腹痛属寒冷者，多是口食寒物，鼻吸冷气，脉涩气阻，则为疼痛。其症四肢逆冷，唇口
变青
，其脉沉或紧。经云∶寒气客于脉中，则脉寒，脉寒则缩绻，缩绻则脉绌急，绌急则外引小
络，故卒然而痛。得炅则痛立止。或吐清水，所谓寒气客于肠胃，厥逆上出，故痛而呕也，
宜温散，或温利之。
《本事》温脾汤
浓朴 干姜 甘草 桂心 附子（各二两） 大黄（四钱）
上 咀，各一两，水二盅，煎六分，顿服。治痼冷在肠胃，泄泻腹痛，宜先取去，然后
调治，不可畏虚以养病也。
温脾丸（《外台》）
大黄 麦芽 干姜（各三两） 浓朴（炙） 当归 附子（炮） 甘草（炙） 桂心 人参 枳
实（炙，各一两）
蜜丸如梧子大，十五丸，日三，增至二十丸。
按∶温脾丸，大黄多而用蜜丸少服，急法缓用也。温脾汤大黄少而作汤服，且不用参、
归，
缓法急用也。总之，病非实热，法不可下，而痼冷在脏，不下则病不去，故权宜于缓急之间
如此。若其中无积滞者，则但宜温之而已，不必下也。或挟虚者，则兼补之。
《外台》附子汤
附子（炮） 甘草（炙，各二两） 宿姜（一两） 仓米（半升） 半夏（制，四两） 白术（三
两） 大枣（二十枚）
水一斗，煮三升，去滓，分三服，治虚冷腹痛佳。
《外台》建中汤 治气血虚寒，不能荣养心脾，其痛连绵不已，而亦无急暴之势
。按
之则痛反缓，或按之便痛，重按却不甚痛，此正是虚证。经所谓虚者聂辟气不足，按之则气
足以温之，故快然而不痛是也。
黄 白芍（各三两） 甘草（炙） 桂心（各二两） 生姜（六两） 半夏（五两） 大枣（十
二枚） 饴糖（十两）
上以水八升，煮取三升，分三服。
治当脐痛，便溺不利，怯寒脉虚者方
熟地（三钱） 肉桂（五分） 白芍（一钱半） 桂枝（五分） 当归 茯苓（各一钱）
水煎服。
治脐下冷撮痛，阴内冷如冰，延胡苦楝汤方
熟地（二钱） 川楝 延胡（各五分） 附子 肉桂（各七分） 炙甘草（一钱）
上都作一服，水四盏，煎至一盏，去滓稍热服，空心食前。
温中汤 治戊土已衰，不能运化，又加客寒，聚为满痛，散以辛热，佐以苦甘，
以淡泄之。气温胃和，痛自止矣。
浓朴（姜制，一两） 橘皮（去白，一两） 干姜（七钱） 甘草（炙） 草豆蔻 茯苓（去皮）
木香（各五钱）
上为粗末，每服五钱，水二盏，姜三片，煎一盏，去粗温服食前。
《局方》神保丸
全蝎 巴豆（各十个，取霜） 木香 胡椒（各二钱五分）
上为末，入巴豆研匀，汤化蒸饼丸如麻子大，朱砂为衣，每服五七丸。此药大能宣通脏
腑，治诸积气为痛。
腹痛属于寒证的情况，大多是因为食用了生冷食物或吸入冷气所致。此时脉象涩滞、气机阻滞，从而引发疼痛。其症状表现为四肢厥冷，嘴唇和口角发青，脉象沉伏或紧束。《内经》说：寒气侵入脉中，导致脉道寒冷；脉道寒冷则收缩卷曲，收缩卷曲则脉道拘急，脉道拘急则牵引周围的小络脉，因此突然发生疼痛。遇到温热刺激，疼痛立即停止。或者出现呕吐清水的症状，这就是所谓寒气客居在肠胃之间，气机厥逆向上冲出，所以既疼痛又呕吐。治疗宜采用温散法，或温利法。
《本事方》温脾汤
厚朴、干姜、甘草、桂心、附子（各二两），大黄（四钱）。
以上药材切碎，每味取一两，加水两盅，煎至六分，一次性服用。主治肠胃中有顽固性冷积，伴有泄泻和腹痛。应当先攻下去除冷积，然后再进行调理，不可因为担心正气虚弱而迁延病情。
温脾丸（出自《外台秘要》）
大黄、麦芽、干姜（各三两），厚朴（炙）、当归、附子（炮制）、甘草（炙）、桂心、人参、枳实（炙，各一两）。
用蜂蜜制成梧桐子大小的丸剂，每次十五丸，每日三次，逐渐增加至二十丸。
按语：温脾丸中大黄用量多但制成蜜丸且少量服用，这是“急法缓用”。温脾汤中大黄用量少且作汤剂服用，并且不用人参、当归，这是“缓法急用”。总之，如果不是实热病，原则上不可使用下法，但如果是脏腑内有顽固性冷积，不下除则病邪不去，所以在这两者之间权衡缓急如此处理。如果其中没有积滞的，则只宜温补即可，不必使用下法。如果兼有虚证，则配合补益之法。
《外台秘要》附子汤
附子（炮制）、甘草（炙，各二两），生姜（一两），粳米（半升），半夏（制，四两），白术（三两），大枣（二十枚）。
加水一斗，煮取三升，去渣，分三次服用。主治虚寒性腹痛效果佳。
《外台秘要》建中汤 主治气血虚寒，不能濡养心脾，疼痛连绵不断，但没有急骤暴烈的态势。按压腹部则疼痛反而缓解，或者轻按时疼痛，重按却不怎么痛，这正是虚证的特征。《内经》所说“虚者聂辟气不足”，按压后气足以温煦局部，所以感到舒适而不痛。
黄芪、白芍（各三两），甘草（炙）、桂心（各二两），生姜（六两），半夏（五两），大枣（十二枚），饴糖（十两）。
以上用水八升，煮取三升，分三次服用。
治疗肚脐周围疼痛，小便不利，畏寒且脉象虚弱的方剂：
熟地黄（三钱），肉桂（五分），白芍（一钱半），桂枝（五分），当归、茯苓（各一钱）。
水煎服。
治疗脐下冷缩样疼痛，阴部内部冷如冰块的延胡苦楝汤方：
熟地黄（二钱），川楝子、延胡索（各五分），附子、肉桂（各七分），炙甘草（一钱）。
以上为一服的量，加水四盏，煎至一盏，去渣，稍热时服用，空腹饭前服。
温中汤 主治脾胃功能衰退，不能运化水谷，又加上外感寒邪，聚结导致胀满疼痛。用辛热药物发散，佐以苦甘药物，并用淡味药物泄浊。气温胃和，疼痛自然停止。
厚朴（姜制，一两），陈皮（去白，一两），干姜（七钱），甘草（炙），草豆蔻，茯苓（去皮），木香（各五钱）。
以上为粗末，每次服用五钱，加水两盏，生姜三片，煎至一盏，去渣，温服，饭前服用。
《太平惠民和剂局方》神保丸
全蝎、巴豆霜（各十个），木香、胡椒（各二钱五分）。
以上研成细末，加入巴豆霜研匀，用米汤化开蒸饼粉制成麻子大小的丸剂，朱砂为衣，每次服用五到七丸。此药能大力宣通脏腑，治疗各种积气引起的疼痛。
Abdominal pain due to cold is mostly caused by consuming cold foods or inhaling cold air. The pulse is choppy (Se) and Qi obstruction occurs, leading to pain. Symptoms include cold limbs, cyanosis of the lips and mouth, with a deep (Chen) or tight (Jin) pulse. The Classics state: "When cold pathogen lodges in the vessels, the vessels become cold; when vessels are cold, they contract and curl; contraction leads to vessel cramping; cramping draws upon small collaterals externally, thus causing sudden pain." Pain ceases immediately upon exposure to heat. Alternatively, vomiting clear fluid may occur; this is described as cold pathogen lodging in the intestines and stomach, with rebellious Qi surging upward, resulting in pain accompanied by vomiting. Treatment should employ warming and dispersing methods, or warming and draining methods.
Wenpi Tang (Warm the Spleen Decoction) from *Ben Shi Fang*:
Houpo (Magnoliae Officinalis Cortex), Ganjiang (Zingiberis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Guixin (Cinnamomi Ramulus), Fuzi (Aconiti Lateralis Radix Praeparata) (each 2 liang); Dahuang (Rhei Radix et Rhizoma) (4 qian).
The herbs are cut into pieces. Take 1 liang of each, add two cups of water, decoct until one-sixth remains, and take in one dose. It treats persistent cold accumulation in the intestines and stomach, presenting with diarrhea and abdominal pain. One must first purge the cold accumulation before regulating the condition; one should not fear deficiency and thereby nurture the disease.
Wenpi Wan (Warm the Spleen Pill) from *Waitai*:
Dahuang (Rhei Radix et Rhizoma), Maiya (Hordei Fructus Germinatus), Ganjiang (Zingiberis Rhizoma) (each 3 liang); Houpo (Magnoliae Officinalis Cortex, stir-fried), Danggui (Angelicae Sinensis Radix), Fuzi (Aconiti Lateralis Radix Praeparata), Gancao (Glycyrrhizae Radix et Rhizoma, stir-fried), Guixin (Cinnamomi Ramulus), Renshen (Ginseng Radix), Zhishi (Aurantii Fructus Immaturus, stir-fried) (each 1 liang).
Make pills using honey, sized like wu zi (Cocculus Indicus seeds). Take 15 pills three times daily, gradually increasing to 20 pills.
Commentary: In Wenpi Wan, Dahuang is used in large amounts but formulated as honey pills taken in small doses, which is an "urgent method applied slowly." In Wenpi Tang, Dahuang is used in small amounts and taken as a decoction, without Renshen or Danggui, which is a "slow method applied urgently." In summary, if the disease is not excess-heat, purgation is generally contraindicated; however, if there is persistent cold in the zang organs, failure to purge will not eliminate the pathogen. Thus, a balance between urgency and slowness is struck here. If there is no stagnation within, only warming is indicated, without purgation. If deficiency is involved, tonification should be added.
Fuzi Tang (Aconite Decoction) from *Waitai*:
Fuzi (Aconiti Lateralis Radix Praeparata), Gancao (Glycyrrhizae Radix et Rhizoma, stir-fried) (each 2 liang); Shengjiang (Zingiberis Rhizoma Recens) (1 liang); Cangmi (Oryzae Semen) (0.5 sheng); Banxia (Pinelliae Rhizoma Praeparatum) (4 liang); Baizhu (Atractylodis Macrocephalae Rhizoma) (3 liang); Dazao (Ziziphi Jujubae Fructus) (20 pieces).
Add ten dou of water, boil down to three sheng, remove dregs, and divide into three doses. It is excellent for treating deficiency-cold abdominal pain.
Jianzhong Tang (Establish the Middle Decoction) from *Waitai*: Treats deficiency-cold of Qi and Blood failing to nourish the Heart and Spleen, resulting in continuous pain without acute or violent intensity. Pressing on the abdomen relieves the pain; light pressure causes pain, but heavy pressure does not cause much pain. This is precisely a deficiency pattern. As stated in the Classics: "In deficiency, Niebi [disordered] Qi is insufficient; pressing allows sufficient Qi to warm the area, thus bringing comfort and cessation of pain."
Huangqi (Astragali Radix), Baishao (Paeoniae Radix Alba) (each 3 liang); Gancao (Glycyrrhizae Radix et Rhizoma, stir-fried), Guixin (Cinnamomi Ramulus) (each 2 liang); Shengjiang (Zingiberis Rhizoma Recens) (6 liang); Banxia (Pinelliae Rhizoma Praeparatum) (5 liang); Dazao (Ziziphi Jujubae Fructus) (12 pieces); Yitang (Maltose) (10 liang).
Add eight sheng of water, decoct to obtain three sheng, and divide into three doses.
Formula for treating periumbilical pain, difficulty in urination and defecation, aversion to cold, and a deficient pulse:
Shudi (Rehmanniae Radix Preparata) (3 qian); Rougui (Cinnamomi Cortex) (5 fen); Baishao (Paeoniae Radix Alba) (1.5 qian); Guizhi (Cinnamomi Ramulus) (5 fen); Danggui (Angelicae Sinensis Radix), Fuling (Poria) (each 1 qian).
Decoct in water and take orally.
Yanhu Kelian Tang (Corydalis and Toosendan Decoction) for treating cold, contracting pain below the umbilicus and coldness in the yin region like ice:
Shudi (Rehmanniae Radix Preparata) (2 qian); Chuanlian (Toosendan Fructus), Yanhu (Corydzidis Rhizoma) (each 5 fen); Fuzi (Aconiti Lateralis Radix Praeparata), Rougui (Cinnamomi Cortex) (each 7 fen); Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma) (1 qian).
Combine all ingredients for one dose. Add four cups of water, decoct to one cup, remove dregs, and take slightly warm on an empty stomach before meals.
Wenzhong Tang (Warm the Middle Decoction): Treats decline of Wu Earth [Spleen/Stomach function], inability to transform and transport, compounded by exogenous cold, gathering to cause fullness and pain. Disperse with pungent-hot herbs, assist with bitter-sweet herbs, and drain with bland herbs. When Qi warms and the Stomach harmonizes, pain stops naturally.
Houpo (Magnoliae Officinalis Cortex, ginger-processed) (1 liang); JuPi (Citri Reticulatae Pericarpium, pith removed) (1 liang); Ganjiang (Zingiberis Rhizoma) (7 qian); Gancao (Glycyrrhizae Radix et Rhizoma, stir-fried); Caodoukou (Alpiniae Katsumadai Semen); Fuling (Poria, peel removed); Muxiang (Aucklandiae Radix) (each 5 qian).
Grind into coarse powder. Take 5 qian per dose, add two cups of water and three slices of ginger, decoct to one cup, remove coarse residue, and take warm before meals.
Shenbao Wan (Divine Preservation Pill) from *Ju Fang*:
Quanxie (Scorpio), Badou (Crotonis Fructus, take the frost/residue) (each 10 pieces); Muxiang (Aucklandiae Radix), Hujiao (Piperis Longi Fructus) (each 2.5 qian).
Grind into powder, mix evenly with Badou frost. Dissolve steamed wheat cake in water to form pills the size of sesame seeds, coated with Zhusha (Cinnabar). Take 5 to 7 pills per dose. This medicine strongly promotes circulation through the zang-fu organs and treats pain caused by various accumulations of Qi.