芍药 甘草 附子
发汗不解。反恶寒者。虚也。当与此汤。 汗后病解。则不恶寒。汗后病不解。而表实者
。亦
收敛津液而益营。附子之辛热固阳气而补卫。甘草调和辛酸而安正气也。
桂枝 甘草 生姜 大枣
太阳下后。脉促胸满。若微寒。加附子。名桂枝去芍药加附子汤。胸满者。不利于酸收
。故去芍药。其曰微寒者。非表寒。乃里寒也。故加附子。祛寒而消满也。
桂枝 黄芩 人参 甘草 芍药 生姜 大枣 柴胡 半夏
伤寒六七日。发热。微恶寒。支节烦疼。微呕。心下支结。外症未去。伤寒至六七日。
邪当传里之时也
可攻里。与柴胡桂枝汤。以和解之。南阳云。外症未解。心下妨闷。谓之支结。非痞也。不
可不辨。
知母 石膏 甘草 粳米
吐下后。七八日不解。热结在里。表里俱热。脉浮滑。大渴而烦。按仲景云。伤寒脉浮
滑。此表有热。里有寒。白虎汤主之。疑必有误。又云。热结在里。表里俱热。大渴饮水。白虎
汤主之。又云。表不解者。不可与白虎汤。又阳明一症云。表热里寒。四逆汤主之。又少阳
一症云。里寒外热。通脉四逆汤主之。乃知其言脉浮滑。表热里寒者。必表里二字传讹也。即仲
景数论而断之。岂有里既寒而反用大寒之剂乎。岂有里寒而脉浮滑者乎。岂有里寒而大热烦
渴者乎。故知白虎为阳明大热而设。其曰。里有寒者。定瘥无疑也。成氏随文注释。惑误后
人。不得不详为之辨也。白虎西方金神也。应秋而归肺。表里俱热。金被火囚。用辛寒以救肺
。所以名为白虎也。活人谓夏月阴气在内。宜戒白虎。明理论云。立秋后不可服。恐白虎大
寒。将变虚羸不食。二说俱偏矣。有是病即当服是药。安可拘于时哉。设使秋冬病。苟无表
症。而大热烦渴。便与白虎。为对症之良剂矣。虽欲不用。其可得乎。
发汗后病证未解，反而出现恶寒症状的，属于虚证。应当给予此汤剂治疗。如果发汗后病证解除，就不会恶寒；如果发汗后病证未解，且表实证仍在……（原文此处似有缺漏或断句问题，结合下文“收敛津液而益营”等语，推测为对芍药、附子、甘草功效的解释）。芍药能收敛津液以滋养营气。附子的辛热之性能够固护阳气以补益卫气。甘草调和酸味与辛味，从而安定正气。
太阳病经过误下之后，出现脉促、胸满的症状。如果伴有轻微恶寒，应加入附子，方名桂枝去芍药加附子汤。胸满的症状，是因为不利于酸收性质的药物，所以去掉芍药。所说的“微寒”，并非表寒，而是里寒，所以加入附子，以祛除寒邪并消除胸满。
伤寒病程到了六七天，出现发热、轻微恶寒、四肢关节烦痛、轻微呕吐、心下部支撑胀闷的症状，这是外症尚未去除的表现。伤寒至六七天，是邪气应当传入里的时期。此时可以攻治里证，给予柴胡桂枝汤，以和解表里。南阳人（指张仲景）说：外症未解，心下部感到妨闷，称为“支结”，并不是“痞证”。这一点不可不加以辨别。
经过吐法或下法治疗后，七八天病证仍未解除，热邪结聚在体内，表现为表里俱热，脉象浮滑，大渴且烦躁。按照张仲景的说法：“伤寒脉浮滑，这是表有热，里有寒，用白虎汤主治。”对此我怀疑必定有误。他又说：“热结在里，表里俱热，大渴饮水，用白虎汤主治。”又说：“表证未解者，不可给予白虎汤。”另外在阳明病条文中提到：“表热里寒，用四逆汤主治。”在少阳病条文中提到：“里寒外热，用通脉四逆汤主治。”由此可知，他说“脉浮滑，表热里寒”中的“表”和“里”二字必定是传写讹误。即使仅凭张仲景的其他论述来推断，难道有里寒却反而使用大寒之剂的道理吗？难道有里寒却出现脉浮滑的情况吗？难道有里寒却出现大热、烦躁、口渴的情况吗？因此知道白虎汤是为阳明经大热证所设。所谓“里有寒”，肯定是错误的，毫无疑问。成无己随文注释，迷惑误导了后人，不得不详细为之辨析。白虎是西方的金神，对应秋季，归属于肺。表里俱热时，金被火所囚困，使用辛寒的药物来救肺，所以命名为白虎汤。《活人书》认为夏季阴气在内，应当戒用白虎汤；《明理论》说立秋后不可服用，恐怕白虎汤大寒会导致身体虚弱消瘦、不能进食。这两种说法都偏颇了。有病即当服相应的药，怎么可以拘泥于时节呢？假使在秋冬季节患病，如果没有表证，而出现大热、烦躁、口渴，就给予白虎汤，这是对证的良剂。虽然想不用它，又怎么可能呢？
Shao Yao (Paeoniae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Fu Zi (Aconiti Lateralis Radix Praeparata)
After sweating therapy, if the disease condition is not resolved and there is instead aversion to cold, this indicates a deficiency syndrome. One should administer this decoction. If the disease resolves after sweating, there will be no aversion to cold; if the disease does not resolve after sweating and the exterior excess remains... [Note: The original text appears fragmented here, transitioning into an explanation of herb functions]. Shao Yao (Paeoniae Radix) can astringe body fluids to nourish Ying Qi (Nutritive Energy). Fu Zi (Aconiti Lateralis Radix Praeparata), with its pungent and hot nature, secures Yang Qi to supplement Wei Qi (Defensive Energy). Gan Cao (Glycyrrhizae Radix et Rhizoma) harmonizes sour and pungent flavors, thereby stabilizing Zheng Qi (Upright Qi).
Gui Zhi (Cinnamomi Ramulus), Gan Cao (Glycyrrhizae Radix et Rhizoma), Sheng Jiang (Zingiberis Rhizoma Recens), Da Zao (Jujubae Fructus)
After inappropriate purgation in Tai Yang Disease (Disease of the Tai Yang Channel), if there is a rapid pulse and chest fullness, and if accompanied by slight aversion to cold, add Fu Zi (Aconiti Lateralis Radix Praeparata). The formula is named Gui Zhi Qu Shao Yao Jia Fu Zi Tang (Cinnamon Twig Decoction Modified by Removing Shao Yao and Adding Aconite). Chest fullness is unfavorable to sour-astringent herbs, hence Shao Yao (Paeoniae Radix) is removed. The term "slight aversion to cold" refers not to exterior cold, but to interior cold; therefore, Fu Zi (Aconiti Lateralis Radix Praeparata) is added to dispel cold and eliminate fullness.
Gui Zhi (Cinnamomi Ramulus), Huang Qin (Scutellariae Radix), Ren Shen (Ginseng Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Shao Yao (Paeoniae Radix), Sheng Jiang (Zingiberis Rhizoma Recens), Da Zao (Jujubae Fructus), Chai Hu (Bupleuri Radix), Ban Xia (Pinelliae Rhizoma)
In Shang Han (Cold Damage) disease, on the sixth or seventh day, symptoms include fever, slight aversion to cold, discomfort and pain in the limbs and joints, slight vomiting, and a sensation of support and obstruction in the epigastrium ("Zhi Jie"). This indicates that the exterior syndrome has not yet resolved. By the sixth or seventh day of Shang Han, the pathogen is at the time when it should transmit inward. At this stage, one may treat the interior by administering Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) to harmonize the exterior and interior. Zhang Zhongjing stated: When exterior symptoms are unresolved and there is a feeling of oppression in the epigastrium, it is called "Zhi Jie" (Supporting Obstruction), not "Pi" (Glomus/Blockage). This distinction must not be overlooked.
Zhi Mu (Anemarrhenae Rhizoma), Shi Gao (Gypsum Fibrosum), Gan Cao (Glycyrrhizae Radix et Rhizoma), Jing Mi (Oryza Sativa Var. Glutinosa)
After emesis or purgation, if the disease persists for seven or eight days without resolution, heat is consolidated within the interior, presenting as heat in both the exterior and interior, a floating and slippery pulse, severe thirst, and irritability. According to Zhang Zhongjing: "In Shang Han, a floating and slippery pulse indicates heat in the exterior and cold in the interior; Bai Hu Tang (White Tiger Decoction) governs this." I suspect this statement contains an error. He also stated: "Heat consolidated in the interior, with heat in both exterior and interior, and severe thirst for water, is governed by Bai Hu Tang (White Tiger Decoction)." Furthermore, he said: "If the exterior is not resolved, Bai Hu Tang (White Tiger Decoction) must not be given." Additionally, in the Yang Ming disease section, it states: "Heat in the exterior and cold in the interior are governed by Si Ni Tang (Frigid Extremities Decoction)." In the Shao Yang disease section, it states: "Cold in the interior and heat in the exterior are governed by Tong Mai Si Ni Tang (Pulse-Resuscitating Frigid Extremities Decoction)." From this, it is known that his mention of "floating and slippery pulse, heat in the exterior and cold in the interior" likely involves a transcription error swapping "exterior" and "interior." Even judging solely by Zhang Zhongjing's other discussions, how could interior cold warrant the use of a major cold-decoction? How could interior cold present with a floating and slippery pulse? How could interior cold present with severe heat, irritability, and thirst? Therefore, it is understood that Bai Hu Tang (White Tiger Decoction) is designed for major heat in the Yang Ming channel. The phrase "cold in the interior" is definitely erroneous. Cheng Wuji's commentary following the text misled later generations, necessitating this detailed clarification. Bai Hu (White Tiger) is the Metal Spirit of the West, corresponding to Autumn and belonging to the Lung. When there is heat in both exterior and interior, Metal is imprisoned by Fire; thus, acrid-cold herbs are used to rescue the Lung, which is why it is named Bai Hu Tang (White Tiger Decoction). *Huo Ren* (The Life-Saving Manual) suggests that in summer, Yin Qi is internal, so one should abstain from Bai Hu Tang (White Tiger Decoction); *Ming Li Lun* (Treatise on Clear Principles) states it should not be taken after Start of Autumn, fearing that the major cold of Bai Hu Tang (White Tiger Decoction) will cause weakness, emaciation, and loss of appetite. Both views are biased. When there is the disease, one should take the corresponding medicine; how can one be constrained by the season? Suppose a disease occurs in autumn or winter; if there are no exterior symptoms but rather severe heat, irritability, and thirst, then Bai Hu Tang (White Tiger Decoction) should be given as an excellent对症 (symptom-matching) remedy. Although one might wish to avoid using it, is it possible?