茯苓半筋 桂枝四两 甘草（炙）一两 大枣（擘）十五枚
右四味，以甘澜水一斗，先煮茯苓，减二升，内诸药，煮取三升，去滓，温服一升，
日三服。作甘澜水法：取水二斗，置大盆内，以杓扬之，水上有珠子五六千颗相逐，
取用之。
【方解】
此方即芩桂术甘汤，去白术加大枣倍茯苓也。彼治心下逆满，气上冲胸，此治脐下悸
，欲作奔豚，盖以水停中焦，故用白术，水停下焦，故倍茯苓。脐下悸，是邪上干心
也，其病由汗后而起，自不外乎桂枝之法。仍以桂枝、甘草补阳气，生心液，倍加茯
苓以君之，专伐肾邪，用大枣以佐之，益培中土，以甘澜水煎，取其不助水邪也。土
强自可制水，阳建则能御阴，欲作奔豚之病，自潜消而默化矣。若已作奔豚，肾阴邪
盛，又非此药所能治，则当从事乎桂枝加桂汤法矣。
服桂枝汤或下之，仍头项强痛，翕翕发热，无汗，心下满，微痛，小便不利者，桂枝
汤去桂加茯苓白术汤主之。
【按】
去桂当是去芍药。此方去桂，将何以治仍头项强痛、发热无汗之表乎？细玩服此汤，
曰余根据桂枝汤法煎服，其意自见。服桂枝汤已，温覆令一时许，通身□□微似有汗，
此服桂枝汤法也。若去桂则是芍药、甘草、茯苓、白术并无辛甘走荣卫之品，而曰余
根据桂枝汤法，无所谓法也。若去桂则是芍药、甘草、茯苓、白术，并无辛甘走荣卫之
品，而曰余根据桂枝汤法，无所谓也。且论中有脉促胸满，汗出恶寒之证，用桂枝去芍
药加附子汤主之，去芍药者、为胸满也。此条证虽稍异，而其满则同，为去芍药可知
矣。
【注】
此条为汗下后表不解，而心下有水气者，立治法也。服桂枝汤或下之，均非其治矣。
仍有头项强痛，翕翕发热，无汗之表证；心下满，微痛，小便不利，停饮之里证。设
未经汗下，则是表不解，而心下有水气，当用小青龙汤汗之；今已经汗下，表里俱虚
，小青龙汤非所宜也。故用桂枝汤去芍药之酸收，避无汗心下之满，加苓术之燥渗，
使表里两解，则内外诸证自愈矣。
【集注】
『外台方议』问曰：心下满微痛，乃是欲成结胸，何缘作停饮治之？答曰：诸证皆似
结胸，但小便不利一证，乃停饮也，故此条仲景只作停饮治之。
喻昌曰：服桂枝汤，病不解而证变，又或下之，则邪势乘虚入里，是益误矣。在表之
邪未除，而在里之饮上逆，故仿五苓两解表里之法也。
张璐曰：此条颇似结胸，所以辨为太阳表证尚在者，全重在翕翕发热无汗上。
林澜曰：头项强痛，经汗下而不解，心下满，微痛，小便不利，此为水饮内蓄，故加
苓术，得小便利，水饮行，腹满减，而表证悉愈矣。如十枣汤证，亦头痛，乃饮热内
蓄，表证已解，故虽头痛，只用逐饮，饮去则病自安也。
茯苓半斤 桂枝四两 甘草（炙）一两 大枣（擘开）十五枚
以上四味药，用甘澜水一斗，先煮茯苓，水量减少二升后，加入其他药物，煎取三升药液，滤去药渣，每次温服一升，每日服用三次。制作甘澜水的方法：取二斗水，放入大盆中，用勺舀起水反复扬洒，直到水面上出现五六千颗像珠子一样互相追逐的水珠，即可取用。
【方解】
此方即苓桂术甘汤（Poria, Cinnamon Twig, Atractylodes Macrocephala and Licorice Decoction），去掉白术，加大枣并加倍茯苓用量。该方治疗心下逆满、气上冲胸的症状；本方治疗脐下悸动，欲发为奔豚病（Bentun disease, characterized by a sensation of Qi rushing up from the lower abdomen）。这是因为水饮停滞在中焦，所以使用白术；水饮停滞在下焦，所以加倍使用茯苓。脐下悸动，是邪气上干犯心脏的表现，其病因多由发汗后引起，大体不离桂枝汤的治法。仍然使用桂枝、甘草来补益阳气，滋生心液，加倍重用茯苓作为君药，专门祛除肾中邪气，使用大枣作为佐药，以培补脾胃（中土），用甘澜水煎煮，取其不助长水邪的特性。脾胃强健自然能制约水湿，阳气健旺则能抵御阴邪，欲作奔豚的病证，自然会潜移默化地消除。如果已经发作奔豚，肾中阴邪亢盛，就不是此药所能治疗的，那就应当采用桂枝加桂汤（Cinnamon Twig Decoction with Added Cinnamon Twig）的治法了。
服用桂枝汤或经过攻下治疗后，仍然头项强痛，翕翕发热（如羽毛覆盖般的轻微发热），无汗，心下胀满，微痛，小便不利者，主治方剂为桂枝去桂加茯苓白术汤（Cinnamon Twig Decoction without Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction）。
【按语】
“去桂”应当是“去芍药”。此方若去掉桂枝，将用什么来治疗仍然存在的头项强痛、发热无汗等表证呢？仔细研读条文说“余根据桂枝汤法煎服”，其中的意思自然显现。服用桂枝汤后，温覆身体约一顿饭工夫，全身微微似有汗出，这才是服用桂枝汤的方法。如果去掉桂枝，剩下的芍药、甘草、茯苓、白术并没有辛甘发散以调和营卫的药物，却说“我根据桂枝汤法”，这就无所谓方法了。况且论中有脉促、胸满、汗出恶寒的证候，使用桂枝去芍药加附子汤主治，去掉芍药是因为胸满。此条证候虽然稍有不同，但都有“满”的症状，因此可知是去掉芍药。
【注释】
此条论述的是经过发汗或攻下后，表证未解，且心下有停饮的情况，确立的治疗方法。服用桂枝汤或经过攻下，都不是正确的治疗方法。仍然有头项强痛、翕翕发热、无汗等表证；心下胀满、微痛、小便不利等停饮的里证。假设未经过发汗或攻下，则是表证未解且心下有停饮，应当用小青龙汤（Minor Blue Dragon Decoction）发汗治疗；现在已经经过发汗和攻下，表里俱虚，小青龙汤就不适宜使用了。因此使用桂枝汤去掉芍药的酸收之性，避免加重无汗和心下的胀满，加入茯苓和白术的燥湿渗利之性，使表里双解，那么内外的各种证候自然痊愈。
【集注】
《外台方议》问道：心下胀满微痛，这似乎是即将形成结胸（Jie Xiong syndrome, characterized by fullness and pain in the epigastrium），为什么当作停饮来治疗？回答说：各种症状都类似结胸，但只有“小便不利”这一症状，表明是停饮，所以张仲景在此条只按停饮来治疗。
喻昌说：服用桂枝汤，病未解除而症状变化，或者又经过攻下，那么邪气就会乘虚入里，这是更加误治了。在表的邪气未除，而在里的水饮上逆，所以仿照五苓散（Wu Ling San, Five-Ingredient Powder with Poria）两解表里的方法。
张璐说：此条症状颇似结胸，之所以辨明为太阳表证仍在，全重在“翕翕发热无汗”这一点上。
林澜说：头项强痛，经过发汗和攻下仍未解除，心下胀满，微痛，小便不利，这是水饮内蓄，所以加入茯苓和白术，得到小便通利，水饮运行，腹部胀满减轻，而表证全部痊愈。如十枣汤（Shi Zao Tang, Ten Jujube Decoction）证，也有头痛，那是饮热内蓄，表证已解，所以虽然有头痛，只用逐饮之法，饮邪去除则病自安。
Poria (Fuling) half jin, Cinnamon Twig (Guizhi) four liang, Licorice (Zhi/Glazed) one liang, Jujube (Bo/Opened) fifteen pieces.
The above four ingredients: Use one dou of Ganlan Water (Gently Agitated Water). First decoct Poria until the volume reduces by two sheng. Then add the remaining herbs. Decoct to obtain three sheng of liquid. Strain the dregs. Take one sheng warm, three times a day.
Method for preparing Ganlan Water: Take two dou of water, place it in a large basin. Use a ladle to scoop and throw the water repeatedly until five or six thousand pearl-like droplets appear on the surface, chasing each other. Use this water.
[Formula Analysis]
This formula is derived from Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala and Licorice Decoction), by removing Atractylodes Macrocephala (Baizhu), adding Jujube, and doubling the dosage of Poria. The former treats fullness and rebellious Qi rising to the chest; this formula treats palpitations below the umbilicus, indicating the impending onset of Bentun Disease (a condition characterized by a sensation of Qi rushing upward from the lower abdomen). This is because fluid retention in the Middle Jiao warrants the use of Atractylodes Macrocephala, while fluid retention in the Lower Jiao warrants doubling the use of Poria. Palpitations below the umbilicus indicate pathogenic factors interfering with the Heart. The etiology often arises after sweating, generally adhering to the principles of Guizhi Tang (Cinnamon Twig Decoction). It still uses Cinnamon Twig and Licorice to tonify Yang Qi and generate Heart fluids. Poria is doubled and used as the Sovereign herb to specifically expel Kidney pathogens. Jujube is used as an Assistant herb to fortify the Spleen (Middle Earth). Decocting with Ganlan Water is intended to avoid assisting fluid pathogens. When Earth (Spleen) is strong, it can control Water; when Yang is established, it can resist Yin. Thus, the impending Bentun Disease will naturally dissipate. If Bentun Disease has already manifested, with excessive Kidney Yin pathogens, this formula is ineffective, and one should adopt the method of Guizhi Jia Gui Tang (Cinnamon Twig Decoction with Added Cinnamon Twig).
If, after taking Guizhi Tang or undergoing purgation, there remain stiff pain in the head and nape, slight fever (like being covered by feathers), absence of sweat, fullness below the heart, slight pain, and difficulty in urination, the governing formula is Guizhi Qu Gui Jia Fuling Baizhu Tang (Cinnamon Twig Decoction without Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction).
[Commentary]
"Removing Cinnamon Twig" should be "Removing White Peony Root (Shaoyao)". If Cinnamon Twig is removed from this formula, what would treat the persistent stiff pain in the head and nape, fever, and absence of sweat (exterior symptoms)? Careful reading reveals that the text states, "I follow the brewing and administration method of Guizhi Tang." The intent becomes clear. After taking Guizhi Tang, covering warmly for about the time it takes to cook a meal results in a slight, uniform sweat; this is the method of taking Guizhi Tang. If Cinnamon Twig is removed, the remaining White Peony Root, Licorice, Poria, and Atractylodes Macrocephala lack acrid-sweet herbs that circulate in Ying and Wei. To say "I follow the method of Guizhi Tang" would be meaningless. Furthermore, the text mentions cases of rapid pulse, chest fullness, sweating, and aversion to cold, treated with Guizhi Qu Shaoyao Jia Fuzi Tang (Cinnamon Twig Decoction without White Peony Root plus Prepared Aconite Root). White Peony Root is removed due to chest fullness. Although the symptoms here differ slightly, the presence of "fullness" indicates that White Peony Root should indeed be removed.
[Annotation]
This clause addresses the treatment method for exterior patterns unresolved after sweating or purgation, accompanied by fluid accumulation in the epigastrium. Taking Guizhi Tang or undergoing purgation are incorrect treatments. There remain exterior signs: stiff pain in the head and nape, slight fever, and absence of sweat; and interior signs of fluid retention: epigastric fullness, slight pain, and difficulty in urination. Had sweating or purgation not occurred, with unresolved exterior and fluid in the epigastrium, Xiao Qing Long Tang (Minor Blue Dragon Decoction) would be indicated for diaphoresis. However, since sweating and purgation have already occurred, both exterior and interior are deficient, making Xiao Qing Long Tang inappropriate. Therefore, Guizhi Tang is used, removing the astringent nature of White Peony Root to avoid aggravating the absence of sweat and epigastric fullness. Poria and Atractylodes Macrocephala are added for their drying and draining properties, resolving both exterior and interior, thereby curing all internal and external symptoms.
[Collected Notes]
*Waitai Fangyi* asks: Epigastric fullness and slight pain seem indicative of Jie Xiong Syndrome (a condition characterized by painful fullness in the epigastrium), why treat it as fluid retention? The answer is: While symptoms resemble Jie Xiong, the specific sign of difficulty in urination indicates fluid retention. Thus, Zhang Zhongjing treats this case solely as fluid retention.
Yu Chang stated: If the illness does not resolve after taking Guizhi Tang and symptoms change, or if purgation is applied, pathogens enter the interior exploiting deficiency, compounding the error. With exterior pathogens unremoved and interior fluid reversing upward, the method mimics Wu Ling San (Five-Ingredient Powder with Poria) to resolve both exterior and interior.
Zhang Lu stated: This case resembles Jie Xiong Syndrome. The differentiation confirming the persistence of Taiyang exterior signs relies entirely on "slight fever and absence of sweat."
Lin Lan stated: Stiff pain in the head and nape persists despite sweating and purgation; epigastric fullness, slight pain, and difficulty in urination indicate internal fluid accumulation. Hence, Poria and Atractylodes Macrocephala are added. Once urination becomes smooth, fluid moves, abdominal fullness decreases, and exterior signs completely resolve. In Shi Zao Tang (Ten Jujube Decoction) cases, headache also occurs due to internal accumulation of fluid and heat, but with resolved exterior signs. Thus, even with headache, only fluid-draining methods are used; once fluid is expelled, the disease resolves.