当归三两 生姜五两 羊肉一筋
右三味，以水八升，煮取三升，温服七合，日三服。若寒多者，加生姜成一筋。痛多
而呕者，加橘皮二两，白术一两。加生姜者，亦加水五升，煮取三升二合，服之。
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寒疝，腹中痛，逆冷，手足不仁，若身疼痛，灸刺、诸药不能治，抵当乌头桂枝汤主
之。
【按】
「抵当」二字，衍文也。
【注】
寒疝腹中痛，逆冷，手足不仁，身体疼痛，此疝之寒重者也。灸刺、诸药不能取效，
则急以乌头煎加桂枝汤五合，以解内外之盛寒也。
【集注】
徐彬曰：起于寒疝腹痛，而至逆冷，手足不仁则阳气大痹，加以身疼痛，荣卫俱不和
，更灸刺诸药不能治，是或攻其外，或攻其内，邪气牵制不服也。故以乌头攻寒为主
，而合桂枝全汤以和荣卫，所谓七分治里、三分治表也。
乌头五枚
右一味，以蜜二筋，煎减半，去滓，以桂枝汤五合解之，令得一升，初服二合不知，
即服三合；又不知，复加至五合。其知者如醉状，得吐者为中病。
【方解】
以桂枝汤五合解之者，溶化也。令得一升，谓以乌头所煎之蜜五合，加桂枝汤五合溶
化，令得一升也。不知，不效也；又不知，又不效也；其知者，已效也。如醉状，外
寒方散。得吐者，内寒已伸，故为中病也。
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问曰：人病有宿食，何以别之？师曰：寸口脉浮而大，按之反涩，尺中亦微而涩，故
知有宿食，大承气汤主之。
【按】
尺中亦微而涩之「微」字，当按『伤寒论』作「大」字是。
【注】
宿食病，即今之伤食病也，谓食隔宿不化也。人病腹满而痛，何以别之为宿食也？寸
口脉浮而大，按之反涩，谓按且大、且涩、且有力也，关上尺中亦然。大涩有力为实
而不利，故知有宿食也。当下之，宜大承气汤。
@@@
脉数而滑者，实也，此有宿食，下之愈，宜大承气汤。
【注】
腹满而痛，脉数而滑者，实也，此有宿食，故当下之。
【集注】
李□日：滑者，水谷之气胜也，若滑而兼数，则实热已入胃府矣。故云：有宿食可下
之。
@@@
下利不欲食者，有宿食也，当下之，宜大承气汤。
【注】
初下利不欲食者是伤食，恶食不欲食也；久下利不欲食者，是伤脾不能食也。今初下
利即不欲食，以有宿食故也。当下之，宜大承气汤无疑矣。
【集注】
沈明宗曰：此伤食而致下利也。骤伤宿食，停滞胃中，壅遏升降之机，不转肠中，水
谷不分而下奔则利，宿食在胃，故不欲食。必当攻去宿食，利得止而欲食，故宜大承
气汤。
@@@
宿食在上脘，当吐之，宜瓜蒂散。
【注】
胃有三脘，宿食在上脘者，隔间痛而吐，可吐不可下也；在中脘者，心中痛而吐，或
痛不吐，可吐可下也；在下脘者，脐上痛而不吐，不可吐可下也。今食在上脘，故当
以瓜蒂散吐之也。
当归三两，生姜五两，羊肉一筋。
以上三味药，用水八升，煮取三升药液，每次温服七合，每日服用三次。如果寒邪较重者，将生姜增加至一筋。如果疼痛剧烈且伴有呕吐者，加入橘皮二两、白术一两。加入生姜的情况，也需加水五升，煮取三升二合，然后服用。
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寒疝（因寒邪引起的腹部拘急疼痛），腹中疼痛，四肢逆冷，手足麻木不仁，若兼有身体疼痛，经过艾灸、针刺及各种药物治疗均无效时，应当用乌头桂枝汤主治。
【按语】
“抵当”二字是衍文（多余的文字）。
【注解】
寒疝导致腹中疼痛、四肢逆冷、手足麻木不仁、身体疼痛，这是寒邪极重的疝病。既然艾灸、针刺和各种药物都不能见效，就急需使用乌头煎剂配合桂枝汤五合，以解除内外的盛寒之邪。
【集注】
徐彬说：病情起于寒疝腹痛，发展到四肢逆冷、手足麻木不仁，说明阳气严重痹阻；再加上身体疼痛，营卫之气都不调和，此时即使艾灸、针刺和各种药物都无法治愈，是因为无论攻治外部还是内部，邪气相互牵制而不顺从。因此以乌头攻逐寒邪为主，同时合用完整的桂枝汤来调和营卫，这就是所谓的七分治里、三分治表。
乌头五枚。
以上一味药，用蜂蜜二筋，煎煮至减半，滤去药渣，再用桂枝汤五合来溶化药汁，使总量达到一升。初次服用二合，若无反应，则服用三合；仍无反应，再增加至五合。服药后出现像醉酒一样的感觉，或者发生呕吐的，说明药力已中病（击中病灶）。
【方解】
用桂枝汤五合来“解之”，意思是溶化。所谓“令得一升”，是指将乌头煎好的蜜汁五合，与桂枝汤五合混合溶化，使总量达到一升。“不知”，指没有疗效；“又不知”，指再次服用仍无疗效；“其知者”，指已经见效。出现像醉酒一样的状态，说明外部的寒邪正在消散。发生呕吐，说明内部的寒邪得以伸展，所以称为中病。
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问：人患病有宿食（积滞的食物），如何辨别？老师说：寸口脉象浮而大，重按反而涩滞，尺部脉象也微而涩，因此知道有宿食，宜用大承气汤主治。
【按语】
尺部脉象“微”字，应当参照《伤寒论》改为“大”字才是正确的。
【注解】
宿食病，就是现在的伤食病，指食物隔宿不能消化。人患腹部胀满疼痛，如何辨别为宿食呢？寸口脉浮而大，重按时感觉既大又涩且有力，关部和尺部也是如此。脉大、涩且有力属于实证且气机不利，因此知道有宿食。应当采用泻下法，适宜用大承气汤。
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脉象数而滑的，属于实证，这是有宿食，通过泻下可以痊愈，适宜用大承气汤。
【注解】
腹部胀满疼痛，脉象数而滑的，属于实证，这是因为有宿食，所以应当采用泻下法。
【集注】
李□说：滑脉是水谷之气旺盛的表现，如果滑脉兼见数脉，说明实热已经侵入胃腑。所以说：有宿食可以通过泻下法治疗。
@@@
腹泻但不想吃东西的，是有宿食，应当采用泻下法，适宜用大承气汤。
【注解】
刚开始腹泻就不想吃东西，是伤食，厌恶食物或不想进食；长期腹泻不想吃东西，是脾脏受损不能运化食物。现在刚开始腹泻就不想吃东西，是因为有宿食的缘故。应当采用泻下法，适宜用大承气汤，这是毫无疑问的。
【集注】
沈明宗说：这是伤食导致的腹泻。突然摄入过多宿食，停滞在胃中，壅塞阻碍了升降的气机，水谷不能在肠中正常转化，清浊不分而下奔，导致腹泻。因为宿食停留在胃中，所以不想吃东西。必须攻逐去除宿食，待腹泻停止且恢复食欲，所以适宜用大承气汤。
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宿食停留在上脘（胃的上部），应当采用催吐法，适宜用瓜蒂散。
【注解】
胃分为上、中、下三脘。宿食在上脘的，表现为膈间疼痛并呕吐，可以用吐法，不能用下法；在中脘的，表现为心中疼痛并呕吐，或者疼痛但不呕吐，可以用吐法也可以用下法；在下脘的，表现为脐上疼痛且不呕吐，不能用吐法，只能用下法。现在食物停留在上脘，所以应当用瓜蒂散进行催吐。
Angelicae Sinensis Radix (Danggui, 当归) three liang, Zingiberis Rhizoma Recens (Shengjiang, 生姜) five liang, Mutton (Rou, 羊肉) one jin.
The above three ingredients are boiled in eight sheng of water to obtain three sheng of decoction. Take seven he of the warm decoction orally, three times a day. If cold pathogen is severe, increase Shengjiang (Zingiberis Rhizoma Recens) to one jin. If pain is severe accompanied by vomiting, add Citri Reticulatae Pericarpium (Chenpi, 橘皮) two liang and Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) one liang. When adding Shengjiang (Zingiberis Rhizoma Recens), also add five sheng of water, boil to obtain three sheng and two he, then take.
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Cold hernia (Han Han, 寒疝 - abdominal cramping pain due to cold), with abdominal pain, cold limbs, numbness and insensitivity of hands and feet, and if accompanied by body pain, which cannot be cured by moxibustion, acupuncture, or various medicines, should be primarily treated with Wutou Guizhi Tang (Cinnamon Twig and Aconite Decoction).
[Note]
The characters "Di Dang" are superfluous.
[Annotation]
Cold hernia causing abdominal pain, cold limbs, numbness of hands and feet, and body pain indicates a severe case of cold hernia. Since moxibustion, acupuncture, and various medicines have failed to produce effects, it is urgent to use Wutou Jian (Aconite Decoction) combined with five he of Guizhi Tang (Cinnamon Twig Decoction) to resolve the severe cold inside and outside the body.
[Collected Notes]
Xu Bin said: The condition starts with cold hernia abdominal pain, progressing to cold limbs and numbness of hands and feet, indicating severe obstruction of Yang Qi. Coupled with body pain, both Ying (Nutritive) and Wei (Defensive) Qi are disordered. At this point, even if moxibustion, acupuncture, and various medicines fail to cure, it is because whether attacking externally or internally, the pathogenic factors constrain each other and do not submit. Therefore, Wutou (Radix Aconiti Lateralis Preparata) is used as the main agent to attack cold, combined with the complete Guizhi Tang (Cinnamon Twig Decoction) to harmonize Ying and Wei Qi. This is what is meant by treating seventy percent internally and thirty percent externally.
Wutou (Radix Aconiti Lateralis Preparata) five pieces.
The above single ingredient is boiled in two jin of honey until reduced by half. Filter out the dregs, then dissolve the residue using five he of Guizhi Tang (Cinnamon Twig Decoction) to obtain one sheng in total. Initially take two he; if there is no response, take three he; if still no response, increase to five he. If the patient experiences a sensation like drunkenness, or vomits, it indicates that the medicine has hit the target (Zhong Bing, 中病).
[Formula Analysis]
"Dissolving with five he of Guizhi Tang (Cinnamon Twig Decoction)" means melting/dissolving. "Obtaining one sheng" refers to mixing five he of the honey-decocted Wutou liquid with five he of Guizhi Tang (Cinnamon Twig Decoction) to melt and obtain one sheng. "No response" means ineffective; "again no response" means still ineffective upon re-administration; "having response" means effective. The drunken-like state indicates that external cold is dissipating. Vomiting indicates that internal cold is being expelled, thus termed "hitting the target."
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Question: How can one distinguish patients with retained food (Su Shi, 宿食)? The Master said: The pulse at Cun Kou (Inch Position) is floating and large, but feels choppy upon deep pressure; the Chi position (Cubit Position) is also slightly choppy. Thus, we know there is retained food, and Da Chengqi Tang (Major Order the Qi Decoction) should be used.
[Note]
The character "Wei" (slight) in "Chi position is also slight and choppy" should be corrected to "Da" (large) according to Shanghan Lun (Treatise on Cold Pathogenic Diseases).
[Annotation]
Su Shi disease (retained food disease) is equivalent to modern food stagnation, referring to food that remains undigested overnight. When a person suffers from abdominal fullness and pain, how do we distinguish it as retained food? The Cun Kou pulse is floating and large, feeling large, choppy, and forceful upon pressing; Guan (Bar Position) and Chi positions are similar. A pulse that is large, choppy, and forceful indicates excess syndrome with obstructed flow, thus confirming retained food. Purging method should be applied, and Da Chengqi Tang (Major Order the Qi Decoction) is suitable.
@@@
A rapid and slippery pulse indicates an excess syndrome, signifying retained food. Purging will lead to recovery; Da Chengqi Tang (Major Order the Qi Decoction) is suitable.
[Annotation]
Abdominal fullness and pain with a rapid and slippery pulse indicate an excess syndrome caused by retained food; therefore, purging should be applied.
[Collected Notes]
Li [Name] said: Slippery pulse indicates abundance of Qi from water and grain. If slippery pulse is accompanied by rapid pulse, it means excess heat has entered the Stomach Fu organ. Hence, it is stated that retained food can be treated by purging.
@@@
Diarrhea accompanied by loss of appetite indicates retained food. Purging should be applied; Da Chengqi Tang (Major Order the Qi Decoction) is suitable.
[Annotation]
Initial diarrhea with loss of appetite indicates food injury, characterized by aversion to food or lack of desire to eat. Prolonged diarrhea with loss of appetite indicates Spleen damage and inability to digest food. Now, initial diarrhea with loss of appetite is due to retained food. Purging should be applied, and Da Chengqi Tang (Major Order the Qi Decoction) is undoubtedly suitable.
[Collected Notes]
Shen Mingzong said: This is diarrhea caused by food injury. Sudden excessive intake of retained food stagnates in the Stomach, blocking the mechanism of ascending and descending. Water and grain fail to transform in the intestines, leading to separation failure and downward rushing, resulting in diarrhea. Because retained food stays in the Stomach, there is no desire to eat. It is necessary to attack and remove the retained food; once diarrhea stops and appetite returns, Da Chengqi Tang (Major Order the Qi Decoction) is suitable.
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Retained food located in the Upper Wan (Upper Part of the Stomach) should be treated by inducing vomiting; Gua Di San (Melon Tip Powder) is suitable.
[Annotation]
The Stomach is divided into Upper, Middle, and Lower Wan. For retained food in the Upper Wan, symptoms include pain in the diaphragm region and vomiting; vomiting method can be used, but purging method cannot. For retained food in the Middle Wan, symptoms include heart pain with vomiting, or pain without vomiting; both vomiting and purging methods can be used. For retained food in the Lower Wan, symptoms include pain above the umbilicus without vomiting; vomiting method cannot be used, only purging method. Since the food is currently in the Upper Wan, Gua Di San (Melon Tip Powder) should be used to induce vomiting.