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。
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。
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。
腹满按之不痛者。无形之气。散而不收。其满为虚。按之而痛者。有形之邪。结而不行。其满为
实。实者可下。虚者不可下也。舌黄者热之征。下之实去。则黄亦去。
腹满时减。复如故。此为寒。当与温药。
腹满不减者。实也。时减复如故者。腹中寒气得阳而暂开。得阴而复合也。此亦寒从内生。故曰
当与温药。
病者痿黄。燥而不渴。胸中寒实而利不止者死。
痿黄、脾虚而色败也。气不至故燥。中无阳故不渴。气竭阳衰。中土已败。而复寒结于上。脏脱
于下。何恃而可以通之止之乎。故死。
寸口脉弦者。即胁下拘急而痛。其人啬啬恶寒也。
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。
夫中寒家喜欠。其人清涕出。发热色和者善嚏。
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。
中寒。其人下利。以里虚也。欲嚏不能。此人肚中寒。
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。
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。
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。势必犯上无等。否亦窃据中
原也。
病腹满。发热十日。脉浮而数。饮食如故。浓朴七物汤主之。
腹满、里有实也。发热脉浮数。表有邪也。而饮食如故。则当乘其胃气未病而攻之。枳、朴、大
黄。所以攻里。
桂枝、生姜。所以攻表。甘草、大枣。则以其内外并攻。故以之安脏气。抑以和药气也。
浓朴七物汤方
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。腹中寒气。雷鸣切痛。胸胁逆满呕吐。附子粳米汤主之。
下焦浊阴之气。不特肆于阴部。而且逆于阳位。中土虚而堤防撤矣。故以附子辅阳驱阴。半夏降
逆止呕。而尤赖粳米、甘、枣。培令土浓。而使敛阴气也。
附子粳米汤方
附子（一枚炮） 半夏 粳米（各半升） 甘草（一两） 大枣（十枚）
上五味。以水八升。煮米熟汤成。去滓。温服一升。日三服。
痛而闭者。浓朴三物汤主之。
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。
按之心下满痛者。此为实也。当下之。宜大柴胡汤。
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。承气独主里实。柴胡兼通阳痹也。
大柴胡汤方
柴胡（半斤） 黄芩 芍药（各三两） 半夏（半升） 枳实（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。
腹满不减。减不足言。当下之。宜大承气汤。
减不足言。谓虽减而不足云减。所以形其满之至也。故宜大下。已上三方。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（见痉病）
心胸中大寒痛。呕不能饮食。腹中满。上冲皮起。出见有头足。上下痛而不可触近者。大建中汤
主之。
心腹寒痛。呕不能食者。阴寒气盛。而中土无权也。上冲皮起。出见有头足。上下痛而不可触近
者。阴凝
成象。腹中虫物乘之而动也。是宜大建中脏之阳。以胜上逆之阴。故以蜀椒、干姜温胃下虫。人参、
饴糖安中益气也。
大建中汤方
蜀椒（二合炒去汗） 干姜（四两） 人参（一两）
上三味。以水四升。煮取二升。去滓。内胶饴一升。微火煎取二升。分温再服。如一炊顷。可饮
粥二升。后更服。当一日食糜粥。温覆之。
胁下偏痛。发热。其脉紧弦。此寒也。以温药下之。宜大黄附子汤。
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。
大黄附子汤方
大黄（三两） 附子（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。
寒气厥逆。赤丸主之。
寒气厥逆。下焦阴寒之气。厥而上逆也。茯苓、半夏降其逆。乌头、细辛散其寒。真朱体重色正。
内之以破
阴去逆也。
赤丸方
乌头（二两炮） 茯苓（四两） 细辛（一两） 半夏（四两）
上四味末之。内真朱为色。炼蜜为丸。如麻子大。先食饮。酒下三丸。日再。夜一服。不知。稍
增之。以知为度。腹满脉弦而紧。弦则卫气不行。即恶寒。紧则不欲食。邪正相搏。即为寒疝。寒疝
绕脐痛。若发则白津出。手足厥冷。其脉沉紧者。大乌头煎主之。
弦紧脉皆阴也。而弦之阴从内生。紧之阴从外得。弦则卫气不行而恶寒者。阴出而痹其外之阳也。
紧则不欲食者。阴入而痹其胃之阳也。卫阳与胃阳并衰。而外寒与内寒交盛。由是阴反无畏而上冲。
阳反不治而下伏。所谓邪正相搏。即为寒疝者也。绕脐痛。发则白津出。手足厥冷。其脉沉紧。皆寒
疝之的证。白津、汗之淡而不咸者。为虚汗也。一作自汗。亦通。大乌头煎大辛大热。为复阳散阴之
峻剂。故云不可一日更服。
大乌头煎
乌头（大者五枚熬去皮不必咀）
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。弱人五合。不瘥。
明日更服。不可一日更服。
寒疝腹中痛。及胁痛里急者。当归生姜羊肉汤主之。
此治寒多而血虚者之法。血虚则脉不荣。寒多则脉绌急。故腹胁痛而里急也。当归、生姜温血散
寒。羊肉补虚益血也。
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。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。抵当乌头桂枝汤主之。
腹中痛。逆冷。阳绝于里也。手足不仁。或身疼痛。阳痹于外也。此为寒邪兼伤表里。故当表里
并治。乌头温里。桂枝解外也。徐氏曰。灸刺诸药不能治者。是或攻其内。或攻其外。邪气牵制不服
也。如醉状则营卫得温而气胜。故曰知。得吐则阴邪不为阳所容而上出。故为中病。
乌头桂枝汤方
乌头
上一味。以水二升。煎减半。去滓。以桂枝汤五合解之。令得一升后。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。
其脉数而紧乃弦。状如弓弦。按之不移。脉数弦者。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。
脉数为阳。紧弦为阴。阴阳参见。是寒热交至也。然就寒疝言。则数反从弦。故其数为阴凝于阳
之数。非阳气生热之数矣。如就风疟言。则弦反从数。故其弦为风从热发之弦。而非阴气生寒之弦者。
与此适相发明也。故曰脉数弦者。当下其寒。紧而迟。大而紧亦然。大虽阳脉。不得为热。正以形其
阴之实也。故曰阳中有阴。可下之。
附方
外台乌头汤 治塞疝。腹中绞痛。贼风入攻五脏。拘急不得转侧。发作有时。令人阴缩。手
足厥逆。（即大乌头煎）
外台柴胡桂枝汤 治心腹卒中痛者。
柴胡（四两） 黄芩 人参 芍药 桂枝 生姜（各一两半） 甘草（一两） 半夏（一合半）
大枣（六枚）
上九味。以水六升。煮取三升。温服一升。日三服。
外台走马汤 治中恶心痛。腹胀。大便不通。
巴豆（二枚去皮心熬） 杏仁（二枚）
上二味。以绵缠。捶令碎。热汤二合。捻取白汁饮之。当下。老小量之。通治飞尸鬼击病。
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。脉数而滑者实也。此有宿食。下之愈。宜大承气汤。下利不欲食者。此有宿食。当下
之。宜大承气汤。
寸口脉浮大者。谷气多也。谷多不能益脾而反伤脾。按之脉反涩者。脾伤而滞。血气为之不利也。
尺中亦微而涩者。中气阻滞。而水谷之精气不能逮下也。是因宿食为病。则宜大承气下其宿食。脉数
而滑与浮大同。盖皆有余之象。为谷气之实也。实则可下。故亦宜大承气。谷多则伤脾。而水谷不分。
谷停则伤胃。而恶闻食臭。故下利不欲食者。知其有宿食当下也。夫脾胃者。所以化水谷而行津气。不
可或止者也。谷止则化绝。气止则机息。化绝机息。人事不其顿乎。故必大承气速去其停谷。谷去则
气行。气行则化续而生以全矣。若徒事消克。将宿食未去而生气已消。岂徒无益而已哉。
大承气汤方（见痉病）
宿食在上脘。当吐之。宜瓜蒂散。
食在下脘者当下。食在上脘者。则不当下而当吐。经云。其高者因而越之也。
瓜蒂散方
瓜蒂（一分熬黄） 赤小豆（三分煮）
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。
脉紧如转索无常者。宿食也。脉紧头痛风寒。腹中有宿食不化也。
脉紧如转索无常者。紧中兼有滑象。不似风寒外感之紧为紧而带弦也。故寒气所束者。紧而不移。
食气所发者。乍紧乍滑。如以指转索之状。故曰无常。脉紧头痛风寒者。非既有宿食。而又感风寒也。
谓宿食不化。郁滞之气。上为头痛。有如风寒之状。而实为食积类伤寒也。仲景恐人误以为外感而发
其汗。故举以示人曰。腹中有宿食不化。意亦远矣。
趺阳脉微而弦。按照医理应当出现腹满症状。如果没有腹满，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。
趺阳脉是胃脉。微弦属于阴象。以阴邪加于阳位（脾胃属土，为阴阳交汇之地），脾胃受邪，就会发生腹满。假如不出现腹满，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，而是从内部下部向上生发，所以病根在于内生。这就是所说的“肾虚则寒动于中”。因此，不应当用发散的方法，而应当用温补的方法。
病人腹部胀满，用手按压如果不痛，属于虚证；如果按压疼痛，属于实证。实证可以使用泻下法。舌苔发黄且尚未使用泻下法的，泻下后黄苔自然去除。
腹部胀满，用手按压不痛的，是无形的正气散漫不收，其胀满属于虚证。按压而痛的，是有形的邪气结聚不行，其胀满属于实证。实证可以泻下，虚证不可泻下。舌苔黄是热象的标志。泻下后实邪去除了，黄苔也会随之消失。
腹部胀满有时减轻，过后又恢复原状，这是寒证，应当给予温性药物。
腹部胀满持续不减的，是实证。时减后又恢复如故的，是因为腹中的寒气遇到阳气暂时消散，遇到阴气又重新聚合。这也是寒从内生的缘故，所以说应当给予温性药物。
病人面色萎黄，皮肤干燥但不口渴，胸中有寒实之邪且腹泻不止的，预后不良，主死。
面色萎黄，是脾虚而气血败坏的表现。气不能到达体表故皮肤干燥。中焦没有阳气故不口渴。气竭阳衰，中焦脾胃之气已败坏，再加上寒邪结聚于上，脏气脱失于下，还有什么依靠来通利或止涩呢？所以会死亡。
寸口脉弦，也是阴邪加于阳位的征象。所以胁下拘急疼痛，且寒邪从外部获得，这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，而这里有怕冷的症状。
患有中寒病的人喜欢打哈欠。如果病人流清鼻涕，发热但面色正常，容易打喷嚏。
阳气想要上升而被阴气牵引，就会打哈欠。阴气想要进入体内而被阳气拒绝，就会打喷嚏。中寒病人的阳气被抑制，所以喜欢打哈欠。流清鼻涕、发热但面色平和，说明邪气不能停留，所以容易打喷嚏。
中寒的病人，如果出现下利，是因为里气虚弱。想打喷嚏却打不出来，这是因为肚子里有寒。
中寒而下利的，是因为里气素来虚弱，没有防御能力，邪气得以直接侵犯内脏。想打喷嚏却打不出来的，是因为正气被邪气逼迫，既不能驱除邪气，又不甘心受邪，于是阳气想要活动却又停止，邪气想要离去却又留下。
瘦人脐周疼痛，必定是有风冷之邪，导致谷气运行不畅。如果反而使用泻下法，气机必然上冲。如果不冲逆，心下部位就会痞塞。
瘦人脏腑虚弱，气力不足，风冷容易侵入。侵入后谷气留滞不行，导致脐周疼痛，看起来像里实证，但实际上是虚冷证。这应当用温性药物来帮助脾气的运行。如果反而使用泻下法，谷物排出了而风冷之邪并没有随之排出，正气更加虚弱，邪气失去制约，势必犯上无度，或者占据中焦。
病人腹部胀满，发热十天，脉象浮而数，饮食如常，用厚朴七物汤主治。
腹部胀满是里有实邪。发热、脉浮数，是表有邪气。而饮食如常，说明胃气未病，应当趁此机会攻逐邪气。枳实、厚朴、大黄，是用来攻逐里实的。桂枝、生姜，是用来攻逐表邪的。甘草、大枣，则是因为在内外同时攻邪的情况下，用来安定脏气，调和药性的。
厚朴七物汤方
厚朴（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。每次温服八合，每日三次。如果有呕吐症状，加半夏五合。如果有下利，去掉大黄。如果寒邪较多，加生姜至半斤。
腹中寒气，肠鸣剧烈疼痛，胸胁气逆胀满并伴有呕吐的，用附子粳米汤主治。
下焦浊阴之气，不仅在阴部肆虐，而且逆乱于阳位。中焦脾胃虚弱，堤防撤毁。所以用附子辅助阳气驱散阴邪，半夏降逆止呕，尤其依赖粳米、甘草、大枣，培补中土，使土气厚实，从而收敛阴气。
附子粳米汤方
附子（一枚，炮制） 半夏 粳米（各半升） 甘草（一两） 大枣（十枚）
以上五味药，用水八升，煮到米熟汤成。滤去渣滓。每次温服一升，每日三次。
腹痛且大便秘结不通的，用厚朴三物汤主治。
腹痛且便秘，说明六腑之气不行。厚朴三物汤与小承气汤组成相同，但小承气汤意在荡涤实邪，所以以大黄为君药；厚朴三物汤意在行气，所以以厚朴为君药。
厚朴三物汤方
厚朴（八两） 大黄（四两） 枳实（五枚）
以上三味药，用水一斗二升，先煮厚朴和枳实，取五升，加入大黄，煮取三升。每次温服一升，以大便通畅为度。
用手按压心下部位感到胀满疼痛的，这是实证。应当使用泻下法，适宜用大柴胡汤。
按压感到胀满疼痛的，是有形的实邪。实证可以泻下，但心下胀满疼痛，说明结聚的部位较高，与腹部胀满疼痛不同。所以不适宜用大承气汤，而适宜用大柴胡汤。大承气汤专主里实，大柴胡汤兼能通达阳气痹阻。
大柴胡汤方
柴胡（半斤） 黄芩 芍药（各三两） 半夏（半升） 枳实（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，滤去渣滓再煎。每次温服一升，每日三次。
腹部胀满持续不减，即使减轻也微不足道，应当使用泻下法，适宜用大承气汤。
“减不足言”，意思是虽然减轻但不足以称为减轻，以此形容胀满到了极点。所以适宜大力泻下。以上三方，虽然缓急不同，但攻泄的原则是一致的。这就是所谓“中满者泻之于内”。
大承气汤方（见痉病篇）
心胸中大寒疼痛，呕吐不能饮食，腹部胀满，气上冲皮肤，突起如头足状，上下疼痛且不可触碰的，用大建中汤主治。
心腹寒痛，呕吐不能进食，是阴寒气盛，中焦脾胃无力制约。气上冲皮肤，突起如头足状，上下疼痛不可触碰，是阴寒凝结成象，腹中虫物乘势而动。这应当大补中焦脏腑的阳气，以战胜上逆的阴寒。所以用蜀椒、干姜温胃杀虫，人参、饴糖安中益气。
大建中汤方
蜀椒（二合，炒去汗） 干姜（四两） 人参（一两）
以上三味药，用水四升，煮取二升，滤去渣滓。加入胶饴一升，用小火煎取二升。分两次温服。服后约一顿饭的时间，可喝粥二升，之后再服药。应当一天吃糜粥，注意保暖覆盖。
胁下偏侧疼痛，发热，脉象紧弦，这是寒证。用温性药物配合泻下法治疗，适宜用大黄附子汤。
胁下偏侧疼痛且脉象紧弦，是阴寒聚集，偏注于一处。虽然有发热，也是阳气被郁遏所致。所以不用温法不能消除寒邪，不用泻下法不能去除结聚。所以说适宜用温药泻下。程氏说：大黄苦寒，走而不守，得到附子、细辛的大热之性，则其寒性散发而走泄的性质保留下来。
大黄附子汤方
大黄（三两） 附子（三枚） 细辛（二两）
以上三味药，用水五升，煮取二升。分三次温服。如果是体质强壮的人，煮取二升半，分三次温服。服药后如人行走四五里的时间，再进服一次。
寒气厥逆，用赤丸主治。
寒气厥逆，是下焦阴寒之气厥逆而上冲。茯苓、半夏降逆，乌头、细辛散寒。真朱（朱砂）体重色正，内服以破阴气、去逆乱。
赤丸方
乌头（二两，炮制） 茯苓（四两） 细辛（一两） 半夏（四两）
以上四味药研成粉末，加入真朱作为颜色，炼蜜为丸，如麻子大小。饭前饮酒送服三丸，每日两次，夜间一次。如果无效，逐渐增加剂量，以见效为度。
腹部胀满，脉象弦而紧。弦则卫气运行不畅，即出现恶寒。紧则不欲饮食。邪正相搏，即为寒疝。寒疝绕脐疼痛，发作时出冷汗（白津），手足厥冷，脉象沉紧的，用大乌头煎主治。
弦紧脉都属于阴脉。弦之阴从内生，紧之阴从外得。弦则卫气不行而恶寒，是阴气外出痹阻体表的阳气。紧则不欲食，是阴气入内痹阻胃中的阳气。卫阳与胃阳并衰，外寒与内寒交盛。由此阴气反无畏而上冲，阳气反不治而下伏。这就是所谓的邪正相搏，即为寒疝。绕脐痛，发作时出白津，手足厥冷，脉象沉紧，都是寒疝的确切证候。白津，是指汗液清淡而不咸，属于虚汗。也有版本作“自汗”，也通。大乌头煎大辛大热，是回复阳气、驱散阴寒的峻剂。所以说不可一日多次服用。
大乌头煎
乌头（大的五枚，熬制，去皮，不必切碎）
以上一味药，用水三升，煮取一升，滤去渣滓。加入蜂蜜二升，煎至水气尽，取二升。体质强壮的人服七合，体质虚弱的人服五合。如果不好转，明天再服。不可一日多次服用。
这是治疗寒多而血虚的方法。血虚则经脉不荣养，寒多则经脉收缩紧急，所以腹胁疼痛且里急。当归、生姜温血散寒，羊肉补虚益血。
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。每次温服七合，每日三次。如果寒邪多，加生姜成一斤。如果疼痛多且呕吐，加陈皮二两，白术一两。加生姜的也要加水五升，煮取三升二合，服用。
寒疝腹中疼痛，四肢逆冷，手足麻木，如果身体疼痛，灸刺各种药物都不能治愈的，用抵当乌头桂枝汤主治。
腹中疼痛，四肢逆冷，是阳气绝于里。手足麻木，或身体疼痛，是阳气痹阻于外。这是寒邪同时伤害表里，所以应当表里同治。乌头温里，桂枝解表。徐氏说：灸刺诸药不能治愈的，是因为要么攻其内，要么攻其外，邪气牵制不服。服药后如有醉酒状，说明营卫得到温煦而气胜，所以叫“知”。如果呕吐，说明阴邪不为阳气所容而上出，所以叫“中病”。
乌头桂枝汤方
乌头
以上一味药，用水二升，煎减半，滤去渣滓。用桂枝汤五合溶解乌头汁，令得一升。初次服二合，无效，即服三合。再无效，再加至五合。服药后如有醉酒状，或呕吐的，为中病。
脉数而紧转为弦，形状如弓弦，按之不移。脉数弦的，应当泻下其寒。脉紧大而迟的，必定心下坚硬。脉大而紧的，是阳中有阴，可以泻下。
脉数为阳，紧弦为阴，阴阳相见，是寒热交错。但就寒疝而言，数脉反从属于弦脉，所以这个数是阴凝于阳之数，不是阳气生热之数。如果就风疟而言，弦脉反从属于数脉，所以这个弦是风从热发的弦，而不是阴气生寒的弦。这与此处正好相互发明。所以说脉数弦的，应当泻下其寒。紧而迟，大而紧也是如此。大虽然是阳脉，但不能认为是热，正是为了形容阴的实邪。所以说阳中有阴，可以泻下。
附方
外台乌头汤 治疗寒疝。腹中绞痛，贼风侵入五脏，拘急不能转侧，发作有时，令人阴缩，手足厥逆。（即大乌头煎）
外台柴胡桂枝汤 治疗心腹突然卒中疼痛。
柴胡（四两） 黄芩 人参 芍药 桂枝 生姜（各一两半） 甘草（一两） 半夏（一合半） 大枣（六枚）
以上九味药，用水六升，煮取三升。每次温服一升，每日三次。
外台走马汤 治疗中恶心痛，腹胀，大便不通。
巴豆（二枚，去皮心，熬制） 杏仁（二枚）
以上两味药，用绵缠住，捶碎，用热汤二合，捻取白汁饮用。应当下利。老人小孩酌情减量。通治飞尸鬼击病。
问曰：人患宿食病，如何辨别？老师说：寸口脉浮而大，按之反涩，尺中亦微而涩。所以知道有宿食。用大承气汤主治。脉数而滑的是实证。这是有宿食，泻下就好了，适宜用大承气汤。下利而不想吃东西的，这是有宿食，应当泻下，适宜用大承气汤。
寸口脉浮大，是谷气多。谷多不能补脾反而伤脾。按之脉反涩，是脾受伤而停滞，气血为之不利。尺中亦微而涩，是中气阻滞，水谷的精气不能下达。这是因为宿食致病，所以宜用大承气汤泻下宿食。脉数而滑与浮大同，都是有余之象，为谷气之实。实则可下，所以也适宜用大承气汤。谷多则伤脾，水谷不分；谷停则伤胃，厌恶闻食物气味。所以下利不想吃的，知道有宿食应当泻下。脾胃，是用来化生水谷而行津气的，不可以停止。谷停止则生化断绝，气停止则机能息灭。生化断绝，机能息灭，人的事情难道不顿时终结吗？所以必须用大承气汤迅速去除停积的谷食。谷食去则气行，气行则生化继续而生全了。如果只是从事消导克伐，将宿食未去而生气已消，岂止是无益而已哉。
大承气汤方（见痉病篇）
食在下脘的应当泻下，食在上脘的，则不应当泻下而应当吐。经云：其高者因而越之。
瓜蒂散方
瓜蒂（一分，熬黄） 赤小豆（三分，煮）
以上两味药，杵为散。用香豉七合，煮取汁。和散一钱匕，温服。不吐的稍微增加剂量，以快吐为度而止。
脉紧如转索无常，是紧中兼有滑象，不像风寒外感的紧为紧而带弦。所以寒气所束的，紧而不移。食气所发的，乍紧乍滑，如用手指转绳索的样子，所以叫无常。脉紧头痛风寒者，不是说既有宿食，又感风寒。是说宿食不化，郁滞之气，上为头痛，有如风寒之状，而实为食积类伤寒。仲景恐怕人误以为外感而发其汗，所以举出来示人曰：腹中有宿食不化，意思也就深远了。
The Fuyang pulse is slightly fine and wiry. According to medical principles, abdominal fullness should occur. If there is no abdominal fullness, there will certainly be difficulty in defecation and pain in the hypochondriac regions on both sides. This is caused by deficiency-cold pathogenic factors ascending from below. It should be treated with warm herbs.
The Fuyang pulse corresponds to the Stomach meridian. A slightly fine and wiry quality represents a Yin pattern. When Yin pathogenic factors affect Yang positions (the Spleen and Stomach belong to Earth, where Yin and Yang intersect), the Spleen and Stomach are compromised, leading to abdominal fullness. If abdominal fullness does not occur, the Yin pathogen must attack laterally towards the hypochondrium and downwardly obstruct the anal opening, resulting in difficult defecation and pain in the bilateral hypochondriac regions. However, this cold pathogen does not enter from the exterior but arises internally from the lower part and ascends; thus, the disease originates from within. This is what is meant by "when the Kidney is deficient, cold moves within." Therefore, dispersing methods should not be used, but rather warming and tonifying methods.
When a patient presents with abdominal fullness, if palpation elicits no pain, it indicates a Deficiency pattern; if palpation elicits pain, it indicates an Excess pattern. The Excess pattern can be treated with purgative methods. If the tongue coating is yellow and purgatives have not yet been administered, the yellow coating will disappear after purgation.
Abdominal fullness that occasionally subsides and then returns to its original state indicates a Cold pattern; warm herbs should be administered.
Abdominal fullness that persists without relief indicates an Excess pattern. Fullness that subsides temporarily and then returns occurs because the cold qi in the abdomen dissipates temporarily upon encountering Yang qi and re-aggregates upon encountering Yin qi. This is also due to cold arising from within; hence, warm herbs should be administered.
If a patient has a sallow complexion, dry skin without thirst, cold-excess in the chest, and unremitting diarrhea, the prognosis is poor, indicating death.
A sallow complexion indicates Spleen deficiency and deterioration of Qi and Blood. Dryness without thirst occurs because Qi fails to reach the surface and Middle Jiao lacks Yang qi. With exhaustion of Qi and decline of Yang, the Middle Jiao Earth energy is already ruined. Furthermore, with cold binding above and Zang organs collapsing below, what reliance is there for unblocking or astringing? Thus, death ensues.
A wiry pulse at the Cunkou position leads to tension and pain in the hypochondrium and aversion to cold.
A wiry pulse at the Cunkou position is also a sign of Yin pathogens affecting Yang positions. Hence, there is tension and pain in the hypochondrium, and the cold is acquired from the exterior. This differs from the bilateral hypochondriac pain caused by a wiry Fuyang pulse. The former is accompanied by difficult defecation, whereas this case features aversion to cold.
Patients suffering from internal cold often yawn. If a patient has clear nasal discharge, fever, a normal facial color, and frequent sneezing: when Yang qi attempts to ascend but is pulled down by Yin, yawning occurs; when Yin qi attempts to enter but is repelled by Yang, sneezing occurs. In cases of internal cold, Yang qi is suppressed, leading to frequent yawning. Clear nasal discharge, fever with a harmonious complexion indicate that the pathogen cannot linger, leading to frequent sneezing.
In cases of internal cold accompanied by diarrhea, it is due to interior deficiency. The inability to sneeze despite the urge indicates cold in the abdomen.
Internal cold with diarrhea occurs because the interior Qi is inherently weak, lacking defense, allowing pathogens to directly invade the Zang organs. The inability to sneeze indicates that Zheng Qi is pressured by the pathogen; it cannot expel the pathogen nor accept it, so Yang qi attempts to move but stops, and the pathogen attempts to leave but remains.
In thin individuals, periumbilical pain indicates wind-cold invasion causing stagnation of Grain Qi. If purgatives are incorrectly used, Qi will counterflow upward. If it does not counterflow, epigastric stuffiness will occur.
Thin individuals have weak viscera and Qi, making them susceptible to wind-cold invasion. Once invaded, Grain Qi stagnates, causing periumbilical pain that resembles interior Excess but is actually Deficiency-Cold. Warm herbs should be used to assist Spleen Qi transport. Incorrect use of purgatives expels grain but leaves wind-cold behind, further weakening Zheng Qi and allowing the pathogen to dominate, potentially attacking upwards or occupying the center.
For abdominal fullness with fever for ten days, floating and rapid pulse, and normal appetite, Houpo Qiwu Tang (Magnolia Bark Seven-Ingredient Decoction) is indicated.
Abdominal fullness indicates interior Excess. Fever with floating and rapid pulse indicates exterior pathogens. Normal appetite suggests the Stomach Qi is intact; treatment should seize this opportunity to attack. Zhi Shi (Immature Bitter Orange), Hou Po (Magnolia Bark), and Da Huang (Rhubarb) attack the interior. Gui Zhi (Cinnamon Twig) and Sheng Jiang (Fresh Ginger) attack the exterior. Gan Cao (Licorice) and Da Zao (Jujube) stabilize Zang Qi and harmonize the herbs during simultaneous interior-exterior treatment.
**Houpo Qiwu Tang Formula**
Hou Po (8 liang), Gan Cao, Da Huang (each 3 liang), Da Zao (10 pieces), Zhi Shi (5 pieces), Gui Zhi (2 liang), Sheng Jiang (5 liang).
Boil these seven ingredients in 1 dou of water to obtain 4 sheng. Take 8 ge warm, three times daily. Add Ban Xia (5 ge) if vomiting occurs. Remove Da Huang if diarrhea occurs. Increase Sheng Jiang to 8 liang if cold is prominent.
For abdominal cold qi, loud borborygmus, severe pain, chest-hypochondriac reverse fullness, and vomiting, Fuzi Jimi Tang (Aconite and Rice Decoction) is indicated.
Turbid Yin qi from the Lower Jiao not only dominates the Yin parts but also rebels into Yang positions. Due to Spleen-Stomach deficiency, the defenses are collapsed. Fu Zi (Prepared Aconite) assists Yang to drive out Yin; Ban Xia (Pinellia) descends rebellion and stops vomiting. Jing Mi (Rice), Gan Cao, and Da Zao strengthen the Earth to consolidate and restrain Yin qi.
**Fuzi Jimi Tang Formula**
Fu Zi (1 piece, processed), Ban Xia, Jing Mi (each 0.5 sheng), Gan Cao (1 liang), Da Zao (10 pieces).
Boil these five ingredients in 8 sheng of water until the rice is cooked. Strain. Take 1 sheng warm, three times daily.
For pain accompanied by constipation, Houpo Sanwu Tang (Magnolia Bark Three-Ingredient Decoction) is indicated.
Pain with constipation indicates failure of the Six Fu organs' Qi movement. Although composed of the same ingredients as Xiao Chengqi Tang, Xiao Chengqi Tang focuses on purging excess, using Da Huang as the sovereign herb. Houpo Sanwu Tang focuses on moving Qi, using Hou Po as the sovereign herb.
**Houpo Sanwu Tang Formula**
Hou Po (8 liang), Da Huang (4 liang), Zhi Shi (5 pieces).
Boil these three ingredients in 1.2 dou of water. First decoct Hou Po and Zhi Shi to obtain 5 sheng. Add Da Huang and decoct to obtain 3 sheng. Take 1 sheng warm. Stop when bowel movement is achieved.
Palpation revealing fullness and pain in the epigastrium indicates Excess. Purging is indicated; Da Chaihu Tang (Major Bupleurum Decoction) is appropriate.
Fullness and pain upon palpation indicate有形 (material) excess pathogens. While purging is indicated for Excess, the location of epigastric fullness/pain is higher than abdominal fullness/pain. Therefore, Da Chengqi Tang is unsuitable; Da Chaihu Tang is preferred. Da Chengqi Tang treats pure interior Excess, whereas Da Chaihu Tang also unblocks Yang obstruction.
**Da Chaihu Tang Formula**
Chai Hu (8 liang), Huang Qin, Shao Yao (each 3 liang), Ban Xia (0.5 sheng), Zhi Shi (4 pieces), Da Huang (2 liang), Da Zao (12 pieces), Sheng Jiang (5 liang).
Decoct these eight ingredients in 1.2 dou of water to obtain 6 sheng. Strain and simmer again. Take 1 sheng warm, three times daily.
Abdominal fullness that does not decrease, or decreases insignificantly, requires purging; Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
"Decreases insignificantly" means any reduction is negligible, emphasizing extreme fullness. Major purging is required. Although the previous three formulas differ in urgency, their purgative nature is consistent, illustrating "fullness in the middle should be drained from within."
**Da Chengqi Tang Formula** (See Spasm Disease Chapter)
For severe cold pain in the heart and chest, vomiting preventing food intake, abdominal fullness, skin protrusions resembling heads and feet, and unbearable tenderness, Da Jianzhong Tang (Major Construct the Middle Decoction) is indicated.
Cold pain in the heart/abdomen with vomiting and anorexia indicates excessive Yin-cold and powerless Middle Earth. Skin protrusions resembling heads and feet and extreme tenderness indicate Yin-cold coagulation and intestinal worms agitated by it. Da Jianzhong Tang greatly tonifies Middle Jiao Yang to overcome rebellious Yin. Shu Jiao (Sichuan Pepper) and Gan Jiang (Dried Ginger) warm the stomach and expel worms; Ren Shen (Ginseng) and Yi Tang (Maltose) calm the middle and boost Qi.
**Da Jianzhong Tang Formula**
Shu Jiao (2 he, stir-fried to remove oil), Gan Jiang (4 liang), Ren Shen (1 liang).
Decoct these three ingredients in 4 sheng of water to obtain 2 sheng. Strain. Add 1 sheng of Yi Tang. Simmer gently to obtain 2 sheng. Divide into two warm doses. After about one meal's time, drink 2 sheng of rice gruel, then take the next dose. Maintain a diet of rice gruel for one day and keep warm.
For unilateral hypochondriac pain with fever and a tight-wiry pulse, indicating Cold, treat with warming purgatives; Da Huang Fu Zi Xi Xin Tang (Rhubarb, Aconite, and Asarum Decoction) is indicated.
Unilateral hypochondriac pain with a tight-wiry pulse indicates Yin-cold aggregation in one area. Fever here results from Yang suppression. Warming is needed to resolve cold; purging is needed to remove accumulation. Thus, warming purgatives are indicated. Professor Cheng stated: Da Huang is bitter and cold, mobile and unretentive; combined with the great heat of Fu Zi and Xi Xin, its cold nature disperses while its mobilizing property remains.
**Da Huang Fu Zi Xi Xin Tang Formula**
Da Huang (3 liang), Fu Zi (3 pieces), Xi Xin (2 liang).
Decoct these three ingredients in 5 sheng of water to obtain 2 sheng. Divide into three warm doses. For robust patients, decoct to 2.5 sheng. Take one dose every four to five li of walking time.
For cold qi causing reversal cold (Jue Ni), Chi Wan (Red Pill) is indicated.
Reversal cold due to cold qi involves Lower Jiao Yin-cold rebelling upward. Fu Ling (Poria) and Ban Xia descend rebellion; Wu Tou (Aconite) and Xi Xin disperse cold. Zhu Sha (Cinnabar), being heavy and red, enters to break Yin and eliminate rebellion.
**Chi Wan Formula**
Wu Tou (2 liang, processed), Fu Ling (4 liang), Xi Xin (1 liang), Ban Xia (4 liang).
Powder these four ingredients. Mix with Zhu Sha for color. Form pills with honey, size of hemp seeds. Take 3 pills with wine before meals, twice daily, once at night. Increase dosage gradually if ineffective, stopping when effective.
Abdominal fullness with a wiry-tight pulse: Wiry indicates Wei Qi stagnation causing aversion to cold; Tight indicates anorexia. Struggle between Pathogen and Zheng Qi constitutes Han Shan (Cold Colic). Han Shan causes periumbilical pain, sweating of clear fluid (Bai Jin), cold extremities, and a deep-tight pulse. Da Wu Tou Jian (Major Aconite Decoction) is indicated.
Wiry and tight pulses are Yin patterns. Wiry Yin arises internally; Tight Yin arises externally. Wiry pulse blocking Wei Qi causes aversion to cold (Yin blocking exterior Yang). Tight pulse causing anorexia indicates Yin blocking Stomach Yang. With decline of both Wei and Stomach Yang, and intensification of external and internal cold, Yin rebels upward unchecked, and Yang lies suppressed below. This struggle is Han Shan. Periumbilical pain, clear sweat, cold extremities, and deep-tight pulse are definitive signs of Han Shan. Bai Jin refers to clear, non-salty sweat (deficiency sweat); some texts read "spontaneous sweat," which is also acceptable. Da Wu Tou Jian is extremely pungent and hot, a potent formula to restore Yang and scatter Yin. It must not be taken multiple times in one day.
**Da Wu Tou Jian Formula**
Wu Tou (5 large pieces, boiled, skin removed, not chopped).
Decoct in 3 sheng of water to obtain 1 sheng. Strain. Add 2 sheng of honey. Boil until water vapor evaporates to obtain 2 sheng. Robust patients take 7 ge; weak patients take 5 ge. If ineffective, administer the next day. Do not take multiple times in one day.
For Han Shan with abdominal pain and hypochondriac pain with interior tension, Dang Gui Sheng Jiang Yang Rou Tang (Angelica, Ginger, and Mutton Decoction) is indicated.
This treats Cold excess with Blood deficiency. Blood deficiency fails to nourish vessels; Cold excess causes vessel contraction. Hence, abdominal/hypochondriac pain and interior tension. Dang Gui and Sheng Jiang warm Blood and scatter Cold; Yang Rou (Mutton) tonifies deficiency and benefits Blood.
**Dang Gui Sheng Jiang Yang Rou Tang Formula**
Dang Gui (3 liang), Sheng Jiang (5 liang), Yang Rou (1 jin).
Decoct in 8 sheng of water to obtain 3 sheng. Take 7 ge warm, three times daily. If Cold is severe, increase Sheng Jiang to 1 jin. If pain is severe with vomiting, add Chen Pi (Tangerine Peel) 2 liang and Bai Zhu (Atractylodes) 1 liang. Add 5 sheng of water if increasing ginger. Decoct to obtain 3.2 sheng.
For Han Shan with abdominal pain, cold limbs, numbness, body pain, unresponsive to moxibustion/acupuncture/herbs, Di Dang Wu Tou Gui Zhi Tang (Aconite and Cinnamon Twig Decoction) is indicated.
Abdominal pain and cold limbs indicate Yang extinction in the interior. Numbness or body pain indicates Yang obstruction in the exterior. This is Cold damaging both interior and exterior, requiring simultaneous treatment. Wu Tou warms the interior; Gui Zhi releases the exterior. Xu stated: Failure of previous treatments implies conflicting attacks on interior/exterior. "Knowing" (Zhi) refers to feeling like drunkenness, indicating Ying-Wei warming and Qi victory. Vomiting indicates Yin pathogen rejected by Yang and expelled upward, constituting "hitting the disease."
**Wu Tou Gui Zhi Tang Formula**
Wu Tou.
Decoct Wu Tou in 2 sheng of water to reduce by half. Strain. Mix with 5 he of Gui Zhi Tang to obtain 1 sheng. Initial dose: 2 ge. If ineffective, take 3 ge. If still ineffective, increase to 5 ge. Drunken sensation or vomiting indicates efficacy.
If a pulse is rapid and tight turning wiry, like a bowstring, unyielding to pressure: Rapid-wiry pulse indicates need to purge Cold. Tight-large-slow pulse indicates epigastric hardness. Large-tight pulse indicates Yang containing Yin; purging is indicated.
Rapid is Yang; Tight/Wiry is Yin. Their appearance together suggests cold-heat intermingling. Regarding Han Shan, the rapid rate follows the wiry quality, representing Yin condensing on Yang, not Yang generating heat. Regarding Wind-Malaria, the wiry quality follows the rapid rate, representing Wind emerging from Heat, not Yin generating Cold. This clarifies the text. Thus, rapid-wiry pulse requires purging Cold. Tight-slow and large-tight are similar. Large is Yang but here indicates Yin Excess ("Yang containing Yin"), warranting purging.
**Supplementary Formulas**
**Waitai Wutou Tang**: Treats Cold Colic. Severe abdominal绞痛 (colicky pain), thief-wind invading five Zang, rigidity preventing turning, periodic attacks, genital retraction, cold extremities. (Identical to Da Wu Tou Jian).
**Waitai Chaihu Guizhi Tang**: Treats sudden heart-abdominal pain.
Chai Hu (4 liang), Huang Qin, Ren Shen, Shao Yao, Gui Zhi, Sheng Jiang (each 1.5 liang), Gan Cao (1 liang), Ban Xia (1.5 he), Da Zao (6 pieces).
Decoct in 6 sheng of water to obtain 3 sheng. Take 1 sheng warm, three times daily.
**Waitai Zouma Tang**: Treats sudden heart pain, abdominal distension, constipation.
Ba Dou (2 pieces, peeled/cored, roasted), Xing Ren (2 pieces).
Wrap in silk, crush. Infuse in 2 he hot water, squeeze juice, drink. Should cause purging. Adjust for age/strength. Treats Fei Shi Gui Ji diseases.
Q: How to distinguish Su Shi (Retained Food)?
A: Cunkou pulse floating and large, pressing reveals roughness (Se); Chi position is also slightly rough (Se). This indicates retained food. Da Chengqi Tang is indicated. Rapid-slippery pulse indicates Excess; retained food; purging cures it. Da Chengqi Tang is indicated. Diarrhea with anorexia indicates retained food; purging is indicated. Da Chengqi Tang is indicated.
Floating-large Cunkou pulse indicates abundant Grain Qi. Excess grain damages Spleen. Roughness indicates Spleen injury and stagnation, impairing Qi-Blood flow. Rough Chi pulse indicates Middle Qi blockage preventing essence transmission downward. Retained food requires Da Chengqi Tang to purge. Rapid-slippery and floating pulses all indicate Excess/Abundance of Grain Qi. Excess warrants purging. Excess grain damages Spleen (water/grain separation); stagnation damages Stomach (aversion to food odor). Diarrhea with anorexia confirms retained food needing purging. Spleen/Stomach transform water/grain and move fluids/Qi; they must not stop. Stagnation leads to cessation of transformation and Qi movement, ending life. Da Chengqi Tang must rapidly remove stagnant grain to restore Qi flow and transformation. Mere digestion aids would consume Zheng Qi before removing the pathogen, offering no benefit.
**Da Chengqi Tang Formula** (See Spasm Disease Chapter)
Retained food in the Upper Wan (upper stomach) requires emesis; Gua Di San (Thistle Powder) is indicated.
Retained food in the Lower Wan requires purging; food in the Upper Wan requires emesis. The Classic states: "Where it is high, induce vomiting."
**Gua Di San Formula**
Gua Di (1 fen, roasted yellow), Chi Xiao Dou (3 fen, boiled).
Powder these two ingredients. Decoct Xiang Chi (Fermented Soybean) 7 he in water to obtain juice. Mix with powder (1 qian bi). Take warm. If no vomiting, slightly increase dose. Stop when vigorous vomiting occurs.
Pulse tight like a turning rope, irregular, indicates retained food. Pulse tight with headache and wind-cold indicates retained food in the abdomen not digesting.
"Tight like a turning rope" indicates tightness combined with slipperiness, unlike wind-cold tightness which is rigid and wiry. Cold binding is tight and fixed; food-induced tightness fluctuates between tight and slippery, like turning a rope, hence "irregular." "Tight pulse with headache/wind-cold" does not mean simultaneous retained food and wind-cold. It means retained food stagnation generates Qi rising to cause headache, mimicking wind-cold, but is actually food accumulation resembling Taiyang disease. Zhang Zhongjing warns against misdiagnosing this as exterior syndrome and inducing sweat, highlighting that abdominal retained food causes such symptoms.