麻黄（二两半去节） 升麻（一两一分） 当归（一两一分） 知母 黄芩 葳蕤（各十八铢） 石膏（碎绵裹） 白
术干姜 芍药 天门冬（去心） 桂枝 茯苓 甘草（炙各六铢）
上十四味。以水一斗。先煮麻黄一两沸。去上沫。内诸药。煮取三升。去滓。分温三服。相去如炊三斗米顷。令尽。
汗出愈。
成注引玉函曰。大热之气。寒以取之。甚热之气。以汗发之。麻黄升麻之甘。以发浮热。正气虚者。以辛润之。当
归桂姜之辛以散寒。上热者。以苦泄之。知母黄芩之苦。凉心去热。津液少者。以甘润之。茯苓白术之甘。缓脾生津。
肺燥气热。以酸收之。以甘缓之芍药之酸。以敛逆气。葳蕤天门冬石膏甘草之甘。润肺除热。
琥按上仲景方。既系错杂。成氏注。又多差误。况系厥阴难治之证。医人何以措手。
琥又按上汤。乃肺脾之药而兼走肝。麻黄升麻升肺脾之阳也。知母黄芩石膏葳蕤天门冬。能清肺家之燥热。以下后。
则津液重亡。兼之唾脓血。则肺愈燥。而热故也。白术茯苓炙甘草。温补脾虚兼主泄利。下多亡阴。故以芍药当归和补
中下二焦之阴。肝与脾兼受其益也。用干姜者。温中气以济知芩石膏之寒也。用桂枝者。调营卫而兼升阳之用也。服药
令尽。使汗出愈者。非用上药以发汗。此以见阴阳和。则汗微出。而厥逆等候自除之意。
伤寒四五日。腹中痛。若转气下趋少腹者。此欲自利也。（此条乃言厥阴腹痛。将欲自利之证也。伤寒四五日。邪气
传里之时。腹中痛者。凡三阴之经皆走腹。若腹中更有转气。下趋少腹。此为厥阴经腹痛明矣。里气虚而遇邪热。故不
上结于胸。遂下移于肠。欲作自利之证。按此条论。仲景无治法。愚意云。未利者。宜四逆散。已利者。宜白头翁汤。
补亡论常器之云。宜四逆汤散。愚以汤散寒热相反。何得误用。）
伤寒本自寒下。医复吐下之。寒格。更逆吐下。若食入口即吐。干姜黄连黄芩人参汤主之。（此条乃言厥阴伤寒过于
吐下之变证也。本自寒下者。谓病患平日。胃气本自虚寒而下利也。厥阴病邪结胸中。心下烦满者。固当吐。前热后厥
者。应宜下。医人倘罔顾其寒热虚实。而吐之下之。凡吐下之药。又皆苦寒。寒格者。两寒格拒其热。为上寒下热。故
其人更逆吐下。谓病上吐下利。为更逆而甚也。食入口即吐者。此形其逆之至也。用干姜芩连人参汤者。以开寒格。清
中下二焦热。而兼补里虚也。）
麻黄（二两半，去节） 升麻（一两一分） 当归（一两一分） 知母 黄芩 葳蕤（各十八铢） 石膏（打碎，用绵布包裹） 白术 干姜 芍药 天门冬（去心） 桂枝 茯苓 甘草（炙，各六铢）
以上十四味药。用水一斗。先煮麻黄，煮沸一两次的次数后。去掉上面的浮沫。加入其余药物。煮取三升药液。去掉药渣。分三次温服。两次服药间隔时间约为煮熟三斗米所需的时间。让患者全部服完。出汗即愈。
成无己注引《玉函经》说：大热之气，用寒凉药来解除它。极热之气，用发汗法来发散它。麻黄、升麻的甘味，用来发散浮游之热。正气虚弱的人，用辛润之法。当归、桂枝、干姜的辛味，用来散寒。上焦有热者，用苦味药泄热。知母、黄芩的苦味，能清心除热。津液不足的人，用甘润之法。茯苓、白术的甘味，能缓和脾气生津液。肺燥气热，用酸味收敛。用甘味缓急。芍药的酸味，用来收敛逆乱之气。葳蕤、天门冬、石膏、甘草的甘味，能润肺除热。
琥按：上述张仲景的方剂，既然属于寒热错杂之证，成无己的注释，又多有误。况且这是厥阴病难治的证候，医生如何下手治疗？
琥又按：上述汤剂，是调理肺脾的药物而兼走肝经。麻黄、升麻提升肺脾之阳气。知母、黄芩、石膏、葳蕤、天门冬，能清除肺家的燥热。因为经过攻下之后，津液严重耗伤。加之唾脓血，则肺更加干燥而有热。白术、茯苓、炙甘草，温补脾虚兼主治泄利。下利多亡阴，所以用芍药、当归调和补益中下二焦之阴。肝与脾同时受益。使用干姜的原因，是温中气以济助知母、黄芩、石膏的寒性。使用桂枝的原因，是调和营卫并兼有升阳的作用。服药令尽，使汗出而愈，并非用上药来强行发汗，此处可见阴阳调和，则微微出汗，而厥逆等证候自然消除的意思。
伤寒四五日，腹中痛。如果感觉气向下运行至小腹，这是将要自利的征兆。（此条讲的是厥阴腹痛，即将发生自利的证候。伤寒四五日，是邪气传入里的时期。腹中痛，凡是三阴经都经过腹部。如果腹中还有转气，向下趋向少腹，这明确是厥阴经腹痛。里气虚弱而遇到邪热，所以不向上结于胸膈，于是向下移于肠道，想要形成自利的证候。按此条论述，张仲景没有给出治法。我个人的意见是：未腹泻者，宜用四逆散；已腹泻者，宜用白头翁汤。补亡论中常器之说，宜用四逆汤散。我认为汤剂散寒，与病情寒热相反，为何会误用？）
伤寒本来就有寒性下利，医生又反复使用吐法和下法。导致寒邪格拒，反而加重了呕吐和下利。如果食物入口即吐，主方用干姜黄连黄芩人参汤。（此条讲的是厥阴伤寒过度使用吐下法后的变证。所谓“本自寒下”，是指病人平时胃气本就虚寒而下利。厥阴病邪结于胸中，心下烦满，固然应当用吐法；前热后厥者，应当用下法。医生如果不顾其寒热虚实，而使用吐下法。凡吐下之药，又都是苦寒之品。寒格，是指两寒格拒其热，造成上寒下热的局面，所以此人反而出现更严重的吐下。指病在上部呕吐下部泄利，是更加逆乱且严重。食物入口即吐，这是形容逆乱之气的极致。使用干姜、黄芩、黄连、人参汤的原因，是为了开通寒格，清泄中下二焦之热，并兼补里虚。）
Ephedrae Herba (Mahuang, 麻黄) (2.5 liang, remove joints), Cimicifugae Rhizoma (Shengma, 升麻) (1.1 liang), Angelicae Sinensis Radix (Danggui, 当归) (1.1 liang), Anemarrhenae Rhizoma (Zhimu, 知母), Scutellariae Radix (Huangqin, 黄芩), Polygonati Rhioma (Weirui, 葳蕤) (each 18 zhu), Gypsum Fibrosum (Shigao, 石膏) (crushed, wrapped in cotton cloth), Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), Zingiberis Rhizoma (Ganjiang, 干姜), Paeoniae Radix Alba (Shaoyao, 芍药), Asparagi Radix (Tianmendong, 天门冬) (remove heart), Cinnamomi Ramulus (Guizhi, 桂枝), Poria (Fuling, 茯苓), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (honey-fried, each 6 zhu).
The above fourteen ingredients. Use one dou of water. First decoct Ephedrae Herba until it boils for the duration of two or three grains of rice falling. Remove the foam on the surface. Add the remaining herbs. Decoct to obtain three sheng of liquid. Remove the dregs. Divide into three warm doses. The interval between doses should be approximately the time it takes to cook three dou of rice. Administer completely. Recovery occurs with sweating.
Cheng Wuji's commentary cites the *Yufang Jing* saying: For severe heat qi, use cold medicines to resolve it. For extreme heat qi, use diaphoresis to disperse it. The sweet nature of Mahuang and Shengma is used to disperse floating heat. For those with deficient righteous qi, use acrid-moistening methods. The acrid nature of Danggui, Guizhi, and Ganjiang is used to dispel cold. For heat in the upper jiao, use bitter drugs to drain heat. The bitter nature of Zhimu and Huangqin cools the heart and removes heat. For those with insufficient body fluids, use sweet-moistening methods. The sweet nature of Fuling and Baizhu soothes the spleen and generates fluids. For lung dryness and qi heat, use sour astringents. Use sweet agents to moderate urgency. The sour nature of Shaoyao is used to constrain rebellious qi. The sweet nature of Weirui, Tianmendong, Shigao, and Gancao moistens the lung and removes heat.
Hu notes: The aforementioned formula by Zhang Zhongjing, being a complex mixture of cold and heat, has annotations by Cheng Shi that contain many errors. Moreover, this is a difficult-to-treat syndrome of Jueyin disease; how can physicians apply treatment?
Hu further notes: The aforementioned decoction consists of herbs acting on the Lung and Spleen, while also affecting the Liver. Mahuang and Shengma ascend the yang of the Lung and Spleen. Zhimu, Huangqin, Shigao, Weirui, and Tianmendong clear dryness-heat in the Lung. Since purgation has already been performed, body fluids are severely depleted. Additionally, expectoration of pus and blood indicates the Lung is even drier and hotter. Baizhu, Fuling, and honey-fried Gancao warm and tonify Spleen deficiency and primarily treat diarrhea. Profuse downward discharge leads to loss of yin; therefore, Shaoyao and Danggui are used to harmonize and tonify the yin of the middle and lower jiao. Both the Liver and Spleen benefit. Dried Ginger (Ganjiang) is used to warm the middle qi to counteract the cold nature of Zhimu, Huangqin, and Shigao. Cinnamon Twig (Guizhi) is used to harmonize Ying and Wei and assist in ascending yang. Taking the medicine completely to induce sweating does not mean using these herbs to forcibly induce perspiration; rather, it demonstrates that when Yin and Yang harmonize, slight sweating occurs, and symptoms such as cold extremities naturally resolve.
In Cold Damage after four or five days, if there is abdominal pain, and one feels gas moving downward toward the lower abdomen, this indicates an impending spontaneous diarrhea. (This clause describes the syndrome of Jueyin abdominal pain preceding spontaneous diarrhea. Four or five days into Cold Damage is the time when pathogenic factors transmit inward. Abdominal pain involves all three Yin meridians traversing the abdomen. If there is additionally gurgling gas moving down to the lower abdomen, this clearly indicates Jueyin meridian abdominal pain. Interior qi is deficient and encounters pathogenic heat, so it does not bind upward in the chest but moves downward into the intestines, intending to form a spontaneous diarrhea syndrome. According to this clause, Zhang Zhongjing provides no treatment method. My opinion is: if diarrhea has not yet occurred, Si Ni San is appropriate; if diarrhea has already occurred, Bai Tou Weng Tang is appropriate. In the *Bu Wang Lun*, Chang Qizhi suggests Si Ni Tang powder. I believe that using a decoction to dispel cold contradicts the cold-heat dynamics; why would it be mistakenly used?)
If Cold Damage originally involved cold-type diarrhea, and the physician repeatedly applies emesis and purgation, cold obstruction occurs, exacerbating vomiting and diarrhea. If food is vomited immediately upon entering the mouth, Gan Jiang Huang Lian Huang Qin Ren Shen Tang is indicated. (This clause discusses the complicated syndrome resulting from excessive emesis and purgation in Jueyin Cold Damage. "Originally involving cold diarrhea" refers to the patient having inherent stomach qi deficiency and cold with diarrhea. When Jueyin pathogenic factors bind in the chest causing fullness and irritability below the heart, emesis is indeed indicated; when there is prior heat followed by cold extremities, purgation is indicated. If the physician ignores the cold, heat, excess, and deficiency and applies emesis and purgation, since these medications are typically bitter-cold, cold obstruction arises from the mutual rejection of cold and heat, creating upper cold and lower heat. Consequently, the patient experiences exacerbated vomiting and diarrhea, meaning the condition worsens with vomiting above and diarrhea below. Vomiting food immediately upon ingestion describes the extremity of rebellious qi. Gan Jiang Huang Lian Huang Qin Ren Shen Tang is used to open the cold obstruction, clear heat in the middle and lower jiao, and simultaneously tonify interior deficiency.)