深意。如太阴发汗而用桂枝汤。厥阴攻表亦用桂枝汤。其义自见。即使少阴之用麻黄。亦必与附子同用者。阴经皆
以阳气为重故也。又如金匮所载云。湿家身烦疼。可与麻加术汤发其汗为宜。慎不可以火攻之一节。因承上文身
疼发热。面黄而喘。头痛鼻塞。烦而脉大。无阴寒之症。故不用附子而忌火攻。既见头痛发热邪。在阳经。况有湿
气而身体烦疼。自宜发汗。故用麻黄全汤。更加术以燥湿也。又金匮湿病条中。更有风湿脉浮。身重汗出恶风者。
不用桂枝汤加减。而用防己黄 汤主之者。以脉浮汗出恶风。似乎风邪在表。应用桂枝。而仲景又侦知其卫气已虚。
皮肤不密。毛孔不闭。所以汗出恶风。乃湿家之表虚者。故用防己利水。以黄 固表。白术甘草燥湿补中而已。
皆因其表气已虚。卫阳不固。并微似汗之桂枝。亦不轻用矣。非用意渊深。而能制方若是邪。
去桂枝加白术汤。即术附汤。
桂枝附子去桂枝加白术汤者。即于桂枝附子汤方内。去桂枝。加术三两。余根据前法。
去桂枝加白术汤者。即术附汤也。因承上文桂枝附子汤加减。故云去桂枝加白术汤也。古方术上无白字。故称术
附汤。成氏不晓。误附于太阳上编遂漏不止之桂枝加附子汤后。前既无仲景原文。方法后但虚悬此方。殊无着落
用处。致方氏无从查考。遂谓加减旧缺。有补出之说。喻氏仅采取方氏条辨作尚论篇。故亦不能分辨。方中用附子二
枚。古之附子。乃山野所生。或小于今之种莳者。亦未可为定法。恐是后人传写之误。以愚意度之。当以应用之分
两为度。桂枝四两。即宋之一两八分。元则较重于宋。今更重矣。生姜三两。即宋之八钱。附子若用一枚。
约重一两二三钱。炮过可得干者三钱半。若分三次服。亦不为过。前人有古方不可治今病之说。皆不知古今斤两
不同故也。
风湿相搏。骨节烦疼掣痛。不得屈伸。近之则痛剧。汗出短气。小便不利。恶风不欲去衣。或微肿者。甘草
附子汤主之。
风湿相搏。与前文同义。掣痛者。谓筋骨肢节抽掣疼痛也。不得屈伸。寒湿之邪。流着于筋骨肢节之间。
故拘挛不得屈伸也。近之则痛剧者。即烦疼之甚也。疼而烦甚。人近之则声步皆畏。如动触之而其痛愈剧也。汗出。
即中风汗自出也。短气。邪在胸膈而气不得伸也。小便不利。寒湿在中。清浊不得升降。下焦真阳之气化不行也。
恶风不欲去衣。风邪在表也。或微肿者。湿淫肌肉。经所谓湿伤肉也。风邪寒湿搏聚而不散。故以甘草附子汤主之。
甘草附子汤方
甘草（二两） 附子（二枚去皮） 白术（二两） 桂枝（四两）
上四味。以水六升。煮取三升。去滓。温服一升。日三服。得微汗则解。能食。汗出复烦者。服五合。恐一升多
者。服六七合为妙。
风邪在表。故汗出恶风而不欲去衣。非桂枝不足以汗解卫邪。湿淫在经。非术不足以助土燥湿。因寒湿流于关节。
致骨节烦疼掣痛而不得屈伸。下焦无火。气化不行而小便不利。故用附子以温经散寒。则阳回气暖而筋脉和同。
东风解冻而水泉流动矣。经云。阳气者。精则养神。柔则养筋。筋柔则无掣痛不得屈伸之患矣。甘草所以缓阴气之
急。且为桂枝汤中本有之物。因汤中之芍药。能收敛助阴。故去之耳。虽名之曰甘草附子汤。实用桂枝去芍药汤。
以汗解风邪。增入附子白术。以驱寒燥湿也。
深意。例如太阴病发汗时选用桂枝汤，厥阴病攻表时也选用桂枝汤，其中的义理自然显现。即使是少阴病使用麻黄（Ephedrae Herba, 麻黄），也必定与附子（Aconiti Lateralis Radix Praeparata, 附子）同用，这是因为阴经都以阳气为重要缘故。又如《金匮要略》所载：“湿家身烦疼，可与麻黄加术汤发其汗为宜。慎不可以火攻之”这一节，是因为承接上文提到的身疼发热、面黄而喘、头痛鼻塞、烦躁而脉大，没有阴寒的症状，所以不用附子而忌讳火攻。既然见到头痛发热，说明邪气在阳经，况且有湿气导致身体烦疼，自然适宜发汗，所以用麻黄全方，再加白术（Atractylodis Macrocephalae Rhizoma, 白术）来燥湿。又在《金匮要略》湿病条文中，更有风湿脉浮、身重、汗出、恶风者，不用桂枝汤加减，而用防己黄芪汤（Fangji Huangqi Tang）主治，是因为脉浮、汗出、恶风，似乎风邪在表，应用桂枝汤，但张仲景又诊察到其卫气已虚，皮肤不致密，毛孔不闭合，所以汗出恶风，这是湿病患者的表虚证，所以用防己（Stephaniae Tetrandrae Radix, 防己）利水，用黄芪（Astragali Radix, 黄芪）固表，用白术、甘草（Glycyrrhizae Radix et Rhizoma, 甘草）燥湿补中罢了。都是因为因其表气已虚，卫阳不固，连微似出汗的桂枝汤也不轻易使用了。如果不是用意深远，怎么能制方如此精妙呢？
所谓去桂枝加白术汤，就是在桂枝附子汤（Guizhi Fuzi Tang）的方剂内，去掉桂枝，加入三两白术，其余按照前面的方法煎服。
所谓去桂枝加白术汤，就是术附汤。因为承接上文桂枝附子汤的加减，所以说去桂枝加白术汤。古方中“术”字前没有“白”字，所以称为术附汤。成无己不懂此意，错误地将其附在太阳上编遂漏不止的桂枝加附子汤之后，前面既没有张仲景的原文，方法后面只是虚悬这个方子，实在没有着落用处，致使方有执无从查考，于是说加减旧缺，有补出的说法。喻嘉言仅采取方有执的条辨作为《尚论篇》，所以也不能分辨。方中使用附子二枚，古代的附子是山野所生，可能比现在种植的还要小，这也不可作为定法，恐怕是后人传写时的错误。依我推测，应当以实际应用的分两为准。桂枝四两，即宋代的一两八分；元代比宋代重，现在更重了。生姜（Zingiberis Rhizoma Recens, 生姜）三两，即宋代的八钱。附子若用一枚，约重一两二三钱，炮制后可得干品三钱半。如果分三次服用，也不算过量。前人常说古方不可治今病，都是不知道古今斤两不同的缘故。
风湿相搏，骨节烦疼掣痛，不得屈伸，近之则痛剧，汗出短气，小便不利，恶风不欲去衣，或微肿者，甘草附子汤（Gancao Fuzi Tang）主治。
风湿相搏，与前文意义相同。掣痛，是指筋骨肢节抽掣疼痛。不得屈伸，是寒湿之邪流注于筋骨肢节之间，所以拘挛不能屈伸。近之则痛剧，就是烦疼得很厉害。疼而烦甚，人靠近它时，声音脚步都害怕，如同触动它而其痛更加剧烈。汗出，就是中风自汗出。短气，是邪气在胸膈而气不得伸展。小便不利，是寒湿在中焦，清浊不得升降，下焦真阳之气化不行。恶风不欲去衣，是风邪在表。或微肿，是湿邪淫溢肌肉，经书所说“湿伤肉”。风邪寒湿搏聚而不散，所以用甘草附子汤主治。
甘草附子汤方
甘草（二两） 附子（二枚去皮） 白术（二两） 桂枝（四两）
以上四味药，用水六升，煮取三升，去渣滓，温服一升，每日三次。得到微微汗出则病解。如果能进食，汗出后又烦躁的，服用五合。恐怕一升药量过多的，服用六七合为妙。
风邪在表，所以汗出恶风而不想脱衣，不是桂枝不足以发汗解除卫分之邪。湿邪淫溢在经络，不是白术不足以助土燥湿。因为寒湿流注于关节，导致骨节烦疼掣痛而不能屈伸，下焦无火，气化不行而小便不利，所以用附子来温经散寒，那么阳气回复，气机温暖而筋脉调和，东风解冻而水泉流动了。经书说：阳气者，精则养神，柔则养筋。筋柔和就没有掣痛不得屈伸的患害了。甘草之所以用来缓急，且它是桂枝汤中原有的药物，因为汤中的芍药（Paeoniae Radix Alba, 芍药）能收敛助阴，所以去掉它。虽然名叫甘草附子汤，实际用的是桂枝去芍药汤（Guizhi Shao Yao Qu Xie Tang）来汗解风邪，增加附子、白术来驱寒燥湿。
Profound meaning. For instance, when treating Taiyin disease with sweating methods, Guizhi Tang (Cinnamon Twig Decoction) is selected; when treating Jueyin disease by attacking the exterior, Guizhi Tang is also used, and the rationale becomes self-evident. Even if Mahuang (Ephedrae Herba) is used for Shaoyin disease, it must be combined with Fuzi (Aconiti Lateralis Radix Praeparata), because the Yin meridians all prioritize Yang Qi. Furthermore, as recorded in *Jinkui Yaolue*: "For a patient with dampness suffering from bodily restlessness and pain, it is appropriate to induce sweating with Mahuang Jia Zhu Tang (Ephedra Decoction plus Atractylodes). One must strictly avoid fire therapy." This section follows the previous description of body ache, fever, yellowish complexion with wheezing, headache, nasal congestion, irritability, and a large pulse. Since there are no symptoms of Yin-cold, Fuzi is not used, and fire therapy is contraindicated. Given the presence of headache and fever, indicating that the pathogen is in the Yang meridians, and considering the bodily restlessness and pain caused by dampness, inducing sweating is naturally suitable. Therefore, the complete Mahuang Tang formula is used, with added Baizhu (Atractylodis Macrocephalae Rhizoma) to dry dampness. Additionally, in the dampness articles of *Jinkui Yaolue*, there is a case of wind-dampness presenting with a floating pulse, heaviness of the body, sweating, and aversion to wind. In this case, Guizhi Tang is not modified but treated with Fangji Huangqi Tang (Stephania and Astragalus Decoction). This is because a floating pulse, sweating, and aversion to wind seem to indicate wind-pathogen at the exterior, which should be treated with Guizhi Tang. However, Zhang Zhongjing further diagnosed that the Wei Qi (Defensive Qi) was deficient, the skin was not dense, and the pores were not closed, leading to sweating and aversion to wind. This represents an exterior deficiency pattern in dampness patients. Thus, Fangji (Stephaniae Tetrandrae Radix) is used to promote urination, Huangqi (Astragali Radix) to consolidate the exterior, and Baizhu and Gancao (Glycyrrhizae Radix et Rhizoma) to dry dampness and tonify the middle. This is due to the fact that the exterior Qi is already deficient, and the Defensive Yang is not secure; even the mild sweating-inducing effect of Guizhi Tang is not lightly employed. If the intention were not profound, how could the prescription be so exquisite?
The formula "Remove Guizhi and Add Baizhu" is the same as Shu Fu Tang (Atractylodes and Aconite Decoction).
The formula "Remove Guizhi and Add Baizhu" refers to taking the Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) formula, removing Guizhi, adding three liang of Baizhu, and following the previous method for preparation.
The formula "Remove Guizhi and Add Baizhu" is indeed Shu Fu Tang. Because it follows the modifications of Guizhi Fuzi Tang mentioned earlier, it is called "Remove Guizhi and Add Baizhu." In ancient formulas, the character "Bai" (White) was not prefixed to "Shu," hence it was called Shu Fu Tang. Cheng Wuji did not understand this and erroneously attached it after the Guizhi Jia Fuzi Tang (Cinnamon Twig plus Aconite Decoction) for continuous leakage in the Taiyang upper chapter. Since there was no original text from Zhang Zhongjing preceding it, and the formula hung loosely without practical application afterwards, Fang Youzhi had no way to verify it, leading him to claim that the old versions lacked additions and that this was a later supplement. Yu Jiayan only adopted Fang Youzhi's annotations for his *Shanglun Pian*, thus failing to distinguish them clearly. The formula uses two pieces of Fuzi. Ancient Fuzi grew in the wild and might have been smaller than modern cultivated ones; this cannot be taken as a fixed rule, and it is likely a transcription error by later generations. In my opinion, one should judge based on the actual dosage equivalents. Four liang of Guizhi equals 1.8 liang in the Song Dynasty; the Yuan Dynasty weights were heavier than the Song, and modern weights are even heavier. Three liang of Shengjiang (Zingiberis Rhizoma Recens) equals eight qian in the Song Dynasty. If one piece of Fuzi is used, it weighs approximately 1.2–1.3 liang; after processing, the dried weight is about 0.35 liang. Taking this divided into three doses is not excessive. Previous scholars claimed that ancient formulas cannot treat modern diseases, simply because they did not realize the differences in weights between ancient and modern times.
When Wind-Dampness combats each other, causing severe joint pain, pulling pain, inability to flex or extend, exacerbation of pain upon touch, sweating, shortness of breath, difficulty in urination, aversion to wind with reluctance to remove clothing, or slight swelling, Gancao Fuzi Tang (Licorice and Aconite Decoction) is indicated.
"Wind-Dampness combats each other" has the same meaning as mentioned earlier. "Pulling pain" refers to the pulling and painful sensation in the sinews, bones, limbs, and joints. "Inability to flex or extend" occurs because Cold-Dampness pathogens flow into the sinews, bones, limbs, and joints, causing stiffness and inability to move. "Exacerbation of pain upon touch" means the pain is extremely severe; when people approach, they fear sound and movement, as touching it intensifies the pain. "Sweating" refers to spontaneous sweating due to Wind-stroke. "Shortness of breath" indicates that the pathogen is in the chest and diaphragm, preventing Qi from extending. "Difficulty in urination" results from Cold-Dampness in the middle jiao, where clear and turbid substances fail to ascend and descend, and the true Yang Qi transformation in the lower jiao fails to function. "Aversion to wind with reluctance to remove clothing" signifies Wind-pathogen at the exterior. "Slight swelling" indicates Dampness overflowing into the muscles, as stated in the classics: "Dampness injures the flesh." Since Wind, Cold, and Dampness combine and do not disperse, Gancao Fuzi Tang is used to treat it.
**Gancao Fuzi Tang Formula:**
Gancao (2 liang), Fuzi (2 pieces, peeled), Baizhu (2 liang), Guizhi (4 liang).
Take these four ingredients, add six sheng of water, boil to obtain three sheng, remove the dregs, and take one sheng warm, three times a day. When a slight sweat appears, the condition resolves. If the patient can eat but becomes irritable again after sweating, take five he. If one sheng is considered too much, taking six or seven he is optimal.
Wind-pathogen at the exterior causes sweating, aversion to wind, and reluctance to remove clothing; only Guizhi is sufficient to induce sweating and resolve the exterior pathogen. Dampness overflowing in the meridians requires Baizhu to assist Earth and dry dampness. Because Cold-Dampness flows into the joints, causing severe joint pain, pulling pain, and inability to flex or extend, and because the lower jiao lacks Fire, leading to failed Qi transformation and difficulty in urination, Fuzi is used to warm the meridians and dissipate Cold. This restores Yang Qi, warms the Qi mechanism, and harmonizes the sinews, akin to the east wind thawing ice and making springs flow. The classics state: "Yang Qi nourishes the spirit when refined, and nourishes the sinews when soft." Soft sinews prevent pulling pain and inability to flex or extend. Gancao is used to relieve urgency, and it is an ingredient originally present in Guizhi Tang. However, Shaoyao (Paeoniae Radix Alba) is removed because it can astringe and aid Yin. Although named Gancao Fuzi Tang, it essentially utilizes Guizhi Shao Yao Qu Xie Tang (Cinnamon Twig Decoction minus Paeonia) to induce sweating and resolve Wind-pathogen, while adding Fuzi and Baizhu to drive out Cold and dry dampness.