中寒之色，必见青者，以青乃肝之色也。故仲景云∶鼻头色青，腹中痛，苦冷者死。
谓厥阴挟少阴肾水为寒，寒极则阳亡，阳亡则死耳。
唇口青，身冷，为入藏即死。
五脏治内属阴，主藏精宅神。血气并寒邪而入堵塞之，藏真之精气不行，神机化灭，升降出入之道皆绝，荣绝则唇
口青。《灵枢》曰∶足厥阴气绝，则唇青。肝藏血，气绝则荣绝可知。
脉脱入藏即死，入府即愈。
脱者，去也。经脉乃脏腑之隧道，为寒气所逼，故经气脱去其脉，而入于内之藏即死，入于内之府即愈也。
经曰∶血气并走于上，则为大厥，暴死。
上者，膻中、三焦之府也，又不尽指入藏言矣。又如邪客五络，状若尸厥者，以通血脉为治。此但于头面络脉所过，
通其血脉则愈，又不尽指入府言矣。可见脉脱入藏入府者，脉之征也；血气走痹于上者，证之征也。参互考订，然
后其死其愈，可得详耳。
中寒脉散者死。
脉脱内入，脉散外出。内入犹有脏腑之分，外出则与阳俱亡而不返矣。
尺脉迟滞沉细，寒在下焦。
温经散寒，其人可愈。
寒痛多见于身之前，以身之背为阳，身之前为阴也。而身之前，又多见于腹，以胸为阴之阳，腹为阴之阴也。仲景
论心胸之痛，属寒证者十之二三；论腰腹之痛，属寒证者十之七八，亦可焕然明矣。兹举《内经》、《金匮》之奥，相与
绎之。
《经》曰∶真心痛者，寒邪伤其君也。手足青至节，甚则旦发夕死，夕发旦死。
心为神明之藏，重重包裹，百骸卫护，千邪万恶，莫之敢干。必自撤其藩，神明不守，寒邪乃得伤犯。其用胜寒峻
猛之剂，僭逼在所不免。昌尝思之，必大剂甘草、人参中，少加姜、附、豆蔻以温之，俾邪去而药亦不存，乃足贵耳。
若无大力者监之，其敢以暴易暴乎？
《针经》云∶足太阴之脉，其支者，复从胃别上注心中。是动则病，舌根胀，食则呕，胃腕痛，腹胀善噫，心中急
痛。
此以脾病四迄之邪，连及于心，其势分而差缓，不若真心痛之卒死矣。即太阴推之，足少阴厥阴客邪，皆可犯心。
惟阳虚阴厥，斯舟中皆敌国矣。
厥心痛，乃中寒发厥而心痛。寒逆心胞，去真心痛一间耳。手足逆而通身冷汗出，便溺清利不渴，气微力弱，亦主
旦发夕死，急以术附汤温之。
诸经心痛，心与背相引，心痛彻背，背痛彻心，宜亟温其经。诸府心痛，难以俯仰，小腹上冲，卒不知人，呕吐泄
泻，其势甚锐，宜亟温其府。至藏邪乘心而痛，不可救药者多，宜亟温其心胞，并注邪别脉，经络脏腑，浅深历然，乃
可图功。
心痛者脉必伏，以心主脉，不胜其痛，脉自伏也。不可因其脉伏神乱，骇为心虚，而用地黄、白术补之。盖邪得温
药则散，加泥药即不散，不可不慎之也。温散之后，可阴阳平补之。
《金匮》论胸痹心痛之脉，当取太过不及，阳微阴弦。
以太过之阴，乘不及之阳，即胸痹心痛。然总因阳虚，故阴得乘之。阳本亲上，阳虚知邪中上焦。设阴脉不弦，则
阳虽虚而阴不上干，惟阴脉弦，故邪气厥逆而上。此与浊气在上，则生 胀，同一病源也。胸痹有微甚不同，微者但
通其上焦不足之阳，甚者必驱其下焦厥逆之阴，通胸中之阳。以薤白、白酒，或栝蒌、半夏、桂枝、枳实、浓朴、干姜、
白术、人参、甘草、茯苓、杏仁、桔皮，择用对病三四味，即成一方。不但苦寒不入，即清凉尽屏。盖以阳通阳，阴分
之药，所以不得预也。甚者则用附子、乌头、蜀椒，大辛热以驱下焦之阴，而复上焦之阳。发明三方于左，临病之工，
宜取则焉。
《金匮》又错出一证云∶病患胸中似喘不喘，似呕不呕，似哕不哕，愦愦然无奈者，生姜半夏汤主之。
此即胸痹一门之证，故用方亦与胸痹无别，必编者之差误，今并论于此。盖阳受气于胸，阴乘阳位，阻其阳气，布
息呼吸往来之道。若喘若呕若哕，实又不然，但觉愦乱无可奈何？故用半夏、生姜之辛温，以燥饮散寒，患斯愈也。缘
阴气上逆，必与胸中之饮，结为一家。两解其邪，则阳得以布，气得以调，而胸际始旷也。其用橘皮、生姜，及加竹茹、
人参，皆此例也。
发明《金匮》心痛彻背，背痛彻心，用乌头赤石脂丸。心痛彻背，背痛彻心，乃阴寒之气，厥逆而上干者，横格于
胸背经脉之间，牵连痛楚，乱其气血，紊其疆界，此而用气分诸药，则转益其痛，势必危殆。仲景用蜀椒、乌头一派辛
辣，以温散其阴邪，然恐胸背既乱之气难安，而即于温药队中，取用干姜之泥，赤石脂之涩，以填塞厥气所横冲之新隧，
俾胸之气自行于胸，背之气自行于背，各不相犯，其患乃除，此炼石补天之精义也。今人知有温气、补气、行气、散气
诸法矣，亦知有堵塞邪气攻冲之窦，令胸背阴阳二气，并行不悖者哉。
发明《金匮》胸痹缓急，用薏苡仁附子散。胸中与太空相似，天日照临之所，而膻中之宗气，又赖以包举一身之气
者也。今胸中之阳，痹而不舒，其经脉所过，非缓即急，失其常度，总因阳气不运，故致然也。用薏苡仁以舒其经脉，
用附子以复其胸中之阳，则宗气大转，阴浊不留，胸际旷若太空。所谓化日舒长，曾何缓急之有哉？
发明《金匮》九痛丸。仲景于胸痹证后，附九痛丸。治九种心痛，以其久着之邪，不同暴病，故药则加峻，而汤改
为丸，取缓攻不取急荡也。九种心痛，乃久客之剧证，即肾水乘心，香港脚攻心之别名也。痛久血瘀，阴邪团结，温散药
中，加生野狼牙、巴豆、吴茱萸驱之，使从阴窍而出。以其邪据胸中，结成坚垒，非捣其巢，邪终不去耳。合三方以观仲
景用意之微，而肾中之真阳，有之则生，无之则死，其所重不可识耶。
《金匮》云∶趺阳脉微弦，法当腹满，不满者必便难，两 疼痛。此虚寒从下上也，当以温药服之。
趺阳脾胃之脉，而见微弦，为厥阴肝木所侵侮，其阴气横聚于腹。法当胀满有加，设其不满，阴邪必转攻而上，决
无轻散之理。盖阴邪既聚，不温必不散，阴邪不散，其阴窍必不通，故知其便必难，势必逆攻两 ，而致疼痛，较腹满
更进一步也。虚寒之气，从下而上，由腹而 ，才见一斑。亟以温药服之，俾阴气仍从阴窍走散，而不至上攻，则善矣。
仲景所谓此虚寒自下上也。当以温药服之，包举阴病证治，了无剩义。盖虚寒从下上，正地气上天之始，用温则上者下
聚者散，直捷痛快，一言而终。故《卒病论》虽亡，其可意会者，未尝不宛在也。
《金匮》云∶病者腹满，按之不痛为虚。
腹满时减，复如故，此为寒，当与温药。
中寒其人下利，以里虚也。
里虚下利，即当温补藏气，防其竭绝。
病者痿黄，躁而不渴，胸中寒实，而利不止者死。
痿黄乃中州土败之象；躁而不渴，乃阴盛阳微之象；胸中寒实，乃坚冰凝 之象，加以下利不止，此时即极力温之，
无能济矣。盖坚在胸而瑕在腹，坚处拒药不纳，势必转趋其瑕，而奔迫无度，徒促其藏气之绝耳。孰谓虚寒下利，可不
乘其胸中阳气未漓，阴寒未实，早为温之也乎。
发明《金匮》腹中寒气，雷鸣切痛，胸胁逆满呕吐，用附子粳米汤。
腹中阴寒奔迫，上攻胸胁，以及于胃，而增呕逆。顷之胃气空虚，邪无所隔，彻入阳位，则殆矣。是其除患之机，
所重全在胃气。乘其邪初犯胃，尚自能食，而用附子粳米之法温饱其胃，胃气温饱，则土浓而邪难上越，胸胁逆满之浊
阴，得温无敢留恋，必还从下窍而出，旷然无余，此持危扶颠之手眼也。
发明《金匮》腹痛脉弦而紧。弦则卫气不行，即恶寒；紧则不欲食。邪正相搏，即为寒疝。寒疝绕脐痛，若发则自
汗出，手足厥冷，其脉沉弦者，用大乌头煎。
由《内经》心疝之名推之，凡腹中结痛之处，皆可言疝，不独睾丸间为疝矣。然寒疝绕腹痛，其脉阳弦阴紧。阳弦
故卫气不行而恶寒，阴紧故胃中寒盛不杀谷。邪即胃中之阴邪，正即胃中之阳气也。论胃中水谷之精气，与水谷之悍气，
皆正气也。今寒入荣中，与卫相搏，则荣即为邪，卫即为正矣。绕脐腹痛，自汗出，手足厥冷，阳微阴盛，其候危矣。
故用乌头之温，合蜜之甘，入胃以建其中而缓其势。俾卫中阳旺，荣中之邪，自不能留，亦不使虚寒自下上之微旨也。
中寒所呈现的面色，必然会出现青色，因为青色是肝脏的本色。所以张仲景说：鼻头颜色发青，伴有腹部疼痛，若患者畏寒严重则预后不良（主死）。
这是指厥阴肝经挟带少阴肾水之寒气，寒邪极盛导致阳气亡脱，阳气亡脱则死亡。
嘴唇和口唇发青，身体冰冷，说明病邪已深入五脏，预后不良（主死）。
五脏在体内属阴，主要功能是贮藏精气、安藏神志。当血气与寒邪共同侵入并堵塞经络时，脏腑真元精气运行受阻，神机化灭，升降出入的气机通道全部断绝，营气枯竭则导致嘴唇和口唇发青。《灵枢》说：足厥阴肝经之气衰竭，就会出现嘴唇发青。肝主藏血，肝气衰竭则营气枯竭，由此可知。
脉象突然消失（脉脱），病邪入脏则预后不良（主死），入腑则痊愈。
“脱”，就是离去的意思。经脉是脏腑之间的通道，被寒气逼迫，导致经气脱离脉道，如果病邪进入内部的脏则预后不良（主死），如果进入内部的腑则会痊愈。
医经说：血气同时向上冲逆，就会发生大厥证，表现为突然昏倒如同死亡。
“上”，是指膻中和三焦所在的部位，这里并不完全是指病邪入脏而言。又如邪气侵犯五络，症状像尸厥一样，治疗以疏通血脉为主。这只是在头面部络脉经过的地方，疏通其血脉即可痊愈，这里也不完全是指病邪入腑而言。由此可见，“脉脱入脏入腑”是脉象的征象；“血气走痹于上”是症状的征象。相互参照考证，然后才能详细判断其预后是死还是愈。
中寒出现散脉的预后不良（主死）。
脉气内陷入脏，脉象散乱外出。内陷入脏还有脏腑之分，而外出则是与阳气一起亡失而不能返回。
尺部脉象迟滞、沉细，表示寒邪在下焦。
寒痛多见于身体的前面，因为背部属阳，身体前面属阴。而在身体前面，又多见于腹部，因为胸部是阴中之阳，腹部是阴中之阴。张仲景论述心胸部位的疼痛，属于寒证的占十分之二三；论述腰腹部位的疼痛，属于寒证的占十分之七八，这一点也可以看得很清楚。现在列举《内经》、《金匮要略》中的深奥理论，与大家一同探讨。
《内经》说：真心痛，是寒邪伤害了心君（心脏）。手足青紫直到关节，严重的甚至早晨发病晚上死亡，晚上发病早晨死亡。
心是神明居住的脏器，有重重包裹，百骸卫护，千邪万恶不敢侵犯。必须自身撤去藩篱，神明不能守舍，寒邪才得以伤犯。此时使用胜寒峻猛的药剂，僭越逼迫在所难免。我（喻昌）曾思考过，必须在大量甘草、人参的药方中，少量加入干姜、附子、豆蔻来温补，使得邪气去除而药力也不至于过度留存，这才是珍贵的治法。如果没有大力者（如参草）监制，怎么敢用猛烈药物以暴易暴呢？
《针经》说：足太阴脾经的支脉，从胃别出上行注入心中。这条经脉发生病变，会出现舌根胀满，进食后呕吐，胃脘疼痛，腹胀容易嗳气，心中急迫疼痛。
这是由于脾病传及四旁的邪气，连累到心脏，其病势分散且较为缓慢，不像真心痛那样突然致死。即使从太阴脾经推论，足少阴肾经、足厥阴肝经受客邪，也都可以侵犯心脏。只有阳气虚弱、阴寒内盛（阴厥），才使得全身都成为敌对势力。
厥心痛，是中寒引发四肢厥冷而导致的心痛。寒邪逆乱侵犯心包，距离真心痛仅一步之遥。手足逆冷且通身冷汗出，大小便清利且不口渴，气息微弱、体力衰弱，也主早晨发病晚上死亡，急需使用术附汤温补。
各条经脉引起的心痛，心与背部互相牵引，心痛放射至背部，背痛放射至心脏，应当紧急温通其经脉。各腑引起的心痛，难以俯仰，小腹气向上冲，突然昏迷不省人事，呕吐泄泻，病势非常锐利，应当紧急温通其腑。至于脏邪乘袭心脏引起的疼痛，大多不可救药，应当紧急温通心包，并引导邪气通过其他脉络排出，这样经络脏腑的深浅层次就清晰明了，才可以图谋疗效。
心痛的患者脉象必然伏匿，因为心主血脉，承受不住剧烈疼痛，脉象自然伏匿。不能因为脉伏、神志紊乱，就惊恐地认为是心虚，而用地黄、白术等滋补。因为邪气遇到温药就会消散，加上滋腻药物就不会消散，不可不谨慎。温散之后，可以进行阴阳平补。
《金匮要略》论述胸痹心痛的脉象，应当取太过与不及，即“阳微阴弦”。
以太过的阴寒，乘袭不及的阳气，就形成胸痹心痛。但这总归是因为阳气虚弱，所以阴寒得以乘袭。阳气本性亲上，阳气虚弱说明邪气侵犯上焦。假设阴脉不弦，那么虽然阳气虚弱但阴寒不会上干，正因为阴脉弦，所以邪气厥逆而上。这与浊气在上，就会产生胀满，是同一病源。胸痹有轻重不同，轻者只需通补上焦不足的阳气，重者必须驱除下焦厥逆的阴寒，通达胸中之阳。选用薤白、白酒，或瓜蒌、半夏、桂枝、枳实、厚朴、干姜、白术、人参、甘草、茯苓、杏仁、橘皮，根据病情选择对症的三四味药，就组成一方剂。不仅苦寒药物不用，就连清凉药物也全部摒弃。这是因为以阳通阳，属于阴分的药物，所以不得参与。重者则使用附子、乌头、蜀椒，大辛大热以驱除下焦阴寒，恢复上焦阳气。以下发明三方，临证医生应当取法。
《金匮要略》又列出一个证候说：病人胸中似喘非喘，似呕非呕，似呃逆非呃逆，心中烦闷无奈，生姜半夏汤主治。
这就是胸痹门中的一个证候，所以用药也与胸痹没有区别，大概是编者差错失误，现在一并讨论于此。这是因为阳气受气于胸中，阴寒乘袭阳位，阻断了阳气布息呼吸往来的通道。如果是喘、呕、呃逆，其实又不是那样，只是觉得烦乱无可奈何？所以使用半夏、生姜的辛温，来燥湿化痰、驱散寒邪，病患就能痊愈。因为阴气上逆，必定与胸中的痰饮结为一伙。两解其邪，则阳气得以布散，气机得以调畅，胸际才开始开阔。其中使用橘皮、生姜，以及加竹茹、人参，都是这个例子。
发明《金匮要略》心痛彻背，背痛彻心，使用乌头赤石脂丸。心痛彻背，背痛彻心，是阴寒之气厥逆而上干，横格于胸背经脉之间，牵连痛楚，扰乱气血，混淆界限，这种情况下如果使用理气分药物，反而会增加疼痛，势必危殆。张仲景使用蜀椒、乌头一派辛辣药物，以温散阴邪，然而担心胸背既乱之气难以安定，所以在温药队中，选取干姜的黏腻、赤石脂的收敛，来填塞厥气横冲的新通道，使得胸之气自行于胸，背之气自行于背，互不侵犯，患难才能消除，这是炼石补天的精义啊。现在的人只知道有温气、补气、行气、散气等方法，也知道有堵塞邪气攻冲的窦道，令胸背阴阳二气并行不悖的吗？
发明《金匮要略》胸痹缓急，使用薏苡仁附子散。胸中与太空相似，是天日照临之所，而膻中的宗气，又依赖它来包举一身之气。现在胸中之阳，痹阻而不舒展，其经脉所过之处，不是舒缓就是拘急，失去了常态，总因阳气不运，所以导致这样。使用薏苡仁来舒缓其经脉，使用附子来恢复胸中之阳，则宗气大转，阴浊不留，胸际开阔如同太空。所谓阳光舒展漫长，哪里还有什么缓急之分呢？
发明《金匮要略》九痛丸。张仲景在胸痹证后，附上九痛丸。治疗九种心痛，因为其久留之邪，不同于暴病，所以药性更加峻猛，且将汤剂改为丸剂，取缓攻而不取急荡之意。九种心痛，是久客之剧证，也就是肾水乘心、脚气攻心的别名。痛久则血瘀，阴邪团结，在温散药中加入生野狼牙、巴豆、吴茱萸来驱除，使其从阴窍而出。因为邪气占据胸中，结成坚垒，不捣毁其巢穴，邪气终究不去。综合三方来看张仲景用意的微妙，而肾中的真阳，有之则生，无之则死，其所重视的不可不知吗？
《金匮要略》说：趺阳脉微弦，依法应当腹满，如果不腹满，必定大便困难，两胁疼痛。这是虚寒从下往上侵犯，应当服用温药。
趺阳脉是脾胃之脉，出现微弦，是被厥阴肝木所侵侮，其阴气横聚于腹部。依法应当胀满加重，假设其不腹满，阴邪必定转而攻上，决不会有轻散的道理。因为阴邪已经聚集，不温必不散，阴邪不散，其阴窍必不通，所以知道其大便必定困难，势必逆攻两胁，导致疼痛，比腹满更进一步。虚寒之气，从下而上，由腹而胁，才可见一斑。亟需服用温药，使得阴气仍从阴窍走散，而不至于上攻，那就好了。张仲景所说的“此虚寒自下上也，当以温药服之”，包举了阴病的证治，毫无遗漏。因为虚寒从下往上，正是地气上天的开始，用温药则上者下聚者散，直捷痛快，一言而终。所以《卒病论》虽然亡佚，但其可意会的内容，未曾不在心中。
《金匮要略》说：病人腹满，按压不痛为虚证。
腹满时而减轻，过后又像原来一样，这是寒证，应当给予温药。
中寒的病人出现下利，是因为里虚。
里虚下利，就应当温补脏气，防止其竭绝。
病人面色萎黄，烦躁但不口渴，胸中有寒实之邪，而下利不止的预后不良（主死）。
萎黄是中州土败的迹象；烦躁但不口渴，是阴盛阳微的迹象；胸中寒实，是坚冰凝结的迹象，再加上腹泻不止，此时即使极力温补，也无能为力了。因为坚实在胸而瑕疵在腹，坚实处拒绝药物纳入，势必转而趋向瑕疵处，而奔迫无度，徒然加速脏气的竭绝。谁说虚寒下利，可不趁着胸中阳气未漓、阴寒未实的时候，早早进行温补呢？
发明《金匮要略》腹中寒气，雷鸣切痛，胸胁逆满呕吐，使用附子粳米汤。
腹中阴寒奔迫，上攻胸胁，以及于胃，而增加呕逆。不久胃气空虚，邪气无所阻隔，彻底进入阳位，就危险了。所以消除祸患的关键，全在于胃气。趁着邪气刚侵犯胃，尚能进食，而使用附子粳米之法温饱其胃，胃气温饱，则土厚而邪气难以上越，胸胁逆满的浊阴，得到温煦不敢留恋，必定还从下窍而出，旷然无余，这是持危扶颠的手眼。
发明《金匮要略》腹痛脉弦而紧。弦则卫气不行，即恶寒；紧则不欲食。邪正相搏，即为寒疝。寒疝绕脐痛，如果发作则自汗出，手足厥冷，其脉沉弦的，使用大乌头煎。
由《内经》中心疝之名推论，凡是腹中结痛之处，都可以称为疝，不仅仅局限于睾丸间为疝。然而寒疝绕腹痛，其脉阳弦阴紧。阳弦故卫气不行而恶寒，阴紧故胃中寒盛不能消化谷物。邪即胃中之阴邪，正即胃中之阳气也。论述胃中水谷的精气，与水谷的悍气，都是正气。现在寒气进入荣分，与卫气相搏，则荣即为邪，卫即为正了。绕脐腹痛，自汗出，手足厥冷，阳微阴盛，其候危矣。所以使用乌头的温性，合蜂蜜的甘味，入胃以建立中气而缓和病势。使得卫中阳气旺盛，荣分中的邪气，自然不能停留，这也是不让虚寒自下而上的微旨。
The complexion of Zhonghan (Cold Damage) must manifest as cyanosis, because cyanosis is the color associated with the Liver. Therefore, Zhang Zhongjing stated: "If the tip of the nose appears cyanotic, accompanied by abdominal pain, and the patient suffers from severe cold aversion, the prognosis is fatal."
This refers to the Jueyin Liver channel carrying the coldness of Shaoyin Kidney water. When cold becomes extreme, Yang Qi perishes; once Yang Qi perishes, death ensues.
Cyanosis of the lips and mouth, along with a cold body, indicates that the pathogen has entered the Zang organs, which is fatal.
The Zang organs are Yin in nature within the interior, primarily responsible for storing essence and housing the Shen (Spirit). When Blood and Qi, together with Cold pathogens, invade and block the meridians, the true essence and Qi of the Zang cannot circulate. The mechanism of Shen transformation ceases, and the pathways of ascending, descending, exiting, and entering are all severed. When Ying (Nutritive) Qi perishes, cyanosis of the lips and mouth occurs. The *Ling Shu* states: "When the Qi of the Foot Jueyin [Liver] meridian perishes, the lips turn cyanotic." Since the Liver stores Blood, it can be understood that when Liver Qi perishes, Ying Qi perishes.
When the pulse vanishes (Mai Tuo), if the pathogen enters the Zang organs, it is fatal; if it enters the Fu organs, recovery occurs.
"Tuo" means departure. The meridians are tunnels connecting the Zang and Fu organs. Pressured by Cold pathogens, the Meridional Qi departs from the pulse. If it enters the interior Zang organs, it is fatal; if it enters the interior Fu organs, recovery occurs.
The medical classics state: "When Blood and Qi rush upward simultaneously, Da Jue (Great Syncope) occurs, presenting as sudden collapse resembling death."
"Upward" refers to the areas of Danzhong (Conception Vessel point CV17) and the Sanjiao (Triple Burner). This does not exclusively refer to the pathogen entering the Zang organs. For example, when pathogens invade the Five Collaterals, presenting like Shi Jue (Corpse Syncope), the treatment focuses on unblocking the blood vessels. This merely involves unblocking the blood vessels at the locations where the head and facial collateral vessels pass, leading to recovery; this also does not exclusively refer to the pathogen entering the Fu organs. Thus, it can be seen that "pulse vanishing with entry into Zang or Fu" is a sign manifested in the pulse, whereas "Blood and Qi stagnating upwards" is a sign manifested in symptoms. By cross-referencing and verifying these, one can accurately determine whether the outcome will be death or recovery.
In Zhonghan, if the pulse is Scattered (San), the prognosis is fatal.
Pulse Qi sinking inward enters the Zang, while a scattered pulse moves outward. Sinking inward still allows for differentiation between Zang and Fu, but moving outward signifies the simultaneous loss of Yang Qi without return.
A Chi (Cun Kou position on the wrist) pulse that is slow, stagnant, deep, and fine indicates Cold in the Lower Jiao.
Employing methods to warm the meridians and dissipate Cold, the patient can recover.
Cold-induced pain often manifests on the anterior aspect of the body, as the back belongs to Yang and the anterior aspect belongs to Yin. Within the anterior aspect, it frequently appears in the abdomen, because the chest is Yang within Yin, and the abdomen is Yin within Yin. Zhang Zhongjing discussed pain in the heart and chest, noting that only two or three out of ten cases belong to Cold syndromes; however, for pain in the waist and abdomen, seven or eight out of ten belong to Cold syndromes. This distinction is clear. Here, we cite profound theories from the *Nei Jing* and *Jin Gui Yao Lue* for discussion.
The *Classic* states: "Zhen Xin Tong (True Heart Pain) occurs when Cold pathogens injure the Monarch [Heart]. The hands and feet become cyanotic up to the joints. In severe cases, onset in the morning leads to death in the evening, and onset in the evening leads to death in the morning."
The Heart is the residence of Shen (Spirit), protected by layers of wrapping and myriad defenses, such that countless evils dare not intrude. Only when the body's own defenses are withdrawn and Shen fails to remain secure can Cold pathogens invade. At this stage, using potent and harsh anti-cold agents inevitably involves overstepping boundaries. I have pondered this: one must use large doses of Gancao (Licorice Root) and Renshen (Ginseng Root), adding small amounts of Jiang (Ginger), Fuzi (Aconite Root), and Doukou (Cardamom Fruit) to warm. This ensures the pathogen is expelled while the medicinal force does not linger excessively, which is truly valuable. Without powerful agents to supervise, how can one dare to use violent measures to replace violence?
The *Zhen Jing* (Needle Classic) says: "The branch of the Foot Taiyin Spleen meridian separates from the stomach and ascends to inject into the heart. When this meridian is disturbed, diseases include swelling at the root of the tongue, vomiting after eating, epigastric pain, abdominal distension with frequent belching, and urgent pain in the heart region."
This results from pathogens spreading from Spleen disease to adjacent areas, affecting the Heart. The condition develops gradually and is less severe than the sudden death caused by Zhen Xin Tong. Extending this logic from Taiyin, pathogens invading the Foot Shaoyin Kidney and Foot Jueyin Liver meridians can also affect the Heart. Only when Yang is deficient and Yin Cold prevails (Yin Jue) does the entire body become hostile territory.
Jue Xin Tong (Syncope-related Heart Pain) is heart pain triggered by Cold causing syncope of the limbs. Cold rebels against the Pericardium, differing from Zhen Xin Tong by only a step. Symptoms include cold extremities, profuse cold sweat over the whole body, clear urination and defecation without thirst, weak breath, and low strength. It also predicts death from morning to evening or vice versa. Urgent treatment with Shu Fu Tang (Atractylodes and Aconite Decoction) is required to warm.
For heart pain originating from various meridians, where heart pain radiates to the back and back pain radiates to the heart, urgently warm the meridians. For heart pain originating from Fu organs, characterized by inability to bend or stretch, Qi rushing from the lower abdomen, sudden unconsciousness, vomiting, and diarrhea, with a sharp and acute progression, urgently warm the Fu organs. Regarding heart pain caused by Zang pathogens attacking the Heart, most cases are incurable; urgently warm the Pericardium and guide pathogens out through other collaterals. Clarifying the depth of meridians and Zang-Fu organs allows for effective treatment.
Patients with heart pain invariably present with a Hidden (Fu) pulse, because the Heart governs the vessels, and the intensity of pain causes the pulse to sink. One must not mistake the hidden pulse and mental confusion for Heart Deficiency, nor use Rehmannia (Dihuang) and Atractylodes (Baizhu) for tonification. Pathogens dissipate with warming herbs but persist with cloying tonics; caution is essential. After warming and dispersing, balance Yin and Yang with mild tonification.
The *Jin Gui Yao Lue* discusses the pulse of Xiong Bi (Chest Bi) and heart pain, emphasizing excess and deficiency: "Yang is subtle (Wei), Yin is string-like (Xian)."
Excess Yin overcoming Deficient Yang results in Xiong Bi and heart pain. Ultimately, this stems from Yang deficiency, allowing Yin to invade. Yang naturally tends upward; Yang deficiency implies pathogens attacking the Upper Jiao. If the Yin pulse were not string-like, Yang deficiency alone would not cause Yin to rebel upward. It is precisely because the Yin pulse is string-like that pathogenic Qi rebels and ascends. This shares the same etiology as "turbid Qi residing above generates distension." Xiong Bi varies in severity: mild cases require only tonifying the insufficient Yang of the Upper Jiao; severe cases require driving out the rebellious Yin of the Lower Jiao and unblocking Yang in the chest. Select three or four appropriate herbs from Xiebai (Macrostemon Rhizome), Baijiu (White Wine), Gualou (Trichosanthes Fruit), Banxia (Pinellia Tuber), Guizhi (Cinnamon Twig), Zhishi (Immature Bitter Orange), Houpo (Magnolia Bark), Ganjiang (Dried Ginger), Baizhu (Atractylodes Macrocephala Rhizome), Renshen (Ginseng Root), Gancao (Licorice Root), Fuling (Poria), Xingren (Apricot Seed), or Jupi (Tangerine Peel) to form a prescription. Bitter-cold herbs are excluded, and even cooling herbs are avoided. This is because Yang is treated with Yang; herbs belonging to the Yin category are not permitted. In severe cases, Fuzi (Aconite Root), Wutou (Aconite Lateral Root), and Shujiao (Sichuan Pepper) are used—greatly acrid and hot—to drive out Lower Jiao Yin and restore Upper Jiao Yang. The following three formulas are elucidated for clinicians to follow.
The *Jin Gui Yao Lue* presents another syndrome: "The patient feels like panting but does not pant, like vomiting but does not vomit, like hiccoughing but does not hiccough, feeling profoundly distressed and helpless. Shengjiang Banxia Tang (Fresh Ginger and Pinellia Decoction) is indicated."
This belongs to the Xiong Bi category, hence the formula is similar to those for Xiong Bi, likely due to an editorial error. We discuss it here. Yang receives Qi in the chest; when Yin invades the Yang position, it obstructs the pathway of respiration and Qi movement. Although it resembles panting, vomiting, or hiccoughing, it is actually just profound distress. Therefore, the acrid-warm properties of Banxia and Shengjiang are used to dry dampness and dissipate Cold, leading to recovery. Since rebellious Yin Qi binds with phlegm-fluid in the chest, resolving both allows Yang to distribute and Qi to regulate, opening the chest. Using Jupi (Tangerine Peel) and Shengjiang, or adding Zhuru (Bamboo Shavings) and Renshen, follows this principle.
Elucidation on *Jin Gui Yao Lue*: "Heart pain penetrating the back, back pain penetrating the heart," treated with Wutou Chishizhi Wan (Aconite and Halloysite Pill). Heart pain penetrating the back and back pain penetrating the heart result from Yin Cold Qi rebelling and attacking upward, blocking the meridians between the chest and back, causing牵连 pain, disrupting Blood and Qi, and blurring boundaries. Using Qi-regulating herbs here would worsen the pain and lead to danger. Zhang Zhongjing uses Shujiao and Wutou, highly acrid and warm, to disperse Yin pathogens. However, fearing the chaotic Qi in the chest and back cannot settle, he adds Ganjiang (Dried Ginger) for its cloying nature and Chishizhi (Halloysite) for its astringency to fill the new channels disrupted by rebellious Qi. This allows Chest Qi to remain in the chest and Back Qi to remain in the back, preventing mutual interference and eliminating the ailment. This is the essence of "smelting stones to mend the sky." Do contemporary practitioners know methods to block pathogenic attacks and allow Yin and Yang Qi in the chest and back to coexist without conflict?
Elucidation on *Jin Gui Yao Lue*: "Xiong Bi alternating between relaxation and spasm," treated with Yiyiren Fuzi San (Coix Seed and Aconite Powder). The chest resembles the vast sky, illuminated by the sun, relying on the Zong Qi (Gathering Qi) of Danzhong to encompass the Qi of the whole body. Now, Yang Qi in the chest is blocked and unrelaxed; the meridians passing through exhibit either laxity or spasm, losing their normal rhythm. This is due to the failure of Yang Qi to circulate. Yiyiren (Coix Seed) relaxes the meridians, and Fuzi restores Yang Qi in the chest. Consequently, Zong Qi turns vigorously, Yin turbidity remains none, and the chest opens like the vast sky. As the saying goes, "Under the long-lasting sun, what need is there for relaxation or spasm?"
Elucidation on *Jin Gui Yao Lue*: Jiutong Wan (Nine Pains Pill). Zhang Zhongjing appended Jiutong Wan after discussing Xiong Bi. It treats Nine Types of Heart Pain. Because the lingering pathogen differs from acute illness, the medication is more potent, and the decoction is changed to pills to achieve gradual rather than drastic expulsion. The Nine Types of Heart Pain are chronic, severe conditions, synonymous with Kidney Water Overacting on the Heart or Jiaoxi (Beriberi) Attacking the Heart. Chronic pain leads to Blood stasis and Yin pathogen aggregation. Adding Sheng Ye Langya (Wild Wolf Tooth Herb), Badou (Croton Seed), and Wuzhuyu (Evodia Fruit) to warming-dispersing herbs drives them out through the Yin orifices. Since the pathogen occupies the chest forming a fortress, its nest must be destroyed for it to leave. Observing Zhang Zhongjing's subtle intent across these three formulas reveals the critical importance of True Yang in the Kidneys: life depends on it, death results from its absence.
The *Jin Gui Yao Lue* states: "The Duyang pulse is subtly string-like. According to law, abdominal fullness should occur. If there is no fullness, there must be difficulty in defecation and pain in the flanks. This is Deficient-Cold rising from below; treat with warming medicines."
The Duyang pulse reflects the Spleen and Stomach. A subtly string-like appearance indicates invasion by Jueyin Liver Wood, with Yin Qi accumulating horizontally in the abdomen. Fullness should increase. If there is no fullness, the Yin pathogen will attack upward, and light dispersal is impossible. Once Yin pathogen accumulates, it will not dissipate without warming. If Yin pathogen does not dissipate, the Yin orifices will not open, leading to difficult defecation and rebellion against the flanks causing pain, progressing beyond simple abdominal fullness. Deficient-Cold Qi rises from below, moving from the abdomen to the flanks. Urgently administer warming medicines so that Yin Qi dissipates through the Yin orifices rather than attacking upward. Zhang Zhongjing’s statement, "This is Deficient-Cold rising from below; treat with warming medicines," comprehensively covers the diagnosis and treatment of Yin diseases without omission. Rising Deficient-Cold marks the beginning of Earth Qi ascending to Heaven; warming causes ascending and gathering Qi to descend and scatter. This is direct and thorough. Thus, although the *Zu Bing Lun* is lost, its principles remain clear in mind.
The *Jin Gui Yao Lue* states: "When a patient has abdominal fullness, pressing elicits no pain; this is Deficiency."
"If abdominal fullness decreases intermittently but returns to normal, this is Cold; treat with warming medicines."
Zhonghan patients experiencing diarrhea do so due to Interior Deficiency.
Interior Deficiency with diarrhea requires warming and tonifying Zang Qi to prevent exhaustion.
If a patient presents with sallow complexion, restlessness without thirst, Excess-Cold in the chest, and unceasing diarrhea, the prognosis is fatal.
Sallow complexion indicates the failure of the Middle Jiao Earth; restlessness without thirst indicates Excess-Yin and Deficient-Yang; Excess-Cold in the chest resembles solidified ice. Added to unceasing diarrhea, even vigorous warming cannot save the patient. The hardness is in the chest while the weakness is in the abdomen. The hard area rejects medicine, forcing it toward the weak area, causing frantic movement and accelerating Zang Qi exhaustion. Why not warm early, while Yang Qi in the chest is not yet depleted and Yin Cold is not yet solidified?
Elucidation on *Jin Gui Yao Lue*: "Abdominal Cold causing rumbling and cutting pain, rebellious fullness in the chest and hypochondrium, vomiting," treated with Fuzi Jingmi Tang (Aconite and Rice Decoction).
Abdominal Yin Cold rushes upward, attacking the chest, hypochondrium, and stomach, increasing vomiting. Soon, Stomach Qi becomes empty, offering no barrier to pathogens, which penetrate the Yang position, leading to danger. The key to eliminating this threat lies entirely in preserving Stomach Qi. While the pathogen initially attacks the Stomach and the patient can still eat, use Fuzi and Jingmi (Rice) to warm and nourish the Stomach. A warm and nourished Stomach strengthens Earth, making it difficult for pathogens to ascend. The turbid Yin causing rebellious fullness in the chest and hypochondrium, warmed, will not linger but will exit through the lower orifices, leaving the chest clear. This is the skill required to stabilize critical conditions.
Elucidation on *Jin Gui Yao Lue*: "Abdominal pain with a string-like and tight pulse. String-like indicates Wei (Defensive) Qi obstruction, leading to cold aversion; tight indicates lack of appetite. Struggle between Pathogen and Righteous Qi constitutes Han Shan (Cold Spasm). Han Shan causes peri-umbilical pain. Upon attack, spontaneous sweating occurs, extremities become cold, and the pulse is deep and string-like. Treat with Da Wutou Jian (Major Aconite Decoction)."
Extending from the concept of Xin Shan (Heart Spasm) in the *Nei Jing*, any painful knot in the abdomen can be called Shan, not limited to the testicles. However, Han Shan peri-umbilical pain presents with a superficially string-like and deeply tight pulse. Superficial stringiness obstructs Wei Qi, causing cold aversion; deep tightness indicates severe Stomach Cold failing to digest grain. The Pathogen is Yin Qi in the Stomach; the Righteous Qi is Yang Qi in the Stomach. Both the essence Qi and the fierce Qi of food and drink in the Stomach are considered Righteous Qi. Now, Cold enters the Ying (Nutritive) level and struggles with Wei (Defensive) Qi; thus, Ying becomes Pathogen and Wei becomes Righteous. Peri-umbilical pain, spontaneous sweating, and cold extremities indicate Deficient Yang and Excess Yin, a critical condition. Therefore, the warmth of Wutou combined with the sweetness of honey enters the Stomach to establish the Middle and缓和 the severity. This strengthens Yang in the Wei level, preventing Pathogen retention in the Ying level, adhering to the subtle principle of preventing Deficient-Cold from rising from below.