（腹满附）
《巢氏病源》小儿伤寒腹满候∶伤寒是寒气客于皮肤，搏于血气，使腠理闭密不宣泄，蕴积生热，故头痛体
疼而壮热。其腹满者，是热入腹，传于脏，气结聚，故令腹满。若挟毒者，则腹满，心烦懊闷，多死。
《活人书》论伤寒小儿、大人治，一般但小分剂，药差凉耳。问∶腹痛者，何也？本太阳病，医反下之，因
尔腹满时痛。是有表，复有里，仲景所以用桂枝加芍药汤主之。痛甚者，加大黄。（桂枝加芍药，却是小建中也。太阴
脉弱自利，设当行大黄、芍药者，宜减之。其人胃虚，阳气易动故也。下利者，先煎芍药十余沸。）《难经》云∶痛为实，
大抵痛宜下。（仲景云∶发汗不解，腹满痛者，急下之，宜大承气汤。又曰∶腹中满痛，此为实，当下之，属大柴胡汤。）
腹痛有二证。有热痛，有冷痛。尺脉弦，肠鸣泄利而痛者，冷痛也，小建中汤主之。仲景云∶阳脉涩，阴脉弦，法当腹
中急痛，先与小建中汤；不瘥者，与小柴胡汤。（小柴胡去黄芩，加芍药。）阴证腹痛，即四逆散、通脉四逆加芍药汤。
腹痛，小便不利者，真武汤也。关脉实，腹满、大便秘，按之而痛者，实痛也。桂枝加大黄汤、黄连汤、大承气汤主之。
又问∶腹胀满者何也？阴阳不和也，桔梗半夏汤最良。仲景论太阳证发汗后腹胀满者，浓朴生姜半夏甘草人参汤。下后
心烦腹满，卧起不安者，栀子浓朴汤。吐后腹胀满者，与调胃承气汤。少阴病六、七日，腹胀不大便者，急下，承气汤
主之。
《活人书》仲景桂枝加芍药汤
桂枝（三两，去皮） 芍药（六两，下利者先煎芍药三四沸） 甘草（二两，炙）
上锉如麻豆大。每服抄五钱匕，生姜四片，枣子一枚，以水一盏半，煮至八分，去滓温服。
《活人书》仲景大承气汤，方见伤寒发喘门中。
《活人书》仲景大柴胡汤，方见伤寒呕噎门中。
《活人书》仲景小建中汤，方见伤寒自汗门中。
《活人书》仲景小柴胡去黄芩加芍药汤，方见伤寒头汗出门中。
《活人书》仲景四逆汤，方见伤寒咳嗽门中。
《活人书》仲景通脉四逆加芍药汤，方见伤寒呕噎门中。
《活人书》仲景真武汤，方见伤寒咳嗽门中。
《活人书》仲景桂枝加大黄汤
桂枝（一两半，去皮） 芍药（三两） 甘草（炙） 大黄（各一两）
痛甚者加大黄。大实痛加一两半，羸者减之。
上锉如麻豆大。每服抄五钱匕，生姜四片，枣子一枚，煮至八分，去滓温服。
《活人书》仲景黄连汤，方见伤寒呕噎门中。
《活人书》仲景桔梗半夏汤
枳实（半两，麸炒赤） 桔梗（微炒，细锉） 半夏（生姜汁制） 陈橘皮（汤浸、去瓤，焙干。各一两）
上为粗末。每服四钱，水一盏，生姜三片，同煎至七分，去滓热服。
《活人书》仲景浓朴生姜半夏人参甘草汤
浓朴（四两，去皮） 半夏（一两一分） 甘草（一两） 人参（半两）
上锉如麻豆大。每服抄五钱匕，水一钟半，生姜五片，煮至八分，去滓温服。
《活人书》仲景栀子浓朴汤
栀子（大者，七枚，掰） 浓朴（去皮，姜汁炙，二两） 枳实（二枚，麸炒，去瓤）
上分二服，以水二盏半，煮至八分，去滓温服。得吐止后服。
《活人书》仲景调胃承气汤，方见伤寒自汗门。
《活人书》仲景承气汤，方见伤寒发喘门中。
（腹满附）
《巢氏病源》中关于小儿伤寒腹满的论述：伤寒是寒邪侵袭皮肤，与血气相搏结，导致腠理闭塞严密而不能宣泄，热气蕴积而生，所以出现头痛、身体疼痛且高热。那些出现腹满症状的，是因为热邪进入腹部，传入脏腑，气机结聚，从而导致腹满。如果兼夹毒邪，则会出现腹满、心烦懊恼闷乱的症状，这种情况大多致死。
《活人书》讨论小儿和大人伤寒的治疗，方法大体相同，只是剂量较小，药性稍凉罢了。问：腹痛是怎么回事？原本患有太阳病，医生反而使用攻下法，因此导致腹满且时常疼痛。这是既有表证又有里证，张仲景因此主张用桂枝加芍药汤主治。疼痛剧烈的，加大黄。（桂枝加芍药汤，实际上就是小建中汤。太阴病脉弱且自利的人，假如应当使用大黄、芍药，应该减少用量。因为此人胃气虚弱，阳气容易浮动。如果有下利的情况，先煎煮芍药十余沸。）《难经》说：痛症属于实证，大抵上痛症适宜用攻下法。（张仲景说：发汗后病不解，出现腹满痛的，急当攻下，宜用大承气汤。又说：腹中满痛，这属于实证，应当攻下，属于大柴胡汤证。）
腹痛有两种证型。有热痛，有冷痛。尺脉弦，伴有肠鸣、泄泻且疼痛的，是冷痛，用小建中汤主治。张仲景说：阳脉涩，阴脉弦，按法应当腹中急痛，先给予小建中汤；如果不愈，给予小柴胡汤。（小柴胡汤去掉黄芩，加入芍药。）阴证腹痛，即用四逆散、通脉四逆加芍药汤。腹痛且小便不利的，是真武汤证。关脉实，腹满、大便秘结，按压时疼痛的，是实痛。用桂枝加大黄汤、黄连汤、大承气汤主治。
又问：腹胀满是怎么回事？这是阴阳不和，桔梗半夏汤效果最好。张仲景论述太阳证发汗后出现腹胀满的，用浓朴生姜半夏甘草人参汤。攻下后出现心烦、腹满，卧起不安的，用栀子浓朴汤。呕吐后出现腹胀满的，给予调胃承气汤。少阴病六七天，腹胀不大便的，急当攻下，承气汤主治。
《活人书》记载张仲景桂枝加芍药汤
桂枝（三两，去皮） 芍药（六两，若有下利者先煎芍药三四沸） 甘草（二两，炙）
以上药材锉成如麻豆大小的颗粒。每次服用五钱匕，生姜四片，枣子一枚，用水一盏半，煮至八分，去渣温服。
《活人书》记载张仲景小柴胡去黄芩加芍药汤，方剂见伤寒头汗出门中。
《活人书》记载张仲景桂枝加大黄汤
桂枝（一两半，去皮） 芍药（三两） 甘草（炙） 大黄（各一两）
疼痛剧烈的加大黄。大实痛加一两半，体虚羸弱者减量。
以上药材锉成如麻豆大小的颗粒。每次服用五钱匕，生姜四片，枣子一枚，煮至八分，去渣温服。
《活人书》记载张仲景桔梗半夏汤
枳实（半两，麸炒至赤色） 桔梗（微炒，细锉） 半夏（生姜汁制） 陈橘皮（汤浸、去瓤，焙干。各一两）
以上药材制成粗末。每次服用四钱，水一盏，生姜三片，同煎至七分，去渣热服。
《活人书》记载张仲景浓朴生姜半夏人参甘草汤
浓朴（四两，去皮） 半夏（一两一分） 甘草（一两） 人参（半两）
以上药材锉成如麻豆大小的颗粒。每次服用五钱匕，水一钟半，生姜五片，煮至八分，去渣温服。
《活人书》记载张仲景栀子浓朴汤
栀子（大的七枚，掰开） 浓朴（去皮，姜汁炙，二两） 枳实（二枚，麸炒，去瓤）
以上药材分为两次服用，用水二盏半，煮至八分，去渣温服。服药后若得吐，停止后续服用。
(Attached: Abdominal Fullness)
*Chao Shi Bing Yuan* (Source of Diseases by Chao Yuanfang) on the syndrome of abdominal fullness in pediatric cold damage: Cold damage occurs when cold pathogenic factors invade the skin and contend with blood and qi, causing the cou li (pores and interstices) to become closed and dense, preventing dispersion. Heat accumulates internally, resulting in headache, body pain, and high fever. In cases where abdominal fullness occurs, it is because heat has entered the abdomen and transmitted to the zang organs, causing qi to knot and accumulate, thus leading to abdominal fullness. If accompanied by toxic pathogens, symptoms include abdominal fullness, mental restlessness, and stifling oppression; such cases often result in death.
*Huo Ren Shu* (The Book That Revives People) discusses the treatment of cold damage for both children and adults. The methods are generally the same, but the dosages are smaller, and the medicinal properties are slightly cooler. Question: What causes abdominal pain? Originally suffering from a Taiyang disease, if the physician incorrectly uses purgation, abdominal fullness and intermittent pain ensue. This indicates the presence of both exterior and interior syndromes. Therefore, Zhang Zhongjing prescribes Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction Plus Paeonia Root) as the primary treatment. For severe pain, add Dahuang (Rhubarb). (Note: Guizhi Jia Shaoyao Tang is essentially Xiaojianzhong Tang. In patients with Taoyin weakness and spontaneous diarrhea, if Dahuang or Shaoyao were to be used, their dosage should be reduced because the person's stomach qi is deficient and yang qi is easily disturbed. If diarrhea is present, decoct Shaoyao first for about ten boils.) *Nan Jing* (Classic of Difficult Issues) states: Pain indicates excess; generally, pain syndromes are suitable for purgation. (Zhang Zhongjing says: If after sweating the disease does not resolve and abdominal fullness and pain occur, urgent purgation is required, using Dachengqi Tang. He also says: Abdominal fullness and pain indicate an excess condition that requires purgation, belonging to the Daichaihu Tang pattern.)
Abdominal pain presents in two types: heat pain and cold pain. If the chi pulse is wiry, accompanied by borborygmus, diarrhea, and pain, it is cold pain, treated with Xiaojianzhong Tang. Zhang Zhongjing states: When the yang pulse is choppy and the yin pulse is wiry, according to the method, there should be acute abdominal pain; initially administer Xiaojianzhong Tang. If it does not improve, administer Xiao Chaihu Tang. (Remove Huangqin from Xiao Chaihu Tang and add Shaoyao.) For yin syndrome abdominal pain, use Sini San (Four Reversal Powder) or Tongmai Sini Jia Shaoyao Tang (Pulse-Reviving Four Reversal Decoction Plus Paeonia Root). For abdominal pain accompanied by difficulty in urination, use Zhenwu Tang (True Warrior Decoction). If the guan pulse is excess, with abdominal fullness, constipation, and tenderness upon pressure, it is excess pain, treated with Guizhi Jia Dahuang Tang, Huanglian Tang, or Dachengqi Tang.
Another question: What causes abdominal distension and fullness? It is due to disharmony between yin and yang; Jiegeng Banxia Tang (Platycodon and Pinellia Decoction) is most effective. Zhang Zhongjing discusses that after sweating a Taiyang syndrome, if abdominal distension and fullness occur, use Nongpo Shengjiang Banxia Gancao Renshen Tang (Magnolia Bark, Fresh Ginger, Pinellia, Licorice, and Ginseng Decoction). After purgation, if mental irritability, abdominal fullness, and restlessness in lying down or sitting up occur, use Zhizi Nongpo Tang (Gardenia and Magnolia Bark Decoction). After vomiting, if abdominal distension and fullness occur, administer Tiaowei Chengqi Tang (Regulate the Stomach and Guide Out the Qi Decoction). In Shaoyin disease lasting six or seven days, if abdominal distension and inability to pass stool occur, urgent purgation is needed, treated with Chengqi Tang.
*Huo Ren Shu* records Zhang Zhongjing's Guizhi Jia Shaoyao Tang:
Guizhi (Cinnamomi Ramulus, 3 liang, bark removed), Shaoyao (Paeoniae Radix, 6 liang; if diarrhea is present, decoct Shaoyao first for three to four boils), Gancao (Licorice Root, 2 liang, honey-fried).
Crush the herbs to the size of hemp seeds. Take 5 qianbi per dose, with 4 slices of fresh ginger and one jujube. Add 1.5 sheng of water, boil until 0.8 sheng remains, strain, and take warm.
*Huo Ren Shu* records Zhang Zhongjing's Dachengqi Tang; see the section on Cold Damage with Asthma for the formula.
*Huo Ren Shu* records Zhang Zhongjing's Daichaihu Tang; see the section on Cold Damage with Vomiting and Dysphagia for the formula.
*Huo Ren Shu* records Zhang Zhongjing's Xiaojianzhong Tang; see the section on Cold Damage with Spontaneous Sweating for the formula.
*Huo Ren Shu* records Zhang Zhongjing's Xiao Chaihu Qu Huangqin Jia Shaoyao Tang; see the section on Cold Damage with Head Sweat for the formula.
*Huo Ren Shu* records Zhang Zhongjing's Sini Tang; see the section on Cold Damage with Cough for the formula.
*Huo Ren Shu* records Zhang Zhongjing's Tongmai Sini Jia Shaoyao Tang; see the section on Cold Damage with Vomiting and Dysphagia for the formula.
*Huo Ren Shu* records Zhang Zhongjing's Zhenwu Tang; see the section on Cold Damage with Cough for the formula.
*Huo Ren Shu* records Zhang Zhongjing's Guizhi Jia Dahuang Tang:
Guizhi (Cinnamomi Ramulus, 1.5 liang, bark removed), Shaoyao (Paeoniae Radix, 3 liang), Gancao (Licorice Root, honey-fried), Dahuang (Rhei Radix et Rhizoma, each 1 liang).
For severe pain, increase Dahuang. For severe excess pain, add 1.5 liang; reduce the dose for frail individuals.
Crush the herbs to the size of hemp seeds. Take 5 qianbi per dose, with 4 slices of fresh ginger and one jujube. Boil until 0.8 sheng remains, strain, and take warm.
*Huo Ren Shu* records Zhang Zhongjing's Huanglian Tang; see the section on Cold Damage with Vomiting and Dysphagia for the formula.
*Huo Ren Shu* records Zhang Zhongjing's Jiegeng Banxia Tang:
Zhishi (Immature Bitter Orange, 0.5 liang, bran-fried until red), Jiegeng (Platycodonis Radix, lightly fried and finely crushed), Banxia (Pinelliae Rhizoma, prepared with fresh ginger juice), Chenpi (Aged Tangerine Peel, soaked in water, pith removed, dried; each 1 liang).
Grind into a coarse powder. Take 4 qian per dose, with 1 sheng of water and 3 slices of fresh ginger. Decoct until 0.7 sheng remains, strain, and take hot.
*Huo Ren Shu* records Zhang Zhongjing's Nongpo Shengjiang Banxia Gancao Renshen Tang:
Nongpo (Magnoliae Officinalis Cortex, 4 liang, bark removed), Banxia (Pinelliae Rhizoma, 1.1 liang), Gancao (Licorice Root, 1 liang), Renshen (Ginseng Radix et Rhizoma, 0.5 liang).
Crush the herbs to the size of hemp seeds. Take 5 qianbi per dose, with 1.5 zhong of water and 5 slices of fresh ginger. Decoct until 0.8 sheng remains, strain, and take warm.
*Huo Ren Shu* records Zhang Zhongjing's Zhizi Nongpo Tang:
Zhizi (Gardeniae Fructus, 7 large fruits, broken), Nongpo (Magnoliae Officinalis Cortex, bark removed, ginger-juice fried, 2 liang), Zhishi (Immature Bitter Orange, 2 fruits, bran-fried, pith removed).
Divide into two doses. Add 2.5 sheng of water, decoct until 0.8 sheng remains, strain, and take warm. If vomiting occurs, stop subsequent doses.
*Huo Ren Shu* records Zhang Zhongjing's Tiaowei Chengqi Tang; see the section on Cold Damage with Spontaneous Sweating.
*Huo Ren Shu* records Zhang Zhongjing's Chengqi Tang; see the section on Cold Damage with Asthma.