麻黄（二两半去节甘温） 升麻（一两一分甘平） 当归（一两一分辛温） 知母
（苦寒） 黄芩（苦寒） 葳蕤（甘平各十八铢） 石膏（碎绵裹甘寒） 白术（甘温）
干姜（辛热） 芍药（甘平） 天门冬（去心甘平） 桂枝（辛热） 茯苓（甘平）
甘草（炙甘平各六铢）
上十四味。以水一斗。先煮麻黄一两。沸去上沫。内诸药。煮取三升。去滓。分温
三服。相去如炊三斗米顷。令尽汗出愈。
玉函曰。大热之气。寒以取之。甚热之气。以汗发之。麻黄升麻之甘。以发浮热。正
气虚者。以辛润之。当归桂姜之辛。以散寒。上热者。以苦泄之。知母黄芩之苦。凉心
去热。津液少者。以甘润之。茯苓白术之甘。缓脾生津。肺燥气热。以酸收之。以甘缓之。
芍药之酸。以敛逆气。葳蕤门冬石膏甘草之甘。润肺除热。
伤寒四五日。腹中痛。若转气。下趋少腹者。此欲自利也。
伤寒四五日。邪气传里之时。腹中痛。转气下趋少腹者。里虚遇寒。寒气下行。欲
作自利也。
伤寒本自寒下。医复吐之。寒格更逆吐下。若食入口即吐。干姜黄连黄芩人参汤主
之。
伤寒邪自传表。为本自寒下。医反吐之。损伤正气。寒气内为格拒。经曰。格则吐
逆。食入口即吐。谓之寒格。更复吐下。则重虚而死。是更逆吐下。与干姜黄连黄芩人
参汤。以通寒格。
王宇泰云。按本自寒下。恐是本自吐下。玩复字可见。盖胃寒则吐。下寒则利。胃
寒者不宜吐。医反吐之。则伤胃气。遂成寒格。下文文气不贯。当有缺文。
张卿子云。本自寒下。如少阳一条。邪高痛下。所谓邪正分争。盖本为寒。而邪为
热素问云。风寒在下。燥热在上。
Mahuang (Ephedrae Herba, two and a half liang, nodes removed, sweet and warm) Shengma (Cimicifugae Rhizoma, one liang and one fen, sweet and neutral) Danggui (Angelicae Sinensis Radix, one liang and one fen, acrid and warm) Zhimu (Anemarrhenae Rhizoma, bitter and cold) Huangqin (Scutellariae Radix, bitter and cold) Weirui (Polygonati Odorati Rhizoma, sweet and neutral, each eighteen zhu) Shigao (Gypsum Fibrosum, crushed, wrapped in cotton, sweet and cold) Baizhu (Atractylodis Macrocephalae Rhizoma, sweet and warm) Ganjiang (Zingiberis Rhizoma Recens, acrid and hot) Shaoyao (Paeoniae Radix Alba, sweet and neutral) Tianmendong (Asparagi Radix, heart removed, sweet and neutral) Guizhi (Cinnamomi Ramulus, acrid and hot) Fuling (Poria, sweet and neutral) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, sweet and neutral, each six zhu)
The above fourteen ingredients. Use ten dou of water. First decoct Mahuang until one sheng remains, skim off the foam on the surface. Then add the remaining herbs. Decoct to obtain three sheng of liquid. Strain out the dregs. Divide into three equal doses to be taken warm. The interval between doses should be approximately the time it takes to cook three dou of rice. After administration, induce sweating for recovery.
The *Yufang Jing* states: For excessive heat qi, use cold medicines to resolve it. For severe heat qi, use diaphoresis to disperse it. The sweetness of Mahuang and Shengma is used to disperse floating heat. For those with deficient righteous qi, use acrid and moistening methods. The acridity of Danggui, Guizhi, and Ganjiang is used to dispel cold. For heat in the upper jiao, use bitter drugs to drain heat. The bitterness of Zhimu and Huangqin cools the heart and removes heat. For those with insufficient body fluids, use sweet and moistening methods. The sweetness of Fuling and Baizhu soothes the spleen and generates fluids. For lung dryness and qi heat, use sour astringents and sweet relaxants. The sourness of Shaoyao is used to constrain rebellious qi. The sweetness of Weirui, Tianmendong, Shigao, and Gancao moistens the lungs and removes heat.
In Shanghan disease lasting four or five days, if there is abdominal pain accompanied by peristaltic sounds moving downward toward the lower abdomen, this indicates an impending spontaneous diarrhea.
During the fourth or fifth day of Shanghan disease, when pathogenic factors transmit inward, abdominal pain and peristaltic sounds moving downward toward the lower abdomen suggest that internal deficiency combined with cold causes cold qi to descend, leading to impending spontaneous diarrhea.
If Shanghan disease originally presented with cold-type diarrhea, and the physician erroneously employed emesis, cold obstruction may worsen vomiting and diarrhea. If food is vomited immediately upon ingestion, Ganjiang Huanglian Huangqi Renshen Tang (Dry Ginger, Coptis, Scutellaria, and Ginseng Decoction) is indicated.
Shanghan pathogens typically transmit from the exterior; however, due to pre-existing cold diarrhea, erroneous emesis damages righteous qi, causing cold qi to obstruct internally. As stated in the classics, "obstruction leads to vomiting and reversal." Vomiting food immediately after ingestion is termed "cold obstruction." Further use of emetic or purgative methods would cause double deficiency and death. Therefore, for such aggravated conditions, Ganjiang Huanglian Huangqi Renshen Tang is used to resolve the cold obstruction.
Wang Yutai commented: Regarding "originally having cold diarrhea," it is likely that the original text read "originally having vomiting and diarrhea." This can be inferred from the character "further" (复). Stomach cold causes vomiting, while lower jiao cold causes diarrhea. Patients with stomach cold should not undergo emesis; doing so damages stomach qi, resulting in cold obstruction. The subsequent text lacks coherence, suggesting missing passages.
Zhang Qingzi stated: "Originally having cold diarrhea" is analogous to the Shaoyang syndrome description of "pathogen high, pain low," representing the struggle between pathogenic and righteous qi. Originally, the condition involves cold, but the pathogen manifests as heat. The *Suwen* states: "Wind-cold is below, dry-heat is above."