腹痛属寒冷者，多是口食寒物，鼻吸冷气，脉涩气阻，则为疼痛。其症四肢逆冷，唇口
变青
，其脉沉或紧。经云∶寒气客于脉中，则脉寒，脉寒则缩绻，缩绻则脉绌急，绌急则外引小
络，故卒然而痛。得炅则痛立止。或吐清水，所谓寒气客于肠胃，厥逆上出，故痛而呕也，
宜温散，或温利之。
《本事》温脾汤
浓朴 干姜 甘草 桂心 附子（各二两） 大黄（四钱）
上 咀，各一两，水二盅，煎六分，顿服。治痼冷在肠胃，泄泻腹痛，宜先取去，然后
调治，不可畏虚以养病也。
温脾丸（《外台》）
大黄 麦芽 干姜（各三两） 浓朴（炙） 当归 附子（炮） 甘草（炙） 桂心 人参 枳
实（炙，各一两）
蜜丸如梧子大，十五丸，日三，增至二十丸。
按∶温脾丸，大黄多而用蜜丸少服，急法缓用也。温脾汤大黄少而作汤服，且不用参、
归，
缓法急用也。总之，病非实热，法不可下，而痼冷在脏，不下则病不去，故权宜于缓急之间
如此。若其中无积滞者，则但宜温之而已，不必下也。或挟虚者，则兼补之。
《外台》附子汤
附子（炮） 甘草（炙，各二两） 宿姜（一两） 仓米（半升） 半夏（制，四两） 白术（三
两） 大枣（二十枚）
水一斗，煮三升，去滓，分三服，治虚冷腹痛佳。
《外台》建中汤 治气血虚寒，不能荣养心脾，其痛连绵不已，而亦无急暴之势
。按
之则痛反缓，或按之便痛，重按却不甚痛，此正是虚证。经所谓虚者聂辟气不足，按之则气
足以温之，故快然而不痛是也。
黄 白芍（各三两） 甘草（炙） 桂心（各二两） 生姜（六两） 半夏（五两） 大枣（十
二枚） 饴糖（十两）
上以水八升，煮取三升，分三服。
治当脐痛，便溺不利，怯寒脉虚者方
熟地（三钱） 肉桂（五分） 白芍（一钱半） 桂枝（五分） 当归 茯苓（各一钱）
水煎服。
治脐下冷撮痛，阴内冷如冰，延胡苦楝汤方
熟地（二钱） 川楝 延胡（各五分） 附子 肉桂（各七分） 炙甘草（一钱）
上都作一服，水四盏，煎至一盏，去滓稍热服，空心食前。
温中汤 治戊土已衰，不能运化，又加客寒，聚为满痛，散以辛热，佐以苦甘，
以淡泄之。气温胃和，痛自止矣。
浓朴（姜制，一两） 橘皮（去白，一两） 干姜（七钱） 甘草（炙） 草豆蔻 茯苓（去皮）
木香（各五钱）
上为粗末，每服五钱，水二盏，姜三片，煎一盏，去粗温服食前。
《局方》神保丸
全蝎 巴豆（各十个，取霜） 木香 胡椒（各二钱五分）
上为末，入巴豆研匀，汤化蒸饼丸如麻子大，朱砂为衣，每服五七丸。此药大能宣通脏
腑，治诸积气为痛。
Abdominal pain due to cold is mostly caused by consuming cold foods or inhaling cold air. The pulse is choppy (Se) and Qi obstruction occurs, leading to pain. Symptoms include cold limbs, cyanosis of the lips and mouth, with a deep (Chen) or tight (Jin) pulse. The Classics state: "When cold pathogen lodges in the vessels, the vessels become cold; when vessels are cold, they contract and curl; contraction leads to vessel cramping; cramping draws upon small collaterals externally, thus causing sudden pain." Pain ceases immediately upon exposure to heat. Alternatively, vomiting clear fluid may occur; this is described as cold pathogen lodging in the intestines and stomach, with rebellious Qi surging upward, resulting in pain accompanied by vomiting. Treatment should employ warming and dispersing methods, or warming and draining methods.
Wenpi Tang (Warm the Spleen Decoction) from *Ben Shi Fang*:
Houpo (Magnoliae Officinalis Cortex), Ganjiang (Zingiberis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Guixin (Cinnamomi Ramulus), Fuzi (Aconiti Lateralis Radix Praeparata) (each 2 liang); Dahuang (Rhei Radix et Rhizoma) (4 qian).
The herbs are cut into pieces. Take 1 liang of each, add two cups of water, decoct until one-sixth remains, and take in one dose. It treats persistent cold accumulation in the intestines and stomach, presenting with diarrhea and abdominal pain. One must first purge the cold accumulation before regulating the condition; one should not fear deficiency and thereby nurture the disease.
Wenpi Wan (Warm the Spleen Pill) from *Waitai*:
Dahuang (Rhei Radix et Rhizoma), Maiya (Hordei Fructus Germinatus), Ganjiang (Zingiberis Rhizoma) (each 3 liang); Houpo (Magnoliae Officinalis Cortex, stir-fried), Danggui (Angelicae Sinensis Radix), Fuzi (Aconiti Lateralis Radix Praeparata), Gancao (Glycyrrhizae Radix et Rhizoma, stir-fried), Guixin (Cinnamomi Ramulus), Renshen (Ginseng Radix), Zhishi (Aurantii Fructus Immaturus, stir-fried) (each 1 liang).
Make pills using honey, sized like wu zi (Cocculus Indicus seeds). Take 15 pills three times daily, gradually increasing to 20 pills.
Commentary: In Wenpi Wan, Dahuang is used in large amounts but formulated as honey pills taken in small doses, which is an "urgent method applied slowly." In Wenpi Tang, Dahuang is used in small amounts and taken as a decoction, without Renshen or Danggui, which is a "slow method applied urgently." In summary, if the disease is not excess-heat, purgation is generally contraindicated; however, if there is persistent cold in the zang organs, failure to purge will not eliminate the pathogen. Thus, a balance between urgency and slowness is struck here. If there is no stagnation within, only warming is indicated, without purgation. If deficiency is involved, tonification should be added.
Fuzi Tang (Aconite Decoction) from *Waitai*:
Fuzi (Aconiti Lateralis Radix Praeparata), Gancao (Glycyrrhizae Radix et Rhizoma, stir-fried) (each 2 liang); Shengjiang (Zingiberis Rhizoma Recens) (1 liang); Cangmi (Oryzae Semen) (0.5 sheng); Banxia (Pinelliae Rhizoma Praeparatum) (4 liang); Baizhu (Atractylodis Macrocephalae Rhizoma) (3 liang); Dazao (Ziziphi Jujubae Fructus) (20 pieces).
Add ten dou of water, boil down to three sheng, remove dregs, and divide into three doses. It is excellent for treating deficiency-cold abdominal pain.
Jianzhong Tang (Establish the Middle Decoction) from *Waitai*: Treats deficiency-cold of Qi and Blood failing to nourish the Heart and Spleen, resulting in continuous pain without acute or violent intensity. Pressing on the abdomen relieves the pain; light pressure causes pain, but heavy pressure does not cause much pain. This is precisely a deficiency pattern. As stated in the Classics: "In deficiency, Niebi [disordered] Qi is insufficient; pressing allows sufficient Qi to warm the area, thus bringing comfort and cessation of pain."
Huangqi (Astragali Radix), Baishao (Paeoniae Radix Alba) (each 3 liang); Gancao (Glycyrrhizae Radix et Rhizoma, stir-fried), Guixin (Cinnamomi Ramulus) (each 2 liang); Shengjiang (Zingiberis Rhizoma Recens) (6 liang); Banxia (Pinelliae Rhizoma Praeparatum) (5 liang); Dazao (Ziziphi Jujubae Fructus) (12 pieces); Yitang (Maltose) (10 liang).
Add eight sheng of water, decoct to obtain three sheng, and divide into three doses.
Formula for treating periumbilical pain, difficulty in urination and defecation, aversion to cold, and a deficient pulse:
Shudi (Rehmanniae Radix Preparata) (3 qian); Rougui (Cinnamomi Cortex) (5 fen); Baishao (Paeoniae Radix Alba) (1.5 qian); Guizhi (Cinnamomi Ramulus) (5 fen); Danggui (Angelicae Sinensis Radix), Fuling (Poria) (each 1 qian).
Decoct in water and take orally.
Yanhu Kelian Tang (Corydalis and Toosendan Decoction) for treating cold, contracting pain below the umbilicus and coldness in the yin region like ice:
Shudi (Rehmanniae Radix Preparata) (2 qian); Chuanlian (Toosendan Fructus), Yanhu (Corydzidis Rhizoma) (each 5 fen); Fuzi (Aconiti Lateralis Radix Praeparata), Rougui (Cinnamomi Cortex) (each 7 fen); Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma) (1 qian).
Combine all ingredients for one dose. Add four cups of water, decoct to one cup, remove dregs, and take slightly warm on an empty stomach before meals.
Wenzhong Tang (Warm the Middle Decoction): Treats decline of Wu Earth [Spleen/Stomach function], inability to transform and transport, compounded by exogenous cold, gathering to cause fullness and pain. Disperse with pungent-hot herbs, assist with bitter-sweet herbs, and drain with bland herbs. When Qi warms and the Stomach harmonizes, pain stops naturally.
Houpo (Magnoliae Officinalis Cortex, ginger-processed) (1 liang); JuPi (Citri Reticulatae Pericarpium, pith removed) (1 liang); Ganjiang (Zingiberis Rhizoma) (7 qian); Gancao (Glycyrrhizae Radix et Rhizoma, stir-fried); Caodoukou (Alpiniae Katsumadai Semen); Fuling (Poria, peel removed); Muxiang (Aucklandiae Radix) (each 5 qian).
Grind into coarse powder. Take 5 qian per dose, add two cups of water and three slices of ginger, decoct to one cup, remove coarse residue, and take warm before meals.
Shenbao Wan (Divine Preservation Pill) from *Ju Fang*:
Quanxie (Scorpio), Badou (Crotonis Fructus, take the frost/residue) (each 10 pieces); Muxiang (Aucklandiae Radix), Hujiao (Piperis Longi Fructus) (each 2.5 qian).
Grind into powder, mix evenly with Badou frost. Dissolve steamed wheat cake in water to form pills the size of sesame seeds, coated with Zhusha (Cinnabar). Take 5 to 7 pills per dose. This medicine strongly promotes circulation through the zang-fu organs and treats pain caused by various accumulations of Qi.