大意
寒气客于五脏。厥逆上出。阴气竭。阳气未入。故卒然痛死不知人。气复返则、生矣。（内经）
病因
中寒之症。不拘冬夏。或外中天地之寒。或内受饮食之冷。元阳既虚。肤腠空豁。寒邪直入三阴之经。其病
骤发。非若伤寒之内有郁热。与邪相拒。循经渐入之缓也。（安道）
见证
其症卒然战栗。面青切牙。吐泻腹痛。或四肢冰冷。或手足挛蜷。或昏迷僵直。身凉不热。或有微热而不渴。
倦于言动者是也。
中分三阴
寒中太阴。则中脘疼痛。寒中少阴。则脐腹疼痛。寒中厥阴。则小腹至阴疼痛。（机要）
死症
如环口唇青。冷过肘膝。舌缩囊卷。脉绝者。须臾即死。又中寒。无汗者吉。有汗者死。（入门）凡跌扑斗殴。轻生
投水而中寒。以及房欲劳力。涉水而中寒者。皆难治。（缵论）
脉法
中寒脉沉缓者。属太阴。沉细。属少阴。沉迟。属厥阴。（仲景）紧涩者。为寒邪外中。代散者。为阳气内脱。（汇
补）
总治
阳虚阴盛。宜温中散寒。补暖下元。则阳气来复。而寒邪自消。（汇补）
急救治
仓卒之际。难分经络。急煎姜汁。热酒和匀灌下。更用葱饼熨脐轮。灸关元气海二三十壮。脉渐渐应手。四
肢微暖者生。若脉不还者死。脉暴出者亦死。
冻死人。用硫黄、半夏、皂角各一字。加麝香末。填脐中。放葱饼于上。以熨斗盛火熨之。葱烂再易。得暖气入
腹渐醒为度。或以灰炒暖。盛囊中。熨心头。冷即易。数次后。若眼开。始进酒浆。或米饮。不醒者以艾炙门牙
缝。候喊声出。即可救矣。若不先温其心。即用火烘。冷与火搏。必死。又冻僵人未醒。勿以热汤灌之。（濒湖）
用药
主以理中汤。加半夏、苍术、浓朴、陈皮、木香。如腹痛。加吴茱萸。呕吐。加藿香。卵缩无脉。加人参、附子。
肢节痛。加桂枝。足膝冷。加肉桂。若阴极发躁。烦扰不宁。口虽渴而不咽水。面虽赤而两足寒。脉虽数而重按空豁
者。将前药煎好。浸水中。冷服之。不拒格矣。若不知此。误以口渴面赤烦躁。认是阳症。妄投寒凉者死。盖周
身无根之火得水击而走散也。设倥偬之时。不敢擅用参、附。先以二陈加苍白二术、浓朴、炮姜、吴茱煎服。
则吐利止而痛自除。尤为稳当。然后审元气虚实而调之。庶无瘥谬也。
【附外感阴毒】
阴毒者受天地杀厉之气。入三阴经而成病。比中寒稍轻。其症头痛恶寒。面目青黑。咽喉疼痛。身如被杖。
手足清冷。短气不得息。四五日可治。六七日不可治。宜用发表之剂。升麻鳖甲汤去蜀椒雄黄主之。（仲景）
【附内伤真阴】
内伤真阴症。因房劳伤肾。生冷伤脾。内既伏阴。外又感寒。比之中寒更重。亦有伤寒阳症。过服凉药而变
成者。其症五六日后。渐见精神恍惚。身倦懒言。头额手背。冷汗时出。舌上生胎。淡黑冷滑。心下结硬如石。
四肢寒冷如冰。唇青甲黑。鼻如烟煤。腹痛吐利。咽痛睛疼。身如被杖。囊缩舌卷。宜温经之剂。回阳散、返阴
丹。并外灸丹田气海两穴数壮。（活人书）
中寒选方
理中汤 治气虚中寒。腹痛吐泻。厥冷倒仆。脉沉迟者。
干姜（炮） 白术（各二钱半） 甘草（一钱）
水煎服。阴躁者。水中浸冷服之。加参、附。名参附理中汤。
四逆汤 治中寒厥冷。脉细。舌卷囊缩。
附子（制一枚） 干姜（一两半） 人参（二两） 甘草（二两）
水三升。煎升三合。分三服。
三建汤 治中寒六脉不到。而太 冲阳尚未绝者。
川乌 附子 天雄（等分）
生姜。水煎。
五积散（和剂） 治中寒轻症。未离于表。头疼身痛。恶寒。腹痛吐泻。脉迟者。
白芷 茯苓 半夏 当归 川芎 甘草
肉桂 芍药（各三两） 枳壳（炒） 麻黄（去根节） 陈皮（各六两） 桔梗（二两）
浓朴（姜炒） 干姜（各四两） 苍术（二十四两）
每服四钱。水一盏。姜三片。葱三茎。煎七分服。
麻附细辛汤（仲景） 治寒中少阴。脉沉细。足冷。反发热而恶寒者。
麻黄 细辛（各四钱） 附子（二钱半）
水煎。
升麻鳖甲汤去蜀椒雄黄方（仲景） 治外感天地毒瓦斯。入阴经而发病者。
甘草 桂枝 升麻 当归 鳖甲
水煎。温服。覆取微汗为度。
回阳散
用附子二枚。炮制为末。生姜酒和匀调服。
返阴丹
硫黄（五两） 附子 干姜 桂心（各半两） 硝石 玄精石（各二两）
为末。糊丸。艾汤下。
[General Principle]
Cold pathogenic factors invade the five zang organs, causing jue-ni (rebellious qi) to ascend. At this time, yin qi is exhausted, and yang qi fails to enter the interior, resulting in sudden severe pain, syncope, and loss of consciousness. If qi mechanism recovers its flow, the patient will survive. (From *Neijing*)
[Etiology]
Zhong-han (cold strike) occurs regardless of winter or summer. It may result from external invasion of heaven-and-earth cold pathogens or internal injury from consuming cold food and drink. Since the primordial yang is already deficient and the skin pores are loose and open, cold pathogens directly invade the three yin meridians. The disease onset is abrupt, unlike Shanghan (cold damage), which involves internal stagnant heat resisting the pathogen and entering gradually along the meridians. (From An Dao)
[Clinical Manifestations]
Symptoms include sudden shivering, cyanotic complexion, teeth grinding, vomiting, diarrhea, abdominal pain, cold limbs, contracture of hands and feet, coma with rigidity. The body is cool without fever, or has slight fever without thirst. Fatigue and reluctance to speak or move characterize this condition.
[Classification by Three Yin Meridians]
Cold invading Taiyin meridian causes pain at Zhongwan (CV12). Cold invading Shaoyin meridian causes pain around the umbilicus and abdomen. Cold invading Jueyin meridian causes pain from the lower abdomen to the genitalia. (From *Jiyao*)
[Prognosis / Fatal Signs]
If the area around the mouth and lips turns blue, cold extends beyond the elbows and knees, the tongue shrinks, the scrotum retracts, and the pulse disappears, death will occur shortly. In Zhong-han, absence of sweating indicates a better prognosis, while sweating indicates a poor prognosis (fatal). (From *Rumen*) Cases involving cold strike after falls, fights, suicide attempts by drowning, excessive sexual activity, overexertion, or wading into water are difficult to treat. (From *Zuanlun*)
[Pulse Diagnosis]
A deep and slow pulse in Zhong-han belongs to Taiyin. A deep and thin pulse belongs to Shaoyin. A deep and delayed pulse belongs to Jueyin. (From Zhang Zhongjing) A tight and choppy pulse indicates external cold invasion. A intermittent and scattered pulse indicates internal collapse of yang qi. (From *Huibu*)
[General Treatment Principle]
When yang is deficient and yin-cold is excessive, treatment should focus on warming the middle and dispelling cold, and tonifying and warming the lower yuan. This allows yang qi to recover and cold pathogens to dissipate naturally. (From *Huibu*)
[Emergency Treatment]
In emergencies where it is difficult to distinguish the affected meridian, urgently decoct ginger juice, mix evenly with hot wine, and administer orally. Apply warm compresses of green onion cakes to the periumbilical region. Moxibustion on Guanyuan (CV4) and Qihai (CV6) for 20-30 moxa cones. If the pulse gradually becomes palpable and limbs slightly warm, survival is likely. If the pulse does not return, death ensues. Sudden emergence of the pulse also indicates death.
For frozen-to-death individuals: Use sulfur, Pinellia Rhizoma (Banxia), and Gleditsia Sinensis Fruit (Zaojiao), each one "yi" unit, mixed with musk powder, fill into the umbilicus. Place a green onion cake on top and apply heat with an iron. Replace the cake when it rots. Continue until warmth enters the abdomen and the patient gradually regains consciousness. Alternatively, use heated ash in a bag to compress the heart region; replace when cool. After several times, if eyes open, administer wine or rice water. If unconscious, moxibustion on the incisor gap is used; hearing a cry indicates rescue is possible. Do not use fire to warm directly before warming the heart, as cold-fire conflict leads to death. Do not pour hot water on frozen-stiffened patients who are not yet awake. (From Li Shizhen's *Bencao Gangmu*)
[Medication]
The primary formula is Lizhong Tang (Regulate the Middle Decoction), added with Pinellia Rhizoma (Banxia), Atractylodes Macrocephala Rhizoma (Cangzhu), Magnolia Bark (Houpo), Tangerine Peel (Chenpi), and Aucklandia Root (Muxiang). For abdominal pain, add Evodia Fruit (Wuzhuyu); for vomiting, add Agastache Herb (Huoxiang); for testicular retraction and absent pulse, add Ginseng Radix et Rhizoma (Renshen) and Aconite Lateralis Radix Praeparata (Fuzi); for limb joint pain, add Cinnamon Twig (Guizhi); for cold feet and knees, add Cinnamon Bark (Rougui).
If extreme yin causes false agitation, restlessness, thirst but inability to swallow, facial redness but cold feet, and rapid pulse that feels empty upon heavy pressure, decoct the aforementioned herbs and soak the cup in cold water before administering cold. This prevents rejection (vomiting). Misinterpreting these signs as yang syndrome and administering cold-cooling herbs leads to death, as rootless fire scatters upon contact with water. In urgent situations where Renshen and Fuzi cannot be used, administer Erchen Tang added with Cangzhu, Baizhu, Houpo, Paojiang (Charred Ginger), and Wuzhuyu. This stops vomiting/diarrhea and relieves pain safely. Subsequently, adjust based on the deficiency or excess of primordial qi to avoid errors.
[Appendix: External Contraction Yin Toxin]
Yin Du (Yin Toxin) results from inhaling killing qi of heaven and earth, entering the three yin meridians. It is slightly milder than Zhong-han. Symptoms include headache, aversion to cold, cyanotic-black face, sore throat, body pain like being beaten, cold extremities, shortness of breath. Treatable within 4-5 days; untreatable after 6-7 days. Use releasing exterior formulas, primarily Shengma Biejia Tang (Cinnabar and Turtle Shell Decoction) removing Sichuan Pepper (Shujiao) and Realgar (Xionghuang). (From Zhang Zhongjing)
[Appendix: Internal Injury True Yin]
Internal Injury True Yin syndrome results from sexual exhaustion damaging the Kidney and raw/cold foods damaging the Spleen. With latent yin inside and cold outside, it is more severe than Zhong-han. It can also arise from Yang syndromes of Shanghan treated excessively with cooling herbs. After 5-6 days, symptoms include mental confusion, fatigue, reluctance to speak, cold sweat on forehead/back of hands, pale-black slippery tongue coating, hardness in the epigastrium, ice-cold limbs, cyanotic lips/black nails, soot-like nose, abdominal pain with vomiting/diarrhea, sore throat/eye pain, body pain like beating, scrotal retraction, tongue curling. Use warming meridian formulas: Huiyang San (Restore Yang Powder) and Fanyin Dan (Return Yin Pill), plus external moxibustion on Dantian (CV8) and Qihai (CV6). (From *Huren Shu*)
[Selected Formulas for Zhong-han]
Lizhong Tang (Regulate the Middle Decoction): For qi-deficiency Zhong-han with abdominal pain, vomiting/diarrhea, cold limbs/syncope, deep-delayed pulse.
Dried Ginger (Pao) 2.5 qian, Atractylodes Rhizoma (Baizhu) 2.5 qian, Licorice Root (Gancao) 1 qian.
Decoct in water. For yin-agitation, take cold after soaking in water. Add Renshen and Fuzi to make Shenfu Lizhong Tang.
Sini Tang (Reverse the Extremity Decoction): For Zhong-han with cold limbs, thin pulse, curled tongue, retracted scrotum.
Prepared Aconite Root (Fuzi) 1 piece, Dried Ginger 1.5 liang, Ginseng 2 liang, Licorice Root 2 liang.
Decoct 3 sheng of water to 3 he. Divide into 3 doses.
Sanjian Tang (Three Establishments Decoction): For Zhong-han with absent six pulses but presence of pulses at Taichong (LR3) and Chongyang (ST42).
Aconite Root (Chuanwu), Prepared Aconite Root (Fuzi), Heavenly Aconite (Tianxiong) in equal parts.
Decoct with Fresh Ginger.
Wuji San (Five Accumulations Powder) (from *Heji Jufang*): For mild Zhong-han, pathogen still in exterior, headache/body ache, aversion to cold, abdominal pain/vomiting/diarrhea, delayed pulse.
Angelica Dahurica Root (Baizhi), Poria (Fuling), Pinellia Rhizoma (Banxia), Angelica Sinensis Root (Danggui), Ligusticum Chuanxiong Rhizoma (Chuanxiong), Licorice Root (Gancao), Cinnamon Bark (Rougui), White Peony Root (Shaoyao) [each 3 liang], Immature Bitter Orange (Zhike, stir-fried), Ephedra Stem (Mahuang, remove roots/joints), Tangerine Peel (Chenpi) [each 6 liang], Platycodon Root (Jiegeng) 2 liang, Magnolia Bark (Houpo, ginger-fried), Dried Ginger (Ganjiang) [each 4 liang], Atractylodes Rhizoma (Cangzhu) 24 liang.
Take 4 qian per dose, with 1 lamp of water, 3 slices of ginger, 3 stalks of green onion. Decoct to 70% volume.
Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) (from Zhang Zhongjing): For cold invading Shaoyin, deep-thin pulse, cold feet, paradoxical fever with aversion to cold.
Ephedra Stem (Mahuang), Asarum Root (Xixin) [each 4 qian], Prepared Aconite Root (Fuzi) 2.5 qian.
Decoct in water.
Shengma Biejia Tang removing Shujiao and Xionghuang (from Zhang Zhongjing): For external contraction of heaven-earth toxic vapors entering yin meridians.
Licorice Root (Gancao), Cinnamon Twig (Guizhi), Cimicifuga Rhizome (Shengma), Angelica Sinensis Root (Danggui), Turtle Carapace (Biejia).
Decoct in water, take warm. Cover to induce slight sweating.
Huiyang San (Restore Yang Powder)
Use 2 Prepared Aconite Roots (Fuzi), grind to powder, mix evenly with fresh ginger and wine, and take.
Fanyin Dan (Return Yin Pill)
Sulfur 5 liang, Prepared Aconite Root (Fuzi), Dried Ginger (Ganjiang), Cinnamon Heart (Guixin) [each 0.5 liang], Niter (Xiaoshi), Aragonite (Xuanjing Shi) [each 2 liang].
Grind to powder, make pills with paste, take with mugwort decoction.