【歌】胃虚肤豁中寒深，厥逆身凉脉细沉。要辨内伤并外感，理中姜附倍加参。
【论】有卒中天地之寒气者，属外因；有口食寒物而得者，属内因。然胃气太虚，肤腠疏豁，故寒邪直
入于中。其病即发，手足厥冷，脉息细微，身蜷不热，或有微热而不渴，倦言动者是也。当急温之，迟则不救，
非若伤寒之邪，循经传里之缓也。东垣云∶内伤极多，外伤间有之。西北极寒，多外感；东南温和，多内伤。
外感者，五积、理中，姜、附、麻黄、细辛之类；内伤者，从补中益气汤，加温散之剂。
【脉】中寒紧涩，阴阳俱盛。法当无汗，有汗伤命。
外因
若平素怯弱之人，外中寒邪而得者，盖虚人腠理疏豁，气血内损，故寒邪直中于中。不作热，手足厥冷，
用麻黄附子细辛汤、五积散。房劳而中寒厥逆者，四逆汤、三建汤主之，外用温脐法。
麻黄附子细辛汤
治少阴始得之病，反发热脉沉者，此方主之。
麻黄 细辛（各四钱） 附子（炮，二钱半）
按∶病发于阴者，当无热。今少阴病，始得之，何以反发热也？盖其病本由太阳传来者，肾虚则真寒直
入而脉沉，表有余邪，因发热。故用麻黄以发太阳之汗，用辛、附以温少阴之经。
五积散
桔梗（十二两） 苍术（米泔浸，去粗皮，二十四两） 陈皮（去白） 麻黄（去
节） 枳壳（去穣，麸炒，各六两） 浓朴（姜制） 干姜（各四两） 白芷 川芎 甘草（炙） 茯苓 肉桂
芍药 当归 半夏（汤泡七次，各三两）
按∶本方治寒客经络，内伤生冷，头身俱痛，呕吐腹疼，恶寒拘急者主之。
每服四钱，水一盏半，生姜三片，葱白二根，煎七分，热服。
挟气，加吴茱萸。
四逆汤
甘草（炙，二两） 干姜（两半） 附子（去皮、脐，半两）
按∶右方治寒中太阴，受病即发，脉微不渴，四肢厥冷者主之。以生附配干姜，补中有发之意也。
每服五钱，水一盏，煎七分，温服，不拘时。
三建汤
大川乌 附子 天雄（并泡，等分）
每服四钱，加生姜十片，煎服。
温脐法
用麝香、半夏、皂荚各一字为末，填脐中，用生姜切薄片贴之，放大艾火于姜片上，蒸灸三七壮。灸关元、
气海二十壮。热气通于内，寒气逼于外，阴自退而阳自复矣。
内因
虚弱人，口食生冷寒凉之物，手足厥冷，脐腹绞痛，脉脱或迟，人参理中汤、姜附汤。因房劳内伤元气，
重中于寒，脉脱者，三建汤。因劳役内伤元气，复感于寒者，补中益气汤加姜、附主之。
人参理中汤
治太阴自病即发，自利不渴，寒多而呕，腹痛鸭溏，蛔厥，霍乱等证。
人参 干姜（炮） 甘草（炙） 白术（各二钱半）
上锉，作一剂，水煎温服。
如吐多，去白术加生姜。下多，倍白术、人参。寒多，加干姜一钱半。有动气，去白术，加肉桂二钱。脉
沉微而迟者，加炮附子二钱，名附子理中汤。
姜附汤
治中寒昏不知人，身体强直，口噤不语，四肢厥冷，脐腹冷痛，霍乱转筋，一切虚寒，并皆治之。
干姜（一两） 附子（生，去皮脐，细切，一枚）
每服三钱，水一盏半，煎七分，食前温服。
挟气不仁，加防风。挟湿，加白术。筋脉拘急，加木瓜。肢节痛，加桂二钱。
补中益气汤（方见劳役内伤条。）
达按∶经云∶夫寒，阴气也。寒中阳经，阳犹能抗阴，其病易愈。寒中阴经，两阴相遇，胶固难愈。故病
太阴、少阴者，必重且危。病厥阴者多死。有等亡命之徒，既跌扑斗殴，内伤于血，复轻生投水，外着于寒。
血得寒而凝结，寒得血而深入，未有能生者也。
【歌诀】胃气虚弱、腠理疏松导致寒邪深入，出现四肢厥冷、身体发凉、脉象细沉。要辨别是内伤还是外感，治疗需用理中汤，并加倍使用干姜、附子和人参。
【论述】有因突然遭受天地寒气侵袭而发病的，属于外因；有因食用寒冷食物而得病的，属于内因。然而，如果胃气极度虚弱，皮肤腠理疏松豁阔，那么寒邪就会直接侵入体内。疾病随即发作，表现为手足冰冷，脉搏细微，身体蜷缩且不发烫，或者仅有轻微发热但不口渴，精神疲倦、言语无力、行动迟缓等。此时应当紧急温补阳气，若拖延则无法救治，这不像伤寒之邪那样循经络逐渐传入里证的缓慢过程。李东垣曾说：内伤疾病非常多见，外伤相对偶尔发生。西北方极寒之地，多患外感病；东南方气候温和之地，多患内伤病。对于外感病，可用五积散、理中汤，以及干姜、附子、麻黄、细辛之类的药物；对于内伤病，应从补中益气汤入手，加入温散性质的药剂。
【脉诊】中寒证的脉象紧涩，表示阴寒与正气（或邪气）俱盛。治法上应当无汗，若有汗出则危及生命。
外因
如果是平时体质怯弱的人，因外感寒邪而致病，这是因为虚人腠理疏松，气血内部受损，所以寒邪直中于中焦。此病不表现为热证，而是手足厥冷，可用麻黄附子细辛汤、五积散治疗。因房事过度而感受寒邪导致四肢厥逆的，用四逆汤、三建汤主治，外用温脐法。
麻黄附子细辛汤
治疗少阴病初起，反而发热且脉象沉的病症，以此方为主。
麻黄 细辛（各四钱） 附子（炮制，二钱半）
按语：凡病发于阴经者，应当没有发热。现在少阴病，刚得病时，为什么反而发热呢？大概是因为本病是由太阳经传来，肾虚则真寒直入而脉沉，体表有余留之邪，因而发热。所以用麻黄来发太阳经之汗，用细辛、附子来温通少阴经。
五积散
桔梗（十二两） 苍术（米泔水浸泡，去粗皮，二十四两） 陈皮（去白） 麻黄（去节） 枳壳（去瓤，麸炒，各六两） 厚朴（姜制） 干姜（各四两） 白芷 川芎 甘草（炙） 茯苓 肉桂 芍药 当归 半夏（汤泡七次，各三两）
按语：本方主治寒邪客于经络，内伤生冷食物，导致头身俱痛，呕吐腹痛，恶寒拘急等症状。
每次服用四钱，加水一盏半，生姜三片，葱白两根，煎至七分，热服。
兼有气滞者，加吴茱萸。
四逆汤
甘草（炙，二两） 干姜（一两半） 附子（去皮、脐，半两）
按语：右方主治寒邪中于太阴经，受病即发，脉微不渴，四肢厥冷的病症。以生附子配伍干姜，体现了补中有发的意思。
每次服用五钱，加水一盏，煎至七分，温服，不拘时间。
三建汤
大川乌 附子 天雄（均炮制，等分）
每次服用四钱，加生姜十片，煎服。
温脐法
用麝香、半夏、皂荚各一字量的粉末，填入肚脐中，用生姜切成薄片贴在上面，将大艾炷放在姜片上，蒸灸三七壮。再灸关元穴、气海穴各二十壮。热气通达于内，寒气逼迫于外，阴寒自退而阳气自复。
内因
体虚之人，口食生冷寒凉之物，导致手足厥冷，脐腹绞痛，脉象微弱或迟滞，用人参理中汤、姜附汤治疗。因房劳内伤元气，再次重感寒邪，脉象微弱欲绝的，用三建汤。因劳役内伤元气，又复感寒邪的，用补中益气汤加干姜、附子主治。
人参理中汤
治疗太阴经自病即发，自利不渴，寒多而呕吐，腹痛腹泻如鸭溏，蛔厥，霍乱等证候。
人参 干姜（炮） 甘草（炙） 白术（各二钱半）
以上锉碎，作一剂，水煎温服。
如果呕吐多，去掉白术加生姜。腹泻多，加倍使用白术、人参。寒邪多，加干姜一钱半。有动气症状，去掉白术，加肉桂二钱。脉象沉微而迟的，加炮附子二钱，名为附子理中汤。
姜附汤
治疗中寒昏迷不知人，身体强直，口噤不能言语，四肢厥冷，脐腹冷痛，霍乱转筋，一切虚寒证候，皆能治疗。
干姜（一两） 附子（生，去皮脐，细切，一枚）
每次服用三钱，加水一盏半，煎至七分，饭前温服。
兼有气滞肢体麻木不仁者，加防风。兼有湿邪，加白术。筋脉拘急者，加木瓜。肢节疼痛者，加桂枝二钱。
补中益气汤（方见劳役内伤条。）
达按：经文说：寒，是阴气。寒邪中于阳经，阳气尚能抵抗阴寒，其病容易治愈。寒邪中于阴经，两阴相遇，胶固难愈。所以病在太阴、少阴的，必定严重且危险。病在厥阴的多死亡。有一类亡命之徒，既跌扑斗殴，内伤于血，又轻生投水，外着于寒。血液遇寒而凝结，寒邪随血而深入，没有能存活的。
[Verse] When Stomach Qi is deficient and the skin pores are loose, cold pathogen penetrates deeply, leading to cold limbs (Jue Ni), cool body, and a fine, deep pulse. To differentiate between internal injury and external contraction, employ Lizhong Tang (Regulate the Middle Decoction), doubling the dosage of Ganjiang (Dried Ginger), Fuzi (Prepared Aconite Root), and Renshen (Ginseng Radix).
[Dissertation] There are cases caused by sudden exposure to the cold air of heaven and earth, which belong to external causes; there are cases caused by ingesting cold foods, which belong to internal causes. However, when Stomach Qi is extremely deficient and the integumentary pores are loose and open, the cold pathogen enters directly into the interior. The disease manifests immediately with cold limbs, fine and minute pulse, curled-up body without fever, or perhaps slight fever without thirst, fatigue, reluctance to speak, and sluggish movement. Urgent warming treatment is required; delay renders it incurable. This differs from the slow progression of Cold Damage (Shang Han) pathogens that transmit along meridians into the interior. Li Dongyuan stated: Internal injuries are very common, while external traumas occur occasionally. In the extremely cold northwest, external contractions are prevalent; in the mild southeast, internal injuries are common. For external contractions, Wujisan (Five Accumulations Powder), Lizhong Tang, and herbs such as Ganjiang, Fuzi, Mahuang (Ephedrae Herba), and Xixin (Asari Radix) may be used; for internal injuries, one should start with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and add warming and dispersing agents.
[Pulse Diagnosis] The pulse in Zhonghan (Cold Striking) is tight and choppy, indicating abundance of both Yin and Yang (or pathogenic and righteous factors). The method dictates no sweating; if sweating occurs, life is endangered.
External Causes
If a person who is usually frail contracts cold pathogen externally, it is because their pores are loose due to deficiency, and Qi and Blood are internally damaged, allowing cold pathogen to strike directly into the middle. This condition does not present with heat but with cold limbs. Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite, and Asari Decoction) or Wujisan (Five Accumulations Powder) may be used. For cold striking causing cold limbs due to sexual exhaustion, Sini Tang (Recover the Prostrate Decoction) and Sanjian Tang (Three Jian Decoction) are indicated, along with external application of Navel Warming Method.
Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite, and Asari Decoction)
Indicated for Shaoyin disease at its onset, presenting with contrary fever and a deep pulse.
Mahuang (Ephedrae Herba) 4 qian, Xixin (Asari Radix) 4 qian, Fuzi (Prepared Aconiti Lateralis Radix Praeparata) 2.5 qian.
Note: Diseases originating from Yin meridians should not have fever. Why does Shaoyin disease show fever at onset? Likely because the disease originated from transmission from Taiyang meridian. Kidney deficiency allows true cold to enter directly, causing a deep pulse, while residual exterior pathogen causes fever. Thus, Mahuang is used to induce sweating from Taiyang, while Xixin and Fuzi warm the Shaoyin meridian.
Wujisan (Five Accumulations Powder)
Jiegeng (Platycodonis Radix) 12 liang, Cangzhu (Atractylodis Rhizoma) soaked in rice water, coarse skin removed, 24 liang, Chenpi (Citri Reticulatae Pericarpium) peeled, Mahuang (Ephedrae Herba) de-jointed, Zhiqiao (Aurantii Fructus) de-pithed, bran-fried, each 6 liang, Houpo (Magnoliae Officinalis Cortex) ginger-processed, Ganjiang (Zingiberis Rhizoma) each 4 liang, Baizhi (Angelicae Dahuricae Radix), Chuanxiong (Chuanxiong Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma) roasted, Fuling (Poria), Rougui (Cinnamomi Cortex), Shaoyao (Paeoniae Radix Alba), Danggui (Angelicae Sinensis Radix), Banxia (Pinelliae Rhizoma) boiled in water seven times, each 3 liang.
Note: This formula treats cold lodging in collaterals and internal injury from raw/cold food, manifesting as headache and body pain, vomiting, abdominal pain, aversion to cold, and stiffness.
Take 4 qian per dose, boil with 1.5 cups of water, 3 slices of Shengjiang (Zingiberis Rhizoma Recens), and 2 stalks of Congbai (Allii Fistulosi Bulbus) until reduced to 0.7 cup. Take hot.
For accompanying Qi stagnation, add Wuzhuyu (Evodiae Fructus).
Sini Tang (Recover the Prostrate Decoction)
Gancao (Glycyrrhizae Radix et Rhizoma) roasted, 2 liang, Ganjiang (Zingiberis Rhizoma) 1.5 liang, Fuzi (Aconiti Radix) peeled and navel removed, 0.5 liang.
Note: The above formula treats Cold striking Taoyin, manifesting immediately upon infection, with minute pulse, no thirst, and cold limbs. Using raw Fuzi paired with Ganjiang embodies the concept of tonification combined with dispersion.
Take 5 qian per dose, boil with 1 cup of water until reduced to 0.7 cup. Take warm, at any time.
Sanjian Tang (Three Jian Decoction)
Da Chuanwu (Aconiti Radix Carminata), Fuzi (Aconiti Lateralis Radix Praeparata), Tianxiong (Aconiti Radix) all prepared, equal parts.
Take 4 qian per dose, add 10 slices of Shengjiang, decoct and take.
Navel Warming Method
Use Moxiang (Moschus), Banxia (Pinelliae Rhizoma), and Zhaojiao (Gleditsiae Fructus) each "yi zi" amount, powdered, fill into the navel. Apply thin slices of Shengjiang on top. Place large moxa cones on the ginger slice and steam-moxibustate for 3-7 Zhu (moxa cones). Also moxibustate Guanyuan (CV4) and Qihai (CV6) for 20 Zhu each. Heat penetrates inward, forcing cold outward, causing Yin to retreat and Yang to recover.
Internal Causes
In weak individuals, ingestion of raw, cold, or cooling foods leads to cold limbs and colicky pain in the umbilical/abdominal region, with absent or slow pulse. Ren Shen Lizhong Tang (Ginseng Regulate the Middle Decoction) or Jiang Fu Tang (Ginger and Aconite Decoction) are used. If Yuan Qi is injured by sexual exertion and subsequently struck heavily by cold, resulting in an absent pulse, Sanjian Tang is used. If Yuan Qi is injured by labor and then exposed to cold, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Ganjiang and Fuzi is indicated.
Ren Shen Lizhong Tang (Ginseng Regulate the Middle Decoction)
Treats Taoyin self-onset disease manifesting as spontaneous diarrhea without thirst, excessive cold with vomiting, abdominal pain with duck-like loose stools, ascariasis convulsion, cholera, etc.
Renshen (Ginseng Radix), Ganjiang (Zingiberis Rhizoma) roasted, Gancao (Glycyrrhizae Radix et Rhizoma) roasted, Baizhu (Atractylodis Macrocephalae Rhizoma) each 2.5 qian.
Crush and decoct as one dose, take warm.
If vomiting is excessive, remove Baizhu and add Shengjiang. If diarrhea is excessive, double Baizhu and Renshen. If cold is excessive, add 1.5 qian Ganjiang. If there is moving Qi, remove Baizhu and add Rougui 2 qian. If the pulse is deep, minute, and slow, add 2 qian Pao Fuzi, named Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction).
Jiang Fu Tang (Ginger and Aconite Decoction)
Treats Zhonghan coma, rigid body, locked jaw unable to speak, cold limbs, cold pain in umbilical/abdominal region, cholera with muscle cramps, and all deficiency-cold conditions.
Ganjiang (Zingiberis Rhizoma) 1 liang, Fuzi (Aconiti Radix) raw, peeled, navel removed, finely cut, 1 piece.
Take 3 qian per dose, boil with 1.5 cups of water until reduced to 0.7 cup. Take warm before meals.
For accompanying Qi stagnation and numbness, add Fangfeng (Saposhnikoviae Radix). For dampness, add Baizhu. For tendon/muscle spasm, add Mugua (Chaenomelis Fructus). For limb/joint pain, add Guizhi (Cinnamomi Ramulus) 2 qian.
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (See section on Labor-induced Internal Injury.)
Da Note: The Classic states: Cold is Yin Qi. When cold strikes Yang meridians, Yang can still resist Yin, making the disease easy to cure. When cold strikes Yin meridians, two Yins meet, becoming stubborn and hard to cure. Therefore, diseases in Taoyin and Shaoyin are severe and critical. Diseases in Jueyin often result in death. Some reckless individuals suffer internal blood injury from falls or fights, then commit suicide by drowning, exposing themselves to external cold. Blood coagulates due to cold, and cold penetrates deeply via blood; survival is impossible.