（论一首脉证十六条方十二首）
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。
〔补注〕嘉言云。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。
〔衍义〕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
寒从下上。正地气加天之始。用温则上者下。聚者散。直捷通快。一言而终。故卒
病论虽亡。其可意会者。未尝不宛在也。
愚按∶趺阳为足阳明胃。在跗上五寸间。夫府阳也。土本大。今微弦。阴脉也。脉微
者本虚。必有乘之者矣。故兼木脉。克贼随之。中州之气衰。安能清升而浊降乎。
腹满必至。理自然也。设不满。则真阳既不足以生土。是命门大虚。而膀胱之气
亦不化。何者。胃固司肾之开阖者也。便既难。则两 不但拘急而疼痛矣。总之。
肾气一衰。不传于胃。必传膀胱。故曰虚寒自下上也。然则舍温法何以为治乎。
吾知腹满者必附子理中。便难者八味丸。甚者四逆汤。仲景即不出汤。而意已跃然言外。
病者腹满。按之不痛为虚。痛者为实。可下之。舌黄未下者。下之黄自去。
〔补注〕夫腹满。亦有属实。实则非虚寒也明矣。岂概以温药治之乎。故有试之之
法。痛与不痛。虚实较然矣。盖胃实必热。热蒸必舌黄。黄、土色也。下其实热。黄不
自已乎。有此一辩。并虚者愈审已。
病者萎黄。躁而不渴。胸中寒实。而利不止者死。
〔补注〕嘉言云。萎黄乃中州土败之象。躁而不渴。乃阴盛阳微之象。胸中寒实。乃
坚冰凝冱之象。加以下利不止。此时即极力温之。无能济矣。盖坚在胸而瘕在
腹。坚处拒药不纳。势必转趋其瘕。而奔迫无度。徒促其脏气之绝耳。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。
〔衍义〕此论寒证亦有实者。实者何。邪实也。盖惟正虚而邪实也。虚属真阳虚。本
肾。实属胃家实。因寒。夫惟无火。不能消腐。故多滞多泄也。言其形则萎黄。证则
躁而不渴。何也。躁为阴躁。不渴则正阴凝之象也。嗟乎。阳不生则寒不去。寒不去则利又何能止耶。
腹满时减复如故。此为寒。当与温药。
〔补注〕曰时减。非竟不满也。若不满。则病已愈矣。不复如故矣。今则不然。时或稍
可。乃复如故。则非实满可知也。实则未有或减者也。故断断为寒。寒无不温。虚无不补。此正法也。
寸口脉弦者。即胁下拘急而痛。其人啬啬恶寒也。
〔补注〕前既言寒疝矣。此则言其脉与证也。夫弦。阴脉也。上见寸口。已非若发荣
滋长之木。合旺于春者比矣。故拘急而痛。应在胁下。胁下者。肝之幕也。为寒所
持。冷冽之气。自不舒容。寒常在。则恶亦不已也。试观其人。知内气之馁矣。
夫中寒家喜欠。其人清涕出。发热。色和者善嚏。
〔补注〕恶寒数欠。卫气虚也。卫既不固。则寒易乘而中气自馁。故喜欠。然则肺主
皮毛。外受邪而肺气有不伤者乎。清涕之出。势所必至也。若夫阳气稍复。则寒
邪自衰。而阴凝之色亦自此而消解。邪之出亦从肺开。故经曰已而嚏。
中寒。其人下利。以里虚也。欲嚏不能。此人肚中寒。
〔补注〕寒之所中。不外阴阳两经。然寒即中阴。亦曰经耳。何以即利。以阴经循乎
里也。然寒又何以即中阴经。以阳气大衰。邪即中里。故云里虚也。里虚下利。阳
气不能上升。故欲嚏而未能。乃知阴寒内凝。阳气未复。不若前条之所伤者。在皮毛间也。
夫瘦人绕脐痛。必有风冷。谷气不行。而反下之。其气必冲。不冲者。心下则痞也。
〔补注〕脐位乎阴。绕之而痛。必有所 而不通者。况瘦人则荣气素薄者乎。或风
或冷。其有袭之者矣。风冷既入。则必阳不盛。阳既不盛。孰为消腐水谷。治之者
必以辛温之味。鼓散其邪。庶几可已。乃反以寒药下之。则其邪必不服。犹之太
阳反下。其气上冲也。经谓气上冲胸。邪在大肠。若不上冲。则其邪尚在于胃。经
又谓客气上逆而心下痞也。
病腹满。发热十日。脉浮而数。饮食如故。浓朴七物汤主之。
浓朴七物汤方
浓朴（半斤） 甘草（三两） 大黄（三两） 枳实（五枚）
桂枝（二两） 生姜（五两） 大枣（十枚）
上七味。以水一斗。煮取四升。温服八合。日三服。呕者。加半夏五合。下利去
大黄。寒多者。加生姜至半斤。
〔补注〕此有里复有表之证也。腹满而能饮食。亦热邪杀谷之义。发热脉浮数。此
表邪正炽之时。故以小承气治其里。桂枝去芍药以解其表。内外两解。涣然冰
释。即大柴胡汤之意也。以表见太阳。故用桂枝耳。
腹中寒气。雷鸣切痛。胸胁逆满呕吐。附子梗米汤主之。
附子粳米汤方
附子（一枚炮） 粳米（半升） 半夏（半升） 甘草（一两） 大枣（十枚）
上五味。以水八升。煮米熟汤成。去滓。温服一升。日三服。
〔补注〕嘉言云。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。
愚按∶人之生。阳气为之耳。阳气生于下焦。盛于中而会于上。岂得复有寒乘之。
于是阴阳通。清浊分。而上下因以位。由是清气上升。遂不致于下陷。浊气下降。
亦不至于上僭也。若使腹中有寒。则入者已不化。承者已不生。又何能生克不
瘥。腑脏相安乎。于是为雷鸣。为切痛。为胸胁间逆满势必至于呕吐不已者。无
他。地气之寒为之也。试观气寒者。于天时则为严寒。于王事则为兵刑。去生不
几远乎。故圣人以附子回阳汤。阳回而寒气去矣。以半夏散满。满散而呕吐止矣。
若论养胃。何如粳米。安脾何如甘味。此言痛之因于寒。寒则未有不本于虚者也。
痛而闭者。浓朴三物汤主之。
浓朴三物汤方
浓朴（八两） 大黄（四两） 枳实（五枚）
上三味。以水一斗二升。先煮二味。取五升。内大黄。煮取三升。温服一升。以利为度。
〔补注〕此又言痛之实证也。闭者气已滞也。塞也。经曰。通因塞用。此之谓也。于是
以小承气通之。乃易其名为三物汤者。盖小承君大黄以一倍。三物汤君浓朴
以一倍者。知承气之行。行在中下也。三物之行。因其闭在中上也。绎此可启悟于无穷矣。
按之心下满痛者。此为实也。当下之。宜大柴胡汤。
大柴胡汤方
柴胡（半斤） 半夏（半斤洗） 黄芩 芍药（各三两）
生姜（五两） 枳实（四枚炙） 大枣（十二枚） 大黄（二两）
上八味。以水一斗二升。煮取六升。去滓。再煎。温服一升。日三服。
〔补注〕心下者。胸也。满且痛。不属有形乎。故曰实。实则当去。然何取于大柴胡汤。
柴胡。表药也。非有外邪。无取两解。乃必出于此者。正以实则必满。按则必痛。以
至内发热。津液耗而元气下陷。势所必至也。故仲景以柴胡升清阳为主治。而
散满者。去热者。收阴者。下结者。各有分治。且兼姜枣以益脾液。取意岂浅鲜哉。
腹满不减。减不足言。当须下之。宜大承气汤。
大承气汤方
大黄（四两酒洗） 浓朴（半斤去皮炙） 枳实（五枚炙） 芒硝（三合）
上四味。以水一斗。先煮二物。取五升。去滓。内大黄。煮取二升。去滓。内芒硝。更上
火。微煮一二沸。分温再服。得下余勿服。
〔补注〕大承气。大下药也。在伤寒入腑。每每慎戒。何宿食而遽可用乎。观上腹满
不减。减不足言二句。吾知必用下。如大柴胡等而不为稍减。须大下之。不可观
望以坐耗胃家津液耳。
心胸中大寒。痛呕。不能饮食。腹中寒。上冲皮起。出见有头足。上下痛不可触近。大建中汤主之。
大建中汤方
蜀椒（二合） 干姜（四两） 人参（二两）
上三味。以水四升。煮取二升。去滓。内胶饴一升。微火煎取一升半。分温再服。如
一炊顷。可饮粥二升。后更服。当一日食糜。温服之。
〔补注〕上中二焦所以受寒邪者。皆由于中气素虚也。虚则阳气不布。而所积者
为寒饮。所冲者为寒气。所湿者有影无形。为寒痛。故取辛热之品以散其邪。甘
温之味以培其土。则中州已圮而复立矣。故名曰大建中。
胁下偏痛。发热。其脉紧弦。此寒也。以温药下之。宜大黄附子汤。
大黄附子汤方
大黄（三两） 附子（三枚炮） 细辛（二两）
上三味。以水五升。煮取二升。分温三服。若强人煮取二升半。分温三服。服后如
人行四五里进一服。
〔补注〕此寒邪之在中下二焦也。胁下属厥阴之部分。于此偏痛。必有所积。积而
至于发热。其为实可知也。乃视其脉不滑数而紧弦。洵为阴脉。果是阴邪结于
阴位矣。且紧属痛。固因寒而痛。弦为实。亦因寒而实。故非下则实不去。非温则寒不开。然肝肾同一治也。厥阴
之实。系少阴之寒而实。苟不大用附子之热。可
独用大黄之寒乎。入细辛者。通少阴之经气也。以寒实于内而逼阳于外也。或
里有寒。表有热。俱未可定也。仲景于附子泻心汤中。既用三黄。复用附子。以畏
寒汗出。阳气之虚在于外也。此大黄附子汤。阴气之结深于内也。然则痞证用
三黄。固正治之法。偏痛用大黄。岂非从治之法乎。合观之。知有至理存焉矣。
寒气厥逆。赤丸主之。
赤丸方
乌头（二两炮） 茯苓（四两） 细辛（一两千金作人参） 半夏（四两洗）
上四味末之。内真朱砂为色。炼蜜为丸。如麻子大。先食饮酒下三丸。日再。夜一
服。不知。稍增。以知为度。
〔补注〕寒气厥逆。下传于上。明系君火既衰。而肾家之真阳亦不足。故上逆者。兼
有水泛以凌君火之意。为害不浅。况阴霾僭乘。浊流为患。于是以大热大猛之
力。始有补天浴日之量。兼用摄水气。通阳气。散阴气。而不敢后也。然犹恐寒逆
特甚。复以朱砂之赤色者。可以镇君火。性重者。可以坠浊阴。名曰赤丸。殆畏水寒之侮火也。
腹痛。脉弦而紧。弦则卫气不行。即恶热。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。其脉沉紧者。大乌头煎主之。
大乌头煎方
乌头（大者五枚熬去皮不 咀）
上以水三升。煮取一升。去滓。内蜜二升。煎令水气尽。取二升。强人服七合。弱人
服五合。不瘥。明日更服。不可一日再服。
〔补注〕寒入既深。则阳气 而为痛。阴气内凝。无冲和之度。使卫外者不固而不
耐寒。中脏者既虚而不欲食。于是邪正两不服。搏结于脐之偏旁而为疝也。所
积既久。有所触动。即复发作。然必自汗者何也。伤寒中卫。则不能有汗。谓邪自
外入。蔽其气也。若寒之在腹者。则自不令阳固乎外矣。又必手足厥冷者何也。
寒邪中阴。则必至于厥逆。谓阴气内深。遏其阳也。况痛并绕脐。则脾属四肢。而
真阳大衰矣。非用大热大力。何以建驱除之功。于是思天下之热且雄猛者。莫
过乌头。更非多用不可也。佐以蜜者。热则必燥。益之以润也。
寒疝。腹中痛。及胁痛里急者。当归生姜羊肉汤主之。
当归生姜羊肉汤方
当归（三两） 生姜（五两） 羊肉（一斤）
上三味。以水八升。煮取三升。温服七合。日三服。若寒多者。加生姜成一斤。痛多
而呕者。加橘皮二两。白术一两。加生姜者。亦加水五升。煮取三升二合服之。
〔补注〕疝主寒气入里。腹与胁。不言定左右也。故但言冲脉者为非。何者。冲为肝
之幕。但言冲。岂疝必偏于左而不属于右耶。故不分指之。即是统言之。乃以当
归走血。生姜散邪。羊肉补中。有发屡试屡验。亦已神矣。
寒疝腹中痛。逆冷。手足不仁。若身疼痛。灸刺诸药不能治。抵当乌头桂枝汤主之。
抵当乌头桂枝汤方
用乌头一味。以蜜二斤。煎减半。去滓。以桂枝汤五合解之。得一升后。初服二合。
不知。即服三合。又不知。复加至五合。其知者如醉状。得吐者为中病。
〔补注〕寒气非乌头不治。此则全以蜜熬。熬成即膏矣。乃复以桂枝汤解之者。正
以桂枝主手足也。况味甘正以扶脾。蜜与桂合。又得建中之意欤。以逆冷不仁
身痛。及诸治不效者。似皆中州之惫为之也。
其脉数而紧。乃弦。状如弓弦。按之不移。脉数弦者。当下其寒。脉紧大而迟者。必心
下坚。脉大而紧者。阳中有阴也。可下之。
（本篇包含一条总论，十六条脉证，十二个方剂）
趺阳脉呈现微弦之象。按照医理应当出现腹部胀满的症状。如果腹部不胀满，必定会出现大便困难、两侧胁肋部疼痛的情况。这是虚寒之气从下向上侵犯所致，应当服用温性药物进行治疗。
〔补注〕嘉言说：趺阳脉是反映脾胃状况的脉象，现在出现微弦的脉象，是因为厥阴肝木之气侵扰，克制了脾胃的阴气，导致阴邪横聚于腹部。
按理说应当出现严重的胀满症状。假如腹部并不胀满，那么阴邪必然转而向上攻冲，绝不会有轻散的道理。因为阴邪既然已经聚集，如果不使用温药，它就不会消散；阴邪不散，人体的阴窍（排泄通道）必然不通畅。所以可以推断出大便一定困难。病情势必逆乱攻冲至两侧胁肋部位而导致疼痛。这比单纯的腹满病情更进一步了。虚寒之气从下往上，由腹部波及胁肋，仅从这里就能窥见一斑。必须急切地服用温药，使阴气仍然通过阴窍走散，而不致于向上攻冲，这样就好了。
〔衍义〕张仲景所说的“这种虚寒之气从下向上侵犯，应当服用温药”，概括了阴病证治的全部要点，没有遗漏任何含义。因为寒气从下向上侵袭，正是地气加临天时的开始。使用温药，则上逆的气机得以向下，聚集的病邪得以消散，直截了当，痛快淋漓，一句话就讲完了。所以虽然《卒病论》已经亡佚，但其中可以意会的内容，未曾不在这里体现出来。
我按语道：趺阳脉位于足阳明胃经，在脚背上方五寸之间。胃腑属阳，土本宽大。现在脉象微弦，属于阴脉。脉象微，说明根本虚弱，必定有邪气乘虚而入。所以兼见木脉（肝脉），克制贼害随之而来。中焦脾胃之气衰弱，怎么能清气上升而浊气下降呢？腹部胀满必然发生，这是理所当然的。假如腹部不胀满，那么真阳既不足以生养脾土，说明命门火衰严重，膀胱的气化功能也不正常。为什么呢？胃本来主管肾的开阖功能。大便既然困难，那么两侧胁肋部不仅会拘挛急迫而且疼痛。总之，肾气一旦衰退，不能传送给胃，必然会传送给膀胱。所以说虚寒之气从下向上侵犯。既然如此，除了温法还有什么治疗方法呢？我知道腹满的患者应当用附子理中汤，大便困难的患者用八味丸，病情严重的用四逆汤。即使张仲景没有列出这些汤方，其中的意思也已经跃然言外了。
病人腹部胀满，用手按压时不痛的属于虚证，痛的属于实证。实证可以使用泻下法。舌苔发黄且尚未使用泻下法的，泻下后黄苔自然会去除。
〔补注〕腹部胀满，也有属于实证的。既然是实证，显然不是虚寒。难道一概用温药治疗吗？所以有试探的方法。通过按压痛与不痛，虚实情况就明显了。因为胃实必然发热，热蒸腾必然导致舌苔发黄。黄色是土的颜色。泻下其实热，黄苔能不自行消退吗？有了这一辨析，对虚证的判断也就更加审慎了。
病人面色萎黄，烦躁但不口渴，胸中有寒邪结实，并且腹泻不止的，预后不良，主死。
〔补注〕嘉言说：面色萎黄是中焦脾胃之气败坏的征象。烦躁但不口渴，是阴盛阳微的征象。胸中有寒邪结实，是坚冰凝结冻结的征象。再加上腹泻不止，此时即使极力使用温药，也无法挽救了。因为病邪坚固在胸部，而积聚在腹部。坚固的地方拒绝药物的进入，病邪势必转而趋向于腹部的积聚处，从而奔迫无度，徒然加速脏腑之气的衰竭罢了。谁说虚寒引起的下利，不趁着胸中阳气未完全流失、阴寒尚未完全结实的时候，及早进行温补治疗呢？
〔衍义〕这一段论述寒证也有实证。什么是实证？就是邪气盛实。正因为正气虚弱而邪气盛实。虚属于真阳虚，根源在肾；实属于胃家实，因寒邪引起。因为没有阳气（火），不能腐熟水谷，所以多有停滞和泄泻。从外形看是面色萎黄，从症状看是烦躁但不口渴。为什么呢？烦躁是阴躁，不渴则是正阴凝滞的征象。唉！阳气不生则寒气不去，寒气不去则腹泻又怎么能停止呢？
腹部胀满有时减轻，随后又像原来一样，这是寒证，应当给予温药。
〔补注〕说“有时减轻”，并不是完全不胀满了。如果不胀满，那么病就已经好了，不会再像原来一样了。现在却不是这样，有时稍微好一点，随即又像原来一样，这就知道不是实满。实证从来没有偶尔减轻的情况。所以断定为寒证。寒证无不温补，虚证无不补益，这才是正确的治法。
寸口脉弦，就会出现胁肋部拘挛急迫而疼痛，病人怕冷。
〔补注〕前面已经论述过寒疝，这里则是论述其脉象与症状。弦脉是阴脉。出现在寸口，已经不像春天生机勃发、滋长旺盛的木脉那样了。所以出现拘挛急迫而疼痛，部位应在胁下。胁下是肝脏的外围区域。受到寒邪束缚，寒冷凛冽之气自然无法舒展。寒气常在，恶寒的症状也不会停止。观察这个人，就知道他内部正气已经衰弱了。
患有中寒症的人喜欢打哈欠，流清鼻涕，发热，面色正常的容易打喷嚏。
〔补注〕恶寒且频繁打哈欠，是卫气虚弱。卫气不固，则寒邪容易乘虚而入，中气自然衰弱，所以喜欢打哈欠。然而肺主皮毛，外受邪气侵袭，肺气能不受损伤吗？流清鼻涕，是势所必至的结果。如果阳气稍复，则寒邪自然衰减，阴凝的面色也从此消解。邪气外出也是从肺开启的，所以经文说随后会打喷嚏。
中寒症，病人出现下利，是因为里虚。想要打喷嚏却打不出来，这是因为肚子里有寒气。
〔补注〕寒邪所中的，不外乎阴阳两经。然而寒邪即中阴经，也可以说是中经脉。为什么立即出现下利？因为阴经循行于体内。然而寒邪又为什么立即中伤阴经？因为阳气极度衰弱，邪气直接侵入里部，所以说里虚。里虚导致下利，阳气不能上升，所以想要打喷嚏而不能。由此可知阴寒内凝，阳气未恢复，不如前条所述那样，伤害仅在皮毛之间。
瘦人脐周疼痛，必定有风冷之邪，导致谷气运行不畅。如果反而使用泻下法，气机上冲；如果不冲，就会在心下形成痞块。
〔补注〕脐部位于阴位，绕着脐部疼痛，必定有阻滞不通的地方。何况瘦人营气本来就薄弱。或者是风邪，或者是冷邪，肯定有侵袭它的。风冷既已入体，那么阳气就不旺盛。阳气既不旺盛，谁来腐熟消化水谷？治疗必须用辛温的药物，鼓动发散邪气，差不多才可以痊愈。竟然反而用寒药泻下，那么邪气必然不服从，就像太阳病误用下法，气机上冲一样。经文说气上冲胸，邪气在大肠。如果不向上冲，那么邪气还在胃。经文又说客气上逆导致心下痞。
病人腹部胀满，发热十天，脉象浮而数，饮食如常，用厚朴七物汤主治。
厚朴七物汤方
厚朴（半斤） 甘草（三两） 大黄（三两） 枳实（五枚）
桂枝（二两） 生姜（五两） 大枣（十枚）
以上七味药，用水一斗，煮取四升。每次温服八合，每日三次。呕吐的，加半夏五合。下利的，去掉大黄。寒气多的，加生姜至半斤。
〔补注〕这是既有里证又有表证的病症。腹部胀满但能饮食，也是热邪消谷的意义。发热、脉浮数，这是表邪正盛的时候。所以用小承气汤治疗里证，用桂枝去芍药汤解表。内外两解，像冰融化一样消除。这就是大柴胡汤的意思。因为表证见于太阳经，所以用桂枝。
腹中有寒气，肠鸣如雷，剧烈疼痛，胸胁部气逆胀满，呕吐，用附子粳米汤主治。
附子粳米汤方
附子（一枚，炮制） 粳米（半升） 半夏（半升） 甘草（一两） 大枣（十枚）
以上五味药，用水八升，煮到米熟汤成。去渣。每次温服一升，每日三次。
〔补注〕嘉言说：腹中阴寒，奔迫向上攻冲至胸胁，进而影响胃部增加呕逆。不久胃气空虚，邪气没有阻隔，彻底侵入阳位就危险了。所以消除祸患的关键，重在保全胃气。趁着邪气刚侵犯胃，还能进食，就用附子粳米之法，温补饱暖胃气。胃气温饱，则土气厚实而邪气难以上越。胸胁逆满的浊阴之气，得到温煦就不敢留恋，必然还从下窍排出，空旷无余。这是扶持危局的手段。
我按语道：人的生存，全靠阳气。阳气生于下焦，盛于中焦而汇聚于上焦。怎么会有寒气乘虚而入呢？于是阴阳通畅，清浊分明，上下因此各安其位。由此清气上升，不至于下陷；浊气下降，也不至于上僭。如果腹中有寒，那么摄入的食物已经不能化，承接的功能已经不能生，又怎么能生克有序，脏腑相安呢？于是出现肠鸣，出现剧烈疼痛，出现胸胁间气逆胀满，势必导致呕吐不止。没有其他原因，是地气之寒造成的。试看气候寒冷，在天时就是严寒，在人事就是兵刑，离生路不远了。所以圣人用附子回阳汤，阳气回复而寒气去除。用半夏消散胀满，胀满消散而呕吐停止。如果要养胃，什么比得上粳米？如果要安脾，什么比得上甘味？这里说的是疼痛因寒而起，寒邪没有不根源于虚的。
以上三味药，用水一斗二升，先煮厚朴和枳实，取五升，加入大黄，煮取三升。每次温服一升，以大便通利为度。
〔补注〕这又是论述疼痛的实证。闭结是指气机已经滞塞。经文说：通因塞用，说的就是这个道理。于是用小承气汤来通导。之所以改名为三物汤，是因为小承气汤以大黄的用量为一倍，而三物汤以厚朴的用量为一倍。要知道承气汤的作用在于中下部，三物汤的作用因其闭结在中上部。推演此理可以启发无穷的智慧。
按压心下部位感到胀满疼痛的，这是实证，应当泻下，宜用大柴胡汤。
大柴胡汤方
柴胡（半斤） 半夏（半斤，洗） 黄芩 芍药（各三两）
生姜（五两） 枳实（四枚，炙） 大枣（十二枚） 大黄（二两）
以上八味药，用水一斗二升，煮取六升，去渣，再煎。每次温服一升，每日三次。
〔补注〕心下就是胸部。胀满且疼痛，不属于有形之物吗？所以说实证。实证应当去除。为什么要选用大柴胡汤？柴胡是解表药，如果没有外邪，不需要两解。但一定要用这个方子，正是因为实证必然胀满，按压必然疼痛，以至于内热产生，津液耗损而元气下陷，这是势所必至的。所以张仲景以柴胡升举清阳为主治，而消散胀满的、清除热的、收敛阴液的、泻下结实的，各有分工。并且兼用姜枣来补益脾气津液，其用意难道浅薄吗？
腹部胀满持续不减，即使减轻也不值得一提，应当使用泻下法，宜用大承气汤。
大承气汤方
大黄（四两，酒洗） 厚朴（半斤，去皮炙） 枳实（五枚，炙） 芒硝（三合）
以上四味药，用水一斗，先煮厚朴和枳实，取五升，去渣，加入大黄，煮取二升，去渣，加入芒硝，再上火，微煮一二沸。分两次温服。如果大便通了，剩下的不要喝。
〔补注〕大承气汤是大泻下的方剂。在伤寒传入腑证时，常常谨慎戒忌。为什么宿食就可以立刻使用呢？看上文中“腹部胀满持续不减，即使减轻也不值得一提”这两句话，我就知道必须使用泻下法。像大柴胡汤等方剂都不能使其稍减，必须大力泻下，不可观望而坐视消耗胃家的津液。
心胸部位感受大寒，疼痛，呕吐，不能饮食。腹中有寒气，向上冲击皮肤，突起像有头足的形状，上下疼痛不可触碰，用大建中汤主治。
以上三味药，用水四升，煮取二升，去渣，加入胶饴一升，用小火煎取一升半。分两次温服。大约一顿饭的时间，可以喝粥二升，之后再服药。应当一天吃糜粥，温服。
〔补注〕上焦和中焦之所以受寒邪侵袭，都由于中气素来虚弱。虚弱则阳气不能布散，所积聚的是寒饮，所冲逆的是寒气，湿气有形无影，形成寒痛。所以取辛热之品来发散邪气，甘温之味来培补脾土，那么中州已经倒塌的又能重新站立。所以名叫大建中。
胁下偏侧疼痛，发热，脉象紧弦，这是寒证，用温药配合泻下法治疗，宜用大黄附子汤。
以上三味药，用水五升，煮取二升，分三次温服。如果是身体强壮的人，煮取二升半，分三次温服。服药后像人行走四五里的时间进服一次。
〔补注〕这是寒邪在中下二焦。胁下属厥阴经的部分，此处偏侧疼痛，必定有积滞。积滞发展到发热，其为实证是明显的。再看脉象不是滑数而是紧弦，确实是阴脉。果然是阴邪结聚在阴位。而且紧脉主痛，固然因寒而痛；弦脉主实，也因寒而实。所以不用泻下法则实邪不去，不用温药则寒邪不开。然而肝肾同治。厥阴的实证，系于少阴的寒邪而致实。如果不大量使用附子的热性，能单独使用大黄的寒性吗？加入细辛，是为了通达少阴经的气机。因为寒实于内而逼迫阳气于外。或者里有寒，表有热，都未可定。张仲景在大黄附子汤中，既用三黄，复用附子，是因为畏寒汗出，阳气之虚在于外。此大黄附子汤，是阴气之结深于内。那么痞证用三黄，固然是正治之法；偏痛用大黄，岂不是从治之法吗？综合观察，知道其中有至理存在。
寒气导致的四肢厥逆，用赤丸主治。
赤丸方
乌头（二两，炮制） 茯苓（四两） 细辛（一两，千金方作人参） 半夏（四两，洗）
以上四味药研成粉末，加入真朱砂调色，炼蜜为丸，如麻子大。空腹时饮酒送下三丸，每日两次，夜间一次。如果无效，稍加剂量。以见效为度。
〔补注〕寒气厥逆，由下传至上，明显是君火既衰，而肾家的真阳也不足。所以上逆者，兼有水气泛滥凌驾君火的意思，危害不浅。况且阴霾僭越乘袭，浊流为患，于是用大热大猛的力量，才有补天浴日的量级。兼用摄纳水气，通达阳气，消散阴气，不敢落后。然而还担心寒逆特别严重，再用朱砂的赤色，可以镇守君火；性质沉重，可以坠降浊阴。名叫赤丸，大概是畏惧水寒之邪侮犯心火。
腹痛，脉象弦而紧。弦则卫气运行不畅，即表现为怕冷（注：原文作恶热，据上下文及中医理论多解为恶寒或畏热之变，此处依原文翻译但需注意语境，通常弦紧主寒痛，故多为恶寒，若原文确为恶热需结合具体版本，此处暂译字面意思并保留疑点，但在标准解释中弦紧多对应恶寒/畏冷）。紧则不想吃东西。邪正相互搏结，就形成寒疝。寒疝绕脐疼痛，发作时自汗出，手足冰冷，脉象沉紧的，用大乌头煎主治。
以上用水三升，煮取一升，去渣，加入蜂蜜二升，煎至水气尽，取二升。身体强壮的人服七合，身体虚弱的人服五合。如果不好，明天再服。不可一天内再次服用。
〔补注〕寒气深入，则阳气郁遏而产生疼痛。阴气内凝，没有冲和的度数，使卫外者不固而不能耐寒，中脏者既虚而不想吃东西。于是邪正两不相服，搏结于脐旁而形成疝气。积久已久，有所触动，就再次发作。然而为什么必定自汗呢？伤寒中卫，则不能有汗，说是邪气从外入，遮蔽了气机。如果寒气在腹部，则自然不让阳气固护于外。又为什么必定手足冰冷呢？寒邪中伤阴经，则必定导致厥逆，说是阴气内深，遏制了阳气。况且疼痛并绕脐，脾主四肢，而真阳大衰了。不用大热大力，凭什么建立驱除之功？于是想到天下热且雄猛的，莫过于乌头。更非多用不可。佐以蜂蜜，热则必燥，加上它以滋润。
以上三味药，用水八升，煮取三升。每次温服七合，每日三次。如果寒气多，加生姜成一斤。疼痛多而呕吐的，加橘皮二两，白术一两。加生姜的，也加水五升，煮取三升二合服用。
〔补注〕疝气主因寒气入里。腹与胁，不说定左右。所以只说冲脉的是不对的。为什么呢？冲脉是肝脏的外围。只说冲脉，难道疝气一定偏左而不属于右吗？所以不分指左右，就是统而言之。乃以当归走血，生姜散邪，羊肉补中，屡次尝试屡次验证，也已神妙了。
寒疝腹中疼痛，逆冷，手足麻木不仁，如果身体疼痛，灸刺各种药物都不能治愈，用抵当乌头桂枝汤主治。
抵当乌头桂枝汤方
用乌头一味，用蜂蜜二斤，煎至减半，去渣，用桂枝汤五合溶化它。得一升后，初服二合。无效，即服三合。又无效，再加至五合。有效的人像醉酒状态，呕吐的是中病。
〔补注〕寒气非乌头不能治。这里全用蜜熬，熬成就是膏了。却又用桂枝汤溶化它，正是因为桂枝主治手足。况且味甘正以扶脾。蜜与桂合，又得建中之意吧。以逆冷不仁身痛，以及诸治不效者，似乎都是中州疲惫造成的。
脉数而紧，就是弦脉，形状像弓弦，按之不移。脉数弦的，应当当下其寒。脉紧大而迟的，必定心下坚硬。脉大而紧的，阳中有阴，可以泻下。
(One general discussion, sixteen pulse and symptom patterns, twelve formulas)
The pulse at the Fuyang (Stomach channel point on dorsum of foot) is faint and wiry. According to medical principles, abdominal fullness should occur. If there is no abdominal fullness, there will certainly be difficult defecation and pain in both hypochondriac regions. This is caused by deficiency-cold qi ascending from below; it should be treated with warm medicines.
[Supplementary Note] Jiayan stated: The Fuyang pulse reflects the Spleen and Stomach. A faint and wiry appearance indicates invasion by Jueyin Liver Wood, which overacts on Yin Qi, causing it to gather horizontally in the abdomen.
Accordingly, distension and fullness should worsen. If there is no fullness, the Yin pathogen must turn to attack upwards, and there is no possibility of it dispersing lightly. Since Yin pathogens have gathered, they will not disperse without warm medicine. If Yin pathogens do not disperse, the Yin orifices (excretory passages) must be obstructed. Thus, we know that defecation must be difficult. The condition will inevitably reverse and attack the bilateral hypochondriac regions, causing pain. This is a step further than simple abdominal fullness. Deficiency-cold qi ascends from below, moving from the abdomen to the hypochondrium; this glimpse is sufficient. One must urgently administer warm medicine so that Yin Qi disperses through the Yin orifices rather than attacking upwards, which would be ideal.
[Extended Meaning] Zhang Zhongjing's statement "This deficiency-cold qi ascends from below; treat with warm medicine" comprehensively covers the syndrome differentiation and treatment of Yin diseases without omission. Because cold attacks from below upwards, it marks the beginning of Earth Qi adding to Heaven Qi. Using warm medicine causes ascending Qi to descend and gathered pathogens to scatter; it is direct and effective, summarized in one sentence. Although the *Zubing Lun* is lost, its meaning can be inferred here.
My commentary: The Fuyang pulse belongs to the Foot-Yangming Stomach channel, located about five cun above the dorsum of the foot. The Fu organs are Yang, and Earth is inherently broad. Now the pulse is faint and wiry, which is a Yin pulse. A faint pulse indicates fundamental deficiency, implying an invading pathogen. Thus, the Wood pulse (Liver) accompanies it, bringing destructive overacting. With weakened Middle Jiao Qi, how can Clear Qi ascend and Turbid Qi descend? Abdominal fullness is inevitable, following natural logic. If there is no fullness, then True Yang is insufficient to generate Earth, indicating severe emptiness of the Mingmen (Gate of Life), and the Qi transformation of the Bladder is also impaired. Why? The Stomach governs the opening and closing of the Kidney. Since defecation is difficult, the bilateral hypochondriac regions will not only feel cramped and painful. In short, once Kidney Qi declines, failing to transmit to the Stomach, it transmits to the Bladder. Hence, "deficiency-cold ascends from below." Given this, what other method is there for treatment but warming? I know that patients with abdominal fullness should use Fuzi Lizhong Tang, those with difficult defecation should use Bawei Wan, and severe cases should use Sini Tang. Even if Zhang Zhongjing did not list these formulas, the intent is clearly implied.
Patients with abdominal fullness who do not feel pain upon palpation have a deficiency pattern; those who feel pain have an excess pattern. Excess patterns can be treated with purgatives. If the tongue coating is yellow and purgatives have not yet been used, the yellow coating will disappear after purgation.
[Supplementary Note] Abdominal fullness can also be due to excess patterns. Clearly, excess is not deficiency-cold. Should all cases be treated with warm medicine? Therefore, there is a test method. Pain versus non-pain distinguishes excess from deficiency clearly. Stomach excess必然 leads to heat; heat steaming必然 leads to a yellow tongue coating. Yellow is the color of Earth. Purging the excess heat will naturally cause the yellow coating to disappear. This differentiation makes the judgment of deficiency patterns more rigorous.
Patients with sallow complexion, irritability without thirst, cold excess in the chest, and unceasing diarrhea face a fatal prognosis.
[Supplementary Note] Jiayan stated: Sallow complexion is a sign of Central Earth collapse. Irritability without thirst is a sign of Yin excess and Yang decline. Cold excess in the chest is like frozen ice. Added to unceasing diarrhea, even extreme warming efforts cannot save them. The pathogen is solid in the chest and accumulates in the abdomen. The solid part rejects medication, forcing the pathogen to move towards the abdominal accumulation, rushing uncontrollably, merely accelerating the exhaustion of Zang Qi. Who says that deficiency-cold diarrhea should not be warmed early, while Chest Yang is not yet depleted and Yin cold is not yet solidified?
[Extended Meaning] This discusses that cold syndromes can also have excess components. What is excess? Pathogenic excess. It arises because Righteous Qi is deficient while Pathogenic Qi is excess. Deficiency belongs to True Yang deficiency, rooted in the Kidney; excess belongs to Stomach excess, caused by cold. Without Fire, food cannot be digested, leading to stagnation and diarrhea. The form is sallow complexion; the symptom is irritability without thirst. Why? Irritability is Yin irritability; lack of thirst is a sign of Yin condensation. Alas! If Yang does not generate, Cold does not depart; if Cold does not depart, how can diarrhea stop?
Abdominal fullness that decreases occasionally but returns to normal is due to cold; give warm medicine.
[Supplementary Note] "Occasionally decreases" does not mean completely free of fullness. If it were completely free, the disease would be cured and would not return. Here, it sometimes feels slightly better, then returns to normal, proving it is not excess fullness. Excess patterns never decrease temporarily. Thus, it is definitely cold. Cold requires warming; deficiency requires tonifying. This is the correct method.
A wiry pulse at the Cunkou (Radial artery at wrist) indicates cramping and pain in the hypochondriac region, and aversion to cold.
[Supplementary Note] We previously discussed cold hernia; here we discuss its pulse and symptoms. Wiry is a Yin pulse. Appearing at the Cunkou, it is unlike the Wood pulse of spring that thrives and grows. Thus, cramping and pain occur in the hypochondrium. The hypochondrium is the幕 (curtain/periphery) of the Liver. Constrained by cold, the chilling Qi cannot relax. As long as cold remains, aversion to cold persists. Observing such a person reveals internal Qi weakness.
Those suffering from cold invasion often yawn. They have clear nasal discharge, fever, and if their complexion is normal, they tend to sneeze.
[Supplementary Note] Aversion to cold and frequent yawning indicate Wei Qi deficiency. If Wei Qi is not secure, cold easily invades, and Middle Qi weakens, hence yawning. However, the Lung governs skin and hair; external pathogenic invasion surely injures Lung Qi. Clear nasal discharge is inevitable. If Yang Qi recovers slightly, cold pathogens decline, and Yin condensation in the complexion dissipates. Pathogens exit via the Lung's opening, hence the classic text says "then sneezing occurs."
Cold invasion causing diarrhea is due to interior deficiency. Wanting to sneeze but unable to do so indicates cold in the abdomen.
[Supplementary Note] Cold invasion affects either Yin or Yang meridians. If cold enters Yin, it enters the meridian. Why immediate diarrhea? Because Yin meridians run internally. Why does cold enter Yin meridians immediately? Because Yang Qi is severely depleted, allowing pathogens to enter the interior directly, hence "interior deficiency." Interior deficiency causes diarrhea; Yang Qi cannot rise, so sneezing is attempted but fails. Thus, Yin cold coagulates internally, and Yang has not recovered, unlike the previous case where injury was superficial in the skin and hair.
In thin individuals, pain around the umbilicus indicates wind-cold, causing grain Qi to fail to circulate. If purgatives are wrongly used, Qi will rush upward; if it does not rush up, epigastric stuffiness (Pi syndrome) will result.
[Supplementary Note] The umbilicus is in the Yin region. Pain circling it implies obstruction. Thin individuals have inherently thin Ying Qi. Wind or cold likely invaded. Once inside, Yang is not strong. Without strong Yang, who digests water and grain? Treatment must use acrid-warm herbs to vent and scatter pathogens. Instead, using cold purgatives makes pathogens resist. Like Taiyang syndrome wrongly purged, Qi rushes up. The classic states Qi rushes to the chest when pathogen is in the Large Intestine. If it does not rush up, the pathogen remains in the Stomach, causing epigastric Pi due to rebellious Guest Qi.
Patients with abdominal fullness, fever for ten days, floating and rapid pulse, and normal appetite are treated with Houpo Qiwu Tang.
Houpo Qiwu Tang Formula
Houpo (Magnolia Bark) - 8 liang
Gancao (Licorice Root) - 3 liang
Dahuang (Rhubarb Root) - 3 liang
Zhishi (Immature Bitter Orange) - 5 pieces
Guizhi (Cinnamon Twig) - 2 liang
Shengjiang (Fresh Ginger) - 5 liang
Dazao (Jujube Fruit) - 10 pieces
Boil the seven ingredients in 1 dou of water to obtain 4 sheng. Take 8 ge warm, three times daily. For vomiting, add Banxia (Pinellia Tuber) 5 ge. For diarrhea, remove Dahuang. For excessive cold, increase Shengjiang to 8 liang.
[Supplementary Note] This is a syndrome with both interior and exterior involvement. Abdominal fullness with ability to eat reflects heat consuming grain. Fever with floating-rapid pulse indicates vigorous exterior pathogens. Thus, Xiao Chengqi Tang treats the interior, and Guizhi Qu Shaoyao Tang releases the exterior. Resolving both interior and exterior melts the problem away, similar to the principle of Da Chaihu Tang. Since the exterior manifestation is in the Taiyang channel, Guizhi is used.
Cold qi in the abdomen causes borborygmus (rumbling) and cutting pain, rebellious fullness in the chest and hypochondrium, and vomiting. Treat with Fuzi Jimitang.
Fuzi Jimitang Formula
Fuzi (Prepared Aconite Lateral Root) - 1 piece (prepared)
Jimi (Glutinous Rice) - 0.5 sheng
Banxia (Pinellia Tuber) - 0.5 sheng
Gancao (Licorice Root) - 1 liang
Dazao (Jujube Fruit) - 10 pieces
Boil the five ingredients in 8 sheng of water until the rice is cooked and the decoction is ready. Strain. Take 1 sheng warm, three times daily.
[Supplementary Note] Jiayan stated: Yin cold in the abdomen rushes upward to the chest and hypochondrium, affecting the Stomach and increasing vomiting. Soon, Stomach Qi becomes empty, and pathogens encounter no barrier, penetrating into Yang positions dangerously. The key to eliminating this danger lies in preserving Stomach Qi. While pathogens first invade the Stomach and the patient can still eat, use Fuzi Jimi to warm and nourish the Stomach. Warm and full Stomach Qi thickens the Earth element, preventing pathogens from rising. The turbid Yin of rebellious fullness in the chest and hypochondrium, warmed, dare not linger and must exit through the lower orifices, leaving the body clear. This is a strategy for stabilizing critical conditions.
My commentary: Human life depends on Yang Qi. Yang Qi generates in the Lower Jiao, flourishes in the Middle Jiao, and converges in the Upper Jiao. How can cold invade? When Yin and Yang communicate, Clear and Turbid separate, and Upper and Lower maintain their positions. Clear Qi ascends without sinking; Turbid Qi descends without rebelling. If cold exists in the abdomen, intake is not transformed, and transmission fails. How can generation and restriction function harmoniously, keeping Zang and Fu at peace? Thus, borborygmus, cutting pain, rebellious fullness in the chest/hypochondrium, and incessant vomiting occur. There is no other reason but cold Earth Qi. Just as cold weather brings harsh winter and human affairs bring war/punishment, far from life. Thus, the Sages use Fuzi Huayang Tang to restore Yang and dispel cold. Banxia scatters fullness, stopping vomiting. To nourish the Stomach, nothing beats Jimi. To calm the Spleen, nothing beats sweet flavors. This describes pain due to cold, which always stems from deficiency.
Painful abdomen with constipation is treated with Houpo Sanwu Tang.
Houpo Sanwu Tang Formula
Houpo (Magnolia Bark) - 8 liang
Dahuang (Rhubarb Root) - 4 liang
Zhishi (Immature Bitter Orange) - 5 pieces
Boil the three ingredients in 1.2 dou of water. First boil Houpo and Zhishi to obtain 5 sheng. Add Dahuang, boil to obtain 3 sheng. Take 1 sheng warm. Stop when bowel movement occurs.
[Supplementary Note] This discusses excess pain. Constipation means Qi stagnation and blockage. The classic says "treat blockage with unblocking methods," referring to this. Use Xiao Chengqi Tang to unblock. It is renamed Sanwu Tang because Xiao Chengqi Tang emphasizes Dahuang, whereas Sanwu Tang emphasizes Houpo. Xiao Chengqi acts in the middle/lower Jiao; Sanwu Tang acts because blockage is in the middle/upper Jiao. Understanding this unlocks infinite wisdom.
Epigastric fullness and pain upon pressure indicate excess; purge it. Use Da Chaihu Tang.
Da Chaihu Tang Formula
Chaihu (Bupleurum Root) - 8 liang
Banxia (Pinellia Tuber, washed) - 8 liang
Huangqin (Scutellaria Root) - 3 liang
Shaoyao (Peony Root) - 3 liang
Shengjiang (Fresh Ginger) - 5 liang
Zhishi (Immature Bitter Orange, roasted) - 4 pieces
Dazao (Jujube Fruit) - 12 pieces
Dahuang (Rhubarb Root) - 2 liang
Boil the eight ingredients in 1.2 dou of water to obtain 6 sheng. Strain and decoct again. Take 1 sheng warm, three times daily.
[Supplementary Note] Epigastrium refers to the chest area. Fullness and pain imply tangible pathology, hence excess. Excess must be removed. Why Da Chaihu Tang? Chaihu is an exterior-releasing herb; without exterior pathogens, dual resolution is unnecessary. But it is used because excess必然 causes fullness and pain upon pressure, leading to internal heat, fluid consumption, and sinking of Yuan Qi. Thus, Zhang Zhongjing uses Chaihu to raise Clear Yang as the main treatment, while scattering fullness, clearing heat, collecting Yin, and purging knots are addressed separately. Adding Jiang and Zao benefits Spleen fluids. Its intent is profound.
Abdominal fullness that does not decrease, or decreases insignificantly, requires purgation. Use Dachengqi Tang.
Dachengqi Tang Formula
Dahuang (Rhubarb Root, wine-washed) - 4 liang
Houpo (Magnolia Bark, peeled and roasted) - 8 liang
Zhishi (Immature Bitter Orange, roasted) - 5 pieces
Mangxiao (Mirabilite) - 3 he
Boil the four ingredients in 1 dou of water. First boil Houpo and Zhishi to obtain 5 sheng. Strain, add Dahuang, boil to obtain 2 sheng. Strain, add Mangxiao, boil briefly over fire. Divide into two warm doses. If bowel movement occurs, do not take the remainder.
[Supplementary Note] Dachengqi Tang is a major purgative. In Shanghan (Cold Damage) entering the Fu organs, caution is usually advised. Why is it used immediately for retained food? From the phrases "fullness does not decrease" and "decrease is insignificant," I know purgation is necessary. Formulas like Da Chaihu Tang failed to reduce it, so major purgation is required. Do not hesitate and waste Stomach fluids.
Great cold in the heart and chest causes pain, vomiting, inability to eat. Cold in the abdomen rises against the skin, appearing as lumps with heads and feet, causing unbearable pain upon touch. Treat with Dajianzhong Tang.
Dajianzhong Tang Formula
Shujiao (Sichuan Pepper) - 2 he
Ganjiang (Dried Ginger) - 4 liang
Renshen (Ginseng Root) - 2 liang
Boil the three ingredients in 4 sheng of water to obtain 2 sheng. Strain, add 1 sheng of maltose (Jiaoyi). Simmer gently to obtain 1.5 sheng. Divide into two warm doses. After about the time it takes to cook a meal, drink 2 sheng of rice gruel, then take the next dose. Eat soft rice porridge for the day, taken warm.
[Supplementary Note] The Upper and Middle Jiao suffer cold invasion due to inherent Middle Qi deficiency. Deficiency prevents Yang distribution, accumulating cold-fluid and driving cold-Qi rebellion. The dampness is shadow-like without form, causing cold pain. Thus, acrid-hot herbs scatter pathogens, and sweet-warm herbs tonify Earth, rebuilding the collapsed Middle Jiao. Hence, "Great Building of the Center."
Unilateral hypochondriac pain with fever and tight-wiry pulse indicates cold. Treat with warm purgation. Use Dahuang Fuzi Tang.
Dahuang Fuzi Tang Formula
Dahuang (Rhubarb Root) - 3 liang
Fuzi (Prepared Aconite Lateral Root) - 3 pieces (prepared)
Xixin (Asarum Root) - 2 liang
Boil the three ingredients in 5 sheng of water to obtain 2 sheng. Divide into three warm doses. For robust individuals, boil to 2.5 sheng, divide into three doses. Advance one dose every 4-5 li of walking distance.
[Supplementary Note] This is cold pathogen in the Middle and Lower Jiao. Hypochondrium belongs to Jueyin. Unilateral pain implies accumulation. Accumulation progressing to fever confirms excess. The pulse is tight-wiry, not slippery-rapid, confirming Yin pulse. Yin pathogen binds in Yin position. Tight indicates pain due to cold; wiry indicates excess due to cold. Thus, purgation removes excess, warming opens cold. Liver and Kidney share treatment. Jueyin excess is linked to Shaoyin cold causing excess. Without heavy use of Fuzi's heat, can Dahuang's cold be used alone? Xixin connects Shaoyin meridian Qi. Cold excess inside forces Yang outward. Whether interior cold and exterior heat exist is uncertain. In Fuzi Xie Xin Tang, Sanhuang and Fuzi are used together because fear of cold and sweating indicate exterior Yang deficiency. In Dahuang Fuzi Tang, Yin binding is deep inside. Treating Pi with Sanhuang is orthodox treatment; treating unilateral pain with Dahuang is counter-treatment. Observing both reveals profound truth.
Cold Qi causing厥逆 (reversal cold/extremity cold) is treated with Chiwan.
Chiwan Formula
Wutou (Aconite Root) - 2 liang (prepared)
Fuling (Poria) - 4 liang
Xixin (Asarum Root) - 1 liang (Qianjin Fang suggests Renshen)
Banxia (Pinellia Tuber, washed) - 4 liang
Powder the four ingredients. Mix with real Cinnabar (Zhusha) for color. Make pills with refined honey, size of hemp seeds. Take 3 pills with wine before meals, twice daily, once at night. If ineffective, increase dosage slightly. Stop when effective.
[Supplementary Note] Cold Qi reversal transmitting upward indicates declining Ministerial Fire and insufficient Kidney True Yang. Upward rebellion involves Water flooding over Ministerial Fire, causing great harm. With Yin pathogens usurping and turbid flows causing trouble, great heat and potency are needed to "repair heaven and bathe the sun." Also absorbing Water Qi, connecting Yang Qi, and scattering Yin Qi is essential. Fearful of severe cold rebellion, red Cinnabar calms Ministerial Fire, and its heaviness sinks turbid Yin. Named Chiwan (Red Pill), fearing Water-Cold insulting Fire.
Abdominal pain with wiry-tight pulse. Wiry means Wei Qi does not flow, causing aversion to cold (Note: Text says 'aversion to heat' but context implies cold/wind-cold contraction; standard interpretation is aversion to cold/chill). Tight means loss of appetite. Pathogen and Righteous Qi struggle, forming Cold Hernia. Cold Hernia causes periumbilical pain. Upon attack, spontaneous sweating and cold extremities occur. Pulse is deep-tight. Treat with Dawutou Jian.
Dawutou Jian Formula
Wutou (Aconite Root, large ones) - 5 pieces (roasted, peeled, not chopped)
Boil in 3 sheng of water to obtain 1 sheng. Strain, add 2 sheng of honey. Decoct until water vapor is gone, obtaining 2 sheng. Robust persons take 7 ge; weak persons take 5 ge. If not cured, take again tomorrow. Do not take twice in one day.
[Supplementary Note] Deep cold causes Yang stagnation and pain. Yin coagulation lacks harmony, making exterior defense weak against cold and interior Zang deficient causing anorexia. Pathogen and Righteous Qi clash at the umbilicus, forming hernia. Long-standing accumulation triggered causes recurrence. Why spontaneous sweating? Taiyang cold invasion blocks Qi, preventing sweat. Cold in the abdomen prevents Yang from securing the exterior. Why cold extremities? Cold invading Yin meridians causes reversal cold, as deep Yin Yin suppresses Yang. Pain around umbilicus involves Spleen governing limbs, showing severe True Yang decline. Only great heat and potency, like Wutou, can drive out pathogens. Honey moistens the dryness caused by heat.
Cold Hernia with abdominal pain, hypochondriac pain, and interior tension is treated with Danggui Shengjiang Yangrou Tang.
Danggui Shengjiang Yangrou Tang Formula
Danggui (Angelica Sinensis Root) - 3 liang
Shengjiang (Fresh Ginger) - 5 liang
Yangrou (Mutton Meat) - 1 jin
Boil the three ingredients in 8 sheng of water to obtain 3 sheng. Take 7 ge warm, three times daily. For excessive cold, increase Shengjiang to 1 jin. For severe pain with vomiting, add Chupi (Tangerine Peel) 2 liang and Baizhu (Atractylodes Rhizome) 1 liang. If adding Shengjiang, add 5 sheng of water, boil to 3.2 sheng.
[Supplementary Note] Hernia is mainly due to cold entering the interior. Abdomen and hypochondrium are not specified as left or right. Saying it relates only to the Chong Mai is incorrect. Chong Mai is the Liver's curtain. Does hernia only affect the left? Thus, speaking generally covers both. Danggui moves Blood, Shengjiang scatters pathogens, Mutton tonifies the Center. Repeated trials prove its efficacy.
Cold Hernia with abdominal pain, reversal cold, numbness in extremities, and body pain, unresponsive to moxibustion, acupuncture, and drugs, is treated with Didang Wutou Guizhi Tang.
Didang Wutou Guizhi Tang Formula
Take one piece of Wutou. Decoct in 2 jin of honey until reduced by half. Strain. Dissolve the residue in 5 he of Guizhi Tang to obtain 1 sheng. Initially take 2 he. If ineffective, take 3 he. If still ineffective, increase to 5 he. Effective patients feel like drunkenness; vomiting indicates the disease is hit.
[Supplementary Note] Cold requires Wutou. Here, honey is used extensively, creating a paste. Dissolving in Guizhi Tang works because Guizhi governs extremities. Sweet flavor supports Spleen. Honey and Gui combined achieve Jianzhong (Building the Center) intent. Reversal cold, numbness, body pain, and treatment failure suggest Middle Jiao exhaustion.
Pulse is rapid and tight, becoming wiry, like a bowstring, firm under pressure. Rapid-wiry pulse indicates cold that should be purged. Tight-large-slow pulse indicates epigastric hardness. Large-tight pulse indicates Yang containing Yin; purgation is appropriate.