桂枝（四两去皮） 甘草（二两炙）
上二味。以水三升。煮取一升。去滓。顿服。
琥按成注云。桂枝之辛走肺而益气。夫桂枝虽系护表助阳之药。然其
味大辛反能散气。又云甘草之甘。入脾而缓中。意即千金所云心劳甚者。补脾气以益之。之谓欤。愚以此等注。不甚晓
畅。删之可也。
发汗后。其人脐下悸者。欲作奔豚。茯苓桂枝甘草大枣汤主之。（发汗后者。即发汗过多之后也。脐下悸者。条辩云。
肾乘心。汗后液虚。欲上陵心而克之。故动惕见于脐下也。奔豚。难经云。肾之积名。发于少腹。上至心下。若豚状。
此言奔豚。乃肾气发动。如欲作奔豚之状。非真脐下有积如豚也。后条辩云。肾气发动。水邪不安其位。急主之以茯苓
桂枝甘草大枣汤。以益心气。伐肾邪。安中补土。水不得肆。而汗后之阳虚。可渐复矣。）
茯苓（半斤） 桂枝（四两去皮） 甘草（二两炙） 大枣（十五枚擘）
上四味。以甘澜水一斗。先煮茯苓减二升。内诸药。煮取三升。去滓。温服一升。日三服。作甘澜水法。取水二斗。
置大盆内。以杓扬之。水上有珠子五六千颗相逐。取用之。
琥按上汤。用茯苓为君。以其能伐肾邪而利水道。桂枝为臣。外能固表。下能泄奔豚之气。甘草为佐。能益气。
补汗后之虚阳。大枣为使。以和中补土而制水。煎用甘澜水者。扬之无力。取其不助肾邪也。
或问此条论。并未言是水气。而诸家之注。皆言是水。何也。余答云。仲景言脐下悸。欲作奔豚。明系是肾邪干心。
肾本北方水。肾邪盛者。水克火也。汤中用茯苓为君。谓非走阴。泄水气之药欤。若桂枝之性。本上行而达表。其能伐
肾而御奔豚者。得茯苓引用故也。盖上条病。但心下悸。故用桂枝甘草汤。此条病。至脐下悸。故用前汤中加茯苓以引
桂。加大枣以辅甘草。表里兼主。上下咸宜。乃仲景用药的。当处。
发汗后。腹胀满者。浓朴生姜甘草半夏人参汤主之。（发汗后者。谓外邪已解也。成注云。外已解而腹胀满。由脾胃
津液不足。气涩不通。壅而为满。与此汤。以和补脾胃。而通泄滞气。按成注云。吐下后。腹胀满。皆为实。言邪气乘
虚入里故也。此必是外邪未解。而早吐早下所致。否则既吐且下。腹中之物已尽。焉知非气虚作胀邪。上云发汗后而腹
胀满。假使其人先伤食而复伤寒。吾恐外邪虽解。腹中之物未消。亦系实证。难言虚也。此条病。乃汗后气虚腹胀满。
其人必内虽作胀。外无脉形。故汤中用人参炙甘草等。甘温补药无疑。）
桂枝（四两，去皮） 甘草（二两，炙）
以上两味药。用水三升。煮取一升。去渣。一次性服用。
琥按：成无己注解说，桂枝的辛味入肺而益气。桂枝虽然是保护体表、辅助阳气的药物，但其味大辛反而能散气。又说甘草的甘味入脾而缓急和中。意思就是《千金方》所说的“心劳甚者，补脾气以益之”的意思吧。我认为这些注解，不够通畅明白，删去也可以。
发汗后，病人感到脐下跳动不安的，是快要发作奔豚病。用茯苓桂枝甘草大枣汤主治。（所谓发汗后，即指发汗过多之后。脐下悸动，根据《伤寒论条辩》的解释，是肾邪乘袭心火，发汗后津液亏虚，肾水欲上凌心火而克制它，所以跳动不安的感觉出现在脐下。奔豚，《难经》中说，是肾脏的积病，名称叫奔豚，发作于少腹，向上至心下，形状像小猪奔跑一样。这里说的奔豚，是指肾气发动，呈现出将要发作奔豚的状态，并不是真的在脐下有像小猪一样的积块。后面的《条辩》说，肾气发动，水邪不安守其位，急忙用茯苓桂枝甘草大枣汤来主治，以补益心气，伐除肾邪，安定中焦补益脾土，使水邪不能肆意妄为，从而发汗后的阳气虚弱可以逐渐恢复。）
茯苓（半斤） 桂枝（四两，去皮） 甘草（二两，炙） 大枣（十五枚，掰开）
以上四味药。用甘澜水一斗。先煮茯苓，减少二升水量。加入其他药物。煮取三升。去渣。温服一升。每天三次服用。制作甘澜水的方法：取水二斗。放在大盆里。用勺子反复扬水。水面上出现五六千颗珠子般的水珠互相追逐滚动时。取这种水使用。
琥按：上面的方子，用茯苓作为君药，因为它能伐除肾邪并通利水道。桂枝作为臣药，对外能固护体表，对内能泄除奔豚之气。甘草作为佐药，能益气，补益发汗后亏损的虚阳。大枣作为使药，用来调和脾胃补益脾土从而制约水邪。煎药使用甘澜水的原因，是因为经过扬动后水性无力，取其不助长肾邪的作用。
有人问这一条论述，并没有说是水气，但各家注解都说是水，为什么呢？我回答说：仲景说脐下悸动，想要发作奔豚，明显是肾邪干犯心火。肾本属北方水，肾邪盛的时候，是水克火。汤剂中用茯苓为君药，难道不是走阴分、泄水气的药物吗？至于桂枝的药性，本是上行而达表，它能伐肾而抵御奔豚，是得到了茯苓引经报使的缘故。上面一条病证，只是心下悸动，所以用桂枝甘草汤；这一条病证，到了脐下悸动，所以在前方中加入茯苓以引导桂枝，加大枣以辅助甘草，表里兼治，上下适宜，这是仲景用药精当的地方。
发汗后，出现腹部胀满的，用厚朴生姜半夏甘草人参汤主治。（所谓发汗后，是指外邪已经解除。成无己注解说，外邪已解而出现腹胀满，是由于脾胃津液不足，气机涩滞不通，壅塞而导致胀满。给予这个汤剂，以调和补益脾胃，而通泄滞气。按成无己的说法，吐下之后，腹胀满，都属于实证，是说邪气乘虚入里所致。这一定是因为外邪未解，而过早使用吐法或下法导致的。否则既然又吐又下，腹中的内容物已经排空，怎么知道不是因为气虚导致的胀满呢？上面说发汗后而腹胀满，假如这个人先伤食然后又感伤寒，我担心外邪虽然解除了，腹中的食物还没有消化，也属于实证，难以说是虚证。这一条病证，是汗后气虚导致的腹胀满，其人必定内部感觉胀满，外部没有脉象上的实形表现，所以汤剂中使用人参、炙甘草等甘温补益的药物，这是毫无疑问的。）
Guizhi (Cinnamon Twig) (4 liang, bark removed) Gancao (Licorice Root) (2 liang, honey-fried)
Take the above two ingredients. Add 3 sheng of water. Boil to obtain 1 sheng. Remove the dregs. Take in one dose.
Hu notes: Cheng Wuji's commentary states that the pungent flavor of Guizhi enters the Lung and benefits Qi. Although Guizhi is a herb that protects the exterior and assists Yang, its strong pungency can actually dissipate Qi. It also states that the sweet flavor of Gancao enters the Spleen and moderates the middle. This implies the meaning from *Qianjin Fang*: "For severe heart fatigue, tonify Spleen Qi to benefit it." I find these commentaries not very clear or fluent; they could be omitted.
After sweating therapy, if the patient experiences palpitations below the umbilicus, indicating an impending Ben Tun (Rushing Pig), Linggui Zhigan Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) is the primary treatment. (The phrase "after sweating" refers to after excessive sweating. Palpitations below the umbilicus: According to *Shanghan Lun Tiaobian*, this is Kidney pathogen attacking Heart Fire. After sweating, body fluids are deficient, and Kidney Water desires to ascend and overwhelm the Heart, causing restlessness and palpitations below the umbilicus. Ben Tun: *Nan Jing* describes it as a accumulation in the Kidney, originating in the lower abdomen and ascending to the epigastrium, resembling a pig running. Here, "Ben Tun" refers to the activation of Kidney Qi presenting as impending Ben Tun, not necessarily a physical mass like a pig below the umbilicus. Later *Tiaobian* states that when Kidney Qi activates and Water Pathogen becomes unsettled in its position, Linggui Zhigan Dazao Tang should be urgently used to benefit Heart Qi, subdue Kidney pathogen, stabilize the Middle and tonify Earth, preventing Water from acting recklessly, thereby allowing the Yang deficiency after sweating to gradually recover.)
Fuling (Poria) (8 liang) Guizhi (Cinnamon Twig) (4 liang, bark removed) Gancao (Licorice Root) (2 liang, honey-fried) Dazao (Jujube Fruit) (15 pieces, split open)
Take the above four ingredients. Use 1 dou of Ganlan Shui (Gently Agitated Water). First boil Fuling until the volume reduces by 2 sheng. Add the remaining herbs. Boil to obtain 3 sheng. Remove the dregs. Take 1 sheng warm. Three times daily. Method for preparing Ganlan Shui: Take 2 dou of water. Place in a large basin. Use a ladle to repeatedly scoop and pour the water. When approximately 5,000 to 6,000 pearl-like bubbles form on the surface chasing each other, use this water.
Hu notes: In the above formula, Fuling is used as the Sovereign herb because it can subdue Kidney pathogen and promote urination. Guizhi is the Minister herb; externally it secures the exterior, internally it drains the Qi of Ben Tun. Gancao is the Assistant herb; it benefits Qi and tonifies the deficient Yang lost through sweating. Dazao is the Envoy herb; it harmonizes the Middle and tonifies Earth to control Water. The reason for using Ganlan Shui for decoction is that the agitated water has weak properties, chosen so as not to assist the Kidney pathogen.
One might ask: This clause does not explicitly mention Water Pathogen, yet all commentators refer to Water. Why? I reply: Zhang Zhongjing mentions palpitations below the umbilicus and impending Ben Tun, clearly indicating Kidney pathogen harassing Heart Fire. The Kidney belongs to Water of the North; when Kidney pathogen is excess, Water overcomes Fire. Using Fuling as the Sovereign herb in the decoction—is it not a herb that travels to the Yin aspect and drains Water Qi? As for Guizhi, its nature is to ascend and reach the exterior. Its ability to subdue the Kidney and resist Ben Tun is due to the guiding effect of Fuling. In the previous clause, the disease was merely palpitations in the epigastrium, hence Guizhi Gancao Tang was used. In this clause, the disease involves palpitations below the umbilicus, hence Fuling is added to guide Guizhi, and Dazao is added to assist Gancao. Treating both interior and exterior, suitable for both upper and lower parts, this represents the precise application of herbs by Zhang Zhongjing.
After sweating therapy, if abdominal fullness occurs, Houpo Shengjiang Banxia Gancao Renshen Tang (Magnolia Bark, Ginger, Pinellia, Licorice, and Ginseng Decoction) is the primary treatment. (The phrase "after sweating" means the exterior pathogen has been resolved. Cheng Wuji comments that abdominal fullness after the exterior is resolved is due to insufficiency of Spleen and Stomach fluids, leading to stagnant Qi that obstructs and causes fullness. This decoction harmonizes and tonifies the Spleen and Stomach while unblocking stagnant Qi. Regarding Cheng's note that fullness after vomiting and purging is always Excess, stating that pathogen enters the interior due to deficiency: This must result from premature vomiting or purging before the exterior pathogen is resolved. Otherwise, if both vomiting and purging have occurred, the stomach contents would be empty; how do we know it is not fullness due to Qi deficiency? The previous text mentions abdominal fullness after sweating. If the person first had food stagnation and then contracted cold, even if the exterior pathogen resolves, the food may remain undigested, which would still be an Excess pattern, difficult to classify as Deficiency. This clause describes abdominal fullness due to Qi deficiency after sweating. The patient likely feels internal fullness but lacks external pulse signs of excess. Therefore, the use of Renshen (Ginseng Root) and honey-fried Gancao, which are sweet and warm tonics, is undoubtedly correct.)