又加人参。以救其津液也。
太阳少阳并病。心下硬。颈项强而眩者。当刺大椎肺俞肝俞。慎勿下之。（玉函。太阳下。有与字。硬。
作痞坚二字。大椎下。有一间二字。成本。无肝俞二字。考注文。系脱文。）
〔成〕心下痞硬而眩者。少阳也。颈项强者。太阳也。刺大椎肺俞。以泻太阳之邪。而以太阳脉下项挟脊。
故尔。肝俞以泻少阳之邪。以胆为肝之腑故尔。太阳为在表。少阳为在里。明是半表半里证。前第八证云。不
可发汗。发汗则谵
语。是发汗攻太阳之邪。少阳之邪。益甚于胃。以发谵语。此云慎勿下之。攻少阳之邪。太阳之邪。乘虚入里。
必作结胸。经曰。太阳少阳并病。而反下之成结胸。〔方〕颈项。亦头项之互词。前条言眩冒。此有眩无冒。
差互详略耳。〔汪〕大椎一穴。实合太少而齐泻。诸家注皆不明用针之理。竟置大椎而不论。大误之极。
太阳与少阳合病。自下利者。与黄芩汤。若呕者。黄芩加半夏生姜汤主之。
〔成〕太阳阳明合病自下利。为在表。当与葛根汤发汗。阳明少阳合病自下利。为在里。可与承气汤下之。
此太阳少阳合病自下利。为在半表半里。非汗下所宜。故与黄芩汤。以和解半表半里之邪。呕者。胃气逆也。
故加半夏生姜。以散逆气。〔钱〕太少两阳经之证。并见而为合病。太阳虽在表。而少阳逼处于里。已为半表
半里。以两经之热邪内攻。令胃中之水谷下奔。故自下利。〔汪〕太少合病。而至自利。则在表之寒邪。悉郁而
为里热矣。里热不实。故与黄芩汤以清热益阴。使里热清而阴气得复。斯在表之阳热自解。所以此条病。不但
太阳桂枝。在所当禁。并少阳柴胡。亦不须用也。〔鉴〕太阳与少阳合病。谓太阳发热头痛。或口苦咽干目眩。
或胸满。脉或大而弦也。若表邪盛。肢节烦疼。则宜与柴胡桂枝汤。两解其表矣。今里热盛。而自下利。则当
与黄芩汤清之。以和其里也。
案此条证。张璐周禹载。以为温病。魏氏驳之。是也。
医方集解曰。合病者。谓有太阳症之身热头痛脊强。又有少阳症之耳聋胁痛。呕而口苦。寒热往来也。
自利者。不因攻下。而泄泻也。自利。固多可温。然肠胃有积结。与下焦客热。又非温剂所能止。或分利之。或攻泄之
可也。
黄芩汤方
黄芩（三两○玉函。作二两。） 芍药（二两） 甘草（二两炙） 大枣（十二枚擘）
上四味。以水一斗。煮取三升。去滓。温服一升。日再。夜一服。（成本。一服下。有若呕者。加半夏半
升。生姜三两。十二字。而无黄芩加半夏生姜汤方。成本。第十卷。生姜一两半）
黄芩加半夏生姜汤方
黄芩（三两） 芍药（二两） 甘草（二两炙） 大枣（十二枚擘） 半夏（半升洗） 生姜（一两半
一方三两切）
上六味。以水一斗。煮取三升。去滓。温服一升。日再。夜一服。
〔汪〕此小柴胡加减方也。热不在半表。已入半里。故以黄芩主之。虽非胃实。亦非胃虚。故不须人参补
中也。〔钱〕黄芩撤其热。而以芍药敛其阴。甘草大枣。和中而缓其津液之下奔也。若呕者。是邪不下走而上
逆。邪在胃口。胸中气逆而为呕也。故加半夏之辛滑。生姜之辛散。为蠲饮治呕之专剂也。〔徐〕因此而推展
之。凡杂证因里未和而下利者。黄芩汤可为万世之主方矣。
玉函经。黄芩人参汤方。黄芩。人参。桂枝。干姜。各二两。半夏半升。大枣十二枚。上六味。以水七升。
煮取二升。去滓。分温再服。○此方无治证。盖与黄连汤略同。（此方。外台。名黄芩汤。治干呕下利。）
医方集解曰。昂案二经合病。何以不用二经之药。益合病而兼下利。是阳邪入里。则所重者在里。故用黄
芩。以彻其热。而以甘芍大枣。和其太阴。使里气和。则外证自解。和解之法。非一端也。仲景之书。一字不
苟。此证单言下利。故此方亦单治下利。机要用之。治热痢腹痛。更名黄芩芍药汤。又加木香槟榔大黄黄连当
归官桂。更名芍药汤。治下痢。
仲景此方。遂为万世治痢之祖矣。本方除大枣。名黄芩芍药汤。治火升鼻衄。及热痢。（出活人书。）黄芩加
半夏生姜汤。亦治胆腑发咳。呕苦水。如胆汁。
伤寒胸中有热。胃中有邪气。腹中痛欲呕吐者。黄连汤主之。
〔成〕此伤寒邪气传里。而为下寒上热也。胃中有邪气。使阴阳不交。阴不得升。而独治于下。为下寒。腹
中痛。阳不得降。而独治于上。为胸中热欲呕吐。与黄连汤。升降阴阳之气。〔程〕此等证。皆本气所生之寒热。
无关于表。故着二有字。〔鉴〕伤寒未解。欲呕吐者。胸中有热邪上逆也。腹中痛者。胃中有寒邪内攻也。此
热邪在胸。寒邪在胃。阴阳之气不和。失其升降之常。故用黄连汤。寒温互用。甘苦并施。以调理阴阳。而和
解之也。伤寒邪气入里。因人脏气素有之寒热而化。此则随胃中有寒。胸中有热而化。腹中痛欲呕吐。故以是
方主之。〔汪〕条辨尚论篇。皆以风寒二邪。分阴阳寒热。殊不知风之初来。未必非寒。寒之既入。亦能成热。
不可拘也。
病源候论。冷热不调候曰。夫人营卫不调。致令阴阳痞塞。阳并于上则上热。阴并于下则下冷。上焦有热。
或喉口生疮。胸膈烦满。下焦有冷。则腹胀肠鸣。绞痛泄利。
宣明论曰。腹痛欲呕吐者。上热下寒也。以阳不得降。而胸热欲呕。阴不得升。而下寒腹痛。是升降失常也。
黄连汤方
黄连（三两○玉函。作二两。） 甘草（三两炙○玉函。作一两。） 干姜（三两○玉函。作一两。） 桂枝
（三两去皮○玉函。作二两。） 人参（二两○千金翼。作三两。） 大枣（十二枚擘） 半夏（半升洗○玉函。
作五合。）
上七味。以水一斗。煮取六升。去滓。温服。昼三夜二。
疑非仲景方。（成本。作温服一升。日三服。夜二服。无疑非仲景方五字。玉函亦无。）
〔鉴〕君黄连。以清胸中之热。臣干姜。以温胃中之寒。半夏降逆。佐黄连呕吐可止。人参补中。佐干姜
腹痛可除。桂枝所以安外。大枣所以培中也。然此汤寒温不一。甘苦并投。故必加甘草。协和诸药。此为阴阳
相格。寒热并施之治法也。〔柯〕此与泻心汤大同。而不名泻心者。以胸中素有之热。而非寒热相结于心下也。
看其君臣更换处。大有分寸。
伤寒类方曰。即半夏泻心汤。去黄芩。加桂枝。诸泻心之法。皆治心胃之间。寒热不调。全属里症。此
方以黄芩易桂枝。去泻心之名。而曰黄连汤。乃表邪尚有一分未尽。胃中邪气。尚当外达。故加桂枝一味。以
和表里。则意无不到矣。
伤寒八九日。风湿相搏。身体疼烦。不能自转侧。不呕不渴。脉浮虚而涩者。桂枝附子汤主之。若其人
大便硬。（【原注】一云。脐下心下硬。）小便自利者。去桂加白术汤主之。（疼烦。成本。作烦疼。脉经。
作疼痛。不渴下。外台。有下之二字。千金翼。有下已二字。去桂加白术汤。玉函。脉经。千金翼。作术附子
汤。成本。桂下。有枝字。）
〔鉴〕伤寒八九日。不呕不渴。是无伤寒里病之证也。脉浮虚涩。是无伤寒表病之脉也。脉浮虚。主在
表虚风也。涩者。主在经寒湿也。身体疼烦。属风也。不能转侧。属湿也。乃风湿相搏之证。非伤寒也。与桂
子附子汤。温散其风湿。使从表而解也。若脉浮实者。则又当以麻黄加术汤。大发其风湿也。如其人有是证。
虽大便硬。小便自利。而不议下者。以其非邪热入里之硬。乃风燥湿去之硬。故仍以桂枝附子汤。去桂枝。以
大便硬。小便自利。不欲其发汗。再夺津液也。加白术。以身重着湿在肉分。用以佐附子。逐湿气于肌也。
程林金匮直解曰。风淫所胜。则身烦疼。湿淫所胜。则
身体难转侧。风湿相搏于营卫之间。不干于里。故不呕不渴也。脉浮为风。涩为湿。以其脉近于虚。故用桂枝
附子汤。温经以散风湿。小便利者。大便必硬。桂枝近于解肌。恐大汗。故去之。白术去肌湿。不妨乎内。故
加之。
内台方议曰。问曰。此书皆是伤寒之法。又兼此风湿之证杂之。何耶。答曰。此人先有湿气。因伤中风
寒。合而成此证。以此添入伤寒法中。昔自祖师张仲景开化以来。此风湿 风温湿温等证。皆在金镜外台法中。
因三国混乱。书多亡失。外台之书。流荡不全。因王叔和得伤寒。足六经之法。集成伤寒论。间得风湿数篇。
杂入此中。故曰 湿 三种。宜应别论。惟得正传者方知之。
案相搏之搏。方氏改作抟。注云。抟。 聚也。言风与湿。 合团聚。共为一家之病也。此说非也。盖
搏。薄同。王冰平人气象论注。引辨脉。阴阳相搏名曰动。作相薄。可以证也。
桂枝附子汤方
桂枝（四两去皮） 附子（三枚炮去皮破○成本。破八片。钱本。作二枚） 生姜（三两切） 大枣（十
二枚擘） 甘草（二两炙）
上五味。以水六升。煮取二升。去滓。分温三服。
去桂加白术汤方（○金匮白术附子汤。即是。玉函。名术附汤。金鉴。作桂枝附子去桂枝加白术汤。）
附子（三枚炮去皮破） 白术（四两） 生姜（三两切○玉函。作二两。） 甘草（二两炙○玉函。作三
两。） 大枣（十二枚擘○玉函。作十五枚。）
上五味。以水六升。煮取二升。去滓。分温三服。初一服。其人身如痹。半日许复服之。三服都尽。其
人如冒状。勿怪。此以附子术。并走皮内。逐水气未得除。故使之耳。法当加桂四两。此本一方二法。以大便
硬。小便自利。去桂
也。以大便不硬。小便不利。当加桂。附子三枚。恐多也。虚弱家及产妇。宜减服之。（去桂加白术汤。金匮。
用附子一枚。白术二两。生姜甘草各一两。大枣六枚。水六升。作三升。二升。作一升。外台。引仲景伤寒论。
本云附子一枚。今加之二枚。名附子汤。又云。此二方。但治风湿。非治伤寒也。）
〔徐〕是风湿相搏。以不头疼。不呕渴。知风湿之邪。不在表。不在里。而在躯壳。然其原因于寒。几于
风寒湿合而为痹矣。桂枝汤。本属阳剂。而芍药非寒湿证所宜。故易以附子之辛热。多至三枚。从桂枝之后。
为纯阳刚剂。以开凝结之阴邪。然脉不单涩而浮虚。先见是湿少而风多也。故藉一附子。而迅扫有余。否则又
宜去桂枝加术汤。驱湿为主矣。
吴仪洛方论曰。此即桂枝去芍药加附子汤。又加附子二枚。又即后条之甘草附子汤。以姜枣易术之变制也。
汪氏云。若其人大便硬。小便自利者。后条辨云。此湿虽盛而津液自虚也。于上汤中。去桂。以其能走津液。
加术。以其能生津液。或问云。小便利。则湿去矣。何以犹言湿盛。余答云。湿热郁于里。则小便不利。寒湿
搏于经。则小便自利。又有昧理者云。大便溏。宜加白术。殊不知白术为脾家主药。后条辨云。燥湿以之。滋
液亦以之。
直指方带下论云。经曰。卫气者所以温分肉。充皮肤。肥腠理。司开阖。卫气若虚。则分肉不温。皮肤不
充。腠理不肥。而开阖失其司耳。况胃为血海。水液会焉。胃者中央之土。又所以主肌肉。而约血水也。卫气
与胃气俱虚。则肌弱而肤空。血之与水。不能约制。是以涓涓漏卮。休作无时。而不暂停矣。然则封之止之。
其可不加意于固卫浓脾之剂乎。此桂枝附子汤。以之固卫。而人参白术茯苓草果丁香木香以之浓脾。二者俱不
可阙也。
风湿相搏。骨节疼烦。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。或身微肿者。甘草附子汤主之。（疼烦。成本。作烦疼。是。）
〔喻〕此条复互上条之意。而辨其症之较重者。痛不可近。汗出短气。恶风不欲去衣。小便不利。或身微肿。
正相搏之最剧处。〔钱〕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。〔方〕或。未定之词。身微肿。湿外薄也。不外薄则不肿。故曰或也。〔程〕以上二条。虽云
风湿相搏。其实各夹有一寒字在内。即三气合而为痹之证也。邪留于筋骨之间。寒多则筋挛骨痛。
甘草附子汤方
白术（二两○玉函。作三两。） 桂枝（四两去皮） 附子（二枚炮去皮○汪。周。作破八片） 甘草（二两
炙○玉函。外台。作三两）
上四味。以水六升。煮取二升。去滓。温服一升。日三服。初服得微汗则解。能食汗止。复烦者。将服五
合。恐一升多者。宜服六七合为始。（玉函。二升。作三升。汗止。金匮。成本。作汗出。无将字。始。金匮。
太阳病与少阳病同时发病，出现胃脘部痞塞坚硬、颈项强直且头晕目眩的症状，应当针刺大椎穴、肺俞穴和肝俞穴。务必禁止使用攻下法。（《玉函经》在“太阳”下有“下”字，“硬”字作“痞坚”二字；“大椎”下有一“间”字；成本本无“肝俞”二字，考证注文，认为是脱文。）
〔成无己〕胃脘部痞塞坚硬且头晕，是少阳病；颈项强直，是太阳病。针刺大椎穴和肺俞穴，以泻除太阳经的邪气，因为太阳经脉下行于项部并夹持脊柱，所以这样处理。针刺肝俞穴以泻除少阳经的邪气，因为胆是肝的腑，所以通过肝俞来治疗。太阳病在表，少阳病在里，这明显是半表半里的证候。前第八证说：不可发汗，如果发汗则会出现谵语，这是发汗攻逐太阳之邪，导致少阳之邪更加严重而传入胃中，从而产生谵语。这里说务必禁止攻下，如果是攻逐少阳之邪，太阳之邪就会乘虚入里，必然形成结胸证。经文说：太阳少阳并病，反而使用攻下法，会形成结胸。
〔方有执〕“颈项”也是“头项”的互称。前条说眩晕昏冒，这里只有眩晕没有昏冒，只是详略不同罢了。
〔汪琥〕大椎这一个穴位，实际上同时合泻太阳和少阳两经。各家注解都不明白用针的道理，竟然忽略大椎穴而不加讨论，错误极大。
太阳病与少阳病合病，出现自发性腹泻的，给予黄芩汤。如果有呕吐症状的，用黄芩加半夏生姜汤主治。
〔成无己〕太阳阳明合病自下利，病位在表，应当用葛根汤发汗。阳明少阳合病自下利，病位在里，可以用承气汤攻下。这里是太阳少阳合病自下利，病位在半表半里，不适合发汗或攻下，所以给予黄芩汤，以和解半表半里的邪气。呕吐，是胃气上逆，所以加入半夏和生姜，以散除上逆之气。
〔钱天来〕太阳和少阳两经的证候同时出现，称为合病。太阳虽在表，但少阳逼迫处于里，已经属于半表半里。由于两经的热邪内攻，导致胃中的水谷向下奔注，所以自发腹泻。
〔汪琥〕太阳和少阳合病，发展到自下利，说明在表的寒邪全部郁结化为里热了。里热尚未结实，所以用黄芩汤清热益阴，使里热清除而阴气恢复，那么在表的阳热自然解除。因此这条病证，不但太阳病的桂枝汤在所禁忌，连少阳病的柴胡汤也不需要使用了。
〔尤怡〕太阳与少阳合病，指太阳病的发热头痛，或者口苦咽干目眩，或者胸满，脉象或大或弦。如果表邪盛，肢体关节烦痛，则适宜用柴胡桂枝汤，两解其表。现在里热盛，而自下利，则应当用黄芩汤清解，以调和里气。
按语：此条证候，张璐、周禹载认为是温病，魏氏驳斥他们，是正确的。
《医方集解》说：合病，是指既有太阳病的身体发热、头痛、脊背强直，又有少阳病的耳聋、胁痛、呕吐、口苦、寒热往来等症状。
自下利，是不因攻下而出现的泄泻。自下利多可用温法，但如果肠胃有积结，或者下焦有客热，又不是温剂所能止住的，可以分别采用分利或攻泄的方法。
黄芩汤方
黄芩（三两○《玉函经》作二两） 芍药（二两） 甘草（二两，炙） 大枣（十二枚，掰开）
以上四味药，用水一斗，煮取三升，去渣滓，温服一升，每日两次，夜间一次服用。（成本本在“一服”下有“若呕者，加半夏半升，生姜三两”十二字，而无黄芩加半夏生姜汤方。成本本第十卷生姜为一两半。）
黄芩加半夏生姜汤方
黄芩（三两） 芍药（二两） 甘草（二两，炙） 大枣（十二枚，掰开） 半夏（半升，洗） 生姜（一两半，一方作三两，切）
以上六味药，用水一斗，煮取三升，去渣滓，温服一升，每日两次，夜间一次服用。
〔汪琥〕这是小柴胡汤的加减方。热邪不在半表，已入半里，所以以黄芩为主药。虽然胃中不实证，也不是胃虚证，所以不需要用人参补中气。
〔钱天来〕黄芩撤除热邪，芍药收敛阴气，甘草和大枣调和脾胃并减缓津液的向下奔注。如果呕吐，是邪气不向下走而向上逆，邪气在胃口，胸中气逆而呕吐，所以加入半夏的辛滑和生姜的辛散，作为祛除饮邪治疗呕吐的专用药剂。
〔徐灵胎〕由此推展开来，凡是杂病因里气不和而下利的，黄芩汤可以作为万世的主方。
《玉函经》黄芩人参汤方：黄芩、人参、桂枝、干姜各二两，半夏半升，大枣十二枚。以上六味药，用水七升，煮取二升，去渣滓，分两次温服。○此方无对应治证，大概与黄连汤大致相同。（此方，《外台秘要》名为黄芩汤，治疗干呕下利。）
《医方集解》说：昂案两条经合病，为什么不用两经的药？是因为合病兼见下利，是阳邪入里，所以重在治里，故用黄芩以彻除其热，并用甘、芍、大枣调和太阴，使里气和顺，则外证自然解除。和解的方法，不止一种。仲景的书，一字不苟。此证单言下利，故此方也单治下利。机要用此方治疗热痢腹痛，更名为芍药汤，又加木香、槟榔、大黄、黄连、当归、官桂，更名为芍药汤，治疗下痢。
仲景的这个方子，遂成为万世治疗痢疾的祖方。本方除去大枣，名为黄芩芍药汤，治疗火升鼻衄及热痢。（出自《活人书》）。黄芩加半夏生姜汤，也治疗胆腑发咳，呕吐苦水，如胆汁状。
〔成无己〕这是伤寒邪气传里，造成下寒上热的证候。胃中有邪气，使阴阳不交，阴气不能上升，独自治理下部，形成下寒，腹中痛；阳气不能下降，独自治理上部，形成胸中热、欲呕吐。给予黄连汤，升降阴阳之气。
〔程知〕这些证候，都是本气所产生的寒热，与表证无关，所以强调两个“有”字。
〔尤怡〕伤寒未解，欲呕吐，是胸中有热邪上逆。腹中痛，是胃中有寒邪内攻。此热邪在胸，寒邪在胃，阴阳之气不和，失去升降的常态，所以用黄连汤，寒温互用，甘苦并施，以调理阴阳而和解之。伤寒邪气入里，随人体脏气素有的寒热而变化，此则随胃中有寒、胸中有热而变化，腹中痛欲呕吐，所以以此方主治。
〔汪琥〕《条辨》和《尚论篇》都用风寒二邪来分阴阳寒热，殊不知风之初来，未必不是寒；寒之既入，也能成热，不可拘泥。
《病源候论·冷热不调候》说：人的营卫不调，导致阴阳痞塞。阳并于上则上热，阴并于下则下冷。上焦有热，或喉口生疮，胸膈烦闷胀满；下焦有冷，则腹胀肠鸣，绞痛泄利。
《宣明论》说：腹痛欲呕吐，是上热下寒。因为阳气不能下降，所以胸热欲呕；阴气不能上升，所以下寒腹痛，这是升降失常。
黄连汤方
黄连（三两○《玉函经》作二两） 甘草（三两，炙○《玉函经》作一两） 干姜（三两○《玉函经》作一两） 桂枝（三两，去皮○《玉函经》作二两） 人参（二两○《千金翼方》作三两） 大枣（十二枚，掰开） 半夏（半升，洗○《玉函经》作五合）
以上七味药，用水一斗，煮取六升，去渣滓，温服。白天三次，夜间两次。
怀疑不是仲景的方子。（成本本作“温服一升，日三服，夜二服”，无“疑非仲景方”五字。《玉函经》也没有。）
〔尤怡〕君药黄连，以清胸中之热；臣药干姜，以温胃中之寒；半夏降逆，佐助黄连使呕吐可止；人参补中，佐助干姜使腹痛可除；桂枝所以安外；大枣所以培补中气。然而此汤寒温不一，甘苦并投，所以必须加甘草，协和诸药。这是阴阳相格拒，寒热并施的治疗方法。
〔柯琴〕此方与泻心汤大同，而不叫泻心汤，是因为胸中素有之热，而非寒热相结于心下。看其君臣更换之处，大有分寸。
《伤寒类方》说：即半夏泻心汤，去掉黄芩，加上桂枝。各种泻心之法，都治疗心胃之间寒热不调，全属里症。此方以黄芩易桂枝（注：此处原文逻辑似有误，应为以桂枝易黄芩或类似变动，依原文翻译），去掉泻心之名，而叫黄连汤，乃表邪尚有一分未尽，胃中邪气尚当外达，所以加桂枝一味，以调和表里，则意无不周到。
伤寒八九日，风湿相搏，身体疼痛烦扰，不能自行转侧，不呕不渴，脉浮虚而涩的，用桂枝附子汤主治。如果其人大便硬（【原注】一说：脐下、心下硬），小便自利的，用去桂加白术汤主治。（疼烦，成本本作“烦疼”。《脉经》作“疼痛”。不渴下，《外台秘要》有“下”之二字。《千金翼方》有“下已”二字。去桂加白术汤，《玉函经》、《脉经》、《千金翼方》作“术附子汤”。成本本在“桂”下有“枝”字。）
〔尤怡〕伤寒八九日，不呕不渴，是没有伤寒里病的证候。脉浮虚涩，是没有伤寒表病的脉象。脉浮虚，主在表虚风；涩者，主在经寒湿。身体疼烦，属风；不能转侧，属湿。这是风湿相搏的证候，不是伤寒。给予桂枝附子汤，温散其风湿，使其从表而解。如果脉浮实，则又应当用麻黄加术汤，大发其风湿。如果人有此证，虽然大便硬，小便自利，而不议攻下，因为其不是邪热入里之硬，而是风燥湿去之硬，所以仍以桂枝附子汤，去掉桂枝，因为大便硬、小便自利，不欲其再发汗，再次夺去津液。加入白术，因为身重着湿在肉分，用以佐助附子，逐湿气于肌肉。
程林《金匮直解》说：风淫胜则身烦疼，湿淫胜则身体难转侧。风湿相搏于营卫之间，不干犯里，所以不呕不渴。脉浮为风，涩为湿，以其脉近于虚，故用桂枝附子汤，温经以散风湿。小便利者，大便必硬。桂枝近于解肌，恐大汗，故去之。白术去肌湿，不妨乎内，故加之。
《内台方议》说：问曰：此书皆是伤寒之法，又兼此风湿之证杂之，为何？答曰：此人先有湿气，因伤中风寒，合而成此证。以此添入伤寒法中。昔自祖师张仲景开化以来，此风湿、风温、湿温等证，皆在金镜外台法中。因三国混乱，书多亡失，外台之书，流荡不全。因王叔和得伤寒足六经之法，集成《伤寒论》，间得风湿数篇，杂入此中。故曰风湿三种，宜应别论，惟得正传者方知之。
按语：“相搏”之“搏”，方氏改作“抟”，注云：“抟，聚也。”言风与湿，聚合团聚，共为一家之病也。此说非也。盖“搏”通“薄”，王冰《平人气象论注》引《辨脉》：“阴阳相搏名曰动”，作“相薄”，可以证明。
桂枝附子汤方
桂枝（四两，去皮） 附子（三枚，炮，去皮，破○成本本：破八片。钱本：作二枚） 生姜（三两，切） 大枣（十二枚，掰开） 甘草（二两，炙）
以上五味药，用水六升，煮取二升，去渣滓，分三次温服。
去桂加白术汤方（○《金匮要略》白术附子汤，即是此方。《玉函经》名术附汤。《金鉴》作桂枝附子去桂枝加白术汤。）
附子（三枚，炮，去皮，破） 白术（四两） 生姜（三两，切○《玉函经》作二两） 甘草（二两，炙○《玉函经》作三两） 大枣（十二枚，掰开○《玉函经》作十五枚）
以上五味药，用水六升，煮取二升，去渣滓，分三次温服。第一次服用后，其人身体如麻痹状，约半小时后再服。三次服完，其人如有头昏蒙状，不要奇怪。这是因为附子和白术并走皮内，逐水气尚未去除，所以使之如此。法当加桂枝四两。此本一方两种用法，因为大便硬、小便自利，所以去桂枝。因为大便不硬、小便不利，应当加桂枝。附子三枚，恐怕多了。虚弱人家及产妇，宜减少服用量。（去桂加白术汤，《金匮要略》用附子一枚，白术二两，生姜甘草各一两，大枣六枚，水六升，作三升，二升，作一升。《外台秘要》引仲景《伤寒论》，本云附子一枚，今加之二枚，名附子汤。又说：此二方，只治风湿，不治伤寒。）
〔徐灵胎〕这是风湿相搏，因为不头疼、不呕渴，知道风湿之邪，不在表，不在里，而在躯壳。然而其原因在于寒，几乎成了风寒湿合而为痹。桂枝汤本属阳剂，而芍药非寒湿证所宜，所以换以附子的辛热，多至三枚，跟在桂枝之后，成为纯阳刚剂，以开凝结之阴邪。然而脉不单涩而浮虚，先见是湿少而风多，所以藉助一个附子，而迅扫有余；否则又宜去桂枝加术汤，以驱湿为主。
吴仪洛《方论》说：此即桂枝去芍药加附子汤，又加附子二枚。又即后条之甘草附子汤，以姜枣易术之变制。
汪氏说：如果其人大便硬，小便自利，后条辨云：此湿虽盛而津液自虚也。于上汤中，去桂枝，因为它能走津液；加白术，因为它能生津液。有人问：小便利，则湿去矣，何以犹言湿盛？我回答：湿热郁于里，则小便不利；寒湿搏于经，则小便自利。又有不明理的人说：大便溏，宜加白术。殊不知白术为脾家主药，后条辨云：燥湿靠它，滋液也靠它。
《直指方·带下论》说：经曰：卫气者，所以温分肉，充皮肤，肥腠理，司开阖。卫气若虚，则分肉不温，皮肤不充，腠理不肥，而开阖失其司耳。况且胃为血海，水液会焉。胃者中央之土，又所以主肌肉，而约血水也。卫气与胃气俱虚，则肌弱而肤空，血之与水，不能约制，是以涓涓漏卮，休作无时，而不暂停矣。然则封之止之，其可不加意于固卫浓脾之剂乎。此桂枝附子汤，以之固卫；而人参、白术、茯苓、草果、丁香、木香以之浓脾。二者俱不可阙也。
风湿相搏，骨节疼烦，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，或身微肿的，用甘草附子汤主治。（疼烦，成本本作“烦疼”，正确。）
〔喻昌〕此条复述上条之意，而辨别其症状较重的情况。痛不可近，汗出短气，恶风不欲去衣，小便不利，或身微肿，正是相搏最剧烈的地方。
〔钱天来〕掣痛，谓筋骨肢节抽掣疼痛。不得屈伸，寒湿之邪，流注于筋骨肢节之间，故拘挛不得屈伸。近之则痛剧，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，故以甘草附子汤主治。
〔方有执〕“或”，未定之词。身微肿，湿外薄也。不外薄则不肿，故曰“或”也。
〔程知〕以上二条，虽云风湿相搏，其实各夹有一寒字在内，即三气合而为痹之证也。邪留于筋骨之间，寒多则筋挛骨痛。
甘草附子汤方
白术（二两○《玉函经》作三两） 桂枝（四两，去皮） 附子（二枚，炮，去皮○汪、周：作破八片） 甘草（二两，炙○《玉函经》、《外台》：作三两）
以上四味药，用水六升，煮取二升，去渣滓，温服一升，每日三次。初次服用得微汗则病解，能食汗止，复烦者，将服五合。恐一升多的，宜服六七合开始。（《玉函经》二升作三升。汗止，《金匮》、成本本作汗出。无“将”字。始，《金匮》...）
Additionally add Ren Shen (Ginseng Radix) to rescue the body's Jin Ye (Body Fluids).
When Tai Yang (Taiyang Syndrome) and Shao Yang (Shaoyang Syndrome) diseases occur simultaneously, presenting with hardness in the epigastrium, stiffness of the neck and nape, and dizziness, one should needle Da Zhui (GV14), Fei Shu (BL13), and Gan Shu (BL18). Strictly avoid purgative methods. (*Yu Han Jing* has "xia" after "Tai Yang"; "ying" is written as "pi jian"; there is a "jian" character after "Da Zhui"; *Cheng Ben* lacks "Gan Shu", which textual research suggests is a missing character.)
[Cheng Wuji] Epigastric fullness, hardness, and dizziness indicate Shaoyang; neck stiffness indicates Taiyang. Needling Da Zhui and Fei Shu drains the pathogenic factors from Taiyang, as the Taiyang meridian descends along the nape and flanks the spine. Needling Gan Shu drains the pathogenic factors from Shaoyang, since Gallbladder is the interior-exterior pair of Liver. Taiyang is exterior, Shaoyang is interior; this is clearly a half-exterior, half-interior syndrome. The previous eighth pattern states: sweating is contraindicated; if sweating is induced, delirium occurs. This implies that inducing sweat to attack Taiyang pathogenic factors causes Shaoyang pathogenic factors to worsen in the Stomach, leading to delirium. Here it states strictly avoid purgation; attacking Shaoyang pathogenic factors allows Taiyang pathogenic factors to enter the interior due to deficiency, inevitably forming Jie Xiong (Chest Binding). The Classic says: When Taiyang and Shaoyang are combined, contrary use of purgatives results in Jie Xiong.
[Fang Youzhi] "Neck and nape" is also an interchangeable term for "head and nape". The previous clause mentions dizziness and vertigo; this one mentions only dizziness without vertigo, differing only in detail.
[Wang Hu] Da Zhui (GV14) effectively drains both Taiyang and Shaoyang simultaneously. Most commentators fail to understand the rationale for acupuncture, ignoring Da Zhui entirely, which is a grave error.
When Taiyang and Shaoyang combine, presenting with spontaneous diarrhea, administer Huang Qin Tang (Scutellaria Decoction). If vomiting occurs, treat with Huang Qin Jia Ban Xia Sheng Jiang Tang (Scutellaria Decoction plus Pinellia and Fresh Ginger).
[Cheng Wuji] Taiyang and Yangming combining with spontaneous diarrhea indicates an exterior location; Ge Gen Tang (Kudzu Decoction) should be used to induce sweat. Yangming and Shaoyang combining with spontaneous diarrhea indicates an interior location; Cheng Qi Tang (Order the Qi Decoction) can be used to purge. Here, Taiyang and Shaoyang combining with spontaneous diarrhea indicates a half-exterior, half-interior location, where neither sweating nor purging is suitable. Thus, Huang Qin Tang is given to harmonize the half-exterior, half-interior pathogenic factors. Vomiting indicates rebellious Stomach Qi; therefore, Ban Xia (Pinellia Rhizome) and Sheng Jiang (Fresh Ginger) are added to disperse the rebellious Qi.
[Qian Tianlai] Symptoms of both Taiyang and Shaoyang meridians appearing together constitute a combined disease. Although Taiyang is exterior, Shaoyang is pressed into the interior, constituting half-exterior, half-interior. Due to heat pathogenic factors from both meridians attacking inward, causing water and grain in the Stomach to rush downward, spontaneous diarrhea occurs.
[Wang Hu] In Taiyang-Shaoyang combined disease progressing to spontaneous diarrhea, the exterior cold pathogenic factors have all stagnated and transformed into interior heat. Since the interior heat is not solidified, Huang Qin Tang is used to clear heat and nourish Yin. Once interior heat is cleared and Yin Qi restored, the exterior Yang heat naturally resolves. Therefore, for this pattern, not only Gui Zhi Tang (Cinnamon Twig Decoction) for Taiyang is contraindicated, but also Chai Hu Tang (Bupleurum Decoction) for Shaoyang is unnecessary.
[You Yi] Taiyang-Shaoyang combined disease refers to Taiyang symptoms of fever and headache, or Shaoyang symptoms of bitter taste, dry throat, and dizziness, or chest fullness, with a pulse that may be large or wiry. If exterior pathogenic factors are abundant, causing limb and joint pain and irritability, Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) is appropriate to resolve both aspects. Now, with abundant interior heat and spontaneous diarrhea, Huang Qin Tang should be used to clear and harmonize the interior.
Note: Zhang Lu and Zhou Yu Zai considered this pattern to be Wen Bing (Warm Disease); Wei Shi refuted them, which is correct.
*Yi Fang Ji Jie* states: Combined disease refers to having Taiyang symptoms of fever, headache, and stiff spine, alongside Shaoyang symptoms of deafness, hypochondriac pain, vomiting, bitter taste, and alternating chills and fever.
Spontaneous diarrhea refers to diarrhea not caused by purgation. While spontaneous diarrhea is often treated with warming methods, if there is accumulation in the intestines and stomach, or guest-heat in the lower Jiao, warming agents cannot stop it; differentiation and drainage or purgation may be used.
Huang Qin Tang Formula
Huang Qin (Scutellariae Radix) (3 liang, *Yu Han Jing* says 2 liang)
Shao Yao (Paeoniae Radix Alba) (2 liang)
Gan Cao (Licorice Root, honey-fried) (2 liang)
Da Zao (Jujubae Fructus) (12 pieces, split)
These four ingredients are boiled in 10 dou of water to obtain 3 sheng. Remove the dregs. Take 1 sheng warm, twice daily and once at night. (*Cheng Ben* adds "if vomiting, add Ban Xia 0.5 sheng, Sheng Jiang 3 liang" after "one dose", but lacks the formula name Huang Qin Jia Ban Xia Sheng Jiang Tang. Volume 10 of *Cheng Ben* lists Sheng Jiang as 1.5 liang.)
Huang Qin Jia Ban Xia Sheng Jiang Tang Formula
Huang Qin (Scutellariae Radix) (3 liang)
Shao Yao (Paeoniae Radix Alba) (2 liang)
Gan Cao (Licorice Root, honey-fried) (2 liang)
Da Zao (Jujubae Fructus) (12 pieces, split)
Ban Xia (Pinelliae Rhizoma) (0.5 sheng, washed)
Sheng Jiang (Zingiberis Rhizoma Recens) (1.5 liang, another source says 3 liang, sliced)
These six ingredients are boiled in 10 dou of water to obtain 3 sheng. Remove the dregs. Take 1 sheng warm, twice daily and once at night.
[Wang Hu] This is a modification of Xiao Chai Hu Tang (Minor Bupleurum Decoction). The heat is no longer at half-exterior but has entered half-interior, hence Huang Qin is the chief herb. Although the Stomach is not excess, it is not deficient, so Ren Shen (Ginseng Radix) to tonify the middle is unnecessary.
[Qian Tianlai] Huang Qin clears heat, while Shao Yao astringes Yin. Gan Cao and Da Zao harmonize the middle and slow the downward rushing of fluids. If vomiting occurs, it means the pathogen does not move downward but rebels upward; the pathogen is at the Stomach gate, causing Qi rebellion in the chest and vomiting. Thus, the pungent and slippery nature of Ban Xia and the pungent and dispersing nature of Sheng Jiang are added as specific agents to dispel fluid retention and treat vomiting.
[Xu Lingtai] Extending from this, for any miscellaneous disease involving diarrhea due to interior disharmony, Huang Qin Tang can serve as a principal formula for generations.
*Yu Han Jing* Huang Qin Ren Shen Tang Formula: Huang Qin (Scutellariae Radix), Ren Shen (Ginseng Radix), Gui Zhi (Cinnamomi Ramulus), Gan Jiang (Zingiberis Rhizoma) each 2 liang; Ban Xia (Pinelliae Rhizoma) 0.5 sheng; Da Zao (Jujubae Fructus) 12 pieces. These six ingredients are boiled in 7 sheng of water to obtain 2 sheng. Remove dregs, divide into two warm doses. ○ This formula has no corresponding clinical indication described; it is likely similar to Huang Lian Tang (Coptis Decoction). (This formula is named Huang Qin Tang in *Wai Tai Mi Yao*, treating dry vomiting and diarrhea.)
*Yi Fang Ji Jie* states: Ang notes: Why not use herbs from both meridians for combined disease? Because combined disease with diarrhea indicates Yang pathogenic factors entering the interior, so the focus is on the interior. Thus, Huang Qin is used to clear heat, and Gan, Shao, and Da Zao are used to harmonize Taiyin, so that when the interior Qi is harmonized, exterior symptoms resolve naturally. Harmonization methods are not limited to one approach. Zhang Zhongjing’s writings are precise. Since this pattern mentions only diarrhea, this formula treats only diarrhea. Ji Yong used this formula for heat-dysentery with abdominal pain, renaming it Shao Yao Tang, and adding Mu Xiang (Aucklandiae Radix), Bing Lang (Arecae Semen), Da Huang (Rhei Radix et Rhizoma), Huang Lian (Coptidis Rhizoma), Dang Gui (Angelicae Sinensis Radix), and Guan Gui (Cinnamomi Cortex), renaming it Shao Yao Tang again to treat dysentery.
Zhang Zhongjing’s formula thus became the ancestor of formulas for treating dysentery for all generations. Removing Da Zao from this formula yields Huang Qin Shao Yao Tang, treating rising fire causing epistaxis and heat-dysentery (from *Huo Ren Shu*). Huang Qin Jia Ban Xia Sheng Jiang Tang also treats cough originating from the Gallbladder organ, vomiting bitter water resembling bile.
In Shang Han (Cold Damage), if there is heat in the chest, pathogenic factors in the stomach, abdominal pain, and desire to vomit, Huang Lian Tang (Coptis Decoction) is the primary treatment.
[Cheng Wuji] This is Shang Han pathogenic factors transmitting to the interior, resulting in lower cold and upper heat. Pathogenic factors in the stomach prevent the interaction of Yin and Yang. Yin fails to ascend and governs the lower exclusively, causing lower cold and abdominal pain. Yang fails to descend and governs the upper exclusively, causing upper heat in the chest and desire to vomit. Huang Lian Tang is given to regulate the ascending and descending of Yin and Yang Qi.
[Cheng Zhi] These patterns arise from the body's own Qi generating cold and heat, unrelated to the exterior, hence emphasizing the word "has/exists".
[You Yi] If Shang Han is unresolved and there is desire to vomit, it indicates Heat pathogenic factors rebelling upward in the chest. Abdominal pain indicates Cold pathogenic factors attacking inward in the stomach. Heat is in the chest, Cold is in the stomach; Yin and Yang Qi are disharmonious and lose their normal ascending/descending rhythm. Thus, Huang Lian Tang is used, combining cold and warm properties, sweet and bitter flavors, to regulate Yin and Yang and harmonize. Shang Han pathogenic factors entering the interior transform according to the pre-existing cold/heat of the Zang organs; here, it transforms according to Cold in the stomach and Heat in the chest, causing abdominal pain and desire to vomit, hence this formula.
[Wang Hu] *Tiao Bian* and *Shang Lun Pian* distinguish Yin/Yang and Cold/Heat using Wind and Cold pathogens separately. However, one must not be rigid; initial Wind may not be Cold, and entered Cold can transform into Heat.
*Bing Yuan Hou Lun · Cold-Heat Disharmony Pattern* states: Disharmony of Ying and Wei leads to obstruction of Yin and Yang. Yang merging upward causes upper heat; Yin merging downward causes lower cold. Upper Jiao heat may cause sores in the throat/mouth, chest oppression, and fullness. Lower Jiao cold causes abdominal distension, borborygmus, colic, and diarrhea.
*Xuan Ming Lun* states: Abdominal pain with desire to vomit is upper heat and lower cold. Yang fails to descend, causing chest heat and vomiting; Yin fails to ascend, causing lower cold and abdominal pain. This is failure of ascending and descending.
Huang Lian Tang Formula
Huang Lian (Coptidis Rhizoma) (3 liang, *Yu Han Jing* says 2 liang)
Gan Cao (Licorice Root, honey-fried) (3 liang, *Yu Han Jing* says 1 liang)
Gan Jiang (Zingiberis Rhizoma) (3 liang, *Yu Han Jing* says 1 liang)
Gui Zhi (Cinnamomi Ramulus, peeled) (3 liang, *Yu Han Jing* says 2 liang)
Ren Shen (Ginseng Radix) (2 liang, *Qian Jin Yi Fang* says 3 liang)
Da Zao (Jujubae Fructus) (12 pieces, split)
Ban Xia (Pinelliae Rhizoma, washed) (0.5 sheng, *Yu Han Jing* says 5 he)
These seven ingredients are boiled in 10 dou of water to obtain 6 sheng. Remove dregs. Take warm, three times during the day and twice at night.
Suspected not to be Zhang Zhongjing's formula. (*Cheng Ben* reads "Take warm 1 sheng, three times daily, twice nightly," omitting the five characters "suspected not Zhang Zhongjing's formula." *Yu Han Jing* also omits this.)
[You Yi] Chief herb Huang Lian clears upper heat; minister herb Gan Jiang warms middle cold. Ban Xia descends rebellion, assisting Huang Lian to stop vomiting. Ren Shen tonifies the middle, assisting Gan Jiang to relieve abdominal pain. Gui Zhi stabilizes the exterior; Da Zao nourishes the middle. Since this decoction combines cold and warm, sweet and bitter, Gan Cao is added to harmonize the herbs. This is a treatment method for Yin-Yang opposition and simultaneous application of cold and warm.
[Ke Qin] This is very similar to Xie Xin Tang (Drain the Epigastrium Decoction) but is not named so because the heat in the chest is inherent rather than Cold-Heat knotting in the epigastrium. The substitution of chief and minister herbs shows great precision.
*Shang Han Lei Fang* states: It is essentially Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction) minus Huang Qin (Scutellariae Radix) plus Gui Zhi (Cinnamomi Ramulus). All Xie Xin methods treat Cold-Heat disharmony between Heart and Stomach, belonging entirely to interior patterns. This formula replaces Huang Qin with Gui Zhi (Note: Text implies substitution logic, though historically Gui Zhi replaces Huang Qin in some contexts or vice versa depending on interpretation, sticking to text: "replaces Huang Qin with Gui Zhi" seems contradictory to standard modifications, but translating literally: "Using Gui Zhi instead of Huang Qin" or similar variation implied by context of changing names). Actually, the text says "Using Huang Qin to replace Gui Zhi" is incorrect based on standard knowledge, but the text says "With Huang Qin replacing Gui Zhi... named Huang Lian Tang". Let's translate faithfully: By swapping Huang Qin for Gui Zhi (or vice versa in variant interpretations), removing the name Xie Xin, it is called Huang Lian Tang. This implies exterior pathogenic factors remain partially unexhausted, and Stomach pathogenic factors should still reach outward, so Gui Zhi is added to harmonize interior and exterior.
After eight or nine days of Shang Han, Feng Shi (Wind-Dampness) intertwine, causing body pain and irritability, inability to turn oneself, no vomiting, no thirst, with a floating, deficient, and choppy pulse. Gui Zhi Fu Zi Tang (Cinnamon Twig and Aconite Decoction) is the primary treatment. If the person has hard stool (Original Note: Alternatively, hardness below the umbilicus or in the epigastrium) and free urination, remove Gui Zhi and add Bai Zhu to create Qu Gui Jia Bai Zhu Tang (Remove Cinnamon Twig and Add Atractylodes Macrocephala Decoction). (Pain and irritability, *Cheng Ben* writes "irritability and pain". *Mai Jing* writes "pain". After "no thirst", *Wai Tai* has "xia" [lower]. *Qian Jin Yi Fang* has "xia yi" [after lowering]. Qu Gui Jia Bai Zhu Tang, *Yu Han Jing*, *Mai Jing*, *Qian Jin Yi Fang* write "Zhu Fu Zi Tang". *Cheng Ben* has "Zhi" [twig] after "Gui".)
[You Yi] After eight or nine days of Shang Han, no vomiting or thirst indicates no interior Shang Han pathology. Floating, deficient, choppy pulse indicates no exterior Shang Han pulse. Floating deficient indicates exterior deficiency wind; choppy indicates channel Cold-Dampness. Body pain and irritability belong to Wind; inability to turn belongs to Dampness. This is Wind-Dampness intertwining, not Shang Han. Gui Zhi Fu Zi Tang is given to warm and disperse Wind-Dampness, allowing resolution from the exterior. If the pulse is floating and excess, Ma Huang Jia Zhu Tang (Ephedra plus Atractylodes Decoction) should be used to vigorously disperse Wind-Dampness. If a person has these symptoms, even with hard stool and free urination, purgation is not considered because the hardness is not due to Heat pathogenic factors entering the interior, but due to Wind drying out Dampness. Thus, Gui Zhi Fu Zi Tang is used, removing Gui Zhi because hard stool and free urination suggest avoiding further sweating to prevent depletion of fluids. Bai Zhu is added because heaviness indicates Dampness in the muscle layer; it assists Fu Zi in driving Dampness from the muscles.
Cheng Lin, *Jin Gui Zhi Jie* states: Excess Wind causes body pain and irritability; excess Dampness causes difficulty turning the body. Wind-Dampness intertwines between Ying and Wei, not affecting the interior, hence no vomiting or thirst. Floating pulse indicates Wind; choppy indicates Dampness. Since the pulse is near deficient, Gui Zhi Fu Zi Tang is used to warm the channels and disperse Wind-Dampness. If urination is free, stool must be hard. Gui Zhi is close to resolving the muscle layer, fearing excessive sweating, so it is removed. Bai Zhu removes muscle Dampness without affecting the interior, so it is added.
*Nei Tai Fang Yi* states: Question: This book contains Shang Han methods, yet mixes in Wind-Dampness patterns. Why? Answer: This person had prior Dampness, then contracted Wind-Cold, combining to form this pattern. It was added to Shang Han methods. Since Grandmaster Zhang Zhongjing began teaching, Wind-Dampness, Wind-Warmth, Damp-Warmth, etc., were all in *Jin Jing Wai Tai*. Due to chaos in the Three Kingdoms period, many books were lost; *Wai Tai* was incomplete. Wang Shuhe collected Shang Han sufficient for the Six Channels, compiling *Shang Han Lun*, interspersing several chapters on Wind-Dampness. Hence, Wind, Cold, and Dampness should theoretically be discussed separately; only those receiving the orthodox transmission know this.
Note: Fang Shi changed "Bo" (intertwine) to "Tuan" (gather), annotating: "Tuan means gather." Saying Wind and Dampness gather together as one disease is incorrect. "Bo" is synonymous with "Bo" (press/thin). Wang Bing in his annotation of *Ping Ren Qi Xiang Lun* cites *Bian Mai*: "Yin and Yang intertwining is called Dong (Movement)," written as "Xiang Bo" (mutually pressing), which proves this.
Gui Zhi Fu Zi Tang Formula
Gui Zhi (Cinnamomi Ramulus, peeled) (4 liang)
Fu Zi (Aconiti Lateralis Radix Praeparata, prepared, peeled, broken) (3 pieces, *Cheng Ben*: broken into 8 slices; Qian Ben: 2 pieces)
Sheng Jiang (Zingiberis Rhizoma Recens, sliced) (3 liang)
Da Zao (Jujubae Fructus, split) (12 pieces)
Gan Cao (Licorice Root, honey-fried) (2 liang)
These five ingredients are boiled in 6 sheng of water to obtain 2 sheng. Remove dregs, divide into three warm doses.
Qu Gui Jia Bai Zhu Tang Formula (○ *Jin Gui* Bai Zhu Fu Zi Tang is identical. *Yu Han Jing* names it Zhu Fu Tang. *Jin Jian* names it Gui Zhi Fu Zi Qu Gui Jia Bai Zhu Tang.)
Fu Zi (Aconiti Lateralis Radix Praeparata, prepared, peeled, broken) (3 pieces)
Bai Zhu (Atractylodis Macrocephalae Rhizoma) (4 liang)
Sheng Jiang (Zingiberis Rhizoma Recens, sliced) (3 liang, *Yu Han Jing* says 2 liang)
Gan Cao (Licorice Root, honey-fried) (2 liang, *Yu Han Jing* says 3 liang)
Da Zao (Jujubae Fructus, split) (12 pieces, *Yu Han Jing* says 15 pieces)
These five ingredients are boiled in 6 sheng of water to obtain 2 sheng. Remove dregs, divide into three warm doses. After the first dose, the patient may feel numbness. After about half a day, take the next dose. After all three doses are consumed, the patient may feel dizzy; do not be alarmed. This is because Fu Zi and Bai Zhu act together within the skin, driving out Water Qi which has not yet been eliminated. The method should add 4 liang of Gui Zhi. This is originally one formula with two methods: Gui Zhi is removed because of hard stool and free urination. Gui Zhi should be added if stool is not hard and urination is not free. Three pieces of Fu Zi may be too much. Patients with weakness and postpartum women should reduce the dosage. (*Qu Gui Jia Bai Zhu Tang* in *Jin Gui* uses 1 piece of Fu Zi, 2 liang Bai Zhu, 1 liang each of Sheng Jiang and Gan Cao, 6 pieces Da Zao, boiled in 6 sheng water to yield 3 sheng, then reduced to 2 sheng, then 1 sheng. *Wai Tai* cites Zhang Zhongjing's *Shang Han Lun*: originally 1 piece of Fu Zi, now added to 2 pieces, named Fu Zi Tang. Also states: These two formulas only treat Wind-Dampness, not Shang Han.)
[Xu Lingtai] This is Wind-Dampness intertwining. Lack of headache, vomiting, or thirst indicates the pathogen is not in the exterior or interior, but in the body shell. However, the cause is Cold, nearly becoming Bi (Obstruction) syndrome of Wind-Cold-Dampness. Gui Zhi Tang is inherently a Yang agent, but Shao Yao is unsuitable for Cold-Dampness. Thus, it is replaced by the pungent-hot Fu Zi, up to 3 pieces, following Gui Zhi, becoming a pure Yang rigid agent to open condensed Yin pathogenic factors. However, the pulse is not merely choppy but floating and deficient, indicating less Dampness and more Wind. Thus, one Fu Zi swiftly sweeps away the excess; otherwise, removing Gui Zhi and adding Zhu Tang would be better to drive out Dampness primarily.
Wu Yiluo, *Fang Lun* states: This is Gui Zhi Qu Shao Yao Jia Fu Zi Tang (Cinnamon Twig Decoction minus White Peony plus Aconite), plus two more pieces of Fu Zi. It is also the later GAN CAO FU ZI TANG, varying by exchanging Ginger/Jujube for Atractylodes.
Wang states: If the person has hard stool and free urination, the later commentary says: Dampness is abundant but fluids are self-deficient. In the above decoction, remove Gui Zhi because it moves fluids; add Bai Zhu because it generates fluids. Someone asks: If urination is free, isn't Dampness gone? How can one say Dampness is abundant? I answer: Damp-Heat stagnating in the interior causes difficult urination; Cold-Dampness battling in the channels causes free urination. Another ignorant person says: Loose stool warrants adding Bai Zhu. They do not know Bai Zhu is the master herb for Spleen; as the later commentary says: It dries Dampness, and it also nourishes fluids.
*Zhi Zhi Fang · Dai Xia Lun* states: The Classic says: Wei Qi (Defensive Qi) warms the flesh, fills the skin, plumps the pores, and controls opening/closing. If Wei Qi is deficient, flesh is not warm, skin not filled, pores not plump, and opening/closing control is lost. Moreover, the Stomach is the Sea of Blood, where fluids gather. The Stomach is Central Earth, governing muscles and regulating blood/fluids. If both Wei Qi and Stomach Qi are deficient, muscles become weak and skin empty; blood and fluids cannot be regulated, leaking continuously without pause. Therefore, to seal and stop this, one must pay attention to formulas that secure Wei and thicken Spleen. Gui Zhi Fu Zi Tang secures Wei; Ren Shen, Bai Zhu, Fu Ling (Poria), Cao Guo (Tsao-ko Fruit), Ding Xiang (Caryophylli Flos), Mu Xiang (Vladimiriae Radix) thicken the Spleen. Neither is dispensable.
Wind-Dampness intertwine, causing bone and joint pain and irritability, pulling pain preventing flexion and extension, severe pain upon touch, sweating, shortness of breath, difficult urination, aversion to wind with desire to keep clothes on, or slight swelling. Gan Cao Fu Zi Tang (Licorice and Aconite Decoction) is the primary treatment. (Pain and irritability, *Cheng Ben* writes "irritability and pain", which is correct.)
[Yu Chang] This clause reiterates the previous one but distinguishes the more severe symptoms. Pain intolerant to touch, sweating, shortness of breath, aversion to wind with desire to keep clothes on, difficult urination, or slight swelling, represent the most intense stage of intertwining.
[Qian Tianlai] Pulling pain means drawing pain in bones, sinews, limbs, and joints. Inability to flex/extend means Cold-Dampness pathogenic factors flow into bones, sinews, limbs, and joints, causing spasms. Severe pain upon touch is extreme irritability/pain. Extreme pain makes people afraid of movement or touch. Sweating is spontaneous sweating from Wind Strike. Shortness of breath is pathogen in chest/diaphragm preventing Qi extension. Difficult urination is Cold-Dampness in middle, preventing clear/turbid separation and failing to activate True Yang Qi in lower Jiao. Aversion to wind with desire to keep clothes on indicates Wind pathogen in exterior. Slight swelling indicates Dampness invading muscles ("Dampness injures flesh"). Wind, Cold, and Dampness battle and gather without dispersing; thus, Gan Cao Fu Zi Tang is used.
[Fang Youzhi] "Or" indicates uncertainty. Slight swelling is Dampness pressing externally. If not pressing externally, no swelling; hence "or".
[Cheng Zhi] The above two clauses, though called Wind-Dampness intertwining, actually each contain a Cold element, constituting Bi syndrome of the three pathogens. Pathogen remaining in bones/sinews: excess Cold causes tendon spasms and bone pain.
Gan Cao Fu Zi Tang Formula
Bai Zhu (Atractylodis Macrocephalae Rhizoma) (2 liang, *Yu Han Jing* says 3 liang)
Gui Zhi (Cinnamomi Ramulus, peeled) (4 liang)
Fu Zi (Aconiti Lateralis Radix Praeparata, prepared, peeled) (2 pieces, Wang/Zhou: broken into 8 slices)
Gan Cao (Licorice Root, honey-fried) (2 liang, *Yu Han Jing/Wai Tai*: 3 liang)
These four ingredients are boiled in 6 sheng of water to obtain 2 sheng. Remove dregs. Take 1 sheng warm, three times daily. Initial dose obtaining slight sweat resolves the condition. Eating and stopping sweat, if irritability returns, take 5 he. If 1 sheng is too much, start with 6-7 he. (*Yu Han Jing*: 2 sheng becomes 3 sheng. Sweat stops, *Jin Gui/Cheng Ben* write "sweat out". No "jiang" [will] character. Start, *Jin Gui*...)