趺阳脉微弦。法当腹满。
按此条证。寒气壅闭。即大黄附子汤所主。宜称之实。而言为虚寒者。虚。犹虚烦之虚。非虚衰之虚。盖指无
形之寒气。对水饮结聚有形之寒而言也。（虚烦义。宜参伤寒论述义。栀子豉汤条。）又程氏注稍不了。
病者腹满。按之不痛为虚。
按四十八难曰。痒者为虚。痛者为实。外痛内快。为外实内虚。内痛外快。为内实外虚。杨玄操注曰。轻手按
之则痛。为外实。病浅故也。重手按之则快。为内虚。病深故也。重手按之则痛。为内实。病深故也。轻手按之则
快。为外虚。病浅故也。凡人病按之则痛者。皆为实。按之则快者。皆为虚也。难经本为有痛立言。而玄操注。亦
与此条相发。
又按阳明篇曰。阳明病。胁下硬满。不大便而呕。舌上白苔者。可与小柴胡汤。其意正与本条互发。以见证虽
似可下。其白苔者。邪未结实。黄苔者。始为热实。乃黑苔之为实。可以知也。且此条。示以按腹知虚实。以验舌
辨寒热。而后宜议攻下矣。要之诊察之大法。莫不可从此条而扩充焉。
病者痿黄。（脉经。胸中。作胃中。利上。有下字。）
寸口脉弦者。（巢源。作寸口脉双弦。则胁下拘急。其人涩涩而寒。）
夫中寒家喜欠。
按中字。金鉴为平声读。其他诸注。皆为去声读。盖此中寒家。言素禀阴脏。动易感寒者。然则二说并存为佳。
又程氏谓寒郁于肺经而为热者。似欠稳当。灵口问篇曰。阳引而上。阴引而下。阴阳相引。故数欠。又曰。阳
气和利。满于心出于鼻。故为嚏。辨脉法曰。客气内入。嚏而出之。
病腹满。发热十日。（本草浓朴条。图经引云。又浓朴七物汤。主腹痛胀满。按此与千金同误。）
按金鉴曰。饮食如故。胃热能消谷也。存考。
浓朴七物汤方（图经引。枳实上。有大字。桂枝之枝字无。）
附子粳米汤方
按弟子村田精一曰。此方。与白虎汤。及加人参加桂二汤。桃花汤。并用粳米。而其煮法。不云至几升。盖是
以米熟为度。不必期至几升者。恐非有脱文。浓朴麻黄汤。煮小麦熟去滓。亦是一辙。此可以备一说。仍存之。
圣惠。治寒疝心痛如刺。绕脐腹中尽痛。白汗出。气欲绝方。
于本方。加川椒。干姜。桂心。
浓朴三物汤方（本草浓朴条。图经云。张仲景治杂病。浓朴三物汤。主腹胀脉数。浓朴半斤。方后。有腹
中转动。更服。不动勿服十字。）
大柴胡汤方（黄芩二两。原本。诸本。并作三两。）
腹满不减。
伤寒补亡论曰。减不足言者。言不甚减也。论言。太阳发汗不彻。不足言。与此同意。俗语所谓不济事者。是
也。
心胸中大寒痛。
按出见有头足上下。句上。上声。下。去声。尤氏以出见有头足。为阴凝成象。腹中虫物。乘之而动。谓蜀椒
干姜。
温中下虫。误甚。
大建中汤方（蜀椒去汗。类聚。无去字。）
大黄附子汤方
按此条证。固属寒实。故大黄附辛。相合成剂。性味融和。自为温利之用。如附子泻心汤。则其证表寒里热。
故别煮附子。而功则各奏。故同是附子大黄并用。而立方之趣。迥乎不均。徐氏说未确切。盖温利之剂实以桂枝加
大黄汤。及此汤为祖。而温脾等诸汤。皆莫不胚胎于此二方矣。
赤丸方
按本草。丹砂黑字云。作末名真朱。
寒疝绕脐痛。（沉紧。类聚。亦作沉弦。）
按素问经脉别论。真虚 心。厥气留薄。发为白汗。（阴阳别论。魄汗。辑义误写作白汗。又生气通天论。魄
汗未尽。魄白音通。）
乌头煎方（宋本外台熬。作炮。无去皮字。白蜜二斤。方后。上以水三升。煮乌头取二升。去乌头内蜜。
煎令水气尽云云。不可一日再服。作日止一服。不可再也。）
按程氏曰。治下焦之药味不宜多。多则气不专。此言。本于至真要大论。补下治下制以急之说。殆不免拘泥。
又按陶氏本草序例曰。附子乌头若干枚者。去皮毕。以半两准一枚。千金方。治风历节。防己汤方后曰。凡用乌头。
皆去皮。熬令黑。乃堪用。不然至毒人。宜慎之。据此。宋本外台。不必是。其不 咀。岂嫌熟烂相和乎。
本草。图经云。崔氏。治寒疝心腹胁引痛。诸药不可近者。蜜煎乌头主之。以乌头五枚大者。去芒角及皮。四破。
以白蜜一斤。煎令透润。取出焙干。捣筛。又以熟蜜丸。冷盐汤吞下二十丸如梧子。永除。又法。用煎乌头蜜
汁。以桂枝汤五合解之。饮三合。不知加五合。其知者如醉。以为中病。
寒疝腹中痛。逆泠手足不仁。
按乌头煎证。寒气专盛于里。此条证。表里俱寒壅。是所以有须于桂枝。灸刺诸药不能治。是言病势之剧。套
法不能得治。不言灸刺诸药之误措。徐氏以为是或攻其内。或攻外。邪气牵制不服。似欠稳贴。（辑义徐注。为阳
所客。客字。宜作容字。）
乌头桂枝汤方（宋本外台。秋乌头。实中大者。十枚。去皮。生用。一方五枚。）
按此方证。最属急剧。治以单捷为妙。桂枝汤。外台引。作单桂汁。盖仲景旧面。其出五味方者。疑后人误据
千金乌头汤（详出后。）所私搀。注家皆仍原文为说。觉未当。（周氏意似单桂汁。然语意不了。且其解欠妥。仍不
录。又按外台。于此方后。注云范汪方同。今检宋本。大书作范汪方云。而直接桂枝汤。仍知其举桂枝汤者。是范
汪方文。而非出仲景也。）
圣惠。治寒疝腹中痛。手足逆冷。身体疼痛。针灸诸药。所不能任者。宜服乌头散方。川乌头。（大者十枚。）
枝枝（二两） 上件药。捣细罗为散。每服二钱。以水一中盏。入生姜半分。煎至五分。次入蜜半合。更煎三两沸
令熟。每以食前和滓。温服之。
圣济。治心腹卒胀痛。桂心丸。桂二两。乌头一两。为末。炼蜜和丸。
其脉数而紧乃弦。
按魏氏以此条脉。为寒疝寒热杂合之候。其说似精。犹不如尤氏以为寒疝阴盛之为优。然此条。该寒实诸
证而为结。盖不特言寒疝也。
附方
外台。乌头汤。
按此方。千金外台所载。并与前方文有异。盖本是别方。林亿等以前有五味方。省之不录也。今从外台拈出于
下。曰。乌头（十五枚。炮。按千金云。要略。五枚。） 芍药（四两。） 甘草（二两炙。） 大枣（十枚擘） 生
姜（一斤○按千金。作老姜。） 桂心（六两） 上六味切。以水七升。煮五味。取三升。去滓。别取乌头。去皮
四破。蜜二升。微火煎令减五六合。内汤中两三沸。去滓。服一合。日三。间食。 人三合。以如醉状为知。不知
渐增。忌海藻菘菜猪肉冷水生葱。深师同。
外台。柴胡桂枝汤（宋本外台。作疗寒疝腹中痛者。）
医心方。范汪方。治寒疝腹中痛。小柴胡汤。（即原方。）
外台。走马汤。
肘后。若唯腹大。动摇水声。皮肤黑。名曰水虫。巴豆九十枚。去皮心。杏仁六十枚。去皮尖。并熬令黄。捣
和之。服如小豆大一枚。以水下为度。勿饮酒佳。
圣惠。治干霍乱。不吐不利。烦闷不知所为方。巴豆（一枚。去皮心。）上以熟水研服之。当快利三两行。即
以浆水粥止。立定。
〔余述〕按本篇先叙腹满如痛者为实条。浓朴七物汤。浓朴三物汤。大柴胡汤。大承气汤四条。此其属热实者
也。如首条。与腹满时减复如故条。此其属寒实者也。次叙寒疝。如腹痛脉弦而紧条。与大乌头煎。当归生
姜羊肉汤。乌头桂枝汤条。皆以寒疝目之矣。如瘦人绕脐痛。与附子粳米汤。大建中汤条。亦是寒疝已。其他诸条。
如寸口脉弦者。即胁下拘急而痛。与大黄附子汤证。即虚寒从下上。此寒气聚着 胁者也。如病者痿黄证。其位虽
异。亦是寒实也。如中寒家二条。即素禀阴脏。外寒易触者也。盖此三等。既非腹满。亦不寒疝。但以其属寒。仍
牵联及之。且以与腹满寒疝。互相发明者已。其脉数而紧一条。即系寒实诸证之诊。以为总结矣。然则二十条者。
学人宜区类而看。如前注家。往往凑合为说。殆不免强会也。
问曰。人病有宿食。何以别之。（故下。原本。有知字。宜补。）伤寒缵论曰。所谓亦微而涩。亦字从上贯下。
言浮大而按之略涩。非涩弱无力之谓。见浮大中。按之略涩。方可用大承气下之。设纯见微涩。按之不实。乃属胃
气虚寒。冷食停滞之候。又当从枳实理中。助胃消导之药矣。岂复为大承气证乎。○按此说似精。然尺中既微。何
能兼大。故张氏于微脉。则略而不论。殊属模糊。但其云涩非涩弱无力之谓者。是矣。然则微。亦沉滞不起之微。
非微弱之谓也。
下利不欲食者（俞本。赵本。欲。作饮。误。）
宿食在上脘。当吐之。〔周〕食既云宿。决非上脘。既非上脘。何以用吐。今言上脘。又言宿食。则必有痰载
物。不使得下。则为喘为满。不言具见。故一吐而痰与食俱出矣。
趺阳脉微而弦。按照此脉象，应当出现腹部胀满的症状。
针对这一条的证候，是寒气壅滞闭阻所致，正是大黄附子汤所主治的。适宜称之为“实”，却说是“虚寒”的，这里的“虚”，就像“虚烦”中的“虚”一样，并非指正气虚衰的“虚”。大概是指无形的寒气，相对于水饮结聚形成的有形的寒邪而言。（关于“虚烦”的含义，请参考《伤寒论》论述义中栀子豉汤条的解释。）另外，程氏的注解稍显不够透彻。
病人腹部胀满，按压时不痛的属于虚证。
按《难经·四十八难》说：痒的是虚证，痛的是实证。外部痛内部舒适，是外实内虚；内部痛外部舒适，是内实外虚。杨玄操注释说：轻手按压就痛，是外实，因为病位浅的缘故；重手按压就觉得舒服，是内虚，因为病位深的缘故；重手按压就痛，是内实，因为病位深的缘故；轻手按压就觉得舒服，是外虚，因为病位浅的缘故。凡是病人患病，按压就痛的，都是实证；按压就觉得舒服的，都是虚证。《难经》本是为有痛的情况立论，而杨玄操的注释，也与本条相互阐发。
又按《阳明病篇》说：阳明病，胁下硬满，不大便且呕吐，舌上白苔的，可以给予小柴胡汤。其用意正与本条相互阐发，因为虽然见证似乎可以使用攻下法，但如果是白苔，说明邪气尚未结实；黄苔，才开始是热实；至于黑苔才是实证，由此可以推知。况且这一条，展示了通过按压腹部来辨别虚实，通过观察舌苔来辨别寒热，然后才适宜讨论攻下法。总之，诊察的大法，没有不可以从这一条扩充而来的。
病人面色萎黄。（《脉经》在胸中部分作“胃中”，“利上”下有“下”字。）
寸口脉弦的。（《诸病源候论》作“寸口脉双弦”，则胁下拘急，其人感觉涩涩怕冷。）
平素受寒的人喜欢打哈欠。
按“中”字，《金鉴》读为平声，其他各位注家都读为去声。大概这个“中寒家”，是说平素禀赋阴脏，容易感受寒邪的人。然而这两种说法并存为佳。另外程氏认为寒郁于肺经而化热，似乎不太稳妥。《灵枢·口问》篇说：阳气向上牵引，阴气向下牵引，阴阳相互牵引，所以频繁打哈欠。又说：阳气调和顺畅，充满于心出于鼻，所以打喷嚏。《辨脉法》说：客气内入，打喷嚏将其排出。
患腹部胀满，发热十天。（《本草纲目》浓朴条，《图经》引用说：还有浓朴七物汤，主治腹痛胀满。按这与《千金方》相同，是错误的。）
按《金鉴》说：饮食如常，是因为胃中有热能消化食物。存疑考察。
浓朴七物汤方（《图经》引用时，“枳实”上有“大”字，“桂枝”的“枝”字无。）
附子粳米汤方
按弟子村田精一说：此方，与白虎汤，以及加人参、加桂枝的二汤，桃花汤，都用粳米，但其煎煮方法，没说煮到几升。大概是以米煮熟为限度，不必期望煮到几升。恐怕不是有脱文。浓朴麻黄汤，煮小麦熟后去渣，也是一样的道理。这可以作为备一说，仍保留它。
《圣惠方》，治疗寒疝心痛如针刺，绕脐腹中尽痛，出冷汗，气欲绝的方子。
在本方基础上，加川椒、干姜、桂心。
浓朴三物汤方（《本草纲目》浓朴条，《图经》说：张仲景治杂病，浓朴三物汤，主治腹胀脉数。浓朴半斤。方后，有“腹中转动，更服。不动勿服”十字。）
大柴胡汤方（黄芩二两，原本、诸本，都作三两。）
腹部胀满不减。
《伤寒补亡论》说：“减不足言者”，意思是说不怎么减轻。论中说：太阳发汗不彻底，“不足言”，与此同意。俗语所谓不起作用、不济事的，就是这个意思。
心胸中大寒痛。
按原文此处有“出见有头足上下”句，上声，“下”读去声。尤氏认为“出见有头足”，是阴凝成象，腹中虫物，乘势而动，主张用蜀椒、干姜温中杀虫。这是很大的错误。
大建中汤方（蜀椒去汗，《类聚》无“去”字。）
大黄附子汤方
按这一条的证候，确实属于寒实，所以大黄、附子、细辛，相互配合组成方剂，性味融合，自然起到温通泻下的作用。如附子泻心汤，则是表寒里热的证候，所以另煮附子，功效各自奏效。所以同样是附子、大黄并用，但组方的旨趣，截然不同。徐氏的说法不够确切。大概温通泻下的剂型，实以桂枝加大黄汤及此汤为祖，而温脾等诸汤，无不胚胎于此二方之中。
赤丸方
按《本草》，丹砂黑字云：研末名为真朱。
寒疝绕脐痛。（脉沉紧，《类聚》也作沉弦。）
按《素问·经脉别论》，真气虚弱，厥气留滞薄积，发为白汗。（《阴阳别论》，魄汗，《辑义》误写作白汗。又《生气通天论》，魄汗未尽，魄音通。）
乌头煎方（宋本《外台秘要》“熬”，作“炮”，无“去皮”字。白蜜二斤。方后，上以水三升，煮乌头取二升，去乌头内蜜，煎令水气尽云云，不可一日再服，作日止一服，不可再也。）
按程氏说：治疗下焦的药，味道不宜多，多了则药气不专。这话本于《至真要大论》“补下治下制以急”的说法，恐怕不免拘泥。
又按陶氏《本草序例》说：附子乌头若干枚者，去皮毕，以半两准一枚。《千金方》治风历节，防己汤方后说：凡用乌头，皆去皮，熬令黑，乃堪用。不然毒性极大伤人，宜谨慎。据此，宋本《外台》未必正确。其不咀嚼，难道是嫌熟烂相和吗？
《本草·图经》说：崔氏，治疗寒疝心腹胁引痛，诸药不可近的，用蜜煎乌头主治。用乌头五枚大的，去芒角及皮，四破，以白蜜一斤，煎令透润，取出焙干，捣筛，又以熟蜜丸，冷盐汤吞下二十丸如梧桐子大，永除。又法，用煎乌头蜜汁，以桂枝汤五合解之，饮三合，不知加五合。其知者如醉，以为中病。
寒疝腹中痛，逆冷手足不仁。
按乌头煎证，寒气专盛于里；此条证，表里俱寒壅滞，所以需要用桂枝。灸刺诸药不能治，是说病势剧烈，套法不能得治，不是说灸刺诸药误用。徐氏认为是或攻其内，或攻其外，邪气牵制不服，似乎不够稳妥。（《辑义》徐注，为阳所客，“客”字，宜作“容”字。）
乌头桂枝汤方（宋本《外台》，秋乌头，实中大者，十枚，去皮，生用。一方五枚。）
按此方证，最属急剧，治疗以单捷为妙。《外台》引桂枝汤，作单桂汁。大概是仲景旧面，其出五味方者，疑后人误据《千金》乌头汤（详出后）所私搀入。注家皆仍原文为说，觉得不妥。（周氏意似单桂汁，然语意不清，且其解欠妥，仍不录。又按《外台》，于此方后，注云范汪方同。今检宋本，大书作范汪方云。而直接桂枝汤，仍知其举桂枝汤者，是范汪方文，而非出仲景也。）
《圣惠方》，治疗寒疝腹中痛，手足逆冷，身体疼痛，针灸诸药，所不能任者，宜服乌头散方。川乌头（大者十枚）。桂枝（二两）。上件药，捣细罗为散。每服二钱，以水一中盏，入生姜半分，煎至五分，次入蜜半合，更煎三两沸令熟。每以食前和滓，温服之。
《圣济总录》，治疗心腹卒胀痛，桂心丸。桂二两，乌头一两，为末，炼蜜和丸。
其脉数而紧乃弦。
按魏氏以此条脉，为寒疝寒热杂合之候，其说似乎精妙，还不如尤氏以为寒疝阴盛之为优。然而此条，该括寒实诸证而为结，盖不仅言寒疝也。
附方
《外台秘要》，乌头汤。
按此方，《千金》《外台》所载，并与前方文有异，盖本是别方。林亿等以前有五味方，省之不录也。今从《外台》拈出于下，曰：乌头（十五枚，炮。按《千金》云：《要略》五枚。）芍药（四两。）甘草（二两炙。）大枣（十枚擘）生姜（一斤○按《千金》，作老姜。）桂心（六两）上六味切，以水七升，煮五味，取三升，去滓，别取乌头，去皮四破，蜜二升，微火煎令减五六合，内汤中两三沸，去滓，服一合，日三，间食。人三合，以如醉状为知。不知渐增。忌海藻菘菜猪肉冷水生葱。《深师》同。
《外台秘要》，柴胡桂枝汤（宋本《外台》，作疗寒疝腹中痛者。）
《医心方》，范汪方，治疗寒疝腹中痛，小柴胡汤。（即原方。）
《外台秘要》，走马汤。
《肘后备急方》，若唯腹大，动摇水声，皮肤黑，名曰水虫。巴豆九十枚，去皮心，杏仁六十枚，去皮尖，并熬令黄，捣和之。服如小豆大一枚，以水下为度。勿饮酒佳。
《圣惠方》，治疗干霍乱，不吐不利，烦闷不知所为方。巴豆（一枚，去皮心。）上以熟水研服之。当快利三两行，即以浆水粥止。立定。
〔余述〕按本篇先叙腹满如痛者为实条，浓朴七物汤，浓朴三物汤，大柴胡汤，大承气汤四条，此其属热实者也。如首条，与腹满时减复如故条，此其属寒实者也。次叙寒疝，如腹痛脉弦而紧条，与大乌头煎，当归生姜羊肉汤，乌头桂枝汤条，皆以寒疝目之矣。如瘦人绕脐痛，与附子粳米汤，大建中汤条，亦是寒疝已。其他诸条，如寸口脉弦者，即胁下拘急而痛，与大黄附子汤证，即虚寒从下上，此寒气聚着胁者也。如病者痿黄证，其位虽异，亦是寒实也。如中寒家二条，即素禀阴脏，外寒易触者也。盖此三等，既非腹满，亦不寒疝，但以其属寒，仍牵联及之。且以与腹满寒疝，互相发明者已。其脉数而紧一条，即系寒实诸证之诊，以为总结矣。然则二十条者，学人宜区类而看，如前注家，往往凑合为说，殆不免强会也。
问曰：人病有宿食，何以别之。（故下，原本，有知字，宜补。）《伤寒缵论》说：所谓亦微而涩，亦字从上贯下，言浮大而按之略涩，非涩弱无力之谓。见浮大中，按之略涩，方可用大承气下之。设纯见微涩，按之不实，乃属胃气虚寒，冷食停滞之候。又当从枳实理中，助胃消导之药矣。岂复为大承气证乎。○按此说似精，然尺中既微，何能兼大。故张氏于微脉，则略而不论，殊属模糊。但其云涩非涩弱无力之谓者，是矣。然则微，亦沉滞不起之微，非微弱之谓也。
下利不欲食者（俞本，赵本，欲，作饮，误。）
宿食在上脘，当吐之。〔周〕食既云宿，决非上脘。既非上脘，何以用吐。今言上脘，又言宿食，则必有痰载物，不使得下，则为喘为满，不言具见，故一吐而痰与食俱出矣。
The pulse at the foot yang (Duyang) is faint and wiry. According to this pulse pattern, abdominal fullness should occur.
Regarding the syndrome of this clause, it is caused by the stagnation and obstruction of cold qi, which is precisely what Dahuang Fuzi Tang (Rhubarb and Aconite Decoction) treats. It is appropriate to call it "excess," yet it is described as "deficient-cold." Here, "deficient" (Xu), similar to the "deficient" in "deficient irritability" (Xu Fan), does not refer to deficiency of vital energy (Qi). It likely refers to formless cold qi, in contrast to the formed cold pathogen resulting from the accumulation of fluid retention (Shuiyin). (For the meaning of "deficient irritability," please refer to the discussion on Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) in the *Treatise on Cold Damage*.) Furthermore, Cheng's commentary is slightly unclear.
When a patient suffers from abdominal fullness, pressing the abdomen without pain indicates a deficient syndrome.
According to Chapter 48 of the *Nan Jing* (Classic of Difficult Issues): Itching indicates deficiency; pain indicates excess. Pain externally with comfort internally indicates external excess and internal deficiency; pain internally with comfort externally indicates internal excess and external deficiency. Yang Xuancao commented: Pain upon light pressure indicates external excess, because the disease is superficial; comfort upon heavy pressure indicates internal deficiency, because the disease is deep; pain upon heavy pressure indicates internal excess, because the disease is deep; comfort upon light pressure indicates external deficiency, because the disease is superficial. In general, for any patient whose disease causes pain upon pressure, it is an excess syndrome; for those who feel comfort upon pressure, it is a deficient syndrome. The *Nan Jing* originally formulated its theory based on the presence of pain, while Yang Xuancao's commentary elucidates this clause mutually.
Furthermore, according to the *Yangming Disease Chapter*: In Yangming disease, if there is hardness and fullness under the hypochondrium, constipation accompanied by vomiting, and a white coating on the tongue, Xiaochaihu Tang (Minor Bupleurum Decoction) may be administered. The intent here mutually elucidates this clause. Although the symptoms might seem suitable for purgation, a white coating indicates that the pathogen has not yet solidified; a yellow coating indicates the onset of heat-excess; and a black coating signifies true excess, from which one can infer. Moreover, this clause demonstrates how to differentiate deficiency and excess by palpating the abdomen, and how to distinguish cold and heat by observing the tongue coating, before discussing purgative methods. In essence, the major principles of diagnosis can be expanded from this clause.
The patient has a sallow complexion. (*Mai Jing* [Pulse Classic] reads "in the stomach" instead of "in the chest"; adds the character "xia" [down] after "li shang" [benefits upper]).
If the pulse at the cunkou (inch position) is wiry. (*Zhubing Yuanhou Lun* [Source Book of Diseases and Etiologies for All Categories] reads "cunkou pulse is double-wiry," then there is tension and urgency under the hypochondrium, and the person feels rough and cold.)
Individuals prone to cold affection often yawn.
Regarding the character "zhong" (middle/contract), *Jin Jian* [Precious Mirror] pronounces it with the level tone, while other commentators pronounce it with the departing tone. Generally, this "individual prone to cold contraction" refers to someone constitutionally endowed with a Yin organ type, who easily contracts cold. Thus, both interpretations are best preserved. Additionally, Cheng's assertion that cold stagnates in the Lung meridian and transforms into heat seems inappropriate. The *Ling Shu: Kou Wen* chapter states: "Yang draws upward, Yin draws downward; when Yin and Yang draw each other, frequent yawning occurs." It also states: "When Yang Qi is harmonious and smooth, filling the heart and emerging through the nose, sneezing occurs." The *Bian Mai Fa* [Method of Pulse Differentiation] states: "When exogenous pathogens enter internally, sneezing expels them."
Abdominal fullness accompanied by fever for ten days. (*Bencao Gangmu* [Compendium of Materia Medica], under the entry for Houpo [Magnolia Bark], cites *Tu Jing*: "Also, Houpo Qiwu Tang [Magnolia Bark Five-Ingredient Decoction] treats abdominal pain and distension." Note: This error aligns with *Qianjin Fang* [Essential Prescriptions Worth a Thousand Gold].)
According to *Jin Jian*: "Food and drink remain normal because stomach heat can digest grains." To be examined and considered.
Houpo Qiwu Tang Formula (Cited in *Tu Jing*: Adds the character "Da" [Large] before "Zhishi" [Immature Bitter Orange]; omits the character "Zhi" [Twig] from "Guizhi" [Cinnamon Twig].)
Fuzi Ximi Tang Formula (Aconite and Rice Decoction)
Disciple Murata Seichi stated: This formula, along with Baihu Tang [White Tiger Decoction], formulas adding Ginseng or Cinnamon Twig, and Taohua Tang [Peach Blossom Decoction], all use glutinous rice. However, their decoction methods do not specify reducing to a certain volume. It is likely that the criterion is simply until the rice is cooked, rather than aiming for a specific reduction. This is probably not a textual omission. The decoction of Hempuga Mahuang Tang [Ephedra and Magnolia Bark Decoction], where wheat is boiled until cooked and then strained, follows the same principle. This can be offered as an alternative view and retained.
*Shenghui Fang* [Holy Wisdom Formulas]: Treats Hanhan (Cold Cramp) with heart pain like stabbing, pain throughout the abdomen around the navel, profuse cold sweat, and impending loss of breath.
Add Chuanjiao (Sichuan Pepper), Ganjiang (Dried Ginger), and Guixin (Cinnamon Heart) to this base formula.
Houpo Sanwu Tang Formula (Magnolia Bark Three-Ingredient Decoction) (*Bencao Gangmu*, citing *Tu Jing*: "Zhang Zhongjing treated miscellaneous diseases with Houpo Sanwu Tang, indicating abdominal distension with a rapid pulse. Houpo half jin. After the formula, it states: 'If bowel movement occurs, take more; if no movement, do not take.'")
Da Chaihu Tang Formula (Major Bupleurum Decoction) (Huangqin [Scutellaria Root] two liang; original and various editions all read three liang.)
Abdominal fullness that does not decrease.
*Shanghan Buwang Lun* [Supplement to Lost Chapters of Cold Damage] explains: "Decrease insufficient to mention" means it does not decrease significantly. The text says: "Taiyang sweating was incomplete, insufficient to mention," which agrees with this. This corresponds to the colloquial expression for ineffectiveness.
Severe cold pain in the heart and chest region.
Note: The phrase "Chu jian you tou zu shang xia" appears here. "Shang" is rising tone; "Xia" is departing tone. You Shi interpreted "Chu jian you tou zu" (seeing head and feet emerge) as Yin condensing into form, causing intestinal parasites to move. He advocated using Shujiao (Sichuan Pepper) and Ganjiang (Dried Ginger) to warm the middle and expel parasites. This is a significant error.
Da Jianzhong Tang Formula (Major Construct the Middle Decoction) (Shujiao [Sichuan Pepper] remove sweat/surface moisture; *Leiju* omits "remove".)
Dahuang Fuzi Tang Formula (Rhubarb and Aconite Decoction)
Regarding the syndrome of this clause, it indeed belongs to cold-excess. Therefore, Dahuang (Rhubarb), Fuzi (Prepared Aconite Root), and Xixin (Asarum) combine to form the prescription. Their properties and flavors blend harmoniously, naturally serving the purpose of warming and purging. For instance, in Fuzi Xie Xin Tang [Aconite Draining the Epigastrium Decoction], the syndrome involves exterior cold and interior heat, so Fuzi is decocted separately, and their effects are achieved independently. Thus, although both use Aconite and Rhubarb, the therapeutic intent of the prescriptions is vastly different. Xu's explanation is not precise. Essentially, warming and purging formulas originated from Guizhi Jia Dahuang Tang [Cinnamon Twig Decoction plus Rhubarb] and this formula, while Wenyi Tang [Warming Spleen Decoction] and others were embryonically derived from these two.
Chi Wan Formula (Red Pill)
According to *Bencao*, the black character for Cinnabar states: Ground powder is called Zhenzhu (True Pearl).
Hanhan (Cold Cramp) with pain around the navel. (Pulse sunken and tight; *Leiju* also reads sunken and wiry.)
According to *Suwen: Jingmai Bie Lun* [Differentiations of Meridians in the Basic Questions]: When true Qi is deficient and rebellious Qi lingers and accumulates, Baohan (White Sweat) occurs. (*Yinyang Bie Lun* [Differentiations of Yin and Yang], *Jiyi* mistakenly writes Baohan as Baohan. Also, *Shengqi Tongtian Lun* [Discussion on Vital Energy Connecting Heaven]: If Baohan is not exhausted, 'Po' sounds like 'Bai'.)
Wutou Jian Formula (Decoction of Aconite) (Song edition of *Waitai*: "Ao" [boil] is written as "Pao" [roast]; omits "Qu pi" [remove skin]. White honey two jin. After the formula: Take water three sheng, boil Wutou [Aconite Root] to obtain two sheng, remove Wutou, add honey, boil until water vapor is gone, etc. Do not take twice a day; take once a day only, do not repeat.)
Cheng Shi stated: Medicines for treating the Lower Jiao should not have too many ingredients; otherwise, the Qi will not be focused. This statement originates from *Zhi Zhen Yao Da Lun* [Great Treatise on the Most Essential Truths], specifically the principle of "tonifying the lower, treating the lower, with urgent preparation." It may be somewhat rigid.
Additionally, Tao Hongjing's *Bencao Xuli* [Preface to Materia Medica] states: For Fuzi and Wutou, after removing the skin, half a liang counts as one piece. *Qianjin Fang* [Essential Prescriptions Worth a Thousand Gold], in the Fangji Tang formula for treating wind and joint pain, states after the formula: "Whenever using Wutou, remove the skin and roast until black before use. Otherwise, it is extremely toxic and harmful to people. Be cautious." Based on this, the Song edition of *Waitai* is not necessarily correct. Regarding "not chewing," is it merely to avoid mixing textures?
*Bencao Tu Jing* [Illustrated Classic of Materia Medica] states: Cui Shi treated Hanhan (Cold Cramp) with heart, abdomen, and hypochondriac pulling pain, where other medicines could not be tolerated, using Honey-fried Wutou. Take five large Wutou roots, remove sharp corners and skin, break into four pieces, add one jin of white honey, boil until thoroughly moist, take out, dry in shade, grind into powder, mix with熟 honey to make pills. Swallow twenty pills the size of wutong seeds with cold salt water, permanently curing the condition. Another method: Use the honey juice from fried Wutou, dissolve it with five he of Guizhi Tang [Cinnamon Twig Decoction]. Drink three he; if no effect, increase by five he. If effective, the patient feels drunk, indicating the medicine has struck the disease.
Hanhan (Cold Cramp) with abdominal pain, cold extremities, and numbness of hands and feet.
In the Wutou Jian syndrome, cold Qi dominates internally. In this clause's syndrome, cold obstructs both interior and exterior, hence the need for Guizhi [Cinnamon Twig]. Acupuncture and moxibustion and other medicines cannot treat it; this refers to the severity of the disease progression, implying that standard methods fail, not that acupuncture/moxibustion are misapplied. Xu Shi believed it meant attacking either the interior or exterior, with pathogenic factors resisting each other, which seems less accurate. (*Jiyi* Xu commentary: "Ke" [guest/pathogen] should be read as "Rong" [contain/admit].)
Wutou Guizhi Tang Formula (Aconite and Cinnamon Twig Decoction) (Song edition of *Waitai*: Autumn Wutou, large and solid, ten pieces, remove skin, raw use. Another version: five pieces.)
This syndrome is most acute; treatment should be simple and swift. *Waitai* cites Guizhi Tang as "Dan Gui Zhi" [Single Cinnamon Twig Juice]. This is likely the original form of Zhang Zhongjing. The five-ingredient version is suspected to be a later interpolation from *Qianjin Fang*'s Wutou Tang (detailed below). Commentators followed the original text, which I find inappropriate. (Zhou Shi seemed to prefer Single Cinnamon Twig Juice, but his explanation was unclear and inadequate, so it is not recorded. Also, *Waitai* notes after this formula: "Fan Wang's formula is the same." Checking the Song edition, it prominently displays "Fan Wang's Formula" and directly lists Guizhi Tang. It is known that citing Guizhi Tang here is from Fan Wang's text, not Zhang Zhongjing's.)
*Shenghui Fang*: Treats Hanhan (Cold Cramp) with abdominal pain, cold extremities, body pain, which cannot be tolerated by acupuncture or medicines. Recommend服用 Wutou San [Aconite Powder]. Chuan Wutou [Sichuan Aconite] (ten large pieces). Guizhi [Cinnamon Twig] (two liang). Grind these herbs into fine powder. Take two qian per dose, with one zhan of water, add half a ban of fresh ginger, boil to five fen, then add half he of honey, boil for three boils until cooked. Take warm with dregs before meals.
*Shengji Zonglu*: Treats sudden heart and abdominal distension and pain, Guixin Wan [Cinnamon Heart Pills]. Guixin [Cinnamon Heart] two liang, Wutou [Aconite Root] one liang, grind into powder, mix with refined honey to make pills.
If the pulse is rapid and tight, it becomes wiry.
Wei Shi interpreted this pulse as a mixed syndrome of cold and heat in Hanhan. His explanation seems refined, but You Shi's interpretation that it represents excessive Yin in Hanhan is superior. However, this clause encompasses various cold-excess syndromes as a conclusion, not just speaking of Hanhan.
Attached Formulas
*Waitai*: Wutou Tang [Aconite Decoction].
Note: The versions in *Qianjin* and *Waitai* differ from the previous formula's text, suggesting they are originally different formulas. Lin Yi et al. omitted the five-ingredient version previously recorded. Now extracted from *Waitai*: Wutou [Aconite Root] (fifteen pieces, roasted. Note: *Qianjin* says *Yaolue* uses five pieces.), Shaoyao [Peony Root] (four liang), Gancao [Licorice Root] (two liang, roasted), Dazao [Jujube] (ten pieces, split), Shengjiang [Fresh Ginger] (one jin. Note: *Qianjin* reads Lao Jiang [Old Ginger].), Guixin [Cinnamon Heart] (six liang). Cut the six ingredients. Add seven sheng of water, boil the first five ingredients to obtain three sheng, strain. Separately take Wutou, remove skin, break into four pieces, add two sheng of honey, simmer over low fire until reduced by five to six he. Add to the decoction, boil two or three times, strain. Take one he, three times a day, between meals. Human dose three he. Effect indicated by a drunken sensation. If no effect, gradually increase. Avoid seaweed, turnip, pork, cold water, and raw green onion. *Shenshi* agrees.
*Waitai*: Chaihu Guizhi Tang [Bupleurum and Cinnamon Twig Decoction] (Song edition of *Waitai*: States it treats Hanhan with abdominal pain.)
*Yixin Fang*: Fan Wang's Formula. Treats Hanhan with abdominal pain, Xiaochaihu Tang [Minor Bupleurum Decoction] (i.e., the original formula.)
*Waitai*: Zouma Tang [Running Horse Decoction].
*Zhouhou Beiji Fang*: If only the abdomen is large, producing splashing sounds when moved, and the skin is black, it is named Shuichong [Water Insect]. Badou [Croton Seed] ninety pieces, remove skin and heart, Xingren [Apricot Seed] sixty pieces, remove skin and tips, roast until yellow, grind and mix. Take one pill the size of a soybean. Stop when bowels move. Avoid alcohol.
*Shenghui Fang*: Treats Gan Huoluan [Dry Cholera] with no vomiting or diarrhea, restlessness and confusion. Badou [Croton Seed] (one piece, remove skin and heart). Grind with hot water and administer. Expect three to four loose stools, then stop with sour rice water porridge immediately. Stabilize.
[Additional Remarks] This chapter first discusses clauses where abdominal fullness with pain indicates excess: Houpo Qiwu Tang, Houpo Sanwu Tang, Da Chaihu Tang, and Dachengqi Tang [Major Order the Qi Decoction]. These belong to Heat-Excess. The first clause and the clause "abdominal fullness decreases occasionally then returns to normal" belong to Cold-Excess. Next, it discusses Hanhan (Cold Cramp): clauses like "abdominal pain with wiry-tight pulse," Dayou Tou Jian [Major Aconite Decoction], Danggui Shengjiang Yangrou Tang [Angelica, Ginger, and Mutton Decoction], and Wutou Guizhi Tang. All are categorized as Hanhan. Clauses like "thin person with pain around the navel," Fuzi Ximi Tang, and Da Jianzhong Tang are also considered Hanhan. Other clauses, such as "wiry pulse at cunkou indicating tension and pain under hypochondrium," and Dahuang Fuzi Tang syndrome indicating deficient-cold rising from below (cold qi gathering in the hypochondrium), and the syndrome of sallow complexion (though location differs, it is also Cold-Excess), and the two clauses about individuals prone to cold (constitutionally Yin-endowed, easily touched by external cold)—these three categories are neither abdominal fullness nor Hanhan, but because they belong to Cold, they are linked. They mutually elucidate Abdominal Fullness and Hanhan. The clause "rapid and tight pulse" serves as a diagnostic summary for all cold-excess syndromes. Therefore, students should categorize and study these twenty clauses. Previous commentators often combined them arbitrarily, which is forced.
Question: How to differentiate chronic food retention in patients? (Originally had the character "Zhi" [know] after "Gu", should be added.) *Shanghan Zuanchun* states: "So-called faint and slight choppy." The character "Yi" [also] connects from above, meaning floating and large, but slightly choppy upon pressing, not referring to weak and powerless choppy. Seeing floating-large with slight choppy upon pressing allows the use of Dachengqi Tang for purging. If purely faint-choppy and pressing feels empty, it belongs to Stomach Qi deficient-cold with cold food stagnation. One should then use Zhishi Lizhong [Immature Bitter Orange and Spleen-Warming] or other medicines to assist Stomach Qi and aid digestion. How could this be a Dachengqi Tang syndrome? ○ Note: This explanation seems refined, but if the chi pulse is faint, how can it be large? Thus, Zhang Shi omitted discussion of the faint pulse, which is vague. However, his statement that "choppy does not mean weak/powerless" is correct. Therefore, "faint" here also refers to sinking and sluggish, not weak/powerless.
Diarrhea with lack of desire to eat. (Yu edition, Zhao edition: "Yu" [desire] written as "Yin" [drink], error.)
Chronic food retention in the Upper Jiao [Upper Stomach] should be treated with emesis. [Zhou]: Since it is called "retained," it certainly is not in the Upper Jiao. If not in the Upper Jiao, why use emesis? Now stating Upper Jiao and retained food implies there must be phlegm carrying the substance, preventing it from descending, causing wheezing and fullness. Not explicitly stated, so one emetic expels both phlegm and food.