仲景治伤寒有表复有里，今例于左，学人审之。表里俱见，疑似之间，最宜详
悉。盖在表者宜汗，在里者
宜下。今既两证俱有，大率表证多者，则先治其表；里证多者，则先和其里。
伤寒脉浮大，是表证，当汗。其人发热烦渴小便赤，当下。此是表里俱见。（五苓
散分利之。）仲景云∶中风发热，六七日不解而烦，有表里证，渴欲饮水，水入即
吐，名曰水逆。（五苓散分利之。）六七日不大便，头痛有热者，是里证，当下。其人小
便清者，知不在里，仍在表，却当汗。此两证俱见。（桂枝汤和之）。病患心下满，不
欲食，大便硬，脉沉细，是里证，当下。其人欲汗出，微恶寒，手足冷，却当汗，此两
证俱见。（小柴胡汤和解。）
太阳病表证未除，医反下之，遂协热而利不止，心下痞硬，谓之表里不解。（桂枝人
参汤。）
太阳病，医反下之，因而腹痛、是有表复有里。（桂枝芍药汤，痛甚加大黄。）
太阳病，桂枝证，误为医下之，利遂不止，脉促者，表未解也。喘而汗出者，（葛
根黄芩黄连汤清之。）
脉浮大是表，其人心下痞闷却当下。若烦渴燥涩，小便赤，宜用大柴胡汤和其胃气。
脉浮紧，咽燥口苦，腹满而喘，发热汗出，不恶寒，反恶热，此阳明证也。脉反浮而
紧，是有表里惧见，不可汗下，宜栀子豆豉汤吐之。
有表证而脉迟者不可汗，亦不可下，宜（小建中汤。）脉弦细不欲食，则当下。其人头上
汗出，身热微恶寒，手足冷，此两证俱见，宜（小柴胡汤和之。）
【和解】小柴胡汤、桂枝人参汤。
【吐】栀子豆豉汤。
张仲景治疗伤寒病，既有表证又有里证，现在列举在左侧，学习的人要仔细审察。表证和里证同时出现，处于疑似难辨之间，最应当详细周全地分析。一般来说，病邪在表的适宜用发汗法，病邪在里的适宜用泻下法。如今既然两种证候都具备，大体上表证多的，就先治疗其表证；里证多的，就先调和其里证。
伤寒脉象浮大，这是表证，应当用发汗法。如果病人发热、烦躁、口渴、小便颜色红赤，应当用泻下法。这是表证和里证同时出现。（可用五苓散分利水湿。）张仲景说：中风发热，经过六七天没有解除并且出现烦躁，有表证和里证的表现，想喝水，但水喝进去就吐出来，这叫做“水逆”。（可用五苓散分利水湿。）
如果六七天不大便，头痛且伴有发热，这是里证，应当用泻下法。如果病人小便清长，就知道病邪不在里，仍在表，却应当用发汗法。这是两种证候同时出现。（可用桂枝汤调和。）
病患胃脘部胀满，不想吃东西，大便干硬，脉象沉细，这是里证，应当用泻下法。如果病人想要出汗，轻微怕冷，手脚冰凉，却应当用发汗法，这是两种证候同时出现。（可用小柴胡汤和解。）
太阳病表证尚未消除，医生反而使用泻下法，于是导致协热下利不止，心下部痞塞坚硬，这叫做表里同病未解。（可用桂枝人参汤。）
太阳病，医生反而使用泻下法，因而导致腹痛，这是有表证又有里证。（可用桂枝芍药汤，疼痛严重加大黄。）
太阳病，具有桂枝汤证，被医生误用泻下法，腹泻随即不止，脉象急促的，说明表证未解。气喘并且出汗的，（可用葛根黄芩黄连汤清热。）
脉象浮大是表证，但病人心下部痞闷却应当用泻下法。如果出现烦躁、口渴、燥涩感，小便红赤，适宜用大柴胡汤调和胃气。
脉象浮紧，咽喉干燥口苦，腹部胀满且气喘，发热出汗，不怕冷反而怕热，这是阳明病证。脉象反而浮而紧，这是表里证同时存在，不可单纯发汗或泻下，适宜用栀子豆豉汤涌吐。
有表证而脉象迟缓的，不可发汗，也不可泻下，适宜用小建中汤。脉象弦细不想吃东西，则应当用泻下法。如果病人头部出汗，身体发热轻微怕冷，手脚冰凉，这是两种证候同时出现，适宜用小柴胡汤调和。
Zhang Zhongjing's treatment of Shanghan (Cold Damage) involves both exterior and interior syndromes, which are listed on the left for students to examine carefully. When exterior and interior symptoms appear simultaneously, creating a state of ambiguity, it is most crucial to analyze them in detail. Generally, pathogens located in the exterior are suitable for diaphoresis (sweating method), while those in the interior are suitable for purgation (draining method). Since both types of syndromes are present, if the exterior syndrome predominates, treat the exterior first; if the interior syndrome predominates, harmonize the interior first.
In Shanghan, a floating and large pulse indicates an exterior syndrome, requiring diaphoresis. If the patient presents with fever, irritability, thirst, and dark urine, purgation is required. This represents simultaneous exterior and interior syndromes. (Wuling San [Five-Ingredient Poria Decoction] can be used to separate and drain dampness.) Zhang Zhongjing stated: In wind-strike with fever, if it persists for six or seven days without resolution accompanied by irritability, and there are signs of both exterior and interior syndromes, with thirst for water but vomiting immediately after drinking, this is named "Water Reversal" (Shui Ni). (Wuling San [Five-Ingredient Poria Decoction] can be used to separate and drain dampness.)
If there has been no bowel movement for six or seven days, accompanied by headache and fever, this is an interior syndrome requiring purgation. However, if the patient's urine is clear, it indicates the pathogen is not in the interior but remains in the exterior, thus requiring diaphoresis. This represents simultaneous syndromes. (Guizhi Tang [Cinnamon Twig Decoction] can be used to harmonize.)
If a patient suffers from fullness below the heart, loss of appetite, hard stools, and a deep, thin pulse, this is an interior syndrome requiring purgation. If the patient desires to sweat, has slight aversion to cold, and cold hands and feet, yet requires diaphoresis, this represents simultaneous syndromes. (Xiao Chaihu Tang [Minor Bupleurum Decoction] can be used to harmonize.)
In Taiyang disease (Taiyang Syndrome), if the exterior syndrome is not resolved and the physician mistakenly uses purgation, it leads to continuous diarrhea with accompanying heat and epigastric hardness, known as unresolved exterior and interior conditions. (Guizhi Renshen Tang [Cinnamon Twig and Ginseng Decoction] is indicated.)
In Taiyang disease, if the physician mistakenly uses purgation resulting in abdominal pain, this indicates the presence of both exterior and interior syndromes. (Guizhi Shaoyao Tang [Cinnamon Twig and Peony Decoction] is indicated; add Dahuang [Rhubarb Rhizome] if pain is severe.)
In Taiyang disease, if a Guizhi Tang pattern is mistakenly treated with purgation by the physician, leading to unceasing diarrhea, a rapid pulse indicates that the exterior is not yet resolved. If there is wheezing and sweating, (Gegen Huangqin Huanglian Tang [Kudzu Root, Scutellaria, and Coptis Decoction] should be used to clear heat.)
A floating and large pulse indicates an exterior syndrome, but if the patient experiences epigastric oppression, purgation may be required. If there is irritability, thirst, dryness, and dark urine, Dachaihu Tang [Major Bupleurum Decoction] is suitable to harmonize stomach qi.
A floating and tight pulse, with dry throat, bitter taste, abdominal fullness, wheezing, fever, sweating, aversion to neither cold nor heat but rather aversion to heat, constitutes a Yangming syndrome (Yangming Disease). If the pulse is surprisingly floating and tight, indicating simultaneous exterior and interior syndromes, neither diaphoresis nor purgation should be used; instead, Zhizi Douchi Tang [Gardenia and Fermented Soybean Decoction] should be used to induce emesis.
If there is an exterior syndrome but the pulse is slow, neither diaphoresis nor purgation should be used; Xiao Jianzhong Tang [Minor Construct the Middle Decoction] is suitable. A wiry and thin pulse with loss of appetite suggests purgation is needed. If the patient has sweating only on the head, body heat, slight aversion to cold, and cold hands and feet, this represents simultaneous syndromes, and Xiao Chaihu Tang [Minor Bupleurum Decoction] should be used to harmonize.
[Harmonizing Methods] Xiao Chaihu Tang [Minor Bupleurum Decoction], Guizhi Renshen Tang [Cinnamon Twig and Ginseng Decoction].
[Emetic Method] Zhizi Douchi Tang [Gardenia and Fermented Soybean Decoction].