伤寒下后表里虚。急当救疗莫踌躇。下利不止身疼痛。救里为先四逆欤。忽若清便自调适。却宜救表桂枝徒。切莫
迟延生别病。过街脉变在斯须。（仲景云。伤寒脉下之。续得下利。消谷不止。身疼痛者。急当救里。后身疼痛清便自调
者。急当救表。救里宜四逆。救表宜桂枝。）
既无里证又无表。随证小柴胡治疗。大便坚 脉浮数。却与大柴胡极妙。（仲景云。病患无表里证。发热七八日。脉
浮数。可与大柴胡汤下之。）七八日后至过经。证候如斯当辨晓。何况热实睛不和。常觉目中不了了。（仲景云。伤寒六
七日。目中不了了。睛不和。无表里证。大便难。微热者。急下之。大承气柴胡。）
有水须分表和里。安可妄投增病势。干呕微利咳发热。谓表有水青龙谛。（仲景云。伤寒。表不解。心下有水气。干
呕发热而咳。或渴。或利。或噎。或小便不利。小腹满。或喘者。小青龙。此谓表有水也。）忽若身凉并汗出。两胁疼痛
心下痞。表解争知里未和。十枣汤方能主治。（太阳中风。心下痞硬。满。引胁下痛。干呕。短气。汗出。不恶寒者。此
表解里未和也。十枣汤主之。）
脉来浮大表证尔。便赤烦渴却在里。（脉浮者。表证也。小便赤而烦渴。又却有里证也。）表里两证俱见时。当用五
苓与调理。（此证宜用五苓散。盖五苓治内外俱热。）又如大便数日结。头痛更兼身有热。其人小便却又清。亦是两证当
区别。（大便结硬。头痛身热。小便却清。知不在里而在表也。）大便坚 脉沉细。里证当下分明谛。头汗出时微恶寒。
手足兼冷却非是。（仲景云。伤寒五六日。头汗出。微恶寒。手足冷。心下满。口不欲食。大便硬。脉细者。此为阳微结。
有表复有里也。脉沉亦在里也。此为半在表半在里焉。）仲景着论非一端。要在审详而已矣。（仲景云。中有两证者。凡
十余法。故此略举一二为例。）
伤寒经过攻下治疗后，表证和里证都呈现虚损状态。此时应当紧急救治，不可犹豫不决。如果腹泻不止且身体疼痛，治疗应以先救里为主，可使用四逆汤。倘若大便自然通畅调和，则适宜先救表证，使用桂枝汤即可。千万不要拖延时间以免引发其他疾病，病情的转变往往就在顷刻之间。（张仲景说：伤寒脉象被误下后，接着出现腹泻、完谷不化、身体疼痛的情况，应当紧急救里；之后若身体仍疼痛但大便已调畅，则应紧急救表。救里适宜用四逆汤，救表适宜用桂枝汤。）
如果没有明显的里证也没有明显的表证，应根据具体症状用小柴胡汤进行治疗。如果大便干结坚硬且脉象浮数，则使用大柴胡汤极为巧妙。（张仲景说：患者没有表里证候表现，发热七八天，脉象浮数，可以使用大柴胡汤攻下。）过了七八天进入传经后期，证候如此应当仔细辨别。何况如果是热邪结实导致眼睛视物不清，常常觉得眼中模糊不明。（张仲景说：伤寒六七天，眼睛视物不清，眼球转动不灵活，没有明显的表里证候，大便困难，仅有轻微发热的，应当紧急攻下，可用大承气汤或大柴胡汤。）
体内有水饮必须区分是表证还是里证，怎么可以胡乱投药增加病情？如果有干呕、轻微腹泻、咳嗽、发热，这是表证伴有水饮，应仔细辨证使用小青龙汤。（张仲景说：伤寒，表证未解，心下有停聚的水气，出现干呕、发热并咳嗽，或者口渴，或者腹泻，或者噎塞，或者小便不利、小腹胀满，或者气喘的，用小青龙汤。这叫做表证有水饮。）倘若身体凉爽并且出汗，两胁疼痛，心下痞塞胀满，这说明表证已解，怎知里证尚未调和？十枣汤才能主治此症。（太阳中风证，心下痞硬胀满，牵引胁下疼痛，干呕，呼吸短促，出汗，不恶寒的，这是表证已解而里证未和，用十枣汤主治。）
脉象来势浮大，这是表证的征象；但小便赤红、心烦口渴却是里证的表现。（脉象浮，是表证；小便赤红且心烦口渴，又是有里证的表现。）当表证和里证同时出现时，应当使用五苓散进行调理。（这种证候适宜用五苓散，因为五苓散能治疗内外俱热的情况。）又如大便几天不通畅而结硬，头痛并且身体发热，但是此人小便却清长，这也是表里两证，应当加以区别。（大便结硬，头痛身热，小便却清长，可知病不在里而在表。）如果大便干结坚硬且脉象沉细，里证应当攻下的指征就很明显确切了。但如果只有头部出汗、轻微恶寒、手脚冰凉，这就不是上述情况了。（张仲景说：伤寒五六天，头部出汗，轻微恶寒，手脚冷，心下胀满，口不想吃东西，大便硬，脉象细的，这叫阳微结，既有表证又有里证。脉沉也属于里证。这是病邪一半在表一半在里。）张仲景撰写医论并非只有一种方法，关键在于审慎详细地分析罢了。（张仲景说：中间有两种证候的，凡有十余种治法，所以这里略举一二作为例子。）
After the purgative treatment for Shanghan (Cold Damage), both the exterior and interior deficiencies manifest. Urgent treatment is required without hesitation. If diarrhea persists accompanied by body pain, treating the interior takes precedence; Sini Tang (Four Reversal Decoction) may be used. However, if the stool becomes naturally regular and comfortable, then it is appropriate to treat the exterior with Guizhi Tang (Cinnamon Twig Decoction). Do not delay, lest other diseases arise; the transformation of the pulse occurs in an instant. (Zhang Zhongjing stated: In Shanghan, if the pulse is treated with purgatives and subsequently diarrhea with undigested food and body pain occur, urgent rescue of the interior is indicated. Later, if body pain persists but the stool is normal, urgent rescue of the exterior is indicated. For rescuing the interior, Sini Tang is suitable; for rescuing the exterior, Guizhi Tang is suitable.)
If there are neither interior nor exterior syndromes, Xiao Chaihu Tang (Minor Bupleurum Decoction) should be administered according to the symptoms. If the stool is hard and the pulse is floating and rapid, Da Chaihu Tang (Major Bupleurum Decoction) is extremely effective. (Zhang Zhongjing stated: When a patient presents with fever for seven or eight days without apparent exterior or interior syndromes and a floating, rapid pulse, Da Chaihu Tang can be used to purge.) After passing seven or eight days, entering the stage beyond the meridian, such symptoms require careful differentiation. Moreover, if heat and excess lead to unclear vision and the eyes appear dull and unresponsive, this requires attention. (Zhang Zhongjing stated: In Shanghan after six or seven days, if the eyes are unclear and the pupils do not move properly, without apparent exterior or interior syndromes, difficulty in defecation, and slight fever, urgent purging is indicated using Dachengqi Tang or Da Chaihu Tang.)
When water retention is present, one must distinguish between exterior and interior conditions; reckless medication only exacerbates the disease. If there is dry retching, mild diarrhea, cough, and fever, this indicates water retention at the exterior level; Xiaolongdan Tang (Minor Blue Dragon Decoction) should be carefully applied. (Zhang Zhongjing stated: In Shanghan, if the exterior syndrome is unresolved and there is water qi in the epigastrium, presenting with dry retching, fever, and cough, or thirst, or diarrhea, or choking, or dysuria with lower abdominal fullness, or wheezing, Xiaolongdan Tang is indicated. This is called water retention at the exterior.) Conversely, if the body feels cool and sweating occurs, accompanied by pain in the hypochondrium and epigastric fullness, the exterior has resolved while the interior remains disharmonious. Shizao Tang (Ten Jujube Decoction) is the primary treatment. (In Taiyang Wind Strike, if there is epigastric hardness and fullness radiating to the hypochondrium, dry retching, shortness of breath, sweating, and aversion to cold is absent, this indicates the exterior has resolved and the interior is disharmonious; Shizao Tang governs this.)
A floating and large pulse indicates an exterior syndrome, whereas red urine, irritability, and thirst indicate an interior syndrome. (A floating pulse signifies an exterior syndrome; red urine with irritability and thirst signify an interior syndrome.) When both exterior and interior syndromes are present simultaneously, Wuling San (Five-Ingredient Powder with Poria) should be used for regulation. (This syndrome is suitable for Wuling San, as it treats heat in both the interior and exterior.) Furthermore, if the stool has been bound for several days, accompanied by headache and fever, but the urination is clear, this also represents a dual syndrome requiring distinction. (Hard stool, headache, and fever with clear urine indicate the pathology is in the exterior, not the interior.) If the stool is hard and the pulse is deep and fine, the indication for purging the interior is clear. However, if there is only head sweating, slight aversion to cold, and cold hands and feet, this is not the case. (Zhang Zhongjing stated: In Shanghan after five or six days, with head sweating, slight aversion to cold, cold extremities, epigastric fullness, lack of appetite, hard stool, and a fine pulse, this is termed Yang Wei Jie (Yang Mild Binding), involving both exterior and interior aspects. A deep pulse also belongs to the interior. This is half-exterior and half-interior.) Zhang Zhongjing’s discussions on these matters are manifold; the key lies in thorough and careful analysis. (Zhang Zhongjing stated: Regarding cases with two simultaneous syndromes, there are over ten methods; thus, only a few examples are briefly presented here.)