猪苓（去黑皮）十八铢 茯苓十八铢 泽泻一两六铢 白术十八铢 桂半两
右五味为散，更于臼中杵之，白饮和方寸匕服之，日三服，多饮暖水，汗出愈。
【方解】
是方也，乃太阳邪热入府，水气不化，膀胱表里药也。一治水逆，水入则吐；一治消
渴，水入则消。夫膀胱者，津液之府，气化则能出矣。邪热入之，与水合化为病，若
水盛于热，则水壅不化，水蓄于上，故水入则吐，乃膀胱之气化不行，致小便不行也
。若热盛于水，则水为热灼，水耗于上，故水入则消，乃膀胱之津液告竭，致小便无
出也。二证皆小便不利，故均得而主之。若小便自利者，不可用，恐重伤津液，以其
属阳阴之里，故不可用也。由此可知五苓散非治水热之专剂，乃治水热小便不利之主
方也。君泽泻之咸寒，咸走水府，寒胜热邪；佐二苓之淡渗，通调水道，下输膀胱，
则水热并泻也；用白术之燥湿，健脾助土，为之堤防以制水也：用桂之辛温，宜通阳
气，蒸化三焦以行水也。泽泻得二苓下降，利水之功倍，则小便利，而水不蓄矣。自
术借桂上升，通阳之效捷，则气腾津化，渴自止也。若发热不解，以桂易桂枝，服后
多服暖水，令汗出愈。是知此方不止治停水小便不利之里，而犹解停水发热之表也。
加人参名春泽汤，其意专在助气化以生津。加茵陈名茵陈五苓散，治湿热发黄，表里
不实，小便不利者，无不效也。
【集解】
程应旄曰：太阳为标，膀胱为本。中风发热，标受邪也。六七日不解，标邪转入膀胱
矣。是谓犯本。五苓散与黄麻、桂枝二汤，虽同为太阳经之药，一则解肌而治表，一
则利小便而治里，标与本所主各有别矣。
【按】
此条谓有表里证者，非发热有汗，口干烦渴，水入则消，小便自利，太阳、阳明之表
里证也。乃发热无汗，口润烦渴，水入则吐，小便不利，太阳、膀胱之表里证也。此
病虽未发明无汗小便不利之证，若汗出小便利，则渴饮之水，得从外越下出，必无水
逆之证。仲景用五苓散，多服暖水令汗出愈，其意在利水发汗，故知必有无汗小便不
利之证也。
太阳病，小便利者，以饮水多，必心下悸，小便少者，必苦里急也。
【注】
太阳初病，不欲饮水，将传阳明，则欲饮水，此其常也。今太阳初病，即饮水多，必
其人平素胃燥可知。设胃阳不衰，则所饮之水，亦可以敷布于外，作汗而解。今饮水
多，而胃阳不充，即使小便利，亦必停中焦，而为心下悸。若更小便少，则水停下焦
，必苦里急矣。
【集注】
方有执曰：饮水多而心下悸者，心为火藏，水多则受制也。小便少则水停，所以里急
也。
汪琥曰：太阳病，小便利者，是膀胱之府无邪热也。若其人饮水多，此热在上焦，心
火亢甚，小便虽利，而渴饮水多，则水停犯火，必心下悸。若其人饮水多而小便少，
此热在下焦，为太阳邪热，随经入府，水积不行，膀胱之里，必苦急也。
发汗后，饮水多必喘，以水灌之亦喘。
【注】
上条未发汗，饮水多，胃热津少也。此条发汗后，饮水多，津亡胃干也。而不病心下
悸，苦里急者；盖以水不停于中焦、下焦，而停于上焦，所以攻肺必作喘也。水灌者
，以水浇洗也。饮水多者必喘，是饮冷，冷伤于内也。以水灌之亦喘者，是形寒，寒
伤于外也。均伤肺，故俱喘。
【集注】
魏荔彤曰：此申明本条喘急一证，有因水而成者。盖渴而饮水多之喘，与不渴而灌之
亦喘，其由虽不同，而致病则一也。
发汗后，不可更行桂枝汤，汗出而喘，无大热者，可与麻黄杏仁甘草石膏汤。
【注】
太阳病，下之后微喘者，表未解也，当以桂枝加厚朴杏仁汤，解太阳肌表，而治其喘
也。太阳病桂枝证，医反下之，下利脉促，汗出而喘，表未解者，当以葛根黄连黄苓
汤，解阳明之肌热，而治其喘也。今太阳病发汗后，汗出而喘，身无大热而不恶寒者
，知邪已不在太阳之表；且汗出而不恶热，知邪亦不在阳明之里。其所以汗出而喘，
即无大热，又不恶寒，是邪独在太阴肺经，故不可更行桂枝汤，可与麻黄杏子甘草石
膏汤，发散肺邪，而汗、喘自止矣。
猪苓（去除黑色外皮）十八铢，茯苓十八铢，泽泻一两六铢，白术十八铢，桂枝半两。
以上五味药研成散剂，再在臼中捣碎均匀，用米汤调和，每次服用一方寸匕，每日三次，服药后多喝温热水，待出汗后即可痊愈。
【方解】
这个方子，是针对太阳经邪热传入膀胱腑，导致水气不能正常气化，是治疗膀胱表里病症的药物。一种情况治疗“水逆”，即喝水就呕吐；另一种情况治疗“消渴”，即喝水后立刻感到口渴。膀胱是津液汇聚的府库，依靠气化作用才能排出尿液。邪热侵入其中，与水结合化为病邪，如果水盛于热，则水液壅滞无法气化，水蓄积在上部，所以喝水就吐，这是膀胱气化功能不行，导致小便不通畅。如果热盛于水，则水被热邪灼烧，水分在上部消耗，所以喝水后很快又渴，这是膀胱津液枯竭，导致小便无出。这两种证候都表现为小便不利，所以都用此方主治。如果小便自然通畅，则不可使用，恐怕会重伤津液，因为此证属于阳明之里，所以不可用。由此可知五苓散并非专门治疗水热互结的方剂，而是治疗因水热导致小便不利的主方。以泽泻的咸寒之性为君药，咸味入水府，寒性能胜热邪；佐以茯苓、猪苓的淡渗之性，通调水道，使水液下输膀胱，从而水热并除；用白术的燥湿之性，健脾助土，如同堤防一样制约水湿；用桂枝的辛温之性，宣通阳气，蒸化三焦以行水。泽泻配合二苓下降，利水功效加倍，则小便通利，水液不再蓄积。白术借助桂枝上升，通阳效果迅速，则气机升腾津液化生，口渴自然停止。如果发热不退，将桂枝改为肉桂（注：原文此处有争议，通常五苓散用桂枝，若发热不解有时指代不同变通，但依原文直译），服药后多饮暖水，令其出汗而愈。由此可见此方不仅治疗停水导致的小便不利的里证，还能解除停水导致的发热的表证。加入人参名为春泽汤，其用意专门在于辅助气化以生津液。加入茵陈名为茵陈五苓散，治疗湿热发黄，表里俱虚，小便不利者，无不有效。
【集解】
程应旄说：太阳经为标，膀胱为本。中风发热，是标受邪。六七天未解，标邪转入膀胱，这叫犯本。五苓散与麻黄汤、桂枝汤这两张方子，虽然都是治疗太阳经的药物，但一张是解肌发表治表，一张是利小便治里，标与本所主治各有区别。
【按】
这一条说的是既有表证又有里证的情况，不是指发热有汗、口干烦渴、喝水就消、小便自利的太阳、阳明表里证。而是指发热无汗、口润烦渴、喝水就吐、小便不利的太阳、膀胱表里证。此病虽然没有明确说明无汗和小便不利的症状，但如果汗出且小便通利，那么喝进去的水就能从体外发散或向下排出，必然不会出现水逆的症状。仲景使用五苓散，要求多服暖水令其出汗而愈，其意图在于利水发汗，所以知道必然存在无汗和小便不利的证候。
太阳病，小便通利的，因为饮水过多，必然出现心下悸动；小便少的，必然感到小腹急迫难受。
【注】
太阳病初起时，不想喝水，将要传变为阳明病时，才会想喝水，这是常理。现在太阳病初起，就大量饮水，必定此人平素胃中干燥。假设胃阳不衰，那么所喝的水，也可以敷布于体表，化作汗液而解。现在饮水多，而胃阳不足，即使小便通利，也必然停滞在中焦，而导致心下悸动。如果更兼小便少，那么水停下焦，必然感到小腹急迫痛苦。
【集注】
方有执说：饮水多而心下悸动的，心属火脏，水多则克制心火。小便少则水停滞，所以感到里急。
汪琥说：太阳病，小便通利的，说明膀胱腑没有邪热。如果此人饮水多，这是热在上焦，心火亢盛，小便虽然通利，但因口渴饮水多，则水停滞侵犯心火，必然心下悸动。如果此人饮水多而小便少，这是热在下焦，为太阳邪热随经脉传入腑中，水积滞不行，膀胱内部必然感到急迫痛苦。
【注】
上一条是说未发汗前，饮水多，是胃热津液少。这一条是说发汗后，饮水多，是津液亡失胃干燥。但不出现心下悸动和小腹急迫痛苦的，是因为水不停留于中焦、下焦，而停留于上焦，所以水气攻肺必然作喘。“水灌”是指用水浇洗。饮水多必然气喘，是因为喝冷水，寒气伤于体内。用水浇洗身体也气喘，是因为形体受寒，寒气伤于体表。都损伤了肺，所以都出现气喘。
【集注】
魏荔彤说：这阐明了本条气喘一证，有因水饮引起的。口渴而饮水多导致的气喘，和不渴而用水浇洗也气喘，其原因虽然不同，但致病机理是一样的。
发汗后，不可再用桂枝汤，如果汗出且气喘，身上没有大热的，可以给予麻黄杏仁甘草石膏汤。
【注】
太阳病，误用下法后出现轻微气喘的，是表证未解，应当用桂枝加厚朴杏子汤，解除太阳肌表之邪，来治疗气喘。太阳病桂枝证，医生反而误用下法，导致下利、脉促、汗出且气喘，表证未解的，应当用葛根黄连黄芩汤，解除阳明肌热，来治疗气喘。现在太阳病发汗后，汗出且气喘，身上没有大热且不恶寒的，知道邪气已不在太阳之表；且汗出而不恶热，知道邪气也不在阳明之里。之所以汗出且气喘，即使没有大热又不恶寒，是因为邪气独在太阴肺经，所以不可再用桂枝汤，可以给予麻黄杏仁甘草石膏汤，发散肺经邪气，则汗止喘平。
Zhu Ling (Polypori Sclerotium, removed black skin) 18 zhu, Fu Ling (Poria, Poriae Cochlidia Sclerotium) 18 zhu, Ze Xie (Alismatis Rhizoma, Alisma orientale) 1 liang 6 zhu, Bai Zhu (Atractylodis Macrocephalae Rhizoma, Atractylodes macrocephala) 18 zhu, Gui Zhi (Cinnamomi Ramulus, Cinnamomum cassia) half liang.
The above five herbs are ground into a powder, further pounded in a mortar until uniform, mixed with rice water, and taken as one fangcun bi (a specific measuring spoon for powder) per dose, three times a day. After taking the medicine, drink plenty of warm water; recovery occurs when sweating ensues.
[Formula Analysis]
This formula targets the condition where pathogenic heat from the Taiyang meridian enters the Bladder fu-organ, leading to failure of Qi transformation and water metabolism. It is a medication for both exterior and interior aspects of the Bladder. One indication is "Water Reversal" (Shui Ni), characterized by vomiting immediately after drinking water; the other is "Xiao Ke" (Wasting-Thirst), characterized by excessive thirst and consumption of water. The Bladder is the residence of body fluids (Jin Ye); it can excrete urine only through Qi transformation. When pathogenic heat enters and combines with water to form pathology: if water predominates over heat, water stagnates and fails to transform, accumulating superiorly, thus causing vomiting upon drinking. This results from the failure of Bladder Qi transformation, leading to dysuria. If heat predominates over water, water is scorched by heat and consumed superiorly, causing immediate thirst after drinking. This results from exhaustion of Bladder fluids, leading to anuria. Both conditions present with dysuria, hence this formula governs them. However, if urination is spontaneous and normal, this formula must not be used, lest it severely damage body fluids, as such cases belong to the Yangming interior, making this formula contraindicated. Thus, Wu Ling San is not exclusively for treating water-heat complex, but is the primary formula for dysuria caused by water-heat retention. Jun herb Ze Xie (Alismatis Rhizoma) uses its salty and cold nature; saltiness directs action to the water residence, and coldness overcomes pathogenic heat. Assistant herbs Fu Ling (Poria) and Zhu Ling (Polyporus) use their bland and permeating nature to regulate water pathways, directing fluids downward to the Bladder, thereby draining both water and heat. Bai Zhu (Atractylodis Macrocephalae Rhizoma) employs its drying-dampness property to strengthen the Spleen and assist Earth, acting as a dike to control water. Gui Zhi (Cinnamomi Ramulus) utilizes its acrid and warm nature to diffuse and unblock Yang Qi, steaming and transforming the Triple Burner to promote water movement. With Ze Xie descending together with the two Polypori, the water-draining effect is doubled, resulting in free urination and no water retention. Bai Zhu ascending with Gui Zhi accelerates the effect of unblocking Yang, causing Qi to rise and fluids to transform, thereby stopping thirst. If fever persists, replace Gui Zhi with Rou Gui (Cinnamomi Cortex, though text implies modification context, strictly translating 'Gui' here as per source structure often implying branch vs trunk distinction or specific clinical adjustment, but standard Wu Ling San uses Gui Zhi; text says "replace Gui with Gui Zhi" which is contradictory to standard composition using Gui Zhi, likely meaning replace a different component or referring to a variation, but literal translation: "If fever does not resolve, replace [the current] Gui with Gui Zhi..."). *Correction based on standard TCM logic in commentary*: The text likely refers to a specific clinical nuance or variant. Literal translation: "If fever does not resolve, substitute [the ingredient] Gui with Gui Zhi..." (Note: Standard Wu Ling San contains Gui Zhi. Some commentaries suggest using Rou Gui for severe cold, but here it suggests changing TO Gui Zhi for sweating. This might be a textual variant or specific instruction for exterior release). After administration, drink more warm water to induce sweating for cure. This indicates that this formula not only treats the interior syndrome of water retention with dysuria but also resolves the exterior syndrome of fever due to water retention. Adding Ren Shen (Ginseng Radix et Rhizoma) creates Chun Ze Tang, specifically intended to assist Qi transformation to generate fluids. Adding Yin Chen (Artemisiae Scopariae Herba) creates Yin Chen Wu Ling San, effective for damp-heat jaundice with deficient exterior and interior and dysuria.
[Collection of Commentaries]
Cheng Yingmao stated: The Taiyang meridian is the Biao (exterior/superficial aspect), and the Bladder is the Ben (root/interior aspect). Wind-stroke with fever indicates the Biao is affected. If unresolved after six or seven days, the Biao pathogen transfers to the Bladder, termed "invading the Ben." Although Wu Ling San, Ma Huang Tang (Ephedra Decoction), and Gui Zhi Tang (Cinnamon Twig Decoction) are all medications for the Taiyang meridian, one releases the muscle layer to treat the exterior, while the other promotes urination to treat the interior; their indications for Biao and Ben are distinct.
[Annotation]
This clause refers to cases with both exterior and interior syndromes, distinguishing them from the Taiyang-Yangming exterior-interior syndromes characterized by fever with sweating, dry mouth, vexing thirst, consumption of water, and spontaneous normal urination. Instead, it refers to Taiyang-Bladder exterior-interior syndromes characterized by fever without sweating, moist mouth, vexing thirst, vomiting upon drinking, and dysuria. Although this disease description does not explicitly mention the symptoms of no sweating and dysuria, if there were sweating and free urination, the ingested water would escape via external diffusion or downward excretion, and Water Reversal would not occur. Zhang Zhongjing's use of Wu Ling San, instructing patients to drink warm water to induce sweating, aims at promoting urination and inducing sweating; therefore, it is inferred that symptoms of no sweating and dysuria must be present.
In Taiyang disease, if urination is free, excessive water intake will inevitably cause palpitations in the epigastrium (Xin Xia Ji); if urination is scanty, there will inevitably be distressing urgency in the lower abdomen (Li Ji).
[Note]
Initially in Taiyang disease, there is no desire for water; as it transmits to Yangming, there is desire for water. This is the norm. Now, in early Taiyang disease, there is excessive desire for water, indicating the person usually has dry Stomach. If Stomach Yang is not deficient, the ingested water can be distributed to the exterior and transformed into sweat for resolution. However, with excessive water intake and insufficient Stomach Yang, even if urination is free, water will stagnate in the Middle Jiao, causing palpitations in the epigastrium. If urination is additionally scanty, water stagnates in the Lower Jiao, causing distressing lower abdominal urgency.
[Collection of Notes]
Fang Youzhi said: Excessive water intake causing epigastric palpitations occurs because the Heart is a Fire organ; excess water suppresses it. Scanty urination leads to water stagnation, causing internal urgency.
Wang Hu said: In Taiyang disease, free urination indicates no pathogenic heat in the Bladder fu. If the person drinks excessively, this indicates heat in the Upper Jiao with hyperactive Heart Fire. Even with free urination, excessive drinking due to thirst causes water stagnation invading Fire, leading to epigastric palpitations. If the person drinks excessively but urinates little, this indicates heat in the Lower Jiao, where Taiyang pathogenic heat follows the meridian into the fu, causing water accumulation and stagnation, leading to distressing urgency in the Bladder interior.
After sweating, excessive water intake will inevitably cause wheezing/asthma; bathing/washing with water will also cause wheezing.
[Note]
The previous clause described excessive water intake before sweating, indicating Stomach heat and scanty fluids. This clause describes excessive water intake after sweating, indicating fluid loss and dry Stomach. The absence of epigastric palpitations and lower abdominal urgency indicates that water does not stagnate in the Middle or Lower Jiao, but accumulates in the Upper Jiao, attacking the Lung and causing wheezing. "Water irrigation" refers to washing the body with water. Wheezing from excessive water intake is due to consuming cold liquids, injuring the interior with cold. Wheezing from water washing is due to external chilling, injuring the exterior with cold. Both injure the Lung, hence both cause wheezing.
[Collection of Notes]
Wei Litong said: This clarifies that the wheezing in this clause is caused by water retention. Wheezing from drinking too much due to thirst and wheezing from washing with water despite no thirst have different causes but identical pathological mechanisms regarding disease induction.
After sweating, Gui Zhi Tang (Cinnamon Twig Decoction) must not be administered again. If there is sweating and wheezing without significant high fever, Ma Huang Xing Gan Shi Gao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be given.
[Note]
In Taiyang disease, if mild wheezing occurs after mistaken purgation, the exterior is unresolved; Gui Zhi Jia Hou Po Xing Zi Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Kernel) should be used to release the Taiyang muscle-layer exterior and treat wheezing. In Taiyang disease with Gui Zhi pattern, if mistaken purgation leads to diarrhea, rapid pulse, sweating, and wheezing with unresolved exterior, Ge Gen Huang Lian Huang Qin Tang (Kudzu, Coptis, and Scutellaria Decoction) should be used to clear Yangming muscle-heat and treat wheezing. Now, in Taiyang disease after sweating, if there is sweating and wheezing, without significant high fever and aversion to cold, it is known that the pathogen is no longer in the Taiyang exterior; since there is sweating without aversion to heat, the pathogen is also not in the Yangming interior. The presence of sweating and wheezing, despite lack of high fever and aversion to cold, indicates the pathogen resides solely in the Taiyin Lung meridian. Therefore, Gui Zhi Tang is contraindicated; instead, Ma Huang Xing Gan Shi Gao Tang should be given to disperse Lung pathogenic factors, resolving sweating and wheezing.