喻昌曰，黄连汤者，仲景治伤寒之方也。伤寒胸中有热，胃中有邪气，腹中痛欲呕吐者，黄连汤主之。以其胃中有
邪气，阻遏阴阳升降之机，而不交于中土，于是阴不得升，而独治于下，为下寒。腹中痛，阳不得降，而独治于上，为
胸中热、欲呕吐，与此汤以升降阴阳固然矣。而湿家下之，舌上如胎者，丹田有热，胸中有寒，亦用此方何耶？后人牵
强作解，不得制方之旨，又安能取裁其方耶？盖伤寒分表里中三治，表里之邪俱盛，则从中而和之，故有小柴胡汤之和
法，于人参、甘草、半夏、生姜、大枣助胃之中，但加柴胡一味透表，黄芩一味透里，尚恐圭角少露，有碍于和，于是
去滓复煎，漫无异同。饮入胃中，听胃气之升者，带柴胡出表；胃气之降者，带黄芩入里，一和而表里之邪尽服。其有
未尽者，加工治之，不相 格矣。至于丹田胸中之邪，则在于上下，而不为表里，即变柴胡汤为黄连汤，和其上下，以
桂枝易柴胡，以黄连易黄芩，以干姜代生姜。饮入胃中，亦听胃气之上下敷布，故不问上热下寒，上寒下热，皆可治之
也。夫表里之邪，则用柴胡、黄芩；上下之邪，则用桂枝、黄连；表里之邪，则用生姜之辛以散之；上下之邪，则用干
姜之辣以开之，仲景圣法灼然矣。昌欲进退其上下之法，操何术以进退之耶？前论中求之于中，握枢而运，以渐透于上
下。俟其荣气前通，卫气前通，而为进退也。然而难言之矣，格则吐逆，进而用此方为宜。盖太阳主
开，太阳不开，则胸间窒塞，食不得入，入亦复出，以桂枝为太阳经药，和荣卫而行阳道，故能开之也。至于五志厥阳
之火上入，桂枝又不可用矣，用之则以火济火，头有汗而阳脱矣，其关则不得小便。退之之法，从胃气以透入阴分，桂
枝亦在所不取，但胃之关门一开，少阴主阖，少阴之气不上，胃之关必不开矣，昌意中尤谓少阴之脉沉而滞，与趺阳之
脉伏而涩，均足虑也。《内经》常两言之∶曰肾气独沉，曰肾气不衡。夫真气之在肾中，犹权衡也，有权有衡，则关门
时开时阖；有权无衡，则关门有阖无开矣。小溲亦何从而出耶？是则肾气丸，要亦退之之中所有事矣，肾气交于胃，则
关门开；交于心，则厥阳之火随之下伏，有不得不用之时矣。进退一方，于中次第若此，夫岂中人所能辨哉？
【律四条】
凡治关格病，不知批 导 ，但冀止呕利溲，亟治其标，伎穷力竭，无益反损，医之罪也。
凡治关格病，不参诊人迎趺阳太冲三脉，独持寸口，已属疏略。若并寸口阴阳之辨懵然，医之罪也。
凡治关格病，不辨脉之阳虚阳实阴虚阴实，而进退其治，盲人适路，不辨东西，医之罪也。
凡治关格病，不崇王道，辄操霸术，逞己之能，促人之死，医之罪也。
喻昌说，黄连汤是张仲景治疗伤寒的方剂。如果伤寒患者胸中有热，胃中有邪气，出现腹痛且想呕吐的症状，应当用黄连汤主治。因为胃中有邪气，阻碍了阴阳之气升降的机制，导致阴阳不能在中焦交汇，于是阴气不能上升，独自在下部发挥作用，形成下寒；表现为腹痛。阳气不能下降，独自在上部发挥作用，形成胸中热、想呕吐。使用这个方剂来调节阴阳的升降，是理所当然的。
但是，对于患有湿病的人，如果误用泻下法，导致舌面上像有一层胎垢一样，同时丹田有热、胸中有寒的情况，也使用这个方剂，这是为什么呢？后人对这种情况牵强附会地解释，没有掌握制方的宗旨，又怎么能正确选用这个方剂呢？
大概伤寒的治疗分为表、里、中三法。如果表邪和里邪都盛，就从中间调和，所以有小柴胡汤（Minor Bupleurum Decoction）的和解法。在人参（Ginseng Radix）、甘草（Licorice Root）、半夏（Pinellia Rhizoma）、生姜（Zingiberis Rhizoma Recens）、大枣（Jujubae Fructus）扶助胃气的基础上，只加一味柴胡（Bupleuri Radix）透达表邪，一味黄芩（Scutellariae Radix）透达里邪。还担心药性锋芒太露，妨碍和解的效果，于是去渣后再煎煮，使得药性浑然一体，没有明显的差异。药液进入胃中，任由胃气升发的部分带着柴胡透出体表；胃气沉降的部分带着黄芩进入体内，一次和解就能使表里之邪全部消除。如果有未尽的邪气，再进一步治疗，就不会相互格拒了。
至于丹田和胸中的邪气，则位于上下的位置，而不属于表里的范畴。这就将小柴胡汤变为黄连汤（Coptis Decoction），以调和上下。用桂枝（Cinnamon Twig）代替柴胡，用黄连（Coptidis Rhizoma）代替黄芩，用干姜（Zingiberis Rhizoma）代替生姜。药液进入胃中，同样任由胃气向上下输布，因此无论是上热下寒，还是上寒下热，都可以治疗。
对于表里之邪，使用柴胡和黄芩；对于上下之邪，使用桂枝和黄连；对于表里之邪，用生姜的辛味来发散；对于上下之邪，用干姜的辣味来开通。张仲景的高明之法是非常明显的。我想对这种调理上下气机的方法进行增减变化，运用什么方法来进退调整呢？在前面的论述中，我主张从中焦寻求平衡，把握枢纽而运转，逐渐透达于上下。等到营气（Nutritive Qi）先行通畅，卫气（Defensive Qi）先行通畅，然后再进行进退调整。然而这很难说清楚。如果出现格拒导致的吐逆，进而使用此方是适宜的。
因为太阳经主司开启，如果太阳经不开，就会导致胸间窒塞，食物吃不下，或者吃了又吐出来。由于桂枝是太阳经的药物，能调和营卫并运行阳道，所以能够开启闭塞。至于五志（喜、怒、忧、思、恐等情志）化生的厥阳之火向上冲入，桂枝就不可以使用了。如果使用桂枝，就是以火助火，会导致头部出汗而阳气外脱，并且会出现小便不通的关格症状。
退法的要领，是从胃气入手透入阴分，此时桂枝也在不取之列。但是，如果胃的“关门”一开，少阴经主司闭合，如果少阴之气不上承，胃的关门必然无法打开。我心中特别担忧的是：少阴脉沉滞，以及趺阳脉伏涩，这两种情况都值得忧虑。《黄帝内经》常常提到这两点：说“肾气独沉”，说“肾气不衡”。真气存在于肾中，就像秤锤和秤杆一样，有权衡作用，这样胃的“关门”才能时开时闭；如果只有权而无衡，那么关门就只有闭没有开了。小便又从哪里排出呢？因此，肾气丸（Kidney Qi Pill）也是退法中需要考虑的事项。当肾气交于胃，则关门开；肾气交于心，则厥阳之火随之潜伏下行，这是不得不使用它的时候。一方之中，进退的次序如此精妙，这难道是普通中人所能辨别清楚的吗？
【医律四条】
凡是治疗关格病，不知道通过疏导的方法来打破格拒，只是希望止住呕吐和小便不利，急于治疗表面症状，手段穷尽、力量衰竭，不仅无益反而有害，这是医生的罪过。
凡是治疗关格病，不参考诊察人迎穴、趺阳穴、太冲穴这三处的脉象，只单独切按寸口脉，已经属于疏忽大意。如果连寸口脉的阴阳辨别都模糊不清，更是医生的罪过。
凡是治疗关格病，不辨别脉象的阳虚、阳实、阴虚、阴实，从而决定治疗的进退策略，就像盲人走路，不分东西方向，这是医生的罪过。
凡是治疗关格病，不崇尚王道（温和公正的治疗原则），却擅自使用霸术（猛烈激进的手段），炫耀自己的才能，加速病人的死亡，这是医生的罪过。
Yu Chang said, Huanglian Tang (Coptis Decoction) is a formula used by Zhang Zhongjing to treat Shanghan (Cold Damage). When Shanghan involves heat in the chest and pathogenic qi in the stomach, accompanied by abdominal pain and a desire to vomit, Huanglian Tang should be administered. This is because pathogenic qi in the stomach obstructs the mechanism of ascending and descending of Yin and Yang, preventing them from interacting in the Middle Jiao. Consequently, Yin cannot ascend and acts exclusively in the lower part, causing Lower Cold, manifested as abdominal pain. Yang cannot descend and acts exclusively in the upper part, causing Heat in the Chest and a desire to vomit. Using this decoction to regulate the ascending and descending of Yin and Yang is indeed appropriate.
However, why is this same formula used for patients with Dampness diseases who have been incorrectly treated with purgatives, resulting in a tongue coating resembling fetal membrane, with Heat in the Dantian and Cold in the chest? Later generations have forced interpretations, failing to grasp the essence of formula formulation; how then can they properly select and apply this formula?
Generally, the treatment of Shanghan is divided into methods for the Exterior, Interior, and Middle. When both Exterior and Interior pathogens are abundant, harmonization from the Middle is employed. Thus, Xiaochaihu Tang (Minor Bupleurum Decoction) utilizes the Harmonizing method. Based on Renshen (Ginseng Radix), Gancao (Licorice Root), Banxia (Pinellia Rhizoma), Shengjiang (Zingiberis Rhizoma Recens), and Dazao (Jujubae Fructus) to support Stomach Qi, only one herb, Chaihu (Bupleuri Radix), is added to penetrate the Exterior, and one herb, Huangqin (Scutellariae Radix), to penetrate the Interior. Fearing that the sharp edges of these herbs might hinder harmonization, the dregs are removed and the liquid is boiled again, blending the properties so that differences are indistinguishable. Upon entering the Stomach, the portion of the liquid carried upward by Stomach Qi brings Chaihu out to the Exterior; the portion carried downward brings Huangqin into the Interior. One act of harmonization eliminates both Exterior and Interior pathogens. Any remaining pathogens can then be addressed further without mutual rejection.
Regarding pathogens in the Dantian and Chest, they reside in the Upper and Lower positions rather than the Exterior and Interior. Therefore, Xiaochaihu Tang is transformed into Huanglian Tang to harmonize the Upper and Lower. Guizhi (Cinnamon Twig) replaces Chaihu, Huanglian (Coptidis Rhizoma) replaces Huangqin, and Ganjiang (Zingiberis Rhizoma) replaces Shengjiang. Upon entering the Stomach, the liquid is allowed to distribute upward and downward by Stomach Qi. Thus, whether there is Upper Heat and Lower Cold, or Upper Cold and Lower Heat, it can be treated.
For Exterior-Interior pathogens, Chaihu and Huangqin are used; for Upper-Lower pathogens, Guizhi and Huanglian are used. For Exterior-Interior pathogens, the pungency of Shengjiang is used to disperse; for Upper-Lower pathogens, the acridity of Ganjiang is used to open. Zhang Zhongjing’s sage methods are clearly evident. I wish to modify and adjust the methods for regulating Upper and Lower Qi. What technique do I employ to advance and retreat? As discussed previously, one seeks balance in the Middle, grasps the pivot to operate, and gradually penetrates to the Upper and Lower. Once Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi) are smoothly flowing forward, advancement and retreat can be executed. However, this is difficult to explain. If rejection leads to vomiting and regurgitation, advancing with this formula is suitable.
Since the Taiyang (Greater Yang) channel governs opening, if Taiyang does not open, obstruction occurs in the chest, leading to inability to eat or immediate regurgitation after eating. Because Guizhi is a herb of the Taiyang channel, it harmonizes Ying and Wei Qi and promotes the flow of Yang Dao, thus capable of opening obstructions. However, when Fire generated by the Five Emotions (Wu Zhi) and Jue Yang (Jueyin Yang) ascends, Guizhi must not be used. Using it would be adding fire to fire, causing sweating on the head and collapse of Yang, resulting in Guan Ge (Obstruction and Rejection) where urination is impossible.
The method of retreat involves penetrating into the Yin aspect through Stomach Qi; in such cases, Guizhi is also excluded. However, if the "gate" of the Stomach opens, and Shaoyin (Lesser Yin) governs closing, if Shaoyin Qi does not ascend, the Stomach's gate will certainly not open. I am particularly concerned that the Shaoyin pulse being deep and sluggish, and the Duyang pulse being hidden and choppy, are both worrisome conditions. The *Neijing* frequently mentions these: "Kidney Qi sinks alone," and "Kidney Qi is unbalanced." True Qi residing in the Kidneys acts like a counterweight and beam; with both weight and balance, the gate opens and closes intermittently. With weight but no balance, the gate only closes and never opens. How then can urine exit? Therefore, Shenqi Wan (Kidney Qi Pill) is also a consideration within the method of retreat. When Kidney Qi interacts with the Stomach, the gate opens; when it interacts with the Heart, Jue Yang Fire descends and settles. There are times when its use is indispensable. The sequence of advancement and retreat within a single formula is so profound; how could an ordinary person discern it?
[Four Medical Laws]
1. In treating Guan Ge disease, if one does not know to use guiding and draining methods to break the rejection, but merely hopes to stop vomiting and urinary difficulty, hastily treating the symptoms while exhausting one's skills and strength, causing harm instead of benefit, is the physician's fault.
2. In treating Guan Ge disease, if one fails to examine the pulses at Renying, Duyang, and Taichong points, relying solely on the Cun Kou (Radial artery) pulse, this is negligence. If one is also ignorant of distinguishing Yin and Yang at the Cun Kou, this is even greater fault.
3. In treating Guan Ge disease, if one does not differentiate between Pulse Deficiency and Excess of Yang and Yin to determine therapeutic advancement or retreat, it is like a blind person walking without knowing east from west; this is the physician's fault.
4. In treating Guan Ge disease, if one abandons the "Kingly Way" (gentle and principled treatment) and resorts to "Hegemonic Methods" (harsh and aggressive tactics), displaying personal prowess and hastening death, this is the physician's fault.