甘草（炙）四两 生姜（切）三两 桂枝三两 麦门冬半升 麻子仁半筋 大枣（擘
）十二枚 人参二两 阿胶二两 生地黄一筋
右九味，以清酒七升，水八升，先煮八味，取三升，去滓，内阿胶，烊消尽，温服一
升，日三服。一名复脉汤。
【集解】
张璐曰：津液枯槁之人，宜预防二便秘涩之虞，麦冬、生地溥滋膀胱之化源；麻仁、
阿胶专主大肠之枯约。免致阴虚泉竭，火燥血枯，此仲景救阴退阳之妙法也。
柯琴曰：仲景凡于不足之脉，阴弱者用芍药以益阴，阳虚者用桂枝以通阳，甚则加人
参以生脉，未有用麦冬者，岂以伤寒之法，义重扶阳乎？抑阴无骤补之法与此以中虚
脉结代，用生地黄为君，麦冬为臣，峻补真阴者，是已开后学滋阴之路矣。然地黄、
麦冬味虽甘而气则寒，非发陈蕃秀之品，必得人参、桂枝以通阳脉，生姜、大枣以和
荣卫，阿胶补血，酸枣安神，甘草之缓，不使速下，清酒之猛，捷于上行，内外调和
，悸可宁而脉可复矣。酒七升、水八升，只取三升者，久煎之则气不峻，此虚家用酒
之法，且知地黄麦冬得酒则良。此证当用酸枣仁，肺痿用麻子仁可也。如无真阿胶，
以龟板胶代之。
未持脉时，病人叉手自冒心，师因教试令咳而不咳者，此必两耳聋无闻也，所以然者
，以重发汗，虚故如此。
【注】
未持脉时，病人叉手自冒其心，师因教试令咳而不咳者，此必两耳聋无所闻也。其聋
与叉手冒心同见，则非少阳之邪可知，乃重发汗，阳虚，故致此也。
【集注】
喻昌曰：此示人推测阳虚之一端也。阳虚耳聋，宜急固其阳，与少阳传经邪盛之耳聋
迥别。
程应旄曰：诸阳受气于胸中，而精气上通于耳，今以重发汗而虚其阳，阳气所不到之
处，精气亦不复注而通之，故聋。
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。
【注】
此申上条，以详其证而明其治也。发汗过多，外亡其液，内虚其气，气液两虚，中空
无倚，故心下悸，惕惕然不能自主，所以叉手冒心，欲得自按，以护庇而求定也，故
用桂枝甘草汤，以补阳气而生津液，自可愈矣。
【集注】
方有执曰：汗多则伤血，血伤则心虚，心虚则动惕而悸，故叉手自冒，而欲得人按也
。桂枝走表，敛液宅心，能固疏漫之表；甘草和里，补中益气，能调不足之中，合二
物以为方，盖敛阴补阳之法也。
程知曰：此汗后心虚补阳法也。阳受气于胸中，胸中阳气衰微，故叉手冒心，心悸欲
按也。程应旄曰：汗为心液，不惟妄汗不可，即当汗而失其分数亦不可。叉手冒心欲
得按者，因阳虚不能自主，而心下悸也。然心悸有心气虚，有水气乘，水乘先因心虚
，今心下悸者，乃阳气虚惕然自恐，欲得按以御之，故用桂枝甘草，载还上焦之阳，
使回旋于胸中也。
魏荔彤曰：此条乃发汗过多之禁也。风伤卫，固不宜汗出如水流漓矣。即寒伤荣，宜
发汗，亦只汗出表解斯已耳！不可听其大汗不止，致有阳虚之变证也。仲景言，其人
叉手自冒心，心下悸欲得按者，乃形容汗多亡阳之象也。
【炙甘草汤方】
炙甘草四两，生姜（切片）三两，桂枝三两，麦门冬半升，麻子仁半升，大枣（掰开）十二枚，人参二两，阿胶二两，生地黄一升。
以上九味药，用清酒七升、水八升，先煎煮前八味药，取汁三升，滤去药渣，加入阿胶，加热使其完全溶化，每次温服一升，每日服用三次。此方又名复脉汤。
【集解】
张璐说：对于津液枯竭的人，应当预防大小便干结不通的隐患，麦冬和生地黄广泛滋助膀胱的气化之源；火麻仁和阿胶专门主治大肠的干枯拘急。这样可以避免导致阴虚枯竭、火燥血枯，这是张仲景救阴退阳的妙法。
柯琴说：张仲景凡是遇到不足之脉，阴弱者用芍药来益阴，阳虚者用桂枝来通阳，严重时加人参来生脉，从未用过麦冬，难道是因为伤寒治法重视扶阳吗？或者认为阴分没有骤补的方法？与此不同，这里因为中气虚弱出现脉结代，用生地黄为君药，麦冬为臣药，峻补真阴，这确实是开启了后世学者滋阴的道路。然而，地黄、麦冬味道虽甘但性质寒凉，不是发陈蕃秀（生长繁荣）的药物，必须依靠人参、桂枝来通阳脉，生姜、大枣来调和营卫，阿胶补血，酸枣仁安神，甘草的缓急作用，防止药力过快下行，清酒的猛烈之性，利于药力迅速上行，内外调和，心悸可宁，脉象可复。用酒七升、水八升，最终只取三升汁液，是因为久煎则药性不峻烈，这是虚证患者使用酒的方法，并且知道地黄、麦冬得酒则疗效更好。此证应当用酸枣仁，若是肺痿则可用火麻仁。如果没有真正的阿胶，可以用龟板胶代替。
在诊脉之前，病人双手交叉护住心口，医生于是教他试着咳嗽，如果他不咳嗽，这一定是双耳失聪听不见声音。之所以这样，是因为过度发汗，导致正气虚弱所以如此。
【注】
在诊脉之前，病人双手交叉护住心口，医生教他试着咳嗽，如果他不咳嗽，这一定是双耳失聪听不见声音。耳聋与双手护心同时出现，这就不是少阳经邪气所致，而是由于过度发汗，阳气虚弱，所以导致这种情况。
【集注】
喻昌说：这是向人展示推测阳气虚弱的一个方面。阳气虚弱导致的耳聋，应当紧急固护阳气，这与少阳经传经邪气盛实导致的耳聋截然不同。
程应旄说：诸阳之气汇聚于胸中，精气上通于耳，现在因为过度发汗而使其阳气虚弱，阳气所不能到达的地方，精气也不再灌注通畅，所以耳聋。
发汗过多，病人双手交叉护住心口，心中悸动不安，想要按压缓解的，用桂枝甘草汤主治。
【注】
这是对上一条文的补充，详细说明症状并阐明治疗方法。发汗过多，体表津液外亡，体内正气虚弱，气液两虚，心中空虚无依靠，所以心下悸动，惊恐不安不能自主，因此双手交叉护住心口，想要自己按压，以寻求庇护和安定，所以用桂枝甘草汤，以补益阳气并生津液，自然可以痊愈。
【集注】
方有执说：汗出过多则伤血，血伤则心虚，心虚则心动惊惕而悸，所以双手交叉护住心口，想要让人按压。桂枝走表，收敛津液安守心神，能固摄疏松的肌表；甘草和里，补中益气，能调补不足的脾胃，将这两味药合为一方，大概是敛阴补阳的方法。
程知说：这是汗后心虚补阳的方法。阳气受气于胸中，胸中阳气衰微，所以双手交叉护住心口，心悸想要按压。
程应旄说：汗是心的体液，不仅误汗不可，即使该发汗而剂量不当也不可。双手交叉护住心口想要按压，是因为阳气虚弱不能自主，而导致心下悸动。然而心悸有心气虚的情况，也有水气乘袭的情况，水气乘袭首先是因为心虚，现在的心下悸动，是阳气虚弱惊恐自恐，想要按压来抵御它，所以用桂枝甘草，承载归还上焦的阳气，使它在胸中回旋。
魏荔彤说：这一条是发汗过多的禁忌。风邪伤卫分，本来就不宜汗出如水流漓。即使是寒邪伤荣分，适宜发汗，也只是汗出表解罢了！不可以听任大汗不止，导致产生阳气虚弱的变证。张仲景说，病人双手交叉护住心口，心下悸动想要按压，这是形容汗多亡阳的现象。
[Recipe for Zhigancao Tang]
Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma) 4 liang, Shengjiang (Fresh Zingiberis Rhizoma, sliced) 3 liang, Guizhi (Cinnamomi Ramulus) 3 liang, Maimendong (Ophiopogonis Radix) half sheng, Maziren (Cannabis Semen) half sheng, Dazao (Jujubae Fructus, split) 12 pieces, Renshen (Ginseng Radix) 2 liang, Ejiao (Asini Corii Colla) 2 liang, Shengdihuang (Rehmanniae Radix) 1 sheng.
The above nine herbs are decocted with 7 sheng of clear wine and 8 sheng of water. First, decoct the first eight herbs to obtain 3 sheng of liquid, remove the dregs, add Ejiao, and melt it completely by heating. Take 1 sheng warm each time, three times a day. This recipe is also known as Fumai Tang (Pulse-Recovering Decoction).
[Collected Explanations]
Zhang Lu said: For individuals with withered fluids, one should prevent the risk of constipation in both bowels. Maimendong and Shengdihuang widely nourish the source of Qi transformation in the Bladder; Maziren and Ejiao specifically treat the dryness and constriction of the Large Intestine. This prevents Yin deficiency leading to exhaustion of the spring source, fire dryness, and blood depletion. This is Zhang Zhongjing's wonderful method for rescuing Yin and retreating Yang.
Ke Qin said: Whenever Zhang Zhongjing encountered deficient pulses, he used Shaoyao (Paeoniae Radix Alba) to benefit Yin for Yin weakness, and Guizhi to unblock Yang for Yang deficiency. In severe cases, he added Renshen to generate pulse Qi. He never used Maimendong. Was it because the treatment of Shanghan (Cold Damage) emphasizes supporting Yang? Or was it that there is no sudden tonification method for Yin? In contrast, here, due to middle Jiao deficiency presenting with knotted and intermittent pulse (Jie Dai Mai), Shengdihuang is used as the sovereign herb, and Maimendong as the minister herb, to vigorously tonify True Yin. This indeed opened the path for later scholars to nourish Yin. However, although Dihuang and Maimendong are sweet in taste, they are cold in nature, not suitable for promoting growth and flourishing. They must rely on Renshen and Guizhi to unblock Yang channels, Shengjiang and Dazao to harmonize Ying and Wei (Nutritive and Defensive levels), Ejiao to tonify blood, Suanzaoren (Ziziphi Spinosae Semen) to calm the spirit, the moderating effect of Gancao to prevent rapid descent, and the potent nature of Qingjiu (Clear Wine) to facilitate rapid ascent. With internal and external harmony, palpitations can be calmed, and the pulse can recover. Using 7 sheng of wine and 8 sheng of water to yield only 3 sheng indicates that prolonged decoction makes the action less vigorous. This is the method of using wine for deficient patients, showing knowledge that Dihuang and Maimendong work better with wine. For this condition, Suanzaoren should be used; for Feiwei (Lung Withering), Maziren can be used. If genuine Ejiao is unavailable, Guibanjiao (Chinensis Testudinis Carapax et Plastrum Colla) can substitute.
Before taking the pulse, the patient crosses their hands over the heart region. The physician instructs them to try to cough; if they do not cough, they will certainly be deaf in both ears. The reason for this is excessive sweating, which causes deficiency, hence this condition.
[Annotation]
Before taking the pulse, the patient crosses their hands over the heart region. The physician instructs them to try to cough; if they do not cough, they will certainly be deaf and unable to hear. The simultaneous occurrence of deafness and crossing hands over the heart indicates that this is not due to Shaoyang (Lesser Yang) pathogenic factors, but rather due to excessive sweating causing Yang deficiency.
[Collected Notes]
Yu Chang said: This demonstrates one aspect of inferring Yang deficiency. Deafness due to Yang deficiency requires urgent consolidation of Yang, which is distinctly different from deafness caused by excess pathogens transmitting through the Shaoyang channel.
Cheng Yingmao said: All Yang Qi gathers in the chest, and essence-Qi connects upwards to the ears. Now, excessive sweating has depleted Yang Qi. Where Yang Qi cannot reach, essence-Qi no longer flows through, resulting in deafness.
When sweating is excessive, and the patient crosses their hands over the heart, experiences palpitations in the epigastrium/heart region, and desires pressure, Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction) is the primary treatment.
[Annotation]
This supplements the previous clause, detailing the symptoms and clarifying the treatment. Excessive sweating leads to the loss of fluids on the exterior and deficiency of Qi internally. With both Qi and fluids deficient, the interior becomes empty and unsupported, causing palpitations in the heart region, fearfulness, and lack of self-control. Thus, the patient crosses their hands over the heart, desiring self-pressing to seek protection and stability. Therefore, Guizhi Gancao Tang is used to tonify Yang Qi and generate fluids, leading to recovery.
[Collected Notes]
Fang Youzhi said: Excessive sweating damages Blood; damaged Blood leads to Heart deficiency. Heart deficiency causes trembling and palpitations, so the patient crosses their hands over the heart and desires manual pressure. Guizhi moves to the exterior, consolidates fluids, and anchors the Heart, securing the loose exterior; Gancao harmonizes the interior, tonifies the Middle and benefits Qi, adjusting the deficient center. Combining these two herbs forms a prescription, representing a method of consolidating Yin and tonifying Yang.
Cheng Zhi said: This is a method for tonifying Yang after sweating when the Heart is deficient. Yang Qi receives Qi in the chest; when chest Yang Qi is weak, the patient crosses hands over the heart and desires pressure for palpitations.
Cheng Yingmao said: Sweat is the fluid of the Heart. Not only mistaken sweating is inadvisable, but even appropriate sweating with incorrect dosage is unacceptable. Crossing hands over the heart and desiring pressure occurs because Yang deficiency prevents self-control, leading to palpitations. Palpitations can arise from Heart Qi deficiency or Water-Qi encroachment. Water encroachment stems initially from Heart deficiency. Current palpitations result from Yang deficiency causing fearfulness, desiring pressure to defend against it. Thus, Guizhi and Gancao are used to carry and return Upper Jiao Yang Qi, allowing it to circulate in the chest.
Wei Litong said: This clause serves as a warning against excessive sweating. Wind damaging the Wei (Defensive) level should not induce sweating like flowing water. Even if Cold damages the Ying (Nutritive) level requiring sweating, it should stop once the exterior is resolved. One must not allow continuous heavy sweating, which leads to complications of Yang deficiency. Zhang Zhongjing’s description of the patient crossing hands over the heart and desiring pressure for palpitations illustrates the image of Yang collapse due to excessive sweating.