下后复发汗, 昼日烦躁不得眠, 夜而安静, 不呕
不渴, 无表证, 脉沉微, 身无大热者, 干姜附子汤主之.
干姜一两 附子 ( 去皮, 生用, 破八片 ) 一枚,, 右二味, 以水三
升,煮取一升 , 去滓, 顿服.
伤寒厥而心下悸, 发汗, 若下之, 病仍不解, 烦
躁者, 茯苓四逆汤主之.
茯苓六两 人参一两 甘草 ( 炙 ) 一两 干姜一两 附子 ( 生用,
破八片 ) 一枚. , 右五味, 以水五升, 煮取三升, 去滓, 温服七合,
日三服.
【注】凡太阳病治不如法, 汗后复下, 或下后复汗, 误而又误, 变成
坏病. 若其人阳盛而从热化, 则转属三阳, 阳衰而从寒化, 则系在三
阴.此二汤所治之烦躁, 皆坏病也. 烦燥虽六经俱有, 而多见于太阳
,少阴者, 太阳为真阴之标, 少阴为真阳之本也. 未经汗下而烦躁,
多属阳, 其脉实大, 其证渴热, 是烦为阳盛, 躁为阴虚. 已经汗下而
烦躁, 多属阴, 其脉沉微, 其证汗厥, 是烦为阳虚, 躁为阴极也. 夫
先下后汗, 于法为逆, 外无大热, 内不渴呕, 似乎阴阳自和, 而实妄
汗亡阳, 所以虚阳扰乱于阳分, 故昼日烦躁不得眠, 盛阴偏安于阴分
,故夜而安静. 脉沉微, 是真阳将脱而烦躁也. 用干姜, 附子壮阳以
配阴. 姜, 附者, 阳中阳也, 生用则力更锐, 不加甘草则势更猛, 是
方比四逆为峻, 救其相离, 故当急也. 先汗后下, 于法虽顺, 若病不
解,厥悸仍然, 骤增昼夜烦躁, 似乎阴盛格阳, 而实肾上凌心, 皆因
水不安其位, 挟阴邪而上乘, 是阳虚有水气之烦躁也. 用茯苓君四逆
,抑阴以伐水. 人参佐四逆, 生气而益阳. 参, 苓君子也, 兼调以甘
草,比四逆为缓, 阴阳不急, 故当缓也. 一去甘草, 一加参, 苓, 而
缓急自别, 仲景用方之妙如此.
在误用攻下法后又错误地发汗，患者白天烦躁不安无法入睡，夜间却安静，没有呕吐，没有口渴，也没有表证，脉象沉而微弱，身体没有明显高热者，应当使用干姜附子汤治疗。
干姜一两，附子（去皮，生用，破成八片）一枚。以上两味药，用水三升，煮取一升，去掉药渣，一次性服用。
伤寒出现四肢厥冷且心下悸动，经过发汗或攻下治疗后，病情仍未解除，出现烦躁症状者，应当使用茯苓四逆汤治疗。
茯苓六两，人参一两，甘草（炙）一两，干姜一两，附子（生用，破成八片）一枚。以上五味药，用水五升，煮取三升，去掉药渣，每次温服七合，每日服用三次。
【注释】凡是太阳病治疗不当，发汗后再次攻下，或者攻下后再次发汗，误治又误治，演变成坏病。如果患者阳气旺盛而向热证转化，则转入三阳经；如果阳气衰弱而向寒证转化，则归属于三阴经。这两个方剂所治疗的烦躁，都属于坏病。烦躁虽然六经都可能出现，但多见于太阳经和少阴经，因为太阳是足少阴真阴的标表，少阴是足太阳真阳的根本。未经过发汗和攻下而出现烦躁，多属于阳证，脉象实大，症状表现为口渴发热，这是烦由阳盛引起，躁由阴虚引起。已经经过发汗和攻下而出现烦躁，多属于阴证，脉象沉微，症状表现为出汗、四肢厥冷，这是烦由阳虚引起，躁由阴寒至极引起。先攻下后发汗，在治法上属于逆治，体表没有大热，体内不渴不呕，表面上看似乎是阴阳自和，但实际上是因为妄用汗法导致亡阳，所以虚阳扰乱于阳分，因此白天烦躁不能入睡；盛阴偏安于阴分，因此夜间安静。脉象沉微，是真阳即将脱失而导致的烦躁。使用干姜、附子来壮阳以配阴。姜、附属于阳中之阳，生用则药力更锐利，不加甘草则药势更猛烈，这个方剂比四逆汤更为峻猛，旨在挽救离决之阳气，所以应当急用。先发汗后攻下，在治法上虽属顺治，但如果病不解，厥冷心悸依然存在，骤然增加昼夜烦躁，表面上看似乎是阴盛格阳，实际上是肾水上凌于心，都是因为水气不安其位，挟带阴邪而上乘，这是阳虚伴有水气的烦躁。使用茯苓作为君药配合四逆汤，抑制阴寒以伐除水气。人参辅助四逆汤，生气并补益阳气。参、苓如同君子，兼用甘草调和，比四逆汤药性缓和，阴阳不急迫，所以应当缓用。一去甘草，一加人参、茯苓，而缓急自然区别开来，张仲景用药的精妙之处就在于此。
After erroneous purgation followed by erroneous sweating, if the patient experiences restlessness during the day preventing sleep, yet remains quiet at night, with no vomiting, no thirst, no exterior syndrome, a deep and faint pulse, and no significant body heat, Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction) should be administered.
Ganjiang (Rhizoma Zingiberis Preparatum), 1 liang; Fuzi (Radix Aconiti Lateralis Preparata, peeled, used raw, broken into eight pieces), 1 piece. These two ingredients are boiled in 3 sheng of water to obtain 1 sheng of decoction. The dregs are removed, and the decoction is taken all at once.
In Shaoyin disease presenting with cold extremities and palpitations in the epigastrium, if sweating or purgation fails to resolve the condition and restlessness ensues, Fuling Sini Tang (Poria and Sini Decoction) should be administered.
Fuling (Poria), 6 liang; Renshen (Radix Ginseng), 1 liang; Gancao (Radix Glycyrrhizae Preparata, honey-fried), 1 liang; Ganjiang (Rhizoma Zingiberis Preparatum), 1 liang; Fuzi (Radix Aconiti Lateralis Preparata, used raw, broken into eight pieces), 1 piece. These five ingredients are boiled in 5 sheng of water to obtain 3 sheng of decoction. The dregs are removed, and 7 ge of the warm decoction is taken three times daily.
[Annotation] Whenever Taiyang disease is treated improperly, such as purging after sweating or sweating after purging, leading to compounded errors and resulting in a "disaster disease" (Huai Bing). If the patient's Yang qi is abundant and transforms into heat, the condition shifts to the Three Yang meridians; if Yang qi is deficient and transforms into cold, it belongs to the Three Yin meridians. The restlessness treated by these two formulas both belong to disaster diseases. Although restlessness can occur in all six meridians, it is more common in Taiyang and Shaoyin, because Taiyang is the superficial aspect of True Yin (Shaoyin), and Shaoyin is the root of True Yang (Taiyang). Restlessness occurring without prior sweating or purgation usually indicates a Yang pattern, characterized by a solid and large pulse, thirst, and fever; here, "fan" (mental agitation) is due to Yang excess, and "zao" (physical restlessness) is due to Yin deficiency. Restlessness occurring after sweating and purgation usually indicates a Yin pattern, characterized by a deep and faint pulse, sweating, and cold extremities; here, "fan" is due to Yang deficiency, and "zao" is due to extreme Yin cold. Purging before sweating is therapeutically adverse. With no significant external heat and no internal thirst or vomiting, it may seem that Yin and Yang are harmonizing themselves, but in reality, reckless sweating has caused Yang collapse. Thus, deficient Yang disturbs the Yang aspect, causing daytime restlessness and insomnia; excessive Yin resides peacefully in the Yin aspect, causing nighttime quietness. A deep and faint pulse indicates impending collapse of True Yang accompanied by restlessness. Ganjiang and Fuzi are used to strengthen Yang to coordinate with Yin. Ginger and Aconite are "Yang within Yang"; used raw, their power is sharper; without Gancao, their momentum is fiercer. This formula is more potent than Sini Tang, aiming to rescue separated Yang, hence it must be used urgently. Sweating before purging is therapeutically orderly, but if the disease persists with lingering cold extremities and palpitations, and sudden昼夜 (day and night) restlessness increases, it may seem like Yin excess repelling Yang, but actually, Kidney Water is overacting on the Heart. This is because Water Qi does not reside in its proper position, carrying Yin pathogenic factors upward. This is restlessness due to Yang deficiency with Water Qi retention. Fuling is used as the sovereign herb with Sini Tang to suppress Yin and eliminate Water Qi. Renshen assists Sini Tang to generate Qi and benefit Yang. Ginseng and Poria act like noble ministers, harmonized with Gancao, making this formula milder than Sini Tang. Since Yin and Yang are not urgent, it should be used slowly. Removing Gancao and adding Renshen and Fuling naturally distinguishes between slow and urgent approaches. Such is the subtlety of Zhang Zhongjing’s prescription usage.