厚朴（炙，去皮）半筋 生姜（洗）半筋 半夏（洗）半升 甘草（炙）二两 人参
一两
右五味，以水一斗，煮取三升，去滓，温服一升，日三服。
@@@
发汗不解，腹满痛者，急下之，宜大承气汤。腹满不减，减不足言，当下之，宜大承
气汤。
【注】
此详申上条，互发其义，以别其治也。发汗后表已解，腹满不痛者，乃腹满时减，减
复如故之虚满也，当温之，厚朴生姜半夏甘草人参汤证也。今发汗后表不解，腹满大
痛者，乃腹满不减，减不足言之实满也，当下之，宜大承气汤，盖以里急，故攻里后
和表也。
【集注】
喻昌曰：「减不足言」四字，形容腹满如绘。见满至十分，即减去一、二分，不足杀
其势也。此所以纵有外邪未解，而当下无疑耳！
程应旄曰：下之而腹满如故，即减去一、二分，算不得减。下之不妨再下，必当以减
尽为度也。
刘宏璧曰：太阴无可下之法也，设在经则各经已无可下之理，在藏则太阴尤无受下之
处，桂枝加大黄汤安能无疑乎？不知脾与胃相表里也，太阳误下，太阴受邪，适胃有
宿食，则脾因胃之实而实，亦即因太阳之邪而痛矣。既大满大痛，已成胃实，又非此
汤之所能治，故宜大承气汤也。
@@@
太阴病，脉浮者，可发汗，宜桂枝汤。
【注】
太阴经病，脉当浮缓；太阴藏病，脉当沉缓。今邪至太阴，脉浮不缓者，知太阳表邪
犹未全罢也。故即有吐利不食，腹满时痛一、二证，其脉不沉而浮，便可以桂枝发汗
，先解其外，俟外解已再调其内可也。于此又可知论中身痛腹满下利，急先救里者，
脉必不浮矣。
【集注】
王肯堂曰：病在太阳脉浮无汗，宜麻黄汤。此脉浮当亦无汗，而不言者，谓阴不得有
汗，不必言也，不用麻黄汤而用桂枝汤。盖以三阴兼表病者。具不当大发汗也，须识
无汗亦有用桂枝者。
程知曰：此言太阴宜散者也。太阴病，谓有腹痛下利证也。太阳脉，尺寸俱浮，今脉
浮则邪还于表可知矣，故宜用桂枝解散。不用麻黄者，阴病不得大发其汗也，桂枝汤
有和里之意焉。
程应旄曰：此太阴中之太阳也，虽有里病，仍从太阳表治，方不引邪入藏。
@@@
本太阳病，医反下之，因而腹满时痛者，属太阴也，桂枝加芍药汤主之。大实痛者，
桂枝加大黄汤主之。
【注】
本太阳中风病，医不以桂枝汤发之而反下之，因而邪陷入里，余无他证，惟腹满时痛
者，此属太阴里虚痛也，故宜桂枝加芍药汤以外解太阳之表，而内调太阴之里虚也。
若大满实痛，则属太阴热化，胃实痛也，故宜桂枝加大黄汤以外解太阳之表，而内攻
太阴之里实也。
【集注】
赵嗣真曰：太阴腹满证有三：有次第传经之邪，有直入中寒之邪，有下后内陷之邪，
不可不辨。
喻昌曰：太阳病之误下，其变皆在胸□以上。此之误下而腹满时痛，无胸□等证，则
其邪已入阴位，所以属在太阴也。仍用桂枝解肌之法，以升发太阳之邪，倍芍药者以
调太阴之气，本方不增一药，斯为神耳！大实、大满宜从急下，然阳分之邪初陷太阴
，未可峻攻，但于桂枝汤中少加大黄，七表三里，以分杀其邪，与大柴胡汤同其义也
。
程应旄曰：误下太阳而成腹满时痛，太阴之证见矣。然表邪内陷，留滞于太阴，非藏
寒病也。仍用桂枝汤升发阳邪，但倍芍药以调和之。倘大实而痛，于证似可急下，然
阴实而非阳实，仍从桂枝例升发阳邪，但加大黄以破结滞之物，使表里两邪各有去路
，则寒随实去，不温而自温矣。然此二证虽属之太阴，实从太阳传来，则脉必尚浮可
知。
厚朴（经炙烤，去皮）半筋 生姜（洗净）半筋 半夏（洗净）半升 甘草（经炙烤）二两 人参一两
以上五味药，用水一斗，煎煮至剩余三升，滤去药渣，每次温服一升，每日服用三次。
@@@
发汗后病邪未解，出现腹部胀满疼痛的，应当急下攻里，适宜使用大承气汤。腹部胀满持续不减，即使有轻微减轻也不足挂齿的，应当用攻下法，适宜使用大承气汤。
【注】
此处详细阐述上一条经文，互相阐发其义理，以区别不同的治疗方法。发汗后表证已解，腹部胀满但不痛的，这是腹部胀满时而减轻、减轻后又像原来一样的虚性胀满，应当用温补法，属于厚朴生姜半夏甘草人参汤证。现在发汗后表证未解，腹部胀满且剧烈疼痛的，这是腹部胀满持续不减、即使减轻也微不足道的实性胀满，应当用攻下法，适宜使用大承气汤，这是因为里气急迫，所以先攻里而后调和表证。
【集注】
喻昌说：“减不足言”这四个字，生动地描绘了腹部胀满的状态。看到胀满达到十分的程度，即使减去一分、二分，也不足以消除其势头。这就是为什么纵然有外邪未解，也毫无疑问应当攻下的原因！
程应旄说：攻下后腹部胀满如故，即减去一分、二分，算不上真正的减轻。攻下不妨再次攻下，必须以胀满完全消除为限度。
刘宏璧说：太阴病没有可攻下的治法。如果是在经络层面，各经络已无可攻下的道理；如果在脏腑层面，太阴尤其没有承受攻下的部位，桂枝加大黄汤难道不是有疑问吗？不知道脾与胃相表里。太阳病误用下法，太阴受邪，恰好胃中有宿食停滞，那么脾就会因为胃的实证而呈现实证，也就是因为太阳的病邪而产生疼痛。既然已经是大满大痛，已成胃实之证，又不是这个方剂所能治疗的，所以适宜使用大承气汤。
@@@
太阴病（Taiyin Disease, 太阴经受邪所致的病证），脉象浮的，可以发汗，适宜使用桂枝汤（Guizhi Tang, Cinnamon Twig Decoction）。
【注】
太阴经病，脉象应当是浮缓；太阴藏病，脉象应当是沉缓。现在病邪到了太阴，脉象浮而不缓，可知太阳表的病邪还没有完全解除。所以即使有呕吐、腹泻、不能进食、腹部胀满时而疼痛等一两个症状，只要脉象不沉而浮，就可以用桂枝汤发汗，先解除表邪，等到表邪解除后再调理内部。从这里又可以知道，论中提到的身体疼痛、腹部胀满、腹泻，需要紧急先救里的情况，脉象必定是不浮的。
【集注】
王肯堂说：病在太阳，脉浮无汗，适宜用麻黄汤（Mahuang Tang, Ephedra Decoction）。此症脉浮也应当是无汗，但没说的原因是，认为阴证不得有汗，不必明说，不用麻黄汤而用桂枝汤。这是因为三阴病兼有表证，都不应当大发汗，必须认识到无汗也有使用桂枝汤的情况。
程知说：这是在说太阴病适宜用发散法。太阴病，指有腹痛、腹泻的症状。太阳脉，寸关尺三部都浮，现在脉浮，说明邪气还归于表，所以适宜用桂枝汤解散。不用麻黄汤的原因，是阴病不得大发其汗，桂枝汤含有调和里的意思。
程应旄说：这是太阴病中的太阳证，虽然有里病，仍然从太阳表证治疗，才不会引邪入脏。
@@@
原本是太阳病（Taiyang Disease, 太阳经受邪所致的病证），医生反而用了下法，因而导致腹部胀满、时而疼痛的，属于太阴病，由桂枝加芍药汤（Guizhi Jia Shaoyao Tang, Cinnamon Twig Decoction with Added Peony Root）主治。如果是大实痛，由桂枝加大黄汤（Guizhi Jia Dahuang Tang, Cinnamon Twig Decoction with Added Rhubarb）主治。
【注】
原本是太阳中风病（Wind-stroke in Taiyang Disease, 太阳病中风证），医生不用桂枝汤发汗，反而用了下法，因而邪气陷入体内，没有其他症状，只有腹部胀满、时而疼痛的，这属于太阴里虚痛，所以适宜用桂枝加芍药汤来外解太阳之表，内调太阴之里虚。如果是大满实痛，则属于太阴热化，是胃实痛，所以适宜用桂枝加大黄汤来外解太阳之表，内攻太阴之里实。
【集注】
赵嗣真说：太阴病的腹部胀满证有三种：有按次序传经而来的邪气，有直接侵入的中寒邪气，有下法后内陷的邪气，不可不辨别。
喻昌说：太阳病误用下法，其变证都在胸膈以上。此症误下后出现腹部胀满、时而疼痛，没有胸膈等症状，说明邪气已进入阴位，所以属于太阴。仍然用桂枝汤解肌的方法，来升发太阳的邪气，加倍芍药是为了调和太阴之气，本方没有增加一味药，这才是神妙之处！大实、大满应当从急下法考虑，然而阳分之邪刚陷入太阴，不可峻猛攻下，只在桂枝汤中少量加入大黄，七分为表三分为里，以分消其邪气，与大柴胡汤（Da Chaihu Tang, Major Bupleurum Decoction）的意义相同。
程应旄说：误下太阳而成腹部胀满、时而疼痛，太阴的症状出现了。然而表邪内陷，留滞于太阴，不是脏寒病。仍然用桂枝汤升发阳邪，只是加倍芍药来调和它。倘若大实而痛，从症状看似乎可以急下，但这是阴实而非阳实，仍然遵循桂枝汤例升发阳邪，只是加入大黄来破除结滞之物，使表和里的邪气各有出路，那么寒气随实证而去，不温而自然温了。然而这两个证虽然属于太阴，实际上是从太阳传来，所以脉象必定还浮，由此可知。
Houpo (Zizhi Magnoliae Officinalis Cortex), roasted and peeled, ban jin; Shengjiang (Fresh Zingiberis Rhizoma), washed, ban jin; Banxia (Pinelliae Rhizoma), washed, half sheng; Gancao (Glycyrrhizae Radix et Rhizoma), roasted, liang; Renshen (Ginseng Radix et Rhizoma), liang.
The above five herbs are decocted with one dou of water until three sheng remain. The dregs are removed, and the liquid is taken warm, one sheng per dose, three times daily.
@@@
If the pathogen remains unresolved after sweating, accompanied by abdominal fullness and pain, urgent purgation is indicated, and Da Chengqi Tang (Major Order the Qi Decoction) is appropriate. If abdominal fullness persists without reduction, or if any reduction is negligible, purgation should be employed, and Da Chengqi Tang is appropriate.
[Annotation]
This passage elaborates on the previous clause, elucidating their mutual meanings to distinguish different treatments. After sweating, if the exterior syndrome is resolved but abdominal fullness exists without pain, this constitutes "deficient fullness" where the abdomen is sometimes relieved but returns to its previous state. Warmtonifying treatment is indicated, corresponding to the Houpo Shengjiang Banxia Gancao Renshen Tang (Magnolia Bark, Fresh Ginger, Pinellia, Licorice, and Ginseng Decoction). However, if after sweating the exterior syndrome remains unresolved, accompanied by significant abdominal fullness and severe pain, this constitutes "excess fullness" where the fullness does not diminish or any diminution is insignificant. Purgation is indicated, and Da Chengqi Tang is appropriate. This is because the interior urgency requires attacking the interior first, followed by harmonizing the exterior.
[Collected Annotations]
Yu Chang stated: The phrase "reduction is negligible" vividly describes the state of abdominal fullness. When fullness reaches ten parts, reducing it by one or two parts is insufficient to curb its momentum. This is why, even if external pathogens remain unresolved, purgation is undoubtedly indicated!
Cheng Yingmao stated: If abdominal fullness persists after purgation, a reduction of one or two parts does not count as true relief. Purgation may need to be repeated until the fullness is completely eliminated.
Liu Hongbi stated: There is no method for purgation in Taiyin disease. If referring to the meridians, there is no rationale for purgation in any meridian; if referring to the zang organs, the Spleen specifically has no capacity to withstand purgation. Is Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction with Added Rhubarb) questionable? One must understand that the Spleen and Stomach are exterior-interior partners. If Taiyang disease is mistakenly treated with purgation, the Taiyin is affected. If there happens to be retained food in the Stomach, the Spleen becomes excess due to the Stomach's excess, and pain arises from the Taiyang pathogen. Since there is now great fullness and severe pain, constituting Stomach excess, this formula cannot treat it; thus, Da Chengqi Tang is appropriate.
@@@
In Taiyin disease (Taiyin Disease), if the pulse is floating, sweating may be induced, and Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
[Annotation]
In Taiyin meridian disease, the pulse should be floating and moderate; in Taiyin zang disease, the pulse should be deep and moderate. Now that the pathogen has reached the Taiyin, a floating pulse without moderation indicates that the Taiyang exterior pathogen has not yet fully resolved. Therefore, even if symptoms such as vomiting, diarrhea, anorexia, and intermittent abdominal fullness and pain are present, as long as the pulse is floating rather than deep, Guizhi Tang can be used to induce sweating, resolving the exterior first. Once the exterior is resolved, the interior can then be regulated. From this, we can also infer that in cases described in the Treatise where body pain, abdominal fullness, and diarrhea require urgent rescue of the interior, the pulse must not be floating.
[Collected Annotations]
Wang Kentang stated: In Taiyang disease with a floating pulse and no sweat, Mahuang Tang (Ephedra Decoction) is appropriate. Here, the floating pulse also implies no sweat, but this is omitted because yin syndromes do not typically present with sweat, so it need not be stated. Instead of Mahuang Tang, Guizhi Tang is used. This is because when three yin syndromes involve the exterior, vigorous sweating should be avoided. One must recognize that Guizhi Tang can be used even in the absence of sweat.
Cheng Zhi stated: This discusses the indication for dispersal in Taiyin disease. Taiyin disease refers to conditions with abdominal pain and diarrhea. A Taiyang pulse is floating at all three positions. A floating pulse here indicates the pathogen returning to the exterior, so Guizhi Tang is appropriate for resolution. Mahuang Tang is not used because yin diseases should not undergo vigorous sweating; Guizhi Tang contains the intent of harmonizing the interior.
Cheng Yingmao stated: This is the Taiyang syndrome within Taiyin. Although there is an interior syndrome, treating it from the Taiyang exterior perspective prevents the pathogen from entering the zang organs.
@@@
Originally a Taiyang disease (Taiyang Disease), if the physician mistakenly applied purgation, resulting in abdominal fullness and intermittent pain, it belongs to Taiyin disease and is primarily treated with Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction with Added Peony Root). If there is severe excess pain, Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction with Added Rhubarb) is primarily indicated.
[Annotation]
Originally a Taiyang wind-stroke syndrome, if the physician failed to use Guizhi Tang for sweating and instead used purgation, the pathogen sinks into the interior. With no other symptoms except abdominal fullness and intermittent pain, this belongs to deficient pain in the Taiyin interior. Thus, Guizhi Jia Shaoyao Tang is appropriate to resolve the Taiyang exterior and regulate the Taiyin interior deficiency. If there is severe fullness and excess pain, it belongs to Taiyin heat transformation and Stomach excess pain. Thus, Guizhi Jia Dahuang Tang is appropriate to resolve the Taiyang exterior and attack the Taiyin interior excess.
[Collected Annotations]
Zhao Sizhen stated: There are three types of abdominal fullness in Taiyin disease: pathogens transmitted sequentially through the meridians, cold pathogens directly invading the middle, and pathogens sinking inward after purgation. These must not be confused.
Yu Chang stated: Mistaken purgation in Taiyang disease results in complications above the chest and diaphragm. Here, mistaken purgation leads to abdominal fullness and intermittent pain without chest/diaphragm symptoms, indicating the pathogen has entered the yin position, hence belonging to Taiyin. Using Guizhi Tang to resolve the muscle layer still serves to raise and release the Taiyang pathogen. Doubling Shaoyao (Peony Root) regulates Taiyin qi. Not adding any new herbs to the base formula is truly miraculous! While severe excess and fullness usually warrant urgent purgation, since the yang pathogen has just sunk into Taiyin, harsh purgation is premature. Adding a small amount of Dahuang (Rhubarb) to Guizhi Tang divides the action seven parts exterior and three parts interior to dissipate the pathogen, sharing the same principle as Da Chaihu Tang (Major Bupleurum Decoction).
Cheng Yingmao stated: Mistaken purgation of Taiyang leading to abdominal fullness and intermittent pain reveals Taiyin symptoms. However, the exterior pathogen has sunk and stagnated in the Taiyin; it is not a cold zang disease. Guizhi Tang is still used to raise and release the yang pathogen, but Shaoyao is doubled to harmonize it. If there is severe excess and pain, urgent purgation might seem indicated, but this is yin excess rather than yang excess. Following the Guizhi principle to raise the yang pathogen, Dahuang is added to break up stagnation, allowing both exterior and interior pathogens to have an exit route. The cold departs with the excess, warming naturally without warming agents. Although these two syndromes belong to Taiyin, they actually originate from Taiyang transmission, so the pulse must still be floating, as can be inferred.