朱砂（五钱，另研水飞为衣） 甘草（五钱五分） 黄连（去须净，酒洗，六钱） 当归（去芦，
二钱五分） 生地黄（一钱五分）
《内经》曰∶热淫所胜，治以甘寒，以苦泻之。以黄连之苦寒，去心烦，除湿热为君。以甘
草、生地黄之甘寒，泻火补气，滋生阴血为臣。以当归补其血不足。朱砂纳浮溜之火，而安神明也。
上件除朱砂外，四味共为细末，汤浸蒸饼为丸，如黍米大，以朱砂为衣。每服十五丸或二十丸，
津唾咽下，食后，或温水、凉水少许送下亦得。此近而奇偶，制之缓也。
《内经》曰∶胃为水谷之海。又云∶肠胃为市，无物不包，无物不入，寒热温凉皆有之。其为
病也不一，故随时证于补中益气汤中，权立四时加
减法于后。
以手扪之而肌表热者，表证也。只服补中益气汤一二服，得微汗则已。非正发汗，乃阴阳气和，
自然汗出也。
若更烦乱，如腹中或周身有刺痛，皆血涩不足，加当归身（五分或一钱）。
如精神短少，加人参（五分），五味子二十个。
头痛加蔓荆子（三分），痛甚加川芎（五分）。
顶痛脑痛，加 本（五分），细辛（三分）。诸头痛，并用此四味足矣。
如头痛有痰，沉重懒倦者，乃太阴痰厥头痛，加半夏（五分），生姜（三分）。
耳鸣，目黄，颊颔肿，颈肩 肘臂外后廉痛，面赤，脉洪大者，以羌活（一钱），防风、 本（以上
各七分），甘草（五分），通其经血；加黄芩、黄连（以上各三分）消其肿；人参（五分），黄 （七分），
益元气而泻火邪。另作一服与之。
嗌痛颔肿，脉洪大，面赤者，加黄芩、甘草（以上各三分），桔梗（七分）。
口干咽干者，加葛根（五分），升引胃气上行以润之。
如夏月咳嗽者，加五味子（二十五个），麦门冬（去心五分）。
如冬月咳嗽，加不去根节麻黄（五分）。
如秋凉亦加。
如春月天温，只加佛耳草、款冬花（以上各五分）。
若久病痰嗽，肺中伏火，去人参，以防痰嗽增益耳。
食不下，乃胸中胃上有寒，或气涩滞，加青皮、木香（以上各三分），陈皮（五分）。此三味为定法。
如冬月，加益智仁，草豆蔻仁（以上各五分）。
如夏月，少加黄芩、黄连（以上各五分）。
如秋月，加槟榔、草豆蔻、白豆蔻、缩砂（以上各五分）。
如春初犹寒，少加辛热之剂，以补春气之不足，为风药之佐，益智、草豆蔻可也。
心下痞，夯闷者，加芍药、黄连（以上各一钱）。
如痞腹胀，加枳实、木香、缩砂仁（以上各三分），浓朴（七分）。如天寒，少加干姜或中桂（桂心也）。
心下痞，觉中寒，加附子、黄连（以上各一钱）。不能食而心下痞，加生姜、陈皮（以上各一钱）。
能食而心下痞，加黄连（五分），枳实（三分）。脉缓有痰而痞，加半夏、黄连（以上各一钱）。脉弦，
四肢满，便难而心下痞，加黄连（五分），柴胡（七分），甘草（三分）。
腹中痛者，加白芍药（五分），甘草（三分）。如恶寒觉冷痛，加中桂（五分）。
如夏月腹中痛，不恶寒，不恶热者，加黄芩、甘草（以上各五分），芍药（一钱），以治时热也。
腹痛在寒凉时，加半夏、益智、草豆蔻之类。
如腹中痛，恶寒而脉弦者，是木来克土也，小建中汤主之；盖芍药味酸，于土中泻木为君。如脉沉
细，腹中痛，是水来侮土，以理中汤主之；干姜辛热，于土中泻水，以为主也。如脉缓，体重节痛，腹
胀自利，米谷不化，是湿胜，以平胃散主之，苍术苦辛温，泻湿为主也。
胁下痛，或胁下缩急，俱加柴胡（三分，甚则五分），甘草（三分）。
脐下痛者，加真熟地黄（五分）；如不已者，乃大寒也，加肉桂（五分）。遍阅《内经》中悉言小腹
痛皆寒，非伤寒厥阴之证也，乃下焦血结膀胱，仲景以抵当汤并抵当丸主之。
小便遗失，肺金虚也，宜安卧养气，以黄 人参之类补之。不愈，则是有热也，黄柏、生地黄（以上各五分），
切禁劳役。如卧而多惊，小便淋溲者，邪在少阳厥阴，宜太阳经所加之药，更添柴胡（五分）；如淋，加泽
泻（五分）。此下焦风寒合病也。经云，肾肝之病同一治，为俱在下焦，非风药行经则不可，乃受客邪之湿
热也，宜升举发散以除之。
大便秘涩，加当归（一钱），大黄（酒洗煨，五分或一钱）。如有不大便者，煎成正药，先用清者一
口，调玄明粉（五分或一钱），如大便行则止。此病不宜大下之，必变凶证也。
脚膝痿软，行步乏力，或痛，乃肾肝伏热，少加黄柏（五分），空心服；不已，更加汉防己（五分）。脉
缓，显沉困怠惰无力者，加苍术、人参、泽泻、白术、茯苓、五味子（以上各五分）。
如风湿相搏，一身尽痛，以除风湿羌活汤主之。
朱砂（五钱，单独研磨，用水飞法作为药衣） 甘草（五钱五分） 黄连（去掉须根并洗净，用酒洗，六钱） 当归（去掉芦头，二钱五分） 生地黄（一钱五分）
《黄帝内经》说：热邪过盛，治疗应用甘寒之品，并用苦味药来泻热。以黄连的苦寒之性，去除心烦，清除湿热，作为君药。以甘草、生地黄的甘寒之性，泻火补气，滋生阴血，作为臣药。以当归补益血液的不足。朱砂能镇纳浮游之火，从而安定心神。
以上药材除朱砂外，其余四味共同研成细末，用汤水浸泡蒸饼制成丸药，大小如黍米，用朱砂粉末作为药衣。每次服用十五丸或二十丸，用唾液咽下，饭后服用；或者用少量温水、凉水送服也可以。这是“近而奇偶”（药物配伍接近且分奇偶），制方缓和的方法。
《黄帝内经》说：胃是水谷汇聚的海。又说：肠胃如同集市，无所不包，无所不入，寒、热、温、凉各种性质的食物都有。因此它们导致的疾病也不单一，所以要根据季节和证候在补中益气汤的基础上，权宜设立四季加减法如下。
用手触摸感觉肌肤表面发热的，是表证。只服用一二剂补中益气汤，得到微微出汗就好了。这不是正治的发汗法，而是阴阳之气调和，自然出汗的结果。
如果更加烦躁混乱，如腹部或全身有刺痛感，都是血行涩滞、血虚不足的表现，加当归身（五分或一钱）。
头顶痛、脑痛，加藁本（五分），细辛（三分）。各种类型的头痛，只用这四味药就足够了。
如果头痛伴有痰湿，感到沉重懒倦的，是太阴痰厥头痛，加半夏（五分），生姜（三分）。
耳鸣，目黄，脸颊和下颌肿胀，颈部、肩部、肘部、手臂外侧后缘疼痛，面色红赤，脉象洪大的，用羌活（一钱），防风、藁本（以上各七分），甘草（五分），来疏通经络气血；加黄芩、黄连（以上各三分）来消除肿胀；加人参（五分），黄芪（七分），来补益元气并泻火邪。另外煎煮一服药给患者服用。
咽喉疼痛，下颌肿胀，脉象洪大，面色红赤的，加黄芩、甘草（以上各三分），桔梗（七分）。
如果是夏季咳嗽的，加五味子（二十五个），麦门冬（去掉心，五分）。
如果是秋季凉爽时节也加上。
饮食不下，是胸中胃上有寒，或者是气机涩滞，加青皮、木香（以上各三分），陈皮（五分）。这三味药是固定的用法。
如果是初春仍然寒冷，少加辛热性质的药物，以补益春气的不足，作为风药的佐使，益智仁、草豆蔻可以。
如果痞塞导致腹胀，加枳实、木香、缩砂仁（以上各三分），厚朴（七分）。如果天气寒冷，少加干姜或肉桂（即桂心）。
心下部痞塞，感觉中间寒冷，加附子、黄连（以上各一钱）。不能进食且心下部痞塞，加生姜、陈皮（以上各一钱）。
能进食但心下部痞塞，加黄连（五分），枳实（三分）。脉缓且有痰湿导致痞塞，加半夏、黄连（以上各一钱）。脉弦，四肢胀满，大便困难且心下部痞塞，加黄连（五分），柴胡（七分），甘草（三分）。
腹部疼痛的，加白芍药（五分），甘草（三分）。如果怕冷且感觉冷痛，加肉桂（五分）。
如果是夏季腹部疼痛，不怕冷也不怕热的，加黄芩、甘草（以上各五分），芍药（一钱），用来治疗时令的热邪。
如果腹部疼痛，怕冷且脉象弦的，是肝木克制脾土，用小建中汤主治；因为芍药味酸，在土中泻木作为君药。如果脉象沉细，腹部疼痛，是水气反侮脾土，用理中汤主治；干姜辛热，在土中泻水，作为主药。如果脉象缓，身体沉重关节疼痛，腹胀自利，米粒不消化，是湿气胜，用平胃散主治，苍术苦辛温，以泻湿为主。
胁下疼痛，或者胁下收缩拘急，都加柴胡（三分，严重时五分），甘草（三分）。
脐下疼痛的，加真熟地黄（五分）；如果不好转，是大寒证，加肉桂（五分）。遍阅《黄帝内经》，其中都说小腹痛皆属寒，不是伤寒厥阴的证候，而是下焦血结于膀胱，张仲景用抵当汤和抵当丸主治。
小便失禁，是肺金虚弱，适宜安卧养气，用黄芪、人参之类的药物补益。如果不愈，那就是有热，用黄柏、生地黄（以上各五分），切忌劳累役作。如果睡觉多梦惊悸，小便淋漓不畅的，邪气在少阳、厥阴经，适宜使用太阳经所加的药剂，再添加柴胡（五分）；如果淋沥，加泽泻（五分）。这是下焦风寒合病。经书说，肾和肝的疾病治疗方法相同，因为它们都在下焦，不用风药疏通经络是不行的，这是受了客邪的湿热，应该升举发散来清除它。
大便秘结涩滞，加当归（一钱），大黄（酒洗后煨，五分或一钱）。如果有不大便的情况，煎好正药后，先用澄清的药液一口，调服玄明粉（五分或一钱），如果大便通畅就停止。此病不宜峻下，否则一定会变成凶险的证候。
脚膝痿软无力，行走乏力，或者疼痛，是肝肾有潜伏的热邪，少加黄柏（五分），空腹服用；如果不好转，再加汉防己（五分）。脉象缓，显现出沉困怠惰无力的，加苍术、人参、泽泻、白术、茯苓、五味子（以上各五分）。
Cinnabar (Wuqian, separately ground and water-washed for coating) Licorice Root (Wuqian wufen) Coptis Rhizome (Quxu jing, wine-washed, Liuqian) Angelica Sinensis Radix (Qu lu, Erqian wufen) Rehmannia Root (Yiqian wufen)
The *Neijing* states: "When heat is excessive, treat with sweet-cold substances, and use bitter flavors to drain it." Using the bitter-cold nature of Huanglian (Coptis Rhizome), it removes mental restlessness and drains damp-heat, serving as the Sovereign drug. Using the sweet-cold nature of Gancao (Licorice Root) and Shengdihuang (Rehmannia Root), they drain fire, tonify qi, and generate yin-blood, serving as the Minister drugs. Danggui (Angelica Sinensis Radix) tonifies blood deficiency. Zhusha (Cinnabar) anchors floating fire and calms the spirit.
Except for Zhusha (Cinnabar), the remaining four ingredients are ground into fine powder. They are mixed with a dough made from steamed leavened bread soaked in decoction to form pills the size of millet seeds, coated with Zhusha (Cinnabar) powder. Take fifteen or twenty pills per dose, swallowing with saliva after meals; alternatively, a small amount of warm or cool water may be used to wash them down. This represents a formulation that is "close yet odd-even" (balanced and moderate), employing a gentle method of preparation.
The *Neijing* states: "The Stomach is the sea of water and grain." It also says: "The intestines and stomach are like a market, containing and accepting everything, whether cold, hot, warm, or cool." Consequently, the diseases they cause vary. Therefore, based on seasonal conditions and syndromes, modifications to Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) are established as follows for the four seasons.
If palpation reveals heat on the skin surface, it is an exterior syndrome. Administer one or two doses of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); once slight sweating occurs, the condition resolves. This is not a proper diaphoretic treatment, but rather natural sweating resulting from the harmony of yin and yang.
If there is further agitation and confusion, such as stabbing pain in the abdomen or throughout the body, this indicates blood stasis and insufficiency. Add Danggui Shen (Body of Angelica Sinensis Radix) (Wufen or Yiqian).
If there is a shortage of spirit, add Renshen (Ginseng Radix et Rhizoma) (Wufen) and Wuweizi (Schisandrae Fructus) (twenty fruits).
For headache, add Manjingzi (Vitex Fruit) (Sanfen); if pain is severe, add Chuanxiong (Ligusticum Chuanxiong Rhizome) (Wufen).
For vertex headache or brain pain, add Gaoben (Ligusticum Jingwei Rhizome) (Wufen) and Xixin (Asari Radix et Rhizoma) (Sanfen). These four herbs suffice for all types of headaches.
If headache is accompanied by phlegm, heaviness, and lethargy, it is Taiyin Phlegm-Jue Headache. Add Banxia (Pinelliae Rhizoma) (Wufen) and Shengjiang (Zingiberis Rhizoma Recens) (Sanfen).
For tinnitus, yellow eyes, swelling of the cheeks and jaw, pain along the posterior-lateral aspect of the neck, shoulder, elbow, and arm, red face, and a洪大 (Hongda, surging and large) pulse, use Qianghuo (Notopterygii Rhizoma et Radix) (Yiqian), Fangfeng (Saposhnikoviae Radix) and Gaoben (Ligusticum Jingwei Rhizome) (each Qifen), Gancao (Licorice Root) (Wufen) to unblock the meridians and blood; add Huangqin (Scutellariae Radix) and Huanglian (Coptis Rhizome) (each Sanfen) to reduce swelling; add Renshen (Ginseng Radix et Rhizoma) (Wufen) and Huangqi (Astragali Radix) (Qifen) to benefit primordial qi and drain pathogenic fire. Prepare and administer a separate dose.
For sore throat and submandibular swelling, with a Hongda (surging and large) pulse and red face, add Huangqin (Scutellariae Radix) and Gancao (Licorice Root) (each Sanfen), and Jiegeng (Platycodonis Radix) (Qifen).
For dry mouth and throat, add Gegen (Puerariae Lobatae Radix) (Wufen) to ascend and guide Stomach qi upward to moisten.
In summer, if there is cough, add Wuweizi (Schisandrae Fructus) (twenty-five fruits) and Maimendong (Ophiopogonis Radix) (quxin Wufen).
In winter, if there is cough, add Mahuang (Ephedrae Herba) without removing root nodes (Wufen).
Add these in autumn when it is cool.
In spring when the weather is warm, only add Foercao (Petasitae Flos) and Kuandonghua (Farfarae Flos) (each Wufen).
For chronic cough with phlegm due to latent fire in the Lungs, remove Renshen (Ginseng Radix et Rhizoma) to prevent aggravating the phlegm-cough.
If food cannot be swallowed, it is due to cold in the chest and upper stomach, or qi stagnation. Add Qingpi (Citri Reticulatae Pericarpium Viride) and Muxiang (Vladimiriae Radix) (each Sanfen), and Chenpi (Citri Reticulatae Pericarpium) (Wufen). These three herbs constitute a fixed method.
In winter, add Yizhiren (Alpiniae Oxyphyllae Fructus) and Caodoukou Ren (Amomi Fructus) (each Wufen).
In summer, add a small amount of Huangqin (Scutellariae Radix) and Huanglian (Coptis Rhizome) (each Wufen).
In autumn, add Binglang (Arecae Semen), Caodoukou (Amomi Fructus), Baodoukou (Amomi Fructus), and Suosha (Amomi Fructus Rotundus) (each Wufen).
In early spring if still cold, add a small amount of acrid-warm agents to supplement the deficiency of spring qi, acting as assistants to wind-dispersing herbs; Yizhiren (Alpiniae Oxyphyllae Fructus) and Caodoukou (Amomi Fructus) are suitable.
If there is epigastric fullness and oppression, add Shaoyao (Paeoniae Radix Alba) and Huanglian (Coptis Rhizome) (each Yiqian).
If fullness leads to abdominal distension, add Zhishi (Aurantii Fructus Immaturus), Muxiang (Vladimiriae Radix), and Suosharen (Amomi Fructus Rotundus) (each Sanfen), and Houpo (Magnoliae Officinalis Cortex) (Qifen). If the weather is cold, add a small amount of Ganjiang (Zingiberis Rhizoma) or Zhonggui (Cinnamomi Cortex).
If there is epigastric fullness with a sensation of internal cold, add Fuzi (Aconiti Lateralis Radix Preparata) and Huanglian (Coptis Rhizome) (each Yiqian). If unable to eat with epigastric fullness, add Shengjiang (Zingiberis Rhizoma Recens) and Chenpi (Citri Reticulatae Pericarpium) (each Yiqian).
If able to eat but with epigastric fullness, add Huanglian (Coptis Rhizome) (Wufen) and Zhishi (Aurantii Fructus Immaturus) (Sanfen). If the pulse is slow with phlegm causing fullness, add Banxia (Pinelliae Rhizoma) and Huanglian (Coptis Rhizome) (each Yiqian). If the pulse is wiry, limbs are full, defecation is difficult, and there is epigastric fullness, add Huanglian (Coptis Rhizome) (Wufen), Chaihu (Bupleuri Radix) (Qifen), and Gancao (Licorice Root) (Sanfen).
If there is abdominal pain, add Baishaoyao (Paeoniae Radix Alba) (Wufen) and Gancao (Licorice Root) (Sanfen). If there is aversion to cold with cold pain, add Zhonggui (Cinnamomi Cortex) (Wufen).
In summer, if there is abdominal pain without aversion to cold or heat, add Huangqin (Scutellariae Radix) and Gancao (Licorice Root) (each Wufen), and Shaoyao (Paeoniae Radix Alba) (Yiqian) to treat seasonal heat.
During cold periods, if there is abdominal pain, add Banxia (Pinelliae Rhizoma), Yizhiren (Alpiniae Oxyphyllae Fructus), and Caodoukou (Amomi Fructus).
If there is abdominal pain, aversion to cold, and a wiry pulse, it is Wood overacting on Earth; treat with Xiaojianzhong Tang (Minor Construct the Middle Decoction); Shaoyao (Paeoniae Radix Alba) is sour and drains Wood within Earth, serving as the Sovereign. If the pulse is deep and fine with abdominal pain, it is Water insulting Earth; treat with Lizhong Tang (Regulate the Middle Decoction); Ganjiang (Zingiberis Rhizoma) is acrid-warm and drains Water within Earth, serving as the Principal. If the pulse is slow, body is heavy with joint pain, abdomen is distended with spontaneous diarrhea and undigested food, it is Dampness excess; treat with Pingwei San (Calm the Stomach Powder); Cangzhu (Atractylodis Rhizoma) is bitter, acrid, and warm, draining Dampness as the primary agent.
For hypochondriac pain or contraction/tightness in the hypochondrium, add Chaihu (Bupleuri Radix) (Sanfen, up to Wufen if severe) and Gancao (Licorice Root) (Sanfen).
For pain below the umbilicus, add Zhen Shudihuang (Prepared Rehmannia Root) (Wufen); if unresolved, it is Extreme Cold; add Rougui (Cinnamomi Cortex) (Wufen). The *Neijing* states that lower abdominal pain is always due to Cold, not a Jueyin syndrome of Cold Damage. It is Blood coagulation in the Bladder at the Lower Jiao; Zhang Zhongjing treats this with Didang Tang and Didang Wan.
Urinary incontinence indicates Lung Metal deficiency; rest and nourish Qi, tonifying with Huangqi (Astragali Radix) and Renshen (Ginseng Radix et Rhizoma). If unresolved, there is Heat; use Huangbai (Phellodendri Cortex) and Shengdihuang (Rehmannia Root) (each Wufen). Strictly avoid labor and exertion. If sleeping involves frequent startles and dribbling urine, the pathogen is in Shaoyang and Jueyin meridians; use formulas added for the Taiyang meridian, adding Chaihu (Bupleuri Radix) (Wufen); if dribbling, add Zexie (Alismatis Rhizoma) (Wufen). This is a combined syndrome of Wind-Cold in the Lower Jiao. The classics state that Kidney and Liver diseases share similar treatments because both are in the Lower Jiao; without wind-dispersing herbs to move the meridians, it is impossible to resolve, as this is damp-heat from exogenous pathogens. Use ascending and dispersing methods to eliminate it.
For constipation and difficulty in defecation, add Danggui (Angelica Sinensis Radix) (Yiqian) and Dahuang (Rhei Radix et Rhizoma) (wine-washed and roasted, Wufen or Yiqian). If there is no bowel movement, prepare the main decoction first. Take one mouthful of the clear liquid, mix with Xuanningfen (Mirabilite) (Wufen or Yiqian), and stop once stool passes. This condition should not be treated with harsh purgatives, as it will lead to ominous complications.
For weak and flaccid legs and knees, weakness in walking, or pain, it is latent heat in the Liver and Kidneys. Add a small amount of Huangbai (Phellodendri Cortex) (Wufen), taken on an empty stomach; if unresolved, add Hanfangji (Stephaniae Tetrandrae Radix) (Wufen). If the pulse is slow, indicating deep fatigue and lack of strength, add Cangzhu (Atractylodis Rhizoma), Renshen (Ginseng Radix et Rhizoma), Zexie (Alismatis Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), and Wuweizi (Schisandrae Fructus) (each Wufen).
If Wind-Dampness combats each other causing whole-body pain, treat with Chu Fengshi Qianghuo Tang (Remove Wind-Dampness and Notopterygium Decoction).