桂枝（四两去皮味辛热） 甘草（四两炙味甘平） 白术（三两味甘平） 人参
（三两味甘温） 干姜（三两味辛热）
上五味。以水九升。先煮四味。取五升。内桂。更煮。取三升。温服一升。日再。夜
一服。
表未解者。辛以散之。里不足者。甘以缓之。此以里气大虚。表里不解。故加桂枝
甘草于理中汤也。
张兼善云。大柴胡汤。泻也。桂枝人参汤。补也。皆治下利。心下痞硬。若伤寒发
热。汗出不解。心下痞硬。呕吐而下利者。表和而里病也。以心中痞硬。故为实。当以
大柴胡汤下之。二者心下痞硬虽同。而虚实之症有异。故用药有攻补之别也。
伤寒大下
后。复发汗。心下痞。恶寒者。表未解也。不可攻痞。当先解表。表解乃可攻
痞。解表宜桂枝汤。攻痞宜大黄黄连泻心汤。
大下后复发汗。则表里之邪当悉已。此心下痞而恶寒者。表里之邪。俱不解也。因
表不解而下之。为心下痞。先与桂枝汤解表。表解。乃与大黄黄连泻心汤攻痞。内经曰。
从外之内。而盛于内者先治其外而后调其内。
活人云。大抵结胸与痞。皆应下。然表未解者。不可攻也。
伤寒发热。汗出不解。心中痞硬。呕吐而下利者。大柴胡汤主之。
伤寒发热。寒已成热也。汗出不解。表和而里病也。吐利心腹濡软。为里虚。呕吐
而下利。心腹痞硬者。是里实也。与大柴胡汤。以下里热。
病如挂枝证。头不痛。项不强。寸脉微浮。胸中痞硬。气上冲咽喉。不得息者。此
为胸有寒也。当吐之。宜瓜蒂散。
病如桂枝证。为发热。汗出。恶风。言邪在表也。头痛项强。为桂枝汤证具。若头
不痛。项不强。则邪不在表而传里也。浮为在表。沉为在里。今寸脉微浮。则邪不在表。
亦不在里。而在胸中也。胸中与表相应。故知邪在胸中者。犹如桂枝证。而寸脉微浮也。
以胸中痞硬。上冲咽喉。不得息。知寒邪客于胸中。而不在表也。千金
曰。气浮上部。填塞心胸。胸中满者。吐之则愈。与瓜蒂散。以吐胸中之邪。
Cinnamon Twig (Guizhi, *Ramulus Cinnamomi*, four liang, bark removed, acrid and hot) Licorice Root (Gancao, *Radix Glycyrrhizae*, four liang, honey-fried, sweet and neutral) Atractylodes Rhizome (Baizhu, *Rhizoma Atractododis Macrocephalae*, three liang, sweet and neutral) Ginseng Root (Renshen, *Radix Ginseng*, three liang, sweet and warm) Dried Ginger (Ganjiang, *Rhizoma Zingiberis Preparatum*, three liang, acrid and hot)
These five herbs. Use nine sheng of water. First decoct the first four herbs. Obtain five sheng of liquid. Add Cinnamon Twig. Decoct further. Obtain three sheng of liquid. Take one sheng warm. Twice daily. Once at night.
When the exterior syndrome is unresolved, use acrid substances to disperse it. When interior deficiency exists, use sweet substances to moderate and tonify. This is because the interior qi is severely deficient, and both exterior and interior syndromes are unresolved; therefore, Cinnamon Twig and Licorice Root are added to Lizhong Tang (Middle-Boosting Decoction).
Zhang Jianshan stated: Dachaihu Tang (Major Bupleurum Decoction) is a method of purging excess. Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) is a method of tonifying deficiency. Both treat diarrhea and epigastric fullness with hardness. If typhoid fever presents with heat, sweating that does not resolve the condition, epigastric fullness with hardness, vomiting, and diarrhea, this indicates the exterior is resolved while the interior is diseased. Because of the epigastric fullness and hardness, it is judged as an excess pattern, and Dachaihu Tang should be used to purge. Although both conditions present with epigastric fullness and hardness, their nature differs between excess and deficiency; thus, the medications differ between attacking pathogens and tonifying.
After severe purgation in typhoid fever, followed by repeated sweating, if epigastric fullness occurs accompanied by aversion to cold, the exterior syndrome remains unresolved. One must not attack the fullness at this time; instead, one should first resolve the exterior. Only after the exterior is resolved can the fullness be attacked. To resolve the exterior, Guizhi Tang (Cinnamon Twig Decoction) is suitable. To attack the fullness, Dahuang Huanglian Xiexin Tang (Rhubarb, Coptis, and Scutellaria Heart-Purging Decoction) is suitable.
After severe purgation and subsequent sweating, theoretically, both exterior and interior pathogens should have been eliminated. The current presentation of epigastric fullness and aversion to cold indicates that neither exterior nor interior pathogens have been resolved. Because the exterior was unresolved when purgation was mistakenly applied, epigastric fullness resulted. First administer Guizhi Tang to resolve the exterior. Once the exterior is resolved, then administer Dahuang Huanglian Xiexin Tang to attack the fullness. The *Neijing* states: When pathogenic factors enter from the exterior and become prevalent internally, one should first treat the exterior and subsequently regulate the interior.
The *Huoren Shu* states: Generally speaking, Jie Xiong (Chest Binding) and Pi (Glomus/Fullness) syndromes should both be treated with purgation. However, if the exterior syndrome is unresolved, purgation is contraindicated.
Typhoid fever with heat, sweating that does not resolve the condition, epigastric fullness with hardness, vomiting, and diarrhea: Dachaihu Tang is the primary formula.
Typhoid fever with heat indicates that cold has transformed into heat. Sweating without resolution indicates the exterior is resolved but the interior is diseased. Vomiting and diarrhea with a soft and flaccid abdomen indicate interior deficiency. Vomiting and diarrhea with epigastric and abdominal fullness and hardness indicate interior excess. Dachaihu Tang is given to purge interior heat.
The condition resembles Guizhi Tang syndrome, but without headache or stiff neck, with a slightly floating pulse at the cun position, epigastric fullness and hardness, qi rushing upward to the throat causing breathing difficulty, this is termed "cold in the chest" (accumulation of phlegm-fluids or yin pathogens in the chest). It should be treated with emesis. Gouti San (Melon Seed Powder) is suitable.
A condition resembling Guizhi Tang syndrome involves heat, sweating, and aversion to wind, indicating pathogenic factors in the exterior. Headache and stiff neck constitute the complete Guizhi Tang syndrome. If there is no headache or stiff neck, the pathogen is not in the exterior but has transmitted inward. A floating pulse indicates disease in the exterior; a deep pulse indicates disease in the interior. Currently, the cun pulse is slightly floating, indicating the pathogen is neither in the exterior nor in the interior, but in the chest. The chest corresponds to the exterior; thus, knowing the pathogen is in the chest is similar to Guizhi Tang syndrome, presenting with a slightly floating cun pulse. Due to epigastric fullness and hardness, qi rushing to the throat, and breathing difficulty, it is known that cold pathogens reside in the chest, not in the exterior. The *Qianjin Fang* states: When qi floats to the upper part, filling the heart and chest, causing chest fullness, emesis leads to cure. Gouti San is given to emetic the pathogens from the chest.