白头翁（三两苦寒） 黄连（三两去须苦寒） 黄柏（三两去皮苦寒） 秦皮（三
两苦寒）
上四味。以水七升煮取二升。去滓。温服一升。不愈。更服一升。
内经曰。肾欲坚。急食苦以坚之。利则下焦虚。是以纯苦之剂坚之。
下利胸胀满。身体疼痛者。先温其里。乃攻其表。温里四逆汤。攻表。桂枝汤。
下利腹满者。里有虚寒。先与四逆汤温里。身疼痛。为表未解。利止里和。与桂枝
汤攻表。
下利欲饮水者。以有热故也。白头翁汤主之。
自利不渴。为脏寒。与四逆汤。以温脏。下利饮水。为有热。与白头翁汤以凉中。
罗天益云。少阴自利而渴。乃下焦虚寒。而用四逆者。恐不可以渴不渴分热寒也。
正当以小便黄白别之耳。
下利谵语者。有燥屎也。宜小承气汤。
经曰。实则谵语。有燥屎。为胃实。下利为肠虚。与小承气汤。以下燥屎。
下利后。更烦。按之心下濡者。为虚烦也。宜栀子豉汤。
下利后不烦。为欲解。若更烦而心下坚者。恐为谷烦。此烦而心下濡者。是邪热乘
虚。客于胸中。为虚烦也。与栀子豉汤。吐之则愈。
呕家有痈脓者。不可治呕。脓尽。自愈。
胃脘有痈。则呕而吐脓。不可治呕。得脓尽。呕亦自愈。
呕而脉弱。小便复利。身有微热。见厥者难治。四逆汤主之。
呕而脉弱。为邪气传里。呕则气上逆。而小盒饭不利。小便复利者。里虚也。身有
微热见厥者。阴胜阳也。为难治。与四逆汤。温里助阳。
干呕。吐涎沫。头痛者。吴茱萸汤主之。
干呕吐涎沫者。里寒也。头痛者。寒气上攻也。与吴茱萸汤。温里散寒。
呕而发热者。小柴胡汤主之。
经曰。呕而发热者。柴胡证具。
伤寒。大吐大下之。极虚。复极汗出者。以其人外气怫郁。复与之水。以发其汗。
因得哕。所以然者。胃中寒冷故也。
大吐大下。胃气极虚。复极发汗。又亡阳气。外邪怫郁于表。则身热。医与之水以
发其汗。胃虚得水。虚寒相搏。成哕也。
或云。吴茱萸汤。理中汤。
活人云。橘皮干姜汤。羌活附子散。半夏生姜汤。退阴散。
伤寒哕而腹满。视其前后。知何部不利。利之则愈。
哕而腹满。气上而不下也。视其前后部有不利者。即利之以降其气。前部。小便
也。后部。大便也。
活人云。前部宜猪苓汤。后部宜调胃承气汤。
白头翁（三两，味苦性寒） 黄连（三两，去须，味苦性寒） 黄柏（三两，去皮，味苦性寒） 秦皮（三两，味苦性寒）
以上四味药。用水七升，煎煮至取汁二升。滤去药渣。温服一升。若病未愈，再服一升。
《内经》说：肾气欲其坚固，急用苦味食物来坚固它。腹泻会导致下焦虚弱，因此使用纯苦味的药剂来坚固它。
腹泻伴有胸部胀满、身体疼痛的，先温补里虚，然后再解表邪。温里用四逆汤，解表用桂枝汤。
腹泻伴有腹部胀满的，是里有虚寒，先给予四逆汤温补里虚；身体疼痛，说明表证未解。待腹泻停止、里气调和后，再用桂枝汤解除表邪。
腹泻且想喝水的，是因为体内有热，用白头翁汤主治。
自发性腹泻且不口渴的，是脏腑寒冷，给予四逆汤以温补脏腑；腹泻且想喝水的，是有热，给予白头翁汤以清中焦之热。
罗天益说：少阴病自发性腹泻且口渴，是下焦虚寒，使用四逆汤。恐怕不能仅凭是否口渴来区分热证和寒证。正当通过小便颜色黄或白来辨别罢了。
腹泻伴发谵语的，是有燥屎内结，适宜用小承气汤。
经典说：实证会出现谵语，有燥屎，属于胃实。腹泻说明肠道虚，给予小承气汤，以攻下燥屎。
腹泻之后，烦躁加重，按压心下部感觉柔软的，是虚烦，适宜用栀子豉汤。
腹泻后不烦躁，说明病情将要缓解。如果再次出现烦躁且心下部坚硬，恐怕是食积导致的烦躁。此处烦躁且心下部柔软，是邪热乘虚客居胸中，属于虚烦，给予栀子豉汤。催吐则痊愈。
患有痈脓而呕吐的，不可治疗呕吐。待脓液排尽，呕吐自愈。
胃脘部有痈肿，则会呕吐并吐出脓液，不可治疗呕吐。待脓液排尽，呕吐也会自愈。
呕吐且脉象微弱，小便反而通利，身体有轻微发热，出现四肢厥冷的，难治，用四逆汤主治。
呕吐且脉象微弱，是邪气传入里部。呕吐导致气机上逆，本应小便不利，但小便反而通利的，是里虚。身体有轻微发热且出现四肢厥冷的，是阴盛阳衰，属于难治之证，给予四逆汤，温补里虚，扶助阳气。
干呕，吐出涎沫，头痛的，用吴茱萸汤主治。
干呕并吐出涎沫，是里寒所致。头痛，是寒气上攻头部所致。给予吴茱萸汤，温补里虚，散除寒邪。
呕吐且发热的，用小柴胡汤主治。
经典说：呕吐且发热的，具备柴胡汤证。
伤寒病，经过剧烈的吐法和下法治疗后，正气极度虚弱，又出现大汗出，因为患者体表之气郁闭不畅，医生又给他喝水以发汗，因而导致呃逆。之所以这样，是因为胃中寒冷所致。
剧烈吐下，胃气极度虚弱，又大量发汗，进一步损耗阳气。外邪郁闭于体表，则身体发热。医生给水以发汗，胃虚得水，虚与寒相互搏结，形成呃逆。
有人说，可用吴茱萸汤、理中汤。
《活人书》说，可用橘皮干姜汤、羌活附子散、半夏生姜汤、退阴散。
伤寒呃逆且腹部胀满，观察前后二便，知道哪一部不通利，通利那一部分则痊愈。
呃逆且腹部胀满，是气机上逆而不能下行。观察前后二便中有不通利的部位，即通利它以降逆气。前部指小便，后部指大便。
《活人书》说，前部（小便不利）适宜用猪苓汤，后部（大便不利）适宜用调胃承气汤。
Baitouweng (Radix Pulsatillae, 3 liang, bitter and cold) Huanglian (Rhizoma Coptidis, 3 liang, remove the rootlets, bitter and cold) Huangbai (Cortex Phellodendri, 3 liang, remove the cork, bitter and cold) Qinpi (Cortex Fraxini, 3 liang, bitter and cold)
The above four herbs. Decoct with seven sheng of water to obtain two sheng of liquid. Strain off the dregs. Take one sheng warm. If not cured, take another sheng.
The *Neijing* states: The Kidney desires firmness; urgently consume bitter substances to firm it. Diarrhea leads to deficiency and cold in the Lower Jiao; therefore, use purely bitter agents to firm it.
In cases of diarrhea accompanied by chest fullness and body pain, first warm the Interior, then attack the Exterior. For warming the Interior, use Sini Tang (Four Reversal Decoction); for attacking the Exterior, use Guizhi Tang (Cinnamon Twig Decoction).
In cases of diarrhea accompanied by abdominal fullness, there is deficiency-cold in the Interior. First administer Sini Tang to warm the Interior. Body pain indicates the Exterior pattern has not yet resolved. Once the diarrhea stops and the Interior harmonizes, administer Guizhi Tang to attack the Exterior.
In cases of diarrhea with a desire to drink water, this is due to Heat. Baitouweng Tang is the primary treatment.
Spontaneous diarrhea without thirst indicates Zang-organ Cold; administer Sini Tang to warm the Zang-organs. Diarrhea with a desire to drink water indicates Heat; administer Baitouweng Tang to cool the Middle Jiao.
Luo Tianyi stated: In Shaoyin disease, spontaneous diarrhea with thirst indicates deficiency-cold in the Lower Jiao, treated with Sini Tang. One should not distinguish between Heat and Cold merely based on the presence or absence of thirst. It is proper to distinguish them by the color of urine (yellow or white).
Diarrhea accompanied by delirium indicates the presence of dry feces; Xiao Chengqi Tang is suitable.
The Classics state: Excess patterns present with delirium and dry feces, indicating Stomach excess. Diarrhea indicates Intestine deficiency. Administer Xiao Chengqi Tang to purge the dry feces.
After diarrhea, if restlessness increases and palpation of the epigastrium reveals softness, this is empty restlessness; Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is suitable.
If there is no restlessness after diarrhea, the condition is resolving. If restlessness recurs and the epigastrium becomes hard, it may be food stagnation causing restlessness. Here, restlessness with a soft epigastrium indicates pathogenic Heat lodging in the Chest due to deficiency, constituting empty restlessness. Administer Zhizi Chi Tang. Inducing vomiting will lead to recovery.
In cases where vomiting is caused by abscess pus, do not treat the vomiting directly. When the pus is exhausted, the vomiting will resolve spontaneously.
If there is an abscess in the stomach region, vomiting and expectoration of pus occur. Do not treat the vomiting directly. When the pus is exhausted, the vomiting will also resolve spontaneously.
In cases of vomiting with a weak pulse, urination that is again profuse, slight body heat, and appearance of cold extremities, the prognosis is difficult. Sini Tang is the primary treatment.
Vomiting with a weak pulse indicates pathogenic Qi transmitting to the Interior. Vomiting causes Qi to rebel upward, which should result in difficulty urinating; however, profuse urination indicates Interior deficiency. Slight body heat with cold extremities indicates Yin excess and Yang deficiency, constituting a difficult case. Administer Sini Tang to warm the Interior and assist Yang.
Dry retching, expectoration of saliva and foam, and headache are primarily treated with Wuzhuyu Tang (Evodia Decoction).
Dry retching with expectoration of saliva and foam indicates Interior Cold. Headache indicates Cold Qi attacking upward. Administer Wuzhuyu Tang to warm the Interior and dissipate Cold.
Vomiting accompanied by fever is primarily treated with Xiaochaihu Tang (Minor Bupleurum Decoction).
The Classics state: Vomiting accompanied by fever presents the complete Chaihu syndrome.
In Shanghan (Cold Damage), after excessive vomiting and purging, the patient is extremely deficient. If excessive sweating occurs subsequently, because the exterior Qi is constrained and depressed, and the physician gives water to induce sweating, hiccups (e) result. This happens because of Cold in the Stomach.
Excessive vomiting and purging cause extreme deficiency of Stomach Qi. Subsequent excessive sweating further depletes Yang Qi. External pathogens constrain at the Exterior, causing body heat. The physician gives water to induce sweating; the deficient Stomach receives water, and deficiency combines with Cold, resulting in hiccups.
Some say: Use Wuzhuyu Tang or Lizhong Tang.
The *Huangdi Bashiyi Nan Jing* (Book of Difficulties/Alive Person's Book) suggests: Jupi Ganjiang Tang (Tangerine Peel and Dried Ginger Decoction), Qianghuo Fuzi San (Notopterygium and Aconite Powder), Banxia Shengjiang Tang (Pinellia and Fresh Ginger Decoction), Tuiyin San (Eliminate Yin Powder).
In Shanghan, if hiccups are accompanied by abdominal fullness, examine the anterior and posterior orifices to determine which part is obstructed. Relieving the obstruction leads to recovery.
Hiccups with abdominal fullness indicate Qi rebelling upward without descending. Observe the anterior (urination) and posterior (defecation) orifices for obstruction; relieve the obstruction to descend the Qi. The anterior part refers to urine; the posterior part refers to stool.
The *Huangdi Bashiyi Nan Jing* states: For anterior obstruction (urinary difficulty), Zhu Ling Tang (Polyporus Decoction) is suitable; for posterior obstruction (stool difficulty), Tiaowei Chengqi Tang (Regulate the Stomach and Guide Out Excess Decoction) is suitable.