桂枝（四两去皮） 甘草（四两炙） 白术（三两） 人参（三两） 干姜（三两）
上五味。以水九升。先煮四味。取五升。肉桂。更煮取三升。去滓。温服一升。日再服。夜一服。
成注云。表未解者。辛以散之。里不足者。甘以缓之。此以里气大虚。表里不解。故加桂枝甘草于理中汤中也。
琥按上条证。用上汤。病者十不得一。倘虚证少有未确。服之必至杀人。盖太阳病。外证未除。而用桂枝。此必是
风邪在表。下之早。多成结胸。只因数下之故。不能成结胸。热移于大肠之间。邪结于胸膈以下。表不解。是外有风邪。
合用桂枝。里不解。恐内有实热。不当投理中也。况仲景法。心下痞硬者。皆用芩连大黄。协热利。复有白头翁汤。学
者宜临证详审虚实寒热。而相参用之可也。
（重出例）伤寒大下后。复发汗心下痞（云云至）。攻痞宜大黄黄连泻心汤（正文与注。见前大黄黄连泻心汤方下）
（附后例）伤寒发热。汗出不解。心下痞硬。呕吐而下利者。大柴胡汤主之。（此条证正文与注并汤。见后第七卷少
阳篇中）
病如桂枝证。头不痛项不强。寸脉微浮。胸中痞。硬气上冲咽喉。不得息者。此为胸有寒也。当吐之宜瓜蒂散。（此
条证。乃仲景议吐法也。成注云。病如桂枝证。为发热汗出恶风。此与太阳病中风无异也。若头不痛。项不强。则邪又
不在太阳经中矣。寸脉微浮者。脉经云。寸主射上焦。为上部。主候从胸以上至头。今者寸脉微浮。则风邪当见于上。
而头又不痛。知其邪在胸中矣。此所以胸中痞硬。不由误下而成。但因邪蕴于胸。其气必上冲咽喉。喘促而不能自布其
鼻息。此为胸有寒也。胸有寒者。乃风寒之邪。蕴蓄于膈间也。仲景法。当吐之。宜瓜蒂散。以吐胸中之邪。后条辩云。
痞硬一证。因吐下者为虚。不因吐下者为实。实邪填塞心胸。中下二焦为之阻绝。自不得不从上焦为出路。所谓在上者。
因而越之是也。愚按伤寒一病。吐法不可不讲。华元化云。伤寒至四日在胸。宜吐之。巢元方云。伤寒病三日以上。气
浮在上部。胸心填塞满闷当吐之。则愈。仲景以此条论。特出之太阳下编者。以吐不宜迟，与太阳汗证相等。当于两三
日间。审其证而用其法也。条辩以胸有寒为痰。亦通。盖胸有风寒。则其人平素饮食之积。必郁而成热。变而为痰。所
以瓜蒂散。亦涌痰热之药也。尚论篇以此条证。竟列入痰病中。误矣。）
桂枝（四两，去皮） 甘草（四两，炙） 白术（三两） 人参（三两） 干姜（三两）
以上五味药。用水九升。先煮前四味药。取药液五升。加入肉桂。再煎煮取三升药液。去渣。温服一升。每日两次。夜间一次。
成无己注解说：表证未解的，用辛味药发散；里气不足的，用甘味药缓急。这是因为里气大虚，表里同病不解，所以在理中汤中加入桂枝和甘草。
琥按：上一条所述的证候，使用上述汤剂的，病人十人中不到一个。如果虚证的判断稍有不确定，服用此方必定导致死亡。因为太阳病，外证未除，而使用桂枝，这必然是风邪在表。如果过早使用下法，多会形成结胸证。只因为多次使用下法，所以不能形成结胸证。热邪转移到大肠之间，邪气结聚于胸膈以下。表证未解，说明外有风邪，应当合用桂枝。里证未解，恐怕内有实热，不应当投用理中汤。况且张仲景的法度，心下痞硬的，都用黄芩、黄连、大黄。协热利，又有白头翁汤。学者应当临证详细审察虚实寒热，然后参酌使用即可。
（重出例）伤寒经过大力攻下后，又发汗，心下痞（云云至）。治疗痞证宜用大黄黄连泻心汤（正文与注释，见前面大黄黄连泻心汤方下方）。
（附后例）伤寒发热，汗出而病不解，心下痞硬，呕吐而下利的，主治以大柴胡汤。（此条证候的正文与注释及汤剂，见后面第七卷少阳篇中）
病症类似桂枝汤证，但头不痛，项不强，寸脉微浮，胸中痞塞硬满，气上冲咽喉，呼吸不畅的，这是胸中有寒邪。应当用吐法，宜用瓜蒂散。（此条证候，是张仲景论述吐法的。成无己注解说：病症类似桂枝汤证，表现为发热、汗出、恶风。这与太阳病中风无异。如果头不痛，项不强，那么邪气就不在太阳经中了。寸脉微浮，《脉经》说：寸部主候上焦，为上部，主候从胸以上至头的部位。现在寸脉微浮，则风邪应当见于上部，而头又不痛，可知邪气在胸中。这就是胸中痞硬，不是由误下造成的。只是因为邪气蕴结在胸中，其气必然上冲咽喉，喘促而不能自如地呼吸鼻息。这是胸中有寒邪。胸中有寒邪，是指风寒之邪蕴蓄在膈间。张仲景的法度，应当用吐法，宜用瓜蒂散，以吐出胸中的邪气。后条辩说：痞硬一证，因吐下造成的为虚证，不因吐下造成的为实证。实邪填塞心胸，中下二焦为之阻绝，自然不得不从上焦作为出路。所谓“在上者，因而越之”就是这个道理。我按：伤寒这一疾病，吐法不可不讲。华元化说：伤寒到第四日邪在胸，宜用吐法。巢元方说：伤寒病三天以上，气浮在上部，胸心填塞满闷当用吐法，则痊愈。张仲景以此条论述，特意列在太阳病误下之后，是因为吐法不宜迟，与太阳病汗法同等重要。应当在两三天间，审察其证候而使用其方法。条辩认为胸有寒是痰，也通顺。大概胸有风寒，那么其人平素饮食的积滞，必然郁结而成热，变而为痰。所以瓜蒂散，也是涌吐痰热的药物。尚论篇将此条证候，竟列入痰病中，是错误的。）
Guizhi (Cinnamon Twig) four liang, peeled; Gancao (Licorice Root) four liang, honey-fried; Baizhu (Atractylodis Macrocephalae Rhizome) three liang; Renshen (Ginseng Radix et Rhizoma) three liang; Ganjiang (Zingiberis Rhizoma) three liang.
The above five herbs. Use nine sheng of water. First decoct the first four herbs, obtain five sheng of liquid. Add Rougui (Cinnamon Bark), decoct further to obtain three sheng of liquid. Remove dregs. Take one sheng warm. Twice a day, once at night.
Cheng Wuji commented: For unresolving exterior syndrome, use pungent substances to disperse it; for insufficient interior qi, use sweet substances to moderate it. This is because the interior qi is greatly deficient, and both exterior and interior are unresolved. Therefore, Guizhi and Gancao are added to Lizhong Tang (Regulate the Middle Decoction).
Hu notes: In the aforementioned syndrome, patients who require the above decoction account for less than one in ten. If there is any uncertainty regarding the deficiency syndrome, administering this formula will certainly lead to death. Because in Taiyang disease (Taiyang Syndrome), if the exterior symptoms remain unremoved, using Guizhi implies that Wind pathogen is on the exterior. If purgation is used too early, it often results in Jie Xiong (Chest Binding). It is only because of multiple purgations that Jie Xiong does not form. Heat shifts to the large intestine, and pathogen binds below the chest and diaphragm. The exterior is unresolved, indicating external Wind pathogen, so Guizhi should be combined. The interior is unresolved, fearing internal excess heat, so Lizhong Tang should not be administered. Moreover, according to Zhang Zhongjing's method, cases of Pi Ying (epigastric fullness and hardness) all use Huangqin (Scutellaria Root), Huanglian (Coptidis Rhizome), and Dahuang (Rhubarb Root and Rhizome). For Xiere Li (diarrhea with fever), there is also Baitouweng Tang (Pulsatilla Decoction). Scholars should carefully examine deficiency/excess and cold/heat during clinical practice and use them accordingly.
(Repeated Example) After severe purgation for Shanghan (Cold Damage), followed by sweating, epigastric fullness (etc.). To treat Pi, Da Huang Huang Lian Xie Xin Tang (Rhubarb and Coptis Decoction to Drain the Epigastrium) is appropriate. (Main text and commentary see under Da Huang Huang Lian Xie Xin Tang formula previously.)
(Attached Example) Shanghan with fever, sweating without resolution, epigastric fullness and hardness, vomiting and diarrhea, is primarily treated with Chai Hu Tang (Bupleurum Decoction - specifically Da Chai Hu Tang). (This syndrome's main text, commentary, and formula see in Volume 7 Shaoyang Chapter later.)
The illness resembles Guizhi Tang syndrome, but the head does not hurt, the nape is not stiff, the cun pulse is slightly floating, there is epigastric fullness and hardness, Qi rushes upward to the throat causing dyspnea. This is Cold pathogen in the chest. Vomiting (emetic therapy) should be induced, using Gou Di San (Melon Seed Powder). (This syndrome discusses Zhang Zhongjing's emetic method. Cheng Wuji commented: Illness resembling Guizhi Tang syndrome involves fever, sweating, and aversion to wind, identical to Taiyang Wind Strike. If the head does not hurt and the nape is not stiff, the pathogen is no longer in the Taiyang meridian. Cun pulse slightly floating: Mai Jing states the Cun position governs the Upper Jiao, the upper part, monitoring from the chest up to the head. Now the Cun pulse is slightly floating, suggesting Wind pathogen appears in the upper part; since the head does not hurt, the pathogen is known to be in the chest. Thus, chest fullness and hardness are not caused by erroneous purgation, but by pathogen accumulation in the chest. Its Qi must rush upward to the throat, causing panting and inability to breathe freely through the nose. This is Cold in the chest. Cold in the chest refers to Wind-Cold pathogen accumulating between the diaphragm. Zhang Zhongjing's method dictates inducing vomiting, using Gou Di San to expel pathogen from the chest. Later commentaries state: Pi Ying syndrome caused by vomiting/purgation is deficiency; otherwise it is excess. Excess pathogen obstructs the heart and chest, blocking the Middle and Lower Jiaos, necessitating an exit via the Upper Jiao. This is "those above, induce evacuation." I note: Emetic therapy for Shanghan cannot be ignored. Hua Yuanhua said: Shanghan on the fourth day affects the chest, suitable for emesis. Chao Yuanfang said: Shanghan after three days, Qi floats in the upper part, chest and heart feel stuffed and full, suitable for emesis to cure. Zhang Zhongjing placed this discussion after Taiyang erroneous purgation because emesis should not be delayed, equal in importance to Taiyang sweating methods. It should be applied within two or three days after examining the syndrome. Commentaries interpreting "Cold in the chest" as Phlegm are also valid. Generally, Wind-Cold in the chest causes stagnation of normal dietary intake to郁结 (accumulate) into heat, transforming into Phlegm. Thus, Gou Di San is also a medicine to surge out Phlegm-Heat. Shanglun Pian incorrectly classified this syndrome under Phlegm diseases.)