成本。作妙。千金翼。作愈。徐彬金匮论注。沈明宗编注。作佳。）
〔徐〕此与桂枝附子汤证。同是风湿相搏。然彼以病浅寒多。故肢体为风湿所困。而患止躯壳之中。此则
风湿两胜。挟身中之阳气。而奔逸为灾。故骨节间。风入增劲。不能屈伸。大伤其卫。而汗出短气恶风。水亦
乘风作势。而身微肿。其病势方欲扰乱于肌表。与静而困者不侔矣。〔吴〕此方用附
子除湿温经。桂枝祛风和营。术去湿实卫。甘草辅诸药。而成敛散之功也。〔周〕此证较前条更重。且里已受
伤。曷为反减去附子耶。前条风湿尚在外。在外者利其速去。此条风湿半入里。入里者妙在缓攻。仲景止恐附
子多。则性猛且急。筋节之窍。未必骤开。风湿之邪。岂能托出。徒使汗大出。而邪不尽耳。君甘草也。欲其
缓也。和中之力短。恋药之用长也。此仲景所以前条用附子三枚者。分三服。此条止二枚者。初服五合。恐一
升为多。宜服六七合。全是不欲尽剂之意。学人于仲景书有未解。即于本文中。求之自得矣。〔钱〕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。〔汪〕后条辨云。以上三方。
俱用附子者。以风伤卫而表阳已虚。加寒湿而里阴更胜。凡所见证。皆阳气不充。故经络关节得着湿。而卫阳
愈虚耳。愚以此言。实发仲景奥义。
案千金方。香港脚门。四物附子汤。即是。方后云。体肿者。加防己四两。悸气小便不利。加茯苓三两。三
因方。六物附子汤。即是。
伤寒脉浮滑。此以表有热。里有寒。白虎汤主之。（【原注】巨亿等谨案前篇云。热结在里。表里俱热者。
白虎汤主之。又云。其表不解。不可与白虎汤。此云脉浮滑。表有热。里有寒者。必表里字差矣。又阳明一证
云。脉浮迟。表热里寒。四逆汤主之。又少阴一证云。里寒外热。通脉四逆汤主之。以此表里自瘥。明矣。千
金翼云。白通汤。非也。○玉函。作伤寒脉浮滑。而表热里寒者。白通汤主之。旧云白通汤。一云白虎者恐非。
注云。旧云以下。出叔和今考千金翼。作白虎汤。疑玉函误矣。此字。玉函。作而。成本。无以字。程本。张
本。作里有热表有寒。盖原于林亿说也。柯氏。作表有热里有邪。盖原于成注。）
〔鉴〕王三阳云。经文寒字。当邪字解。亦热也。其说甚是。若是寒字。非白虎汤证矣。此言伤寒太阳证罢。邪传
阳
明。表里俱热。而未成胃实之病也。脉浮滑者。浮为表有热之脉。阳明表有热。当发热汗出。滑为里有热之脉。
阳明里有热。当烦渴引饮。故曰表有热。里有热也。此为阳明表里俱热之证。白虎乃解阳明表里俱热之药。故
主之也。不加人参者。以其未经汗吐下不虚也。〔钱〕若胃实而痛者。为有形之邪。当以承气汤下之。此但外
邪入里。为无形之热邪。故用寒凉清肃之白虎汤。以解阳明胃腑之邪热也。
案此条诸说不一。成氏云。里有寒。有邪气传里也。以邪未入腑。故止言寒。如瓜蒂散证云。胸上有寒
者。是也。方氏云。里有寒者。里字非对表而称。以热之里言。盖伤寒之热。本寒因也。故谓热。里有寒。指
热之所以然者言也。喻氏云。里有寒者。伤寒传入于里。更增里热。但因起于寒。故推本而曰里有寒。程氏云。
读厥阴篇中。脉滑而厥者。里有热也。白虎汤主之。则知此处表里二字。为错简。里有热。表有寒。亦是热结
在里。郁住表气于外。但较之时时恶风。背微恶寒者。少倏忽零星之状。张氏亦改表有寒里有热云。热邪初乘
肌表。表气不能胜邪。其外反显假寒。故言表有寒。而伏邪始发未尽。里热犹盛。故云里有热。志聪云。此表
有太阳之热。里有癸水之寒。夫癸水虽寒。而与阳明相搏。则戊已化火。为阳热有余。故以白虎汤。清两阳之
热。锡驹云。太阳之标热在表。此表有热也。太阳之本寒在里。此里有寒也。凡伤于寒。则为病热。故宜白虎
汤主之。魏氏云。此里尚为经络之里。非脏腑之里。亦如卫为表。营为里。非指脏腑而言也。钱氏云。白虎汤
为表邪未解之所忌用。若云伤寒表有热。固非所宜。而曰里有寒。尤所当忌。而仲景反以白虎汤主之。何也。
以意推之。恐是先受之寒邪。已经入里。郁而为热。本属寒因。故曰里有寒。邪既入里。已入阳明。
发而为蒸蒸之热。其热自内达外。故曰表有热。柯氏改寒作邪。云旧本作里有寒者误。此虽表里并言。而重在
里热。所谓结热在里。表里俱热者也。以上诸说如此。特林氏程氏解。似义甚切当。其余则含糊牵扭。难以适
从。至其顺文平稳。则金鉴为得。故姑揭其说尔。
汤液本草。东垣云。胸中有寒者。瓜蒂散吐之。又表热里寒者。白虎汤主之。瓜蒂知母。味苦寒。而治胸
中寒。又里寒。何也。答曰。成无己注云。即伤寒。寒邪之毒。为热病也。读者要逆识之。如论语言乱臣十人。
书言唯以乱民。其能而乱四方。乱。皆治也。乃治乱者也。故云乱臣乱四方也。仲景所言寒之一字。举其初而
言之。热病在其中矣。若以寒为寒冷之冷。无复用苦寒之剂。兼言白虎。订脉尺寸俱长。则热可知矣。
白虎汤方
知母（六两） 石膏（一斤碎） 甘草（二两炙） 粳米（六合）
上四味。以水一斗。煮米熟。汤成去滓。温服一升。日三服。（外台。作水一斗二升。煮取米熟。去米纳
药。煮取六升。去滓。分六服。）
〔柯〕阳明邪从热化。故不恶寒而恶热。热蒸外越。故热汗出。热烁胃中。故渴欲饮水。邪盛而实。故
脉滑。然犹在经。故兼浮也。盖阳明属胃。外主肌肉。虽内外大热而未实。终非苦寒之味所宜也。石膏辛寒。
辛能解肌热。寒能胜胃火。寒能沉内。辛能走外。此味两擅内外之能。故以为君。知母苦润。苦以泻火。润以
滋燥。故用为臣。甘草粳米。调和于中宫。且能土中泻火。稼穑作甘。寒剂得之缓其寒。苦剂得之平其苦。使
二味为佐。庶大寒大苦之品。无伤损脾胃之虑也。煮汤入胃。输脾归肺。水精四布。大烦大渴可除矣。白虎为
西方金神。取以名汤者。秋金得令。而炎暑自解。
伤寒明理论曰。白虎。西方金神也。应秋而归肺。热甚于内者。以寒下之。热甚于外者。以凉解之。其
有中外俱热。内不得泄。外不得发者。非此汤则不能解也。夏热秋凉。暑 之气。得秋而止。秋之令曰处暑。
是汤以白虎名之。谓能止热也。
活人书化斑汤。治斑毒。
于本方加葳蕤。用糯米。云。大抵发斑。不可用表药。表虚里实。若发汗开泄。更增斑烂也。当用此汤。
又曰。问两胫逆冷。胸腹满。多汗。头目痛。苦妄言。此名湿温病。苦两胫逆冷。腹满。又胸多汗。头
目痛。苦妄言。其脉阳濡而弱。阴小而急。治在太阴。不可发汗。汗出必不能言。耳聋不知痛所在。身青面色
变。名曰重 。如此死者。医杀之耳。白虎加苍术汤。
于本方。加苍术三两。此方出伤寒微旨。亦仿金匮白虎加桂汤。
和剂局方。白虎汤。治伤寒大汗出后。表证已解。心胸大烦渴欲饮水。及吐或下后。七八日邪毒不解。
热结在里。表里俱热。时时恶风大渴。舌上干燥而烦。欲饮水数升者。宜服之。又治夏月中暑毒。汗出恶寒。
身热而渴。医学纲目曰。孙兆治一人自汗。两足逆冷至膝下。腹满不省人事。孙诊六脉。小弱而急。问其所服
药。取视皆阴病药也。孙曰。此非受病重。药能重病耳。遂用五苓散白虎汤。十余帖。病少苏。再服痊愈。或
问治法。孙曰。病患伤暑也。始则阳微厥。而脉小无力。医谓阴病。遂误药。其病厥。用五苓散利小便。则腹
减。白虎解利邪热。则病愈。凡阴病胫冷。则臂亦冷。汝今胫冷。臂不冷。则非下厥上行。所以知是阳微厥也。
又曰火喘。用本方。加栝蒌仁。枳壳。黄芩。神效。出初虞世。医方选要。人参石膏汤。治膈消。上焦燥
渴。不饮多食。于本方。加黄芩杏仁人参。
活人大全。病在半表半里。热不退。脉尚浮洪者。当微表者。小柴胡汤。合本方和之。
方脉正宗。治胃家实热或嘈杂。消渴善饥。或齿痛。
于本方。去粳米。加竹叶芍药。（出本草汇言。）
伤寒脉结代。心动悸。炙甘草汤主之。（心动悸。玉函。作心中惊悸。）
〔鉴〕心动悸者。谓心下筑筑惕惕然。动而不自安也。若因汗下者。多虚。不因汗下者。多热。欲饮水。
小便不利者。属饮。厥而下利者。属寒。今病伤寒。不因汗下。而心动悸。又无饮热寒虚之证。但据结代不足
之阴脉。即主以炙甘草汤者。以其人平日血气衰微。不任寒邪。故脉不能续行也。此时虽有伤寒之表未罢。亦
在所罔顾。总以补中生血复脉为急。通行营卫为主也。
炙甘草汤方
甘草（四两炙） 生姜（三两切） 人参（二两） 桂枝（三两去皮） 生地黄（一斤○金匮。有酒洗字。
千金翼。有切字。） 大枣（三十枚擘○成本。玉函。作十二枚。） 阿胶（二两） 麦门冬（半升去心）
麻仁（半升○成本。作麻子仁义。）
上九味。以清酒七升。水八升。先煮八味。取三升。去滓。纳胶烊消尽。温服一升。日三服。一名复脉汤。
〔柯〕一百十三方。未有用及地黄麦冬者。恐亦叔和所附。然以二味。已载神农本经。为滋阴之上品。因
伤寒一书。故置之不用耳。此或阳亢阴竭而然。复出补阴制阳之路。以开后学滋阴一法。生地黄麦冬阿胶滋阴。
人参桂枝清酒以通脉。甘草姜枣。以和营卫。结代可和。而悸动可止矣。〔张〕津液枯槁之人。宜预防二便秘
涩之虞。麦冬生地。溥滋膀胱之化
源。麻仁阿胶。专主大肠之枯约。免致阴虚泉竭。火燥血枯。此仲景救阴退阳之妙法也。
柯氏方论曰。仲景凡于不足之脉。阴弱者用芍药以益阴。阳虚者用桂枝以通阳。甚则加人参以生脉。此以
中虚脉结代。用生地黄为君。麦冬为臣。峻补真阴者。然地黄麦冬。味虽甘。而气则寒。非发陈蕃秀之品。必
得人参桂枝。以通阳脉。生姜大枣。以和营卫。阿胶补血。甘草之缓。不使速下。清酒之猛。捷于上行。内外
调和。悸可宁而脉可复矣。酒七升。水八升。只取三升者。久煎之则气不峻。此虚家用酒之法。且知地黄麦冬。
得酒则良。此证当用酸枣仁。肺痿用麻子仁。可也。如无真阿胶。以龟板胶代之。
案名医别录。甘草。通经脉。利血气。证类本草。伤寒类要。治伤寒心悸。脉结代者。甘草二两。水三升。
煮一半。服七合。日一服。由是观之。心悸脉结代。专主甘草。乃是取乎通经脉利血气。此所以命方曰炙甘草
汤也。诸家厝而不释者何。
千金翼。复脉汤。治虚劳不足。汗出而闷。脉结心悸。行动如常。不出百日。危急者二十一日死。越公杨
素。因患失脉七日。服五剂而复。
千金方。炙甘草汤。治肺痿涎唾多出血。心中温温液液者。（即本方。外台秘要。引仲景伤寒论。主疗并同。）
卫生宝鉴。至元庚辰。六月中。许伯威五旬有四。中气本弱。病伤寒。八九日。医者见其热甚。以凉剂下
之。又食梨三四枚。伤脾胃。四肢冷。时昏愦。请予治之。诊其脉。动而中止。有时自还。乃结脉也。亦心动
悸。吃噫不绝。色青黄。精神减少。目不欲开。蜷卧恶人语。予以炙甘草汤治之。减生地黄。恐损阳气。锉一
两。服之不效。再于市铺。
选尝气味浓者。再煎服之。其病减半。再服而愈。凡药昆虫草木。生之有地。根叶花实。采之有时。失其地性
味少异。失其时气味不全。又况新陈不同。精粗不等。倘不择用。用之不效。医之过也。
张氏医通曰。酒色过度。虚劳少血。津液内耗。心火自炎。致令燥热乘肺。咯唾脓血。上气涎潮。其嗽连
续不已。加以邪客皮毛。入伤于肺。而自背得之尤速。当炙甘草汤。徐彬金匮论注曰。余外家曾病此。初时涎沫
成碗。服过半月。痰少而愈。但最难吃。三四日内。猝无捷效耳。
脉按之来缓。时一止复来者。名曰结。又脉来动而中止。更来小数。中有还者。反动。名曰结阴也。脉来
动而中止。不能自还。因而复动者。名曰代阴也。得此脉者。必难治。（成本。缓下。有而字。无复动之者。
玉函。无此条。）
〔喻〕此段。本为结代二脉下注脚。〔方〕此承结代。而推言结阴代阴。以各皆详辨其状。与辨脉第九章
意同。〔汪〕脉以指按之来。来者。滑伯仁云。自骨肉之分。而出于皮肤之际。气之升者。是也。〔钱〕结者。
邪结也。脉来停止暂歇之名。犹绳之有结也。凡物之贯于绳上者。遇结必碍。虽流走之甚者。亦必少有逗留。
乃得过也。此因气虚血涩。邪气间隔于经脉之间耳。虚衰则气力短浅。间隔则经络阻碍。故不得快于流行而止
歇也。动而中止者。非辨脉法中阴阳相搏之动也。谓缓脉正动之时。忽然中止。若有所遏而不得动也。更来小
数者。言止后更勉强作小数。小数者。郁而复伸之象也。小数之中。有脉还而反动者。名曰结阴。辨脉法云。
（成本本作“妙”，千金翼本作“愈”。徐彬《金匮论注》、沈明宗编注本作“佳”。）
〔徐〕此条证候与桂枝附子汤证相同，都是风湿相互搏结。然而彼证病位较浅，寒邪偏多，所以肢体被风湿所困，病痛仅局限于躯壳之内。此证则是风与湿两势均胜，挟带体内的阳气，奔逸妄行造成灾害。因此骨节之间，风邪侵入加剧劲力，导致关节不能屈伸。严重损伤了卫气，出现汗出、短气、恶风等症状。水湿也乘着风气作势，导致身体轻微浮肿。其病势正欲在肌表扰乱，与那种静止而困顿的情况截然不同。
〔吴〕此方使用附子除湿温经，桂枝祛风和营，白术去湿实卫，甘草辅助诸药，从而形成收敛与发散相协调的功效。
〔周〕此证比前一条更重，且里气已经受伤，为何反而减去附子的用量呢？前一条风湿尚在体表，在表的病邪利于速去；此条风湿半入于里，入里的病邪妙在缓攻。仲景只是担心附子用量过多，则药性猛烈急切，筋节的孔窍未必能骤然打开，风湿之邪怎能托举排出？只会导致大汗出而邪气不尽。重用甘草，是希望药性缓和。调和中焦的力量虽短，留恋药力的作用却长。这就是仲景在前一条用附子三枚，分三次服用；此条只用二枚，初次服用五合，恐怕一升太多，适宜服用六七合的原因。这都是不想让药力尽出的意思。学者对仲景书中不解之处，只需在本文中寻找，自然会有心得。
〔钱〕虽然名为甘草附子汤，实际上是用桂枝去芍药汤来发汗解风邪，增加附子和白术，以驱散寒邪、燥化湿气。
〔汪〕后条辨文中说：以上三方都使用附子，是因为风伤卫气而表阳已虚，加上寒湿，里阴更盛。凡是所见症状，都是阳气不充，所以经络关节容易受湿邪侵袭，卫阳更加虚弱。我认为这番话，确实阐发了仲景的深奥义理。
按语：《千金方》脚气门中的四物附子汤，就是此方。方后注说：身体浮肿者，加防己四两；心悸、小便不利者，加茯苓三两。《三因方》中的六物附子汤，也是此方。
伤寒脉象浮滑，这是因为表有热，里有寒，用白虎汤主治。（【原注】林亿等谨案：前篇说：“热结在里，表里俱热者，白虎汤主之。”又说：“其表不解，不可与白虎汤。”这里说脉浮滑，表有热，里有寒，必定是“表里”二字互换了位置。又阳明病证说：“脉浮迟，表热里寒，四逆汤主之。”少阴病证说：“里寒外热，通脉四逆汤主之。”由此看来，表里二字互换是明显的错误。《千金翼》说是白通汤，不对。《玉函经》作“伤寒脉浮滑，而表热里寒者，白通汤主之”。旧注说“白通汤”或“白虎汤”恐怕都不对。注云：旧说以下出自王叔和。今考《千金翼》，作白虎汤，怀疑《玉函经》有误。这个“而”字，《玉函经》作“而”，成本无“有”字，程本、张本作“里有热表有寒”，大概源于林亿的说法。柯氏作“表有热里有邪”，大概源于成无己的注释。）
〔鉴〕王三阳说：经文中的“寒”字，应当解释为“邪”字，也就是热的意思。这种说法很正确。如果是“寒”字，就不是白虎汤证了。这里说的是伤寒太阳证罢休，邪气传入阳明，表里俱热，但尚未形成胃家实的病证。脉浮滑，浮是表有热的脉象，阳明表有热，应当发热汗出；滑是里有热的脉象，阳明里有热，应当烦渴引饮。所以说表有热，里有热。这是阳明表里俱热的证候，白虎汤是解除阳明表里俱热的药物，所以主治它。不加人参，是因为患者未经过汗、吐、下法治疗，正气未虚。
〔钱〕如果胃实且疼痛，是有形之邪，应当用承气汤攻下。这里仅是外邪入里，化为无形之热邪，所以用寒凉清肃的白虎汤，以解除阳明胃腑的邪热。
按语：此条各家的说法不一。成无己说：里有寒，是指邪气传里。因为邪气未入腑，所以只说寒，如瓜蒂散证说“胸上有寒者”，就是这个意思。方有执说：里有寒的“里”字，不是相对于表而言，而是指热的内部。因为伤寒的热，本源是寒引起的，所以称热，“里有寒”是指产生热的原因。喻嘉言说：里有寒，是伤寒传入于里，增加了里热，但因为起于寒，所以追根溯源说里有寒。程知说：读厥阴篇中“脉滑而厥者，里有热也，白虎汤主之”，就知道此处“表里”二字是错简。“里有热，表有寒”，也是热结在里，郁阻表气于外。但这比时时恶风、背微恶寒的症状稍微轻缓零星一些。张隐庵也改为“表有寒里有热”，认为热邪初乘肌表，表气不能胜邪，外表反而显现假寒，所以说表有寒；而伏邪始发未尽，里热犹盛，所以说里有热。志聪说：此表有太阳之热，里有癸水之寒。癸水虽寒，但与阳明相搏，则戊己化火，成为阳热有余，所以用白虎汤清两阳之热。锡驹说：太阳的标热在表，此即表有热；太阳的本寒在里，此即里有寒。凡伤于寒，就变成热病，所以宜用白虎汤主治。魏荔彤说：此里尚为经络之里，非脏腑之里，也像卫为表、营为里，不是指脏腑而言。钱潢说：白虎汤是表邪未解时所忌用的。如果说伤寒表有热，固然不宜；而说里有寒，更是禁忌，而仲景反以白虎汤主治，为什么呢？凭意推测，恐怕是先受的寒邪，已经入里，郁结而为热，本源属于寒，所以说里有寒；邪既入里，已入阳明，发作而为蒸蒸之热，其热自内达外，所以说表有热。柯琴改“寒”为“邪”，说旧本作“里有寒”是错误的。这里虽然表里并言，但重在里热，所谓“结热在里，表里俱热”。以上诸说如此，特别林亿、程知的解释，似乎义理非常恰当，其余则含糊牵强，难以适从。至于顺文平稳，则《医宗金鉴》最为得当，所以姑且揭示其说。
《汤液本草》东垣说：胸中有寒者，用瓜蒂散吐之。又说表热里寒者，白虎汤主之。瓜蒂、知母味苦寒，却能治胸中寒，以及里寒，为什么呢？回答说：成无己注解说：即伤寒，寒邪的毒，变成了热病。读者要逆向识别它。如《论语》说“乱臣十人”，《尚书》说“唯以乱民”，他们的才能治理四方，“乱”都是治理的意思，是治乱的人。所以说乱臣、乱四方。仲景所说的“寒”字，是举其初始而言，热病包含在其中了。如果把寒理解为寒冷的冷，就不再用苦寒的药剂了。兼言白虎，诊脉尺寸俱长，那么热就可以知道了。
白虎汤方
知母（六两） 石膏（一斤，碎） 甘草（二两，炙） 粳米（六合）
以上四味，用水一斗，煮至米熟，汤成，去渣滓。温服一升，每日三次。（《外台秘要》作水一斗二升，煮取米熟，去米纳药，煮取六升，去渣滓，分六次服用。）
〔柯〕阳明邪气从热化，所以不恶寒而恶热。热蒸腾外越，所以热汗出。热灼烧胃中，所以渴欲饮水。邪盛而实，所以脉滑。然而邪气仍在经脉，所以兼见浮象。盖阳明属胃，外主肌肉，虽然内外大热但未结实，终究不是苦寒味道所适宜的。石膏辛寒，辛能解肌热，寒能胜胃火，寒能沉入内部，辛能走散外部，此药两擅内外之功，所以作为君药。知母苦润，苦以泻火，润以滋燥，所以用作臣药。甘草、粳米，调和于中宫，且能在土中泻火，稼穑作甘，寒剂得之缓和其寒，苦剂得之平抑其苦，使这两味作为佐药，那么大寒大苦之品，就不会损伤脾胃了。煮汤入胃，输布脾肺，水精四布，大烦大渴可除矣。白虎是西方金神，取名此汤，是因为秋金得令，而炎暑自解。
《伤寒明理论》说：白虎，是西方金神，应秋季而归肺。热甚于内的，用寒下法；热甚于外的，用凉解法。如果有中外俱热，内不得泄，外不得发的情况，不用此汤就不能解决。夏热秋凉，暑气得到秋天就停止。秋天的命令叫处暑，此汤以白虎命名，谓能止热。
《活人书》化斑汤，治疗斑毒。
在本方基础上加葳蕤，用糯米。说：大抵发斑，不可用表药。表虚里实，若发汗开泄，更增斑烂。应当用此汤。
又说：问两胫逆冷，胸腹满，多汗，头目痛，苦于妄言，这名叫湿温病。苦于两胫逆冷，腹满，又胸多汗，头目痛，苦于妄言，其脉阳濡而弱，阴小而急，治在太阴，不可发汗。汗出必不能言，耳聋不知痛所在，身青面色变，名叫重暍。如此死者，是医生杀了他。白虎加苍术汤。
在本方基础上，加苍术三两。此方出自《伤寒微旨》，也是仿照《金匮》白虎加桂汤。
《和剂局方》白虎汤，治疗伤寒大汗出后，表证已解，心胸大烦渴欲饮水，以及吐或下后，七八日邪毒不解，热结在里，表里俱热，时时恶风大渴，舌上干燥而烦，欲饮水数升者，宜服之。又治疗夏月中暑毒，汗出恶寒，身热而渴。《医学纲目》说：孙兆治疗一人自汗，两足逆冷至膝下，腹满不省人事。孙诊六脉，小弱而急，问其所服药物，取来看视都是阴病药。孙曰：这不是病重，是药能重病罢了。于是用五苓散合白虎汤，十余帖，病稍苏，再服痊愈。有人问治法，孙曰：病患伤暑。开始则阳微厥，而脉小无力，医生认为是阴病，于是误药。其病厥，用五苓散利小便，则腹减；白虎解利邪热，则病愈。凡阴病胫冷，则臂亦冷。你如今胫冷，臂不冷，则不是下厥上行，所以知道是阳微厥。
又说火喘，用本方，加栝蒌仁、枳壳、黄芩，神效。出自《初虞世·医方选要》。人参石膏汤，治疗膈消，上焦燥渴，不饮多食，在本方基础上，加黄芩、杏仁、人参。
《活人大全》病在半表半里，热不退，脉尚浮洪者，当微表者，用小柴胡汤合本方和解。
《方脉正宗》治疗胃家实热或嘈杂，消渴善饥，或齿痛。
在本方基础上，去粳米，加竹叶、芍药。（出自《本草汇言》。）
伤寒脉结代，心动悸，炙甘草汤主治。（心动悸，《玉函经》作心中惊悸。）
〔鉴〕心动悸，是说心下筑筑惕惕然，跳动而不安。如果因汗下所致，多属虚；不因汗下所致，多属热。想喝水，小便不利者，属饮邪。四肢厥冷而下利者，属寒。如今患伤寒，不因汗下，而心动悸，又没有饮、热、寒、虚的证候，只根据结代不足的阴脉，就主治以炙甘草汤，是因为此人平日血气衰微，不耐受寒邪，所以脉不能续行。此时虽然有伤寒之表未罢，也在所不顾，总以补中生血复脉为急，通行营卫为主。
炙甘草汤方
甘草（四两，炙） 生姜（三两，切） 人参（二两） 桂枝（三两，去皮） 生地黄（一斤○《金匮》有酒洗字，《千金翼》有切字。） 大枣（三十枚，擘○成本、《玉函》作十二枚。） 阿胶（二两） 麦门冬（半升，去心） 麻仁（半升○成本作麻子仁义。）
以上九味，用清水酒七升，水八升，先煮八味，取三升，去渣滓，纳胶烊化消尽。温服一升，每日三次。一名复脉汤。
〔柯〕一百十三方中，没有用过地黄、麦冬的，恐怕也是王叔和所附加的。然而这两味，已载于《神农本草经》，为滋阴之上品，因为《伤寒》一书，所以置之不用。这或许是阳亢阴竭所致，又复出补阴制阳的路子，以开后学滋阴一法。生地黄、麦冬、阿胶滋阴，人参、桂枝、清酒以通脉，甘草、姜、枣，以和营卫。结代可和，而悸动可止矣。
〔张〕津液枯槁之人，宜预防二便秘涩之虞。麦冬、生地，广滋膀胱之化源；麻仁、阿胶，专主大肠之枯约。免致阴虚泉竭，火燥血枯。这是仲景救阴退阳的妙法。
柯氏方论说：仲景凡是对于不足之脉，阴弱者用芍药以益阴，阳虚者用桂枝以通阳，甚者加人参以生脉。此以中虚脉结代，用生地黄为君，麦冬为臣，峻补真阴。然而地黄、麦冬，味虽甘，而气则寒，不是发陈蕃秀之品，必须得人参、桂枝，以通阳脉，生姜、大枣，以和营卫，阿胶补血，甘草之缓，不使速下，清酒之猛，捷于上行。内外调和，悸可宁而脉可复矣。酒七升，水八升，只取三升，是因为久煎则气不峻。这是虚家用酒的方法，且知地黄、麦冬，得酒则良。此证当用酸枣仁，肺痿用麻子仁，可以。如果没有真阿胶，以龟板胶替代。
按语：《名医别录》说：甘草，通经脉，利血气。《证类本草》、《伤寒类要》治伤寒心悸，脉结代者，甘草二两，水三升，煮一半，服七合，日一服。由此观之，心悸脉结代，专主甘草，乃是取其通经脉利血气。这就是命方名为炙甘草汤的原因。诸家搁置而不解释，为什么呢？
《千金翼》复脉汤，治疗虚劳不足，汗出而闷，脉结心悸，行动如常，不出百日，危急者二十一日死。越公杨素，因患失脉七日，服五剂而复。
《千金方》炙甘草汤，治疗肺痿涎唾多出血，心中温温液液者。（即本方，《外台秘要》引《仲景伤寒论》，主疗并同。）
《卫生宝鉴》至元庚辰，六月中，许伯威五旬有四，中气本弱，病伤寒，八九日，医者见其热甚，以凉剂下之，又食梨三四枚，伤脾胃，四肢冷，时昏愦，请予治之。诊其脉，动而中止，有时自还，乃结脉也。亦心动悸，吃噫不绝，色青黄，精神减少，目不欲开，蜷卧恶人语，予以炙甘草汤治之。减生地黄，恐损阳气。锉一两，服之不效，再于市铺选尝气味浓者，再煎服之，其病减半，再服而愈。凡药昆虫草木，生之有地，根叶花实，采之有时，失其地性味少异，失其时气味不全，又况新陈不同，精粗不等，倘不择用，用之不效，医之过也。
《张氏医通》说：酒色过度，虚劳少血，津液内耗，心火自炎，致令燥热乘肺，咯唾脓血，上气涎潮，其嗽连续不已，加以邪客皮毛，入伤于肺，而自背得之尤速，当用炙甘草汤。徐彬《金匮论注》说：我的外家曾患此病，初时涎沫成碗，服过半月，痰少而愈。但最难吃，三四日内，猝无捷效耳。
脉按之来缓，时一止复来者，名叫结。又脉来动而中止，更来小数，中有还者，反动，名叫结阴也。脉来动而中止，不能自还，因而复动者，名叫代阴也。得此脉者，必难治。（成本在“缓”下有“而”字，无“复动之者”。《玉函》无此条。）
〔喻〕这段文字，本是给结代二脉下的注脚。
〔方〕这是承接结代，而推言结阴代阴，以各自详细辨别其状，与《辨脉法》第九章意思相同。
〔汪〕脉以指按之来，来者，滑伯仁说：自骨肉之分，而出于皮肤之际，气之升者，是也。
〔钱〕结者，邪结也。脉来停止暂歇之名，犹绳之有结也。凡物之贯于绳上者，遇结必碍，虽流走之甚者，亦必少有逗留，乃得过也。此因气虚血涩，邪气间隔于经脉之间耳。虚衰则气力短浅，间隔则经络阻碍，故不得快于流行而止歇也。动而中止者，非《辨脉法》中阴阳相搏之动也。谓缓脉正动之时，忽然中止，若有所遏而不得动也。更来小数者，言止后更勉强作小数。小数者，郁而复伸之象也。小数之中，有脉还而反动者，名叫结阴。《辨脉法》说：
(Cost edition reads "Miao", Qianjin Yi edition reads "Yu". Xu Bin's *Jinkui Lunzhu* and Shen Mingzong's annotated edition read "Jia".)
[Xu] This syndrome is identical to the Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) syndrome, both involving the intermingling of wind and dampness. However, in the former, the disease is superficial with excess cold, so the limbs are constrained by wind-dampness, and the pathology is confined within the body shell. In this case, both wind and dampness are vigorous, carrying the body's yang qi to run wild and cause disaster. Therefore, wind enters the joints between bones, increasing its force, leading to an inability to flex or extend. It severely damages the Wei Qi (Defensive Qi), resulting in sweating, shortness of breath, and aversion to wind. Damp water also takes advantage of the wind to create swelling, causing slight edema of the body. The pathological trend is disturbing the muscle and surface, which is incomparable to the static and constrained condition.
[Wu] This formula uses Fuzi (Aconiti Lateralis Radix Praeparata) to remove dampness and warm the meridians, Guizhi (Cinnamomi Ramulus) to dispel wind and harmonize the Ying (Nutritive) level, Baizhu (Atractodis Rhizoma) to remove dampness and solidify the exterior, and Gancao (Glycyrrhizae Radix et Rhizoma) to assist the other herbs, thereby achieving a balance of astringency and dispersion.
[Zhou] This syndrome is more severe than the previous one, and the interior has already been injured. Why reduce the dosage of Fuzi? In the previous clause, wind-dampness was still on the exterior; for pathogens on the exterior, rapid elimination is beneficial. Here, wind-dampness is half-internal; for internalized pathogens, slow attack is subtle. Zhongjing feared that excessive Fuzi would have a fierce and urgent nature, and the orifices of the sinews and joints might not open suddenly, making it impossible to expel the wind-damp pathogen. It would only cause profuse sweating without eliminating the pathogen. Using Gancao as the sovereign herb aims at slowing down the action. Its power to harmonize the middle is short, but its ability to retain the medicinal effect is long. This is why Zhongjing used three pieces of Fuzi in the previous clause, divided into three doses, whereas here he uses only two pieces: initially taking five he, fearing that one sheng is too much, it is appropriate to take six or seven he. This reflects the intention not to exhaust the dose. Scholars who do not understand Zhongjing's book should seek answers within the text itself.
[Qian] Although named Gancao Fuzi Tang (Licorice and Aconite Decoction), it essentially uses Guizhi Qu Shaoyao Tang (Cinnamon Twig Decoction minus Peony) to induce sweating and resolve wind pathogens, adding Fuzi and Baizhu to drive out cold and dry dampness.
[Wang] The subsequent differentiation states: All three formulas above use Fuzi because wind injures the Wei Qi and the exterior Yang is already deficient; adding cold-dampness makes the interior Yin even stronger. All observed symptoms indicate insufficient Yang Qi, so the meridians and joints are susceptible to dampness, and the Wei Yang becomes increasingly deficient. I believe these words truly elucidate Zhongjing's profound meaning.
Note: The Siwu Fuzi Tang (Four Substances and Aconite Decoction) in the Foot-Cold section of *Qianjin Fang* is this formula. The post-formula note says: For body swelling, add Fangji (Stephaniae Radix) four liang; for palpitations and difficult urination, add Fuling (Poria) three liang. The Liwu Fuzi Tang (Six Substances and Aconite Decoction) in *Sanyin Fang* is also this formula.
In Shanghan (Cold Damage), if the pulse is floating and slippery, it indicates heat on the exterior and cold on the interior; Baihu Tang (White Tiger Decoction) is the primary treatment. ([Original Note] Lin Yi et al. respectfully note: The previous chapter states, "When heat is knotted in the interior and there is heat on both the exterior and interior, Baihu Tang is indicated." It also states, "If the exterior is not resolved, Baihu Tang must not be given." Here it says the pulse is floating and slippery, with heat on the exterior and cold on the interior. It is certain that the characters "exterior" and "interior" are transposed. Another Yangming syndrome states, "Pulse floating and slow, heat on the exterior and cold on the interior, Sini Tang (Frigid Extremities Decoction) is indicated." Another Shaoyin syndrome states, "Cold on the interior and heat on the exterior, Tongmai Sini Tang (Pulse-Returning Frigid Extremities Decoction) is indicated." From this, the transposition of "exterior" and "interior" is clear. *Qianjin Yi* says it is Baitong Tang, which is incorrect. *Yukan* reads, "Shanghan, pulse floating and slippery, with heat on the exterior and cold on the interior, Baitong Tang is indicated." Old notes say "Baitong Tang" or "Baihu Tang" are likely incorrect. The note below comes from Wang Shuhe. Upon examination, *Qianjin Yi* reads Baihu Tang, suggesting *Yukan* is erroneous. The character "er" (and) appears in *Yukan*; Cost edition omits "you"; Cheng Ben and Zhang Ben read "heat on the interior and cold on the exterior," likely derived from Lin Yi's theory. Ke Shi reads "heat on the exterior and evil on the interior," likely derived from Cheng Zhu.)
[Jian] Wang Sanyang says: The character "Han" (cold) in the text should be interpreted as "Xie" (evil/pathogen), which implies heat. This explanation is very correct. If it were truly "cold," it would not be a Baihu Tang syndrome. This passage describes the Taiyang syndrome of Shanghan resolving, with the pathogen transmitting to Yangming, resulting in heat on both the exterior and interior, but without forming a stomach-fullness (Wei Shi) condition. A floating pulse indicates heat on the exterior; Yangming heat on the exterior manifests as fever and sweating. A slippery pulse indicates heat on the interior; Yangming heat on the interior manifests as irritability, thirst, and desire to drink. Thus, it is said there is heat on the exterior and heat on the interior. This is a Yangming syndrome of heat on both the exterior and interior. Baihu Tang resolves heat on both the exterior and interior of Yangming, hence it is indicated. Ren Shen (Ginseng Radix) is not added because the patient has not undergone sweating, vomiting, or purging, and thus is not deficient.
[Qian] If there is stomach fullness and pain, it is a tangible pathogen, and Chengqi Tang (Downward-Pouring Decoction) should be used to purge. Here, the external pathogen has entered the interior and transformed into intangible heat, so the cooling and clearing Baihu Tang is used to resolve the pathogenic heat of the Yangming Stomach Fu organ.
Note: Various interpretations of this clause differ. Cheng Wuji says: "Cold on the interior" refers to the pathogen transmitting to the interior. Since the pathogen has not entered the Fu organs, it is only called "cold," similar to the Genti San (Throat-Vomit Powder) syndrome stating, "There is cold in the chest." Fang Youzhi says: The "interior" in "cold on the interior" does not contrast with "exterior" but refers to the inside of the heat. Because the heat of Shanghan originates from cold, it is called heat; "cold on the interior" refers to the cause of the heat. Yu Jiayan says: "Cold on the interior" means the Shanghan has transmitted to the interior, increasing interior heat, but since it originated from cold, tracing back to the root, it is called cold on the interior. Cheng Zhi says: Reading the Jueyin chapter, "Pulse slippery and cold extremities, heat on the interior, Baihu Tang is indicated," reveals that the characters "exterior" and "interior" here are misplaced. "Heat on the interior, cold on the exterior" also results from heat knotted in the interior, stagnating exterior Qi. However, this is slightly milder and more sporadic than "frequent aversion to wind and slight aversion to cold on the back." Zhang Yinzan also changes it to "cold on the exterior, heat on the interior," believing that when heat pathogen first attacks the muscle surface, the exterior Qi cannot overcome the pathogen, manifesting false cold externally, hence "cold on the exterior"; while the latent pathogen has not fully emerged, interior heat remains strong, hence "heat on the interior." Zhicong says: There is Taiyang heat on the exterior and Gui Water (Kidney Water) cold on the interior. Although Gui Water is cold, when it contends with Yangming, Wu and Ji transform into fire, resulting in excess Yang-heat; thus, Baihu Tang clears the heat of the Two Yangs. Xiju says: The marked heat of Taiyang is on the exterior, which is "heat on the exterior"; the root cold of Taiyang is on the interior, which is "cold on the interior." Any injury from cold transforms into heat disease, so Baihu Tang is indicated. Weilitong says: This "interior" refers to the interior of the meridians, not the Zang-Fu organs, just as Wei is exterior and Ying is interior, not referring to Zang-Fu. Qian Rong says: Baihu Tang is contraindicated when exterior pathogen is unresolved. If it says Shanghan has heat on the exterior, it is indeed unsuitable; saying "cold on the interior" is even more contraindicated. Yet Zhongjing uses Baihu Tang. Why? Speculating by intent, perhaps the initial cold pathogen has entered the interior, stagnated, and transformed into heat. Since the origin is cold, it is called "cold on the interior." Once the pathogen enters the interior and reaches Yangming, it erupts as steaming heat, radiating from inside to outside, hence "heat on the exterior." Ke Qin changed "cold" to "evil," stating that the old version reading "cold on the interior" was wrong. Although both exterior and interior are mentioned, the emphasis is on interior heat, i.e., "heat knotted in the interior, heat on both exterior and interior." Among these theories, those of Lin Yi and Cheng Zhi seem most appropriate, while others are vague and forced. Regarding smooth textual interpretation, *Yizong Jinjian* is the best, so I present it tentatively.
*Tangye Bencao* (Herbal Materia Medica of Liquid Extracts) records Dongyuan: "For cold in the chest, use Genti San to vomit." Also, "For heat on the exterior and cold on the interior, Baihu Tang is indicated." Genti and Zhimu are bitter and cold, yet they treat cold in the chest and interior cold. Why? The answer is: Cheng Wuji's commentary states: This refers to Shanghan, where the toxicity of the cold pathogen becomes a heat disease. Readers must recognize this inversely. As the *Analects* says "ten chaotic ministers" and the *Book of Documents* says "only using chaotic people," their talent governs the four directions; "chaos" here means governance. They are governors of chaos. Thus, "chaotic ministers" and "governing the four directions." The word "cold" used by Zhongjing refers to the beginning, implying the heat disease is contained within. If "cold" were understood as chilling cold, bitter-cold agents would not be used again. Mentioning Baihu Tang and diagnosing the Cun and Chi pulses as long indicates heat.
Baihu Tang Formula
Zhimu (Mueller's Goldthread Rhizome, 6 liang) Shigao (Gypsum Fibrosum, 1 jin, crushed) Gancao (Prepared Licorice Root and Rhizome, 2 liang) Jingmi (Oryza Sativa Var. Glutinosa, 6 he)
These four ingredients are boiled in one dou of water until the rice is cooked. Strain the decoction. Take one sheng warm, three times daily. (*Waitai Miyao* states: Boil in one dou two sheng of water until rice is cooked, remove rice, add herbs, boil to obtain six sheng, strain, divide into six doses.)
[Ke] Yangming pathogens transform via heat, so there is no aversion to cold but aversion to heat. Heat steams outward, causing sweaty heat. Heat scorches the Stomach, causing thirst and desire to drink. Pathogen is abundant and substantial, causing a slippery pulse. However, it is still in the meridians, hence accompanied by floating. Yangming belongs to the Stomach and governs the muscles externally. Although there is great heat internally and externally without fullness, bitter-cold flavors are not entirely suitable. Shigao is acrid and cold; acridity can resolve muscle heat, coldness can overcome Stomach fire. Cold sinks inward, acridity moves outward. This herb excels in both internal and external functions, hence used as the Sovereign. Zhimu is bitter and moist; bitterness drains fire, moisture nourishes dryness, hence used as Minister. Gancao and Jingmi harmonize in the Middle Palace and drain fire from Earth. Sweetness arises from sowing and reaping; cold agents become milder with them, bitter agents become balanced with them. These two serve as Assistants, ensuring that harsh cold and bitter agents do not damage the Spleen and Stomach. The decoction enters the Stomach, distributes to the Spleen and Lung, fluids spread everywhere, and severe irritability and thirst are resolved. Baihu is the Golden Deity of the West; naming the decoction after it signifies that when Autumn Metal rules, summer heat naturally resolves.
*Shanghan Mingli Lun* states: Baihu is the Golden Deity of the West, corresponding to Autumn and governing the Lung. For heat severe in the interior, use cold purgation; for heat severe in the exterior, use cool resolution. For cases where there is heat both inside and outside, unable to vent internally or sweat externally, this decoction is the only solution. Summer heat and autumn coolness: the Qi of summer heat stops with autumn. The command of autumn is called Chushu (End of Heat). This decoction is named Baihu, meaning it can stop heat.
*Huo Ren Shu* Huaban Tang (Spot-Resolving Decoction) treats spot-toxin.
Add Weirui (Polygonati Odorati Rhizoma) to this base formula, using Nuomi (Glutinous Rice). It states: Generally, for spots, exterior-releasing drugs must not be used. Exterior deficiency and interior excess: if sweating and opening are induced, spots will worsen. This decoction should be used.
Also states: Question: Cold feet upward, chest and abdominal fullness, profuse sweating, headache and eye pain, delirious speech. This is named Wet-Warmth disease. With cold feet upward, abdominal fullness, chest sweating, headache, and delirium, the pulse is superficial soggy and weak, deep small and rapid. Treatment focuses on Taiyin; sweating is contraindicated. Sweating will cause muteness, deafness, unawareness of pain location, cyanosis, and color change. This is called Heavy Miasma. Those who die like this are killed by the doctor. Baihu Jia Cangzhu Tang (White Tiger Decoction plus Atractylodes Macrocephala Rhizoma).
Add Cangzhu (Atractylodis Rhizoma) three liang to this base formula. This formula comes from *Shanghan Weizhi*, imitating *Jinkui*'s Baihu Jia Guizhi Tang.
*Heji Jufang* Baihu Tang treats Shanghan after profuse sweating, where exterior syndrome has resolved, chest and heart are severely irritated and thirsty for water, and after vomiting or purging, seven to eight days later the pathogen toxin remains unresolved, heat knots in the interior, heat on both exterior and interior, frequent aversion to wind, severe thirst, dry tongue with irritability, desire to drink several sheng of water. It is suitable to take this. It also treats Summerheat-Toxin contracted in summer, with sweating, aversion to cold, body heat, and thirst. *Yixue Gangmu* states: Sun Zhao treated a patient with spontaneous sweating, cold feet up to the knees, abdominal fullness, and unconsciousness. Sun diagnosed the six pulses as small, weak, and rapid. Asking about taken medicines, he saw they were all for Yin diseases. Sun said: The disease is not severe; the medicine made it severe. He used Wuling San (Five-Ingredient Powder with Poria) combined with Baihu Tang. After more than ten doses, the patient recovered slightly; continued administration led to full recovery. When asked about the method, Sun said: The patient suffered Summerheat. Initially, Yang was weak with cold extremities, and the pulse was small and powerless. The doctor considered it a Yin disease and administered wrong medicine. For the cold extremities, Wuling San promotes urination, reducing abdominal fullness; Baihu resolves pathogenic heat, curing the disease. For Yin diseases, cold calves imply cold arms. Your calves are cold, but arms are not, so it is not lower-Jue ascending; thus, it is known as Yang-weak cold extremities.
Also states: For Fire Asthma, use this base formula plus Gualou Ren (Trichosanthis Semen), Zhike (Aurantii Fructus Perfricatus), Huangqin (Scutellariae Radix), with miraculous effect. From *Chuyushi Yifang Xuanyao*. Renshen Shigao Tang (Ginseng and Gypsum Decoction) treats Ge Xiao (Diaphragm Consumption), upper-Jiao dryness and thirst, lack of appetite but increased hunger. Add Huangqin, Xingren (Armeniacae Semen Amarum), and Renshen to this base formula.
*Huoren Daquan*: For disease in half-exterior half-interior, heat unresolvable, pulse still floating and surging, when slight exterior release is needed, combine Xiaochaihu Tang (Minor Bupleurum Decoction) with this base formula to harmonize.
*Fangmai Zhengzong*: Treats Stomach Full-Heat or epigastric discomfort, consumption-thirst with good appetite, or toothache.
Remove Jingmi from this base formula, add Zhuye (Phyllostachys Folium) and Shaoyao (Paeoniae Radix Alba). (From *Bencao Huiyan*.)
In Shanghan, if the pulse is Knotted (Jie) or Intermittent (Dai), with Palpitations (Xindong Ji), Zhigancao Tang (Honey-Fried Licorice Decoction) is indicated. (Palpitations, *Yukan* reads "startled palpitations in the heart.")
[Jian] Palpitations refer to a trembling and anxious sensation in the heart region, beating without peace. If caused by sweating or purging, it is mostly deficiency; if not caused by sweating or purging, it is mostly heat. Desire to drink and difficult urination indicate Fluid retention. Cold extremities with diarrhea indicate Cold. Now, suffering from Shanghan, without sweating or purging, yet experiencing palpitations, and lacking signs of Fluid, Heat, Cold, or Deficiency, relying solely on the Yin pulse of Knotted/Intermittent insufficiency, Zhigancao Tang is indicated because the person normally has weak Blood and Qi, unable to withstand cold pathogen, so the pulse cannot continue flowing. At this time, although the Shanghan exterior may not have resolved, it is disregarded; the priority is tonifying the Middle, generating Blood, restoring the pulse, and circulating Ying and Wei.
Zhigancao Tang Formula
Gancao (Honey-fried Licorice Root and Rhizome, 4 liang) Shengjiang (Fresh Ginger Rhizome, 3 liang, sliced) Renshen (Ginseng Radix, 2 liang) Guizhi (Cinnamon Twig, 3 liang, bark removed) Shengdihuang (Rehmanniae Radix Recens, 1 jin [note: *Jinkui* mentions wine-washing; *Qianjin Yi* mentions slicing]) Dazao (Jujubae Fructus, 30 pieces, split [Cost and *Yukan* read 12 pieces]) Ejiao (Colla Corii Asini, 2 liang) Maimendong (Ophiopogonis Radix, half sheng, heart removed) Mahuang (Cannabis Seed, half sheng [Cost reads Hemp Seed]).
These nine ingredients are boiled in seven sheng of clear wine and eight sheng of water. First, boil the eight ingredients to obtain three sheng, strain, add Ejiao, melt completely. Take one sheng warm, three times daily. Also known as Fumai Tang (Pulse-Returning Decoction).
[Ke] Among the 113 formulas, none used Dihuang or Maimendong, possibly added by Wang Shuhe. However, these two are recorded in *Shennong Bencao Jing* as top-tier Yin-nourishing herbs, omitted from *Shanghan* due to the context of cold damage. This may be due to Yang hyperactivity and Yin exhaustion, offering a path of tonifying Yin to control Yang, opening the method of Yin-nourishing for future scholars. Shengdihuang, Maimendong, and Ejiao nourish Yin; Renshen, Guizhi, and clear wine unblock the pulse; Gancao, Shengjiang, and Dazao harmonize Ying and Wei. Knotted/Intermittent pulses can be harmonized, and palpitations stopped.
[Zhang] For persons with withered fluids, prevent constipation and difficulty in urination. Maimendong and Shengdihuang broadly nourish the source of Bladder transformation; Mahuang and Ejiao specifically address Large Intestine dryness and contraction, preventing Yin deficiency, spring depletion, fire dryness, and blood withering. This is Zhongjing's wonderful method of saving Yin and retreating Yang.
Ke Shi's Formula Theory states: Zhongjing, for deficient pulses, uses Shaoyao to benefit Yin when Yin is weak, and Guizhi to unblock Yang when Yang is deficient. Severe cases add Renshen to generate the pulse. Here, for Middle deficiency with Knotted/Intermittent pulse, Shengdihuang is Sovereign, Maimendong is Minister, fiercely tonifying True Yin. Although Dihuang and Maimendong are sweet, their Qi is cold, not promoting growth and flourishing. They require Renshen and Guizhi to unblock Yang pulses, Shengjiang and Dazao to harmonize Ying and Wei, Ejiao to nourish Blood, Gancao's mildness to prevent rapid descent, and clear wine's potency to accelerate ascent. Internal and external harmony allows palpitations to calm and pulses to return. Using seven sheng of wine and eight sheng of water to extract only three sheng ensures prolonged boiling prevents excessive potency. This is the method of using wine for deficiency cases, knowing Dihuang and Maimendong work well with wine. For this syndrome, Suanzaoren (Ziziphi Spinosae Semen) could be used; for Feiwei (Lung Flaccidity), Maziren (Hemp Seed) is appropriate. If true Ejiao is unavailable, Guibanjiao (Tortoise Shell Collagen) can substitute.
Note: *Mingyi Bielu* states: Gan通畅 meridians and benefits Blood and Qi. *Zhenglei Bencao* and *Shanghan Leiyao* treat Shanghan palpitations with Knotted/Intermittent pulse using two liang of Gancao, boiled in three sheng of water to half volume, taking seven he once daily. From this, palpitations with Knotted/Intermittent pulse are primarily treated with Gancao, utilizing its ability to unblock meridians and benefit Blood and Qi. This is why the formula is named Zhigancao Tang. Why did various commentators omit explanation?
*Qianjin Yi* Fumai Tang treats deficiency-labor insufficiency, sweating with stuffiness, Knotted/Intermittent pulse with palpitations. If movement is normal, death occurs within 100 days; if critical, within 21 days. Yue Gong Yang Su, suffering from lost pulse for seven days, recovered after five doses.
*Qianjin Fang* Zhigancao Tang treats Feiwei with excessive saliva and blood in sputum, and a warm, liquid sensation in the heart. (This is the same formula; *Waitai Miyao* cites *Zhongjing Shanghan Lun*, with indications identical.)
*Weisheng Baojian*: In the sixth month of Gengchen year of Zhiyuan, Xu Bowei, aged 54, had weak Middle Qi. Contracting Shanghan, on the eighth or ninth day, the physician saw severe heat and administered cold purgatives. He also ate three or four pears, injuring Spleen and Stomach. His limbs became cold, and he experienced periodic fainting. He sought my treatment. Diagnosing his pulse, it moved then stopped, sometimes returning on its own; this is a Knotted pulse. He also had palpitations, continuous belching, blue-yellow complexion, reduced spirit, reluctance to open eyes, curled posture, and aversion to people speaking. I treated him with Zhigancao Tang. Reducing Shengdihuang to avoid damaging Yang Qi, I ground one liang. It was ineffective. I selected herbs with strong aroma and flavor from the market, decocted and administered again. Symptoms halved; continued administration led to recovery. Herbs, insects, and plants grow in specific places; roots, leaves, flowers, and fruits are harvested at specific times. Losing place alters flavor slightly; losing time diminishes aroma and flavor. Freshness and age differ; quality varies. Failure to select properly leads to ineffectiveness, which is the doctor's fault.
*Zhangshi Yitong* states: Excessive sexual activity and alcohol lead to deficiency-labor and low blood, internal consumption of fluids, spontaneous flaming of Heart Fire, causing dryness-heat to invade the Lung, resulting in coughing up pus and blood, rising Qi with salivary tide, continuous coughing. Plus pathogen invading skin and hair, entering and injuring the Lung, especially quickly from the back. Zhigancao Tang should be used. Xu Bin's *Jinkui Lunzhu* states: My maternal relative suffered this. Initially, saliva filled bowls; after half a month of administration, phlegm decreased and he recovered. But it was hardest to take; no quick effect in three or four days.
When pressing the pulse, if it comes slowly and occasionally stops before returning, it is named Jie (Knotted). If the pulse moves then stops, returns slightly faster, with a returning beat intervening, it is named Jie Yin (Knotted Yin). If the pulse moves then stops, cannot return on its own, and subsequently moves again, it is named Dai Yin (Intermittent Yin). Obtaining this pulse indicates a difficult-to-treat condition. (Cost edition adds "er" after "huan"; omits "fu dong zhi zhe". *Yukan* lacks this clause.)
[Yu]: This section serves as a footnote for the Jie and Dai pulses.
[Fang]: This follows Jie and Dai, expanding to discuss Jie Yin and Dai Yin, detailing their characteristics, consistent with Chapter 9 of *Bian Mai Fa*.
[Wang]: Pressing the pulse to feel its arrival: "Arrival" refers to what Hua Borin said: emerging from the bone and flesh division to the skin surface, the rising Qi.
[Qian]: Jie means pathogen knotting. It is the name for the temporary cessation of the pulse, like a knot in a rope. Anything threaded on a rope encounters resistance at a knot; even fast-flowing things must linger slightly to pass. This is due to Qi deficiency and Blood stasis, with pathogen intervals between meridians. Deficiency leads to short Qi strength; interval leads to meridian obstruction, preventing rapid flow and causing pauses. The stopping movement is not the "Dong" (Agitated) pulse of Yin-Yang contention in *Bian Mai Fa*. It means when the Huan (Slow) pulse is moving, it suddenly stops, as if obstructed. "Returning slightly faster" means after stopping, it forces a slightly faster rate. Slightly faster represents depression followed by extension. Within the slightly faster, if the pulse returns and agitates again, it is named Jie Yin. *Bian Mai Fa* states: