【纲】仲景曰。太阳病。二三日不得卧。但欲起。心下必结。脉微弱者。此本有寒分也。反下
之。若利止。必作结胸。未止者。四日复下之。必作协热利。太阳病。外症未除。而数下之。遂协
热而利。利下不止。心下痞硬。表理不解者。桂枝人参汤主之。太阳病。桂枝症。医反下之。利
遂不止。脉促者。表未解也。喘而汗出。葛根黄连黄芩汤主之。
【目】张兼善曰。仲景言表症未除而误下之。因致外热未退。内复作利。故云协热下利。此一
热字。乃言表热也。非言内热也。夫协者协同之协。非挟藏之挟。即表里俱病之谓。故治此者。
止有桂枝人参汤一方。其又显然可见。即如成无己曰。表邪传里。里虚协热则利。是亦以表邪为言
也。奈何后学不明。止因协热二字。但见作利者。无论表里虚实。
即认为内热。便云协热下利。且近有不必误下。而妄用芩连治表热者。表症得寒。热愈不退。力致
下利。或脾素弱。逢寒即泄者。皆是此症。既见下利。盖云协热。其谬甚矣。独不观仲景桂枝人参
汤。岂治内热之剂乎。寒热倒施。杀人多矣。
柯琴曰。首条。论协热之因。二条。明下利之治。桂枝人参汤。双解表里也。三条。利遂不止。
所谓暴注下迫。皆属于热。盖微热在表。大热入里者。故与首条脉弱而协热下利不同。
【纲】仲景曰。太阳病。下之。其脉促。不结胸者。为欲解。脉沉滑者。协热利。脉浮滑者。
必下血。
【目】王肯堂曰。协热利。热病也。
【纲】张仲景说：太阳病（太阳经受邪所致的病证），发病两三天后无法平卧，只想坐起，胃脘部必然有痞结感。如果脉象微弱，说明患者体内原本就有寒湿之邪。此时若错误地使用攻下法，如果腹泻停止，必然会形成结胸（水热互结于胸膈的病症）；如果腹泻未止，到了第四天再次使用攻下法，必然会发展为协热利（表证未解兼见里热的下利）。
太阳病，体表的证候尚未解除，却多次使用攻下法，于是导致表邪内陷与里热相合而下利。腹泻不止，胃脘部痞塞坚硬，表证与里证均未解除的，用桂枝人参汤主治。
太阳病，出现桂枝汤证（中风表虚证），医生反而使用攻下法，导致腹泻不停。如果脉象急促，说明表证仍未解除。伴有气喘且出汗的，用葛根黄芩黄连汤主治。
【目】张兼善说：张仲景指出，表证未除而误用攻下法，导致体表的热邪未退，内部又发生腹泻，所以称为“协热下利”。这里的“热”字，指的是表热，而不是内热。“协”是协同的意思，不是挟带的“挟”，即指表里同时患病。因此治疗此症，只有桂枝人参汤这一方剂，这是显而易见的。就像成无己所说：“表邪传入体内，因里气虚弱，协同热邪而导致下利。”这也是以表邪为立论依据。然而后世学者不明白这一点，仅仅因为“协热”二字，只要见到腹泻，无论表里虚实，就认为是内热，便称之为协热下利。况且近来有人并未误用攻下法，却妄用黄芩、黄连来治疗表热。表证遇到寒凉药物，热邪更加不退，反而导致下利。或者患者脾脏素来虚弱，遇到寒邪即泄泻的，都是这类症状。既然见到下利，就说是协热，这种谬误太严重了。难道没看过张仲景的桂枝人参汤吗？那难道是治疗内热的方剂吗？寒热治法颠倒，害死了许多人。
柯琴说：第一条论述协热利的成因，第二条阐明下利的治法。桂枝人参汤能表里双解。第三条提到腹泻不止，这就是所谓的“暴注下迫，皆属于热”。大概是微弱的热邪在表，强烈的热邪入里，所以与第一条中脉弱而协热下利的情况不同。
【纲】张仲景说：太阳病，使用攻下法后，如果脉象急促，没有形成结胸的，说明病情即将解除。如果脉象沉滑，则是协热利。如果脉象浮滑，必然会出现便血。
[Outline] Zhang Zhongjing stated: In Taiyang disease (a syndrome caused by pathogenic factors affecting the Taiyang meridian), if after two or three days the patient cannot lie flat but desires to sit up, there will inevitably be a sensation of fullness and obstruction in the epigastrium. If the pulse is faint and weak, this indicates that cold-dampness was originally present within the body. If purgatives are erroneously administered, and the diarrhea stops, Jie Xiong (Chest Binding, a condition characterized by the accumulation of water-heat in the chest and diaphragm) will inevitably develop. If the diarrhea does not stop, and purgatives are administered again on the fourth day, Xie Re Li (Diarrhea accompanying exterior heat) will inevitably result.
In Taiyang disease, if the exterior symptoms have not been resolved but multiple purgative treatments are used, the exterior pathogen may penetrate inward, combining with interior heat to cause diarrhea. If the diarrhea persists incessantly, accompanied by a hard and obstructed sensation in the epigastrium, and neither the exterior nor the interior pattern is resolved, Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) should be administered.
In Taiyang disease, if Gui Zhi Tang Syndrome (Exterior deficiency syndrome characterized by wind-cold invasion) is present, but the physician erroneously uses purgatives, leading to incessant diarrhea, and the pulse is rapid (Cu), it indicates that the exterior pattern has not yet resolved. If accompanied by wheezing and sweating, Gegen Huanglian Huangqin Tang (Kudzu, Coptis, and Scutellaria Decoction) should be administered.
[Commentary] Zhang Jianshan stated: When Zhang Zhongjing mentioned that erroneous purgation while the exterior pattern remains leads to unresolved exterior heat and subsequent internal diarrhea, he termed it "Xie Re Xia Li" (Diarrhea accompanying exterior heat). The character "Re" (Heat) here refers to exterior heat, not interior heat. The character "Xie" (Coordinate/Assist) denotes coordination, not "Xia" (Clutch/Carry); it signifies that both exterior and interior are diseased. Therefore, for treating this condition, there is only one formula, Guizhi Renshen Tang, which is evident. As Cheng Wuji stated, "When exterior pathogens transmit to the interior, interior deficiency coordinates with heat to cause diarrhea." This also bases its argument on exterior pathogens. However, later scholars failed to understand this; merely because of the term "Xie Re," whenever they observed diarrhea, regardless of whether it involved exterior/interior or deficiency/excess, they assumed it was interior heat and labeled it Xie Re Xia Li. Moreover, recently some practitioners, without prior erroneous purgation, recklessly use Huang Qin (Scutellariae Radix) and Huang Lian (Coptidis Rhizoma) to treat exterior heat. When exterior patterns are treated with cold-natured herbs, the heat fails to dissipate and instead induces diarrhea. Or, in patients with inherently weak Spleen function who experience loose stools upon exposure to cold, these are all such cases. To label such diarrhea as "Xie Re" is a grave error. Have they not examined Zhang Zhongjing's Guizhi Renshen Tang? Is that not a formula for treating interior heat? Reversing cold and heat treatments has killed many people.
Ke Qin stated: The first paragraph discusses the etiology of Xie Re (accompanying heat); the second clarifies the treatment for diarrhea. Guizhi Renshen Tang resolves both the exterior and interior. The third paragraph mentions incessant diarrhea, which corresponds to the principle that "acute watery diarrhea and tenesmus belong to heat." This implies that mild heat resides in the exterior, while severe heat enters the interior. Thus, it differs from the case in the first paragraph where the pulse is weak and accompanied by Xie Re diarrhea.
[Outline] Zhang Zhongjing stated: In Taiyang disease, after purgation, if the pulse is rapid (Cu) and Jie Xiong (Chest Binding) does not form, it indicates that the condition is about to resolve. If the pulse is deep and slippery (Chen Hua), it indicates Xie Re Li (Diarrhea accompanying exterior heat). If the pulse is floating and slippery (Fu Hua), hematochezia (blood in stool) will inevitably occur.
[Commentary] Wang Kentang stated: Xie Re Li (Diarrhea accompanying exterior heat) is a type of heat disease.