真定府张大。年二十有九。素好嗜酒。至元辛未五月间。病手指节肿痛。屈伸不利。膝膑亦然
。心下痞满。身体沉重。不欲饮食。食即欲吐。面色痿黄。精神减少。至六月间。来求予治之。诊
其脉沉而缓。缓者脾也。难经云。 主体重节痛。 者脾之所主。四肢属脾。盖其人素饮酒。加之
时助。湿气大胜。流于四肢。故为肿痛。内经云。诸湿肿痛。皆属脾土。仲景云。湿流关节。肢体
烦痛。此之谓也。宜以大羌活汤主之。内经云。湿淫于内。治以苦温。以苦发之。以淡渗之。又云
。风能胜湿。羌活、独活。苦温透关节而胜湿。故以为君。升麻苦平。威灵仙、防风、苍术、苦辛
温发之者也。故以为臣。血壅而不流则痛。当归辛温以散之。甘草甘温。益气缓中。泽泻
咸平。茯苓甘平。导湿而利小便。以淡渗之也。使气味相合。上下分散其湿也。
【大羌活汤】
羌活 升麻（各一钱） 独活（七分） 苍术
防风（去芦） 威灵仙（去芦） 白术 当归
白茯苓（去皮） 泽泻（各半钱）
上十味 咀。作一服。水二盏。煎至一盏。去渣温服。食前一服。食后一服。忌酒面生冷硬物
。
参政商公。时年六旬有二。元有胃虚之证。至元己巳夏。上都住。时值六月。霖雨大作。连日
不止。因公务劳役过度。致饮食失节。每旦则脐腹作痛。肠鸣自利。须去一二行乃少定。不喜饮食
。懒于言语。身体倦困。召予治之。予诊其脉沉缓而弦。参政以年高气弱。脾胃宿有虚寒之证。加
之霖雨及劳役饮食失节。重虚中气。难经云。饮食劳倦则伤脾。不足而往。有余随之。若岁火不及
。寒乃大行。民病骛溏。今脾胃正气不足。肾水必挟木势。反来侮土。乃薄所不胜乘所胜也。此疾
非甘辛大热之剂。则不能泻水补土。虽夏暑之时。有用热远热之戒。又云。有假者反之。是从权
而治其急也。内经云。寒淫于内。治以辛热。干姜、附子辛甘大热。以泻寒水。用以为君。脾不足
者。以甘补之。人参、白术、甘草、陈皮。苦甘温以补脾土。胃寒则不欲食。以生姜、草豆蔻辛温
治客寒犯胃。浓朴辛温浓肠胃。白茯苓甘平助姜附。以导寒湿。白芍药酸微寒。补金泻木以
防热伤肺气为佐也。不数服良愈。
【附子温中汤】治中寒腹痛自利。米谷不化。脾胃虚弱。不喜饮食。懒言语。困倦嗜卧。
干姜（炮） 黑附子（炮。去皮脐。各七钱） 人参（去芦）
甘草（炙） 白芍药 白茯苓（去皮） 白术（各五钱）
草豆蔻（面裹煨。去皮） 浓朴（姜制） 陈皮（各三钱）
上十味 咀。每服五钱。或一两。水二盏半。生姜五片。煎至一盏三分。去渣。温服。食前。
Mr. Zhang from Zhengding Prefecture, aged twenty-nine. He had a long-standing habit of indulging in alcohol. In the fifth month of the Xinsi year of the Zhiyuan era, he suffered from swelling and pain in the finger joints, with limited flexion and extension; the same condition affected his knee patellae. He experienced epigastric fullness and stuffiness, heaviness of the body, anorexia, and nausea after eating. His complexion was sallow and dull, and his spirit was diminished. In the sixth month, he sought my treatment. I palpated his pulse as deep (Chen) and slow (Huan). The Huan pulse indicates Spleen pathology. The *Nan Jing* states: "The Huan pulse primarily manifests as heaviness of the body and joint pain." This is governed by the Spleen. The four limbs belong to the Spleen. It is likely that due to his habitual drinking, combined with the seasonal dampness, Dampness became excessive and flowed into the four limbs, causing swelling and pain. The *Nei Jing* states: "All swelling and pain caused by Dampness belong to the Earth element of the Spleen." Zhang Zhongjing stated: "When Dampness flows into the joints, it causes vexing pain in the limbs." This refers to such cases. It is appropriate to treat this with Da Qianghuo Tang (Major Notopterygium Decoction) as the primary formula. The *Nei Jing* states: "When Dampness overflows internally, treat it with Bitter-Warm herbs; disperse it with Bitter flavors, and leach it out with Acrid flavors." It also states: "Wind can overcome Dampness." Qianghuo (Notopterygii Rhizoma et Radix) and Duhuo (Angelicae Pubescentis Radix), being Bitter-Warm, penetrate the joints and overcome Dampness, thus serving as the Sovereign (Jun) herbs. Shengma (Cimicifugae Rhizoma), being Bitter-Flat, along with Weilingxian (Syringae Ramulus et Folium), Fangfeng (Saposhnikoviae Radix), and Cangzhu (Atractylodis Rhizoma), possess Bitter-Acrid-Warm properties to disperse Dampness, thus serving as the Minister (Chen) herbs. Blood stagnation and lack of flow cause pain; Danggui (Angelicae Sinensis Radix), being Acrid-Warm, disperses blood stasis. Gancao (Glycyrrhizae Radix et Rhizoma), being Sweet-Warm, tonifies Qi and harmonizes the middle. Zexie (Alismatis Rhizoma), being Salty-Flat, and Fuling (Poria), being Sweet-Flat, guide Dampness and promote urination, utilizing the method of leaching with Acrid flavors. The combination of these medicinal flavors allows for the dispersion of Dampness throughout the upper and lower body.
[Da Qianghuo Tang]
Qianghuo (Notopterygii Rhizoma et Radix) and Shengma (Cimicifugae Rhizoma) (1 qian each), Duhuo (Angelicae Pubescentis Radix) (0.7 qian), Cangzhu (Atractylodis Rhizoma), Fangfeng (Saposhnikoviae Radix, removed rhizome base), Weilingxian (Syringae Ramulus et Folium, removed rhizome base), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), Bai Fuling (Poria, peeled), Zexie (Alismatis Rhizoma) (0.5 qian each).
These ten ingredients are coarsely crushed. Take one dose, add two cups of water, decoct until one cup remains, remove the dregs, and take warm. Take one dose before meals and one dose after meals. Avoid alcohol, wheat products, raw/cold foods, and hard-to-digest items.
Vice Director Shang, aged sixty-two at the time. He originally had symptoms of Spleen and Stomach deficiency. In the summer of the Jisi year of the Zhiyuan era, while residing in Shangdu, heavy rains persisted for days. Due to excessive official duties and labor, his diet became irregular. Every morning, he experienced pain around the umbilicus and abdomen, borborygmus, and spontaneous diarrhea, which only subsided slightly after one or two bowel movements. He lacked appetite, was reluctant to speak, and felt physically fatigued and lethargic. I treated him. I palpated his pulse as deep-slow (Chen-Huan) and wiry (Xian). Given his advanced age and weak constitution, he had a pre-existing pattern of Cold-deficiency in the Spleen and Stomach. Combined with the prolonged rain, labor, and dietary irregularity, his Middle Qi was further depleted. The *Nan Jing* states: "Irregular diet and fatigue injure the Spleen." When deficiency exists, excess pathogens follow. If the Fire element of the year is insufficient, Cold dominates, leading to watery diarrhea among the people. Now, with insufficient Righteous Qi in the Spleen and Stomach, Kidney Water likely borrows the force of Wood to insult Earth, invading what it cannot conquer (Metal) and overcoming what it conquers (Earth). This disease requires Sweet-Acrid Great-Hot formulas to drain Water and tonify Earth. Although it is summer, a season where Hot herbs should generally be avoided ("avoid heat when using heat"), the classics state: "In cases of false presentation, reverse the approach." This is a pragmatic measure to address the acute condition. The *Nei Jing* states: "When Cold overflows internally, treat it with Acrid-Hot herbs." Ganjiang (Zingiberis Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata), being Sweet-Acrid Great-Hot, drain Cold Water and serve as the Sovereign (Jun) herbs. For Spleen deficiency, tonify with Sweet flavors. Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), and Chenpi (Citri Reticulatae Pericarpium), being Bitter-Sweet-Warm, tonify Spleen Earth. For Stomach Cold causing anorexia, use Shengjiang (Zingiberis Rhizoma Recens) and Caodoukou (Cardamomi Fructus), being Acrid-Warm, to treat external Cold invading the Stomach. Houpo (Magnoliae Officinalis Cortex), being Acrid-Warm, thickens the intestines and stomach. Bai Fuling (Poria), being Sweet-Flat, assists Jiang and Fu in guiding out Cold-Dampness. Baishao (Paeoniae Radix Alba), being Sour-Mild-Cold, tonifies Metal (Lung) to drain Wood (Liver), preventing Heat from injuring Lung Qi, serving as the Assistant (Zuo) herb. After a few doses, he recovered well.
[Fuzi Wenzhong Tang] Treats abdominal pain and spontaneous diarrhea due to Middle Cold, undigested food, Spleen-Stomach weakness, anorexia, reluctance to speak, fatigue, and somnolence.
Ganjiang (Zingiberis Rhizoma, processed), Hei Fuzi (Aconiti Lateralis Radix Praeparata, processed, peeled and navel removed, 7 qian each), Renshen (Ginseng Radix, removed rhizome base), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried), Baishao (Paeoniae Radix Alba), Bai Fuling (Poria, peeled), Baizhu (Atractylodis Macrocephalae Rhizoma) (5 qian each), Caodoukou (Cardamomi Fructus, roasted in flour, peeled), Houpo (Magnoliae Officinalis Cortex, ginger-processed), Chenpi (Citri Reticulatae Pericarpium) (3 qian each).
These ten ingredients are coarsely crushed. Take 5 qian or 1 liang per dose, add 2.5 cups of water and 5 slices of Shengjiang (Zingiberis Rhizoma Recens), decoct until 1.3 cups remain, remove dregs, and take warm. Take before meals.