大意
寒气客于五脏。厥逆上出。阴气竭。阳气未入。故卒然痛死不知人。气复返则、生矣。（内经）
病因
中寒之症。不拘冬夏。或外中天地之寒。或内受饮食之冷。元阳既虚。肤腠空豁。寒邪直入三阴之经。其病
骤发。非若伤寒之内有郁热。与邪相拒。循经渐入之缓也。（安道）
见证
其症卒然战栗。面青切牙。吐泻腹痛。或四肢冰冷。或手足挛蜷。或昏迷僵直。身凉不热。或有微热而不渴。
倦于言动者是也。
中分三阴
寒中太阴。则中脘疼痛。寒中少阴。则脐腹疼痛。寒中厥阴。则小腹至阴疼痛。（机要）
死症
如环口唇青。冷过肘膝。舌缩囊卷。脉绝者。须臾即死。又中寒。无汗者吉。有汗者死。（入门）凡跌扑斗殴。轻生
投水而中寒。以及房欲劳力。涉水而中寒者。皆难治。（缵论）
脉法
中寒脉沉缓者。属太阴。沉细。属少阴。沉迟。属厥阴。（仲景）紧涩者。为寒邪外中。代散者。为阳气内脱。（汇
补）
总治
阳虚阴盛。宜温中散寒。补暖下元。则阳气来复。而寒邪自消。（汇补）
急救治
仓卒之际。难分经络。急煎姜汁。热酒和匀灌下。更用葱饼熨脐轮。灸关元气海二三十壮。脉渐渐应手。四
肢微暖者生。若脉不还者死。脉暴出者亦死。
冻死人。用硫黄、半夏、皂角各一字。加麝香末。填脐中。放葱饼于上。以熨斗盛火熨之。葱烂再易。得暖气入
腹渐醒为度。或以灰炒暖。盛囊中。熨心头。冷即易。数次后。若眼开。始进酒浆。或米饮。不醒者以艾炙门牙
缝。候喊声出。即可救矣。若不先温其心。即用火烘。冷与火搏。必死。又冻僵人未醒。勿以热汤灌之。（濒湖）
用药
主以理中汤。加半夏、苍术、浓朴、陈皮、木香。如腹痛。加吴茱萸。呕吐。加藿香。卵缩无脉。加人参、附子。
肢节痛。加桂枝。足膝冷。加肉桂。若阴极发躁。烦扰不宁。口虽渴而不咽水。面虽赤而两足寒。脉虽数而重按空豁
者。将前药煎好。浸水中。冷服之。不拒格矣。若不知此。误以口渴面赤烦躁。认是阳症。妄投寒凉者死。盖周
身无根之火得水击而走散也。设倥偬之时。不敢擅用参、附。先以二陈加苍白二术、浓朴、炮姜、吴茱煎服。
则吐利止而痛自除。尤为稳当。然后审元气虚实而调之。庶无瘥谬也。
【附外感阴毒】
阴毒者受天地杀厉之气。入三阴经而成病。比中寒稍轻。其症头痛恶寒。面目青黑。咽喉疼痛。身如被杖。
手足清冷。短气不得息。四五日可治。六七日不可治。宜用发表之剂。升麻鳖甲汤去蜀椒雄黄主之。（仲景）
【附内伤真阴】
内伤真阴症。因房劳伤肾。生冷伤脾。内既伏阴。外又感寒。比之中寒更重。亦有伤寒阳症。过服凉药而变
成者。其症五六日后。渐见精神恍惚。身倦懒言。头额手背。冷汗时出。舌上生胎。淡黑冷滑。心下结硬如石。
四肢寒冷如冰。唇青甲黑。鼻如烟煤。腹痛吐利。咽痛睛疼。身如被杖。囊缩舌卷。宜温经之剂。回阳散、返阴
丹。并外灸丹田气海两穴数壮。（活人书）
中寒选方
理中汤 治气虚中寒。腹痛吐泻。厥冷倒仆。脉沉迟者。
干姜（炮） 白术（各二钱半） 甘草（一钱）
水煎服。阴躁者。水中浸冷服之。加参、附。名参附理中汤。
四逆汤 治中寒厥冷。脉细。舌卷囊缩。
附子（制一枚） 干姜（一两半） 人参（二两） 甘草（二两）
水三升。煎升三合。分三服。
三建汤 治中寒六脉不到。而太 冲阳尚未绝者。
川乌 附子 天雄（等分）
生姜。水煎。
五积散（和剂） 治中寒轻症。未离于表。头疼身痛。恶寒。腹痛吐泻。脉迟者。
白芷 茯苓 半夏 当归 川芎 甘草
肉桂 芍药（各三两） 枳壳（炒） 麻黄（去根节） 陈皮（各六两） 桔梗（二两）
浓朴（姜炒） 干姜（各四两） 苍术（二十四两）
每服四钱。水一盏。姜三片。葱三茎。煎七分服。
麻附细辛汤（仲景） 治寒中少阴。脉沉细。足冷。反发热而恶寒者。
麻黄 细辛（各四钱） 附子（二钱半）
水煎。
升麻鳖甲汤去蜀椒雄黄方（仲景） 治外感天地毒瓦斯。入阴经而发病者。
甘草 桂枝 升麻 当归 鳖甲
水煎。温服。覆取微汗为度。
回阳散
用附子二枚。炮制为末。生姜酒和匀调服。
返阴丹
硫黄（五两） 附子 干姜 桂心（各半两） 硝石 玄精石（各二两）
为末。糊丸。艾汤下。
【大意】
寒气侵袭五脏，导致厥逆之气上冲。此时阴气耗竭，阳气未能入里，因此突然发生剧痛、昏死且不知人事。如果气机能够恢复通畅，则患者可以存活。（出自《内经》）
【病因】
中寒病症，不分冬夏季节。可能是外感天地间的寒邪，也可能是内伤饮食生冷。由于人体元阳已经虚弱，肌肤腠理疏松空虚，寒邪直接侵入三阴经。这种病发作急骤，不像伤寒那样内部有郁热与邪气相争，而是循着经络逐渐深入的那种缓慢过程。（出自安道论述）
【见证】
其症状表现为突然战栗，面色青紫，咬牙，呕吐腹泻，腹痛，或者四肢冰冷，手足拘挛蜷曲，或者昏迷僵直。身体发凉而不发热，或者有轻微发热但不口渴，疲倦不想说话和活动的，就是中寒症。
【分属三阴】
寒邪侵犯太阴经，则出现中脘穴部位疼痛；寒邪侵犯少阴经，则出现脐腹部疼痛；寒邪侵犯厥阴经，则出现从小腹到生殖器部位的疼痛。（出自《机要》）
【死症】
如果出现口唇周围发青，寒冷超过肘部和膝盖，舌头萎缩，阴囊收缩，脉搏消失的，不久就会死亡。另外，中寒症中，无汗的预后较好，有汗的预后不良（致死）。（出自《入门》）凡是因跌打斗殴、轻生投水而受寒，以及因房事过度或劳累涉水而受寒的，都难以治疗。（出自《缵论》）
【脉法】
中寒症脉象沉缓的，属于太阴经病变；脉象沉细的，属于少阴经病变；脉象沉迟的，属于厥阴经病变。（出自张仲景）脉象紧涩的，为寒邪从外部侵袭；脉象代散（间歇且散乱）的，为阳气在内脱失。（出自本书汇补）
【总治原则】
阳气虚弱，阴寒盛极，适宜温中散寒，补益温暖下焦元气，这样阳气就能恢复，寒邪自然消除。（出自本书汇补）
【急救治疗】
在紧急情况下，难以分辨具体是哪条经络受病，应急煎姜汁，与热酒混合均匀灌服。再用葱白饼熨烫肚脐周围，灸关元穴和气海穴二三十壮。如果脉搏渐渐恢复应手，四肢微微回暖的，可活。如果脉搏不恢复的，死亡。脉搏突然暴出的，也死亡。
对于冻死的人，用硫黄、半夏、皂角各一字量，加入麝香末，填入肚脐中，上面放葱饼，用熨斗盛火熨烫。葱烂了再换新的，直到感到暖气进入腹部，患者逐渐苏醒为止。或者用灰炒热，装在袋子里，熨烫心窝处，冷了再换。几次之后，如果眼睛睁开，才开始给予酒浆或米汤饮用。如果不醒，用艾条灸门牙缝隙，等到听到喊声出来，就可以救活了。如果不先温暖心脏部位，就用火烘烤，冷与火相搏结，必然死亡。还有冻僵的人未苏醒时，不要用热汤灌服。（出自李时珍《濒湖》）
【用药】
主要使用理中汤，加半夏、苍术、厚朴、陈皮、木香。如果腹痛，加吴茱萸；呕吐，加藿香；睾丸收缩且无脉，加人参、附子；肢节疼痛，加桂枝；足膝寒冷，加肉桂。如果是阴寒至极出现烦躁不安，烦扰不宁，口虽渴但不想喝水，面虽红但双脚寒冷，脉虽快但重按空虚无力的，将前面的药煎好后，浸入水中冷却后服用，就不会出现格拒（呕吐）现象。如果不懂这个道理，误以为口渴面赤烦躁是阳证，妄投寒凉药物，会导致死亡。这是因为周身无根之火遇到水打击而走散。如果在匆忙之时，不敢擅自使用人参、附子，先用二陈汤加苍术、白术、厚朴、炮姜、吴茱萸煎服，那么呕吐腹泻停止，疼痛自然消除，尤为稳妥。然后再审察元气的虚实进行调理，才不会有差错。
【附：外感阴毒】
阴毒症是受到天地间杀厉之气，侵入三阴经而形成的疾病，比中寒稍轻。其症状为头痛恶寒，面目青黑，咽喉疼痛，身体像被棍棒打过一样疼痛，手足清冷，短气呼吸困难。四五日尚可治疗，六七日不可治疗。适宜使用发表剂，升麻鳖甲汤去掉蜀椒、雄黄为主方。（出自张仲景）
【附：内伤真阴】
内伤真阴症，因房劳损伤肾脏，生冷损伤脾脏，内部既有伏阴，外部又感受寒邪，比中寒更重。也有因伤寒阳证，过服凉药而转变成的。其症状在五六日后，逐渐出现精神恍惚，身体疲倦懒言，头额手背冷汗不时流出，舌苔淡黑冷滑，心下部结硬如石头，四肢寒冷如冰，嘴唇青紫指甲发黑，鼻子如烟煤色，腹痛吐利，咽痛眼疼，身体像被棍棒打过，阴囊收缩舌头卷曲。适宜使用温经剂，回阳散、返阴丹，并外用艾灸丹田、气海两穴数壮。（出自《活人书》）
【中寒选方】
理中汤：治疗气虚中寒，腹痛吐泻，四肢厥冷倒仆，脉象沉迟者。
干姜（炮制） 白术（各二钱半） 甘草（一钱）
水煎服。阴躁者，在水中浸冷后服用。加人参、附子，名为参附理中汤。
四逆汤：治疗中寒四肢厥冷，脉细，舌卷缩，阴囊收缩。
附子（炮制一枚） 干姜（一两半） 人参（二两） 甘草（二两）
水三升，煎至三合，分三次服用。
三建汤：治疗中寒六脉摸不到，但太冲穴、冲阳穴的脉搏尚未绝灭者。
川乌 附子 天雄（等分）
生姜，水煎。
五积散（出自《和剂局方》）：治疗中寒轻症，病邪未离开体表，头疼身痛，恶寒，腹痛吐泻，脉迟者。
白芷 茯苓 半夏 当归 川芎 甘草
肉桂 芍药（各三两） 枳壳（炒） 麻黄（去根节） 陈皮（各六两） 桔梗（二两）
厚朴（姜炒） 干姜（各四两） 苍术（二十四两）
每次服用四钱，水一盏，生姜三片，葱三茎，煎至七分服。
麻黄附子细辛汤（出自张仲景）：治疗寒邪侵入少阴经，脉象沉细，足冷，反而发热且恶寒者。
麻黄 细辛（各四钱） 附子（二钱半）
水煎。
升麻鳖甲汤去蜀椒雄黄方（出自张仲景）：治疗外感天地毒瓦斯，侵入阴经而发病者。
甘草 桂枝 升麻 当归 鳖甲
水煎，温服，覆盖取微汗为度。
[General Principle]
Cold pathogenic factors invade the five zang organs, causing jue-ni (rebellious qi) to ascend. At this time, yin qi is exhausted, and yang qi fails to enter the interior, resulting in sudden severe pain, syncope, and loss of consciousness. If qi mechanism recovers its flow, the patient will survive. (From *Neijing*)
[Etiology]
Zhong-han (cold strike) occurs regardless of winter or summer. It may result from external invasion of heaven-and-earth cold pathogens or internal injury from consuming cold food and drink. Since the primordial yang is already deficient and the skin pores are loose and open, cold pathogens directly invade the three yin meridians. The disease onset is abrupt, unlike Shanghan (cold damage), which involves internal stagnant heat resisting the pathogen and entering gradually along the meridians. (From An Dao)
[Clinical Manifestations]
Symptoms include sudden shivering, cyanotic complexion, teeth grinding, vomiting, diarrhea, abdominal pain, cold limbs, contracture of hands and feet, coma with rigidity. The body is cool without fever, or has slight fever without thirst. Fatigue and reluctance to speak or move characterize this condition.
[Classification by Three Yin Meridians]
Cold invading Taiyin meridian causes pain at Zhongwan (CV12). Cold invading Shaoyin meridian causes pain around the umbilicus and abdomen. Cold invading Jueyin meridian causes pain from the lower abdomen to the genitalia. (From *Jiyao*)
[Prognosis / Fatal Signs]
If the area around the mouth and lips turns blue, cold extends beyond the elbows and knees, the tongue shrinks, the scrotum retracts, and the pulse disappears, death will occur shortly. In Zhong-han, absence of sweating indicates a better prognosis, while sweating indicates a poor prognosis (fatal). (From *Rumen*) Cases involving cold strike after falls, fights, suicide attempts by drowning, excessive sexual activity, overexertion, or wading into water are difficult to treat. (From *Zuanlun*)
[Pulse Diagnosis]
A deep and slow pulse in Zhong-han belongs to Taiyin. A deep and thin pulse belongs to Shaoyin. A deep and delayed pulse belongs to Jueyin. (From Zhang Zhongjing) A tight and choppy pulse indicates external cold invasion. A intermittent and scattered pulse indicates internal collapse of yang qi. (From *Huibu*)
[General Treatment Principle]
When yang is deficient and yin-cold is excessive, treatment should focus on warming the middle and dispelling cold, and tonifying and warming the lower yuan. This allows yang qi to recover and cold pathogens to dissipate naturally. (From *Huibu*)
[Emergency Treatment]
In emergencies where it is difficult to distinguish the affected meridian, urgently decoct ginger juice, mix evenly with hot wine, and administer orally. Apply warm compresses of green onion cakes to the periumbilical region. Moxibustion on Guanyuan (CV4) and Qihai (CV6) for 20-30 moxa cones. If the pulse gradually becomes palpable and limbs slightly warm, survival is likely. If the pulse does not return, death ensues. Sudden emergence of the pulse also indicates death.
For frozen-to-death individuals: Use sulfur, Pinellia Rhizoma (Banxia), and Gleditsia Sinensis Fruit (Zaojiao), each one "yi" unit, mixed with musk powder, fill into the umbilicus. Place a green onion cake on top and apply heat with an iron. Replace the cake when it rots. Continue until warmth enters the abdomen and the patient gradually regains consciousness. Alternatively, use heated ash in a bag to compress the heart region; replace when cool. After several times, if eyes open, administer wine or rice water. If unconscious, moxibustion on the incisor gap is used; hearing a cry indicates rescue is possible. Do not use fire to warm directly before warming the heart, as cold-fire conflict leads to death. Do not pour hot water on frozen-stiffened patients who are not yet awake. (From Li Shizhen's *Bencao Gangmu*)
[Medication]
The primary formula is Lizhong Tang (Regulate the Middle Decoction), added with Pinellia Rhizoma (Banxia), Atractylodes Macrocephala Rhizoma (Cangzhu), Magnolia Bark (Houpo), Tangerine Peel (Chenpi), and Aucklandia Root (Muxiang). For abdominal pain, add Evodia Fruit (Wuzhuyu); for vomiting, add Agastache Herb (Huoxiang); for testicular retraction and absent pulse, add Ginseng Radix et Rhizoma (Renshen) and Aconite Lateralis Radix Praeparata (Fuzi); for limb joint pain, add Cinnamon Twig (Guizhi); for cold feet and knees, add Cinnamon Bark (Rougui).
If extreme yin causes false agitation, restlessness, thirst but inability to swallow, facial redness but cold feet, and rapid pulse that feels empty upon heavy pressure, decoct the aforementioned herbs and soak the cup in cold water before administering cold. This prevents rejection (vomiting). Misinterpreting these signs as yang syndrome and administering cold-cooling herbs leads to death, as rootless fire scatters upon contact with water. In urgent situations where Renshen and Fuzi cannot be used, administer Erchen Tang added with Cangzhu, Baizhu, Houpo, Paojiang (Charred Ginger), and Wuzhuyu. This stops vomiting/diarrhea and relieves pain safely. Subsequently, adjust based on the deficiency or excess of primordial qi to avoid errors.
[Appendix: External Contraction Yin Toxin]
Yin Du (Yin Toxin) results from inhaling killing qi of heaven and earth, entering the three yin meridians. It is slightly milder than Zhong-han. Symptoms include headache, aversion to cold, cyanotic-black face, sore throat, body pain like being beaten, cold extremities, shortness of breath. Treatable within 4-5 days; untreatable after 6-7 days. Use releasing exterior formulas, primarily Shengma Biejia Tang (Cinnabar and Turtle Shell Decoction) removing Sichuan Pepper (Shujiao) and Realgar (Xionghuang). (From Zhang Zhongjing)
[Appendix: Internal Injury True Yin]
Internal Injury True Yin syndrome results from sexual exhaustion damaging the Kidney and raw/cold foods damaging the Spleen. With latent yin inside and cold outside, it is more severe than Zhong-han. It can also arise from Yang syndromes of Shanghan treated excessively with cooling herbs. After 5-6 days, symptoms include mental confusion, fatigue, reluctance to speak, cold sweat on forehead/back of hands, pale-black slippery tongue coating, hardness in the epigastrium, ice-cold limbs, cyanotic lips/black nails, soot-like nose, abdominal pain with vomiting/diarrhea, sore throat/eye pain, body pain like beating, scrotal retraction, tongue curling. Use warming meridian formulas: Huiyang San (Restore Yang Powder) and Fanyin Dan (Return Yin Pill), plus external moxibustion on Dantian (CV8) and Qihai (CV6). (From *Huren Shu*)
[Selected Formulas for Zhong-han]
Lizhong Tang (Regulate the Middle Decoction): For qi-deficiency Zhong-han with abdominal pain, vomiting/diarrhea, cold limbs/syncope, deep-delayed pulse.
Dried Ginger (Pao) 2.5 qian, Atractylodes Rhizoma (Baizhu) 2.5 qian, Licorice Root (Gancao) 1 qian.
Decoct in water. For yin-agitation, take cold after soaking in water. Add Renshen and Fuzi to make Shenfu Lizhong Tang.
Sini Tang (Reverse the Extremity Decoction): For Zhong-han with cold limbs, thin pulse, curled tongue, retracted scrotum.
Prepared Aconite Root (Fuzi) 1 piece, Dried Ginger 1.5 liang, Ginseng 2 liang, Licorice Root 2 liang.
Decoct 3 sheng of water to 3 he. Divide into 3 doses.
Sanjian Tang (Three Establishments Decoction): For Zhong-han with absent six pulses but presence of pulses at Taichong (LR3) and Chongyang (ST42).
Aconite Root (Chuanwu), Prepared Aconite Root (Fuzi), Heavenly Aconite (Tianxiong) in equal parts.
Decoct with Fresh Ginger.
Wuji San (Five Accumulations Powder) (from *Heji Jufang*): For mild Zhong-han, pathogen still in exterior, headache/body ache, aversion to cold, abdominal pain/vomiting/diarrhea, delayed pulse.
Angelica Dahurica Root (Baizhi), Poria (Fuling), Pinellia Rhizoma (Banxia), Angelica Sinensis Root (Danggui), Ligusticum Chuanxiong Rhizoma (Chuanxiong), Licorice Root (Gancao), Cinnamon Bark (Rougui), White Peony Root (Shaoyao) [each 3 liang], Immature Bitter Orange (Zhike, stir-fried), Ephedra Stem (Mahuang, remove roots/joints), Tangerine Peel (Chenpi) [each 6 liang], Platycodon Root (Jiegeng) 2 liang, Magnolia Bark (Houpo, ginger-fried), Dried Ginger (Ganjiang) [each 4 liang], Atractylodes Rhizoma (Cangzhu) 24 liang.
Take 4 qian per dose, with 1 lamp of water, 3 slices of ginger, 3 stalks of green onion. Decoct to 70% volume.
Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) (from Zhang Zhongjing): For cold invading Shaoyin, deep-thin pulse, cold feet, paradoxical fever with aversion to cold.
Ephedra Stem (Mahuang), Asarum Root (Xixin) [each 4 qian], Prepared Aconite Root (Fuzi) 2.5 qian.
Decoct in water.
Shengma Biejia Tang removing Shujiao and Xionghuang (from Zhang Zhongjing): For external contraction of heaven-earth toxic vapors entering yin meridians.
Licorice Root (Gancao), Cinnamon Twig (Guizhi), Cimicifuga Rhizome (Shengma), Angelica Sinensis Root (Danggui), Turtle Carapace (Biejia).
Decoct in water, take warm. Cover to induce slight sweating.
Huiyang San (Restore Yang Powder)
Use 2 Prepared Aconite Roots (Fuzi), grind to powder, mix evenly with fresh ginger and wine, and take.
Fanyin Dan (Return Yin Pill)
Sulfur 5 liang, Prepared Aconite Root (Fuzi), Dried Ginger (Ganjiang), Cinnamon Heart (Guixin) [each 0.5 liang], Niter (Xiaoshi), Aragonite (Xuanjing Shi) [each 2 liang].
Grind to powder, make pills with paste, take with mugwort decoction.