少阴病，下利清谷，里寒外热，手足厥逆，脉微欲绝，身反不恶寒，其人面色赤，或腹痛，或干呕，或
咽痛，或利止脉不出者，通脉四逆汤主之。其脉即出者愈。下利清谷，里寒外热，汗出而厥者，通脉四逆汤
主之。
按此证乃寒积于中，热越于外，寒为真寒，热乃假热，故以表热里寒证属之。
通脉四逆汤
甘草（二钱） 干姜（三钱） 附子（一钱生用） 水煎服。面赤者加连须葱三茎，腹痛
者去葱加芍药二钱，呕者加生姜三钱，咽痛去芍药、加桔梗二钱，利止脉不出者，去桔梗、加人参二钱。按寒
凝于内，热郁于外，此乃阴盛格阳，温里即所以达表，故用姜甘温中而培土，附子暖下而回阳也。
发汗后，腹胀满者，浓朴生姜甘草半夏人参汤主之。伤寒汗出解之后，胃中不和，心下痞硬，干噫食臭，
胁下有水气，腹中雷鸣下利者，生姜泻心汤主之。伤寒中风，医反下之，其人下利日数十行，谷不化，腹中雷
鸣，心下痞硬而满，干呕心烦不得安。医见其心下痞，谓病不尽，复下之，其痞益甚。此非结热，但以胃中虚
，客气上逆，故便硬也。甘草泻心汤主之。伤寒五六日，呕而发热者，柴胡证具，而以他药下之，柴胡证仍在
者，复与柴胡汤。此虽已下之，不为逆。必蒸蒸而振，却发热汗出而解。若心下满而硬痛者，此为结胸也。大
陷胸汤主之。但满而不痛者，此为痞，柴胡汤不中与也，宜半夏泻心汤。伤寒发，汗若吐若下，解后心下痞硬
，噫气不除者，旋复花代赭石汤主之。太阳与少阳合病，若呕者，黄芩加半夏生姜
汤。伤寒胸中有热，胃中有邪气，腹中痛，欲呕吐者，黄连汤主之。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。
按以上诸证，均系汗吐下后，表气已虚，而内证或痞硬，或满痛，或下利，或噫气，或呕吐，仍属实邪在
里，故以表虚里实证统之。
浓朴生姜甘草半夏人参汤
浓朴（四钱） 生姜（四钱） 半夏（一钱五分） 甘草（二钱） 人参
（五分） 水煎服。按汗泄中气，阳虚湿旺，枢轴不运，脾陷胃逆，则生胀满，故用人参、甘草补中而扶阳，
朴夏生姜降浊而行郁也。
生姜泻心汤
生姜（二钱） 甘草（一钱五分） 人参（一钱五分） 干姜（五分） 黄芩（一钱五分）
半夏（一钱） 大枣（二枚） 黄连（五分） 水煎服。按汗出解后，中气已虚，而胸中复有实邪填塞，但其
邪有寒有热，故用生姜、半夏降其浊阴，黄芩、黄连清其心胆之热，姜甘参枣温补中气以转枢轴也。
甘草泻心汤
甘草（二钱） 黄芩（一钱五分） 干姜（一钱五分） 半夏（一钱） 黄连（五分） 大
枣（二枚） 水煎服。按当解表而反下之，败其中气，水谷不化，土木皆郁，升降倒行，故用甘草姜枣补中而温
下寒，半夏芩连降逆而清上热也。
半夏泻心汤
半夏（三钱） 黄芩（一钱五分） 干姜（一钱五分） 甘草（一钱五分） 人参（一钱
五分） 黄连（五分） 大枣（二枚） 水煎服，按下后中气已虚，里阴上逆而为痞，故用参甘姜枣温补中
脘之虚寒，黄芩黄连清泄上焦之郁热，半夏降浊阴而消痞满也。
旋复代赭石汤
旋复花（一钱五分） 代赭石（五分） 人参（一钱） 甘草（一钱） 半夏（一钱）
生姜（二钱五分） 大枣（二枚） 水煎服。按汗吐下后，中气已败，肺气郁蒸而化痰饮，胃土壅遏而生哕噫
，故用参甘大枣补其中脘，姜赭降其逆气，旋复花行痰
饮而开郁浊也。
黄芩加半夏生姜汤
黄芩（三钱） 甘草（二钱） 芍药（二钱） 半夏（二钱） 生姜（三钱）
大枣（三枚） 水煎服。按太少合病，少阳经气郁而克戊土，土败而自下利，故用甘草大枣补其脾精，
黄芩芍药泄其相火，半夏生姜降胃逆而止呕吐也。
黄连汤
黄连（一钱五分） 甘草（一钱五分） 干姜（一钱五分） 人参（五分） 桂枝（一钱五
分） 半夏（一钱） 大枣（二枚） 水煎服。按肝邪克脾，腹中疼痛，胆邪克胃，欲作呕吐，故用黄连、半
夏清上热而止呕吐，参甘姜枣温中寒而止疼痛，桂枝疏木而通经也。
干姜黄连黄芩人参汤
干姜（一钱五分） 黄芩（一钱五分） 黄连（一钱五分） 人参（一钱五分）
水煎服。按中脘虚寒，而上焦有热，故用干姜、人参温补中脘之虚寒，黄连、黄芩清泄下焦之虚热也。
少阴病，出现下利且排泄物中有未消化的食物（完谷不化），这是里寒外热的表现，伴有手足冰冷逆冷，脉搏微弱几乎摸不到，身体反而不怕冷，患者面部发红，或者出现腹痛，或者干呕，或者咽喉疼痛，或者腹泻停止但脉搏仍摸不到的情况，应当用通脉四逆汤主治。如果脉搏随即恢复的就会痊愈。如果是下利且排泄物中有未消化的食物，里寒外热，出汗并且四肢厥冷的，也用通脉四逆汤主治。
按：此证乃是寒邪积聚在体内，热气发散于体表，寒是真正的寒，热是假的热，因此将此证归类为表热里寒证。
通脉四逆汤
甘草（二钱） 干姜（三钱） 附子（一钱，生用） 用水煎服。如果面部发红的，加带须葱白三根；如果腹痛的，去掉葱白，加芍药二钱；如果呕吐的，加生姜三钱；如果咽喉痛的，去掉芍药，加桔梗二钱；如果腹泻停止但脉搏仍摸不到的，去掉桔梗，加人参二钱。按：寒邪凝结在内，热气郁结在外，这是阴气过盛格拒阳气于外（阴盛格阳），温补里寒即所以通达表阳，因此使用干姜、甘草温中并培补脾胃（培土），附子温暖下焦并回阳救逆。
发汗治疗后，出现腹部胀满的，用厚朴生姜甘草半夏人参汤主治。伤寒通过发汗解除后，胃气不和，心窝部痞塞硬满，嗳气带有食物腐臭味，胁下有水饮之气，肠中雷鸣般作响并伴有下利的，用生姜泻心汤主治。伤寒或中风，医生反而使用攻下法，导致患者每天腹泻几十次，食物不消化，肠中雷鸣般作响，心窝部痞塞硬满，干呕，心烦意乱不得安宁。医生见其心窝部痞塞，认为病邪未尽，再次使用攻下法，导致痞塞更加严重。这并非实热结聚，只是因为胃气虚弱，客气上逆，所以导致大便硬结。用甘草泻心汤主治。伤寒五六天，出现呕吐且发热的，具备柴胡汤证，却用了其他药物攻下，如果柴胡汤证仍然存在，再次给予柴胡汤。这种情况虽然已经经过攻下，但不算误治。患者必定会出现全身蒸蒸发热并伴有战栗，随后发热出汗而病解。如果心窝部胀满且硬痛，这是结胸证。用大陷胸汤主治。只是胀满而不疼痛的，这是痞证，不宜使用柴胡汤，适宜用半夏泻心汤。伤寒经过发汗、催吐或攻下，病解后心窝部痞塞硬满，嗳气不止的，用旋复代赭石汤主治。太阳经与少阳经合病，如果有呕吐症状的，用黄芩加半夏生姜汤主治。伤寒胸中有热，胃中有邪气，腹部疼痛，想要呕吐的，用黄连汤主治。伤寒原本就有虚寒性下利，医生又反复使用催吐或攻下法，导致寒邪格拒，进一步引起呕吐和下利，如果食物入口即吐，用干姜黄连黄芩人参汤主治。
按：以上诸证，均是在发汗、催吐、攻下之后，表气已经虚弱，而内部症状或是痞塞硬满，或是胀满疼痛，或是下利，或是嗳气，或是呕吐，仍然属于实邪留在体内，因此将这些证候统称为表虚里实证。
厚朴生姜甘草半夏人参汤
厚朴（四钱） 生姜（四钱） 半夏（一钱五分） 甘草（二钱） 人参（五分） 用水煎服。按：发汗导致中气耗泄，阳气虚弱湿气旺盛，气机枢轴运转失常，脾气下陷胃气上逆，从而产生胀满，因此使用人参、甘草补益中气并扶助阳气，厚朴、半夏、生姜降浊气并疏通郁滞。
生姜泻心汤
生姜（二钱） 甘草（一钱五分） 人参（一钱五分） 干姜（五分） 黄芩（一钱五分） 半夏（一钱） 大枣（两枚） 黄连（五分） 用水煎服。按：发汗解除后，中气已经虚弱，而胸中又有实邪填塞，但这些邪气有寒有热，因此使用生姜、半夏降逆浊阴，黄芩、黄连清泄心胆之热，干姜、甘草、人参、大枣温补中气以转动气机枢轴。
甘草泻心汤
甘草（二钱） 黄芩（一钱五分） 干姜（一钱五分） 半夏（一钱） 黄连（五分） 大枣（两枚） 用水煎服。按：本应解表却反而攻下，败坏了中气，导致水谷不能消化，肝脾（土木）皆郁结，升降功能倒行，因此使用甘草、干姜、大枣补益中气并温煦下焦寒邪，半夏、黄芩、黄连降逆气并清泄上焦热邪。
半夏泻心汤
半夏（三钱） 黄芩（一钱五分） 干姜（一钱五分） 甘草（一钱五分） 人参（一钱五分） 黄连（五分） 大枣（两枚） 用水煎服。按：攻下后中气已虚，里阴之气上逆而形成痞证，因此使用人参、甘草、干姜、大枣温补中脘的虚寒，黄芩、黄连清泄上焦的郁热，半夏降逆浊阴并消除痞满。
旋复代赭石汤
旋复花（一钱五分） 代赭石（五分） 人参（一钱） 甘草（一钱） 半夏（一钱） 生姜（二钱五分） 大枣（两枚） 用水煎服。按：发汗、催吐、攻下后，中气已败坏，肺气郁蒸而生痰饮，胃土壅遏而产生呃逆和嗳气，因此使用人参、甘草、大枣补益中脘，生姜、代赭石降逆气，旋复花行化痰饮并开通郁浊。
黄芩加半夏生姜汤
黄芩（三钱） 甘草（二钱） 芍药（二钱） 半夏（二钱） 生姜（三钱） 大枣（三枚） 用水煎服。按：太阳与少阳合病，少阳经气郁结而克制胃土（戊土），胃气衰败而自然下利，因此使用甘草、大枣补益脾精，黄芩、芍药泄除相火，半夏、生姜降胃逆并止呕吐。
黄连汤
黄连（一钱五分） 甘草（一钱五分） 干姜（一钱五分） 人参（五分） 桂枝（一钱五分） 半夏（一钱） 大枣（两枚） 用水煎服。按：肝邪克制脾土，导致腹部疼痛，胆邪克制胃土，导致想要呕吐，因此使用黄连、半夏清上焦热并止呕吐，人参、甘草、干姜、大枣温中寒并止疼痛，桂枝疏理肝木并通经络。
干姜黄连黄芩人参汤
干姜（一钱五分） 黄芩（一钱五分） 黄连（一钱五分） 人参（一钱五分） 用水煎服。按：中脘虚寒，而上焦有热，因此使用干姜、人参温补中脘的虚寒，黄连、黄芩清泄下焦的虚热。
Shaoyin disease (Disease of the Shaoyin channel), characterized by diarrhea with undigested food (Wan Gu Bu Hua), indicates interior cold and exterior heat. Symptoms include cold extremities (Shou Zu Jue Ni) and a faint pulse nearly imperceptible (Mai Wei Yu Jue). The body is paradoxically not averse to cold, and the patient's face appears red. There may also be abdominal pain, dry retching, sore throat, or cessation of diarrhea with an unpalpable pulse. Tongmai Sini Tang (Pulse-Returning Decoction) is the primary treatment. If the pulse returns, the patient will recover. In cases of diarrhea with undigested food, interior cold and exterior heat, accompanied by sweating and cold extremities, Tongmai Sini Tang is also indicated.
Note: This syndrome involves cold accumulation in the interior and heat dissipating to the exterior. The cold is true cold, while the heat is false heat; thus, it is classified as Exterior Heat and Interior Cold Syndrome (Biao Re Li Han Zheng).
Tongmai Sini Tang (Pulse-Returning Decoction)
Gancao (Licorice Root, 2 qian)
Ganjiang (Dried Ginger, 3 qian)
Fuzi (Prepared Aconite Root, 1 qian, raw use)
Decoct in water and take orally. Add three stalks of scallion white (Lian Xu Cong) if the face is red; remove scallion and add Shaoyao (Peony Root, 2 qian) if there is abdominal pain; add Shengjiang (Fresh Ginger, 3 qian) if there is vomiting; remove Shaoyao and add Jiegeng (Platycodon Root, 2 qian) if there is a sore throat; remove Jiegeng and add Renshen (Ginseng Root, 2 qian) if diarrhea stops but the pulse remains unpalpable. Note: Cold coagulates internally, and heat is constrained externally. This is Yin Excess repelling Yang (Yin Sheng Ge Yang). Warming the interior serves to reach the exterior. Therefore, Ganjiang and Ganjiang warm the middle and strengthen the Earth (Pi Wei), while Fuzi warms the lower jiao and restores Yang.
After perspiration therapy, if abdominal distension occurs, Houpo Shengjiang Gancao Banxia Renshen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction) is indicated. After Taiyang disease resolves through sweating, if the stomach qi is disharmonious, resulting in epigastric fullness and hardness (Xin Xia Pi Ying), belching with a rotten food odor, fluid retention under the hypochondrium, borborygmus, and diarrhea, Shengjiang Xiexin Tang (Fresh Ginger Harmonizing Decoction) is indicated. In Taiyang or Shaoyang disease, if the physician incorrectly uses purgation, leading to frequent diarrhea (dozens of times daily) with undigested food, borborygmus, epigastric fullness and hardness, dry retching, irritability, and restlessness. Seeing the epigastric fullness, the physician assumes the pathogen remains and purges again, worsening the fullness. This is not heat binding, but rather deficiency of stomach qi with rebellious pathogenic qi ascending, causing constipation. Gancao Xiexin Tang (Licorice Harmonizing Decoction) is indicated. In Taiyang disease, after five or six days, if there is vomiting and fever, indicating Chaihu syndrome, but other purgatives were used, if the Chaihu syndrome persists, Chaihu Tang (Bupleurum Decoction) should be administered again. Although purged, this is not a contraindication. The patient will likely experience intense warmth followed by shivering, then fever and sweating, leading to resolution. If the epigastrium is full, hard, and painful, this is Jie Xiong (Chest Binding), treated with Da Xianxiong Tang (Major Draining the Chest Decoction). If it is full but not painful, it is Pi (Glomus/Fullness), and Chaihu Tang is contraindicated; Banxia Xiexin Tang (Pinellia Harmonizing Decoction) is appropriate. After Taiyang disease is treated with sweating, emesis, or purgation, if the disease resolves but epigastric fullness and hardness persist with incessant belching, Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction) is indicated. In combined Taiyang and Shaoyang disease, if vomiting occurs, Huangqin Jia Banxia Shengjiang Tang (Scutellaria plus Pinellia and Fresh Ginger Decoction) is used. In Taiyang disease, if there is heat in the chest, pathogenic qi in the stomach, abdominal pain, and desire to vomit, Huanglian Tang (Coptis Decoction) is indicated. If Taiyang disease originally involved cold-type diarrhea, and the physician repeatedly used emesis or purgation, causing cold rejection and aggravated vomiting and diarrhea, especially if food is vomited immediately upon ingestion, Ganjiang Huanglian Huangqin Renshen Tang (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction) is used.
Note: All the above syndromes occur after sweating, emesis, or purgation, where exterior qi is already deficient. Internal symptoms such as glomus/hardness, distension/pain, diarrhea, belching, or vomiting indicate that excess pathogens remain in the interior. Thus, they are collectively categorized as Exterior Deficiency and Interior Excess Syndrome (Biao Xu Li Shi Zheng).
Houpo Shengjiang Gancao Banxia Renshen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction)
Houpo (Magnolia Bark, 4 qian)
Shengjiang (Fresh Ginger, 4 qian)
Banxia (Pinellia Tuber, 1.5 qian)
Gancao (Licorice Root, 2 qian)
Renshen (Ginseng Root, 0.5 qian)
Decoct in water and take orally. Note: Sweating depletes Middle Qi, leading to Yang deficiency and dampness abundance. The pivot mechanism fails to transport, spleen qi sinks, and stomach qi rebels, causing distension. Therefore, Renshen and Gancao tonify the middle and support Yang, while Houpo, Banxia, and Shengjiang descend turbidity and move stagnation.
Shengjiang Xiexin Tang (Fresh Ginger Harmonizing Decoction)
Shengjiang (Fresh Ginger, 2 qian)
Gancao (Licorice Root, 1.5 qian)
Renshen (Ginseng Root, 1.5 qian)
Ganjiang (Dried Ginger, 0.5 qian)
Huangqin (Scutellaria Root, 1.5 qian)
Banxia (Pinellia Tuber, 1 qian)
Dazao (Jujube, 2 pieces)
Huanglian (Coptis Rhizome, 0.5 qian)
Decoct in water and take orally. Note: After resolving via sweating, Middle Qi is deficient, yet excess pathogens fill the chest. These pathogens have both cold and heat qualities. Shengjiang and Banxia descend turbid yin; Huangqin and Huanglian clear heat from the Heart and Gallbladder; Ganjiang, Gancao, Renshen, and Dazao warm and tonify Middle Qi to rotate the pivot mechanism.
Gancao Xiexin Tang (Licorice Harmonizing Decoction)
Gancao (Licorice Root, 2 qian)
Huangqin (Scutellaria Root, 1.5 qian)
Ganjiang (Dried Ginger, 1.5 qian)
Banxia (Pinellia Tuber, 1 qian)
Huanglian (Coptis Rhizome, 0.5 qian)
Dazao (Jujube, 2 pieces)
Decoct in water and take orally. Note: When exterior resolution was required but purgation was incorrectly used, Middle Qi is damaged. Food and fluids fail to digest, Liver and Spleen (Wood and Earth) become constrained, and ascending/descending functions reverse. Gancao, Ganjiang, and Dazao tonify the middle and warm lower cold; Banxia, Huangqin, and Huanglian descend rebellion and clear upper heat.
Banxia Xiexin Tang (Pinellia Harmonizing Decoction)
Banxia (Pinellia Tuber, 3 qian)
Huangqin (Scutellaria Root, 1.5 qian)
Ganjiang (Dried Ginger, 1.5 qian)
Gancao (Licorice Root, 1.5 qian)
Renshen (Ginseng Root, 1.5 qian)
Huanglian (Coptis Rhizome, 0.5 qian)
Dazao (Jujube, 2 pieces)
Decoct in water and take orally. Note: After purgation, Middle Qi is deficient, and interior Yin rebels upward forming Glomus (Pi). Renshen, Gancao, Ganjiang, and Dazao warm and tonify the deficiency-cold of the Middle Jiao; Huangqin and Huanglian clear constrained heat in the Upper Jiao; Banxia descends turbid yin and eliminates fullness.
Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction)
Xuanfuhua (Inula Flower, 1.5 qian)
Daizhishi (Hematite, 0.5 qian)
Renshen (Ginseng Root, 1 qian)
Gancao (Licorice Root, 1 qian)
Banxia (Pinellia Tuber, 1 qian)
Shengjiang (Fresh Ginger, 2.5 qian)
Dazao (Jujube, 2 pieces)
Decoct in water and take orally. Note: After sweating, emesis, or purgation, Middle Qi is damaged. Lung Qi constraint steams phlegm-fluids; Stomach Earth obstruction generates hiccups and belching. Renshen, Gancao, and Dazao tonify the Middle Jiao; Shengjiang and Daizhishi descend rebellious qi; Xuanfuhua moves phlegm-fluids and opens constrained turbidity.
Huangqin Jia Banxia Shengjiang Tang (Scutellaria plus Pinellia and Fresh Ginger Decoction)
Huangqin (Scutellaria Root, 3 qian)
Gancao (Licorice Root, 2 qian)
Shaoyao (Peony Root, 2 qian)
Banxia (Pinellia Tuber, 2 qian)
Shengjiang (Fresh Ginger, 3 qian)
Dazao (Jujube, 3 pieces)
Decoct in water and take orally. Note: In combined Taiyang-Shaoyang disease, Shaoyang channel qi is constrained and attacks Stomach Earth (Wu Tu). Stomach qi fails, leading to spontaneous diarrhea. Gancao and Dazao tonify Spleen essence; Huangqin and Shaoyao drain Ministerial Fire; Banxia and Shengjiang descend Stomach rebellion and stop vomiting.
Huanglian Tang (Coptis Decoction)
Huanglian (Coptis Rhizome, 1.5 qian)
Gancao (Licorice Root, 1.5 qian)
Ganjiang (Dried Ginger, 1.5 qian)
Renshen (Ginseng Root, 0.5 qian)
Guizhi (Cinnamon Twig, 1.5 qian)
Banxia (Pinellia Tuber, 1 qian)
Dazao (Jujube, 2 pieces)
Decoct in water and take orally. Note: Liver pathogen attacks Spleen, causing abdominal pain; Gallbladder pathogen attacks Stomach, causing desire to vomit. Huanglian and Banxia clear upper heat and stop vomiting; Renshen, Gancao, Ganjiang, and Dazao warm middle cold and stop pain; Guizhi soothes Wood and unblocks channels.
Ganjiang Huanglian Huangqin Renshen Tang (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction)
Ganjiang (Dried Ginger, 1.5 qian)
Huangqin (Scutellaria Root, 1.5 qian)
Huanglian (Coptis Rhizome, 1.5 qian)
Renshen (Ginseng Root, 1.5 qian)
Decoct in water and take orally. Note: The Middle Jiao has deficiency-cold, while the Upper Jiao has heat. Ganjiang and Renshen warm and tonify Middle Jiao deficiency-cold; Huanglian and Huangqin clear Lower Jiao deficiency-heat.