恶寒有阳虚阳郁之异，阳虚者宜补而温之，阳郁者宜开发上焦，以升阳明之气。丹溪所
谓久病恶寒，当用解郁是也。
桂枝加人参附子汤 治阳虚腠理不固，恶寒自汗，其脉浮虚。
桂枝 白芍（各一两半） 甘草（炙，一两） 附子（炮，半个） 人参（一两半）
每服五钱，生姜三片，枣一枚，水煎服。
阳郁治案∶
进士周，年近四十，得恶寒证，服附子数百帖而病益甚，脉弦而缓。遂以江茶入生姜汁
、香
油些少调饮之，吐痰一升许，减大半。又与通圣散去麻黄、硝、黄，加当归、地黄百帖而安
。
一女子恶寒，用苦参、赤小豆各一钱为末，齑水调饮之，吐痰甚多，继用南星、川芎、
苍术
、黄芩，酒打面为丸服愈。《元珠》云∶上焦不通，则阳气抑遏，而皮肤分肉，无以温之，
故寒栗。东垣升阳益胃汤用升发之剂，开发上焦，以升阳明之气，出于表而温之也。丹溪吐
出湿痰，亦开发上焦，使阳气随吐伸发出外而温之也。故寒栗皆愈。二者乃阳郁表寒之要。
大建中汤 疗中虚怯寒。
黄 当归 桂心 白芍（各二钱） 人参（一钱） 甘草（一钱） 半夏 黑附
（炮去皮，各二钱半）
上八味 咀，每服五钱，水二盏，姜三片，枣二枚，煎至一盏，去滓，食后温服。
罗谦甫治佥院董诚彦，夏月劳役过甚，烦渴不上，极饮潼乳，又伤冷物，遂自利，肠鸣
腹痛，
四肢逆冷，冷汗自出，口鼻气亦冷，六脉如珠丝，时发昏愦。众大医议以葱熨脐下，又以四
逆汤五两，生姜二十片，连须葱白九茎，水三升，煮取一升，去滓凉服。至夜半，气温身热
思粥饮，至天明而愈。许鲁斋先生闻知叹曰∶病有轻重，方有大小，治有缓急，佥院之病，
非大方从权急治，不能愈也。
昔有一妇人恶寒特甚，盛暑亦必服皮衣数件，昼夜常坐卧床褥，饮食如常，亦一无所苦
，更
名医数四，终莫能治。补泻寒热温凉备尝之矣。一医以玉屏风散大剂煎水，以大锅令患者熏
蒸半日许，汗出得愈。（鹤年识）
恶寒有阳虚和阳郁的区别。阳虚者适宜用补益温里的方法治疗，阳郁者适宜开发上焦，以升发阳明之气。这就是丹溪所说的久病恶寒，应当使用解郁的方法。
桂枝加人参附子汤：治疗阳虚导致腠理不固，出现恶寒、自汗，脉象浮而虚弱的症状。
药物组成：桂枝、白芍（各一两半）、甘草（炙，一两）、附子（炮制，半个）、人参（一两半）。
用法：每次服用五钱，加入生姜三片、大枣一枚，用水煎服。
阳郁治案：
进士周某，年龄近四十岁，患恶寒证，服用附子数百帖后病情反而加重，脉象弦而缓。于是用江茶加入生姜汁、少许香油调匀饮用，吐出痰液约一升，病情减轻大半。随后给予通圣散去掉麻黄、芒硝、大黄，加入当归、地黄，服用百余帖后痊愈。
另一位女子患恶寒，用苦参、赤小豆各一钱研为末，用腌菜水调服，吐出大量痰液，随后使用南星、川芎、苍术、黄芩，用酒泛丸服用而愈。《元珠》说：上焦不通，则阳气被抑制遏止，皮肤和分肉得不到温煦，所以出现寒战。东垣的升阳益胃汤使用升发之剂，开发上焦，以升发阳明之气，使阳气出于体表而起到温煦作用。丹溪通过催吐排出湿痰，也是开发上焦，使阳气随着呕吐伸展发出体外而起到温煦作用。因此寒战都痊愈了。这两者是治疗阳郁表寒的关键。
大建中汤：治疗中气虚弱导致的怯寒。
药物组成：黄芪、当归、桂心、白芍（各二钱）、人参（一钱）、甘草（一钱）、半夏、黑附子（炮制去皮，各二钱半）。
用法：以上八味药捣碎，每次服用五钱，加水两盏，生姜三片，大枣二枚，煎至一盏，去渣，饭后温服。
罗谦甫治疗佥院董诚彦，夏季因过度劳累，烦渴不止，又大量饮用潼乳，并食用生冷食物，导致腹泻，肠鸣腹痛，四肢逆冷，冷汗自出，口鼻呼出的气也冷，六脉如珠丝般细微，时常发生昏厥。众位大夫商议用葱熨法熨烫脐下，又用四逆汤五两，生姜二十片，连须葱白九茎，水三升，煮取一升，去渣后凉服。到了半夜，体温回升身体发热想喝粥，到天亮时痊愈。许鲁斋先生听说后感叹道：疾病有轻重之分，方剂有大小区别，治疗有缓急不同。佥院的病，不用大方从权进行紧急治疗，是不能痊愈的。
过去有一位妇人恶寒特别严重，即使在盛夏也必须穿几件皮衣，昼夜常坐卧在床褥上，饮食正常，也没有其他痛苦，更换多位名医诊治，始终无法治愈。补泻寒热温凉的药物都尝试过了。一位医生用玉屏风散大剂量煎水，用大锅让患者熏蒸约半天，出汗后痊愈。（鹤年记录）
Chills and aversion to cold differ in being caused by Yang deficiency or Yang stagnation. For those with Yang deficiency, tonification and warming are appropriate; for those with Yang stagnation, the Upper Jiao should be unblocked to raise the Qi of the Yangming channel. This is what Danxi meant when he said that chills and aversion to cold in chronic illness should be treated by resolving stagnation.
Guizhi Jia Renshen Fuzi Tang (Cinnamon Twig Decoction plus Ginseng and Aconite): Treats Yang deficiency leading to insecure Couli (pores/skin texture), manifesting as chills and aversion to cold, spontaneous sweating, and a floating and deficient pulse.
Ingredients: Guizhi (Ramulus Cinnamomi) and Baishao (Radix Paeoniae Alba) (each 1 liang 5 qian); Gancao (Radix Glycyrrhizae Preparata) (1 liang); Fuzii (Radix Aconiti Lateralis Preparata) (half piece); Renshen (Radix Ginseng) (1 liang 5 qian).
Usage: Take 5 qian per dose, add 3 slices of Shengjiang (Rhizoma Zingiberis Recens) and 1 date, decoct in water and take orally.
Case of Yang Stagnation:
An Jinshi (Metropolitan Graduate) named Zhou, nearly forty years old, suffered from chills and aversion to cold. After taking hundreds of doses of Fuzi (Radix Aconiti Lateralis Preparata), his condition worsened. His pulse was wiry and moderate. He was then given Jiangcha (Jiang tea) mixed with Shengjiang juice (Rhizoma Zingiberis Recens Juice) and a little Xiangyou (Sesame Oil), which induced vomiting of approximately one sheng of phlegm, reducing the symptoms by more than half. Subsequently, Tongsheng San (Tongsheng Powder) was prescribed without Mahuang (Herba Ephedrae), Xiaoshi (Natrii Sulfas), and Dahuang (Radix et Rhizoma Rhei), but with Danggui (Radix Angelicae Sinensis) and Dihuang (Radix Rehmanniae Preparata). After taking over a hundred doses, he recovered.
A young woman suffering from chills and aversion to cold was treated with Kusenshen (Radix Sophorae Flavescentis) and Chixiaodou (Semina Phaseoli Angularis), each 1 qian, ground into powder and taken with pickled vegetable water. She vomited a large amount of phlegm. Thereafter, Nanxing (Rhizoma Arisaematis Cum Bile), Chuanxiong (Rhizoma Chuanxiong), Cangzhu (Rhizoma Atractylodis Chinensis), and Huangqin (Radix Scutellariae) were used, made into pills with wine and flour paste, which cured her. *Yuanzhu* states: "When the Upper Jiao is not free, Yang Qi is suppressed and obstructed, and the skin and muscles cannot be warmed, resulting in shivering." Dongyuan's Shengyang Yizhe Tang (Shengyang Yizhe Decoction) uses ascending agents to open the Upper Jiao and raise the Qi of the Yangming channel, allowing Yang Qi to emerge to the exterior and provide warmth. Danxi’s method of inducing vomiting to expel damp-phlegm also opens the Upper Jiao, allowing Yang Qi to extend and emerge outward through vomiting to provide warmth. Thus, both methods cure shivering. These two approaches are key to treating Yang stagnation with exterior cold.
Dajianzhong Tang (Greatly Building the Middle Decoction): Treats timidity and coldness due to Middle Jiao deficiency.
Ingredients: Huangqi (Radix Astragali Membranacei), Danggui (Radix Angelicae Sinensis), Guixin (Cortex Cinnamomi Cassiae), Baishao (Radix Paeoniae Alba) (each 2 qian); Renshen (Radix Ginseng) (1 qian); Gancao (Radix Glycyrrhizae Preparata) (1 qian); Banxia (Rhizoma Pinelliae Preparata); Heifuzi (Radix Aconiti Lateralis Preparata, peeled after processing) (each 2.5 qian).
Usage: The above eight herbs are crushed. Take 5 qian per dose, add 2 zhan of water, 3 slices of ginger, and 2 dates. Decoct until 1 zhan remains, strain, and take warm after meals.
Luo Qianfu treated Dong Chengyan, a Jianyuan (Assistant Judge), who had worked excessively hard in summer. He suffered from irritability and thirst, drank a large amount of Tongru (donkey milk), and ate cold foods, leading to diarrhea, borborygmus, abdominal pain, cold limbs, spontaneous cold sweating, cold breath from mouth and nose, and a pulse like fine threads in all six positions, with occasional fainting. The physicians discussed using Congyi (scallion moxibustion) on the lower abdomen and administering SiNi Tang (Frigid Extremities Decoction) 5 liang, Shengjiang (Rhizoma Zingiberis Recens) 20 slices, and Lianxu Congbai (Scallion White with roots) 9 stalks, boiled in 3 sheng of water to yield 1 sheng. It was strained and taken cool. By midnight, his body temperature rose, he felt hot, and desired porridge. By dawn, he had recovered. Mr. Xu Luzhai sighed upon hearing this, saying: "Illnesses vary in severity, formulas in size, and treatments in urgency. This case required a large formula applied flexibly and urgently to achieve recovery."
In the past, a woman suffered from severe chills and aversion to cold. Even in midsummer, she had to wear several layers of fur clothing. She sat or lay on her bed day and night, ate normally, and had no other discomfort. Several famous doctors failed to cure her despite trying all tonifying, purging, cooling, heating, warming, and clearing methods. One doctor prepared a large dose of Yupingfeng San (Jade Windscreen Powder), boiled it in a large pot, and let the patient fumigate herself for about half a day. Sweating ensued, and she was cured. (Recorded by Henian)