黄 （病甚，劳役热者一钱） 甘草（以上各五分，炙） 人参（去节，三分，有嗽去之。）
以上
当归身（三分，酒焙干，或日干，以和血脉） 橘皮（不去白，
二分或三分，以导气，又能益元气，得诸甘药乃可，若独用泻脾胃） 升麻（二分或三分，引胃
气上腾而复其本位，便是行春升之令） 柴胡（二分或三分，引清气，行少阳之气上升） 白术
（三分，降胃中热，利腰脐间血） 上件药 咀。都作一服，水二盏，煎至一盏，量气弱气盛，临病斟酌水盏大小，去
渣，食远，稍热服。如伤之重者，不过二服而愈；若病日久者，以权立加减法治之。
如恶寒冷痛者，加去皮中桂一分或三分（桂心是也）。
如恶热喜寒而腹痛者，于已加白芍药二味中更加生黄芩三分或二分；如夏月腹痛，
而不恶热者亦然，治时热也。
如天凉时恶热而痛，于已加白芍药、甘草、黄芩中，更少加桂。
如天寒时腹痛，去芍药，味酸而寒故也，加益智三分或二分，或加半夏五分、生姜三片。
如头痛，加蔓荆子二分或三分。
如痛甚者，加川芎二分；如顶痛脑痛，加 本三分或五分。
如苦痛者，加细辛二分，华阴者。诸头痛者，并用此四味足矣；如头上有热，则此不能治，
别以清空膏主之。
如脐下痛者，加真熟地黄五分，其痛立止；如不已者，乃大寒也，更加肉
桂（去皮）二分或三分。《内经》所说少腹痛，皆寒证，从复法相报中来也。经云∶大胜必大
复，从热病中变而作也，非伤寒厥阴之证也（仲景以抵当汤并丸主之，乃血结下焦膀胱也）。
如胸中气壅滞，加青皮二分；如气促，少气者，去之。
如身有疼痛者，湿，若身重者，亦湿，加去桂五苓散一钱。
如风湿相搏，一身尽痛，加羌活、防风、 本根，以上各五分，升麻、
苍术以上各一钱，勿用五苓，所以然者，为风药已能胜湿，故别作一服与之；如病去，勿再
服，以诸风之药，损人元气，而益其病故也。
如大便秘涩，加当归梢一钱；闭涩不行者，煎
成正药，先用一口，调玄明粉五分或一钱，得行则止，此病不宜下，下之恐变凶证也；
如久病痰嗽者，去人参；初病者，勿去之；冬月或春寒，或秋凉时，各宜加去根节麻黄五
分；如春令大温，只加佛耳草三分，款冬花一分；如夏月病嗽，加五味子三十二枚，麦门冬
（去心）二分或三分；如舌上白滑苔者，是胸中有寒，勿用之；如夏月不嗽，亦加人参三分或
二分，并五味子、麦门冬各等分，救肺受火邪也；如病患能食而心下痞，加黄连一分或三分
；如不能食，心下痞，勿加黄连；如胁下痛，或胁下急缩，俱加柴胡三分，甚则五分。
上一方加减，是饮食劳倦，喜怒不节，始病热中，则可用之；若末传为寒中，则不可用
也，盖甘酸适足益其病尔，如黄 、人参、甘草、芍药、五味子之类也。
今详《内经》、《针经》热中寒中之证列于下。
《调经论》云∶血并于阳，气并于阴，乃为炅中。血并于上，气并于下，心烦惋善怒。
又云∶其生于阴者，得之饮食居处，阴阳喜怒。又云∶有所劳倦，形气衰少，谷气不盛，上
焦不行，下脘不通，胃气热，热气熏胸中，故曰内热。阴盛生内寒，厥气上逆，寒气积于胸
中而不泻；不泻则温气去，寒独留；寒独留则血凝泣；血凝泣则脉不通，其脉盛大以涩，故
曰寒中。
先病热中证者，冲脉之火附二阴之里，传之督脉；督脉者，第二十一椎下长强穴是
也。与足太阳膀胱寒气为附经督脉，其盛也，如巨川之水，疾如奔马，其势不可遏。太阳
寒气，细细如线，逆太阳寒气上行，冲顶入额，下鼻尖，入手太阳于胸中，手太阳者，丙，
热气也；足膀胱者，壬，寒气也。壬能克丙，寒热逆于胸中，故脉盛大。其手太阳小肠热气
不能交入膀胱经者，故十一经之盛气积于胸中，故其脉盛大。其膀胱逆行，盛之极，子能
令母实，手阳明大肠经，金，即其母也，故燥旺，其燥气挟子之势，故脉涩而大便不通。以
此言脉盛大以涩者，手阳明大肠脉也。
《黄帝针经》∶胃病者，腹胀，胃脘当心而痛，上支两胁，膈咽不通，饮食不下，取三
里以补之。
若见此病中一证，皆大寒，禁用诸甘酸药，上已明之矣。
黄芪（病情严重，或有劳役发热者用一钱） 甘草（以上各五分，炙烤） 人参（去除芦头，三分，若有咳嗽则去掉此药）。
当归身（三分，用酒焙干，或晒干，以调和血脉） 陈皮（不去白瓤，二分或三分，以疏导气机，又能补益元气，必须配合甘味药物使用，若单独使用则会泻脾胃之气） 升麻（二分或三分，引导胃气上升并恢复其本位，这就是施行春季生发之令） 柴胡（二分或三分，引导清气，使少阳之气上升） 白术（三分，降低胃中热邪，疏通腰脐间的血行）。
上述药材切碎。全部作为一剂服用，加水两盏，煎煮至一盏，根据患者气弱或气盛的情况，临症斟酌水量多少，滤去药渣，在饭后稍长时间，趁温热服用。如果损伤较重，不超过两剂即可痊愈；如果病程日久，则依据权变原则进行加减法治疗。
如果怕热喜冷且腹痛，在上述已加的白芍药基础上再加生黄芩三分或二分；如果是夏季腹痛，但不怕热的，也照此办理，这是治疗时令热邪所致。
如果在天气凉爽时怕热且疼痛，在上述已加的白芍药、甘草、黄芩中，再少量加入肉桂。
如果在天气寒冷时腹痛，去掉芍药，因为芍药味酸性寒，加益智仁三分或二分，或者加半夏五分、生姜三片。
如果疼痛剧烈，加川芎二分；如果是头顶痛或脑痛，加藁本三分或五分。
如果痛苦难忍，加细辛二分（选用华阴产的）。各种头痛，用这四味药就足够了；如果头部有热邪，则这些药不能治疗，另外用清空膏主治。
如果肚脐下疼痛，加真熟地黄五分，疼痛立即停止；如果不停止，那是大寒证，再加肉桂（去皮）二分或三分。《内经》所说的少腹痛，都是寒证，是从“复气”相报应中产生的。经书说：大胜之后必有复气，这是从热病变化而来的，不是伤寒厥阴的证候（张仲景用抵当汤和丸来主治，那是下焦膀胱的血结证）。
如果身体疼痛，是湿邪；如果身体沉重，也是湿邪，加五苓散一钱（去掉方中的肉桂）。
如果风湿相互搏结，全身都疼痛，加羌活、防风、藁本根，以上各五分，升麻、苍术以上各一钱，不要用五苓散。之所以这样，是因为风药已经能胜湿，所以另外做一剂给予；如果病好了，不要再服，因为各种风药会损伤人的元气，从而加重病情。
如果大便秘结涩滞，加当归梢一钱；如果闭塞不通，先煎好正药，先用一口，调服玄明粉五分或一钱，大便通畅就停止，这种病不宜攻下，攻下恐怕会变成凶险的证候；
如果久病痰嗽，去掉人参；初病的，不要去掉；冬季或春寒，或秋凉时，各宜加去根节的麻黄五分；如果春季气候大暖，只加佛耳草三分，款冬花一分；如果夏季病咳，加五味子三十二枚，麦门冬（去心）二分或三分；如果舌上有白滑苔，这是胸中有寒，不要用此方；如果夏季不咳嗽，也加人参三分或二分，并五味子、麦门冬各等分，这是为了救肺免受火邪侵害；
如果病人能吃但心下痞满，加黄连一分或三分；如果不能吃，心下痞满，不要加黄连；如果胁下疼痛，或胁下拘急收缩，都加柴胡三分，严重时加五分。
以上方的加减法，适用于饮食劳倦、喜怒不节，起初病在热中，就可以使用；如果末传变为寒中，就不可以用了，因为甘酸药正好会增加病情，如黄芪、人参、甘草、芍药、五味子之类就是如此。
《调经论》说：血偏并于阳分，气偏并于阴分，这就称为炅中（热中）。血偏并于上，气偏并于下，就会心烦郁闷易怒。
又说：生于阴分的病，是由于饮食起居、阴阳失调、喜怒过度引起的。又说：由于劳倦，形体和气衰少，谷气不旺盛，上焦不通畅，下脘不通利，胃气热，热气熏蒸胸中，所以称为内热。
阴盛产生内寒，厥逆之气上行，寒气积聚在胸中而不能排泄；不排泄则温气离去，寒气独留；寒气独留则血液凝滞；血液凝滞则脉道不通，脉象盛大而涩，所以称为寒中。
先患热中证的人，冲脉之火依附于二阴之里，传变到督脉；督脉，是在第二十一椎下的长强穴。与足太阳膀胱的寒气结合，附属于督脉，其气势之盛，像大河之水，快如奔马，势头不可遏制。太阳寒气细细如线，逆着太阳寒气上行，冲顶入额，向下经过鼻尖，进入手太阳经到达胸中。手太阳经属丙，是热气；足太阳膀胱经属壬，是寒气。壬水克丙火，寒热逆乱于胸中，所以脉象盛大。手太阳小肠的热气不能交入膀胱经，所以十一经的盛气积聚在胸中，因此脉象盛大。膀胱逆行，盛极之时，子能令母实，手阳明大肠经属金，即是母经，所以燥气旺盛，燥气挟带子经的气势，所以脉涩且大便不通。以此来说明脉盛大而涩的，是指手阳明大肠脉。
《黄帝针经》说：胃病，表现为腹胀，胃脘当心而痛，向上支撑两胁，膈咽不通，饮食不下，取足三里穴来补益它。
如果见到上述病证中的一证，都是大寒证，禁用各种甘酸药，上面已经说明白了。
Astragali Radix (Huangqi) [1 qian if the condition is severe or accompanied by heat from overwork]; Glycyrrhizae Radix et Rhizoma (Gancao) [5 fen for each of the above, roasted]; Ginseng Radix (Renshen) [3 fen, rhizome removed; omit if coughing].
Angelicae Sinensis Radix (Danggui Shen) [3 fen, dried with wine or in the sun, to harmonize the blood vessels]; Citri Reticulatae Pericarpium (Chenpi) [2-3 fen, white pith retained, to guide qi and benefit primordial qi; must be used with sweet herbs, otherwise it drains Spleen-Stomach qi]; Cimicifugae Rhizoma (Shengma) [2-3 fen, to guide Stomach qi upward to restore its proper position, thus executing the ascending function of Spring]; Bupleuri Radix (Chaihu) [2-3 fen, to guide clear qi and ascend Shaoyang qi]; Atractylodis Macrocephalae Rhizoma (Baizhu) [3 fen, to descend heat in the Stomach and promote blood flow in the waist and umbilical region].
The above ingredients are coarsely crushed. Combine all as one dose. Add two cups of water, decoct until one cup remains. Adjust the amount of water based on whether the patient's qi is weak or strong. Strain the dregs. Take slightly warm, well after meals. If the injury is severe, recovery will occur in no more than two doses; if the disease has been chronic, apply modification methods according to principles of flexibility.
If there is aversion to cold and pain, add Cinnamomi Cortex (Rougui) [1-3 fen, peeled; this refers to Guixin].
If there is aversion to heat, preference for cold, and abdominal pain, add Scutellariae Radix (Huangqin) [3-2 fen, raw] to the previously added White Peony Root (Baishao). If abdominal pain occurs in summer without aversion to heat, treat similarly, addressing seasonal heat pathogens.
If there is aversion to heat and pain during cool weather, add a small amount of Cinnamomi Cortex (Rougui) to the mixture of Baishao, Gancao, and Huangqin.
If abdominal pain occurs in cold weather, remove Baishao because its sour taste and cold nature are contraindicated; add Alpiniae Oxyphyllae Fructus (Yizhi) [3-2 fen], or add Pinelliae Rhizoma (Banxia) [5 fen] and Zingiberis Rhizoma Recens (Shengjiang) [3 slices].
If there is headache, add Viticis Fructus (Manjingzi) [2-3 fen].
If pain is severe, add Chuanxiong Rhizoma (Chuanxiong) [2 fen]; if there is vertex or brain pain, add Ligustici Rhizoma (Gaoben) [3-5 fen].
If suffering from intense pain, add Asari Radix et Rhizoma (Xixin) [2 fen, preferably from Huayin]. These four herbs suffice for various headaches; however, if there is heat in the head, these cannot treat it; instead, use Qingkong Gao.
If there is pain below the umbilicus, add Rehmanniae Radix Praeparata (Shudihuang) [5 fen]; pain stops immediately. If not, it indicates extreme cold; add Cinnamomi Cortex (Rougui) [2-3 fen, peeled]. The "lower abdominal pain" mentioned in *Neijing* refers to cold syndromes arising from the retribution of excessive pathogenic factors. The classics state: "Great excess leads to great counteraction." This arises from transformation in heat diseases, not Jueyin Cold Damage (Zhang Zhongjing treats blood stasis in the Lower Jiao Bladder with Didang Tang/Pills).
If there is chest qi stagnation, add Aurantii Fructus Immaturus (Qingpi) [2 fen]; remove if there is shortness of breath or deficient qi.
If there is body pain due to dampness, or heaviness of the body indicating dampness, add Wuling San [1 qian, excluding Cinnamomi Cortex (Guirui)].
If Wind-Dampness intertwines causing whole-body pain, add Qianghuo, Fangfeng, and Gaoben root [each 5 fen], Shengma and Cangzhu [each 1 qian]. Do not use Wuling San, because wind herbs can overcome dampness. Prepare separately; stop when cured, as wind herbs damage primordial qi and worsen the condition.
If constipation with dryness, add Angelicae Sinensis Radix Caulis (Danggui Shao) [1 qian]. If blocked, take one mouthful of the decocted main medicine, mixed with Mirabilite (Xuanmingfen) [5 fen-1 qian]; stop once bowel movement occurs. Purging is contraindicated here to avoid ominous transformations.
For chronic phlegm-cough, remove Renshen; do not remove for acute cases. In winter, spring cold, or autumn chill, add Ephedrae Herba (Mahuang) [5 fen, roots/rhizomes removed]. In warm springs, add Petasitae Flos (Foercao) [3 fen] and Tussilaginis Flos (Kuandonghua) [1 fen]. In summer coughs, add Schisandrae Fructus (Wuweizi) [32 berries] and Ophiopogonis Radix (Maidong) [2-3 fen, heart removed]. If there is a white slippery coating on the tongue indicating cold in the chest, do not use this formula. If no cough in summer but lung protection against fire is needed, add Renshen [2-3 fen], Wuweizi, and Maidong in equal parts.
If the patient eats well but has epigastric fullness, add Coptidis Rhizoma (Huanglian) [1-3 fen]; if unable to eat with epigastric fullness, do not add Huanglian. For hypochondriac pain or tightness, add Chaihu [3 fen, up to 5 fen if severe].
These modifications apply to initial Heat-Zhong syndrome caused by diet, overwork, and emotional imbalance. They are contraindicated in late-stage Cold-Zhong, as sweet and sour herbs would exacerbate the condition (e.g., Huangqi, Renshen, Gancao, Baishao, Wuweizi).
Below are the Heat-Zhong and Cold-Zhong syndromes detailed in *Neijing* and *Zhenjing*.
*Tiaojing Lun* states: Blood pooling in Yang and Qi pooling in Yin constitutes Jie-Zhong (Heat-Zhong). Blood pooling above and Qi pooling below causes vexation and irritability. It also states: Diseases originating in Yin arise from diet, lifestyle, yin-yang imbalance, and emotions. Furthermore: Fatigue leads to decline of form and qi, insufficient grain qi, failure of Upper Jiao circulation, and obstruction of the lower stomach opening. Stomach qi becomes hot, steaming the chest, termed Internal Heat.
Excess Yin generates Internal Cold. Rebellious Qi ascends, accumulating cold in the chest without discharge. Lack of discharge expels warming qi, leaving only cold. Cold retention causes blood congealing and pulse obstruction, resulting in a large yet choppy pulse, termed Cold-Zhong.
In initial Heat-Zhong, Fire of the Chong Mai attaches to the interior of the Two Yin meridians and transmits to the Du Mai. The Du Mai connects at Changqiang (GV1), below the 21st vertebra. It attaches to the Cold Qi of the Foot-Taiyang Bladder Meridian. Its momentum is like a great river or galloping horse, unstoppable. Taiyang cold qi rises like a thread, piercing the vertex and forehead, descending past the nose tip into the Hand-Taiyang meridian in the chest. Hand-Taiyang corresponds to Bing (Fire/Heat); Foot-Taiyang corresponds to Ren (Water/Cold). Ren controls Bing; cold and heat rebel in the chest, causing a large pulse. Since Hand-Taiyang Small Intestine heat cannot enter the Bladder meridian,盛 qi of the eleven meridians accumulates in the chest, causing a large pulse. Extreme rebellion of Bladder qi leads to "Child making Mother Excess"; Hand-Yangming Large Intestine (Metal, the Mother) becomes dry and vigorous. Dryness carries the child's momentum, causing a choppy pulse and constipation. Thus, the "large and choppy" pulse refers to the Hand-Yangming Large Intestine pulse.
*Huangdi Zhenjing* states: Stomach disease presents as abdominal distension, pain in the epigastrium centering on the heart, radiating to both hypochondria, blockage of the diaphragm and throat, and inability to swallow food. Treat by tonifying Zusanli (ST36).
Any single symptom from the above indicates extreme Cold; all sweet and sour herbs are strictly prohibited, as clarified above.