误汗者。非必不当汗而汗之。方为误汗。即应用麻黄汤症。亦但许发微似汗而已。宁许其大汗出乎。即使太阳
中风。发热汗出之症。亦当以桂枝汤发其微似汗。尚有如水流漓之戒。若使犯之。亦为误汗。况麻黄汤乎。后人
但知麻黄汤为发汗之药。而以桂枝为止汗之药。殊不知麻黄桂枝两汤。皆能使人误汗亡阳。故上编亦有误
汗之变。乃中风伤寒之所均有。因难以分篇。不得已而俱入中篇。读者审之。
发汗已。脉浮数。烦渴者。五苓散主之。
此条无伤寒二字者。以下节承上文语中有之。是以知其为伤寒也。此条义理深微。最不易解。若以常法论之。则脉
之浮数。当云浮则为风。数则为热。似与上文脉浮而数可发汗。用麻黄汤之同类矣。以证之烦渴论之。则烦为热邪
在里。渴则胃中热燥。又当与白虎加人参汤症相类矣。而长沙以五苓散主之。似乎以热治热。其义令人不解。所以
历代注家。俱不得其旨。故成氏有脉浮数为表邪未尽。烦渴为亡津液而胃燥之解。与五苓散和表润燥。遂以桂改
桂枝。而曰两解表里。然桂枝虽能和表。岂能润燥。况原方本来用桂而非桂枝乎。条辨又以汗出过多。腠理反开。风
邪又入。烦热而脉转浮数。渴者。亡津液而内燥。故用四苓以滋之。一桂以和之。亦以五苓为两解。愚窃谓津液既亡。
四苓之淡渗下走。如何可滋。津液既燥。一桂之辛散温热。如何治燥。尚论一如其说而不改。致仲景之旨晦而不彰
者久矣。余欲析其义。深思而未得其解。阁笔者半月余。因思天地阴阳升降之道。乃悟阴阳应象论所谓地气上为
云。天气下为雨。雨出地气。云出天气之义。而得烦渴用五苓散之旨。其故在发汗已三字。盖因汗多亡阳。下焦真阳
已虚。无蒸腾之用。乃地气不升之所致也。然渴之一症。各有不同。如太阳之渴。以膀胱之气化言。因气液不得上腾。
故专用五苓散主之。阳明之渴。以胃中津液枯燥言。故以白虎汤主之。少阳以邪在半表半里。往来寒热。或作或辍。
故或渴或不渴。而以小柴胡汤加减主之也。至于三阴则无渴证矣。虽有少阴引水自救。及厥阴消渴等证。非真渴
也。历代以来。唯李东垣知清阳有上升之义。故云渴为太阳之本证也。然五苓散凡六见于论中。皆以之专治太阳
渴证。而兼利小便者。以气化言也。盖因深明经义。知阴阳升降。天地气交之妙。默会膀胱为州都之官。津液藏焉。气
化则能出矣。及三焦为决渎之官。水道出焉之奥义。故知气上腾而为津液涕唾则不渴。气下降而成水。液则便泻。
所谓气化之功也。若下焦无蒸腾之用。是肾脏之地气不升。则上焦无气液之润而渴矣。地气既不升腾。则肺脏之
天气不降。无雨露之施。而小便不利矣。是以太阳之表。为膀胱之经。膀胱为肾之腑。过发其汗。卫阳败泄。
真阳虚衰。下焦无火。肾气不蒸。故上无津液而渴也。其立方之义。用桂以助肾脏蒸腾之气。更用诸轻淡以沛
肺家下降之功。使天地阴阳之气交通。气化流行。而上下之气液皆通矣。义详五苓散方论中。
辨误 五苓散一方。后人不能窥仲景立法之微妙。俱惮桂之辛热而不敢用。遂改桂为桂枝。而以四苓滋其内。桂
枝以解其外。为表里两解之剂。喻氏更以为术用苍。桂用枝。则于立方本意愈远愈失矣。岂以仲景立法之祖。不知
畏避。反于脉浮数而烦渴之证。偏用之耶。又于痞证中之泻心所不能解。其人渴而口燥烦。小便不利者。及阳明证
中不更衣十日。渴欲饮水者。亦概用之耶。读古人书而不知古人之工夫学力。漫以讹传俗习之肤见窥之。遂至不
达其意。致废而不用。惜哉。
伤寒汗出而渴者。五苓散主之。不渴者。茯苓甘草汤主之。
此条欲言汗出不渴之治。故复叙上文汗出而渴之症。非另立一证也。其不再言脉浮数而烦渴者。因是承上文语。
故略之也。其所以又出不渴一条者。所以形容上文汗出而渴之一证。难测难治。最易误人。以最烦热之脉症。而用
最不易用之热药也。唯其有此平常容易。乃见上文之隐晦难明。观其文理之密。别识之精。而注家茫然不知。良可
为之浩叹也。言上文所云伤寒服麻黄汤后。汗出多而渴者。为真阳已虚。非五苓散不足以治之矣。若汗出而不渴
者。则其汗未为太过。知阳气未虚。津液无损。气化如常矣。然初汗之后恐卫气未和。津液未布。故但以茯苓甘草汤
主之。亦收拾余邪之意也。
茯苓甘草汤方
茯苓（二两） 桂枝（二两） 生姜（二两） 甘草（一两）
上四味。以水四升。煮取二升。去滓。分温三服。
辨误 前中风篇内。明言桂枝本为解肌。若脉浮紧发热汗不出者。不可与也。此条明系伤寒。何故反用桂枝。
若不明辨。何怪前人以桂枝为固卫止汗乎。盖仲景之用桂枝汤者。以阳浮热自发。故以桂枝之辛温解散。
发卫家之微汗。又以阴弱汗自出。故以芍药之酸收。敛营阴之汗液也。夫汗者。阳气蒸阴液之所成也。阴液者。
营血之所化也。若寒邪入营。正宜以麻黄汤泄其营内之寒邪。岂宜以芍药之酸收。敛其营气乎。故曰不可与也。
此条虽系伤寒。而已经发汗矣。犹恐尚有遗邪。营气终未当敛。故以茯苓之渗利代之。但以桂枝甘草。调和卫气而已。
较之用芍药之桂枝汤。非大相迳庭乎。所谓不可与者。盖不与桂枝汤耳。非不与桂枝也。
发汗后。水药不得入口为逆。若更发汗。必吐下不止。
旧说桂枝有四禁。此条亦在禁例。余阅仲景论中。既有桂枝本为解肌。其人脉浮紧发热汗不出者。不可与也一条。
则凡寒伤营之证。皆在所禁。岂止四条。此所谓发汗者。用麻黄汤发汗过多也。误汗则胃中阳气虚损。胃本司纳。因
胃中虚冷。气上逆而不受。故水药俱不得入口。以主纳者不得纳。故谓之逆。然与水逆证之水入则吐不同也。彼以
未经汗解。表里俱有邪。水既入而后吐。故曰水逆。此以误汗亡阳。胃虚气逆。水药不得暂入。故但谓之逆。言误汗变
逆。已致水药不得入口矣。若又不知而更发其汗。则胃阳愈败。必至中气不守。上吐下泄而不止矣。此条仲景虽未
立方。然温中扶胃之法。如人参桂枝汤之类。可酌用也。或曰误汗亡阳。不过损泄卫气耳。既非误下。何
至内伤胃气而水药不得入口。且甚至吐下不止乎。夫人身先天阳气。藏于两肾之中。其清阳升发而为三焦之气。附于肝
胆。
布其阳气而为后天之火。温养脾胃。故饮食入胃。谷之浊气下降。为命门真火之所蒸腾。则阳气发越。其 悍滑疾之
气。直达皮肤而为卫气。是以误汗则卫气丧失。真阳大虚。胃气亦随之而损也。恶得有卫阳败泄而胃气无损者乎。
仲景深知经义。故能言之。但未肯道其详耳。后人每以心火相火三焦火胃火分论。不知天之六气。地之五行。即阴
阳二气之分也。二气之分。又即一气之升降也。孙真人云。不知太易。不足以言医。况并不知经义。更曷足以言医。呜
呼。斯道之不振。又安足怪乎。
发汗后。其人脐下悸者。欲作奔豚。茯苓桂枝甘草大枣汤主之。
奔豚者。即前烧针令汗。针处被寒所发之奔豚。乃肾家奔突上冲之阴邪也。悸者。筑筑然惕动。状若心惊而恍惚跳
跃也。误汗之后。阳气已虚。下焦阴寒之气。欲作奔豚而气先上逆。故从脐下忽筑筑然而悸动也。前针处被寒。以必
作奔豚。从少腹上攻心。其势较甚。故以桂枝加桂汤温散其寒邪。此条但云欲作奔豚。欲作非必作可比。乃可作可
不作之间耳。但因脐下悸。知阴气已动。恐其欲作奔豚。故以茯苓桂枝甘草大枣汤主之也。
茯苓桂枝甘草大枣汤方
茯苓（半斤） 桂枝（四两） 甘草（二两炙） 大枣（十五枚擘）
上四味。以甘澜水一斗。先煮茯苓减一升。内诸药煮取三升。去滓。温服一升。日三服。
取甘澜水法 取水二斗。置大盆内。以杓扬之。水上有珠子五六千颗相逐。取用之。
茯苓气味淡而渗。阳中之阴。其性上行而后下降。能滋水之源而降下。本草谓其能利小便而伐肾邪。故倍
用之以为君。桂枝辛温和卫。而能宣通阳气。故多用之以为臣。李东垣云。阳不足者补之以甘。故凤髓丹
用甘草。以缓肾之急而生元气也。更用大枣以和润其津液而剂成矣。用甘澜水者。动则其性属阳。扬则其势下
走故也。
发汗后。腹胀满者。浓朴生姜甘草半夏人参汤主之。
腹胀满者。太阴脾土之本证也。发汗后。阳气虚损。胃气不行。脾弱不运。津液不流。阴气内壅。胃病而
脾亦病也。虽非误下成痞。而近于气痞矣。以浓朴生姜甘草半夏人参汤主之。
浓朴生姜甘草半夏人参汤方
浓朴（半斤去皮炙） 生姜（半斤切） 半夏（半斤洗） 人参（一两） 甘草（二两炙）
上五味。以水一斗。煮取三升。去滓。温服一升。日三服。
浓朴味苦辛而性温。下气开滞。豁饮泄实。故能平胃气而除腹满。张元素云。治寒胀而与热药同用。乃
结者散之之神药也。此虽阳气已伤。因未经误下。故虚中有实。以胃气未平。故以之为君。生姜宣通阳气。半夏蠲
饮利膈。故以之为臣。参甘补中和胃。所以益汗后之虚耳。然非胀满之要药。所以分两独轻。由此推之。若胃气不
甚亏而邪气反觉实者。尚当消息而去取之。未可泥为定法也。观金匮之治腹痛腹满。仲景以浓朴三物七物两汤治之。皆
与枳实大黄同用。则虚实之分自见矣。
发汗过多。其人叉手自冒心。心下悸。欲得按者。桂枝甘草汤主之。
发汗过多者。前桂枝本为解肌。过多尚有如水流漓之戒。若过用麻黄汤。尤为发汗过多。则阳气大虚。
阳本受气于胸中。故膻中为气之海。上通于肺而为呼吸。位处心胸之间。发汗过多。则阳气散亡。气海空虚。
所以叉手自冒覆其心胸。而心下觉惕惕然悸动也。凡病之实者。皆不可按。按之则或满或痛而不欲也。故素
问举痛论云。寒气客于经脉之中。与炅气相薄则脉满。满则痛而不可按也。又云脉充大而血气乱。故痛甚不
可按也。此以误汗亡阳。心胸真气空虚而悸动。故欲得按也。因此条是误汗所致。故以桂枝甘草和卫扶阳。
补中益气。但此方性味和平。力量浅鲜。如参芍之补敛。恐不可少。仲景立方。谅不止此。或有脱落。未可
知也。若方氏以心血为重。置阳虚而弗论。尚论讥之。不亦宜乎。
桂枝甘草汤方
桂枝（四两） 甘草（二两炙）
上二味。以水三升。煮取一升。去滓顿服。（义具注中不另立论）
未持脉时。病患叉手自冒心。师因教试令咳而不咳者。此必两耳无闻也。所以然者。以重发汗。虚故如
此。
此论误汗阳虚之耳聋。以辨不必邪在少阳。然后耳聋也。夫足少阳之脉。起于目锐 。上抵头角。下耳后。
其支者从耳后入耳中。出走耳前。下胸中。贯膈络肝属胆。循胁里。故素问热论篇云。少阳主胆。其脉循胁络
于耳。故胸胁痛而
耳聋也。若夫汗后阳虚。皆以发汗过多。卫阳散亡之故。非邪在少阳也。以服桂枝而如水流漓。已为痛戒。
如麻黄汤者。其可重用乎。所以古人用药治病。中病即已。五常政大论所谓小毒治病。十去其八。无毒治病。
十去其九。无使过之。伤其正也。然以卫气散亡而能令人耳聋者。何也。耳者。肾之窍也。阴阳应象论云。
在脏为肾。在窍为耳。卫气者。乃胃中谷气下降。为肾中真阳之所蒸腾。发越而布于皮肤。以捍卫风寒者也。
营卫皆属太阳而为表。真阳藏于少阴两肾之中而为里。故一脏一腑。相为表里而成一合也。误汗亡阳。则肾家
之真阳败泄。所以肾窍之两耳无闻。犹老年肾惫阳衰。亦两耳无闻。其义一也。仲景虽不立治。然欲治之。
亦不外乎汗多亡阳之法也。
发汗病不解。反恶寒者。虚故也。芍药甘草附子汤主之。
发汗病不解者。发汗过多而阳气虚损。故生外寒。仍如未解之状也。恶寒而曰反者。不当恶而恶也。本
以发热恶寒而汗之。得汗则邪气当解而不恶寒矣。今病不解而反恶寒者。非风寒在表而恶寒。乃
误汗亡阳。卫气丧失。阳虚不能卫外而恶寒也。或曰。既云发汗病不解。安知非表邪未尽乎。曰。若伤寒
汗出不解。则当仍有头痛发热。脉浮紧之辨矣。而仲景非唯不言发热。且毫不更用解表。而毅然断之曰虚故也。
即以芍药甘草附子汤主之。则知所谓虚者。阳气也。与上文虚字无异。其脉必微弱。或虚大虚数而见汗出但
恶寒之证。如附子泻心证。及用桂枝加附子汤。桂枝去芍药加附子汤之类。故曰虚故也。而以芍药甘草附子汤主之。
芍药甘草附子汤方
芍药（三两） 甘草（三两炙） 附子（一枚炮去皮破八片）
以上三味。以水五升。煮取一升五合。去滓分温服。
芍药酸收。敛汗液而固营阴。附子辛热。补真阳而强卫气。甘草扶植中州。调和营卫。所谓温经复阳之治也。
发汗后。恶寒者。虚故也。不恶寒但恶热者。实也。当和胃气。与调胃承气汤。
误汗，并不一定是指在不应当发汗的情况下使用了发汗法才叫误汗。即使是应用麻黄汤的证候，也只允许发出微微似有汗出的效果，岂能允许大汗淋漓呢？即使是太阳中风，出现发热、汗出的症状，也应当用桂枝汤发出微微似有汗出的效果，尚且有像水流漓淋那样的禁忌告诫。如果违背了这个原则，也是误汗，更何况是麻黄汤呢？后人只知道麻黄汤是发汗的药，而把桂枝汤当作止汗的药，却不知道麻黄汤和桂枝汤这两首方剂，都能导致人因误汗而亡阳。所以上编也有误汗产生的变证，这是中风和伤寒都会有的情况，因为难以分篇论述，不得已都放入中篇。读者要仔细审察。
发汗之后，脉象浮数，心烦口渴的，用五苓散主治。
这一条没有“伤寒”二字，是因为下文承接上文语意中有提到，所以知道它是属于伤寒。这一条的义理深奥微妙，最不容易理解。如果用常法来讨论，那么脉象浮数，按理说浮则为风邪，数则为热邪，似乎与上文的“脉浮而数可发汗，用麻黄汤”属于同类了。从症状的心烦口渴来看，烦是热邪在里，渴则是胃中热燥，又应当与白虎加人参汤的证候相似了。但张仲景却用五苓散来主治，似乎是用热药治热病，其中的义理令人不解。所以历代注家，都不能领会其宗旨。因此成无己解释说：脉浮数是表邪未尽，烦渴是亡失津液而导致胃燥，主张用五苓散和解表里，于是把原方中的桂改为桂枝，说是两解表里。然而桂枝虽然能和表，怎么能润燥呢？况且原方本来用的就是桂（肉桂）而不是桂枝啊。柯韵伯又在条辨中说：因为出汗过多，腠理反而开放，风邪又侵入，导致烦热而脉转浮数，口渴，是亡失津液而内部干燥，所以用四苓（茯苓、猪苓、泽泻、白术）来滋润它，用一桂（桂枝）来调和它，也是把五苓散看作两解之剂。我私下认为，津液既然已经亡失，四苓的淡渗下走之性，怎么可以滋润呢？津液既然已经干燥，一桂的辛散温热之性，怎么可以治疗燥证呢？尚论篇依然沿袭这种说法而不改正，导致张仲景的宗旨晦暗不明已经很久了。我想要剖析其中的义理，深思却没有得到解答，搁笔半月多。后来思考天地阴阳升降的道理，才领悟到《阴阳应象大论》所说的“地气上为云，天气下为雨，雨出地气，云出天气”的含义，从而得到了烦渴用五苓散的旨意。其关键就在“发汗已”这三个字。大概是因为汗多导致亡阳，下焦真阳已经虚弱，失去了蒸腾的作用，这是地气不升所致。然而口渴这一症状，各有不同。如太阳病的口渴，是从膀胱的气化功能来说的，因为气液不能上腾，所以专用五苓散主治。阳明病的口渴，是从胃中津液枯燥来说的，所以用白虎汤主治。少阳病邪在半表半里，往来寒热，发作有时，所以有时渴有时不渴，用小柴胡汤加减主治。至于三阴病则没有渴证了。虽然有少阴病引水自救，及厥阴病消渴等证，也不是真正的渴。历代以来，只有李东垣知道清阳有上升的意义，所以说渴是太阳的本证。然而五苓散在《伤寒论》中凡六次出现，都是专门用来治疗太阳渴证，并兼有利小便的作用，这是从气化功能来说的。大概是因为深深明白经义，知晓阴阳升降、天地气交的精妙，默会膀胱作为州都之官，津液藏于此，气化后才能排出；以及三焦作为决渎之官，水道由此而出的奥义。所以知道气上腾成为津液涕唾则不渴，气下降形成水液则便泻，这就是所谓气化的功效。如果下焦没有蒸腾的作用，就是肾脏的地气不升，那么上焦就没有气液的滋润而口渴了。地气既不升腾，那么肺脏的天气也不降，没有雨露的施予，而小便就不利了。所以太阳之表，是膀胱之经，膀胱是肾之腑。过度发汗，卫阳败坏泄越，真阳虚衰，下焦无火，肾气不蒸，所以上面没有津液而口渴。其立方的意义，用桂来辅助肾脏蒸腾之气，再用诸味轻淡的药物来沛助肺家下降的功能，使天地阴阳之气交通，气化流行，而上下的气液都通畅了。义理详见五苓散方论中。
辨误：五苓散这一方子，后人不能窥探张仲景立法的微妙之处，都畏惧桂的辛热而不敢使用，于是改桂为桂枝，而以四苓滋养其内，桂枝以解除其外，作为表里两解的方剂。喻嘉言更认为白术改用苍术，桂改用桂枝，那就离立方本意越来越远，更加失当了。难道以为张仲景是立法的始祖，不知道畏避吗？反而在脉浮数而烦渴的证候中，偏要使用它呢？又在痞证中，泻心汤所不能解决的，其人渴而口燥烦，小便不利的，以及阳明证中，十天不大便，想喝水的，也都一概使用它吗？读古人的书却不知道古人的工夫学力，随意以讹传俗习的肤浅见解去窥探，以至于不理解其意，导致废弃不用，可惜啊。
伤寒汗出而口渴的，五苓散主治。不口渴的，茯苓甘草汤主治。
这一条想要论述汗出不渴的治疗，所以再次叙述上文汗出而渴的症状，并不是另外设立一个证候。其中不再提脉浮数而烦渴，是因为承接上文语意，所以省略了。之所以又列出不渴的一条，是为了形容上文汗出而渴这一证候，难测难治，最容易误导人。以最烦热的脉症，却用最不易使用的热药。正因为有这个平常容易的情况，才显出上文的隐晦难明。看其文理的严密，别识的精微，而注家茫然不知，实在值得为之长叹。说的是上文所说的伤寒服用麻黄汤后，汗出多而口渴的，是真阳已经虚弱，非五苓散不足以治疗。如果汗出而不渴，那么他的汗还没有太过，知道阳气未虚，津液无损，气化如常。然而在初汗之后，恐怕卫气未和，津液未布，所以只用茯苓甘草汤主治，这也是收拾余邪的意思。
茯苓甘草汤方
茯苓（二两） 桂枝（二两） 生姜（二两） 甘草（一两）
以上四味药，用水四升，煮取二升，去掉药渣，分三次温服。
辨误：前中风篇内，明确说明桂枝本是解肌的，如果脉浮紧、发热、汗不出者，不可给予。这一条明确是伤寒，为什么反而用桂枝？如果不明白辨析，难怪前人把桂枝当作固卫止汗的药。大概张仲景使用桂枝汤，是因为阳浮热自发，所以用桂枝的辛温解散，发出卫气的微汗；又因为阴弱汗自出，所以用芍药的酸收，收敛营阴的汗液。汗，是阳气蒸腾阴液所形成的。阴液，是由营血所化生的。如果寒邪入营，正宜用麻黄汤泄其营内的寒邪，岂能用芍药的酸收，收敛其营气呢？所以说不可给予。这一条虽然是伤寒，但已经发过汗了，还恐怕尚有遗留的邪气，营气终究不应当收敛，所以用茯苓的渗利来代替，只用桂枝甘草来调和卫气罢了。这与使用芍药的桂枝汤，不是大相径庭吗？所谓“不可与”，是不给桂枝汤而已，不是不给桂枝。
发汗后，水药不得入口为逆证。如果再发汗，必定呕吐下利不止。
旧说桂枝有四禁，这一条也在禁忌之列。我阅读仲景的论述中，既有“桂枝本为解肌，其人脉浮紧发热汗不出者，不可与也”一条，那么凡是寒伤营的证候，都在所禁之内，岂止四条。这里所说的发汗，是用麻黄汤发汗过多。误汗导致胃中阳气虚损，胃本司纳受，因为胃中虚冷，气上逆而不受纳，所以水药都不得入口。因为主纳者不能纳，所以叫做逆。但这与水逆证的水入则吐不同。水逆证是因为未经汗解，表里俱有邪气，水既入而后吐，所以叫水逆。这里是误汗亡阳，胃虚气逆，水药不得暂入，所以只叫逆。意思是误汗变成逆证，已经导致水药不得入口了。如果又不知道而再发其汗，那么胃阳更加败坏，必定至中气不守，上吐下泄而不止。这一条仲景虽然没有立方，但温中扶胃的方法，如人参桂枝汤之类，可以酌情使用。有人问：误汗亡阳，不过是损泄卫气罢了，既然不是误下，怎么会内伤胃气而水药不得入口，甚至吐下不止呢？回答是：人身先天阳气，藏在两肾之中，其清阳升发成为三焦之气，依附于肝胆，布散其阳气成为后天之火，温养脾胃。所以饮食入胃，谷之浊气下降，为命门真火所蒸腾，则阳气发越，那剽悍滑疾之气，直达皮肤成为卫气。所以误汗则卫气丧失，真阳大虚，胃气也随之而损伤。哪里有卫阳败泄而胃气无损的呢？仲景深知经义，所以能这样说，只是不肯道其详细罢了。后人每每用心火、相火、三焦火、胃火分别论述，不知道天的六气、地的五行，就是阴阳二气的分别。二气的分别，又是一气升降的表现。孙真人说：不知道太易，不足以言医。何况并不知道经义，更凭什么言医？唉，这门学问的不振兴，又有什么奇怪的呢？
发汗后，其人脐下悸动的，欲作奔豚，用茯苓桂枝甘草大枣汤主治。
奔豚，就是前文烧针令汗，针处被寒邪所引发的奔豚，是肾家奔突上冲的阴邪。悸，是筑筑然惕动，状若心惊而恍惚跳跃。误汗之后，阳气已虚，下焦阴寒之气，欲作奔豚而气先上逆，所以从脐下忽然筑筑然而悸动。前文针处被寒，以必作奔豚，从少腹上攻心，其势较甚，所以用桂枝加桂汤温散其寒邪。这一条只说欲作奔豚，“欲作”不同于“必作”，是可作可不作之间罢了。但因为脐下悸，知道阴气已动，恐怕其欲作奔豚，所以用茯苓桂枝甘草大枣汤主治。
茯苓桂枝甘草大枣汤方
茯苓（半斤） 桂枝（四两） 甘草（二两炙） 大枣（十五枚擘）
以上四味药，用甘澜水一斗，先煮茯苓减少一升，加入其他药物煮取三升，去掉药渣，温服一升，每日三次。
取甘澜水法：取水二斗，放在大盆内，用杓扬之，水上有珠子五六千颗相逐，取用之。
茯苓气味淡而渗，属阳中之阴，其性上行而后下降，能滋水之源而降下。本草说它能利小便而伐肾邪，所以倍用之为君药。桂枝辛温和卫，而能宣通阳气，所以多用之为臣药。李东垣说：阳不足者补之以甘，所以凤髓丹用甘草，以缓肾之急而生元气。更用大枣来和润其津液而完成方剂。用甘澜水的道理，动则其性属阳，扬则其势下走。
发汗后，腹胀满的，厚朴生姜甘草半夏人参汤主治。
腹胀满，是太阴脾土的本证。发汗后，阳气虚损，胃气不行，脾弱不运，津液不流，阴气内壅，胃病而脾亦病。虽然不是误下成痞，但近于气痞了。用厚朴生姜甘草半夏人参汤主治。
厚朴生姜甘草半夏人参汤方
厚朴（半斤去皮炙） 生姜（半斤切） 半夏（半斤洗） 人参（一两） 甘草（二两炙）
以上五味药，用水一斗，煮取三升，去掉药渣，温服一升，每日三次。
厚朴味苦辛而性温，下气开滞，豁饮泄实，所以能平胃气而除腹满。张元素说：治寒胀而与热药同用，乃是结者散之的神药。这虽然阳气已伤，但因未经误下，故虚中有实，因胃气未平，所以用它为君药。生姜宣通阳气，半夏蠲饮利膈，所以用它为臣药。参甘补中和胃，所以益汗后之虚。然而它们不是胀满的要药，所以分量独轻。由此推之，如果胃气不甚亏而邪气反觉实者，还应当斟酌而去取，不可拘泥为定法。看《金匮要略》治疗腹痛腹满，仲景用厚朴三物汤、厚朴七物汤治疗，都与枳实大黄同用，则虚实之分自然可见了。
发汗过多，其人叉手自冒心，心下悸，欲得按的，桂枝甘草汤主治。
发汗过多，前文说桂枝本为解肌，过多尚有如水流漓的禁忌告诫。如果过用麻黄汤，尤为发汗过多，则阳气大虚。阳本受气于胸中，所以膻中为气之海，上通于肺而为呼吸，位处心胸之间。发汗过多，则阳气散亡，气海空虚，所以叉手自冒覆其心胸，而心下觉惕惕然悸动。凡病之实者，皆不可按，按之则或满或痛而不欲按。所以《素问·举痛论》说：寒气客于经脉之中，与炅气相薄则脉满，满则痛而不可按也。又说脉充大而血气乱，故痛甚不可按也。这里是误汗亡阳，心胸真气空虚而悸动，所以欲得按。因为这一条是误汗所致，所以用桂枝甘草和卫扶阳，补中益气。但这个方子性味和平，力量浅鲜，如参芍之补敛，恐怕不可少。仲景立方，谅不止此。或有脱落，不可知也。如果方氏以心血为重，置阳虚而不论，尚论讥之，不也是应该的吗？
桂枝甘草汤方
桂枝（四两） 甘草（二两炙）
以上两味药，用水三升，煮取一升，去掉药渣顿服。（义理具注中，不另立论）
未持脉时，病患叉手自冒心，医生因此教他试令咳嗽而不咳的，这必定两耳听不见。之所以这样，是因为重发汗，虚的缘故如此。
这一段论述误汗阳虚导致的耳聋，以辨别不必邪在少阳，然后才有耳聋。足少阳之脉，起于目锐眦，上抵头角，下耳后，其支者从耳后入耳中，出走耳前，下胸中，贯膈络肝属胆，循胁里。所以《素问·热论篇》说：少阳主胆，其脉循胁络于耳，故胸胁痛而耳聋也。如果是汗后阳虚，都是因为发汗过多，卫阳散亡的缘故，并非邪在少阳。服用桂枝汤而如水流漓，已是痛戒，如麻黄汤者，岂可重用呢？所以古人用药治病，中病即止。《五常政大论》所谓小毒治病，十去其八，无毒治病，十去其九，无使过之，伤其正也。然而卫气散亡而能令人耳聋，为什么呢？耳，是肾之窍。《阴阳应象大论》说：在脏为肾，在窍为耳。卫气，乃胃中谷气下降，为肾中真阳所蒸腾，发越而布于皮肤，以捍卫风寒者也。营卫皆属太阳而为表，真阳藏于少阴两肾之中而为里。所以一脏一腑，相为表里而成一合。误汗亡阳，则肾家之真阳败泄，所以肾窍之两耳无闻，犹如老年肾惫阳衰，亦两耳无闻，其义是一样的。仲景虽不立治法，但要治疗，也不外乎汗多亡阳之法。
发汗病不解，反恶寒的，虚的缘故。芍药甘草附子汤主治。
发汗病不解，是发汗过多而阳气虚损，故生外寒，仍如未解之状。恶寒而曰反者，是不当恶而恶。本以发热恶寒而汗之，得汗则邪气当解而不恶寒矣。现在病不解而反恶寒，不是风寒在表而恶寒，而是误汗亡阳，卫气丧失，阳虚不能卫外而恶寒。有人问：既然说发汗病不解，怎么知道不是表邪未尽呢？回答说：如果伤寒汗出不解，则应当仍有头痛发热、脉浮紧的辨别了。而仲景不仅不说发热，而且毫不更用解表，而毅然断之曰虚故也。即以芍药甘草附子汤主治，则知所谓虚者，是阳气也。与上文虚字无异。其脉必微弱，或虚大虚数而见汗出但恶寒之证，如附子泻心证，及用桂枝加附子汤、桂枝去芍药加附子汤之类。所以说虚故也。而以芍药甘草附子汤主治。
芍药甘草附子汤方
芍药（三两） 甘草（三两炙） 附子（一枚炮去皮破八片）
以上三味药，用水五升，煮取一升五合，去掉药渣分温服。
芍药酸收，敛汗液而固营阴。附子辛热，补真阳而强卫气。甘草扶植中州，调和营卫。所谓温经复阳的治法。
Misu Han (Erroneous Sweating) does not necessarily refer to the application of sweating therapy when it is contraindicated. Even in cases suitable for Mahuang Tang (Ephedra Decoction), only a slight perspiration resembling moisture on the skin is permitted; how could profuse sweating be allowed? Even in Taiyang Wind Strike (Taiyang Syndrome due to Wind pathogen), presenting with fever and spontaneous sweating, Guizhi Tang (Cinnamon Twig Decoction) should be used to induce only a slight perspiration resembling moisture on the skin. There is even a warning against sweating as if water were pouring down. If this principle is violated, it constitutes Misu Han. How much more so with Mahuang Tang? Later practitioners only know that Mahuang Tang is a diaphoretic agent and regard Guizhi Tang as an antiperspirant. They fail to realize that both Mahuang Tang and Guizhi Tang can lead to Yang collapse due to erroneous sweating. Therefore, the first section also discusses complications arising from Misu Han, which can occur in both Wind Strike and Cold Damage syndromes. Due to difficulty in separating them into different chapters, they are included together in the middle section. Readers should examine this carefully.
After sweating, if the pulse is floating and rapid, accompanied by vexation and thirst, Wuling San (Five-Ingredient Poria Pill) is indicated.
This clause lacks the term "Cold Damage" because it continues the context from the previous text, implying it belongs to Cold Damage. The principles here are profound and subtle, making it difficult to interpret. By conventional methods, a floating and rapid pulse suggests Wind and Heat respectively, seemingly similar to the earlier case where a floating and rapid pulse indicated the use of Mahuang Tang for sweating. Regarding symptoms of vexation and thirst: vexation indicates Heat pathogen in the interior, and thirst indicates dryness and heat in the Stomach, resembling Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction). However, Zhang Zhongjing uses Wuling San, seemingly treating heat with heat, which is puzzling. Thus,历代 commentators have failed to grasp its essence. Cheng Wuji explained that floating and rapid pulse indicates incomplete exterior pathogens, while vexation and thirst result from fluid depletion and Stomach dryness, proposing Wuling San to harmonize the exterior and moisten dryness, changing Gui (Cinnamon Bark) to Guizhi (Cinnamon Twig) to achieve dual resolution of exterior and interior. However, although Guizhi can harmonize the exterior, how can it moisten dryness? Moreover, the original formula uses Gui (Cinnamon Bark), not Guizhi. Ke Yunbo argued in his annotations that excessive sweating opens the pores, allowing Wind to re-enter, causing vexation, heat, floating-rapid pulse, and thirst due to fluid depletion and internal dryness. He suggested using Si Ling (Four-Ingredient Poria) to nourish and one portion of Guizhi to harmonize, viewing Wuling San as a dual-resolving formula. I privately believe that since fluids are depleted, the diuretic nature of Si Ling cannot nourish; since dryness exists, the acrid-warm dispersing nature of Guizhi cannot treat dryness. Shanglun followed this view without correction, obscuring Zhang Zhongjing’s intent for a long time. I pondered deeply but found no solution until contemplating the ascending and descending of Yin and Yang in Heaven and Earth, realizing the meaning of "Earth Qi ascends to form clouds, Heaven Qi descends to form rain; rain comes from Earth Qi, clouds come from Heaven Qi." This revealed the rationale for using Wuling San for thirst after sweating. The key lies in "after sweating." Excessive sweating leads to Yang collapse, weakening the True Yang in the Lower Jiao, losing its steaming function, causing Earth Qi not to ascend. Thirst varies by syndrome: Taiyang thirst relates to Bladder Qi transformation failing to ascend fluids, treated specifically with Wuling San. Yangming thirst relates to Stomach fluid dryness, treated with Baihu Tang. Shaoyang involves half-exterior/half-interior pathogens with alternating chills and fever, causing variable thirst, treated with Xiaochaihu Tang (Minor Bupleurum Decoction) modifications. Three Yin syndromes generally lack thirst; although Shaoyin has self-induced drinking and Jueyin has Xiao Ke (Wasting-Thirst), these are not true thirst. Only Li Dongyuan understood the ascending nature of Clear Yang, stating thirst is a fundamental symptom of Taiyang. Wuling San appears six times in the Treatise, specifically for Taiyang thirst with diuresis, emphasizing Qi transformation. Understanding the profound meaning that the Bladder (Palace of Water) stores fluids and excretes them via Qi transformation, and the Triple Burner (Sanjiao) regulates water passages, one realizes that ascending Qi becomes fluids preventing thirst, while descending Qi forms urine. If Lower Jiao lacks steaming, Kidney Earth Qi does not ascend, leading to Upper Jiao fluid deficiency and thirst. Without ascending Earth Qi, Lung Heaven Qi does not descend, lacking rain-like nourishment, causing urinary difficulty. Taiyang exterior corresponds to the Bladder meridian, the Bladder being the Fu organ of the Kidney. Over-sweating damages Wei Yang, depleting True Yang, leaving Lower Jiao fireless and Kidney Qi un-steamed, resulting in upper fluid deficiency and thirst. The formula uses Gui to assist Kidney steaming Qi, and light, bland herbs to aid Lung descending function, facilitating communication between Heaven and Earth Qi, promoting Qi transformation, and ensuring smooth flow of fluids above and below. See detailed discussion in Wuling San commentary.
Correction: Later practitioners, unable to perceive the subtlety of Zhang Zhongjing’s formulation, fear the acrid-warm nature of Gui and dare not use it, replacing it with Guizhi and using Si Ling internally while Guizhi addresses the exterior, creating a dual-resolving formula. Yu Jiayou further modified Atractylodes to Cang Zhu and Gui to Guizhi, deviating further from the original intent. Did Zhang Zhongjing, the ancestor of formulation, not know to avoid such ingredients? Yet he used them for floating-rapid pulse with vexation and thirst. Also, in Pi (Glomus) syndrome where Xiexin Tang fails, for patients with thirst, dry mouth, vexation, and dysuria, or Yangming syndrome with ten days without stool and desire to drink, are they all treated with Wuling San? Reading ancient texts without understanding the authors' scholarly effort, relying on superficial popular misconceptions, leads to misunderstanding and abandonment of effective treatments. Regrettable.
In Cold Damage, sweating with thirst is treated with Wuling San. Sweating without thirst is treated with Fuling Jiangzhi Tang (Poria, Cinnamon Twig, Ginger, and Licorice Decoction).
This clause introduces the treatment for sweating without thirst by reiterating the previous sweating-with-thirst syndrome, not establishing a new syndrome. It omits floating-rapid pulse and vexation-thirst as it continues the previous context. Including the non-thirst clause highlights the difficulty and potential for error in treating the sweating-with-thirst syndrome, where severe heat symptoms require careful use of warm herbs. The ordinary nature of the non-thirst case contrasts with the obscurity of the thirst case. The previous text states that after taking Mahuang Tang for Cold Damage, excessive sweating leading to thirst indicates True Yang deficiency, requiring Wuling San. If sweating occurs without thirst, the sweating was not excessive, indicating intact Yang Qi, undamaged fluids, and normal Qi transformation. However, post-sweating, Wei Qi may be disordered and fluids unspread, so Fuling Jiangzhi Tang is used to resolve residual pathogens.
Fuling Jiangzhi Tang Formula
Fuling (Poria) (2 liang) Guizhi (Cinnamon Twig) (2 liang) Shengjiang (Fresh Ginger) (2 liang) Gancao (Licorice Root) (1 liang)
These four ingredients are boiled in 4 sheng of water to obtain 2 sheng. Remove dregs and take warm in three divided doses.
Correction: In the Wind Strike chapter, it is explicitly stated that Guizhi is for resolving the muscle layer; if the pulse is floating-tight, with fever but no sweating, it is contraindicated. This clause clearly describes Cold Damage, yet uses Guizhi. Without clear distinction, predecessors wrongly viewed Guizhi as a stabilizer to stop sweating. Zhang Zhongjing uses Guizhi Tang because floating Yang causes spontaneous heat, so Guizhi’s acrid-warm nature disperses slightly to release Wei Qi sweat; Yin weakness causes spontaneous sweating, so Shaoyao’s sour-astringent nature retains Ying Yin sweat. Sweat is formed by Yang Qi steaming Yin fluids, which are transformed from Ying Blood. If Cold Pathogen enters Ying, Mahuang Tang should be used to vent Cold from Ying; using Shaoyao to astringe Ying Qi would be inappropriate, hence "contraindicated." Although this is Cold Damage, sweating has already occurred. To prevent lingering pathogens and improper Ying astringency, Fuling’s draining property replaces Shaoyao, while Guizhi and Gancao harmonize Wei Qi. This differs significantly from Guizhi Tang containing Shaoyao. "Contraindicated" means contraindicated for Guizhi Tang, not for Guizhi itself.
After sweating, if water and medicine cannot be tolerated orally, it is considered Ni (Rebellious/Adverse). If sweating is induced again, vomiting and diarrhea will ceaselessly continue.
Old theories list four contraindications for Guizhi; this clause falls under them. Since Zhang Zhongjing stated that for floating-tight pulse, fever, and no sweating (Cold damaging Ying), Guizhi is contraindicated, all Cold-damaging-Ying cases are forbidden, not just four. Here, "sweating" refers to excessive sweating via Mahuang Tang. Erroneous sweating damages Stomach Yang. The Stomach governs reception; due to Stomach deficiency-cold, Qi rebels upward, rejecting intake. Thus, water and medicine cannot enter. Because the receiver cannot receive, it is called Ni (Rebellious). This differs from Shui Ni (Water Reversal) where water is vomited immediately upon ingestion due to unresolved exterior-interior pathogens. Here, erroneous sweating causes Yang collapse, Stomach deficiency, and Qi rebellion, preventing temporary retention of intake, termed simply Ni. If sweating is induced again unknowingly, Stomach Yang will further deteriorate, leading to loss of Middle Qi control, resulting in ceaseless vomiting and diarrhea. Although Zhang Zhongjing provides no formula here, warming the Middle and supporting Stomach methods, such as Renshen Guizhi Tang (Ginseng and Cinnamon Twig Decoction), can be considered. One might ask: Does erroneous sweating Yang collapse only damage Wei Qi? Why does it injure Stomach Qi to the point of oral intolerance and ceaseless vomiting/diarrhea? Answer: Congenital Yang Qi resides in the two Kidneys. Clear Yang ascends to become Sanjiao Qi, attaching to Liver and Gallbladder, distributing Yang Qi as Postnatal Fire to warm Spleen and Stomach. Food entering the Stomach, turbid Qi descends, steamed by Mingmen True Fire, causing Yang Qi to expand. The vigorous, slippery Qi reaches the skin as Wei Qi. Thus, erroneous sweating loses Wei Qi, severely depletes True Yang, and damages Stomach Qi. How can Wei Yang collapse occur without Stomach Qi damage? Zhang Zhongjing understands these principles well but does not elaborate fully. Later practitioners distinguish Heart Fire, Ministerial Fire, Sanjiao Fire, and Stomach Fire separately, ignoring that Heaven’s Six Qi and Earth’s Five Elements are divisions of Yin and Yang, which are themselves divisions of one Qi’s ascent and descent. Sun Simiao said: "Not knowing Taiyi (Great Unity), one cannot speak of medicine." How much less those who ignore classical principles! Alas, why wonder at the decline of this art?
After sweating, if palpitations arise below the umbilicus, suggesting impending Ben Tun (Running Piglet), Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) is indicated.
Ben Tun refers to the Running Piglet caused by cold invading the puncture site after burning needle sweating, representing Yin pathogen surging upward from the Kidneys. Ji (Palpitations) describes a throbbing, startled sensation, like heart fright jumping. After erroneous sweating, Yang is deficient, and Yin-Cold in the Lower Jiao rises prematurely, causing sudden throbbing below the umbilicus. Previously, cold at the needle site guaranteed Ben Tun attacking from lower abdomen to heart, treated with Guizhi Jia Guizhi Tang (Cinnamon Twig Plus More Cinnamon Twig Decoction) to warm and disperse cold. Here, "impending Ben Tun" implies it may or may not develop. Palpitations below the umbilicus indicate moving Yin Qi, fearing Ben Tun development, hence Fuling Guizhi Gancao Dazao Tang.
Fuling Guizhi Gancao Dazao Tang Formula
Fuling (Poria) (8 liang) Guizhi (Cinnamon Twig) (4 liang) Gancao (Licorice Root, honey-fried) (2 liang) Dazao (Jujube, broken) (15 pieces)
These four ingredients are boiled in 1 dou of Ganlan Water (Agitated Water). First boil Fuling until reduced by 1 sheng, then add other herbs. Boil to obtain 3 sheng. Remove dregs and take 1 sheng warm, three times daily.
Method for preparing Ganlan Water: Take 2 dou of water, place in a large basin, and ladle it vigorously until 5,000–6,000 bubbles chase each other on the surface. Use this water.
Fuling has a bland taste and penetrating nature, belonging to Yin within Yang. Its action ascends then descends, nourishing the source of Water and directing it downward. Materia Medica states it promotes urination and suppresses Kidney pathogenic factors, hence used double dose as Sovereign herb. Guizhi is acrid, warm, and harmonizes Wei Qi, disseminating Yang Qi, thus used heavily as Minister herb. Li Dongyuan stated: "For Yang deficiency, supplement with sweet." Hence Fengsui Dan uses Gancao to ease Kidney urgency and generate Yuan Qi. Dazao harmonizes and moistens fluids to complete the formula. Ganlan Water is used because agitation gives it Yang nature, and ladling directs its energy downward.
After sweating, abdominal fullness is treated with Houpo Shengjiang Gancao Banxia Renshen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction).
Abdominal fullness is a fundamental syndrome of Taiyin Spleen Earth. After sweating, Yang Qi is damaged, Stomach Qi stagnates, Spleen is weak and fails to transport, fluids do not flow, Yin Qi obstructs internally. Stomach disease affects Spleen. Though not Pi (Glomus) from erroneous purgation, it resembles Qi Glomus. Treated with Houpo Shengjiang Gancao Banxia Renshen Tang.
Houpo Shengjiang Gancao Banxia Renshen Tang Formula
Houpo (Magnolia Bark, peeled and fried) (8 liang) Shengjiang (Fresh Ginger, sliced) (8 liang) Banxia (Pinellia, washed) (8 liang) Renshen (Ginseng) (1 liang) Gancao (Licorice Root, honey-fried) (2 liang)
These five ingredients are boiled in 1 dou of water to obtain 3 sheng. Remove dregs and take 1 sheng warm, three times daily.
Houpo is bitter, acrid, and warm, directing Qi downward, opening stagnation, resolving phlegm-fluids, and expelling excess, thus calming Stomach Qi and relieving abdominal fullness. Zhang Yuansu said: Treating Cold distension with hot herbs is a divine method for resolving accumulation. Although Yang is injured, without erroneous purgation, there is deficiency with excess. As Stomach Qi is unsettled, Houpo is Sovereign. Shengjiang disseminates Yang Qi; Banxia resolves phlegm-fluids and benefits the diaphragm, serving as Ministers. Renshen and Gancao tonify and harmonize the Middle, addressing post-sweat deficiency. However, they are not primary drugs for fullness, hence lighter doses. Inferring from this, if Stomach Qi is not severely deficient but pathogens appear excess, dosage should be adjusted. Do not rigidly adhere to fixed methods. In Jin Gui Yao Lue, Zhang Zhongjing treats abdominal pain/fullness with Houpo Sanwu Tang and Houpo Qiwu Tang, combined with Zhishi and Dahuang, clarifying deficiency-excess distinctions.
After excessive sweating, if the patient crosses hands over the heart region, feels palpitations in the epigastrium, and desires pressure, Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction) is indicated.
Excessive sweating, previously warned against even with Guizhi (resembling pouring water), is worse with Mahuang Tang, causing severe Yang deficiency. Yang receives Qi from the Chest Middle, where Danzhong is the Sea of Qi, connecting to Lungs for respiration, located between Heart and Chest. Excessive sweating scatters Yang Qi, emptying the Qi Sea. Hence, crossing hands over the chest-heart region and feeling palpitations. Solid conditions cannot be pressed; pressing causes fullness or pain. Suwen Ju Tong Lun states: Cold Qi lodging in meridians clashes with Heat Qi, causing vessel fullness, pain, and inability to press. Vessel fullness and chaotic Qi/Blood cause severe pain unrelieved by pressure. Here, erroneous sweating causes Yang collapse, emptiness of True Qi in Heart/Chest, leading to palpitations relieved by pressure. Since caused by erroneous sweating, Guizhi Gancao Tang harmonizes Wei, supports Yang, and tonifies Middle Qi. However, this formula is mild and weak. Tonics like Renshen and Shaoyao for astringency might be necessary. Zhang Zhongjing’s formulas likely had omissions. Fang Yi prioritizing Blood over Yang deficiency was rightly criticized by Shanglun.
Guizhi Gancao Tang Formula
Guizhi (Cinnamon Twig) (4 liang) Gancao (Licorice Root, honey-fried) (2 liang)
These two ingredients are boiled in 3 sheng of water to obtain 1 sheng. Remove dregs and take in one dose. (Principles detailed in notes, no separate theory).
Before taking the pulse, if the patient crosses hands over the heart, and the physician instructs coughing but the patient cannot cough, hearing is likely lost in both ears. This results from heavy sweating causing deficiency.
This discusses deafness due to Yang deficiency from erroneous sweating, distinguishing it from Shaoyang syndrome deafness. Shaoyang Meridian starts at outer eye corner, goes to head corner, behind ear, enters ear, exits front, passes chest, pierces diaphragm, connects Liver/Gallbladder, follows hypochondrium. Suwen Re Lun states: Shaoyang governs Gallbladder, meridian follows hypochondrium to ear, causing hypochondriac pain and deafness. Post-sweat Yang deficiency deafness is due to excessive sweating scattering Wei Yang, not Shaoyang pathogen. Sweating excessively with Guizhi is a warning; Mahuang Tang is certainly contraindicated. Ancient practitioners stopped medication once illness resolved. Wuchang Zheng Da Lun states: Toxic medicines remove 8/10 of disease, non-toxic remove 9/10. Do not overdo it and injure Healthy Qi. Why does Wei Yang scattering cause deafness? Ears are orifices of Kidneys. Yin-Yang Ying Xiang Da Lun states: In Zang organs is Kidney, in orifices is Ear. Wei Qi descends from Stomach Grain Qi, steamed by Kidney True Yang, expands to skin to defend against Wind-Cold. Ying and Wei belong to Taiyang (Exterior); True Yang hides in Shaoyang Kidneys (Interior). Zang-Fu pairs form exterior-interior unity. Erroneous sweating collapses Yang, damaging Kidney True Yang, causing bilateral deafness, similar to elderly Kidney exhaustion and Yang decline. Zhang Zhongjing offers no specific treatment, but the principle remains managing Yang collapse from excessive sweating.
After sweating, if illness persists and chills reverse (appear unexpectedly), it is due to deficiency. Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) is indicated.
Illness persisting after sweating indicates excessive sweating damaging Yang Qi, generating external cold, resembling unresolved state. Chills described as "reverse" imply unexpected occurrence. Originally fever/chills treated by sweating; sweat should resolve pathogens and chills. Now illness persists with reverse chills, not due to exterior Wind-Cold, but erroneous sweating collapsing Yang, losing Wei Qi, and Yang deficiency failing to protect exterior. One might ask: If illness persists, isn't it incomplete exterior pathogens? Answer: If Cold Damage sweating fails to resolve, headache, fever, and floating-tight pulse should remain. Zhang Zhongjing mentions neither fever nor uses exterior-resolving herbs, decisively diagnosing deficiency. Using Shaoyao Gancao Fuzi Tang confirms "deficiency" refers to Yang Qi, consistent with previous usage. Pulse must be weak, or vacuous-large/rapid, with sweating and only chills, similar to Fuzi Xie Xin Tang or Guizhi Jia Fuzi Tang/Guizhi Qu Shaoyao Jia Fuzi Tang cases. Hence "deficiency."
Shaoyao Gancao Fuzi Tang Formula
Shaoyao (Peony Root) (3 liang) Gancao (Licorice Root, honey-fried) (3 liang) Fuzi (Prepared Aconite Root, roasted, peeled, broken into 8 pieces) (1 piece)
These three ingredients are boiled in 5 sheng of water to obtain 1.5 sheng. Remove dregs and take warm in divided doses.
Shaoyao is sour and astringent, retaining sweat and securing Ying Yin. Fuzi is acrid and hot, tonifying True Yang and strengthening Wei Qi. Gancao supports the Middle and harmonizes Ying-Wei. This represents warming meridians and restoring Yang treatment.
After sweating, chills indicate deficiency. Absence of chills but aversion to heat indicates excess. Harmonize Stomach Qi with Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction).