比。且先食服之。故知其责在下焦也。弦脉主痛。今心痛彻背。背痛彻心。皆由于肝肾之邪。故知其阴弦在尺
中。而非三条之所谓关上脉云云者也。凡胸无痹病。而乍中寒者。亦有心背彻痛之症。并主此丸。故曰。此
与上条俱就胸痹之症。而推展言之者。
一条 趺阳脉微弦。法当腹满。不满、必便难。两 疼痛。此虚、寒从下上也。当以温药服之。趺阳。足阳明
脉也。其
脉微弦、微为胃中之阳土虚弱。弦为肝木之脉。木乘弱土。而凌其所胜。则其气尝纵肆于中部。故法当腹满。
若趺阳脉微。而腹又不满。则是微为中气不足。不能传送。弦为寒燥津液。故必便难。两胁曰 。少阳之部也。
微为中焦之膈气不足。不能捍御。弦为肝邪有余。上冲少阳。故两胁板疼而切痛。盖便难者。气机不下畅。故
变为上逆矣。此虚二字。当少顿。犹云此因中虚。而下焦之寒气上冲阳位故也。温药。当指十五条之大黄附
子汤。并理中四逆辈而言。门人问曰。弦脉气削。是为寒诊。夫子言之有素。颇闻梗概。然虚寒之脉。理宜泄
泻。今又云寒燥其津液。而有便难一症。是何理也。答曰。阳脏得暴寒。则下生泄注。阴脏得固冷。则内结便干。
此天地之化。当春夏之阴晦。则云行雨施。入秋冬之严肃。则冰坚水涸矣。又曰。同一趺阳之脉。微而且弦。何
以有腹满 痛之异乎。曰。胃中之腑气微。则弦脉下寒之邪。从中行直上。故腹满。胃外之膈气微。则弦脉下
寒之邪。从两旁挟上。故两 疼痛矣。
二条 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。
虚痞无形。故按之不痛为虚。热实有形。故按之痛者为实。承上文言寒气上冲而腹满者。当服温药。若实痛
者。则又非温药之例。而为可下之症也。胃中热实。则火土之色上浮。故舌黄。未经下过者而下之。则热实下
散。而火土上浮之色必消。故黄自去。则既经下之而黄尚未去者。是为虚热。其主竹叶石膏之候耶。
三条 腹满时减。复如故。此为寒。当与温药。
腹满不减。固为热实。即或少减。亦有胃气渐复。而其热实之满。亦渐次消下者。故犹不得直断为寒也。惟时
减而复如故。则知人身之微阳有起伏。阳起则如阴晦欲霁。太阳一照。而山岚海氛有卷藏之象。故其满时
减。阳伏则又如方晴复晦。阴云郁蒸。故其满复如故。此非寒气上冲之满而何。是当与辛甘之温药。益阳光
以消阴气矣。此又申明首条宜温之诊法。
四条 病者萎黄。躁而不渴。胸中寒实。而利不止者。死。
承上文言腹满之人。阳气垂亡。又有温之而不受温之死症。病者。即上文所云腹满者。是也。萎。指面无生动
之神气而言。黄者。脾色外窜之应。躁则浑身毛窍。如有芒刺。亡阳之汗将作也。不渴。则内无阳热可知。胸为
阳位。今寒邪固蔽。由腹满而上实胸中。于是寒气凭高鼓吹。而下利不止。夫萎黄为脾阳中绝。躁为肾阳外
绝。不渴为胃阳内绝。胸中寒实。为胸分之阳上绝。利不止。为元阳下绝。总以大剂姜附温之。其能使既冷之
灰复热乎。故死。
五条 寸口脉弦者。即胁下拘急而痛。其人啬啬恶寒也。
寸口上应膈气。为肺金之部。寸口脉弦。则肝脉之寒邪。上冲胸分之两旁。不但纵以乘其所胜。而凌趺阳之
胃土。并横以乘其所不胜。而犯太阴之肺金矣。故胁下拘急而痛者。肝邪上乘。肺气缩而不舒之应也。肝为
阴脏。又寸口之部。亦外应表气。今其脉上乘寸口。则阴气外出以干阳位。故恶寒也。啬啬见伤寒论注。此
申言首节两 疼痛句。
六条 夫中寒家喜欠。其人清涕出。发热。色和者善嚏。
脏腑诸阳之气。其在人身也。如轻烟薄雾。周流匀满。故经脉安和。中寒。则脏腑之本气。为寒所逼而内伏。经
络之余气。为寒所逼而上浮。上下薄引。则经脉乍弛。而络脉乍满。经脉乍弛。故喜实其气而腰欲伸。络脉乍
满。故喜引其端而辅呵欠也。李氏引内经太阳司天。寒气下临。心气上从、寒清时举。鼽嚏数欠。与此处之欠
颇合。其引阴气积于下。阳气未尽上浮。阳引而上。阴引而下。阴阳相引。故数欠。是平人卧起之欠。并非倦怠
欲卧之欠。与本文中寒喜欠者何涉。至其云欲入于阴。或阴加于阳二语。并不知内经所言阴阳上下相引
之义。更误。内经之意。盖谓阴气将积于下。阳气未尽上浮。故阴阳各相引于上下。而中虚作欠。则欲入于阴。
或阴加于阳。为何语耶。若倦怠欲卧之欠。则又系阳气将伏于下。阴气未尽上浮。阳引而下。阴引而上。阴阳
相引而欠矣。故曰并非倦怠欲卧之欠也。其人、中寒喜欠之人。肺脏恶寒而开窍于鼻。肺寒。则自出其液。而
推逐其所恶于上窍。故清涕。清涕者。金寒水冷之应也。肺合皮毛而主气。寒则气郁而不与皮毛相合。故发
热。色和为阳气未服之应。嚏从搏击而出。其象为雷。盖肺能奋发而搏击。以出其郁寒之义也。仲景盖谓中
寒喜欠之人。肺气不能震作而嚏。但出清涕。则肺已受寒。而其气自阻。与皮毛之气两相拂郁。故必发热。若
其人面色冲和。知阳气自胜。肺尚有权。故能奋发而搏击。以出其郁寒矣。然则中寒喜欠者。但得色和善嚏。
其不发热可知也。此及下文三条。又论外寒中入。而成腹满之症。本条言中寒而有嚏以出之者。有不能
嚏出而发为表热者。此虽非腹满正文。然实为中寒腹满之来路。故首及之。非泛言中寒之外感已也。二条
正言中寒之腹满。三条言中风冷之人。本不腹满。因误下而致成腹满之症也。
七条 中寒。其人下利。以里虚也。欲嚏不能。此人肚中寒。
中寒之人。但凡下利。则脾胃之阳气里虚。而腹中受寒。故不能分别水谷而下利也。脾肺同属太阴。脾阳不
振。肺气可知。故不能嚏以出之矣。曰肚中寒。则腹之作胀。已在言外。
八条 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。心下则痞也。
肥人阴津不亏。瘦人阳气不亏。此定理也。今以阳气不亏之人。而绕脐作痛。则知痛非下焦虚寒上乘。明系
风冷从脐入腹。而为邪正相持之痛也。但风冷在腹。脾胃之阳。失运动之用。故谷气不行者。常也。是宜桂枝
加芍汤。外加干姜细辛。以驱风散寒为合。乃误以谷气不行为积滞。而反下之。则气机因下而下陷者。必反
浮而上冲胸膈。以致喘急矣。若不从胸膈上冲。则胃阳亏于寒下之药。而下阴上乘胃脘。遂致痞塞腹满矣。
夫以阳气不亏之瘦人。误下之变。尚如此。则肥人而阳气衰者。其害可胜言哉。前两条是从肩背所感之寒
而言。此条又是从口鼻及腹脐所感之风寒而言也。
九条 病腹痛。发热十日。脉浮而数。饮食如故。浓朴七物汤主之。
浓朴七物汤方
浓朴（半斤） 大黄（三两） 枳实（五枚） 桂枝（二两） 甘草（三两） 生姜（五两） 大枣（十枚）
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
此表热日久不解。热伤胃液。以致内实之腹满也。言病腹满之人。发热已十日不解。则津液热伤。是症已可
据。其脉浮而且数。夫浮为在表。以应发热。数为在腑。以应胃热。是脉又可据。饮食如故。则所进不少。是水谷
又可据。其腹满之为胃实无疑。然因发热十日所致。且其脉尚浮数。则又不得遗表热。而单攻腹满。是宜主
浓朴枳黄三物。援承气汤之例。攻症之腹满。并责其脉之数。桂甘姜枣四物。援桂枝汤之例。解症之发热。并
责其脉之浮也。于承气去芒硝者。因饮食如故。则知胃为经表之移热。而非邪入中土之候。故不使咸寒者
损胃阳也。于桂枝去芍药者。因已有浓朴之降。大黄之沉。少留其走表之性。故不使酸敛者。过牵其发散也。
呕者。下气上逆。半夏降逆。故加之。下利无积滞。而腹满又为虚痞矣。大黄伤胃阳。能令虚痞益甚。故去之。胃
阳虚寒。则下阴上塞。故腹为之虚满。生姜能填胸中胃中之阳。排降阴逆以消满。故寒多者加之。曰寒多者
加至半斤。则原方之桂甘姜枣。不但解表。并亦填其中气。而助下运之机者乎。仲景之方。真常山之蛇也。
此承六条中寒喜欠。清涕出。发热等句。而言其变症也。
十条 腹中寒气。雷鸣切痛。胸胁逆满。呕吐。附子粳米汤主之。（中去声）
附子粳米汤方 附子（一枚炮） 粳米（半升） 半夏（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。
此承七条中寒下利而言。故直接此人肚中寒。而曰腹中寒气也。阴阳相搏。故雷鸣。寒邪凝敛。故切痛。胸为
太阳之部。胁为少阳之部。实邪上凌阳位。故逆满也。呕吐者。胃中阳气。为寒所逼。而有欲遁之象。夫腹为阳
明之署。雷鸣切痛。以及呕吐。是其本症。合胸胁而并见逆满。则太少二阳之署。几几乎有阴寒蔽塞之势矣。
故主附子之大热。交于守中之甘草。温胃之粳米。而引至阳明之腹。盖以扶阳者胜阴也。然后以大枣填上
焦。半夏泻阴气。而胸胁自平。呕吐自止矣。七条曰中寒。其人下利。以里虚也。盖先以里虚。遂中寒而下利。
后以下利。遂寒逆而里益虚。故见种种之候也。
十一条 痛而闭者。浓朴三物汤主之。
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。
此及下条。当从上文作一节。盖腹中寒气之症治。上文已完。此又因上文之症。旁及风寒入腹而化热者。与
下卷十六篇吐衄门病患面无血色一条同例。金匮之省笔。多用此法。细读前后三条之文气自见。言下利
里虚。固宜大温大补如彼。若雷鸣等症全具。其人痛而便闭者。则又以气不下通。而实热之邪势由上逆。故
见种种急切之候也。浓朴降气。枳实泄气。大黄下气。则闭者下通。而诸症自息。岂止痛止云乎哉。
十二条 按之心下满痛者。此为实也。当下之。宜大柴胡汤。
大柴胡汤方
柴胡（半斤） 半夏（半斤洗） 黄芩（三两） 生姜（五两） 大枣（十二枚） 大黄（一两）
枳实（四枚） 芍药（三两）
上八味。以水一斗二升。煮取六升。去滓。再煎。温服一升。日三服。（以一升三服计之。则再煎下。
当有取三升三字。）
若雷鸣等前症具。而按其心下满痛。心下为胃之应。按之满痛。是有形之积聚在胃。故为内实而当下之也。
但不主大小承气。及调胃等汤。而独任大柴者。以前症之胸胁逆满。及呕吐等候。系阳明腑实。因而溢出少
阳之部者居多。故以柴半黄芩为主。降少阳部署之逆。所以治胁满。并止其呕吐也。以姜枣填太阳部署之
气。使下焦不得上犯。所以治胸满。并止其雷鸣切痛也。然后以大黄之寒下。枳实之消散。总托于酸敛之芍
药。而并力下趋耳。此岂大小承气及调胃等汤所能胜任者乎。
十三条 腹满不减。减不足言。当须下之。宜大承气汤。
大承气汤方 大黄（四两酒洗） 芒硝（三合） 枳实（五枚炙） 浓朴（半斤去皮炙）
上四味。以水一斗。先煮二物。取五升。去滓。内大黄。煮取二升。去滓。内芒硝。更上火。微煮一二沸。
分温再服。得下。止服。
腹满时减。以阳气有起伏。阳起则阴伏。故其满有时或减。此为虚痞。若腹满昼夜并不减动。及些小减去而
不足言减。犹曰算不得减。此为胃脘渐下渐实之应。故与腹满不减者同。宜大承下之而无疑也。李注大谬。
方论见伤寒注本方下。
十四条 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。
大建中汤方 人参（二两） 干姜（四两） 蜀椒（二合炒去汗）
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。可饮粥二升。后更
服。当一日食糜。温覆之。
此亦口鼻及腹脐所中之寒也。寒从皮毛经络袭入。则先见表症。如头痛、恶寒、发热等类。而后入里。或止病
表而不入里者亦有之。详伤寒论中。寒从口、鼻、腹、脐袭入。则先见里症。如腹满、呕痛、下利等类。而后出表。或
止病里而不及出表。遂致不救者比比也。条中曰心胸中大寒云云。备言里症而不及表症一语。故知为口
鼻及腹脐所中之寒。而未及出表者也。痛呕当指胃脘而言。寒气切责阳位。故痛。胃阳不能自安。故呕。中土
虚寒。失运饮化食之用。故不能饮食也。腹中寒冷之气。上冲胸分。言病者之自觉也。阴阳相搏。腹皮鼓起。出
见如有头足之状。言旁人之可外见也。阴寒之邪。上则抬高阳气。而令阳位逼侧。故上痛不可触近。下则直
入少腹。而与浊阴凝冱。故下痛不可触近也。夫心胸中大寒。与上下痛而不可触近。由于腹中寒气。上充下
比较（前文）。并且先吃饭后服用此药。所以知道病责在下焦。弦脉主痛证。现在心痛放射至背部，背痛放射至心部，都由于肝肾的邪气所致。所以知道是尺中脉现阴弦之象，而不是前文所谓关脉的情况。凡是胸中没有痹病，而突然受寒的人，也有心背相互牵引疼痛的症状，也都用此丸治疗。所以说，这一条与上一条都是就胸痹的症状，而推展论述的。
一条 趺阳脉微而弦，按法应当出现腹满。如果不腹满，必定是大便困难，两胁疼痛。这是虚寒从下向上冲逆所致。应当用温性药物治疗。趺阳脉，是足阳明胃经的脉。其脉微弦，微表示胃中阳气虚弱，弦表示肝木的脉象。肝木乘袭虚弱的脾土，并凌犯其所胜的脏腑，那么它的邪气常常放纵肆行于中部，所以按法应当腹满。如果趺阳脉微，而腹部又不满，则是微表示中气不足，不能传导糟粕；弦表示寒燥津液，所以必定大便困难。两胁称为“䐜”（chēn，指胁肋部位），是少阳的部位。微表示中焦膈间之气不足，不能抵御外邪；弦表示肝邪有余，上冲少阳，所以两胁板滞疼痛且剧烈疼痛。大概大便困难，是因为气机不畅，所以变为上逆了。这“虚”字，应当在诵读时稍作停顿，意思是说这是因为中焦虚损，而下焦的寒气上冲阳位所致。温药，应当指第十五条的大黄附子汤，以及理中汤、四逆汤之类的方剂。门人问：弦脉气削，这是寒证的脉象，老师您讲过有常规道理，我略知梗概。然而虚寒之脉，按理应当导致泄泻，现在又说寒燥津液而有便秘一症，这是什么道理？回答说：阳脏之人突受暴寒，则下部产生泄泻；阴脏之人感受固冷，则内部结聚导致大便干结。这是天地变化的规律，就像春夏季节阴雨晦暗时，云行雨施；进入秋冬肃杀严酷之时，则冰坚水涸。又问：同样是趺阳脉，既微又弦，为什么会有腹满和胁痛的不同呢？回答说：胃中的腑气微弱，则弦脉所主的下寒之邪，从中路直上，所以腹满；胃外的膈气微弱，则弦脉所主的下寒之邪，从两旁挟持而上，所以两胁疼痛。
二条 病人腹满，按压不痛的属于虚证，按之痛的属于实证，可以用攻下法。舌苔黄而未经过攻下治疗的，可以攻下。攻下后，黄苔自然消退。
虚痞无形，所以按压不痛属于虚证。热实有形，所以按之痛属于实证。承接上文说的寒气上冲而腹满的，应当服用温药。如果是实痛，那就不是温药的适应证，而是可以攻下的病症。胃中有热实，则火土之色上浮，所以舌苔黄。未经攻下而攻下后，热实向下消散，火土上浮的颜色必然消失，所以黄苔自然消退。如果已经攻下而黄苔尚未消退的，这是虚热，主治可能是竹叶石膏汤的证候吧。
三条 腹满有时减轻，随后又像原来一样，这是寒证，应当给予温药。
腹满不减，固然是热实。即使稍微减轻，也有可能是胃气逐渐恢复，而其热实的腹满也渐渐消减的情况。所以还不能直接断定为寒证。只有那种时减而复如故的，才知道人身微小的阳气有起伏。阳气升起时，就像阴天欲晴，太阳一照，山岚海雾就有卷藏收敛的景象，所以腹满有时减轻。阳气潜伏时，又像刚放晴又变阴暗，阴云郁蒸，所以腹满又恢复原状。这难道不是寒气上冲导致的腹满吗？这应当给予辛甘温性的药物，益助阳光以消除阴气。这又是申明第一条适宜用温法的诊法。
四条 病人面色萎黄，烦躁但不口渴，胸中有寒实邪气，而且腹泻不止的，预后不良（死证）。
承接上文说腹满的人，阳气垂危将亡，又有服用温药而不受纳的死证。病人，就是上文所说的腹满者。萎，指面部没有生动的神气而言。黄，是脾色外现的反应。躁，则浑身毛孔如有芒刺，是亡阳之汗将要发出的征兆。不渴，则内里没有阳热可知。胸为阳位，现在寒邪固闭，由腹满而上实胸中，于是寒气凭借高位鼓吹，而下利不止。夫萎黄为脾阳中绝，躁为肾阳外绝，不渴为胃阳内绝，胸中寒实为胸分之阳上绝，利不止为元阳下绝。总之需要用大剂量的姜、附子温补，那能使已经冷却的灰烬重新发热吗？所以预后不良（死）。
五条 寸口脉弦，就会出现胁下拘急而痛，病人啬啬恶寒。
寸口上部对应膈气，是肺金的部位。寸口脉弦，则肝脉的寒邪上冲胸分的两旁，不但纵向乘袭其所胜的脾土，并凌犯趺阳的胃土，还横向乘袭其所不胜的太阴肺金。所以胁下拘急而痛，是肝邪上乘，肺气收缩而不舒展的反应。肝为阴脏，又寸口部位也外应表气。现在其脉上乘寸口，则阴气外出干扰阳位，所以恶寒。啬啬见《伤寒论》注。这是申言首节两胁疼痛的句子。
六条 患中寒病的人喜欢打哈欠，其人流清鼻涕，发热，面色平和的善于打喷嚏。
脏腑诸阳之气，在人身中，像轻烟薄雾，周流均匀充满，所以经脉安和。中寒，则脏腑的本气被寒邪逼迫而内伏，经络的余气被寒邪逼迫而上浮。上下牵引，则经脉乍弛，络脉乍满。经脉乍弛，所以喜欢充实气息而腰部想伸展；络脉乍满，所以喜欢牵引末端而辅助打哈欠。李氏引用《内经》“太阳司天，寒气下临，心气上从，寒清时举，鼽嚏数欠”，与此处的打哈欠颇合。他引用“阴气积于下，阳气未尽上浮，阳引而上，阴引而下，阴阳相引，故数欠”，这是平人卧起时的打哈欠，并非倦怠想睡的哈欠，与本文中寒喜打哈欠有什么关系？至于他说“欲入于阴，或阴加于阳”两句话，并不知《内经》所言阴阳上下相引的意义，更是错误。《内经》的意思，大概是说阴气将积聚于下，阳气未尽上浮，所以阴阳各相引于上下，而中虚作欠，则欲入于阴。或者阴加于阳，是什么话呢？若是倦怠想睡的哈欠，则是阳气将伏于下，阴气未尽上浮，阳引而下，阴引而上，阴阳相引而打哈欠。所以说并非倦怠想睡的哈欠。其人，中寒喜打哈欠的人，肺脏恶寒而开窍于鼻。肺寒，则自然流出液体，并推逐其所厌恶之物于上窍，所以流清涕。清涕，是金寒水冷反应。肺合皮毛而主气，寒则气郁而不能与皮毛相合，所以发热。色和为阳气未服（未屈从/未受损）的反应。喷嚏从搏击而出，其形象为雷。盖肺能奋发而搏击，以排出其郁积寒气的意义。仲景大概认为中寒喜打哈欠的人，肺气不能振奋而打喷嚏，只流出清涕，则肺已受寒，而其气自阻，与皮毛之气两相拂郁，所以必定发热。如果其人面色冲和，知道阳气自胜，肺尚有权柄，所以能奋发而搏击，以排出其郁积寒气。那么中寒喜打哈欠的人，只要面色平和善于打喷嚏，就可以知道他不会发热。这一条及下文两条，又讨论外寒中入，而成腹满的病症。本条说中寒而有喷嚏以排出的，有不能打出喷嚏而发为表热的。这虽然不是腹满的正题，但实为中寒腹满的来路，所以首先提及它，不是泛泛谈论中寒的外感而已。二条正说中寒的腹满，三条说中风冷的人，本来不腹满，因误下而导致成腹满的病症。
七条 中寒，其人下利，因为里虚。想打喷嚏却打不出，此人肚中寒。
中寒的人，但凡下利，则脾胃的阳气里虚，而腹中受寒，所以不能分别水谷而下利。脾肺同属太阴，脾阳不振，肺气可知。所以不能打喷嚏以排出寒气。说“肚中寒”，则腹部胀作胀，已在言外。
八条 瘦人绕脐痛，必有风冷，谷气不行，反而用攻下法，其气必上冲，不上冲的，心下就会痞塞。
肥人阴津不亏，瘦人阳气不亏，这是定理。现在以阳气不亏的人，而绕脐作痛，则知道痛非下焦虚寒上乘，明显是风冷从脐入腹，而为邪正相持的痛。只是风冷在腹，脾胃的阳气，失去运动的作用，所以谷气不行是常理。这宜用桂枝加芍药汤，外加干姜细辛，以驱风散寒为合适。乃误以为谷气不行是积滞，而反而用攻下法，则气机因攻下而下陷的，必反浮而上冲胸膈，以致喘急。如果不从胸膈上冲，则胃阳亏于寒下药，而下阴上乘胃脘，遂致痞塞腹满。夫以阳气不亏的瘦人，误下后的变化，尚且如此，则肥人而阳气衰的，其危害岂可尽言？前两条是从肩背所感的寒而言，此条又是从口鼻及腹脐所感的风寒而言。
九条 病人腹痛，发热十日，脉浮而数，饮食如故，用浓朴七物汤主治。
浓朴七物汤方
浓朴（半斤） 大黄（三两） 枳实（五枚） 桂枝（二两） 甘草（三两） 生姜（五两） 大枣（十枚）
以上七味，用水一斗，煮取四升，温服八合，每日三次。呕者，加半夏五合。下利，去大黄。寒多者，加生姜至半斤。
这是表热日久不解，热伤胃液，以致内实之腹满。说病腹满的人，发热已十日不解，则津液热伤，此症已有依据。其脉浮而且数，浮为在表，以应发热；数为在腑，以应胃热，脉象也可作为依据。饮食如故，则进食不少，是水谷也可作为依据。其腹满是胃实无疑。然而因发热十日所致，且其脉尚浮数，则又不能遗漏表热，而单攻腹满。这宜主用浓朴、枳实、大黄三物，援引承气汤的例，攻治症的腹满，并针对脉之数。桂枝、甘草、生姜、大枣四物，援引桂枝汤的例，解治症的发热，并针对脉之浮。在承气汤中去掉芒硝，是因为饮食如故，则知胃为经表之移热，而非邪入中土的证候，所以不用咸寒之品损伤胃阳。在桂枝汤中去掉芍药，是因为已有浓朴之降、大黄之沉，少留其走表之性，所以不用酸敛之品过度牵制其发散。呕者，是下气上逆，半夏降逆，所以加上。下利无积滞，而腹满又为虚痞，大黄伤胃阳，能使虚痞更甚，所以去掉。胃阳虚寒，则下阴上塞，所以腹为之虚满，生姜能填胸中胃中之阳，排降阴逆以消满，所以寒多者加上。说“寒多者加至半斤”，则原方的桂甘姜枣，不但解表，也是填补其中气，而助下运之机啊。仲景的方子，真是常山之蛇。
这承接六条中寒喜欠、清涕出、发热等句，来说明其变症。
十条 腹中寒气，雷鸣切痛，胸胁逆满，呕吐，用附子粳米汤主治。（去声）
附子粳米汤方 附子（一枚炮） 粳米（半升） 半夏（半升） 甘草（一两） 大枣（十枚）
以上五味，用水八升，煮米熟汤成，去滓，温服一升，每日三次。
这承接七条中寒下利而言，所以直接说此人肚中寒，而说腹中寒气。阴阳相搏，所以雷鸣。寒邪凝敛，所以切痛。胸为太阳之部，胁为少阳之部，实邪上凌阳位，所以逆满。呕吐者，是胃中阳气，被寒邪逼迫，而有欲遁之象。夫腹为阳明之署，雷鸣切痛，以及呕吐，是其本症，合胸胁而并见逆满，则太少二阳之署，几乎有阴寒蔽塞之势。所以主用附子之大热，交于守中的甘草，温胃的粳米，而引至阳明之腹。盖以扶阳者胜阴。然后用大枣填上焦，半夏泻阴气，而胸胁自平，呕吐自止。七条说中寒，其人下利，因为里虚。盖先以里虚，遂中寒而下利，后以下利，遂寒逆而里益虚，所以见种种之候。
十一条 痛而大便闭结的，用浓朴三物汤主治。
浓朴三物汤方 浓朴（八两） 大黄（四两） 枳实（五枚）
以上三味，用水一斗二升，先煮二味，取五升，内大黄，煮取三升，温服一升，以利为度。
这及下条，应当从上文作一节。盖腹中寒气之症治，上文已完。这又因上文之症，旁及风寒入腹而化热者，与下卷十六篇吐衄门病患面无血色一条同例。《金匮》的省笔，多用此法，细读前后三条之文气自见。说下利里虚，固宜大温大补如彼。若雷鸣等症全具，其人痛而便闭的，则是以气不下通，而实热之邪势由上逆，所以见种种急切之候。浓朴降气，枳实泄气，大黄下气，则闭者下通，而诸症自息。岂仅是止痛止云乎哉。
十二条 按之心下满痛的，此为实证，当下之，宜大柴胡汤。
大柴胡汤方
柴胡（半斤） 半夏（半斤洗） 黄芩（三两） 生姜（五两） 大枣（十二枚） 大黄（一两）
枳实（四枚） 芍药（三两）
以上八味，用水一斗二升，煮取六升，去滓，再煎，温服一升，每日三次。（以一升三服计之，则再煎下，当有取三升三字。）
若雷鸣等前症具备，而按其心下满痛，心下为胃之应，按之满痛，是有形之积聚在胃，故为内实而当下之。但不主大小承气，及调胃等汤，而独任大柴胡者，以前症之胸胁逆满，及呕吐等候，系阳明腑实，因而溢出少阳之部的居多，故以柴胡、半夏、黄芩为主，降少阳部署之逆，所以治胁满，并止其呕吐。以姜枣填太阳部署之气，使下焦不得上犯，所以治胸满，并止其雷鸣切痛。然后以大黄之寒下，枳实之消散，总托于酸敛之芍药，而并力下趋耳。这岂是大小承气及调胃等汤所能胜任的？
十三条 腹满不减，减不足言，当须下之，宜大承气汤。
大承气汤方 大黄（四两酒洗） 芒硝（三合） 枳实（五枚炙） 浓朴（半斤去皮炙）
以上四味，用水一斗，先煮二物，取五升，去滓，内大黄，煮取二升，去滓，内芒硝，更上火，微煮一二沸，分温再服，得下，止服。
腹满时减，以阳气有起伏，阳起则阴伏，故其满有时或减，此为虚痞。若腹满昼夜并不减动，及些小减去而不足言减，犹曰算不得减，此为胃脘渐下渐实之应，故与腹满不减者同，宜大承气下之而无疑。李注大谬。方论见《伤寒注》本方下。
十四条 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，用大建中汤主治。
大建中汤方 人参（二两） 干姜（四两） 蜀椒（二合炒去汗）
以上三味，用水四升，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，可饮粥二升，后更服，当一日食糜，温覆之。
这也是口鼻及腹脐所中之寒。寒从皮毛经络袭入，则先见表症，如头痛、恶寒、发热等类，而后入里。或止病表而不入里的也有。详《伤寒论》中。寒从口、鼻、腹、脐袭入，则先见里症，如腹满、呕痛、下利等类，而后出表。或止病里而不及出表，遂致不救者比比也。条中说“心胸中大寒”云云，备言里症而不及表症一语，故知为口鼻及腹脐所中之寒，而未及出表的。痛呕当指胃脘而言，寒气切责阳位，故痛。胃阳不能自安，故呕。中土虚寒，失运饮化食之用，故不能饮食。腹中寒冷之气，上冲胸分，言病者的自觉。阴阳相搏，腹皮鼓起，出见如有头足之状，言旁人之可外见。阴寒之邪，上则抬高阳气，而令阳位逼侧，故上痛不可触近。下则直入少腹，而与浊阴凝冱，故下痛不可触近。夫心胸中大寒，与上下痛而不可触近，由于腹中寒气，上充下
Comparison (with the preceding text). And take this medicine after eating. Thus, it is known that the pathology lies in the Lower Jiao (Lower Burner). The Xian (Wiry) pulse governs pain syndromes. Now, heart pain radiating to the back and back pain radiating to the heart are all caused by pathogenic factors of the Liver and Kidney. Therefore, it is known that there is a Yin-Xian (Wiry) pulse at the Chi (Cun Cun) position, rather than the Guan (Bar) pulse situation mentioned earlier. In cases where there is no Bi syndrome (Obstruction Syndrome) in the chest, but sudden exposure to cold occurs, symptoms of mutual pulling pain between the heart and back may also appear; these are also treated with this pill. It is said that this article and the previous one both expand upon the discussion starting from the symptoms of Chest Bi Syndrome.
Article 1: The Duyang (Foot-Yangming) pulse is faint and wiry. According to the method, abdominal fullness should occur. If there is no abdominal fullness, there must be difficulty in defecation and pain in the two flanks (Ce Dan). This is due to deficiency-cold rising from below. Warm medicines should be administered. The Duyang pulse refers to the pulse of the Foot-Yangming Stomach Meridian. A faint-wiry pulse indicates that the faintness represents the weakness of Yang-Earth in the Stomach, while the wiry nature represents the pulse of Liver-Wood. When Wood overacts on weak Earth and encroaches upon what it normally controls, its qi tends to act recklessly in the Middle Jiao. Thus, according to the method, abdominal fullness should occur. If the Duyang pulse is faint, yet there is no abdominal fullness, then the faintness indicates insufficiency of Middle Qi, unable to transport waste. The wiry nature indicates cold drying up body fluids, hence difficulty in defecation. The two flanks are called "Chen" (flank region), which is the domain of Shaoyang (Lesser Yang). Faintness indicates insufficiency of Diaphragm-Qi in the Middle Jiao, unable to defend against pathogens; wiryness indicates excess Liver pathogen rushing upward to Shaoyang, causing stiffness and severe pain in the two flanks. Generally, difficulty in defecation arises because the mechanism of Qi does not flow smoothly downward, thus transforming into upward reversal. The character "Deficiency" (Xu) here should be paused slightly when reciting, implying that this is due to Middle Deficiency, allowing Cold-Qi from the Lower Jiao to rush upward to the Yang positions. "Warm medicines" refer to Da Huang Fu Zi Tang (Rhubarb and Aconite Decoction) from Article 15, as well as Li Zhong Tang (Regulate the Middle Decoction) and Si Ni Tang (Frigid Extremities Decoction) categories. A disciple asked: The Qi is depleted in the Wiry pulse, which is a sign of cold. You have stated principles before, and I know the outline. However, deficiency-cold pulses theoretically lead to diarrhea. Now you say cold dries fluids causing constipation. What is the logic? I replied: When a Yang constitution suffers sudden cold, diarrhea occurs below. When a Yin constitution suffers persistent cold, internal binding leads to dry stools. This is the transformation of Heaven and Earth: like cloudy and rainy days in Spring and Summer, clouds move and rain falls; entering the stern and severe times of Autumn and Winter, ice hardens and water dries. Another question: The same Duyang pulse is both faint and wiry. Why is there a difference between abdominal fullness and flank pain? I answered: If the Fu-Qi (Gallbladder/Stomach Qi) in the Stomach is faint, the lower cold pathogen associated with the Wiry pulse rises straight up through the center, causing abdominal fullness. If the Diaphragm-Qi outside the Stomach is faint, the lower cold pathogen associated with the Wiry pulse rises from the sides, causing pain in the two flanks.
Article 2: The patient has abdominal fullness. Pressing without pain indicates Deficiency; pressing with pain indicates Excess. Purging may be used. If the tongue coating is yellow and purging has not been performed, purging can be applied. After purging, the yellow coating will disappear naturally.
Empty fullness (Pi) is formless, so pressing without pain indicates Deficiency. Heat-Excess is tangible, so pressing with pain indicates Excess. Continuing from the previous text regarding abdominal fullness caused by cold Qi rushing upward, warm medicines should be taken. If it is painful Excess, it is not suitable for warm medicines but is a condition amenable to purging. Heat-Excess in the Stomach causes the color of Fire and Earth to float upward, resulting in a yellow tongue coating. If purged without prior treatment, the Heat-Excess scatters downward, and the floating color of Fire and Earth must vanish, so the yellow coating disappears naturally. If the yellow coating remains after purging, this is Deficient-Heat; perhaps Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) is indicated.
Article 3: Abdominal fullness that decreases intermittently and then returns to normal indicates Cold. Warm medicines should be given.
Abdominal fullness that does not decrease is certainly Heat-Excess. Even if it decreases slightly, it might be due to gradual recovery of Stomach Qi, with Heat-Excess fullness gradually subsiding. Thus, it cannot be directly diagnosed as Cold. Only when it decreases intermittently and returns to normal do we know that the subtle Yang Qi of the body has fluctuations. When Yang rises, it is like dark weather clearing up; once the sun shines, mountain mists and sea vapors gather and hide, so fullness decreases. When Yang hides, it is like clear weather turning cloudy again, with Yin clouds stagnating, so fullness returns to normal. Is this not fullness caused by Cold Qi rushing upward? Warm medicines of Pungent and Sweet nature should be given to benefit Sunlight (Yang) to eliminate Yin Qi. This further clarifies the diagnostic method for using warm medicines mentioned in the first article.
Article 4: The patient has sallow complexion, restlessness without thirst, Cold-Excess in the Chest, and unceasing diarrhea. This is a death prognosis.
Continuing from the previous text about patients with abdominal fullness whose Yang Qi is perishing, there are death conditions where warm medicines are not tolerated. The patient refers to the abdominal fullness mentioned above. "Wei" (withered) refers to the lack of vibrant spirit on the face. "Huang" (yellow) is the manifestation of Spleen color escaping outward. "Zao" (restlessness) means the hair follicles feel like having thorns, indicating impending sweat of Yang exhaustion. "No thirst" indicates no internal Yang heat. The Chest is a Yang position. Now, Cold pathogen blocks firmly, spreading from abdominal fullness to make the Chest solid. Thus, Cold Qi blows from a high position, causing unceasing diarrhea. Sallow complexion indicates interruption of Spleen Yang internally; restlessness indicates external interruption of Kidney Yang; no thirst indicates internal interruption of Stomach Yang; Cold-Excess in the Chest indicates upper interruption of Yang in the Chest division; unceasing diarrhea indicates lower interruption of Primordial Yang. Overall, large doses of Ginger and Aconite are needed to warm, but can they reheat cooled ashes? Therefore, it is fatal.
Article 5: If the Cunkou (Radial) pulse is Wiry, there will be tension and pain under the hypochondrium, and the person will shiver with aversion to cold.
The upper part of the Cunkou corresponds to Diaphragm Qi and is the domain of Lung-Metal. A Wiry Cunkou pulse means Cold pathogen of the Liver Meridian rushes upward to the sides of the Chest division. Not only does it longitudinally overact on what it controls and bully the Stomach-Earth at Duyang, but it also transversely overacts on what it does not control and offends Taiyin-Lung Metal. Thus, tension and pain under the hypochondrium are responses to Liver pathogen attacking upward and Lung Qi contracting without relaxing. The Liver is a Yin organ, and the Cunkou area also externally corresponds to Exterior Qi. Now that its pulse mounts the Cunkou, Yin Qi goes out to interfere with Yang positions, hence aversion to cold. "Se Se" (shivering) is explained in the commentary on Shanghan Lun. This reiterates the sentence about flank pain in the first section.
Article 6: People suffering from Central Cold love to yawn. They have clear nasal discharge, fever, and if their complexion is harmonious, they sneeze easily.
The Yang Qi of the Zang-Fu organs in the human body flows evenly and fully like light smoke and thin mist, keeping meridians harmonious. Central Cold forces the root Qi of Zang-Fu to hide inward due to cold pressure, while residual Qi of collaterals floats upward due to cold pressure. Upper and lower traction causes meridians to relax suddenly and collaterals to fill suddenly. Sudden relaxation of meridians makes one desire to fill Qi and stretch the waist; sudden filling of collaterals makes one desire to pull ends and assist yawning. Li cited Nei Jing: "When Taiyin governs, Cold descends, Heart Qi follows upward... frequent yawning." This matches yawning here. He cited "Yin accumulates below, Yang has not fully floated up, Yang pulls up, Yin pulls down, Yin-Yang attract, hence frequent yawning." This refers to yawning during lying down/waking, not yawning from fatigue wanting to sleep, which has nothing to do with Central Cold yawning in this text. His phrases "desire to enter Yin" or "Yin adds to Yang" show ignorance of the meaning of Yin-Yang attraction in Nei Jing, which is erroneous. Nei Jing means: Yin accumulates below, Yang hasn't fully floated up, so Yin and Yang attract each other up and down, and central deficiency causes yawning to enter Yin. Or Yin adds to Yang—what language is this? If yawning from fatigue wanting to sleep, it is because Yang is about to sink below, Yin hasn't fully floated up, Yang pulls down, Yin pulls up, Yin-Yang attract, causing yawning. Hence, it is not yawning from fatigue. For those who Central Cold and love to yawn, the Lung dislikes Cold and opens to the nose. Lung Cold causes fluid secretion and pushes disliked substances to upper orifices, hence clear nasal discharge. Clear discharge is the response of Metal-Cold and Water-Cold. Lung combines with skin/hair and governs Qi. Cold causes Qi stagnation and prevents combination with skin/hair, hence fever. Harmonious complexion indicates Yang Qi is not subdued. Sneezing comes from impact, resembling thunder. Lung can surge and impact to expel stagnant Cold. Zhang Zhongjing implies that for those who Central Cold and yawn, if Lung Qi cannot surge to sneeze but only discharges clear fluid, the Lung is already cold, Qi is blocked, conflicting with skin/hair Qi, hence fever. If the person's face is harmonious, knowing Yang Qi prevails and Lung still has authority, it can surge and impact to expel stagnant Cold. Thus, for those who Central Cold and yawn, if the complexion is harmonious and they sneeze easily, they will not have fever. This and the next two articles discuss exterior Cold entering to cause abdominal fullness. This article says Central Cold with sneezing to expel it; some cannot sneeze and develop exterior heat. Although not the main topic of abdominal fullness, it is the origin of Central Cold abdominal fullness, hence mentioned first, not merely discussing general Central Cold exterior contraction. Article 2 discusses Central Cold abdominal fullness directly; Article 3 discusses Wind-Cold people who originally had no abdominal fullness but developed it due to mistaken purging.
Article 7: Central Cold, the person has diarrhea because of Interior Deficiency. Wants to sneeze but cannot; this person has Cold in the Belly.
For those with Central Cold, any diarrhea indicates Interior Deficiency of Spleen-Stomach Yang and Cold in the abdomen, preventing separation of food and drink, leading to diarrhea. Spleen and Lung belong to Taiyin. If Spleen Yang fails, Lung Qi is known to fail. Hence, inability to sneeze to expel Cold. Saying "Cold in the Belly" implies abdominal distension is implied.
Article 8: Thin people with pain around the umbilicus must have Wind-Cold. Grain Qi does not move. Mistakenly purging will cause Qi to rush upward; if it does not rush, Epigastric Pi (Glomus) will form.
Fat people do not lack Yin-Jin (Fluids); thin people do not lack Yang Qi. This is a fixed principle. Now, for a person with sufficient Yang Qi, pain around the umbilicus indicates the pain is not from Lower Jiao Deficiency-Cold rising, but clearly Wind-Cold entering from the umbilicus into the abdomen, causing pain from struggle between Evil and Righteous Qi. Wind-Cold in the abdomen causes Spleen-Stomach Yang to lose movement function, so Grain Qi not moving is normal. Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony) with added Gan Jiang (Dried Ginger) and Xi Xin (Asarum) to dispel Wind and scatter Cold is appropriate. Mistaking Grain Qi stagnation for accumulation and mistakenly purging causes Qi mechanism to sink due to purging, then float and rush upward to Chest-Diaphragm, causing panting. If it does not rush from Chest-Diaphragm, Stomach Yang is deficient due to cold-purging herbs, and Lower Yin attacks the Stomach, causing Pi obstruction and abdominal fullness. For a thin person with sufficient Yang Qi, the changes from mistaken purging are thus; how much worse for fat people with deficient Yang? The previous two articles discussed Cold felt from shoulders/back; this article discusses Wind-Cold felt from mouth/nose and abdomen/umbilicus.
Article 9: Patient has abdominal pain, fever for ten days, pulse is Floating and Rapid, diet is normal. Niu Pi Qi Wu Tang (Magnolia Bark Seven Ingredient Decoction) governs.
Niu Pi Qi Wu Tang Formula
Hou Po (Magnolia Bark) - 8 liang
Da Huang (Rhubarb) - 3 liang
Zhi Shi (Immature Bitter Orange) - 5 pieces
Gui Zhi (Cinnamon Twig) - 2 liang
Gan Cao (Licorice) - 3 liang
Sheng Jiang (Fresh Ginger) - 5 liang
Da Zao (Jujube) - 10 pieces
These seven ingredients, boil in 1 dou (approx. 10 liters) of water, extract 4 sheng (approx. 4 liters). Take 8 ge (approx. 0.8 liters) warm, three times daily. If vomiting, add Ban Xia (Pinellia) 5 he. If diarrhea, remove Da Huang. If much Cold, add Sheng Jiang to 8 liang.
This is prolonged unresolved Exterior Heat damaging Stomach fluids, leading to Interior Excess abdominal fullness. Saying the patient with abdominal fullness has had fever for ten days unresolved means Jin-Ye (Body Fluids) are damaged by Heat, confirming the symptom. Pulse Floating and Rapid: Floating indicates Exterior, corresponding to fever; Rapid indicates Fu-organ, corresponding to Stomach Heat. Pulse confirms. Diet normal means intake is sufficient, confirming food/drink status. Abdominal fullness is undoubtedly Stomach Excess. However, caused by ten days of fever and pulse still Floating/Rapid, Exterior Heat cannot be ignored while solely attacking abdominal fullness. Use Hou Po, Zhi Shi, Da Huang (three ingredients), following Cheng Qi Tang example, to attack abdominal fullness and address Rapid pulse. Gui Zhi, Gan Cao, Sheng Jiang, Da Zao (four ingredients), following Gui Zhi Tang example, to resolve fever and address Floating pulse. Removing Mang Xiao (Mirabilite) from Cheng Qi Tang is because diet normal indicates Heat shifted from channels/exterior to Stomach, not pathogen entering Middle Earth, so avoid Salty-Cold damaging Stomach Yang. Removing Shao Yao (Peony) from Gui Zhi Tang is because Hou Po descends and Da Huang sinks, retaining some exterior-moving property, so avoid Sour-Astringent overly restraining dispersal. Vomiting is Lower Qi reversing upward; Ban Xia descends rebellion, so add. Diarrhea without accumulation and abdominal fullness being Empty Pi: Da Huang damages Stomach Yang, worsening Empty Pi, so remove. Stomach Yang Deficiency-Cold causes Lower Yin blocking upward, causing Empty Fullness; Sheng Jiang fills Chest/Stomach Yang, expels Yin rebellion to reduce fullness, so add for much Cold. Saying "add Sheng Jiang to 8 liang for much Cold" implies original Gui-Gan-Jiang-Zao not only resolves Exterior but also fills Middle Qi and aids downward transport. Zhang Zhongjing's formulas are truly like the Snake of Changshan.
This continues from Article 6 Central Cold yawning, clear discharge, fever, etc., explaining variant symptoms.
Article 10: Cold Qi in abdomen, rumbling sound and cutting pain, reverse fullness in Chest/Hypochondrium, vomiting. Fu Zi Mi Tang (Aconite and Rice Decoction) governs.
Fu Zi Mi Tang Formula
Fu Zi (Prepared Aconite Root) - 1 piece (prepared)
Jing Mi (Rice) - 0.5 sheng
Ban Xia (Pinellia Tuber) - 0.5 sheng
Gan Cao (Licorice Root) - 1 liang
Da Zao (Jujube Fruit) - 10 pieces
These five ingredients, boil in 8 sheng of water until rice is cooked and soup is ready. Remove dregs. Take 1 sheng warm, three times daily.
This continues from Article 7 Central Cold diarrhea, directly addressing Cold in Belly, saying Cold Qi in Abdomen. Yin and Yang contend, hence rumbling. Cold pathogen condenses, hence cutting pain. Chest is Taiyang domain, Hypochondrium is Shaoyang domain. Excess pathogen attacks Yang positions, hence reverse fullness. Vomiting is Stomach Yang forced by Cold to want to flee. Abdomen is Yangming domain. Rumbling, cutting pain, and vomiting are primary symptoms. Combined with reverse fullness in Chest/Hypochondrium, Taiyang and Shaoyang domains nearly have Yin-Cold blocking tendency. Hence use Fu Zi's great heat, combined with Gan Cao guarding Middle, Jing Mi warming Stomach, guiding to Yangming Abdomen. Supporting Yang defeats Yin. Then Da Zao fills Upper Jiao, Ban Xia drains Yin Qi, making Chest/Hypochondrium calm and stopping vomiting. Article 7 said Central Cold, diarrhea due to Interior Deficiency. First Interior Deficiency led to Central Cold and diarrhea; later diarrhea led to Cold reversal and increased Interior Deficiency, hence various symptoms.
Article 11: Pain with constipation. Niu Pi San Wu Tang (Magnolia Bark Three Ingredient Decoction) governs.
Niu Pi San Wu Tang Formula
Hou Po (Magnolia Bark) - 8 liang
Da Huang (Rhubarb) - 4 liang
Zhi Shi (Immature Bitter Orange) - 5 pieces
These three ingredients, boil in 1.2 dou of water. First boil two ingredients, extract 5 sheng. Add Da Huang, boil to extract 3 sheng. Take 1 sheng warm, stop when bowel movement occurs.
This and the next article should be read as one section from the previous text. Treatment of Cold Qi in Abdomen was completed above. This extends from previous symptoms to Wind-Cold entering abdomen transforming into Heat, similar to Article on pale-faced patients in Hematemesis/Epistaxis chapter, Vol 16. Jin Gui uses concise writing often; reading前後 three articles reveals this. Diarrhea with Interior Deficiency requires great Warmth and Tonification as before. If rumbling symptoms are complete, and patient has pain with constipation, it is because Qi does not descend, and Excess Heat pathogen reverses upward, causing urgent symptoms. Hou Po descends Qi, Zhi Shi drains Qi, Da Huang lowers Qi, closing opens downward, symptoms cease. Is it just stopping pain?
Article 12: Pressing Epigastrium causes fullness and pain. This is Excess. Must purge. Da Chai Hu Tang (Major Bupleurum Decoction) is suitable.
Da Chai Hu Tang Formula
Chai Hu (Bupleurum Root) - 8 liang
Ban Xia (Pinellia Tuber) - 8 liang (washed)
Huang Qin (Scutellaria Root) - 3 liang
Sheng Jiang (Fresh Ginger) - 5 liang
Da Zao (Jujube Fruit) - 12 pieces
Da Huang (Rhubarb) - 1 liang
Zhi Shi (Immature Bitter Orange) - 4 pieces
Shao Yao (White Peony Root) - 3 liang
These eight ingredients, boil in 1.2 dou of water, extract 6 sheng. Remove dregs, decoct again. Take 1 sheng warm, three times daily. (Calculating 1 sheng divided into three doses, after second decoction, should extract 3 sheng.)
If previous symptoms like rumbling are present, and pressing Epigastrium causes fullness and pain, Epigastrium corresponds to Stomach. Fullness and pain upon pressing indicate tangible accumulation in Stomach, hence Interior Excess requiring purging. But not using Xiao/Cheng Qi or Tiao Wei Tang, but relying solely on Da Chai Hu, is because previous symptoms of reverse fullness in Chest/Hypochondrium and vomiting mostly stem from Yangming Fu-organ Excess overflowing into Shaoyang domain. Hence Chai Hu, Ban Xia, Huang Qin are main, descending Shaoyang rebellion to treat flank fullness and stop vomiting. Jiang and Zao fill Taiyang domain Qi, preventing Lower Jiao from attacking upward, treating Chest fullness and stopping rumbling/cutting pain. Then Da Huang's cold purging and Zhi Shi's dissipation are entrusted to Sour-Astringent Shao Yao, jointly driving downward. Can Xiao/Cheng Qi or Tiao Wei Tang handle this?
Article 13: Abdominal fullness does not decrease, slight decrease is insignificant. Must purge. Da Cheng Qi Tang (Major Order the Qi Decoction) is suitable.
Da Cheng Qi Tang Formula
Da Huang (Rhubarb) - 4 liang (wine washed)
Mang Xiao (Mirabilite) - 3 he
Zhi Shi (Immature Bitter Orange) - 5 pieces (roasted)
Hou Po (Magnolia Bark) - 8 liang (skin removed, roasted)
These four ingredients, boil in 1 dou of water. First boil two ingredients, extract 5 sheng. Remove dregs, add Da Huang, boil to extract 2 sheng. Remove dregs, add Mang Xiao, heat again, boil lightly 1-2 boils. Divide warm, take twice. Stop taking when bowel movement occurs.
Abdominal fullness decreasing intermittently is due to Yang Qi fluctuation; Yang rising suppresses Yin, so fullness sometimes decreases, indicating Empty Pi. If abdominal fullness does not decrease day or night, and slight decrease is negligible ("cannot be called decrease"), this is response of Gradual Solidification of Stomach Intestines. Same as abdominal fullness not decreasing, Da Cheng Qi Tang purges without doubt. Li's commentary is greatly erroneous. Formula theory see Shanghan Commentary under this formula.
Article 14: Great Cold in Heart and Chest, pain, vomiting, inability to eat. Cold Qi in Abdomen rushes upward, skin rises showing head-and-tail shapes, pain above and below unapproachable. Da Jian Zhong Tang (Major Construct the Middle Decoction) governs.
Da Jian Zhong Tang Formula
Ren Shen (Ginseng Root) - 2 liang
Gan Jiang (Dried Ginger) - 4 liang
Shu Jiao (Sichuan Pepper) - 2 he (stir-fried to remove sweat/oil)
These three ingredients, boil in 4 sheng of water, extract 2 sheng. Remove dregs, add Yi Tang (Maltose) 1 sheng. Simmer gently to extract 1.5 sheng. Divide warm, take twice. After one meal time, drink 2 sheng of porridge, take again later. Eat congee for one day, keep warm covering.
This is Cold entered via Mouth/Nose and Abdomen/Umbilicus. Cold entering via Skin/Hair/Meridians first shows Exterior symptoms like headache, aversion to cold, fever, then enters Interior. Or stays in Exterior without entering Interior, detailed in Shanghan Lun. Cold entering via Mouth/Nose/Abdomen/Umbilicus first shows Interior symptoms like abdominal fullness, vomiting/pain, diarrhea, then emerges to Exterior. Or stays in Interior without emerging, leading to untreatable cases frequently. The article says "Great Cold in Heart/Chest," detailing Interior symptoms without mentioning Exterior, indicating Cold entered via Mouth/Nose/Abdomen/Umbilicus and did not emerge to Exterior. Pain/Vomiting refers to Epigastrium. Cold Qi harshly attacks Yang position, hence pain. Stomach Yang cannot settle, hence vomiting. Middle Earth Deficiency-Cold loses function of transporting drinks/food, hence inability to eat. Cold Qi in Abdomen rushing to Chest is patient's subjective feeling. Yin-Yang contention causes abdominal skin to bulge, showing head-and-tail shapes externally. Yin-Cold pathogen raises Yang Qi above, compressing Yang positions, hence upper pain unapproachable. Directly enters Lower Abdomen below, freezing with Turbid Yin, hence lower pain unapproachable. Great Cold in Heart/Chest and unapproachable pain above/below are due to Cold Qi in Abdomen rushing up and filling down.