甘草中黄皮赤，确是心脾二经之药，然五脏六腑皆受气于脾，心为一身之宰，甘草味至
甘，性至平，故能由心脾以及于他脏他腑，无处不到，无邪不祛。其功能全在于甘，甘则补，
甘则缓。凡仲圣方补虚缓急，必以炙用，泻火则生用，虽泻亦兼有缓意。如治咽痛肺痿，火
在上焦者为多。以其为心药也，甘草泻心汤，是泻心痞非泻心火，泻痞有黄连芩夏，甘草特
以补胃，故炙用。炙用而以甘草泻心名汤者，甘草之奏绩可思也。
李东垣谓甘草生用泻心火，熟用散表寒。散表寒之方，无如桂枝麻黄二汤。自汗者表虚
，故桂枝汤以桂芍散邪风，姜枣和营卫。无汗者表实，故麻黄汤以麻桂散寒，更加杏仁。然
解表而不安中，则中气一匮，他患随生。故二汤皆有炙甘草以安中。表实与表虚不同，故二
汤甘草亦分多寡。可见用炙甘草者，所以资镇抚，非以资摧陷也。东垣不加分辨，非示学人
以准的之道。
东垣又云∶心火乘脾，腹中急痛，腹肉急缩者，甘草宜倍用之。按小建中汤治里急腹痛
，甘草炙用，病非心火乘脾。生甘草泻心火，而不治心火乘脾之腹痛。本经黄连主腹痛，治
心火乘脾之腹痛，即仲圣黄连汤是。东垣之说，殊有未合。刘潜江发心火乘脾之义，而深赞
之。邹氏又引东垣此说，以证栀子甘草豉汤之虚烦不得眠。不得眠岂是脾病。三君皆名家，
而于甘草不细辨如是，真为不解。
王海藏谓附子理中汤用甘草，恐其僭上。调胃承气汤用甘草，恐其速下。按伤寒论无附
子理中汤，理中汤之附子，腹满则加。腹满而加附子，盖以其为中宫药不可缺也。若恐附子
僭上，则白通汤乃少阴下利用附子，何以反无甘草。至生用而不炙用，则固有义在。寒多之
霍乱，非全不挟热，温中补虚，既有干姜参术，故加以生甘草之微凉，即别录除烦满，东垣
养阴血之谓。以是汤用于胸痹，则生甘草亦因气结在胸，不欲其过守也。调胃承气汤，是治
胃气不和之内实，以调胃为下，是下法之元妙者。舍枳朴而取炙甘草，以与黄硝一补一攻，
适得
海藏又谓凤髓丹用甘草，以缓肾急而生元气。窃谓亦非也。是方不知制自何人，名医方
论云，治梦遗失精及与鬼交。医方集解云，治心火旺盛，肾精不固易于施泄。其方义之精微，
则未有见及之者。夫元阴听命于元阳，元阳听命于天君。故心火炽而感其肾，肾感之而阳动
阴随有必然者。黄柏靖肾中之火，防肾中之水；火不作则阳蛰，水不泛则阴坚。砂仁摄火土
之气于水，而使肾得藏密。然心肾二家，交通最易，治肾而不治心，未善也。生甘草泻心火
，宁心气。大甘为土之正味，且能止肾水越上之火（洄溪语）。集解治心火旺盛一语，实即
用
甘草与人参，皆能补中气调诸药，而仲圣用于方剂，则确有分别，不稍通融。姑举二方
以明之，厥阴病有呕吐则兼少阳，仲圣法，转少阳之枢，多以干姜黄连并用，余已着其说于
干姜。干姜黄连人参汤，是以小柴胡汤加减，乃舍甘草而用人参，几不可晓。夫不曰食入口
即吐乎。少阳上升之气，得食即拒，难缓须臾。甘草甘壅，讵能任受。人参甘与苦均，为和
少阳之专药，枢机利则食自下，甘草所以非其匹也。其舍人参而用甘草者。栀子豉汤治虚烦
不得眠，若少气则栀子甘草豉汤主之。此在粗工，必以人参益气矣。庸讵知人参益气而亦升
气，栀豉汤之吐，由二物一升一降之相激，得人参则升不成升，降不成降，挟其补性，反足
窒邪。夫懊 者反复之甚，少气者懊 之甚，非元气之有亏，乃郁热之伤气。栀豉能吐去其
邪，不能安定其气，此仲圣所以有取于甘平清心火之甘草，而人参亦不得跻其列也。
邹氏以黄 桂枝五物汤为治下，治下制方宜急，急则去甘草而多其分数。桂枝加黄 汤
为治上，治上制方宜缓，缓则加甘草而减其分数。于是于血痹则但摘尺中小紧句为病在下，
且别引本篇首条以证其治下之说。不思尺中小紧，下句身体不仁，谓为非病，宁有是理。本
篇首条本与本病不属，况有关上小紧句，岂尺中小紧为病在下，关上小紧亦病在下乎。于黄
汗则摘腰以上汗出句为病在上，且别引本篇第二条以证其治上之说。不思腰以上汗出，下句
腰驰痛小便不利，谓非下体，宁有是理。本篇第二条非本条之病而引之，则他条又有黄汗
之为病，身体肿，汗沾衣等句，亦得谓但指上体乎。血痹篇尤注阐发宜针引阳气句，至为精
审。黄 桂枝五物汤，尤云和营之滞，助卫之行。亦针引阳气之意。经所谓阴阳形气俱不足
者，勿刺以针而调以甘药也。引经语解此方，亦正切合。夫血痹者，痹在表不痹在里。以甘
药代针，亦调其表非调其里。 桂姜枣，甘与辛合，所以补虚而宣阳。芍药佐桂，则能入营
而调血。去甘草且加多生姜者，不欲其中守而欲其解表也。甘草中又有斟酌如此。以非桂枝
汤加减，故不曰桂枝加黄 汤。然则桂枝加黄 汤，可不于桂枝汤一致思乎。愚于黄 已详
着于方之义。甘草自是桂枝汤不可少之物，安得去之。桂芍减而甘草不减，则阳虚之与邪风
有异也。邹氏不悟仲圣制方之所以然，而肆其臆说，疵 丛生，无谓甚矣。
甘草外皮呈黄色，内里偏赤色，确实是入心和脾两经的药物。然而五脏六腑的气血都来源于脾胃，心是全身的主宰，甘草味道极甘，药性极平和，所以它能从心脾二经扩展到其他的脏腑，无处不到，没有不能祛除的病邪。它的功效完全在于“甘”字，甘能补益，甘能缓急。凡是张仲景的方剂中用于补虚和缓解急迫症状的，必定使用炙甘草；用于泻火的则用生甘草，即使是泻火，也兼有缓急的意思。比如治疗咽痛和肺痿，大多是因为火邪在上焦。因为甘草是入心的药物，甘草泻心汤是用来泻除心下痞满，而不是泻心火，消除痞满有黄连、黄芩、半夏等药，甘草在这里仅仅是用来补益胃气，所以使用炙甘草。既然使用了炙甘草却以“甘草泻心”命名方剂，可见甘草在其中发挥的关键作用值得深思。
李东垣说：生甘草能泻心火，熟（炙）甘草能发散表寒。发散表寒的方剂，没有比桂枝汤和麻黄汤更好的了。自汗的人属于表虚，所以桂枝汤用桂枝和白芍来疏散风邪，生姜和大枣来调和营卫。无汗的人属于表实，所以麻黄汤用麻黄和桂枝来散寒，再加杏仁。但是如果解表而不顾护中焦脾胃之气，那么中气一旦亏虚，其他疾病就会随之产生。所以这两个方剂中都含有炙甘草来安固中气。表实证和表虚证不同，所以两个方剂中甘草的用量也有多寡之分。由此可见，使用炙甘草是为了资助和镇抚正气，而不是为了协助攻伐邪气。李东垣不加区分地论述，并不是给学习者提供准确的方法。
李东垣又说：如果是心火侵犯脾土，导致腹中急痛、腹部肌肉紧急收缩的情况，应该加倍使用甘草。按小建中汤治疗里急腹痛来看，其中甘草也是炙用的，但这并非心火乘脾的病证。生甘草能泻心火，但不治疗心火乘脾引起的腹痛。《本经》记载黄连主治腹痛，治疗心火乘脾引起的腹痛，就是张仲景的黄连汤。李东垣的说法，确实有不妥当之处。刘潜江阐发了心火乘脾的理论，并对此深表赞同。邹氏又引用李东垣的这个说法，来证明栀子甘草豉汤治疗虚烦不得眠的道理。不得眠怎么可能是脾病呢？这三位都是名医，但对于甘草如此不加以细致辨析，真是让人无法理解。
王海藏说：附子理中汤中使用甘草，是担心它助长附子上炎。调胃承气汤中使用甘草，是担心它加速泻下。按《伤寒论》中并没有附子理中汤这个方名，理中汤中加入附子，是在出现腹满症状时加用的。腹满而加附子，大概是因为附子是调理中宫（脾胃）不可或缺的药物。如果担心附子上炎，那么白通汤是少阴病下利用附子，为什么反而没有甘草呢？至于生用而不炙用，其中自有道理。寒邪多的霍乱，并非完全不挟带热邪，温中补虚已经有干姜、人参、白术，所以加上微凉的生甘草，这正是《别录》所说的除烦满，以及李东垣所说的养阴血的作用。将此方用于治疗胸痹，生甘草也是因为气结在胸，不希望药性过于守中。调胃承气汤，是治疗胃气不和导致的内实，以“调胃”为下法中的精妙之法。舍弃枳实、厚朴而选用炙甘草，是与大黄、芒硝形成一补一攻的配合，恰好符合……
王海藏又说：凤髓丹中使用甘草，是为了缓和肾急从而生成元气。我认为这也是不对的。这个方子不知道是谁制定的，《名医方论》说它治疗梦遗失精以及与鬼交合。《医方集解》说它治疗心火旺盛、肾精不固容易泄出。对于方义的精微之处，没有人深入探讨过。元阴听从元阳的指挥，元阳听从天君（心）的指挥。所以心火炽盛会感应到肾，肾受到感应后阳气发动，阴液随之而动，这是必然的。黄柏平靖肾中的火，防止肾中的水泛滥；火不妄动则阳气潜藏，水不泛溢则阴精坚固。砂仁收纳火土之气于水中，使肾得以闭藏。然而心肾两家，交通最容易，只治肾不治心，是不完善的。生甘草能泻心火，宁心安神。大甘是土的纯正味道，并且能制止肾水上越之火（洄溪语）。《医方集解》中关于“治心火旺盛”的一句话，实际上就是用到了甘草与人参。甘草与人参都能补中气、调和诸药，但张仲景用在方剂中，则有明确的分别，毫不通融。姑且举两个方子来说明：厥阴病如果有呕吐，则兼有少阳病，张仲景的法则是转枢少阳，多用干姜和黄连并用，我已经在干姜条下阐述过我的观点。干姜黄连人参汤，是由小柴胡汤加减而来，却是舍弃甘草而用人参，几乎让人难以理解。不是说“食入口即吐”吗？少阳上升之气，遇到食物就拒绝，难以忍受片刻。甘草味甘壅滞，怎么能承受得住？人参甘苦相济，是和缓少阳的专药，枢机通畅则食物自然下行，所以甘草不是它的对手。那些舍弃人参而用甘草的情况呢？栀子豉汤治疗虚烦不得眠，如果伴有少气，就用栀子甘草豉汤主治。这在粗疏的医生看来，一定会用人参来益气。哪里知道人参补气同时也升气，栀豉汤的呕吐，是由于这两味药一升一降相互激荡造成的，得到人参后，升不成升，降不成降，夹杂其补性，反而足以阻滞邪气。所谓懊憹，是反复烦闷之甚；少气是懊憹之甚，并不是元气亏损，而是郁热损伤了气。栀豉能吐出邪气，但不能安定气机，这就是张仲景之所以取用甘平清心火的甘草，而人参不能列入其中的原因。
邹氏认为黄芪桂枝五物汤是治疗下部的，治疗下部制方宜急，急则去掉甘草而增加药量。桂枝加黄芪汤是治疗上部的，治疗上部制方宜缓，缓则加入甘草而减少药量。于是他在血痹证中，只摘录“尺中小紧”这一句作为病在下部的证据，并且另外引用本篇首条来证明他治疗下部的说法。却不思考“尺中小紧”下一句是“身体不仁”，如果说这不是病，哪有这种道理？本篇首条本来与本病无关，况且有关“关上小紧”的句子，难道只有“尺中小紧”是病在下部，“关上小紧”也是病在下部吗？在黄汗证中，他摘录“腰以上汗出”这一句作为病在上部的证据，并且另外引用本篇第二条来证明他治疗上部的说法。却不思考“腰以上汗出”下一句是“腰弛痛、小便不利”，如果说这不是下体有病，哪有这种道理？本篇第二条并非本条的病证却引用它，那么其他条文又有黄汗之为病，身体肿，汗沾衣等句子，难道也能说只是指上体吗？血痹篇尤注阐发“宜针引阳气”一句，非常精当。对于黄芪桂枝五物汤，尤其说是调和营血的滞涩，帮助卫气的运行。这也是针引阳气的意思。经文所说“阴阳形气俱不足者，勿刺以针而调以甘药也”，引用经文来解释此方，也正切合。夫血痹者，痹在表不在里。用甘药代替针刺，也是调其表而非调其里。黄芪、桂枝、生姜、大枣，甘味与辛味结合，所以能补虚而宣通阳气。芍药辅助桂枝，就能入营而调血。去掉甘草且多加生姜的原因，是不希望药性守中，而希望其解表。甘草的运用还有这样的斟酌。因为不是桂枝汤的加减方，所以不叫桂枝加黄芪汤。然而桂枝加黄芪汤，难道不可以对桂枝汤进行深入思考吗？我认为黄芪自然是桂枝汤不可少的药物，怎么能去掉它呢？桂枝和白芍减量而甘草不减，说明阳虚与邪风是不同的。邹氏不明白张仲景制方的原理，肆意发表主观见解，瑕疵丛生，实在毫无意义。
Gancao (Radix Glycyrrhizae) has yellow skin and reddish interior, confirming it as a herb entering the Heart and Spleen meridians. However, the Qi of the Five Zang and Six Fu organs all derives from the Spleen, and the Heart is the sovereign of the body. Gancao possesses an extremely sweet taste and a very neutral nature; therefore, its effects can extend from the Heart and Spleen to other Zang and Fu organs, reaching everywhere and dispelling all pathogenic factors. Its efficacy lies entirely in its sweetness: sweetness tonifies and sweetness moderates. In all formulas by Zhang Zhongjing used for tonifying deficiency and relieving urgency, roasted Gancao is invariably employed; for clearing heat, raw Gancao is used, though even in clearing heat, there is an element of moderation. For instance, treating sore throat and lung abscess often involves fire in the Upper Jiao. Since Gancao enters the Heart, Ganxixin Decoction (Cordate Licorice Decoction) is used to drain Heart epigastric fullness (Pi), not Heart fire. To resolve fullness, herbs like Huanglian (Rhizoma Coptidis), Huangqin (Radix Scutellariae), and Banxia (Rhizoma Pinelliae) are used; Gancao here merely tonifies the Stomach, hence the roasted form is used. The fact that a formula using roasted Gancao is named after Gancao highlights the significant role played by this herb.
Li Dongyuan stated: Raw Gancao drains Heart fire, while cooked (roasted) Gancao disperses exterior cold. Among formulas for dispersing exterior cold, Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang (Ephedra Decoction) are paramount. Patients with spontaneous sweating have exterior deficiency; thus, Guizhi Tang uses Guizhi (Ramulus Cinnamomi) and Baishao (Radix Paeoniae Alba) to disperse wind pathogens, and Shengjiang (Rhizoma Zingiberis Recens) and Dazao (Fructus Jujubae) to harmonize Ying and Wei. Patients without sweating have exterior excess; thus, Mahuang Tang uses Mahuang (Herba Ephedrae) and Guizhi to dispel cold, augmented with Xingren (Semen Armeniacae Amarum). However, if exterior resolution neglects the Middle Jiao, a depletion of Middle Qi will lead to subsequent ailments. Therefore, both formulas contain roasted Gancao to stabilize the Middle. Since exterior excess and exterior deficiency differ, the dosage of Gancao varies between the two. This demonstrates that roasted Gancao is used to support and pacify righteous Qi, not to assist in destructive attacks. Li Dongyuan’s lack of distinction fails to provide students with accurate guidelines.
Li Dongyuan further claimed: When Heart fire invades the Spleen, causing abdominal urgency and pain with muscle contraction, Gancao should be doubled. Examining Xiaojianzhong Tang (Minor Construct the Middle Decoction), which treats internal urgency and abdominal pain, uses roasted Gancao, yet this condition is not Heart fire invading the Spleen. Raw Gancao drains Heart fire but does not treat abdominal pain caused by Heart fire invading the Spleen. The *Shennong Bencao Jing* states Huanglian (Rhizoma Coptidis) treats abdominal pain; specifically for Heart fire invading the Spleen, one should use Zhang Zhongjing’s Huanglian Tang (Coptis Decoction). Li Dongyuan’s statement is indeed inconsistent. Liu Qianjiang elucidated the meaning of Heart fire invading the Spleen and praised it deeply. Zou then cited Li’s statement to justify the use of Gancao in Zhizi Ganchi Tang (Gardenia, Licorice, and Fermented Soybean Decoction) for treating vexation and insomnia. How can insomnia be attributed solely to Spleen disease? These three were renowned masters, yet their failure to distinguish Gancao’s nuances so thoroughly is incomprehensible.
Wang Haicang stated: Gancao is used in Fuzi Lizhong Tang (Aconite Decoction to Regulate the Middle) to prevent Fuzi (Radix Aconiti Lateralis Preparata) from flaming upward. Gancao is used in Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction) to prevent rapid purgation. However, *Shanghan Lun* does not list "Fuzi Lizhong Tang"; adding Fuzi to Lizhong Tang (Regulate the Middle Decoction) occurs only when abdominal fullness arises. Adding Fuzi for abdominal fullness implies it is indispensable for regulating the Central Palace (Middle Jiao). If one fears Fuzi flaming upward, consider Baitong Tang (White Onion Decoction), which uses Fuzi for Shaoyin syndrome with diarrhea, yet contains no Gancao. Regarding the choice of raw over roasted Gancao, there is inherent logic. In cold-dominant Huoluan (Cholera-like disorder), heat may still be present. While Ganjiang (Rhizoma Zingiberis), Renshen (Radix Ginseng), and Baizhu (Rhizoma Atractylodis Macrocephalae) warm the middle and tonify deficiency, adding raw Gancao provides slight coolness, aligning with *Bencao Jing Jiu*’s description of relieving vexation and fullness, and Li Dongyuan’s concept of nourishing Yin blood. When applied to Xinbi (Chest Bi), raw Gancao addresses Qi stagnation in the chest, avoiding excessive retention. Tiaowei Chengqi Tang treats internal excess due to Stomach Qi disharmony; its method of "regulating the Stomach" is subtle. By discarding Zhishi (Fructus Aurantii Immaturus) and Zhiike (Pericarpium Citri Reticulatae) and selecting roasted Gancao, it pairs with Dahuang (Radix et Rhizoma Rhei) and Mangxiao (Natrii Sulfas) in a complementary tonifying and draining manner...
Wang Haicang also stated: Gancao is used in Fengsui Dan (Phoenix Marrow Pill) to moderate Kidney urgency and generate Yuan Qi. I believe this is incorrect. The origin of this formula is unknown. *Mingyi Fanglun* states it treats nocturnal emission and spermatorrhea or sexual intercourse with spirits. *Yifang Jijie* states it treats excessive Heart fire and insecure Kidney essence prone to leakage. No one has explored its profound principles. Yuan Yin obeys Yuan Yang, and Yuan Yang obeys Tianjun (Heart). Thus, blazing Heart fire affects the Kidney; upon stimulation, Yang moves and Yin follows inevitably. Huangbai (Cortex Phellodendri) calms fire in the Kidney and prevents water from flooding; if fire does not flare, Yang remains dormant; if water does not overflow, Yin remains firm. Sharen (Fructus Amomi Rotundus) gathers Fire and Earth Qi into Water, allowing the Kidney to store securely. However, Heart and Kidney communicate easily; treating only the Kidney without addressing the Heart is incomplete. Raw Gancao drains Heart fire and calms the Spirit. Sweetness is the true flavor of Earth and can suppress fire rising from overflowing Kidney Water (Huíxī’s words). The phrase in *Jijie* regarding "treating excessive Heart fire" actually utilizes Gancao and Renshen. Both tonify Middle Qi and harmonize formulas, but Zhang Zhongjing distinguishes their usage strictly. Consider two examples: In Jueyin syndrome with vomiting, Shaoyang involvement is treated by pivoting Shaoyang, often using Ganjiang and Huanglian together (as detailed under Ganjiang). Ganjiang Huanglian Renshen Tang modifies Xiao Chaihu Tang but replaces Gancao with Renshen, which is puzzling. Does it not say "vomiting immediately after eating"? Shaoyang ascending Qi rejects food instantly; urgency cannot wait. Gancao’s cloying sweetness cannot bear this burden. Renshen, with balanced sweet and bitter properties, is the specific herb for harmonizing Shaoyang; once the pivot functions, food descends naturally, making Gancao unsuitable. Conversely, when Gancao replaces Renshen: Zhichi Chi Tang treats vexation and insomnia; if accompanied by shortness of breath, Zhizi Ganchi Tang is indicated. Crude practitioners would likely use Renshen to tonify Qi. Yet, Renshen tonifies and ascends Qi. The vomiting in Zhichi Chi Tang results from the mutual agitation of ascending and descending actions of its ingredients; adding Renshen disrupts this balance, and its tonifying nature may obstruct pathogens. "Ao'ao" refers to severe restlessness; "shortness of breath" here is severe restlessness damaging Qi, not Yuan Qi deficiency. Zhichi can expel pathogens via vomiting but cannot calm Qi. Thus, Zhang Zhongjing chose sweet, neutral Gancao to clear Heart fire, excluding Renshen.
Zou argued that Huangqi Guizhi Wuwu Tang targets the lower body, requiring urgent action, hence removing Gancao and increasing dosages. Guizhi Jia Huangqi Tang targets the upper body, requiring slow action, hence adding Gancao and reducing dosages. In Blood Bi syndrome, he isolated "slight tightness at the Chi pulse" as evidence of lower pathology, citing the first line of the chapter to support treating the lower. He ignored that the next line mentions "numbness of the body," implying pathology exists. The first line of the chapter is irrelevant to this disease; moreover, if Chi pulse tightness indicates lower pathology, does Guan pulse tightness also indicate lower pathology? In Yellow Sweat syndrome, he isolated "sweating above the waist" as evidence of upper pathology, citing the second line. He ignored that the next line mentions "loosening pain in the lower back and difficulty urinating," implying lower pathology. Citing the second line, which describes different symptoms like swelling and sticky sweat, proves his selective interpretation flawed. You Zhu’s commentary on "suitable to needle and guide Yang Qi" is precise. Huangqi Guizhi Wuwu Tang harmonizes Ying stagnation and assists Wei movement, reflecting the intent of guiding Yang Qi. The Classic states: "When Yin, Yang, Form, and Qi are all deficient, do not needle; regulate with sweet herbs." Applying this to the formula fits perfectly. Blood Bi affects the exterior, not the interior. Using sweet herbs instead of needles regulates the exterior. Huangqi, Guizhi, Shengjiang, and Dazao combine sweet and pungent flavors to tonify deficiency and disseminate Yang. Shaoyao assisting Guizhi enters Ying to regulate blood. Removing Gancao and increasing Shengjiang avoids interior retention and promotes exterior resolution. Such nuance exists in Gancao’s use. It is not a modification of Guizhi Tang, hence not named Guizhi Jia Huangqi Tang. However, one must reflect on Guizhi Tang when considering Guizhi Jia Huangqi Tang. Huangqi is integral to Guizhi Tang; how can it be removed? Reducing Guizhi and Shaoyao but keeping Gancao constant shows that Yang deficiency differs from wind pathogens. Zou failed to understand Zhang Zhongjing’s formulation principles, offering subjective speculations riddled with errors, which is meaningless.