【方解及其應用範圍】桂枝湯有調和營衛，滋陰和陽的作用。本方即桂枝湯倍芍藥生薑加人參而成。倍生薑者，以脈沉遲營中寒也；倍芍藥者，以營不足，血少故也；加人參者，補諸虛也。補營陰而益衛陽，表虛身疼自愈。故汗出太過津液受傷，不能濡養筋脈而身疼痛者；氣血不足之身疼痛；正氣不足，風濕在表之痹證。均可酌用本方治療。
二十一、發汗後，不可更行①桂枝湯，（若）汗出而喘，無大熱者，可與麻黃杏仁〔甘草〕石膏湯。發汗後飲水多（者）必喘，以水灌②之亦喘。原文63、75後段
①更行：行、施也、用也。更行就是再用的意思。
②灌：洗也，即以水冼浴之意思。
鄭論：按此條所論，與前論不符。此言發汗後，不可更行桂枝湯，若其人桂枝證仍在者，原有再用桂枝之法，此說不可用，非不符而何？又雲：發汗出而喘，無大熱者，可與麻杏石膏〔甘草〕湯。據餘所見，果係大熱、口渴、飲冷、氣喘者，則為火刑於肺，而麻杏石膏〔甘草〕湯可用。若無大熱、口渴等情，只見汗出而喘，吾恐汗出亡陽，若再以麻黃杏仁之方治之，能不速其亡乎？又雲：“發汗後，飲水多者必喘，以水灌之亦喘。”此必因發汗而津液傷，故渴欲飲水；水入亦喘者，是為水逆於中，而中州氣化不宣故也。
【闡釋】本條分為兩節，“發汗後”至“可與麻黃杏仁石膏甘草湯”為一節，即傷寒論63條全文；“發汗後”至“以水灌之亦喘”為後一節，即傷寒論75條後段。鄭氏謂“此條所論，與前論不符”，其解麻杏石甘湯之可用與不可用，確有見地，非隨文釋義可及。又原文“發汗後，飲水多者必喘，以水灌之亦喘”鄭氏釋為津液傷，氣化不宣。蓋汗後表氣虛，水氣乘虛，客於腠理皮毛之間，則皮毛之開闔不利，皮毛內合於肺，故肺之呼吸迫促，而為喘也。
麻黃杏仁甘草石膏湯方（校補）
麻黃四兩（去節）杏仁五十個（去皮尖）甘草二兩（炙）石膏半斤（碎、綿裹）上四味，以水七升，煮麻黃減二升，去上沫，內諸藥，煮取二升，去滓，溫服一升。
【方解及其應用範圍】本方是麻黃湯去桂枝加石青而成。麻黃辛溫開泄肺氣；杏仁苦降，宣肺平喘；石膏辛甘寒直清裏熱；甘草以和諸藥。四味配合，有清肺定喘之功。此方除治本條所舉之證外，適用於邪熱壅肺各種病證，如風熱感冒，氣管炎、哮喘、百日咳、肺炎等。筆者常用此方治寒包熱之咳嗽、哮喘、肺炎，以及風溫初起，無汗而喘者，屢用屢效，獲得滿意效果。
二十二、下後不可更行桂枝湯，若汗出而喘，無大熱者，可與麻〔黃〕杏（仁）〔子〕〔甘草〕石膏湯。原文162
鄭論：按下後不可更行桂枝湯，此語皆非確論，其間有因下而引邪深入，其脈尚浮，病機尚欲外出，仍當以桂枝湯，因其勢而導之，方為合法，何得拘泥？至“汗出而喘，無大熱”句，更要仔細推求，果見脈浮緊，有熱象可征，而麻杏甘膏湯，方是的對之方。若汗出，脈浮空，面舌俱青、白、黑色者，回陽猶恐不及，尚得以原文方治之乎？學者務要留心，探究陰陽消息，切勿死守陳言，為方所囿，則得矣。
【闡釋】下後不可更行桂枝湯，鄭氏謂此語非確論。若其人桂枝證仍在者，原有再用桂枝之法。太陽上篇第三十一條、三十二條，太陽中篇第二十九條，都是下後而又用桂枝湯之例。至“汗出而喘，無大熱”者，可否用麻杏甘膏湯，則應如鄭氏所說：探求陰陽實據，切勿死守陳言，為方所囿。
二十三、發汗過多，其人叉手自冒心①，心下悸②，欲得按者，桂枝〔甘草〕湯主之。原文64
①叉手自冒心：叉手即兩手交叉，冒即按捺，形容病人的兩手複蓋在自己的心胸部位。
鄭論：按汗為心之液，今發汗過多，則心陽不足，其人叉手自冒者，是欲扶心之意，外援之一助也。至心下悸欲按，皆本此。
【闡釋】此乃汗出過多，損傷胸中陽氣。因胸中陽虛，以致心下悸動不寧。叉手自冒心，亦是汗出多而胸陽虛的原故。
桂枝甘草湯方（校補）
桂枝四兩（去皮）甘草二兩（炙）上二味，以水三升，煮取一升，去滓，頓服。
【方解及其應用範圍】桂枝甘草湯方，桂枝並非解表，乃取其入心而益陽，配以甘草補虛以益氣。
桂枝配甘草，則桂枝溫而不熱，所以能益陽而不致發汗。辛甘合用，陽氣乃生，心陽得複而悸動可愈。現本方廣泛用於治療心血管系統疾病，可調整血液迴圈功能。如心陽虛是受腎陽虛所引起，可酌加附子。
二十四、未持脈時①，病人叉手自冒心，師因教〔試〕令咳而不咳者，此必兩耳聾無聞也，所以然者，以重發汗，虛，故如此也。原文75前段
①持脈：與診脈同義。
鄭論：此條是教人探陰陽之妙諦，若其人令咳而能咳，則耳聰，令咳而不咳，則耳聾。故斷之曰，重發汗，以致心陽虛，濁陰上幹，閉其輕竅，故耳聾也，此與風寒閉束者，大有涇渭之別，學者宜細察焉。
【闡釋】本條通過望診與問診來診斷病情，決其陰陽，重發汗，以致心陽虛，心寄竅於耳，心虛故耳聾，此與肝膽風木之火上升，阻滯清竅而耳聾迥然不同，以小柴胡湯加減治之必不效，必大劑參附湯加味治之。
二十五、發汗後，其人臍下悸者，欲作奔豚②，茯苓桂枝甘草大棗湯主之。原文65
②奔豚：諸病源候論雲“奔豚者，氣上下游走，如豚之奔，故曰奔豚”。此兩字在這裏是形容悸氣自小腹上沖心胸之勢，與腎積為奔豚不同。
鄭論：既稱發汗後其人臍下悸者，是必因發汗而傷及腎陽也，腎陽既衰，不能鎮納下元水氣，以致臍下悸，欲作奔豚，法宜回陽為是。原文所主之方，取茯苓以伐腎邪，而使水氣下泄，不致上奔，真立法之妙諦也。
【闡釋】歷代注家認為發汗後心陽虛而腎水上逆臍下。鄭氏則謂傷及腎陽，不能鎮納下元水氣，以致臍下悸，欲作奔豚，法宜回陽為是。原文主以茯苓桂枝甘草大棗湯雖佳，但不若再加附片以扶腎陽，效果更好。
茯苓桂枝甘草大棗湯方（校補）
茯苓半斤桂枝四兩（去皮）甘草二兩（炙）大棗十五枚上四味，以甘瀾水①一鬥，先煮茯苓，減二升，內諸藥，煮取三升，去滓，溫服一升，日三服。作甘瀾水法，取水二鬥，置大盆內，以杓揚之，水上有珠子五六千顆相逐，取用之。
①甘瀾水：一名勞水。程林曰：“揚之無力，取其不助腎邪也。”錢天來曰：“動則其性屬陽，揚則其勢下走故也。”
【方解及其應用範圍】《醫宗金鑒》雲：“本方即苓桂朮甘湯去白朮加大棗倍茯苓也，彼治心下逆滿，氣沖胸，此則臍下悸欲作奔豚。蓋以水停中焦，故用白朮，水停下焦，故倍茯苓，其病由汗後而起，自不外乎桂枝之法也。”本方與苓桂朮甘湯、茯苓甘草湯的作用大致相同，都能治水氣疾患。苓桂朮甘湯證，心下逆滿，氣上沖胸；茯苓甘草湯證，厥而心下悸，其病理機轉偏於中焦，所以一用白朮運脾，一用生薑溫胃。本湯證臍下悸欲作奔豚，其病理機轉偏于下焦，所以用大棗培土制水，倍茯苓以伐腎邪。
二十六、發汗後，腹脹滿者，厚朴生薑半夏甘草人參湯主之。原66
鄭論：此病腹脹滿由於發汗後，明是汗出傷及胸中之陽，以致濁陰上幹，閉其清道，壅而為滿，法宜補中宣通，原方亦可用，似不若理中加行滯藥為當。
【闡釋】此條為發汗後脾陽虛弱，不能運化轉輸，虛氣壅滯腹脹滿的治法。
鄭氏雲：“原方亦可用，似不若理中加行滯藥為當”。筆者治此類脾虛脹滿者，常用理中湯加丁香治之輒效。
厚朴生薑半夏甘草人參湯方（校補）
厚樸半斤（炙、去皮）生薑半斤（切）半夏半升（洗）甘草二兩人參一兩上五味，以水一鬥，煮取三升，去滓，溫服一升，日三服。
【方解及其應用範圍】本方為溫運脾陽，寬中除滿，消補兼施之劑。厚朴味苦辛，性溫，下氣開滯，豁痰泄實，故能平胃氣而除腹滿，生薑辛開理氣，半夏開結燥濕，人參、甘草健脾培土以助運用。參、草非脹滿之要藥，臨床時分量宜輕。除用治脾虛作脹外，近人推廣用於慢性胃炎、胃、腸消化不良等病症。
二十七、傷寒汗出解之後，胃中不和，心下痞鞭，幹（嘔）〔噫〕食臭①，脅下有水氣，腹中雷鳴②下利者，宜生薑瀉心湯〔主之〕。原文157
①幹噫食臭：噫同噯，即噯氣帶有食臭味。
②腹中雷鳴：形容腹腸間的響聲。
鄭論：此證既稱汗解，是外邪已去，何至胃中不和，心下痞鞭？此是因發汗過多，以致濁陰上逆于心而成痞乎？是因挾有宿食滯於心下而成痞鞭乎？是因有邪熱結於心下而成痞鞭乎？是因有寒水逆於心下而成痞鞭乎？不能無疑。又雲：“幹（嘔）〔噫〕食臭，脅下有水氣，至雷鳴下利”句，定是太陽氣化失職，以致寒水彌漫四旁，一切病情，俱由此而生。但原文以生薑瀉心湯主之，似不恰切。
【闡釋】鄭氏所注，與歷代注家不同，首先提出心下痞鞭有四種不同情況，此條心下痞鞭，是因寒水逆於心下而成，此太陽氣化失職，以致寒水彌漫，原文主以生薑瀉心湯為不恰當。筆者認為可用五苓倍桂以化太陽膀胱之氣，加附子以扶腎陽，較為妥切。
生薑瀉心湯（校補）
生薑四兩（切）甘草三兩（炙）人參三兩乾薑一兩黃芩三兩半夏半升（洗）黃連一兩大棗十二枚（擘）上八味，以水一鬥，煮取六升，去滓，再煎取三升，溫服一升，日三服。附子瀉心湯，本雲加附子。半夏瀉心湯、甘草瀉心湯，同體別名耳。生薑瀉心湯，本雲理中人，參黃琴湯，去桂枝、朮加黃連，並瀉肝法。
【方解及其應用範圍】本方生薑、半夏辛溫散寒，除脅下水氣以和胃，人參、大棗以補中，乾薑、甘草以溫裏，黃芩、黃連以除痞結。因本方以胃不和有水氣為主，故重用生薑以和胃散水，因以名方。本方主治皆屬裏證，寒多熱少，升降失司、虛實錯雜之證。
現應用本方以治急慢性腸炎、消化不良，胃擴張，胃酸過多，腸胃功能紊亂等症。
二十八、傷寒中風，醫反下之，其人下利，日數十（次）〔行〕，（完）穀不化①，腹中雷鳴，心下痞鞭而滿，幹嘔心煩不得安。醫見心下痞，謂病不盡，複下之，其痞益甚，此非結熱，但以胃中虛，客氣上逆②，故使鞭也，甘草瀉心湯主之。原文158
①穀不化：就是食穀不消化。
鄭論：此條既已誤下，而又複下，所現之症，既稱虛冷，此非結熱，原文以甘草瀉心湯主之，方中芩連之苦寒，而複可用乎？仲景不當處此。
【闡釋】兩次誤下，其痞益甚，此非熱邪痞結，而是胃中虛冷之極也，理當急投四逆以救其陽，稍加人參以潤之，即四逆加人參湯。在臨床上，人參確有振奮胃機能，緩解虛性痞滿的作用。故鄭氏駁其不可用芩、連之苦寒，而曰仲景不當處此。
甘草瀉心湯方（校補）
甘草四兩（炙）黃岑三兩乾薑三兩半夏半升（洗）大棗十二枚（擘）黃連一兩上六味，以水一鬥，煮取六升，去滓，再煎取三升，溫服一升，日三服。
【方解及其應用範圍】本方用甘、棗以補中，乾薑、半夏，辛以通達，岑、連苦寒瀉痞清熱。甘草用至四兩，為本方君藥，故名甘草瀉心湯。現今推廣用以治療胃及十二指腸潰瘍多效，其證多為寒熱錯雜。
二十九、傷寒大下後，複發汗，心下痞，惡寒者，表未解也，不可攻痞③，當先解表，表解乃可攻痞，解表宜桂枝湯，攻痞宜大黃黃連瀉心湯。原文164
③攻痞（pǐ）：即治療痞證。痞：痞塊、痞積，腹中可觸摸之硬塊，傷寒病等會發生此症狀。
鄭論：既稱下汗後，以致心下痞，明是下汗，虧損表裏之陽，以致濁陰上幹，結於心下而為痞，法宜溫中扶陽，宣中散逆為是。又雲：惡寒者表未解，惡寒二字，雖雲太陽面目，究竟陽虛而畏外寒，亦見惡寒，況既大下發汗後，果見脈尚浮緊，周身尚在疼痛，發熱，惡寒，如此可以解表，不然，祗見惡寒兩字，不得即當解表。至於攻痞之說，雖有次弟，以此症而論，則攻痞之大黃黃連瀉心湯，亦未恰切，何也？未見有熱象足征，祗有痞象一症，況此由下汗而成，並非未經汗下而見，前之大下，是大黃苦寒一派而致痞，既前之大黃不效，今又用之，又豈能必其效乎？吾想再下之，而命不永也。
【闡釋】鄭氏所按，層層分析，與歷代注家迥異。下汗後，以致心下痞，乃虧損表裏之陽，陰氣結於心下而成痞，法宜溫中扶陽，宣中散逆，所論極是。
至惡寒二字，亦有陽虛而畏寒者，則不在解表之例。至於攻痞之說，大黃黃連瀉心湯，亦不恰切，蓋只有痞象一症，而未見有熱象足征，況此痞由下汗而成，並非未經汗下而見，前用大黃下之而成痞，今又用之，豈能必其效乎？故鄭氏慨然曰：“吾想再下之，而命不永也”。
三十、脈浮而緊，而複下之，緊反入裏，則作痞，按之自濡①，但氣痞耳②。心下痞，按之濡，其脈關上浮（大）〔者〕，大黃黃連瀉心湯主之。心下痞。而複惡寒汗出者，附子瀉心湯主之。原文151、154、155
①濡：與軟同，柔軟之意。
【方解及其應用範圍】桂枝湯（Cinnamon Twig Decoction）具有調和營衛（調節營養氣與防禦氣）、滋陰和陽的作用。本方即由桂枝湯加倍芍藥（White Peony Root）和生薑（Fresh Ginger Rhizome），並加入人參（Ginseng Radix et Rhizoma）而成。加倍使用生薑，是因為脈象沉遲，表明營分中有寒邪；加倍使用芍藥，是因為營氣不足、血液虧少；加入人參，是為了補益各種虛損。通過補益營陰來增益衛陽，表虛引起的身體疼痛自然會癒合。因此，對於因發汗過多導致津液受損，無法濡養筋脈而身體疼痛的情況；或因氣血不足導致的身体疼痛；以及正氣不足、風濕之邪在表的痹證（Bi Syndrome，以疼痛為主要特徵的病症），均可酌情使用本方治療。
二十一、發汗後，不可再次使用桂枝湯。（若出現）汗出且喘息，沒有大熱症狀的，可以給予麻黃杏仁甘草石膏湯（Ephedra, Apricot Kernel, Licorice and Gypsum Decoction）。發汗後如果飲水過多必然會引起喘息，即使用水洗浴也會引起喘息。原文出自《傷寒論》第63條和第75條後半段。
①更行：行、施、用之意。“更行”就是再用的意思。
②灌：洗的意思，即以水洗浴。
鄭欽安評論：按此條所論述的內容，與前文的論述不符。這裡說發汗後，不可再用桂枝湯，但如果此人桂枝湯證仍然存在，原本就有再次使用桂枝湯的方法，這種說法不可取，這難道不是不符嗎？又說：“發汗後汗出而喘，無大熱者，可與麻杏石甘湯。”根據我的見解，確實是大熱、口渴、想喝冷飲、氣喘的患者，則屬於火邪刑剋肺金，此時可以使用麻杏石甘湯。如果沒有大熱、口渴等情況，只見到汗出而喘，我擔心這是汗出導致亡陽（Yang Collapse），如果再使用麻黃、杏仁這類方劑治療，豈不是加速其死亡嗎？又說：“發汗後，飲水多者必喘，以水灌之亦喘。”這一定是因為發汗導致津液受傷，所以口渴想喝水；喝水後也喘，這是水氣逆亂於中焦，導致中焦脾胃氣化功能不能宣通所致。
【闡釋】本條分為兩節，“發汗後”至“可與麻黃杏仁甘草石膏湯”為一節，即《傷寒論》第63條全文；“發汗後”至“以水灌之亦喘”為後一節，即《傷寒論》第75條後半段。鄭氏認為“此條所論，與前論不符”，他對於麻杏石甘湯可用與不可用的解釋，確有見地，不是隨文釋義所能達到的。另外，原文中“發汗後，飲水多者必喘，以水灌之亦喘”，鄭氏解釋為津液受傷，氣化不宣。大概發汗後表氣虛弱，水氣乘虛而入，客居於腠理皮毛之間，導致皮毛開闔不利，皮毛內合於肺，所以肺的呼吸迫促，從而形成喘息。
麻黃杏仁甘草石膏湯方（校補）
麻黃四兩（去除節） 杏仁五十個（去皮尖） 甘草二兩（蜜炙） 石膏半斤（打碎，用綿布包裹）以上四味藥，用水七升，先煮麻黃，減少二升，去掉上面的浮沫，加入其他藥物，煮取二升，去渣，溫服一升。
【方解及其應用範圍】本方是由麻黃湯去掉桂枝，加上石膏而成。麻黃辛溫，能開泄肺氣；杏仁苦降，能宣肺平喘；石膏辛甘寒，能直接清瀉裏熱；甘草用來協調諸藥。四味藥配合，具有清肺定喘的功效。此方除了治療本條所列的證候外，還適用於邪熱壅塞於肺的各种病證，如風熱感冒、支氣管炎、哮喘、百日咳、肺炎等。筆者常用此方治療寒包熱型的咳嗽、哮喘、肺炎，以及風溫初起、無汗而喘的患者屢用屢效，獲得滿意效果。
二十二、攻下後，不可再次使用桂枝湯，若汗出且喘息，沒有大熱症狀的，可以給予麻黃杏仁甘草石膏湯。原文出自《傷寒論》第162條。
鄭欽安評論：按“攻下後不可再用桂枝湯”這句話都不是確切的結論，其中有因為攻下而引邪深入，但脈象仍然浮淺，病機仍然想要向外透發的，仍當使用桂枝湯，順應病勢而引導它外出，這才符合法度，怎麼能夠拘泥固執呢？至於“汗出而喘，無大熱”這一句，更要仔細推求，如果確實見到脈浮緊，有熱象可徵，那麼麻杏甘膏湯才是對症的方子。如果汗出，脈浮空，面色和舌頭呈現青、白、黑色，回陽救逆還怕來不及，還能用原文中的方劑治療嗎？學者務必留心，探究陰陽消長的規律，切勿死守陳舊言論，被方劑所局限，這樣就可以了。
【闡釋】“攻下後不可再用桂枝湯”，鄭氏認為這句話不是確切結論。如果此人桂枝湯證仍然存在，原本就有再次使用桂枝湯的方法。《太陽上篇》第三十一條、三十二條，《太陽中篇》第二十九條，都是攻下後又使用桂枝湯的例子。至於“汗出而喘，無大熱”者，是否可以運用麻杏甘膏湯，則應該像鄭氏所說：探求陰陽的實據，切勿死守陳言，被方劑所局限。
二十三、發汗過多，病人雙手交叉覆蓋在心口部位，心下部悸動不安，喜歡被人按壓的，用桂枝甘草湯（Cinnamon Twig and Licorice Decoction）主治。原文出自《傷寒論》第64條。
①叉手自冒心：叉手即兩手交叉，冒即按捺，形容病人的兩手覆蓋在自己的心胸部位。
鄭欽安評論：按汗水是心的液體，現在發汗過多，則心陽不足，病人雙手交叉覆蓋在心口，是想扶持心陽的意思，尋求外援的一點幫助。至於心下部悸動喜歡按壓，都是基於這個原因。
【闡釋】這是因出汗過多，損傷了胸中的陽氣。因為胸中陽虛，導致心下部悸動不安。雙手交叉覆蓋在心口，也是因為出汗多而胸陽虛的缘故。
桂枝甘草湯方（校補）
桂枝四兩（去皮） 甘草二兩（蜜炙）以上兩味藥，用水三升，煮取一升，去渣，一次性服完。
【方解及其應用範圍】桂枝甘草湯方中，桂枝並不是為了發汗解表，而是取其入心經以益陽，配以甘草補虛以益氣。桂枝配伍甘草，則桂枝溫而不燥熱，所以能益陽而不致發汗。辛味與甘味合用，陽氣乃生，心陽得以恢復，悸動即可癒合。現在本方廣泛用於治療心血管系統疾病，可以調整血液循環功能。如果是心陽虛是由腎陽虛引起的，可酌情加入附子（Aconite Lateralis Radix Praeparata）。
二十四、還沒有診脈時，病人雙手交叉覆蓋在心口，醫生於是教他咳嗽，如果不咳嗽的，這一定是雙耳聽不見聲音，之所以這樣，是因為重發汗，導致虛損，所以如此。原文出自《傷寒論》第75條前半段。
①持脈：與診脈同義。
鄭欽安評論：此條是教導人們探求陰陽的奧妙真谛，如果讓他咳嗽他能咳，則耳聰；讓他咳嗽他不咳，則耳聾。所以斷定說，重發汗，以致心陽虛，濁陰上幹擾，閉塞了輕竅，所以耳聾，這與風寒閉束導致的耳聾，大有區別，學者應該細心觀察。
【闡釋】本條通過望診與問診來診斷病情，判斷陰陽。重發汗，以致心陽虛，心寄竅於耳，心虛故耳聾，這與肝膽風木之火上升，阻滯清竅而導致的耳聾截然不同，用小柴胡湯加減治療必然無效，必須用大劑量的參附湯加味治療。
二十五、發汗後，病人臍下悸動，快要發作奔豚（Ben Tun，一種氣從小腹上衝心胸的病證）的，用茯苓桂枝甘草大棗湯（Poria, Cinnamon Twig, Licorice and Jujube Decoction）主治。原文出自《傷寒論》第65條。
②奔豚：《諸病源候論》說：“奔豚，氣上下游走，如豚之奔，故曰奔豚”。這兩個字在這裏是形容悸動之氣自小腹上衝心胸的勢態，與腎積形成的奔豚不同。
鄭欽安評論：既然稱發汗後病人臍下悸動，這一定是因為發汗而傷及腎陽，腎陽既已衰弱，不能鎮納下元的水氣，以致臍下悸動，快要發作奔豚，治法宜回陽為是。原文所主的方劑，取茯苓來伐除腎邪，使水氣下泄，不致上衝，真是立法的妙諦啊。
【闡釋】歷代注家認為發汗後心陽虛而腎水上逆至臍下。鄭氏則認為傷及腎陽，不能鎮納下元水氣，以致臍下悸動，快要發作奔豚，治法宜回陽為是。原文主以茯苓桂枝甘草大棗湯雖然好，但不如再加附片以扶助腎陽，效果更好。
茯苓桂枝甘草大棗湯方（校補）
茯苓半斤 桂枝四兩（去皮） 甘草二兩（蜜炙） 大棗十五枚以上四味藥，用甘瀾水一鬥，先煮茯苓，減少二升，加入其他藥物，煮取三升，去渣，溫服一升，每日三次服用。製作甘瀾水的方法：取水二鬥，放在大盆內，用勺子攪揚它，水上有珠子五六千顆相互追逐，取用這些水。
①甘瀾水：一名勞水。程林說：“攪揚使其無力，是不取它助長腎邪。”錢天來說：“動則其性屬陽，攪揚則其勢下走。”
【方解及其應用範圍】《醫宗金鑒》說：“本方即苓桂朮甘湯去掉白朮，加大棗並加倍茯苓而成，苓桂朮甘湯治療心下逆滿，氣衝胸，此方則是臍下悸欲作奔豚。大概是因為水停在中焦，所以用白朮；水停下焦，所以倍用茯苓，其病由發汗後而起，總離不開桂枝湯的法度。”本方與苓桂朮甘湯、茯苓甘草湯的作用大致相同，都能治療水氣疾患。苓桂朮甘湯證，心下逆滿，氣上衝胸；茯苓甘草湯證，手足厥冷而心下悸，其病理機轉偏於中焦，所以一個用白朮運脾，一個用生薑溫胃。本湯證臍下悸欲作奔豚，其病理機轉偏於下焦，所以用大棗培土制水，倍用茯苓以伐除腎邪。
二十六、發汗後，腹部脹滿的，用厚朴生薑半夏甘草人參湯（Magnolia Bark, Fresh Ginger Rhizome, Pinellia, Licorice and Ginseng Decoction）主治。原文出自《傷寒論》第66條。
鄭欽安評論：此病腹脹滿由於發汗後，明顯是汗出傷及胸中之陽，以致濁陰上幹擾，閉塞清道，壅滯而為滿，治法宜補中宣通，原方也可以使用，似乎不如理中湯加上行滯藥更為妥當。
【闡釋】此條為發汗後脾陽虛弱，不能運化轉輸，虛氣壅滯導致腹脹滿的治法。
鄭氏說：“原方也可以使用，似乎不如理中湯加上行滯藥更為妥當”。筆者治療此類脾虛脹滿者，常用理中湯加丁香治療，往往有效。
厚朴生薑半夏甘草人參湯方（校補）
厚樸半斤（炙、去皮） 生薑半斤（切片） 半夏半升（洗淨） 甘草二兩 人參一兩以上五味藥，用水一鬥，煮取三升，去渣，溫服一升，每日三次服用。
【方解及其應用範圍】本方是溫運脾陽，寬中除滿，消補兼施的方劑。厚樸味苦辛，性溫，能下氣開滯，豁痰泄實，所以能平胃氣而除腹滿；生薑辛開理氣，半夏開結燥濕，人參、甘草健脾培土以助運化。參、草並非脹滿的要藥，臨床時分量宜輕。除了用於治療脾虛作脹外，近人推廣用於慢性胃炎、胃腸消化不良等病症。
二十七、傷寒發汗後症狀緩解，但胃中不和，心下部痞塞堅硬，噫氣帶有食物臭味，脅下有水氣，腹中雷鳴並伴有下利的，宜用生薑瀉心湯（Fresh Ginger Decoction for Draining the Epigastrium）主治。原文出自《傷寒論》第157條。
①幹噫食臭：噫同噯，即噯氣帶有食臭味。
②腹中雷鳴：形容腹腸間的響聲。
鄭欽安評論：此證既然稱為汗解，說明外邪已去，為什麼會胃中不和，心下部痞塞堅硬？這是因為發汗過多，以致濁陰上逆于心而成痞嗎？還是因為挾有宿食滯於心下而成痞硬嗎？還是因為有邪熱結於心下而成痞硬嗎？還是因為有寒水逆於心下而成痞硬嗎？不能不懷疑。又說：“幹噫食臭，脅下有水氣，至雷鳴下利”，這一定是太陽氣化失職，以致寒水彌漫四旁，一切病情，俱由此而生。但原文以生薑瀉心湯主治，似乎不太恰切。
【闡釋】鄭氏的註解，與歷代注家不同，首先提出心下部痞塞堅硬有四種不同情況，此條心下部痞塞堅硬，是因寒水逆於心下而成，這是太陽氣化失職，以致寒水彌漫，原文主以生薑瀉心湯為不恰當。筆者認為可以用五苓散加倍桂枝以化太陽膀胱之氣，加附子以扶腎陽，較為妥切。
生薑瀉心湯（校補）
生薑四兩（切片） 甘草三兩（蜜炙） 人參三兩 乾薑一兩 黃芩三兩 半夏半升（洗淨） 黃連一兩 大棗十二枚（掰開）以上八味藥，用水一鬥，煮取六升，去渣，再煎取三升，溫服一升，每日三次服用。附子瀉心湯，原本說是加附子。半夏瀉心湯、甘草瀉心湯，是同體別名而已。生薑瀉心湯，原本說是理中人參黃芩湯，去掉桂枝、白朮，加入黃連，並瀉肝法。
【方解及其應用範圍】本方中生薑、半夏辛溫散寒，除脅下水氣以和胃，人參、大棗以補中，乾薑、甘草以溫裏，黃芩、黃連以除痞結。因為本方以胃不和有水氣為主，所以重用生薑以和胃散水，因此命名為本方。本方主治皆屬裏證，寒多熱少，升降失司、虛實錯雜之證。
現在應用本方以治療急慢性腸炎、消化不良，胃擴張，胃酸過多，腸胃功能紊亂等症。
二十八、傷寒中風，醫生反而攻下，病人下利，每天數十次，完穀不化，腹中雷鳴，心下部痞塞堅硬而滿，幹嘔心煩不得安寧。醫生見心下部痞，以為病未盡，再次攻下，其痞更加嚴重，這不是結熱，只是因為胃中虛，客氣上逆，所以使痞塞堅硬，用甘草瀉心湯（Licorice Decoction for Draining the Epigastrium）主治。原文出自《傷寒論》第158條。
①穀不化：就是食穀不消化。
鄭欽安評論：此條已經誤下，而又再次攻下，所現之症，既然稱為虛冷，這不是結熱，原文以甘草瀉心湯主治，方中芩連的苦寒，又可以使用嗎？仲景不應當處置此方。
【闡釋】兩次誤下，其痞更加嚴重，這不是熱邪痞結，而是胃中虛冷之極也，理當急投四逆湯（Four-Reverse Decoction）以救其陽，稍加人參以潤之，即四逆加人參湯。在臨床上，人參確實有振奮胃機能，緩解虛性痞滿的作用。故鄭氏駁斥其不可用芩、連之苦寒，而說仲景不應當處置此方。
甘草瀉心湯方（校補）
甘草四兩（蜜炙） 黃芩三兩 乾薑三兩 半夏半升（洗淨） 大棗十二枚（掰開） 黃連一兩以上六味藥，用水一鬥，煮取六升，去渣，再煎取三升，溫服一升，每日三次服用。
【方解及其應用範圍】本方用甘、棗以補中，乾薑、半夏，辛以通達，芩、連苦寒瀉痞清熱。甘草用至四兩，為本方君藥，故名甘草瀉心湯。現今推廣用以治療胃及十二指腸潰瘍多效，其證多為寒熱錯雜。
二十九、傷寒大下後，再次發汗，心下部痞，惡寒的，表證未解，不可攻痞，當先解表，表解乃可攻痞，解表宜用桂枝湯，攻痞宜用大黃黃連瀉心湯（Rhubarb, Coptis and Scutellaria Decoction for Draining the Epigastrium）。原文出自《傷寒論》第164條。
③攻痞：即治療痞證。痞：痞塊、痞積，腹中可觸摸之硬塊，傷寒病等會發生此症狀。
鄭欽安評論：既然稱下汗後，以致心下部痞，明顯是下汗虧損表裏之陽，以致濁陰上幹擾，結於心下而為痞，治法宜溫中扶陽，宣中散逆為是。又說：惡寒者表未解，惡寒二字，雖說太陽病面目，究竟陽虛而畏外寒，也見惡寒，況既然大下發汗後，果真見到脈尚浮緊，周身尚在疼痛，發熱，惡寒，如此才可以解表，不然，只見惡寒兩字，不得就當作解表。至於攻痞的說法，雖有次第，以此症而論，則攻痞的大黃黃連瀉心湯，也未恰切，為什麼呢？未見有熱象足徵，只有痞象一症，況且此由下汗而成，並非未經汗下而見，前的大下，是大黃苦寒一派而致痞，既前的大黃不效，今又用之，又豈能保證其有效乎？我想再下之，而命不永也。
【闡釋】鄭氏所按，層層分析，與歷代注家迥異。下汗後，以致心下部痞，乃虧損表裏之陽，陰氣結於心下而成痞，治法宜溫中扶陽，宣中散逆，所論極是。
至於惡寒二字，亦有陽虛而畏寒者，則不在解表之例。至於攻痞的說法，大黃黃連瀉心湯，也不恰切，蓋只有痞象一症，而未見有熱象足徵，況且此痞由下汗而成，並非未經汗下而見，前用大黃下之而成痞，今又用之，豈能保證其有效乎？故鄭氏慨然曰：“吾想再下之，而命不永也”。
三十、脈浮而緊，而又再次攻下，緊脈反入裏，則形成痞，按之柔軟，只是氣痞而已。心下部痞，按之柔軟，其脈關部浮大的，用大黃黃連瀉心湯主治。心下部痞，而又惡寒汗出的，用附子瀉心湯（Aconite Decoction for Draining the Epigastrium）主治。原文出自《傷寒論》第151、154、155條。
①濡：與軟同，柔軟之意。
[Formula Analysis and Scope of Application] Guizhi Tang (Cinnamon Twig Decoction) has the functions of harmonizing Ying Wei (nutritive and defensive qi), nourishing Yin and harmonizing Yang. This formula is composed of Guizhi Tang with doubled Shaoyao (White Peony Root) and Shengjiang (Fresh Ginger Rhizome), plus Renshen (Ginseng Radix et Rhizoma). The reason for doubling Shengjiang is that the pulse is deep and slow, indicating cold in the Ying level; the reason for doubling Shaoyao is that Ying Qi is insufficient and blood is scanty; the reason for adding Renshen is to tonify various deficiencies. By tonifying Ying Yin to benefit Wei Yang, body pain due to exterior deficiency will heal spontaneously. Therefore, for cases where excessive sweating damages body fluids, preventing them from nourishing sinews and vessels, resulting in body pain; or body pain due to insufficiency of Qi and Blood; as well as Bi syndrome (a condition characterized mainly by pain) caused by deficiency of Zheng Qi and wind-dampness at the exterior, this formula can be used酌情ly.
21. After inducing sweating, Guizhi Tang should not be administered again. (If there is) sweating accompanied by wheezing and without significant heat, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice and Gypsum Decoction) may be given. If too much water is drunk after sweating, wheezing will inevitably occur; bathing with water will also cause wheezing. Original text from Chapters 63 and the latter half of Chapter 75 of Shanghan Lun.
① Gengxing: To act, to apply, to use. "Gengxing" means to use again.
② Guan: To wash, meaning to bathe with water.
Commentary by Zheng Qin'an: According to the discussion in this clause, it contradicts the previous discussion. It states that after sweating, Guizhi Tang should not be used again; however, if the Guizhi Tang pattern persists, there is originally a method to use Guizhi Tang again. This statement is unacceptable; how is this not a contradiction? It also says: "After sweating, if there is sweating and wheezing without significant heat, Mahing Xinggan Shigan Tang can be given." Based on my observations, if there is indeed significant heat, thirst, desire for cold drinks, and wheezing, it indicates fire punishing the lungs, and Mahuang Xingren Gancao Shigao Tang can be used. If there is no significant heat or thirst, but only sweating and wheezing, I fear this is Yang collapse due to sweating. If one treats it with a formula containing Ephedra and Apricot Kernel, would it not hasten death? It also says: "After sweating, drinking too much water will inevitably cause wheezing, and bathing with water will also cause wheezing." This must be because sweating injured body fluids, causing thirst and desire to drink; wheezing after drinking indicates water counterflow in the middle jiao, leading to failure of Qi transformation in the spleen and stomach.
[Interpretation] This clause is divided into two sections. From "after sweating" to "can be given Mahuang Xingren Gancao Shigao Tang" is the first section, which is the full text of Clause 63 of Shanghan Lun. From "after sweating" to "bathing with water will also cause wheezing" is the second section, which is the latter half of Clause 75 of Shanghan Lun. Zheng believed that "the discussion in this clause contradicts the previous one." His explanation of when Mahing Xinggan Shigan Tang is applicable and when it is not shows insight, going beyond mere textual interpretation. Regarding the original text "after sweating, drinking too much water will inevitably cause wheezing, and bathing with water will also cause wheezing," Zheng interpreted it as injury to body fluids and failure of Qi transformation. Generally, after sweating, the exterior Qi is deficient, allowing water Qi to enter vacuously and lodge between the couli (interstices) and skin/hair. This leads to dysfunction in opening and closing of the skin/hair. Since skin/hair internally connects to the lungs, lung respiration becomes rapid, resulting in wheezing.
Mahuang Xingren Gancao Shigao Tang Formula (Corrected and Supplemented)
Mahuang (Ephedrae Herba) 4 liang (remove nodes)
Xingren (Armeniacae Semen Amarum) 50 pieces (remove skin and tips)
Gancao (Glycyrrhizae Radix et Rhizoma) 2 liang (honey-fried)
Shigao (Gypsum Fibrosum) 0.5 jin (crushed, wrapped in cotton cloth)
The above four ingredients are boiled in 7 sheng of water. First boil Mahuang until reduced by 2 sheng, remove the foam on top, then add the remaining herbs. Boil until 2 sheng remain, strain, and take 1 sheng warm.
[Formula Analysis and Scope of Application] This formula is derived from Mahuang Tang by removing Guizhi and adding Shigao. Mahuang is acrid and warm, opening and draining Lung Qi; Xingren is bitter and descending, diffusing the Lung and calming wheezing; Shigao is acrid, sweet, and cold, directly clearing interior heat; Gancao harmonizes the herbs. The combination of these four ingredients has the effect of clearing the Lung and calming wheezing. Besides treating the patterns listed in this clause, this formula is applicable to various conditions where pathogenic heat obstructs the Lung, such as wind-heat common cold, bronchitis, asthma, whooping cough, and pneumonia. The author often uses this formula to treat cough, asthma, and pneumonia caused by cold enveloping heat, as well as early-stage wind-warmth with no sweat and wheezing, achieving satisfactory results repeatedly.
22. After purgation, Guizhi Tang should not be administered again. If there is sweating accompanied by wheezing and without significant heat, Mahuang Xingren Gancao Shigao Tang may be given. Original text from Clause 162 of Shanghan Lun.
Commentary by Zheng Qin'an: The statement "after purgation, Guizhi Tang should not be used again" is not entirely accurate. In some cases, purgation may draw pathogens deeper, but if the pulse remains floating and the pathological mechanism still tends outward, Guizhi Tang should still be used to guide the pathogen out according to its trend, which is the correct approach. How can one be so rigid? As for the phrase "sweating and wheezing without significant heat," careful deduction is required. If the pulse is floating and tight, with evident signs of heat, then Mahuang Xinggan Gaotang is indeed the appropriate formula. However, if there is sweating, a floating and empty pulse, and the face and tongue appear cyanotic, white, or black, saving Yang is barely sufficient; how can one use the formula from the original text? Scholars must pay attention to exploring the waxing and waning of Yin and Yang, and must not blindly adhere to old sayings or be confined by formulas.
[Interpretation] Regarding "after purgation, Guizhi Tang should not be used again," Zheng argued that this is not an absolute rule. If the Guizhi Tang pattern persists, there is originally a method to use Guizhi Tang again. Clauses 31 and 32 of the Taiyang Upper Chapter, and Clause 29 of the Taiyang Middle Chapter of Shanghan Lun, are examples of using Guizhi Tang after purgation. As for whether Mahuang Xinggan Gaotang can be used for "sweating and wheezing without significant heat," one should follow Zheng's advice: seek solid evidence of Yin and Yang, do not rigidly stick to old words, and avoid being confined by formulas.
23. After excessive sweating, if the patient crosses their hands over their heart, feels palpitations in the epigastric region, and desires pressure, Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction) is the primary treatment. Original text from Clause 64 of Shanghan Lun.
① Chashou Zimao Xin: Crossing hands refers to crossing both hands; maon means pressing. It describes the patient covering their chest and heart area with both hands.
② Ji: Palpitation or throbbing. "Xinxia Ji" refers to a sensation of tense palpitation in the epigastric region.
Commentary by Zheng Qin'an: Sweat is the fluid of the Heart. Excessive sweating leads to deficiency of Heart Yang. The patient crossing their hands over the heart is an attempt to support Heart Yang, seeking external assistance. The palpitations in the epigastric region and the desire for pressure are all based on this principle.
[Interpretation] This occurs because excessive sweating damages the Yang Qi in the chest. Due to deficiency of Yang in the chest, palpitations in the epigastric region occur. Crossing hands over the heart is also due to excessive sweating leading to deficiency of chest Yang.
Guizhi Gancao Tang Formula (Corrected and Supplemented)
Guizhi (Cinnamomi Ramulus) 4 liang (remove bark)
Gancao (Glycyrrhizae Radix et Rhizoma) 2 liang (honey-fried)
The above two ingredients are boiled in 3 sheng of water until 1 sheng remains. Strain and take all at once.
[Formula Analysis and Scope of Application] In the Guizhi Gancao Tang formula, Guizhi is not used for releasing the exterior, but rather to enter the Heart channel to benefit Yang. Paired with Gancao to tonify deficiency and benefit Qi, Guizhi becomes warm but not hot, thus benefiting Yang without inducing sweating. The combination of acrid and sweet flavors generates Yang. Once Heart Yang is restored, palpitations subside. Currently, this formula is widely used to treat cardiovascular diseases and adjust blood circulation function. If Heart Yang deficiency is caused by Kidney Yang deficiency, Fuzi (Aconite Lateralis Radix Praeparata) can be added酌情ly.
24. Before taking the pulse, if the patient crosses their hands over their heart, and the doctor instructs them to cough, and they cannot cough, this indicates bilateral deafness. The reason is that heavy sweating caused deficiency, leading to this condition. Original text from the first half of Clause 75 of Shanghan Lun.
① Chi Mai: Same as diagnosing the pulse.
Commentary by Zheng Qin'an: This clause teaches people to explore the profound truth of Yin and Yang. If the patient can cough when instructed, their hearing is clear; if they cannot cough, they are deaf. Thus, it is concluded that heavy sweating led to Heart Yang deficiency, turbid Yin rose to interfere, blocking the delicate orifices, causing deafness. This is vastly different from deafness caused by wind-cold constriction. Scholars should observe carefully.
[Interpretation] This clause diagnoses the condition and determines Yin and Yang through observation and inquiry. Heavy sweating leads to Heart Yang deficiency. The Heart opens into the ears; Heart deficiency causes deafness. This is completely different from deafness caused by the rising fire of Liver-Gallbladder wind-wood obstructing the clear orifices. Treating this with Xiao Chaihu Tang加减 would be ineffective; large doses of Shenfu Tang加减 must be used.
25. After sweating, if the patient feels palpitations below the navel and is about to develop Ben Tun (a condition where Qi rushes from the lower abdomen to the chest), Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice and Jujube Decoction) is the primary treatment. Original text from Clause 65 of Shanghan Lun.
② Ben Tun: Zhu Bing Yuan Hou Lun states, "Ben Tun refers to Qi moving up and down like a running piglet, hence the name." Here, these two characters describe the momentum of palpitations rushing from the lower abdomen to the chest, which differs from Ben Tun caused by Kidney accumulation.
Commentary by Zheng Qin'an: Since it states that after sweating, the patient feels palpitations below the navel, it must be due to sweating injuring Kidney Yang. With weakened Kidney Yang, it cannot anchor and control the water Qi in the lower origin, leading to palpitations below the navel and impending Ben Tun. The treatment method should be to restore Yang. The formula in the original text uses Fuling to attack Kidney evil and drain water Qi downward, preventing it from rushing upward, which is truly a subtle point of legislative wisdom.
[Interpretation]历代 commentators believe that after sweating, Heart Yang deficiency leads to Kidney Water counterflow to below the navel. Zheng argued that Kidney Yang was injured, failing to anchor Lower Origin water Qi, leading to palpitations below the navel and impending Ben Tun, and the treatment should be to restore Yang. Although the original text prescribes Fuling Guizhi Gancao Dazao Tang, adding Fupian (Prepared Aconite Root) to support Kidney Yang would yield better results.
Fuling Guizhi Gancao Dazao Tang Formula (Corrected and Supplemented)
Fuling (Poria) 0.5 jin
Guizhi (Cinnamomi Ramulus) 4 liang (remove bark)
Gancao (Glycyrrhizae Radix et Rhizoma) 2 liang (honey-fried)
Dazao (Ziziphi Jujubae Fructus) 15 pieces
The above four ingredients are boiled in 1 dou of Ganlan Shui (Ganlan Water). First boil Fuling until reduced by 2 sheng, then add the other herbs. Boil until 3 sheng remain, strain, and take 1 sheng warm, three times a day. Method for preparing Ganlan Shui: Take 2 dou of water, place in a large basin, and stir vigorously with a ladle until small bubbles resembling pearls chase each other on the surface. Use this water.
① Ganlan Shui: Also known as Lao Shui. Cheng Lin said, "Stirring reduces its power, avoiding aiding Kidney evil." Qian Tianlai said, "Movement makes its nature Yang; stirring directs its force downward."
[Formula Analysis and Scope of Application] Yi Zong Jin Jian states: "This formula is Ling Gui Zhu Gan Tang minus Baizhu, plus Dazao and doubled Fuling. Ling Gui Zhu Gan Tang treats fullness and Qi rushing to the chest; this formula treats palpitations below the navel and impending Ben Tun. Water stagnating in the Middle Jiao requires Baizhu; water stagnating in the Lower Jiao requires doubled Fuling. Since the disease arises after sweating, it essentially follows the principles of Guizhi Tang." This formula has similar effects to Ling Gui Zhu Gan Tang and Fuling Gancao Tang, all treating water-Qi disorders. Ling Gui Zhu Gan Tang pattern involves epigastric fullness and Qi rushing to the chest; Fuling Gancao Tang pattern involves cold extremities and epigastric palpitations. Their pathological mechanisms lean towards the Middle Jiao, hence one uses Baizhu to transport Spleen Qi, and the other uses Shengjiang to warm the Stomach. This formula's pattern involves palpitations below the navel and impending Ben Tun, with a pathological mechanism leaning towards the Lower Jiao, hence Dazao is used to cultivate Earth to control Water, and Fuling is doubled to attack Kidney evil.
26. After sweating, if abdominal fullness occurs, Houpo Shengjiang Banxia Gancao Renshen Tang (Magnolia Bark, Fresh Ginger Rhizome, Pinellia, Licorice and Ginseng Decoction) is the primary treatment. Original text from Clause 66 of Shanghan Lun.
Commentary by Zheng Qin'an: Abdominal fullness after sweating clearly indicates that sweating injured Yang in the chest, causing turbid Yin to rise and block the clear pathways, leading to stagnation and fullness. The treatment should tonify the center and promote circulation. The original formula can be used, but it seems more appropriate to use Lizhong Tang plus Qi-moving herbs.
[Interpretation] This clause addresses the treatment of abdominal fullness caused by Spleen Yang deficiency after sweating, where the Spleen fails to transform and transport, leading to stagnation of deficient Qi.
Zheng stated, "The original formula can be used, but it seems more appropriate to use Lizhong Tang plus Qi-moving herbs." The author often treats such Spleen-deficiency fullness with Lizhong Tang plus Dingxiang (Caryophylli Flos), achieving frequent success.
Houpo Shengjiang Banxia Gancao Renshen Tang Formula (Corrected and Supplemented)
Houpo (Magnoliae Officinalis Cortex) 0.5 jin (fried, remove bark)
Shengjiang (Zingiberis Rhizoma Recens) 0.5 jin (sliced)
Banxia (Pinelliae Tuber) 0.5 sheng (washed)
Gancao (Glycyrrhizae Radix et Rhizoma) 2 liang
Renshen (Ginseng Radix et Rhizoma) 1 liang
The above five ingredients are boiled in 1 dou of water until 3 sheng remain. Strain, take 1 sheng warm, three times a day.
[Formula Analysis and Scope of Application] This formula warms and moves Spleen Yang, broadens the middle and removes fullness, combining draining and tonifying actions. Houpo is bitter and acrid, warm in nature, descending Qi and resolving stagnation, resolving phlegm and draining excess, thus pacifying Stomach Qi and removing abdominal fullness. Shengjiang is acrid and opens Qi; Banxia resolves knots and dries dampness; Renshen and Gancao strengthen the Spleen and cultivate Earth to assist transformation. Renshen and Gancao are not key herbs for fullness; their dosage should be light clinically. Besides treating Spleen-deficiency bloating, modern practitioners have extended its use to chronic gastritis and gastrointestinal indigestion.
27. After treating Cold Damage with sweating and symptoms resolving, if there is disharmony in the Stomach, epigastric stuffiness and hardness, belching with food odor, water Qi under the hypochondrium, borborygmus, and diarrhea, Shengjiang Xiexin Tang (Fresh Ginger Decoction for Draining the Epigastrium) is suitable. Original text from Clause 157 of Shanghan Lun.
① Gan Yi Shi Chou: Yi is equivalent to Ai, meaning belching with a smell of undigested food.
② Fuzhong Leiming: Describes the sound of intestines rumbling.
Commentary by Zheng Qin'an: Since this pattern is described as resolved by sweating, the exterior pathogen is gone. Why is there disharmony in the Stomach and epigastric stuffiness/hardness? Is it because excessive sweating caused turbid Yin to counterflow to the Heart, forming stuffiness? Or is it due to retained food stagnating in the epigastrium? Or is it due to pathogenic heat knotting in the epigastrium? Or is it due to cold-water counterflow in the epigastrium? These doubts cannot be dismissed. Furthermore, regarding "belching with food odor, water Qi under the hypochondrium, borborygmus, and diarrhea," this must be due to failure of Taiyang Qi transformation, causing cold water to permeate everywhere, generating all these symptoms. However, prescribing Shengjiang Xiexin Tang in the original text seems inappropriate.
[Interpretation] Zheng's commentary differs from历代 commentators. He first proposes four different situations for epigastric stuffiness and hardness. For this clause, epigastric stuffiness and hardness are caused by cold-water counterflow to the epigastrium due to failure of Taiyang Qi transformation and permeation of cold water. Prescribing Shengjiang Xiexin Tang is inappropriate. The author believes using Wuling San with doubled Guizhi to transform Taiyang Bladder Qi, plus Fuzi to support Kidney Yang, would be more appropriate.
Shengjiang Xiexin Tang Formula (Corrected and Supplemented)
Shengjiang (Zingiberis Rhizoma Recens) 4 liang (sliced)
Gancao (Glycyrrhizae Radix et Rhizoma) 3 liang (honey-fried)
Renshen (Ginseng Radix et Rhizoma) 3 liang
Ganjiang (Zingiberis Rhizoma) 1 liang
Huangqin (Scutellariae Radix) 3 liang
Banxia (Pinelliae Tuber) 0.5 sheng (washed)
Huanglian (Coptidis Rhizoma) 1 liang
Dazao (Ziziphi Jujubae Fructus) 12 pieces (broken open)
The above eight ingredients are boiled in 1 dou of water until 6 sheng remain. Strain, decoct again until 3 sheng remain. Take 1 sheng warm, three times a day. Fuzi Xiexin Tang originally added Fuzi. Banxia Xiexin Tang and Gancao Xiexin Tang are alternative names for the same body. Shengjiang Xiexin Tang was originally called Lizhong Renshen Huangqin Tang, removing Guizhi and Baizhu, adding Huanglian, and employing the method of draining the Liver.
[Formula Analysis and Scope of Application] In this formula, Shengjiang and Banxia are acrid and warm, dispersing cold and removing water Qi under the hypochondrium to harmonize the Stomach. Renshen and Dazao tonify the center. Ganjiang and Gancao warm the interior. Huangqin and Huanglian resolve stuffiness and knots. Since the main issue is Stomach disharmony with water Qi, Shengjiang is heavily used to harmonize the Stomach and scatter water, hence the name. All indications belong to interior patterns, characterized by more cold than heat, dysfunction of ascending and descending, and mixed deficiency and excess.
Currently, this formula is applied to treat acute and chronic enteritis, indigestion, gastric dilation, hyperacidity, and gastrointestinal dysfunction.
28. In Cold Damage Wind Strike, if the physician incorrectly uses purgation, the patient suffers diarrhea dozens of times a day, passing undigested food, borborygmus, epigastric stuffiness, hardness, and fullness, dry retching, irritability, and restlessness. Seeing epigastric stuffiness, the physician thinks the disease is not fully resolved and purges again, worsening the stuffiness. This is not heat knotting, but rather Stomach deficiency with guest Qi counterflow, causing hardness. Gancao Xiexin Tang (Licorice Decoction for Draining the Epigastrium) is the primary treatment. Original text from Clause 158 of Shanghan Lun.
① Gu Bu Hua: Undigested food.
② Keqi Shangni: Not the body's righteous Qi, but deficient Qi in the Stomach counterflowing upward.
Commentary by Zheng Qin'an: This clause involves incorrect purgation followed by repeated purgation. The presented symptoms indicate deficiency-cold. This is not heat knotting. How can the bitter-cold Huangqin and Huanglian in Gancao Xiexin Tang be used? Zhongjing should not have prescribed this.
[Interpretation] Two instances of incorrect purgation worsened the stuffiness. This is not heat knotting, but extreme Stomach deficiency-cold. One should urgently administer Sini Tang (Four-Reverse Decoction) to save Yang, adding a little Renshen to moisten, i.e., Sini Jia Renshen Tang. Clinically, Renshen does振奋 Stomach function and relieve deficient stuffiness. Thus, Zheng refuted the use of bitter-cold Huangqin and Huanglian, stating Zhongjing should not have prescribed this.
Gancao Xiexin Tang Formula (Corrected and Supplemented)
Gancao (Glycyrrhizae Radix et Rhizoma) 4 liang (honey-fried)
Huangqin (Scutellariae Radix) 3 liang
Ganjiang (Zingiberis Rhizoma) 3 liang
Banxia (Pinelliae Tuber) 0.5 sheng (washed)
Dazao (Ziziphi Jujubae Fructus) 12 pieces (broken open)
Huanglian (Coptidis Rhizoma) 1 liang
The above six ingredients are boiled in 1 dou of water until 6 sheng remain. Strain, decoct again until 3 sheng remain. Take 1 sheng warm, three times a day.
[Formula Analysis and Scope of Application] This formula uses Gancao and Dazao to tonify the center. Ganjiang and Banxia are acrid to promote circulation. Huangqin and Huanglian are bitter and cold to drain stuffiness and clear heat. Gancao is used in high dose (4 liang) as the sovereign herb, hence the name Gancao Xiexin Tang. It is now widely promoted for treating gastric and duodenal ulcers, often presenting as mixed cold and heat patterns.
29. After severe purgation and subsequent sweating in Cold Damage, if there is epigastric stuffiness and aversion to cold, the exterior is unresolved. Do not attack the stuffiness; first resolve the exterior. After the exterior is resolved, then attack the stuffiness. To resolve the exterior, use Guizhi Tang; to attack the stuffiness, use Dahuang Huanglian Xiexin Tang (Rhubarb, Coptis and Scutellaria Decoction for Draining the Epigastrium). Original text from Clause 164 of Shanghan Lun.
③ Gong Pi: Treating Pi syndrome. Pi: Mass or accumulation, a hard mass palpable in the abdomen, occurring in Cold Damage etc.
Commentary by Zheng Qin'an: Since it states that after purgation and sweating, epigastric stuffiness occurred, it is clear that purgation and sweating damaged exterior and interior Yang, causing turbid Yin to rise and knot in the epigastrium, forming stuffiness. The treatment should warm the middle, support Yang, and dissipate counterflow. It also says: "Aversion to cold indicates unresolved exterior." Although aversion to cold is a sign of Taiyang, ultimately Yang deficiency fearing external cold also presents with aversion to cold. Moreover, after severe purgation and sweating, if the pulse is still floating and tight, with body pain, fever, and aversion to cold, then resolving the exterior is possible. Otherwise, merely seeing aversion to cold is not sufficient to justify resolving the exterior. Regarding attacking the stuffiness, although there is a sequence, for this specific case, Dahuang Huanglian Xiexin Tang is not appropriate. Why? There are no sufficient signs of heat, only the sign of stuffiness. Furthermore, this stuffiness resulted from purgation and sweating, not from untreated exterior. The previous severe purgation used bitter-cold Dahuang to cause stuffiness. Since Dahuang failed previously, using it again guarantees no efficacy. I think purging again would shorten life.
[Interpretation] Zheng's analysis is layered and distinct from历代 commentators. After purgation and sweating, epigastric stuffiness results from damaging exterior and interior Yang, with Yin Qi knotting in the epigastrium. The treatment should warm the middle, support Yang, and dissipate counterflow, which is very correct.
Regarding aversion to cold, there are cases of Yang deficiency fearing cold, which are not indications for resolving the exterior. As for attacking the stuffiness, Dahuang Huanglian Xiexin Tang is also inappropriate, as there is only the sign of stuffiness without sufficient heat signs. Moreover, this stuffiness arose from purgation and sweating. Using Dahuang previously caused stuffiness; using it again cannot guarantee efficacy. Thus, Zheng exclaimed, "I think purging again would shorten life."
30. If the pulse is floating and tight, and purgation is performed again, the tight pulse enters the interior, forming Pi (stuffiness). Pressing it feels soft; it is merely Qi Pi. For epigastric stuffiness that feels soft upon pressure, with a floating-large pulse at the Guan position, Dahuang Huanglian Xiexin Tang is the primary treatment. For epigastric stuffiness accompanied by aversion to cold and sweating, Fuzi Xiexin Tang (Aconite Decoction for Draining the Epigastrium) is the primary treatment. Original texts from Clauses 151, 154, and 155 of Shanghan Lun.
① Ru: Same as Ruan, meaning soft.