主之。
【按】“抵当”二字，衍文也。
【注】寒疝腹中痛，逆冷，手足不仁，身体疼痛，此疝之寒重者也。灸刺、诸药不能
取效，则急以乌头煎加桂枝汤五合，以解内外之盛寒也。
【集注】徐彬曰∶起于寒疝腹痛，而至逆冷，手足不仁则阳气大痹；加以身疼痛，营
卫俱不和，更灸刺诸药不能治，是或攻其外，或攻其内，邪气牵制不服也。故以乌头攻寒
为主，而合桂枝全汤以和营卫，所谓七分治里，三分治表也。
乌头桂枝汤方
乌头
上一味，以蜜二斤，煎减半，去滓，以桂枝汤五合解之，令得一升，初服二合；不
知，即服三合；又不知，复加至五合。其知者如醉状，得吐者为中病。
【方解】以桂枝汤五合解之者，溶化也。令得一升，谓以乌头所煎之蜜五合，加桂枝
汤五合溶化，令得一升也。不知，不效也；又不知，又不效也；其知者，已效也。如醉状，
外寒方散。得吐者，内寒已伸，故为中病也。
问曰∶人病有宿食，何以别之？师曰∶寸口脉浮而大，按之反涩，尺中亦微而涩，故
知有宿食，大承气汤主之。
【按】尺中亦微而涩之“微”字，当按《伤寒论》作“大”字是。
【注】宿食病，即今之伤食病也，谓食隔宿不化也。人病腹满而痛，何以别之为宿食
也？寸口脉浮而大，按之反涩，谓按且大、且涩，且有力也，关上尺中亦然，大涩有力为
实而不利，故知有佰食也。当下之，宜大承气汤。
脉数而滑者，实也，此有宿食，下之愈，宜大承气汤。
【注】腹满而痛，脉数而滑者，实也，此有宿食，故当下之。
【集注】李 曰∶滑者，水谷之气胜也，若滑而兼数，则实热已入胃腑矣。故云∶有
宿食可下之。
下利不欲食者，有宿食也，当下之，宜大承气汤。
【注】初下利不欲食者是伤食，恶食不欲食也；久下利不欲食者，是伤脾不能食也。今
初下利即不欲食，以有宿食故也。当下之，宜大承气汤无疑矣。
【集注】沈明宗曰∶此伤食而致下利也。骤伤宿食，停滞胃中，壅遏升降之机，不转
肠中，水谷不分而下奔则利，宿食在胃，故不欲食。必当攻去宿食，利得止而欲食，故
宜大承气汤。
宿食在上脘，当吐之，宜瓜蒂散。
【注】胃有三脘，宿食在上脘者，隔间痛而吐，可吐不可下也；在中脘者，心中痛而
吐，或痛不吐，可吐可下也；在下脘者，脐上痛而不吐，不可吐可下也。今食在上脘，故
当以瓜蒂散吐之也。
瓜蒂散方
瓜蒂（熬黄，一分） 赤小豆（煮，一分）
上二味，杵为散，以香豉七合煮取汁，和散一钱匕，温服之，不吐者少加之，以快吐
为度而止。亡血及虚者，不可与之。
脉紧如转索无常者，有宿食也。
【注】转索元常，紧脉之状也。若浮紧，伤寒；沉紧，冷痛。冷犯胃脘，谷气不行，故
曰∶有宿食也。
脉紧，头痛风寒，腹中有宿食不化也（一云寸口脉紧）。
【注】脉紧头痛，是外伤风寒病也，脉紧腹痛，是内伤宿食病也。
【集注】李 曰∶按此脉与证，似伤寒而非伤寒者，以身不疼。腰脊不强故也。然脉
紧亦有辨浮而紧者，为伤寒；沉而紧者，为伤食。《甲乙经》曰∶人迎紧甚伤于寒，气口
紧甚伤于食，则寒与食又以左右手为辨已。是以知腹中有宿食不化也。
（前文省略，此处接正文）主治此证。
【按语】“抵当”二字为衍文（多余的文字）。
【注释】寒疝（一种以腹部冷痛为主要特征的病证）导致腹中疼痛，四肢逆冷，手足麻木不仁，身体疼痛，这是寒气极重的寒疝。如果艾灸、针刺及其他药物均不能取效，则应立即使用乌头煎剂配合桂枝汤五合（容量单位），以解除内外的盛寒之邪。
【集注】徐彬说：病情起于寒疝腹痛，发展到四肢逆冷、手足麻木不仁，说明阳气严重痹阻；再加上身体疼痛，表明营卫（营气和卫气）都不调和。此时若艾灸、针刺及其他药物都无法治愈，是因为无论攻治外部还是内部，邪气相互牵制而不顺从治疗。因此，以乌头攻逐寒邪为主，同时合用全量的桂枝汤来调和营卫，这就是所谓的七分治里，三分治表。
乌头桂枝汤方
乌头
以上一味药，用蜂蜜二斤，煎煮至减半，滤去药渣，将所得药液与桂枝汤五合混合溶化，最终得到一升药液。初次服用二合；若无反应，则服用三合；仍无反应，再增加至五合。服药后若出现如醉酒般的状态，或者发生呕吐，即为中病（药效达到预期）。
【方解】所谓“以桂枝汤五合解之”，是指溶化混合。所谓“令得一升”，是指将乌头煎煮后的蜜汁五合，加上桂枝汤五合进行溶化混合，最终得到一升药液。“不知”，指没有疗效；“又不知”，指再次服用仍无疗效；“其知者”，指已经见效。出现如醉酒般的状态，说明外部的寒邪正在消散。发生呕吐，说明内部的寒邪得以伸展，所以称为中病。
问：人患病有宿食（积滞不化的食物），如何辨别？老师说：寸口脉浮而大，重按反而涩滞，尺部脉也微而涩，因此知道有宿食，以大承气汤主治。
【按语】尺部脉“微而涩”中的“微”字，应当参照《伤寒论》改为“大”字才是正确的。
【注释】宿食病，就是现在的伤食病，指食物隔宿不消化。人患腹部胀满疼痛，如何辨别是宿食所致呢？寸口脉浮而大，重按时感觉既大且涩且有力，关部和尺部也是如此。脉大、涩且有力属于实证且伴有不通利，因此知道有宿食。应当采用下法，适宜用大承气汤。
脉象数而滑的，属于实证，这是有宿食，通过泻下可愈，适宜用大承气汤。
【注释】腹部胀满疼痛，脉象数而滑的，属于实证，这是因为有宿食，所以应当采用下法。
【集注】李曰：滑脉，是水谷之气偏胜的表现。如果滑脉兼见数脉，说明实热已传入胃腑。所以说：有宿食可以运用下法。
腹泻但不想进食的，是有宿食，应当采用下法，适宜用大承气汤。
【注释】刚开始腹泻就不想进食的，是伤食，表现为厌恶食物或不想进食；长期腹泻不想进食的，是脾脏受伤导致无法进食。现在刚开始腹泻就不想进食，是因为有宿食的缘故。应当采用下法，适宜用大承气汤无疑了。
【集注】沈明宗说：这是因伤食导致的腹泻。突然摄入过多宿食，停滞在胃中，壅遏阻碍了气机升降，水谷不能在肠中正常转化，不分清浊而下奔形成腹泻。因为宿食停留在胃中，所以不想进食。必须攻除宿食，待腹泻停止且恢复食欲，所以适宜用大承气汤。
宿食位于上脘（胃的上部），应当采用吐法，适宜用瓜蒂散。
【注释】胃分为上、中、下三脘。宿食在上脘的，表现为膈间疼痛并呕吐，可以用吐法，不可用下法；在中脘的，表现为心中疼痛并呕吐，或者疼痛但不呕吐，可以用吐法也可以用下法；在下脘的，表现为脐上疼痛且不呕吐，不可用吐法，可用下法。现在食积在上脘，所以应当用瓜蒂散催吐。
瓜蒂散方
瓜蒂（炒至黄色，一分） 赤小豆（煮熟，一分）
以上两味药，捣碎过筛成散剂，用香豉七合煮取汁液，将散剂一钱匕混入药汁中，温服。若不呕吐，可稍加剂量，以剧烈呕吐为度而停止。失血患者及体虚者，不可服用。
脉象紧如转动绳索般无常变化的，是有宿食。
【注释】“转索无常”是紧脉的形状。如果是浮紧脉，是伤寒；沉紧脉，是冷痛。寒气侵犯胃脘，谷气运行不畅，所以说：是有宿食。
脉紧，头痛，风寒侵袭，腹中有宿食不化（另一种说法是寸口脉紧）。
【注释】脉紧且头痛，是外感风寒的病证；脉紧且腹痛，是内伤宿食的病证。
【集注】李曰：根据此脉象与症状，看似伤寒而非伤寒，是因为身体不疼、腰脊不强。然而脉紧也有区别：浮而紧的是伤寒；沉而紧的是伤食。《甲乙经》说：人迎脉（左手）紧甚表示伤于寒，气口脉（右手）紧甚表示伤于食，那么寒邪与食积就可以通过左右手来辨别了。因此知道腹中有宿食不化。
(Previous text omitted, continuing with the main text) It is the primary treatment for this condition.
[Annotation] The characters "Didang" are superfluous (erroneous additions).
[Commentary] Cold hernia (a disease characterized mainly by cold pain in the abdomen) causing abdominal pain, coldness of the limbs, numbness and insensibility of the hands and feet, and body pain, indicates a severe case of cold hernia. If moxibustion, acupuncture, and other medications fail to produce an effect, one should urgently administer Wutou Jian (Aconite Decoction) combined with five he (a unit of volume) of Guizhi Tang (Cinnamon Twig Decoction) to resolve the excessive cold in both the interior and exterior.
[Collected Commentaries] Xu Bin stated: The condition originates from cold hernia abdominal pain, progressing to cold extremities and numbness/insensibility of the hands and feet, indicating severe obstruction of Yang Qi; coupled with body pain, it shows that Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi) are disharmonious. At this point, if moxibustion, acupuncture, and other drugs cannot cure it, it is because whether attacking the exterior or the interior, the pathogenic factors resist and do not respond to treatment. Therefore, using Wutou (Radix Aconiti Lateralis Preparata) to attack cold as the main strategy, while combining the full dose of Guizhi Tang (Cinnamon Twig Decoction) to harmonize Ying and Wei Qi, is what is meant by treating seventy percent internally and thirty percent externally.
Formula for Wutou Guizhi Tang (Aconite and Cinnamon Twig Decoction)
Wutou (Radix Aconiti Lateralis Preparata)
Take the above single herb, add two jin (units of weight) of honey, decoct until reduced by half, remove the dregs, and mix the resulting liquid with five he of Guizhi Tang (Cinnamon Twig Decoction) to dissolve/mix, yielding one sheng (unit of volume). Initially take two he; if there is no response, take three he; if still no response, increase to five he. If the patient experiences a sensation resembling drunkenness, or vomits, it indicates the medicine has taken effect (hits the target).
[Formula Analysis] "Mixing with five he of Guizhi Tang (Cinnamon Twig Decoction)" refers to dissolving and mixing. "Yielding one sheng" means mixing five he of the honey decocted from Wutou with five he of Guizhi Tang (Cinnamon Twig Decoction) to yield one sheng. "No response" means ineffective; "again no response" means ineffective even after repeated dosing; "having a response" means effective. The sensation resembling drunkenness indicates that external cold is dissipating. Vomiting indicates that internal cold is being expelled, thus constituting hitting the target.
Question: How can one distinguish a patient suffering from Su Shi (retained undigested food)? The Master said: If the pulse at the Cun Kou (Inch Position) is floating and large, but feels choppy upon deep pressure, and the Chi Position (Cubit Position) is also slightly choppy, then one knows there is retained food, and Da Chengqi Tang (Major Order the Qi Decoction) should be used as the primary treatment.
[Annotation] The character "wei" (slight/faint) in "Chi position is slight and choppy" should be corrected to "da" (large), according to Shanghan Lun (Treatise on Cold Damage).
[Commentary] Su Shi disease (retained food disease) is equivalent to modern food stagnation injury, referring to food that remains undigested overnight. When a patient suffers from abdominal fullness and pain, how is it distinguished as caused by retained food? The pulse at the Cun Kou is floating and large; upon pressing, it feels large, choppy, and forceful. The Guan (Bar) and Chi positions exhibit the same. A pulse that is large, choppy, and forceful indicates excess syndrome with obstruction, hence knowing there is retained food. Purging method should be applied, and Da Chengqi Tang (Major Order the Qi Decoction) is suitable.
If the pulse is rapid and slippery, it indicates excess syndrome; this is due to retained food. Purging will lead to recovery; Da Chengqi Tang (Major Order the Qi Decoction) is suitable.
[Commentary] Abdominal fullness and pain accompanied by a rapid and slippery pulse indicate excess syndrome due to retained food; therefore, purging is indicated.
[Collected Commentaries] Li said: Slippery pulse indicates an abundance of water and grain qi. If slippery pulse is combined with rapid pulse, it means excess heat has entered the Stomach Fu organ. Thus, it is said: Retained food can be treated with purging.
Diarrhea accompanied by loss of appetite indicates retained food; purging is indicated, and Da Chengqi Tang (Major Order the Qi Decoction) is suitable.
[Commentary] Initial diarrhea with loss of appetite indicates food injury, characterized by aversion to food or lack of desire to eat; prolonged diarrhea with loss of appetite indicates Spleen injury leading to inability to eat. Now, initial diarrhea immediately accompanied by loss of appetite is due to retained food. Purging is indicated, and Da Chengqi Tang (Major Order the Qi Decoction) is undoubtedly suitable.
[Collected Commentaries] Shen Mingzong said: This is diarrhea caused by food injury. Sudden ingestion of excessive retained food stagnates in the Stomach, obstructing the mechanism of Qi ascent and descent. Water and grain fail to separate in the intestines and rush downward causing diarrhea. Because retained food stays in the Stomach, there is no desire to eat. One must attack and remove the retained food; once diarrhea stops and appetite returns, Da Chengqi Tang (Major Order the Qi Decoction) is suitable.
If retained food is located in the Upper Wan (upper part of the Stomach), emesis (vomiting) method should be used, and Gouti San (Thistle Powder) is suitable.
[Commentary] The Stomach is divided into Upper, Middle, and Lower Wan. For retained food in the Upper Wan, pain occurs in the diaphragm region accompanied by vomiting; emesis is applicable, purging is not. For retained food in the Middle Wan, pain occurs in the heart region accompanied by vomiting, or pain without vomiting; both emesis and purging may be applicable. For retained food in the Lower Wan, pain occurs above the umbilicus without vomiting; emesis is not applicable, purging is. Since the food is now in the Upper Wan, Gouti San (Thistle Powder) should be used to induce vomiting.
Formula for Gouti San (Thistle Powder)
Gouti (Fructus Momordicae, fried until yellow, one fen) Chixiaodou (Semen Phaseoli Rubri, boiled, one fen)
Grind the above two herbs into a powder. Boil Xiangchi (Fermented Soybean Mass) seven he to extract the juice. Mix one qianbi (unit of measure) of the powder into the juice and take warm. If vomiting does not occur, slightly increase the dose. Stop when vigorous vomiting is achieved. Do not administer to patients with blood loss or deficiency.
A pulse that is tight and changes like a turning rope indicates retained food.
[Commentary] "Turning rope irregularly" describes the shape of a Tight Pulse. Floating and tight pulse indicates Cold Damage; sinking and tight pulse indicates cold pain. Cold invading the Stomach region causes Grain Qi to fail to move, hence it is said: there is retained food.
Tight pulse, headache, wind-cold invasion, and undigested retained food in the abdomen (another version states: tight pulse at the Cun Kou).
[Commentary] Tight pulse with headache indicates external Wind-Cold damage; tight pulse with abdominal pain indicates internal injury from retained food.
[Collected Commentaries] Li said: Based on this pulse and symptoms, it resembles Cold Damage but is not Cold Damage, because the body does not ache and the waist/spine is not stiff. However, Tight pulses have distinctions: floating and tight indicates Cold Damage; sinking and tight indicates Food Injury. The Jiayi Jing (Classic of Eight Meridians) states: Excessively tight Renying pulse (on the left hand) indicates injury from cold; excessively tight Qikou pulse (on the right hand) indicates injury from food. Thus, cold and food injuries can be differentiated by the left and right hands. Therefore, one knows there is undigested retained food in the abdomen.