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
芍药（四两） 甘草（四两炙）
上 咀以水三升煮取升半去滓分温再服
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温胫尚微拘急重与甘草芍药汤尔乃胫伸以承气汤微溏则止其谵语
故知病可愈
此复述上章设为问答证象阳旦即证象桂枝之互文（金匮产后中风数十日不解头痛恶寒时时有热干呕汗出虽久阳旦证
续在耳可与阳旦汤林亿以为即桂枝汤按证是桂枝汤无疑）按法治之即上章以桂枝攻其表及此章因加附子增桂令汗出也寸
口脉浮而大浮则为风大则为虚载在脉法（脉法寸口脉浮而紧浮则为风紧则为寒脉弦而大大则为芤芤则为虚也）所谓风则
浮虚也（脉法语）风则生其微热虚则两胫挛急病与桂枝汤证形象符合而热微足挛又似阳虚因增桂枝而加附子以发其表附
子温经汗多亡阳是以厥逆咽干而生烦躁汗出津枯胃腑燥结是以谵语烦乱不知寸口脉浮大是阳明之里实（阳明篇大便硬者
脉浮而缓为阳明病伤寒三日阳明脉大三阳合病脉浮而大）而非太阳之表虚误以桂附发汗重亡其阳里实变而为里虚更饮甘
草干姜阳回足温重与芍药甘草汤即胫伸少与调胃承气变结粪为微溏止其谵语药良法精应手愈矣何不可知之有（喻嘉言误
会阳旦阴旦二汤谓桂枝加黄芩为阳旦汤加桂枝为阴旦汤按法用之即桂枝加黄芩之法所以得之便厥误在黄芩仲景即行桂枝
之法增桂枝令其汗出更加附子温经悖缪极矣嗣后医书俱袭其说皆载阳旦阴旦二方不通之至仲景自有桂枝加桂汤不名阴旦
阴旦之名荒唐怪诞所谓不知而妄作也）
甘草（四两，炙） 干姜（二两，炮制）
以上药材切碎，用水三升，煎煮至一升五合，滤去药渣，分两次温服。
芍药（四两） 甘草（四两，炙）
以上药材切碎，用水三升，煎煮至一升半，滤去药渣，分两次温服。
问：病症表现像阳旦证（即桂枝汤证），按照相应方法治疗却病情加重，出现四肢厥冷、咽喉干燥、双腿拘挛以及胡言乱语。老师说半夜时手脚应当回暖，双脚应当伸直，后来果然如老师所说。为什么能预知这一点？
答：寸口脉象浮而大。浮脉主风邪，大脉主虚证。风邪侵袭则产生轻微发热，正气虚弱则导致双腿拘挛。病症形象符合桂枝汤证，因此加入附子在其中，并增加桂枝用量以促使发汗。这是因为附子能温通经脉，但因汗出过多导致阳气亡失，所以出现四肢厥冷、咽喉干燥、烦躁不安等症。此时阳明胃腑内部结滞，出现胡言乱语和烦乱。再次服用甘草干姜汤，到半夜阳气回复，双脚应当回暖；小腿虽然仍有轻微拘挛，再给予芍药甘草汤，于是小腿得以伸直。随后用承气汤轻微通便，大便变软即可停止，以此消除胡言乱语。因此知道病可以痊愈。
这是复述上一章的内容，采用设问问答的形式。“证象阳旦”即是“证象桂枝”的互文见义。（《金匮要略》中记载产后中风数十日不解，头痛恶寒，时常有热，干呕，汗出，即使时间很久，阳旦证依然存在，可以使用阳旦汤。林亿认为阳旦汤就是桂枝汤，按此证候判断确实是桂枝汤无疑。）所谓“按法治之”，即上一章中以桂枝汤攻解表邪，以及本章中因加入附子、增加桂枝用量以促使发汗的情况。寸口脉浮而大，浮主风，大主虚，这在脉法中有记载（《脉法》云：寸口脉浮而紧，浮则为风，紧则为寒；脉弦而大，大则为芤，芤则为虚）。这就是所谓的“风则浮虚”（《脉法》语）。风邪导致轻微发热，虚证导致双腿拘挛。病症与桂枝汤证的形象相符，且发热轻微、足部拘挛又似乎像阳虚，因此增加桂枝并加入附子以发散表邪。附子温通经脉，但汗出过多导致阳气亡失，从而产生四肢厥冷、咽干而生烦躁。汗出导致津液枯竭，胃腑燥结，从而产生胡言乱语和烦乱。如果不了解寸口脉浮大实际上是阳明里实（《阳明篇》云：大便硬者，脉浮而缓，为阳明病；伤寒三日，阳明脉大，三阳合病，脉浮而大），而不是太阳表虚，误用桂枝、附子发汗，会再次耗伤阳气，使里实证转变为里虚证。此时再饮用甘草干姜汤，阳气回复，脚部变暖；再给予芍药甘草汤，小腿就能伸直；稍加调胃承气汤，将结粪变为轻微溏便，停止胡言乱语。药物精良，法度精妙，应手而愈，有什么不能预知的呢？（喻嘉言误解了阳旦汤和阴旦汤，认为桂枝加黄芩是阳旦汤，加桂枝是阴旦汤。按照这种方法使用，就是桂枝加黄芩的方法，所以导致了四肢厥逆的错误，错误在于使用了黄芩。张仲景原本是用桂枝之法，增加桂枝令其发汗，再加附子温经，这极其荒谬悖理。后来的医书都沿袭这种说法，都记载阳旦、阴旦两个方剂，不通达到极点。张仲景自有桂枝加桂汤，并不命名为阴旦。阴旦之名荒唐怪诞，所谓不知而妄作。）
Gancao (Radix Glycyrrhizae, four liang, honey-fried) Ganjiang (Rhizoma Zingiberis Preparatum, two liang, processed)
Crush the above ingredients. Boil in three sheng of water until one sheng and five he remain. Strain off the dregs. Divide into two doses and take warm.
Shaoyao (Radix Paeoniae Alba, four liang) Gancao (Radix Glycyrrhizae, four liang, honey-fried)
Crush the above ingredients. Boil in three sheng of water until one sheng and half remain. Strain off the dregs. Divide into two doses and take warm.
Question: The symptoms resemble Yangdan Syndrome (i.e., Guizhi Tang Syndrome). Following the appropriate treatment method, the condition worsened, presenting with Jue Ni (cold extremities), dryness in the throat, spasms in both calves, and delirium. The Master said that at midnight, the hands and feet would become warm, and the legs would extend. This later happened exactly as predicted. How was this known?
Answer: The Cun Kou pulse is floating and large. A floating pulse indicates Wind pathogen; a large pulse indicates Deficiency. Wind pathogen generates slight fever; Deficiency causes spasms in both calves. The symptom pattern resembles Guizhi Tang Syndrome, so Fuzi (Radix Aconiti Lateralis Preparata) was added to the formula, and the dosage of Guizhi (Ramulus Cinnamomi) was increased to induce sweating. This is because Fuzi warms the meridians, but excessive sweating led to the loss of Yang Qi, resulting in cold extremities, dry throat, and irritability. At this point, Yangming internal binding occurred, causing delirium and mental confusion. Administering Gancao Ganjiang Tang again, by midnight, Yang Qi returned, and the feet became warm. Although the calves remained slightly spasmodic, administering Shaoyao Gancao Tang subsequently allowed the calves to extend. Then, using Chengqi Tang to induce mild loose stools stopped the delirium. Therefore, it was known that the disease could be cured.
This reiterates the previous chapter using a Q&A format. "Symptoms resembling Yangdan" is synonymous with "symptoms resembling Guizhi." (In *Jin Gui Yao Lue*, it is recorded that postpartum wind-strike lasting dozens of days without resolution, with headache, aversion to cold, intermittent fever, dry retching, and sweating, even if prolonged, the Yangdan syndrome persists and can be treated with Yangdan Tang. Lin Yi considered Yangdan Tang to be identical to Guizhi Tang; based on the symptoms, it is undoubtedly Guizhi Tang.) "Following the appropriate treatment method" refers to using Guizhi Tang to attack the exterior in the previous chapter, and in this chapter, adding Fuzi and increasing Guizhi to induce sweating. The Cun Kou pulse being floating and large—floating indicating Wind and large indicating Deficiency—is documented in Pulse Methods (*Mai Fa*): "Cun Kou pulse floating and tight, floating indicates Wind, tight indicates Cold; pulse wiry and large, large indicates Kou [empty], Kou indicates Deficiency." This is what is meant by "Wind implies floating and deficiency" (*Mai Fa* language). Wind generates slight fever, and deficiency causes calf spasms. The illness matches the image of Guizhi Tang syndrome, and since the fever is slight and leg spasms suggest Yang deficiency, Guizhi was increased and Fuzi added to release the exterior. Fuzi warms the meridians, but excessive sweating caused Yang collapse, leading to cold extremities, dry throat, and irritability. Sweating depleted fluids, causing stomach dryness and binding, leading to delirium and confusion. If one does not realize that the floating and large Cun Kou pulse actually indicates Yangming interior excess (as stated in the *Yangming Chapter*: "Hard stool, floating and slow pulse, is Yangming disease; after three days of cold damage, the Yangming pulse is large; combined three-yang disease, the pulse is floating and large") rather than Taiyang exterior deficiency, mistakenly using Guizhi and Fuzi to sweat will further deplete Yang, transforming interior excess into interior deficiency. Drinking Gancao Ganjiang Tang restores Yang and warms the feet; administering Shaoyao Gancao Tang extends the calves; giving a small amount of Tiaowei Chengqi Tang turns bound stool into mild loose stools, stopping delirium. The medicine is excellent, the method is precise, and recovery is immediate. How could this not be known? (Yu Jiayan misunderstood Yangdan Tang and Yindan Tang, claiming that Guizhi Tang with Huangqin (Scutellariae Radix) is Yangdan Tang and Guizhi Tang with extra Guizhi is Yindan Tang. Applying this method leads to the error of cold extremities due to the use of Huangqin. Zhang Zhongjing originally used the Guizhi method, increasing Guizhi to induce sweating, and adding Fuzi to warm the meridians, which is extremely absurd and erroneous. Later medical books followed this saying, recording both Yangdan and Yindan formulas, which is extremely ignorant. Zhang Zhongjing naturally had Guizhi Jia Guizhi Tang, not named Yindan. The name Yindan is absurd and bizarre, representing speculation without knowledge.)