茯苓二两 桂枝二两 生姜（切）三两 甘草（炙）一两。
右四味，以水四升，煮取三升，去滓，分温三服。
【方解】
是方乃仿桂枝、五苓二方之义，小制其法也。有脉浮数汗出之表，故主以桂枝。去大
枣芍药者，因有小便不利之里，恐滞敛而有碍于癃闭也。五苓去术、泽、猪芩者，因
不渴不烦，里饮无多，惟小便一利可愈，恐过于燥渗伤阴也。
【集解】
汪琥曰：五苓散、茯苓甘草汤二方，皆太阳标本齐病，表里兼主之剂。何谓标？太阳
之经是也。何谓本？膀胱之府是也。经在表，本在里。五苓散，邪已入府表证已微，
故方中只用桂枝一味主表，其余四味皆主里之药也。茯苓甘草证，邪犹在经，里证尚
少，故方中又用茯苓一味以主里，其余三味皆主表之药也。
脉浮数者，法当汗出而愈，若下之，身重心悸者，不可发汗，当自汗出乃解。所以然
者，尺中脉微，此里虚，须表里实，津液自和，便自汗出愈 。
【注】
伤寒未发热，脉多浮紧，寒盛也。已发热。脉多浮数，热盛也。均宜麻黄汤发汗则愈
。若不发汗而误下之，不成逆坏者，必其人里气素实也。故惟见失汗身重之表，误下
心悸之里，则不可复发其汗，当待其表里自和，自然汗出而解。所以然者，因失汗表
实，误下里虚，尺中脉微，表里未谐，故不即解也。须待其里亦实而与表平，平则和
，和则阳津阴液自相和谐，所以便自汗出而愈也。使里实之法，即下条用小建中汤法
也。
【集注】
喻昌曰：此亦先建中而后发汗之变法。要知仲景云：尺脉微者，不可发汗。又云：尺
微者，不可下。无非相人津液之奥旨，所以误下之，脉虽浮数不改，亟宜发汗者，亦
必当谛其尺脉，不可率意径情有如此者。
张璐曰：误下身重心悸，纵脉仍浮数，亦不可复发其汗。设尺脉微，为里阴素虚，尤
宜戒也。脉浮而数，热邪已甚，将欲作汗，今误下之，故身重心悸，当与小建中和其
津液，汗出而愈。
伤寒二、三日，心中悸而烦者，小建中汤主之。
【注】
伤寒二、三日，未经汗下，即心悸而烦，必其人中气素虚，虽有表证，亦不可汗之。
盖心悸阳已微，心烦阴已弱，故以小建中汤先建其中，兼调荣卫也。
【集注】
王肯堂曰：伤寒二三日，心中悸而烦者，小建中汤主之。伤寒脉胘细，属少阳，不可
汗，汗之则谵语胃不和则烦而悸。大抵先烦而后悸者是热，先悸而后烦者是虚，治病
必求其本者此也。
程应旄曰：可见阳去入阴，必有其先兆，善治者，急宜杜之于未萌，心中悸而烦，则
里气虚而阳为阴袭，建中汤补虚和里，保定中州，以资气血为主。虽悸与烦，皆小柴
胡汤中兼见之证，而得之二三日，里证未必即具，小柴胡汤非所宜也。
魏荔彤曰：建中者治其本也。与建中后，除审其在表，则仍当发汗，以中州既建，虽
发汗阳亦不致亡矣。审其传里，则应下之，以中州既建，虽下阳亦不致陷矣。所谓急
则从标，而缓则从本也。
茯苓二两，桂枝二两，生姜（切片）三两，甘草（蜜炙）一两。
以上四味药，用水四升，煎煮至三升，滤去药渣，分三次温服。
【方解】
此方是仿照桂枝汤和五苓散两方的义理，缩小其制法而制定的。患者有脉浮数、汗出等表证，所以以桂枝为主药。去掉大枣和芍药的原因，是因为伴有小便不利的里证，担心它们收敛滞涩而妨碍癃闭（排尿困难）的缓解。五苓散去掉了白术、泽泻、猪苓，是因为患者口不渴、心不烦，体内水饮不多，只要小便通畅即可痊愈，担心这些药物过于燥湿渗利而损伤阴液。
【集解】
汪琥说：五苓散和茯苓甘草汤这两个方子，都是治疗太阳经腑同病、表里兼顾的药剂。什么叫“标”？是指太阳经脉。什么叫“本”？是指膀胱之腑。经脉在表，腑在里。五苓散中，邪气已经传入腑中，表证已经轻微，所以方中只用桂枝一味药来主治表证，其余四味药都是主治里证的。茯苓甘草汤证中，邪气还在经脉，里证还很少，所以方中又用茯苓一味药来主治里证，其余三味药都是主治表证的。
脉象浮数，按常理应当通过出汗而痊愈，如果误用攻下法，出现身体沉重、心悸的症状，就不可再发汗，应当等待自然出汗才能解除。之所以这样，是因为尺部脉微，这是里虚的表现，需要表里之气充实，津液自然调和，就会自然出汗而痊愈。
【注】
伤寒病尚未发热时，脉象多浮紧，这是寒邪盛的表现。已经发热后，脉象多浮数，这是热邪盛的表现。这两种情况都适宜用麻黄汤发汗则能痊愈。如果不发汗而误用攻下法，没有造成逆乱坏证的，一定是因为此人里气素来充实。所以只见到因失汗导致的身体沉重的表证，以及因误下导致的心悸的里证，这时就不可再次发汗，应当等待表里自然调和，自然出汗而解除。之所以这样，是因为失汗导致表实，误下导致里虚，尺部脉微，表里不调和，所以不能立即痊愈。必须等待里气也充实并与表气平衡，平衡则调和，调和则阳津与阴液自然和谐，所以便会自然出汗而痊愈。使里气充实的方法，就是下一条用小建中汤的方法。
【集注】
喻昌说：这也是先建立中气而后发汗的变法。要知道张仲景说：尺脉微者，不可发汗。又说：尺脉微者，不可攻下。这无非是探究人体津液深奥的道理，所以误用攻下后，脉象虽然仍浮数，急需发汗，但也必须仔细诊察尺脉，不可随意行事竟至于此。
张璐说：误用攻下后出现身体沉重、心悸，即使脉象仍浮数，也不可再次发汗。如果尺脉微，说明里阴素来虚弱，尤其应该戒慎。脉象浮而数，热邪已经很甚，将要作汗，现在误用攻下法，所以身体沉重、心悸，应当用小建中汤调和津液，出汗而痊愈。
伤寒二、三天，心中悸动且烦躁的，以小建中汤主治。
【注】
伤寒二、三天，未经过发汗或攻下，就出现心悸且烦躁，一定是因为此人中气素来虚弱，虽然有表证，也不可以发汗。大概心悸说明阳气已微弱，心烦说明阴气已虚弱，所以用小建中汤先建立中气，兼调营卫。
【集注】
王肯堂说：伤寒二三天，心中悸动且烦躁的，以小建中汤主治。伤寒脉象细弱，属于少阳病，不可发汗，发汗则会出现谵语、胃不和从而烦躁且心悸。大抵先烦躁而后心悸的是热证，先心悸而后烦躁的是虚证，治病必求其根本，就是这个道理。
程应旄说：可见阳气离去转入阴分，必有其先兆，善于治疗的人，应当在未萌发时就杜绝它。心中悸动且烦躁，说明里气虚弱而阳气被阴邪侵袭，建中汤补虚和里，保卫中焦，以资助气血为主。虽然悸与烦，都是小柴胡汤证中兼见的症状，但得病仅二三天，里证未必完全具备，小柴胡汤并不适宜。
魏荔彤说：建中就是治其根本。在建中之后，如果审察病邪仍在表，则仍当发汗，因为中州既已建立，即使发汗阳气也不会亡失。如果审察病邪传入里，则应当攻下，因为中州既已建立，即使攻下阳气也不会陷入。这就是所谓急则治其标，缓则治其本。
Fuling (Poria) 2 liang, Guizhi (Cinnamon Twig) 2 liang, Shengjiang (Fresh Ginger, sliced) 3 liang, Gancao (Licorice Root, honey-fried) 1 liang.
The above four ingredients are boiled in 4 sheng of water until reduced to 3 sheng. The dregs are removed, and the decoction is divided into three doses to be taken warm.
[Fangjie: Analysis of the Formula]
This formula is derived from the principles of Guizhi Tang (Cinnamon Twig Decoction) and Wuling San (Five-Ingredient Powder with Poria), but with a reduced dosage and simplified method. Since there are exterior signs such as floating and rapid pulse with sweating, Guizhi (Cinnamon Twig) is used as the principal herb. Dazao (Jujube) and Shaoyao (Peony Root) are omitted because there is an interior condition of impaired urination; it is feared that their astringent properties might obstruct the relief of strangury (difficulty in urination). Baizhu (Atractylodes Rhizome), Zexie (Alisma Rhizome), and Zhuling (Polyporus) from Wuling San are omitted because the patient has no thirst or irritability, indicating little interior fluid retention; only promoting urination is needed for recovery. It is feared that these herbs might be too drying and draining, thereby damaging Yin fluids.
[Jijie: Collected Explanations]
Wang Hu stated: Both Wuling San (Five-Ingredient Powder with Poria) and Fuling Jiangzhi Tang (Poria, Cinnamon Twig, and Fresh Ginger Decoction) are formulas that treat simultaneous disease of the Taiyang (Greater Yang) channel and its associated fu organ, addressing both exterior and interior aspects. What is referred to as "biao" (branch/exterior)? It is the Taiyang channel. What is referred to as "ben" (root/interior)? It is the Bladder fu organ. The channel is located in the exterior, while the fu organ is in the interior. In Wuling San, the pathogenic factor has entered the fu organ, and the exterior syndrome is already mild; therefore, only one herb, Guizhi (Cinnamon Twig), is used to address the exterior, while the remaining four herbs address the interior. In the case of Fuling Jiangzhi Tang, the pathogenic factor remains in the channel, and interior syndromes are few; thus, Fuling (Poria) is used to address the interior, while the other three herbs address the exterior.
A floating and rapid pulse indicates that healing should occur through sweating according to standard methods. If purgation is mistakenly applied, resulting in heavy body sensation and palpitations, sweating should not be induced again. Healing will occur when spontaneous sweating takes place. This is because a faint pulse at the cunian (inch position on the radial artery, reflecting kidney/interior status) indicates interior deficiency. When both exterior and interior qi become solid and yin-yang fluids harmonize naturally, spontaneous sweating occurs, leading to recovery.
[Zhu: Commentary]
In cold damage (Shanghan) before fever appears, the pulse is often floating and tight, indicating excess cold. After fever appears, the pulse is often floating and rapid, indicating excess heat. Both conditions are suitable for treatment with Mahuang Tang (Ephedra Decoction) to induce sweating for cure. If sweating is not induced and purgation is mistakenly applied, cases that do not develop adverse complications indicate that the patient's interior qi was originally strong. Therefore, if one observes only the exterior sign of heavy body due to missed sweating and the interior sign of palpitations due to mistaken purgation, further sweating is contraindicated. One must wait for the natural harmony of exterior and interior, after which spontaneous sweating will resolve the condition. This is because missing sweating leads to exterior excess, while mistaken purgation leads to interior deficiency. With a faint pulse at the cunian, the exterior and interior are disharmonious, preventing immediate resolution. Recovery requires waiting until the interior also becomes solid and balances with the exterior. Balance leads to harmony; harmony allows yang jin (yang fluids) and yin ye (yin fluids) to interact harmoniously, resulting in spontaneous sweating and cure. The method to strengthen the interior is described in the next section using Xiaojianzhong Tang (Minor Construct the Middle Decoction).
[Jizhu: Collected Annotations]
Yu Chang stated: This is also a modified approach of establishing the middle jiao first, followed by inducing sweating. It must be understood that Zhang Zhongjing said: "If the cunian pulse is faint, sweating is contraindicated." He also said: "If the cunian pulse is faint, purgation is contraindicated." These statements explore the profound principles of human body fluids. Even if mistaken purgation results in a floating and rapid pulse requiring urgent sweating, one must carefully examine the cunian pulse and not act arbitrarily.
Zhang Lu stated: After mistaken purgation causing heavy body and palpitations, even if the pulse remains floating and rapid, further sweating is contraindicated. If the cunian pulse is faint, indicating original deficiency of interior yin, caution is especially warranted. A floating and rapid pulse indicates severe heat pathogen, suggesting impending sweating. Mistaken purgation causes heavy body and palpitations; Xiaojianzhong Tang (Minor Construct the Middle Decoction) should be used to harmonize fluids, leading to sweating and cure.
"In cold damage lasting two to three days, if there are palpitations and irritability, Xiaojianzhong Tang (Minor Construct the Middle Decoction) is the primary treatment."
[Zhu: Commentary]
In cold damage lasting two to three days, without prior sweating or purgation, if palpitations and irritability appear, it indicates that the person's middle qi (spleen/stomach qi) was originally deficient. Although exterior signs exist, sweating is contraindicated. Palpitations indicate that yang qi is already weak, and irritability indicates that yin qi is already weak. Therefore, Xiaojianzhong Tang (Minor Construct the Middle Decoction) is used to first establish the middle jiao and simultaneously regulate Ying (nutritive) and Wei (defensive) qi.
[Jizhu: Collected Annotations]
Wang Kentang stated: "In cold damage lasting two to three days, if there are palpitations and irritability, Xiaojianzhong Tang (Minor Construct the Middle Decoction) is the primary treatment." In cold damage, if the pulse is fine and thin, it belongs to Shaoyang (Lesser Yang); sweating is contraindicated. Sweating leads to delirious speech and stomach disharmony, causing irritability and palpitations. Generally, irritability preceding palpitations indicates heat, while palpitations preceding irritability indicate deficiency. Treating diseases by seeking their root follows this principle.
Cheng Yingmao stated: This shows that the departure of yang qi entering yin has precursors. Skilled practitioners prevent this before it manifests. Palpitations and irritability indicate interior qi deficiency and yang being invaded by yin pathogens. Jianzhong Tang tonifies deficiency and harmonizes the interior, protecting the central jiao to support qi and blood production. Although palpitations and irritability are concurrent symptoms in Xiao Chaihu Tang (Minor Bupleurum Decoction), after only two to three days, interior signs may not yet be fully present, making Xiao Chaihu Tang unsuitable.
Wei Litong stated: Establishing the middle addresses the root. After establishing the middle, if the pathogen is still in the exterior, sweating should still be induced; since the central jiao is established, sweating will not cause loss of yang. If the pathogen has transmitted to the interior, purgation should be applied; since the central jiao is established, purgation will not cause sinking of yang. This is what is meant by treating the branch in acute cases and the root in chronic cases.