治阴毒伤寒。面青。张口出气。心下硬。身不热。只额上有汗。烦渴不止。舌黑多睡。四肢俱冷。
甘草（一分炙锉） 附子（一两炮裂去皮脐） 麝香（一钱细研入） 干姜（一分炮裂锉） 皂荚（一挺去黑皮涂
酥炙令黄色去子）
上件捣罗为细末。每服钞二钱匕。水一中盏。煮至五分。不计时候。和滓热服。
琥按上方。海藏虽云治厥阴小腹痛。而活人书本治阴毒伤寒。面青舌黑等证。愚以方中药味。齐走三阴。善开风寒
痰塞。来阳伯云。阴证亦有舌黑。渴及昏愦者。学人非工力深到。差谬多矣。
治阴毒伤寒。面青。手足逆冷。心腹气胀。脉候沉细。
荜澄茄（半两） 木香 干蝎（各半两） 吴茱萸（半两汤浸七遍焙干微炒） 硫黄（细研入半两） 附子（炮裂
去皮脐半两） 干姜（一分炮裂锉）
上件药。捣罗为细末。酒煮面糊为丸。如梧桐子大。每服三十丸。不计时候。生姜汤下。频服三服。复以热酒一盏
投之。以浓衣盖定。取汗为度。
琥按上方。亦三阴经齐走。而干全蝎吴茱萸。专主厥阴风寒。故海藏云其治小腹痛。为最重之剂也。
刘河间云。寒者。上下所生水液。澄彻清冷。谷不化小便清白不涩。身凉不渴。本末不经有见阳热证。其脉迟者是
也。此因饮食冷物过多。阴胜阳衰而为中寒也。或冷热相并。而反阳气怫郁。不能宣散。怫热内作。以成热证者。不可
亦言为冷。当以成证辩之。
琥按上论云。本末不经者。言始终不常也。始见本寒证。末后又见阳热。乃阴极似阳。阴胜阳衰而脉迟。为中寒也。
或冷热相并云云者。推刘氏之意。以热病多而寒证少。学人不可不细辩也。
丹溪云。中寒主乎温散。有卒中天地之寒气者。有口得寒物者。从补中益气汤。加发散药。属内伤者。十居八九。
其法。邪之所凑。其气必虚。只用前汤中。从所见之证。出入加减。必先用参 托住正气。气虚甚者。少加附子以行参
之剂。如果气虚者。方可用此法。胃气大虚。必当温散。理中汤相宜。甚者加附子。仓卒感受大寒之气。其病即发。
非若伤寒之邪。循经。以渐而深也。以上治法。宜于南。不宜北。
琥按上丹溪论中寒之人。本气虚。以气不虚。则不中也。故用补中益气汤加减。附录云。西北二方。极寒肃杀之地。
故外感甚多。东南二方。温和之地。外感极少。故当从内伤例治之。
【活人书】正阳散方
治疗阴毒伤寒。症见面色发青。张口呼吸。心窝部硬满。身体不发热。仅额头有汗。烦躁口渴不止。舌苔黑。嗜睡。四肢冰冷。
甘草（一分，炙后锉碎） 附子（一两，炮裂，去皮脐） 麝香（一钱，细研后加入） 干姜（一分，炮裂后锉碎） 皂荚（一挺，去除黑色外皮，涂酥油炙至黄色，去籽）
以上药物捣碎过筛成细末。每次服用二钱匕。用水一中盏，煮至五分量。不限时间，连渣一起热服。
王琥按：上述方剂，海藏（张元素）虽然说是治疗厥阴经小腹痛，但《活人书》原文是治疗阴毒伤寒，症见面色发青、舌苔黑等证候。我认为方中的药味，共同作用于三阴经，善于开通风寒痰浊的闭塞。来阳伯说，阴证也有舌苔黑、口渴及神志昏沉的情况。学习者如果不是功力深厚，很容易出现差错谬误。
回阳丹方
治疗阴毒伤寒。症见面色发青。手足逆冷。心腹部气胀。脉象沉细。
荜澄茄（半两） 木香 干蝎（各半两） 吴茱萸（半两，用汤浸泡七遍，焙干微炒） 硫黄（细研后加入半两） 附子（炮裂，去皮脐，半两） 干姜（一分，炮裂后锉碎）
以上药物，捣碎过筛成细末，用酒煮面糊制成丸药，如梧桐子大小。每次服用三十丸。不限时间，用生姜汤送下。频繁服用三次后，再饮一盏热酒以助药力。用厚衣服盖好身体，以出汗为度。
王琥按：上述方剂，也是共同作用于三阴经。而干全蝎、吴茱萸，专门主治厥阴经的风寒，所以海藏说它治疗小腹痛是最重的药剂。
刘河间说：寒证的表现，是上下产生的水液清澈寒冷，食物不消化，小便清白且不涩痛，身体凉爽不口渴。从头到尾都没有见到阳热证候，其脉象迟缓，就是这种情况。这是因为饮食生冷过多，阴气胜而阳气衰，从而形成中寒。或者冷热邪气相并，反而导致阳气郁结，不能宣散，郁热在内产生，从而形成热证，这种情况下，也不能再说它是冷证，应当根据形成的证候来辨别。
王琥按：上述论述中说“本末不经”，意思是始终不正常。开始见到本寒证，后来又见到阳热证，这是阴极似阳，阴胜阳衰且脉迟，属于中寒。或者说“冷热相并”等等，是推测刘氏的本意，因为热病多而寒证少，学习者不可不仔细辨别。
朱丹溪说：中寒的治疗主要在于温散。有的是突然遭受天地之间的寒气侵袭，有的是口食寒凉之物。对于内伤导致的，十之八九适用补中益气汤，加上发散药。其法则是：邪气聚集的地方，正气必然虚弱。只使用前面的汤剂，根据所见证候进行加减出入。必须先用参类药材托住正气。如果气虚严重，可少量加附子以推动参剂的运行。如果是确实气虚者，才可以采用这种方法。胃气大虚，必须温散，理中汤适宜。严重的加附子。仓促之间感受大寒之气，疾病立即发作，不像伤寒之邪那样循着经络逐渐深入。以上的治法，适用于南方，不适用于北方。
王琥按：上述丹溪关于中寒的论述，认为中寒之人根本原因是气虚，因为如果不气虚，就不会被中伤。所以用补中益气汤加减。附录中提到：西北两个地方，是极寒肃杀之地，所以外感病很多；东南两个地方，是温和之地，外感病极少。所以应当从内伤的例子来治疗。
[From "Liu Hou's Essential Manual"] Zhengyang San Formula
Indicated for Yin-Du Cold Damage (Yin-Toxic Cold Damage). Manifestations include cyanotic complexion, gasping with open mouth, hardness in the epigastrium, absence of fever on the body, sweating only on the forehead, incessant irritability and thirst, black tongue coating, somnolence, and coldness of all four limbs.
Gancao (Licorice Root), one fen, roasted and chopped; Fuzi (Prepared Aconite Lateral Root), one liang, processed until cracked, skin and placenta removed; Shexiang (Musk), one qian, finely ground and added; Ganjiang (Dried Ginger Rhizome), one fen, processed until cracked and chopped; Zaojiao (Tamarindus Indica Fruit), one ting, black skin removed, coated with butter, roasted until yellow, seeds removed.
The above ingredients are pounded and sifted into a fine powder. Each dose is two qian bi (a small measuring spoon). Use one zhuan of water, boil down to five fen. Take at any time, decocted with the dregs, served hot.
Wang Hu notes: Regarding the above formula, Haicang (Zhang Yuansu) stated it treats lower abdominal pain due to Jueyin channel involvement, but the original text of *Liu Hou's Essential Manual* indicates it treats Yin-Du Cold Damage with manifestations such as cyanotic complexion and black tongue coating. I believe the herbs in this formula collectively act upon the Three Yin channels, effectively opening obstructions caused by Wind-Cold and Phlegm turbidity. Lai Yangbo stated that Yin syndromes can also present with black tongue coating, thirst, and confusion. If learners do not possess profound clinical skills, errors and deviations will be frequent.
Huiyang Dan Formula
Indicated for Yin-Du Cold Damage. Manifestations include cyanotic complexion, cold reversal of hands and feet, Qi distension in the heart and abdomen, and a deep, thin pulse.
Bichengqie (Long Pepper Fruit), half liang; Muxiang (Costus Root); Ganzhe (Dried Scorpion), each half liang; Wuzhuyu (Evodia Fruit), half liang, soaked in boiling water seven times, dried and lightly stir-fried; Liuhuang (Sulfur), finely ground, half liang added; Fuzi (Prepared Aconite Lateral Root), processed until cracked, skin and placenta removed, half liang; Ganjiang (Dried Ginger Rhizome), one fen, processed until cracked and chopped.
The above herbs are pounded and sifted into a fine powder. Boil with wine and wheat paste to make pills, sized like wutong tree seeds. Each dose is thirty pills. Take at any time, washed down with ginger decoction. Administer frequently for three doses, then follow with one zhuan of hot wine to enhance the effect. Cover tightly with thick clothing until sweating occurs, which marks the limit of treatment.
Wang Hu notes: The above formula also acts collectively upon the Three Yin channels. However, Ganzhe (Scorpion) and Wuzhuyu specifically target Wind-Cold of the Jueyin channel. Therefore, Haicang stated it is the heaviest agent for treating lower abdominal pain.
Liu Hejian said: The manifestation of Cold syndromes involves clear, cold fluids produced throughout the body, undigested food, clear and white urine without dysuria, cool body temperature, and absence of thirst. Throughout the course of the disease, there is no appearance of Yang-Heat syndromes; the pulse is slow. This is due to excessive consumption of cold foods, leading to Yin excess and Yang deficiency, resulting in Zhong-Han (Middle Cold). Alternatively, if Cold and Heat pathogens combine, they may cause Yang Qi to become constrained and unable to disperse, generating internal constrained heat and forming a Heat syndrome. In such cases, one cannot simply label it as Cold; differentiation must be based on the manifested syndrome.
Wang Hu notes: In the above discussion, "ben mo bu jing" means the condition is inconsistent from beginning to end. Initially presenting with Ben-Cold syndromes, followed later by Yang-Heat syndromes, this represents Extreme Yin resembling Yang, with Yin excess, Yang deficiency, and a slow pulse, classified as Zhong-Han. The phrase "Cold and Heat pathogens combining..." reflects Liu's intent: since Heat diseases are more common than Cold syndromes, learners must differentiate carefully.
Zhu Danxi said: The treatment principle for Zhong-Han is primarily warming and dispersing. Some cases result from sudden exposure to Heaven and Earth's cold qi, while others result from ingesting cold substances. For those stemming from internal injury, ten out of nine cases are suitable for Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) combined with dispersing herbs. The method is: where pathogenic factors gather, Qi is necessarily deficient. One should use the aforementioned decoction, modifying it according to the observed syndromes. It is essential to first use Ginseng (Renshen) to anchor and support the Righteous Qi. If Qi deficiency is severe, add a small amount of Fuzi (Aconite) to facilitate the action of Renshen. This method is applicable only if Qi deficiency is confirmed. For significant Stomach Qi deficiency, warming and dispersing are necessary; Lizhong Tang (Regulate the Middle Decoction) is appropriate. Severe cases require adding Fuzi. When exposed to extreme cold qi suddenly, the disease manifests immediately, unlike Cold Damage pathogens that penetrate gradually along the channels. The above treatment methods are suitable for the South but not for the North.
Wang Hu notes: Regarding Danxi's discussion on Zhong-Han, the root cause is Qi deficiency; if Qi were not deficient, one would not be struck by Cold. Therefore, modifications of Buzhong Yiqi Tang are used. The appendix states: The Northwest regions are extremely cold and austere places, so external contraction diseases are frequent; the Southeast regions are mild and warm, so external contraction diseases are rare. Thus, treatment should follow the pattern of internal injury.