治四时之气。寒疫时气。山岚瘴气。两湿 气。或中寒腹痛吐利。中暑冒风吐泻。中湿身重泄泻。或不伏水土。脾
胃不和。或饮食停滞。复感外寒。头痛增寒。或呕逆恶心。胸膈痞闷或发寒热无汗者。
藿香（上） 白术（中。发汗。用苍术。） 浓朴 陈皮 半夏（俱中。呕吐倍用。口渴去之。） 白茯苓 白芷 桔
梗大腹皮（俱中。内虚去之） 紫苏（发汗为君。自汗少用。） 甘草（下。呕吐去之。）
水二钟。姜五片。煎一钟。通口徐徐服。以衣被温覆取汗。腹中寒痛。佐官桂。冷甚。加干姜。名正气温中汤。饮
食不化。加香附砂仁。名香砂正气散。心下痞。加枳实青皮。名正气宽中汤。
琥按上方。乃脾胃停冷。兼感风寒之剂。非中寒正治之要药也。
又云。阴证似阳者。乃水极似火也。盖伤寒传变。或误服凉药。攻热太速。其人素本肾气虚寒。遂变阴证。冷甚于
内。逼其浮阳之火。发于外。其人面赤烦躁。身有微热。渴欲饮水。复不能饮。大便阴结不通。小水淡黄。或呕逆。或
气促。或郑声。或咽喉痛。所以状似阳证。或者不识。见面赤烦渴。大便秘结。认作阳证。妄投寒凉之药。下咽遂毙。
可不谨哉。切其脉沉细迟微者。急以通脉四逆汤。倍加人参附子。以接其真阳之气。为紧要之治也。设或差迟。遂至阴
盛阳衰。参附亦不能救之。此与阴盛格阳例同。王太仆所谓身热脉数。按之不鼓击者。此名阴盛格阳。非热也。东垣又
谓之面赤目赤。烦渴引饮。脉来七八至。按之则散者。此无根之脉。用姜附汤。加人参治之而愈。此阴阳幽显之奥。水
火征兆之微。学人当求内经之旨。则造化之理。可得而明矣。
琥按阴证似阳。乃直中三阴者居多。上论但云伤寒传变或攻热太速所致其言犹未尽然。
广笔记云。若从无阳邪表证。从不头疼发热。寒邪直中阴经。此必元气素虚之人。或在极北高寒之地。始有是证。
法宜温补以接其阳。附子人参干姜官桂。大剂与之。阳回寒退。即以平补之剂调之。勿过用桂附。以防其毒。
琥按上论。乃知极北高寒之地。始有真中寒证。东南之人。病中寒。皆由元气素虚。内伤生冷。或系过服凉药所致。
此即东垣所云。内伤极多。外伤间而有之。诚确论也。
仲景原论中三阴寒证。但云心烦而渴。咽痛干呕。面色赤。反发热。欲去衣被。无汗而烦。喉痹。便脓血。下利。
腹胀满。及小腹满。按之痛。其人躁。无暂安时。全似阳热之证。此为医人所知。至于发斑发黄。舌黑便闭。恐无所谓
阴证者。曾考海藏阴证略例。又证治准绳。及薛氏医按外伤金镜图方。乃知真寒阴证。反见阳热之形。虽病者百不一遇。
要之昔贤所着方论。皆以传信。必非虚语。后之学人。可不临证细详之乎。
阴证略例云。阴证发斑。亦出胸背。又出手足。但稀少而微红。此人元气素虚。或先因欲事。内损肾气。或误服凉
药大过。遂成阴证。伏寒于下。逼其无根失守之火。聚于胸中。上独熏肺。传于皮肤。而为斑点。但如蚊蚋蚤虱所咬形
状。而非锦文也。与调中汤温胃。加以茴香炒芍药主之。寒甚脉微者。以大建中之类。其火自下。斑自退。可谓治本而
不治标也。
治疗四季的邪气。寒疫时行邪气。山林间的瘴气。内外两感之湿气。或者感受寒邪导致腹痛、呕吐、腹泻。中暑受风导致的呕吐、泄泻。中湿导致身体沉重、泄泻。或者水土不服。脾胃不和。或者饮食停滞，又外感寒邪。头痛加重恶寒。或者呕吐逆气、恶心。胸膈部痞塞闷胀，或者出现寒热往来、无汗的情况。
藿香（上焦药） 白术（中焦药。若要发汗，应用苍术。） 厚朴 陈皮 半夏（均属中焦药。呕吐者加倍使用。若口渴则去掉。） 白茯苓 白芷 桔梗 大腹皮（均属中焦药。内虚者去掉） 紫苏（发汗为主药。自汗者少用。） 甘草（下焦药。呕吐者去掉。）
用水二钟，生姜五片，煎煮至一钟。缓缓通口服下。用衣被温暖覆盖以取汗。腹部有寒痛者，佐以官桂。寒冷严重者，加干姜，名为正气温中汤。饮食不消化者，加香附、砂仁，名为香砂正气散。心下部痞塞者，加枳实、青皮，名为正气宽中汤。
琥按：上述方剂，是治疗脾胃停聚冷邪，兼感风寒的药剂，并非治疗中寒证的正治要药。
又说：阴证似阳证，是水极而似火的表现。大概伤寒传变过程中，或者误服凉药，清热太急。其人原本肾气虚寒，于是变为阴证。内部寒冷至极，逼迫浮越在外的阳气之火发散于体表。其人面部发红、烦躁，身体有轻微发热，想喝水却又喝不下。大便阴结不通，小便淡黄。或者呕吐逆气。或者气促。或者语言重复（郑声）。或者咽喉痛。所以症状看起来像阳证。有些人不认识这种情况，见到面红烦渴、大便秘结，就认定为阳证，妄投寒凉药物，咽下后随即死亡。能不谨慎吗？切其脉象沉细迟微的，紧急使用通脉四逆汤，倍加人参、附子，以接续其真阳之气，这是紧要的治疗手段。如果稍有差迟，就会导致阴盛阳衰，即使用人参、附子也不能挽救了。这与阴盛格阳的例子相同。王太仆所说的身热脉数，但按之无力鼓动的，这名叫阴盛格阳，并不是热证。李东垣又称之为面赤目赤，烦渴引饮，脉搏来去急促（七八至），但按之则散的，这是无根之脉，用姜附汤加人参治疗而痊愈。这是阴阳幽显的奥妙，水火征兆的细微之处，学医的人应当探求《内经》的宗旨，那么造化的道理，就可以明白了。
琥按：阴证似阳证，大多是直中三阴经所致。上面的论述只说伤寒传变或攻热太速所致，其言论还不够详尽。
广笔记云：如果从无阳邪表证，从不头疼发热，寒邪直中阴经，这必定是元气素来虚弱的人，或者在极北高寒之地，才会有这种证候。治法适宜温补以接续阳气。附子、人参、干姜、官桂，大剂量给予。阳气回复、寒邪退去后，即用平补的药剂调理。不要过度使用桂枝、附子，以防其毒性。
琥按：从上述论述可知，只有在极北高寒之地，才有真正的中寒证。东南地区的人，患中寒病，都是由元气素来虚弱，内伤生冷，或者是过服凉药所导致的。这就是李东垣所说的：内伤极多，外伤间或有之。确实是确切的论断。
张仲景原论中的三阴寒证，只说心烦而渴，咽痛干呕，面色赤，反发热，想要脱去衣被，无汗而烦躁，喉痹，便脓血，下利，腹胀满，以及小腹满，按之疼痛。其人躁动，没有片刻安宁的时候，完全像阳热之证。这是医生们所知道的。至于发斑发黄，舌黑便闭，恐怕没有所谓的阴证吧。我曾考证海藏的《阴证略例》，又参考《证治准绳》，以及薛氏医案《外伤金镜图方》，才知道真正的寒性阴证，反而出现阳热的形态。虽然病人百中难遇一例，但总之是先贤所著的方论，都是用来传递可信信息的，必定不是虚语。后来的学医者，能不临证仔细详查吗？
《阴证略例》云：阴证发斑，也出现在胸背，又出现在手足。只是稀少且颜色微红。这种人元气素来虚弱，或者先前因为房事，内损肾气，或者误服凉药太过，于是成为阴证。伏寒在下，逼迫那无根失守的火气，聚集于胸中，向上独熏肺脏，传导到皮肤，而形成斑点。形状只是像蚊子、苍蝇、跳蚤、虱子叮咬的样子，而不是锦纹状。用调中汤温胃，加上炒过的茴香、芍药主治。寒冷严重、脉微弱的，用大建中汤之类的方剂。火气从下退去，斑点自然消退。可以说是治本而不治标。
Treats the pathogenic factors of the four seasons. Cold epidemic seasonal pathogens, miasma in mountainous areas, dampness affecting both interior and exterior. Or cold invasion causing abdominal pain, vomiting, and diarrhea; heatstroke with wind invasion causing vomiting and diarrhea; dampness invasion causing heavy body and diarrhea; or acclimatization issues, spleen and stomach disharmony, or food stagnation compounded by external cold invasion. Headache with worsening aversion to cold, or retching, nausea, chest and diaphragm fullness and oppression, or alternating chills and fever without sweating.
Huoxiang (Upper Jiao herb) Baizhu (Middle Jiao herb. For inducing sweating, use Cangzhu.) Houpo Chenpi Banxia (All Middle Jiao herbs. Double the dose for vomiting. Remove if thirsty.) Bai Fuling Baizhi Jiegeng Dafupi (All Middle Jiao herbs. Remove if there is internal deficiency.) Zisu (Principal herb for inducing sweating. Use sparingly if spontaneous sweating occurs.) Gancao (Lower Jiao herb. Remove if vomiting.)
Add two zhong of water and five slices of ginger. Decoct to one zhong. Take slowly through the mouth. Cover warmly with blankets to induce sweating. For cold abdominal pain, add Guigui. For severe cold, add Ganjiang, named Zhengqi Wenzhong Tang. For indigestion, add Xiangfu and Sharen, named Xiangsha Zhengqi San. For epigastric fullness, add Zhishi and Qingpi, named Zhengqi Kuanzhong Tang.
Hu notes: The above formula treats cold retention in the spleen and stomach combined with wind-cold invasion. It is not the primary remedy for direct cold invasion (Zhonghan).
It is also said: Yin syndrome resembling Yang syndrome is when water extreme resembles fire. Generally, during the transmission of Shanghan (Cold Damage), or due to mistaken administration of cooling medicines that clear heat too rapidly, if the person originally has deficient and cold kidney qi, it transforms into a Yin syndrome. Internal cold becomes extreme, forcing floating yang fire to manifest externally. The patient presents with facial redness, irritability, slight body heat, desire to drink but inability to swallow, yin constipation (dry stool), pale yellow urine, retching, shortness of breath, delirious speech (Zhengsheng), or sore throat. Thus, symptoms resemble Yang syndrome. Some, failing to recognize this, see facial redness, irritability, thirst, and constipation, misdiagnose it as Yang syndrome, and recklessly administer cold-natured medicines, leading to death upon ingestion. How can one not be cautious? If the pulse is deep, fine, slow, and faint, urgently administer Tongmai Sini Tang, doubling the dosage of Renshen and Fuzi to reconnect the true yang qi. This is a critical treatment. If delayed even slightly, yin excess and yang decline will ensue, and even Renshen and Fuzi cannot save the patient. This is analogous to Yin excess repelling Yang. Wang Taipu stated that body heat with a rapid pulse that does not throb under pressure is named Yin excess repelling Yang, which is not heat. Li Dongyuan called it facial and ocular redness, irritability and thirst with drinking, a pulse coming and going rapidly (7-8 beats per breath) but scattering under pressure, which is a rootless pulse. Treat with Jiang Fu Tang plus Renshen for recovery. This involves the profound mystery of yin and yang, and the subtle signs of water and fire. Students should seek the principles of the Neijing, so that the laws of creation may be understood.
Hu notes: Yin syndrome resembling Yang syndrome mostly results from direct invasion of the Three Yin meridians. The previous discussion only mentioned transmission of Shanghan or excessive clearing of heat, which is incomplete.
Guang Biji states: If there are no exterior syndromes of yang pathogens, no headache or fever, and cold pathogens directly invade the yin meridians, this must occur in persons with constitutionally deficient yuan qi, or in extremely northern, high-cold regions. The method should be warming and tonifying to restore yang. Use large doses of Fuzi, Renshen, Ganjiang, and Guigui. Once yang returns and cold retreats, regulate with mild tonifying agents. Do not overuse Guizhi and Fuzi to prevent toxicity.
Hu notes: From the above discussion, we know that true cold invasion (Zhen Zhonghan) occurs only in extremely northern, high-cold regions. In southeastern people, cold invasion diseases arise from constitutionally deficient yuan qi, internal injury from raw/cold foods, or excessive intake of cooling medicines. This aligns with Li Dongyuan’s statement: "Internal injuries are very common; external injuries occur occasionally." This is indeed an accurate argument.
In Zhang Zhongjing’s original treatise on Three Yin cold syndromes, it mentions irritability and thirst, sore throat, dry retching, red face, contrary fever, desire to remove clothing/blankets, restlessness without sweat, bi-throat obstruction, pus and blood in stool, diarrhea, abdominal distension, lower abdominal fullness painful to touch, agitation with no moment of rest, completely resembling Yang heat syndromes. These are known to physicians. Regarding macules, jaundice, black tongue, and constipation, one might doubt if they constitute Yin syndromes. I have examined Haicang’s *Yin Zheng Lue Li*, *Zheng Zhi Zhun Sheng*, and Xue’s medical records *Wai Shang Jin Jing Tu Fang*. I learned that true cold Yin syndromes can present with Yang heat manifestations. Although rare (one in a hundred), the formulas and theories of past sages are reliable and not false words. Should later students not examine carefully at the bedside?
*Yin Zheng Lue Li* states: Yin syndrome macules also appear on the chest and back, and hands and feet. They are sparse and slightly red. This person has constitutionally deficient yuan qi, or prior sexual excess damaging kidney qi, or excessive mistaken use of cooling medicines, resulting in Yin syndrome. Cold pathogens hide below, forcing rootless and unanchored fire to gather in the chest, steaming the lungs upward, transmitting to the skin, forming spots. The shape resembles bites from mosquitoes, flies, fleas, or lice, not brocade patterns. Treat with Tiaozhong Tang to warm the stomach, adding fried Huixiang and Shaoyao. For severe cold and faint pulse, use Da Jianzhong Tang class. As the fire recedes from below, the macules fade. This is treating the root rather than the branch.