治一切吐逆。伤寒四肢逆冷。粥食不下。
硫黄 水银（各半两）
上先碾硫黄极细。次下水银同碾。至黑色为度。每服一钱。重者二钱。温米饮调。服无时。
琥按上方。用硫黄性热属火。有毒。上助心包。中益脾胃。下补命门。得水银同碾。结成黑砂。盖水银亦辛寒有毒
之物。可暂用之。以开胸膈之冷热不调。寒气上逆。呕吐不下食。拯救一切危病。或时取效。倘伤寒四肢逆冷。不用理
中四逆等汤丸。反用此纯阳纯阴大毒之剂。能不执方以夭人命邪。愚因录出。特发明之。以警后之学人。
川乌（生） 南星（生） 半夏（生） 天麻（生去芦各等分）
上为细末。每服一钱。煎豆淋酒下。稍温服。次用一二盏投之。若牙关噤。斡灌之。但药得下。无不活者。
琥按上言伤寒。乃中寒也。厥阴阳明之气上逆。风痰寒饮。壅于胸膈。欲死者。非此药不能开之。川乌头祛风而天
麻辅之。半夏逐饮而南星辅之。二药相反而相为用。乃救急之方也。
治久寒积冷。脏腑虚弱。心腹疼痛。胸胁胀满。泄泻肠鸣。自利自汗。米谷不化。阳气暴衰。阴气独盛。手足厥冷。
伤寒阴盛。神昏脉短。四肢怠惰。并宜服之。
干姜（六斤炮） 高良姜（六斤炮） 桂（四斤） 荜茇（四斤，此下当有脱字）
每服五十丸。米饮下。此药热燥。能治脏腑虚寒。滑而下利。及泄泻肠鸣。水谷不化。若心腹疼痛中脘停寒。大便
溏泄者。尤宜服之。
琥按己者。中央阴土也。土寒则万物不生。上方药味皆辛热。乃温暖脾胃之剂。
此事难知云。阴证身静重。语无声。气难布息。目睛不了了。鼻中呼不出。吸不入。往来口与鼻中气冷。水浆不入。
大小便不禁。面上恶寒。有如刀刮。又云。身表凉。知在阴经也。名曰阴证。又云。腹痛部分。当分三阴。中脘痛。太
阴也。理中。建中。黄 汤之类主之。脐腹痛。少阴也。四逆。真武。附子汤之类主之。小腹痛。厥阴也。重则正阳散。
回阳丹之类。轻则当归四逆汤。（理中汤以见前。建中汤。即仲景小建中汤方。乃桂枝汤内倍芍药。加胶饴。黄 汤。
愚以即建中汤内加黄 。内台方云。治虚痛宜之也。或云黄 汤。乃黄 人参茯苓白术芍药甘草。呕吐者。加藿香生姜
陈皮。主治详阴证略例中。余汤方已见前。正阳散。回阳丹。见活人书十六卷杂方中今采附后。）
【元戎】调胃散方 / 又治伤寒将死者方 / 【局方】大已寒丸方
治疗各种呕吐逆气。伤寒导致的四肢厥冷。无法进食粥食。
硫黄、水银（各半两）
先将硫黄研磨至极细，再放入水银一同研磨，直到变成黑色为止。每次服用一钱，病情重者服用二钱。用温热的米汤调服。服药时间不拘。
琥按：上述方剂中，使用性热属火的硫黄，有毒。上可助益心包，中可补益脾胃，下可补益命门。与水银同研，结成黑砂。大概因为水银也是辛寒有毒之物。可以暂时使用它，来开通胸膈间冷热不调之气，以及寒气上逆导致的呕吐、不能进食，以拯救各种危重疾病。有时能取得疗效。倘若遇到伤寒四肢厥冷，不使用理中汤、四逆汤等汤剂或丸剂，反而使用这种纯阳纯阴且有大毒的药剂，难道不是拘泥于方剂而害人性命吗？我因此记录并列出此方，特意阐明其理，以警示后来的学医者。
川乌（生）、南星（生）、半夏（生）、天麻（生，去芦，各等分）
以上药物研为细末。每次服用一钱，用煎好的豆淋酒送服，稍温时服用。随后再喝一二盏。如果牙关紧闭，强行灌入。只要药力能够进入体内，没有救不活的。
琥按：上面所说的伤寒，实际上是中寒证。厥阴经和阳明经的气机上逆，风痰寒饮壅塞在胸膈，导致濒临死亡的情况，非此药不能开通。川乌头祛风，天麻辅助它；半夏逐除饮邪，南星辅助它。这两组药性相反却相互为用，是急救的方剂。
治疗久寒积冷。脏腑虚弱。心腹疼痛。胸胁胀满。泄泻肠鸣。自汗。完谷不化。阳气突然衰微。阴气独盛。手足厥冷。
伤寒阴寒内盛。神志昏迷。脉象短促。四肢倦怠无力。都适宜服用此药。
干姜（六斤，炮制）、高良姜（六斤，炮制）、桂枝（四斤）、荜茇（四斤，此处下方应当有脱漏的文字）
每次服用五十丸。用米汤送服。此药性热燥烈，能治疗脏腑虚寒引起的滑脱下利，以及泄泻肠鸣、水谷不化。如果是心腹疼痛、中脘部停聚寒邪、大便溏泄的情况，尤其适宜服用。
琥按：己土属于中央的阴土。土寒则万物不能生长。上述方剂中的药味都是辛热的，是温暖脾胃的药剂。
《此事难知》记载：阴证患者身体安静沉重，说话声音低微，气息难以布散，眼睛视物不清，鼻中呼气不出，吸气不入，口鼻间呼出的气寒冷，饮食水浆无法入口，大小便失禁，面部感觉恶寒，如同刀刮一般。又说：身体表凉，可知病在阴经。称为阴证。又说：腹痛的部位，应当区分三阴经。中脘痛，属于太阴经，由理中汤、建中汤、黄芪汤等主治。脐腹痛，属于少阴经，由四逆汤、真武汤、附子汤等主治。小腹痛，属于厥阴经，重症用正阳散、回阳丹等。轻症用当归四逆汤。（理中汤见前文。建中汤，即张仲景的小建中汤方，是在桂枝汤内加倍芍药，加入胶饴。黄芪汤，我认为就是建中汤内加黄芪。《内台方议》说，治疗虚痛适宜使用。有人说黄芪汤是由黄芪、人参、茯苓、白术、芍药、甘草组成，呕吐者，加藿香、生姜、陈皮。主治详情见《阴证略例》。其余汤方已见前文。正阳散、回阳丹，见《活人书》第十六卷杂方中，现采集附在后面。）
[From Yuan Rong] Tiaowei San Formula / Also a formula for treating typhoid fever in critical condition / [from Ju Fang] Da Yi Han Wan Formula
Treats all kinds of vomiting and regurgitation. Cold limbs due to Shanghan (Exogenous Febrile Disease). Inability to consume porridge or food.
Shihuang (Realgar, *Auripigmentum*), Shuiyin (Quicksilver, *Hydrargyrum*) (each half liang)
First grind Shihuang into an extremely fine powder. Then add Shuiyin and grind them together until the mixture turns black. Take one qian per dose; for severe cases, take two qian. Mix with warm rice water for administration. There are no restrictions on the time of taking the medicine.
Hu notes: In the above formula, Shihuang is used, which is hot in nature and belongs to Fire. It is toxic. It assists the Pericardium superiorly, benefits the Spleen and Stomach centrally, and tonifies the Mingmen (Gate of Vitality) inferiorly. When ground with Shuiyin, it forms black cinnabar-like particles. This is because Shuiyin is also acrid, cold, and toxic. It can be used temporarily to open up the disharmony of cold and heat in the chest and diaphragm, and to address the rebellious upward flow of cold qi causing vomiting and inability to eat, thereby saving patients from various critical conditions. Occasionally, it may yield results. However, if one encounters cold limbs due to Shanghan and instead of using formulas such as Lizhong Tang (Regulate the Middle Decoction) or Sini Tang (Frigid Extremities Decoction), uses this agent which is purely Yang and purely Yin and highly toxic, would this not be adhering rigidly to a formula and harming people's lives? I therefore record and present this formula, specifically elucidating its rationale, to warn future students of medicine.
Chuanwu (Raw, *Radix Aconiti Lateralis Preparata* - note: text says raw, usually processed but here specified as raw for external/special use context or specific preparation method implied by grinding), Nanxing (Raw, *Rhizoma Arisaematis*), Banxia (Raw, *Rhizoma Pinelliae*), Tianma (Raw, removed rhizome, equal parts)
Grind the above ingredients into a fine powder. Take one qian per dose. Administer with Doulin Jiu (Soybean Dripping Wine), slightly warm. Follow with one or two cups. If the jaw is clenched (trismus), force-feed the medicine. As long as the medicine enters the body, there is no case that cannot be saved.
Hu notes: The "Shanghan" mentioned above actually refers to Zhonghan (Cold Damage). The Qi of the Jueyin and Yangming meridians is rebelling upward. Wind-phlegm and cold-fluid retention obstruct the chest and diaphragm, leading to a near-death state. Only this medicine can open these obstructions. Chuanwu dispels wind, assisted by Tianma; Banxia drives out fluid retention, assisted by Nanxing. These pairs of herbs have contrary properties yet work synergistically. This is an emergency rescue formula.
Treats chronic cold accumulation and deep cold. Weakness of the Zang-Fu organs. Pain in the heart and abdomen. Distension and fullness in the chest and hypochondrium. Diarrhea with borborygmus. Spontaneous sweating. Undigested food in stool. Sudden decline of Yang Qi. Predominance of Yin Qi. Cold limbs.
In Shanghan with excess Yin, coma, short pulse, and lethargy of the four limbs, this formula is suitable.
Ganjiang (Six jin, prepared/pao), Gaoliangjiang (Six jin, prepared/pao), Gui (Four jin, Cinnamon Twig/Cortex Cinnamomi), Bibai (Four jin, there should be missing characters below this line)
Take fifty pills per dose, administered with rice water. This medicine is hot and drying. It treats deficiency-cold of the Zang-Fu organs causing slippery diarrhea, as well as diarrhea with borborygmus and undigested food. For cases of heart and abdominal pain, cold stagnation in the Zhongwan region, and loose stools, it is especially suitable.
Hu notes: Ji Earth belongs to the central Yin Earth. If the Earth is cold, all things fail to grow. The medicinal ingredients in the above formula are all acrid and hot, constituting a formula to warm and nourish the Spleen and Stomach.
*Cishi Nanzhi* states: In Yin syndromes, the body is quiet and heavy, speech is silent, breathing is difficult to distribute, vision is unclear, nasal exhalation does not reach out and inhalation does not enter, the breath from mouth and nose feels cold, fluids and food cannot be taken in, and urination and defecation are incontinent. The face feels aversion to cold, as if scraped by a knife. It also states: If the body surface is cool, the disease is known to be in the Yin meridians. This is named Yin Syndrome. It further states: Abdominal pain locations should be differentiated among the Three Yin meridians. Pain in the Zhongwan area belongs to the Taiyin Meridian, treated with Lizhong Tang (Regulate the Middle Decoction), Jianzhong Tang (Establish the Middle Decoction), Huangqi Tang (Astragalus Decoction), etc. Pain around the umbilicus belongs to the Shaoyin Meridian, treated with Sini Tang (Frigid Extremities Decoction), Zhenwu Tang (True Warrior Decoction), Fuzi Tang (Aconite Decoction), etc. Pain in the lower abdomen belongs to the Jueyin Meridian. Severe cases are treated with Zhengyang San (Upright Yang Powder) or Huiyang Dan (Return Yang Pill). Mild cases are treated with Danggui Sini Tang (Angelica Frigid Extremities Decoction). (Lizhong Tang is seen earlier. Jianzhong Tang refers to Zhang Zhongjing's Xiaojianzhong Tang Formula, which is Guizhi Tang with doubled Shaoyao and added Jiaoyi. Huangqi Tang, I believe, is Jianzhong Tang with added Huangqi. *Neitai Fangyi* states it is suitable for treating deficiency pain. Some say Huangqi Tang consists of Huangqi, Renshen, Fuling, Baizhu, Shaoyao, and Gancao. For those with vomiting, add Huoxiang, Shengjiang, and Chenpi. Details on indications are found in *Yinzheng Lüeli*. Other decoctions have been mentioned previously. Zhengyang San and Huiyang Dan are found in Volume 16 Miscellaneous Formulas of *Huo Ren Shu*, now collected and appended here.)