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。
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].