趺阳脉微弦。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。（脉经必下。有下部
闭塞大五字。千金同。千金。作此虚寒气从下向上。赵。脱当字。）
〔尤〕趺阳胃脉也。微弦阴象也。以阴加阳。脾胃受之。则为腹满。设不满则阴邪必旁攻 胁。而下闭
谷道。为便难为两 疼痛。然其寒不从外入。而从下上。则病自内生。所谓肾虚则寒动于中也。故不当
散而当温。
〔程〕若寒实。则用后条温药下之也。
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。（玉函病者。作伤寒。去下。有宜大承气汤五字。）
〔沈〕此以手按。辨腹满虚实也。按之不痛。内无痰食燥屎壅滞。即知虚寒而满。当以温药。若按之痛。乃
以外手。而就内结食痰燥屎。则知内实。是可下之。而又以舌黄验定虚实。若舌有黄苔。即是湿热内蒸。为未
经下过。必须下之。则黄自去。而胀满自除。舌无黄苔。是近虚寒。又非下法矣。
〔魏〕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。
张氏伤寒集注云。中胃按之而痛。世医便谓有食。夫胃为水谷之海。又
为仓廪之官。胃果有食。按必不痛。试将饱
食之人按之痛否。惟邪气内结。正气不能从膈出入。按之则痛。又胃无谷神。脏气虚而外浮。按之亦痛。若
不审邪正虚实。概谓有食。伤人必多。又按者轻虚平按。若不得法。加以手力。未有不痛者。
腹满时减。复如故。此为寒。当与温药。（脉经。减下。更有减字。）
〔徐〕腹满有增减。则非脏真粘着之病。所以得阳即减。得阴加满。故曰此为寒。当温药。
〔程〕腹满不减。故用承气下之。此腹满时减。则寒气或聚或散。当与温药以散其寒。
案金鉴云。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。此说觉未允焉。
病者痿黄。躁而不渴。胸中寒实。而利不止者死。（徐沈尤金鉴。躁作燥。今从之。）
〔徐〕痿者。黄之黯淡者也。
〔尤〕痿黄。脾虚而色败也。气不至故燥。中无阳故不渴。气竭阳衰。中
上已败。而复寒结于上。脏脱于下。何恃而可以通之止之乎。故死。
案程魏以躁为阴躁。不可从。本条不言腹满。而徐注以为虚寒腹满。未详然否。脉经以此条。列于呕
吐下利篇似是。
寸口脉弦者。即胁下拘急而痛。其人啬啬恶寒也。
〔尤〕寸口脉弦。亦阴邪加阳之象。故胁下拘急而痛。而
寒从外得。与趺阳脉弦之两 疼痛有别。故彼兼便难。而此有恶寒也。
夫中寒家善欠。其人清涕出。发热色和者善嚏。
〔程〕云寒则面惨而不和。今发热色和。则寒郁于肺经。而为热也。
〔鉴〕中寒家。谓素有中寒病之人也。
〔尤〕阳欲上而阴引之则欠。阴欲入而阳拒之则嚏。中寒者。阳气被抑。
故喜欠清涕出。发热色和。则邪不能留。故善嚏。
〔魏〕此诸证俱为外感寒邪者言也。外感寒邪。于胀满病
何与。以胀满病。其中亦有内外合邪者。故必明辨乎外中寒之证。所以为内中寒之应也。
案千金。此次一条云。凡觇病者。未脉望之。口燥清涕出喜嚏欠。此人中寒。乃接下条。连
此条而为一条。知此条为下条欲嚏不能者发耳。
中寒其人下利。以里虚也。欲嚏不能。此人肚中寒。（〔原注〕一云。痛。○千金。作腹中痛。）
〔尤〕中寒而下利者。里气素虚。无为捍蔽。邪得直侵中脏也。欲嚏不能者。正为邪逼。既不能却。又不
甘受。于是阳欲动而复止。邪欲去而仍留也。
〔沈〕阳和则嚏。而欲嚏不能。乃阴寒凝滞于里。所以肚中痛也。
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。
〔程〕瘦人。虚弱人也。若绕脐作痛。必有风冷。有谷气着而不行。瘦人未可剧下。而反下之。则风冷
之气必上冲。如不上冲。必乘虚而结于心下为痞也。
〔尤〕此有似里实。而实为虚冷。是宜温药以助脾之行者
也。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。
病腹满。发热十日。脉浮而数。饮食如故。浓朴七物汤
主之。（脉经。千金。以此条为浓朴三物汤主疗。而本方主疗云。治腹满气胀。恐是互误。）
〔徐〕此有表复有里。但里挟燥邪。故小承气为主。而合桂甘姜枣。以和其表。盖腹之满。初虽因
微寒。乃胃素强。故表寒不入。而饮食如故。但腹满发热。且脉浮数。相持十
日。此表里两病。故两解之耳。此即大柴胡之法也。但脉浮数。邪尚在太阳。故用桂枝去芍药。合小承气耳。
浓朴七物汤方（外台。引千金。名浓朴七味汤。主腹满气胀方。）
浓朴（半斤） 甘草 大黄（各三两） 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。（外台不用生姜。用干姜。云。此本仲景伤寒论方。）
张氏医通云。较之桂枝加大黄汤。多枳朴。而少芍药。以枳朴专泄壅滞之气。故用之。芍药专收耗散之
阴。此腹但满。而不痛。与阴血无预。故去之。
三因。七物浓朴汤。治腹满发热。以阳并阴。则阳实而阴虚。阳盛生外热。阴虚生内热。脉必浮数。浮则
为虚。数则为热。阴虚不能宣导。饮食如故。致胀满者。为热胀。（即本方。）
腹中寒气。雷鸣切痛。胸胁逆满呕吐。附子粳米汤主之。（
千金。作腹中塞气。胀满肠鸣切痛。外台。引范汪作腹中寒气胀雷鸣。）
〔程〕灵枢经曰。邪在脾胃。阳气不足。阴气有余。则寒中肠鸣腹痛。盖脾胃喜温。而恶寒。寒气客
于中。奔迫于肠胃之间。故作雷鸣切痛。胸胁逆满呕吐也。附子粳米汤。散寒止逆。
张氏医通云。腹中寒气。奔迫上攻胸胁。以及于胃。而增呕逆。顷之胃气空虚。邪无所砥。辄入阳位
则殆矣。是以除患之机。所重全在胃气。乘其邪初犯胃。尚自能食。而用附子粳米之法。温饱其胃。胃气
温饱。则土浓而邪难上越。胸胁逆满之浊阴。得温无敢留恋。必还从下窍而出矣。
附子粳米汤方
附子（一枚炮） 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。（外台。作以水八升煮米取熟。去米内药。
煮取三升。去滓。适寒温。饮之。与仲景伤寒论同。集验。加干姜二两。案本条煮法。必有脱文。）
〔程〕疗寒以热药。腹中寒气。非附子辛热。不足以温之。雷鸣切痛。非甘草大枣粳米之甘。不足以
和之。逆满呕吐。非半夏之辛。不足以散之。五物相需。而为佐使。
外台。仲景论。霍乱四逆。吐少呕多者。附子粳米汤主之。
方与本条同。（千金同。）
又删繁。附子汤。疗肺虚劳损。腹中寒鸣切痛。胸胁逆满气喘。
于本方内。加宿姜白术。（粳米。作仓米。）
又短剧。解急蜀椒汤。主寒疝气心痛如刺。绕脐腹中尽痛。白汗出欲绝。又疗心腹痛。困急欲死。解
结逐寒。上下痛良。
于本方内。加蜀椒干姜。
三因胀满门。附子粳米汤。治忧怒相乘。神志不守。思
虑兼并扰乱。脏气不主传导。使诸阳不舒。反顺为逆。中寒气胀。肠鸣切痛。胸胁逆满。呕吐不食。
即于本方。加干姜。
百一选方。附子粳米汤。补虚生胃气。逐冷痰和五脏。快胸膈止泻利。
于本方内。加人参黄 白术川姜木香。去大枣。用陈仓米。（活人事证方。名附子仓廪汤。）
证治要诀。翻胃门。若胃寒甚。服药而翻者。宜附子粳
米汤。加丁香十粒。砂仁半钱。大便秘者。更加枳壳半钱。
又呃逆门。若胃中寒甚。呃逆不已。或复呕吐。轻剂不能取效。宜附子粳米汤。加炒川椒丁香。每服各三十五粒。
痛而闭者。浓朴三物汤主之。（痛而闭。脉经作腹满痛。）
〔魏〕闭者。即胃胀便难之证也。
〔尤〕痛而闭。六腑之气不行矣。浓朴三物汤。与小承气同。但
承气意在荡实。故君大黄。三物意在行气。故君浓朴。
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。（三升下。千金。有去滓二字。）
千金云。腹中转动者勿服。不动者更服。
按之心下满痛者。此为实也。当下之。宜大柴胡汤。（脉经。无宜大柴胡汤五字。接前七物汤三物
汤为一条。伤寒论可下编。作病腹中满痛者。宜下有大承气三字。）
〔尤〕按之而满痛者。为有形之实。邪实则可下。而心下满痛。则结处尚高。与腹中满痛不同。故不宜大
承气。而宜大柴胡。
〔魏〕此为邪实。而且挟热者言也。仲景已叙之伤寒论中太阳篇矣。云。伤寒十余日。
热结在里者。与大柴胡汤主之。宜下之。而不用大承气。乃出大柴胡者。正与伤寒论篇中所言相符也。
张氏医通云。邪从胸胁而入于阳位。合用大柴胡两解之。与脐腹硬痛。承气证不同。○案数说如是。而
金鉴谓满痛之下。当有有潮热之三字。若无此三字。则不当与大柴胡汤。此尤有理。然今据脉经。而
味经旨。此亦浓朴三物汤之证。宜大柴胡汤五字。恐是衍文。其方亦错出。
大柴胡汤方
柴胡（半斤） 黄芩（二两） 芍药（三两） 半夏（半升） 枳实（四枚炙） 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。
腹满不减。减不足言。当须下之。宜大承气汤。（不足言。千金。作不惊人。）
〔鉴〕腹满时减时满。虚满也。腹满常常而满。实满也。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。
〔尤〕减不足言。谓虽减。而不足云减。所以形其满之至也。故宜
大下。以上三方。虽缓急不同。而攻泄则一。所谓中满者。泻之于内也。
大承气汤方（见前 病中。）
心胸中大寒痛。呕不能饮食。腹中寒上冲皮起。出见有头足。上下痛而不可触近。大建中汤主之。（千金。
作心胁中大寒大痛。呕不能饮食。饮食下咽。自知偏从一面下流。有声决决然。若腹中寒气上冲。皮起出
见。有头足上下。而痛。其头不可触近。程本金鉴。无痛而之而。）
〔鉴〕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。
〔程〕寒气搏于肠胃之外。冲突出见于
皮肤膜原之分。如有头足。其痛则近于外。故不可以手触近也。
大建中汤方
蜀椒（二合去汗） 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。如一炊顷。如饮粥二升。后更服。当一日食糜温覆之。（一炊顷。千金。作炊三升米。）
张氏千金衍义云。虚寒积聚之治。此方最力。其方中人参辅椒姜。温散之法。人皆得之。至于胶饴。
为助满之首。列而反用。以治痛呕不能食。是专用助满之味。引领椒姜人参。为泄满之通使也。
千金大建中汤 治虚劳。寒 饮在胁下。决决有声。
饮已如从一边下。决决然也。有头并冲皮起。引两乳内痛。里急善梦。失精气短。目KT KT 惚惚多忘。
蜀椒（二合） 半夏（一升） 生姜（一斤） 甘草（二两） 人参（三两） 饴糖（八两）
上六味 咀。以水一斗。煮取三升。去滓内糖。温服七
合。里急拘引。加芍药桂心各三两。手足厥。腰背冷。加附子一枚。劳者加黄 一两。
胁下偏痛发热。其脉紧弦。此寒也。以温药下之。宜大黄附子汤。（脉经。无发热二字。）
〔尤〕胁下偏痛。而脉紧弦。阴寒成聚。偏着一处。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。程氏曰。大黄苦寒。走而不守。得附子细辛之大热。则寒性散。而
走泄之性存是也。
〔魏〕此发热。或有形之物。积于肠胃。而皮肤热作。故在可下之例。未必为假热症。
〔徐〕附子细辛与大黄。今用并行。而不倍。此即伤寒论大黄附子泻心汤之法也。
千金衍义云。少阴病始得之。反发热脉沉。用麻黄附子细辛汤。以治太阳少阴之两感。此治胁下偏痛。
趺阳脉微而弦。按照医理应当出现腹部胀满。如果不胀满，必定是大便困难，两侧胁肋部疼痛。这是虚寒之邪从下向上侵犯所致。应当服用温性药物来治疗。（《脉经》中“必”字下有“下部闭塞大”五个字，《千金方》相同。《千金方》作“此虚寒气从下向上”。赵氏注：脱漏了“当”字。）
〔尤在泾〕趺阳脉是胃脉。微弦属于阴象。以阴邪加于阳位，脾胃受邪，就会发生腹部胀满。假设不胀满，那么阴邪必然向旁侧攻冲胁肋，向下闭塞谷道（肛门），导致大便困难和两侧胁肋疼痛。然而这种寒邪不是从外部侵入，而是从下向上内生，病根在于内部，这就是所谓的肾虚则寒动于中。所以不应当用发散法，而应当用温补法。
〔程林〕如果是寒实之证，就使用后面条文提到的温药攻下法。
病人腹部胀满，按压时不痛的属于虚证，痛的属于实证，可以使用攻下法。如果舌苔发黄且未经过攻下治疗的，攻下后黄苔自然消退。（《玉函经》中“病人”作“伤寒”，去掉“下”字，有“宜大承气汤”五个字。）
〔沈明宗〕这是通过手按来辨别腹部胀满的虚实。按压不痛，说明内部没有痰饮、食积或燥屎壅滞，可知是虚寒导致的胀满，应当用温药。如果按压痛，是因为外部的力量作用于内部的结聚，如宿食、痰饮、燥屎等，可知内部是实证，可以攻下。又通过舌苔颜色来验证虚实。如果有黄苔，就是湿热内蒸，且未经过攻下，必须攻下，黄苔自去，胀满自除。如果没有黄苔，则是近于虚寒，又不适用攻下法了。
〔魏荔彤〕无形的气机阻滞造成痞塞，按压时没有实物，怎么会痛呢？倘若夹杂有形的实物为患，如宿食在胃，疝气在少腹等情况，按压时有实物，阻碍在脏腑侧面，哪有会不痛的道理呢？这就是通过按压痛否来判断虚实的方法。
张氏《伤寒集注》说，中焦胃部按压而痛，世间的医生便认为是有食积。但是胃是水谷之海，又是仓廪之官，胃里如果有食物，按压一定不痛。试问吃饱的人按压痛不痛？只有邪气内结，正气不能从膈肌出入，按压才会痛。另外，如果胃中没有水谷精气，脏气虚弱而外浮，按压也会痛。如果不审察邪气和正气的虚实，一概认为是食积，伤害人一定很多。还有，按压要轻虚平按，如果不得法，加上手劲，没有不痛的。
腹部胀满有时减轻，过后又像原来一样，这是寒证，应当给予温药。（《脉经》在“减”字下，多一个“减”字。）
〔徐灵胎〕腹部胀满有增减，就不是脏气真元粘着固定的病，所以得阳气就减轻，得阴气就胀满加重。所以说这是寒证，应当用温药。
〔程林〕腹部胀满不减，所以用承气汤攻下。这里腹部胀满有时减轻，说明寒气或聚或散，应当用温药来散寒。
案语：金鉴说，本篇没有治疗虚寒腹满的方子，“当与温药”之下，应该有“宜浓朴生姜甘草半夏人参汤主之”十四个字，一定是脱简。阅读《伤寒论》太阴篇就知道了。这种说法我觉得不太妥当。
病人面色萎黄，烦躁但不口渴，胸中有寒实之邪，而且腹泻不止的，预后不良，属死证。（徐、沈、尤、金鉴将“躁”作“燥”，现在依从这一说法。）
〔徐灵胎〕痿黄，是指黄色黯淡无光的样子。
〔尤在泾〕痿黄，是脾虚而面色败坏的表现。气不到故感到干燥，中焦无阳气故不口渴。气竭阳衰，中上焦已经败坏，而又寒邪结聚于上，脏气脱失于下，凭借什么来通利或止泻呢？所以死。
案语：程、魏认为“躁”是阴躁，不可依从。本条没说腹部胀满，但徐注认为是虚寒腹满，不知是否详细准确。《脉经》将此条列在呕吐下利篇，似乎是合理的。
寸口脉弦，就会出现胁肋下拘急而痛，病人怕冷。（啬啬恶寒：形容怕冷的样子。）
〔尤在泾〕寸口脉弦，也是阴邪加于阳位的征象。所以胁肋下拘急而痛，而且寒邪从外部获得，与趺阳脉弦导致的两侧胁肋疼痛不同。所以前者兼有大便困难，而有后者有怕冷的症状。
患有中寒病的人喜欢打哈欠，流清鼻涕，发热且面色正常的喜欢打喷嚏。
〔程林〕说寒冷则面色惨淡不和，现在发热且面色正常，说明寒郁于肺经而化热。
〔金鉴〕中寒家，指素来患有中寒病的人。
〔尤在泾〕阳气想上升而被阴气牵引就打哈欠，阴气想进入而被阳气抗拒就打喷嚏。中寒者，阳气被抑制，所以喜欢打哈欠、流清鼻涕。如果发热且面色正常，说明邪气不能停留，所以喜欢打喷嚏。
〔魏荔彤〕这些症状都是针对外感寒邪而言的。外感寒邪与胀满病有什么关系呢？因为胀满病中也有内外合邪的情况，所以必须辨明外中寒的症状，以此作为内中寒的对应表现。
案语：《千金方》在此条之后有一条说：“凡是观察病人，未切脉先望诊，口燥、流清鼻涕、喜欢打喷嚏、打哈欠，这个人中了寒邪。”接着接下条，把这两条连成一条，知道此条是为下条“想打喷嚏却打不出来”发端的。
中寒的病人出现下利，是因为里气虚弱。想打喷嚏却打不出来，这是肚中寒冷。（〔原注〕一说痛。○《千金方》作腹中痛。）
〔尤在泾〕中寒而下利的，是里气素来虚弱，没有防御能力，邪气得以直接侵犯中脏。想打喷嚏却打不出来的，是因为正气被邪气逼迫，既不能驱赶邪气，又不甘心受邪，于是阳气想动却又停止，邪气想离去却又留下。
〔沈明宗〕阳气调和则会打喷嚏，而想打喷嚏却打不出来，是阴寒凝滞在体内，所以肚中痛。
瘦人脐周疼痛，必定有风冷，谷气运行不畅，反而使用攻下法，气机上冲，如果不冲，心下就会痞塞。
〔程林〕瘦人是虚弱的人。如果脐周作痛，必定有风冷，谷气附着而不运行。瘦人不可峻下，反而攻下，那么风冷之气必会上冲。如不上冲，必定乘虚结于心下形成痞证。
〔尤在泾〕这看起来像里实证，实际上是虚冷，适宜用温药来助脾的运行。反而攻下，谷气排出而风冷不与之一同排出，正气更加虚弱，邪气失去制约，势必上冲。若不冲，心下就会痞塞。
病人腹部胀满，发热十天，脉浮而数，饮食正常，用浓朴七物汤主治。（《脉经》、《千金方》将此条列为浓朴三物汤主治，而本方主治云治腹满气胀，恐怕是互误。）
〔徐灵胎〕这里有表证又有里证，但里证挟带燥邪，所以以小承气汤为主，配合桂枝、甘草、姜、枣，以调和表证。大概腹部的胀满，起初虽因微寒，但胃气素强，所以表寒不入，饮食正常。只是腹满发热，且脉浮数，相持十天，这是表里两病，所以表里双解。这就是大柴胡汤的法度。只是脉浮数，邪气尚在太阳经，所以用桂枝去芍药汤，合小承气汤。
浓朴七物汤方（《外台秘要》引《千金方》，名浓朴七味汤，主治腹满气胀方。）
浓朴（半斤） 甘草 大黄（各三两） 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，每日三次。○若有呕吐，加半夏五合。○若下利，去大黄。○寒多者，加生姜至半斤。（《外台秘要》不用生姜，用干姜，说：“这原本是仲景《伤寒论》的方子。”）
张氏《医通》说，相比桂枝加大黄汤，多了枳实、厚朴，少了芍药。因为枳实、厚朴专门泄除壅滞之气，所以用它们。芍药专门收敛耗散的阴气，此病只是胀满而不痛，与阴血无关，所以去掉它。
《三因极一病证方论》中的七物浓朴汤，治疗腹满发热，因阳并入阴，则阳实而阴虚，阳盛生外热，阴虚生内热。脉必浮数，浮则为虚，数则为热。阴虚不能宣导，饮食正常，导致胀满的，称为热胀。（即本方。）
腹中寒气，肠鸣如雷，剧烈疼痛，胸胁逆满呕吐，用附子粳米汤主治。（《千金方》作腹中塞气，胀满肠鸣切痛。《外台秘要》引范汪作腹中寒气胀雷鸣。）
〔程林〕《灵枢经》说：邪在脾胃，阳气不足，阴气有余，则寒中，肠鸣腹痛。大概脾胃喜温而恶寒，寒气客居在中焦，奔迫于肠胃之间，所以作雷鸣切痛、胸胁逆满呕吐。附子粳米汤，能散寒止逆。
张氏《医通》说：腹中寒气，奔迫上攻胸胁，以及于胃，而增加呕逆。不久胃气空虚，邪气无所抵挡，辄入阳位就危险了。所以除患的关键，重在保全胃气。趁邪气刚犯胃，还能进食，用附子粳米汤之法，温饱其胃。胃气温饱，则土厚而邪难上越。胸胁逆满的浊阴，得温不敢留恋，必还从下窍而出。
附子粳米汤方
附子（一枚炮制） 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，煮米熟汤成，去渣，温服一升，每日三次。（《外台秘要》作用水八升煮米取熟，去米内药，煮取三升，去渣，适寒温，饮之，与仲景《伤寒论》相同。《集验方》加干姜二两。案：本条煮法，必有脱文。）
〔程林〕疗寒用热药。腹中寒气，非附子辛热，不足以温之。雷鸣切痛，非甘草、大枣、粳米的甘缓，不足以和之。逆满呕吐，非半夏之辛，不足以散之。五物相辅相成，而为佐使。
《外台秘要》载仲景论：霍乱四逆，吐少呕多的，用附子粳米汤主治。
方与本条相同。（《千金方》同。）
又《删繁方》：附子汤，治疗肺虚劳损，腹中寒鸣切痛，胸胁逆满气喘。
于本方内加宿姜、白术。（粳米，作仓米。）
又《短剧方》：解急蜀椒汤，主治寒疝气心痛如刺，绕脐腹中尽痛，出冷汗欲绝。又治疗心腹痛，困急欲死。解结逐寒，上下痛良效。
于本方内加蜀椒、干姜。
《三因方》胀满门：附子粳米汤，治疗忧怒相乘，神志不守，思虑兼并扰乱，脏气不主传导，使诸阳不舒，反顺为逆，中寒气胀，肠鸣切痛，胸胁逆满，呕吐不食。
即于本方加干姜。
《百一选方》：附子粳米汤，补虚生胃气，逐冷痰和五脏，快胸膈止泻利。
于本方内加人参、黄芪、白术、川姜、木香，去大枣，用陈仓米。（《活人事证方》名附子仓廪汤。）
《证治要诀》翻胃门：若胃寒甚，服药而翻吐者，宜附子粳米汤，加丁香十粒，砂仁半钱。大便秘者，更加枳壳半钱。
又呃逆门：若胃中寒甚，呃逆不已，或复呕吐，轻剂不能取效，宜附子粳米汤，加炒川椒、丁香。每服各三十五粒。
腹痛而大便闭结不通的，用浓朴三物汤主治。（“痛而闭”，《脉经》作腹满痛。）
〔魏荔彤〕闭者，就是胃胀便难的证候。
〔尤在泾〕痛而闭，是六腑之气不行。浓朴三物汤，与小承气汤组成相同，但承气汤意在荡涤实邪，所以以大黄为君药；三物汤意在行气，所以以浓朴为君药。
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，先煮前二味，取五升，内大黄，煮取三升，温服一升，以利为度。（“三升”下，《千金方》有“去滓”二字。）
《千金方》说：腹中转动者勿服，不动者更服。
按压心下满痛的，这是实证，当下之，宜用大柴胡汤。（《脉经》无“宜大柴胡汤”五个字，接前七物汤、三物汤为一条。《伤寒论·可下编》作“病腹中满痛者”，宜下有大承气三字。）
〔尤在泾〕按之而满痛者，是有形之实邪，邪实则可下。而心下满痛，则结处尚高，与腹中满痛不同。所以不宜大承气汤，而宜大柴胡汤。
〔魏荔彤〕这是邪实，而且挟热的情况。仲景已在《伤寒论》太阳篇叙述过了。说：伤寒十余日，热结在里的，与大柴胡汤主治。宜下之，而不用大承气汤，乃出大柴胡汤，正与《伤寒论》篇中所言相符。
张氏《医通》说：邪从胸胁而入于阳位，合用大柴胡汤两解之。与脐腹硬痛，承气证不同。○案：数说如此，而金鉴认为满痛之下，应当有“潮热”这三个字。若无此三字，则不当与大柴胡汤。这很有道理。然而今据《脉经》，而体味经旨，这也是浓朴三物汤的证候，“宜大柴胡汤”五个字，恐怕是衍文。其方亦错出。
大柴胡汤方
柴胡（半斤） 黄芩（二两） 芍药（三两） 半夏（半升） 枳实（四枚炙） 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，去渣，再煎，温服一升，每日三次。
腹部胀满不减，即使减轻也微不足道，应当须攻下，宜用大承气汤。（“不足言”，《千金方》作“不惊人”。）
〔金鉴〕腹部胀满时减时满，是虚满。腹部胀满常常而满，是实满。腹部胀满不减，虽然减也不过稍减，不值得说减。虚满当温，实满当下，故宜大承气汤下之。
〔尤在泾〕减不足言，谓虽然减，而不足以称减，所以形容胀满到了极点。故宜大下。以上三方，虽缓急不同，而攻泄则一。所谓中满者，泻之于内也。
大承气汤方（见前 病中。）
心胸中大寒痛，呕吐不能饮食，腹中寒气上冲皮起，出现有头足状的隆起，上下痛而不可触近，用大建中汤主治。（《千金方》作心胁中大寒大痛，呕吐不能饮食，饮食下咽，自知偏从一面下流，有声决决然。若腹中寒气上冲，皮起出见，有头足上下，而痛，其头不可触近。程林、金鉴无“痛而”二字。）
〔金鉴〕心胸中大寒痛，谓腹中上连心胸大痛。而名大寒痛者，因为有厥逆、脉伏等大寒证的意思。呕逆不能饮食者，是寒甚，拒格于中。上冲皮起，出见头足者，是寒甚聚坚于外。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。这是治心胸中寒的方法。
〔程林〕寒气搏于肠胃之外，冲突出见于皮肤膜原之分，如有头足，其痛则近于外，故不可以手触近也。
大建中汤方
蜀椒（二合去汗） 干姜（四两） 人参（二两）
以上三味药，用水四升，煮取二升，去渣，内胶饴一升，微火煎，取一升半，分温再服。如一炊顷（约一顿饭时间），如饮粥二升，后更服。当一日食糜，温覆之。（“一炊顷”，《千金方》作“炊三升米”。）
张氏《千金衍义》说：虚寒积聚的治疗，此方最有力。其方中人参辅佐椒姜，温散之法，人皆得之。至于胶饴，为助满之首，列而反用，以治痛呕不能食，是专用助满之味，引领椒姜人参，为泄满之通使也。
《千金方》大建中汤：治疗虚劳，寒饮在胁下，决决有声。
饮已如从一边下，决决然也。有头并冲皮起，引两乳内痛，里急善梦，失精气短，目KT KT惚惚多忘。
蜀椒（二合） 半夏（一升） 生姜（一斤） 甘草（二两） 人参（三两） 饴糖（八两）
以上六味药，咀碎，用水一斗，煮取三升，去渣内糖，温服七合。里急拘引，加芍药、桂心各三两。手足厥，腰背冷，加附子一枚。劳者加黄芪一两。
胁下偏痛发热，其脉紧弦，这是寒证，用温药攻下，宜大黄附子汤。（《脉经》无“发热”二字。）
〔尤在泾〕胁下偏痛，而脉紧弦，阴寒成聚，偏着一处。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。程氏说：大黄苦寒，走而不守，得附子、细辛之大热，则寒性散，而走泄之性存是也。
〔魏荔彤〕此发热，或有形之物，积于肠胃，而皮肤热作，故在可下之例，未必为假热症。
〔徐灵胎〕附子、细辛与大黄，今用并行，而不倍，此即《伤寒论》大黄附子泻心汤之法也。
《千金衍义》说：少阴病始得之，反发热脉沉，用麻黄附子细辛汤，以治太阳少阴之两感。此治胁下偏痛。
The Fuyang pulse is faint and wiry. According to medical principles, abdominal fullness should occur. If there is no fullness, there must be difficulty in defecation and pain in the hypochondriac regions on both sides. This is caused by deficiency-cold pathogen ascending from below. It should be treated with warm herbs. (In *Mai Jing*, under the character "bi" [must], there are five characters "xiabu bisai da" [lower part obstruction large]. *Qianjin Fang* is the same. *Qianjin Fang* reads "ci xuxu qi cong xia xiang shang" [this deficiency-cold qi ascends from below upward]. Zhao's annotation: The character "dang" [should] is missing.)
[You Zaijing] The Fuyang pulse is the stomach pulse. Faint and wiry represents a yin pattern. When yin pathogen adds to yang position, the spleen and stomach receive it, resulting in abdominal fullness. If there is no fullness, the yin pathogen must attack laterally to the hypochondrium and block the lower orifice (anus) downward, causing difficulty in defecation and pain in the bilateral hypochondria. However, this cold pathogen does not enter from the exterior but arises internally from below; the disease originates within, as described: "Kidney deficiency causes cold to move within." Therefore, dispersing methods should not be used, but warming methods should be employed.
[Cheng Lin] If it is a cold-excess condition, the warming purgative method mentioned in the following clause should be used.
The patient has abdominal fullness. Pressing it yields no pain, indicating a deficiency pattern; pain indicates an excess pattern. Purging may be indicated. If the tongue coating is yellow and purging has not yet been performed, the yellow coating will disappear after purging. (*Yuhan Jing* reads "shanghan" [cold damage] instead of "bingren" [patient], removes the character "xia" [purge], and includes five characters "yi Dachengqi Tang" [suitable for Dachengqi Decoction].)
[Shen Mingzong] This distinguishes the deficiency or excess of abdominal fullness by manual palpation. No pain upon pressing indicates no accumulation of phlegm-fluids, food retention, or dry stool inside, confirming deficiency-cold fullness, which should be treated with warm herbs. Pain upon pressing indicates internal exuberance due to external force acting on internal accumulations such as retained food, phlegm, or dry stool, confirming an excess pattern suitable for purging. Furthermore, the tongue coating verifies the nature: a yellow coating indicates steaming damp-heat internally and that purging has not occurred; purging is necessary, after which the yellow coating disappears and distension resolves. Absence of a yellow coating suggests proximity to deficiency-cold, making purging inappropriate.
[Wei Liting] Formless qi stagnation causing stuffiness results in no tangible object upon pressing, hence no pain. If accompanied by tangible pathological products, such as retained food in the stomach or hernia in the lower abdomen, pressing reveals objects obstructing the sides of the zang-fu organs, inevitably causing pain. Thus, determining deficiency or excess relies on whether pressing causes pain.
Zhang's *Shanghan Jizhu* states that pain upon pressing the middle jiao leads physicians to assume food retention. However, the stomach is the sea of water and grain and the official of granaries; if food were truly present, pressing would not cause pain. Consider a person who has just eaten—does pressing hurt? Only when pathogenic factors bind internally and righteous qi cannot move freely across the diaphragm does pressing cause pain. Additionally, if the stomach lacks grain essence and organ qi is deficient and floating externally, pressing also causes pain. Without examining the deficiency or excess of pathogen and righteous qi, and generally attributing symptoms to food retention causes much harm. Moreover, pressing should be light and level; improper technique applying excessive force will invariably cause pain.
Abdominal fullness that decreases intermittently and returns to its original state indicates cold; warm herbs should be administered. (*Mai Jing* adds another character "jian" [decrease] after "jian".)
[Xu Lingtai] Abdominal fullness with fluctuations indicates a disease not fixed by true organ qi. It decreases with yang and increases with yin. Hence, it is said to be cold, requiring warm herbs.
[Cheng Lin] Abdominal fullness without decrease warrants Chengqi decoction for purging. Here, abdominal fullness decreases intermittently, suggesting cold qi gathers and scatters; warm herbs should be given to dissipate the cold.
Case note: Jin Jian states that this section lacks a formula for treating deficiency-cold abdominal fullness. Under "dang yu wen yao" [should give warm medicine], the fourteen characters "yi Nongpou Shengjiang Gancao Banxia Renshen Tang Zhu Zhi" [suitable for Nongpou Shengjiang Gancao Banxia Renshen Decoction as main treatment] are likely missing due to textual loss. Reading the Taiyin chapter of *Shanghan Lun* confirms this. I find this argument unconvincing.
The patient presents with sallow complexion, restlessness without thirst, cold-excess in the chest, and unremitting diarrhea; this is a fatal prognosis. (Xu, Shen, You, and Jin Jian read "zao" [restless] as "zao" [dry]; we follow this reading.)
[Xu Lingtai] "Wei huang" refers to a dull, dark yellow color.
[You Zaijing] Sallow complexion indicates spleen deficiency and deterioration of complexion. Qi fails to reach, causing dryness; lack of yang in the middle causes absence of thirst. Qi exhaustion and yang decline indicate failure of the upper-middle jiao, compounded by cold binding above and organ depletion below. How can one rely on methods to unblock or stop diarrhea? Thus, death ensues.
Case note: Cheng and Wei interpret "zao" as yin restlessness, which is incorrect. This clause does not mention abdominal fullness, yet Xu's commentary assumes deficiency-cold abdominal fullness, which is unclear. *Mai Jing* places this clause in the Vomiting and Diarrhea chapter, which seems appropriate.
A wiry pulse at the Cunkou position indicates tightness and pain in the hypochondrium, accompanied by aversion to cold. (Sese ehan: describing the sensation of aversion to cold.)
[You Zaijing] A wiry pulse at Cunkou also reflects yin pathogen adding to yang. Hence, tightness and pain in the hypochondrium, and cold acquired from the exterior. This differs from the bilateral hypochondriac pain associated with a wiry Fuyang pulse. The former involves difficulty in defecation, while this involves aversion to cold.
Patients suffering from interior cold often yawn. Those with clear nasal discharge, fever, and normal facial color tend to sneeze.
[Cheng Lin] Cold typically causes a grimace and discordant appearance. Now, with fever and normal color, it indicates cold constrained in the Lung meridian transforming into heat.
[Jin Jian] "Zhong han jia" refers to individuals chronically suffering from interior cold.
[You Zaijing] When yang desires to ascend but is pulled down by yin, yawning occurs. When yin desires to enter but is rejected by yang, sneezing occurs. In interior cold, yang is suppressed, leading to preference for yawning and clear nasal discharge. If there is fever with normal color, the pathogen cannot linger, hence sneezing occurs.
[Wei Liting] These symptoms refer to exterior cold invasion. What does exterior cold have to do with abdominal fullness? Because abdominal fullness cases may involve combined interior and exterior pathogens, one must clearly distinguish exterior cold invasion signs as responses to interior cold invasion.
Case note: *Qianjin Fang* adds a clause here: "Generally observing patients, before taking the pulse, look at them: dry mouth, clear nasal discharge, desire to sneeze and yawn—this person has interior cold." It then connects to the next clause, combining them into one, implying this clause introduces the next one regarding inability to sneeze.
Interior cold patients with diarrhea suffer because of interior deficiency. Desire to sneeze but inability to do so indicates cold in the abdomen. ([Original Note] Alternatively, pain. ○ *Qianjin Fang* reads "abdominal pain".)
[You Zaijing] Interior cold with diarrhea implies chronic interior deficiency lacking defense, allowing pathogen to directly invade the central organs. Inability to sneeze despite the urge indicates righteous qi being pressured by pathogen; unable to repel it, yet unwilling to accept it, yang attempts to move but stops, and pathogen attempts to leave but remains.
[Shen Mingzong] Harmonized yang causes sneezing. Inability to sneeze indicates yin-cold stagnating in the interior, hence abdominal pain.
Thin individuals with periumbilical pain surely have wind-cold, causing grain qi to fail to circulate. If purged inappropriately, qi will surge upward; if it does not surge, epigastric stuffiness will result.
[Cheng Lin] Thin individuals are weak. Periumbilical pain indicates wind-cold and adherent, non-circulating grain qi. Thin individuals should not undergo harsh purging. Inappropriate purging causes wind-cold qi to surge upward. If it does not surge, it will bind in the epigastrium due to deficiency, causing stuffiness.
[You Zaijing] This resembles interior excess but is actually deficiency-cold, warranting warm herbs to assist spleen transport. Inappropriate purging expels grain qi but leaves wind-cold behind, further weakening righteousness and leaving pathogen unchecked, inevitably causing upward surging. If no surging occurs, epigastric stuffiness results.
Patient with abdominal fullness, fever for ten days, floating and rapid pulse, normal diet, should be treated with Nongpou Qiwu Tang. (*Mai Jing* and *Qianjin Fang* list this clause under Nongpou Sanwu Tang treatment, while the formula's indication says treating abdominal fullness and qi distension, likely a mutual error.)
[Xu Lingtai] This case involves both exterior and interior syndromes, with interior dryness pathogen. Thus, Xiao Chengqi Tang is primary, combined with Guizhi, Gancao, Jiang, and Zao to harmonize the exterior. Abdominal fullness initially caused by mild cold, but strong stomach qi prevents exterior cold invasion, maintaining normal diet. However, with fullness, fever, and floating-rapid pulse persisting for ten days, it is a simultaneous exterior-interior disease requiring dual resolution. This follows the principle of Da Chaihu Tang. Since the pulse is floating-rapid, pathogen remains in the Taiyang stage, so Guizhi Qu Shaoyao Tang is combined with Xiao Chengqi Tang.
Nongpou Qiwu Tang Formula (Waitai Mi Yao cites Qianjin Fang, naming it Nongpou Qiwei Tang, indication: abdominal fullness and qi distension.)
Houpo (8 liang), Gancao, Dahuang (each 3 liang), Dazao (10 pieces), Zhishi (5 pieces), Guizhi (2 liang), Shengjiang (5 liang).
These seven ingredients, boil in 1 dou of water until 4 sheng remain. Warm dose 8 ge, three times daily. ○ For vomiting, add Banxia 5 ge. ○ For diarrhea, remove Dahuang. ○ For more cold, increase Shengjiang to half jin. (Waitai Mi Yao uses Ganjiang instead of Shengjiang, stating: "This is originally Zhongjing's Shanghan Lun formula.")
Zhang Shi Yi Tong states: Compared to Guizhi Jiadahuang Tang, this has more Zhishi and Houpo, less Shaoyao. Zhishi and Houpo specifically drain stagnant qi, hence used. Shaoyao specifically collects dissipating yin blood; this case has only fullness without pain, unrelated to yin blood, hence removed.
Sanyin Fang's Qiwu Nongpou Tang treats abdominal fullness and fever. Yang merging into yin makes yang excess and yin deficiency. Yang excess generates exterior heat; yin deficiency generates interior heat. Pulse is floating-rapid; floating indicates deficiency, rapid indicates heat. Yin deficiency fails to guide, diet remains normal, causing distension known as heat-distension (i.e., this formula).
Cold qi in the abdomen, borborygmus like thunder, severe cutting pain, reverse fullness in chest and hypochondrium, vomiting, should be treated with Fuzi Jingmi Tang. (*Qianjin Fang* reads abdominal blocking qi, distension, borborygmus, severe pain. Waitai Mi Yao cites Fan Wang reading abdominal cold qi distension, thunderous borborygmus.)
[Cheng Lin] *Ling Shu* states: Pathogen in spleen and stomach, insufficient yang, excess yin, leads to cold center, borborygmus, and abdominal pain. Spleen and stomach prefer warmth and dislike cold. Cold lodging in the middle rushes between intestines and stomach, causing thunderous borborygmus, severe pain, reverse fullness in chest/hypochondrium, and vomiting. Fuzi Jingmi Tang dissipates cold and stops rebellion.
Zhang Shi Yi Tong states: Cold qi in abdomen rushes upward attacking chest/hypochondrium and stomach, increasing vomiting/rebellion. Soon stomach qi empties, pathogen faces no resistance, entering yang positions becomes dangerous. Thus, removing disaster focuses on preserving stomach qi. While pathogen first invades stomach and eating is still possible, use Fuzi Jingmi Tang method to warm and nourish stomach. Warmed stomach strengthens earth, preventing pathogen from rising. Reverse fullness turbid yin in chest/hypochondrium, warmed, dare not linger, must exit via lower orifices.
Fuzi Jingmi Tang Formula
Fuzi (one piece, prepared), Banxia (half sheng), Gancao (1 liang), Dazao (10 pieces), Jingmi (half sheng).
These five ingredients, boil in 8 sheng of water until rice is cooked and soup ready. Remove dregs, warm dose 1 sheng, three times daily. (Waitai Mi Yao: boil 8 sheng water with rice until cooked, remove rice, add medicine, boil to 3 sheng, remove dregs, drink at appropriate temperature, same as Zhongjing's Shanghan Lun. Jiyan Fang adds Ganjiang 2 liang. Case: The cooking method in this clause must have textual loss.)
[Cheng Lin] Treat cold with hot herbs. Abdominal cold qi requires Fuzi's acrid-hot nature to warm. Thunderous borborygmus and severe pain require Gancao, Dazao, and Jingmi's sweetness to harmonize. Reverse fullness and vomiting require Banxia's acridity to dissipate. These five items complement each other as assistants and guides.
Waitai Mi Yao cites Zhongjing's discussion: Huoluan with Sini syndrome, less vomiting than retching, treat with Fuzi Jingmi Tang.
Formula same as this clause. (*Qianjin Fang* agrees.)
Also, Shanfan Fang: Fuzi Tang, treats lung deficiency consumptive injury, abdominal cold borborygmus severe pain, chest/hypochondrium reverse fullness, asthma.
Add Su Jiang and Baizhu to this formula. (Jingmi changed to Cangmi.)
Also, Duanji Fang: Jieji Shujiao Tang, treats cold hernia, heart pain like stabbing, periumbilical abdominal complete pain, profuse sweating approaching collapse. Also treats heart/abdominal pain, distress approaching death. Resolves knots, expels cold, good for upper/lower pain.
Add Shujiao and Ganjiang to this formula.
Sanyin Fang Distension Section: Fuzi Jingmi Tang, treats sorrow and anger interacting, spirit not guarded, thoughts interfering and disturbing, organ qi failing to conduct, causing yang discomfort, reversing順 to逆, interior cold qi distension, borborygmus severe pain, chest/hypochondrium reverse fullness, vomiting anorexia.
Add Ganjiang to this formula.
Baiyi Xuanfang: Fuzi Jingmi Tang, tonifies deficiency, generates stomach qi, expels cold-phlegm, harmonizes five zang, clears chest/diaphragm, stops diarrhea.
Add Renshen, Huangqi, Baizhu, Chuanning, Muxiang; remove Dazao; use aged Cangmi. (Huoshi Renzheng Fang names it Fuzi Canglin Tang.)
Zhengzhi Yaojue Fanwei Section: If stomach cold is severe, causing regurgitation after taking medicine, use Fuzi Jingmi Tang, add Dingxiang 10 grains, Sharen half qian. For constipation, add Zhike half qian.
Also Eni Section: If stomach cold is severe, persistent hiccups, or recurrent vomiting, mild agents ineffective, use Fuzi Jingmi Tang, add fried Chuanning and Dingxiang. Each dose 35 grains.
Pain with constipation should be treated with Nongpou Sanwu Tang. ("Tong er bi", Mai Jing reads "fumantong".)
[Wei Liting] Bi refers to stomach distension and difficulty defecating.
[You Zaijing] Pain with constipation indicates six fu organs' qi failing to circulate. Nongpou Sanwu Tang shares ingredients with Xiao Chengqi Tang, but Chengqi aims to purge excess, using Dahuang as sovereign. Sanwu aims to move qi, using Houpo as sovereign.
Nongpou Sanwu Tang Formula
Houpo (8 liang), Dahuang (4 liang), Zhishi (5 pieces).
These three ingredients, boil in 1.2 dou of water. First boil two ingredients to get 5 sheng. Add Dahuang, boil to 3 sheng. Warm dose 1 sheng, stop when bowel movement occurs. (After "3 sheng", Qianjin Fang has "remove dregs".)
Qianjin Fang says: Do not take if abdomen moves; take more if it does not move.
Pressing epigastrium causing fullness and pain indicates excess; purge it. Suitable for Da Chaihu Tang. (*Mai Jing* omits "suitable for Da Chaihu Tang"; connects previous Qiwu and Sanwu tangs as one clause. Shanghan Lun Ke Xia Bian reads "disease abdominal fullness/pain", suitable for purging has Dachengqi three characters.)
[You Zaijing] Fullness and pain upon pressing indicates tangible excess. Excess allows purging. Epigastric fullness/pain binds higher than abdominal fullness/pain, differing from the latter. Thus, Dachengqi is unsuitable; Da Chaihu is suitable.
[Wei Liting] This describes excess pathogen with heat. Zhongjing narrated this in Shanghan Lun Taiyang chapter: Cold damage ten-plus days, heat binding inside, treat with Da Chaihu Tang. Purge, but not Dachengqi, thus issuing Da Chaihu aligns with Shanghan Lun text.
Zhang Shi Yi Tong states: Pathogen enters yang positions from chest/hypochondrium, requiring Da Chaihu Tang dual resolution. Differs from umbilical/abdominal hard pain, Chengqi syndrome. ○ Case: These views hold, but Jin Jian argues "chao re" [tidal fever] three characters should follow "man tong" [fullness/pain]. Without these, Da Chaihu is inappropriate. This is reasonable. However, based on Mai Jing and interpreting classic intent, this is also a Nongpou Sanwu Tang syndrome; "suitable for Da Chaihu Tang" five characters are likely interpolations. The formula is also misplaced.
Da Chaihu Tang Formula
Chaihu (8 liang), Huangqin (2 liang), Shaoyao (3 liang), Banxia (half sheng), Zhishi (4 pieces, roasted), Dahuang (2 liang), Dazao (12 pieces), Shengjiang (5 liang).
These eight ingredients, boil in 1.2 dou of water to get 6 sheng. Remove dregs, decoct again. Warm dose 1 sheng, three times daily.
Abdominal fullness does not decrease, or decrease is negligible, requiring purging. Suitable for Dachengqi Tang. ("Bu zu yan", Qianjin Fang reads "bu jing ren".)
[Jin Jian] Intermittent fullness/decrease is deficiency fullness. Constant fullness is excess fullness. Fullness not decreasing, even if slightly decreased, is not worth mentioning decrease. Deficiency fullness needs warming; excess fullness needs purging. Hence, suitable for Dachengqi purging.
[You Zaijing] "Decrease not worth mentioning" means although slight decrease occurs, it is insufficient to call decrease, emphasizing extreme fullness. Hence, heavy purging is needed. The above three formulas differ in urgency but share purging action. As stated: "Fullness in middle, drain from within."
Dachengqi Tang Formula (See previous Disease section.)
Severe cold pain in heart/chest, vomiting unable to eat, cold qi in abdomen surging up raising skin showing head-and-foot shapes, upper/lower pain untouchable, treat with Da Jianzhong Tang. (*Qianjin Fang* reads heart/hypochondrium severe cold/pain, vomiting unable to eat, food swallowing known to flow down one side, sound jujue ran. If abdominal cold qi surges, skin raises showing head/foot upper/lower, pain, head untouchable. Cheng Lin/Jin Jian omit "tong er".)
[Jin Jian] Severe cold pain in heart/chest means abdominal pain extending up to heart/chest. Named severe cold pain due to symptoms like reversal cold and hidden pulse indicating severe cold syndrome. Vomiting/rebellion unable to eat indicates severe cold rejecting in middle. Surging skin showing head/foot indicates severe cold gathering firmly outside. Untouchable upper/lower pain indicates severe pain in internal zang-fu and external meridians due to severe cold. Main treatment is Da Jianzhong Tang. Shujiao and Ganjiang severely dissipate cold; Renshen and Jiaoyi severely build middle deficiency. After taking, cover warmly to induce slight sweat, cold goes, pain stops. This is the method for treating heart/chest cold.
[Cheng Lin] Cold qi fights outside intestines/stomach, protrudes to skin/membrane origins, appearing with head/foot. Pain is near exterior, hence untouchable.
Da Jianzhong Tang Formula
Shujiao (2 he, remove sweat), Ganjiang (4 liang), Renshen (2 liang).
These three ingredients, boil in 4 sheng of water to get 2 sheng. Remove dregs, add 1 sheng Jiaoyi. Simmer gently to get 1.5 sheng. Divide into two warm doses. After one meal time, drink 2 sheng porridge, then take more. Eat millet gruel for one day, cover warmly. ("One meal time", Qianjin Fang reads "cook three sheng rice".)
Zhang Shi Qianjin Yanyi states: For treating deficiency-cold accumulation, this formula is most powerful. Renshen assists Jiao/Jiang in warming/dispersing, a method everyone knows. Jiaoyi, though aiding fullness, is used contrary to listing, to treat pain/vomiting/anorexia. It uses fullness-aiding flavor to lead Jiao/Jiang/Renshen as the messenger for draining fullness.
Qianjin Da Jianzhong Tang: Treats deficiency consumption, cold-fluid in hypochondrium, jujue sound.
Fluid flows down one side, jujue. Head rises pushing skin, pulling inner pain in both breasts, inner urgency, frequent dreams, loss of essence/qi, shortness of breath, blurry vision, forgetfulness.
Shujiao (2 he), Banxia (1 sheng), Shengjiang (1 jin), Gancao (2 liang), Renshen (3 liang), Yitang (8 liang).
These six ingredients, crush. Boil in 1 dou water to get 3 sheng. Remove dregs, add sugar. Warm dose 7 ge. For inner urgency/tightness pulling, add Shaoyao and Guixin each 3 liang. For cold extremities/back, add Fuzi one piece. For consumption, add Huangqi 1 liang.
Oblique pain in hypochondrium with fever, pulse tight-wiry, indicates cold. Treat with warming purgation. Suitable for Dahuang Fuzi Tang. (*Mai Jing* omits "fever".)
[You Zaijing] Oblique hypochondriac pain with tight-wiry pulse indicates yin-cold aggregation focusing in one area. Fever, if present, is due to yang suppression. Thus, warming is needed to resolve cold, purging to remove knot. Hence, "suitable to purge with warming herbs." Cheng states: Dahuang is bitter-cold, moving without staying. With Fuzi/Xixin's great heat, cold nature disperses, while moving/draining nature remains.
[Wei Liting] This fever may be due to tangible accumulation in intestines/stomach causing skin heat, thus falling under purging indications, not necessarily false heat.
[Xu Lingtai] Fuzi, Xixin, and Dahuang used together without doubling dosage follows the method of Dahuang Fuzi Xie Xin Tang in Shanghan Lun.
Qianjin Yanyi states: Shaoyin disease onset, reverse fever with sunken pulse, use Mahuang Fuzi Xixin Tang to treat Taiyang-Shaoyin simultaneous contraction. This treats oblique hypochondriac pain.