治三阳合病, 头痛发热, 心烦不眠, 嗌干耳聋, 恶
寒无汗, 三阳证同见者.
石膏 柴胡 羌活 白芷 黄芩 芍药 桔梗 甘草 葛根 加姜枣
,水煎服.
【注】陶华制此以代葛根汤. 不知葛根汤, 只是太阳, 阳明药, 而此
方君柴胡, 则是又治少阳也; 用之于太阳, 阳明合病, 不合也. 若用
之以治三阳合病, 表里邪轻者, 无不效也. 仲景于三阳合病, 用白虎
汤主之者, 因热甚也. 曰汗之则谵语遗尿, 下之则额汗厥逆, 正示人
惟宜以和解立法, 不可轻于汗下也. 此方得之葛根, 白芷, 解阳明正
病之邪. 羌活解太阳不尽之邪. 柴胡解少阳初入之邪. 佐膏, 芩治诸
经热, 而专意在清阳明. 佐芍药敛诸散药而不令过汗. 桔梗载诸药上
行三阳. 甘草和诸药通调表里. 施于病在三阳, 以意增减, 未有不愈
者也. 若渴引饮者, 倍石膏加栝蒌根, 以清热而生津也. 若恶寒甚无
汗,减石膏, 黄芩加麻黄, 春夏重加之, 以发太阳之寒. 若有汗者,
加桂枝以解太阳之风, 无不可也.
升麻 葛根 芍药 甘草 ( 炙 ), 右四味, 水煎服.
【集注】柯琴曰: 此为阳明初病, 解表和里之剂, 可用以散表热, 亦
可用以治里虚, 一方而两擅其长也. 夫身热汗自出, 不恶寒反恶热,
是阳明之本证. 仲景未尝立治表之方, 见阳明初起, 汗出多而恶寒者
,便用枝汤; 及无汗而恶寒者, 则用葛根汤. 证同太阳而称阳明者,
是阳明之表病自太阳传来, 故治仍同太阳也. 此方治阳明自病, 不用
麻桂者, 恐汗太过而亡津液, 反致胃燥也. 用升麻, 葛根发胃脘之阳
,以散肌肉之表热; 芍药, 甘草泻脾经之火, 以解胃腑之里热. 有汗
则发, 无汗则止, 功同桂枝, 而已远于姜, 桂, 且不须啜稀粥以助阳
也.胃实为阳明之里证, 仲景用承气三方, 然阳明初病, 往往有移热
于脾而下痢者, 『内经』所谓暴注下迫, 皆属于热也. 下痢, 正是胃
热之兆, 故太阳阳明合病, 必自下痢, 仲景用葛根汤以发两阳之表热
,即所以治里热也. 此方即仿其义, 去姜, 桂之辛热, 以升麻代麻黄
,便是阳明表剂, 而非太阳表剂矣. 葛根禀性甘凉, 可以散表实, 协
升麻以上升, 则使清阳达上而浊阴下降. 可知芍药收敛脾阴, 甘草缓
急和里, 则下痢自止; 可知治里仍用表药者, 以表实下痢, 而非里实
故也. 痘疹自里达表, 出于少阴而发于太阳, 初起则内外皆热, 故亦
宜于凉散耳. 若无汗加麻黄, 有汗加桂枝, 渴热加石膏, 咽痛加桔梗
,头痛合芎芷散, 头面肿合消毒饮, 有少阳证加柴, 芩, 火盛加芩 ,
连,凡邪在三阳, 以此出入, 无不利也.
治疗三阳合病，症状包括头痛、发热、心烦失眠、咽喉干燥、耳聋，伴有恶寒无汗，且太阳、阳明、少阳三经证候同时出现的情况。
石膏、柴胡、羌活、白芷、黄芩、芍药、桔梗、甘草、葛根，加入生姜、大枣，用水煎煮后服用。
【注释】陶华配制此方是为了替代葛根汤（Ge Gen Tang）。但他不知道葛根汤只是针对太阳经和阳明经的药物，而此方以柴胡（Chai Hu）为君药，则是又用于治疗少阳经；如果将其用于太阳经与阳明经的合病，并不合适。若用它来治疗三阳合病中表里邪气较轻的患者，没有不有效的。张仲景在治疗三阳合病时，使用白虎汤（Bai Hu Tang）为主治方剂，是因为热势极盛。他说：发汗会导致谵语和遗尿，攻下会导致额头出汗和四肢厥冷，这正是提示人们只适宜采用和解的方法立法，不可轻易使用发汗或攻下的方法。此方得益于葛根（Ge Gen）、白芷（Bai Zhi），能解除阳明经正病的邪气。羌活（Qiang Huo）解除太阳经未尽的邪气。柴胡解除少阳经初入的邪气。佐以石膏、黄芩治疗各经的热邪，而专门意在清解阳明经的热邪。佐以芍药收敛各种发散药物，防止发汗过度。桔梗（Jie Geng）引导诸药上行至三阳经。甘草（Gan Cao）调和诸药，通调表里。施用于病在三阳经的情况，根据病情意旨增减药味，没有不痊愈的。如果有口渴引饮的症状，加倍使用石膏并加入栝蒌根（Gua Lou Gen），以清热生津。如果恶寒严重且无汗，减少石膏、黄芩的用量，加入麻黄（Ma Huang），春夏季节加重用量，以发散太阳经的寒邪。如果有汗出的情况，加入桂枝（Gui Zhi）以解除太阳经的风邪，没有不可以的。
升麻（Sheng Ma）、葛根、芍药、炙甘草（Zhi Gan Cao），以上四味药，用水煎煮后服用。
【集注】柯琴说：这是治疗阳明经初起疾病的方剂，是解表和里的药剂，既可以用来疏散表热，也可以用来治疗里虚，一方而兼有两方面的长处。身体发热、自然汗出、不恶寒反而恶热，这是阳明经的本证。张仲景未曾设立专门治疗表证的方剂，见到阳明经初起，汗出多且恶寒的，便使用桂枝汤（Gui Zhi Tang）；以及无汗且恶寒的，则使用葛根汤。证候与太阳经相同却称为阳明经的，是因为阳明经的表病是从太阳经传来的，所以治疗方法仍同于太阳经。此方治疗阳明经自发的疾病，不使用麻黄、桂枝，是担心发汗太过而耗伤津液，反而导致胃燥。使用升麻、葛根发散胃脘的阳气，以疏散肌肉层面的表热；芍药、甘草泻除脾经的火邪，以解胃腑的里热。有汗则能止汗，无汗则能发汗，功效同于桂枝汤，但远离了生姜、桂枝的辛热之性，而且不需要喝稀粥来助阳。胃实是阳明经的里证，张仲景使用承气汤三方，然而阳明经初起疾病，往往有热邪移于脾脏而导致下痢的情况，《黄帝内经》所谓“暴注下迫，皆属于热”。下痢，正是胃热的征兆，所以太阳阳明合病，必然会出现下痢，张仲景使用葛根汤以发散两阳经的表热，这也就是治疗里热的方法。此方即仿效其义理，去掉生姜、桂枝的辛热之性，用升麻代替麻黄，便是阳明经的表剂，而不是太阳经的表剂了。葛根禀性甘凉，可以解散表实，配合升麻以上升，从而使清阳之气达于上部而浊阴之气下降。可知芍药收敛脾阴，甘草缓和急迫并调和里气，则下痢自然停止；可知治疗里证仍使用表药的原因，是因为这是表实导致的下痢，而非里实所致。痘疹从里达表，出于少阴经而在太阳经发出，初起时内外皆热，所以也适宜用凉散的方法。如果无汗加麻黄，有汗加桂枝，口渴热盛加石膏，咽痛加桔梗，头痛配合川芎、白芷散（Xiong Zhi San），头面肿胀配合消毒饮（Xiao Du Yin），有少阳经证候加柴胡、黄芩，火邪旺盛加黄芩、黄连（Huang Lian），凡是邪气在三阳经，以此方加减出入，没有不利的。
Treats combined diseases of the three Yang meridians, characterized by headache, fever, mental restlessness and insomnia, dry throat, deafness, aversion to cold, absence of sweating, where symptoms of all three Yang meridians appear simultaneously.
Shi Gao (Gypsum Fibrosum), Chai Hu (Bupleuri Radix), Qiang Huo (Notopterygii Rhizoma et Radix), Bai Zhi (Angelicae Dahuricae Radix), Huang Qin (Scutellariae Radix), Shao Yao (Paeoniae Radix), Jie Geng (Platycodonis Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Ge Gen (Puerariae Lobatae Radix). Add Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus). Decoct in water and take orally.
[Annotation] Tao Hua formulated this prescription to replace Ge Gen Tang (Cinnamon Twig and Kudzu Root Decoction). However, he did not realize that Ge Gen Tang acts only on the Taiyang (Greater Yang) and Yangming (Yang Brightness) meridians, whereas this prescription uses Chai Hu as the sovereign drug, thereby also treating Shaoyang (Lesser Yang); thus, it is not suitable for combined diseases of Taiyang and Yangming. If used for combined diseases of the three Yang meridians where pathogenic factors in both exterior and interior are mild, it will invariably be effective. Zhang Zhongjing treats combined diseases of the three Yang meridians with Bai Hu Tang (White Tiger Decoction) because the heat is severe. He stated: "Sweating induces delirium and urinary incontinence; purging causes sweating on the forehead and cold extremities." This serves as a warning that only harmonizing methods should be employed, and one should not lightly resort to sweating or purging techniques. This prescription benefits from Ge Gen and Bai Zhi to resolve pathogens of the primary disease of the Yangming meridian. Qiang Huo resolves residual pathogens of the Taiyang meridian. Chai Hu resolves newly entered pathogens of the Shaoyang meridian. Assisted by Shi Gao and Huang Qin to treat heat in various meridians, with a specific focus on clearing Yangming heat. Shao Yao assists in astringing the dispersing properties of other herbs to prevent excessive sweating. Jie Geng guides the herbs upward to the three Yang meridians. Gan Cao harmonizes the various herbs and regulates the exterior and interior. When applied to diseases involving the three Yang meridians, adjusting the ingredients according to clinical judgment ensures recovery. For cases with thirst and desire to drink, double the dosage of Shi Gao and add Gua Lou Gen (Trichosanthis Radix) to clear heat and generate fluids. For severe aversion to cold and absence of sweating, reduce the dosages of Shi Gao and Huang Qin, add Ma Huang (Ephedrae Herba), and increase the dosage during spring and summer to disperse Taiyang cold. For cases with sweating, add Gui Zhi (Cinnamomi Ramulus) to dispel Taiyang wind; there is no situation where this would not work.
Sheng Ma (Cimicifugae Rhizoma), Ge Gen, Shao Yao, Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma). The above four ingredients, decoct in water and take orally.
[Collected Annotations] Ke Qin said: This is a formula for early-stage Yangming disease, serving to release the exterior and harmonize the interior. It can be used to dissipate exterior heat or treat interior deficiency, excelling in both aspects. Fever with spontaneous sweating, aversion neither to cold nor preference for heat, constitutes the fundamental syndrome of the Yangming meridian. Zhang Zhongjing did not establish a specific formula for releasing the exterior; when observing early Yangming onset with profuse sweating and aversion to cold, he used Gui Zhi Tang (Cinnamon Twig Decoction); when there was no sweating and aversion to cold, he used Ge Gen Tang. Although the symptoms resembled those of Taiyang, they were termed Yangming because the exterior disease of Yangming originated from Taiyang, hence the treatment remained similar to that of Taiyang. This prescription treats spontaneous Yangming disease without using Ma Huang or Gui Zhi, fearing that excessive sweating would damage body fluids and lead to stomach dryness. Sheng Ma and Ge Gen are used to diffuse the yang qi of the stomach region to dissipate exterior heat at the muscle level; Shao Yao and Gan Cao purge fire from the Spleen meridian to resolve interior heat in the Stomach fu-organ. It stops sweating if present and induces sweating if absent, functioning similarly to Gui Zhi Tang but avoiding the acrid-warm nature of Sheng Jiang and Gui Zhi, and without the need for warm gruel to assist yang. Excess in the Stomach is an interior syndrome of Yangming; Zhang Zhongjing used the three Cheng Qi Tang formulas. However, in early Yangming disease, heat often shifts to the Spleen causing diarrhea. As stated in the *Nei Jing* (Inner Canon): "Sudden violent diarrhea and tenesmus belong to heat." Diarrhea is indeed a sign of stomach heat. Therefore, in combined diseases of Taiyang and Yangming, spontaneous diarrhea occurs; Zhang Zhongjing used Ge Gen Tang to release the exterior heat of both Yang meridians, which simultaneously treats the interior heat. This prescription imitates this principle, removing the acrid-warm Sheng Jiang and Gui Zhi, replacing Ma Huang with Sheng Ma, making it an exterior-releasing formula for Yangming rather than Taiyang. Ge Gen has a sweet-cool nature, capable of resolving exterior excess; cooperating with Sheng Ma to ascend, it allows clear yang to reach the upper part while turbid yin descends. Thus, Shao Yao astringes Spleen yin, and Gan Cao moderates urgency and harmonizes the interior, stopping diarrhea naturally. The reason interior treatments still use exterior-releasing herbs is that this diarrhea results from exterior excess, not interior excess. Erythema and measles emerge from the interior to the exterior, originating from Shaoyin and manifesting in Taiyang; in the initial stage, both interior and exterior are hot, so cooling and dispersing methods are appropriate. If there is no sweating, add Ma Huang; if sweating, add Gui Zhi; if thirsty and hot, add Shi Gao; if sore throat, add Jie Geng; if headache, combine with Xiong Zhi San (Ligusticum and Angelica Powder); if swelling of head and face, combine with Xiao Du Yin (Detoxification Decoction); if Shaoyang symptoms exist, add Chai Hu and Huang Qin; if fire is excessive, add Huang Qin and Huang Lian (Scrophulariae Radix). For pathogens in the three Yang meridians, modifying this formula accordingly yields favorable results.