胸中支饮咳源头，方外奇方勿慢求（熟读《金匮》者自得之，）又有小柴加减法，通调津液
治优优。
伤寒病阳明经大渴，大热，法用白虎汤，为表中之里证。及其传里，谵语，胸腹满，不
大便，为里中之里证，宜三承气汤择用。详于《伤寒》门，不赘。刘河间先生用三一承气汤
代上三方。
表中之里是阳明，热渴汗多白虎（汤）行，胃实晡潮膨谵语，里中之里枳（实大）黄平（二承气汤
随其见症而用之。）
心痛（心为君主之官，受邪而痛，手足寒至节，名真心痛，不治。此云心痛，乃心包络痛
也，）胸膺痛（肺气不调，）胃脘痛（胃气不和，）两胁痛（肝胆之病，）大腹痛（属脾，）小腹痛（肝肾之病，
昔人每证当分别九种∶曰饮、曰食、曰热、曰冷、曰风、曰虫、曰悸、曰注、曰去来。悸者
，心虚而动痛也。注者，邪气着而痛也。去来者，作止不常，亦邪气也。但注阴而去来为阳
耳，其实是小家伎俩，不必泥也。宜以上中下两旁部位分之，自心胸至胃脘为上部，宜宣其
阳气。阳气虚宜黄 ，气实宜枳实，气结宜贝母、栝蒌皮，气逆宜半夏、薤白，气滞宜檀香
、砂仁之类，自胃脘至脾为中部，宜调其阴阳。仲景理中丸，以人参（甘寒多液为阴分药、）甘
草（味胜于气，亦阴分药。）补阴。以白术、干姜补阳，为万古准绳。即如通脉四逆汤，急于回
阳，若有腹苦，必加苦寒如芍药以养阴。黄连汤重于清火，因有腹痛，不离辛热之姜桂以开
阳。此理甚微，非熟于《内经》者，不可与语也。自脐下至阴器为下部，宜破其阴气，《金
匮》名为寒疝（金人以睾丸肿大为疝，《金匮》则以腹中痛剧为寒疝。）所主皆附子、乌头、蜀
椒大热之性，扶阳以破阴。若前痛彻后，后痛彻前，阴阳无分界限，宜加赤石脂一、二两以
堵截之，而生姜当归羊肉汤，籍羊肉之浊气引入阴分以破阴，尤为神妙也。胁肋一带为侧部
，宜利其枢转，肝胆之气，其行在侧，小柴胡汤为少阳之正药，当归四逆汤为厥阴之正药，或
再加鲜橘叶四十九片则得矣。以上诸证，脉细而迟，寒也，以姜桂附子吴茱萸之类为主。脉
大而数，热也，以金铃子、黄连、沙参、芍药之类为主。痛而利者，虚也，以附子理中汤之
类为主。痛而闭者，实也，以小承气汤之类为主。亦有寒实而痛者，宜大黄附子汤以温通之
。若吐虫，则用附子理中汤，去甘草，加当归、川椒、黄连、乌梅。若食积，则先以平胃散
加麦芽、山楂以消导之，否则以承气汤下之。若因怒气而痛，则以七气汤加贝母、抚芎、香
附以解之，人人共喻，不必赘也。又《仁斋直指》治脾痛攻刺，百药罔效，用和剂抽刀散如
神。此方医家秘不轻传，嘉庆十八年，长州徐炳南，梓尤氏《金匮翼》载之。心腹为阴，故
列于里证。
（经义）《举痛论》曰∶“经脉流行不止，环周不休，寒气入经而稽迟，滞而不行，客于脉
外则血少，客于脉中则气不通，故卒然而痛。”《厥病篇》曰∶“真心痛，手足青至节，心
痛甚，旦发夕死，夕发旦死。”按∶经文极繁，此不过摘其要语。
胸中支饮（水饮停聚于胸膈）导致咳嗽的根源，方书之外的奇效良方不要急于寻求（熟读《金匮要略》的人自然懂得，）还有小柴胡汤的加减法，能够通调津液，治疗忧郁不舒的症状。
伤寒病传入阳明经，出现大渴、大热，依法应当使用白虎汤，这属于表证中的里证。等到病邪进一步传变入里，出现谵语（神志不清，胡言乱语）、胸腹部胀满、大便不通，这属于里证中的里证，适宜在三承气汤中选择使用。详细内容在《伤寒论》章节中已有记载，此处不再赘述。刘河间先生使用三一承气汤代替上述三方。
表证中的里证是阳明病，表现为发热、口渴、多汗，使用白虎汤治疗；胃腑实证，傍晚潮热，腹胀如鼓，谵语，这是里证中的里证，用枳实大黄汤（指调胃承气汤等，原文括号内提示“实大”可能指调胃承气或大承气，结合下文“二承气随症用之”，此处泛指承气类方）来平复（根据具体症状选用另外两个承气汤）。
心痛（心为君主之官，若受邪而痛，且手足寒冷至关节，称为真心痛，属不治之症。此处所说的心痛，实际上是心包络疼痛），胸膺部疼痛（肺气不调所致），胃脘部疼痛（胃气不和所致），两侧胁肋疼痛（肝胆疾病所致），大腹疼痛（归属于脾），小腹疼痛（肝肾疾病所致）。古人通常将心痛分为九种：即饮痛、食痛、热痛、冷痛、风痛、虫痛、悸痛、注痛、去来痛。悸痛，是心虚而动而致痛。注痛，是邪气附着而致痛。去来痛，是发作停止无常，也是邪气作祟。只是注痛属阴，去来痛属阳罢了，这其实是医家的小技巧，不必拘泥。应当以上、中、下及两旁部位来区分，自心胸至胃脘为上部，宜宣通阳气。阳气虚宜用黄芪，气实宜用枳实，气结宜用贝母、瓜蒌皮，气逆宜用半夏、薤白，气滞宜用檀香、砂仁之类。自胃脘至脾为中部，宜调和阴阳。张仲景的理中丸，用人参（甘寒多液，属阴分药）、甘草（味道重于气味，亦属阴分药）来补阴。用白术、干姜来补阳，这是万古不变的准则。就像通脉四逆汤，急于回阳救逆，如果伴有腹部苦痛，必定加入苦寒的芍药以滋养阴液。黄连汤重在清火，因为伴有腹痛，离不开辛热的生姜、肉桂来开通阳气。这个道理非常微妙，不熟悉《黄帝内经》的人，无法与他谈论。自脐下至生殖器为下部，宜破散阴寒之气，《金匮要略》称之为寒疝（金代医家以睾丸肿大为疝，《金匮要略》则以腹中剧烈疼痛为寒疝）。其所主药物皆用附子、乌头、蜀椒等大热之性，扶助阳气以破除阴寒。如果前痛彻后，后痛彻前，阴阳界限不分，宜加赤石脂一两到二两以堵截邪气，而生姜当归羊肉汤，借助羊肉的浊气引入阴分以破除阴寒，尤为神妙。胁肋一带为侧部，宜利其枢机运转，肝胆之气，其运行在侧面，小柴胡汤是少阳经的正药，当归四逆汤是厥阴经的正药，或者再加鲜橘叶四十九片就可以了。以上各种证候，脉象细而迟，属于寒证，以生姜、肉桂、附子、吴茱萸之类为主药。脉象大而数，属于热证，以金铃子、黄连、沙参、芍药之类为主药。疼痛伴腹泻的，属于虚证，以附子理中汤之类为主药。疼痛伴便秘的，属于实证，以小承气汤之类为主药。也有寒实凝结而痛的，宜用大黄附子汤以温通之。如果呕吐出蛔虫，则用附子理中汤，去掉甘草，加入当归、川椒、黄连、乌梅。如果是食积，则先用平胃散加麦芽、山楂以消导之，否则用承气汤攻下。如果是因怒气而痛，则用七气汤加贝母、抚芎、香附来解郁，这是人人共知的道理，不必赘述。另外，《仁斋直指方》治疗脾痛攻刺，百药无效，使用和剂抽刀散如神。此方医家秘而不轻传，嘉庆十八年，长州人徐炳南，刊刻尤氏《金匮翼》时记载了此方。心腹属阴，所以列在里证中。
（经文依据）《素问·举痛论》说：“经脉流行不止，环周不休，寒气侵入经脉则运行迟缓，停滞不行，客于脉外则血少，客于脉中则气不通，所以突然发生疼痛。”《素问·厥病篇》说：“真心痛，手足青紫至关节，心痛剧烈，早晨发病晚上死亡，晚上发病早晨死亡。”按：经文非常繁杂，这里不过摘录其中的关键语句。
The source of cough caused by *Zhiyin* (fluid retention in the chest) in the chest can be addressed without hastily seeking miraculous formulas outside standard texts (those who have thoroughly studied *Jingui Yaolue* will naturally understand this). There is also the method of modifying *Xiaochaihu Tang* (Minor Bupleurum Decoction) to freely regulate body fluids and treat symptoms of depression or melancholy.
In *Shanghan* (Cold Damage) disease involving the Yangming channel, presenting with great thirst and high fever, the indicated treatment is *Baihu Tang* (White Tiger Decoction), which addresses a "li" (interior) syndrome within the "biao" (exterior) stage. When the pathogen transmits further into the interior, presenting with delirium, fullness in the chest and abdomen, and constipation, this constitutes an "interior-of-interior" syndrome. In such cases, one of the three *Chengqi Tang* (Descending to Restore Harmony Decoctions) should be selected according to the specific presentation. Details are provided in the *Shanghan* section and will not be repeated here. Liu Hejian used *Sanyi Chengqi Tang* (Three-One Descending to Restore Harmony Decoction) to replace the aforementioned three formulas.
The "interior-of-exterior" refers to Yangming syndrome: heat, thirst, and profuse sweating are treated with *Baihu Tang*. Stomach excess, afternoon tidal fever, abdominal distension like a drum, and delirium indicate the "interior-of-interior"; these are pacified using *Zhishi Dahuang Tang* (Rhubarb and Immature Bitter Orange Decoction, referring generally to the *Chengqi* family; specifically, the other two *Chengqi* formulas are used based on symptoms).
Heart pain (the Heart is the sovereign organ; if it suffers from pathogenic invasion causing pain, accompanied by cold limbs extending to the joints, it is called *Zhenxintong* (True Heart Pain), which is incurable. The heart pain mentioned here actually refers to pain of the Pericardium). Chest and precordial pain (caused by disordered Lung Qi). Epigastric pain (caused by disordered Stomach Qi). Bilateral hypochondriac pain (indicative of Liver and Gallbladder disorders). Greater abdominal pain (associated with the Spleen). Lesser abdominal pain (associated with the Liver and Kidneys). Ancients often categorized heart/abdominal pain into nine types: Yin (fluid), Shi (food), Re (heat), Leng (cold), Feng (wind), Chong (parasites), Ji (palpitation), Zhu (transmission), and Qulai (intermittent). *Ji* pain arises from Heart deficiency and internal movement. *Zhu* pain results from pathogenic adherence. *Qulai* pain is irregular in onset and cessation, also due to pathogenic factors. The distinction between *Zhu* (Yin) and *Qulai* (Yang) is minor and need not be rigidly adhered to. Instead, differentiate by upper, middle, lower, and lateral regions. From the heart/chest to the epigastrium is the upper region; Yang Qi should be diffused. If Yang Qi is deficient, use Huangqi (Astragali Radix); if Qi is excess, use Zhishi (Immature Bitter Orange); if Qi is knotted, use Beimu (Fritillariae Bulbus) and Gualoupi (Trichosanthis Pericarpium); if Qi rebels, use Banxia (Pinelliae Rhizoma) and Xiebai (Allii Macrostemonis Bulbus); if Qi is stagnant, use Tanxiang (Santalum Album Lignum) and Sharen (Amomi Fructus). From the epigastrium to the Spleen is the middle region; Yin and Yang should be harmonized. Zhang Zhongjing's *Lizhong Wan* (Regulate the Middle Pill) uses Renshen (Ginseng Radix et Rhizoma) and Gancao (Glycyrrhizae Radix et Rhizoma)—both sweet, cold, and fluid-rich, belonging to the Yin category—to tonify Yin. It uses Baizhu (Atractylodis Macrocephalae Rhizoma) and Ganjiang (Zingiberis Rhizoma) to tonify Yang. This serves as an eternal standard. For instance, *Tongmai Sini Tang* (Pulse-Returning Decoction) urgently restores Yang; if there is abdominal distress, bitter-cold Shaoyao (Paeoniae Radix Alba) is added to nourish Yin. *Huanglian Tang* (Coptis Decoction) focuses on clearing fire; because abdominal pain is present, pungent-warming Jiang (Zingiberis Rhizoma) and Rougui (Cinnamomi Cortex) are indispensable to open Yang. This principle is subtle; only those well-versed in the *Neijing* can discuss it. From the umbilicus to the genitalia is the lower region; Yin Cold should be broken. *Jingui Yaolue* calls this *Hanhan* (Cold Hernia) [Note: Jin dynasty physicians defined hernia as testicular swelling, whereas *Jingui* defines it as severe abdominal pain]. The primary herbs are Fuzi (Aconiti Lateralis Radix Praeparata), Wutou (Aconiti Radix), and Shujiao (Zanthoxyli Pericarpium), utilizing their intense heat to support Yang and break Yin. If anterior pain penetrates posteriorly and posterior pain penetrates anteriorly, indicating indistinct boundaries between Yin and Yang, add Chishizhi (Halloysit Rubrum) 1–2 liang to block the pathogen. Additionally, *Shengjiang Danggui Yangrou Tang* (Fresh Ginger, Angelica, and Mutton Decoction) uses the turbid essence of mutton to guide action into the Yin level to break Yin, which is particularly miraculous. The hypochondriac region is the lateral side; the pivot mechanism should be facilitated. Liver and Gallbladder Qi moves laterally. *Xiaochaihu Tang* (Minor Bupleurum Decoction) is the principal formula for Shaoyang, and *Danggui Sini Tang* (Angelica Sinensis Decoction for Frigid Extremities) is the principal formula for Jueyin. Adding 49 fresh Juye (Citri Reticulatae Pericarpium Viride/Fresh Tangerine Peel) leaves may be beneficial.
For the above syndromes: A fine and slow pulse indicates Cold; treat primarily with Jiang (Zingiberis Rhizoma), Rougui (Cinnamomi Cortex), Fuzi (Aconiti Lateralis Radix Praeparata), and Wuzhuyu (Evodiae Fructus). A large and rapid pulse indicates Heat; treat primarily with Jinlingzi (Meliosmae Fructus), Huanglian (Coptidis Rhizoma), Shashen (Glehniae Radix), and Shaoyao (Paeoniae Radix Alba). Pain with diarrhea indicates Deficiency; treat primarily with *Fuzi Lizhong Tang* (Aconite Regulate the Middle Decoction). Pain with constipation indicates Excess; treat primarily with *Xiao Chengqi Tang* (Minor Descending to Restore Harmony Decoction). There are also cases of Cold-Excess pain, treated with *Dahuang Fuzi Tang* (Rhubarb and Aconite Decoction) to warm and unblock. If vomiting worms occurs, use *Fuzi Lizhong Tang*, remove Gancao, and add Danggui (Angelicae Sinensis Radix), Chuanjiao (Zanthoxyli Pericarpium), Huanglian (Coptidis Rhizoma), and Wumei (Mume Fructus). If food stagnation is present, first use *Pingwei San* (Powder to Level the Stomach) with Maiya (Hordei Fructus Germinatus) and Shanzha (Crataegi Fructus) to digest and guide out; otherwise, purge with *Chengqi Tang*. If pain is caused by anger, use *Qi Qi Tang* (Seven Qi Decoction) with Beimu (Fritillariae Bulbus), Fuxiong (Ligustici Chuanxiong Rhizoma), and Xiangfu (Cyperi Rhizoma) to resolve stagnation; this is common knowledge and needs no elaboration. Furthermore, *Ren Zhi Zhi Zhi Fang* treats stabbing Spleen pain refractory to all medicines using *Heji Choudao San* (Harmonizing Extractor Knife Powder) with miraculous effect. This formula was kept secret by physicians until the 18th year of the Jiaqing reign, when Xu Bingnan of Changzhou included it in his publication of You Shi's *Jingui Yi*. The Heart and Abdomen belong to Yin, hence they are listed under Interior Syndromes.
(Classical Text Basis) *Suwen: Ju Tong Lun* states: "Meridian Qi flows continuously, circling without end. When Cold Qi enters the meridians, its flow becomes sluggish and stagnant. If it resides outside the vessels, Blood becomes deficient; if it resides inside the vessels, Qi becomes obstructed, resulting in sudden pain." *Suwen: Jue Bing Pian* states: "True Heart Pain presents with cyanosis of hands and feet up to the joints, severe heart pain. Onset in the morning leads to death in the evening; onset in the evening leads to death in the morning." Note: The classical texts are extensive; this excerpt captures only the essential points.