干姜 黄连 黄芩 人参各三两
右四味，以水六升，煮取二升，去滓，分温再服。
@@@
伤寒，医下之，续得下利清谷不止，身疼痛者，急当救里；后身疼痛，清便自调者，
急当救表。救里宜四逆汤，救表宜桂枝汤。
【注】
伤寒，医不分表里、寒热、虚实，而误下之，续得下利清谷不止者，寒其里也。虽有
通身疼痛之表未除，但下利清谷不止，里寒已盛，法当急救其里；俟便利自调，仍身
疼痛不止，再救其表可也。救里宜四逆汤，温中胜寒；救表宜桂枝汤，调荣和卫也。
【集注】
王三阳曰：此证当照顾协热利，须审其利之色何如？与势之缓急，不可轻投四逆、桂
枝也。
喻昌曰：攻里必须先表后里，始无倒行逆施之患。惟在里之阴寒极盛，不得不急救其
里，俟里证稍定，仍救其表，盖谓救里后再行救表也。
@@@
下利清谷，不可攻表，汗出必胀满。
【注】
此详上条不先救里而发其表，以明太阴、少阴同病之证也。下利清谷，太阴寒邪已传
少阴，即有身痛不可攻表。若误攻其表，即使汗出，太阳表解而太阴寒凝，必胀满矣
。
@@@
下利，腹胀满，身体疼痛者，先温其里，乃攻其表，温里宜四逆汤，攻表宜桂枝汤。
【注】
此承上条互发其证，以明先里后表之治也。下利腹胀满者，里寒邪也；身体疼痛者，
表寒邪也。凡表里寒邪之证同见，总以温里为急。故当先温其里，后攻其表。温里宜
四逆汤，攻表宜桂枝汤。
【集注】
方有执曰：里虚表实，惟其虚也，故必先之，惟其实也，故可后焉。
@@@
发汗后，腹胀满者，厚朴生姜半夏甘草人参汤主之。
【注】
发汗后表已解而腹满者，太阴里虚之胀满也。故以厚朴生姜甘草半夏人参汤主之。消
胀散满，补中降逆也。
【集注】
成无己曰：吐后胀满，与下后胀满，皆为实者，言邪气乘虚入里而为实也。发汗后则
外已解，腹胀满知非里实，由太阴不足，脾气不通，故壅而为满也。与此汤和脾胃而
降逆气宜矣。
汪琥曰：此条乃汗后气虚腹胀满，其人虽作胀满而内无实形，所以用人参、炙甘草等
甘温补药无疑也。
张锡驹曰：此言发汗而伤其脾气也。脾主腹，故腹满为太阴主病。发汗后而腹胀满，
则知其人脾气素虚，今脾气愈虚，则不能转输，浊气不降，清气不升，而胀满作矣。
干姜、黄连、黄芩、人参各三两。
以上四味药，用水六升，煎煮至剩余二升，滤去药渣，分两次温服。
@@@
伤寒病，医生误用泻下法治疗，随后出现完谷不化的腹泻不止，身体疼痛的，应当紧急救治里证；待身体疼痛仍在，但大小便正常调和的，应当紧急救治表证。救治里证适宜使用四逆汤（Sini Decoction），救治表证适宜使用桂枝汤（Guizhi Tang）。
【注】
伤寒病，医生不分表里、寒热、虚实，而误用泻下法，导致随后出现完谷不化的腹泻不止，这是里寒证。虽然全身疼痛的表证未除，但既然完谷不化的腹泻不止，说明里寒已经亢盛，按照法则应当紧急救治其里证；等到大便自然调和，仍然身体疼痛不止时，再救治其表证即可。救治里证适宜使用四逆汤，以温中散寒；救治表证适宜使用桂枝汤，以调和营卫。
【集注】
王三阳说：此证应当注意鉴别协热利（伴随发热的腹泻），必须审察腹泻的颜色如何？以及病势的缓急，不可轻易投用四逆汤、桂枝汤。
喻昌说：攻里必须先解表后治里，才没有颠倒错乱的祸患。只有在里的阴寒极盛，不得不紧急救治其里，等里证稍微安定，再救治其表，这说的是在救治里证之后再行救治表证。
@@@
完谷不化的腹泻，不可攻表，若发汗导致出汗，必然导致腹部胀满。
【注】
此条详细阐述上一条不先救里而先发其表证的后果，以阐明太阴病与少阴病同病的证候。完谷不化的腹泻，是太阴寒邪已传入少阴，即使有身体疼痛也不可以攻表。如果误用攻表法，即使出汗，太阳表证虽解，但太阴寒凝，必然导致腹部胀满。
@@@
腹泻，腹部胀满，身体疼痛的，先温补其里，然后攻治其表，温里适宜使用四逆汤，攻表适宜使用桂枝汤。
【注】
此条承接上一条互相发挥其证候，以阐明先治里后治表的疗法。腹泻且腹部胀满，是里寒邪气；身体疼痛，是表寒邪气。凡是表里寒邪证候同时出现，总以温里为急务。所以应当先温补其里，后攻治其表。温里适宜使用四逆汤，攻表适宜使用桂枝汤。
【集注】
方有执说：里虚表实，正因为里虚，所以必须先治；正因为表实，所以可以后治。
@@@
发汗后，出现腹部胀满的，由厚朴生姜半夏甘草人参汤（Houpo Shengjiang Banxia Gancao Renshen Decoction）主治。
【注】
发汗后表证已解而出现腹满的，是太阴里虚导致的胀满。所以用厚朴生姜甘草半夏人参汤主治。功效为消胀散满，补益中焦，降逆气。
【集注】
成无己说：呕吐后胀满，与泻下后胀满，都属于实证，是说邪气乘虚入里而成为实证。发汗后则外邪已解，腹胀满知道不是里实，是由于太阴不足，脾气不通，所以壅滞而成胀满。与此汤调和脾胃而降逆气是适宜的。
汪琥说：此条乃是发汗后气虚导致的腹胀满，其人虽然感到胀满但内部没有实邪形质，所以用人参、炙甘草等甘温补药是毫无疑问的。
张锡驹说：此言发汗损伤了脾气。脾主腹部，所以腹满是太阴经的主病。发汗后出现腹胀满，就知道其人脾气素来虚弱，如今脾气更虚，就不能转输，浊气不降，清气不升，从而产生胀满。
Dried Ginger (Ganjiang), Coptis Rhizome (Huanglian), Scutellaria Root (Huangqin), and Ginseng Radix et Rhizoma (Renshen) each three liang.
The above four herbs, with six sheng of water, are decocted to obtain two sheng. The dregs are removed, and the liquid is divided into two doses for warm administration.
@@@
In Cold Damage (Shanghan), if a physician mistakenly applies purgation, followed by incessant diarrhea with undigested food (xieli qinggu), and body pain, urgent treatment of the interior syndrome is required. If body pain persists after the diarrhea stops and bowel movements normalize, urgent treatment of the exterior syndrome is required. For treating the interior, Sini Decoction (Sini Tang) is appropriate; for treating the exterior, Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
[Annotation]
In Cold Damage, if a physician fails to distinguish between exterior/interior, cold/heat, and deficiency/excess, and mistakenly applies purgation, resulting in incessant diarrhea with undigested food, this indicates Interior Cold. Although the exterior symptom of whole-body pain remains, since the diarrhea with undigested food is incessant, Interior Cold is already severe. According to the principles, the interior must be urgently treated first. Once bowel movements normalize, if body pain persists, then the exterior may be treated. Treating the interior with Sini Decoction warms the middle and overcomes cold; treating the exterior with Guizhi Tang harmonizes Ying (Nutrient Qi) and Wei (Defensive Qi).
[Collected Annotations]
Wang Sanyang states: This syndrome requires attention to differentiate from "Xiere Li" (diarrhea accompanying heat). One must examine the color of the stool and the urgency of the condition; one should not lightly administer Sini Decoction or Guizhi Tang.
Yu Chang states: Generally, treating the interior should follow releasing the exterior to avoid counterproductive measures. However, when Interior Yin-Cold is extremely severe, it is imperative to urgently treat the interior first. Once the interior syndrome stabilizes, the exterior can then be treated. This implies treating the interior before addressing the exterior.
@@@
Diarrhea with undigested food contraindicates attacking the exterior. If sweating occurs due to mistaken diaphoresis, abdominal fullness will inevitably result.
[Annotation]
This detail elaborates on the consequences of failing to treat the interior first and instead attacking the exterior, clarifying the syndrome where Taiyin and Shaoyin diseases coexist. Diarrhea with undigested food indicates that Taiyin Cold pathogen has transmitted to Shaoyin. Even if there is body pain, attacking the exterior is contraindicated. If the exterior is mistakenly attacked, causing sweating, although the Taiyang exterior may resolve, the Taiyin Cold stagnation will inevitably lead to abdominal fullness.
@@@
In cases of diarrhea, abdominal fullness, and body pain, first warm the interior, then attack the exterior. Warming the interior is appropriate with Sini Decoction; attacking the exterior is appropriate with Guizhi Tang.
[Annotation]
This section continues from the previous passage to elaborate on the syndrome, illustrating the treatment principle of treating the interior before the exterior. Diarrhea with abdominal fullness indicates Interior Cold pathogen; body pain indicates Exterior Cold pathogen. When both exterior and interior Cold pathogen syndromes appear simultaneously, warming the interior is the priority. Therefore, one must first warm the interior, then attack the exterior. Warming the interior is appropriate with Sini Decoction; attacking the exterior is appropriate with Guizhi Tang.
[Collected Annotations]
Fang Youzhi states: When the interior is deficient and the exterior is excess, because of the deficiency, the interior must be treated first; because of the excess, the exterior can be treated later.
@@@
After diaphoresis, if abdominal fullness occurs, Houpo Shengjiang Banxia Gancao Renshen Decoction (Magnolia Bark, Fresh Ginger, Pinellia, Licorice, and Ginseng Decoction) is the primary formula.
[Annotation]
If abdominal fullness occurs after diaphoresis when the exterior syndrome has resolved, it is fullness due to Taiyin Interior Deficiency. Therefore, Houpo Shengjiang Banxia Gancao Renshen Decoction is used. Its function is to dissipate fullness, relieve distension, tonify the Middle Jiao, and direct rebellious Qi downward.
[Collected Annotations]
Cheng Wuji states: Abdominal fullness after vomiting or purgation belongs to Excess syndromes, indicating that pathogens have entered the interior due to deficiency, creating an Excess state. After diaphoresis, the exterior is resolved; thus, abdominal fullness is known not to be Interior Excess. It arises from Taiyin insufficiency and blocked Spleen Qi, leading to stagnation and fullness. Administering this decoction to harmonize the Spleen and Stomach and direct rebellious Qi downward is appropriate.
Wang Hu states: This passage refers to abdominal fullness due to Qi deficiency after diaphoresis. Although the patient feels full, there is no tangible Excess pathogen inside. Therefore, using sweet-warm tonics such as Ginseng Radix et Rhizoma (Renshen) and Honey-fried Licorice Root (Zhi Gancao) is undoubtedly correct.
Zhang Xiju states: This explains that diaphoresis damages Spleen Qi. The Spleen governs the abdomen, so abdominal fullness is a primary disease of the Taiyin channel. Abdominal fullness after diaphoresis indicates that the person's Spleen Qi was originally deficient. Now, with further depletion of Spleen Qi, transportation and transformation fail, turbid Qi does not descend, clear Qi does not ascend, resulting in fullness.