桂枝 甘草 白术 人参 干姜
太阳病。外症未除。而数下之。遂协热而利不止。心下痞硬。表里不解。 仲景论太阳
病桂枝症。医反下之。利遂不止。与葛根黄连黄芩汤。此又与桂枝人参汤。二症俱系表不解。而
下之成利者。何故用药有温凉之异乎。二症虽同是内虚热入。协热遂利。但脉症不同，故用
药有别耳。前言脉促者。表未解。喘而汗出者。主葛根黄连黄芩汤。夫脉促为阳盛喘汗为里
热。用葛根芩连。理所宜也。且前症但曰下之。此曰数下之。前症但曰利下。此曰利不止。
两论细味之。即有虚实之分矣。
瓜蒂 赤小豆 香豉
病如桂枝症。头不痛。项不强。寸脉微浮。痞硬。气上冲咽喉。不得息。此胸有寒也。当
以瓜蒂散吐之。 病在上者。因而越之。邪客胸中。至气冲不得息。非吐之不可也。寒气在胸。瓜
蒂之苦寒。从其
。然此为快剂。重亡津液。与栀子豉汤。大不相侔也。故亡血虚家。特为申禁。
黄连 甘草 干姜 桂枝 人参 半夏 大枣
胸中有热。胃中有邪气。腹痛欲呕吐。此方主之。 邪气传里。下寒上热。夫胃中有邪
。则阴阳不交。阴不得升。而独治于下。为下寒而腹痛。阳不得降。而独治于上。为上热而呕吐
。上热者泄之以苦。黄连之职也。下寒者。散之以辛。姜桂半夏之任也。脾欲缓急食甘以缓
之。人参甘枣之用。其在斯乎。
太阳病（太阳经受邪所致的病证），表证未解，却多次使用攻下法治疗，导致伴随发热而下利不止。胃脘部痞塞胀硬，表里之邪均未解除。张仲景在论述太阳病时提到，若出现桂枝汤证（以汗出、恶风、脉浮缓为特征的表虚证），医生反而误用攻下法，导致腹泻不止，此时应给予葛根黄芩黄连汤（由葛根、黄芩、黄连、甘草组成）。此处则给予桂枝人参汤（即理中汤加桂枝）。这两种病症都属于表证未解，因误用攻下法而致泻，为何用药有温性与凉性的区别呢？这两类病症虽然同样是内部虚弱、热邪内陷，协热下利，但脉象和症状不同，所以用药有所区别。前一种情况脉象急促，说明表证未解；气喘且出汗，主治用葛根黄芩黄连汤。脉促表示阳气盛，喘和汗出表示里有热，使用葛根、黄芩、黄连是合乎情理的。况且前一种情况只说“误下”，这里说“多次误下”；前一种情况只说“下利”，这里说“下利不止”。仔细品味两篇论述，就能看出虚实之分了。
病情类似桂枝汤证，但头部不痛，颈部不强直，寸脉微浮，胃脘部痞塞胀硬，气向上冲至咽喉，呼吸不畅。这是胸中有寒饮（痰饮等病理产物）所致。应当用瓜蒂散催吐。病位在上焦的，应当顺势通过涌吐的方法祛除。邪气客居胸中，导致气逆上冲、呼吸不畅，非用吐法不可。寒气停留在胸中，瓜蒂味苦性寒，顺应其势将其吐出。然而这是一种峻猛的吐剂，会严重耗伤津液，与栀子豉汤（由栀子、淡豆豉组成，用于清宣郁热）大不相同。因此，对于失血患者和体质虚弱的人，特别加以禁止。
胸中有热，胃中有邪气（指寒邪），腹痛且想呕吐，此方主治。邪气传入体内，形成下寒上热的局面。胃中有邪气，导致阴阳之气不能交通。阴气不能上升，独自治理于下部，造成下寒而腹痛；阳气不能下降，独自治理于上部，造成上热而呕吐。对于上部的热邪，用苦味药泄降，这是黄连的职责。对于下部的寒邪，用辛味药发散，这是干姜、桂枝、半夏的任务。脾脏喜欢缓和拘急，食用甘味食物来缓解它，这就是用人参和大枣的原因吧。
Cinnamon Twig (Guizhi), Licorice Root (Gancao), Atractylodes Macrocephala Rhizome (Baizhu), Ginseng Radix (Renshen), Dried Ginger (Ganjiang)
Taiyang disease (disease of the Taiyang channel), where exterior symptoms persist, yet multiple purgative treatments have been applied. This results in diarrhea that continues incessantly, accompanied by fever (xie re). There is fullness and hardness in the epigastrium (xin xia pi ying), with both exterior and interior pathogens unresolved. In his treatise on Taiyang disease, Zhang Zhongjing discusses cases where a Guizhi Tang pattern (exterior deficiency pattern characterized by sweating, aversion to wind, and floating-slow pulse) is present, but the physician erroneously applies purgatives, leading to persistent diarrhea. In such cases, Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, Coptis, and Licorice Decoction) is indicated. Here, however, Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction, essentially Lizhong Tang plus Cinnamon Twig) is prescribed. Both conditions involve an unresolved exterior pathogen leading to diarrhea due to erroneous purgation. Why is there a difference between using warming versus cooling formulas? Although both conditions share internal deficiency and heat entering internally, causing diarrhea with fever, the pulse and symptoms differ, necessitating different prescriptions. The former case mentions a rapid pulse (cu mai), indicating the exterior is not resolved; panting and sweating indicate interior heat, for which Gegen Huangqin Huanglian Tang is the primary treatment. A rapid pulse signifies excess Yang, while panting and sweating signify interior heat; thus, using Gegen, Huangqin, and Huanglian is appropriate. Furthermore, the former case merely states "purgation was applied," whereas this case states "multiple purgations were applied." The former mentions "diarrhea," while this one specifies "incessant diarrhea." Careful comparison reveals the distinction between deficiency and excess.
Melon Seed (Gua Di), Red Bean (Chi Xiaodou), Fermented Soybean (Xiang Chi)
The condition resembles a Guizhi Tang pattern, yet there is no headache or neck stiffness. The cun (inch) pulse is slightly floating. There is epigastric fullness and hardness, with qi rushing upward to the throat, causing difficulty in breathing. This indicates the presence of cold-fluid retention (han) in the chest. One should induce vomiting using Gua Di San (Melon Seed Powder). For pathogens located in the upper jiao, the method of expulsion via vomiting ("yin er yue zhi") should be employed. When pathogens lodge in the chest, causing qi rebellion and respiratory distress, vomiting is the only effective remedy. Cold fluids stagnating in the chest are expelled by the bitter-cold nature of Gua Di, following its natural tendency. However, this is a harsh emetic that severely depletes body fluids (jin ye). It is vastly different from Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction), which clears and disperses constrained heat. Therefore, it is strictly contraindicated for patients with blood loss or those who are constitutionally deficient.
Coptis Rhizome (Huanglian), Licorice Root (Gancao), Dried Ginger (Ganjiang), Cinnamon Twig (Guizhi), Ginseng Radix (Renshen), Pinellia Tuber (Banxia), Jujube Fruit (Dazao)
There is heat in the chest and pathogenic factors (specifically cold) in the stomach, accompanied by abdominal pain and nausea/vomiting. This formula is indicated. When pathogens transmit inward, they create a pattern of lower cold and upper heat. Pathogens in the stomach disrupt the interaction between Yin and Yang. Yin fails to ascend and remains isolated in the lower jiao, resulting in lower cold and abdominal pain. Yang fails to descend and remains isolated in the upper jiao, resulting in upper heat and vomiting. To drain upper heat, bitter herbs are used; this is the function of Huanglian. To disperse lower cold, acrid herbs are used; this is the role of Ganjiang, Guizhi, and Banxia. The Spleen desires relaxation to relieve tension; sweet flavors soothe this condition. Hence, the use of Renshen and Dazao serves this purpose.