（此方自仲景原论中第七卷集入于此）
人参 甘草（炙） 白术 干姜（各三两）
上四味。捣筛为末。蜜和丸。如鸡子黄大。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。
成注引内经曰。脾欲缓。急食甘以缓之。用甘补之。人参白术甘草之甘。以缓脾气调中。寒淫所胜。平以辛热。干
姜之辛。以温胃散寒。
琥按上方。本系仲景治霍乱呕吐泄利。寒多不饮水者。故活人书复云。四肢拘急。腹满下利。或转筋者。皆系真寒
之象。而非暑邪实热比也。倘病患中气虚而不寒。或寒而不虚者。宜审用之。
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。
（活人书云。四肢拘急。腹满下利。或转筋者。去术。加附子一枚。生用。）服汤后。如食顷。饮热粥一升许。微自温。
勿发揭衣被。
琥按上加减法。内台方议曰。若脐上筑者云云。脾虚则肾气发动。故脐上筑也。术能壅气。故去桂泄奔豚。故加之。
吐多者。加生姜止呕。辛以散之也。呕家不喜术。故去之。下多者。还用术以去湿。悸者。愚以水停心下。水来犯火则
悸。茯苓之甘淡。能利水止泄也。渴欲得水者。非热渴。乃脾胃虚寒。津液凝滞而作渴也。本草白术能益津液。故倍加
之。腹中痛者。里虚不足也。故倍加人参以补之。内台方云。渴痛不止。再加黄芩芍药误矣。寒者加干姜。寒淫所胜。
平以辛热也。腹满者。愚以寒气实也。白术能壅气。故去之。然胃中虚寒。中空无物而满。白术在所不忌。寒甚。若脉
微。手足厥逆恶寒者。加附子。
又问胸膈不快。 满闭塞。唇青。手足冷。脉沉细。少情绪。或腹痛。答曰。此名太阴也。近人多不识阴证。才见
胸膈不快。便投食药。非其治也。大抵阴证者。由冷物伤脾胃。阴经受之也。主胸膈 满。面色及唇。皆无色泽。手足
冷。脉沉细。少情绪。亦不因嗜欲。但内伤冷物。或损动胃气。遂成阴证。复投巴豆之类。胸膈愈不快。或吐而利。经
一二日。遂致不救。盖不知寒中太阴也。太阴者。脾之经也。又问万一饮食不节。胸膈不快。寒中阴经。何法以治之。
答曰。急作理中汤。加青橘陈橘。 如麻豆大。服一二剂。胸膈即快。枳实理中丸。五积散尤良。
琥按上条论。实发仲景未发之旨。其云胸膈不快。 满闭塞。有似伤食证。亦知其人胃气本虚。中焦无火。以致饮
食不化。验其面色及唇。皆无色泽。手足冷。脉沉细。少情绪。其为虚寒之证无疑。又云。不因嗜欲者。言不必近房室
而后谓之阴证也。所以丹溪起而云。中寒主于温散。有卒中天地之风寒者。有口得寒物者。愚以果系胃气大虚。理中汤
相宜。倘胃气大寒而不虚。用枳实理中丸。但其中参术辈。又宜审投也。
(This prescription was collected from Volume 7 of Zhang Zhongjing's original treatise and included here.)
Ren Shen (Ginseng Radix), Gan Cao (Licorice Root, prepared with honey), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Gan Jiang (Zingiberis Rhizoma) (each three liang).
The above four herbs. Pound and sieve into powder. Mix with honey to form pills. Size like a chicken egg yolk. Take one pill, dissolve in several he of boiling water. Crush and take warm. Three or four times daily, two times at night. If there is no warmth in the abdomen, increase to three or four pills per dose. However, it is inferior to the decoction. Method for decoction: Use the original dosage of the four herbs. Cut them. Add eight sheng of water. Boil to obtain three sheng. Remove dregs. Take one sheng warm. Three times daily.
Cheng Wuji's commentary cites the *Neijing* saying: The spleen desires relaxation; urgently use sweet substances to relax it. Use sweet to tonify it. The sweetness of Ren Shen, Bai Zhu, and Gan Cao relaxes spleen qi and regulates the middle jiao. When cold pathogen prevails, use pungent-hot substances to level it. The pungency of Gan Jiang warms the stomach and disperses cold.
Hu notes: The above prescription originally belonged to Zhang Zhongjing's treatment of huoluan (cholera-like syndrome) with vomiting and diarrhea, where cold predominates and the patient does not desire water. Therefore, the *Liuren Shu* (Book of Vitality) further states: Spasm and tightness of the four limbs, abdominal fullness, diarrhea, or muscle twitching are all signs of true cold, not comparable to summer-heat pathogenic factor excess heat. If the patient has deficiency of middle qi without cold, or cold without deficiency, it should be used after careful examination.
Modifications
If there is a pulsating sensation above the umbilicus, it indicates kidney qi moving. Remove Bai Zhu. Add Gui Zhi (Cinnamon Twig) four liang. For excessive vomiting, remove Bai Zhu. Add Sheng Jiang (Fresh Ginger Rhizome) three liang. For excessive diarrhea, continue using Bai Zhu. For palpitations, add Fu Ling (Poria) two liang. For thirst desiring water, increase Bai Zhu so that the total amount becomes four liang and half. For abdominal pain, add Ren Shen so that the total amount becomes four liang and half. For cold conditions, add Gan Jiang so that the total amount becomes four liang and half. For abdominal fullness, remove Bai Zhu. Add Fu Zi (Aconiti Lateralis Radix Praeparata) one piece.
(The *Liuren Shu* states: For spasm and tightness of the four limbs, abdominal fullness, diarrhea, or muscle twitching, remove Bai Zhu. Add Fu Zi one piece, used raw.) After taking the decoction, approximately the time it takes to eat a meal, drink about one sheng of hot porridge. Keep slightly warm. Do not uncover clothes or blankets.
Hu notes regarding the above modifications: The *Neitai Fangyi* discusses: If there is a pulsating sensation above the umbilicus, etc., spleen deficiency causes kidney qi to move, hence the pulsation. Bai Zhu can obstruct qi, hence Gui Zhi is removed to drain ben tun (rushing pig, a condition of qi rushing upward); thus it is added. For excessive vomiting, add Sheng Jiang to stop vomiting, as pungent substances disperse. Those who vomit dislike Bai Zhu, hence it is removed. For excessive diarrhea, continue using Bai Zhu to remove dampness. For palpitations, I believe water retention below the heart causes palpitations when water attacks fire. The sweet and bland nature of Fu Ling can promote urination and stop diarrhea. Thirst desiring water is not due to heat-thirst, but rather spleen and stomach deficiency-cold, where body fluids stagnate causing thirst. The *Bencao* states Bai Zhu can benefit body fluids, hence it is doubled. Abdominal pain indicates interior deficiency and insufficiency, hence Ren Shen is doubled to tonify it. The *Neitai Fang* states that adding Huang Qin (Scutellaria Root) and Shao Yao (Peony Root) for unrelenting thirst and pain is erroneous. For cold conditions, add Gan Jiang, as cold pathogen prevails and is leveled by pungent-hot substances. For abdominal fullness, I believe it is due to excess cold. Bai Zhu can obstruct qi, hence it is removed. However, if the stomach has deficiency-cold and fullness arises from emptiness, Bai Zhu is not contraindicated. For severe cold, if pulse is faint, hands and feet are cold and reversed, and there is aversion to cold, add Fu Zi.
Another question: Chest and diaphragm discomfort, fullness and obstruction, cyanotic lips, cold hands and feet, deep and fine pulse, low spirit, or abdominal pain. Answer: This is named Taiyin disease. Modern people mostly do not recognize yin syndromes. Upon seeing chest and diaphragm discomfort, they immediately administer digestive medicines, which is incorrect treatment. Generally, yin syndromes result from cold substances injuring the spleen and stomach, affecting the yin meridians. Main manifestations include chest and diaphragm fullness, lack of luster in facial complexion and lips, cold hands and feet, deep and fine pulse, and low spirit. It is not necessarily due to sexual indulgence, but rather internal injury from cold substances or damage to stomach qi, leading to yin syndrome. Administering drugs like Ba Dou (Croton Seed) again makes chest and diaphragm more uncomfortable, or causes vomiting and diarrhea. After one or two days, this leads to untreatable conditions. This is because one does not know that cold has struck the Taiyin. Taiyin is the meridian of the spleen. Another question: What if dietary irregularities cause chest and diaphragm discomfort, and cold strikes the yin meridians? What method treats it? Answer: Immediately prepare Lizhong Tang (Regulate the Middle Decoction), add Qing Ju Pi (Green Tangerine Peel) and Chen Ju Pi (Aged Tangerine Peel), cut into sizes of hemp or mustard seeds. Take one or two doses, and chest and diaphragm will feel comfortable. Zhishi Lizhong Wan (Immature Bitter Orange Regulate the Middle Pill) and Wuji San (Five Accumulations Powder) are especially good.
Hu notes: The above discussion actually expounds on the principles not fully expressed by Zhang Zhongjing. It states that chest and diaphragm discomfort and fullness/obstruction resemble food stagnation syndrome, but also recognizes that the person's stomach qi is originally deficient, and the middle jiao lacks fire, leading to undigested food. Verifying the lack of luster in facial complexion and lips, cold hands and feet, deep and fine pulse, and low spirit, it is undoubtedly a deficiency-cold syndrome. It also states "not due to sexual indulgence," meaning one does not need to engage in sexual activity to have a yin syndrome. Thus, Zhu Danxi arose saying: Treatment of cold strike mainly involves warming and dispersing. There are cases of sudden exposure to heaven and earth wind-cold, and cases of ingesting cold substances. I believe if stomach qi is severely deficient, Lizhong Tang is appropriate. If stomach qi is severely cold but not deficient, Zhishi Lizhong Wan is used. However, the inclusion of Ren Shen and Bai Zhu requires careful consideration.