发热脉紧。变表法为下法。立大黄附子汤。以治寒从下上之瘕积。赖附子把守真阳。不随汗下亡脱。设无发热外
证。岂不可变大黄附子甘草之治乎。况治食已则吐之大黄甘草汤。具有成法。
始知权变之方。不在规矩之外也。
张氏医通云。色瘅者。身黄额上微黄。小便利。大便黑。
此因房事过伤。血蓄小腹。而发黄。故小腹连腰下痛。大黄附子汤。去细辛。加肉桂。
案篇首第一条云。不满者。必便难两 疼痛。此虚寒从
下上也。当以温药服之。大黄附子汤。盖其方也。金鉴。改偏痛。作满痛。不可从。
大黄附子汤方
大黄（三两） 附子（三枚炮） 细辛（二两）
上三味。以水五升。煮取二升。分温三服。若强人煮取
二升半。分温三服。服后如人行四五里。进一服。（外台。引短剧云。仲景同。）
寒气厥逆。赤丸主之。（此条。脉经无。）
〔鉴〕此条之文之方。必有简脱。难以为后世法。不释。
〔程〕温经散寒。无非辛热之剂。四逆汤辈。可选用之。不必拘泥。
赤丸方（千金。载痼冷积热门。主疗同。）
茯苓（四两） 半夏（四两洗一方用桂○案千金用桂枝不用半夏） 乌头（二两炮
）细辛（一两千金作人参○案今考千金用细辛不用人参更有附子二两射罔一两凡六味）
上四味。末之。内真朱为色。炼蜜丸。如麻子大。先食。
酒饮下三丸。日再夜一服。不知。稍增之。以知为度。（四味。原本作六味。今根据赵本改之。）
〔徐〕真朱。即朱砂也。
案千金伤寒神丹丸。治伤寒敕涩。恶寒发热体疼者。即本方。用人参。不用细辛。更有附子。并
朱砂凡六味。徐释本条云。此即伤寒论。直中之类也。盖据于千金与。
腹痛脉弦而紧。弦则卫气不行。即恶寒。紧不欲食。邪
正相搏。即为寒疝。寒疝绕脐痛。若发则白汗出。手足厥逆。其脉沉紧者。大乌头煎主之。（腹痛。脉经千
金作寸口。至即为寒疝。为别条。外台不载腹痛以下二十八字。即为寒疝下。脉经有跗阳脉浮而迟。浮则为
风虚。迟则为寒疝十六字。明是寒疝绕脐以下。为别作矣。原本。若发。作苦发。白汗。作白津。今
根据程本及千金外台。改定。其脉沉紧。赵本脉经千金外台。程徐诸本。作其脉沉弦。）
〔尤〕弦紧脉皆阴也。而弦之阴从内生。紧之阴从外得。弦则卫气不行。而恶寒者。阴出而痹其外之
阳也。紧则不欲食者。阴入而痹其胃之阳也。卫阳与胃阳并衰。而外寒与内寒交盛。由是阴反无畏而上冲。
阳反不治而下伏。所谓邪正相搏。即为寒疝者也。
〔鉴〕疝病犯寒即发。故谓之寒疝也。
〔魏〕平素阳虚阴盛。积寒在里。以召外寒。夹杂于表里。而为患者也。表里之寒邪既盛。而正阳与之相搏。
寒邪从下起。结聚于至阴之分。而寒疝成矣。寒疝既成。伏于少腹。绕脐痛。发止有时。发则白津出。此汗
本下部虚寒。阴邪逼迫外越故也。及阴寒积久而发。四肢厥冷。脉得沉紧。何非寒厥之气为害也耶。
案素长刺节论云。病在少腹。腹痛不得大小便。病名曰疝。得之寒。王氏注大奇论云。疝者。寒气结聚之
所为也。急就篇。颜师古注云。疝。腹中气疾。上下引也。楼氏纲目云。疝名虽七。寒疝即疝之总名也。巢源
云。疝者。痛也。此由阴气积于内。寒气结搏而不散。腑脏虚弱。风冷邪气相击。则腹痛里急。故云寒疝腹痛也。
案阴阳别论。白汗王氏释为流汗。淮南修务训云。奉一爵酒。不知于色。挈一石之尊。则白汗交流。此
云白汗出者。盖不堪痛苦之甚。而汗出也。程云。冷汗也。徐沈尤魏仍原文。作白津。而解之。赵本作自汗。并非。
乌头煎方（千金注云。仲景名二物乌头煎。三因。名大乌头汤。）
乌头（大者五枚。熬去皮。不 咀。○千金。作十五枚。外台引仲景伤寒论。亦作
十五枚。千金。熬下。有黑字。三因云。大乌头。五个。洗净。细沙炒令黑。不 咀。）
上以水三升。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。不瘥明日更服。不可一日再服。（二升。千金外台。作二斤。）
〔程〕乌头。大热大毒。破积聚寒热。治脐间痛不可俯仰。故用之以治绕脐寒疝痛苦。治下焦之药味。不
宜多。多则气不专。此沉寒痼冷。故以一味单行。则其力大而浓。甘能解药毒。故内蜜以制乌头之大热大毒。
王冰至真要注云。夫大寒内结。 聚疝瘕。以热攻除。寒格热反纵。反纵之则痛发尤甚。攻之则热不
得前。方以蜜煎乌头。佐之以热蜜。多其药服。已便消。是则张公从此。而以热因寒用也。
寒疝腹中痛。及胁痛里急者。当归生姜羊肉汤主之。
外台。仲景伤寒论。作腹中痛。引胁痛及腹里急。
〔尤〕此治寒多而血虚者之法。血虚则脉不荣。寒多则脉绌急。故腹胁痛而里急也。当归生姜。温
血散寒。羊肉。补虚益血也。
〔鉴〕李 云。疝属肝病。肝藏血。其经布胁肋。腹胁并痛者。血气寒而凝泣
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。
当归生姜羊肉汤方（千金。妇人门名当归汤。注云。胡洽名小羊肉汤。）
当归（三两） 生姜（五两） 羊肉（一斤○外台云去脂）
上三味。以水八升。煮取三升。温服七合。日三服。若寒多者。加生姜成一斤。痛多而呕者。加橘皮二
两。白术一两。加生姜者。亦加水五升。煮取三升二合服之。（千金。用芍药二两。注云。子母秘录有甘草。）
王氏古方选注云。寒疝为沉寒在下。由阴虚得之。阴虚则不得用辛烈热燥之药。重劫其阴。故仲景另立
一法。以当归羊肉。辛甘重浊。温暖下元。而不伤阴。佐以生姜五两。加至一斤。随血肉有情之品。引入下
焦。温散冱寒。若痛多而呕。加陈皮白水。奠安中气。以御寒逆。本方三味。非但
治疝气逆冲。移治产后下焦虚寒。亦称神剂。
张氏千金衍义云。凡少腹 痛。用桂心等药不应者。用之辄效。
寇氏本草衍义云。张仲景治寒疝。用生姜羊肉汤服之。无不应验。有一妇人。产当寒月。寒气入产门。腹
脐以下胀满。手不敢犯。此寒疝也。师将治之以抵当汤。谓有瘀血。
非其治也。可服张仲景羊肉汤。二服遂愈。
外台。短剧。寒疝气腹中虚痛。及诸胁痛里急。当归生姜等四味主之。
于本方内。加芍药。
圣济总录。四味当归汤。治卒疝腹痛里急。（即本方。）
寒疝腹中痛。逆冷手足不仁。若身疼痛。灸刺诸药不能治。抵当乌头桂枝汤主之。（千金。程本无抵当二字。）
〔徐〕起于寒疝腹痛。而至逆冷手足不仁。则阳气大痹。加以身疼痛。荣卫俱不和。更灸刺诸药不能治。
是或攻其内。或攻其外。邪气牵制不服。故以乌头攻寒为主。而合桂枝全汤。以和荣卫。所谓七分治里。
三分治表也。如醉状。则荣卫得温而气胜。故曰知。得吐则阴邪不为阳所客。故上出。
而为中病。
〔程〕寒淫于内。则腹中痛。寒胜于外。则手足逆冷。甚则至于不仁。而身疼痛。此内外
有寒也。
〔鉴〕抵当二字。衍文也。
乌头桂枝汤方
乌头（案千金云。秋干乌头实中者五枚除去角。外台作实中大者十枚。知本文脱枚数）
上一味。以蜜二斤。煎减半。去滓。以桂枝汤五合解之。令得一升。后初服二合。不知。即服三合。
又不知。复加至五合。其知者。如醉状。得吐者为中病。（二斤。千金。作一斤。外台
引仲景伤寒论作二斤。云。一方。一斤。用桂心四两云。上三味先以蜜。微火煎乌头。减
半去乌头。别一处以水二升半。煮桂。取一升。去滓以桂汁和前蜜。合煎之。得一升许。
初服二合。不知更服。至三合云云。范汪同。而又出五味桂枝汤方云。仲景伤寒论。千金
同。其既用单味桂心而合煎。又出五味桂枝汤恐误。沈云。解之。恐是煎之。非也。金鉴。删后字。）
〔程〕乌头煎。热药也。能散腹中寒痛。桂枝汤表药也。能解外证身腹。二方相合。则能达脏腑。而
利荣卫和血气。而播阴阳。其药势翕翕。行于肌肉之间。恍如醉状。如此则外之凝寒已行。得吐则内之冷结
将去。故为中病。
〔徐〕解之。恐是合煎。
〔鉴〕以桂枝汤五合解之者。溶化也。令得一升。
谓以乌头所煎之蜜五合。加桂枝汤五合。溶化令得一升也。不知。不效也。其知者。已效也。如醉状。
外寒方散。得吐者。内寒已伸。故为中病也。
案如醉状也。得吐也。乃乌头之瞑眩使然。程注是。
桂枝汤方（程尤金鉴。并不载。）
桂枝（三两去皮） 芍药（三两） 甘草（二两炙） 生姜（三两） 大枣（十二枚）
上五味。锉。以水七升。微火煮。取三升。去滓。
三因。大乌头桂枝汤。治风寒疝腹中痛。逆冷手足不仁。
身体疼痛。灸刺诸药不能疗。及贼风入腹。攻刺五脏。拘急不得转侧。发作叫呼阴缩悉主之。
即本方。一法。用附子一个。不使乌头。为蜜附汤。（易简
云。疝气发作。当于附子建中汤。煎时加蜜一箸头许。名蜜附子汤。）
其脉数而紧乃弦。状如弓弦。按之不移。脉数弦者。当
下其寒。脉紧大而迟者。必心下坚。脉大而紧者。阳中有阴。可下之。（其脉数。脉经。作其脉浮。案可下
篇。紧大。作双弦。可下之下。有宜大承气汤五字。不载其脉数以下二十三字。知是别为一条。）
〔尤〕脉数为阳。紧弦为阴。阴阳参见。是寒热交至也。然就寒疝言。则数反从弦。故其数为阴。疑于阳
之数。非阳气生热之数矣。如就风疟言。则弦反从数。故其弦为风。从热发之弦。而非阴气生寒之弦者。与此
适相发明也。故曰。脉数弦者。当下其寒。紧而迟。大而紧亦然。大虽阳脉。不
得为热。正以形其阴之实也。故曰。阳中有阴可下之。
案辨脉法云。脉浮而紧者。名曰弦也。弦者状如弓弦。按之不移也。是与脉经合。则此条数作浮为是。
金鉴自其脉数至脉弦数者十九字为衍文。以当下其寒之四字。移必心下坚之下。未知是否。
附方
外台。乌头汤。治寒疝腹中绞痛。贼风入攻五脏。拘急不得转恻。发作有时。使人阴缩。手足厥逆。（
方见上○案此本出于千金贼风门。转侧下。有叫呼二字。外台。引千金即乌头桂枝汤也。徐沈魏尤。以为大乌
头煎何不检之于外台。误甚。）
外台柴胡桂枝汤方 治心腹卒中痛者。（外台。引仲景伤寒论。无卒字。）
柴胡（四两） 黄芩 人参 芍药 桂枝 生姜（各一两半） 甘草（一两） 半夏（二合半） 大枣（六枚）
上九味。以水六升。煮取三升。温服一升。日三服。
〔魏〕有表邪而挟内寒者。乌头桂枝汤证也。有表邪而挟内热者。柴胡桂枝汤证也。以柴胡桂枝生姜。
升阳透表。人参半夏甘草大枣。补中开郁。黄芩芍药。治寒中有热。杂合
此表里两解。寒热兼除之法也。
〔沈〕予以此方。每于四时加减。治胃脘心腹疼痛。功效如神。
仁斋直指云。柴胡桂枝汤。治肾气冷热不调证。案肾气。即疝也。
外台。走马汤。治中恶心痛腹胀。大便不通。
巴豆（二枚去皮心熬） 杏仁（二枚）
上二味。以绵缠捶令碎。热汤二合。捻取白汁饮之。当下。老小量之。通治飞尸鬼击病。
〔沈〕中恶之证。俗谓绞肠乌痧。即臭秽恶毒之气。直从口鼻。入于心胸。肠胃脏腑壅塞。正气不行。
故心痛腹胀。大便不通。是为实证。非似六淫侵入。而有表里虚实清浊之分。故用巴豆极热大毒。峻猛之剂。
急攻其邪。佐杏仁以利肺与大肠之气。使邪从后阴。一扫尽除。则病得愈。若缓须臾。正气不通。营卫阴阳。
机息则死。是取通则不痛之义也。肘后。飞尸走马汤。通治诸飞尸鬼击。（即本方。）
外台。文仲。疗卒得诸疝。少腹及阴中。相引绞痛。白汗出欲死。此名寒疝。亦名阴疝。张仲景飞
尸走马汤。方同。案此为治寒疝。附于本篇之末者。而主疗与外台异者何。
问曰。人病有宿食。何以别之。师曰。寸口脉浮而大。
按之反涩。尺中亦微而涩。故有宿食。大承气汤主之。
〔尤〕寸口脉浮大者。谷气多也。谷多不能益脾。而反伤脾。按之脉反涩者。脾伤而滞。血气为之不
利也。尺中亦微而涩者。中气阻滞。而水谷之精气。不能逮下也。是因宿食为病。则宜大承气。下其宿食。
案金鉴云。按尺中亦微而涩之微字。当按伤寒论作大字是。今考伤寒论可下编。亦作微字。而金鉴
又云。微字当是大字。若是微字。断无当下之理。彼注如此。今引以为证。误也。
巢源。宿食不消候云。宿谷未消。新谷又入。脾气既弱故不能磨之。则经宿而不消也。令人腹
胀气急。噫气醋臭。时复憎寒壮热是也。
程知云。滑为有食结滞。经宿则脉涩矣。尺以候内。沉以候里。故宿食之脉。按之反涩。尺中亦大而涩也。
脉数而滑者实也。此有宿食。下之愈。宜大承气汤。
Fever with a tight pulse. This transforms the exterior-releasing method into a purgative method. Da Huang Fu Zi Tang (Rhubarb and Aconite Decoction) is established to treat zhang masses (abdominal masses) caused by cold qi ascending from below. It relies on Fu Zi (Prepared Aconite Root) to guard the true yang, preventing its collapse and loss through sweating or purging. If there were no exterior signs of fever, could one not change to a treatment using Da Huang (Rhubarb), Fu Zi, and Gan Cao (Licorice)? Moreover, for treating vomiting immediately after eating, Da Huang Gan Cao Tang (Rhubarb and Licorice Decoction) already has established methods. Thus, we know that flexible and adaptive formulas do not lie outside the rules and regulations.
Zhang Shi Yi Tong states: For those with a yellowish complexion, the body is yellow with slight yellowness on the forehead, urination is free, and stools are black. This is due to excessive sexual activity causing blood stasis in the lower abdomen, leading to yellowing. Hence, pain extends from the lower abdomen to the waist and below. Da Huang Fu Zi Tang is used, with Xi Xin (Asarum) removed and Rou Gui (Cinnamon Bark) added.
Note: The first item at the beginning of the chapter states: "If there is no fullness, there must be difficult urination and pain in both flanks/abdomen." This is deficiency-cold ascending from below. One should take warm medicines. Da Huang Fu Zi Tang is likely the formula for this. *Yi Zong Jin Jian* changes "pain on one side" to "fullness and pain," which should not be followed.
Da Huang Fu Zi Tang Formula
Da Huang (3 liang), Fu Zi (3 pieces, processed), Xi Xin (2 liang).
These three ingredients are boiled in 5 sheng of water to obtain 2 sheng. Divide into three warm doses. For strong individuals, boil to obtain 2.5 sheng and divide into three warm doses. After taking the medicine, wait as long as it takes a person to walk four or five li before administering the next dose. (*Wai Tai Mi Yao* cites *Duan Ju Fang*: Same as Zhang Zhongjing's formula.)
Cold qi causing cold limbs is primarily treated with Chi Wan (Red Pill). (This clause is absent in *Mai Jing*.)
[*Yi Zong Jin Jian*]: The text and formula of this clause must have suffered from omission or loss, making it difficult to serve as a standard for later generations. No explanation is provided.
[Cheng Zhi]: Warming meridians and dispersing cold involves only acrid-hot agents. Si Ni Tang (Frigid Extremities Decoction) and similar formulas can be selected for use; one need not be rigid.
Chi Wan Formula (Recorded in *Qian Jin Yao Fang* under the section on Chronic Cold and Accumulation, with identical indications.)
Fu Ling (Poria, 4 liang), Ban Xia (Pinellia Tuber, 4 liang, washed; one version uses Gui Zhi ○ Note: *Qian Jin* uses Gui Zhi instead of Ban Xia), Wu Tou (Aconite Lateral Root, 2 liang, processed), Xi Xin (Asarum, 1 liang; *Qian Jin* uses Ren Shen ○ Note: Current examination of *Qian Jin* shows Xi Xin is used instead of Ren Shen, with additional Fu Zi 2 liang and She Wang 1 liang, totaling six ingredients).
The above four ingredients are powdered. Add Zhen Zhu (Cinnabar) to color it red. Refine honey to make pills the size of hemp seeds. Take before meals, washed down with wine, three pills at a time. Administer twice during the day and once at night. If ineffective, slightly increase the dosage until therapeutic effects are observed. (Four ingredients; originally six, corrected here according to Zhao Ben.)
[Xu Lingtai]: Zhen Zhu is Cinnabar.
Note: *Qian Jin Yao Fang*'s Shang Han Shen Dan Wan treats Shang Han with aversion to cold, fever, and body ache, which is essentially this formula. It uses Ren Shen, not Xi Xin, and includes Fu Zi and Cinnabar, totaling six ingredients. Xu Lingtai explains this clause: This belongs to the category of direct invasion by cold in *Shang Han Lun*. It is likely based on *Qian Jin Yao Fang*.
Abdominal pain with a wiry and tight pulse. A wiry pulse indicates obstructed Wei Qi, resulting in aversion to cold. A tight pulse indicates anorexia. When pathogenic factors and righteous qi struggle, it forms Han Shan (Cold Hernia). Han Shan presents with periumbilical pain. Upon attack, cold sweat appears, hands and feet become cold, and the pulse is deep and tight. Da Wu Tou Jian (Major Aconite Decoction) is the primary treatment. (Abdominal pain, *Mai Jing* and *Qian Jin* locate the pulse at Cun Kou; "to form Han Shan" is listed as a separate clause. *Wai Tai Mi Yao* does not record the twenty-eight characters from "abdominal pain" onwards, placing them under "forming Han Shan". *Mai Jing* contains sixteen characters: "Fuyang pulse floating and slow; floating indicates wind and deficiency, slow indicates cold hernia," clearly indicating that "below periumbilical pain" was composed as a separate clause. Original text: "Ru Fa" is written as "Ku Fa"; "Bai Han" is written as "Bai Jin". Corrected here according to Cheng Ben, *Qian Jin*, and *Wai Tai Mi Yao*. "Qi Mai Chen Jin", Zhao Ben, *Mai Jing*, *Qian Jin*, *Wai Tai Mi Yao*, Cheng Zhi, and Xu Lingtai versions read "Qi Mai Chen Xian".)
[You Zaijing]: Both wiry and tight pulses are Yin. However, the Yin of the wiry pulse arises internally, while the Yin of the tight pulse is acquired externally. A wiry pulse obstructs Wei Qi, causing aversion to cold, meaning Yin exits and blocks the Yang of the exterior. A tight pulse causes anorexia, meaning Yin enters and blocks the Yang of the Stomach. With both Wei Yang and Stomach Yang declining, and external cold and internal cold intensifying, Yin rises without fear, while Yang fails to govern and sinks. This struggle between pathogen and righteousness constitutes Han Shan.
[*Yi Zong Jin Jian*]: Hernia diseases manifest upon exposure to cold, hence called Cold Hernia.
[Wei Litong]: Normally, Yang is deficient and Yin is abundant, with accumulated cold inside attracting external cold. These mix in the interior and exterior, causing disease. With excess cold in both layers, righteous Yang struggles with it. Cold qi rises from below, accumulating in the extreme Yin regions, forming Cold Hernia. Once formed, it lurks in the Shaoyin area, causing periumbilical pain with timed attacks and cold sweat. This is because the root of sweat lies in deficiency-cold of the lower part, forcing Yin evil to escape outward. When accumulated Yin-cold erupts after a long period, limbs become cold, and the pulse becomes deep and tight. Is this not harm caused by the Qi of Cold Jue?
Note: *Su Wen: Chang Ci Jie Lun* states: Disease in the lower abdomen, abdominal pain, inability to pass stool or urine, is named Shan. It results from cold. Wang Bing's commentary on *Su Wen: Da Qi Lun* states: Shan is caused by the aggregation of cold qi. Yan Shigu's commentary on *Ji Jiu Pian* states: Shan is a Qi disorder in the abdomen, pulling up and down. Lou's *Gang Mu* states: Although there are seven types of Shan, Cold Hernia is the general name. Chao Yuanfang's *Zhu Bing Yuan Hou Lun* states: Shan means pain. This occurs when Yin qi accumulates internally, cold qi binds and does not disperse, and weak organs allow wind-cold pathogens to strike, causing abdominal pain and tension. Hence, Cold Hernia Abdominal Pain.
Note: In *Su Wen: Yin Yang Bie Lun*, Wang Bing interprets "Bai Han" as flowing sweat. *Huainanzi: Xiu Wu Xun* states: Holding one cup of wine, one remains calm; lifting a vessel holding one dan of wine, white sweat flows. The "white sweat" mentioned here refers to sweating due to unbearable pain. Cheng Zhi says: It is cold sweat. Xu Lingtai, Shen Mingsheng, You Zaijing, and Wei Litong retain the original text "Bai Jin" and interpret it. Zhao Ben writes "Zi Han" (spontaneous sweating), which is incorrect.
Wu Tou Jian Formula (*Qian Jin* note: Zhang Zhongjing calls it Er Wu Wu Tou Jian. *San Yin Fang* calls it Da Wu Tou Tang.)
Wu Tou (Five large pieces, roasted, skin removed, not chewed/crushed ○ *Qian Jin* uses fifteen pieces. *Wai Tai Mi Yao* citing Zhang Zhongjing's *Shang Han Lun* also uses fifteen pieces. *Qian Jin* adds "black" after roasting. *San Yin Fang* says: Five large Wu Tou, washed clean, stir-fried in fine sand until black, not crushed.)
Boil these in 3 sheng of water to obtain 1 sheng. Remove dregs. Add 2 sheng of honey. Simmer until the water vapor is gone. Obtain 2 sheng. Strong individuals take 7 he; weak individuals take 5 he. If not cured, take again the next day. Do not administer twice in one day. (2 sheng; *Qian Jin* and *Wai Tai Mi Yao* write 2 jin.)
[Cheng Zhi]: Wu Tou is extremely hot and toxic. It breaks up accumulations and cold-heat, treating umbilical pain where bending and stretching are impossible. Thus, it is used for periumbilical Cold Hernia pain. Medicines for the Lower Jiao should not have too many flavors; otherwise, the Qi will not be focused. This is a case of entrenched cold, so using a single herb alone makes its power great and concentrated. Sweet flavor resolves drug toxicity, so honey is added to control the extreme heat and toxicity of Wu Tou. Wang Bing's commentary on *Su Wen: Zhi Yao Yao Da Lun* states: When severe cold aggregates internally forming hernias and masses, using heat to attack may cause cold rejection of heat, worsening pain. By decocting Wu Tou with honey and using hot honey as an assistant, and administering larger doses, the accumulation dissipates. This is Zhang Gong's application of "treating heat with cold administration" (Re Yin Han Yong).
For Cold Hernia with abdominal pain, hypochondriac pain, and internal tension, Dang Gui Sheng Jiang Yang Rou Tang (Angelica Sinensis, Ginger, and Mutton Decoction) is the primary treatment.
*Wai Tai Mi Yao* citing Zhang Zhongjing's *Shang Han Lun* reads: "Abdominal pain radiating to hypochondrium and internal tension."
[You Zaijing]: This is the method for treating cases with excessive cold and blood deficiency. Blood deficiency leads to un-nourished vessels; excessive cold causes vessel contraction and urgency. Hence, abdominal and hypochondriac pain with internal tension. Dang Gui and Sheng Jiang warm blood and disperse cold; Yang Rou (Mutton) tonifies deficiency and benefits blood.
[*Yi Zong Jin Jian*]: Li Chan states: Hernia belongs to the Liver. The Liver stores blood, and its meridian spreads over the hypochondrium. Abdominal and hypochondriac pain together indicate cold coagulation and stagnation of Qi and Blood. Dang Gui unblocks meridians and invigorates blood; Sheng Jiang warms the middle and disperses cold. Internal tension indicates interior deficiency. Yang Rou is used to tonify. *Nei Jing* states: For insufficiency of form, warm with Qi; for insufficiency of essence, tonify with flavor. This applies here.
Dang Gui Sheng Jiang Yang Rou Tang Formula (*Qian Jin* Women's Section names it Dang Gui Tang. Note: Hu Qia names it Xiao Yang Rou Tang.)
Dang Gui (3 liang), Sheng Jiang (Fresh Ginger, 5 liang), Yang Rou (Mutton, 1 jin ○ *Wai Tai Mi Yao* says remove fat).
These three ingredients are boiled in 8 sheng of water to obtain 3 sheng. Take 7 he warm, three times daily. If cold is excessive, increase Sheng Jiang to 1 jin. If pain is severe with vomiting, add Ju Pi (Tangerine Peel) 2 liang and Bai Zhu (Atractylodes Rhizome) 1 liang. If adding Sheng Jiang, also add 5 sheng of water. Boil to obtain 3.2 sheng and take. (*Qian Jin* uses Shao Yao 2 liang. Note: *Zi Mu Mi Lu* contains Gan Cao.)
Wang Shi's *Gu Fang Xuan Zhu* states: Cold Hernia is deep cold in the lower part, arising from Yin deficiency. Yin deficiency precludes the use of acrid, harsh, hot, and drying drugs to avoid further damaging Yin. Thus, Zhang Zhongjing establishes a new method using Dang Gui and Yang Rou. Their acrid-sweet and heavy nature warms the Lower Jiao without injuring Yin. Assisted by 5 liang (up to 1 jin) of Sheng Jiang, following the nature of blood and flesh products, it guides the medicine to the Lower Jiao to warm and disperse frozen cold. If pain is severe with vomiting, add Chen Pi and Bai Zhu to stabilize Middle Qi and resist cold rebellion. These three ingredients not only treat rebellious Qi in Hernia but are also miraculous for postpartum Lower Jiao deficiency-cold.
Zhang Shi's *Qian Jin Yan Yi* states: Whenever lower abdominal pain does not respond to Gui Xin (Cinnamon Heart) and other drugs, this formula works effectively.
Kou Shi's *Ben Cao Yan Yi* states: Zhang Zhongjing treated Cold Hernia with Dang Gui Sheng Jiang Yang Rou Tang, always effective. A woman gave birth in a cold month; cold qi entered the birth canal, causing distension below the navel, untouchable by hand. This was Cold Hernia. The physician intended to use Di Dang Tang, suspecting blood stasis. This was incorrect. She could take Zhang Zhongjing's Mutton Decoction; two doses cured her.
*Wai Tai Mi Yao* citing *Duan Ju Fang*: For Cold Hernia Qi with empty abdominal pain and various hypochondriac pains with tension, use Dang Gui, Sheng Jiang, and four other ingredients.
Add Shao Yao to this formula.
*Sheng Ji Zong Lu*: Si Wei Dang Gui Tang (Four-Ingredient Angelica Decoction) treats sudden Hernia abdominal pain and tension. (This is the same formula.)
For Cold Hernia with abdominal pain, cold and numb hands and feet, and if body aches prevent cure by moxibustion, acupuncture, or other drugs, Di Dang Wu Tou Gui Zhi Tang (Di Dang Aconite and Cinnamon Twig Decoction) is the primary treatment. (*Qian Jin* and Cheng Zhi's version lack the words "Di Dang".)
[Xu Lingtai]: Starting from Cold Hernia abdominal pain progressing to cold and numb hands and feet indicates severe obstruction of Yang Qi. Added with body aches, Ying and Wei are both discordant. Further treatments like moxibustion and drugs fail. Whether attacking the interior or exterior, the pathogen resists control. Thus, Wu Tou is used to attack cold as the main agent, combined with the full Gui Zhi Tang to harmonize Ying and Wei. This is seventy percent treating the interior and thirty percent treating the exterior. Feeling like drunkenness indicates Ying and Wei are warmed and Qi prevails; thus, it is called "Zhi" (effective). Vomiting indicates Yin evil is expelled by Yang Qi, emerging upward, constituting "Zhong Bing" (therapeutic hit).
[Cheng Zhi]: Cold invading the interior causes abdominal pain. Cold dominating the exterior causes cold limbs, even numbness and body aches. This is cold in both interior and exterior.
[*Yi Zong Jin Jian*]: The characters "Di Dang" are superfluous.
Wu Tou Gui Zhi Tang Formula
Wu Tou (Note: *Qian Jin* says: Five dried autumn Wu Tou with solid centers, remove corners. *Wai Tai Mi Yao* says ten large solid ones. Knowing the original text omitted the quantity.)
Take this single ingredient, boil in 2 jin of honey until reduced by half. Remove dregs. Dissolve in 5 he of Gui Zhi Tang to obtain 1 sheng. Initially take 2 he. If ineffective, take 3 he. If still ineffective, increase to 5 he. Effective response feels like drunkenness; vomiting indicates therapeutic success. (2 jin; *Qian Jin* uses 1 jin. *Wai Tai Mi Yao* citing *Shang Han Lun* uses 2 jin, noting another formula uses 1 jin with 4 liang Gui Xin. Instructions: First simmer Wu Tou in honey over low fire until half reduced, remove Wu Tou. Separately boil Gui in 2.5 sheng water to get 1 sheng, remove dregs. Mix Gui juice with previous honey, simmer to get approx 1 sheng. Initial dose 2 he, increase to 3 he if needed. Fan Wang agrees. Also lists Five-Ingredient Gui Zhi Tang, citing Zhang Zhongjing's *Shang Han Lun* and *Qian Jin*. Using single Gui Xin mixed with decoction, yet listing Five-Ingredient Gui Zhi Tang seems erroneous. Shen Mingsheng says: "Jie Zhi" might mean "Jian Zhi" (decoct), which is wrong. *Yi Zong Jin Jian* deletes the last character.)
[Cheng Zhi]: Wu Tou Jian is a hot medicine, dispersing abdominal cold pain. Gui Zhi Tang is an exterior medicine, resolving exterior symptoms of body and abdomen. Combined, they reach the Zang-Fu, benefit Ying and Wei, harmonize blood and Qi, and distribute Yin and Yang. The medicinal force moves warmly between muscles, feeling like drunkenness. Thus, external congealed cold is dispersed; vomiting removes internal cold knots, constituting therapeutic success.
[Xu Lingtai]: "Jie Zhi" likely means mixing/decocting together.
[*Yi Zong Jin Jian*]: "Dissolve in 5 he of Gui Zhi Tang" means melting/dissolving. Obtaining 1 sheng means mixing 5 he of honey-decocted Wu Tou liquid with 5 he of Gui Zhi Tang to melt and obtain 1 sheng. "Bu Zhi" means ineffective. "Qi Zhi" means effective. Like drunkenness, external cold is scattering. Vomiting means internal cold is extending, constituting therapeutic success.
Note: Feeling like drunkenness and vomiting are the "Ming Xuan" (medicinal reaction/toxicity) effects of Wu Tou. Cheng Zhi's annotation is correct.
Gui Zhi Tang Formula (Cheng Zhi, You Zaijing, and *Yi Zong Jin Jian* do not record it.)
Gui Zhi (Cinnamon Twig, 3 liang, peeled), Shao Yao (Peony Root, 3 liang), Gan Cao (Licorice Root, 2 liang, honey-fried), Sheng Jiang (Fresh Ginger, 3 liang), Da Zao (Jujube, 12 pieces).
These five ingredients are chopped. Boil in 7 sheng of water over low heat to obtain 3 sheng. Remove dregs.
*San Yin Fang*: Da Wu Tou Gui Zhi Tang treats Wind-Cold Hernia with abdominal pain, cold and numb hands and feet, body aches unresponsive to moxibustion/drugs, and thief-wind entering the abdomen striking the five Zang, causing stiffness preventing turning, crying out during attacks, and penile retraction. All are treated by this.
This is the same formula. Another method uses one Fu Zi instead of Wu Tou, made into Mi Fu Zi Tang. (*Yi Jian Fang* states: For Hernia attacks, use Fu Zi Jian Zhong Tang, adding a stick-head amount of honey during decoction, named Mi Fu Zi Tang.)
If the pulse is rapid and tight, it becomes wiry, shaped like a bowstring, unmoving upon pressure. A rapid and wiry pulse indicates cold should be purged. A large, tight, and slow pulse indicates hardness in the epigastrium. A large and tight pulse indicates Yang containing Yin, and purging is permissible. (Its pulse rapid, *Mai Jing* reads "Its pulse floating". Note: In *Ke Xia Pian*, "tight large" is read as "double wiry". Below "Ke Xia", the five characters "Yi Da Cheng Qi Tang" appear, but the twenty-three characters from "pulse rapid" downwards are missing, indicating this is a separate clause.)
[You Zaijing]: Rapid pulse is Yang, tight/wiry is Yin. Seeing both indicates alternating cold and heat. However, regarding Cold Hernia, the rapidness follows the wiry, so the rapidness is Yin. Suspect this is not the Yang rapidness generating heat. Regarding Wind-Malaria, the wiry follows the rapid, so the wiry is Wind, originating from heat, not Yin generating cold. This clarifies the previous point. Thus, rapid and wiry pulse requires purging cold. Tight, slow, large, and tight are similar. Large is a Yang pulse but cannot be heat; it manifests substantial Yin. Thus, Yang containing Yin allows purging.
Note: *Bian Mai Fa* states: Floating and tight pulse is named Wiry. Wiry is shaped like a bowstring, unmoving upon pressure. This matches *Mai Jing*, so reading "rapid" as "floating" in this clause is correct. *Yi Zong Jin Jian* considers the nineteen characters from "its pulse rapid" to "pulse wiry rapid" as superfluous, moving the four characters "should purge cold" below "must have epigastric hardness". Uncertain if correct.
Attached Formulas
*Wai Tai Mi Yao*: Wu Tou Tang treats Cold Hernia with colicky abdominal pain, thief-wind attacking five Zang, stiffness preventing turning, timed attacks causing penile retraction and cold limbs. (Formula seen above ○ Note: This originates from *Qian Jin Yao Fang* Thief-Wind Section, with "crying out" below "turning". *Wai Tai Mi Yao* cites *Qian Jin* as Wu Tou Gui Zhi Tang. Xu Lingtai, Shen Mingsheng, Wei Litong, and You Zaijing ask why they didn't check *Wai Tai Mi Yao* for Da Wu Tou Jian; this is very mistaken.)
*Wai Tai Mi Yao* Chai Hu Gui Zhi Tang Formula treats sudden heart and abdominal pain. (*Wai Tai Mi Yao* citing Zhang Zhongjing's *Shang Han Lun* lacks the character "Zu" [sudden].)
Chai Hu (Bupleurum Root, 4 liang), Huang Qin (Scutellaria Root), Ren Shen (Ginseng Root), Shao Yao (Peony Root), Gui Zhi (Cinnamon Twig), Sheng Jiang (Fresh Ginger) (each 1.5 liang), Gan Cao (Licorice Root, 1 liang), Ban Xia (Pinellia Tuber, 2.5 he), Da Zao (Jujube, 6 pieces).
These nine ingredients are boiled in 6 sheng of water to obtain 3 sheng. Take 1 sheng warm, three times daily.
[Wei Litong]: Exterior pathogen with interior cold is Wu Tou Gui Zhi Tang syndrome. Exterior pathogen with interior heat is Chai Hu Gui Zhi Tang syndrome. Chai Hu, Gui Zhi, and Sheng Jiang raise Yang and release the exterior. Ren Shen, Ban Xia, Gan Cao, and Da Zao tonify the middle and open depression. Huang Qin and Shao Yao treat heat within cold. This combines methods of resolving both interior and exterior, and clearing both cold and heat.
[Shen Mingsheng]: I use this formula with seasonal modifications to treat epigastric and abdominal pain, with miraculous efficacy.
Yang Shi's *Ren Zhi Zhi Zhi Fang* states: Chai Hu Gui Zhi Tang treats Kidney Qi cold-heat imbalance. Note: Kidney Qi refers to Hernia.
*Wai Tai Mi Yao*: Zou Ma Tang treats sudden poisoning with abdominal pain and distension, and constipation.
Ba Dou (Croton Seed, 2 pieces, skin and heart removed, roasted), Xing Ren (Apricot Seed, 2 pieces).
These two ingredients are wrapped in silk, beaten until crushed. Take 2 he of hot water, squeeze out the white juice, and drink. It should cause purging. Adjust for old and young. Universally treats Fei Shi (Flying Corpse) and Gui Ji (Ghost Strike) diseases.
[Shen Mingsheng]: Sudden poisoning, commonly known as intestinal cramping black plague, is foul and toxic Qi entering directly from mouth and nose into heart and chest, blocking intestines and stomach, stopping righteous Qi. Thus, heart pain, abdominal distension, and constipation. This is an excess syndrome, unlike Six Evils invading with exterior-interior and deficiency-excess distinctions. Thus, Ba Dou, extremely hot and toxic, is used as a fierce agent to urgently attack the pathogen. Assisted by Xing Ren to benefit Lung and Large Intestine Qi, expelling pathogen via the posterior orifice, sweeping it all away for cure. If delayed, righteous Qi stops, Ying-Wei-Yin-Yang cease, and death ensues. This takes the meaning that "unblocked means no pain." *Zhou Hou Bei Ji Fang*: Fei Shi Zou Ma Tang universally treats all Fei Shi and Gui Ji. (This is the same formula.)
*Wai Tai Mi Yao* citing Wen Zhong Fang: Treats sudden onset of various Hernias, with lower abdomen and genitalia pulling and colicky pain, cold sweat causing near-death, named Cold Hernia or Yin Hernia. Zhang Zhongjing's Fei Shi Zou Ma Tang formula is the same. Note: This is attached at the end of this chapter for treating Cold Hernia, but why are the indications different from *Wai Tai Mi Yao*?
Question: How to distinguish a patient with retained food? Master said: Cun Kou pulse is floating and large, but pressing reveals roughness; Chi position is also faint and rough. Thus, there is retained food. Da Cheng Qi Tang is the primary treatment.
[You Zaijing]: Floating and large Cun Kou pulse indicates abundant grain Qi. Excess grain cannot benefit Spleen but damages it. Pressing reveals roughness because Spleen damage causes stagnation, hindering blood and Qi. Faint and rough Chi pulse indicates Middle Qi blockage, preventing essence of water and grain from reaching below. Since disease is caused by retained food, Da Cheng Qi Tang should be used to purge the retained food.
Note: *Yi Zong Jin Jian* states: The character "Wei" (faint) in "Chi position is also faint and rough" should be "Da" (large) according to *Shang Han Lun*. Examining *Shang Han Lun: Ke Xia Pian*, it also reads "Wei". *Yi Zong Jin Jian* again claims "Wei" should be "Da". If it is "Wei", purging is impossible. His annotation is thus cited here as evidence of error.
Chao Yuanfang's *Zhu Bing Yuan Hou Lun: Retained Food Not Digesting Syndrome* states: Undigested old grain enters while new grain arrives. Weak Spleen Qi cannot grind it, so it remains undigested overnight. This causes abdominal distension, shortness of breath, belching with sour odor, and intermittent aversion to cold with high fever.
Cheng Zhi states: Slippery pulse indicates food stagnation; after a night, the pulse becomes rough. Chi reflects interior, deep reflects interior. Thus, retained food pulse is rough upon pressing, and Chi position is large and rough.
Rapid and slippery pulse indicates excess. This is retained food. Purging cures it. Da Cheng Qi Tang is appropriate.