太阳。故以五苓散主之。今大烦渴。而脉见洪大。则邪不在太阳。而已传入阳明矣。即阳明篇所谓。阳明脉大
者。是也。故以白虎汤。解胃中之烦热。加人参。以补其大汗之虚。救其津液之枯竭也。
白虎加人参汤方
知母（六两） 石膏（一斤碎绵裹） 甘草（炙二两） 粳米（六合） 人参（三两）
上五味。以水一斗。煮米熟。汤成去滓。温服一升。日三服。（外台秘要。作上五味切。以水一斗二升。
煮米熟。去米。纳诸药。煮取六升。去滓。温服一升。日三。成本云。于白虎汤内加人参三两。余根据白虎汤法。
案外台所载。当仲景旧法。）
活人辨疑。化斑汤。治赤斑口燥。烦渴中 。（即本方）
保命集。人参石膏汤。治膈消。上焦烦渴。不欲多食。
于本方。去粳米。（东垣。加黄芩。杏仁。）
徐同知方。人参白虎汤。治伏暑发渴。呕吐身热。脉虚自汗。（即本方）如伏暑作寒热未解。宜和五苓散。
同煎服。疹科
纂要。人参白虎汤。治麻疹。化斑发疹止渴如神。
于本方。去粳米。加桔梗。竹叶。
医史云。吕沧洲治赵氏子。病伤寒余十日。身热而人静。两手脉尽伏。俚医以为死也。弗与药。翁诊之。
三部举按皆无。其舌苔滑。而两颧赤如火。语言不乱。因告之曰。此子必大发赤斑。周如锦文。夫脉血之波澜
也。今血为邪热所搏。淖而为斑。外见于皮肤。呼吸之气。无形可根据。犹沟隧之无水。虽有风不能成波谰。斑
消则脉出矣。及揭其衾。而赤斑烂然。即用白虎加人参汤。化其斑。脉乃复常。继投承气下之愈。发斑无脉。
长沙所未论。翁盖以意消息耳。
太阳病。发热恶寒。热多寒少。脉微弱者。此无阳也。不可发汗。宜桂枝二越婢一汤。（者。千金翼。作
则。发汗上。玉函。有复字。全书。作更汗。）
〔柯〕本论无越婢证。亦无越婢方。不知何所取义。窃谓其二字。必误也。此热多。是指发热。不是内热。
无阳。是阳已虚。而阴不虚。不烦不躁。何得妄用石膏。观麻黄桂枝合半。桂枝二麻黄一二方。皆当汗之证。
此言不可发汗。何得妄用麻黄。凡读古人书。须传信阙疑。不可文饰。况为性命所关者乎。且此等脉证最多。
无阳不可发汗。便是仲景法旨。柴胡桂枝汤。乃是仲景佳方。若不头项强痛。并不须合桂枝矣。读书无目。至
于病患无命。愚故表而出之。
舒氏云。热多寒少四字。是条中关键。必其人平素热盛津衰。故方中用石膏。以保其津液也。但无阳二字
有误。如果无阳。则必寒多热少。当用附子。石膏又在所禁矣。案无阳。方氏亦尝疑之。然犹释为疾在阴而无
在阳之义。张志聪张锡驹。从其说为解。喻氏周氏张璐。则曰无津液之谓。金鉴亦云。无太阳表脉。皆强解也。
程氏云。正阳虚。钱氏云。
命门真阳之虚。果然则安有用石膏之理乎。其他魏氏汪氏辈。皆属傅会。只成氏于此一条。不下注解。盖有所
见也。至于柯氏。断然阙疑。可谓卓越之识矣。今仍不繁参量说云。
案发汗后病篇。发汗多。亡阳谵语者。不可下。与柴胡桂枝汤。和其荣卫。以通津液。后自愈。柯氏以柴
胡桂枝汤。主此条证者。以其无阳。乃亡阳之义故也。
桂枝二越婢一汤方
桂枝（去皮） 芍药 甘草（各十八铢。炙。成本。无炙字。） 大枣（四枚擘） 生姜（一两二铢切○
玉函。千金翼。二作三。成本。作三钱。盖讹。） 石膏（二十四铢。碎。绵裹。） 麻黄
上七味。以水五升。煮麻黄一二沸。去上沫。纳诸药。煮取二升。去滓。温服一升。本云。当裁为越婢汤
桂枝汤。合之饮一升。今合为一方。桂枝汤二分。越婢汤一分。（【原注】臣亿等谨案桂枝汤方。桂枝。芍药。
生姜。各三两。甘草二两。大枣十二枚。越婢汤方。麻黄二两。生姜三两。甘草二两。石膏半斤。大枣十五枚。
今以算法约之。桂枝汤。取四分之一。即得桂枝。芍药。生姜。各十八铢。甘草十二铢。大枣三枚。越婢汤。
取八分之一。即得麻黄十八铢。生姜九铢。甘草六铢。石膏二十四铢。大枣一枚。八分之七。弃之二汤所取相
合。即共得桂枝。芍药。甘草。麻黄。各十八铢。生姜一两三铢。石膏二十四铢。大枣四枚合方。旧云桂枝三。
今取四分之一。即当云桂枝二也。越婢汤方。见仲景杂方中。外台秘要。一云。起脾汤。○煮麻黄上。玉函。
千金翼。有先字。云。玉函。成本。作方。玉函。煎法二婢字。并作脾。案一云起脾汤。见外台肉极门。）
〔成〕胃为十二经之主。婢治水谷。为卑藏。若婢。内经曰。脾主为胃行其津液。是汤所以谓之越婢者。
以发越脾气。通行津液。外台方。一名越脾汤。即此义也。〔柯〕此大青龙。无桂枝杏仁。与麻黄杏仁石膏汤。
同为凉解表里之剂。此不用杏仁之苦。而用姜枣之辛甘。可以治太阳阳明合病。热多寒少。而无汗者。犹白虎
汤证。背微恶寒之类。而不可以治
脉弱无阳之证也。
案越婢。未审何义。成氏引外台。为发越脾气。似稳当。续医说。引赵良仁金匮衍义。驳成注。然其说
与成同。方氏喻氏。以婢女之义为解。亦未太允。至钱氏云以此治越人之婢而得效。杜撰甚矣。
服桂枝汤。或下之。仍头项强痛。翕翕发热。无汗。心下满微痛。小便不利者。桂枝去桂加茯苓白术汤
主之。（脉经。千金翼。无或字。仍字。满下。玉函。有而字。脉经。无白字。）
〔成〕头项强痛。翕翕发热。虽经汗下。为邪气仍在表也。心下满微痛。小便利者。则欲成结胸。今外证
未罢。无汗小便不利。则心下满微痛。为停饮也。与桂枝汤。以解外。加茯苓白术。利小便行留饮也。〔钱〕
头项强痛。中风伤寒。均有之证也。翕翕发热。是热在皮毛。中风证也。无汗。则又伤寒之本证矣。就此诸证。
为风寒兼有无疑矣。而但服桂枝汤。是治风而未治寒也。故仍头项强痛。翕翕发热。无汗而不解也。又或误下
之。所以有心下满微痛之证。乃下后邪气陷入。而欲结也。小便不利。太阳之热邪。内犯膀胱。气化不行也。
治之以桂枝去桂加茯苓白术汤。未详其义。恐是后人传写之误。未可知也。即或用之。恐亦未能必效也。仲景
立法。岂方不对证。而能为后世训乎。余窃疑之。大约是历年久远。后人舛误所致。非仲景本来所系原方。近
代名家。悉遵成氏之训。俱强解以合其说。谓用之而诸证悉愈。吾不信也。
案成注不及去桂之义。但云桂枝汤以解外。则成所注本。无去桂二字欤。若不去桂。而用此方于此证。
或有效验。王肯堂以降。多为水饮所致。然无的据。金鉴则根据桂枝去芍药之例。为去芍药之误。其说亦难从矣。
桂枝去桂加茯苓白术汤方
芍药（三两） 甘草（二两炙） 生姜（切） 白术 茯苓（各三两） 大枣（十二枚擘）
上六味。以水八升。煮取三升。去滓。温服一升。小便利则愈。本云桂枝汤。今去桂枝。加茯苓白术。
（玉函。六味下。有 咀字。八升。作七升。云。作方。成本。不载本方。第十卷云。于桂枝汤内。去桂枝。
加茯苓。白术。各三两。余仿前法煎服。小便利则愈。）
伤寒类方云。凡方中有加减法。皆佐使之药。若去其君药。则另立方名。今去桂枝。而仍以桂枝为名。所
不可解也。
伤寒脉浮。自汗出。小便数。心烦。微恶寒。脚挛急。反与桂枝。欲攻其表。此误也。得之便厥。咽中干。
烦躁吐逆者。作甘草干姜汤与之。以复其阳。若厥愈。足温者。更作芍药甘草汤与之。其脚即伸。若胃气不和。
谵语者。少与调胃承气汤。若重发汗。复加烧针者。四逆汤主之。（心烦。玉函。作颇字。云。论曰心烦。脉
经。作颇复。注。仲景。作心烦。成本。桂枝下。有汤字。是。躁。作燥。误。玉函。脚上。有两字。脉经。
无调胃字。）
〔成〕脉浮自汗出。小便数。而恶寒者。阳气不足也。心烦脚挛急者。阴气不足也。阴阳血气俱虚。则不
可发汗。若与桂枝汤攻表。则又损阳气。故为误也。得之便厥。咽中干。烦躁吐逆者。先作甘草干姜汤。复其
阳气。得厥愈足温。乃与芍药甘草汤。益其阴血。则脚HT 得伸。阴阳虽复。其有胃燥谵语。少与调胃承气汤。
微溏以和其胃。重发汗为亡阳。加烧针则损阴。内经曰。荣气微者。加烧针则血不流行。重发汗复烧针。是阴
阳之气大虚。四逆汤以复阴阳之气。〔鉴〕是当与桂枝增桂加附子汤。以温经止汗。今反与桂枝汤。攻发其表。
此大误也。〔汪〕脉浮自汗出。小便数者。阳虚气不收摄也。心烦者。真阳虚脱。其气浮游而上走也。咽中干
烦躁者。误汗损阳。津液耗竭。阳虚烦躁。作假热之象也。吐
逆者。阴寒气盛而拒膈也。〔程〕脉浮自汗出。虽似桂枝证。而头项不痛。知阳神自歉于上部。阳明内结。得
之自汗出小便数上。盖津液外越。而下部之阴分。更无阳以化气也。故阳回而结未破。不妨少从胃实例。一去
其胃燥。〔鉴〕若重发汗者。谓不止误服桂枝汤。而更误服麻黄汤也。或复加烧针。劫取其汗。以致亡阳证具。
则又非甘草干姜汤所能治。故又当与四逆汤。以急救其阳也。
甘草干姜汤方
甘草（四两炙） 干姜（二两）
上二味。以水三升。煮取一升五合。去滓。分温再服。（玉函。甘草二两。成本。干姜下。有炮字。玉
函。成本。味下。有 咀二字。）
芍药甘草汤方
白芍药（○玉函。无白字。） 甘草（各四两炙）
上二味。以水三升。煮取一升五合。去滓。分温再服。（玉函。成本。味下。有 咀二字。成本。五合。
作半。服下。有之字。）
〔柯〕仲景回阳。每用附子。此用干姜甘草者。正以见阳明之治法。夫太阳少阴。所谓亡阳者。先天之
元阳也。故必用附子之下行者回之。从阴引阳也。阳明所谓亡阳者。后天胃脘之阳也。取甘草干姜以回之。从
乎亡也。盖桂枝之性辛散。走而不守。即佐以芍药。尚能亡阳。干姜之味苦辛。守而不走。故君以甘草。便能
回阳。然先天太少之阳不易回。回则诸证悉解。后天阳明之阳虽易回。既回而前证仍在。变证又起。故更作芍
药甘草汤继之。盖脾主四肢。胃主津液。阳盛阴虚。脾不能为胃行津液。以灌四旁。故足挛急。用甘草以生阳
明之津。芍药以和太阴之液。其脚即伸。此亦用阴和阳法也。甘草干姜汤。得理中之半。取其守中。不须其补
中。芍药甘草汤。减桂枝之半。用其和里。不取其攻表。
胡遵程方注云。甘草干姜汤。即四逆汤。去附子也。辛甘合用。专复胸中之阳气。其夹食夹阴。面赤足冷。
发热喘咳。腹痛便滑。外内合邪。难于发散。或寒药伤胃。合用理中。不便参术者。并宜服之。真胃虚挟寒之
圣剂也。若夫脉沉畏冷。呕吐自利。虽无厥逆。仍属四逆汤。芍药甘草汤。此即桂枝汤。去桂枝姜枣也。甘酸
合用。专治营中之虚热。其阴虚阳乘。至夜发热。血虚筋挛。头面赤热。过汗伤阴。发热不止。或误用辛热。
扰其营血。不受补益者。并宜用之。真血虚挟热之神方也。
外台。备急。疗吐逆水米不下。干姜甘草汤。（即本方）
直指方。干姜甘草汤。治脾中冷痛。呕吐不食。
于本方。加大枣一枚。
又甘草干姜汤。治男女诸虚出血。胃寒不能引气归元。无以收约其血。（即本方）
朱氏集验方。二神汤。治吐血极妙。治男子妇人。吐红之疾。盖是久病。或作急劳。损其荣卫。塞滞气上。
血之妄行所致。若投以藕汁生地黄等凉剂治之。必求其死矣。每遇患者。用药甚简。（即甘草干姜汤）每服二
钱。水一中盏。煎至五七沸。带热呷。空心日午进之。和其气血荣卫。自然安痊。不可不知。
证治要诀。饮酒过多而衄甚。则用理中汤。加干葛。川芎。各半钱。或止用干姜甘草二味。
证治准绳。曹氏必用方。吐血。须煎干姜甘草。作汤与服。或四物理中汤亦可。如此无不愈者。若服生地
黄竹茹藕汁。去生便远。
魏氏家藏方。六半汤。治热湿香港脚。不能行步。
即芍药甘草汤。入无灰酒少许。再煎服。
朱氏集验方。去杖汤。治脚弱无力。行步艰难。友人戴明远用之有验。（即芍药甘草汤）
活人事证方。神功散。治消渴。（即芍药甘草汤）
医学心悟。芍药甘草汤。止腹痛如神。脉迟为寒。加干姜。脉洪为热。加黄连。
调胃承气汤方
大黄（四两去皮清酒洗○阳明篇。玉函。无去皮字。洗。成本。玉函。作浸。） 甘草（二两炙○外台。作
三两。） 芒硝（半升○千金翼。作半两。全书。方本。作半 。）
上三味。以水三升。煮取一升。去滓。纳芒硝。更上火。微煮令沸。少少温服之。（阳明篇。上三味切。
以水三升。煮二物至一升。去滓。纳芒硝。更上微火一二沸。温顿服之。以调胃气。成本。玉函。味下。有
咀二字。）
〔汪〕误与桂枝汤。复与甘草干姜汤。姜桂辛热。耗胃中津液。因而谵语。方后云。少少温服。此不过
太阳病。所以用五苓散来主治。现在出现严重的烦渴，且脉象呈现洪大，说明邪气已不在太阳经，而是已经传入阳明经了。这就是《阳明篇》中所说的“阳明脉大”的情况。因此使用白虎汤，以清除胃中的烦热；加入人参，是为了补益因大汗造成的虚损，挽救津液的枯竭。
白虎加人参汤方
知母（六两） 石膏（一斤，打碎，用绵布包裹） 甘草（炙，二两） 粳米（六合） 人参（三两）
以上五味药，用水一斗，煮至米熟，药汤成后滤去药渣。每次温服一升，每日服用三次。（《外台秘要》记载：将以上五味药切碎，用水一斗二升，煮至米熟，去掉米粒，放入其他药物，煮取六升，滤去药渣，温服一升，每日三次。成本注云：在白虎汤中加入人参三两，其余按照白虎汤的方法煎服。按语：《外台秘要》所载的，应当是张仲景的旧法。）
《活人书》辨疑：化斑汤，治疗赤斑、口燥、烦渴。（即本方）
《保命集》：人参石膏汤，治疗膈消（上焦烦渴，不想多吃东西）。
在本方基础上，去掉粳米。（李东垣建议：加入黄芩、杏仁。）
徐同知方：人参白虎汤，治疗伏暑引起的口渴、呕吐、身热、脉虚、自汗。（即本方）如果伏暑表现为寒热往来未解，宜将五苓散与本方同煎服用。
《疹科纂要》：人参白虎汤，治疗麻疹，能像神一样地化解斑疹、发疹并止渴。
在本方基础上，去掉粳米，加入桔梗、竹叶。
《医史》记载：吕沧洲治疗赵氏的儿子，患伤寒余十日，身体发热但神志安静，两手脉搏完全伏匿不见。庸医认为是死证，不给用药。吕翁诊察发现，寸关尺三部举按皆无脉，舌苔滑润，但两颧红赤如火，语言清晰不乱。于是告诉他说：“这个孩子一定会大发赤斑，遍布全身如锦纹。脉是血的波澜，现在血液被邪热搏结，变得浑浊而化为斑疹，外现于皮肤。呼吸之气无形，无法凭据，就像沟渠中没有水，虽然有风也不能形成波浪。等斑疹消退，脉象就会出来。”等到揭开被子，果然看到满身的赤斑。随即使用白虎加人参汤，化解斑疹，脉象才恢复正常。随后又投予承气汤攻下，病愈。发斑而无脉，这是长沙太守（张仲景）未曾论述过的，吕翁大概是凭借意会来推断的吧。
太阳病，发热恶寒，热多寒少，脉象微弱的人，这是“无阳”（阳气虚弱），不可发汗，适宜用桂枝二越婢一汤。（“者”字，《千金翼方》作“则”，《发汗上》篇，《玉函经》有“复”字，《全书》作“更汗”。）
〔柯琴〕本论中没有越婢证的描述，也没有越婢方的记载，不知道这是什么意思。我私下认为，“二”字必定是误字。这里的“热多”，是指发热多，不是指内热。“无阳”，是指阳气已虚，而阴气不虚。如果不烦躁不躁动，怎么能妄用石膏呢？看麻黄桂枝合半的桂枝二麻黄一汤，都是应当发汗的证候。这里说不可发汗，怎么能妄用麻黄呢？凡是读古人的书，必须相信可信的，存疑的暂且搁置，不可文过饰非，何况这关系到性命的大事呢？况且这种脉证很多，“无阳不可发汗”就是张仲景的法旨。柴胡桂枝汤，确实是张仲景的好方子，但如果头项不强痛，就不需要合用桂枝了。读书没有眼光，以至于让病患失去生命，所以我特意指出这一点。
舒驰远说：“热多寒少”这四个字，是这一条的关键。一定是这个人平素热盛津液亏损，所以方中用石膏，来保护他的津液。但是“无阳”二字有误。如果真的无阳，那就一定是寒多热少，应当用附子，石膏就在禁忌之列了。按语：方有执也曾怀疑“无阳”二字，但仍然解释为病在阴分而无在阳分的意义。张志聪、张锡驹顺着这个说法进行解释。喻嘉言、周学海、张璐则说这是指津液匮乏。《医宗金鉴》也说这是指没有太阳表脉，都是牵强附会的解释。程郊倩说：这是正阳虚。钱潢说：是命门真阳之虚。如果真的这样，哪里有用石膏的道理呢？其他的魏荔彤、汪琥等人，都属于穿凿附会。只有成无己对这一条不下注解，大概是有见地吧。至于柯琴，断然存疑，可以说是卓越的见识了。现在不再繁琐地罗列各家学说。
按语：《伤寒论·发汗后病篇》中提到，发汗过多，亡阳谵语的，不可用下法，给予柴胡桂枝汤，调和营卫，以通津液，后来自然痊愈。柯琴认为柴胡桂枝汤主治这一条证候，是因为这里的“无阳”，就是亡阳的意思。
桂枝二越婢一汤方
桂枝（去皮） 芍药 甘草（各十八铢，炙。成本注：无“炙”字。） 大枣（四枚，掰开） 生姜（一两二铢，切○《玉函经》、《千金翼方》，“二”作“三”。成本注：作“三钱”，大概是讹误。） 石膏（二十四铢，打碎，用绵布包裹。） 麻黄
以上七味药，用水五升，先煮麻黄一二沸，去掉上面的浮沫，放入其他药物，煮取二升，滤去药渣，温服一升。原本的说法是：应当裁减为越婢汤和桂枝汤，合起来饮一升。现在合并为一个方子，桂枝汤占二分，越婢汤占一分。（【原注】臣亿等谨慎考证：桂枝汤方，桂枝、芍药、生姜各三两，甘草二两，大枣十二枚。越婢汤方，麻黄二两，生姜三两，甘草二两，石膏半斤，大枣十五枚。现在用算法约简：桂枝汤取四分之一，即得桂枝、芍药、生姜各十八铢，甘草十二铢，大枣三枚。越婢汤取八分之一，即得麻黄十八铢，生姜九铢，甘草六铢，石膏二十四铢，大枣一枚。八分之七舍弃。两汤所取部分相合，共得桂枝、芍药、甘草、麻黄各十八铢，生姜一两三铢，石膏二十四铢，大枣四枚，合方。旧称桂枝三，现在取四分之一，就应当称桂枝二。越婢汤方，见于张仲景杂方中。《外台秘要》一说，起脾汤。○煮麻黄上，《玉函经》、《千金翼方》有“先”字。云：《玉函经》、成本作“方”。《玉函经》煎法中“二婢”字，都作“脾”。按语：一说起脾汤，见于《外台》肉极门。）
〔成无己〕胃是十二经的主宰，脾（婢）主管水谷，是卑下的脏腑，如同婢女。《内经》说：脾主为胃运行津液。这个汤之所以叫越婢，是因为发越脾气，通行津液。《外台方》一名越脾汤，就是这个意思。〔柯琴〕这个方子是大青龙汤去掉桂枝、杏仁，与麻黄杏仁石膏汤，同为凉解表里的剂型。这个方子不用杏仁的苦味，而用姜枣的辛甘，可以治疗太阳阳明合病，热多寒少，而无汗的情况，类似于白虎汤证中背微恶寒之类，但不能治疗脉弱无阳的证候。
按语：越婢的含义不明，成无己引用《外台》，说是发越脾气，似乎比较妥当。《续医说》引用赵良仁《金匮衍义》，驳斥成无己的注释，但他的说法与成无己相同。方有执、喻嘉言以“婢女”之义来解释，也不太恰当。至于钱潢说用它治疗越人的婢女而见效，更是杜撰得很厉害。
服用桂枝汤，或者经过攻下治疗后，仍然头项强痛，翕翕发热，无汗，心下满微痛，小便不利者，用桂枝去桂加茯苓白术汤主治。（《脉经》、《千金翼方》无“或”字、“仍”字、“满”字下，《玉函经》有“而”字。《脉经》无“白”字。）
〔成无己〕头项强痛，翕翕发热，虽然经过汗下治疗，但邪气仍在表。心下满微痛，如果小便利，就要形成结胸。现在外证未罢，无汗且小便不利，那么心下满微痛，是由于停饮（水饮停留）所致。给予桂枝汤以解表，加上茯苓、白术，利小便以行留饮。〔钱潢〕头项强痛，中风和伤寒都有这个证候。翕翕发热，是热在皮毛，属于中风证。无汗，则是伤寒的本证。综合这些证候，肯定是风寒兼有无疑。但只服用桂枝汤，是治风而未治寒，所以仍然头项强痛，翕翕发热，无汗而不解。又或者误用攻下法，所以有心下满微痛的证候，这是下后邪气陷入，想要结聚。小便不利，是太阳的热邪内犯膀胱，气化不行。用桂枝去桂加茯苓白术汤治疗，不详其含义，恐怕是后人传写之误，也不可知。即使使用它，恐怕也不能保证有效。张仲景立法，难道方子不对证，还能成为后世的准则吗？我私下怀疑，这大约是年代久远，后人错误导致的结果，不是张仲景原本的处方。近代名家，都遵循成无己的训导，都强行解释以符合其说，说用了之后各种证候都痊愈了，我不相信。
按语：成无己的注释没有涉及去桂的含义，只说桂枝汤以解外，那么成无己所注的版本，难道没有“去桂”二字吗？如果不去桂，而用此方治疗这个证候，或许有效。从王肯堂以来，多认为是水饮所致，但没有确凿证据。《医宗金鉴》则根据桂枝去芍药之例，认为是去芍药的误写，这种说法也难以遵从。
桂枝去桂加茯苓白术汤方
芍药（三两） 甘草（二两，炙） 生姜（切） 白术 茯苓（各三两） 大枣（十二枚，掰开）
以上六味药，用水八升，煮取三升，滤去药渣，温服一升，小便利则病愈。原本说是桂枝汤，现在去掉桂枝，加入茯苓、白术。
（《玉函经》：六味下有“咀”字。八升，作七升。云：作方。成本注：不载本方。第十卷云：在桂枝汤内，去掉桂枝，加入茯苓、白术各三两，其余仿照前法煎服，小便利则病愈。）
《伤寒类方》说：凡方中有加减法，都是佐使之药。如果去掉君药，则另立方名。现在去掉桂枝，却仍以桂枝为名，令人不解。
伤寒脉浮，自汗出，小便数，心烦，微恶寒，脚挛急，反而给予桂枝汤，想要攻表，这是错误的。服药后立即出现四肢厥冷，咽中干，烦躁吐逆的，制作甘草干姜汤给予服用，以恢复其阳气。如果厥冷愈，足部温暖，再制作芍药甘草汤给予服用，他的脚就能伸直。如果胃气不和，谵语的，少量给予调胃承气汤。如果再次发汗，又加用烧针的，用四逆汤主治。（“心烦”，《玉函经》作“颇”字。云：论曰心烦。《脉经》作“颇复”。注：仲景作“心烦”。成本：桂枝下有“汤”字，是正确的。“躁”，作“燥”，是误字。《玉函经》：脚上有“两”字。《脉经》：无“调胃”字。）
〔成无己〕脉浮自汗出，小便数，而恶寒，是阳气不足。心烦脚挛急，是阴气不足。阴阳血气俱虚，则不可发汗。如果给予桂枝汤攻表，则会进一步损伤阳气，所以是错误的。服药后立即出现四肢厥冷，咽中干，烦躁吐逆的，先制作甘草干姜汤，恢复其阳气。得到厥愈足温后，再给予芍药甘草汤，增益其阴血，则脚得以伸直。阴阳虽然恢复，如果有胃燥谵语，少量给予调胃承气汤，轻微通便以调和胃气。重发汗导致亡阳，加烧针则损伤阴气。《内经》说：营气微弱的，加烧针则血液不流行。重发汗又加烧针，是阴阳之气大虚，用四逆汤来恢复阴阳之气。〔鉴〕这应当给予桂枝增桂加附子汤，以温经止汗。现在反而给予桂枝汤，攻发其表，这是大错误。〔汪〕脉浮自汗出，小便数，是阳虚气不收摄。心烦，是真阳虚脱，其气浮游而上走。咽中干烦躁，是误汗损伤阳气，津液耗竭，阳虚烦躁，作假热之象。吐逆，是阴寒气盛而拒膈。〔程〕脉浮自汗出，虽然看似桂枝证，但头项不痛，知道阳气神气自歉于上部，阳明内结，得之自汗出小便数之上，盖津液外越，而下部的阴分，更没有阳气来化气。所以阳气回复而结滞未破，不妨稍微顺从胃实的例子，一去其胃燥。〔鉴〕如果重发汗，是指不止误服桂枝汤，而且更误服麻黄汤。或者又加烧针，劫取其汗，以致亡阳证具，这就不是甘草干姜汤所能治疗的，所以又当给予四逆汤，以急救其阳气。
甘草干姜汤方
甘草（四两，炙） 干姜（二两）
以上两味药，用水三升，煮取一升五合，滤去药渣，分两次温服。（《玉函经》：甘草二两。成本注：干姜下有“炮”字。《玉函经》、成本：味下有“咀”二字。）
芍药甘草汤方
白芍药（○《玉函经》：无“白”字。） 甘草（各四两，炙）
以上两味药，用水三升，煮取一升五合，滤去药渣，分两次温服。（《玉函经》、成本：味下有“咀”二字。成本：五合，作“半”。服下，有“之”字。）
〔柯琴〕张仲景回阳，每用附子，这里用干姜甘草的，正是为了显示阳明治法。夫太阳少阴，所谓亡阳，是先天之元阳，所以必用附子之下行者来回阳，是从阴引阳。阳明所谓亡阳，是后天胃脘之阳，取甘草干姜来回阳，是随乎亡阳的性质。盖桂枝之性辛散，走而不守，即使佐以芍药，尚能亡阳。干姜之味苦辛，守而不走，所以君以甘草，便能回阳。然而先天太少之阳不易回，回了则诸证悉解。后天阳明之阳虽易回，既回而前证仍在，变证又起，所以再作芍药甘草汤继之。盖脾主四肢，胃主津液，阳盛阴虚，脾不能为胃行津液，以灌四旁，故足挛急。用甘草以生阳明之津，芍药以和太阴之液，其脚即伸。这也是用阴和阳的方法。甘草干姜汤，得理中之半，取其守中，不须其补中。芍药甘草汤，减桂枝之半，用其和里，不取其攻表。
胡遵程方注云：甘草干姜汤，就是四逆汤去掉附子。辛甘合用，专门恢复胸中之阳气。其夹食夹阴，面赤足冷，发热喘咳，腹痛便滑，外内合邪，难于发散，或者寒药伤胃，合用理中，不便参术者，都适宜服用。真是胃虚挟寒的圣剂。如果脉沉畏冷，呕吐自利，虽然没有厥逆，仍属四逆汤。芍药甘草汤，这就是桂枝汤去掉桂枝、姜、枣。甘酸合用，专门治疗营中之虚热。其阴虚阳乘，至夜发热，血虚筋挛，头面赤热，过汗伤阴，发热不止，或者误用辛热，扰其营血，不受补益者，都适宜使用。真是血虚挟热的神方。
《外台秘要》、《备急千金要方》：疗吐逆水米不下，干姜甘草汤。（即本方）
《直指方》：干姜甘草汤，治疗脾中冷痛，呕吐不食。
在本方基础上，加大枣一枚。
又甘草干姜汤，治疗男女诸虚出血，胃寒不能引气归元，无以收约其血。（即本方）
朱氏集验方：二神汤，治疗吐血极妙。治疗男子妇人，吐红之疾，盖是久病，或者作急劳，损其荣卫，塞滞气上，血之妄行所致。如果投以藕汁、生地黄等凉剂治疗，必然求死。每当遇到患者，用药甚简。（即甘草干姜汤）每服二钱，水一中盏，煎至五七沸，带热呷，空心日午进之，和其气血荣卫，自然安痊，不可不知。
《证治要诀》：饮酒过多而衄甚，则用理中汤，加干葛、川芎各半钱。或者只用干姜甘草二味。
《证治准绳》、曹氏必用方：吐血，须煎干姜甘草，作汤与服。或者四物理中汤亦可。如此无不愈者。如果服生地黄、竹茹、藕汁，去生便远。
魏氏家藏方：六半汤，治疗热湿香港脚，不能行步。
即芍药甘草汤，入无灰酒少许，再煎服。
朱氏集验方：去杖汤，治疗脚弱无力，行步艰难。友人戴明远用之有验。（即芍药甘草汤）
《活人事证方》：神功散，治疗消渴。（即芍药甘草汤）
《医学心悟》：芍药甘草汤，止腹痛如神。脉迟为寒，加干姜。脉洪为热，加黄连。
调胃承气汤方
大黄（四两，去皮，清酒洗○《阳明篇》、《玉函经》：无“去皮”字。洗，成本、《玉函经》作“浸”。） 甘草（二两，炙○《外台》：作三两。） 芒硝（半升○《千金翼方》：作半两。《全书》、方本：作半升。）
以上三味药，用水三升，煮取一升，滤去药渣，纳入芒硝，再上火，微煮令沸，少量多次温服。（《阳明篇》：上三味切，以水三升，煮二物至一升，去滓，纳芒硝，更上微火一二沸，温顿服之，以调胃气。成本、《玉函经》：味下有“咀”二字。）
〔汪〕误与桂枝汤，复与甘草干姜汤，姜桂辛热，耗胃中津液，因而谵语。方后云：少少温服，这不过是……
Taiyang (Sun-Yang channel disease). Therefore, Wuling San (Five-Ingredient Powder with Poria) is the primary treatment. Now, with severe restlessness and thirst, and a pulse appearing flooding and large, the pathogenic factor is no longer in Taiyang but has already transmitted to Yangming. This corresponds to what is said in the Yangming chapter: "Yangming pulse is large." Therefore, Baihu Tang (White Tiger Decoction) is used to resolve the heat and restlessness in the stomach; Ginseng is added to tonify the deficiency caused by profuse sweating and to rescue the exhaustion of body fluids.
Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) Formula
Zhimu (Anemarrhenae Rhizoma, six liang) Shigao (Gypsum Fibrosum, one jin, crushed, wrapped in cotton cloth) Gancao (Licorice Root, honey-fried, two liang) Jingmi (Oryza Sativa var. glutinosa, six he) Renshen (Panax Ginseng, three liang)
The above five ingredients are boiled in ten dou of water until the rice is cooked. The decoction is strained. Take one sheng warm, three times a day. (*Waitai Miyao* records: Cut the above five ingredients, boil in twelve dou of water until the rice is cooked, remove the rice, add the other herbs, boil to obtain six sheng, strain, take one sheng warm, three times a day. *Chengben* note says: Add three liang of Renshen to Baihu Tang, follow the method of Baihu Tang for the rest. Note: What is recorded in *Waitai Miyao* should be Zhang Zhongjing's old method.)
*Huoren Shu* (Book of Living People) Doubts: Huaban Tang (Spot-Resolving Decoction), treats red macules, dry mouth, restlessness and thirst. (This is the same formula.)
*Bao Ming Ji* (Collection for Preserving Life): Renshen Shigao Tang (Ginseng and Gypsum Decoction), treats Ge Xiao (thirst in the diaphragm/upper jiao with restlessness and thirst, unwillingness to eat much).
Based on this formula, remove Jingmi. (Li Dongyuan suggests adding Huangqin (Scutellariae Radix) and Xingren (Armeniacae Semen Amarum).)
Xu Tongzhi's Formula: Renshen Baihu Tang (Ginseng White Tiger Decoction), treats latent summerheat causing thirst, vomiting, fever, deficient pulse, and spontaneous sweating. (This is the same formula.) If latent summerheat presents with alternating chills and fever not yet resolved, it is suitable to decoct Wuling San together with this formula.
*Zhenke Zuan Yao* (Essentials of Rash Medicine): Renshen Baihu Tang, treats measles, resolving macules, erupting rashes, and stopping thirst as if by magic.
Based on this formula, remove Jingmi, add Jiegeng (Platycodonis Radix) and Zhuye (Bambusae Folium).
*Yi Shi* (History of Medicine) records: Lu Cangzhou treated the son of the Zhao family who had suffered from Shanghan (Cold Damage) for ten days. He had fever but was quiet, and his pulses in both hands were completely hidden. Quack doctors considered it a death case and did not prescribe medicine. Master Lu diagnosed that the pulses at the cun, guan, and chi positions on both hands were imperceptible upon lifting and pressing. His tongue coating was slippery, but his malar regions were red like fire, and his speech was coherent and clear. He then told them, "This child will certainly develop widespread red macules, covering the body like brocade patterns. The pulse is the wave of blood. Now, the blood is constrained by pathogenic heat, becoming turbid and manifesting as macules on the skin. Breath is formless and cannot be relied upon, just like a ditch without water; even with wind, waves cannot form. When the macules subside, the pulse will emerge." Upon uncovering him, indeed, red macules were clearly visible. Immediately, Baihu Jia Renshen Tang was administered to resolve the macules, and the pulse returned to normal. Subsequently, Chengqi Tang (Major/Minor/Gastrointestinal Regulating Purging Decoction) was given to purge, and he recovered. Macules appearing without a pulse was something not discussed by Changsha (Zhang Zhongjing); Master Lu probably inferred this through intuition.
Taiyang disease, with fever and aversion to cold, more heat than cold, and a weak pulse, indicates "Wu Yang" (deficiency of Yang Qi). Sweating methods should not be used; Guizhi Er Yuebi Yi Tang (Guizhi Twice Yuebi One Time Decoction) is appropriate. ("Zhe" character, *Qianjin Yifang* makes it "Ze"; *Fahan Shang* chapter, *Yuhan Jing* has the character "Fu"; *Quan Shu* makes it "Geng han".)
[Ke Qin] The main text does not describe Yuebi syndrome nor provide the Yuebi formula; I do not know its meaning. I suspect the character "Er" (two) must be an error. Here, "more heat" refers to more fever, not internal heat. "Wu Yang" means Yang Qi is already deficient while Yin is not deficient. Without restlessness or agitation, how can one recklessly use Shigao? Looking at Guizhi Er Mahuang Yi Tang (Guizhi Twice Mahuang One Time Decoction), where Mahuang and Guizhi are combined half-and-half, these are all syndromes requiring sweating. Here it says sweating should not be used, so how can one recklessly use Mahuang? When reading ancient books, one must trust what is credible and leave doubts aside; one should not embellish the text, especially when life and death are at stake. Moreover, such pulse and syndrome combinations are common. "Wu Yang implies no sweating" is the principle of Zhang Zhongjing. Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is indeed an excellent formula of Zhang Zhongjing, but if there is no stiffness and pain in the head and neck, there is no need to combine it with Guizhi. Reading without discernment leads to patients losing their lives; therefore, I point this out explicitly.
Shu Chi Yuan said: The four characters "more heat than cold" are the key to this clause. It must be that the person usually has excessive heat and depleted fluids, which is why Shigao is used in the formula to protect his fluids. However, the two characters "Wu Yang" are erroneous. If there were truly no Yang, there would be more cold than heat, and Fuzi (Aconiti Lateralis Radix Praeparata) should be used; Shigao would then be contraindicated. Note: Fang Youzhi also doubted the term "Wu Yang," but still interpreted it as the disease being in the Yin aspect and not in the Yang aspect. Zhang Zhicong and Zhang Xiju followed this interpretation. Yu Jia Yan, Zhou Xuehai, and Zhang Lu stated that it refers to the lack of body fluids. *Yizong Jinjian* (Golden Mirror of Medicine) also claimed it meant the absence of a Taiyang exterior pulse; all are forced interpretations. Cheng Jiaoqian said: It is Zheng Yang (Direct Yang) deficiency. Qian Huang said: It is the deficiency of True Yang from the Gate of Vitality. If this were true, what reason would there be to use Shigao? Others like Wei Litong and Wang Hu belong to forced associations. Only Cheng Wuji provided no annotation for this clause, presumably because he had insights. As for Ke Qin, decisively leaving it as a doubt shows卓越 (outstanding) insight. Now, I will not burdenously list various theories.
Note: In the chapter on diseases after sweating, it states: After excessive sweating, if Yang deficiency causes delirium, purgatives should not be used; instead, give Chaihu Guizhi Tang to harmonize Ying and Wei and promote the flow of fluids, after which it will heal naturally. Ke Qin believes Chaihu Guizhi Tang treats this clause because "Wu Yang" here means loss of Yang.
Guizhi Er Yuebi Yi Tang (Guizhi Twice Yuebi One Time Decoction) Formula
Guizhi (Cinnamomi Ramulus, peeled) Shaoyao (Paeoniae Radix Alba) Gancao (Licorice Root, honey-fried, each 18 zhu. *Chengben* note: No "fried" character.) Dazao (Jujubae Fructus, four pieces, split) Shengjiang (Zingiberis Rhizoma Recens, 1 liang 2 zhu, sliced ○ *Yuhan Jing*, *Qianjin Yifang*: "Er" makes "San". *Chengben* note: Makes "3 qian", likely an error.) Shigao (Gypsum Fibrosum, 24 zhu, crushed, wrapped in cotton cloth.) Mahuang (Ephedrae Herba)
The above seven ingredients are boiled in five sheng of water. First, boil Mahuang for one or two boils, remove the foam on top, then add the other ingredients. Boil to obtain two sheng, strain, and take one sheng warm. The original method states: It should be adjusted to Yuebi Tang and Guizhi Tang, combined and drunk one sheng. Now they are combined into one formula: Guizhi Tang accounts for two parts, Yuebi Tang for one part. ([Original Note] Chen Yi et al. carefully examined: Guizhi Tang formula, Guizhi, Shaoyao, Shengjiang each three liang, Gancao two liang, Dazao twelve pieces. Yuebi Tang formula, Mahuang two liang, Shengjiang three liang, Gancao two liang, Shigao half jin, Dazao fifteen pieces. Now using arithmetic simplification: Take one-fourth of Guizhi Tang, yielding Guizhi, Shaoyao, Shengjiang each 18 zhu, Gancao 12 zhu, Dazao three pieces. Take one-eighth of Yuebi Tang, yielding Mahuang 18 zhu, Shengjiang 9 zhu, Gancao 6 zhu, Shigao 24 zhu, Dazao one piece. Discard seven-eighths. Combining the taken portions of both formulas yields Guizhi, Shaoyao, Gancao, Mahuang each 18 zhu, Shengjiang 1 liang 3 zhu, Shigao 24 zhu, Dazao four pieces, combined. Old text calls it Guizhi Three, now taking one-fourth, it should be called Guizhi Two. Yuebi Tang formula is found in Zhang Zhongjing's miscellaneous formulas. *Waitai Miyao* says alternatively, Qipi Tang. ○ Before boiling Mahuang, *Yuhan Jing*, *Qianjin Yifang* have the character "Xian". Says: *Yuhan Jing*, *Chengben* make it "Fang". *Yuhan Jing* decoction method: "Er Bi" characters are both written as "Pi". Note: Alternatively, Qipi Tang is found in *Waitai* Rou Ji Men.)
[Cheng Wuji] The Stomach is the master of the twelve channels. Pi (Spleen/Bi) manages water and grain, being a humble organ, like a maid. *Neijing* says: The Spleen governs transporting fluids for the Stomach. This decoction is called Yuebi because it promotes the ascending function of the Spleen Qi and circulates fluids. *Waitai Fang* names it Yuepi Tang, which is the same meaning. [Ke Qin] This formula is Da Qing Long Tang (Major Green Dragon Decoction) minus Guizhi and Xingren, along with Mahuang Xing Shi Gao Tang (Ephedra, Apricot Kernel, and Gypsum Decoction), all being cooling agents that resolve both exterior and interior. This formula does not use the bitter nature of Xingren but uses the pungent-sweet nature of Jiang and Zao. It can treat Taiyang-Yangming combined disease with more heat than cold and no sweating, similar to Baihu Tang syndrome where there is slight aversion to cold on the back, but it cannot treat syndromes with weak pulse and Wu Yang.
Note: The meaning of Yuebi is uncertain. Cheng Wuji citing *Waitai* as promoting Spleen Qi seems reasonable. *Xu Yi Shuo* cites Zhao Liangren's *Jinkui Yanyi* refuting Cheng's note, but his argument is similar to Cheng's. Fang Youzhi and Yu Jia Yan interpret "Bi" as a maid, which is not entirely appropriate. As for Qian Huang saying it was effective in treating a maid of Yue Ren, it is highly fabricated.
After taking Guizhi Tang, or after purgation, if there is still stiffness and pain in the head and neck, mild fever, no sweating, fullness and slight pain in the epigastrium, and difficulty urinating, Guizhi Qu Gui Jia Fuling Baizhu Tang (Guizhi Decoction minus Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction) is the primary treatment. (*Mai Jing*, *Qianjin Yifang* lack "Huo" (or), "Reng" (still), and under "Man" (fullness); *Yuhan Jing* has "Er" (and); *Mai Jing* lacks "Bai" (white).)
[Cheng Wuji] Stiffness and pain in the head and neck, mild fever, indicate that despite sweating and purgation, the pathogenic factor remains in the exterior. Fullness and slight pain in the epigastrium, if urination is free, suggests impending Jie Xiong (Chest Binding). Now, since exterior symptoms persist, and there is no sweating and difficulty urinating, the fullness and slight pain in the epigastrium are due to retained fluid. Give Guizhi Tang to resolve the exterior, and add Fuling (Polyporus) and Baizhu (Atractylodis Macrocephalae Rhizoma) to promote urination and move retained fluid. [Qian Huang] Stiffness and pain in the head and neck occur in both Feng Zhong (Wind Strike) and Shang Han. Mild fever indicates heat in the skin and hair, characteristic of Feng Zhong. No sweating is the fundamental symptom of Shang Han. Considering these symptoms, it is undoubtedly a combination of Wind and Cold. But only taking Guizhi Tang treats Wind but not Cold, hence the persistence of stiffness, fever, and no sweating. Or, if mistakenly purged, leading to fullness and slight pain in the epigastrium, this is because pathogenic factors sank inward after purgation and intended to bind. Difficulty urinating is due to Taiyang heat invading the Bladder internally, failing to transform Qi. Treating with Guizhi Qu Gui Jia Fuling Baizhu Tang, the rationale is unclear; it may be a transcription error by later generations. Even if used, efficacy is not guaranteed. Did Zhang Zhongjing establish laws with formulas mismatched to syndromes to serve as models for later generations? I privately doubt this. It is likely due to errors by later generations over long years, not Zhang Zhongjing's original prescription. Modern masters all follow Cheng Wuji's guidance, forcing interpretations to fit, claiming all symptoms resolve upon use. I do not believe this.
Note: Cheng Wuji's annotation does not address the removal of Gui. He only says Guizhi Tang resolves the exterior, implying his annotated version might lack the words "Qu Gui" (remove Cinnamon Twig). If Gui is not removed and this formula is used for this syndrome, it might be effective. Since Wang Kentang, many attribute it to fluid retention, but without solid evidence. *Yizong Jinjian* bases its view on the example of Guizhi Qu Shao Yao Tang (Guizhi Decoction minus Peony Root Decoction), suggesting it was an error to remove Shao Yao instead of Gui. This view is also difficult to accept.
Guizhi Qu Gui Jia Fuling Baizhu Tang (Guizhi Decoction minus Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction) Formula
Shaoyao (Paeoniae Radix Alba, three liang) Gancao (Licorice Root, honey-fried, two liang) Shengjiang (Zingiberis Rhizoma Recens, sliced) Baizhu (Atractylodis Macrocephalae Rhizoma) Fuling (Polyporus, each three liang) Dazao (Jujubae Fructus, twelve pieces, split)
The above six ingredients are boiled in eight sheng of water to obtain three sheng. Strain, take one sheng warm. Healing occurs when urination becomes free. Originally said to be Guizhi Tang, now Gui is removed, and Fuling and Baizhu are added.
(*Yuhan Jing*: Under "six ingredients" there is the character "Ju" (chew/crush). Eight sheng, makes seven sheng. Says: Make formula. *Chengben* note: Does not record this formula. Volume 10 says: In Guizhi Tang, remove Gui, add Fuling and Baizhu each three liang, follow previous method for decoction, healing occurs when urination becomes free.)
*Shanghan Leifang* (Classified Formulas for Cold Damage) states: Whenever a formula has modification instructions, they refer to assistant and guide herbs. If the sovereign herb is removed, a new formula name should be created. Now, Gui is removed, yet it retains the name Guizhi, which is inexplicable.
Shanghan (Cold Damage) with floating pulse, spontaneous sweating, frequent urination, vexation, slight aversion to cold, and cramped legs, if mistakenly given Guizhi Tang to attack the exterior, is an error. Immediately after, cold limbs, dry throat, restlessness, and vomiting occur. Prepare Gangcao Ganjiang Tang (Licorice and Dried Ginger Decoction) to administer, to restore Yang Qi. If cold limbs resolve and feet become warm, prepare Shaoyao Gancao Tang (Peony and Licorice Decoction) to administer, and the legs will extend. If stomach Qi is disharmonious and delirium occurs, give a small amount of Tiaowei Chengqi Tang (Regulating the Stomach and Purging Decoction). If heavily sweated again, and moxibustion with burning needles is added, Sini Tang (Four Reversal Decoction) is the primary treatment. ("Xinfan" (vexation), *Yuhan Jing* makes it "Po" (quite). Says: Lun says Xinfan. *Mai Jing* makes it "Po Fu". Note: Zhongjing makes it "Xinfan". *Chengben*: Under Guizhi there is "Tang" (decoction), which is correct. "Zao" (agitation), makes "Zao" (dry), is an error. *Yuhan Jing*: Above "Jiao" (foot) there are "Liang" (two) characters. *Mai Jing*: Lacks "Tiaowei" (Regulate Stomach).)
[Cheng Wuji] Floating pulse, spontaneous sweating, frequent urination, and aversion to cold indicate insufficient Yang Qi. Vexation and cramped legs indicate insufficient Yin Qi. With deficiency of Yin, Yang, Blood, and Qi, sweating should not be used. If Guizhi Tang is given to attack the exterior, it further damages Yang Qi, thus it is an error. Immediately developing cold limbs, dry throat, restlessness, and vomiting: First prepare Gangcao Ganjiang Tang to restore Yang Qi. Once cold limbs resolve and feet warm, then give Shaoyao Gancao Tang to benefit Yin and Blood, so the legs can extend. Although Yin and Yang are restored, if there is stomach dryness and delirium, give a small amount of Tiaowei Chengqi Tang to slightly loosen stool and harmonize the Stomach. Heavy sweating leads to loss of Yang; adding burning needles damages Yin. *Neijing* says: If Ying Qi is weak, adding burning needles causes blood circulation to stagnate. Heavy sweating plus burning needles results in great deficiency of Yin and Yang Qi; Sini Tang is used to restore Yin and Yang Qi. [Jian] This should be treated with Guizhi Zeng Gui Jia Fuzi Tang (Guizhi Decoction increased Cinnamon Twig plus Prepared Aconite Decoction) to warm meridians and stop sweating. Giving Guizhi Tang to attack the exterior is a major error. [Wang] Floating pulse, spontaneous sweating, frequent urination indicate Yang deficiency and failure of Qi to secure. Vexation indicates true Yang deficiency and floating, upward drifting of Qi. Dry throat and restlessness indicate mistaken sweating damaging Yang, exhausting fluids, Yang deficiency causing restlessness presenting as false heat. Vomiting indicates excess Yin-Cold rejecting at the diaphragm. [Cheng] Floating pulse and spontaneous sweating seem like Guizhi syndrome, but without head/neck stiffness, indicating Yang Shen (Spirit) is deficient in the upper part. Yangming internal binding, resulting from spontaneous sweating and frequent urination, implies fluids escape outward, and the lower Yin division lacks Yang to transform Qi. Thus, although Yang returns, the binding is not broken; it is acceptable to slightly follow the Stomach excess pattern to remove stomach dryness. [Jian] "Heavy sweating" means not only mistakenly taking Guizhi Tang but also mistakenly taking Mahuang Tang. Or adding burning needles to force sweat, leading to complete Yang loss syndrome, which Gangcao Ganjiang Tang cannot treat. Therefore, Sini Tang should be given to urgently rescue Yang.
Gangcao Ganjiang Tang (Licorice and Dried Ginger Decoction) Formula
Gancao (Licorice Root, honey-fried, four liang) Ganjiang (Zingiberis Rhizoma, two liang)
The above two ingredients are boiled in three sheng of water to obtain one sheng five he. Strain, divide into two warm doses. (*Yuhan Jing*: Gancao two liang. *Chengben* note: Under Ganjiang there is "Pao" (parched). *Yuhan Jing*, *Chengben*: Under "wei" (ingredient) there are "Ju" (chew) two characters.)
Shaoyao Gancao Tang (Peony and Licorice Decoction) Formula
Baishaoyao (Paeoniae Radix Alba, ○ *Yuhan Jing*: Lacks "Bai" (white) character.) Gancao (Licorice Root, each four liang, honey-fried)
The above two ingredients are boiled in three sheng of water to obtain one sheng five he. Strain, divide into two warm doses. (*Yuhan Jing*, *Chengben*: Under "wei" there are "Ju" characters. *Chengben*: Five he, makes "Ban" (half). Under "fu" (take), there is "Zhi" (it) character.)
[Ke Qin] Zhang Zhongjing often uses Fuzi to restore Yang; here using Ganjiang and Gancao precisely demonstrates the treatment method for Yangming. The "loss of Yang" in Taiyang and Shaoyin refers to the primordial Yang of the先天 (Pre-heaven), so Fuzi, which descends, is used to restore it, drawing Yang from Yin. The "loss of Yang" in Yangming refers to the postnatal Yang of the stomach and intestines; Gancao and Ganjiang are taken to restore it, following the nature of the loss. Guizhi is pungent and dispersing, moving without staying; even assisted by Shaoyao, it can still cause loss of Yang. Ganjiang is bitter and pungent, staying without moving; thus, with Gancao as sovereign, it can restore Yang. However, the Yang of Pre-heaven Shaoyin and Jueyin is hard to restore; once restored, all symptoms resolve. The Yang of Post-heaven Yangming is easier to restore, but if prior symptoms remain and new complications arise, Shaoyao Gancao Tang is prepared subsequently. The Spleen governs the four limbs, the Stomach governs fluids. With Yang excess and Yin deficiency, the Spleen cannot transport fluids for the Stomach to irrigate the surroundings, causing leg cramps. Gancao generates Yangming fluids, Shaoyao harmonizes Taiyin fluids, so the legs extend. This is also a method of using Yin to harmonize Yang. Gangcao Ganjiang Tang obtains half of Lizhong Tang, taking its ability to stay central, not needing its tonifying center function. Shaoyao Gancao Tang reduces Guizhi by half, using its ability to harmonize the interior, not its ability to attack the exterior.
Hu Zuncheng's formula annotation says: Gangcao Ganjiang Tang is Sini Tang minus Fuzi. Pungent and sweet combined, specifically restores Yang Qi in the chest. For cases with food stagnation and Yin-cold, red face, cold feet, fever, wheezing cough, abdominal pain, loose stools, external and internal combined pathogens difficult to disperse, or cold medicines damaging the Stomach, combining with Lizhong but inconvenient to use Renshen and Baizhu, all are suitable for this. It is a sacred agent for Stomach deficiency with cold. If pulse is deep, fear of cold, vomiting, spontaneous diarrhea, even without cold limbs, it still belongs to Sini Tang. Shaoyao Gancao Tang is Guizhi Tang minus Guizhi, Jiang, and Zao. Sweet and sour combined, specifically treats deficiency-heat in Ying. For Yin deficiency with Yang overriding, fever at night, blood deficiency with tendon cramping, red-hot head and face, excessive sweating damaging Yin, continuous fever, or mistakenly using pungent-hot herbs disturbing Ying-Blood, unable to accept tonification, all are suitable for this. It is a divine formula for blood deficiency with heat.
*Waitai Miyao*, *Beiji Qianjin Yaofang*: Treats vomiting inability to keep down water and rice, Ganjiang Gancao Tang. (This is the same formula.)
*Zhizhi Fang*: Ganjiang Gancao Tang, treats cold pain in the Spleen, vomiting, unwillingness to eat.
Based on this formula, add one Dazao.
Also, Gangcao Ganjiang Tang treats various deficiencies and bleeding in men and women, Stomach cold preventing Qi from returning to its origin, unable to constrain blood. (This is the same formula.)
Zhu Shi Jiyan Fang: Ershen Tang (Two Spirit Decoction), treats hematemesis excellently. Treats men and women with red spitting disease, likely chronic illness or acute consumption, damaging Ying and Wei, obstructing Qi upward, causing reckless blood flow. If treated with coolants like Lotus Root Juice or Shengdi Huang, it seeks death. When encountering patients, medication is very simple. (This is Gangcao Ganjiang Tang.) Take two qian per dose, one zhann of water, boil for five to seven boils, drink warm, on an empty stomach at noon. Harmonize Qi, Blood, Ying, and Wei, naturally recover. Must not ignore this.
*Zhengzhi Yaojue*: Excessive drinking causing severe epistaxis, use Lizhong Tang, add Gegen (Puerariae Radix) and Chuanxiong (Chuanxiong Rhizoma) half qian each. Or simply use Ganjiang and Gancao two ingredients.
*Zhengzhi Zhunsheng*, Cao Shi Biyong Fang: Hematemesis, must decoct Ganjiang and Gancao as a decoction to take. Or Siwu Lizhong Tang is also acceptable. There is no cure not achieved this way. If taking Shengdi Huang, Zhuru, Lotus Root Juice, distance from life increases.
Wei Shi Jiacang Fang: Liuban Tang (Six-Half Decoction), treats hot-damp Hong Kong foot (podagra/gout), inability to walk.
This is Shaoyao Gancao Tang, add a little non-filtered wine, decoct again and take.
Zhu Shi Jiyan Fang: Quzhang Tang (Remove Crutch Decoction), treats weak legs, difficulty walking. Friend Dai Mingyuan used it with effect. (This is Shaoyao Gancao Tang.)
*Huoren Shizheng Fang*: Shengong San (Divine Merit Powder), treats Xiao Ke (Wasting-Thirst). (This is Shaoyao Gancao Tang.)
*Yixue Xinwu* (Heart of Medical Learning): Shaoyao Gancao Tang stops abdominal pain as if by magic. Pulse slow indicates cold, add Ganjiang. Pulse flooding indicates heat, add Huanglian (Scutellariae Radix).
Tiaowei Chengqi Tang (Regulating the Stomach and Purging Decoction) Formula
Dahuang (Rhei Radix et Rhizoma, four liang, peeled, washed with clear wine ○ *Yangming Chapter*, *Yuhan Jing*: Lacks "peeled" character. Wash, *Chengben*, *Yuhan Jing* make it "Immerse".) Gancao (Licorice Root, honey-fried, two liang ○ *Waitai*: Makes three liang.) Mangxiao (Natrii Sulfas, half sheng ○ *Qianjin Yifang*: Makes half liang. *Quan Shu*, *Fangben*: Makes half sheng.)
The above three ingredients are boiled in three sheng of water to obtain one sheng. Strain, add Mangxiao, heat again, bring to a slight boil, take small amounts warm. (*Yangming Chapter*: Cut the above three ingredients, boil in three sheng of water, boil two ingredients to one sheng, strain, add Mangxiao, heat again on slight fire for one or two boils, take warm in one dose to regulate Stomach Qi. *Chengben*, *Yuhan Jing*: Under "wei" there are "Ju" characters.)
[Wang] Mistakenly given Guizhi Tang, then given Gangcao Ganjiang Tang, the pungent-hot nature of Jiang and Gui consumes Stomach fluids, leading to delirium. The formula notes say: Take small amounts warm; this is merely...