【纲】仲景曰。伤寒若吐若下后。心下逆满。气上冲胸。起则头眩。脉沉紧。发汗则动经。身为
振振摇者。茯苓桂枝白术甘草汤主之。
【目】喻昌曰。心下逆满。气上冲胸。塞涌于膈。所以起则头眩。脉见沉紧。明系饮中留结外
邪。若但发汗以强解其外。外虽解而津液尽竭。反足伤动经脉。有身为振摇之患。盖人身经脉。赖
津液以滋养。吐下而津液一伤。发汗而津液再伤。令经脉失养而身摇。故遇此等症。不得不重在表。
此症外邪已散。止存饮中之邪。故以桂枝加入制饮药内。俾之邪尽散。津液得以四布。而滋养其
经脉。千百年来。孰窥其批却导 之妙乎。
魏荔彤曰。沉则为里。紧则为寒。是里虚阳微。而阴邪为患也。原在经络之症。误吐误下。乃
为在脏腑之症矣。复不从里治。而又发汗以伤动其经络之表。卫外之阳。亦自汗出而虚。身为振摇。
亡阳之兆也。仲师以苓桂术甘内治其沉紧。阴寒上逆之邪可除。外治其振摇。表虚恶寒之象可止。
四物俱投阳分。治表里阴邪至当之剂也。方喻皆谓挟饮为患。不知阴邪内盛。有饮固然。无饮亦
然。饮或因阴盛而起。非饮独为病。阴消而饮亦安。非饮自为安也。则亦不必论列于饮矣。
鳌按。喻氏留饮之论。未尝不是本条病因。而魏氏专主阴邪内盛。包括留饮。见理自更圆通。
夫世固有饮家而患本条之症者。则知喻氏非尽谬理也。亦有非饮家而犯本条之症者。则知魏氏为尤
当也。故并存之。
【纲】张仲景说：患伤寒病，如果经过催吐或泻下治疗后，出现胃脘部胀满不适、气逆上冲至胸部、起身时头晕目眩、脉象沉而紧。此时若再发汗，就会扰动经脉，导致身体震颤动摇。应当用茯苓桂枝白术甘草汤主治。
【目】喻昌说：胃脘部胀满不适，气逆上冲至胸部，水饮之气壅塞涌溢于膈膜，所以起身时头晕目眩，脉象呈现沉紧，这明确是水饮停滞结聚并兼感外邪所致。如果仅仅通过发汗来强行解除表邪，虽然表邪解除了，但津液会完全枯竭，反而足以损伤动经脉，产生身体震颤动摇的祸患。大概人体的经脉，依赖津液来滋养。经过吐法、下法后津液已经受损，如果再发汗，津液再次受损，致使经脉失去滋养而身体摇动。因此遇到这类病症，不得不重视体表（的治疗）。此症的外邪已经消散，只残留水饮之邪，所以加入桂枝到制约水饮的药物中，使邪气彻底消散，津液得以向四周布散，从而滋养其经脉。千百年来，谁能洞察其中剖析关键、顺势引导的奥妙呢？
魏荔彤说：脉沉主里证，脉紧主寒证，这是里虚阳气微弱，阴寒邪气为患的表现。原本是在经络的病症，误用吐法和下法，就变成了在脏腑的病症了。又不从里证治疗，反而发汗以损伤动经络的表层，卫护体表的阳气也因自汗而出而虚弱，身体震颤动摇，这是亡阳的先兆。张仲景用茯苓、桂枝、白术、甘草在内治疗沉紧脉所代表的阴寒上逆之邪可以消除，在外治疗身体震颤动摇、表虚恶寒的现象可以停止。这四味药都作用于阳分，是治疗表里阴寒邪气最恰当的方剂。方剂和喻氏都认为夹杂水饮为患，不知道阴寒邪气内盛，有水饮固然如此，没有水饮也是如此。水饮或许是因为阴寒盛而起，并非水饮单独成为病，阴寒消退而水饮也就安定，并非水饮自己安定。那么也不必专门讨论水饮了。
沈金鳌按语：喻氏关于留滞水饮的论述，未尝不是本条文的病因，而魏氏专门主张阴寒邪气内盛，包含了留滞水饮，见解道理自然更加圆融通达。世间确实有素有痰饮的人患上本条所述病症的，就知道喻氏并非完全没有道理；也有不是痰饮体质却犯本条所述病症的，就知道魏氏的观点更为恰当。所以将两种观点并存。
[Outline] Zhang Zhongjing stated: In cases of Shanghan (Cold Damage), if emesis or purgation has been performed, and the patient presents with fullness and rebellious Qi in the epigastrium, Qi rushing upward to the chest, dizziness upon rising, and a deep, tight pulse. If sweating is induced at this stage, it will disturb the meridians, resulting in tremors and shaking of the body. It should be treated with Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractodes Macrocephala, and Licorice Decoction).
[Commentary] Yu Chang stated: Fullness and rebellious Qi in the epigastrium, with Qi rushing upward to the chest, indicates fluid retention obstructing and surging in the diaphragm, which causes dizziness upon rising. The appearance of a deep, tight pulse clearly indicates that pathogenic factors are retained within fluids and combined with external pathogens. If one merely induces sweating to forcibly resolve the exterior, although the exterior pathogens may be resolved, the body fluids will be completely depleted, thereby damaging the meridians and causing the affliction of bodily tremors and shaking. Generally, the human body's meridians rely on body fluids for nourishment. Emesis and purgation injure the fluids once; inducing sweating injures them again. Consequently, the meridians lose nourishment, leading to bodily shaking. Therefore, when encountering such conditions, priority must be given to the exterior. In this condition, the external pathogens have already dispersed, leaving only the pathogen of retained fluids. Thus, Guizhi (Cinnamon Twig) is added to the formula controlling fluids, allowing the pathogens to be thoroughly dispersed and the fluids to distribute evenly, thereby nourishing the meridians. For thousands of years, who has perceived the subtlety of analyzing the key points and guiding the flow?
Wei Litong stated: A deep pulse indicates interior involvement, and a tight pulse indicates cold. This signifies interior deficiency and weak Yang, with Yin-cold pathogens causing disease. Originally an ailment of the meridians, mistaken use of emesis and purgation transformed it into an ailment of the Zang-Fu organs. Furthermore, failing to treat from the interior and instead inducing sweating damages the exterior of the meridians. The Wei-Yang (Defensive Yang) protecting the exterior becomes deficient due to spontaneous sweating. Tremors and shaking of the body are signs of Yang depletion. Zhang Zhongjing uses Fuling (Poria), Guizhi (Cinnamon Twig), Baizhu (Atractodes Macrocephala), and Gancao (Licorice) internally to treat the deep, tight pulse and eliminate the Yin-cold rebellious pathogen; externally, they treat the tremors and shaking, stopping the signs of exterior deficiency and aversion to cold. All four herbs act on the Yang aspect; this is the most appropriate formula for treating Yin-cold pathogens in both the interior and exterior. Fang Yi and Yu Chang attribute the pathology to combined fluid retention. They fail to realize that excessive internal Yin-cold manifests similarly whether fluid retention is present or not. Fluid retention may arise due to Yin excess, but it is not the sole cause of disease. When Yin-cold dissipates, the fluid retention stabilizes naturally, not because the fluid itself stabilizes. Therefore, there is no need to specifically discuss fluid retention.
Shen Jin'ao's Note: Yu Chang's theory regarding retained fluids is not incorrect as an etiology for this clause. However, Wei Litong’s focus on excessive internal Yin-cold encompasses retained fluids, making his reasoning more comprehensive and logical. Indeed, there are individuals with chronic phlegm-fluid retention who suffer from the symptoms described in this clause, indicating that Yu Chang is not entirely erroneous. Conversely, there are those without a history of fluid retention who contract these symptoms, suggesting that Wei Litong’s view is particularly appropriate. Therefore, both views are preserved.