麻黄（四两去节） 杏人（五十个去皮尖） 甘草（二两炙） 石膏（半斤碎绵裹）
上四味。以水七升。先煮麻黄减二升。去上沫。内诸药。煮取二升。去滓。温服一升。本云黄耳 （想系置水器也。）
成注引内经曰。肝苦急。急食甘以缓之。风气通于肝。风邪外甚。故以纯甘之剂发之。则是成氏以此条病。为太阳
中风。桂枝汤未尝误用。大谬之极。又上四味药。麻黄石膏俱带辛杏人带苦。若云纯甘又非定论。
琥按上汤。即麻黄汤小变其制仲景法。伤风证汗出而喘。当作桂枝汤加浓朴杏人。今虽汗出。原系伤寒无汗证。医
人误用桂枝汤以强发其汗。汗出后。依然气逆而喘。所以还当用麻黄汤其去桂枝者。谓前汤中。已受其辛热之误。而喘
愈甚。故易以石膏之甘寒。彻其邪而下其喘也。内台方议云。不可以汗出为伤风证。再用。桂枝汤。只宜麻黄汤中除桂
枝。加石膏。以散余邪。后条辩云。误服桂枝汤而汗出。究竟伤寒之汗未尝出也。故用石膏止桂枝之汗。用麻黄出未出
之汗。去其桂枝。则汤中辛凉之功胜。清肃在肺。而喘热自平矣。
（附例）下后。不可更行桂枝汤。若汗出而喘无大热者。可与麻黄杏子甘草石膏汤。（此即上条证。医人误用桂枝汤
汗出而喘不解。复认以为阳明府证。而误下之。下后汗出。而喘依然。细诊其人。里无大热者。方知其下之之误。以寒
邪犹郁于表而发热也。知其在表。不可更行桂枝汤。可与麻黄杏子甘草石膏汤。发其寒邪。下其喘热。盖下虽复误。成
注云。邪气所传既同。遂用一法治之。后条辩评云。下在用桂枝汤后。是从更字上看出。）
发汗过多。其人叉手自冒心。心下悸。欲得按者。桂枝甘草汤主之。（汗者心之液。发汗过多。则阳亡而心液虚耗。
心虚则动惕而悸。故其人叉手自冒心胸之间而欲得按也。冒字作覆字解。发汗过多。必是多服麻黄汤之故。所以仲景法。
用桂枝者。以固表而守其阳。用甘草者。以益气而缓其悸也。要之阳气得守。则津液归复。渐长于心胸之分。复何悸之
有焉。成注云。汗多亡阳。阳受气于胸中。即同此义。）
麻黄（四两，去节） 杏仁（五十个，去皮尖） 甘草（二两，炙） 石膏（半斤，碎后用绵布包裹）
以上四味药。用水七升。先煮麻黄，水量减少二升时，撇去水面上的浮沫。加入其余药物。煮取药液二升。滤去药渣。温服一升。原方注云“黄耳”（推测是指放置水器的动作）。
成无己注解引用《内经》说：“肝苦急，急食甘以缓之。”风气通于肝。风邪外盛，所以用纯甘的药剂来发散它。这样成氏就把这一条的病证当作太阳中风证。认为是桂枝汤误用所致。这是极大的谬误。另外这四味药中，麻黄、石膏都带有辛味，杏仁带有苦味。如果说它是纯甘之剂，又不是确定的结论。
琥按：上述汤剂，即是在麻黄汤基础上稍作变化，遵循张仲景的法度。伤风证见汗出而喘，应当用桂枝汤加浓朴、杏仁。现在虽然汗出，但原本属于伤寒无汗证。医生误用桂枝汤强行发汗。汗出之后，依然气逆而喘。所以仍然应当使用麻黄汤。去掉桂枝的原因，是因为前次服用桂枝汤已受其辛热之性的误治，导致喘证更加严重。所以改用石膏的甘寒之性，以透达邪气并降下喘逆。《内台方议》议论说：不可以因为有汗出就认为是伤风证，再用桂枝汤。只宜在麻黄汤中去掉桂枝，加入石膏，以疏散残余邪气。后条辩评论说：误服桂枝汤导致汗出，究其根本，伤寒的汗并未真正发出。所以用石膏制止桂枝汤导致的汗出，用麻黄发出未发出的汗。去掉桂枝，则汤剂中辛凉的功效占优势，清肃肺气，喘热自然平息。
（附例）经过攻下治疗后，不可再使用桂枝汤。如果汗出而喘且没有大热的，可以给予麻黄杏子甘草石膏汤。（这即是上一条的证候。医生误用桂枝汤导致汗出而喘不解，又误认为阳明腑实证而误用攻下法。攻下后汗出，而喘症依旧。仔细诊察其人，体内没有大热，才知道攻下是错误的。因为寒邪仍然郁结在表而发热。知道病邪在表，不可再使用桂枝汤，可以给予麻黄杏子甘草石膏汤。发散寒邪，降下喘热。虽然攻下是再次误治，成注说：邪气传变既然相同，就用一种方法治疗。后条辩评论说：攻下是在使用桂枝汤之后进行的，是从“更”字上看出来的。）
发汗过多，病人两手交叉按住心口，心下悸动，喜欢按压的，用桂枝甘草汤主治。（汗是心的津液。发汗过多，则阳气亡失而心液虚耗。心虚则跳动不安而悸动。所以病人两手交叉捂住心胸之间并且想要按压。冒字解释为覆盖。发汗过多，必定是多服麻黄汤的缘故。所以张仲景的法度中，使用桂枝，是为了固护体表而守住阳气；使用甘草，是为了益气而缓解悸动。总之，阳气得以守持，则津液恢复，逐渐充盈于心胸部位，还有什么悸动呢？成注说：汗多亡阳，阳气受气于胸中，与此意义相同。）
Ephedrae Herba (Mahuang, 麻黄) four liang, remove joints; Armeniacae Semen Amarum (Xingren, 杏仁) fifty kernels, remove skin and tips; Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) two liang, honey-fried; Gypsum Fibrosum (Shigao, 石膏) half jin, crushed and wrapped in cotton cloth.
The above four ingredients. Use seven sheng of water. First decoct Ephedrae Herba until the volume reduces by two sheng. Remove the foam on the surface. Add the remaining herbs. Decoct to obtain two sheng of liquid. Filter out the dregs. Take one sheng warm. The original note says "Huang Er" (presumably referring to the action of placing a water vessel).
Cheng Wuji's commentary cites the *Neijing*: "When the Liver suffers from tension, use sweet flavors to relax it." Wind Qi connects with the Liver. When wind pathogen is excessive externally, pure sweet agents are used to disperse it. Thus, Cheng regarded this clause as Taiyang Wind Strike syndrome, attributing it to the erroneous use of Guizhi Tang. This is extremely erroneous. Furthermore, among these four herbs, Mahuang and Shigao both carry acrid properties, while Xingren carries bitter properties. To claim it is a purely sweet formula is not a definitive conclusion.
Hu notes: The above decoction is essentially a slight modification of Mahuang Tang, following Zhang Zhongjing's methodology. For Shangfeng (Wind Strike) syndrome presenting with sweating and wheezing, Guizhi Tang plus Houpo and Xingren should be used. Although there is sweating here, the original condition was Taihan (Cold Damage) without sweating. The physician erroneously used Guizhi Tang to force sweating. After sweating, the qi rebellion and wheezing persisted. Therefore, Mahuang Tang should still be used. The reason for removing Guizhi is that the previous use of Guizhi Tang caused error due to its acrid-warm nature, exacerbating the wheezing. Thus, Shigao's sweet-cold nature is substituted to vent the pathogen and descend the wheezing. *Neitai Fangyi* discusses: One cannot assume Wind Strike syndrome merely because of sweating and re-use Guizhi Tang. It is appropriate to remove Guizhi from Mahuang Tang and add Shigao to disperse residual pathogens. Later commentaries state: Erroneous administration of Guizhi Tang led to sweating, but fundamentally, the Taihan sweat had not truly been released. Therefore, Shigao is used to stop the sweating induced by Guizhi Tang, while Mahuang is used to release the unreleased sweat. Removing Guizhi enhances the acrid-cool efficacy of the decoction, clearing and purifying the Lung, thereby naturally calming wheezing and heat.
(Attached Example) After purgation, Guizhi Tang must not be administered again. If there is sweating and wheezing without significant heat, Mahuang Xingren Gancao Shigao Tang may be given. (This corresponds to the syndrome in the preceding clause. The physician erroneously used Guizhi Tang, leading to sweating and unresolved wheezing, and mistakenly diagnosed Yangming Fu syndrome, resulting in erroneous purgation. After purgation, sweating continued and wheezing persisted. Careful examination revealed no significant internal heat, indicating the error of purgation. Since cold pathogen remains constrained at the exterior causing fever, knowing the pathogen is at the exterior, Guizhi Tang must not be used again. Instead, Mahuang Xingren Gancao Shigao Tang can be given to disperse cold pathogen and descend wheezing-heat. Although purgation was a repeated error, Cheng's note states: Since the transmission of pathogen is similar, one treatment method applies. Later commentaries note: Purgation occurred after the use of Guizhi Tang, deduced from the character "Geng" [again].)
Excessive sweating causes the patient to cross their hands over the heart region, experiencing palpitations (Ji) below the heart, desiring pressure. Guizhi Gancao Tang is the primary treatment. (Sweat is the fluid of the Heart. Excessive sweating leads to loss of Yang and depletion of Heart fluids. Heart deficiency causes trembling and palpitations. Hence, the patient crosses hands over the chest and desires pressure. "Mao" means covering. Excessive sweating is likely due to overdosing on Mahuang Tang. Therefore, in Zhang Zhongjing's methodology, Guizhi is used to secure the exterior and preserve Yang, while Gancao is used to tonify Qi and relieve palpitations. Ultimately, if Yang is preserved, fluids return and gradually fill the chest region, eliminating palpitations. Cheng's note states: Excessive sweating leads to loss of Yang; Yang receives Qi in the chest, which shares this meaning.)