趺阳（为胃脉。其）脉微弦。（微弦。为阴象也。阴加于阳。其）法当腹满。
（若）不满者。（其阴邪下攻）必便难。（或）两 疼痛。此虚寒（不从外得。而从内
生。其气）欲（从）下（而之）上也。（此证不可散表）当以温（中之）药服之。（以
散内结之阴寒也。）
此言趺阳微弦。为中寒而腹满也。其实病根在下。所谓肾虚则寒动于中是也。与上
一篇首节参看。自得。 、音区。腋下胁也。
（趺阳脉微弦。固为虚证。然腹满亦有实证。辨之奈何。）病者腹满。按之不痛为
虚。（不可下也。）痛者为实。可下之。（胃实者。舌有黄苔。若）舌黄（而）未（经
）下者。下之黄（苔）自去。
此言虚实之辨法。而并及治法也。
（虚而生寒证。不拒按之外。又有辨法。若）腹满时减。复如故。此为（虚）寒。
当与温药。
此承上节而申言虚寒之证治也。
尤在泾云、腹满不减者。实也。时减复如故者。腹中寒气。得阳而暂开。得阴而复
合也。此亦寒从内生。故曰当与温药。
（又虚有实象之危证。不可不知。）病者（面色）痿黄。（若燥而渴者。热实也。
今）燥而不渴。（腹满连及）胸中（均作）寒实。（实证当不下利。若下利。则是虚
寒之极。反有实象。）而（且下）利不止者。（是虚寒胃气下脱也。必）死。
此言真虚反有实象。假实不可以直攻。真虚不能以遽挽也。
（微弦脉见于趺阳。与见于寸口者不同。以趺阳主胃。病从内生。寸口主营卫。病
从外至也。若）寸口脉弦者。（弦为寒而主痛。其人）即胁下拘急而痛。（与两 疼痛
不同。盖彼主乎内。而此主乎外也。主乎内
者。其人痛而兼便难。主乎外者。）其人（痛而兼）啬啬恶寒也。
此言寸口之弦。与趺阳之弦。同属阴邪。而有内外之别也。
（寒有内外之别。上虽详之于脉。更当辨之于所见之证。曰喜欠。曰清涕。曰色和。
曰善嚏。以此而泛求于偶然病寒之人。犹恐其不足凭也。）夫（唯取证于素寒之人。名
曰）中寒家。（始得其不易之准。吾观人欲睡而喜欠者。阴引阳入也。睡觉而喜欠者。
阳引阴出也。今其人为中寒家而）喜欠。（其为阴盛引阳也奚疑。又尝观年老之人。清
涕出者。阳虚所致也。遇寒之人。清涕出者。寒盛所致也。今）其人（为中寒家而）清
涕出（其为阳气虚寒也奚疑。若）发热色和者。（非中寒也。乃为外寒所搏。虽有清涕
出。亦因其）善嚏。（寒不能留而自出矣。）
此以中寒家立论。以明中寒证。而并及外寒之轻证也。
（上言善嚏。果何取于嚏乎。盖嚏者。雷气之义也。阴盛则阳伏。阳一得气而奋发。
在天为雷。在人为嚏也。若）中（气素）寒。其人下利。以里虚（而阳气不振）也。（若
）欲嚏不能。（是阳欲奋发。却被阴留而中止。阴气盛也。故知）此人肚中寒。
此承上节善嚏二字。言中气虚寒之人。欲嚏不能嚏也。中寒之中。是平声。尤氏作去
声读。误也。伤寒金匮无中寒二字。不可不知。宋元后注家。附会此二字。不知遮蔽多
少聪明人耳目。
（若）夫瘦人（形气虚弱。难御外邪。忽而）绕脐痛。必有（外入之）风冷。（风冷
入内。则）谷气（留滞而。）不行（医者不晓以温药助脾之行。）而反（以寒药）下之。（虽下
药推荡其谷气。而寒性反增其风冷。由是正乃益虚。邪乃无制。）其气必（犯上而为）
冲。（即）不（上）冲者。（亦必窃据流连。）心下则痞。
此言素虚人。一伤风冷。其腹满虽为积滞。法宜温行。不宜寒下以致变也。
（兹试言诸证之方治。）病腹满。（为里实。）发热（为表邪。表里之邪。相持至于
）十日。（而）脉（尚）浮而数。（为日虽久。而表邪犹未已也。）饮食如故。（其表虽
实。而胃气犹未伤也。法宜两解。以）浓朴七物汤主之。
此言腹满发热。而出表里两解之方也。但发热疑是中风证。风能消谷。伤寒云、能
食为中风。可以参看。
浓朴七物汤方
浓朴（半斤） 甘草 大黄（各三两） 大枣（十枚） 枳实（五枚） 桂枝（二
两） 生姜（五两）
上七味。以水一斗。煮取四升。温服八合。日三服。呕者加半夏五合。下利去大黄。
寒多者加生姜至半斤。
（虽然。表里之辨犹易也。而虚寒欲下上之旨。最元妙而难言。何也。）腹中（为
阴部。下也。阴部有）寒气。（气逆则为）雷鸣（寒盛则为）切痛。（而且从下而上。其）胸（中两
）胁逆满。（兼见）呕吐。（是阴邪不特自肆于阴部。而阳位亦任其横行而无忌。所谓
肾虚则寒动于中。急以）附子粳米汤主之。
此言寒气之自下而上僭。中上之阳必虚。惟恐胃阳随其呕吐而脱。故于温暖胃阳方
中。而兼补肾阳也。
附子粳米汤方
附子（一枚炮） 半夏 粳米（各半升） 甘草（一两） 大枣（十枚）
上五味。以水八升。煮米熟汤成。去滓。温服一升。日三服。
（上用浓朴七物汤。以其发热。尚有表邪也。今腹）痛而（不发热。止是大便）
闭者。（为内实气滞之的证也。通则不痛。以）浓朴三物汤主之。
此节合下二节。皆言实则可下之证也。重在气滞一边。
浓朴三物汤方
浓朴（八两） 大黄（四两） 枳实（五枚）
上三味。以水一斗二升。先煮二味。取五升。内大黄。煮取三升。温服一升。以利
为度。
（以手按辨其虚实。既言不复再赘矣。若）按之心下满痛者。（虽云其结尚高。与
腹中满痛不同。而既已拒按若此。）此为（有形之）实（邪）也。（实则）当下之。宜
大柴胡汤。
此亦言实则可下之证。但以邪在心下。故以大柴胡汤为的方。可见古人用方。斟酌
尽善。不差一黍。
大柴胡汤方
柴胡（半斤） 黄芩 芍药（各三两） 半夏（半升） 枳实（四枚） 大黄（二
两） 大枣（十二枚） 生姜（五两）
上八味。以水一斗二升。煮取六升。去滓再煎。温服一升。日三服。
（前言腹满时减。当与温药矣。若）腹（常）满（而）不减。（当责其实。时）减（者
当防其虚。故曰）不足言。（即无余议之辞。然满而不减者。）当下之。宜大承气汤。
此言满在腹部。与在心下者不同。故用大承气汤以急攻之。此三方均是下药。当分
别于几微而用之。
大承气汤方（见痉病）
（至若寒痛而救治。另有方法。）心胸中（本阳气用事。今有）大寒（与正气相阻
而为）痛。（寒气上逆则为）呕。（胃阳为寒所痹。则）不能饮食。（且阴寒据于）
腹中（而作）满。（寒气）上冲（于）皮（肤而突）起出见（之形。似）有头足。上下
（俱）痛。而（手）不可触近者。（此虚而有实象也。以）大建中汤主之。
此言心胃受寒。引动下焦之阴气上逆而痛甚也。方中姜参饴糖。创建中气。而椒
性下行者。温起下焦之阳。以胜上弥之阴也。
大建中汤方
蜀椒（二合炒去汗） 干姜（四两） 人参（一两）
上三味。以水四升。煮取二升。去滓。内胶饴一升。微火煎。取二升。分温再服。
如一炊顷。可饮粥二升。后更服。当一日食糜粥。温覆之。
（虚寒则温补之。实热则寒下之。固也。然有阴寒成聚之证。治之者当知法外有法。
）胁下偏痛发热。（若脉数大。热邪实也。今按）其脉紧弦。此（阴）寒（成聚）也。
（虽有发热。亦是阳气挟郁所致。若非温药。不能已其寒。若非下药。不能去其结。所）
以（当以）温药下之。宜大黄附子汤。
此承上节而言阴寒中不无实证。温药中可杂以下药也。
大黄附子汤方
大黄（三两） 附子（三两） 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。寒气厥逆。赤丸主之。
此言厥逆。而未言腹满痛者。从所急而救治也。
徐忠可云、四肢乃阳气所起。寒气格之。故阳气不顺接而厥。阴气冲满而逆。故以
乌头细辛伐内寒。苓半以下其逆上之痰气。真朱为色者。寒则气浮。故重以镇之。且以
护其心也。真朱。即朱砂也。
沈自南云、本经凡病仅言风寒。不言暑湿燥火。何也。盖以寒湿燥属阴同类。以湿
燥统于寒下。风暑火
属阳同类。以火暑统于风下。所以仅举风寒二大法门。不言燥湿火暑之繁也。
赤丸方
乌头（二两炮） 茯苓（四两） 细辛（一两） 半夏（四两）
上四味。末之。内真朱为色。炼蜜为丸。如麻子大。先食饮酒下三丸。日再。夜一
服。不知。稍增。以知为度。
（寒结腹中。因病又叠聚如山。犯寒即发。谓之寒疝。
其初亦止）腹满（而）脉（独）弦而紧。（弦紧。皆阴也。但弦之阴。从内生。紧之阴。
从外得。）弦则卫气不行。即恶寒。（阴出而痹其外之阳也。）紧则不欲食。（阴入
而痹其胃之阳也。卫阳与胃阳并衰。而内寒与外寒交盛。由是阴反无畏而上冲。阳反
不治而下伏。谓为）邪正相搏。即为寒疝。寒疝绕脐痛。若发（作之时。是阴寒内动。
或则迫其汗而外出。或）则（迫其）白津（而下）出。（出则为阴阳离脱也。故）手足
厥冷。（并见）其脉沉紧者。（沉为里。紧为寒。阴寒聚结。急宜以辛甘辛温之品。散结
以救阳。）大乌头煎主之。
此言寒疝之总证总脉。而出其救治也。
大乌头煎
乌头（大者五枚熬去皮不必咀）
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。不可一日更服。
（然大乌头煎祛寒则有余。而补血则不足也。若）寒疝（之为寒多而血虚者。其）
腹中痛。及胁痛里急者。（以血虚则脉不荣。寒多则脉结急故也。以）当归生姜羊肉汤
主之。
此治寒多而血虚者之法。养正为本。散寒为次。治寒疝之和剂也。
当归生姜羊肉汤方
当归（三两） 生姜（五两） 羊肉（一斤）
上三味。以水八升。煮取三升。温服七合。日三服。若寒多。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。
寒疝（有里外俱病之证。其）腹中痛。逆冷。（阳绝于里也。）手足不仁。若身疼
痛。（阳痹于外也。医者或攻其外。或攻其内。邪气牵制不服。所以）灸刺诸药（皆）
不能治。（里外交迫。孰可）抵当（惟有）乌头桂枝汤（之两顾。可以）主之。
此言寒疝之表里兼剧。而出其并治之方也。
乌头桂枝汤方
乌头（五枚）
上一味。以蜜二升。煎减半。去滓。以桂枝汤五合解之。合得一升（解之者。溶化
也。合得一升。以乌头所煎之蜜五合。加桂枝汤五合。合
得一升也。）后。初服五合。不知。即服三合。又不知。复加至五合。其知者。（知。效
也。）如醉状。（寒方解也。）得吐者。（内寒已伸也。）为中病。
（由此观之。寒疝之证。不外于寒。而寒中之虚实。固所当辨。寒疝之脉。不外弦
紧。而弦紧之互见。更不可不知。寒疝病。按）其脉数（为寒疝之变脉。）
而（数中仍不离于本脉之）紧乃弦。（紧脉之状易明。而弦脉）状如弓弦。按之不移。
（此寒疝之本脉。不以数而掩其真面目也。若）脉数弦者（数虽阳脉。而见之于弦中。
是阴在阳中）当下其寒。（若）脉紧大而迟者。必心下坚。（迟为在脏。病应心下奚疑。
而坚为阴象。与大为阳脉而相反。其义何居。而不知）脉大（为阳。）而（与）紧（
脉并见。即为阴所窃附于此）者。（因以断之曰。）阳中有阴。可下之。
此言脉紧为寒疝主脉。又有数而弦。大而紧。俱是阳中有阴。是寒疝之脉之变。其
云当下其寒。想即大
黄附子汤也。
尤在泾云、脉数为阳。紧弦为阴。阴阳参见。是寒热交至。然就寒疝言。则数反从弦。
故其数为阴凝于阳之数。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。
附方
外台乌头汤 治寒疝腹中绞痛。贼风入攻。五脏拘急。不得转侧。发作有时。
令人阴缩。手足厥逆。（即大乌头煎）
外台柴胡桂枝汤 治心腹卒中痛者。
柴胡（四两） 黄芩 人参 芍药 桂枝（各一两半） 生姜（三两） 甘草（三两
）半夏（二合半） 大枣（十二枚）
上九味。以水六升。煮取三升。温服一升。日三服。
此证由风邪乘侮脾胃者多。然风气通于肝。此方提肝木之气。驱邪外出。而补中消
痰化热。宣通营卫次之。沈自南谓加减治胃脘痛如神。
外台走马汤 治中恶。心痛腹胀。大便不通。
巴豆（一枚去皮心熬） 杏仁（二枚）
上二味。以绵缠槌令碎。热汤二合。捻取白汁饮之。当下。老小量之。通治飞尸鬼击病。
The Fuyang pulse (the artery of the Stomach channel) is slightly wiry (a thin, straight, and long pulse shape, indicating cold and pain). A slightly wiry pulse belongs to the Yin aspect. When Yin pathogen adds to the Yang position, according to standard principles, abdominal fullness should occur.
If there is no abdominal fullness, then there must be difficulty in defecation, or pain in the bilateral hypochondriac regions. This is because the deficiency-cold qi does not come from external contraction but arises internally; its qi mechanism desires to rush upward from the Lower Jiao. This syndrome cannot be treated with methods that disperse exterior pathogens; instead, one should administer warming middle-jiao herbs to dissipate the internal condensed Yin cold.
This section discusses how a slightly wiry Fuyang pulse indicates abdominal fullness due to middle-cold. The root of the pathology lies in the Lower Jiao, as stated: "When Kidney Qi is deficient, cold moves within the Middle Jiao." Compare this with the first section of the previous chapter for clarity. "Xi" (pronounced *qu*) refers to the axillary hypochondriac region.
(Although a slightly wiry Fuyang pulse indicates a deficiency syndrome, abdominal fullness can also be an excess syndrome. How to differentiate them?) If the patient has abdominal fullness and it is painless upon palpation, it is a deficiency syndrome; purgatives are contraindicated. If it is painful upon palpation, it is an excess syndrome; purgatives may be used. (In cases of Stomach excess-heat, the tongue coating will be yellow. If the tongue coating is yellow but has not yet been treated with purgatives, the yellow coating will naturally disappear after purgation.)
This section discusses the method for differentiating deficiency and excess, and briefly mentions treatment methods.
(Besides not resisting pressure in deficiency-cold syndromes, there are other differentiation methods. If abdominal fullness sometimes decreases and then returns to normal, this is a deficiency-cold syndrome, and warming herbs should be administered.)
This continues the previous section to elaborate on the treatment of deficiency-cold syndromes.
You Zaijing said: Abdominal fullness that does not decrease indicates an excess syndrome. Fullness that decreases temporarily and then returns occurs because the cold qi in the abdomen opens temporarily when encountering Yang qi and condenses again when encountering Yin qi. This is also cold arising from within, hence the statement that warming herbs should be administered.
(There are also critical syndromes where deficiency presents with false-excess signs, which must be known.) The patient's complexion is sallow and lusterless. If dry and thirsty, it is an excess-heat syndrome. Now, although dry, there is no thirst, indicating that both the chest and hypochondrium are affected by cold-excess pathogens. (Excess syndromes typically do not present with diarrhea; if diarrhea occurs, it indicates extreme deficiency-cold, presenting with false-excess signs.) Moreover, if diarrhea is unceasing, (this indicates deficiency-cold causing the descent of Stomach Qi), death is inevitable.
This section discusses true-deficiency presenting with false-excess signs. False-excess syndromes should not be directly attacked, and true-deficiency syndromes cannot be hastily rescued.
(A slightly wiry pulse appearing at the Fuyang location differs from one appearing at the Cun Kou location. Because Fuyang governs the Stomach, the disease arises from within; Cun Kou governs Ying and Wei, so the disease comes from outside.) If the Cun Kou pulse is wiry, (the wiry pulse indicates cold and pain), the person will experience tightness and pain in the hypochondrium. (This differs from pain in the bilateral hypochondrium; the former is internal, the latter external. In internal cases,) the person experiences pain accompanied by difficulty in defecation; in external cases,) the person experiences pain accompanied by aversion to cold with shivering.
This section discusses that both the wiry pulse at Cun Kou and Fuyang belong to Yin pathogens but differ in being internal versus external.
(Cold pathogens have internal and external distinctions. Although pulses were detailed above, differentiation must also be based on observed symptoms, such as frequent yawning, clear nasal discharge, normal facial color, and frequent sneezing. Using these to search for occasional cold patients may not be reliable enough.) Only by taking evidence from individuals with a history of chronic cold, termed "Zhong Han Jia" (individuals prone to cold invasion), can one obtain a consistent standard. I observe that those who wish to sleep and frequently yawn are experiencing Yin pulling Yang inward; those who wake up and frequently yawn are experiencing Yang pulling Yin outward. Now, since this person is a Zhong Han Jia and frequently yawns, could it be anything other than excessive Yin pulling Yang? What else could it be? I have also observed that elderly people producing clear nasal discharge do so due to deficient Yang; those exposed to cold produce clear nasal discharge due to excessive cold. Now, since this person is a Zhong Han Jia and produces clear nasal discharge, could it be anything other than deficient and cold Yang? What else could it be? If there is fever and the facial color is peaceful, (this is not Zhong Han, but rather external cold constraining the body; even if there is clear nasal discharge, it is because they sneeze easily, allowing) the cold to exit spontaneously without lingering.
This section establishes the argument based on Zhong Han Jia to clarify Zhong Han syndromes, while also covering mild exterior cold syndromes.
(Regarding the mention of sneezing earlier, what is the significance? Sneezing embodies the meaning of thunder. When Yin is excessive, Yang is suppressed; when Yang Qi finally stirs and erupts, in Heaven it manifests as thunder, and in Humans as sneezing.) If the Middle Qi is chronically cold, the person suffers from diarrhea due to interior deficiency (and weak Yang Qi). (If they) desire to sneeze but cannot, (it means Yang wants to erupt but is detained by Yin, indicating Yin excess); therefore, we know this person has cold in the abdomen.
This follows up on the previous section's mention of "frequent sneezing," discussing how individuals with deficient and cold Middle Qi desire to sneeze but cannot. "Zhong Han" (Middle Cold) is pronounced with a level tone; You read it with a departing tone, which is incorrect. There is no term "Zhong Han" in *Shanghan Lun* or *Jingui Yaolue*, which must be noted. Commentators after the Song and Yuan dynasties attached this term, obscuring the understanding of many scholars.
(In the case of thin individuals, whose form and Qi are weak and difficult to defend against external pathogens, sudden periumbilical pain must be caused by externally invading wind-cold. (Once wind-cold enters the interior, it causes) Gu Qi (Grain Qi) to stagnate and fail to move. (Doctors ignorant of using warming herbs to assist Spleen Qi movement) instead use cold-purgative herbs. (Although purgatives push out the stagnant Grain Qi, their cold nature increases the wind-cold, thereby further weakening Zheng Qi and leaving Xie Qi unchecked.) The Qi will inevitably (attack upward causing) Chong Qi (Rebellious Qi). (Even if it does not) rebel upward, (it will surely linger locally,) causing Pi (fullness/stuffiness) in the Xin Xia (subcostal/epigastric region).
This section discusses how a constitutionally weak person, once injured by wind-cold, may have abdominal fullness due to accumulation. The method should be warming and moving, not cold purgation, to avoid complications.
(Now let us discuss the formulas for various syndromes.) For abdominal fullness, (it is interior excess.) With fever, (it is exterior pathogen. When exterior and interior pathogens contend for) ten days, (and the) pulse remains floating and rapid, (indicating that despite the duration, the exterior pathogen persists.) Diet remains normal, (showing that although the exterior is excess, the Stomach Qi is not yet damaged. The method should be resolving both exterior and interior simultaneously, using) Nong Po Qi Wu Tang as the primary formula.
This section discusses abdominal fullness with fever and provides a formula for resolving both exterior and interior. However, the fever suggests a Wind Strike syndrome; Wind can digest food, and *Shanghan Lun* states that ability to eat indicates Wind Strike, which can be referenced.
**Nong Po Qi Wu Tang Formula**
Nong Po (Cortex Magnoliae Officinalis) (8 liang)
Gan Cao (Radix Glycyrrhizae Uralensis)
Da Huang (Radix et Rhizoma Rhei) (each 3 liang)
Da Zao (Fructus Jujubae) (10 pieces)
Zhi Shi (Fructus Aurantii Immaturus) (5 pieces)
Gui Zhi (Ramulus Cinnamomi) (2 liang)
Sheng Jiang (Rhizoma Zingiberis Recens) (5 liang)
Take seven ingredients, add one dou of water, decoct to obtain four sheng. Take eight ge warm, three times daily. Add Ban Xia (Rhizoma Pinelliae Preparata) 5 ge if vomiting. Remove Da Huang if diarrhea. Increase Sheng Jiang to half a jin if there is much cold.
(Although distinguishing exterior and interior is relatively easy, the principle of deficiency-cold rising from below and attacking above is most profound and difficult to explain. Why?) The abdomen (belongs to the Yin sector, located inferiorly. If there is) cold qi in the Yin sector, (rebellious Qi causes) Lei Ming (borborygmus/rumbling). (If cold is severe, it causes) Qie Tong (cutting pain). (And moving upward from below, it causes) chest (and bilateral) hypochondriac rebellious fullness, (accompanied by) vomiting. (This shows that Yin pathogens not only肆肆意 in the Yin sector but also横行 freely in the Yang positions, as stated: "When Kidney Qi is deficient, cold moves within the Middle Jiao." Urgently treat with) Fu Zi Jing Mi Tang.
This section discusses cold qi usurping from below upwards, causing deficiency in the Middle and Upper Yang. We fear the Stomach Yang will escape with vomiting, so in formulas warming Stomach Yang, we simultaneously tonify Kidney Yang.
**Fu Zi Jing Mi Tang Formula**
Fu Zi (Radix Aconiti Lateralis Preparata) (one piece, processed)
Ban Xia (Rhizoma Pinelliae Preparata)
Jing Mi (Oryza Sativa Germen) (each half sheng)
Gan Cao (Radix Glycyrrhizae Uralensis) (1 liang)
Da Zao (Fructus Jujubae) (10 pieces)
Take five ingredients, add eight sheng of water, decoct until rice is cooked and liquid is ready. Strain. Take one sheng warm, three times daily.
(Above, Nong Po Qi Wu Tang was used because there was fever and remaining exterior pathogen. Now, for abdominal pain without fever, only constipation,) (this is a definitive sign of interior excess and Qi stagnation. Since free flow prevents pain, use) Nong Po San Wu Tang.
This section, combined with the next two, discusses syndromes suitable for purgation in excess conditions, focusing on Qi stagnation.
**Nong Po San Wu Tang Formula**
Nong Po (Cortex Magnoliae Officinalis) (8 liang)
Da Huang (Radix et Rhizoma Rhei) (4 liang)
Zhi Shi (Fructus Aurantii Immaturus) (5 pieces)
Take three ingredients, add one dou two sheng of water. First decoct the first two ingredients to obtain five sheng. Add Da Huang, decoct to obtain three sheng. Take one sheng warm, adjusting dosage to achieve bowel movement.
(Differentiating deficiency and excess by palpation was mentioned earlier and need not be repeated. If pressing the Xin Xia causes fullness and pain,) (although the obstruction is higher than in abdominal fullness and pain, and resists pressure severely,) this is an excess of (tangible) pathogen. (For excess,) it should be purged. Use Da Chai Hu Tang.
This also discusses excess syndromes suitable for purgation, but since the pathogen is in the Xin Xia, Da Chai Hu Tang is the specific formula. This shows ancient physicians' meticulous prescription selection, down to the finest detail.
**Da Chai Hu Tang Formula**
Chai Hu (Radix Bupleuri) (8 liang)
Huang Qin (Radix Scutellariae)
Bai Shao (Radix Paeoniae Alba) (each 3 liang)
Ban Xia (Rhizoma Pinelliae Preparata) (half sheng)
Zhi Shi (Fructus Aurantii Immaturus) (4 pieces)
Da Huang (Radix et Rhizoma Rhei) (2 liang)
Da Zao (Fructus Jujubae) (12 pieces)
Sheng Jiang (Rhizoma Zingiberis Recens) (5 liang)
Take eight ingredients, add one dou two sheng of water, decoct to obtain six sheng. Strain and decoct again. Take one sheng warm, three times daily.
(Above, it was said that if abdominal fullness decreases intermittently, warming herbs should be given. If abdominal) fullness is constant and does not decrease, (attribute it to excess. Intermittent decrease warns of deficiency, hence the phrase) bu zu yan (insufficient to mention). (However, for constant fullness without decrease,) it should be purged. Use Da Cheng Qi Tang.
This section discusses fullness in the abdomen, differing from fullness in the Xin Xia, thus using Da Cheng Qi Tang for urgent attack. These three formulas are all purgatives; they must be distinguished carefully in subtle details.
**Da Cheng Qi Tang Formula** (See Jing Bing Chapter)
(As for treating cold pain, there are other methods.) The Xin and Zhong (Heart and Stomach) (normally governed by Yang Qi, now have) severe cold (obstructing righteous Qi causing) pain. (Cold Qi rebelling upward causes) vomiting. (Stomach Yang blocked by cold leads to inability to eat/drink), (and Yin cold occupying the) abdomen causes fullness. (Cold Qi) rushes upward to the skin (appearing raised like) heads and feet, causing pain throughout upper and lower parts that cannot be touched. (This is deficiency with false-excess signs. Use) Da Jian Zhong Tang.
This section discusses Heart and Stomach suffering from cold, triggering rebellious Yin Qi from the Lower Jiao causing severe pain. The formula uses Ginger, Ginseng, and Maltose to establish Middle Qi, while Sichuan Pepper, descending in nature, warms Lower Jiao Yang to overcome the ascending Yin.
**Da Jian Zhong Tang Formula**
Shu Jiao (Fructus Zanthoxyli) (2 he, stir-fried to remove oil)
Gan Jiang (Rhizoma Zingiberis Secati) (4 liang)
Ren Shen (Radix Ginseng) (1 liang)
Take three ingredients, add four sheng of water, decoct to obtain two sheng. Strain, add Yi Tang (Maltose) one sheng. Simmer over low heat to obtain two sheng. Divide into two warm doses. After a meal's time, drink two sheng of congee, then take another dose. Maintain a diet of congee for one day and keep warm.
(Deficiency-cold is warmed and tonified; excess-heat is cleared and purged, which is correct. However, for syndromes where Yin cold aggregates, practitioners must know methods beyond standard methods.) Pain in one side of the hypochondrium with fever. (If the pulse is rapid and large, it is excess heat. Now, palpating,) the pulse is tight and wiry, indicating (Yin) cold (aggregation). (Even with fever, it is caused by Yang Qi constrained by depression. Without warming herbs, the cold cannot cease; without purgative herbs, the knot cannot be removed. Therefore,) use warming herbs to purge. Use Da Huang Fu Zi Tang.
This follows the previous section stating that Yin cold syndromes may have excess components, allowing purgatives to be mixed with warming herbs.
**Da Huang Fu Zi Tang Formula**
Da Huang (Radix et Rhizoma Rhei) (3 liang)
Fu Zi (Radix Aconiti Lateralis Preparata) (3 liang)
Xi Xin (Herba Asari) (2 liang)
Take three ingredients, add five sheng of water, decoct to obtain two sheng. Divide into three warm doses. For strong individuals, decoct to obtain two and a half sheng, divide into three warm doses. After taking the medicine, wait the time it takes to walk four or five li, then take another dose. For cold-induced jue ni (cold reversal), Chi Wan is indicated.
This section discusses jue ni without mentioning abdominal fullness/pain, addressing the urgency.
Xu Zhongke said: The limbs are where Yang Qi originates. Cold blocks it, so Yang Qi fails to connect smoothly, causing jue. Yin Qi rushes and fills, causing ni. Thus, Wu Tou and Xi Xin attack internal cold, Fu Ling and Ban Xia descend rebellious phlegm-Qi. Zhen Zhu (Cinnabar) is used for color; cold causes Qi to float, so heavy sedatives calm it and protect the Heart. Zhen Zhu is Cinnabar.
Shen Zinan said: *Ben Jing* only mentions Wind-Cold, not Summer-Heat, Dampness, Dryness, and Fire. Why? Because Cold, Dampness, and Dryness belong to Yin and are similar, with Dampness and Dryness subsumed under Cold. Wind, Summer-Heat, and Fire belong to Yang and are similar, with Fire and Summer-Heat subsumed under Wind. Thus, only the two major categories of Wind and Cold are cited, avoiding the complexity of Dryness, Dampness, Fire, and Summer-Heat.
**Chi Wan Formula**
Wu Tou (Radix Aconiti Kusnezoffii) (2 liang, processed)
Fu Ling (Poria) (4 liang)
Xi Xin (Herba Asari) (1 liang)
Ban Xia (Rhizoma Pinelliae Preparata) (4 liang)
Process the four ingredients into powder. Add Zhen Zhu (Cinnabar) for color. Make pills with refined honey, size of hemp seeds. Take three pills with wine on an empty stomach, twice daily, once at night. If ineffective, increase slightly. Stop when effective.
(Cold knotting in the abdomen, accumulating like mountains, triggered by cold exposure, is called Han Shan (Cold Colic). Initially, it is just) abdominal fullness with a (uniquely) wiry and tight pulse. (Wiry and tight are both Yin. But Wiry Yin arises from within; Tight Yin comes from outside.) Wiry implies Wei Qi does not circulate, leading to aversion to cold. (Yin exits and obstructs external Yang.) Tight implies loss of appetite. (Yin enters and obstructs Stomach Yang. Both Wei Yang and Stomach Yang decline, while internal and external cold intensify. Thus, Yin boldly rebels upward, and Yang fails to control and sinks downward. This interaction of Pathogenic and Righteous Qi constitutes) Han Shan. Han Shan involves periumbilical pain. During attacks, internal Yin cold moves, either forcing sweat outward or) forcing Bai Jin (clear fluid/saliva) downward. (Exit signifies separation of Yin and Yang, hence) cold hands and feet, (along with) a sinking and tight pulse. (Sinking indicates interior, tight indicates cold. Yin cold aggregation requires urgent dispersal with acrid-sweet and acrid-warm herbs to save Yang.) Da Wu Tou Jian is indicated.
This section discusses the general signs and pulses of Han Shan and provides treatment.
**Da Wu Tou Jian**
Wu Tou (Radix Aconiti Kusnezoffii) (five large pieces, boiled, peel removed, not chopped)
Take one ingredient, add three sheng of water, decoct to obtain one sheng. Strain, add two sheng of honey. Decoct until water vapor is gone to obtain two sheng. Strong individuals take seven ge; weak individuals take five ge. If not cured, take again tomorrow. Do not take more than once a day.
(However, Da Wu Tou Jian is sufficient for dispelling cold but insufficient for nourishing blood. If) Han Shan (is due to excessive cold and blood deficiency, with) abdominal pain and hypochondriac pain with interior tension, (because blood deficiency fails to nourish vessels, and excessive cold causes vessel knotting and tension, use) Dang Gui Sheng Jiang Yang Rou Tang.
This section discusses treating excessive cold with blood deficiency. Nourishing righteousness is fundamental; dispelling cold is secondary. It is a harmonizing formula for Han Shan.
**Dang Gui Sheng Jiang Yang Rou Tang Formula**
Dang Gui (Radix Angelicae Sinensis) (3 liang)
Sheng Jiang (Rhizoma Zingiberis Recens) (5 liang)
Yang Rou (Carne Ovis/Arietis) (1 jin)
Take three ingredients, add eight sheng of water, decoct to obtain three sheng. Take seven ge warm, three times daily. If cold is excessive, increase Sheng Jiang to one jin. If pain is severe with vomiting, add Ju Pi (Pericarpium Citri Reticulatae) 2 liang and Bai Zhu (Rhizoma Atractylodis Macrocephalae) 1 liang. If adding Sheng Jiang, also add five sheng of water, decoct to obtain three sheng two ge, and take.
Han Shan (has syndromes involving both interior and exterior. With) abdominal pain, reverse cold, (Yang exhausted in the interior,) numbness in hands and feet, and body pain, (Yang obstructed in the exterior. If doctors attack the exterior or interior separately, the pathogen resists, making) moxibustion, acupuncture, and other drugs ineffective. (With interior and exterior pressures, nothing else can match) Wu Tou Gui Zhi Tang (which addresses both) as the primary treatment.
This section discusses Han Shan with severe interior-exterior involvement and provides a simultaneous treatment formula.
**Wu Tou Gui Zhi Tang Formula**
Wu Tou (Radix Aconiti Kusnezoffii) (5 pieces)
Take one ingredient, add two sheng of honey, decoct until reduced by half. Strain. Dissolve in five he of Gui Zhi Tang. Combine to obtain one sheng (Dissolving means melting. Combining one sheng means mixing five he of honey-decocted Wu Tou with five he of Gui Zhi Tang). Afterwards, initially take five he. If no effect, take three he. If still no effect, increase to five he. Those who feel effects (Effectiveness,) will appear drunk (as cold resolves). Those who vomit (internal cold has extended) have reached the target illness.
(From this, we see Han Shan syndromes are not outside of cold, and the deficiency/excess within cold must be differentiated. Han Shan pulses are not outside wiry/tight, and their co-occurrence must be known. Palpating Han Shan,) if the pulse is rapid, (it is a variant pulse for Han Shan.) But (within rapidity, it still adheres to the fundamental) tight and wiry. (Tight pulse shape is easy to understand, while wiry pulse) feels like a bowstring, unmoving upon pressure. (This is the fundamental pulse of Han Shan, not obscured by rapidity. If) the pulse is rapid and wiry, (although rapid is a Yang pulse, appearing within wiry indicates Yin within Yang,) purge the cold. (If) the pulse is tight, large, and slow, there must be hardness in the Xin Xia. (Slow indicates Zang disease, why doubt Xin Xia involvement? Hardness is Yin sign, opposite to Large which is Yang. What is the meaning? Not knowing that) Large pulse (is Yang.) but (when seen together with) tight (pulse, it is Yin secretly attaching to it,) (judge it as:) Yang containing Yin, purgation is possible.
This section discusses tight pulse as the main pulse for Han Shan, with rapid/wiry and large/tight as variants showing Yang containing Yin. "Purge the cold" likely refers to Da Huang Fu Zi Tang.
You Zaijing said: Rapid pulse is Yang, tight/wiry is Yin. Seeing Yin and Yang together indicates cold-heat intermingling. However, regarding Han Shan, rapid follows wiry, so the rapidity is Yin condensing on Yang, not Yang generating heat. Regarding Feng Nue (Wind Malaria), wiry follows rapid, so wiry is Wind emerging from Heat, not Yin generating cold, which complements this text. Hence, "rapid and wiry pulse, purge the cold." Tight, slow, large, and tight are similar. Large is Yang pulse, but cannot indicate heat; it precisely forms the reality of Yin. Hence, "Yang containing Yin, purgation is possible."
**Supplementary Formulas**
**Waitai Wu Tou Tang**: Treats Han Shan with colicky abdominal pain, thief-wind attacking, five Zang organs tense and cramped, unable to turn, occurring at specific times, causing genital retraction and cold hands/feet. (This is Da Wu Tou Jian)
**Waitai Chai Hu Gui Zhi Tang**: Treats sudden pain in heart and abdomen.
Chai Hu (Radix Bupleuri) (4 liang)
Huang Qin (Radix Scutellariae)
Ren Shen (Radix Ginseng)
Bai Shao (Radix Paeoniae Alba)
Gui Zhi (Ramulus Cinnamomi) (each 1.5 liang)
Sheng Jiang (Rhizoma Zingiberis Recens) (3 liang)
Gan Cao (Radix Glycyrrhizae Uralensis) (3 liang)
Ban Xia (Rhizoma Pinelliae Preparata) (2.5 he)
Da Zao (Fructus Jujubae) (12 pieces)
Take nine ingredients, add six sheng of water, decoct to obtain three sheng. Take one sheng warm, three times daily.
This syndrome often results from Wind pathogen invading and insulting Spleen and Stomach. However, Wind Qi connects to Liver; this formula lifts Liver Wood Qi, expels pathogens outward, tonifies middle, eliminates phlegm, clears heat, and secondarily promotes circulation of Ying and Wei. Shen Zinan stated that modified versions treat epigastric pain miraculously.
**Waitai Zou Ma Tang**: Treats Zhong E (sudden evil invasion), heart pain, abdominal distension, and constipation.
Ba Dou (Fructus Crotonis Tiglii) (one piece, peel and heart removed, roasted)
Xing Ren (Semen Armeniacae Amarum) (two pieces)
Wrap the two ingredients in silk, crush with a pestle. Add two he of hot water, squeeze out white juice and drink. Should cause purging. Adjust dosage for old and young. Universally treats Fei Shi Gui Ji diseases.