桂枝四两 甘草（炙）四两 白术三两 人参三两 干姜三两
右五味，以水九升，先煮四味，取五升，内桂更煮，取三升，去滓，温服一升，日再
服，夜一服。
太阳病，桂枝证，医反下之，利遂不止，脉促者，表未解也，喘而汗出者，葛根黄芩
黄连汤主之。
【注】
此承上条、又言协热利之脉促者，以别其治也。太阳病桂枝证，宜以桂枝解肌，而医
反下之，利遂不止者，是误下，遂协表热陷入而利不止也。若表未解，而脉缓无力，
即有下利而喘之里证，法当从桂枝人参汤以治利，或从桂枝加杏子厚朴汤，以治喘矣
。今下利不止，脉促有力，汗出而喘，表虽未解，而不恶寒，是热已陷阳明，即有桂
枝之美，亦当从葛根黄芩黄连汤主治也。方中四倍葛根以为君，芩连甘草为之佐，其
意专解阳明之肌表，兼清胃中之里热，此清解中兼解表里法也。若脉沉迟，或脉微弱
，则为里寒且虚，又当用理中汤加桂枝矣。于此可见上条之协热利，利不止，心下痞
□，表里不解者，脉不微弱，必沉迟也。
【按】
协热利二证，以脉之阴、阳分虚、实，主治固当矣。然不可不辨其下利之粘秽、鸭溏
，小便或白或赤，脉之有力无力也。
【集注】
成无己曰：病有汗出而喘者，谓自汗出而喘也，是邪气外甚所致。若喘而汗出者，谓
因喘而汗出也，是里热气逆所致，故与葛根黄芩黄连汤，散表邪除里热也。
方有执曰：利与上条同。而上条用理中者，以痞□，脉弱属寒也。此用芩、连者，以
喘汗、脉促属热也。
喻昌曰：太阳病，原无下法，当用桂枝解外，医反下之，则邪热之在太阳者，未传阳
明之表，已入阳明之里。所以其脉促急，其汗外越，其热上奔则喘，下奔则泄。故舍
桂枝而用葛根，以专主阳明之表，加芩、连以清里热，则不治喘而喘止，不治利而利
止。此又太阳、阳明两解表里之变法也。
汪琥曰：误下虚其肠胃，为热所乘，遂利不止，此非肠胃真虚证，乃胃有邪热，下通
于肠而作泄也。脉促者，脉来数时一止复来也，此为阳独盛之脉也。脉促见阳，知表
未解，此表乃阳明经病，非犹太阳桂枝之表证也。喘而汗出者，亦阳明胃府里热气逆
所致，非太阳风邪气壅之喘，亦非桂枝汤汗出之证也。故当解阳明表邪，清胃府里热
也。
桂枝四两，炙甘草四两，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，再加入桂枝继续煎煮，取药液三升，滤去药渣，每次温服一升，白天服两次，晚上服一次。
太阳病（太阳经受邪所致的病证），出现桂枝汤证（表现为发热、恶风、汗出、脉浮缓等），医生反而使用攻下法治疗，导致腹泻不止，脉搏急促的，说明表证尚未解除；如果伴有气喘且出汗的，应当用葛根黄芩黄连汤主治。
【注】
这一段承接上一条，又论述了协热利（外感表证未解兼有里热之泄泻）中脉象急促的情况，以此区分不同的治疗方法。太阳病桂枝汤证，本应用桂枝汤解肌发表，但医生反而使用攻下法，导致腹泻不止，这是误用下法，致使表热内陷而引发持续腹泻。如果表证未解，且脉象缓弱无力，即使有腹泻和气喘的里证，治法应当选用桂枝人参汤来治疗腹泻，或者选用桂枝加厚朴杏子汤来治疗气喘。如今腹泻不止，脉象急促有力，出汗且气喘，虽然表证未解，但不怕冷，说明热邪已经陷入阳明经，即便有桂枝汤的美名（指原本适用的桂枝类方），也应当以葛根黄芩黄连汤为主治方剂。方中以四倍量的葛根为君药，黄芩、黄连、甘草作为佐使药，其意图专门解除阳明经肌表之邪，兼清胃腑中的里热，这是清解法中兼顾表里的治法。如果脉象沉迟，或脉象微弱，则属于里寒且虚，又应当使用理中汤加桂枝了。从这里可以看出，上一条提到的协热利，腹泻不止，心下痞塞，表里同病者，脉象不微弱，必定是沉迟的。
【按】
协热利的两种证候，通过脉象的阴（虚寒）阳（实热）来区分虚实，主治原则是正确的。然而不可不辨别腹泻物的粘腻秽臭还是稀薄如鸭粪，小便颜色是白还是赤，以及脉象的有力与无力。
【集注】
成无己说：有病证表现为出汗且气喘的，是指自然出汗同时伴有气喘，这是邪气在体表较盛所致。如果是气喘且出汗的，是指因为气喘而导致出汗，这是里热气逆所致，所以给予葛根黄芩黄连汤，以疏散表邪、清除里热。
方有执说：腹泻与上一条相同。但上一条使用理中汤，是因为心下痞塞、脉弱属于寒证。这里使用黄芩、黄连，是因为气喘、出汗、脉促属于热证。
喻昌说：太阳病，本来没有攻下的治法，应当用桂枝汤解表，医生反而使用攻下法，那么停留在太阳经的邪热，尚未传入阳明经的表分，就已经进入阳明经的里分。所以脉象急促，汗液外越，热邪上冲则气喘，下趋则泄泻。因此舍弃桂枝而用葛根，专门主司阳明经的表邪，加入黄芩、黄连以清里热，这样不治气喘而气喘自止，不治腹泻而腹泻自止。这又是太阳、阳明两经表里同解的变法。
汪琥说：误用下法损伤肠胃，被热邪乘虚而入，于是腹泻不止，这并不是肠胃真正的虚证，而是胃中有邪热，下通于肠道而导致的泄泻。脉促，是指脉搏跳动快速，偶尔停跳一下后又恢复跳动，这是阳气独盛的脉象。脉促出现在阳位，可知表证未解，此处的“表”乃阳明经病，不再是像太阳病桂枝汤证那样的表证。气喘且出汗，也是阳明胃腑里热气逆所致，不是太阳风邪气壅滞引起的气喘，也不是桂枝汤证那种汗出的表现。所以应当解除阳明经表邪，清泄胃腑里热。
Cinnamon Twig (Guizhi) four liang, Honey-fried Licorice Root (Zhi Gancao) four liang, Atractylodes Macrocephala Rhizome (Baizhu) three liang, Ginseng Radix et Rhizoma (Renshen) three liang, Dried Ginger (Ganjiang) three liang.
The above five herbs are boiled with nine sheng of water. First, decoct the first four herbs to obtain five sheng of liquid. Then add Cinnamon Twig (Guizhi) and continue to decoct to obtain three sheng of liquid. Strain the dregs, and take one sheng warm. Administer twice during the day and once at night.
In Taiyang disease (disease pattern resulting from pathogenic invasion of the Taiyang channel), presenting with Guizhi Tang syndrome (characterized by fever, aversion to wind, sweating, and floating-slow pulse), if the physician erroneously applies purgation, leading to persistent diarrhea, and the pulse is rapid and intermittent (Cu Mai), it indicates that the exterior syndrome has not yet resolved. If accompanied by wheezing and sweating, Gegen Huangqin Huanglian Tang (Kudzu Root, Scutellaria, and Coptis Decoction) should be primarily prescribed.
[Annotation]
This passage follows the previous article and discusses the rapid and intermittent pulse (Cu Mai) in cases of "collateral heat diarrhea" (Xiere Li - diarrhea accompanying an exterior syndrome with internal heat), to distinguish the treatment. In Taiyang disease presenting with Guizhi Tang syndrome, Guizhi Tang should be used to release the muscle layer. However, if the physician erroneously uses purgation, causing persistent diarrhea, this results from the erroneous purgation allowing exterior heat to sink inward, leading to continuous diarrhea. If the exterior syndrome remains unresolved but the pulse is slow and weak, even if there are interior symptoms of diarrhea and wheezing, the treatment method should employ Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) to treat the diarrhea, or Guizhi Houpo Mazi Tang (Cinnamon Twig, Magnolia Bark, and Ephedra Decoction) to treat the wheezing. Now, with persistent diarrhea, a forceful rapid and intermittent pulse, sweating, and wheezing, although the exterior syndrome is unresolved, the absence of aversion to cold indicates that the heat has sunk into the Yangming channel. Even if the merits of Guizhi Tang were applicable, Gegen Huangqin Huanglian Tang (Kudzu Root, Scutellaria, and Coptis Decoction) should be the primary prescription. In this formula, Kudzu Root (Gegen) is used in four times the quantity as the sovereign herb, while Scutellaria Root (Huangqin), Coptis Rhizome (Huanglian), and Licorice Root (Gancao) serve as assistant ministers. The intent is specifically to resolve the muscle-layer pathogen of the Yangming channel and simultaneously clear the interior heat of the stomach. This represents a method of clearing and resolving that addresses both exterior and interior aspects. If the pulse is deep and slow, or weak and faint, it indicates interior cold and deficiency; in such cases, Lizhong Tang (Regulate the Middle Decoction) plus Cinnamon Twig (Guizhi) should be used. From this, we can see that in the previous article regarding collateral heat diarrhea with persistent diarrhea and epigastric fullness/stuffiness, where exterior and interior are both unresolved, the pulse is not weak and faint but must be deep and slow.
[Commentary]
For the two syndromes of collateral heat diarrhea, distinguishing deficiency and excess based on yin (deficiency-cold) and yang (excess-heat) pulses is indeed correct for determining treatment. However, one must differentiate whether the stool is sticky and foul-smelling or thin like duck feces, whether the urine is white or red, and whether the pulse is forceful or weak.
[Collected Annotations]
Cheng Wuji states: When a disease presents with sweating and wheezing, it refers to spontaneous sweating accompanied by wheezing, caused by pathogenic factors being excessive on the exterior. If it is wheezing followed by sweating, it means sweating occurs due to wheezing, which is caused by rebellious qi and heat in the interior. Therefore, Gegen Huangqin Huanglian Tang (Kudzu Root, Scutellaria, and Coptis Decoction) is given to disperse exterior pathogens and clear interior heat.
Fang Youzhi states: The diarrhea is the same as in the previous article. However, the previous article used Lizhong Tang (Regulate the Middle Decoction) because epigastric stuffiness and a weak pulse indicate cold. Here, Scutellaria Root (Huangqin) and Coptis Rhizome (Huanglian) are used because wheezing, sweating, and a rapid and intermittent pulse indicate heat.
Yu Chang states: Taiyang disease originally has no indication for purgation; Guizhi Tang should be used to release the exterior. If the physician erroneously uses purgation, the pathogenic heat remaining in Taiyang, without having transmitted to the exterior of Yangming, has already entered the interior of Yangming. Thus, the pulse is rapid and urgent, sweat escapes outward, heat rushes upward causing wheezing, and rushes downward causing diarrhea. Therefore, abandoning Cinnamon Twig (Guizhi) and using Kudzu Root (Gegen) specifically targets the exterior of Yangming, adding Scutellaria Root (Huangqin) and Coptis Rhizome (Huanglian) to clear interior heat. Consequently, wheezing stops without directly treating it, and diarrhea stops without directly treating it. This is another variable method for simultaneously resolving the exterior and interior of both Taiyang and Yangming channels.
Wang Hu states: Erroneous purgation damages the intestines and stomach, allowing heat pathogens to invade, leading to persistent diarrhea. This is not a true deficiency of the intestines and stomach, but rather evil heat in the stomach passing down to the intestines, causing diarrhea. A rapid and intermittent pulse (Cu Mai) refers to a pulse that beats rapidly but occasionally pauses before resuming; this is a pulse indicating exclusive excess of yang. Observing a rapid and intermittent pulse in the yang position indicates that the exterior syndrome is unresolved. However, this "exterior" refers to a disease of the Yangming channel, not the exterior syndrome of Taiyang Guizhi Tang. Wheezing and sweating are also caused by rebellious qi and heat in the interior of the Yangming Stomach organ, not by wind-pathogen qi congestion in Taiyang, nor is it the sweating syndrome of Guizhi Tang. Therefore, one should resolve the exterior pathogens of the Yangming channel and clear the interior heat of the Yangming Stomach organ.