桂枝 芍药 甘草 大枣 生姜
本太阳病。医反下之。因尔腹满时痛者。属太阴也。此汤主之。 按邪气入里。则为腹
痛。盖邪气传里而痛者。其痛不常。法当下之。此因太阳误下而痛。故以桂枝和卫芍药和营。中
气受调。满痛自愈。
桂枝 芍药 甘草 大黄 大枣 生姜
本太阳病。医反下之。腹满而大实痛者。此汤主之。 或问太阴病。用四逆辈。固所宜
也。然复用桂枝大黄。何也。大黄至寒。何为用于阴经耶。又何为与桂枝寒热互用耶。曰。自利
而渴者。属少阴为寒。在下焦。宜行四逆。自利而不渴者。属太阴为寒。在中焦。宜与理中
。若太阳病。误下之。则表邪未解。乘虚陷入太阴。因而满痛。且见大实脉症者。当以桂枝
除表邪。大黄除里邪。若脉无力。而大便自利者。大黄又在禁例矣。 按太阴腹满痛。其症
有三。如腹满咽干者。此传经之阳邪。在法当下。如吐食自利而复满痛。此直
入本经之阴邪。在法当温。如太阳误下。因而满痛。此乘虚内陷之邪。法当以桂枝加芍药汤
和之。若手不可按。脉洪有力。此为大实。当以桂枝加大黄汤和之。设使直入之阴症。而脉
来沉细者。非二汤所宜也。大抵阴邪满痛。宜与理中。热邪满痛。宜与大柴胡。惟误下满痛。
宜用二汤。不可不辨也。
原本患有太阳病（太阳经受邪所致的病证）。医生反而使用了攻下法。因此出现腹部胀满、阵发性疼痛的症状，这属于太阴病（脾虚寒湿证）。此方主治。按：邪气入里，就会引起腹痛。一般来说，邪气传入里部而致痛的，其疼痛不是持续性的，治法应当使用攻下法。但此处是因为太阳病误用攻下法导致的疼痛，所以用桂枝调和卫气，芍药调和营血，使中焦之气得到调理，胀满和疼痛自然痊愈。
原本患有太阳病。医生反而使用了攻下法。出现腹部胀满且剧烈实痛的症状，此方主治。有人问：治疗太阴病，使用四逆汤类方剂，固然是适宜的。然而这里又使用桂枝和大黄，为什么呢？大黄性质极寒，为何用于阴经呢？又为何与桂枝的温热之性相互配伍呢？回答说：如果是自发性腹泻且口渴的，属于少阴病（心肾阳虚证），为寒证，病位在下焦，适宜使用四逆汤。如果是自发性腹泻且不口渴的，属于太阴病，为寒证，病位在中焦，适宜使用理中汤。如果是太阳病，误用攻下法，那么表邪尚未解除，乘正气虚弱陷入太阴，因而导致胀满疼痛，并且出现大实证的脉象和症状时，应当用桂枝祛除表邪，用大黄祛除里邪。如果脉象无力，且大便自行通畅的，大黄又在禁忌之列了。按：太阴病的腹部胀满疼痛，其症状有三种情况。如腹部胀满伴有咽干的，这是传经而来的阳热邪气，在治法上应当使用攻下法。如呕吐食物、自发性腹泻而又伴随胀满疼痛的，这是直接侵入本经的阴寒邪气，在治法上应当使用温补法。如太阳病误用攻下法，因而导致胀满疼痛的，这是乘虚内陷的邪气，治法应当用桂枝加芍药汤来调和它。如果疼痛剧烈到手不能按压，脉象洪大有力，这是大实证，应当用桂枝加大黄汤来调和它。假设是直入的阴寒证，而脉象沉细的，就不适宜使用这两首方剂了。大致来说，阴寒邪气导致的胀满疼痛，适宜使用理中汤；热邪导致的胀满疼痛，适宜使用大柴胡汤；只有误用攻下法导致的胀满疼痛，才适宜使用这两首方剂，不可不加以辨别。
Cinnamon Twig (Guizhi), White Peony Root (Shaoyao), Licorice Root (Gancao), Jujube Fruit (Dazao), Fresh Ginger (Shengjiang)
Originally suffering from Taiyang disease (disease syndrome caused by pathogenic factors invading the Taiyang channel). The physician inappropriately employed purgation. Consequently, abdominal fullness and intermittent pain occurred, indicating involvement of the Taiyin organ (Taiyin disease, characterized by Spleen deficiency and cold-dampness). This decoction is indicated. Note: When pathogenic factors enter the interior, abdominal pain results. Generally, when pain arises from pathogenic transmission to the interior, the pain is not constant, and the treatment method should involve purgation. However, in this case, the pain is due to erroneous purgation of a Taiyang condition; therefore, Cinnamon Twig harmonizes the Defensive Qi (Wei Qi), and White Peony Root harmonizes the Nutritive Qi (Ying Qi). By regulating the Middle Jiao Qi, the fullness and pain resolve spontaneously.
Cinnamon Twig (Guizhi), White Peony Root (Shaoyao), Licorice Root (Gancao), Rhubarb (Dahuang), Jujube Fruit (Dazao), Fresh Ginger (Shengjiang)
Originally suffering from Taiyang disease. The physician inappropriately employed purgation. Abdominal fullness accompanied by severe, solid pain occurs; this decoction is indicated. A question arises: In treating Taiyin disease, employing formulas from the Si Ni Tang category is indeed appropriate. Yet why are Cinnamon Twig and Rhubarb used here? Rhubarb is extremely cold in nature; why is it used for a Yin channel? And why is it combined with the warm-natured Cinnamon Twig? The answer is: Spontaneous diarrhea with thirst indicates Shaoyin disease (Shaoyin disease, characterized by Heart and Kidney Yang deficiency), which is a cold pattern located in the Lower Jiao, suitable for Si Ni Tang. Spontaneous diarrhea without thirst indicates Taiyin disease, a cold pattern located in the Middle Jiao, suitable for Li Zhong Tang. If Taiyang disease is erroneously purged, the exterior pathogen remains unresolved and sinks into the Taiyin due to deficiency, causing fullness and pain. If signs and pulses of severe excess are present, Cinnamon Twig should be used to expel the exterior pathogen, and Rhubarb to expel the interior pathogen. However, if the pulse is weak and spontaneous defecation occurs, Rhubarb is contraindicated. Note: Abdominal fullness and pain in Taiyin disease manifest in three patterns. If abdominal fullness is accompanied by a dry throat, this is a Yang-heat pathogen transmitted via channels, and purgation is indicated. If vomiting food, spontaneous diarrhea, and subsequent fullness and pain occur, this is a Yin-cold pathogen directly entering the primary channel, and warming therapy is indicated. If fullness and pain result from erroneous purgation of Taiyang disease, this is a pathogen sinking inward due to deficiency, and Gui Zhi Jia Shao Yao Tang (Cinnamon Twig Decoction Augmented with White Peony Root) should be used to harmonize. If the abdomen is tender to touch and the pulse is surging and forceful, this constitutes a severe excess pattern, and Gui Zhi Jia Da Huang Tang (Cinnamon Twig Decoction Augmented with Rhubarb) should be used to harmonize. Conversely, if it is a direct invasion of Yin-cold pathology with a deep and fine pulse, neither of these two decoctions is suitable. Generally speaking, fullness and pain caused by Yin-cold pathogens are suitable for Li Zhong Tang; those caused by heat pathogens are suitable for Da Chai Hu Tang (Major Bupleurum Decoction); only fullness and pain resulting from erroneous purgation are suitable for these two decoctions. This distinction must not be overlooked.