伤寒四五日。或十余日。邪结在里。大便秘涩腹满。或胀痛。或绕脐刺痛。或谵语。或心下痞
硬。脉长。脉沉实。或下利心下坚硬。或已经下。其脉浮沉尚有力。用仲景大柴胡汤治之。
柴胡（八两） 黄芩 赤芍药（各三两） 大黄（二两）
半夏（二两半） 枳实（半两。麸炒）
上六味。每服五钱。水一盏半。生姜五片。枣子一枚。煎至八分。去渣。热服。不拘时候。
恶热不恶寒。手心腋下 汗出。胃中干涸。燥粪结聚。潮热。大便硬。小便如常。或腹满而喘
。或谵语。脉沉而滑。用仲景调胃承气汤治之。
硝（一斤） 甘草（炙。二两） 大黄（四两。去皮。酒洗）
上锉。每服临期斟酌多少。先煮二味熟。去渣。下硝。上火煮二三沸。顿服之。
始初发热恶寒。今汗后不恶寒。但大热发而躁。始初脉浮大。今脉洪实。或沉细数。始初惺惺
。今狂语。用调胃承气汤治之。（方见前）
心胸连脐腹大闷。腹中疼。坐卧不安。胃闷喘急。或腹中微满不大便。用仲景小承气汤治之。
大黄（四两） 浓朴（二两。姜炒） 枳实（大者三个。炒）
上锉碎二味。大黄切如棋子大。临证斟酌多少用之。
胸腹胀满。按之痛。日久不大便。小便赤涩。表里俱热。或烦渴谵妄。或狂妄不识人。或潮热
懊。又如疟状。
或大渴反不能饮。或喘急胃闷。或微喘直视。脉实数而沉。用大承气汤、或三一承气汤治之。
【仲景大承气汤】
大黄（四两。如棋子大。酒洗） 浓朴（八两。姜炒） 枳实（大者五枚。炒）
芒硝（二合）
上四味。每服看证斟酌多少。用水三盏。先煮二物取一盏半。去渣。纳大黄。煮取八分。去渣
。纳芒硝。微煎
一两沸。温服。得下。余勿服。
【启源三一承气汤】
大黄(酒洗） 芒硝 浓朴（姜炒） 枳实（炒。各半两）
甘草（炙。一两）
上五味。每服斟酌多少。用水一盏半。生姜三片。煎八分。热服。得利则止。未利再服。
伤寒手足温。自利不渴。腹满时痛。咽干脉沉细。用三因治中汤治之。（活人书同）
人参 干姜（炮） 白术 甘草（炙）
陈皮（去白） 青皮（炒。各等分）
上六味锉。每服五钱。水一盏半。煎七分。去渣。食前服。
伤寒病经过四五日，或者十余日，邪气结聚在体内（里证），导致大便秘结不通、腹部胀满，或者出现胀痛，或者肚脐周围刺痛，或者胡言乱语，或者胃脘部痞塞坚硬。脉象表现为长脉、沉实脉，或者虽然下利但心下部坚硬，或者已经使用过泻下法，其脉象浮取沉取依然有力。此时应使用张仲景的大柴胡汤进行治疗。
方药组成：柴胡（八两）、黄芩、赤芍药（各三两）、大黄（二两）、半夏（二两半）、枳实（半两，麸皮炒）。
以上六味药，每次服用五钱，加水一盏半，生姜五片，大枣一枚，煎煮至剩余八分药液，滤去药渣，趁热服用，不限定具体时间。
如果患者怕热不怕冷，手心腋下出汗，胃中干燥枯竭，燥屎结聚，出现潮热，大便干硬，小便正常，或者腹部胀满且气喘，或者胡言乱语，脉象沉而滑。此时应使用张仲景的调胃承气汤进行治疗。
方药组成：芒硝（一斤）、甘草（炙，二两）、大黄（四两，去皮，酒洗）。
以上药物切碎，每次服用时根据情况斟酌用量。先煮甘草和大黄至熟，滤去药渣，加入芒硝，再上火煮两三沸，一次性服下。
起初发热恶寒，现在发汗后不再恶寒，只是大热发作且烦躁不安。起初脉象浮大，现在脉象洪实，或者沉细数。起初神志清醒，现在胡言乱语。使用调胃承气汤治疗。（方剂见前文）
心胸连及脐腹部位感到严重闷堵，腹部疼痛，坐卧不宁，胃部闷塞气喘急促，或者腹部轻微胀满不大便。此时应使用张仲景的小承气汤进行治疗。
方药组成：大黄（四两）、厚朴（二两，姜炒）、枳实（大的三枚，炒）。
以上将厚朴和枳实切碎，大黄切成棋子大小。临证时根据病情斟酌用量。
胸腹胀满，按压时疼痛，多日不大便，小便赤涩，表里俱热，或者烦渴谵妄，或者狂妄不识人，或者潮热懊恼，又像疟疾症状，或者极度口渴反而不能饮水，或者气喘急促胃闷，或者微喘直视，脉象实数而沉。此时使用大承气汤，或者三一承气汤治疗。
【张仲景大承气汤】
大黄（四两，如棋子大，酒洗）、厚朴（八两，姜炒）、枳实（大的五枚，炒）、芒硝（二合）。
以上四味药，每次服用根据病情斟酌用量。用水三盏，先煮厚朴和枳实取出一盏半药液，滤去药渣，加入大黄，煮取八分药液，滤去药渣，加入芒硝，微煎一两沸，温服。若大便通下，余药勿服。
【启源三一承气汤】
大黄（酒洗）、芒硝、厚朴（姜炒）、枳实（炒，各半两）、甘草（炙，一两）。
以上五味药，每次服用斟酌用量。用水一盏半，生姜三片，煎至八分药液，热服。若得利则停服，未得利可再服。
伤寒病患者手足温暖，自发性腹泻且不口渴，腹部胀满时而疼痛，咽干脉象沉细。此时使用三因治中汤治疗。（《活人书》中相同）
方药组成：人参、干姜（炮制）、白术、甘草（炙）、陈皮（去白）、青皮（炒，各等分）。
以上六味药切碎，每次服用五钱，加水一盏半，煎至七分药液，滤去药渣，饭前服用。
After four or five days, or even more than ten days of contracting a cold damage (Shanghan), the pathogenic factor becomes entrenched in the interior (Li syndrome). This presents with constipation and abdominal fullness, distending pain, stabbing pain around the umbilicus, delirium, or epigastric stuffiness and hardness. The pulse is long, deep and forceful, or there is diarrhea with hardness in the epigastrium. Even if purgatives have already been used, if the pulse remains forceful on both superficial and deep palpation, treat with Zhang Zhongjing's Chaihu Dahu Tang (Bupleurum and Rhubarb Decoction).
Ingredients: Chai Hu (Radix Bupleuri, 8 liang), Huang Qin (Scutellariae Radix, 3 liang), Chi Shao Yao (Paeoniae Radix Rubra, 3 liang), Da Huang (Rhei Radix et Rhizoma, 2 liang), Ban Xia (Pinelliae Tuber, 2.5 liang), Zhi Shi (Immature Bitter Orange, 0.5 liang, bran-fried).
These six herbs are taken together. Each dose consists of 5 qian, boiled with 1.5 sheng of water, 5 slices of fresh ginger, and one jujube. Decoct until 0.8 sheng remains, strain, and take warm. No specific timing is required.
If the patient fears heat but not cold, sweats from the palms, axillae, and soles, has dryness in the stomach, accumulated dry feces, tidal fever, hard stools, normal urination, abdominal fullness with panting, or delirium, and the pulse is deep and slippery, treat with Zhang Zhongjing's Tiaowei Chengqi Tang (Regulate the Stomach and Guide Out the Feces Decoction).
Ingredients: Xiao Ming Piao (Mirabilite, 1 jin), Gan Cao (Licorice Root, fried, 2 liang), Da Huang (Rhei Radix et Rhizoma, peeled, wine-washed, 4 liang).
Crush the herbs. Adjust the dosage according to the condition before administration. First decoct Gan Cao and Da Huang until cooked, strain, then add Xiao Ming Piao. Boil for two or three boils over fire, and take in one dose.
Initially, there was fever and aversion to cold. After sweating, aversion to cold ceases, but high fever with restlessness appears. Initially, the pulse was floating and large; now it is surging and solid, or deep, fine, and rapid. Initially, the patient was alert; now there is wild talk/delirium. Treat with Tiaowei Chengqi Tang (see formula above).
Severe stifling sensation extending from the chest and heart to the umbilicus and abdomen, abdominal pain, restlessness in sitting and lying, gastric stuffiness with urgent panting, or slight abdominal fullness with infrequent bowel movements. Treat with Zhang Zhongjing's Xiaochengqi Tang (Minor Order the Qi Decoction).
Ingredients: Da Huang (Rhei Radix et Rhizoma, 4 liang), Hou Po (Magnoliae Officinalis Cortex, 2 liang, ginger-fried), Zhi Shi (Immature Bitter Orange, three large ones, fried).
Crush Hou Po and Zhi Shi. Cut Da Huang into pieces the size of chessmen. Adjust the dosage clinically as needed.
Chest and abdominal distension and fullness, painful upon pressure, no bowel movement for many days, red and scanty urine, heat in both exterior and interior, irritability, thirst, delirium, madness with inability to recognize people, tidal fever, vexation, symptoms resembling malaria, extreme thirst yet inability to drink, urgent panting with gastric stuffiness, slight panting with fixed gaze, and a solid, rapid, deep pulse. Treat with Dachengqi Tang (Major Order the Qi Decoction) or Sanyichengqi Tang (Three-One Order the Qi Decoction).
[Zhang Zhongjing's Dachengqi Tang]
Da Huang (Rhei Radix et Rhizoma, 4 liang, cut like chessmen, wine-washed), Hou Po (Magnoliae Officinalis Cortex, 8 liang, ginger-fried), Zhi Shi (Immature Bitter Orange, five large ones, fried), Mang Xiao (Mirabilite, 2 he).
For these four herbs, adjust the dosage based on the condition. Use 3 sheng of water. First decoct Hou Po and Zhi Shi to obtain 1.5 sheng, strain, add Da Huang, decoct to obtain 0.8 sheng, strain, add Mang Xiao, simmer briefly for one or two boils, take warm. If bowel movement occurs, do not take the remainder.
[Qiyuan Sanyichengqi Tang]
Da Huang (Rhei Radix et Rhizoma, wine-washed), Mang Xiao (Mirabilite), Hou Po (Magnoliae Officinalis Cortex, ginger-fried), Zhi Shi (Immature Bitter Orange, fried, each 0.5 liang), Gan Cao (Licorice Root, fried, 1 liang).
For these five herbs, adjust the dosage. Use 1.5 sheng of water and 3 slices of fresh ginger. Decoct to 0.8 sheng, take warm. Stop if loose stools occur; if not, administer again.
In cold damage, if the hands and feet are warm, spontaneous diarrhea without thirst, abdominal fullness with intermittent pain, dry throat, and a deep, fine pulse, treat with Sanyin Zhizhong Tang (Three Causes Regulate the Middle Decoction) (also found in *Ren Shu*).
Ingredients: Ren Shen (Ginseng Radix et Rhizoma), Gan Jiang (Zingiberis Rhizoma, processed), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Gan Cao (Licorice Root, fried), Chen Pi (Citri Reticulatae Pericarpium, white pith removed), Qing Pi (Citri Reticulatae Pericarpium Viride, fried, equal parts).
Crush these six herbs. Each dose is 5 qian, boiled with 1.5 sheng of water to 0.7 sheng, strained, and taken before meals.