柴胡半筋 黄芩三两 芍药三两 半夏（洗）半筋 枳实（炙）四枚 大黄二两 大
枣十二枚 生姜五两
右八味，以水一斗二升，煮取六升，去滓再煎，温服一升，日三服。
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腹痛，脉弦而紧，弦则卫气不行，即恶寒，紧则不欲食，邪正相抟，即为寒疝。绕脐
痛苦，发则白汗出，手足厥冷，其脉沉紧者，大乌头煎主之。
【按】
此条脉重出，下条有证无脉，「其脉沉紧者」之五字，当在下条里急之下。然脉弦而
紧，是劲急之甚，当属寒疝之重者。其白汗之「白」字，当是「自」字。下条其脉沉
紧是里痛之脉，当属寒疝之轻者，必是传写之□。
【注】
疝病犯寒即发，故谓之寒疝也。其病发则绕脐少腹急痛，恶寒汗出，手足厥冷，不欲
饮食，脉弦而紧，主急主痛，此寒疝应有之证脉也。主之乌头煎者，是专以破邪治标
为急，虚实在所不论，故曰：强人服七合，弱人服五合也。
乌头（熬，去皮，不□咀）大者五枚
右以水三升，煮取一升，去滓，内蜜二升，煎令水气尽，取二升，强人服七合，弱人
服五合，不差明日更服，不可一日再服。
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寒疝，腹中痛，及□痛里急者，当归生姜羊肉汤主之。
【按】
□痛里急之下，当有上条「其脉沉紧」四字。
【注】
寒疝腹中痛及□痛里急，脉见沉紧，较之绕脐苦痛轻矣。且无恶寒汗出，手足厥冷，
故不用乌头煎之大温大散，而用当归生姜羊肉汤，养正为本，散寒为次，此治寒疝之
利剂也。服乌头煎病势退者，亦当与之。
【集注】
李□曰：疝属肝病，肝藏血，其经布□肋，腹□并痛者，血气寒而凝涩也。当归通经
活血，生姜温中散寒。里急者，内虚也，用羊肉补之，『内经』云：形不足者，温之
以气，精不足者，补之以味是也。
沈明宗曰：按此连冲脉为疝，治当温补也。肝木受邪，乘脾则腹中痛，本经之气不舒
，故□亦痛，连及冲脉则里急矣。所以当归补养冲任而散风寒，羊肉温补荣卫之气，
脾邪散而痛自止。方后云：痛而多呕，乃肝气上逆临胃，故加橘、术补之。
Bupleuri Radix (Chaihu) half a jin, Scutellariae Radix (Huangqin) three liang, Paeoniae Radix (Shaoyao) three liang, Pinelliae Rhizoma Preparatum (Banxia, prepared by washing) half a jin, Aurantii Fructus Immaturus (Zhishi, roasted) four pieces, Rheum Palmatum (Dahuang) two liang, Jujubae Fructus (Dazao) twelve pieces, Zingiberis Rhizoma Recens (Shengjiang) five liang.
The above eight ingredients are decocted in one dou and two sheng of water to obtain six sheng of liquid. The dregs are removed, and the liquid is boiled again. It is taken warm, one sheng per dose, three times daily.
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Abdominal pain with a wiry (Xuan) and tight (Jin) pulse. A wiry pulse indicates that Wei Qi (Defensive Qi) circulation is obstructed, leading to aversion to cold; a tight pulse indicates anorexia. When pathogenic factors and healthy Qi contend with each other, Cold Hernia (Han Shen) is formed. Pain surrounds the umbilicus, accompanied by spontaneous sweating during attacks, coldness of the hands and feet. If the pulse is deep and tight (Chen Jin), Da Wutou Jian (Major Aconite Decoction) is indicated.
[Commentary]
The pulse description here is repetitive. The following clause presents symptoms without a pulse description; the phrase "if the pulse is deep and tight" should logically follow the symptom "internal urgency" in the next clause. However, a wiry and tight pulse indicates extreme tension, suggesting a severe case of Cold Hernia. The character "white" (Bai) in "white sweat" is likely a typo for "self/spontaneous" (Zi). In the subsequent clause, a deep and tight pulse indicates internal pain, suggesting a milder case of Cold Hernia; this discrepancy is likely due to transcription errors.
[Annotation]
Hernia diseases manifest upon exposure to cold, hence termed Cold Hernia. Upon onset, there is urgent pain around the umbilicus and lower abdomen, aversion to cold, sweating, cold extremities, and anorexia. The wiry and tight pulse signifies urgency and pain, which are characteristic signs and pulses of Cold Hernia. Da Wutou Jian is prescribed because it focuses on expelling pathogens and treating the branch (symptoms) urgently, regardless of deficiency or excess. Hence, it states: robust individuals take seven he, while frail individuals take five he.
Aconiti Lateralis Radix Praeparata (Wutou, stewed, skin removed, not crushed) large ones, five pieces.
One ingredient is decocted in three sheng of water to obtain one sheng of liquid. The dregs are removed, and two sheng of honey are added. The mixture is boiled until all moisture evaporates, yielding two sheng of liquid. Robust individuals take seven he, frail individuals take five he. If the condition does not improve, administer again the next day. Do not administer twice within one day.
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For Cold Hernia with abdominal pain, as well as [missing character] pain accompanied by internal urgency, Danggui Shengjiang Yangrou Tang (Angelica Sinensis, Ginger, and Mutton Decoction) is indicated.
[Commentary]
Following "[missing character] pain and internal urgency," the phrase "its pulse is deep and tight" from the previous clause should be inserted.
[Annotation]
Cold Hernia with abdominal pain and [missing character] pain accompanied by internal urgency, presenting with a deep and tight pulse, is milder than pain surrounding the umbilicus. Furthermore, there is no aversion to cold, sweating, or cold extremities. Therefore, the strongly warming and dispersing Da Wutou Jian is not used. Instead, Danggui Shengjiang Yangrou Tang is employed, prioritizing the nourishment of healthy Qi and secondarily dispelling cold. This is a beneficial formula for treating Cold Hernia. Patients whose condition has subsided after taking Da Wutou Jian should also receive this formula.
[Collected Annotations]
Li [Name Missing] stated: Hernia belongs to the Liver organ. The Liver stores Blood, and its meridian distributes along the [missing character] costal region. Simultaneous pain in the abdomen and [missing character] region indicates stagnation and sluggishness of Qi and Blood due to cold. Danggui (Angelicae Sinensis Radix) unblocks meridians and invigorates blood; Shengjiang (Zingiberis Rhizoma Recens) warms the middle and dispels cold. Internal urgency indicates internal deficiency; Mutton is used to tonify this. As stated in the *Neijing* (Inner Canon): For insufficiency of form, warm with Qi; for insufficiency of essence, tonify with flavor.
Shen Mingzong stated: According to this text, this involves the Chong Mai (Penetrating Vessel) and constitutes a hernia; treatment should involve warming and tonifying. When Liver Wood is invaded by pathogens and overacts on Spleen Earth, abdominal pain occurs. When the Qi of the primary meridian is not free-flowing, [missing character] pain ensues. Involvement of the Chong Mai leads to internal urgency. Thus, Danggui tonifies and nourishes the Chong and Ren vessels while dispersing wind-cold; Mutton warms and tonifies Ying and Wei Qi. Once the pathogenic influence on the Spleen dissipates, the pain ceases. The post-prescription notes state: if pain is accompanied by frequent vomiting, it indicates Liver Qi rebelling upward against the Stomach; therefore, Citri Reticulatae Pericarpium (Chenpi) and Atractylodis Macrocephalae Rhizoma (Baizhu) are added to tonify.