四三、湿之入中焦，有寒湿，有热湿，有自表传来，有水谷内蕴，有内外相合。其中伤也，有伤脾
阳，有伤脾阴，有伤胃阳，有伤胃阴，有两伤脾胃。伤脾胃之阳者十常八、九，伤脾胃之阴者十居一、
二。彼此混淆，治不中款，遗患无穷，临证细推，不可泛论。
此统言中焦湿证之总纲也。寒湿者，湿与寒水之气相搏也，盖湿水同类，其在天之阳时为雨
露，阴时为霜雪，在江河为水，在土中为湿，体本一源，易于相合，最损人之阳气。热湿者，在天时长
夏之际，盛热蒸动湿气流行也；在人身湿郁；本身
阳气久而生热也，兼损人之阴液。自表传来，一由经络而脏腑，一由肺而脾胃。水谷内蕴，肺虚不能
化气，脾虚不能散津，或形寒饮冷，或酒客中虚。内外相合，客邪既从表入，而伏邪又从内发也。伤
脾阳，在中则不运痞满，传下则洞泄腹痛。伤胃阳，则呕逆不食，膈胀胸痛。两伤脾胃，既有脾证，
又有胃证也。其伤脾胃之阴若何？湿久生热，热必伤阴，古称湿火者是也。伤胃阴，则口渴不饥。伤
脾阴，则舌先灰滑，后反黄燥，大便坚结。湿为阴邪，其伤人之阳也，得理之正，故多而常见。其伤
人之阴也，乃势之变，故罕而少见。治湿者必须审在何经何脏，兼寒兼热，气分血分，而出辛凉、辛
温、甘温、苦温、淡渗、苦渗之治，庶所投必效。若脾病治胃，胃病治脾，兼下焦者，单治中焦，或笼统
混治，脾胃不分，阴阳寒热不辨，将见肿胀、黄胆、洞泄、衄血、便血、诸证蜂起矣。惟在临证者细心
推求，下手有准的耳。盖土为杂气，兼证甚多，最难分析，岂可泛论湿气而已哉！
四四、足太阴寒湿，痞结胸满，不饥不食，半苓汤主之。
此书以温病名，并列寒湿者，以湿温紧与寒湿相对，言寒湿而湿温更易明析。
痞结胸满，仲景列于太阴篇中，乃湿郁脾阳，足太阴之气，不为鼓动营运。脏病而累及腑，痞结
于中，故亦不能食也。故以半夏、茯苓培阳土以吸阴土之湿，浓朴苦温以泻湿满，黄连苦以渗湿，重
用通草以利水道，使邪有出路也。
半苓汤方（此苦辛淡渗法也）
半夏（五钱） 茯苓块（五钱） 川连（一钱） 浓朴（三钱） 通草（八钱，煎汤煮前药）
水十二杯，煮通草成八杯，再入余药煮成三杯，分三次服。
四五、足太阴寒湿，腹胀，小便不利，大便溏而不爽，若欲滞下者，四苓加浓朴秦皮汤主之，
五苓散亦主之。
经谓太阴所至，发为 胀，又谓厥阴气至为 胀，盖木克土也。太阴之气不运，以致膀胱之
气不化，故小便不利。四苓辛淡渗湿，使膀胱开而出邪，以浓朴泻胀，以秦皮洗肝也。其或肝气不
热，则不用秦皮，仍用五苓中之桂枝以和肝，通利三焦而行太阳之阳气，故五苓散亦主之。
四苓加浓朴秦皮汤方（苦温淡法）
茅术（三钱） 浓朴（三钱） 茯苓块（五钱） 猪苓（四钱） 秦皮（二钱） 泽泻（四钱）
水八杯，煮成八分三杯，分三次服。
五苓散（甘温淡法）
猪苓（一两） 赤术（一两） 茯苓（一两） 泽泻（一两六钱） 桂枝（五钱）
共为细末，百沸汤和服三钱，日三服。
四六、足太阴寒湿，四肢乍冷，自利，目黄，舌白滑，甚则灰，神倦不语，邪阻脾窍，舌蹇语重，四
苓加木瓜草果浓朴汤主之。
脾主四肢，脾阳郁故四肢乍冷。湿渍脾而脾气下溜，故自利。目白精属肺，足太阴寒则手太阴不能独治，两
太阴同气也，且脾主地气，肺主天气，地气上蒸，天气不化，故目睛黄也。白滑与灰，寒湿苔也。湿困中焦，则
中气虚寒，中气虚寒，则阳光不治，主正阳者心也，心藏神，故神昏。心主言，心阳虚故不语。脾窍在舌，湿邪
阻窍，则舌蹇
而语声迟重。湿以下行为顺，故以四苓散驱湿下行，加木瓜以平木，治其所不胜也。浓朴以温中行
滞，草果温太阴独胜之寒，芳香而达窍，补火以生土，驱浊以生清也。
四苓加木瓜浓朴草果汤方（苦热兼酸淡法）
生于白术（三钱） 猪苓（一钱五分） 泽泻（一钱五分） 赤
苓块（五钱） 木瓜（一钱） 浓朴（一钱） 草果（八分） 半夏（三钱）
水八杯，煮取八分三杯，分三次服。阳素虚者，加附子二钱。
四七、足太阴寒湿，舌灰滑，中焦滞痞，草果茵陈汤主之；面目俱黄，四肢常厥者，茵陈四逆汤主之。
湿滞痞结，非温通而兼开窍不可，故以草果为君。茵陈因陈生新，生发阳气之机最速，故以之为
佐。广皮、大腹、浓朴，共成泻痞之功。猪苓、泽泻，以导湿外出也。若再加面黄肢逆，则非前汤所
能济，故以四逆回厥，茵陈宣湿退黄也。
草果茵陈汤方（苦辛温法）
草果（一钱） 茵陈（三钱） 茯苓皮（三钱） 浓朴（二钱） 广皮（一钱五分） 猪苓（二钱） 大腹皮（二
钱） 泽泻（一钱五分）
水五杯，煮取二杯，分二次服。
茵陈四逆汤方（苦辛甘热复微寒法）
附子（三钱，炮） 干姜（五钱） 炙甘草（二钱） 茵陈（六钱）
水五杯，煮取二杯。温服一杯，厥回止后服；仍厥，再服；尽剂，厥不回，再作服。
四八、足太阴寒湿，舌白滑，甚则灰，脉迟，不食，不寐，大便窒塞，浊阴凝聚，阳伤腹痛，痛甚则
肢逆，椒附白通汤主之。
此足太阴寒湿，兼足少阴、厥阴证也。白滑灰滑，皆寒湿苔也。脉迟者，阳为寒湿所困，来去俱
迟也。不食，胃阳痹也。不寐，中焦湿聚，阻遏阳气不得下交于阴也。大便窒塞，脾与大肠之阳，不
能下达也。阳为湿困，返逊位于浊阴，故浊阴得以蟠踞中焦而为痛也；凡痛皆邪正相争之象，虽曰阳
困，究竟阳未绝灭，两不相下，故相争而痛也（后凡言痛者仿此）。椒附白通汤，齐通三焦之阳，而急
驱浊阴也。
椒附白通汤方
生附子（炒黑，三钱） 川椒（炒黑，二钱） 淡干姜（二钱） 葱白（三茎） 猪胆汁（半烧酒杯，去渣后调入）
水五杯，煮成二杯，分二次凉服。
〔方论〕此苦辛热法复方也。苦与辛合，能降能通，非热不足以胜重寒而回阳。附子益太阳之
标阳，补命门之真火，助少阳之火热。盖人之命火，与太阳之阳少阳之阳旺，行水自速。三焦通利，湿
不得停，焉能聚而为痛，故用附子以为君，火旺则土强。干姜温中逐湿痹，太阴经之本药，川椒燥湿
除胀消食，治心腹冷痛，故以二物为臣。葱白由内而达外，中空通阳最速，亦主腹痛，故以为之使。浊阴凝聚不
散，有格阳之势，故反佐以猪胆汁，猪水畜，属肾，以阴求阴也；胆乃甲木，从少阳，少阳主开泄，生发之机最
速。此用仲景白通汤，与许学士椒附汤，合而裁制者也。
四九、阳明寒湿，舌白腐，肛坠痛，便不爽，不喜食，附子理中汤去甘草加广皮浓朴汤主之。
九窍不和，皆属胃病。胃受寒湿所伤，故肛门坠痛而便不爽；阳明失阖，故不喜食。理中之
人参补阳明之正，苍术补太阴而渗湿，姜、附运坤阳以劫寒，盖脾阳转而后湿行，湿行而后胃阳复。
去甘草，畏其满中也。加浓朴、广皮，取其行气。合而言之，辛甘为阳，辛苦能通之义也。
附子理中汤去甘草加浓朴广皮汤方（辛甘兼苦法）
生茅术（三钱） 人参（一钱五分） 炮干姜（一钱五分） 浓朴（二钱） 广皮（一钱五分） 生附子（一
钱五分，炮黑）
水五杯，煮取八分二杯，分二次服。
五十、寒湿伤脾胃两阳，寒热，不饥，吞酸，形寒，或脘中痞闷，或酒客湿聚，苓姜术桂汤主之。
此兼运脾胃，宣通阳气之轻剂也。
苓姜术桂汤方（苦辛温法）
茯苓块（五钱） 生姜（三钱） 炒白术（三钱） 桂枝（三钱）
水五杯，煮取八分二杯，分温再服。
五一、湿伤脾胃两阳，既吐且利，寒热身痛，或不寒热，但腹中痛，名曰霍乱。寒多，不欲饮水
者，理中汤主之。热多，欲饮水者，五苓散主之。吐利汗出，发热恶寒，四肢拘急，手足厥逆，四逆汤主
之。吐利止而身痛不休者，宜桂枝汤小和之。
按霍乱一证，长夏最多，本于阳虚寒湿凝聚，关系非轻，伤人于顷刻之间。奈时医不读《金匮》，
不识病源，不问轻重，一概主以藿香正气散，轻者原有可愈之理，重者死不旋踵；更可笑者，正气散
中加黄连、麦冬，大用西瓜治渴欲饮水之霍乱，病者岂堪命乎！瑭见之屡矣，故将采《金匮》原文，备
录于此。胃阳不伤不吐，脾阳不伤不泻，邪正不争不痛，营卫不乖不寒热。以不饮水之故，知其为寒
多；主以理中汤（原文系理中丸，方后自注云∶然丸不及汤，盖丸缓而汤速也；且恐丸药不精，故直改
从汤），温中散寒。人参甘草，胃之守药；白术甘草，脾之守药；干姜能通能守，上下两泄者，故脾胃
两守之；且守中有通，通中有守，以守药作通用，以通药作守用。若热欲饮水之证，饮不解渴，而吐泄
不止，则主以五苓。邪热须从小便去，膀胱为小肠之下游，小肠，火腑也，五苓通前阴，所以守后阴
也。太阳不开，则阳明不阖，开太阳正所以守阳明也。此二汤皆有一举两得之妙。吐利则脾胃之阳
虚，汗出则太阳之阳亦虚；发热者，浮阳在外也；恶寒者，实寒在中也；四肢拘急，脾阳不荣四末；手足
厥冷，中土湿而厥阴肝木来乘病者，四逆汤善救逆，故名四逆汤。人参甘草守中阳，干姜附子通中
阳，人参附子护外阳，干姜甘草护中阳，中外之阳复回，则群阴退避，而厥回矣。吐利止而身痛不休
者，中阳复而表阳不和也，故以桂枝汤温经络而微和之。
理中汤方（甘热微苦法，此方分量以及后加减法，悉照《金匮》原文，用者临时斟酌）
人参 甘草 白术 干姜（各三两）
水八杯，煮取三杯，温服一杯，日三服。
〔加减法〕若脐上筑者，肾气动也，去术加桂四两。吐多者，去术加生姜三两。下多者还用术。
悸者加茯苓二两。渴欲饮水者，加术足前成四两半。腹中痛者，加人参足前成四两半。寒者，加干
姜足前成四两半。腹满者，去术加附子一枚。服汤后，如食顷，饮热粥一升许，微自汗，勿发揭衣服。
五苓散方（见前）
〔加减法〕腹满者，加浓朴、广皮各一两。渴甚面赤，脉大紧而急，扇扇不知凉，饮冰不知冷，腹痛
甚，时时躁烦者，格阳也，加干姜一两五钱（此条非仲景原文，余治验也）。
百沸汤和，每服五钱，日三服。
四逆汤方（辛甘热法，分量临时斟酌）
炙甘草（二两） 干姜（一两半） 生附子（一枚，去皮） 加人参（一两）
水五茶碗，煮取二碗、分二次服。
按∶原方无人参，此独加人参者，前条寒多不饮水，较厥逆尚轻，仲景已用人参；此条诸阳欲脱，
中虚更急，不用人参，何以固内。柯韵伯伤寒注云∶仲景凡治虚证，以里为重，协热下利，脉微弱
者，便用人参；汗后身痛，脉沉迟者，便加人参。此脉迟而利清谷，且不烦不咳，中气大虚，元气已脱，
但温不补，何以救逆乎！观茯苓四逆之烦躁，且以人参；况通脉四逆，岂得无参。是必有脱落耳，备
录于此存参。
五二、霍乱兼转筋者，五苓散加防己桂枝薏仁主之；寒甚脉紧者，再加附子。
肝藏血，主筋，筋为寒湿搏急而转，故于五苓和霍乱之中，加桂枝温筋，防己急驱下焦血分之寒
湿，薏仁主湿痹香港脚，扶土抑木，治筋急拘挛。甚寒脉紧，则非纯阳之附子不可。
五苓散加防己桂枝薏仁方
即于前五苓散内，加防己一两，桂枝一两半，足前成二两，薏仁二两。寒甚者，加附子大者一
枚。杵为细末，每服五钱，百沸汤和，日三，剧者日三夜一，得卧则勿令服。
五三、卒中寒湿，内挟秽浊，眩冒欲绝，腹中绞痛，脉沉紧而迟，甚则伏，欲吐不得吐，欲利不得
利，甚则转筋，四肢欲厥，俗名发痧，又名干霍乱，转筋者，俗名转筋火，古方书不载（不载者，不载上
三条之俗名耳；若是证，当于《金匮》腹满、腹痛、心痛、寒疝、诸条参看自得），蜀椒救中汤主之，九痛
丸亦可服；语乱者，先服至宝丹，再与汤药。
按此证夏日湿蒸之时最多，故因霍乱而类记于此。中阳本虚，内停寒湿，又为蒸腾秽浊之气所
干，由口鼻而直行中道，以致腹中阳气受逼，所以相争而为绞痛；胃阳不转，虽欲吐而不得；脾阳困
闭，虽欲利而不能，其或经络亦受寒湿，则筋如转索，而后者向前矣；中阳虚而肝木来乘，则厥。俗
名发痧者何？盖以此证病来迅速，或不及延医，或医亦不识，相传以钱，或用瓷碗口，蘸姜汤或麻油，
刮其关节，刮则其血皆分，住则复合，数数分合，动则生阳，关节通而气得转，往往有随手而愈者，刮
处必现血点，红紫如沙，故名痧也。但刮后须十二时不饮水，方不再发。不然则留邪在络，稍受寒发
怒，则举发矣。以其欲吐不吐，欲利不利而腹痛，故又名干霍乱。其转筋名转筋火者，以常发于夏
月，夏月火令，又病迅速如火也，其实乃伏阴与湿相搏之故。以大建中之蜀椒，急驱阴浊下行，干姜
四三、湿邪侵入中焦，有寒湿，有热湿，有从体表传变而来，有水谷停滞体内蕴结，有内外因素相结合。其中损伤脾胃的，有损伤脾阳，有损伤脾阴，有损伤胃阳，有损伤胃阴，有两伤脾胃。损伤脾胃之阳的情况十有八九，损伤脾胃之阴的情况十有一二。彼此混淆，治疗不切实际，遗留无穷后患，临证时必须仔细推敲，不可泛泛而谈。
这是统论中焦湿证的总纲。寒湿，是湿与寒水之气相互搏结；因为湿与水同类，在天上阳气旺盛时化为雨露，阴气旺盛时化为霜雪，在江河中为水，在土壤中为湿，本源相同，易于相合，最易损伤人的阳气。热湿，是在天长夏之际，盛热蒸动湿气流行；在人体则是湿郁滞，本身阳气久郁而生热，兼损人的阴液。从表传来，一是由经络传入脏腑，一是由肺传入脾胃。水谷内蕴，因肺虚不能化气，脾虚不能散津，或因形寒饮冷，或酒客中气虚弱。内外相合，外邪既从表入，伏邪又从内发。损伤脾阳，在中焦则运化失职痞满，传至下焦则洞泄腹痛。损伤胃阳，则呕吐逆气不食，膈胀胸痛。两伤脾胃，既有脾的病证，又有胃的病证。那损伤脾胃之阴是怎样的呢？湿久生热，热必伤阴，古人称为湿火。损伤胃阴，则口渴不饥。损伤脾阴，则舌苔先灰滑，后来反见黄燥，大便坚结。湿为阴邪，它损伤人的阳气，符合常理，所以多且常见。它损伤人的阴液，是形势的变化，所以罕见少见。治疗湿病必须审察在何经何脏，兼寒兼热，在气分血分，从而采用辛凉、辛温、甘温、苦温、淡渗、苦渗等治法，这样投药才能见效。如果脾病治胃，胃病治脾，兼及下焦者单治中焦，或笼统混治，脾胃不分，阴阳寒热不辨，将见肿胀、黄疸、洞泄、衄血、便血等诸证蜂起。只有临证者细心推求，下手有准星罢了。因为土性杂气，兼证甚多，最难分析，岂可只泛论湿气而已！
这本书以温病命名，却并列寒湿，是因为湿温紧挨着寒湿相对，言明寒湿而湿温更易明晰。
痞结胸满，张仲景列于太阴篇中，乃是湿郁脾阳，足太阴之气，不为鼓动营运。脏病累及腑，痞结于中，所以也不能进食。因此用半夏、茯苓培补阳土以吸收阴土之湿，厚朴苦温以泻湿满，黄连苦味以渗湿，重用通草以利水道，使邪气有出路。
半苓汤方（此乃苦辛淡渗法）
半夏（五钱） 茯苓块（五钱） 川连（一钱） 厚朴（三钱） 通草（八钱，煎汤煮前药）
水十二杯，煮通草成八杯，再入其余药物煮成三杯，分三次服。
四五、足太阴寒湿，腹胀，小便不利，大便溏而不爽，若欲成痢疾者，用四苓加厚朴秦皮汤主治，五苓散也可主治。
经文说太阴所至，发为腹胀，又说厥阴气至为腹胀，盖因木克土。太阴之气不运，以致膀胱之气不化，所以小便不利。四苓散辛淡渗湿，使膀胱开而出邪，用厚朴泻胀，用秦皮洗肝。如果肝气不热，则不用秦皮，仍用五苓散中的桂枝以和肝，通利三焦而行太阳之阳气，所以五苓散也可主治。
四苓加厚朴秦皮汤方（苦温淡法）
茅术（三钱） 厚朴（三钱） 茯苓块（五钱） 猪苓（四钱） 秦皮（二钱） 泽泻（四钱）
水八杯，煮成八分三杯，分三次服。
五苓散（甘温淡法）
猪苓（一两） 赤术（一两） 茯苓（一两） 泽泻（一两六钱） 桂枝（五钱）
共为细末，百沸汤和服三钱，日三服。
四六、足太阴寒湿，四肢乍冷，自利，目黄，舌白滑，甚则灰，神倦不语，邪阻脾窍，舌蹇语重，用四苓加木瓜草果厚朴汤主治。
脾主四肢，脾阳郁故四肢乍冷。湿渍脾而脾气下溜，故自利。目白精属肺，足太阴寒则手太阴不能独治，两太阴同气也，且脾主地气，肺主天气，地气上蒸，天气不化，故目睛黄也。白滑与灰，是寒湿苔。湿困中焦，则中气虚寒，中气虚寒，则阳光不治，主正阳者心也，心藏神，故神昏。心主言，心阳虚故不语。脾窍在舌，湿邪阻窍，则舌蹇而语声迟重。湿以下行为顺，故以四苓散驱湿下行，加木瓜以平木，治其所不胜也。厚朴以温中行滞，草果温太阴独胜之寒，芳香而达窍，补火以生土，驱浊以生清也。
四苓加木瓜厚朴草果汤方（苦热兼酸淡法）
生于白术（三钱） 猪苓（一钱五分） 泽泻（一钱五分） 赤苓块（五钱） 木瓜（一钱） 厚朴（一钱） 草果（八分） 半夏（三钱）
水八杯，煮取八分三杯，分三次服。阳素虚者，加附子二钱。
四七、足太阴寒湿，舌灰滑，中焦滞痞，用草果茵陈汤主治；面目俱黄，四肢常厥者，用茵陈四逆汤主治。
湿滞痞结，非温通而兼开窍不可，故以草果为君药。茵陈因陈生新，生发阳气之机最速，故以之为佐。广皮、大腹、厚朴，共成泻痞之功。猪苓、泽泻，以导湿外出也。若再加面黄肢逆，则非前汤所能济，故以四逆回厥，茵陈宣湿退黄也。
草果茵陈汤方（苦辛温法）
草果（一钱） 茵陈（三钱） 茯苓皮（三钱） 厚朴（二钱） 广皮（一钱五分） 猪苓（二钱） 大腹皮（二钱） 泽泻（一钱五分）
水五杯，煮取二杯，分二次服。
茵陈四逆汤方（苦辛甘热复微寒法）
附子（三钱，炮） 干姜（五钱） 炙甘草（二钱） 茵陈（六钱）
水五杯，煮取二杯。温服一杯，厥回止后服；仍厥，再服；尽剂，厥不回，再作服。
四八、足太阴寒湿，舌白滑，甚则灰，脉迟，不食，不寐，大便窒塞，浊阴凝聚，阳伤腹痛，痛甚则肢逆，用椒附白通汤主治。
此足太阴寒湿，兼足少阴、厥阴证也。白滑灰滑，皆寒湿苔也。脉迟者，阳为寒湿所困，来去俱迟也。不食，胃阳痹也。不寐，中焦湿聚，阻遏阳气不得下交于阴也。大便窒塞，脾与大肠之阳，不能下达也。阳为湿困，返逊位于浊阴，故浊阴得以蟠踞中焦而为痛也；凡痛皆邪正相争之象，虽曰阳困，究竟阳未绝灭，两不相下，故相争而痛也（后凡言痛者仿此）。椒附白通汤，齐通三焦之阳，而急驱浊阴也。
椒附白通汤方
生附子（炒黑，三钱） 川椒（炒黑，二钱） 淡干姜（二钱） 葱白（三茎） 猪胆汁（半烧酒杯，去渣后调入）
水五杯，煮成二杯，分二次凉服。
〔方论〕此苦辛热法复方也。苦与辛合，能降能通，非热不足以胜重寒而回阳。附子益太阳之标阳，补命门之真火，助少阳之火热。盖人之命火，与太阳之阳少阳之阳旺，行水自速。三焦通利，湿不得停，焉能聚而为痛，故用附子以为君，火旺则土强。干姜温中逐湿痹，太阴经之本药，川椒燥湿除胀消食，治心腹冷痛，故以二物为臣。葱白由内而达外，中空通阳最速，亦主腹痛，故以为之使。浊阴凝聚不散，有格阳之势，故反佐以猪胆汁，猪水畜，属肾，以阴求阴也；胆乃甲木，从少阳，少阳主开泄，生发之机最速。此用仲景白通汤，与许学士椒附汤，合而裁制者也。
四九、阳明寒湿，舌白腐，肛坠痛，便不爽，不喜食，用附子理中汤去甘草加广皮厚朴汤主治。
九窍不和，皆属胃病。胃受寒湿所伤，故肛门坠痛而便不爽；阳明失阖，故不喜食。理中之人参补阳明之正，苍术补太阴而渗湿，姜、附运坤阳以劫寒，盖脾阳转而后湿行，湿行而后胃阳复。去甘草，畏其满中也。加厚朴、广皮，取其行气。合而言之，辛甘为阳，辛苦能通之义也。
附子理中汤去甘草加厚朴广皮汤方（辛甘兼苦法）
生茅术（三钱） 人参（一钱五分） 炮干姜（一钱五分） 厚朴（二钱） 广皮（一钱五分） 生附子（一钱五分，炮黑）
水五杯，煮取八分二杯，分二次服。
五十、寒湿伤脾胃两阳，寒热，不饥，吞酸，形寒，或脘中痞闷，或酒客湿聚，用苓姜术桂汤主治。
苓姜术桂汤方（苦辛温法）
茯苓块（五钱） 生姜（三钱） 炒白术（三钱） 桂枝（三钱）
水五杯，煮取八分二杯，分温再服。
五一、湿伤脾胃两阳，既吐且利，寒热身痛，或不寒热，但腹中痛，名曰霍乱。寒多，不欲饮水者，用理中汤主治。热多，欲饮水者，用五苓散主治。吐利汗出，发热恶寒，四肢拘急，手足厥逆，用四逆汤主治。吐利止而身痛不休者，宜桂枝汤小和之。
按霍乱一证，长夏最多，本于阳虚寒湿凝聚，关系非轻，伤人于顷刻之间。奈时医不读《金匮》，不识病源，不问轻重，一概主以藿香正气散，轻者原有可愈之理，重者死不旋踵；更可笑者，正气散中加黄连、麦冬，大用西瓜治渴欲饮水之霍乱，病者岂堪命乎！瑭见之屡矣，故将采《金匮》原文，备录于此。胃阳不伤不吐，脾阳不伤不泻，邪正不争不痛，营卫不乖不寒热。以不饮水之故，知其为寒多；主以理中汤（原文系理中丸，方后自注云∶然丸不及汤，盖丸缓而汤速也；且恐丸药不精，故直改从汤），温中散寒。人参甘草，胃之守药；白术甘草，脾之守药；干姜能通能守，上下两泄者，故脾胃两守之；且守中有通，通中有守，以守药作通用，以通药作守用。若热欲饮水之证，饮不解渴，而吐泄不止，则主以五苓。邪热须从小便去，膀胱为小肠之下游，小肠，火腑也，五苓通前阴，所以守后阴也。太阳不开，则阳明不阖，开太阳正所以守阳明也。此二汤皆有一举两得之妙。吐利则脾胃之阳虚，汗出则太阳之阳亦虚；发热者，浮阳在外也；恶寒者，实寒在中也；四肢拘急，脾阳不荣四末；手足厥冷，中土湿而厥阴肝木来乘病者，四逆汤善救逆，故名四逆汤。人参甘草守中阳，干姜附子通中阳，人参附子护外阳，干姜甘草护中阳，中外之阳复回，则群阴退避，而厥回矣。吐利止而身痛不休者，中阳复而表阳不和也，故以桂枝汤温经络而微和之。
理中汤方（甘热微苦法，此方分量以及后加减法，悉照《金匮》原文，用者临时斟酌）
人参 甘草 白术 干姜（各三两）
水八杯，煮取三杯，温服一杯，日三服。
〔加减法〕若脐上筑者，肾气动也，去术加桂四两。吐多者，去术加生姜三两。下多者还用术。悸者加茯苓二两。渴欲饮水者，加术足前成四两半。腹中痛者，加人参足前成四两半。寒者，加干姜足前成四两半。腹满者，去术加附子一枚。服汤后，如食顷，饮热粥一升许，微自汗，勿发揭衣服。
五苓散方（见前）
〔加减法〕腹满者，加厚朴、广皮各一两。渴甚面赤，脉大紧而急，扇扇不知凉，饮冰不知冷，腹痛甚，时时躁烦者，格阳也，加干姜一两五钱（此条非仲景原文，余治验也）。
百沸汤和，每服五钱，日三服。
四逆汤方（辛甘热法，分量临时斟酌）
炙甘草（二两） 干姜（一两半） 生附子（一枚，去皮） 加人参（一两）
水五茶碗，煮取二碗、分二次服。
按∶原方无人参，此独加人参者，前条寒多不饮水，较厥逆尚轻，仲景已用人参；此条诸阳欲脱，中虚更急，不用人参，何以固内。柯韵伯伤寒注云∶仲景凡治虚证，以里为重，协热下利，脉微弱者，便用人参；汗后身痛，脉沉迟者，便加人参。此脉迟而利清谷，且不烦不咳，中气大虚，元气已脱，但温不补，何以救逆乎！观茯苓四逆之烦躁，且以人参；况通脉四逆，岂得无参。是必有脱落耳，备录于此存参。
五二、霍乱兼转筋者，用五苓散加防己桂枝薏仁主治；寒甚脉紧者，再加附子。
肝藏血，主筋，筋为寒湿搏急而转，故于五苓和霍乱之中，加桂枝温筋，防己急驱下焦血分之寒湿，薏仁主湿痹香港脚，扶土抑木，治筋急拘挛。甚寒脉紧，则非纯阳之附子不可。
五苓散加防己桂枝薏仁方
即于前五苓散内，加防己一两，桂枝一两半，足前成二两，薏仁二两。寒甚者，加大附子一枚。杵为细末，每服五钱，百沸汤和，日三，剧者日三夜一，得卧则勿令服。
五三、卒中寒湿，内挟秽浊，眩冒欲绝，腹中绞痛，脉沉紧而迟，甚则伏，欲吐不得吐，欲利不得利，甚则转筋，四肢欲厥，俗名发痧，又名干霍乱，转筋者，俗名转筋火，古方书不载（不载者，不载上三条之俗名耳；若是证，当于《金匮》腹满、腹痛、心痛、寒疝、诸条参看自得），用蜀椒救中汤主治，九痛丸亦可服；语乱者，先服至宝丹，再与汤药。
按此证夏日湿蒸之时最多，故因霍乱而类记于此。中阳本虚，内停寒湿，又为蒸腾秽浊之气所干，由口鼻而直行中道，以致腹中阳气受逼，所以相争而为绞痛；胃阳不转，虽欲吐而不得；脾阳困闭，虽欲利而不能，其或经络亦受寒湿，则筋如转索，而后者向前矣；中阳虚而肝木来乘，则厥。俗名发痧者何？盖以此证病来迅速，或不及延医，或医亦不识，相传以钱，或用瓷碗口，蘸姜汤或麻油，刮其关节，刮则其血皆分，住则复合，数数分合，动则生阳，关节通而气得转，往往有随手而愈者，刮处必现血点，红紫如沙，故名痧也。但刮后须十二时不饮水，方不再发。不然则留邪在络，稍受寒发怒，则举发矣。以其欲吐不吐，欲利不利而腹痛，故又名干霍乱。其转筋名转筋火者，以常发于夏月，夏月火令，又病迅速如火也，其实乃伏阴与湿相搏之故。以大建中之蜀椒，急驱阴浊下行，干姜
43. When dampness enters the Middle Jiao (Middle Burner), it can be Cold-Damp or Damp-Heat; it may transmit from the Exterior, accumulate internally from food and water retention, or result from a combination of internal and external factors. The injury to the Spleen and Stomach involves damaging Spleen Yang, Spleen Yin, Stomach Yang, Stomach Yin, or both Spleen and Stomach simultaneously. Injury to Spleen and Stomach Yang accounts for eight or nine out of ten cases, while injury to Spleen and Stomach Yin accounts for one or two out of ten. Confusing these conditions leads to ineffective treatment and endless complications; clinical judgment requires careful deduction and cannot be generalized.
This paragraph serves as the general outline for all Dampness syndromes in the Middle Jiao. Cold-Damp is the struggle between Dampness and Cold-Water Qi. Since Dampness and Water are of the same nature—manifesting as rain and dew when Heaven's Yang is active, frost and snow when Yin is active, water in rivers, and dampness in soil—they share a common source and easily combine, most readily damaging human Yang Qi. Damp-Heat occurs during the long summer when intense heat steams and moves Dampness; in the human body, Dampness stagnates, and prolonged Yang Qi stagnation generates Heat, thereby damaging Yin fluids. Transmission from the Exterior occurs either via meridians into zang-fu organs or from the Lung to the Spleen and Stomach. Internal accumulation of food and water results from Lung deficiency failing to transform Qi, Spleen deficiency failing to distribute Jin-Ye, exposure to cold with cold drinks, or middle-jiao deficiency in wine drinkers. Internal-external combination occurs when pathogenic factors enter from the exterior while latent pathogens erupt from within. Injury to Spleen Yang causes stagnation and fullness in the middle jiao due to failed transportation, and severe diarrhea with abdominal pain if transmitted downward. Injury to Stomach Yang causes vomiting, regurgitation, anorexia, chest diaphragm distension, and chest pain. Simultaneous injury to both Spleen and Stomach presents with symptoms of both organs. How is Spleen and Stomach Yin injured? Prolonged Dampness generates Heat, which inevitably damages Yin, known in ancient texts as "Damp-Fire." Injury to Stomach Yin causes thirst without hunger. Injury to Spleen Yin causes the tongue coating to first appear gray and slippery, then yellow and dry, with hard constipation. Dampness is a Yin pathogen; its damage to Yang follows normal principles, hence it is common. Its damage to Yin is a variation of circumstances, hence rare. Treating Dampness requires determining the affected meridian and organ, whether accompanied by Cold or Heat, and whether in the Qi or Blood level, employing methods such as Acrid-Cool, Acrid-Warm, Sweet-Warm, Bitter-Warm, Light-Leaching, or Bitter-Leaching. Only then will treatments be effective. Treating Stomach disease as Spleen disease, or vice versa; treating only the Middle Jiao when the Lower Jiao is involved; or treating vaguely without distinguishing Spleen/Stomach or Yin/Yang/Cold/Heat will lead to a swarm of symptoms like edema, jaundice, severe diarrhea, epistaxis, and hematochezia. Only careful clinical deduction ensures precise intervention. Earth element is complex with many combined syndromes, making analysis difficult; how can one merely generalize about Dampness!
44. Foot-Taiyin Cold-Damp presenting with epigastric blockage, chest fullness, lack of appetite, and anorexia is primarily treated with Ban Ling Tang (Half-Poria Decoction).
Although this book is named on Warm Diseases, Cold-Damp is listed alongside because Damp-Warmth is closely contrasted with Cold-Damp; clarifying Cold-Damp makes Damp-Warmth easier to understand.
Epigastric blockage and chest fullness are listed in Zhang Zhongjing’s Taiyin chapter, resulting from Dampness depressing Spleen Yang, causing Foot-Taiyin Qi to fail in its driving and circulating functions. Zang disease affecting Fu organs leads to blockage in the middle, preventing eating. Therefore, Ban Xia (Pinelliae Rhizoma) and Fu Ling (Poria) are used to cultivate Yang Earth to absorb Yin Earth’s Dampness; Hou Po (Magnoliae Officinalis Cortex), bitter and warm, drains Damp-fullness; Huang Lian (Coptidis Rhizoma), bitter, leaches Dampness; and Tong Cao (Tetrapanacis Medulla) is heavily used to benefit water passages, providing an exit for pathogens.
Ban Ling Tang Formula (Bitter-Acid-Light Leaching Method)
Ban Xia (Pinelliae Rhizoma) (5 qian)
Fu Ling Kuai (Poria) (5 qian)
Chuan Lian (Coptidis Rhizoma) (1 qian)
Hou Po (Magnoliae Officinalis Cortex) (3 qian)
Tong Cao (Tetrapanacis Medulla) (8 qian, decocted in soup to cook other herbs)
Twelve cups of water: decoct Tong Cao until 8 cups remain, add remaining herbs, decoct until 3 cups remain. Divide into three doses.
45. Foot-Taiyin Cold-Damp presenting with abdominal distension, dysuria, loose stools that are not smooth, or impending dysentery, is primarily treated with Si Ling Jia Hou Po Qin Pi Tang (Four-Poria Decoction plus Magnolia Bark and Fraxinus Bark); Wu Ling San (Five-Poria Powder) is also applicable.
The Classics state that Taiyin arrival causes abdominal distension, and Jueyin arrival causes abdominal distension, due to Wood overcoming Earth. Taiyin Qi failure leads to Bladder Qi failing to transform, causing dysuria. Si Ling Tang (Four-Poria Powder) uses acrid-light leaching to open the Bladder and expel pathogens; Hou Po drains distension; Qin Pi (Fraxini Cortex) clears the Liver. If Liver Qi is not hot, Qin Pi is omitted, and Gui Zhi (Cinnamomi Ramulus) from Wu Ling San is used to harmonize the Liver, unblock the Triple Burner, and promote Taiyang Yang Qi; thus, Wu Ling San is also applicable.
Si Ling Jia Hou Po Qin Pi Tang Formula (Bitter-Warm-Light Method)
Mao Zhu (Atractylodis Macrocephalae Rhizoma) (3 qian)
Hou Po (Magnoliae Officinalis Cortex) (3 qian)
Fu Ling Kuai (Poria) (5 qian)
Zhu Ling (Polypori Umbellati mycelium) (4 qian)
Qin Pi (Fraxini Cortex) (2 qian)
Ze Xie (Alismatis Rhizoma) (4 qian)
Eight cups of water: decoct until 3 and 1/3 cup remains. Divide into three doses.
Wu Ling San (Sweet-Warm-Light Method)
Zhu Ling (Polypori Umbellati mycelium) (1 liang)
Chi Zhu (Atractylodis Rhizoma Rubra) (1 liang)
Fu Ling (Poria) (1 liang)
Ze Xie (Alismatis Rhizoma) (1.6 liang)
Gui Zhi (Cinnamomi Ramulus) (5 qian)
Grind to fine powder. Mix with boiling water, take 3 qian per dose, three times daily.
46. Foot-Taiyin Cold-Damp presenting with intermittent cold limbs, spontaneous diarrhea, jaundice, white slippery tongue coating (gray if severe), mental fatigue, silence, pathogen blocking Spleen orifices, stiff tongue, and heavy speech, is primarily treated with Si Ling Jia Mu Gua Cao Guo Hou Po Tang (Four-Poria Decoction plus Quince, Tsaoko Cardamom, and Magnolia Bark).
Spleen governs the four limbs; Spleen Yang stagnation causes intermittent cold limbs. Dampness soaking the Spleen causes Spleen Qi to sink, leading to spontaneous diarrhea. The whites of the eyes belong to the Lung; Foot-Taiyin Cold prevents Hand-Taiyin from functioning independently, as both Taiyin share similar Qi. Spleen governs Earth Qi, Lung governs Heaven Qi; Earth Qi steaming upward without Heaven Qi transforming causes yellow eyes. White-slippery and gray coatings indicate Cold-Damp. Dampness trapping the Middle Jiao causes Middle Qi deficiency and Cold; Middle Qi deficiency fails to control Sunlight (Heart Yang); Heart governs Zheng Yang and houses Shen (Spirit), so Shen becomes confused. Heart governs speech; Heart Yang deficiency causes silence. Spleen orifice is in the tongue; Dampness blocking orifices causes tongue stiffness and slow, heavy speech. Dampness flows downward smoothly; thus, Si Ling San drives Dampness downward. Mu Gua (Chaenomelis Fructus) pacifies Wood, treating what overcomes it. Hou Po warms the middle and moves stagnation; Cao Guo (Tsao-ko Fructus) warms the exclusive Cold of Taiyin, is aromatic to reach orifices, tonifies Fire to generate Earth, and drives turbidity to generate clarity.
Si Ling Jia Mu Gua Cao Guo Hou Po Tang Formula (Bitter-Hot-Sour-Light Method)
Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma) (3 qian)
Zhu Ling (Polypori Umbellati mycelium) (1.5 qian)
Ze Xie (Alismatis Rhizoma) (1.5 qian)
Chi Fu Ling Kuai (Red Poria) (5 qian)
Mu Gua (Chaenomelis Fructus) (1 qian)
Hou Po (Magnoliae Officinalis Cortex) (1 qian)
Cao Guo (Tsao-ko Fructus) (0.8 qian)
Ban Xia (Pinelliae Rhizoma) (3 qian)
Eight cups of water: decoct until 3 and 1/3 cup remains. Divide into three doses. For those with inherent Yang deficiency, add Fu Zi (Aconiti Lateralis Radix Praeparata) 2 qian.
47. Foot-Taiyin Cold-Damp presenting with gray slippery tongue coating, middle jiao stagnation and blockage, is primarily treated with Cao Guo Yin Chen Tang (Tsaoko Cardamom and Coptis Decoction); if face and eyes are yellow and limbs are constantly cold, Yin Chen Si Ni Tang (Coix Seed and Four-Reversal Decoction) is primarily treated.
Damp stagnation and blockage require warming, unblocking, and opening orifices; thus, Cao Guo is the sovereign herb. Yin Chen (Artemisiae Scopariae Herba) generates new from old, having the fastest mechanism for generating Yang Qi, serving as the assistant. Guang Pi (Citri Reticulatae Pericarpium), Da Fu Pi (Arecae Pericarpium), and Hou Po work together to drain blockage. Zhu Ling and Ze Xie guide Dampness outward. If jaundice and limb reversal are added, the previous formula is insufficient; thus, Si Ni Tang reverses cold, and Yin Chen promotes Dampness and resolves jaundice.
Cao Guo Yin Chen Tang Formula (Bitter-Acid-Warm Method)
Cao Guo (Tsao-ko Fructus) (1 qian)
Yin Chen (Artemisiae Scopariae Herba) (3 qian)
Fu Ling Pi (Poria Cum Syllogene) (3 qian)
Hou Po (Magnoliae Officinalis Cortex) (2 qian)
Guang Pi (Citri Reticulatae Pericarpium) (1.5 qian)
Zhu Ling (Polypori Umbellati mycelium) (2 qian)
Da Fu Pi (Arecae Pericarpium) (2 qian)
Ze Xie (Alismatis Rhizoma) (1.5 qian)
Five cups of water: decoct until 2 cups remain. Divide into two doses.
Yin Chen Si Ni Tang Formula (Bitter-Acid-Sweet-Hot with slight Cold method)
Fu Zi (Aconiti Lateralis Radix Praeparata) (3 qian, processed)
Gan Jiang (Zingiberis Rhizoma) (5 qian)
Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata) (2 qian)
Yin Chen (Artemisiae Scopariae Herba) (6 qian)
Five cups of water: decoct until 2 cups remain. Take 1 cup warm after reversal stops; if reversal persists, take again; finish the dose; if reversal does not stop, prepare another dose.
48. Foot-Taiyin Cold-Damp presenting with white slippery tongue coating (gray if severe), slow pulse, anorexia, insomnia, fecal impaction, condensation of Turbid Yin, Yang-injury abdominal pain, and limb reversal if pain is severe, is primarily treated with Jiao Fu Bai Tong Tang (Sichuan Pepper, Aconite, and White Scallion Decoction).
This is Foot-Taiyin Cold-Damp combined with Foot-Shaoyin and Jueyin syndromes. White-slippery and gray-slippery coatings are Cold-Damp. Slow pulse indicates Yang trapped by Cold-Damp, moving slowly in both directions. Anorexia indicates Stomach Yang obstruction. Insomnia indicates Middle Jiao Dampness aggregation obstructing Yang Qi from descending to interact with Yin. Fecal impaction indicates Spleen and Large Intestine Yang failing to descend. Trapped Yang yields position to Turbid Yin, allowing Turbid Yin to occupy the Middle Jiao and cause pain; pain is always a sign of struggle between Pathogen and Righteous Qi. Although Yang is trapped, it is not extinguished; the stalemate causes struggle and pain (see subsequent mentions of pain). Jiao Fu Bai Tong Tang unblocks Yang of the Triple Burner and urgently drives out Turbid Yin.
Jiao Fu Bai Tong Tang Formula
Sheng Fu Zi (Aconiti Radix) (3 qian, stir-fried black)
Chuan Jiao (Zanthoxyli Pericarpium) (2 qian, stir-fried black)
Dan Gan Jiang (Zingiberis Rhizoma) (2 qian)
Cong Bai (Allii Fistulosi Bulbus) (3 stems)
Zhu Dan (Porci Bile) (half burnt wine cup, strain and mix in)
Five cups of water: decoct until 2 cups remain. Divide into two doses, take cool.
[Formula Commentary] This is a compound formula using Bitter-Acid-Hot method. Bitter and Acrid combined can descend and unblock; only Heat is sufficient to overcome severe Cold and restore Yang. Fu Zi benefits Taiyang marked Yang, tonifies Mingmen True Fire, and assists Shaoyang Fire. Human Mingming Fire, along with Taiyang and Shaoyang Yang, accelerates water movement. When Triple Burner is unblocked, Dampness cannot stagnate or gather to cause pain. Thus, Fu Zi is sovereign; strong Fire strengthens Earth. Gan Jiang warms the middle and expels Cold-Damp Bi, the fundamental herb for Taiyin channel. Chuan Jiao dries Dampness, relieves distension, aids digestion, and treats cold pain in heart and abdomen; they serve as ministers. Cong Bai reaches from inside to outside; its hollow structure unblocks Yang rapidly and treats abdominal pain; it serves as envoy. Turbid Yin condenses and does not disperse, showing signs of repelling Yang; thus, Zhu Dan is used as a counter-agent. Pig is water animal, belongs to Kidney, seeking Yin with Yin; Gallbladder is Jia Wood, follows Shaoyang, which governs opening and releasing, having the fastest mechanism for generation. This combines Zhang Zhongjing’s Bai Tong Tang with Xu Xueshi’s Jiao Fu Tang.
49. Yangming Cold-Damp presenting with white rotting tongue coating, anal prolapse pain, unsatisfactory defecation, and aversion to food, is primarily treated with Fu Zi Li Zhong Tang minus Gan Cao plus Guang Pi and Hou Po (Aconite and Cinnamon Pill minus Licorice plus Tangerine Peel and Magnolia Bark).
Disorder of the nine orifices all belong to Stomach disease. Stomach injured by Cold-Damp causes anal prolapse pain and unsatisfactory defecation; Yangming fails to close, causing aversion to food. Ren Shen (Ginseng Radix) in Li Zhong Tang tonifies Yangming righteousness; Cang Zhu (Atractylodis Rhizoma) tonifies Taiyin and leaches Dampness; Jiang (Ginger) and Fu Zi (Aconite) move Kun Yang to dispel Cold. Once Spleen Yang turns, Dampness moves; once Dampness moves, Stomach Yang recovers. Remove Gan Cao to avoid causing fullness. Add Hou Po and Guang Pi for their Qi-moving properties. In summary, Acrid-Sweet is Yang; Bitter-Acid can unblock.
Fu Zi Li Zhong Tang minus Gan Cao plus Hou Po Guang Pi Tang Formula (Acrid-Sweet combined with Bitter Method)
Sheng Mao Zhu (Raw Atractylodis Macrocephalae Rhizoma) (3 qian)
Ren Shen (Panacis Ginseng Radix) (1.5 qian)
Pao Gan Jiang (Processed Zingiberis Rhizoma) (1.5 qian)
Hou Po (Magnoliae Officinalis Cortex) (2 qian)
Guang Pi (Citri Reticulatae Pericarpium) (1.5 qian)
Sheng Fu Zi (Raw Aconiti Radix) (1.5 qian, processed black)
Five cups of water: decoct until 2 and 1/3 cup remains. Divide into two doses.
50. Cold-Damp injuring both Spleen and Stomach Yang, presenting with alternating chills and fever, lack of appetite, acid regurgitation, aversion to cold, epigastric stuffiness, or Dampness accumulation in wine drinkers, is primarily treated with Ling Jiang Zhu Gui Tang (Poria, Ginger, Atractylodes, and Cinnamon Decoction).
This is a mild formula that simultaneously moves Spleen and Stomach and promotes Yang Qi circulation.
Ling Jiang Zhu Gui Tang Formula (Bitter-Acid-Warm Method)
Fu Ling Kuai (Poria) (5 qian)
Sheng Jiang (Zingiberis Rhizoma Recens) (3 qian)
Chao Bai Zhu (Stir-fried Atractylodis Macrocephalae Rhizoma) (3 qian)
Gui Zhi (Cinnamomi Ramulus) (3 qian)
Five cups of water: decoct until 2 and 1/3 cup remains. Divide into two warm doses.
51. Dampness injuring both Spleen and Stomach Yang, presenting with simultaneous vomiting and diarrhea, alternating chills and fever with body pain, or no chills/fever but only abdominal pain, is named Huoluan (Colic and Vomiting/Dysentery Syndrome). If Cold predominates and there is no desire for water, Li Zhong Tang is primarily treated. If Heat predominates and there is desire for water, Wu Ling San is primarily treated. If vomiting, diarrhea, sweating, fever, aversion to cold, limb cramping, and hand-foot cold occur, Si Ni Tang is primarily treated. If vomiting and diarrhea stop but body pain persists, Gui Zhi Tang should be used gently to harmonize.
Regarding Huoluan syndrome, it is most common in late summer, rooted in Yang deficiency and Cold-Damp condensation, posing serious risk, harming people instantly. Unfortunately, contemporary physicians do not read *Jin Gui Yao Lue*, do not recognize disease sources, ignore severity, and uniformly prescribe Huo Xiang Zheng Qi San. Mild cases may recover, but severe cases die quickly; more laughably, some add Huang Lian and Mai Dong to Zheng Qi San, or use large amounts of watermelon to treat thirst in Huoluan patients, endangering lives! I have seen this repeatedly, so I record the original text from *Jin Gui* here. Stomach Yang injury causes vomiting; Spleen Yang injury causes diarrhea; Pathogen-Righteous struggle causes pain; Ying-Wei disharmony causes chills and fever. Lack of desire for water indicates Cold predominance; Li Zhong Tang (original text says Li Zhong Wan, note says pills are slower than decoctions, and pills may be impure, so changed to decoction) warms the middle and disperses Cold. Ren Shen and Gan Cao guard Stomach; Bai Zhu and Gan Cao guard Spleen; Gan Jiang can unblock and guard; since both upper and lower leak, both Spleen and Stomach are guarded; guarding contains unblocking, unblocking contains guarding, using guarding herbs for unblocking function and unblocking herbs for guarding function. If Heat causes desire for water, drinking does not quench thirst, and vomiting/diarrhea persist, Wu Ling San is primary. Pathogenic Heat must exit via urination; Bladder is downstream of Small Intestine; Small Intestine is Fire Fu; Wu Ling San opens anterior yin, thus guarding posterior yin. If Taiyang does not open, Yangming does not close; opening Taiyang guards Yangming. Both formulas achieve two goals with one action. Vomiting/diarrhea deplete Spleen-Stomach Yang; sweating depletes Taiyang Yang; fever indicates floating Yang outside; aversion to cold indicates solid Cold inside; limb cramping indicates Spleen Yang failing to nourish extremities; hand-foot cold indicates Middle Earth Dampness allowing Jueyin Liver Wood to invade; Si Ni Tang saves reversal well, hence the name. Ren Shen and Gan Cao guard Middle Yang; Gan Jiang and Fu Zi unblock Middle Yang; Ren Shen and Fu Zi protect External Yang; Gan Jiang and Gan Cao guard Middle Yang; when Internal-External Yang return, Yin retreats, and reversal stops. If vomiting/diarrhea stop but body pain persists, Middle Yang has returned but Exterior Yang is disharmonious; Gui Zhi Tang warms meridians and gently harmonizes.
Li Zhong Tang Formula (Sweet-Hot slight Bitter Method, dosages and modifications follow *Jin Gui* original, adjust as needed)
Ren Shen (Ginseng Radix)
Gan Cao (Glycyrrhizae Radix et Rhizoma)
Bai Zhu (Atractylodis Macrocephalae Rhizoma)
Gan Jiang (Zingiberis Rhizoma) (each 3 liang)
Eight cups of water: decoct until 3 cups remain. Take 1 cup warm, three times daily.
[Modifications] If pulsation above navel, Kidney Qi is moving; remove Bai Zhu, add Gui Zhi 4 liang. If excessive vomiting, remove Bai Zhu, add Sheng Jiang 3 liang. If excessive diarrhea, continue using Bai Zhu. If palpitations, add Fu Ling 2 liang. If desire for water, increase Bai Zhu to total 4.5 liang. If abdominal pain, increase Ren Shen to total 4.5 liang. If Cold, increase Gan Jiang to total 4.5 liang. If abdominal fullness, remove Bai Zhu, add one Fu Zi. After taking decoction, wait time equivalent to eating, drink approx. 1 sheng hot porridge, induce slight sweat, do not uncover clothes.
Wu Ling San Formula (See above)
[Modifications] If abdominal fullness, add Hou Po and Guang Pi each 1 liang. If extreme thirst, red face, large/tight/rapid pulse, fan unaware of coolness, ice unaware of cold, severe abdominal pain, frequent restlessness, this is Repelled Yang; add Gan Jiang 1.5 liang (this clause is not Zhang Zhongjing original, but my clinical experience).
Mix with boiling water, take 5 qian per dose, three times daily.
Si Ni Tang Formula (Acrid-Sweet-Hot Method, dosage adjust as needed)
Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata) (2 liang)
Gan Jiang (Zingiberis Rhizoma) (1.5 liang)
Sheng Fu Zi (Aconiti Radix) (one piece, peeled)
Add Ren Shen (Panacis Ginseng Radix) (1 liang)
Five tea bowls of water: decoct until 2 bowls remain. Divide into two doses.
Note: Original formula lacks Ren Shen; adding it here is because the previous clause (Cold predominance, no water desire) is milder than reversal, where Zhang Zhongjing already used Ren Shen; this clause involves impending collapse of all Yang and urgent Middle deficiency; without Ren Shen, how to secure interior? Ke Yunbo’s commentary on Shang Han Lun states: Zhang Zhongjing prioritizes interior for deficiency syndromes; for協热下利 (heat-collapsing diarrhea) with weak pulse, he uses Ren Shen; for body pain after sweating with deep-slow pulse, he adds Ren Shen. Here, slow pulse with clear grain diarrhea, no irritability/cough, indicates great Middle Qi deficiency and Yuan Qi depletion; merely warming without tonifying, how to save reversal? Observing Fan Lin Si Ni Tang’s irritability uses Ren Shen; how much more would Tong Mai Si Ni Tang need it? There must be missing text; recorded here for reference.
52. Huoluan combined with tendon twitching is primarily treated with Wu Ling San plus Fang Ji, Gui Zhi, and Yi Yi Ren; if Cold is severe and pulse is tight, add Fu Zi additionally.
Liver stores Blood and governs tendons; tendons twist due to Cold-Damp contraction. Thus, in Wu Ling San harmonizing Huoluan, Gui Zhi warms tendons; Fang Ji urgently drives Cold-Damp from Lower Jiao Blood level; Yi Yi Ren (Coicis Semen) treats Damp-Bi and Hong Kong Foot (gout), supports Earth to suppress Wood, and treats tendon urgency and cramping. Severe Cold and tight pulse require pure Yang Fu Zi.
Wu Ling San plus Fang Ji Gui Zhi Yi Yi Ren Formula
To the previous Wu Ling San, add Fang Ji (Stephaniae Tetrandrae Radix) 1 liang, Gui Zhi (Cinnamomi Ramulus) 1.5 liang, totaling 2 liang; Yi Yi Ren (Coicis Semen) 2 liang. For severe Cold, add one large Fu Zi. Grind to fine powder. Take 5 qian mixed with boiling water, three times daily. For severe cases, three times daily and once at night; if patient sleeps, do not administer.
53. Sudden attack of Cold-Damp, internally mixed with filth-turbidity, presenting with vertigo nearly fatal, abdominal colic, deep-tight-slow pulse (even hidden), inability to vomit or defecate despite desire, severe tendon twitching, impending limb cold, commonly named Fa Sha (Scratching Miasma), also called Gan Huoluan (Dry Colic); tendon twitching is commonly named Zhuan Jin Huo (Twitching Fire), not recorded in ancient formularies (not recording refers to not recording these common names; for such syndromes, refer to *Jin Gui* chapters on abdominal fullness, pain, heart pain, Cold Hernia for understanding), primarily treated with Shu Jiao Jiu Zhong Tang (Sichuan Pepper Saving Middle Decoction); Jiu Tong Wan (Nine-Pain Pill) can also be taken; if speech is disordered, first take Zhi Bao Dan (Precious Treasure Pill), then give decoction.
Note: This syndrome is most common during summer Damp steaming, so classified here with Huoluan. Middle Yang is inherently deficient, internally stopping Cold-Damp, further disturbed by steaming filth-turbidity Qi entering directly through mouth/nose to the central pathway, forcing Abdominal Yang, causing struggle and colic; Stomach Yang fails to turn, so although desiring to vomit, cannot; Spleen Yang is trapped, so although desiring to defecate, cannot; if meridians also suffer Cold-Damp, tendons twist like ropes, rear facing forward; Middle Yang deficiency allows Liver Wood to invade, causing reversal. Why commonly named Fa Sha? Because this disease comes rapidly, sometimes too fast to summon a doctor, or doctors don’t recognize it; tradition passes down using coins or porcelain bowl rims dipped in Ginger Soup or Sesame Oil to scrape joints. Scraping divides blood; stopping reunites it; repeated division/reunion generates Yang, joints unblock, Qi turns, often curing instantly; scraped areas show red-purple dots like sand, hence named Sha. However, must not drink water for 12 hours after scraping to prevent recurrence; otherwise, pathogen remains in collaterals, slight cold/anger triggers recurrence. Because desiring to vomit/defecate but unable, causing abdominal pain, also named Gan Huoluan. Tendon twitching named Zhuan Jin Huo because it often occurs in summer (Fire season), and disease is rapid like fire; actually, it is latent Yin struggling with Dampness. Using Shu Jiao (Zanthoxyli Pericarpium) from Da Jian Zhong Tang to urgently drive Yin-Turbidity downward, Gan Jiang...