治太阳病外证未除而数下之。遂协热而利。利下不止。心下痞硬。表里不解者
之。
桂枝（四两） 人参（三两） 白术（三两） 干姜（三两） 甘草（四两）
上五味。以水九升。先煮四味。取五升。内桂枝。煮取三升。去滓。温服一升。日再夜
一服。
歌曰 人参汤即理中汤。加桂后煎痞利尝。桂草方中皆四两。同行三两术参姜。
蔚按。太阳外证未除而数下之。未有不致虚者。里虚则外热内陷。故为协热利不止。协。
合也
阳之气因误下而陷于下。则寒水之阴气反居于阳位。故为心下痞硬。可与甘草泻心汤条。此
非热结。但以胃中虚客气上逆。故使硬句互参。方用人参汤以治里虚。桂枝以解表邪。而煮
法桂枝后纳者。欲其于治里药中越出于表以解邪也。
沈丹彩曰。此与葛根黄连汤同一误下而利不止之证也。而寒热各别。虚实对待。可于此
互参之。彼因实热而用清邪。此因虚邪而从补正。彼得芩、连而喘汗安。此得理中而痞硬解。
彼得葛根以升下陷而利止。此藉桂枝以解表邪而利亦止矣。
治病如桂枝证。头不痛。项不强。寸脉微浮。胸中痞硬。气上冲咽喉不得息者。此
有寒也。当吐之。
瓜蒂（一分 熬黄。） 赤小豆（一分）
上二味。各别捣。筛为散已。合治之。取一钱匕。以香豉一合。用热汤七合。煮作稀粥。
去滓。取汁和散。温顿服之。不吐者少少加。得快吐乃止。诸亡血虚家。不可与瓜蒂散。（按
。内台方有昏愦者亦不可吐句。）
歌曰 病在胸中气分乖。咽喉息碍痞难排。平行瓜豆还调豉。寸脉微浮涌吐佳。
蔚按。太阳之脉连风府上头项。今云不痛不强者。不在经脉也。太阳之气出入于心胸。
今云胸中痞硬气上冲咽喉不得息者。是邪气欲从太阳之气上越也。寸脉微浮者。气欲上越之
象也。然欲越而不能遽越。其寒水之气不在经亦不在表。而惟在于胸中。故曰胸中寒。方取
瓜蒂之苦涌。佐以赤小豆之色赤而性降。香豉之色黑而气升。能使心肾相交。即大吐之顷神
志不溃。此所以为吐法之神也。又论云。病患手足厥冷。脉乍紧者。邪在胸中。心下满而烦。
饥不
四达解之。甚为简妙。
治疗太阳病（太阳经受邪所致的病证），表证未解，却多次使用攻下法。于是导致协热利（伴随发热的腹泻）。腹泻不止，胃脘部痞塞坚硬，表里之邪均未解除的病症。
桂枝（四两） 人参（三两） 白术（三两） 干姜（三两） 甘草（四两）
以上五味药。用水九升。先煮前四味药。取五升药液。加入桂枝。再煮取三升药液。去渣。温服一升。白天服两次，晚上服一次。
歌诀曰：理中汤即为人参汤。加入桂枝后煎，可治痞满与下利。方中桂枝、甘草均为四两。白术、人参、干姜各为三两。
蔚按（陈念祖自注）：太阳表证未解而多次攻下，没有不导致虚损的。里气虚则外热内陷，所以出现协热利且不止。协，意为合。阳气因误用下法而陷入下部，则寒水阴气反而占据阳位，所以出现心下痞硬。可与甘草泻心汤条文中“此非热结，但以胃中虚客气上逆，故使硬”的句子互相参照。方中用人参汤来治疗里虚，用桂枝来解除表邪。而煎煮方法中桂枝后下，是希望它在治疗里虚的药物中能够透出体表以解除邪气。
沈丹彩说：此证与葛根黄连黄芩汤证同属误下后腹泻不止的情况。但寒热性质不同，虚实相对，可以在此互相参照。彼证因实热而用清热祛邪之法，此证因虚邪而从补益正气入手。彼证得黄芩、黄连而喘促汗出得以安宁，此证得理中汤而痞硬得以解除。彼证得葛根以升提下陷之气而止利，此证借桂枝以解表邪而利亦止。
出现类似桂枝汤证的病症，但头不痛，项不强，寸脉微浮，胸中痞塞坚硬，气向上冲撞咽喉导致呼吸不畅的，这是有寒邪。应当采用涌吐法治疗。
瓜蒂（一分，炒至黄色） 赤小豆（一分）
以上两味药。分别捣碎，筛成细粉，混合均匀。取一方寸匕的药散。用香豉一合，热汤七合，煮成稀粥。去渣。取药汁调和药散。温顿服下。若不吐，逐渐少量增加剂量，直到快吐出来为止。凡是失血患者及体质虚弱者，不可服用瓜蒂散。（按：《内台方》中有昏愦者也不可用吐法的记载。）
歌诀曰：病在胸中气机乖乱，咽喉呼吸受阻痞闷难排。瓜蒂、赤小豆平行配合，再用香豉调和，寸脉微浮时用涌吐法效果佳。
蔚按：太阳经脉连接风府穴上行至头项。现在说头不痛、项不强，说明病不在经脉。太阳之气出入于心胸。现在说胸中痞硬，气上冲咽喉导致呼吸不畅，这是邪气欲随太阳之气向上向外发散的表现。寸脉微浮，是气欲向上发散的现象。然而想发散而不能立即发散，那寒水之气既不在经脉也不在体表，而只在胸中，所以说胸中有寒。方中取瓜蒂的苦味以涌吐，佐以赤小豆色赤性降，香豉色黑气升，能使心肾相交，即使在剧烈呕吐时神志也不会溃散。这就是吐法的精妙之处。又论中说：病患手足厥冷，脉象突然紧束，邪气在胸中，心下满闷而烦，虽饥但不能进食，四肢不能温暖，用此法解散邪气，极为简妙。
Treats Taiyang disease (a syndrome caused by pathogenic factors affecting the Taiyang channel) where the exterior symptoms have not subsided, yet purgation has been applied multiple times. Consequently, this leads to *xie re li* (diarrhea accompanied by fever). The diarrhea persists incessantly, there is epigastric fullness and hardness, and neither the exterior nor the interior pathogens are resolved.
Guizhi (Cinnamon Twig) [4 liang], Renshen (Ginseng Root) [3 liang], Baizhu (Atractylodes Rhizome) [3 liang], Ganjiang (Dried Ginger) [3 liang], Gancao (Licorice Root) [4 liang].
The above five herbs. Use nine sheng of water. First decoct the first four herbs, obtain five sheng of liquid. Add Guizhi, decoct again to obtain three sheng of liquid. Remove the dregs. Take one sheng warm. Administer twice during the day and once at night.
Song says: Ren Shen Tang is identical to Lizhong Tang. After adding Guizhi and decocting, it treats epigastric fullness and diarrhea. In the formula, Guizhi and Gancao are both four liang. Baizhu, Renshen, and Ganjiang are each three liang.
Wei's commentary: When Taiyang exterior symptoms remain unresolved but purgation is applied repeatedly, deficiency inevitably results. Interior deficiency causes exterior heat to sink inward, thus causing persistent *xie re li*. "Xie" means combination. Yang Qi sinks to the lower part due to erroneous purgation, while Cold-Water Yin Qi occupies the Yang position, resulting in epigastric fullness and hardness. This can be cross-referenced with the text on Ganxiao Xiexin Tang: "This is not a heat knot, but rather stomach deficiency with rebellious hostile Qi, hence the hardness." The formula uses Ren Shen Tang to treat interior deficiency and Guizhi to resolve exterior pathogens. The decoction method specifies adding Guizhi last, intending for it to emerge from the interior-treating medicines to the exterior to dispel pathogens.
Shen Dancai said: This condition is similar to Gegen Lian Huang Qin Tang in that both result from erroneous purgation leading to persistent diarrhea. However, their cold-heat natures differ, and they represent opposing excess-deficiency patterns; they can be compared here. The former involves excess-heat treated by clearing pathogens; this case involves deficient-pathogens treated by tonifying righteous Qi. The former achieves relief from wheezing and sweating via Huangqin and Huanglian; this case resolves epigastric fullness and hardness via Lizhong Tang. The former stops diarrhea by using Gegen to raise sinking Qi; this case stops diarrhea by borrowing Guizhi to resolve exterior pathogens.
When presenting with symptoms resembling Guizhi Tang syndrome, but without headache or stiff neck, with a slightly floating pulse at the Cun position, epigastric fullness and hardness, and Qi rushing upward to the throat causing respiratory difficulty, this indicates the presence of Cold. Purging via emesis should be employed.
Gua Di (Thistle Fruit) [1 fen, stir-fried until yellow], Chi Xiao Dou (Adzuki Bean) [1 fen].
The above two herbs. Grind separately into powder, sift, and mix. Take one qian bi (measure) of the powder. Use Xiang Chi (Prepared Soybean) one he, add seven he of hot water, boil into a thin porridge. Remove dregs. Mix the juice with the powder. Take warm in one dose. If vomiting does not occur, gradually increase the dose slightly until vigorous vomiting ensues, then stop. Patients who have lost blood or are constitutionally deficient must not take Gua Di San. (Note: Neitai Fang states that patients with confusion/dizziness also cannot undergo emesis.)
Song says: Pathogen in the chest disrupts Qi mechanism, causing throat obstruction and difficult-to-resolve fullness. Equal parts Gua Di and Chi Xiao Dou mixed with Xiang Chi make an excellent emetic when the Cun pulse is slightly floating.
Wei's commentary: The Taiyang channel connects to Fengfu and ascends to the head and neck. Since there is no pain or stiffness, the pathology is not in the channel. Taiyang Qi enters and exits the heart and chest. The description of epigastric fullness and hardness, with Qi rushing to the throat causing breathing difficulty, indicates that pathogenic Qi desires to ascend and disperse along with Taiyang Qi. A slightly floating Cun pulse is the sign of Qi attempting to ascend. However, since it cannot immediately disperse, the Cold-Water Qi resides neither in the channel nor on the exterior, but solely in the chest; hence, it is called "Cold in the Chest." The formula employs the bitter property of Gua Di to induce vomiting, assisted by Chi Xiao Dou (red in color, descending nature) and Xiang Chi (black in color, ascending nature), facilitating the interaction between Heart and Kidney. Even during intense vomiting, the spirit remains intact. This demonstrates the divine efficacy of the emetic method. Another discussion states: When patients present with cold extremities, sudden tightness of the pulse, pathogen in the chest, epigastric fullness and irritability, hunger but inability to eat, and cold limbs, resolving the pathogen in the chest is extremely simple and effective.