【大已寒丸】治脏腑虚寒。心腹 痛。泄泻肠鸣。自利自汗。米谷不化。手足厥冷。
荜茇 肉桂（各六两半） 干姜 良姜（各十两）
上为末。面糊丸如桐子大。每服二十丸。米饮汤下。食前服。
【四逆汤】治伤寒自利不渴。呕哕不止。或吐利俱发。小便或涩或利。或汗出过多。脉
微欲绝。腹痛胀满。手足逆冷。及一切虚寒逆冷。并宜服之。
甘草（炙。二两） 干姜（一两半） 附子（生。去皮脐。细切。半两）
上 咀。每服三钱。水一盏半。煎至八分。去渣。温服。不计时。
至元己巳夏六月。予住于上都。佥院董彦诚。年逾四旬。因劳役过甚。烦渴不止。极饮 乳。
又伤冷物。遂自利肠鸣腹痛。四肢逆冷。冷汗自出。口鼻气亦冷。六脉如蛛丝。时发昏愦。众太医
议之。以葱熨脐下。又以四逆汤五两。生姜二十片。连须葱白九茎。水三升。煮至一升。去渣凉服
。至夜半。气温身热。思粥饮。至天明而愈。玉机真脏论云。脉细皮寒。气少泄利。饮食不入。此
谓五虚。浆粥入胃。则虚者活。信哉。鲁斋许先生闻之。叹曰。病有轻重。方有大小。治有缓急。
佥院之证。非大方从权急治则不能愈也。至真要大论云。补下治下。制以急。急则气味浓。此之谓也
。
真定府武德卿。年四十六岁。至元丙子三月间。因忧思劳役。饮食失节。得病肢体冷。口鼻气
亦凉。额上冷汗出。时发昏愦。六脉如蛛丝。一医作风证。欲以宣风散下之。予因思钱氏小儿论。
制宣风散。谓小儿内伤脾胃。或吐或泻。久则风邪陷入胃中而作飧泄。散中有结。恐传慢惊。以宣风
散导去风邪。内经云。久风为飧泄。正此谓也。今德卿形证。乃阴盛阳虚。苦寒之剂。非所宜也。
内经云。阴气有余为多汗身寒。又阴阳应象论云。阴盛则身寒汗出。身常清。数栗而寒。寒而厥。
调经篇亦云。阴盛生内寒。岐伯曰。厥气上逆。寒气积于胸中而不泻。不泻则温气去。寒独留。故
寒中。东垣解云。此脾胃不足。劳役形体。中焦营气受病。末传寒
中。惟宜补阳。遂以理中汤加黑附子。每服五钱。多用葱白煎羊肉汤。取清汁一大盏。调服之。至
夕四肢渐温。汗出少。夜深再服。翌日精神出。六脉生。数服而愈。尝记李思顺云。证者证也。病
状于中。证形于外。凡学医道。不看内经。不求病源。妄意病证。又执其方。此皆背本趣末之务。
其误多矣。宜慎思之。
【大已寒丸】治疗脏腑虚寒。心腹疼痛。泄泻肠鸣。自利自汗。米谷不化。手足厥冷。
荜茇、肉桂（各六两半）、干姜、良姜（各十两）。
以上药材研为细末，用面糊制成如梧桐子大小的丸剂。每次服用二十丸，用米汤送服。饭前服用。
【四逆汤】治疗伤寒引起的自利且不口渴。呕吐呃逆不止。或者吐利同时发作。小便或涩滞或通利。或者出汗过多。脉微细欲绝。腹痛胀满。手足逆冷。以及一切虚寒导致的逆冷症状，都适宜服用此方。
甘草（炙，二两）、干姜（一两半）、附子（生用，去皮脐，细切，半两）。
以上药材切碎。每次服用三钱，加水一盏半，煎至八分，去渣，温服。不拘时间服用。
至元己巳年夏六月，我居住在上都。佥院董彦诚，年龄超过四十岁。因为劳役过度，烦渴不止。大量饮用乳汁。又吃了生冷食物。于是出现自利、肠鸣、腹痛。四肢逆冷。冷汗自出。口鼻呼出的气也是冷的。六脉像蛛丝一样细微。时常发生昏愦。众太医商议治疗方案。用葱熨法熨烫脐下。又用四逆汤五两，生姜二十片，带须葱白九茎，水三升，煮至一升，去渣后凉服。到了半夜，体温回升，身体发热，想喝粥饮。到了天明痊愈。《玉机真脏论》说：脉细、皮寒、气少、泄利、饮食不入。这叫做“五虚”。浆粥进入胃中，那么虚证患者就能存活。确实如此啊。鲁斋许先生听到这件事，感叹道：病有轻重之分，方有大小区别，治疗有缓急之别。佥院的病症，不用大方权宜急治就不能痊愈啊。《至真要大论》说：补下治下，制方要急。急则药气味浓厚。说的就是这个道理。
真定府武德卿，年龄四十六岁。至元丙子年三月间。因为忧思劳役，饮食不节，得了肢体冷的病。口鼻呼出的气也凉。额头出冷汗。时常发生昏愦。一位医生诊断为风证，打算用宣风散攻下。我想到钱乙小儿科的论述，制作宣风散，说是小儿内伤脾胃，或者吐或者泻，久了风邪陷入胃中导致飧泄。散中有结聚，恐怕传变为慢惊风。用宣风散导去风邪。《内经》说：久风为飧泄。正是这个意思。现在武德卿的形证，是阴盛阳虚。苦寒的药剂，并不适宜。《内经》说：阴气有余会导致多汗身寒。《阴阳应象大论》说：阴盛则身寒汗出，身体常清冷，频繁战栗而寒，寒而厥逆。《调经篇》也说：阴盛产生内寒。岐伯说：厥气上逆，寒气积聚在胸中而不排泄。不排泄则温气离去，寒气独留。所以产生寒中症。李东垣解释云：这是脾胃不足，形体劳役，中焦营气受病，最终传变为寒中症。只适宜补阳。于是用理中汤加黑附子。每次服用五钱，多用葱白煎羊肉汤，取清汁一大盏，调服。到了傍晚四肢逐渐温暖，出汗减少。夜深再服。第二天精神恢复，六脉有生气象。服用数剂后痊愈。曾经记得李思顺说过：证就是征验。病状表现于内，证候显现于外。凡是学习医道，不看《内经》，不探究病源，随意猜测病证，又固执于某一方剂。这都是背离根本追求末节的务求。其错误很多。应该慎重思考。
[Da Yi Han Wan] (Great Cold-Dispelling Pill) treats deficiency-cold of the Zang-Fu organs. Heart and abdominal pain, diarrhea with borborygmus, spontaneous diarrhea and sweating, undigested food in stool, coldness of hands and feet.
Bibo (Long Pepper Fruit), Rougui (Cinnamon Bark) (each 6.5 liang), Ganjiang (Dried Ginger), Liangjiang (Galangal Rhizome) (each 10 liang).
Grind the above into powder, make pills with wheat paste the size of paulownia seeds. Take 20 pills each time, swallow with rice water. Take before meals.
[Sini Tang] (Decoction for Reversal of Yin) treats spontaneous diarrhea without thirst caused by Shanghan (Cold Damage). Unceasing vomiting and hiccups, or simultaneous vomiting and diarrhea. Urine may be scanty or free-flowing. Or excessive sweating. Pulse is faint and nearly imperceptible. Abdominal pain and distension, coldness of hands and feet extending upwards. And all kinds of deficiency-cold causing reversal coldness. It is suitable to take this prescription.
Gancao (Licorice Root) (honey-fried, 2 liang), Ganjiang (Dried Ginger) (1.5 liang), Fuzi (Aconite Lateralis Radix Praeparata) (raw, peeled, navel removed, finely sliced, 0.5 liang).
Cut the above into small pieces. Take 3 qian each time, add 1.5 sheng of water, decoct until 0.8 sheng remains, remove dregs, take warm. Take at any time.
In the summer of the sixth month of the Jisi year of Zhiyuan, I resided in Shangdu. Qianyuan Dong Yancheng, aged over forty, due to excessive labor and fatigue, suffered from incessant irritability and thirst. He drank milk excessively. Then he injured himself with cold foods. Subsequently, he developed spontaneous diarrhea, borborygmus, and abdominal pain. His four limbs were cold, cold sweat came out spontaneously, and the breath from his mouth and nose was also cold. The six pulses were as fine as spider threads. He occasionally fell into a state of confusion and unconsciousness. The Imperial Physicians discussed the case. They used scallion moxibustion on the lower abdomen. They also prescribed Sini Tang (Decoction for Reversal of Yin) 5 liang, fresh ginger 20 slices, scallion white with roots 9 stalks, water 3 sheng, boiled down to 1 sheng, dregs removed, taken cool. By midnight, body temperature rose, body became hot, and he desired porridge and drinks. By dawn, he recovered. The *Yu Ji Zhen Zang Lun* states: Fine pulse, cold skin, shortness of breath, diarrhea, inability to eat. This is called "Five Deficiencies". If gruel enters the stomach, then the deficient patient will survive. Truly so. Mr. Xu Luzhai heard of this and sighed, saying: Diseases have severity, prescriptions have size, treatments have urgency. For the Qianyuan's condition, only a large prescription applied urgently can cure it. The *Zhi Yao Da Lun* states: Tonifying the lower and treating the lower requires urgent preparation. Urgency implies strong flavor and potency. This is what is meant.
Wu Deqing from Zhending Prefecture, aged forty-six. In March of the Bingzi year of Zhiyuan, due to worry, thought, labor, and fatigue, and irregular diet, he contracted a disease characterized by cold limbs. The breath from his mouth and nose was also cool. Cold sweat appeared on his forehead. He occasionally fell into confusion. A physician diagnosed it as Wind Syndrome and intended to purge him with Xuanfeng San (Wind-Dispersing Powder). I recalled Qian Yi's pediatric theories regarding the formulation of Xuanfeng San, which states that children suffering internal injury to the Spleen and Stomach, with either vomiting or diarrhea, if prolonged, wind pathogen sinks into the Stomach causing unformed stools (Sunxie). There is accumulation within the powder, fearing transmission to slow convulsions. Xuanfeng San guides out the wind pathogen. The *Neijing* states: Long-standing wind leads to Sunxie. This is precisely what is meant. Now, Wu Deqing's signs and symptoms indicate Excess of Yin and Deficiency of Yang. Bitter-cold agents are not suitable. The *Neijing* states: Excess of Yin Qi leads to profuse sweating and coldness of the body. The *Yin Yang Ying Xiang Da Lun* states: Excess of Yin leads to coldness of the body, sweating, constant feeling of cold, frequent shivering and chills, chills leading to reversal coldness. The *Tiao Jing Pian* also states: Excess of Yin generates internal cold. Qibo said: Reversal Qi moves upward, Cold Qi accumulates in the chest and does not dissipate. If it does not dissipate, Warm Qi departs, leaving Cold alone. Thus, Internal Cold arises. Li Dongyuan explained: This is insufficiency of the Spleen and Stomach, physical labor injuring the Middle Jiao Ying Qi, eventually transmitting to Internal Cold. Only tonifying Yang is appropriate. Therefore, Lizhong Tang (Regulate the Middle Decoction) plus Hei Fuzi (Black Prepared Aconite) was used. Each dose was 5 qian, decocted with abundant scallion white in mutton soup, taking one large cup of clear liquid to mix and take. By evening, the four limbs gradually warmed, sweating decreased. Taken again late at night. The next day, spirit returned, the six pulses showed life. After several doses, he recovered. I once remembered Li Sishun saying: Zheng (signs/symptoms) are evidence. Disease manifestations are internal, Zheng manifests externally. Anyone learning medicine who does not study the *Neijing*, does not seek the source of disease, guesses symptoms arbitrarily, and clings to specific formulas. These are all pursuits that abandon the root for the branch. Their errors are numerous. One should ponder carefully.