治发汗后不可更行桂枝汤。若汗出而喘。无大热者。此汤主之。下后
麻黄（四两 去节。） 杏仁（五十枚） 甘草（二两 炙。） 石膏（半斤）
上四味。以水七升。先煮麻黄。去上沫。纳诸药。煮取二升。去滓。温服一升。
歌曰 四两麻黄八两膏。二甘五十杏同熬。须知禁桂为阳盛。喘汗全凭热势操。
男元犀按。此借治风温之病。论曰。太阳病发热而渴不恶寒者。为温病。若发
灼热者名风温一节。未出其方。此处补之。其文略异。其实互相发明。不然。汗后病不解。
正宜桂枝汤。曰不可更行者。知阳盛于内也。汗出而喘者。阳盛于内。火气外越
气上越而喘也。其云无大热。奈何。前论温病曰发热而渴不恶寒者。邪从内出。得太阳之标
热。无太阳之本寒也。今曰无大热。邪已蕴酿成热。热盛于内。以外热较之而转轻也。读书
要得间。不可死于句下。至于方解。柯韵伯最妙。宜熟读之。
柯韵伯云。此方为温病之主剂。凡冬不藏精之人。热邪伏于脏腑。至春风解冻。伏邪自
内而
证
此法是也。此病得于寒时。而发于风令。故又名曰风温。其脉阴阳俱浮。其证自汗身重。盖
阳浮则强于卫外而闭气。故身重。当用麻黄开表以逐邪。阴浮不能藏精而汗出。当用石膏镇
阴以清火。表里俱热。则中气不运。升降不得自如。故多眠鼻鼾。语言难出。当用杏仁、甘
草以调气。此方备升降轻重之性。足以当之。若攻下火熏等法。此粗工促病之术也。盖内蕴
之火邪与外感之余热。治不同法。是方温病初起。可用以解表清里。汗后可复用以平内热之
猖狂。下后可复用以彻伏邪之留恋。与风寒不解用桂枝汤同法。例云。桂枝下咽。阳盛则毙。
特开此凉解一法。为大青龙汤之变局。白虎汤之先着也。然此证但热无寒。用青龙则不宜姜
、桂。恐脉流薄疾。斑黄狂乱作矣。此证但热不虚用白虎。则不宜参、米。恐食入于阴则长
气于阳。谵语腹胀矣。此为解表之剂。若无喘鼾语言难出等证。则又白虎之证治矣。凡治温
病表里之实。用此汤。治温病表里之虚。用白虎加参、米。相须相济者也。若葛根黄芩黄连
汤则治痢而不治喘。要知温病下后。无利不止证。葛根黄连之燥。非治温药。且麻黄专于外
达。与葛根之和中发表不同。石膏甘润。与黄连之苦燥悬殊。同是凉解表里。同是汗出而喘。
而用药有毫厘之辨矣。
治疗发汗之后，不可再使用桂枝汤。如果患者出现汗出且气喘，体表没有明显高热者，此方主治。经过攻下法治疗后：
麻黄（四两，去节） 杏仁（五十枚） 甘草（二两，炙） 石膏（半斤）
以上四味药，用水七升，先煮麻黄，去掉水面上的浮沫，再加入其他药物，煮取二升药液，去渣，温服一升。
歌诀曰：四两麻黄八两石膏，二两甘草五十枚杏仁一同熬制。必须知道禁用桂枝是因为阳气盛于内，气喘和出汗完全由热势决定。
陈元犀按语：此处借用治疗风温病的道理。医论中说：“太阳病发热而口渴、不恶寒的，称为温病。”若提到“身体灼热”的情况名为风温这一节，原文未给出方剂，此处予以补充。文字略有差异，但实质上是互相阐明的。否则，发汗后病邪未解，正适宜用桂枝汤，说“不可再用”，是知道体内阳气亢盛。汗出而气喘，是因为阳气盛于内，火气向外越，肺气上逆而致喘。文中说“无大热”，怎么解释呢？前文论述温病时说“发热而渴不恶寒”，说明邪气从内出，得到太阳经标阳之热，而没有太阳经本寒之象。现在说“无大热”，是因为邪气已经蕴酿成热，热盛于内，与体表的热相比显得较轻。读书要得其要领，不可拘泥于字句。至于方义解析，柯韵伯最为精妙，应当熟读。
柯韵伯说：此方是治疗温病的主方。凡是冬天未能藏精的人，热邪潜伏在脏腑，到了春天冰雪消融时，伏邪自内发出。这是正确的治法。此病得于寒冷之时，而发作于风气当令之时，所以又名风温。其脉象寸关尺三部皆浮，症状为自汗、身体沉重。大概阳气浮越则卫外功能过强而闭塞气机，所以身体沉重，应当用麻黄开泄腠理以驱除邪气；阴气浮越不能固藏精气而汗出，应当用石膏镇摄阴分以清降火热。表里俱热，导致中焦之气不运，升降失常，所以多睡、鼻鼾、语言困难，应当用杏仁、甘草来调畅气机。此方具备升降轻重的药性，足以应对此证。如果用攻下、火熏等方法，这是粗劣医生加速病情恶化的手段。因为内蕴的火邪与外感之余热，治疗方法不同。此方用于温病初起，可以解表清里；发汗后可再次使用以平息内部猖狂的热势；攻下后可再次使用以清除留恋的伏邪。这与风寒不解用桂枝汤的道理相同。经云：“桂枝汤入口，若阳气亢盛则会致死。”这里特开设清凉解表一法，是大青龙汤的变化格局，也是白虎汤的先导。然而此证只有热没有寒，如果用大青龙汤就不宜用生姜、桂枝，恐怕会导致血脉流动急疾，出现发斑、发黄、狂乱等症状。此证只有热而不虚，如果用白虎汤就不宜用人参、粳米，恐怕食物进入阴分会助长阳气，导致谵语、腹胀。这是解表的方剂，如果没有气喘、鼻鼾、语言困难等症状，那就是白虎汤的适应证了。凡治疗温病表里俱实的，用此汤；治疗温病表里俱虚的，用白虎加人参、粳米，二者相辅相成。至于葛根黄芩黄连汤则是治疗痢疾而不是治疗气喘的。要知道温病攻下后，若无腹泻不止的症状，葛根、黄连的燥性并非治疗温病的良药。况且麻黄专于向外达邪，与葛根调和其中并发表不同；石膏甘润，与黄连的苦燥截然不同。同样是凉解表里，同样有汗出而气喘的症状，但用药却有毫厘之差。
Treats the condition after sweating therapy where Guizhi Tang (Cinnamon Twig Decoction) should not be used again. If there is spontaneous sweating and wheezing, without significant external heat, this decoction is indicated. After purgation therapy:
Mahuang (Ephedrae Herba, four liang, remove joints) Xingren (Prunus Armeniaca Seed, fifty seeds) Gancao (Glycyrrhizae Radix et Rhizoma, two liang, honey-fried) Shigao (Gypsum Fibrosum, half jin)
The above four ingredients are boiled in seven sheng of water. First boil Mahuang, remove the foam on the surface, then add the other herbs. Boil until two sheng remain, strain, and take one sheng warm.
Song says: Four liang of Mahuang and eight liang of Shigao; two liang of Gancao and fifty Xingren are boiled together. One must know that Gui Zhi is prohibited because Yang is abundant internally; wheezing and sweating are entirely controlled by the heat pathogenesis.
Chen Yuanxi notes: This borrows from the treatment of Wind-Warmth disease. The treatise states: "Taiyang disease with fever, thirst, and no aversion to cold is called Warmth disease." Regarding the section mentioning "scorching heat" named Wind-Warmth, the original text did not provide a formula, which is supplemented here. The wording differs slightly, but they mutually elucidate each other. Otherwise, if the disease persists after sweating, Guizhi Tang would be appropriate. Saying it "should not be used again" indicates that Yang is hyperactive internally. Sweating and wheezing occur because Yang is abundant internally, fire qi escapes outward, and Lung Qi rebels upward causing wheezing. What does "no significant heat" mean? The previous discussion on Warmth disease said "fever, thirst, no aversion to cold," indicating the pathogen emerges from within, acquiring the superficial heat of Taiyang without its fundamental cold. Now saying "no significant heat" means the pathogen has fermented into heat, which is abundant internally; compared to external heat, it appears lighter. Reading requires grasping the essence, not being rigidly bound by words. Regarding the analysis of the formula, Ke Yunbo's explanation is the most exquisite and should be studied carefully.
Ke Yunbo says: This formula is the main agent for treating Warmth disease. For those who failed to store essence during winter, heat pathogens lie dormant in the zang-fu organs. When spring arrives and ice thaws, the latent pathogen emerges from within. This is the correct method. This disease originates from cold times but manifests during windy seasons, hence also called Wind-Warmth. The pulse is floating at all three positions (Yin and Yang). Symptoms include spontaneous sweating and heavy body. Generally, floating Yang strengthens the defensive exterior but closes the qi mechanism, causing heaviness; thus, Mahuang should be used to open the exterior and expel pathogens. Floating Yin fails to store essence, causing sweating; thus, Shigao should be used to anchor Yin and clear fire. Heat in both interior and exterior causes middle jiao qi stagnation, impairing ascending and descending functions, leading to somnolence, snoring, and difficulty speaking; thus, Xingren and Gancao should be used to regulate qi. This formula possesses properties of ascending/descending and light/heavy, sufficient to address this syndrome. Using purgation or moxibustion/fire methods are techniques of crude physicians to hasten illness. Internal latent fire pathogens and external residual heat require different treatments. This formula can resolve exterior and clear interior in early Warmth disease; it can be reused after sweating to quell rampant internal heat; and reused after purgation to eliminate lingering latent pathogens. This is similar to using Guizhi Tang for unresolved wind-cold. The classic states: "If Guizhi Tang enters the stomach and Yang is abundant, death ensues." Here, a cool resolving method is specifically established, as a variation of Da Qing Long Tang (Major Blue Green Dragon Decoction) and a precursor to Bai Hu Tang (White Tiger Decoction). However, this syndrome has heat only, no cold; using Qing Long Tang without Ginger and Cinnamon Twig is advisable, lest rapid blood flow cause macules, jaundice, and mania. This syndrome has heat but no deficiency; using Bai Hu Tang without Ginseng and Rice is advisable, lest food entering yin nourish yang, causing delirium and abdominal distension. This is an exterior-resolving agent. Without symptoms like wheezing, snoring, and speech difficulty, it becomes a Bai Hu Tang syndrome. For real excess in both exterior and interior of Warmth disease, use this decoction; for deficiency in both exterior and interior, use Bai Hu Tang plus Ginseng and Rice; they complement each other. Gegen Huangqin Huanglian Tang (Kudzu Root, Scutellaria Root, and Coptis Rhizome Decoction) treats dysentery, not wheezing. Note that after purgation in Warmth disease, if there is no persistent diarrhea, the drying nature of Gegen and Huangqin is not suitable for Warmth drugs. Moreover, Mahuang specializes in reaching outward, differing from Gegen's harmonizing middle and releasing exterior; Shigao is sweet and moist, vastly different from Huanglian's bitter and drying. Although both cool and resolve exterior/interior, and both present with sweating and wheezing, the medication choice differs by mere millimeters.