〔子和〕一妇人身冷脉微，食沸热粥饭，六月重衣，以衣帽蒙其首，犹觉寒，泄注不止。常服姜、附、硫
黄燥热之剂，仅得平和，稍用寒凉，其病转加，三年不愈。戴人诊其两手脉，皆如横绳有力，一息六七至。脉
诀曰∶六数七极热生多。以凉布熨心，以新汲水淋其病处，妇乃叫杀人不止。令人时时复以冷水淋之，至三四
十桶，大战汗出，昏困一二日，而向之所恶者皆除，此法本于华佗所用，世无知者。
〔《素》〕阳明所谓洒洒振寒者，阳明者午也，五月盛阳之阴也，阳盛而阴气加之，故洒洒振寒也。（脉解篇）
上寒实反治，盖谓脉实而恶寒者设也。脉实恶寒，假寒也，故反治。
〔丹〕久病恶寒，当用解郁。湿痰积中，抑遏阳气，不得外泄，身必恶寒。
进士周本道，年近四十，得恶寒症，服附子数百帖而病甚。予诊其脉弦而缓，遂以红茶入生姜汁香油些少，
吐痰一升许，减大半。又与通圣散去麻黄、大黄、芒硝，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，齑水吐后，用后药∶
川芎 南星 苍术 黄芩 酒面丸服。
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，以伸
阳明出外，温之也。丹溪吐出湿痰，亦开发上焦，使阳气随吐升发出外，温之也，故寒栗皆愈。二者治阳
虚表寒之要
运气 恶寒有三∶
一曰火热。经曰∶诸禁鼓栗，如丧神守，皆属于火。又云∶少阳所至，为恶寒战。又云∶少阳在泉，客胜
则腰腹痛而反恶寒。治以寒剂是也。
二曰风。经云∶厥阴在泉，风淫所胜，病洒洒振寒。治以辛凉是也。
三曰寒湿包热。经云∶阳明司天之政，清热之气，持于气交，民病振寒。四之气，寒雨降，病振栗。治视
寒热轻重，多少其制是也。
〔《灵》〕阴阳者，寒暑也。热则滋雨而在上，根 少汁，人气在外，皮肤缓，腠理开，血气减，汗大泄，
皮淖泽。寒则地冻水冰，人气在中，皮肤致，腠理闭，汗不出，血气强，肉坚涩。当是之时，善行水者不能往
冰，善穿地者不能凿冻。善用针者，亦不能取四厥。血脉凝结，坚搏不往来者，亦未可即柔。故行水者必待天
温，冰释冻解，而水可行地可穿也。人脉犹是也。治厥者，必先熨，调和其经，掌与腋，肘与脚，项与脊以调
之，火气已通，血脉乃行。然后视其病脉淖泽者，刺而平之。坚紧者，破而散之。气下乃止，此所谓以解结者
也。（刺节真邪篇 下同）用针之类，在于调气。气积于胃，以通荣卫，各行其道。宗气留于海，其下者注于气街，其
上者走于息道。故厥在于足，宗气不下，脉中之血，凝而留止，弗之火调，弗能取之。用针者，必先察其经络
之实虚，切而循之，按而弹之，视其应动者，乃后取之而下之。六经调者，谓之不病，虽病谓之自已也。
大寒在外，留而补之。入于中者，从合泻之。针所不为，灸之所宜。（官能篇 从合治之。）
黄帝曰∶人之振寒者，何气使然？岐伯曰∶寒气客于皮肤，阴气盛，阳气虚，故为振寒寒栗，补诸阳。
针灸 脏腑恶寒有三∶
其一取肺。经云∶振寒鼓颔，不得汗出，腹胀烦冤，取手太阳是也。其二取胃。经云∶胃足阳明之脉，
是动，则病洒洒振寒，善伸数欠，视盛虚热寒，陷下取之也。其三取胆。经云∶胆足少阳之脉，所生病者，汗
出振寒，视盛虚热寒，陷下取之也。
〔《撮》〕下部寒冷∶关元、肾俞。
〔桑君〕又法∶气海、中极。
〔《甲》〕振寒螈 ，手不伸，咳嗽唾浊，气膈善呕，鼓颔不得汗，烦满身痛，因为螈 ，尺泽主之。
头项恶风，汗不出，凄厥恶寒，呕吐，目系急，痛引额，头重项痛，玉枕主之。凄凄振寒，数欠伸，鬲俞
主之。
〔《密语》〕通身恶寒，筋脉拘急，十指不得近风∶绝骨（二寸半。推而上之，令气中和为解）。
[刘完素（字守真，号河间居士，世称刘河间）] 有一位妇女身体冰冷，脉象微弱，食用滚烫的粥饭，六月天穿着厚重的衣服，用帽子和头巾蒙住头部，仍然觉得寒冷，腹泻如水注下不止。她长期服用姜、附子、硫黄等燥热性质的药物，只能暂时得到平和，稍微使用寒凉药，病情就加重，三年未能痊愈。戴人（张从正，字子和，号戴人）诊察她的两手脉象，都像横着的绳子一样有力，一呼一吸之间跳动六七次。《脉诀》说：“六数七极热生多。”（意为脉率快主热证）。用凉布敷熨心部，用新汲井水淋浇患病部位，妇人于是大声呼叫不止。让人时时再用冷水淋浇她，直到用了三四十桶水，大汗淋漓如战栗般出汗，昏沉困倦了一两天，之前所厌恶的寒冷症状都消除了。此法本于华佗所用之法，世上无人知晓。
[《黄帝内经·素问》] 阳明经所说的“洒洒然振栗恶寒”，是因为阳明对应午时，是五月盛阳中的阴气，阳气极盛而阴气加之，所以出现洒洒然振栗恶寒。（出自《脉解篇》）这是针对上焦寒实证的反治法，大概是指脉象实大而却恶寒的情况。脉实而恶寒，是假寒证，所以采用反治法。
[朱震亨（字彦修，号丹溪，世称朱丹溪）] 久病恶寒，应当使用解郁法。湿痰积聚在中焦，抑制遏制阳气，使其不能向外宣泄，身体必然恶寒。
进士周本道，年龄近四十岁，患上恶寒症，服用附子数百帖后病情反而加重。我诊察他的脉象弦而缓，于是用红茶加入少许生姜汁和香油，让他吐出痰液约一升，病情减轻大半。又给予通圣散去掉麻黄、大黄、芒硝，加入当归、地黄，服用一百帖后痊愈。
一位女子恶寒，用苦参、赤小豆各一钱，研为末，用醋水漱口催吐后，服用以下药物：
川芎、南星、苍术、黄芩，用酒面制成丸剂服用。
上焦不通畅，则阳气被抑制遏制，皮肤分肉得不到温煦，所以发生寒战栗抖。李东垣的升阳益胃汤，使用升发之剂，开发上焦，使阳明之气外出，从而起到温煦作用。丹溪通过吐出湿痰，也是开发上焦，使阳气随呕吐升发出外，起到温煦作用，所以寒战栗抖都治愈了。这两者是治疗阳虚表寒的关键方法。
运气学说中，恶寒有三种情况：
一是火热。经文说：“各种禁固鼓栗，如同丧失神志守护，都属于火。”又说：“少阳之气到来时，表现为恶寒战栗。”又说：“少阳在泉，客气胜则腰腹痛反而恶寒。”治疗使用寒凉药剂。
二是风邪。经文说：“厥阴在泉，风邪淫胜，病症表现为洒洒然振栗恶寒。”治疗使用辛凉之剂。
三是寒湿包裹热邪。经文说：“阳明司天之政，清热之气持于气交之中，民众发病表现为振栗恶寒。四之气时，寒雨下降，病症表现为振栗。”治疗视寒热轻重，调整方剂的多少比例。
[《黄帝内经·灵枢》] 阴阳，对应寒暑。热的时候，雨水滋润在上，根部缺少汁液，人气在外，皮肤松弛，腠理开泄，血气减少，汗大泄出，皮肤湿润光泽。冷的时候，地面冻结水结冰，人气在内，皮肤致密，腠理闭合，汗不出，血气强盛，肌肉坚实涩滞。在这个时候，善于行水的人不能前往冰区，善于穿地的人不能凿开冻土。善于用针的人，也不能取治四肢厥逆。血脉凝结，坚硬搏结不往来者，也不可立即使之柔和。所以行水的人必须等待天气温暖，冰释冻解，然后水可行、地可穿。人的经脉也是这样。治疗厥证，必须先进行熨法，调和其经脉，手掌与腋窝，肘部与脚部，颈部与脊背以此调治，火气已通达，血脉乃运行。然后视其病症，脉象濡润光泽的，针刺以平复之。脉象坚紧的，攻破并消散之。气下行后才停止，这叫做解开结聚的方法。（出自《刺节真邪篇》，下同）用针之类的方法，在于调气。气积聚于胃，用来通行营卫，各自运行其道。宗气留于膻中（气海），其下部注入气街，其上部分走息道。所以厥逆发生在足部，宗气不下行，脉中之血，凝结而停留止息，不用火法调治，就不能取效。用针者，必须先察视经络的虚实，切按循摸，按压弹击，观察其有反应跳动的地方，然后才取穴施治。六经调和的，称为不病，即使有病也会自愈。
大寒在外，停留而补之。侵入内部的，从合穴泻之。针刺不能奏效的，艾灸适宜。（出自《官能篇》，从合治之。）
黄帝说：“人之所以振栗恶寒，是什么气导致的？”岐伯说：“寒气客居于皮肤，阴气盛，阳气虚，所以产生振栗寒战，补益诸阳经。”
针灸方面，脏腑恶寒有三种情况：
其一取肺经相关穴位。经文说：“振栗寒战鼓颔，不得汗出，腹胀烦闷冤结，取手太阳经。”其二取胃经。经文说：“足阳明胃经，是动则病洒洒然振栗恶寒，喜欢伸展频繁打哈欠，视其盛虚热寒，陷下者取之。”其三取胆经。经文说：“足少阳胆经，所生病者，汗出振栗恶寒，视其盛虚热寒，陷下者取之。”
[《甲乙经》] 振栗寒战抽搐，手不能伸展，咳嗽唾吐浊物，气膈善呕，鼓颔不得汗，烦满身痛，因为抽搐，尺泽穴主治。
头项恶风，汗不出，凄惨厥冷恶寒，呕吐，目系紧急，疼痛牵引额部，头重项痛，玉枕穴主治。凄凄振栗恶寒，频繁打哈欠伸懒腰，膈俞穴主治。
[Liu Wansu (courtesy name Shouzhen, pseudonym Hejian Jushi, known as Liu Hejian)] A woman had a cold body and a faint pulse. She consumed boiling hot porridge and rice, wore heavy clothes in June, covered her head with a hat and scarf, yet still felt cold. She suffered from incessant watery diarrhea. She had long taken drying and heating agents such as ginger, Aconite (Fuzi), and sulfur, achieving only temporary mildness; whenever slightly cooling medicines were used, her condition worsened. This persisted for three years without cure. Dairen (Zhang Congzheng, courtesy name Zihe, pseudonym Dairen) examined her pulses on both hands, which felt like horizontal ropes and were forceful, beating six or seven times per breath cycle. The *Maijue* (Pulse Classic) states: "Six rapid beats indicate excessive heat." (Meaning: fast pulse rate indicates heat syndromes). Using cool cloth to compress the heart region, and splashing fresh well water on the affected areas, the woman screamed incessantly. People were instructed to repeatedly splash cold water on her until thirty or forty buckets were used. She then profusely sweated with chills, remained drowsy and exhausted for one or two days, and all the previously disliked cold symptoms were eliminated. This method originated from Hua Tuo's practice, but was unknown to the world.
*[Suwen]* What Yangming refers to as "shivering with aversion to cold" occurs because Yangming corresponds to the Wu hour, representing Yin within the peak Yang of the fifth month. When Yang is at its peak and Yin qi acts upon it, shivering with aversion to cold results. (From *Maijie Pian*) This is the counter-treatment for upper jiao cold-excess, specifically referring to cases where the pulse is full and large yet there is aversion to cold. Full pulse with aversion to cold indicates false cold, hence the counter-treatment is applied.
[Zhu Zhenheng (courtesy name Yanxiu, pseudonym Danxi, known as Zhu Danxi)] For aversion to cold resulting from chronic illness, one should use methods to resolve stagnation. When damp-phlegm accumulates in the middle jiao, it suppresses and obstructs Yang qi, preventing it from venting outward, causing the body to feel cold.
The Jinshi Zhou Bendao, nearly forty years old, suffered from an aversion-to-cold syndrome. After taking hundreds of doses of Aconite (Fuzi), his condition worsened. I palpated his pulse, which was wiry and slow. I prescribed black tea mixed with a small amount of fresh ginger juice and sesame oil, inducing him to vomit approximately one liter of phlegm, reducing his symptoms by more than half. Subsequently, I administered *Tongsheng San* (Universal Rescue Powder) modified by removing Ephedrae Herba (Mahuang), Rhubarbi Radix et Rhizoma (Dahuang), and Mirabilits Sal (Mangxiao), adding Angelicae Sinensis Radix (Danggui) and Rehmanniae Radix (Dihuang). After one hundred doses, he recovered.
A young woman suffering from aversion to cold was treated with Coptidis Rhizoma (Kushen) and Adzuki Bean (Chixiaodou), each one qian, ground into powder. After gargling with vinegar water to induce vomiting, she took the following prescription:
Ligusticum Chuanxiong Rhizome (Chuanxiong), Pinelliae Rhizoma Preparatum (Nanxing), Atractylodis Macrocephalae Rhizoma (Cangzhu), Scutellariae Radix (Huangqin), made into pills with wine and flour.
When the upper jiao is blocked, Yang qi is suppressed, and the skin and muscle spaces fail to receive warmth, resulting in chills and trembling. Li Dongyuan's *Shengyang Yiwetang* (Raise Yang Tonify Stomach Decoction) uses ascending and dispersing agents to open the upper jiao, allowing Yangming Qi to emerge outward, thereby providing warmth. Danxi's induction of vomiting to expel damp-phlegm also opens the upper jiao, allowing Yang qi to ascend and emerge outward through vomiting, providing warmth. Thus, chills and trembling are cured. These two approaches are key treatments for deficiency of Yang with exterior cold.
In the theory of Six Qi (Yunqi), there are three types of aversion to cold:
First, Fire-Heat. The classics state: "All cases of inhibition, drumming, and tremors, resembling loss of spiritual control, belong to Fire." It also says: "When Shaoyang arrives, it manifests as aversion to cold and shaking." And again: "When Shaoyang is in the Earthly Position, if guest qi prevails, waist and abdominal pain occur with contrary aversion to cold." Treatment involves cold-natured agents.
Second, Wind. The classics say: "When Jueyin is in the Earthly Position, if Wind pathogen prevails, the disease manifests as shivering with aversion to cold." Treatment involves acrid-cool agents.
Third, Cold-Damp enveloping Heat. The classics state: "When Yangming governs the Heavenly Position, the clearing-heat qi persists at the intersection of qi, and the people suffer from shivering and aversion to cold. In the fourth qi period, when cold rain descends, the disease manifests as shivering and trembling." Treatment depends on the severity of cold and heat, adjusting the proportions of the formula accordingly.
*[Lingshu]* Yin and Yang correspond to cold and heat. In heat, rain nourishes above, roots lack juice, human qi is external, skin is relaxed, pores are open, blood and qi decrease, sweat flows heavily, and skin becomes moist and glossy. In cold, the ground freezes and water turns to ice, human qi is internal, skin is dense, pores are closed, sweat does not exit, blood and qi are strong, and muscles are firm and stiff. At this time, those skilled in moving water cannot go to ice, and those skilled in digging earth cannot pierce frozen soil. Those skilled in acupuncture also cannot treat four extremities reversal (Jue). When blood vessels are coagulated and hard, resisting flow, they cannot be immediately softened. Therefore, those who move water must wait for warm weather, when ice melts and frost dissolves, so that water can flow and earth can be penetrated. Human meridians are similar. To treat Jue (reversal/cold limbs), one must first apply moxibustion compression (Wen) to harmonize the meridians, treating the palms and axillae, elbows and feet, neck and spine. Once fire qi has circulated and blood vessels are flowing, one then examines the condition. If the pulse is soft and glossy, puncture to level it. If hard and tight, break and disperse it. Stop when qi descends. This is called untying knots. (From *Cijie Zhenxie Pian*, same below) The essence of acupuncture lies in regulating Qi. Qi accumulates in the stomach to circulate Ying and Wei, each following its own path. Zong Qi (Gathering Qi) remains in the Sea of Qi (Dan Zhong); its lower part pours into the Qichai (Stomach meridian point ST30), and its upper part travels to the respiratory tract. Therefore, if Jue is in the feet, Zong Qi fails to descend, blood in the vessels coagulates and stops. Without fire therapy regulation, it cannot be treated. Acupuncturists must first observe the excess or deficiency of meridians, palpate and follow them, press and flick them, observing where there is a reactive movement, then select points and reduce. When the six meridians are harmonious, it is called no disease; even if diseased, it will self-heal.
Great cold remaining externally requires tonification. Pathogens entering internally require reduction via He-Sea points. Where acupuncture is ineffective, moxibustion is suitable. (From *Gonneng Pian*, treat via He-Sea points.)
Yellow Emperor asked: "What causes shivering and aversion to cold?" Qibo answered: "Cold pathogen lodges in the skin, Yin qi is abundant, Yang qi is deficient, thus causing shivering and cold tremors. Tonify the Yang meridians."
Regarding acupuncture for organ-related aversion to cold, there are three types:
First, take Lung-related points. The classics say: "Shivering, jaw quivering, inability to sweat, abdominal distension with vexation, take Hand-Taiyang points." Second, take Stomach points. The classics say: "The Foot-Yangming Stomach Meridian, when moved, causes shivering with aversion to cold, frequent stretching and yawning. Observe excess/deficiency, heat/cold, and sinking; treat accordingly." Third, take Gallbladder points. The classics say: "The Foot-Shaoyang Gallbladder Meridian, diseases arising from it include sweating with shivering and aversion to cold. Observe excess/deficiency, heat/cold, and sinking; treat accordingly."
*[Zhenjiu Dacheng]* Coldness in the lower part: Guanyuan (CV4), Shenshu (BL23).
[Sang Jun] Another method: Qihai (CV6), Zhongji (CV3).
*[Jiayi Jing]* Shivering with spasms, inability to extend hands, coughing with turbid sputum, chest diaphragm obstruction with frequent vomiting, jaw quivering without sweat, vexation with whole-body pain, due to spasms: primarily treated with Chize (LU5).
Head and neck aversion to wind, no sweat, chilling with cold limbs and aversion to cold, vomiting, tension of eye connections, pain radiating to forehead, heavy head and painful neck: primarily treated with Yuzhen (GB9). Chilling shivering with frequent yawning and stretching: primarily treated with Geshu (BL17).
*[Mi Yu]* Whole-body aversion to cold, tendon and vessel constraint, ten fingers unable to tolerate wind: Jiexu (GB39) (located 2.5 cun above the tip of the lateral malleolus. Push upwards until Qi feels balanced for relief).