阴寒一症。向谓寒邪直中。便尔四肢厥逆。阳气顿竭。身如被杖。腹中绞痛。
下利清谷。脉微欲绝。急投四逆理中辈以温之。犹恐不及。窃思人之一身。
有卫气营气。宗气元气。春升之气。水谷之气。种种护持。发源于三焦命门。
以为生生之用者也。何寒邪一犯。辄尔深入至此。不知此非外中之寒。乃
本身无火。命门真原。早已衰绝。即不受寒。而阴惨之象。已具于身中。偶或
触之。而遂至是也。或以为阳气暴绝。或以为生冷内伤。或以为大寒侵犯。
皆言其标而不言其本。所以仲景取方。止曰救里。意可知矣。况此症生气
索然。变异顷刻。非姜桂参附。不足回垂绝之元阳。犹得借口于外中也哉。
一少阴下利清谷。手足厥逆。脉微欲绝。身反不恶寒。其人面赤色。或腹痛。
或干呕。或咽痛。或利止脉不出者。通脉四逆汤。生附子一钱。炙甘草一
钱。干姜一钱五分。温服。面赤。加葱。腹痛。加芍药。呕。加生姜。咽痛。加桔梗。
利止脉不出。加人参。
一伤寒已发汗。不解。反恶寒者。虚也。仲景用白芍药三钱。炙甘草三钱。炮
附子二钱补之。黄 建中汤。亦可用。
一伤寒下后。又发其汗。昼日烦躁不得眠。夜而安静。不呕不渴。无表症。脉
沉微。身无大热者。干姜附子汤温之。
一伤寒阴盛格阳。其人必躁热而不饮水。脉沉手足厥逆者。是此症也。孙
兆用霹雳散。附子一枚。烧存性。为末。蜜水调服。节庵用回阳返本汤更
胜。李东垣治冯翰林侄。阴盛格阳伤寒。面红目赤。烦渴引饮。脉来七八
至。但按之则散。用姜附汤加人参投入。两服之。得汗而愈。此则神圣之妙也。
一夹阴伤寒。先因欲事。后感寒邪。阳衰阴盛。六脉沉伏。小腹绞痛。四肢逆
冷。呕吐清水。不假此药。无以回阳。人参炮姜各一两。生附子一枚。破作
八片。水煎分服。脉出身温而愈。吴绶曰。附子乃阴症要药。凡伤寒传变
三阴。及中寒夹阴。虽身大热而脉沉者。必用之。或厥冷腹痛。脉沉细。甚
则唇青囊缩者。急须用之。有退阴回阳之力。起死回生之功。近世阴症
伤寒。往往疑似。不敢用附子。直待阴极阳竭而用之。已迟矣。且夹阴伤
寒。内外皆阴。阳气顿衰。必须急用人参。健脉以益其元。佐以附子温经
散寒。拾此不用。将何以救之。
按阴寒之症。为害迅速。余所以详列之者。盖欲临是症者。加意焉而不
敢忽也。
通脉四逆汤
四逆汤加甘草一倍
干姜附子汤
干姜（二钱） 附子（三钱）
水煎服
回阳反本汤
熟附子 干姜 甘草 人参 麦门冬 五味子 腊茶 陈皮
面戴阳者。下虚也。加葱七茎。黄连少许。用澄清泥浆水煎。临服。入蜜五匙。顿冷冻饮料之。
黄 建中汤
黄 （蜜炙一钱五分） 芍药（二钱炒） 肉桂（一钱去皮） 甘草（五分炙）
加姜枣水煎。去渣。入饧一大匙。煎一沸服。若大便溏利。或呕者。不用饧
参附汤
人参（半两） 附子（炮去皮脐一两）
分作三服。姜水煎。
阴寒这一病症，过去认为寒邪直接侵入体内，就会导致四肢厥冷逆乱，阳气突然衰竭，身体感觉像被棍棒打过一样疼痛，腹部剧烈绞痛，腹泻且排出未消化的食物残渣，脉搏微弱几乎摸不到。此时必须紧急投用四逆汤、理中汤之类的方剂来温补阳气，还担心来不及救治。我私下思考，人的全身有卫气、营气、宗气、元气，以及春季升发之气、水谷精微之气等，种种气息相互护持，都发源于三焦和命门，作为生命生生不息的动力来源。为什么寒邪一侵犯，就会深入至此程度呢？不知道这并非外来的寒邪所致，而是本身体内没有火（阳气不足），命门的真元早已衰败枯竭。即使不受到寒冷刺激，阴冷惨烈的景象也已经具备在身体内部了，偶然触碰到寒气，才导致这样的后果。有人认为是阳气暴绝，有人认为是生冷食物内伤，有人认为是大寒侵犯，这些都是只说表象而没有触及根本。所以张仲景选取方剂时，只说是“救里”，其中的用意就可以知道了。况且这种病症生机索然，变化就在顷刻之间，不用干姜、肉桂、人参、附子这些药物，不足以挽回即将断绝的元阳，还能借口说是外感寒邪吗？
一例少阴病下利清谷，手足厥冷逆乱，脉搏微弱几乎摸不到，身体反而不恶寒，病人面色发红，或者腹痛，或者干呕，或者咽痛，或者腹泻停止但脉搏不出。使用通脉四逆汤：生附子一钱，炙甘草一钱，干姜一钱五分，温服。如果面色发红，加葱白；如果腹痛，加芍药；如果呕吐，加生姜；如果咽痛，加桔梗；如果腹泻停止但脉搏不出，加人参。
一例伤寒已经发汗，但病不解，反而更加恶寒，这是虚证。张仲景用白芍药三钱，炙甘草三钱，炮附子二钱来补益。黄耆建中汤也可以使用。
一例伤寒经过泻下后，又发其汗，白天烦躁不得睡眠，夜间却安静，不呕吐不口渴，没有表证，脉搏沉微，身体没有大热的，用干姜附子汤温补。
一例伤寒阴盛格阳，病人必然躁热但不想喝水，脉搏沉，手足厥冷的，就是这种病症。孙兆用霹雳散：附子一枚，烧至存性，研为粉末，用蜂蜜水调服。节庵用回阳返本汤效果更好。李东垣治疗冯翰林的侄子，患阴盛格阳伤寒，面红目赤，烦躁口渴想喝水，脉搏跳动七八次一息，但按下去则散漫无力，用姜附汤加入人参投服，服用两剂后，出汗而痊愈。这真是神圣医术的奇妙之处啊。
一例夹阴伤寒，先因房事欲望，后感寒邪，阳气衰弱阴气旺盛，六脉沉伏，小腹绞痛，四肢逆冷，呕吐清水，不使用这种药，无法回阳。人参、炮姜各一两，生附子一枚，破成八片，用水煎煮分次服用。脉象出现，身体温暖即愈。吴绶说：附子是阴症的要药。凡是伤寒传变至三阴经，以及中寒夹阴，虽然身体大热但脉搏沉的，必须使用它。如果出现厥冷腹痛，脉搏沉细，甚至嘴唇青紫、睾丸收缩的情况，急需使用它。它有退阴回阳的力量，起死回生的功效。近代治疗阴症伤寒，往往因为疑似而不敢用附子，一直等到阴极阳竭时才使用，那就太迟了。而且夹阴伤寒，内外皆属阴，阳气突然衰弱，必须紧急用人参，强健脉道以增益元气，佐以附子温经散寒。舍弃这个不用，将用什么来救治呢？
按语：阴寒之症，危害迅速。我之所以详细列举它，是希望遇到这种病症的人，多加注意而不敢忽视。
回阳反本汤
熟附子 干姜 甘草 人参 麦门冬 五味子 腊茶 陈皮
面部戴阳（面红如妆）的，是下虚。加葱七茎，少许黄连，用澄清的泥浆水煎煮。临服用时，加入五匙蜂蜜，顿服冷冻过的饮料。
黄耆建中汤
黄耆（蜜炙一钱五分） 芍药（二钱炒） 肉桂（一钱去皮） 甘草（五分炙）
加生姜、大枣用水煎煮，去渣，加入一大匙饴糖，再煎一沸后服用。如果大便溏泄或呕吐，不用饴糖。
Yin-cold syndrome is a condition where, traditionally, it was believed that cold pathogenic factors directly invade the interior, leading to cold reversal of the four limbs (Ji Ni), sudden exhaustion of Yang Qi, a sensation as if the body has been beaten with a staff, severe colicky pain in the abdomen, diarrhea with undigested food residues (Qing Gu), and a faint pulse nearly imperceptible (Mai Wei Yu Jue). In such emergencies, decoctions like Sini Tang (Four Reversal Decoction) or Lizhong Tang (Regulate the Middle Decoction) must be urgently administered to warm the interior, yet one still fears it may be too late. I have pondered that the human body is protected by Wei Qi (Defensive Qi), Ying Qi (Nutritive Qi), Zong Qi (Gathering Qi), Yuan Qi (Source Qi), Spring-rising Qi, and Grain-and-Water Qi. These various energies are nurtured together, originating from the Sanjiao (Triple Burner) and Mingmen (Gate of Life), serving as the source of continuous life processes. Why does a mere invasion of cold pathogen lead to such deep penetration? The truth is, this is not caused by external cold invading an intact body, but rather by an inherent lack of internal fire (Yang deficiency). The true essence of the Mingmen has already declined and exhausted. Even without exposure to cold, the Yin-cold manifestations are already present within the body; only upon accidental contact with cold does the condition manifest severely. Some attribute it to sudden collapse of Yang Qi, some to internal injury from raw/cold foods, and others to invasion by extreme cold. All these explanations address the branch (symptoms) but ignore the root (cause). Therefore, when Zhang Zhongjing selected formulas, he simply referred to "rescuing the interior" (Jiu Li), which reveals his intent. Moreover, in this syndrome, vital energy is depleted, and changes occur within moments. Without potent herbs like Shengjiang (Dried Ginger), Rougui (Cinnamon Bark), Renshen (Ginseng Root), and Fuzi (Aconite Root), it is impossible to restore the nearly extinct primal Yang. How can one still make excuses about external invasion?
Case 1: Shaoyin disease presenting with diarrhea of undigested food, cold reversal of hands and feet, and a faint pulse nearly imperceptible. However, the patient does not feel aversion to cold, and the face appears red (Mian Chi). There may also be abdominal pain, dry retching, sore throat, or cessation of diarrhea with non-palpable pulse. Treatment: Tongmai Sini Tang (Pulse-Resuscitating Four Reversal Decoction). Ingredients: Sheng Fuzi (Raw Aconite Root) 1 qian, Zhi Gancao (Honey-fried Licorice Root) 1 qian, Ganjiang (Dried Ginger) 1.5 qian. Take warm. Modifications: Add Congbai (Scallion Stem) for facial redness; add Baishao (White Peony Root) for abdominal pain; add Shengjiang (Fresh Ginger) for vomiting; add Jiegeng (Platycodon Root) for sore throat; add Renshen (Ginseng Root) if diarrhea stops but pulse remains absent.
Case 2: After sweating therapy for Shanghan (Cold Damage), the condition persists, and aversion to cold worsens. This indicates deficiency. Zhang Zhongjing prescribed Baishao (White Peony Root) 3 qian, Zhi Gancao (Honey-fried Licorice Root) 3 qian, and Pao Fuzi (Processed Aconite Root) 2 qian to tonify. Huangqi Jianzhong Tang (Astragalus Decoction to Establish the Middle) is also applicable.
Case 3: Following purgation and subsequent sweating for Shanghan, the patient experiences daytime irritability and insomnia, but quietness at night. There is no vomiting, no thirst, no exterior syndrome signs, a deep and faint pulse, and no significant fever. Treatment: Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction) to warm the interior.
Case 4: Shanghan with Yin excess repelling Yang (Yin Sheng Ge Yang). The patient exhibits restlessness and heat sensation but refuses to drink water. The pulse is deep, and the extremities are cold. Sun Zhao treated this with Pili San (Thunderbolt Powder): one piece of Fuzi (Aconite Root), roasted until carbonized but retaining its nature, ground into powder, and taken with honey-water. Jie'an used Huiyang Fanben Tang (Return-Yang Restore-Root Decoction) with even better results. Li Dongyuan treated the nephew of Hanlin Academician Feng, who suffered from Yin excess repelling Yang Shanghan, presenting with red face, red eyes, irritability, excessive thirst, and a rapid pulse (7-8 beats per breath) that felt scattered upon pressure. He used Jiangfu Tang (Ginger-Aconite Decoction) supplemented with Renshen (Ginseng Root). After two doses, the patient sweated and recovered. This demonstrates the miraculous efficacy of divine medicine.
Case 5: Jia Yin Shanghan (Shanghan complicated by Kidney-Yang deficiency due to sexual activity). Initially caused by sexual desire, followed by cold invasion, leading to Yang deficiency and Yin excess. The six pulses are deep and hidden, with severe lower abdominal colic, cold reversal of limbs, and vomiting of clear fluid. Without this specific prescription, Yang cannot be restored. Prescription: Ren Shen (Ginseng Root) and Pao Jiang (Processed Dried Ginger) each 1 liang; Sheng Fuzi (Raw Aconite Root) 1 piece, broken into eight slices. Decoct in water and take in divided doses. Recovery is indicated by the reappearance of the pulse and warming of the body. Wu Shou stated: Fuzi (Aconite Root) is the essential herb for Yin syndromes. Whenever Shanghan transmits to the Three Yin meridians, or in cases of middle-cold with Yin complication, even if the body is hot but the pulse is deep, Fuzi must be used. If there is cold reversal, abdominal pain, deep-thin pulse, or even cyanotic lips and retracted testicles, urgent use is required. It has the power to dispel Yin and restore Yang, bringing the dead back to life. In recent times, practitioners often hesitate to use Fuzi for Yin-complicated Shanghan due to diagnostic uncertainty, waiting until Yin is extreme and Yang is exhausted, which is too late. Furthermore, in Jia Yin Shanghan, both interior and exterior are Yin, and Yang Qi suddenly declines. Urgent use of Renshen (Ginseng Root) is necessary to strengthen the vessels and boost Yuan Qi, assisted by Fuzi (Aconite Root) to warm the channels and disperse cold. Abandoning this approach leaves no means of rescue.
Note: Yin-cold syndromes cause harm rapidly. I have detailed them here so that clinicians pay close attention and do not neglect them.
Tongmai Sini Tang (Pulse-Resuscitating Four Reversal Decoction)
Sini Tang with double the amount of Gancao (Licorice Root).
Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction)
Ganjiang (Dried Ginger) 2 qian; Fuzi (Aconite Root) 3 qian.
Decoct in water and take.
Huiyang Fanben Tang (Return-Yang Restore-Root Decoction)
Shu Fuzi (Prepared Aconite Root); Ganjiang (Dried Ginger); Gancao (Licorice Root); Renshen (Ginseng Root); Maidong (Ophiopogon Tuber); Wuweizi (Schisandra Berry); Lacha (Winter Tea); Chenpi (Aged Tangerine Peel).
For patients with Dai Yang (False Heat on the face, appearing red like makeup), indicating lower deficiency: Add 7 stalks of Congbai (Scallion Stem) and a small amount of Huanglian (Coptis Rhizome). Decoct using clarified muddy water. Before administration, add 5 spoons of honey. Drink cold in one dose.
Huangqi Jianzhong Tang (Astragalus Decoction to Establish the Middle)
Huangqi (Astragalus Root, honey-fried) 1.5 qian; Shaoyao (Peony Root, stir-fried) 2 qian; Rougui (Cinnamon Bark, peeled) 1 qian; Gancao (Licorice Root, honey-fried) 0.5 qian.
Decoct with Shengjiang (Fresh Ginger) and Dazao (Jujube). Strain the dregs, add 1 large spoon of Yitang (Maltose), boil briefly, and take. If there is loose stool/diarrhea or vomiting, omit Yitang.
Shenfu Tang (Ginseng and Aconite Decoction)
Renshen (Ginseng Root) 0.5 liang; Fuzi (Aconite Root, processed, peeled, navel removed) 1 liang.
Divide into three doses. Decoct with ginger water.