姜（炒） 薄桂（各七分） 麻黄（一钱五分或二钱无汗用。有汗去之。）
上作一服。姜五片。枣二枚。淡豆豉半合、水二钟。煎钟。食远热服。
潮热。加柴胡、黄芩（各一钱）。
头痛。加羌活（二钱）、细辛（五分）。
呕吐。加藿香（一钱）、丁香（七粒）。
胃脘痛。加木香、吴茱萸（各六分）、香附（一钱）。
食积痛。加白术（一钱）、枳实、山楂、神曲（各八分）、木香、槟榔、砂仁（各五分）。
一身尽痛如被杖。加羌活、独活（各一钱）、柴、荆、皮（八分）。
香港脚。加羌活、独活、防风、木瓜、牛膝、汉防己（各八分）。
咳嗽。加杏仁、款冬花（各八分）、五味子（五分），去姜桂。
痰嗽。加栝蒌仁、贝母、百合（各一钱），去姜桂。
嗽而声哑。加天门冬（一钱）、百药箭（八分）、乌梅（二个），去姜桂。
产后感寒。加柴胡、黄芩（各一钱）、人参（八分）。
经水感寒。加柴胡、荆芥穗、防风（各一钱）、生地、红花（各六分）。
上以上方。皆非正伤寒药。乃刘张李诸公所立。治非时伤寒。或挟内伤者。或挟食。或兼风
减用。若正伤寒。仍遵仲景六经传变施治。庶无误也。
脉 六脉沉微而伏。重按至骨乃见。或迟而涩。挟风则带浮。眩运不仁。兼湿则带濡。而四
脉多沉细而微。四肢厥。而手足爪甲青。
症 集成云。中寒者。寒邪直中三阴也。非比伤寒。邪从外循经而入。以麻桂辈微表而安。
寒则仓猝感受。因其腠理疏豁。一身受邪。难分经络。无热可散。温补自
为寒所中。则昏不知人事。口噤失音。四肢僵直。
及脐腹疼痛。此皆中寒之候
治 蕴要云寒中太阴。则中脘疼痛。宜理中汤。加附子。寒中少阴。则脐腹疼痛。宜五积散
脉沉足冷者。四逆加吴茱萸。厥阴则小腹疼痛。宜当归四逆汤加吴茱萸。
脉浓缩
药。急用茱萸一合。煎浓汤灌下亦妙。大抵寒者温之。治宜姜附等药。以
不治。
方 附子理中汤治中寒及一切寒症。随症加减用。
人参（二钱） 白术（二钱） 甘草（五分） 干姜（炮二钱） 附子（面包煨二钱）
上用水一钟半。煎至八分。食远服。
寒中太阴。根据本方。
寒中少阴。加吴茱萸（二钱）。
寒中厥阴。加当归、芍药、桂枝（各一钱五分）、吴茱萸（二钱）。
沉寒痼冷。加丁香（一钱）、官桂（一钱五分）、沉香（七分）。
心腹冷痛。加官桂、吴茱萸、白芍药、玄胡索（各一钱五分）、木香（一钱）。
胃寒咳逆。加丁香（一钱）、柿蒂（一钱五分）。
妇人血虚寒。加当归、官桂、艾叶、吴茱萸（各一钱五分）、益志（一钱）。
男妇下元冷极。久不孕育。加鹿茸、官桂、茱萸（各一钱五分）、蕲艾（一钱）、沉香（一钱）。
小儿冷泻。加肉豆蔻（一钱五分）、丁香（七分）。
脚膝冷痛。加鹿茸、牛膝、官桂（各等分）、或丸。或煎。
腰冷如冰。加鹿茸、杜仲、破故纸、肉苁蓉（各等分）、或丸亦可。
精清如水。精冷如冰。加肉苁蓉、韭子、鹿茸（各等分）、海狗肾（一具）。
【方剂组成】
生姜（炒制）七分，薄桂（即肉桂，去粗皮者）七分。麻黄一钱五分至二钱：若无汗症使用；若有汗症则去除麻黄。
【煎服方法】
以上药材为一剂用量。加入生姜五片、大枣二枚、淡豆豉半合，加水两钟（约400-500毫升），煎煮至一钟（约200-250毫升）。在饭后稍远时热服。
【随症加减】
若出现潮热（定时发热），加柴胡、黄芩各一钱。
若头痛，加羌活二钱、细辛五分。
若呕吐，加藿香一钱、丁香七粒。
若胃脘疼痛，加木香、吴茱萸各六分、香附一钱。
若因食积引起的疼痛，加白术一钱、枳实、山楂、神曲各八分、木香、槟榔、砂仁各五分。
若全身疼痛如被杖击般剧烈，加羌活、独活各一钱、柴胡、荆芥、陈皮各八分。
若患香港脚（脚气病），加羌活、独活、防风、木瓜、牛膝、汉防己各八分。
若咳嗽，加杏仁、款冬花各八分、五味子五分，并去掉生姜和肉桂。
若痰多咳嗽，加瓜蒌仁、贝母、百合各一钱，并去掉生姜和肉桂。
若咳嗽且声音嘶哑，加天门冬一钱、百药箭八分、乌梅二个，并去掉生姜和肉桂。
若产后感受寒邪，加柴胡、黄芩各一钱、人参八分。
若经期感受寒邪，加柴胡、荆芥穗、防风各一钱、生地、红花各六分。
【按语】
上述方剂均非治疗典型伤寒的正统药物，而是由刘完素、张元素、李东垣等医家所创立，主要用于治疗非时之伤寒，或兼有内伤、食滞的情况，需酌情减量使用。若是典型的伤寒，仍应遵循张仲景的六经传变理论进行施治，这样才能避免错误。
【脉象】
六脉沉微而伏，重按至骨方能触及。或者脉迟而涩。若兼夹风邪，则脉带浮象。伴有眩晕、肢体麻木不仁。若兼夹湿邪，则脉带濡象，且四脉多表现为沉细而微。四肢厥冷，手足指甲青紫。
【症状】
《集成》记载：中寒证，是寒邪直接侵入三阴经。不同于伤寒，伤寒之邪是从体表循经络而入，可用麻黄汤、桂枝汤等轻微发汗以安顿正气。而中寒则是仓促感受寒邪，因为腠理疏松，全身受邪，难以区分具体经络，体内无热可散，故宜用温补法。
若被寒邪所中，则会出现昏迷不知人事、牙关紧闭、失音、四肢僵硬挺直。
以及脐腹部疼痛，这些都是中寒的表现。
【治法】
《蕴要》记载：寒邪中于太阴经，则中脘穴处疼痛，宜用理中汤加附子。寒邪中于少阴经，则脐腹部疼痛，宜用五积散。
若脉沉、足冷者，用四逆汤加吴茱萸。寒邪中于厥阴经，则小腹部疼痛，宜用当归四逆汤加吴茱萸。
若脉象沉伏细微，用药急迫时，可用茱萸一合，煎成浓汤灌服，效果亦妙。大抵寒证宜用温法，治疗适宜选用干姜、附子等药物。若不治疗，病情会恶化。
【方剂：附子理中汤】
主治中寒及一切寒证，随症状加减使用。
人参二钱，白术二钱，甘草五分，干姜（炮制）二钱，附子（面粉包裹煨熟）二钱。
以上用水一钟半，煎至八分，饭后稍远时服用。
【附子理中汤加减】
寒中太阴：依本方原方使用。
寒中少阴：加吴茱萸二钱。
寒中厥阴：加当归、芍药、桂枝各一钱五分、吴茱萸二钱。
沉寒痼冷（久治不愈的深重寒邪）：加丁香一钱、官桂（肉桂）一钱五分、沉香七分。
心腹冷痛：加官桂、吴茱萸、白芍药、玄胡索各一钱五分、木香一钱。
胃寒咳逆：加丁香一钱、柿蒂一钱五分。
妇人血虚寒证：加当归、官桂、艾叶、吴茱萸各一钱五分、益智仁一钱。
男女下元极冷，长期不孕：加鹿茸、官桂、茱萸各一钱五分、蕲艾一钱、沉香一钱。
小儿冷泻：加肉豆蔻一钱五分、丁香七分。
脚膝冷痛：加鹿茸、牛膝、官桂各等分，可制成丸剂或煎剂。
腰部寒冷如冰：加鹿茸、杜仲、破故纸（补骨脂）、肉苁蓉各等分，也可制成丸剂。
精液清稀如水，精冷如冰：加肉苁蓉、韭子、鹿茸各等分、海狗肾一个。
[Formula Composition]
Shengjiang (Fried Ginger Rhizome) 7 fen, Bo Gui (Thin Cinnamon Bark, *Cinnamomi Cortex*) 7 fen. Mahuang (Ephedra Herb, *Ephedrae Herba*) 1.5 qian to 2 qian: Use if there is no sweating; remove if there is sweating.
[Decoction and Administration]
The above herbs constitute one dose. Add Shengjiang (Ginger Rhizome) 5 slices, Dazao (Jujube Fruit, *Ziziphi Jujubae Fructus*) 2 pieces, Danshichi (Fermented Soybean, *Sojae Semen Preparatum*) half he, with two zhong of water. Decoct until one zhong remains. Take hot on an empty stomach, some time after meals.
[Symptomatic Modifications]
If tidal fever (fever at specific times) occurs, add Chaihu (Bupleurum Root, *Bupleuri Radix*) and Huangqin (Scutellaria Root, *Scutellariae Radix*), each 1 qian.
If headache occurs, add Qianghuo (Notopterygium Rhizome, *Notopterygii Rhizoma et Radix*) 2 qian, and Xixin (Asarum Root, *Asari Radix et Rhizoma*) 5 fen.
If vomiting occurs, add Huoxiang (Patchouli Herb, *Agastaches Herba*) 1 qian, and Dingxiang (Clove, *Caryophylli Flos*) 7 grains.
If epigastric pain occurs, add Muxiang (Aucklandia Root, *Aucklandiae Radix*), Wuzhuyu (Evodia Fruit, *Evodiae Fructus*), each 6 fen, and Xiangfu (Cyperus Rhizome, *Cyperī Rhizoma*) 1 qian.
If pain due to food stagnation occurs, add Baizhu (Atractylodes Macrocephala Rhizome, *Atractylodis Macrocephalae Rhizoma*) 1 qian, Zhishi (Immature Bitter Orange, *Aurantii Fructus Immaturus*), Shanzha (Hawthorn Fruit, *Crataegi Fructus*), Shenqu (Medicated Leaven, *Massa Medicata Fermentata*), each 8 fen, Muxiang (Aucklandia Root, *Aucklandiae Radix*), Binglang (Areca Seed, *Arecae Semen*), and Sharen (Amomum Fruit, *Amomi Fructus*), each 5 fen.
If the whole body aches severely as if beaten by a stick, add Qianghuo (Notopterygium Rhizome, *Notopterygii Rhizoma et Radix*), Duhuo (Angelica Pubescens Root, *Angelicae Pubescentis Radix*), each 1 qian, Chaihu (Bupleurum Root, *Bupleuri Radix*), Jingjie (Schizonepeta Spike, *Schizonepetae Spica*), and Pimen (Tangerine Peel, *Citri Reticulatae Pericarpium*), each 8 fen.
If Hongxiangjiao (Beriberi/Jiaqi disease) occurs, add Qianghuo (Notopterygium Rhizome, *Notopterygii Rhizoma et Radix*), Duhuo (Angelica Pubescens Root, *Angelicae Pubescentis Radix*), Fangfeng (Saposhnikovia Root, *Saposhnikoviae Radix*), Mugua (Chaenomeles Fruit, *Chaenomelis Fructus*), Niuxi (Achyranthes Root, *Achyranthis Bidentatae Radix*), Hanfangji (Stephania Tetrandra Root, *Stephaniae Tetrandrae Radix*), each 8 fen.
If cough occurs, add Xingren (Apricot Seed, *Armeniacae Semen Amarum*), Kuandonghua (Coltsfoot Flower, *Farfarae Flos*), each 8 fen, and Wuweizi (Schisandra Fruit, *Schisandrae Chinensis Fructus*) 5 fen; remove Shengjiang (Ginger Rhizome, *Zingiberis Rhizoma Recens*) and Guizhi (Cinnamon Twig, *Cinnamomi Ramulus*).
If phlegm-cough occurs, add Gualouren (Trichosanthes Seed, *Trichosanthis Semen*), Beimu (Fritillaria Bulb, *Fritillariae Cirrhosae Bulbus*), Baihe (Lily Bulb, *Lilii Bulbus*), each 1 qian; remove Shengjiang (Ginger Rhizome, *Zingiberis Rhizoma Recens*) and Guizhi (Cinnamon Twig, *Cinnamomi Ramulus*).
If cough with hoarseness occurs, add Tianmendong (Asparagus Root, *Asparagi Radix*) 1 qian, Baiyaojian (Polygala Tenuifolia Root, *Polygalae Radix*), 8 fen, and Wumei (Mume Fruit, *Mume Fructus*) 2 pieces; remove Shengjiang (Ginger Rhizome, *Zingiberis Rhizoma Recens*) and Guizhi (Cinnamon Twig, *Cinnamomi Ramulus*).
If cold pathogen is contracted after childbirth, add Chaihu (Bupleurum Root, *Bupleuri Radix*), Huangqin (Scutellaria Root, *Scutellariae Radix*), each 1 qian, and Renshen (Ginseng Root, *Panacis Ginseng Radix*) 8 fen.
If cold pathogen is contracted during menstruation, add Chaihu (Bupleurum Root, *Bupleuri Radix*), Jingjie Sui (Schizonepeta Spike, *Schizonepetae Spica*), Fangfeng (Saposhnikovia Root, *Saposhnikoviae Radix*), each 1 qian, and Shengdi (Rehmannia Root, *Rehmanniae Radix*), Honghua (Carthamus Flower, *Carthami Flos*), each 6 fen.
[Commentary]
The above formulas are not orthodox medicines for treating typical Shanghan (Cold Damage). They were established by physicians such as Liu Wansu, Zhang Yuansu, and Li Dongyuan. They treat non-seasonal Shanghan or cases complicated by internal injury or food retention, and should be used in reduced doses. If it is typical Shanghan, treatment should still follow Zhang Zhongjing's theory of Six Meridian transmission to avoid errors.
[Pulse Diagnosis]
The six pulses are deep, faint, and hidden (Fu pulse), only palpable when pressed heavily to the bone. Or the pulse is slow and choppy. If complicated by wind, the pulse may have a floating quality. Accompanied by dizziness and numbness/loss of sensation. If complicated by dampness, the pulse has a soggy (Ru) quality, and the four pulses are often deep, fine, and faint. Cold extremities (Jue limb), with cyanosis of fingernails and toenails.
[Symptoms]
*Jicheng* records: Zhonghan (Mid-Cold syndrome) refers to cold pathogen directly invading the Three Yin meridians. It differs from Shanghan, where the pathogen enters from the exterior along the meridians, which can be treated with mild diaphoresis using Mahuang Tang or Guizhi Tang. Zhonghan is contracted suddenly because the pores are open, affecting the whole body without clear meridian differentiation. There is no heat to dissipate, so warming and tonifying methods are appropriate.
If struck by cold, one may experience coma/unconsciousness, locked jaw (trismus), loss of voice, and stiff, straight limbs.
Also, pain in the umbilical and abdominal regions. These are all signs of Zhonghan.
[Treatment Methods]
*Yunyao* records: If cold invades the Taiyin meridian, pain occurs at the Zhongwan point (CV12); use Lizhong Tang plus Fuzi. If cold invades the Shaoyin meridian, pain occurs in the umbilical and abdominal regions; use Wuji San.
If the pulse is deep and feet are cold, use Sini Tang plus Wuzhuyu. If cold invades the Jueyin meridian, pain occurs in the lower abdomen; use Danggui Sini Tang plus Wuzhuyu.
If the pulse is deep, hidden, and minute, and urgent treatment is needed, decoct Yuzhu (Evodia Fruit, *Evodiae Fructus*) 1 he into a thick decoction and administer orally, which is also effective. Generally, cold syndromes require warming methods; treatment should utilize herbs such as Shengjiang (Ginger Rhizome, *Zingiberis Rhizoma Recens*) and Fuzi (Prepared Aconite Root, *Aconiti Lateralis Radix Praeparata*). Without treatment, the condition will worsen.
[Formula: Fuzi Lizhong Tang]
Treats Zhonghan and all cold syndromes; modify according to symptoms.
Renshen (Ginseng Root, *Panacis Ginseng Radix*) 2 qian, Baizhu (Atractylodes Macrocephala Rhizome, *Atractylodis Macrocephalae Rhizoma*) 2 qian, Gancao (Licorice Root, *Glycyrrhizae Radix et Rhizoma*) 5 fen, Ganjiang (Dried Ginger Rhizome, *Zingiberis Rhizoma*) 2 qian (fried), Fuzi (Prepared Aconite Root, *Aconiti Lateralis Radix Praeparata*) 2 qian (wrapped in flour and baked).
Add one and a half zhong of water, decoct until eight parts remain. Take some time after meals.
[Fuzi Lizhong Tang Modifications]
Cold invading Taiyin: Use the base formula as is.
Cold invading Shaoyin: Add Wuzhuyu (Evodia Fruit, *Evodiae Fructus*) 2 qian.
Cold invading Jueyin: Add Danggui (Angelica Sinensis Root, *Angelicae Sinensis Radix*), Shaoyao (Peony Root, *Paeoniae Radix*), Guizhi (Cinnamon Twig, *Cinnamomi Ramulus*), each 1.5 qian, and Wuzhuyu (Evodia Fruit, *Evodiae Fructus*) 2 qian.
Deep-seated chronic cold: Add Dingxiang (Clove, *Caryophylli Flos*) 1 qian, Guanzi Gui (Cinnamon Bark, *Cinnamomi Cortex*) 1.5 qian, Chenxiang (Aquilaria Wood, *Aquilariae Lignum Resinatum*) 7 fen.
Cold pain in heart and abdomen: Add Guanzi Gui (Cinnamon Bark, *Cinnamomi Cortex*), Wuzhuyu (Evodia Fruit, *Evodiae Fructus*), Baishao Yao (White Peony Root, *Paeoniae Radix Alba*), Yuanhusuo (Corydalis Rhizome, *Corydalidis Rhizoma*), each 1.5 qian, and Muxiang (Aucklandia Root, *Aucklandiae Radix*) 1 qian.
Stomach cold with cough and reverse qi: Add Dingxiang (Clove, *Caryophylli Flos*) 1 qian, Shidi (Persimmon Calyx, *Kaki Calyx*) 1.5 qian.
Women with blood deficiency and cold: Add Danggui (Angelica Sinensis Root, *Angelicae Sinensis Radix*), Guanzi Gui (Cinnamon Bark, *Cinnamomi Cortex*), Aiye (Mugwort Leaf, *Artemisiae Argyi Folium*), Wuzhuyu (Evodia Fruit, *Evodiae Fructus*), each 1.5 qian, and Yizhi (Alpinia Oxyphylla Fruit, *Alpiniae Oxyphyllae Fructus*) 1 qian.
Men and women with extreme cold in the lower origin, leading to long-term infertility: Add Lurong (Deer Antler Glue/Horn, *Cervi Cornu Degelatinatum*), Guanzi Gui (Cinnamon Bark, *Cinnamomi Cortex*), Yuzhu (Evodia Fruit, *Evodiae Fructus*), each 1.5 qian, Qi Ai (Qicheng Mugwort, *Artemisiae Argyi Folium*), 1 qian, and Chenxiang (Aquilaria Wood, *Aquilariae Lignum Resinatum*) 1 qian.
Children with cold diarrhea: Add Roudoukou (Nutmeg, *Myristicae Semen*) 1.5 qian, Dingxiang (Clove, *Caryophylli Flos*) 7 fen.
Cold pain in legs and knees: Add Lurong (Deer Antler Glue/Horn, *Cervi Cornu Degelatinatum*), Niuxi (Achyranthes Root, *Achyranthis Bidentatae Radix*), Guanzi Gui (Cinnamon Bark, *Cinnamomi Cortex*), equal parts; can be made into pills or decoction.
Lower back cold as if ice: Add Lurong (Deer Antler Glue/Horn, *Cervi Cornu Degelatinatum*), Duzhong (Eucommia Bark, *Eucommiae Cortex*), Poguzhi (Psoralea Fruit, *Psoraleae Fructus*), Roucongrong (Cistanche Stem, *Cistanches Herba*), equal parts; pills are also acceptable.
Seminal fluid clear as water, seminal cold as ice: Add Roucongrong (Cistanche Stem, *Cistanches Herba*), Jiu Zi (Leek Seed, *Allii Tuberosi Semen*), Lurong (Deer Antler Glue/Horn, *Cervi Cornu Degelatinatum*), equal parts, and Haigoushen (Sea Dog Kidney, *Odobeni Rosmarinus Ren*) one piece.