人参 白术 甘草（炙） 干姜各三两
右四味，捣筛，蜜和为丸，如鸡子黄许大，以沸汤数合，和一丸，研碎温服之，日三
、四，夜二服。腹中未热，益至三、四丸，然不及汤。汤法以四物，根据两数切，用水
八升，煮取三升，去滓，温服一升，日三服。
加减法：若脐上筑者，肾气动也，去术加桂四两。吐多者，去术加生姜三两。下多者
，还用术；悸者，加茯苓二两。渴欲得水者，加术，足前成四两半。腹中痛者，加人
参，足前成四两半。寒者，加干姜，足前成四两半。腹满者，去术加附子一枚。服汤
后，如食顷，饮热粥一升许，微自温，勿发揭衣被。
【集解】
程应旄曰：阳之动，始于温，温气得而谷精运，谷气升而中气赡，故名曰理中，实以
燮理之功，予中焦之阳也。盖谓阳虚即中气失守，膻中无发宣之用，六府无洒陈之功
，犹如斧薪失焰，故下至清谷，上失滋味，五藏凌夺，诸证所由来也。参、术、炙草
，所以守中州，干姜辛以温中，必假之以燃斧薪而腾阳气，是以谷入于阴，长气于阳
，上输华盖，下摄州都，五藏六府皆受气矣，此理中之旨也。若水寒互胜，即当脾肾
双温，加之以附子，则命门益而土母温矣。白术补脾，得人参则壅气，故脐下动气，
吐多腹满，皆去术也。加桂以伐肾邪，加生姜以止呕也，加附子以消阴也。下多者，
湿胜也，还用术燥湿也。渴欲饮水，饮渴也，加术使饮化津生也。心下悸，停水也，
加茯苓导水也。腹中痛，倍人参，虚痛也。寒者，加干姜，寒甚也。
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伤寒，本自寒下，医复吐下之，寒格，更逆吐下，若食入口即吐，干姜黄连黄芩人参
汤主之。
【按】
经论中并无寒下之病，亦无寒下之文。玩本条下文，寒格更逆吐下，可知寒下之「下
」字，当是「格」字，文义始相属。注家皆释胃寒下利，不但文义不属，且与芩、连
之药不合。
【注】
经曰：格则吐逆，格者吐逆之病名也。朝食暮吐，脾寒格也；食入即吐，胃热格也。
本自寒格，谓其人本自有朝食暮吐寒格之病也。今病伤寒，医见可吐、可下之证，遂
执成法，复行吐、下，是寒格更逆于吐下也，当以理中汤温其太阴，加丁香降其寒逆
可也。若食入口即吐，则非寒格乃热格也，当用干姜、人参安胃，黄连、黄芩降胃火
也。
人参、白术、甘草（炙）、干姜各三两。
以上四味药，捣碎并过筛，用蜂蜜调和制成丸药，大小如鸡蛋黄，用沸水几合（约200毫升），将一丸研碎后温服，每日三到四次，夜间服用两次。如果腹部没有感到温热，增加到每次三到四丸，但效果不如汤剂。汤剂的用法是：将四味药按照规定的分量切好，用水八升，煮取三升，去掉药渣，温服一升，每日服用三次。
加减法：如果脐上跳动不安，这是肾气发动的表现，应去掉白术，加入桂枝四两。呕吐较多者，去掉白术，加入生姜三两。腹泻较多者，仍保留使用白术；心悸者，加入茯苓二两。口渴想喝水者，增加白术用量，使其总量达到四两半。腹中疼痛者，增加人参用量，使其总量达到四两半。畏寒者，增加干姜用量，使其总量达到四两半。腹部胀满者，去掉白术，加入附子一枚。服用汤药后，大约一顿饭的时间，喝热粥一升左右，使身体微微温暖，不要掀开衣被散热。
【集解】
程应旄说：阳气的发动，始于温暖，温暖的气机通畅则谷物的精微得以运化，谷气上升则中焦之气充足，所以名叫“理中”，实际上是运用燮理（调理）的功效，给予中焦阳气。大概意思是说，阳虚就会导致中气失守，膻中失去宣发肃降的功能，六腑失去洒陈（布散营养）的作用，就像斧头砍柴失去了火焰，所以下部出现完谷不化的泄泻，上部失去味觉享受，五脏相互凌犯掠夺，各种病症由此产生。人参、白术、炙甘草，是用来固守中州的；干姜辛热以温中，必须借助它来点燃柴薪从而腾起阳气，因此谷物进入阴分，在阳分生长壮大，向上输送到华盖（肺），向下摄纳州都（膀胱），五脏六腑都接受了气，这就是理中的宗旨。如果水寒互相胜负，就应当脾肾双温，加上附子，那么命门之火就会增强，土母（脾）就会温暖。白术补脾，得到人参则容易导致气机壅滞，所以脐下动气、呕吐多、腹部胀满时，都要去掉白术。加入桂枝是为了伐除肾邪，加入生姜是为了止呕，加入附子是为了消除阴寒。腹泻多的是湿胜，所以仍用白术燥湿。想喝水，是饮停所致，加白术使饮邪化解、津液生成。心下悸动，是水饮停留，加茯苓导引水邪。腹中痛，加倍用人参，是虚痛。畏寒，加干姜，是寒邪严重。
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伤寒病，原本就有寒性下利，医生又误用吐法和下法，导致寒邪格拒，反而加重了呕吐和下利，如果食物刚入口就立即吐出，应用干姜黄连黄芩人参汤主治。
【按】
经典论述中没有“寒下”这种病名，也没有“寒下”的文字。玩味本条下文提到的“寒格更逆吐下”，可知“寒下”的“下”字，应该是“格”字，文义才能连贯。注释家都解释为胃寒下利，这不仅文义不通，而且与黄连、黄芩的药性不符。
【注】
经文说：格则吐逆，“格”是吐逆这种病的名称。早上吃晚上吐，是脾寒导致的格拒；食物吃下去立即吐出，是胃热导致的格拒。原文说“本自寒格”，是指这个人本来就有早上吃晚上吐的寒格病。现在得了伤寒，医生看到可以吐、可以下的证候，于是拘泥于成法，再次施行吐法和下法，这使得寒格更加逆乱于吐下之中，应当用理中汤温补太阴，加上丁香以降其寒逆即可。如果食物入口即吐，那就不是寒格而是热格了，应当用干姜、人参安胃，黄连、黄芩清降胃火。
Ginseng Radix (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Gancao Zhi), and Zingiberis Rhizoma (Ganjiang) are each used in the amount of three liang.
These four ingredients are crushed, sifted, and mixed with honey to form pills, sized like a chicken egg yolk. One pill is crushed and taken with warm decoction made from boiling water (approximately 200 ml). The dosage is three to four times daily, and twice at night. If warmth is not felt in the abdomen, increase the dose to three or four pills per administration; however, the efficacy is inferior to that of the decoction. For the decoction method, cut the four ingredients according to the specified weights, add eight sheng of water, and boil until three sheng remain. Strain the dregs, and take one sheng of the liquid warm, three times daily.
Modifications:
If there is throbbing above the umbilicus, indicating movement of Kidney Qi, remove Baizhu and add Rougui (Cinnamon Twig) four liang.
If vomiting is frequent, remove Baizhu and add Shengjiang (Fresh Ginger) three liang.
If diarrhea is frequent, continue using Baizhu; if palpitations occur, add Fuling (Poria) two liang.
If there is thirst and desire for water, increase the amount of Baizhu so that the total reaches four and a half liang.
If there is abdominal pain, increase the amount of Renshen so that the total reaches four and a half liang.
If there is cold sensation, increase the amount of Ganjiang so that the total reaches four and a half liang.
If there is abdominal fullness, remove Baizhu and add one Fuzi (Prepared Aconite Root).
After taking the decoction, approximately after the time it takes to eat a meal, drink about one sheng of hot porridge to induce slight warmth; do not uncover clothes or blankets to cool down.
[Collected Commentary]
Cheng Yingmao stated: The movement of Yang Qi begins with warmth. When warm Qi flows freely, the essence of grains is transported; when grain Qi ascends, the Middle Jiao Qi is sufficient. Hence, it is named "Li Zhong" (Regulating the Middle), actually employing the function of regulation to provide Yang Qi to the Middle Jiao. This implies that Yang deficiency leads to the loss of Middle Qi control, causing the Danzhong (Sea of Qi) to lose its dispersing and descending functions, and the Six Fu Organs to lose their sprinkling and arranging functions. It is like an axe chopping wood without fire; thus, lower clear undigested stool appears, upper taste perception is lost, and the Five Zang Organs invade and plunder each other, giving rise to various symptoms. Renshen, Baizhu, and Zhi Gancao serve to guard the Central State; Ganjiang is pungent and warm to heat the Middle. It is necessary to borrow its power to ignite the wood and raise Yang Qi. Thus, grain enters the Yin, grows in the Yang, transports upward to the Huagai (Lungs), and controls downward the Zhoudou (Bladder), so that all Zang and Fu organs receive Qi. This is the purport of Li Zhong. If Water and Cold compete mutually, both Spleen and Kidney should be warmed simultaneously by adding Fuzi, thereby benefiting the Mingmen (Gate of Life) and warming the Mother of Earth (Spleen). Baizhu tonifies the Spleen, but combined with Renshen may cause Qi stagnation; therefore, in cases of Qi movement below the umbilicus, frequent vomiting, or abdominal fullness, Baizhu is removed. Adding Rougui attacks Kidney pathogenic factors; adding Shengjiang stops vomiting; adding Fuzi eliminates Yin Cold. Frequent diarrhea indicates excessive Dampness, hence Baizhu is still used to dry Dampness. Desire to drink water indicates retained fluid; adding Baizhu helps transform fluid and generate Jin-Ye (Body Fluids). Palpitations in the epigastrium indicate retained water; adding Fuling guides out water. Abdominal pain requires doubling Renshen due to deficiency pain. Cold sensations require adding Ganjiang due to severe cold.
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In Shaoyang disease (Taiyang disease in Shanghan Lun context), originally presenting with cold-type diarrhea, if the physician erroneously applies emetic and purgative methods, Cold obstruction occurs, exacerbating vomiting and diarrhea. If food is vomited immediately upon entering the mouth, Ganjiang Huanglian Huangqin Renshen Tang (Dry Ginger, Coptis, Scutellaria, and Ginseng Decoction) is indicated.
[Annotation]
The Classics do not mention a disease called "Han Xia" (Cold Downward), nor does the text contain this phrase. Examining the subsequent text "Han Ge Geng Ni Tu Xia" (Cold obstruction further reverses vomiting and diarrhea), it can be deduced that the character "Xia" (Downward) in "Han Xia" should be "Ge" (Obstruction/Rejection), making the textual meaning coherent. Commentators have interpreted this as Stomach Cold with diarrhea, which not only contradicts the textual logic but also conflicts with the properties of Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma).
[Note]
The Classic states: "Ge results in vomiting and reversal." "Ge" is the name of the disease characterized by vomiting and reversal. Vomiting in the evening what was eaten in the morning indicates Spleen Cold Ge; vomiting immediately after eating indicates Stomach Heat Ge. "Originally having Han Ge" means the patient inherently suffers from the disease of morning-eating-evening-vomiting caused by Cold Ge. Now, contracting Taiyang disease, the physician sees signs suitable for emesis or purgation and rigidly adheres to established protocols, applying emetic and purgative treatments again. This causes the Cold Ge to become more reversed and chaotic under the influence of these treatments. One should use Lizhong Tang (Regulate the Middle Decoction) to warm the Taiyin, possibly adding Dingxiang (Caryophylli Flos) to descend Cold reversal. However, if food is vomited immediately upon entry, this is not Cold Ge but Heat Ge. In this case, Ganjiang and Renshen should be used to calm the Stomach, while Huanglian and Huangqin should be used to descend Stomach Fire.