麻黄（二两半去节甘温） 升麻（一两一分甘平） 当归（一两一分辛温） 知母
（苦寒） 黄芩（苦寒） 葳蕤（甘平各十八铢） 石膏（碎绵裹甘寒） 白术（甘温）
干姜（辛热） 芍药（甘平） 天门冬（去心甘平） 桂枝（辛热） 茯苓（甘平）
甘草（炙甘平各六铢）
上十四味。以水一斗。先煮麻黄一两。沸去上沫。内诸药。煮取三升。去滓。分温
三服。相去如炊三斗米顷。令尽汗出愈。
玉函曰。大热之气。寒以取之。甚热之气。以汗发之。麻黄升麻之甘。以发浮热。正
气虚者。以辛润之。当归桂姜之辛。以散寒。上热者。以苦泄之。知母黄芩之苦。凉心
去热。津液少者。以甘润之。茯苓白术之甘。缓脾生津。肺燥气热。以酸收之。以甘缓之。
芍药之酸。以敛逆气。葳蕤门冬石膏甘草之甘。润肺除热。
伤寒四五日。腹中痛。若转气。下趋少腹者。此欲自利也。
伤寒四五日。邪气传里之时。腹中痛。转气下趋少腹者。里虚遇寒。寒气下行。欲
作自利也。
伤寒本自寒下。医复吐之。寒格更逆吐下。若食入口即吐。干姜黄连黄芩人参汤主
之。
伤寒邪自传表。为本自寒下。医反吐之。损伤正气。寒气内为格拒。经曰。格则吐
逆。食入口即吐。谓之寒格。更复吐下。则重虚而死。是更逆吐下。与干姜黄连黄芩人
参汤。以通寒格。
王宇泰云。按本自寒下。恐是本自吐下。玩复字可见。盖胃寒则吐。下寒则利。胃
寒者不宜吐。医反吐之。则伤胃气。遂成寒格。下文文气不贯。当有缺文。
张卿子云。本自寒下。如少阳一条。邪高痛下。所谓邪正分争。盖本为寒。而邪为
热素问云。风寒在下。燥热在上。
麻黄（二两半，去节，性味甘温） 升麻（一两一分，性味甘平） 当归（一两一分，性味辛温） 知母（苦寒） 黄芩（苦寒） 葳蕤（甘平，各十八铢） 石膏（打碎，用绵布包裹，性味甘寒） 白术（甘温） 干姜（辛热） 芍药（甘平） 天门冬（去心，性味甘平） 桂枝（辛热） 茯苓（甘平） 甘草（炙过，性味甘平，各六铢）
以上十四味药。用水一斗。先煮麻黄，煮至一升时，撇去水面浮沫。然后加入其余药物。继续煎煮，取汁三升。滤去药渣。分三次温服。每次服药间隔时间约为煮熟三斗米所需的时间。服药后令全身出汗即可痊愈。
《玉函经》记载：大热之气，用寒凉药来祛除它。极热之气，用发汗法来发散它。麻黄、升麻的甘味，用来发散浮游之热。正气虚弱的人，用辛润之法调理。当归、桂枝、干姜的辛味，用来散寒。上部有热者，用苦味药泄热。知母、黄芩的苦味，能清心除热。津液不足的人，用甘润之法滋养。茯苓、白术的甘味，能缓和脾气、生津液。肺燥气热者，用酸味收敛，用甘味缓急。芍药的酸味，用来收敛上逆之气。葳蕤、天门冬、石膏、甘草的甘味，能润肺除热。
伤寒病四五日，腹中疼痛，若有肠鸣气转，向下趋向少腹部的，这是将要发生自发性腹泻的症状。
伤寒病四五日，是邪气传入体内的时期。腹中疼痛，肠鸣气转向下趋向少腹部，这是因为里虚遇寒，寒气下行，即将发生自发性腹泻。
伤寒本已有寒性下利，医生反而使用吐法。导致寒邪格拒，更加引起呕吐和下利。如果食物入口即吐，应用干姜黄连黄芩人参汤主治。
伤寒邪气本应从表传变，但因患者本有寒性下利，医生反而使用吐法。损伤了正气，寒气在内部形成格拒。经书说：“格则吐逆。”食物入口即吐，称为寒格。如果再继续使用吐下法，就会导致双重虚损而死亡。因此，对于这种更逆的吐下情况，使用干姜黄连黄芩人参汤，以通解寒格。
王宇泰说：按照“本自寒下”的说法，恐怕原文应是“本自吐下”。从文中的“复”字可以看出。胃寒则呕吐，下焦寒则腹泻。胃寒的人不应当使用吐法，医生反而使用吐法，就会损伤胃气，从而形成寒格。下文文意不连贯，应当有脱漏的文字。
张卿子说：“本自寒下”，类似于少阳病条文中提到的“邪高痛下”，所谓邪正分争的情况。盖原本为寒邪，而邪气表现为热象。《素问》说：“风寒在下，燥热在上。”
Mahuang (Ephedrae Herba, two and a half liang, nodes removed, sweet and warm) Shengma (Cimicifugae Rhizoma, one liang and one fen, sweet and neutral) Danggui (Angelicae Sinensis Radix, one liang and one fen, acrid and warm) Zhimu (Anemarrhenae Rhizoma, bitter and cold) Huangqin (Scutellariae Radix, bitter and cold) Weirui (Polygonati Odorati Rhizoma, sweet and neutral, each eighteen zhu) Shigao (Gypsum Fibrosum, crushed, wrapped in cotton, sweet and cold) Baizhu (Atractylodis Macrocephalae Rhizoma, sweet and warm) Ganjiang (Zingiberis Rhizoma Recens, acrid and hot) Shaoyao (Paeoniae Radix Alba, sweet and neutral) Tianmendong (Asparagi Radix, heart removed, sweet and neutral) Guizhi (Cinnamomi Ramulus, acrid and hot) Fuling (Poria, sweet and neutral) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, sweet and neutral, each six zhu)
The above fourteen ingredients. Use ten dou of water. First decoct Mahuang until one sheng remains, skim off the foam on the surface. Then add the remaining herbs. Decoct to obtain three sheng of liquid. Strain out the dregs. Divide into three equal doses to be taken warm. The interval between doses should be approximately the time it takes to cook three dou of rice. After administration, induce sweating for recovery.
The *Yufang Jing* states: For excessive heat qi, use cold medicines to resolve it. For severe heat qi, use diaphoresis to disperse it. The sweetness of Mahuang and Shengma is used to disperse floating heat. For those with deficient righteous qi, use acrid and moistening methods. The acridity of Danggui, Guizhi, and Ganjiang is used to dispel cold. For heat in the upper jiao, use bitter drugs to drain heat. The bitterness of Zhimu and Huangqin cools the heart and removes heat. For those with insufficient body fluids, use sweet and moistening methods. The sweetness of Fuling and Baizhu soothes the spleen and generates fluids. For lung dryness and qi heat, use sour astringents and sweet relaxants. The sourness of Shaoyao is used to constrain rebellious qi. The sweetness of Weirui, Tianmendong, Shigao, and Gancao moistens the lungs and removes heat.
In Shanghan disease lasting four or five days, if there is abdominal pain accompanied by peristaltic sounds moving downward toward the lower abdomen, this indicates an impending spontaneous diarrhea.
During the fourth or fifth day of Shanghan disease, when pathogenic factors transmit inward, abdominal pain and peristaltic sounds moving downward toward the lower abdomen suggest that internal deficiency combined with cold causes cold qi to descend, leading to impending spontaneous diarrhea.
If Shanghan disease originally presented with cold-type diarrhea, and the physician erroneously employed emesis, cold obstruction may worsen vomiting and diarrhea. If food is vomited immediately upon ingestion, Ganjiang Huanglian Huangqi Renshen Tang (Dry Ginger, Coptis, Scutellaria, and Ginseng Decoction) is indicated.
Shanghan pathogens typically transmit from the exterior; however, due to pre-existing cold diarrhea, erroneous emesis damages righteous qi, causing cold qi to obstruct internally. As stated in the classics, "obstruction leads to vomiting and reversal." Vomiting food immediately after ingestion is termed "cold obstruction." Further use of emetic or purgative methods would cause double deficiency and death. Therefore, for such aggravated conditions, Ganjiang Huanglian Huangqi Renshen Tang is used to resolve the cold obstruction.
Wang Yutai commented: Regarding "originally having cold diarrhea," it is likely that the original text read "originally having vomiting and diarrhea." This can be inferred from the character "further" (复). Stomach cold causes vomiting, while lower jiao cold causes diarrhea. Patients with stomach cold should not undergo emesis; doing so damages stomach qi, resulting in cold obstruction. The subsequent text lacks coherence, suggesting missing passages.
Zhang Qingzi stated: "Originally having cold diarrhea" is analogous to the Shaoyang syndrome description of "pathogen high, pain low," representing the struggle between pathogenic and righteous qi. Originally, the condition involves cold, but the pathogen manifests as heat. The *Suwen* states: "Wind-cold is below, dry-heat is above."