道光三年，家君年七十一岁。于三月初旬，右胁之旁生一疮疖，大约有二指长，不及一
寸，其痛时竟如刀刺。城中诸外科无不延而诊之，每敷药而痛更甚。端午后肌肉渐消，饮食
亦渐减，再后一月，日间只饮稀粥，多不过一、二茶钟。新秋以后病转剧，烦躁不宁，日夜
不得安枕，水米不能沾牙者十余日（HT ）不得已急备后事。忽于中秋夜半略醒（HT ）以米汤半杯饮之
，更见饱胀（HT ）思天下岂有半月绝谷之人，尚能生存之理，婉劝家君，每日强饮稀粥数匙。三
日后，每早晚可进一茶杯，精神甫定，即命（HT ）曰∶我数年所着之书尚未完备，即霍乱吐泻二
条，亦须重补。前三年患此病而死者十有八、九，其死为死于药。霍乱一证，今有无知辈以
“绞肠痧”疾食谷则死之实证，妄名为“干霍乱”，以伤寒霍乱证名为“湿霍乱”，两峰相
峙，其药互相通用，贻害岂止一、二人乎。命录仲景理中汤，孙真人治中汤，一以正群言之
失，亦以见古人立法之纯也。
治中汤
人参 干姜 白术 甘草（各三两
上四味， 咀，以水八升，煮取三升，分三服，不瘥，频服三剂。远行防霍乱，根据前
作
丸，如桐子大，服三十丸，如作散，服方寸匕，酒服亦得。若转筋者，加石膏三两，予恐石
膏味薄，再加三两，合前成六两（仲景云∶若脐上筑者，肾气动也，去术加桂心四两；吐多者
去术加生姜三两；下多者复用术；悸者加茯苓三两；渴欲饮水者，加术合前成四两半；腹中
痛者加人参，合前共四两半；若寒者，加干姜，合前共四两半；腹满者，去术加附子七枚。
服汤后一食顷，服热粥一升，微自温，勿发揭衣被。圣训煌煌不忌粥也。）
张路玉曰∶“《经》云∶清气在阴，浊气在阳，荣气顺行，卫气逆行，清浊相干，乱于
肠胃，则为霍乱。”多由寒邪传入下焦，中焦饮食因之不知，是即形寒饮冷者，三焦伤也。
然质有阴阳偏胜，病有寒热乖暌，所以《伤寒论》首言热多欲饮水者五苓散，寒多不欲饮水
者理中丸。《千金》更名“治中”列之三焦。理是理寒热不和，治是治挥霍撩乱。总取干姜
之辛温，以鼓舞参术之健运，行甘草之纡缓，与五苓散中用桂之意不殊，虽寒热多少不同，
而温散之理则一。朱奉议加青橘二皮，以治饮食所伤，《千金》又增转筋一则，补《伤寒论
》之未备。举世知转筋用木瓜，专取酸收夏秋之湿热伤脾。此因清气在阴，而走肠胃，故用
干姜；浊气在阳，而扰筋脉，故用石膏，至于理中丸加减诸法，并宜确遵。观吐利止，而身
痛不休者，宜桂枝汤小和之，及四逆汤、通脉四逆汤、甘草泻心汤、附子粳米汤等方，端不
出《伤寒》、《金匮》厥气逆上诸治也。
臌胀证。因食积而起者，宜胃苓汤加半夏、干姜、五谷虫、木瓜，以麦芽打糊为丸，陈
米汤送下三钱。因热而起者，亦用前丸加黄连为佐，此皆实证易治也。惟有虚证，必用圣术
煎加附子，守服四、五十剂方效，即单腹胀亦不外此法。更有因于吐酸而起者，宜理中加黄
连名连理丸，以刚药变胃，不受胃变，此喻嘉言秘法也。心下结聚如盘者，宜桂枝汤去芍药
，加麻黄、附子、细辛，日服二剂，夜服一剂，取微汗，令大气一转，其结乃散，即以枳术
汤，苦以泄其满，此仲景圣法也。此病属寒者多，故列于寒证。
（经义）《腹中论》曰∶“有病心腹满，旦食则不能暮食，名为鼓胀，治之以鸡矢醴，一剂
知二剂已。”《水胀篇》∶“帝曰∶鼓胀何如。岐伯曰∶腹胀身皆大，大与肤胀等也，色苍
黄，腹筋起，此其候也。”《阴阳应象大论》曰∶“浊气则上，则生腹胀。”《经脉篇》
曰
∶“足太阴虚则鼓胀，胃中寒则胀满。”《本神篇》曰∶“脾气实则腹胀，肾气实则胀。”
《至真要大论》曰∶“诸湿肿满，皆属于脾，诸腹胀大，皆属于热。”《太阴阳明论》曰∶
“食饮不节，起居不时，阴受之。阴受之则入五脏，入五脏则胀满闭塞。”《异法方宜论》
曰∶“北方者，其民乐野处而乳食，脏寒生满病。”按∶治此病，必以经旨为主，取用仲景
之方，方可全愈。唐以后各书，皆臆断驳杂，不可姑试。方书谓单腹胀为鼓胀，以如坚中空
，其象如鼓也，又名蛊胀，以血气结聚，不可解散，其毒如蛊也。
道光三年，家父七十一岁。在三月初旬，右侧胁部旁边长了一个疮疖，大约有两指长，不足一寸，疼痛剧烈时竟像刀刺一样。城里的各位外科医生都请去诊治，每次敷药后疼痛反而加剧。端午节后肌肉逐渐消瘦，饮食也逐渐减少，再过一个月，白天只喝稀粥，最多不过一两杯茶钟。立秋之后病情加重，烦躁不安，日夜无法安睡，有十多天连水和米都沾不到嘴（HT）。不得已急忙准备后事。忽然在中秋夜半稍微清醒（HT），喂他喝了半杯米汤，随即感到饱胀（HT）。心想天下哪有半个月不吃五谷的人还能存活的道理，便委婉劝慰家父，每天强行喂几匙稀粥。三天后，早晚各能进一茶杯，精神才安定下来，随即命令（HT）道：“我多年来著述的书尚未完备，其中关于霍乱吐泻两条，也必须重新补充。前三年患此病而死的有十之八九，他们的死是因为用药不当。霍乱这一病症，如今有无知之辈将‘绞肠痧’这种进食则死的实证，妄称为‘干霍乱’；将伤寒霍乱的证候名称称为‘湿霍乱’。两派观点对峙，药物互相通用，造成的危害岂止是一两个人呢。”于是命人记录张仲景的理中汤和孙思邈的治中汤，以此来纠正各种言论的错误，也以此展示古人立法的纯正。
治中汤
人参、干姜、白术、甘草（各三两）
以上四味药，切碎，用水八升，煮取三升，分三次服用。如果没好，频繁服用三剂。远行预防霍乱，按照前面的方法制作成丸药，如梧桐子大，每次服三十丸；如果做成散剂，每次服一方寸匕，用酒送服也可以。如果出现转筋（肌肉痉挛），加石膏三两，我担心石膏药力单薄，再加三两，与前药合共六两。（张仲景说：如果脐上跳动，是肾气发动，去掉白术，加桂心四两；呕吐多的，去掉白术，加生姜三两；腹泻多的，再用白术；心悸的，加茯苓三两；想喝水的，加白术与前药合共四两半；腹中痛的，加人参，与前药合共四两半；如果怕冷的，加干姜，与前药合共四两半；腹部胀满的，去掉白术，加附子七枚。服药后一顿饭的时间，喝热粥一升，保持微微温暖，不要掀开衣被。圣人的教诲光辉灿烂，并不忌讳喝粥。）
张路玉说：“《内经》说：清气在下，浊气在上，营气顺行，卫气逆行，清浊之气相互干扰，扰乱肠胃，就形成霍乱。”这多由寒邪传入下焦，导致中焦饮食不知消化，这就是形体受寒、饮食生冷损伤了三焦。然而体质有阴阳偏胜，疾病有寒热乖违，所以《伤寒论》首先提到热多欲饮水的用五苓散，寒多不欲饮水的用理中丸。《千金方》将其更名为“治中”，列在三焦篇中。“理”是调理寒热不和，“治”是治疗挥霍撩乱的症状。总体取干姜的辛温，来鼓舞人参、白术的健运作用，配合甘草的缓和，与五苓散中使用桂枝的意思没有不同，虽然寒热多少不同，但温散的道理是一致的。朱奉议加入青橘皮、陈皮，以治疗饮食所伤，《千金方》又增加了转筋一条，补足了《伤寒论》未完备之处。世人只知道转筋用木瓜，专门取其酸收夏秋湿热伤脾的特性。这是因为清气在下，走窜肠胃，所以用干姜；浊气在上，扰动筋脉，所以用石膏。至于理中丸加减的各种方法，都应当严格遵守。看到吐利停止，但身体疼痛不止的，宜用桂枝汤小剂量调和，以及四逆汤、通脉四逆汤、甘草泻心汤、附子粳米汤等方剂，这些都不超出《伤寒论》、《金匮要略》中厥气逆上的各种治法范围。
鼓胀证。因食积引起的，宜用胃苓汤加半夏、干姜、五谷虫、木瓜，以麦芽打糊为丸，陈米汤送服三钱。因热引起的，也用前面的丸药加黄连作为佐药，这些都是实证，容易治疗。唯有虚证，必须用圣术煎加附子，坚持服用四五十剂才见效，即使是单腹胀也不外乎这种方法。更有因为吐酸水引起的，宜用理中汤加黄连，名为连理丸，以刚药改变胃的状态，而不是让胃去适应药物，这是喻嘉言的秘法。心下结聚如盘状的，宜用桂枝汤去掉芍药，加麻黄、附子、细辛，每天服两剂，晚上服一剂，取微汗，使大气运转，结聚才能消散，随后即用枳术汤，用苦味药泄除胀满，这是张仲景的圣法。这种病属寒的多，所以列在寒证中。
（经义）《腹中论》说：“有病人心腹满，早上吃饭晚上就不能吃，名叫鼓胀，治疗用鸡矢醴，一剂见效，两剂痊愈。”《水胀篇》：“黄帝问：鼓胀怎么样？岐伯说：腹胀身皆大，大小与肤胀相等，颜色苍黄，腹部筋脉突起，这是它的征候。”《阴阳应象大论》说：“浊气上升，就会生腹胀。”《经脉篇》说：“足太阴脾经虚则鼓胀，胃中有寒则胀满。”《本神篇》说：“脾气实则腹胀，肾气实则胀。”《至真要大论》说：“各种湿肿胀满，都归属于脾，各种腹胀大，都归属于热。”《太阴阳明论》说：“饮食不节制，起居不规律，阴经受邪。阴经受邪则入五脏，入五脏则胀满闭塞。”《异法方宜论》说：“北方的人，喜欢野外居住且以乳食为主，内脏寒冷产生胀满病。”按语：治疗这个病，必须以经典旨意为主要依据，选用张仲景的方剂，才可以完全治愈。唐以后的各本书，都是主观臆断驳杂不一，不可以姑且尝试。方书称单腹胀为鼓胀，因为像坚硬的中间空心的东西，其形象像鼓，又名蛊胀，因为血气结聚，不可解散，其毒如同蛊虫。
In the third year of Daoguang, my father was seventy-one years old. In early March, a boil (furuncle) appeared on the side of his right hypochondrium, approximately two fingers long and less than one inch in diameter. The pain was so severe that it felt like being stabbed with a knife. All the surgeons in the city were consulted, but every time herbal poultices were applied, the pain intensified. After the Dragon Boat Festival, his flesh gradually wasted away, and his appetite decreased. A month later, during the day he could only drink thin rice gruel, no more than one or two teacups. After the beginning of autumn, his condition worsened; he became restless and irritable, unable to sleep peacefully day or night, and for over ten days he could not even touch water or grain (HT). We had no choice but to hastily prepare for his death. Suddenly, around midnight on the Mid-Autumn Festival, he briefly regained consciousness (HT). We gave him half a cup of rice soup, after which he felt bloated (HT). I thought, how could anyone survive without eating grains for half a month? So, gently persuading my father, I urged him to force down a few spoonfuls of thin rice gruel each day. Three days later, he could consume one teacup morning and evening. Only then did his spirit stabilize. He then commanded (HT), "The books I have authored over the years are still incomplete. Specifically, the sections on cholera with vomiting and diarrhea must be rewritten. In the past three years, eight or nine out of ten who died from this disease died due to improper medication. Regarding cholera, ignorant people today wrongly label the excess syndrome of 'intestinal colic' (Jiao Chang Sha), where eating causes death, as 'dry cholera' (Gan Huo Luan); and they name the cholera syndrome associated with Cold Damage as 'wet cholera' (Shi Huo Luan). These two opposing views lead to the interchangeable use of medicines, causing harm far beyond just one or two individuals." He ordered me to record Zhang Zhongjing's Lizhong Tang and Sun Simiao's Zhizhong Tang, to correct the errors of various theories and to demonstrate the purity of ancient medical legislation.
Zhizhong Tang
Renshen (Ginseng Radix), Ganjiang (Zingiberis Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma) [each 3 liang].
The above four ingredients are crushed. Boil in 8 sheng of water to obtain 3 sheng. Divide into three doses. If not cured, administer frequently for three courses. For traveling to prevent cholera, prepare pills according to the previous method, sized like tung seeds. Take 30 pills per dose. If prepared as powder, take one fangcun bi (a square-inch measure) per dose. Taking with wine is also acceptable. If muscle cramps occur, add Shigao (Gypsum Fibrosum) 3 liang. I fear Gypsum Fibrosum is too mild, so add another 3 liang, totaling 6 liang combined with the original formula. (Zhang Zhongjing stated: If there is palpitation above the navel, indicating Kidney Qi movement, remove Baizhu and add Guixin (Cinnamomi Ramulus) 4 liang; if vomiting is excessive, remove Baizhu and add Shengjiang (Zingiberis Rhizoma Recens) 3 liang; if diarrhea is excessive, reuse Baizhu; if palpitations occur, add Fuling (Poria) 3 liang; if thirsty for drinking water, increase Baizhu to make a total of 4.5 liang; if abdominal pain occurs, add Renshen to make a total of 4.5 liang; if cold sensations prevail, add Ganjiang to make a total of 4.5 liang; if abdominal fullness exists, remove Baizhu and add Fuzi (Aconiti Lateralis Radix Praeparata) 7 pieces. After taking the decoction, wait about the time of one meal, then drink 1 sheng of hot porridge to maintain slight warmth. Do not expose yourself to cold by removing clothes or blankets. The sage's teachings are brilliant and do not forbid consuming porridge.)
Zhang Luyu said: "The Classic states: Clear Qi descends, Turbid Qi ascends; Ying Qi flows smoothly, Wei Qi moves counter-current. When clear and turbid qi interfere with each other and disturb the intestines and stomach, it results in cholera." This is mostly caused by cold pathogens transmitting to the Lower Jiao, causing the Middle Jiao to fail in digesting food and drink. This damages the San Jiao (Triple Burner) in cases of external cold exposure and internal consumption of cold drinks/foods. However, constitutions vary in Yin-Yang bias, and diseases differ in cold-heat patterns. Therefore, Shanghan Lun first mentions Wuling San (Five-Ling Powder) for those with heat predominance and thirst, and Lizhong Wan (Regulate the Middle Pill) for those with cold predominance and no thirst. Qianjin Fang renamed this 'Zhizhong' and listed it under the San Jiao chapter. 'Li' refers to regulating disharmony between cold and heat; 'Zhi' refers to treating the chaotic symptoms of cholera. The formula primarily uses Ganjiang's acrid-warm nature to encourage the strengthening and transport functions of Renshen and Baizhu, coordinating with Gancao's moderating effect. This is similar to the use of Guizhi (Cinnamon Twig) in Wuling San. Although the degree of cold and heat differs, the principle of warming and dispersing remains the same. Zhu Fengyi added Qingju Pi (Citri Reticulatae Pericarpium Viride) and Chenpi (Citri Reticulatae Pericarpium) to treat food injury. Qianjin Fang added the treatment for muscle cramps, supplementing the incompleteness of Shanghan Lun. The world knows to use Mugua (Chaenomelis Fructus) for muscle cramps, specifically utilizing its sour-astringent property to handle damp-heat injuring the Spleen in summer and autumn. This is because Clear Qi descends and affects the intestines and stomach, hence Ganjiang is used; Turbid Qi ascends and disturbs the sinews, hence Shigao is used. As for the various modifications of Lizhong Wan, they should be strictly followed. Observing that when vomiting and diarrhea cease but body pain persists, one should use Guizhi Tang (Cinnamon Twig Decoction) in small doses to harmonize, as well as Sini Tang (Frigid Extremities Decoction), Tongmai Sini Tang (Pulse-Restoring Frigid Extremities Decoction), Gancao Xiexin Tang (Licorice Heart-Draining Decoction), and Fuzi Jingmi Tang (Aconite and Rice Decoction). These methods do not exceed the treatments for rebellious Qi ascending found in Shanghan Lun and Jingui Yaolue.
Distension Abdomen Syndrome (Gu Zhang). Caused by food stagnation, use Weiling Tang (Stomach and Five-Ling Decoction) plus Banxia (Pinelliae Rhizoma), Ganjiang, Wugu Chong (Bombyx Batryticatus), and Mugua. Make pills using malt paste starch, and swallow 3 qian with aged rice soup. Caused by heat, use the previous pill formula plus Huanglian (Coptidis Rhizoma) as an assistant. These are excess syndromes and are easy to treat. Only deficiency syndromes require Shengshu Jian (Holy Artisan Decoction) plus Fuzi, taken continuously for 40-50 courses to show efficacy. Even isolated abdominal distension does not go beyond this method. Furthermore, cases arising from acid regurgitation should use Lizhong Tang plus Huanglian, named Lianli Wan (Coptis and Regulate-Middle Pill), to use strong medicine to transform the Stomach's state, rather than letting the Stomach adapt to the medicine. This is Yu Jiayan's secret method. For sub-xiphoid aggregation resembling a plate, use Guizhi Tang removing Shaoyao (Paeoniae Radix Alba), adding Mahuang (Ephedrae Herba), Fuzi, and Xixin (Asari Radix et Rhizoma). Take two doses daily and one dose at night, inducing slight sweating to rotate the Great Qi, so the aggregation dissipates. Then use Zhizhu Tang (Immature Bitter Orange and Atractylodes Decoction) to drain fullness with bitter flavors. This is Zhang Zhongjing's holy method. Most cases of this disease belong to cold, so it is listed under cold syndromes.
(Classic Meanings) Fu Zhong Lun states: "There is a disease with fullness in the heart and abdomen, where one cannot eat dinner if they ate breakfast, named Distension Abdomen (Gu Zhang). Treat it with Jishi Li (Chicken Excrement Ferment). One dose brings knowledge of improvement, two doses cure it." Shui Zhang Pian: "The Yellow Emperor asked: How is Distension Abdomen? Qibo answered: Abdominal distension with general body enlargement, equal in size to Skin Distension. The complexion is dark yellow, and abdominal veins protrude. This is its sign." Yin Yang Ying Xiang Da Lun states: "Turbid Qi ascending generates abdominal distension." Jing Mai Pian states: "Deficiency of Foot Taiyin leads to Distension Abdomen; Cold in the Stomach leads to fullness." Ben Shen Pian states: "Excess of Spleen Qi leads to abdominal distension; Excess of Kidney Qi leads to distension." Zhi Zhen Yao Da Lun states: "All dampness, swelling, and fullness belong to the Spleen; all abdominal distension and enlargement belong to Heat." Tai Yin Yang Ming Lun states: "Irregular diet and起居 (daily routine) injure the Yin. Injury to Yin enters the Five Zang organs. Entering the Zang organs leads to distension, fullness, and obstruction." Yi Fa Fang Yi Lun states: "People in the North enjoy living in the wild and consuming dairy products. Internal cold generates fullness diseases." Commentary: To treat this disease, one must base treatment on classic principles and select formulas from Zhang Zhongjing to ensure complete recovery. Books after the Tang Dynasty are speculative and mixed, and should not be tentatively tried. Medical texts call isolated abdominal distension 'Gu Zhang' because it resembles a drum—hard yet hollow inside. It is also called 'Gu Zhang' (Poison Worm Distension) because blood and Qi aggregate and cannot disperse, with toxicity like a poison worm.