Qi transformation is promoted, water passages unblock, interior Qi flows smoothly, and ascent/descent functions normally, ensuring recovery.
[Explanation] This section discusses different treatments for Stomach and Bladder injuries caused by sweating damaging fluids. Mr. Zheng states: "Sweat is blood/fluid; over-injury leads to loss of Stomach nourishment, causing dryness." Here, calling sweat "blood" does not refer to general blood but to a type of fluid insufficient to nourish Ying. Insufficient Stomach fluids cause vexation, restlessness, and thirst; drinking water to harmonize Stomach Qi suffices for recovery; this is not a Wuling San syndrome. If the pulse is floating, urination is difficult, and there is slight fever with intense thirst, this indicates failure of Bladder Qi transformation.
The Bladder is the Fu organ of Taiyang. Floating pulse and slight fever indicate that Taiyang exterior pathogens are not fully cleared; therefore, Wuling San is used to simultaneously resolve the exterior and interior. When urination becomes smooth, water is eliminated and thirst ceases. Powder form is used rather than decoction to ensure the medicinal properties reach the lower jiao directly.
Wuling San Formula (Corrected and Supplemented)
Zhu Ling (Polyporus Umbellatus) 18 zhu (peeled), Ze Xie (Alisma Rhizome) 1 liang 6 zhu, Bai Zhu (Atractylodes Macrocephala Rhizome) 18 zhu, Fu Ling (Poria) 18 zhu, Gui Zhi (Cinnamon Twig) 0.5 liang (peeled). The above five ingredients are pounded into a powder. Mix with rice water and take one fang cun bi (square-inch scoop) per dose, three times daily. Drink plenty of warm water afterwards; sweating indicates recovery. Follow standard dietary precautions.
② San (Powder): Medicines pounded into powder.
③ Bai Yin (White Drink): Rice water. Fang Cun Bi: An ancient eating utensil, similar to a modern spoon, square-shaped with a curved handle. *Mingyi Bielu* states: "One fang cun bi is made square, one inch on each side, sufficient to hold powder without spilling."
[Formula Analysis and Scope of Application] This formula specializes in promoting diuresis and is a agent for transforming Qi and moving fluids. It is the principal formula for Taiyang Fu syndromes in the *Shanghan Lun*. Fu Ling is sweet and warm, assisting Yang and benefiting the Spleen, leaching dampness through bland taste, clearing heat, and entering the Lung to descend to the Bladder. Zhu Ling is sweet and bland, entering the Lung and connecting to the Bladder, promoting urination and moving fluids similarly to Fu Ling. Ze Xie is sweet, bland, and slightly salty, entering the Bladder, promoting urination, and specializing in removing dampness and moving fluids. All three guide water downward and promote urination. Strengthening Earth controls Water; thus, Bai Zhu is used to strengthen the Spleen and remove dampness. The most ingenious ingredient is Gui Zhi, which transforms Bladder Qi mechanism, allowing Bladder fluids to be regulated. Externally, it transports fluids to the skin and hair; internally, it circulates fluids up and down, naturally promoting urination and relieving thirst. The note "drink plenty of warm water; sweating indicates recovery" shows that this formula not only promotes diuresis but also induces sweating. Thus, Wuling San can be considered a formula that simultaneously resolves Taiyang Jing and Fu levels. Currently, this formula is mostly prepared as a decoction. Regarding its application, the *Shanghan Lun* lists it as the principal formula for Taiyang Fu syndromes, treating thirst, difficulty urinating, Bladder water accumulation, and simultaneous exterior-interior and upper-lower pathologies. In *Yifa Yuantong*, Mr. Zheng further uses it for: (1) Diarrhea with watery stools and complete absence of urine; (2) Dizziness, cough, vomiting, abdominal distension, and scanty urine; (3) Cholera-like vomiting and diarrhea with craving for cold water. Although these three conditions are not traditionally treated by this formula, their symptoms of absent or scanty urine allow for successful treatment, demonstrating skillful application of established formulas. I have used this formula to treat ascites and abdominal distension. A patient presented with abdominal fullness, poor appetite worsening after eating, dry mouth without desire to drink, scanty urine, lethargy, white greasy tongue coating, and deep, rapid, slippery pulse. This indicated Spleen failure in transportation, failed Qi transformation, and stagnation of water-dampness. I used Wuling San with doubled Gui Zhi and Bai Zhu, plus additional Gui Zhi to transform Bladder Qi. As Qi moves, water moves. Adding Jiao Mu (Seed of Capsicum Frutescens) specifically targets water passages to reduce water swelling, resolving the abdominal distension. Another case involved cough due to dampness injury, with yellowish skin, dizziness, copious phlegm and foam, epigastric discomfort, occasional vomiting of clear fluid, fatigue, difficulty urinating, excessive oral saliva despite thirst without desire to drink, white greasy tongue coating, and deep, fine, slippery pulse. This was caused by unfavorable Bladder Qi mechanism, with dampness rebelling upwards to obstruct the clear orifices causing cough. Treatment focused on leaching and draining, using modified Wuling San. The root of phlegm-fluid cough is water-fluid; eliminating water-fluid resolves cough. For cases with middle abdominal distension, wheezing, difficulty in bowel/bladder movements, or generalized edema, this indicates phlegm-water congestion. Wuling San can distribute and eliminate phlegm-water from above and below, curing the condition. Modern practitioners have expanded its application; any disorder of fluid metabolism can be treated with modifications of this formula with good effect.
Twenty-One. In Taiyang disease, after inducing sweating, if the condition does not resolve and the patient still has fever, palpitations in the heart region (Xin Xia Ji), dizziness, muscle twitching (Shen Sun), and trembling instability as if falling to the ground (Zhen Zhen Yu Pi Di), Zhenwu Tang (True Warrior Decoction) is the primary formula. Original Text 82
① Xin Xia Ji: Palpitations felt in the epigastric/cardiac region.
② Shen Sun Dong: Twitching or tremors of the whole body muscles.
③ Zhen Zhen Yu Pi Di: Unsteady standing, swaying as if about to fall.
Mr. Zheng's Commentary: Inducing sweating is originally for resolving the exterior; once resolved, fever should subside. This is an immutable principle. Now, despite sweating, fever persists. The various symptoms presented are not signs of unresolved exterior pathogens but indications of Yang collapse, likely due to excessive sweating injuring Kidney Yang. The underside of Taiyang is Shaoyin. Fever at this stage indicates Yang floating outward. Palpitations, dizziness, and muscle twitching indicate Yang collapsing outward while Yin rebels upward. Trembling instability indicates Yang attempting to hide but failing. Primordial True Yang prefers concealment over exposure; concealment secures life, while exposure leads to imminent danger. Prescribing Zhenwu Tang emphasizes the intention to conceal Yang.
[Explanation] Mr. Zheng's analysis shows profound insight, differing from commentators like Cheng Wuji, Zhang Yin'an, and Chen Xiuyuan who interpret "still having fever" as unresolved pathogens or persistent Taiyang disease. Mr. Zheng states: "The various symptoms are not signs of unresolved exterior pathogens but indications of Yang collapse, likely due to excessive sweating injuring Kidney Yang. The underside of Taiyang is Shaoyin. Fever indicates Yang floating outward; palpitations, dizziness, and twitching indicate Yang collapsing outward and Yin rebelling upward; trembling indicates Yang unable to hide." Essentially, excessive sweating damages Kidney Yang. Prescribing Zhenwu Tang warms the meridians and restores Yang, preventing Yin from rebelling upward. (Zhenwu Tang formula is recorded in the Shaoyin chapter.)
Twenty-Two. In Taiyang disease, [after inducing sweating], if sweating continues uncontrollably (Lou Bu Zhi), the patient has aversion to wind, difficulty urinating (Xiao Bian Nan), slight stiffness of the four limbs making flexion and extension difficult, Guizhi Jia Fuzi Tang (Guizhi Tang Added with Aconite) is the primary formula. Original Text 20
① Lou: Continuous leakage, describing profuse sweating here.
② Nan: Difficulty or obstruction.
③ Ji: Stiffness or tension, meaning involuntary movement is restricted.
Mr. Zheng's Commentary: Sweating progressing to continuous leakage clearly indicates injury to Kidney Yang. The underside of Taiyang is Shaoyin. Aversion to wind indicates loose exterior defenses. Difficulty urinating occurs because sweat is fluid; Qi transformation acts externally but not internally. Slight limb stiffness and difficulty moving indicate blood/fluid loss externally and malnourishment of sinews and vessels.
At this stage, supporting Yang is appropriate. The original text prescribes Guizhi Tang added with Fuzi. The intent is to use Fuzi internally to secure the root, and Gui Zhi externally to expel remaining pathogens. Combining internal and external approaches avoids major harm, preserving the ingenuity of the prescription.
[Explanation] The treatment for Taiyang disease primarily involves sweating, but mild perspiration is ideal. Excessive sweating leading to continuous leakage injures Kidney Yang. Kidney and Bladder are exterior-interior pairs; Kidney Yang decline causes Bladder cold coagulation, leading to difficulty urinating. The four limbs are the root of all Yang Qi; lacking Yang nourishment, they become stiff and difficult to move. Mr. Zheng states: "Using Fuzi internally secures the root, and Gui Zhi externally expels remaining pathogens, combining internal and external measures." This is a rescue method for Yang deficiency and fluid depletion caused by excessive sweating.
Guizhi Jia Fuzi Tang Formula (Corrected and Supplemented)
Gui Zhi (Cinnamon Twig) 3 liang (peeled), Shao Yao (Peony Root) 3 liang, Gan Cao (Licorice Root) 3 liang (roasted), Sheng Jiang (Fresh Ginger) 3 liang (sliced), Da Zao (Jujube) 12 pieces (split), Fu Zi (Prepared Aconite Root) 1 piece (roasted, peeled, broken into eight pieces). The above six ingredients are boiled in seven sheng of water to obtain three sheng. Strain and take one sheng warm. Originally Guizhi Tang, now added with Fuzi. Follow previous dietary precautions.