赤石脂（一斤一半全用一半筛末） 干姜（一两） 粳米（一升）
上三味。以水七升。煮米令熟。去滓。温服七合。内赤石脂末方寸匕。日三服。若一服。愈余勿服。
成注云。湿可去脱。赤石脂之涩。以固肠胃。辛以散之。干姜之辛。以散里寒。粳米之甘。以补正气。内台方
议云。阳病下利便脓血者。为协热也。属白头翁汤。少阴病下利便脓血者。为下焦不约而里寒也。故用赤石脂为君
而固肠胃。涩可去脱也。干姜为臣。散寒温气。辛以散之也。粳米为佐使。以补正气而安其中。甘以缓之也。
或问桃花汤。非入少阴之剂。何以治少阴下利。余答云。邪中少阴。寒在肠胃。仲景用桃花汤以治寒利。亦犹
之治少阴病自利清水。色纯青。心下必痛。口干燥者。宜大承汤。其汤未尝入少阴。止以下肠胃中之实。而经中之
热自平。同一理耳。
少阴病。二三日。至四五日。腹痛。小便不利。下利不止。便脓血者。桃花汤主之。（此条少阴病。下利更加
腹痛。其中寒则甚于前矣。少阴之脉行于腹。今病起自二三日至四五日。寒邪入里已深。故腹痛也。小便不利者。
下焦为寒邪所阻。阑门受伤。水液并入大肠。遂下利不止。甚至津液滑脱而为脓血。成注云。肠胃虚弱。下焦不固
也。与桃花汤。以温胃。固肠。散寒气。○或问下利脓血。使不问病于何日起。兼之腹痛。小便不利。焉知非协热
证。余答云。少阴里寒便脓血。所下之物。其色必黯而不鲜。乃肾受寒湿之邪。水谷之津液。为其凝泣。酝酿于肠
胃之中。而为脓血。非若火性急速而色鲜明。盖水伏已久。其色黯黑。其气不臭。其人必脉微细。神气静而腹不甚
痛。喜就温暖。欲得手按之。腹痛即止。斯为少阴寒利之微。）
少阴病。下利。便脓血者。可刺。（当作灸○少阴病下利。便脓血。最前条已言其治矣。兹又重出其治而云刺
者。当是可灸之误。盖少阴不下利而便脓血。此是阳经传来之热。壅遏于少阴之经。故宜刺以通泄之。今少阴病既
下利矣。复见脓血。曾用桃花汤以温涩之。倘温涩不止。继之以灸。此为辅治之法。方氏条辩既认以为里寒滑脱证。
复注云。刺者。所以通其壅瘀也。借问经中壅瘀。寒邪热邪。知刺法之不可。末又云。可者仅可之词。措词牵强。
大谬之极。○愚按此条论。仲景不言当刺何穴。补亡论常器之云。可刺幽门交信。郭白云云。可灸。考幽门二穴。
在腹部第二行挟巨阙两旁各五分。冲脉足少阴之会。治泄利脓血。可灸五壮。交信二穴在足少阴肾经。内踝上二寸。
少阴前。太阴后廉前筋骨间。治泄利赤白。女子漏血不止。可灸三壮。）
\r幽门交信穴图\pt158a3.bmp\r
少阴病。吐利。手足厥冷。烦躁欲死者。吴茱萸汤主之。此条乃少阴中寒。胃中虚冷。大宜温补之证。少阴
之脉。其直者。上膈。循喉咙。其支者。注胸中。少阴之寒邪甚。则胃中阳气受伤。因作吐利。四肢者禀受于胃。
胃中阳气伤。则手足之气不接续。故厥逆而冷也。经中之寒邪。与阳气相争。阳将耗散。故烦躁欲死。烦出胸中。
此以吐利而因致躁。非吐利躁烦四逆之比。宜吴茱萸汤。以温中补虚散寒。○或问吐利。手足逆冷。烦躁欲死。焉
知非热厥霍乱之证。余答云。热厥霍乱。若吐利。则邪气得泄。手足必温。遂不烦躁欲死矣。今者既吐且利。手足
又冷。烦躁欲死。此烦躁必不如霍乱之甚。其欲死者。必精采不与人相当。而气脱欲死。不若热证之扬手掷足。而
口中大呼欲死。且有少阴病脉微细但欲寐以为证。则知其为虚寒必矣。
Chishizhi (Lithogypsi Folium, one jin; half used whole, half sifted into powder) Ganjiang (Zingiberis Rhizoma, one liang) Jingmi (Oryzae Fructus Rotundatus, one sheng)
The above three ingredients. Boil with seven sheng of water. Cook the rice until soft. Remove the dregs. Take seven he of the decoction warm. Add one fangcunbi of Chishizhi powder to the dose. Administer three times daily. If cured after one dose, do not take the remaining medicine.
Cheng Wuji's commentary states: Moistening agents can treat sliding and incontinence. The astringent nature of Chishizhi secures the intestines and stomach. Pungent agents disperse pathogenic factors. The pungency of Ganjiang disperses interior cold. The sweetness of Jingmi tonifies healthy qi. *Neitai Fangyi* comments: In Yang disease, diarrhea with pus and blood indicates heat-coupling (Xie Re). It belongs to the syndrome treated by Baitouweng Tang. In Shaoyin disease, diarrhea with pus and blood indicates failure of the lower jiao to constrain and interior cold. Therefore, Chishizhi is used as the sovereign drug to secure the intestines and stomach. Astringency treats sliding and incontinence. Ganjiang serves as the minister drug, dispelling cold and warming yang. This utilizes its pungency to disperse pathogenic factors. Jingmi serves as the assistant and envoy drugs, tonifying healthy qi and harmonizing the middle jiao. This utilizes its sweetness to relieve urgency and pain.
A question arises: Taohua Tang is not a formula specifically entering the Shaoyin channel; why does it treat diarrhea in Shaoyin disease? I answer: Pathogens invade Shaoyin, and cold remains in the intestines and stomach. Zhang Zhongjing uses Taohua Tang to treat cold-type diarrhea, just as he treats Shaoyin disease with spontaneous diarrhea of clear water, pure green color, severe pain in the epigastrium, and dry mouth/throat, for which Dachengqi Tang is indicated. Although that formula does not directly target the Shaoyin channel, it merely purges excess heat from the intestines and stomach, thereby naturally resolving the heat within the channels. The principle is the same.
Shaoyin disease. After two or three days, progressing to four or five days, abdominal pain occurs. Urination is difficult. Diarrhea persists without cessation. Stool contains pus and blood. Taohua Tang is the primary treatment. (In this clause regarding Shaoyin disease, the diarrhea is more severe accompanied by abdominal pain, indicating that the interior cold is heavier than before. The Shaoyin meridian runs along the abdomen. Now, since the illness has progressed from two or three days to four or five days, the cold pathogen has entered deeply into the interior, causing abdominal pain. Difficulty in urination occurs because the lower jiao is obstructed by cold pathogens, damaging the Lanmen [gate between small and large intestine], causing fluids to merge into the large intestine, leading to persistent diarrhea. Eventually, body fluids slide out uncontrollably, forming pus and blood. Cheng Wuji notes: Intestines and stomach are weak, and the lower jiao is insecure. Provide Taohua Tang to warm the stomach, secure the intestines, and dissipate cold qi. ○ A question arises: Regarding diarrhea with pus and blood, if one does not ask when the disease started, and given abdominal pain and difficulty in urination, how can one know it is not a heat-coupling syndrome? I answer: In Shaoyin interior cold causing pus and blood in stool, the discharged material must be dark and not bright. This is because the Kidney receives cold-damp pathogens, condensing the fluids of food and drink, which ferment in the intestines and stomach to form pus and blood. Unlike fire pathology which is rapid and bright in color, water pathogens have been latent for a long time, hence the dark black color and lack of foul odor. The patient will definitely present with a faint and fine pulse, quiet spirit, mild abdominal pain, preference for warmth, and desire for abdominal pressure, which stops the pain. This represents the mild presentation of Shaoyin cold diarrhea.)
Shaoyin disease. Diarrhea. Stool contains pus and blood. Acupuncture may be applied. (Should be moxibustion ○ Shaoyin disease with diarrhea and pus/blood was already addressed in the previous clause. Repeating the treatment here as "acupuncture" is likely an error for "moxibustion". Generally, if Shaoyin disease presents with pus/blood but no diarrhea, it is heat transmitted from Yang channels obstructing the Shaoyin channel, suitable for acupuncture to vent and drain. However, now that Shaoyin disease involves diarrhea and pus/blood, having already used Taohua Tang for warming and astringing, if ineffective, moxibustion follows as an auxiliary treatment. Fang Youzhi's *Shanghan Lun Tiaobian*, recognizing this as interior cold and sliding incontinence, yet annotating "acupuncture" as a method to unblock stagnation and stasis, asks whether the stagnation is due to cold or heat, concluding acupuncture is inappropriate. He further claims "ke" (may/can) implies "only barely," a forced phrasing, extremely erroneous. ○ I observe that in this clause, Zhang Zhongjing does not specify which acupoints to needle. Chang Qizhi in *Buwang Lun* states: One may needle Yongmen and Jiaoxin. Guo Baiyun states: One may apply moxibustion. Examining Yongmen points: located on the second row of the abdomen, five fen lateral to Juque, intersections of the Chong Mai and Foot-Shaoyin meridians, treating diarrhea with pus/blood; moxa five zhuang. Jiaoxin points: on the Foot-Shaoyin Kidney Meridian, two cun above the medial malleolus, anterior to Shaoyin, posterior to Taiyin, between the tibia and bone; treating dysentery with red/white discharge and metrorrhagia in women; moxa three zhuang.)
\rImage of Yongmen and Jiaoxin Acupoints\pt158a3.bmp\r
Shaoyin disease. Vomiting and diarrhea. Cold extremities. Restlessness bordering on death. Wuzhuyu Tang is the primary treatment. This clause describes Shaoyin cold invasion, deficiency-cold in the stomach, a syndrome highly suitable for warming and tonification. The Shaoyin meridian, the straight branch, ascends through the diaphragm and follows the throat. The branch enters the chest. Severe Shaoyin cold damages stomach yang, causing vomiting and diarrhea. Limbs derive their qi from the stomach. Damage to stomach yang causes discontinuity of qi in hands and feet, resulting in reversal cold (Jue Ni). Cold pathogens in the channels contend with healthy qi, which is about to dissipate, causing restlessness bordering on death. Restlessness originates from the chest; this is agitation caused by vomiting and diarrhea, distinct from the combination of vomiting, diarrhea, restlessness, and cold extremities. Wuzhuyu Tang is indicated to warm the middle, tonify deficiency, and dissipate cold. ○ A question arises: Vomiting and diarrhea, cold extremities, restlessness bordering on death; how can one know it is not Heat-Jue or Huoluan? I answer: In Heat-Jue or Huoluan, if vomiting and diarrhea occur, pathogens are expelled, extremities become warm, and restlessness ceases. Now, with both vomiting and diarrhea, and cold extremities, the restlessness is certainly less severe than in Huoluan. The "bordering on death" state implies spirit disconnects from the exterior and qi is about to collapse, unlike heat syndromes where patients throw limbs about and shout loudly. Furthermore, the presence of Shaoyin disease indicators—faint/fine pulse and desire to sleep—confirms this is undoubtedly a deficiency-cold syndrome.