中寒者。寒邪不从阳经传入。直中阴经。故曰中寒。其症有轻有重。重者。脉来沉微。一息三至。腹痛唇青。
四肢厥冷。此因先有房事。胃气衰微。口食寒物。鼻吸冷气。中宫不能担当。直入少阴肾脏。气
冷而血不流。顷刻死矣。治是症者。只以回阳为主。虽有他症。不必兼治。宜用附子理中汤。大剂救之。
此症有兼自利。无脉者。生气已绝。似不可治。然寒极则伏。生机尚存一线。当以前药浸冷与之。一周时许。
自然脉出而解。盖厥利无脉。阴盛格阳。热药入口。格绝而不入。惟以前药冷服。直达病所。自无格拒之患。
内经所谓。寒因寒用者是也。但脉出之时。又要徐徐浮大。不宜暴出。暴出则气从外
脱。非其所宜。故仲景云。微续者生。暴出者死。旨哉言乎。又云。下利清谷。里寒外热。面赤烦躁。其脉即
出者愈。似与前说相背。不知前症无热。故脉不宜暴出。此症热浮于外。全要脉之速出。阳通于阴。豁然解矣。
阴症如此变幻。奈何不体古训。执一方以司人命耶。最可笑者。庸工动用吴萸。以为其性大热。可以回阳。
不知吴萸气热而味大辛。辛能散气。阳未回而气已脱。较之挺刃杀人。特一间耳。至若舌卷囊缩。自汗多出。断致不起。
里寒阴症。古言之矣。又有非时暴寒。从口鼻而入。或食生冷凉物。以致呕
吐痰水。微寒微热。甚则昏晕不醒。二便皆遗。亦名中寒。诸家未之详也。盖
里寒阴症。先因欲事伤肾。先天命门真火。不可守邪。故令外邪斩关而入。
此则胃气虚衰。不能胜寒。命门全然无恙。故可一温而愈。脉虽沉细。一息四至。与前之三至者不同。宜用
香砂六君子汤。少加炮姜为妙。切不可兼用辛散之药。患是症者。又有轻重。轻者。脉来洪缓。按
之无力。寒为标而热为本。先用香砂六君子汤。止其吐逆。后以杏仁玄明粉。加入柴陈剂中。无
不获痊。重者。脉沉细缓。香砂六君子为丸。久服桂附八味丸。亦不可少也。
（按辛能散气吴萸味辛故不可妄用以及寒为标热为本始用香砂六君子汤以止呕逆继用杏仁明粉加
柴陈之治皆历练见道之言尤宜三复勿失）
附子理中汤
人参 白术 炮姜 甘草 肉桂 附子 黄
桂附炮姜。俱为热药。但炮姜温肺之功居多。肉桂温脾之功居多。附子温肾之功居多。里寒症重。故三味合用
也。有汗宜加五味。自利宜加茯苓。更加丹参为妙。以其活血故也。
灸法
用葱一大把。以带轻束。切去两头。留白二寸。以一面熨热置于脐上。用
熨斗盛炭火葱上熨之。取其热气从脐入腹。甚者连熨二三饼。
香砂六君子汤
陈皮 半夏 白茯 甘草 白术 人参 香附 砂仁 藿香 炮姜
中寒多有胸中不宽。宜加浓朴。若滞重者。宜去参术（按随机应变智者之能事岂可执一以误人哉）
中寒，是指寒邪不经过阳经传入，而是直接侵入阴经。因此称为“中寒”。其症状有轻有重。重症表现为：脉象沉而微弱，一呼一吸之间脉搏仅跳动三次；腹痛，嘴唇发青，四肢冰冷。这通常是因为此前有过房事，导致胃气衰微，又食用了寒凉食物或吸入冷气，中焦脾胃无法承受，寒气直入少阴肾经。由于寒气导致气血凝滞不通，患者可能在短时间内死亡。治疗此类病症，应以回阳救逆为主。即使伴有其他症状，也不必兼顾治疗。适宜使用附子理中汤，大剂量服用以挽救生命。
这种病症如果兼有自发性腹泻且无脉象，说明生机已绝，似乎不可救治。然而，极寒之时脉象可能伏匿不见，但生机尚存一线希望。应当将上述药物放冷后给患者服用。大约一周时（此处原文可能有误，通常指片刻或短时间，依文意理解为服药后一段时间）后，脉象自然会恢复而出，病情得以缓解。这是因为厥逆、下利且无脉，属于阴盛格阳之证。若热药入口，会被格拒而无法进入体内。只有将热药冷服，才能直达病所，避免格拒之患。这正是《内经》所说的“寒因寒用”的道理。但是，当脉象出现时，应当是逐渐浮大，不宜突然暴出。如果突然暴出，会导致阳气从体表脱失，这是不适宜的。所以张仲景说：“脉象微微续接者生，突然暴出者死。”这话真是精辟啊。他又说：“下利完谷不化，里有寒而外有热，面色赤红烦躁，如果脉象随即出现则预后良好。”这似乎与前一种说法相矛盾。不知道前一种情况没有外热，所以脉象不宜突然暴出；而这一种情况热气浮越于外，全赖脉象迅速出现，使阳气通达于阴分，从而豁然痊愈。阴症的变幻如此之多，为何不体察古人的训诫，固执地用一方来掌管人命呢？最可笑的是，庸医动辄使用吴茱萸，认为其性大热可以回阳。却不知道吴茱萸气热味大辛，辛能散气，在阳气未回之前，元气已经耗散，这与用刀杀人相比，只不过是一步之遥罢了。至于出现舌卷缩、囊缩、自汗过多等症状，必定导致死亡。
除了里寒阴症，古人已有论述外，还有非季节性的暴寒，从口鼻侵入，或者食用生冷凉物，导致呕吐痰水，轻微恶寒发热，严重时昏晕不醒，大小便失禁，这也称为中寒。各家医书对此记载不详。这是因为里寒阴症，先因房事损伤肾脏，先天命门的真火不足，不能抵御邪气，所以外邪长驱直入。而这种情况则是胃气虚衰，不能胜寒，但命门根本完好无损，所以只需温补即可痊愈。脉象虽然沉细，但一息四至，与前述的一息三至不同。适宜使用香砂六君子汤，稍加炮姜效果更佳。切不可兼用辛散的药物。患此症的患者又有轻重之分。轻症，脉象洪大而缓，按之无力，这是寒为标象而热为本源。先用香砂六君子汤止住呕吐逆气，随后在柴胡和陈皮的方剂中加入杏仁和玄明粉，无不痊愈。重症，脉象沉细而缓，可将香砂六君子汤制成丸药长期服用，并久服桂附八味丸，这也是必不可少的。
（按语：辛味能散气，吴茱萸味辛，故不可妄用；以及寒为标、热为本，始用香砂六君子汤以止呕逆，继用杏仁、玄明粉加入柴陈类方剂治疗，这些都是经过历练、悟道之言，尤其应该反复体会，不要丢失。）
附子理中汤
人参、白术、炮姜、甘草、肉桂、附子、黄（此处原文似有缺漏或排版错误，通常附子理中汤不含黄，或指黄芪/黄连等，依原文列出）。
桂枝、附子、炮姜均为热药。但炮姜温肺的功效居多，肉桂温脾的功效居多，附子温肾的功效居多。里寒重症，所以这三味药合用。如果有汗，宜加五味子；若有自利，宜加茯苓；再加丹参更为巧妙，因为它具有活血的作用。
灸法
用一大把葱，轻轻捆扎，切去两头，保留中间白色部分二寸长。将一面熨热后置于脐上，用熨斗盛炭火在葱上熨烫。取其热气从脐部进入腹部。病情严重者，连续熨烫两三块葱饼。
香砂六君子汤
陈皮、半夏、白茯苓、甘草、白术、人参、香附、砂仁、藿香、炮姜。
中寒多有胸中不畅的感觉，宜加厚朴。如果积滞严重，应去掉人参和白术。（按语：随机应变是智者的能力，岂可固执一端而误人？）
Zhonghan (Direct Invasion of Cold) refers to a condition where the cold pathogen does not transmit through the Yang meridians but directly invades the Yin meridians. Hence, it is called "Zhonghan." Its symptoms vary in severity. In severe cases, the pulse is deep and faint, beating only three times per respiratory cycle; there is abdominal pain, cyanosis of the lips, and coldness of the four limbs. This is often due to prior sexual activity leading to a decline in Stomach Qi, followed by the consumption of cold foods or inhalation of cold air. The Middle Jiao (Spleen and Stomach) cannot withstand the cold, allowing the pathogen to directly enter the Shaoyin Kidney Meridian. The cold causes Qi stagnation and blood stasis, potentially leading to death within moments. Treatment for this condition should focus primarily on restoring Yang and rescuing from collapse. Even if other symptoms are present, they need not be treated simultaneously. It is appropriate to use Fuzi Lizhong Tang (Aconite Decoction for Regulating the Middle) in a large dose to save life.
If this condition is accompanied by spontaneous diarrhea and an absent pulse, it indicates that the vital energy has been severed, and it seems untreatable. However, when cold is extreme, the pulse may become hidden, yet a thread of vitality remains. The aforementioned medicine should be cooled and administered to the patient. After approximately one week (note: likely a textual error for a shorter duration), the pulse will naturally emerge, and the condition will resolve. This is because in cases of Jue (cold extremities), Li (diarrhea), and absent pulse, Yin excess repels Yang. If hot medicine is taken orally, it may be rejected and fail to enter the body. Only by taking the hot medicine cold can it reach the disease site directly, avoiding rejection. This aligns with the principle stated in the *Neijing*: "Treating cold with cold" (Han yin han yong). However, when the pulse emerges, it should gradually become floating and large, not suddenly burst forth. A sudden emergence would cause Qi to escape from the exterior, which is inadvisable. Therefore, Zhang Zhongjing said: "If the pulse slowly continues, there is life; if it bursts forth suddenly, there is death." These words are profound. He also stated: "In cases of diarrhea with undigested food, interior cold with exterior heat, red face, and restlessness, if the pulse appears quickly, the prognosis is good." This seems contradictory to the previous statement. The difference lies in the fact that the former case lacks exterior heat, so the pulse should not emerge suddenly; whereas in this case, heat floats on the exterior, relying on the rapid emergence of the pulse to allow Yang to communicate with Yin, resulting in resolution. Yin syndromes are so variable; why not observe ancient teachings and avoid treating lives with a single rigid formula? Most laughably, incompetent physicians often use Wu Zhu Yu (Evodiae Fructus), believing its great heat can restore Yang. They do not realize that Wu Zhu Yu is hot in nature and pungent in flavor; pungency disperses Qi, causing Qi depletion before Yang is restored. This is akin to killing someone with a sword, differing only in degree. Symptoms such as tongue retraction, scrotal retraction, and profuse sweating inevitably lead to death.
Besides the interior cold Yin syndrome discussed by ancients, there is also sudden cold occurring out of season, entering through the mouth and nose, or caused by eating raw/cold foods, leading to vomiting of phlegm-water, slight aversion to cold and fever, and in severe cases, unconsciousness and incontinence of urine and feces. This is also named Zhonghan, yet detailed records are lacking in various texts. This is because interior cold Yin syndrome first results from kidney damage due to sexual indulgence, where the true fire of the Mingmen (Gate of Life) is insufficient to resist pathogens, allowing external evil to enter unimpeded. In contrast, this condition arises from deficient and declining Stomach Qi unable to overcome cold, while the Mingmen remains intact. Thus, it can be cured with a single warming treatment. Although the pulse is deep and fine, it beats four times per respiratory cycle, differing from the three beats mentioned earlier. Xiangsha Liujunzi Tang (Costus and Amomum Six Gentlemen Decoction) is suitable, preferably with added Pao Jiang (Prepared Ginger). Pungent-dispersing herbs must strictly be avoided. Patients with this condition have varying severities. In mild cases, the pulse is surging and slow, weak upon pressure; here, cold is the manifestation (Biao) and heat is the root (Ben). First, use Xiangsha Liujunzi Tang to stop vomiting and regurgitation, then add Xing Ren (Apricot Seed) and Xuanming Fen (Nitratum) to a Chaihu and Chenpi-based formula, which invariably leads to recovery. In severe cases, the pulse is deep, fine, and slow; Xiangsha Liujunzi Tang can be made into pills for long-term use, combined with Gui Fu Bawei Wan (Cinnamon Twig and Aconite Eight-Ingredient Pill), which is indispensable.
(Note: Pungent flavors disperse Qi; since Wu Zhu Yu is pungent, it should not be used recklessly. Regarding using Xiangsha Liujunzi Tang first to stop vomiting when cold is the branch and heat is the root, followed by adding Xing Ren and Xuanming Fen to Chai-Chen formulas, these are insights gained from experience and enlightenment. They should be repeatedly studied and preserved.)
Fuzi Lizhong Tang (Aconite Decoction for Regulating the Middle)
Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Paojiang (Zingiberis Rhizoma Preparatum), Gancao (Glycyrrhizae Radix et Rhizoma), Rougui (Cinnamomi Cortex), Fuzi (Aconiti Lateralis Radix Praeparata), Huang (Herba/Astragali Radix - *Note: Text implies Huang, likely Astragalus or a typo*).
Guizhi (Cinnamomi Ramulus), Fuzi, and Paojiang are all hot herbs. However, Paojiang mostly warms the Lung, Rougui mostly warms the Spleen, and Fuzi mostly warms the Kidney. For severe interior cold, these three are combined. If sweating is present, add Wuweizi (Schisandrae Fructus); if spontaneous diarrhea occurs, add Fuling (Poria); adding Danshen (Salviae Miltiorrhizae Radix et Rhizoma) is excellent due to its blood-invigorating properties.
Moxibustion Method
Take a large bunch of Congbai (Allii Fistulosi Bulbus), tie it lightly, cut off both ends, leaving two cun of the white part. Heat one side and place it on the navel. Use a moxibustion iron filled with charcoal fire to press-heat the onion. This directs the warm qi from the navel into the abdomen. For severe cases, continue pressing with two or three onion cakes.
Xiangsha Liujunzi Tang (Costus and Amomum Six Gentlemen Decoction)
Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Bai Fu Ling (Poria cum Risu), Gancao, Baizhu, Renshen, Xiangfu (Cyperi Rhizoma), Sharen (Amomi Fructus), Huoxiang (Agastaches Herba), Paojiang.
Zhonghan often involves chest fullness; Houpo (Magnoliae Officinalis Cortex) should be added. If stagnation is heavy, remove Renshen and Baizhu. (Note: Adapting to changes is the skill of the wise; how can one adhere rigidly to one method and harm people?)