后汉张仲景着《伤寒杂病论》。以伤寒二字。统括四时六气之外感证。以杂病二字。统括全体脏腑
之内伤证。外感时病者。言其病从外受。非专指正伤寒也。内伤杂病者。言其病从内生。非但属虚损病也。
伤寒最多夹证。其病内外夹发。较兼证尤为难治。凡伤寒用正治法。而其病不愈。或反加重者。必有所
夹而致。或夹食。或夹痰。或夹饮。或夹血。或夹阴。或夹哮。或夹痞。或夹痛。或夹胀。或夹泻。
或夹痢。或夹疝。或夹痨。或夹临经。或夹妊娠。或夹产后。必先辨明因证。刻意精别。用药庶无差误。
故前哲善治伤寒者。其致力虽在杂病未研之先。而得心转在杂病悉通之后。不亲历者不知也。临证不
博者更不知也。其证约计十六。条治于后。
（一名伤寒夹食 或名停食感冒）
【因】伤寒夹食。十常七八。或先伤食而后感寒。或先受寒而后伤食。或病势少间。强与饮食。重复发热。
变证百出。
【证】头痛身热。恶寒无汗。胸痞恶心。嗳腐吞酸。甚或呕吐泄泻。或脘闷腹痛。剧则昏厥不语。舌苔
白浓。或兼淡黄。或兼灰腻。
【脉】左右俱紧盛有力。沉涩似伏者。食填膈上。仲景所谓宿食在上脘者。当吐之是也。右数而滑者。食积
胃肠。仲景所谓下利不欲食者。有宿食故。脉反滑。当有所去。下之乃愈是也。紧如转索无常者。
宿食中结。仲景所谓脉紧头痛有风寒。腹中有宿食不化也。
【治】先去外邪。春冬香苏葱豉汤。加生枳壳（一钱或钱半。）苦桔梗（八分。）夏秋藿香正气
汤加枳桔。继除里实。在胃宜消。消导二陈汤主之。（生枳壳钱半、六和曲三钱、炒楂肉二钱、真川朴
一钱、仙半夏二钱、广皮红一钱、焦苍术八分、童桑枝一两。）急则先用吐法。姜盐汤探吐最稳。
（生姜末五分、拌炒食盐五钱、开水冲一汤碗、顿服后、以鸡毛掀其咽喉、于不透风处吐之。）在肠宜下。
枳实导滞汤主之。不应。可用大承气汤急下之。若因冷食固结者。大黄必须姜炒。略加附子行经。庶免
下利稀水之弊。总以舌干口燥。大便不通。手按胸胁脐腹。硬满而痛。手不可近。频转矢气。方是急下之证。
前哲谓发表未除。不可攻里。上盛未除。不可下夺。真先后缓急之定例也。另有一种刚刚感冒风寒。
而误食冷物。或先食冷物。而又感冒风寒。此冷物入于胃邪传于脾。而为寒中太阴之证。其证胸膈 满。
腹胀闭塞。面目及唇。皆无色泽。手足冷。脉沉细。或腹痛少神。治宜理中汤加青皮、陈皮。或枳实理中丸
（即理中丸加枳实）及五积散之类。若误投巴霜急下。必愈不快。甚或吐利。一二日后。遂致不救。盖不
知寒中太阴及损动胃气而成也。
【秀按】古谚云。病从口入。故凡外感时证。夹食最多。不但正伤寒为然。如初起头痛身热。
不论恶风恶寒恶热。即见胸前大热。颅胀腹满。按之痛。或呕逆。或泄利。或腹疼。皆是外感夹食之候。
俞君先表后里。在胃则消。在肠则下。法固井然有条。即春冬主香苏葱豉。夏秋主藿香正气。二汤均加
枳桔。理气疏滞。既不纯用升散表药。使宿食上逆。而成 胀不通之弊。又不混用消导里药。致引邪内陷。
而成结胸下利之患。必俟表
邪解散。或消或下。庶免引贼破家之虑。方法恰当。若四五日右脉滑数。苔白转黄。宿食化火也。法当清化。
小陷胸合栀朴枳实汤。（全栝蒌四钱、半夏曲二钱、姜炒川连八分、焦山栀三钱、川朴、枳实各一钱。）口甜
而腻。加苏佩兰。（钱半至二钱）腹满而痛。加酒炒延胡。（一钱至钱半。）痛甚便秘。加青木香（六分。）酒
炒生川军（钱半至三钱。）若因误下而热邪内陷。中气受伤。愈加胀满。热虽不止而右脉虚小者。小陷胸合枳
实理中汤。（栝蒌仁四钱、姜半夏二钱、姜炒川连一钱、小枳实一钱拌炒生晒术一钱、米炒潞党参一钱、炒干
姜五分、炙黑甘草三分。）若右脉坚大。重按沉滞有力。便秘已五六日。脐下按之痛甚者。此为大肠气郁而实
也。当用大承气汤急下之。虽然。脏性有阴阳。宿食亦有寒热。如其人胃素虚寒。寒食结而不化。右脉反涩滞
伏结。身虽热而两足反冷者。必兼温中疏滞。神术汤加减为主。如其人胃素强盛。宿食不久化热。右脉多洪盛
滑数。身壮热而胸膈烦闷者。必兼清中疏滞。调中饮加减为主。（小枳实、姜炒川连各一钱、六神曲、炒楂肉各二
钱、真川朴、广橘红各八分、青木香汁两匙、生萝卜汁一瓢同冲。）若过用消克伤胃。其证自利肢厥。胸膈痞
满。按之不坚不痛。时胀时减。右脉始虽浮大。久按渐转虚小者。必兼温和脾胃。白术和中汤为主。总之右脉
滑盛。手足温和者易治。右脉短涩。四肢逆冷者难疗。此为外感夹食之总诀。
【廉勘】傅学渊曰。凡外感病挟食者颇多。当思食为邪裹。散其邪则食自下。若杂消导于发散中。不专达
表。胃汁复伤。因而陷闭者有之。说与俞氏符合。然亦不可尽拘。凡治外感夹食。先辨舌苔。挟食者苔必白
浓。根兼黄腻。或黄白相兼而必浓。次察胸脘。挟食者胸脘必痞满。且必拒按。按之坚痛。虽舌赤神昏。但胸
下拒按。即不可率投凉润。及早用苦寒。发表药中。必参以辛开之品。轻则葱、豉、橘、蔻。重则枳、朴、
蒌、薤。始有效力。虽然。伤寒为外感通称。凡勘夹食证治。不但四时有异。即四方风土。亦各不同。如西北
高原。病多风寒。东南卑下。病多湿热。即四季之中。亦有暴冷暴暖。久晴久雨之各殊。风寒风热。不少变迁。
寒湿温燥。常多间杂。虽同一夹食。而感症不同。治法亦异。就余所验。凡有外感。胃肠中气。即不
健运。不必伤于食也。特伤于食者。多而尤甚。故余治外感夹食。必先辨其病因。因于风寒者。荆
防楂曲汤加减。（荆芥防风各钱半、苏叶梗二钱、苦桔梗一钱、建神曲三钱、南楂炭二钱、莱菔子钱
半拌炒春砂仁六分、伤面食、加焦麦芽钱半、伤饭食、加焦谷芽二钱、伤酒、加生葛花一钱、枳 子
三钱、伤瓜果冷食、加公丁香七支、清化桂二三分、黑炮姜五分、方载陆九芝先生《世补斋》。）因
于风热者。葱豉桔梗汤加枳壳为主。或陆氏桑薄银翘汤加减。（冬桑叶钱半、苏薄荷八分、济银花钱半、
青连翘二钱、光杏仁三钱、广橘红一钱、生枳壳一钱、苦桔梗八分、生甘草四分、鲜淡竹叶三十片、
目赤加滁菊花、夏枯草各二钱、颐肿、加鲜大青、天葵草各三钱、牙疼加谷精草二钱、北细辛二分、
白知母三钱、喉痧加牛蒡子钱半、用水芦笋二两、青箬叶一两、煎汤代水。）因于湿温者。三仁汤加保
和丸。（光杏仁、生苡仁各三钱、蔻末六分拌滑石四钱、姜半夏钱半、真川朴一钱、丝通草、淡竹叶各
钱半、丹溪保和丸四钱包煎。）因于伤暑者。陆氏青蒿二香汤加减。（青蒿脑钱半、杜藿香二钱、西香
薷、薄川朴、扁豆花、陈木瓜各一钱、六一散三钱荷叶包煎。用西瓜翠衣嫩桑枝各一两、煎汤代水。）因
于风燥者。陆氏桑杏蒌贝汤加减。（冬桑叶、光杏仁、栝蒌皮、川贝母各二钱、苏薄荷一钱、牛蒡子
钱半、生枳壳一钱、苦桔梗七分、生甘草三分、鲜枇杷叶五钱、去毛筋净。）因于痧疹者。陆氏蒡葛银
翘汤加减。（牛蒡子钱半、生葛根一钱、济银花钱半、青连翘三钱、净蝉蜕一钱、制僵蚕、焦栀皮、绿豆
皮各钱半、生甘草四分。）继则辨其在胃宜消者。会解神曲汤加减。（范制曲三钱、炒山楂二钱、半夏曲、
生枳壳各钱半、广橘红一钱、连翘壳二钱、焦麦芽一钱、莱菔子钱半拌炒砂仁六分。）或用枳实栀豉汤加
生萝卜汁、淡竹沥（各二瓢）、生姜汁（四滴、和匀、同冲。）在肠宜下者。栀朴枳实汤合陆氏润字丸为主。
（汤方焦山栀三钱、川朴、枳实各钱半、丸方半夏、橘红、牙皂各一两、杏仁、前胡、花粉、枳实、楂肉
各二两、炙甘草三
钱、槟榔七钱、生川军十二两、水发丸、每服三钱或四钱。）其间有 疹内伏。连用开透而不出。
用消导法。如会解神曲汤加芦笋（二两）细辛（二分）往往 出神清而愈。若因肝火甚而热结不下者。
另吞更衣丸一钱。最效。惟荤腥油腻。与邪热 毒。纽结不解。唇舌焦裂。口臭牙疳。烦热昏沉。
与以寻常消导。病必不解。徒用清里。其热愈甚。设用下夺。其死更速。惟用秦皇士升麻清胃汤加枳
壳、楂肉。（升麻五分、丹皮钱半、鲜生地五钱、小川连八分、细木通一钱、生甘细梢七分、生枳壳
钱半、炒楂肉二钱。）庶能清理肠胃血分中之膏粱积热。多获生全。故临证处方之际。苟非胸有定
规。必难合辙。
后汉时期，张仲景撰写了《伤寒杂病论》。用“伤寒”二字，概括了四季六气所致的外感病证；用“杂病”二字，概括了全身脏腑所致的内伤病证。所谓外感时病，是指疾病从外部感受邪气所致，并非专指典型的伤寒；所谓内伤杂病，是指疾病从内部产生所致，并不仅仅属于虚损类疾病。
伤寒病中夹杂其他证候的情况最为多见，其病情内外夹杂发作，比单纯的兼证更加难以治疗。凡是使用正治法治疗伤寒，但病情不愈或反而加重的，必定是因为有所夹杂所致。可能是夹食（饮食停滞）、夹痰、夹饮（水饮内停）、夹血、夹阴、夹哮（哮喘）、夹痞（痞满）、夹痛、夹胀、夹泻、夹痢、夹疝、夹痨（劳损）、夹临经（临近月经期）、夹妊娠或夹产后。必须首先辨明病因和证候，刻意精细区分，用药才可能没有差错。所以前代善于治疗伤寒的医家，他们的精力虽然花在研究杂病之前，但真正心得的转变是在通晓杂病之后，不亲身经历的人不知道这一点，临床见识不广博的人更不知道这一点。这类证候大约计有十六种，条文治法列于后面。
【病因】伤寒夹食，十人中常有七八人患病。有的是先伤食后感寒，有的是先受寒后伤食，有的是病势稍缓时，强行进食，导致发热复发，变证百出。
【症状】头痛身热，恶寒无汗，胸脘痞闷恶心，嗳气腐臭吞酸，甚至呕吐泄泻，或胃脘闷痛腹痛，严重时昏厥不语，舌苔白厚，或兼淡黄色，或兼灰腻色。
【脉象】左右手脉象都紧盛有力，沉涩似伏的，是食物填塞膈上，即张仲景所说的宿食在上脘，应当用吐法治疗。右手脉数而滑的，是食积在胃肠，即张仲景所说的下利不欲食者，因为有宿食，脉反滑，应当用攻下法祛除，下之则愈。脉紧如转索无常的，是宿食结在中焦，即张仲景所说的脉紧头痛有风寒，腹中有宿食不化。
【治法】先去除外邪，春冬季用香苏葱豉汤，加生枳壳（一钱或钱半）、苦桔梗（八分）；夏秋季用藿香正气汤加枳壳、桔梗。继而去除湿滞里实，病在胃宜用消导法，主方为消导二陈汤。（生枳壳钱半、六和曲三钱、炒山楂肉二钱、真川朴一钱、仙半夏二钱、广皮红一钱、焦苍术八分、童桑枝一两。）急症则先用吐法，姜盐汤探吐最稳妥。（生姜末五分、拌炒食盐五钱、开水冲一碗，顿服后，以鸡毛探咽喉，在不透风处催吐。）病在肠宜用下法，主方为枳实导滞汤。若无效，可用大承气汤急下。若是因冷食固结者，大黄必须用姜炒，略加附子行经，以免出现下利稀水的弊端。总之，以舌干口燥，大便不通，手按胸胁脐腹，硬满而痛，手不可近，频繁放屁，这才是急下的证候。前代医家说发表未除，不可攻里；上盛未除，不可下夺，这是处理先后缓急的定例。另有一种情况，刚刚感冒风寒，却误食冷物，或先食冷物而又感冒风寒，此冷物入胃，邪气传脾，形成寒中太阴的证候。其症状为胸膈满闷，腹胀闭塞，面目及嘴唇都没有色泽，手足冷，脉沉细，或腹痛少神。治宜理中汤加青皮、陈皮，或枳实理中丸（即理中丸加枳实）及五积散之类。若误投巴豆霜急下，必然病情加重，甚至呕吐泄泻，一二日后便导致不治。这是因为不知寒中太阴及损伤胃气所致。
【俞秀按语】古谚语说：病从口入。所以凡是外感时证，夹食最多，不仅典型伤寒如此。如初起头痛身热，不论恶风、恶寒还是恶热，只要见到胸前大热，颅胀腹满，按压疼痛，或呕逆，或泄利，或腹痛，都是外感夹食的征候。俞君主张先解表后治里，病在胃则消导，病在肠则攻下，方法固然井然有序。即春冬主用香苏葱豉汤，夏秋主用藿香正气汤，两方均加枳壳、桔梗，理气疏滞，既不纯用升散表药，使宿食上逆而成胀满不通的弊端，又不混用消导里药，致引邪内陷而成结胸下利的祸患。必须等到表邪解散，或消或下，才免除引贼破家的顾虑。方法恰当。如果四五天后右脉滑数，苔白转黄，是宿食化火，治法当清化，用小陷胸汤合栀朴枳实汤。（全瓜蒌四钱、半夏曲二钱、姜炒川连八分、焦山栀三钱、川朴、枳实各一钱。）口甜而腻，加苏佩兰（钱半至二钱）。腹满而痛，加酒炒延胡索（一钱至钱半）。痛甚便秘，加青木香（六分）、酒炒生大黄（钱半至三钱）。若因误下导致热邪内陷，中气受伤，更加胀满，热虽不止但右脉虚小者，用小陷胸汤合枳实理中汤。（瓜蒌仁四钱、姜半夏二钱、姜炒川连一钱、小枳实一钱拌炒生晒术一钱、米炒潞党参一钱、炒干姜五分、炙黑甘草三分。）若右脉坚大，重按沉滞有力，便秘已五六日，脐下按压疼痛剧烈者，这是大肠气郁而实，当用大承气汤急下。虽然如此，脏腑性质有阴阳之分，宿食也有寒热之别。如其人胃素来虚寒，寒食结聚不化，右脉反涩滞伏结，身体虽热但两脚反而冷者，必须兼用温中疏滞，以神术汤加减为主。如其人胃素来强盛，宿食不久化热，右脉多洪盛滑数，身体壮热且胸膈烦闷者，必须兼用清中疏滞，以调中饮加减为主。（小枳实、姜炒川连各一钱、六神曲、炒山楂肉各二钱、真川朴、广橘红各八分、青木香汁两匙、生萝卜汁一瓢同冲。）若过用消克药物损伤胃气，其证自利肢厥，胸膈痞满，按压不坚不痛，时胀时减，右脉始虽浮大，久按渐转虚小者，必须兼用温和脾胃，以白术和中汤为主。总之，右脉滑盛，手足温和者易治；右脉短涩，四肢逆冷者难疗。这是外感夹食的总诀。
【廉勘按语】傅学渊说：凡外感病挟食者很多，应当想到食邪被邪气包裹，疏散邪气则食自下。若在发散药中杂入消导药，不专力达表，胃汁又受损伤，因而导致邪气陷闭的情况是有过的。这种说法与俞氏相符，但也不可完全拘泥。凡治疗外感夹食，先辨舌苔，挟食者苔必白厚，根部兼黄腻，或黄白相间而必厚。其次察胸脘，挟食者胸脘必痞满，且必拒按，按压坚硬疼痛。即使舌赤神昏，只要胸下拒按，就不可贸然投用凉润药，及早用苦寒药。在发表药中，必须参以辛开之品，轻则用葱、豉、橘、蔻，重则用枳、朴、蒌、薤，始有效力。虽然如此，伤寒是外感的通称，凡勘验夹食证治，不但四季不同，即四方风土也各不相同。如西北高原，病多风寒；东南卑下之地，病多湿热。即四季之中，也有暴冷暴暖、久晴久雨的不同。风寒风热，不少变迁；寒湿温燥，常多间杂。虽同为夹食，但感症不同，治法亦异。就我个人的经验，凡有外感，胃肠中气即不健运，不必一定伤于食。只是伤于食者，多而且尤甚。所以我治疗外感夹食，必先辨明病因。因于风寒者，用荆防楂曲汤加减。（荆芥防风各钱半、苏叶梗二钱、苦桔梗一钱、建神曲三钱、南楂炭二钱、莱菔子钱半拌炒春砂仁六分、伤面食，加焦麦芽钱半、伤饭食，加焦谷芽二钱、伤酒，加生葛花一钱、枳子三钱、伤瓜果冷食，加公丁香七支、清化桂二三分、黑炮姜五分，方载陆九芝先生《世补斋》。）因于风热者，用葱豉桔梗汤加枳壳为主，或陆氏桑薄银翘汤加减。（冬桑叶钱半、苏薄荷八分、济银花钱半、青连翘二钱、光杏仁三钱、广橘红一钱、生枳壳一钱、苦桔梗八分、生甘草四分、鲜淡竹叶三十片、目赤加滁菊花、夏枯草各二钱、颐肿，加鲜大青、天葵草各三钱、牙疼加谷精草二钱、北细辛二分、白知母三钱、喉痧加牛蒡子钱半、用水芦笋二两、青箬叶一两，煎汤代水。）因于湿温者，用三仁汤加保和丸。（光杏仁、生苡仁各三钱、蔻末六分拌滑石四钱、姜半夏钱半、真川朴一钱、丝通草、淡竹叶各钱半、丹溪保和丸四钱包煎。）因于伤暑者，用陆氏青蒿二香汤加减。（青蒿脑钱半、杜藿香二钱、西香薷、薄川朴、扁豆花、陈木瓜各一钱、六一散三钱荷叶包煎。用西瓜翠衣嫩桑枝各一两，煎汤代水。）因于风燥者，用陆氏桑杏蒌贝汤加减。（冬桑叶、光杏仁、栝蒌皮、川贝母各二钱、苏薄荷一钱、牛蒡子钱半、生枳壳一钱、苦桔梗七分、生甘草三分、鲜枇杷叶五钱，去毛筋净。）因于痧疹者，用陆氏蒡葛银翘汤加减。（牛蒡子钱半、生葛根一钱、济银花钱半、青连翘三钱、净蝉蜕一钱、制僵蚕、焦栀皮、绿豆皮各钱半、生甘草四分。）继则辨其在胃宜消者，用会解神曲汤加减。（范制曲三钱、炒山楂二钱、半夏曲、生枳壳各钱半、广橘红一钱、连翘壳二钱、焦麦芽一钱、莱菔子钱半拌炒砂仁六分。）或用枳实栀豉汤加生萝卜汁、淡竹沥（各二瓢）、生姜汁（四滴，和匀，同冲。）在肠宜下者，用栀朴枳实汤合陆氏润字丸为主。（汤方焦山栀三钱、川朴、枳实各钱半、丸方半夏、橘红、牙皂各一两、杏仁、前胡、花粉、枳实、楂肉各二两、炙甘草三钱、槟榔七钱、生川军十二两，水发丸，每服三钱或四钱。）其间有疹毒内伏，连用开透而不出，用消导法，如会解神曲汤加芦笋（二两）细辛（二分），往往疹出神清而愈。若因肝火甚而热结不下者，另吞更衣丸一钱，最效。惟荤腥油腻，与邪热毒纽结不解，唇舌焦裂，口臭牙疳，烦热昏沉，给予寻常消导，病必不解；徒用清里，其热愈甚；设用下夺，其死更速。惟用秦皇士升麻清胃汤加枳壳、楂肉。（升麻五分、丹皮钱半、鲜生地五钱、小川连八分、细木通一钱、生甘细梢七分、生枳壳钱半、炒楂肉二钱。）庶能清理肠胃血分中之膏粱积热，多获生全。故临证处方之际，苟非胸有定规，必难合辙。
In the Later Han Dynasty, Zhang Zhongjing wrote *Shanghan Zabing Lun* (Treatise on Cold Damage and Miscellaneous Diseases). The term "Shanghan" (Cold Damage) encompasses exogenous syndromes caused by the external pathogens of the six Qi (Six Climatic Factors) across the four seasons. The term "Zabing" (Miscellaneous Diseases) encompasses endogenous syndromes involving the internal organs of the whole body. Exogenous seasonal diseases refer to illnesses contracted from the exterior, not specifically referring to typical Shanghan. Endogenous miscellaneous diseases refer to illnesses arising from within, not merely belonging to deficiency-consumption diseases.
Among Shanghan diseases, complicated syndromes with concurrent pathologies are most common. These conditions involve simultaneous internal and external pathology onset and are more difficult to treat than simple concurrent syndromes. Whenever standard treatment methods for Shanghan fail to resolve the disease or cause it to worsen, it is necessarily due to a concurrent pathology. This may include food stagnation (Jia Shi), phlegm retention, fluid retention (Jia Yin), blood stasis, yin deficiency, asthma (Jia Xiao), chest stuffiness (Jia Pi), pain (Jia Tong), distension (Jia Zhang), diarrhea (Jia Xie), dysentery (Jia Li), hernia (Jia Shan), consumptive disease (Jia Lao), menstruation approaching (Jia Lin Jing), pregnancy (Jia Ren Shen), or postpartum state (Jia Chan Hou). One must first clearly differentiate the etiology and syndrome, meticulously distinguishing them, so that medication will be free from error. Therefore, ancient masters skilled in treating Shanghan exerted their efforts in studying miscellaneous diseases before mastering Shanghan, but their true clinical insight was gained only after thoroughly understanding miscellaneous diseases. Those who have not experienced this personally do not know it; those with limited clinical experience certainly do not know it. There are approximately sixteen such syndromes, with their diagnostic criteria and treatments listed below.
(Also known as Shanghan with Food Stagnation, or Food Retention Cold-Flu)
[Etiology] Shanghan with food stagnation accounts for seven or eight out of ten cases. Some patients suffer from food injury first and then catch cold; others catch cold first and then suffer from food injury. In some cases, when the disease intensity subsides slightly, forced feeding leads to recurrent fever and a hundred variations of complications.
[Symptoms] Headache, feverish body, aversion to cold, absence of sweating, chest and epigastric stuffiness with nausea, belching with putrid odor and acid regurgitation. Severe cases may present vomiting and diarrhea, epigastric oppression and abdominal pain, or even coma with inability to speak. The tongue coating is white and thick, possibly mixed with pale yellow or grayish greasy coating.
[Pulse] Both left and right pulses are tight, vigorous, and forceful. If deep, choppy, and seemingly hidden, it indicates food filling the upper diaphragm, which Zhang Zhongjing described as "retained food in the upper jiao," requiring emesis. If the right pulse is rapid and slippery, it indicates food accumulation in the stomach and intestines, corresponding to Zhang Zhongjing's statement: "Diarrhea with loss of appetite indicates retained food; the pulse is surprisingly slippery, indicating something should be expelled; purgation leads to recovery." If the pulse is tight like a turning rope and irregular, it indicates retained food knotting in the middle jiao, matching Zhang Zhongjing's description: "Tight pulse with headache indicates wind-cold; retained food in the abdomen fails to digest."
[Treatment] First, eliminate the exterior pathogen. In spring and winter, use Xiangsu Congchi Tang (Perilla and Scallion Decoction) with added Sheng Zhi Qiao (Immature Bitter Orange, 1 qian or 1.5 qian) and Ku Jie Geng (Bitter Platycodon Root, 8 fen). In summer and autumn, use Huoxiang Zhengqi Tang (Agastache Powder for Regulating the Qi) with added Zhi Qiao and Jie Geng. Subsequently, remove interior excess. For pathology in the stomach, use digestion-promoting methods; the main formula is Xiaodao Erchen Tang (Digestion-Promoting Two-Aged Phlegm Decoction) [Ingredients: Sheng Zhi Qiao 1.5 qian, Liuhe Qu 3 qian, Chao Zha Rou 2 qian, Zhen Chuan Po 1 qian, Xian Ban Xia 2 qian, Guang Pi Hong 1 qian, Jiao Cang Zhu 8 fen, Tong Sang Zhi 1 liang]. In acute cases, use emesis first; Jiang Yan Tang (Ginger-Salt Soup) for inducing vomiting is safest [Ingredients: Sheng Jiang Mo 5 fen, stir-fried salt 5 qian, dissolved in one bowl of boiling water, taken at once; then stimulate the throat with a chicken feather and induce vomiting in a draft-free place]. For pathology in the intestines, use purgation; the main formula is Zhishi Daozhi Tang (Immature Bitter Orange Decoction for Guiding Out Stagnation). If ineffective, use Dachengqi Tang (Major Order the Qi Decoction) for urgent purgation. If caused by solidified cold food, Da Huang (Rhubarb Rhizome) must be stir-fried with ginger, with a slight addition of Fu Zi (Aconite Lateral Root) to promote circulation, avoiding the adverse effect of watery diarrhea. Generally, indications for urgent purgation include dry tongue and mouth, constipation, hardness and fullness with pain upon palpation of the chest, hypochondrium, umbilicus, and abdomen, tenderness preventing touch, and frequent passage of flatus. Ancient masters stated: "If exterior release is not achieved, interior attack is contraindicated; if upper excess is not resolved, downward purging is contraindicated." This is the fixed rule for handling priority and urgency.
Another scenario involves catching a cold-wind pathogen and mistakenly consuming cold food, or eating cold food first and then catching cold-wind. The cold food enters the stomach, and the pathogen transmits to the spleen, resulting in a Taiyin Cold-Center syndrome. Symptoms include chest and diaphragm fullness, abdominal distension and blockage, lack of luster in the face, eyes, and lips, cold hands and feet, deep and fine pulse, or abdominal pain with lethargy. Treatment should employ Lizhong Tang (Regulate the Middle Decoction) with added Qing Pi (Green Tangerine Peel) and Chen Pi (Aged Tangerine Peel), or Zhishi Lizhong Wan (Immature Bitter Orange Pill for Regulating the Middle, i.e., Lizhong Wan plus Zhishi), or Wuji San (Five Accumulations Powder). Mistakenly using Ba Shuang (Croton Seed Extract) for urgent purgation will worsen the condition, potentially causing vomiting and diarrhea, leading to death within one or two days. This occurs because the practitioner fails to recognize Taiyin Cold-Center and damage to stomach qi.
[Commentary by Yu Xiu] An old proverb says, "Disease enters through the mouth." Thus, among exogenous seasonal diseases, food stagnation is most common, not just in typical Shanghan. Initially, with headache and fever, regardless of aversion to wind, cold, or heat, if there is intense heat in the chest, cranial distension, abdominal fullness, pain on pressure, vomiting/reversal, diarrhea/dysentery, or abdominal pain, these are all signs of exogenous disease with food stagnation. Mr. Yu advocates releasing the exterior first and treating the interior later: digestion for stomach involvement, purgation for intestinal involvement. This method is orderly. Using Xiangsu Congchi Tang in spring/winter and Huoxiang Zhengqi Tang in summer/autumn, both adding Zhi Qiao and Jie Geng to regulate qi and relieve stagnation, avoids purely using ascending/dispersing exterior drugs that might cause food stagnation to reverse upward leading to obstruction, and avoids indiscriminately using digestive interior drugs that might draw pathogens inward causing chest binding or diarrhea. Only after the exterior pathogen is resolved should one proceed to digestion or purgation, thus avoiding the risk of "inviting thieves to break the house." The method is appropriate.
If after four or five days the right pulse is slippery and rapid, and the coating turns from white to yellow, it indicates food stagnation transforming into fire. The treatment should clear and transform using Xiaoxianxiong Tang (Minor Chest-Unblocking Decoction) combined with Zhi Po Zhishi Tang (Gardenia, Magnolia, and Immature Bitter Orange Decoction) [Ingredients: Quan Gua Lou 4 qian, Ban Xia Qu 2 qian, Jiang Chao Chuan Lian 8 fen, Jiao Shan Zhi 3 qian, Chuan Po and Zhishi each 1 qian]. Sweet and greasy taste in the mouth adds Su Pei Lan (Perilla Leaf, 1.5-2 qian). Abdominal fullness and pain add Jiu Chao Yan Hu Suo (Wine-processed Corydalis Rhizome, 1-1.5 qian). Severe pain with constipation adds Qing Mu Xiang (Vladimiria Root, 6 fen) and Jiu Chao Sheng Jun Yu (Wine-processed Raw Rhubarb, 1.5-3 qian).
If mistaken purgation causes heat pathogens to sink inward, damaging middle qi, worsening distension, with persistent heat but a deficient/small right pulse, use Xiaoxianxiong Tang combined with Zhishi Lizhong Tang [Ingredients: Gua Lou Ren 4 qian, Jiang Ban Xia 2 qian, Jiang Chao Chuan Lian 1 qian, Xiao Zhishi 1 qian stir-fried with Sheng Bai Zhu 1 qian, Mi Chao Lu Dang Shen 1 qian, Chao Gan Jiang 5 fen, Zhi Hei Gan Cao 3 fen]. If the right pulse is firm and large, deep and sluggish yet forceful upon heavy pressure, with constipation for 5-6 days and severe pain upon pressing below the umbilicus, this is excessive qi stagnation and excess in the large intestine; use Dachengqi Tang for urgent purgation.
However, organ nature has yin and yang distinctions, and food stagnation also has cold and heat differences. If the person has a constitutionally deficient and cold stomach, with cold food knotting and failing to digest, the right pulse may be choppy, sluggish, hidden, and knotted; although the body is hot, the legs are cold. One must combine warming the middle and relieving stagnation, primarily using Shenzhu Tang (Divine Power Decoction) modified. If the person has a robust stomach, with food stagnation quickly transforming into heat, the right pulse is often surging, vigorous, slippery, and rapid; the body has high fever and chest/diaphragm irritability. One must combine clearing the middle and relieving stagnation, primarily using Tiaozhong Yin (Regulate the Middle Drink) modified [Ingredients: Xiao Zhishi and Jiang Chao Chuan Lian each 1 qian, Liu Shen Qu and Chao Zha Rou each 2 qian, Zhen Chuan Po and Guang Ju Hong each 8 fen, Qing Mu Xiang juice 2 spoons, raw radish juice one ladle, mixed together].
If overuse of digestive/clearing drugs damages stomach qi, symptoms include spontaneous diarrhea, cold limbs, chest/diaphragm stuffiness, non-hard/non-painful upon pressure, intermittent distension and reduction, and the right pulse initially floating and large but becoming deficient and small upon prolonged pressure. One must combine warming and harmonizing the spleen and stomach, primarily using Baizhu Hezhong Tang (Atractylodes Harmonizing the Middle Decoction). In summary, slippery and vigorous right pulse with warm hands and feet indicates easy treatment; short and choppy right pulse with cold extremities indicates difficult treatment. This is the general principle for exogenous disease with food stagnation.
[Commentary by Lian Kan] Fu Xueyuan said: Many exogenous diseases involve food stagnation. One should consider that food is wrapped by the pathogen; dispersing the pathogen allows the food to descend. Mixing digestive drugs with dispersing drugs fails to focus on releasing the exterior and further injures stomach fluids, leading to sinking and closure. This aligns with Mr. Yu’s view, but one should not be rigidly bound by it. When treating exogenous disease with food stagnation, first examine the tongue coating: food stagnation presents with thick white coating, root mixed with yellow/greasy or yellow-white thick coating. Second, inspect the chest and epigastrium: food stagnation causes stuffiness/fullness and tenderness against pressure, feeling hard and painful. Even with red tongue and coma, if the lower chest resists pressure, do not rashly use cooling/moistening drugs or bitter-cold drugs early. In exterior-releasing formulas, add acrid-opening agents: mild cases use Cong, Chi, Ju, Kou; severe cases use Zhi, Po, Lou, Xie. Effectiveness follows.
Although Shanghan is a general term for exogenous diseases, diagnosing food stagnation varies by season and region. Northwest plateaus have more wind-cold; southeast lowlands have more damp-heat. Even within seasons, sudden cold/warmth and long sunny/rainy periods differ. Wind-cold and wind-heat change frequently; cold-damp and warm-dry often mix. Although all involve food stagnation, the specific exogenous patterns differ, requiring different treatments. Based on my experience, whenever there is an exogenous disease, the middle qi of the stomach and intestines fails to transport smoothly, even without food injury. However, cases with food injury are more numerous and severe. Therefore, I first differentiate the etiology when treating exogenous disease with food stagnation.
For wind-cold etiology, use Jing Fang Zha Qu Tang (Schizonepeta and Saposhnikovia Hawthorn-Qu Decoction) modified [Ingredients: Jing Jie and Fang Feng each 1.5 qian, Su Ye Geng 2 qian, Ku Jie Geng 1 qian, Jian Shen Qu 3 qian, Nan Zha Tan 2 qian, Lai Fu Zi 1.5 qian stir-fried with Chun Sha Ren 6 fen; for noodle injury add Jiao Mai Ya 1.5 qian; for rice injury add Jiao Gu Ya 2 qian; for wine injury add Sheng Ge Hua 1 qian and Zhi Zi 3 qian; for fruit/vegetable/cold food injury add Gong Ding Xiang 7 pieces, Qing Hua Gui 2-3 fen, Hei Pao Jiang 5 fen. Formula recorded in Mr. Lu Jiuzhi's *Shibu Zhai*].
For wind-heat etiology, use Cong Chi Jie Geng Tang (Scallion, Fermented Soybean, and Platycodon Decoction) with Zhi Qiao as the main formula, or Lu’s Sang Bo Yin Qiao Tang (Mulberry Leaf, Mint, Honeysuckle, and Forsythia Decoction) modified [Ingredients: Dong Sang Ye 1.5 qian, Su Bo He 8 fen, Ji Jin Yin Hua 1.5 qian, Qing Lian Qiao 2 qian, Guang Xing Ren 3 qian, Guang Ju Hong 1 qian, Sheng Zhi Qiao 1 qian, Ku Jie Geng 8 fen, Sheng Gan Cao 4 fen, Xian Dan Zhu Ye 30 slices; for red eyes add Chu Ju Hua and Xia Ku Cao each 2 qian; for swollen jaw add Xian Da Qing and Tian Kui Cao each 3 qian; for toothache add Gu Jing Cao 2 qian, Bei Xi Xin 2 fen, Bai Zhi Mu 3 qian; for scarlet fever add Niu Bang Zi 1.5 qian, decoct with Shui Lu Sun 2 liang and Qing Ruo Ye 1 liang instead of water].
For damp-warmth etiology, use San Ren Tang (Three Seeds Decoction) with Baohe Wan (Preserve Harmony Pill) [Ingredients: Guang Xing Ren and Sheng Yi Yi Ren each 3 qian, Kou Mo 6 fen mixed with Hua Shi 4 qian, Jiang Ban Xia 1.5 qian, Zhen Chuan Po 1 qian, Si Tong Cao and Dan Zhu Ye each 1.5 qian, Danxi Baohe Wan 4 qian wrapped in decoction].
For summerheat injury etiology, use Lu’s Qing Hao Er Xiang Tang (Artemisia and Two Aromatics Decoction) modified [Ingredients: Qing Hao Nao 1.5 qian, Du Huo Xiang 2 qian, Xi Xiang Ru, Bo Chuan Po, Bian Dou Hua, and Chen Mu Gua each 1 qian, Liu Yi San 3 qian wrapped in Lotus Leaf. Decoct with Xi Gua Cui Yi and Nen Sang Zhi each 1 liang as water substitute].
For wind-dryness etiology, use Lu’s Sang Xing Lou Bei Tang (Mulberry Leaf, Apricot Seed, Trichosanthes Peel, and Fritillaria Decoction) modified [Ingredients: Dong Sang Ye, Guang Xing Ren, Gua Lou Pi, and Chuan Bei Mu each 2 qian, Su Bo He 1 qian, Niu Bang Zi 1.5 qian, Sheng Zhi Qiao 1 qian, Ku Jie Geng 7 fen, Sheng Gan Cao 3 fen, Xian Pi Pa Ye 5 qian, cleaned of hairs and veins].
For rash/toxin etiology, use Lu’s Bang Ge Yin Qiao Tang (Toadflax, Kudzu, Honeysuckle, and Forsythia Decoction) modified [Ingredients: Niu Bang Zi 1.5 qian, Sheng Ge Gen 1 qian, Ji Jin Yin Hua 1.5 qian, Qing Lian Qiao 3 qian, Jing Chan Tui 1 qian, Zhi Jiang Can, Jiao Zhi Pi, and Lv Dou Pi each 1.5 qian, Sheng Gan Cao 4 fen].
Subsequently, differentiate whether to use digestion for stomach involvement or purgation for intestinal involvement. For stomach involvement, use Huijie Shen Qu Tang (Resolve Knots Divine Qu Decoction) modified [Ingredients: Fan Zhi Qu 3 qian, Chao Shan Zha 2 qian, Ban Xia Qu and Sheng Zhi Qiao each 1.5 qian, Guang Ju Hong 1 qian, Lian Qiao Ke 2 qian, Jiao Mai Ya 1 qian, Lai Fu Zi 1.5 qian stir-fried with Sha Ren 6 fen]. Or use Zhishi Zhichi Tang (Immature Bitter Orange, Gardenia, and Fermented Soybean Decoction) with added Sheng Luo Bo Zhi, Dan Zhu Li (each two ladles), and Sheng Jiang Zhi (four drops, mixed and taken together). For intestinal involvement, use Zhi Po Zhishi Tang combined with Lu’s Runzi Wan (Moisten Intestines Pill) as main [Decoction: Jiao Shan Zhi 3 qian, Chuan Po and Zhishi each 1.5 qian; Pill: Ban Xia, Ju Hong, Ya Zao each 1 liang, Xing Ren, Qian Hu, Hua Fen, Zhishi, Zha Rou each 2 liang, Zhi Gan Cao 3 qian, Bing Lang 7 qian, Sheng Jun Yu 12 liang, made into pills with water, take 3-4 qian per dose].
In cases where rash toxins are trapped internally and fail to emerge despite repeated opening/transmitting methods, using digestive methods like Huijie Shen Qu Tang with Lu Sun (2 liang) and Xi Xin (2 fen) often results in rash emergence, clarity of mind, and recovery. If liver fire is severe causing heat knotting and failure to descend, swallowing 1 qian of Gengyi Wan (Change Clothes Pill) separately is most effective.
However, if meat/fat/oily foods bind with heat-toxins, causing cracked/scorched lips and tongue, foul breath, periodontal disease, irritability, fever, and lethargy, ordinary digestive methods will not resolve the disease. Purely clearing the interior increases heat; purging accelerates death. Instead, use Qin Huangshi’s Shengma Qingwei Tang (Cimicifuga Stomach-Clearing Decoction) with added Zhi Qiao and Zha Rou [Ingredients: Sheng Ma 5 fen, Dan Pi 1.5 qian, Xian Sheng Di 5 qian, Xiao Chuan Lian 8 fen, Xi Mu Tong 1 qian, Sheng Gan Xi Shao 7 fen, Sheng Zhi Qiao 1.5 qian, Chao Zha Rou 2 qian]. This can clear accumulated heat from rich foods in the stomach/intestines and blood levels, often ensuring survival. Thus, when prescribing clinically, unless one has a definite plan in mind, it is difficult to hit the mark.