跗阳脉微弦，法当腹满，不满者必便难，两 疼痛，此虚寒从下上也，当以温药服之。
【注】跗阳胃脉也，当缓而和，今见弦脉，是肝脉也。肝脉见于脾部，是木盛土虚也，法
当腹满。今不腹满者，肝脉微弦，不盛而脾不虚，故脾未受病也，肝自郁则失其条达之
性，必本经自病，故便难两 痛也。然非肝火实病，此乃虚寒从下上也，当以温药服之。
腹满时减，复如故，此为寒，当与温药。
【按】此篇无治虚寒腹满之方。当与温药之下，当有“宜浓朴生姜甘草半夏人参汤主
之”十四字，必是脱简，阅《伤寒论·太阴篇》自知。
【注】此承上条，互详其证，以明其治也。腹满便难，脾实病也，今腹满而不便难，脾
虚病也。且腹满有时而减，有时复如不满，乃虚寒也，当与温药主之。以浓朴生姜甘草半
夏人参汤，消满散寒，缓中降逆补虚，乃治虚满之法也。
【集注】魏荔彤曰∶腹满或服下药，或服补药。有时减退，未几旋腹满如故，则不可
作实与热治也。仲景明此为寒，里寒从无下法，惟有温药与服，虚者以温中补气，实者亦以温
中行气为义，是治气寒腹满第一善法也。
浓朴生姜甘草半夏人参汤方
浓朴（半斤） 生姜（半斤） 半夏（半斤） 人参（一两） 甘草（炙，三两）
上五味，以水一斗，煮取三升，去滓，温服一升，日三服。
腹满不减，减不足言，当须下之，宜大承气汤。
【注】腹满时减、时满，虚满也；腹满常常而满，实满也。腹满不减，减不足言，谓
腹满不减，虽减不过稍减，不足言减也。虚满当温，实满当下，故宜大承气汤下之，此
治实满之法也。
【集注】尤怡曰∶减不足言，谓虽减而不足云减，所以形其满之至也，故宜大下。所
谓中满者，泻之于内也。
大承气汤方（见前痉病中）
病者腹满，按之不痛为虚，痛者为实，可下之。舌黄未下者，下之黄自去。
【注】前条腹满，以时减、时不减别虚实；此条腹满，以痛、不痛辨有余不足也。腹满
按之不痛为虚，虚者脾虚也，可温之，则当与浓朴生姜甘草半夏人参汤也。按而痛者为
实，实者胃实也，可下之，当与大承气汤。胃实者舌苔必黄，若未下者，下之黄苔自去也。
【集注】赵良曰∶腹满亦有属实，实则非虚寒也明矣，岂概以温药治之乎？故有试之
之法，在痛与不痛之分，虚实较然矣。盖胃实必热，热蒸必舌黄，下其实热，舌黄不自
已乎？有此一辨，并虚者愈审已。
魏荔彤曰∶无形之虚气作痞塞，则按之无物，何痛之有？倘挟有形之实物为患，如
宿食在胃，疝气在少腹等是也。按之有物阻碍于脏腑之侧焉，有不痛者乎？是于按之痛
否，以决其虚实之法也。
病者痿黄，躁而不渴，胸中寒实而利不止者，死。
【按】躁而不渴，当是“燥而不渴”，文始通顺。胸中寒实，当是“胃中寒实”。若是
胸中寒实，如何曰下利不止者死？皆是传写之讹。
【注】病者面色痿黄，若口燥而渴者，热实也；今痿黄口燥不渴，寒实也。寒实者当
不下利，若下利是寒虚也；今下利不止，乃寒虚胃气下脱，故死也。
【集注】程林曰∶痿黄者，脾胃病也。见燥而渴者为热，不渴者为寒。病患既痿黄，又
兼下利不禁，则脾气衰绝，故死。
李 曰∶下利若燥而渴者为热，阳气尚存，犹为可治。今燥而不渴，胃中寒邪盛也，
若利不止，则阴盛阳衰，气下脱矣，故死。
夫瘦人，绕脐痛，必有风冷，谷气不行，而反下之，其气必冲。不冲者，心下则痞。
【注】此承上条“寒实证误以寒药下之”之义也。瘦人形气虚弱，难御外邪，若绕脐
痛，必有风冷伤胃，致令谷气不行也。绕脐疼痛，虽属实邪，但因风冷则为寒实，医者
当温而行之，今反以寒药下之，其风冷之邪，若上虚则气上冲，中虚则痞结心下，理必然
也。
【集注】尤怡曰∶瘦人脏虚气弱，风冷易入，入则谷气留滞不行，绕脐疼痛，有似里
实而实为虚冷。是宜温药以助脾之行，乃反下之，谷出而风冷不与俱出，正乃益虚，邪
乃无制，势必上冲，若不冲者，心下则痞。
寸口脉弦者，即胁下拘急而痛，其人啬啬恶寒也。
【注】此详申首条，两 疼痛属寒之义也。寸口脉弦，即首条之弦也。胁下拘急而痛，即
首条之两 疼痛也。何以知其为寒也？然必其人有阳虚啬啬恶寒之证，始为肝寒而痛也，
即有腹满，亦当温之可也。
【集注】程林曰∶弦，肝脉阴也。肝脉循胁里，寒主收引，故胁下拘急而痛。以寒胜
于内，而阳气不行于外，故外亦啬啬而恶寒也。
夫中寒家，喜欠，其人清涕出，发热色和者，善嚏。
【注】中寒家，谓素有中寒病之人也。前以时减辨腹满之中寒，又以恶寒辨胁痛之中
寒，此以喜欠清涕出而辨心胸之中寒也。欠者，呵欠也。夫人欲睡喜欠者，阴引阳入也；
睡觉喜欠者，阳引阴出也。今中寒喜欠者，是阴盛引阳也。年老之人清涕出者，是阳虚也；
遇寒之人清涕出者，是寒盛也。今中寒而清涕出者，是阳气虚寒也。若发热色和者，非
为中寒也，乃为外寒所搏，虽有清涕出，亦因善嚏而出也。
中寒，其人下利，以里虚也，欲嚏不能，此人肚中寒（一云痛。）
【注】上条以喜欠、清涕自出，辨心胸之中寒；此条以下利、欲嚏不能嚏，而辨腹中
寒也。其人下利里气素虚也，欲嚏不能嚏，何以知此人腹中寒也？盖喷嚏者，雷气之义也，
其人内阳外阴，阳气奋发而为嚏也。今欲嚏不能嚏，是阳欲出而复留，阴气盛也，故知
腹中寒也。
【集注】沈明宗曰∶此脾经受寒现证也。寒中太阴，阴寒湿盛，阳虚不固，其人下利，
但通多不足，故为里虚。盖阳和则嚏，而欲嚏不能，乃阴寒凝滞于里，所以肚中病也。
腹中寒气，雷鸣切痛，胸胁逆满，呕吐，附子粳米汤主之。
【注】腹中切痛寒也，腹中雷鸣气，腹中寒气，故雷鸣切痛。而胸胁逆满者，肠胃
之外寒气为之也；腹痛雷鸣呕吐者，肠胃之中，寒气为之也。主之以附子粳米汤，胜寒
气，和内外，此治腹中寒之法也。
附子粳米汤方
附子（炮，一枚） 半夏（半升） 甘草（一两） 大枣（十枚） 粳米（半升）
上五味，以水八升，煮米熟汤成，去滓，温服一升，日三服。
心胸中大寒痛，呕不能饮食，腹中寒，上冲皮起，出见有头足，上下痛不可触近，大
建中汤主之。
【注】心胸中大寒痛，谓腹中上连心胸大痛也。而名大寒痛者，以有厥逆、脉伏等大
寒证之意也。呕逆不能饮食者，是寒甚拒格于中也。上冲皮起，出见头足者，是寒甚聚
坚于外也。上下痛不可触近，是内而脏腑，外而经络，痛之甚亦由寒之甚也，主之以大建
中汤，蜀椒、干姜大散寒邪，人参、胶饴大建中虚。服后温覆，令有微汗，则寒去而痛
止。此治心胸中寒之法也。
大建中汤方
蜀椒（去汗，二合） 干姜（四两） 人参（二两）
上三味，以水四升，煮取二升，去滓，内胶饴一升，微火煎取一升半，分温再服，如
一爨顷可饮粥二升，后更服，当一日食糜温覆之。
寒气厥逆，赤丸主之。
【按】此条之文、之方，必有简脱，难以为后世法，不释。
赤丸方
茯苓（四两） 半夏（洗，四两一方用桂） 乌头（炮，二两） 细辛（一两）
上四味，末之，真朱为色炼丸，丸如麻子大，先食，酒饮下三丸，日再夜一服。不
知稍增之，以知为度。
痛而闭者，浓朴三物汤主之。
【注】腹满而痛下利者，用理中汤，所以温其中也；腹满而痛便闭者，用浓朴三物汤，
所以开其下也。
浓朴三物汤方
浓朴（八两） 大黄（四两） 枳实（五枚）
上三味，以水一斗二升，先煮二味，取五升，内大黄，煮取三升，温服一升，以利
为度。
其脉数而紧，乃弦，状如弓弦，按之不移。脉弦数者，当下其寒。脉紧大而迟者，必
心下坚。脉大而紧者，阳中有阴，可下之。
【按】“其脉数而紧，乃弦，状如弓弦，按之不移，脉弦数者”之十九字，当是衍文，阅
《伤寒论·辨脉法》自知。“当下其寒”之四
字，当在“必心下坚”之下，文义始属。
【注】脉紧大而迟者，必心下坚硬，乃寒实也，当下其寒。脉大而紧者，阳中有阴也，
大者阳实，紧者阴实也，故可下之。
胁下偏痛，发热，其脉紧弦，此寒也，宜温药下之，以大黄附子汤。
【按】胁下偏痛之“偏”字，当是“满”字，必是传写之讹。
【注】腹满而痛，脾实邪也；胁下满痛，肝实邪也；发热若脉数大，胃热实邪也。今
脉紧弦，脾寒实邪也，当以温药下之，故以大黄附子汤下其寒实。方中佐细辛者，以散
其肝邪，此下肝脾寒实之法也。
【集注】尤怡曰∶胁中满痛而脉紧弦，阴
寒成聚也，虽有发热，亦是阳气被郁所致。是以非温不能已其寒，非下不能去其结，故曰∶
宜以温药下之。
大黄附子汤方
大黄（三两） 附子（炮，三枚） 细辛（二两）
上三味，以水五升，煮取二升，分温三服；若强人煮取二升半，分温三服。服后如
人行四五里，进一服。
病腹满，发热，十日脉浮而数，饮食如故，浓朴七物汤主之。
【注】病腹满，里证也。发热，里热也。然十日脉浮而数，表热亦未已也。饮食如故，
胃热能消谷也。因胃热里实，表热发热，故用浓朴七物汤，表里均解，腹满发热两除也。
此桂枝汤、小承气汤之复方也。
【集注】程林曰∶腹满者，内有实热也。十日脉尚浮而数，浮为在表，表热邪未已，故
发热。数为在里，里热能消谷，故饮食如故。与此方荡腹满而除表热。夫表里俱实，当先
解表，乃可攻里，今表邪微而里邪甚，故用承气桂枝二汤，相合以和表里，如伤寒之用
大柴胡，此其义也。
浓朴七物汤方
浓朴（半斤） 甘草（三两） 大黄（二两） 大枣（十枚） 枳实（五枚） 桂枝（二
两） 生姜（五两）
上七味，以水一斗，煮取四升，温服八合，日三服。呕者加半夏五合。下利去大黄。
寒多者，加生姜至半斤。
按之心下满痛者，此为实也，当下之，宜大柴胡汤。
【按】按之心下满痛之下，当有“有潮热”之三字，若无此三字，则不当与大柴胡
汤，是必传写之遗。
【注】按之心下满痛，有潮热者，此为表里俱实，当下之，宜大柴胡汤两解之。此二
治皆下实满之法也。
大柴胡汤方
柴胡（半斤） 黄芩（三两） 芍药（三两） 半夏（洗，半斤） 枳实（炙，四枚） 大
黄（二两） 大枣（十二枚） 生姜（五两）
上八味，以水一斗二升，煮取六升，去滓再煎，温服一升，日三服。
腹痛，脉弦而紧，弦则卫气不行，即恶寒，紧则不欲食，邪正相搏，即为寒疝。绕
脐痛苦，发则白汁出，手足厥冷，其脉沉紧者，大乌头煎主之。
【按】此条脉重出，下条有证无脉，“其脉沉紧者”之五字，当在下条里急之下。然脉弦
而紧，是劲急之甚，当属寒疝之重者，其白汗之“白”字，当是“自”字。下条其脉沉紧是里痛
之脉，当属寒疝之轻者，必是传写之讹。
【注】疝病犯寒即发，故谓之寒疝也。其病发则绕脐少腹急痛，恶寒汗出，手足厥冷，
不欲饮食，脉弦而紧，主急主痛，此寒疝应有之证脉也。主之乌头煎者，是专以破邪治
标为急，虚实在所不论，故曰∶强人服七合，弱人服五合也。
乌头煎方
乌头（熬，去皮，不 咀，大者五枚)
上以水三升，煮取一升，去滓，内蜜二升，煎令水气尽，取二升，强人服七合，弱
人服五合，不瘥明日更服，不可一日再服。
寒疝，腹中痛，及胁痛里急者，当归生姜羊肉汤主之。
【按】胁痛里急之下，当有上条“其脉沉紧”四字。
【注】寒疝腹中痛及胁痛里急，脉见沉紧，较之绕脐苦痛轻矣。且无恶寒汗出，手足厥
冷，故不用乌头煎之大温大散，而用当归生姜羊肉汤，养正为本，散寒为次，此治寒疝
之和剂也。服乌头煎病势退者，亦当与之。
【集注】李 曰∶疝属肝病，肝藏血，其经布胁肋，腹胁并痛者，血气寒而凝涩也。当
归通经活血，生姜温中散寒。里急者内虚也，用羊肉补之。《内经》云∶形不足者，温之以
气，精不足者，补之以味是也。
沈明宗曰∶按此连冲脉为疝，治当温补也。肝木受邪，乘脾则腹中痛；本经之气不
舒，故胁亦痛；连及冲脉则里急矣，所以当归补养冲任而散风寒，羊肉温补营卫之气，脾
邪散而痛自止。方后云∶痛而多呕，乃肝气上逆临胃，故加橘、术补之。
当归生姜羊肉汤方
当归（三两） 生姜（五两） 羊肉（一斤）
上三味，以水八升，煮取三升，温服七合，日三服。若寒多者，加生姜成一斤。痛
多而呕者，加橘皮二两。白术一两。加生姜者，亦加水五升，煮取三升二合，服之。
寒疝，腹中痛，逆冷，手足不仁，若身疼痛，灸刺、诸药不能治，抵当乌头桂枝汤
跗阳脉（此处指足阳明胃经之脉，实指右关脉）微现弦象，按照医理应当出现腹部胀满；若没有腹满，则必然出现大便困难、两侧胁肋部疼痛。这是虚寒之气从下向上侵犯所致，应当服用温性药物进行治疗。
【注】跗阳脉（此处指右关脉，候脾胃）本应呈现缓而和缓的脉象，现在却见到弦脉，这是肝脉的表现。肝脉出现在脾部（右关），说明木气过盛而土气虚弱，按照医理应当出现腹部胀满。如今不出现腹满，是因为肝脉只是微弦，并不旺盛，且脾气未虚，所以脾脏尚未受病。但是肝气自身郁结，失去了条达舒畅的特性，必然导致本经自病，所以出现大便困难和两胁疼痛。然而这并非肝火实证，而是虚寒之气从下向上侵犯，应当服用温性药物。
腹部胀满有时减轻，过后又像原来一样，这是寒证，应当给予温性药物治疗。
【按语】这一篇中没有治疗虚寒性腹满的方剂。“当与温药”之下，应当有“宜浓朴生姜甘草半夏人参汤主之”这十四个字，必定是简牍脱漏，阅读《伤寒论·太阴篇》自然知晓。
【注】此条承接上一条，互相详述其证候，以阐明治疗方法。腹满伴有大便困难，是脾实证；如今腹满而不伴大便困难，是脾虚证。而且腹满有时减轻，有时又恢复如不满的状态，属于虚寒证，应当用温性药物主治。使用浓朴生姜甘草半夏人参汤，可以消除胀满、驱散寒气、缓和其中焦气机、降逆止呕并补益虚弱，这是治疗虚性胀满的方法。
【集注】魏荔彤说：腹满有的服用泻下药，有的服用补药。如果有时减退，不久又恢复腹满如故，就不能当作实证和热证来治疗。张仲景明确指出这是寒证，里寒证从无使用下法的道理，只有服用温药。虚证通过温中补气治疗，实证也通过温中行气的意义来治疗，这是治疗气寒腹满的第一种良法。
浓朴生姜甘草半夏人参汤方
浓朴（半斤） 生姜（半斤） 半夏（半升） 人参（一两） 甘草（炙，三两）
以上五味药，用水一斗，煮取三升药液，去掉药渣，每次温服一升，每天服用三次。
腹部胀满持续不减，即使减轻也微不足道，应当必须使用攻下法，适宜用大承气汤。
【注】腹满时减时满，是虚性胀满；腹满持续存在，是实性胀满。腹满不减，减不足言，意思是腹满不减轻，即使减轻也不过是稍微减轻，不足以称为减轻。虚性胀满应当温治，实性胀满应当攻下，所以适宜用大承气汤攻下，这是治疗实性胀满的方法。
【集注】尤怡说：减不足言，意思是虽然减轻但不足以称之为减轻，以此形容胀满到了极点，所以适宜大力攻下。这就是所说的“中满者，泻之于内”。
病人腹部胀满，按压时不痛的为虚证，痛的为实证，可以使用攻下法。舌苔发黄且未经过攻下治疗的，攻下后黄苔自然会去除。
【注】前一条腹满，通过时减、时不减来辨别虚实；这一条腹满，通过痛与不痛来辨别有余和不足。腹部胀满按压不痛的是虚证，虚证是脾虚，可以用温法，就应当给予浓朴生姜甘草半夏人参汤。按压疼痛的是实证，实证是胃实，可以用攻下法，应当与大承气汤。胃实证舌苔必然发黄，如果没有经过攻下，攻下后黄苔自然就会去除。
【集注】赵良说：腹满也有属于实证的，实证就不是虚寒，这很明白，难道一概用温药治疗吗？所以有试探的方法，在于痛与不痛的区别，虚实非常明显。大概胃实必然有热，热蒸腾必然舌苔发黄，攻下其实热，舌黄能不自己去除吗？有了这一辨别，对虚证的判断也更加审慎了。
魏荔彤说：无形的虚气造成痞塞，那么按压时没有实物，怎么会痛呢？倘若夹杂有形的实物为患，比如宿食在胃，疝气在少腹等就是这种情况。按压时有物体阻碍在脏腑旁边，会有不痛的吗？这就是通过按压痛否来判断虚实的方法。
病人面色萎黄，烦躁但不口渴，胸中有寒实邪气且腹泻不止的，预后不良（死证）。
【按语】“躁而不渴”，应当是“燥而不渴”，文意才通顺。“胸中寒实”，应当是“胃中寒实”。如果是胸中寒实，怎么说是腹泻不止者死？这些都是传抄书写造成的错误。
【注】病人面色萎黄，如果口燥而渴，是热实证；如今萎黄、口燥但不渴，是寒实证。寒实证应当不腹泻，如果腹泻那是寒虚证；如今腹泻不止，是寒虚导致胃气下脱，所以预后不良（死证）。
【集注】程林说：萎黄，是脾胃的病。见到口燥而渴的是热证，不渴的是寒证。病人既然面色萎黄，又兼有下利不禁，那么脾气衰败绝灭，所以死亡。
李 说：下利如果口燥而渴的是热证，阳气尚存，还可以治疗。如今口燥但不渴，是胃中寒邪盛极，如果腹泻不止，那么阴盛阳衰，气机下脱，所以死亡。
瘦人，脐周疼痛，必定有风冷邪气，谷气运行不畅，如果反而使用攻下法，气机必然上冲。如果不冲逆，心下部就会形成痞证。
【注】此条承接上一条“寒实证误用寒药攻下”的意义。瘦人体形和气机虚弱，难以抵御外邪，如果脐周疼痛，必定有风冷伤胃，导致谷气运行不畅。绕脐疼痛，虽然属实邪，但因为风冷所以成为寒实证，医者应当用温法治疗，如今反而用寒药攻下，风冷之邪，如果上部虚则气机上冲，中部虚则痞结于心下，道理必然是这样。
【集注】尤怡说：瘦人脏气虚弱，风冷容易侵入，侵入后谷气留滞不行，绕脐疼痛，看似里实证但实际上是虚冷。适宜用温药帮助脾的运行，反而攻下，谷气排出而风冷邪气不随之排出，正是更加虚弱，邪气失去制约，势必上冲，如果不冲逆，心下部就会痞塞。
【注】此条详细阐述第一条，说明两胁疼痛属于寒证的意义。寸口脉弦，就是第一条中的弦脉。胁下拘急疼痛，就是第一条中的两胁疼痛。怎么知道它是寒证呢？然而必须有阳气虚弱、啬啬怕冷的症状，才是肝寒而痛，即使有腹满，也应当用温法治愈。
【集注】程林说：弦，是肝脉，属阴。肝脉循行于胁肋内部，寒主收引，所以胁下拘急疼痛。因为寒胜于内，阳气不能行于外，所以体表也啬啬怕冷。
患有中寒病的人，喜欢打哈欠，此人清鼻涕流出，如果发热且面色正常，善于打喷嚏。
【注】中寒家，谓素来患有中寒病的人。前面通过时减辨别腹满中的中寒，又通过恶寒辨别胁痛中的中寒，这里通过喜欢打哈欠、流清鼻涕来辨别心胸部位的中寒。欠，就是打哈欠。人想睡觉时喜欢打哈欠，是阴气牵引阳气入内；睡醒时喜欢打哈欠，是阳气牵引阴气外出。如今中寒喜欢打哈欠，是阴盛牵引阳气。年老之人流清鼻涕，是阳气虚；遇寒之人流清鼻涕，是寒盛。如今中寒而流清鼻涕，是阳气虚寒。如果发热且面色平和，不是中寒，而是被外寒所搏，虽然有清鼻涕流出，也是因为善于打喷嚏而出。
中寒，此人腹泻，是因为里气虚，想要打喷嚏但不能打出，这个人肚中寒冷（一说腹痛）。
【注】上一条通过喜欢打哈欠、清鼻涕自出，辨别心胸中的中寒；这一条通过腹泻、欲嚏不能，辨别腹中的寒。此人腹泻，里气素来虚弱。想要打喷嚏但不能打出，怎么知道这个人腹中寒呢？大概喷嚏，是雷气的含义，人内阳外阴，阳气奋发而为喷嚏。如今欲嚏不能，是阳气想出来又停留，阴气盛，所以知道腹中寒。
【集注】沈明宗说：这是脾经受寒的表现。寒中太阴，阴寒湿盛，阳虚不固，此人腹泻，大多正气不足，所以为里虚。大概阳气和顺则打喷嚏，而欲嚏不能，是阴寒凝滞在里，所以肚中病。
腹中寒气，肠鸣如雷，剧烈疼痛，胸胁气逆胀满，呕吐，用附子粳米汤主治。
【注】腹中剧烈疼痛是寒，腹中肠鸣是气，腹中有寒气，所以肠鸣剧烈疼痛。胸胁气逆胀满，是肠胃之外的寒气造成的；腹痛肠鸣呕吐，是肠胃之中的寒气造成的。用附子粳米汤主治，战胜寒气，调和内外，这是治疗腹中寒的方法。
附子粳米汤方
附子（炮，一枚） 半夏（半升） 甘草（一两） 大枣（十枚） 粳米（半升）
以上五味药，用水八升，煮到米熟汤成，去掉药渣，每次温服一升，每天服用三次。
心胸中大寒痛，呕吐不能饮食，腹中寒冷，气上冲皮肤隆起，出现像头足一样的形状，上下疼痛不可触碰接近，用大建中汤主治。
【注】心胸中大寒痛，谓腹中向上连及心胸剧烈疼痛。命名为大寒痛，是因为有四肢厥逆、脉伏等大寒证的意思。呕吐逆乱不能饮食，是寒邪甚盛格拒于中焦。气上冲皮肤隆起，出现头足形状，是寒邪甚盛聚结于体表。上下疼痛不可触碰接近，是内部脏腑、外部经络，疼痛严重也是由于寒邪严重，用大建中汤主治，蜀椒、干姜大大驱散寒邪，人参、胶饴大大建立中焦虚弱。服药后温覆身体，令有微汗，则寒去而痛止。这是治疗心胸中寒的方法。
大建中汤方
蜀椒（去汗，二合） 干姜（四两） 人参（二两）
以上三味药，用水四升，煮取二升药液，去掉药渣，加入胶饴一升，用微火煎取一升半，分两次温服。如果一顿饭的工夫可以喝粥二升，之后再次服用，应当一天吃糜粥，并温覆身体。
【按语】此条的文字和方剂，必定有简牍脱漏，难以作为后世效法的标准，不解释。
赤丸方
茯苓（四两） 半夏（洗，四两一方用桂） 乌头（炮，二两） 细辛（一两）
以上四味药，研成粉末，用真朱砂调色，炼蜜为丸，丸如麻子大，饭前，用酒送服三丸，白天服两次，晚上服一次。无效稍加剂量，以见效为度。
【注】腹满而痛伴腹泻的，用理中汤，用来温暖中焦；腹满而痛伴便秘的，用浓朴三物汤，用来开通下部。
浓朴三物汤方
浓朴（八两） 大黄（四两） 枳实（五枚）
以上三味药，用水一斗二升，先煮浓朴和枳实，取五升药液，加入大黄，煮取三升，温服一升，以大便通畅为度。
脉数而紧，就是弦脉，形状像弓弦，按压不移位。脉弦数的，应当攻下其寒。脉紧大而迟的，必定心下坚硬。脉大而紧的，阳中有阴，可以攻下。
【按语】“其脉数而紧，乃弦，状如弓弦，按之不移，脉弦数者”这十九个字，应当是衍文，阅读《伤寒论·辨脉法》自然知晓。“当下其寒”这四个字，应当在“必心下坚”之下，文义才连贯。
【注】脉紧大而迟的，必定心下坚硬，是寒实证，应当攻下其寒。脉大而紧的，阳中有阴，大者是阳实，紧者是阴实，所以可以攻下。
胁下偏侧疼痛，发热，脉紧弦，这是寒证，适宜用温药攻下，用大黄附子汤。
【按语】胁下偏痛之“偏”字，应当是“满”字，必定是传抄错误。
【注】腹满而痛，是脾实邪；胁下满痛，是肝实邪；发热若脉数大，是胃热实邪。如今脉紧弦，是脾寒实邪，应当用温药攻下，所以用大黄附子汤攻下其寒实。方中佐以细辛，是为了驱散肝邪，这是下肝脾寒实的方法。
【集注】尤怡说：胁中满痛而脉紧弦，阴寒成聚，虽然有发热，也是阳气被郁遏所致。所以非温不能止其寒，非下不能去其结，所以说：适宜用温药攻下。
大黄附子汤方
大黄（三两） 附子（炮，三枚） 细辛（二两）
以上三味药，用水五升，煮取二升，分三次温服；如果体质强壮者煮取二升半，分三次温服。服药后如人行走四五里的时间，再进一服。
病腹部胀满，发热，十日脉浮而数，饮食如常，用浓朴七物汤主治。
【注】病腹部胀满，是里证。发热，是里热。然而十日脉浮而数，表热也未停止。饮食如常，是胃热能消谷。因为胃热里实，表热发热，所以用浓朴七物汤，表里双解，腹满发热两除。这是桂枝汤和小承气汤的复方。
【集注】程林说：腹满是内有实热。十日脉尚浮而数，浮为在表，表热邪未已，所以发热。数为在里，里热能消谷，所以饮食如常。给此方荡涤腹满而除去表热。表里俱实，应当先解表，才可攻里，如今表邪微而里邪甚，所以用承气桂枝二汤，相合以调和表里，如同伤寒之用大柴胡，其义相同。
浓朴七物汤方
浓朴（半斤） 甘草（三两） 大黄（二两） 大枣（十枚） 枳实（五枚） 桂枝（二两） 生姜（五两）
以上七味药，用水一斗，煮取四升，温服八合，每天服用三次。呕吐者加半夏五合。腹泻者去大黄。寒多者，加生姜至半斤。
【按语】按压心下部胀满疼痛之下，应当有“有潮热”这三个字，如果没有这三个字，就不应当用大柴胡汤，必定是传抄遗漏。
【注】按压心下部胀满疼痛，有潮热的，这是表里俱实，应当攻下，适宜用大柴胡汤两解。这两种治法都是下实满的方法。
大柴胡汤方
柴胡（半斤） 黄芩（三两） 芍药（三两） 半夏（洗，半斤） 枳实（炙，四枚） 大黄（二两） 大枣（十二枚） 生姜（五两）
以上八味药，用水一斗二升，煮取六升，去掉药渣再煎，温服一升，每天服用三次。
腹痛，脉弦而紧，弦则卫气不行，即恶寒，紧则不欲食，邪正相搏，即为寒疝。绕脐痛苦，发作时出白汁（自汗），手足厥冷，脉沉紧的，用大乌头煎主治。
【按语】此条脉象重出，下条有证无脉，“其脉沉紧者”这五个字，应当在下条里急之下。然而脉弦而紧，是劲急之甚，当属寒疝之重者，其白汗之“白”字，应当是“自”字。下条其脉沉紧是里痛之脉，当属寒疝之轻者，必定是传抄错误。
【注】疝病犯寒即发，所以叫寒疝。其病发作则绕脐少腹急痛，恶寒汗出，手足厥冷，不欲饮食，脉弦而紧，主急主痛，这是寒疝应有的证候脉象。主治用乌头煎，是专以破邪治标为急，不论虚实在所不问，所以说：强壮人服七合，体弱者服五合。
乌头煎方
乌头（熬，去皮，不切碎，大者五枚)
以上用水三升，煮取一升药液，去掉药渣，加入蜜二升，煎令水气尽，取二升，强壮人服七合，体弱者服五合，不好明天再服，不可一天服两次。
【注】寒疝腹中痛及胁痛里急，脉见沉紧，比绕脐苦痛轻了。而且没有恶寒汗出，手足厥冷，所以不用乌头煎的大温大散，而用当归生姜羊肉汤，养正为本，散寒为次，这是治疗寒疝的和剂。服乌头煎病势退者，也应当服用它。
【集注】李 说：疝属肝病，肝藏血，其经脉布于胁肋，腹胁并痛，是血气寒而凝涩。当归通经活血，生姜温中散寒。里急是内虚，用羊肉补之。《内经》说：形不足者，温之以气，精不足者，补之以味。
沈明宗说：按此连冲脉为疝，治当温补。肝木受邪，乘脾则腹中痛；本经之气不舒，所以胁亦痛；连及冲脉则里急了，所以当归补养冲任而散风寒，羊肉温补营卫之气，脾邪散而痛自止。方后说：痛而多呕，是肝气上逆临胃，所以加橘皮、白术补之。
当归生姜羊肉汤方
当归（三两） 生姜（五两） 羊肉（一斤）
以上三味药，用水八升，煮取三升，温服七合，每天服用三次。如果寒多者，加生姜成一斤。痛多而呕者，加橘皮二两，白术一两。加生姜者，也加水五升，煮取三升二合，服用。
The Fuyang pulse (here referring to the foot Yangming stomach meridian pulse, actually indicating the right Guan pulse) is slightly wiry. According to medical principles, abdominal fullness should occur; if there is no abdominal fullness, there must be difficulty in defecation and pain in both hypochondriac regions. This is caused by deficiency-cold qi invading from below upwards, and warming medicines should be administered.
[Annotation] The Fuyang pulse (here referring to the right Guan pulse, which monitors the spleen and stomach) should naturally present as slow and harmonious. The appearance of a wiry pulse indicates a liver pulse. When the liver pulse appears in the spleen area (right Guan), it signifies excessive wood qi and deficient earth qi. Medically, abdominal fullness should ensue. Since abdominal fullness does not currently occur, it is because the liver pulse is only slightly wiry, not vigorous, and the spleen qi is not deficient, so the spleen has not yet been diseased. However, the liver qi itself is stagnant, losing its free-flowing nature, leading to disease within its own meridian, resulting in difficulty in defecation and pain in the two hypochondriac regions. Yet this is not a liver fire excess syndrome, but rather deficiency-cold qi invading from below upwards; warming medicines should be taken.
Abdominal fullness that decreases intermittently and returns to its original state is a cold syndrome; warming medicines should be given.
[Commentary] This chapter lacks a formula for treating deficiency-cold abdominal fullness. Below "warming medicines should be given," the fourteen characters "Yi Niu Pi Sheng Jiang Gan Cao Ban Xia Ren Shen Tang Zhu Zhi" (Niu Pi Sheng Jiang Gan Cao Ban Xia Ren Shen Decoction should be used as the principal treatment) are likely missing due to bamboo slip loss. Reading the *Taiyin Chapter* of the *Shanghan Lun* will clarify this.
[Annotation] This clause follows the previous one, detailing symptoms mutually to elucidate treatment. Abdominal fullness with difficulty in defecation indicates a spleen excess syndrome; abdominal fullness without difficulty in defecation indicates a spleen deficiency syndrome. Furthermore, abdominal fullness that sometimes decreases and sometimes returns to a state of no fullness belongs to deficiency-cold. Warming medicines should be used as the principal treatment. Niu Pi Sheng Jiang Gan Cao Ban Xia Ren Shen Decoction eliminates fullness, disperses cold, moderates the middle jiao, directs rebellious qi downward, and tonifies deficiency. This is the method for treating deficiency-type fullness.
[Collected Annotations] Wei Litong stated: For abdominal fullness, some take purgatives, others take tonics. If it decreases at times but returns to fullness shortly after, it cannot be treated as an excess or heat syndrome. Zhang Zhongjing explicitly identifies this as a cold syndrome. Interior cold never uses purgation; only warming medicines are appropriate. Deficiency is treated by warming the middle and tonifying qi, while excess is treated by warming the middle and moving qi. This is the first excellent method for treating qi-cold abdominal fullness.
**Niu Pi Sheng Jiang Gan Cao Ban Xia Ren Shen Tang Formula**
Niu Pi (Magnoliae Officinalis Cortex), half jin; Sheng Jiang (Zingiberis Rhizoma Recens), half jin; Ban Xia (Pinelliae Tuber), half sheng; Ren Shen (Ginseng Radix et Rhizoma), one liang; Gan Cao (Licorice Root, honey-fried), three liang.
These five ingredients are boiled in ten dou of water to yield three sheng of decoction. The dregs are removed. One sheng is taken warm, three times daily.
Abdominal fullness that does not decrease, or where any decrease is negligible, requires purgation. Da Cheng Qi Tang is indicated.
[Annotation] Intermittent abdominal fullness is deficiency-fullness; persistent abdominal fullness is excess-fullness. "Fullness does not decrease, decrease is insufficient to mention" means the fullness does not subside; even if it lessens slightly, it is insignificant. Deficiency-fullness requires warming; excess-fullness requires purgation. Thus, Da Cheng Qi Tang is suitable for purging, which is the method for treating excess-fullness.
[Collected Annotations] You Yi stated: "Decrease is insufficient to mention" implies that although there is some reduction, it is not worth mentioning, indicating extreme fullness. Therefore, strong purgation is suitable. This refers to "fullness in the center should be drained internally."
**Da Cheng Qi Tang Formula** (See earlier Spasm Disease section)
When a patient presents with abdominal fullness, palpation reveals no pain in deficiency cases and pain in excess cases; purgation may be used. If the tongue coating is yellow and purgation has not yet been performed, the yellow coating will disappear after purgation.
[Annotation] The previous clause distinguished deficiency and excess in abdominal fullness based on intermittent decrease versus persistence. This clause distinguishes surplus and insufficiency based on pain versus non-pain. Abdominal fullness with no pain upon palpation indicates deficiency (spleen deficiency), treatable with warming methods using Niu Pi Sheng Jiang Gan Cao Ban Xia Ren Shen Tang. Pain upon palpation indicates excess (stomach excess), treatable with purgation using Da Cheng Qi Tang. Stomach excess manifests with a yellow tongue coating; if purgation is applied to those who have not undergone it, the yellow coating will naturally clear.
[Collected Annotations] Zhao Liang said: Abdominal fullness can also be excess; clearly, excess is not deficiency-cold. How can it generally be treated with warming medicines? Thus, there is a testing method based on pain versus non-pain, making deficiency and excess distinct. Generally, stomach excess involves heat; heat steaming causes a yellow tongue coating. Purging the excess heat will naturally remove the yellow coating. This differentiation makes the assessment of deficiency more precise.
Wei Litong said: Formless deficiency qi causing stagnation feels empty upon palpation, hence no pain. If accompanied by formless pathogenic factors, such as retained food in the stomach or hernia in the lower abdomen, there is obstruction felt beside the zang-fu organs upon palpation, which inevitably causes pain. This is the method of determining deficiency and excess by whether palpation elicits pain.
A patient with sallow complexion, restlessness without thirst, interior cold-excess in the chest, and unceasing diarrhea faces a fatal prognosis.
[Commentary] "Restlessness without thirst" should likely be "dryness without thirst" for the text to make sense. "Interior cold-excess in the chest" should likely be "interior cold-excess in the stomach." If it were chest cold-excess, why would unceasing diarrhea indicate death? These are errors from transcription.
[Annotation] A sallow complexion with dry mouth and thirst indicates heat-excess. Sallow complexion with dry mouth but no thirst indicates cold-excess. Cold-excess should not cause diarrhea; if diarrhea occurs, it is cold-deficiency. Unceasing diarrhea here indicates cold-deficiency leading to the collapse of stomach qi downwards, resulting in death.
[Collected Annotations] Cheng Lin said: Sallow complexion indicates spleen-stomach disease. Dryness and thirst indicate heat; lack thereof indicates cold. If a patient has sallow complexion combined with uncontrollable diarrhea, the spleen qi is exhausted, leading to death.
Li [Name obscured] said: Diarrhea with dryness and thirst indicates heat; yang qi remains, so it is treatable. Dryness without thirst indicates盛 (excess) of cold evil in the stomach. If diarrhea is unceasing, yin becomes excessive and yang declines, with qi collapsing downwards, leading to death.
In thin individuals, periumbilical pain indicates wind-cold obstructing the movement of grain qi. If purgation is incorrectly applied, qi will rebel upwards. If it does not rebel, epigastric stuffiness (pi syndrome) will occur.
[Annotation] This clause follows the meaning of the previous one regarding the error of purging cold-excess with cold medicines. Thin individuals have weak constitution and qi, unable to resist external pathogens. Periumbilical pain suggests wind-cold injuring the stomach, obstructing grain qi. Although periumbilical pain seems like excess, the presence of wind-cold makes it cold-excess. Physicians should use warming methods. Incorrectly using cold purgatives causes the wind-cold pathogen to rebel upwards if the upper part is deficient, or cause epigastric stagnation if the middle part is deficient. This is logical.
[Collected Annotations] You Yi said: Thin individuals have weak internal organs and qi, making them susceptible to wind-cold. Once entered, grain qi stagnates, causing periumbilical pain. It resembles interior excess but is actually deficiency-cold. Warming medicines should aid spleen function. Instead, purgation was used. Grain exits, but wind-cold does not, further weakening the body and leaving the pathogen unchecked. It will inevitably rebel upwards; if not, epigastric stagnation occurs.
Wiry pulse at the Cunkou position indicates hypochondriac tension and pain, accompanied by aversion to cold.
[Annotation] This elaborates on the first clause, explaining that bilateral hypochondriac pain belongs to cold. A wiry pulse at Cunkou corresponds to the wiry pulse in the first clause. Hypochondriac tension and pain correspond to the bilateral pain mentioned earlier. How do we know it is cold? There must be signs of yang deficiency and aversion to cold ("se se e han") to confirm liver-cold pain. Even if abdominal fullness exists, it should be treated with warming methods.
[Collected Annotations] Cheng Lin said: Wiry is a liver pulse, belonging to yin. The liver meridian runs through the hypochondrium. Cold causes contraction and pulling, leading to hypochondriac tension and pain. With cold prevailing internally, yang qi cannot circulate externally, causing external aversion to cold.
Individuals suffering from interior cold often yawn. If they have clear nasal discharge and fever with a normal complexion, they tend to sneeze frequently.
[Annotation] "Zhong Han Jia" refers to those chronically suffering from interior cold. Previously, interior cold in abdominal fullness was distinguished by intermittent decrease, and in hypochondriac pain by aversion to cold. Here, interior cold in the chest and heart is distinguished by yawning and clear nasal discharge. Yawning (qian) occurs when one desires sleep (yin drawing yang inward) or upon waking (yang drawing yin outward). In interior cold, yawning indicates yin excess drawing yang. Clear nasal discharge in the elderly indicates yang deficiency; in those exposed to cold, it indicates cold excess. In interior cold, clear nasal discharge indicates yang deficiency-cold. Fever with a normal complexion is not interior cold but external cold attacking; clear nasal discharge here results from frequent sneezing.
In interior cold, if the patient has diarrhea due to interior deficiency, and desires to sneeze but cannot, this indicates cold in the abdomen (or pain).
[Annotation] The previous clause distinguished interior cold in the chest/heart via yawning and spontaneous clear nasal discharge. This clause distinguishes abdominal cold via diarrhea and inability to sneeze. Diarrhea indicates chronic interior qi deficiency. Why does the inability to sneeze indicate abdominal cold? Sneezing represents the movement of thunder qi (yang emerging). Normally, inner yang and outer yin allow yang to surge forth as a sneeze. Inability to sneeze means yang wants to emerge but is retained by excess yin, indicating abdominal cold.
[Collected Annotations] Shen Mingzong said: This is the manifestation of spleen meridian cold damage. Cold enters Taiyin, causing yin-cold and dampness excess. Yang deficiency fails to secure, leading to diarrhea and general insufficiency, hence interior deficiency. Harmony of yang produces sneezing; inability to sneeze indicates yin-cold stagnating internally, causing abdominal pathology.
Cold qi in the abdomen causing borborygmus (rumbling) and severe pain, with rebellious fullness in the chest and hypochondrium, and vomiting, is treated principally with Fuzi Ximi Tang.
[Annotation] Severe abdominal pain is due to cold; borborygmus is due to qi. Cold qi in the abdomen causes rumbling and severe pain. Rebellious fullness in the chest and hypochondrium is caused by cold qi outside the intestines and stomach. Abdominal pain, rumbling, and vomiting are caused by cold qi inside the intestines and stomach. Fuzi Ximi Tang is used to overcome cold qi and harmonize interior and exterior, which is the method for treating abdominal cold.
**Fuzi Ximi Tang Formula**
Fuzi (Aconiti Lateralis Radix Praeparata, prepared, one piece); Ban Xia (Pinelliae Tuber, half sheng); Gan Cao (Licorice Root, one liang); Da Zao (Jujubae Fructus, ten pieces); Jing Mi (Oryza Sativa Germ, half sheng).
These five ingredients are boiled in eight sheng of water until the rice is cooked and the decoction is ready. The dregs are removed. One sheng is taken warm, three times daily.
Severe cold pain in the chest and heart, vomiting preventing food intake, cold in the abdomen, upward rushing of qi causing skin elevation with visible undulations resembling heads and feet, and unbearable pain throughout the upper and lower body upon touch, is treated principally with Da Jian Zhong Tang.
[Annotation] Severe cold pain in the chest and heart refers to severe pain extending from the abdomen up to the chest. It is named "severe cold pain" due to accompanying signs of severe cold such as limb reversal (jue ni) and hidden pulse. Vomiting and inability to eat indicate severe cold rejecting and blocking the middle jiao. Upward rushing causing skin elevation with head-and-foot-like shapes indicates severe cold accumulating firmly externally. Unbearable pain upon touch indicates that severe pain in both internal zang-fu and external meridians is due to severe cold. Da Jian Zhong Tang is used; Shu Jiao (Sichuan Pepper) and Gan Jiang (Dried Ginger) strongly disperse cold evil; Ren Shen (Ginseng) and Jiao Yi (Maltose) strongly establish middle deficiency. After taking the medicine, covering warmly to induce slight sweating dispels cold and stops pain. This is the method for treating cold in the chest and heart.
**Da Jian Zhong Tang Formula**
Shu Jiao (Sichuan Pepper, sweat removed, two he); Gan Jiang (Zingiberis Rhizoma, four liang); Ren Shen (Ginseng Radix et Rhizoma, two liang).
These three ingredients are boiled in four sheng of water to yield two sheng of decoction. The dregs are removed. Add one sheng of Jiao Yi (Maltose) and simmer gently over low heat to yield one and a half sheng. Divide into two warm doses. After one meal's time, two sheng of porridge may be drunk, followed by another dose. The patient should consume congee for a day and remain covered warmly.
Cold qi causing limb reversal is treated with Chi Wan.
[Commentary] The text and formula for this clause likely suffer from bamboo slip loss and are difficult to serve as a standard for later generations; therefore, no explanation is provided.
**Chi Wan Formula**
Fu Ling (Poria, four liang); Ban Xia (Pinelliae Tuber, washed, four liang; one version uses Gui Zhi); Wu Tou (Aconiti Radix, prepared, two liang); Xi Xin (Asari Radix et Rhizoma, one liang).
These four ingredients are powdered. True cinnabar (Zhen Zhu) is used for color. Honey-refined pills are made, size of hemp seeds. Taken before meals, washed down with wine, three pills at a time. Taken twice during the day and once at night. If ineffective, increase dosage slightly until efficacy is achieved.
Pain accompanied by constipation is treated with Niu Pi San Wu Tang.
[Annotation] Abdominal fullness with pain and diarrhea is treated with Li Zhong Tang to warm the middle. Abdominal fullness with pain and constipation is treated with Niu Pi San Wu Tang to open the lower jiao.
**Niu Pi San Wu Tang Formula**
Niu Pi (Magnoliae Officinalis Cortex, eight liang); Da Huang (Rhei Radix et Rhizoma, four liang); Zhi Shi (Aurantii Fructus Immaturus, five pieces).
These three ingredients are boiled in twelve dou of water. First boil Niu Pi and Zhi Shi to yield five sheng. Add Da Huang and boil to yield three sheng. Take one sheng warm. Stop when bowel movement occurs.
If the pulse is rapid and tight, it is wiry, resembling a bowstring, firm upon pressure. A wiry-rapid pulse indicates cold should be purged. A large-tight-slow pulse indicates hardness below the heart. A large-tight pulse indicates yang containing yin, and purgation is permissible.
[Commentary] The nineteen characters "Its pulse is rapid and tight, thus wiry, resembling a bowstring, firm upon pressure, wiry-rapid pulse" are likely interpolations. See *Bian Mai Fa* in *Shanghan Lun*. The four characters "purge its cold" should follow "hardness below the heart" for coherent meaning.
[Annotation] Large-tight-slow pulse indicates hardness below the heart, which is cold-excess; purge the cold. Large-tight pulse indicates yang containing yin; large indicates yang excess, tight indicates yin excess, so purgation is allowed.
Unilateral pain in the hypochondrium with fever and a tight-wiry pulse indicates cold. Warming purgation is suitable, using Da Huang Fu Zi Tang.
[Commentary] The character "pian" (unilateral/side) in "hypochondriac unilateral pain" should likely be "man" (fullness), a transcription error.
[Annotation] Abdominal fullness with pain is spleen excess; hypochondriac fullness with pain is liver excess. Fever with rapid-large pulse is stomach heat-excess. Tight-wiry pulse here indicates spleen cold-excess. Warming purgation is required, hence Da Huang Fu Zi Tang is used to purge cold-excess. Xi Xin is added to disperse liver pathogen. This is the method for purging liver-spleen cold-excess.
[Collected Annotations] You Yi said: Fullness and pain in the hypochondrium with tight-wiry pulse indicates accumulation of yin-cold. Even with fever, it is caused by depressed yang. Therefore, only warming can stop the cold, and only purging can remove the knot. Hence, "suitable to use warming purgation."
**Da Huang Fu Zi Tang Formula**
Da Huang (Rhei Radix et Rhizoma, three liang); Fu Zi (Aconiti Lateralis Radix Praeparata, prepared, three pieces); Xi Xin (Asari Radix et Rhizoma, two liang).
These three ingredients are boiled in five sheng of water to yield two sheng. Divide into three warm doses. For robust individuals, boil to yield two and a half sheng, divided into three warm doses. After taking the medicine, wait the time it takes to walk four or five li, then administer the next dose.
Abdominal fullness with fever, persisting for ten days with floating-rapid pulse, and normal appetite, is treated with Niu Pi Qi Wu Tang.
[Annotation] Abdominal fullness is a interior syndrome. Fever indicates interior heat. However, a floating-rapid pulse after ten days indicates exterior heat persists. Normal appetite indicates stomach heat can digest food. Due to stomach heat and interior excess combined with exterior heat fever, Niu Pi Qi Wu Tang is used to resolve both exterior and interior, eliminating abdominal fullness and fever. This is a compound of Gui Zhi Tang and Xiao Cheng Qi Tang.
[Collected Annotations] Cheng Lin said: Abdominal fullness indicates interior excess-heat. Floating-rapid pulse after ten days indicates floating (exterior) heat persists, causing fever. Rapid indicates interior heat, which digests food, hence normal appetite. This formula clears abdominal fullness and removes exterior heat. When exterior and interior are both excess, usually release the exterior first, then attack the interior. Here, exterior pathogen is mild while interior pathogen is severe, so Cheng Qi and Gui Zhi formulas are combined to harmonize exterior and interior, similar to using Da Chai Hu Tang in Shanghan.
**Niu Pi Qi Wu Tang Formula**
Niu Pi (Magnoliae Officinalis Cortex, half jin); Gan Cao (Licorice Root, three liang); Da Huang (Rhei Radix et Rhizoma, two liang); Da Zao (Jujubae Fructus, ten pieces); Zhi Shi (Aurantii Fructus Immaturus, five pieces); Gui Zhi (Cinnamomi Ramulus, two liang); Sheng Jiang (Zingiberis Rhizoma Recens, five liang).
These seven ingredients are boiled in ten dou of water to yield four sheng. Take eight ge warm, three times daily. Add Ban Xia (Pinelliae Tuber, five he) for vomiting. Remove Da Huang for diarrhea. Increase Sheng Jiang to half jin for excessive cold.
Tenderness and pain upon palpation of the epigastrium indicate excess; purgation is required. Da Chai Hu Tang is indicated.
[Commentary] Below "tenderness and pain upon palpation of the epigastrium," the three characters "with tidal fever" (you chao re) are likely missing. Without these, Da Chai Hu Tang would not be indicated, suggesting a transcription omission.
[Annotation] Epigastric tenderness/pain with tidal fever indicates exterior-interior excess. Purgation is required; Da Chai Hu Tang is suitable for dual resolution. Both treatments are methods for purging excess-fullness.
**Da Chai Hu Tang Formula**
Chai Hu (Bupleuri Radix, half jin); Huang Qin (Scutellariae Radix, three liang); Shao Yao (Paeoniae Radix Alba, three liang); Ban Xia (Pinelliae Tuber, washed, half jin); Zhi Shi (Aurantii Fructus Immaturus, roasted, four pieces); Da Huang (Rhei Radix et Rhizoma, two liang); Da Zao (Jujubae Fructus, twelve pieces); Sheng Jiang (Zingiberis Rhizoma Recens, five liang).
These eight ingredients are boiled in twelve dou of water to yield six sheng. Remove dregs and decoct again. Take one sheng warm, three times daily.
Abdominal pain with wiry-tight pulse: Wiry indicates defensive qi stagnation, leading to aversion to cold. Tight indicates desire for no food. Pathogen and righteous qi struggle, resulting in Cold Hernia (Han Shan). Pain around the umbilicus, sweating (white fluid/self-sweat) during attacks, cold limbs, and deep-tight pulse are treated principally with Da Wu Tou Jian.
[Commentary] The pulse description is repeated. The next clause has symptoms but no pulse; "deep-tight pulse" should likely follow "internal urgency" in the next clause. However, wiry-tight pulse indicates extreme tension, fitting severe Cold Hernia. The character "bai" (white) in "bai han" (white sweat) should be "zi" (self). The deep-tight pulse in the next clause fits mild Cold Hernia with interior pain, likely a transcription error.
[Annotation] Hernia diseases triggered by cold are called Cold Hernia. Attacks involve periumbilical and lower abdominal urgent pain, aversion to cold, sweating, cold limbs, anorexia, and wiry-tight pulse (indicating urgency and pain). These are the expected signs and pulses for Cold Hernia. Da Wu Tou Jian is used to urgently break pathogenic factors and treat symptoms, regardless of deficiency or excess. Hence, robust individuals take seven he, weak individuals five he.
**Da Wu Tou Jian Formula**
Wu Tou (Aconiti Radix, roasted, skin removed, not chopped, five large pieces).
Boil in three sheng of water to yield one sheng. Remove dregs. Add two sheng of honey. Simmer until moisture evaporates, yielding two sheng. Robust individuals take seven he; weak individuals take five he. If not cured, repeat tomorrow. Do not take twice in one day.
Cold Hernia with abdominal pain, hypochondriac pain, and internal urgency is treated with Dang Gui Sheng Jiang Yang Rou Tang.
[Commentary] Below "hypochondriac pain and internal urgency," the four characters "its pulse is deep-tight" from the previous clause are likely missing.
[Annotation] Cold Hernia with abdominal and hypochondriac pain/internal urgency, presenting deep-tight pulse, is milder than periumbilical severe pain. Absence of aversion to cold, sweating, and cold limbs means Da Wu Tou Jian's strong warming and dispersing action is unnecessary. Instead, Dang Gui Sheng Jiang Yang Rou Tang is used, focusing on tonifying righteousness with cold-dispersion as secondary. This is a harmonizing formula for Cold Hernia. Those whose condition improves with Da Wu Tou Jian should also take this.
[Collected Annotations] Li [Name obscured] said: Hernia belongs to the liver. The liver stores blood, and its meridian spreads through the hypochondrium. Abdominal and hypochondriac pain indicates blood and qi cold-stagnation. Dang Gui promotes meridian flow and activates blood; Sheng Jiang warms the middle and disperses cold. Internal urgency indicates interior deficiency, treated with mutton. *Neijing* states: "For deficiency of form, warm with qi; for deficiency of essence, tonify with flavor."
Shen Mingzong said: This involves the Chong meridian in hernia; treatment should be warming and tonifying. Liver wood pathogen overacting on spleen causes abdominal pain; stagnation of the primary meridian causes hypochondriac pain; involvement of Chong meridian causes internal urgency. Dang Gui tonifies Chong/Ren and disperses wind-cold; mutton warms Ying-Wei qi. As spleen pathogen disperses, pain stops. The post-formula note says: Pain with frequent vomiting indicates liver qi rebelling against the stomach; add Chen Pi (Tangerine Peel) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) to tonify.
**Dang Gui Sheng Jiang Yang Rou Tang Formula**
Dang Gui (Angelicae Sinensis Radix, three liang); Sheng Jiang (Zingiberis Rhizoma Recens, five liang); Yang Rou (Mutton Meat, one jin).
These three ingredients are boiled in eight sheng of water to yield three sheng. Take seven ge warm, three times daily. For excessive cold, increase Sheng Jiang to one jin. For frequent pain and vomiting, add Chen Pi (Tangerine Peel, two liang) and Bai Zhu (Atractylodis Macrocephalae Rhizoma, one liang). If adding Sheng Jiang, add five sheng of water, boil to yield three sheng two ge, and take.
Cold Hernia with abdominal pain, cold reversal, numbness in hands and feet, and body pain, which cannot be treated by moxibustion, acupuncture, or other medicines, is treated with Di Dang Wu Tou Gui Zhi Tang.