葛根（半斤） 甘草（二两炙） 黄芩（二两） 黄连（三两）
上四味。以水八升。先煮葛根。减二升。内诸药。煮取二升。去滓。分温再服。
琥按成注引经云。甘发散为阳。表未解者。散以葛根甘草之甘。愚以葛根味甘而带辛。成氏不言辛者。乃缺义也。
又云。苦以坚里。里气弱者。坚以黄芩黄连之苦。愚以肠胃协热。阳邪亢盛则阴气自弱。芩连虽非补药。其力能抑阳而
扶阴。阴气得扶。则利自止。喘自息。成氏云。苦以坚里者。乃固其人肠胃中阴气之谓也。
琥又按内台方议此汤云。用葛根为君。以通阳明之津而散表邪。黄连为臣黄芩为佐。以通里气之热。降火清金而下
逆气。此即解成注云。喘而汗出者。乃因喘而汗出。即里热气逆所致故也。又云甘草为使。以缓其中而调和诸药。总而
论之。此方亦能治阳明大热下利者。又能治嗜酒之人热喘者。取用无穷也。
琥按上方。乃治阳明病内外挟热。表里均解之剂。其入太阳篇者。是因桂枝证误下之所致也。或问利既不止。何以
不用五苓等药。愚以下焦蓄水。小便不利。此太阳府病也。方可用五苓等利水之药。今阳明病。肠胃协热而利。大肠为
手阳明。胃为足阳明。阳明本燥化。燥金之性。喜寒恶热。故汤中用芩连。不过顺其性以救肠胃之热。故尚论篇亦云。
不治利而利自止也。
太阳病。头痛发热。身疼腰痛。骨节疼痛。恶风。无汗而喘者。麻黄汤主之。（此太阳伤寒也。成注云。寒则伤营。
头痛身疼腰痛。以致牵连骨节疼痛者。太阳经营血不利也。内经曰风寒客于人。使人毫毛毕直。皮肤闭而为热者。寒在
表也。愚以寒邪在表。皮肤闭而为热。则其人当无汗。而恶风寒。今但言恶风者。乃缺文也。喘者。气逆也。肺属气。
外主皮毛。今者毫毛伤寒。气而毕直。皮表发热。汗不得泄。则肺叶必张。举而作喘。仲景用麻黄汤者。专以发太阳经
无汗之伤寒也。）
葛根（半斤） 甘草（二两，炙） 黄芩（二两） 黄连（三两）
以上四味药。用水八升。先煮葛根。水量减少二升。加入其余药物。煮取二升药液。滤去药渣。分两次温服。
琥按：成无己注解说《内经》云：“甘味发散属于阳。”表证未解者，用葛根、甘草的甘味来发散。我认为葛根味甘而兼带辛味，成氏没有提到辛味，这是遗漏了含义。
又云：“苦味能坚固里气。”里气虚弱者，用黄芩、黄连的苦味来坚固。我认为肠胃协热（胃肠有热邪夹杂），阳邪亢盛则阴气自然虚弱。黄芩、黄连虽然不是补药，但其力量能抑制阳热而扶持阴气。阴气得扶，则下利自然停止，气喘自然平息。成氏说“苦以坚里”，是指巩固其人肠胃中的阴气而言。
琥又按：《内台方议》讨论此汤剂说：用葛根为君药，以疏通阳明经的津液并疏散表邪；黄连为臣药，黄芩为佐药，以疏通里气的热邪，降火清金（肺）并下行逆气。这也就是解释成注中“喘而汗出”的原因，是因为气喘导致汗出，即由里热气逆所致。又说：甘草为使药，以缓和其中焦之气并调和诸药。总而言之，此方也能治疗阳明大热引起的下利，又能治疗嗜酒之人出现的热性气喘，应用无穷。
琥按：上方是治疗阳明病内外挟热、表里同治的方剂。它被收入太阳篇，是因为桂枝证误用下法所导致的。有人问：下利既然不止，为什么不用五苓散等药？我认为下焦蓄水、小便不利，这是太阳腑病，方可使用五苓散等利水药物。现在是阳明病，肠胃协热而下利，大肠为手阳明经，胃为足阳明经，阳明本气为燥化，燥金的特性是喜寒恶热，所以汤剂中使用芩连，不过是顺应其本性以救治肠胃之热。所以《尚论篇》也说：不治下利而下利自止。
太阳病（太阳经受邪所致的病证），头痛发热，身体疼痛，腰痛，骨节疼痛，恶风，无汗且气喘者，用麻黄汤主治。（这是太阳伤寒证。成注云：寒邪伤营血，头痛、身疼、腰痛，以致牵连骨节疼痛，是太阳经营血运行不利。《内经》说：风寒客居人体，使人毫毛竖立，皮肤闭塞而产生热象，这是寒在体表。我认为寒邪在表，皮肤闭塞产生热象，那么此人应当无汗，且恶风寒。现在只说恶风，是原文缺漏。气喘，是气逆。肺属气，外主皮毛。如今毫毛受寒，气机竖立，皮表发热，汗不得泄，则肺叶必张举而作喘。仲景用麻黄汤，专门用于发汗解除太阳经无汗的伤寒。）
Ge Gen (Radix Puerariae, half jin) Gan Cao (Radix Glycyrrhizae Preparata, two liang), Huang Qin (Cortex Scutellariae, two liang), Huang Lian (Rhizoma Coptidis, three liang).
The above four ingredients. Use eight sheng of water. First decoct Ge Gen until the volume reduces by two sheng. Then add the remaining herbs. Decoct to obtain two sheng of liquid. Remove the dregs. Divide into two doses and take warm.
Hu notes: Cheng Wuji's commentary cites the *Neijing* stating that "Sweet flavor disperses and belongs to Yang." For unresolved exterior syndrome, disperse with the sweet flavor of Ge Gen and Gan Cao. I believe Ge Gen has a sweet taste with an acrid quality; Cheng omitted the acrid nature, which is an omission of meaning.
It also states: "Bitter flavor consolidates the interior." For weak interior qi, consolidate with the bitter flavor of Huang Qin and Huang Lian. I believe in intestinal-heat collusion (gastrointestinal heat pathogen intermingling), when yang pathogen is hyperactive, yin qi naturally becomes weak. Although Huang Qin and Huang Lian are not tonifying herbs, their power can suppress yang heat and support yin qi. When yin qi is supported, diarrhea stops spontaneously, and wheezing subsides. Cheng's statement "bitter flavor consolidates the interior" refers to consolidating the yin qi within the person's intestines and stomach.
Hu further notes: The *Neitai Fangyi* discusses this formula saying: Ge Gen is used as the Sovereign herb to unblock the fluids of the Yangming channel and scatter exterior pathogens; Huang Lian is the Minister herb, Huang Qin is the Assistant herb, to clear heat from the interior qi, descend fire, clear Metal (Lung), and direct rebellious qi downward. This explains Cheng's commentary on "wheezing with sweating," attributing it to rebellious qi due to interior heat causing wheezing and subsequent sweating. It also states: Gan Cao is used as the Envoy herb to moderate the middle jiao and harmonize the various herbs. In summary, this formula can also treat diarrhea caused by severe Yangming heat, and wheezing due to heat in individuals addicted to alcohol, offering boundless applications.
Hu notes: The above formula is a remedy for Yangming disease with interior-exterior heat collusion, resolving both exterior and interior simultaneously. Its inclusion in the Taiyang chapter is due to it resulting from mistaken purgation in a Guizhi Tang pattern. One might ask: Since diarrhea persists, why not use Wuling San or similar formulas? I reason that lower jiao fluid retention with difficult urination constitutes a Taiyang Fu organ disease, where diuretic formulas like Wuling San are appropriate. Now, in Yangming disease, intestinal-heat collusion causes diarrhea. The Large Intestine is the Hand-Yangming channel, and the Stomach is the Foot-Yangming channel. Yangming originates from dryness transformation; the nature of Dryness-Metal prefers cold and dislikes heat. Therefore, using Huang Qin and Huang Lian in the decoction merely follows its nature to rescue the intestines and stomach from heat. Thus, the *Shanglun Pian* also states: Treating the diarrhea is unnecessary as the diarrhea will stop itself.
Taiyang disease (disease of the Taiyang channel), characterized by headache, fever, body pain, lower back pain, bone and joint pain, aversion to wind, absence of sweating, and wheezing, should be treated with Mahuang Tang (Ephedra Decoction). (This is Taiyang Cold Damage. Cheng's commentary states: Cold injures the Ying blood; headache, body pain, and lower back pain extending to bone and joint pain indicate impaired circulation of Ying and Blood in the Taiyang channel. The *Neijing* says: When Wind-Cold invades the human body, causing hair follicles to stand erect and skin pores to close, generating heat, this indicates Cold at the exterior. I believe that when Cold pathogen is at the exterior and skin pores close generating heat, the person should have no sweat and be averse to Wind-Cold. The text only mentions aversion to wind here, implying a textual lacuna. Wheezing is rebellious Qi. The Lung governs Qi and controls the exterior skin and hair. Now, with Cold damaging the hair follicles, Qi stands erect, skin surface heats up, and sweat cannot vent, causing the Lung lobes to expand and result in wheezing. Zhang Zhongjing uses Mahuang Tang specifically to induce sweating and resolve Cold Damage without sweating in the Taiyang channel.)