佚庵刘尚书第五子太常少卿叔谦之内李氏。中统三年春。欲归宁父母不得。情动于中。又因劳
役。四肢困倦。躁热恶寒。时作疼痛。不欲食。食即呕吐。气弱短促、怠惰嗜卧。医作伤寒治之。解表发汗
。次日传变。又以大小柴胡之类治之。至十余日之后。病证愈剧。病家云。前药无效。莫非他病否
。医曰。此伤寒六经传变。至再经传尽。当得汗而愈。翌日。见爪甲微青黑色。足胫至腰如冰冷。
目上视而睹不转睛。咽溢不利。小腹冷。气上冲心而痛。呕吐不止。气短欲绝。召予治之。予诊其
脉沉细而微。不见伤寒之证。此属中气不足。妄作伤寒治之。发表攻里。中气愈损。坏证明矣。太夫
人泣下避席曰。病固危困。君尽心救治。予以辛热之药。 咀一两。作一服。至夜药熟而不能饮。
续续灌下一口。饮至半夜。稍有呻吟之声。身体渐温。忽索粥饮。至旦食粥两次。又煎一服。投之
。至日高。众医皆至。诊之曰。脉生证回矣。众喜而退。后越三日。太夫人曰。病患大便不利。或
以用脾约丸润之可乎。予曰。前证用大辛热之剂。阳生阴退而愈。若以大黄之剂下之。恐寒不协。
转生他证。众以为不然。遂用脾约丸二十丸润之。至夜下利而行。翌日面色微青。精神困弱。呕吐复
作。予再以辛热前药温之而愈矣。故制此方。
【温中益气汤】
附子（炮。去皮脐） 干姜（炮。各五钱） 草豆蔻 甘草（炙。各三钱）
益智仁 白芍药 丁香 藿香
白术（各二钱） 人参 陈皮 吴茱萸（各一钱半）
当归（一钱）
上十三味。 咀。每服五钱。水二盏。煎至一盏。去渣。温服食前。病势大者。服一两重。
论曰。内经云。寒淫于内。治以辛热。佐以苦甘温。附子、干姜大辛热。助阳退阴。故以为君
。丁香、藿香、豆蔻、益智、茱萸辛热。温中止吐。用以为臣。人参、当归、白术、陈皮、白芍药
、炙。甘草苦甘温。补中益气。和血脉协力。用以为佐使矣。
Ms. Li, the wife of Shuqian, Vice Minister of the Court of Imperial Sacrifices and the fifth son of Liu Yi'an, Minister of Revenue, experienced emotional distress in the spring of the Zhongtong era (1262) because she could not return to her parental home. Due to labor and fatigue, she suffered from exhaustion of the four limbs, irritability with fever, aversion to cold, intermittent pain, anorexia, vomiting after eating, weak and short breath, lethargy, and drowsiness. Physicians treated it as Taiyang disease (a syndrome caused by pathogenic factors affecting the Taiyang channel), using methods to release the exterior and induce sweating. The condition transmitted on the next day, and they then treated it with formulas such as Da Chaihu Tang (Major Bupleurum Decoction). After more than ten days, the symptoms worsened. The family asked, "The previous medicines were ineffective; could it be a different disease?" The physician replied, "This is the transmission through the six meridians of Taiyang disease. When the transmission through the second meridian cycle completes, sweating should occur for recovery." The following day, the patient's fingernails turned slightly cyanotic and black, her calves and thighs down to the waist felt as cold as ice, her eyes stared upward without moving, her throat was obstructed and difficult to swallow, her lower abdomen was cold, Qi rushed up to the heart causing pain, vomiting continued incessantly, and her breath was so short it seemed about to cease. I was summoned to treat her. Upon palpating her pulse, it was deep, fine, and faint. There were no signs of Taiyang disease. This belonged to deficiency of Middle Qi (the vital energy derived from the Spleen and Stomach). Mistakenly treating it as Taiyang disease and using methods to release the exterior and purge the interior further damaged the Middle Qi, resulting in a complicated disease (illness worsened by improper treatment). The Grand Madam wept and stepped aside, saying, "The illness is indeed critical and difficult. Please exert your utmost effort to save her." I prescribed pungent-hot herbs, one liang (approx. 37.5g or 50g depending on historical standard, here referring to the dose weight), processed into a decoction. At night, when the medicine was ready, she could not drink it. A mouthful was administered intermittently. By midnight, she made slight groaning sounds, and her body gradually warmed. Suddenly, she requested porridge. By dawn, she ate porridge twice. Another dose was decocted and administered. By mid-morning, other physicians arrived. Upon examination, they said, "The pulse has recovered, and the syndromes have reversed." Everyone rejoiced and withdrew. Three days later, the Grand Madam reported that the patient had difficulty with bowel movements. Someone suggested using Pi Yue Wan (Splee Restriction Pill) to moisten the intestines. I said, "The previous syndrome was cured by large pungent-hot agents, where Yang generated and Yin receded. If purgatives like Rhubarb are used, it may conflict with the cold nature, potentially generating other complications." The others disagreed and administered twenty pills of Pi Yue Wan to moisten the bowels. That night, diarrhea occurred. The next day, her complexion turned slightly cyanotic, her spirit was exhausted and weak, and vomiting recurred. I again treated her with the previous pungent-hot warming prescription, and she recovered. Therefore, this formula was formulated.
[Formula: Wen Zhong Yi Qi Tang (Warm the Middle and Benefit Qi Decoction)]
Fuzi (Prepared Aconite Lateral Root, prepared, skin and umbilicus removed) [Aconiti Lateralis Radix Praeparata]
Ganjiang (Dried Ginger Rhizome, prepared) [Zingiberis Rhizoma]
Caodoukou (Grass Cardamom Seed) [Alpiniae Katsumadai Semen]
Gancao (Licorice Root, honey-fried) [Glycyrrhizae Radix et Rhizoma]
Yizhiren (Alpine Sweetflag Fruit) [Alpiniae Oxyphyllae Fructus]
Baishao (White Peony Root) [Paeoniae Radix Alba]
Dingxiang (Clove) [Syzygii Flos]
Huoxiang (Patchouli Herb) [Agastaches Herba]
Baizhu (Atractylodes Macrocephala Rhizome) [Atractylodis Macrocephalae Rhizoma]
Renshen (Ginseng Root) [Panacis Ginseng Radix]
Chenpi (Aged Tangerine Peel) [Citri Reticulatae Pericarpium]
Wuzhuyu (Evodia Fruit) [Evodiae Fructus]
Danggui (Angelica Sinensis Root) [Angelicae Sinensis Radix]
The above thirteen ingredients. Process them. For each dose, use five qian (approx. 18.75g or 25g). Add two cups of water, decoct until one cup remains, remove the dregs, and take warm before meals. For severe conditions, administer a dose weighing one liang.
Commentary: The *Neijing* states: "When cold invades internally, treat with pungent-hot substances, assisted by bitter-sweet-warm substances." Fuzi and Ganjiang are greatly pungent-hot, assisting Yang and retreating Yin, thus serving as the Sovereign (Jun) herbs. Dingxiang, Huoxiang, Caodoukou, Yizhiren, and Wuzhuyu are pungent-hot, warming the middle and stopping vomiting, serving as the Minister (Chen) herbs. Renshen, Danggui, Baizhu, Chenpi, Baishao, and Zhi Gancao are bitter-sweet-warm, tonifying the middle and benefiting Qi, harmonizing the vessels and collaborating, serving as the Assistant (Zuo) and Envoy (Shi) herbs.