（此方自仲景原论中第七卷集入于此）
人参 甘草（炙） 白术 干姜（各三两）
上四味。捣筛为末。蜜和丸。如鸡子黄大。以沸汤数合。和一丸。研碎。温服之。日三四。夜二服。腹中未热。益
至三四丸。然不及汤。汤法。以四物根据两数。切。用水八升。煮取三升。去滓。温服一升。日三服。
成注引内经曰。脾欲缓。急食甘以缓之。用甘补之。人参白术甘草之甘。以缓脾气调中。寒淫所胜。平以辛热。干
姜之辛。以温胃散寒。
琥按上方。本系仲景治霍乱呕吐泄利。寒多不饮水者。故活人书复云。四肢拘急。腹满下利。或转筋者。皆系真寒
之象。而非暑邪实热比也。倘病患中气虚而不寒。或寒而不虚者。宜审用之。
加减法
若脐上筑者。肾气动也。去术。加桂四两。吐多者去术。加生姜三两。下多者还用术。悸者。加茯苓二两。渴欲得
水者。加术足前成四两半。腹中痛者。加人参。足前成四两半。寒者加干姜。足前成四两半。腹满者去术。加附子一枚。
（活人书云。四肢拘急。腹满下利。或转筋者。去术。加附子一枚。生用。）服汤后。如食顷。饮热粥一升许。微自温。
勿发揭衣被。
琥按上加减法。内台方议曰。若脐上筑者云云。脾虚则肾气发动。故脐上筑也。术能壅气。故去桂泄奔豚。故加之。
吐多者。加生姜止呕。辛以散之也。呕家不喜术。故去之。下多者。还用术以去湿。悸者。愚以水停心下。水来犯火则
悸。茯苓之甘淡。能利水止泄也。渴欲得水者。非热渴。乃脾胃虚寒。津液凝滞而作渴也。本草白术能益津液。故倍加
之。腹中痛者。里虚不足也。故倍加人参以补之。内台方云。渴痛不止。再加黄芩芍药误矣。寒者加干姜。寒淫所胜。
平以辛热也。腹满者。愚以寒气实也。白术能壅气。故去之。然胃中虚寒。中空无物而满。白术在所不忌。寒甚。若脉
微。手足厥逆恶寒者。加附子。
又问胸膈不快。 满闭塞。唇青。手足冷。脉沉细。少情绪。或腹痛。答曰。此名太阴也。近人多不识阴证。才见
胸膈不快。便投食药。非其治也。大抵阴证者。由冷物伤脾胃。阴经受之也。主胸膈 满。面色及唇。皆无色泽。手足
冷。脉沉细。少情绪。亦不因嗜欲。但内伤冷物。或损动胃气。遂成阴证。复投巴豆之类。胸膈愈不快。或吐而利。经
一二日。遂致不救。盖不知寒中太阴也。太阴者。脾之经也。又问万一饮食不节。胸膈不快。寒中阴经。何法以治之。
答曰。急作理中汤。加青橘陈橘。 如麻豆大。服一二剂。胸膈即快。枳实理中丸。五积散尤良。
琥按上条论。实发仲景未发之旨。其云胸膈不快。 满闭塞。有似伤食证。亦知其人胃气本虚。中焦无火。以致饮
食不化。验其面色及唇。皆无色泽。手足冷。脉沉细。少情绪。其为虚寒之证无疑。又云。不因嗜欲者。言不必近房室
而后谓之阴证也。所以丹溪起而云。中寒主于温散。有卒中天地之风寒者。有口得寒物者。愚以果系胃气大虚。理中汤
相宜。倘胃气大寒而不虚。用枳实理中丸。但其中参术辈。又宜审投也。
（此方从张仲景的原著第七卷收录于此）
人参、甘草（炙）、白术、干姜（各三两）。
以上四味药。捣碎并过筛成粉末。用蜂蜜调和做成丸剂。大小如鸡蛋黄。用沸水几合，放入一丸。研碎后。温服。每日三四次，夜间两次服用。如果腹中没有温热感，增加到每次三四丸。然而效果不如汤剂。汤剂的用法是：按照四味药的原始剂量。切碎。用水八升。煮取三升。去渣。温服一升。每日三次。
成无己注解说引用《内经》说：脾脏喜欢舒缓，紧急时用甘味食物来缓和它。用甘味来补益它。人参、白术、甘草的甘味，用来缓和脾气，调理中焦。寒邪盛行时，用辛热之品来平抑它。干姜的辛味，用来温暖胃脏，驱散寒气。
琥按：上述方子，原本是张仲景治疗霍乱呕吐泄泻，寒多而不想喝水的病证。所以《活人书》又说：四肢拘挛紧急，腹部胀满，下利，或者转筋的，都是真寒的表现，而不是暑邪实热所能比拟的。如果病患中气虚但不寒，或者寒但不虚的，应当仔细审察使用。
加减法
如果脐上跳动不安的，是肾气发动。去掉白术，加桂枝四两。呕吐多的，去掉白术，加生姜三两。腹泻多的，仍用白术。心悸的，加茯苓二两。口渴想要喝水的，加白术使总量达到前方的四两半。腹中痛的，加人参，使总量达到前方的四两半。有寒象的加干姜，使总量达到前方的四两半。腹部胀满的，去掉白术，加附子一枚。
（《活人书》说：四肢拘挛紧急，腹部胀满，下利，或者转筋的，去掉白术，加附子一枚，生用。）服用汤药后，大约一顿饭的时间，喝热粥一升左右，微微保暖。不要掀开衣被。
琥按：上述加减法，《内台方议》议论说：如果脐上跳动不安等等，脾虚则肾气发动，所以脐上跳动。白术能壅滞气机，所以去掉桂枝以泄奔豚（气上冲心），所以加上它。呕吐多的，加生姜止呕，因为辛味能发散。呕吐的人不喜欢白术，所以去掉它。腹泻多的，仍用白术以祛湿。心悸的，我认为水饮停聚在心下，水来克火则悸动。茯苓的甘淡之性，能利水止泄。口渴想要喝水的，不是热渴，而是脾胃虚寒，津液凝滞而作渴。《本草》说白术能益生津液，所以加倍加入。腹中痛的，是里虚不足。所以倍加人参以补益它。《内台方》说：渴痛不止，再加黄芩芍药是错误的。有寒象的加干姜，这是寒邪盛行，用辛热来平抑。腹部胀满的，我认为寒气实盛。白术能壅滞气机，所以去掉它。然而胃中虚寒，中空无物而胀满，白术在所不忌。寒甚，如果脉微，手足厥冷恶寒的，加附子。
又问：胸膈不快，胀满闭塞，嘴唇青紫，手足冷，脉沉细，精神萎靡，或者腹痛。回答说：这名叫太阴病。近代人大多不认识阴证，才见到胸膈不快，就投喂食药，这不是正确的治法。大抵阴证，是由冷物损伤脾胃，阴经受邪所致。主要表现是胸膈胀满，面色及嘴唇都没有光泽，手足冷，脉沉细，精神萎靡。也不是因为房事过度，只是内伤冷物，或者损伤胃气，遂成阴证。再投巴豆之类药物，胸膈更加不快，或者呕吐而下利，经过一两天，遂致不治。这是因为不知道寒邪中于太阴。太阴，是脾的经脉。又问：万一饮食不节制，胸膈不快，寒中阴经，用什么方法治疗？回答说：急做理中汤，加青橘皮、陈橘皮，切成麻豆大小。服用一二剂，胸膈即快。枳实理中丸、五积散尤其好。
琥按：上述条文论述，实际上是阐发张仲景未发之意。它说胸膈不快，胀满闭塞，有点像伤食证，但也知道其人胃气本虚，中焦无火，以致饮食不化。验证其面色及嘴唇，都没有光泽，手足冷，脉沉细，精神萎靡，其为虚寒之证毫无疑问。又说：不因房事过度的，意思是未必亲近房室后才叫阴证。所以朱丹溪起来说：中寒主要在于温散。有突然遭受天地风寒的，有口吃寒物的。我认为如果确实是胃气大虚，理中汤适宜。如果胃气大寒但不虚，用枳实理中丸。但其中的参、术等药，又应当仔细投予。
(This prescription was collected from Volume 7 of Zhang Zhongjing's original treatise and included here.)
Ren Shen (Ginseng Radix), Gan Cao (Licorice Root, prepared with honey), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Gan Jiang (Zingiberis Rhizoma) (each three liang).
The above four herbs. Pound and sieve into powder. Mix with honey to form pills. Size like a chicken egg yolk. Take one pill, dissolve in several he of boiling water. Crush and take warm. Three or four times daily, two times at night. If there is no warmth in the abdomen, increase to three or four pills per dose. However, it is inferior to the decoction. Method for decoction: Use the original dosage of the four herbs. Cut them. Add eight sheng of water. Boil to obtain three sheng. Remove dregs. Take one sheng warm. Three times daily.
Cheng Wuji's commentary cites the *Neijing* saying: The spleen desires relaxation; urgently use sweet substances to relax it. Use sweet to tonify it. The sweetness of Ren Shen, Bai Zhu, and Gan Cao relaxes spleen qi and regulates the middle jiao. When cold pathogen prevails, use pungent-hot substances to level it. The pungency of Gan Jiang warms the stomach and disperses cold.
Hu notes: The above prescription originally belonged to Zhang Zhongjing's treatment of huoluan (cholera-like syndrome) with vomiting and diarrhea, where cold predominates and the patient does not desire water. Therefore, the *Liuren Shu* (Book of Vitality) further states: Spasm and tightness of the four limbs, abdominal fullness, diarrhea, or muscle twitching are all signs of true cold, not comparable to summer-heat pathogenic factor excess heat. If the patient has deficiency of middle qi without cold, or cold without deficiency, it should be used after careful examination.
Modifications
If there is a pulsating sensation above the umbilicus, it indicates kidney qi moving. Remove Bai Zhu. Add Gui Zhi (Cinnamon Twig) four liang. For excessive vomiting, remove Bai Zhu. Add Sheng Jiang (Fresh Ginger Rhizome) three liang. For excessive diarrhea, continue using Bai Zhu. For palpitations, add Fu Ling (Poria) two liang. For thirst desiring water, increase Bai Zhu so that the total amount becomes four liang and half. For abdominal pain, add Ren Shen so that the total amount becomes four liang and half. For cold conditions, add Gan Jiang so that the total amount becomes four liang and half. For abdominal fullness, remove Bai Zhu. Add Fu Zi (Aconiti Lateralis Radix Praeparata) one piece.
(The *Liuren Shu* states: For spasm and tightness of the four limbs, abdominal fullness, diarrhea, or muscle twitching, remove Bai Zhu. Add Fu Zi one piece, used raw.) After taking the decoction, approximately the time it takes to eat a meal, drink about one sheng of hot porridge. Keep slightly warm. Do not uncover clothes or blankets.
Hu notes regarding the above modifications: The *Neitai Fangyi* discusses: If there is a pulsating sensation above the umbilicus, etc., spleen deficiency causes kidney qi to move, hence the pulsation. Bai Zhu can obstruct qi, hence Gui Zhi is removed to drain ben tun (rushing pig, a condition of qi rushing upward); thus it is added. For excessive vomiting, add Sheng Jiang to stop vomiting, as pungent substances disperse. Those who vomit dislike Bai Zhu, hence it is removed. For excessive diarrhea, continue using Bai Zhu to remove dampness. For palpitations, I believe water retention below the heart causes palpitations when water attacks fire. The sweet and bland nature of Fu Ling can promote urination and stop diarrhea. Thirst desiring water is not due to heat-thirst, but rather spleen and stomach deficiency-cold, where body fluids stagnate causing thirst. The *Bencao* states Bai Zhu can benefit body fluids, hence it is doubled. Abdominal pain indicates interior deficiency and insufficiency, hence Ren Shen is doubled to tonify it. The *Neitai Fang* states that adding Huang Qin (Scutellaria Root) and Shao Yao (Peony Root) for unrelenting thirst and pain is erroneous. For cold conditions, add Gan Jiang, as cold pathogen prevails and is leveled by pungent-hot substances. For abdominal fullness, I believe it is due to excess cold. Bai Zhu can obstruct qi, hence it is removed. However, if the stomach has deficiency-cold and fullness arises from emptiness, Bai Zhu is not contraindicated. For severe cold, if pulse is faint, hands and feet are cold and reversed, and there is aversion to cold, add Fu Zi.
Another question: Chest and diaphragm discomfort, fullness and obstruction, cyanotic lips, cold hands and feet, deep and fine pulse, low spirit, or abdominal pain. Answer: This is named Taiyin disease. Modern people mostly do not recognize yin syndromes. Upon seeing chest and diaphragm discomfort, they immediately administer digestive medicines, which is incorrect treatment. Generally, yin syndromes result from cold substances injuring the spleen and stomach, affecting the yin meridians. Main manifestations include chest and diaphragm fullness, lack of luster in facial complexion and lips, cold hands and feet, deep and fine pulse, and low spirit. It is not necessarily due to sexual indulgence, but rather internal injury from cold substances or damage to stomach qi, leading to yin syndrome. Administering drugs like Ba Dou (Croton Seed) again makes chest and diaphragm more uncomfortable, or causes vomiting and diarrhea. After one or two days, this leads to untreatable conditions. This is because one does not know that cold has struck the Taiyin. Taiyin is the meridian of the spleen. Another question: What if dietary irregularities cause chest and diaphragm discomfort, and cold strikes the yin meridians? What method treats it? Answer: Immediately prepare Lizhong Tang (Regulate the Middle Decoction), add Qing Ju Pi (Green Tangerine Peel) and Chen Ju Pi (Aged Tangerine Peel), cut into sizes of hemp or mustard seeds. Take one or two doses, and chest and diaphragm will feel comfortable. Zhishi Lizhong Wan (Immature Bitter Orange Regulate the Middle Pill) and Wuji San (Five Accumulations Powder) are especially good.
Hu notes: The above discussion actually expounds on the principles not fully expressed by Zhang Zhongjing. It states that chest and diaphragm discomfort and fullness/obstruction resemble food stagnation syndrome, but also recognizes that the person's stomach qi is originally deficient, and the middle jiao lacks fire, leading to undigested food. Verifying the lack of luster in facial complexion and lips, cold hands and feet, deep and fine pulse, and low spirit, it is undoubtedly a deficiency-cold syndrome. It also states "not due to sexual indulgence," meaning one does not need to engage in sexual activity to have a yin syndrome. Thus, Zhu Danxi arose saying: Treatment of cold strike mainly involves warming and dispersing. There are cases of sudden exposure to heaven and earth wind-cold, and cases of ingesting cold substances. I believe if stomach qi is severely deficient, Lizhong Tang is appropriate. If stomach qi is severely cold but not deficient, Zhishi Lizhong Wan is used. However, the inclusion of Ren Shen and Bai Zhu requires careful consideration.