桂枝（去皮） 芍药 甘草（各十八铢） 生姜（一两三钱切） 大枣（四枚擘） 麻黄（十八铢去节） 石膏（二
十四铢碎绵裹）
上七味。 咀。以水五升。先煮麻黄一二沸。去上沫。内诸药。煮取二升。去滓。温服一升。本方当裁为越婢汤。
桂枝汤合饮一升。今合为一方。桂枝二。越婢一。
成注云。胃为十二经之主。脾治水谷为卑藏。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。
内台方议问云。汤名越婢。其义何取。答曰。婢。即脾也。岁久传写之误。经注虽云脾为卑藏。卑者若婢。此非成
无己之语。乃后人穿凿强注之耳。所谓越婢汤者。以石膏麻黄甘草。发越脾之正气。以通行津液。且散虚邪之留。滞于
经而不去者。此因脉微弱无阳。而不敢大汗者之所设也。琥按上条论既云。此无阳也。不可发汗。而汤中复用麻黄。殊
觉不解。又按内台方议云。此方即上麻黄桂枝之合方。减杏人加石膏。谓杏人能发汗。石膏能去虚热。愚谓彼议石膏之
去热。故加之犹可。议杏人之发汗故去之。则非夫麻黄之发汗。岂不更甚于杏人。而独留之乎。吾恐即用二分之桂枝。
终是发汗之剂。若云和解。吾不信矣。或云石膏解肌。又能制麻黄而发越脾气。且不使之汗出。亦非正解。愚反复思之。
而知不可发汗四字。当是不可大发汗。因其人脉微弱无阳。而津液少耳。此方比上小发汗之方更轻。
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。（头痛项
强。发热无汗此因误服桂枝。而在表之寒。犹未解也。心下满痛。小便不利。此复因误下。而寒邪入里。水停心下。不
可认作结胸证也。斯时而欲发表。则表无寒邪可发。故不惟不用麻黄汤。止用桂枝汤。而亦去桂也。斯时而欲下里。则
里无实热可下。故不用陷胸承气。止加茯苓白术。以利小便燥停饮也。成注云。与桂枝汤以解外。夫桂枝汤既去桂矣。
复云。解外。误甚误甚。愚以或下之三字。当在发热无汗之下。既下之后。则头痛发热之候。必去表而入于里矣。此条
病愚于初时观之。满拟再汗再下。及细思之。心下满微痛。小便不利。此为停饮之证无疑。故张兼善云。此非桂枝证。
乃属饮家也。夫头项强痛。既经汗下而不解。心下满而微痛。小便不利。此为水饮内蓄。邪不在表。故云去桂枝。加茯
苓白术。若得小便利。水饮行。腹满减而热自除。则头项强痛悉愈矣。内台方议问云。心下满微痛。此乃结胸欲成。何
缘作停饮治之。答曰余证皆似结胸。但取小便不利者。知非结胸。乃停饮也。故此条证。仲景止作停饮治之。）
桂枝（去皮） 芍药 甘草（各十八铢） 生姜（一两三钱，切块） 大枣（四枚，掰开） 麻黄（十八铢，去节） 石膏（二十四铢，打碎，用绵布包裹）
以上七味药。捣碎。用水五升。先煮麻黄一两次沸腾。去掉上面的浮沫。加入其余药物。煮取二升药液。去掉药渣。温服一升。本方应当裁减为越婢汤与桂枝汤合饮一升。现在合并为一个方剂。桂枝汤占二分，越婢汤占一分。
成无己注解说：胃是十二经脉的主宰。脾处理水谷，如同卑贱的婢女。《内经》说：脾主为胃运行津液。这个汤之所以叫越婢汤，是因为它能发越脾气，通行津液。《外台秘要》中的方子一名为越脾汤，就是此意。
《内台方议》问答说：汤名叫越婢，其含义是什么？回答说：婢，即脾也。这是年代久远传抄造成的错误。经注虽然说是“脾为卑藏”，卑者若婢，这并不是成无己的话，而是后人穿凿附会、强行解释的。所谓越婢汤，是用石膏、麻黄、甘草，发越脾的正气，以通行津液，并且疏散滞留于经络中未能去除的虚邪。这是因为脉象微弱、无阳，而不敢大发汗的人所设立的方剂。我（作者）按：上一条条文论述既然说“此无阳也，不可发汗”，而汤中又复用麻黄，实在让人不解。又按《内台方议》说：此方即是上条麻黄汤与桂枝汤的合方，减去杏仁，加入石膏。说杏仁能发汗，石膏能去虚热。我认为因为石膏能去热，所以加入还可以；说因为杏仁能发汗所以去掉它，那么麻黄的发汗作用难道不比杏仁更强烈吗？为什么唯独留下麻黄呢？我恐怕即使只用二分量的桂枝，终究仍是发汗的药剂，如果说它是和解之剂，我不相信。有人说石膏能解肌，又能制约麻黄从而发越脾气，且不使之出汗，这也不是正确的解释。我反复思考后知道，“不可发汗”这四个字，应当理解为“不可大发汗”。因为其人脉象微弱、无阳，且津液少。此方比上一条的小发汗方剂更轻。
服用桂枝汤后，或者经过攻下治疗，仍然头项强痛，微微发热，无汗，心下满闷微痛，小便不利者，用桂枝去桂加茯苓白术汤主治。（头痛项强，发热无汗，这是因为误服桂枝汤，而在表的寒邪，仍未解除。心下满痛，小便不利，这是因为又误用攻下法，导致寒邪入里，水饮停聚在心下，不可认作结胸证。此时若想发表，则表无寒邪可发，故不仅不用麻黄汤，就连桂枝汤也要去掉桂枝。此时若想攻下里实，则里无实热可下，故不用陷胸承气汤，只加茯苓、白术，以利小便、燥湿除停饮。成无己注解说：给予桂枝汤以解外。既然桂枝汤已经去掉了桂枝，又说解外，错误极大，错误极大。我认为“或下之”这三个字，应当放在“发热无汗”之下。既然后面进行了攻下，那么头痛发热的症状，必然由表入里了。这一条病证，我起初观察时，本想再汗再下，但仔细思考后认为，心下满微痛，小便不利，这无疑是停饮的证候。所以张兼善说：这不是桂枝证，乃属于饮家。头项强痛，经过汗法和下法治疗后仍未解除，心下满而微痛，小便不利，这是水饮内蓄，邪气不在表，所以说去掉桂枝，加入茯苓、白术。如果小便利，水饮行，腹满减而热自除，那么头项强痛也就全部痊愈了。《内台方议》问答说：心下满微痛，这乃是结胸欲成，为何当作停饮来治疗？回答说：其他症状都似结胸，但只要取小便不利这一点，就知道不是结胸，乃是停饮。所以这一条证候，仲景只作为停饮来治疗。）
Cinnamon Twig (with bark removed) [Guizhi], White Peony Root [Baishao], Licorice Root [Gancao] (each 18 zhu), Fresh Ginger [Shengjiang] (1 liang 3 qian, sliced), Jujube [Dazao] (4 pieces, split open), Ephedra Herb [Mahuang] (18 zhu, nodes removed), Gypsum Fibrosum [Shigao] (24 zhu, crushed, wrapped in cotton).
The above seven ingredients. Coarsely crush. Add five sheng of water. First decoct Mahuang for one or two boils. Remove the foam on the surface. Add the remaining herbs. Decoct to obtain two sheng of liquid. Remove the dregs. Take one sheng warm. This formula should be adjusted as a combination of Yuebi Tang and Guizhi Tang, taking one sheng of each. Now they are combined into one formula. The proportion is two parts Guizhi Tang to one part Yuebi Tang.
Cheng Wuji's commentary states: The Stomach is the master of the twelve meridians. The Spleen manages water and grain, acting like a humble servant. The *Neijing* states: "The Spleen governs the distribution of fluids for the Stomach." This decoction is called Yuebi Tang because it stimulates the Qi of the Spleen and promotes the circulation of fluids. The *Waitai Mi Yao* lists this formula under the name Yuepi Tang, which reflects this meaning.
The *Neitai Fangyi* Q&A asks: What is the rationale behind the name Yuebi Tang? The answer is: "Bi" refers to the Spleen. It is an error resulting from long-term copying and transmission. Although the commentary mentions "the Spleen is a humble organ," equating "humble" with "servant," this is not Cheng Wuji's words but rather forced interpretations by later scholars. The so-called Yuebi Tang uses Shigao, Mahuang, and Gancao to stimulate the righteous Qi of the Spleen, promote fluid circulation, and disperse lingering pathogenic factors that have stagnated in the meridians. This formula was designed for cases where the pulse is weak and faint, indicating a lack of Yang, making severe sweating inadvisable. I note: In the previous clause, it was stated that "there is no Yang here, and sweating is contraindicated," yet Mahuang is used again in this formula, which is puzzling. Furthermore, according to the *Neitai Fangyi*, this formula is a combination of the previous Mahuang Tang and Guizhi Tang, with Xingren removed and Shigao added. It claims Xingren induces sweating while Shigao clears deficient heat. I believe adding Shigao for its heat-clearing property is acceptable; however, removing Xingren because it induces sweating is flawed. Does not Mahuang induce sweating more strongly than Xingren? Why retain Mahuang alone? I suspect that even with only two parts of Guizhi, this remains a diaphoretic agent. If it were described as a harmonizing formula, I would not believe it. Some argue that Shigao releases the muscle layer and constrains Mahuang to stimulate Spleen Qi without causing sweating, but this is not the correct interpretation. After repeated reflection, I understand that "sweating is contraindicated" should be interpreted as "severe sweating is contraindicated." This is because the patient has a weak pulse, lacks Yang, and has insufficient fluids. This formula is milder than the slight-sweating formula mentioned in the previous clause.
After taking Guizhi Tang, or after purgative treatment, if there is still stiffness and pain in the head and neck, slight fever, absence of sweat, fullness and slight pain in the epigastrium, and difficulty in urination, treat with Guizhi Qu Guizi Jia Fuling Baizhu Tang. (Headache, neck stiffness, fever, and absence of sweat occur because the exterior cold pathogen has not been resolved due to the mistaken use of Guizhi Tang. Fullness and pain in the epigastrium, along with urinary difficulty, result from the mistaken use of purgatives, allowing cold pathogens to enter the interior and causing water retention in the epigastrium. This should not be diagnosed as Jie Xiong syndrome. At this stage, if one attempts to release the exterior, there is no exterior cold pathogen to expel; thus, not only is Mahuang Tang avoided, but Guizhi Tang also has Guizhi removed. If one attempts to purge the interior, there is no excess heat to clear; thus, Xuanxiong Chengqi Tang is avoided, and Fuling and Baizhu are added to promote urination and dry dampness/stagnant fluids. Cheng Wuji commented: "Administer Guizhi Tang to resolve the exterior." Since Guizhi has been removed from Guizhi Tang, claiming it resolves the exterior is a significant error. I believe the phrase "or after purgative treatment" should follow "fever and absence of sweat." After purgation, symptoms such as headache and fever would likely move from the exterior to the interior. Initially observing this case, I considered further sweating and purging, but upon careful consideration, the epigastric fullness, slight pain, and urinary difficulty clearly indicate stagnant fluids. Thus, Zhang Jianshan stated: "This is not a Guizhi pattern, but belongs to patients with fluid retention." Since headache and neck stiffness persisted despite sweating and purging, and given the epigastric fullness, slight pain, and urinary difficulty, this indicates internal accumulation of water-fluids, with the pathogen no longer in the exterior. Hence, Guizhi is removed, and Fuling and Baizhu are added. If urination becomes smooth, fluids circulate, abdominal fullness subsides, and heat dissipates, then headache and neck stiffness will completely resolve. The *Neitai Fangyi* Q&A asks: Epigastric fullness and slight pain suggest impending Jie Xiong; why treat it as fluid retention? The answer is: Other symptoms resemble Jie Xiong, but the presence of urinary difficulty confirms it is not Jie Xiong but fluid retention. Therefore, Zhongjing treats this pattern solely as fluid retention.)