每服内加二钱匕，以意消息。
每服内加二钱匕，以意消息。
问病患中霜露山岚雨湿之气，头项身体不甚痛，但四肢沉困，饮食减少，或食已痞闷
，寸脉隐小，与内伤饮冷相似，何也？
答曰∶此膏粱少有，贫素气弱之人多有之，以其内阴已伏，或空腹晨行，或语言太过，
口鼻
气消，阴气复加，所以成病。经云∶天之邪气，感则害人五脏。虽不饮冷，寸口亦小。又云
∶伤于湿者，下先受之。故从内感而求其类也。仲景云∶浊气中于下焦，以此。
经云∶清邪中于上焦。浊邪中于下焦。均雾露也。故寸口小，内伤饮冷寸口亦小。雾露入腹虽不饮冷与饮冷同，内
伤饮冷虽非雾露与雾露同，何哉？脉皆阴而寸口小耳。此云岐子复断浊邪中于下为饮冷同伤也。韩氏言寸口脉微而小，
即不可下，则阴盛阳气不能升于九天可知矣。
治内伤冷物，外感风邪有汗者。
白术（二两） 防风（二两） 甘草（一两，炙）
上 咀，每服称三钱，水一盏，生姜三片，同煎至七分，去滓温服，无时一口，止一二服，待二三日渐渐汗少为解。
《活人》防风白术牡蛎汤当在此下。
风温证，面赤自汗，嘿嘿不欲语，但欲寐，两手脉浮而缓，或微弱，此证不宜发汗。若
汗之
，似令人筋惕肉 ，或谵言独语，或烦躁不卧。若下之，直视失溲便。若火之，发狂似惊痫
，一逆尚引日，再逆促命期。《活人》本方葳蕤汤，以有麻黄，故不敢用，宜用上白术汤主
之。
头眩汗出，筋惕肉 者，加牡蛎。
腰背强硬者，加羌活。
舌干发渴者，加人参。
身灼热甚者，加知母。若内伤冷者不加。
体重多汗者，加黄 。
每次服药时加入二钱匕的药末，根据病情轻重灵活调整用药剂量。
问：如果病人感染了霜露、山岚及雨湿等外邪，头部、颈部和身体疼痛不明显，只是四肢沉重困倦，食欲减退，或者进食后感到胸脘痞闷，寸脉隐伏细小，这与内伤饮食生冷相似，是怎么回事？
答曰：这种情况多见于平时很少食用肥甘厚味、体质素来虚弱的人。因为体内阴寒之气已经潜伏，如果在空腹时早晨出行，或者说话过多，导致口鼻呼吸耗散阳气，阴气相对加重，从而致病。《内经》说：“天之邪气，感则害人五脏。”即使没有饮用冷水，寸口脉也会变小。又说：“伤于湿者，下先受之。”所以要从内部感受邪气来寻求其同类病机。张仲景说：“浊气中于下焦”，指的就是这种情况。
《内经》说：“清邪中于上焦，浊邪中于下焦。”雾露属于同一类邪气。所以寸口脉小，如果是内伤饮冷，寸口脉也小。雾露进入腹中，虽然没有饮用冷水，但其伤害与饮冷相同；内伤饮冷，虽然并非雾露所致，但与雾露的伤害相同，为什么呢？因为两者的脉象都是阴脉，且寸口脉都细小。这里引用岐伯的话再次判断，认为浊邪中于下焦与饮冷造成的损伤是相同的。韩祗和说寸口脉微而小，就不可使用攻下法，由此可知阴盛而阳气不能升发至九天（高位）。
治疗因内伤冷物、外感风邪且有汗出的证候。
白术（二两） 防风（二两） 甘草（一两，炙）
以上药物捣碎，每次称取三钱，用水一盏，生姜三片，共同煎煮至七分满，去渣温服，不拘时候服用一口，通常一二服即可，等待两三天后汗出逐渐减少即为痊愈。
《伤寒百问歌》中的防风白术牡蛎汤应当列在此方之下。
风温证，见面部发红、自汗、沉默不想说话、只想睡觉，两手脉象浮而缓，或微弱。此证不宜发汗。如果误用发汗法，可能会导致筋惕肉瞤（肌肉跳动），或者胡言乱语、烦躁不卧。如果误用攻下法，会导致直视、大小便失禁。如果误用火疗，会导致发狂、类似惊痫的症状。一次误治尚能拖延时日，再次误治则会加速死亡。《伤寒百问歌》中的本方葳蕤汤，因为含有麻黄，所以不敢使用，适宜使用上述的白术汤为主治方剂。
头眩、出汗、筋惕肉瞤的，加牡蛎。
腰背强硬的，加羌活。
舌干、口渴的，加人参。
身体灼热严重的，加知母。如果是内伤冷物引起的则不加。
身体沉重、多汗的，加黄芪。
Add two qian bi (a traditional unit of measurement for powder) to each dose, adjusting the dosage flexibly according to the patient's condition.
Question: If a patient is affected by external pathogens such as frost, dew, mountain mist, and rain dampness, with no significant pain in the head, neck, or body, but only heaviness and fatigue in the four limbs, decreased appetite, or chest and epigastric fullness after eating, and the Cun pulse (radial artery at the wrist position closest to the thumb) is hidden and small, which resembles internal injury from drinking cold substances, what is the cause?
Answer: This condition is common in people who rarely consume rich and sweet foods and have a constitutionally weak qi. This is because yin-cold qi has already latent within the body. If one travels early in the morning on an empty stomach, or speaks excessively, causing the qi expelled through the mouth and nose to dissipate, the yin qi becomes relatively stronger, leading to disease. The *Classic of Difficult Issues* states: "Pathogenic qi from heaven, when contracted, harms the five zang organs." Even without drinking cold water, the Cun pulse will be small. It also states: "Those injured by dampness are first affected from below." Therefore, one should seek the similar pathogenesis from internal contraction of pathogens. Zhang Zhongjing said: "Turbid qi attacks the lower jiao," referring to this situation.
The *Classic of Difficult Issues* states: "Clear pathogens attack the upper jiao; turbid pathogens attack the lower jiao." Fog and dew belong to the same category of pathogens. Thus, the Cun pulse is small; similarly, in cases of internal injury from drinking cold, the Cun pulse is also small. When fog and dew enter the abdomen, although no cold water is drunk, the damage is equivalent to that of drinking cold; conversely, internal injury from drinking cold, although not caused by fog and dew, is equivalent to the damage caused by them. Why? Because in both cases, the pulse is yin-type, and the Cun pulse is small. Here, quoting Qibo again to judge, it is concluded that turbid qi attacking the lower jiao causes damage similar to that of drinking cold. Han Zhihe stated that if the Cun pulse is faint and small, purgative methods should not be used; from this, it can be known that yin is excessive and yang qi cannot ascend to the highest heaven.
Treatment for conditions involving internal injury from cold substances and external contraction of wind pathogens, presenting with sweating.
Baizhu (Atractylodis Macrocephalae Rhizoma, 2 liang)
Fangfeng (Saposhnikoviae Radix, 2 liang)
Gancao (Glycyrrhizae Radix et Rhizoma, roasted, 1 liang)
Crush the above herbs. For each dose, weigh 3 qian. Add one lamp of water and three slices of fresh ginger. Decoct together until reduced to seven-tenths. Strain and take warm. Take one sip regardless of time. Usually, one or two doses are sufficient. Wait for two to three days until sweating gradually decreases, indicating recovery.
The Fangfeng Baizhu Muli Tang (Windproof Atractylodes and Oyster Shell Decoction) from *Huo Ren* (likely referring to *Shanghan Baiwen Ge*) should be listed below this formula.
In Wind-Warmth syndrome, symptoms include red face, spontaneous sweating, silence with unwillingness to speak, desire to sleep, and floating-slow or faint pulses in both hands. This syndrome is unsuitable for diaphoresis (sweating therapy). If diaphoresis is incorrectly applied, it may lead to muscle twitching (jin ti rou tian), delirious speech, restlessness, and inability to lie down. If purgation is incorrectly applied, it may lead to fixed staring and incontinence of urine and feces. If fire therapy is incorrectly applied, it may lead to mania resembling convulsive epilepsy. One misstep may prolong the illness, but a second misstep will hasten death. The Benfang Weirui Tang (Reed Rhizome Decoction) from *Huo Ren* contains Mahuang (Ephedrae Herba), so it dare not be used. Instead, the aforementioned Baizhu Tang should be used as the primary treatment.
For dizziness, sweating, and muscle twitching, add Muli (Ostreae Concha).
For stiffness and rigidity of the waist and back, add Qianghuo (Notopterygii Rhizoma et Radix).
For dry tongue and thirst, add Renshen (Ginseng Radix).
For severe burning heat of the body, add Zhimu (Anemarrhenae Rhizoma). Do not add if caused by internal injury from cold.
For heavy body and profuse sweating, add Huangqi (Astragali Radix).