仲景曰。脉尺寸俱沉者。少阴受病也。当五六日发。以其脉贯
肾。络于肺。系舌本。故口燥舌干而渴。庞氏云。宜大承气汤。雍曰
未可也。更宜详余证。可下则下之。
又曰。少阴之为病。脉微细。但欲寐也。
又曰。少阴病。欲吐不吐。心烦。但欲寐。五六日。自利而渴者。
属少阴也。虚故引水自救。若小便色白者。少阴病形悉具。小便白
者。以下焦虚。有寒。不能制水。故令色白也。常氏云。可四逆汤、甘
草干姜汤。（金匮方）
又曰。病患脉阴阳俱紧。反汗出者。亡阳也。此属少阴。法当咽
痛而复吐利。常氏云。可猪肤汤。雍曰。少阴有伏气。病亦如伤寒。法
先咽痛。次必下利。与前证相似。古人谓之肾伤寒。其病轻。不传经。
治法不可同。咽痛则半夏桂枝甘草汤。下利用四逆汤。二三日即愈。
又曰。少阴病。咳而下利。谵语者。被火气劫故也。小便必难。以
强责少阴汗也。常氏云。桂枝去芍药加蜀漆龙骨牡蛎救逆汤以救火
逆。猪苓汤、五苓散以通小便。
又曰。少阴病。脉细沉数。病为在里。不可发汗。
又曰。少阴病。脉微。不可发汗。亡阳故也。阳已虚。尺脉弱涩
者。复不可下之。雍曰。可附子汤。
又曰。少阴病。脉紧。至七八日。自下利。脉暴微。手足反温。脉
紧反去者。为欲解也。虽烦下利。必自愈。
又曰。少阴病下利。若利自止。恶寒而蜷卧。手足温者。可治。常
氏云。可当归四逆汤。
又曰。少阴病。恶寒而蜷。时自烦。欲去衣被者。可治。常氏云。
吴茱萸汤。雍曰。凡少阴病。烦躁者。不可下。先服吴茱萸汤。以烦躁
非实热。且手足多逆冷也。
又曰。少阴中风。脉阳微阴浮者。为欲愈。
又曰。少阴病欲解时。从子至寅上。
又曰。少阴病。吐利。手足不逆冷。反发热者。不死。脉不至者。
灸少阴七壮。常氏云。少阴。太溪穴也。庞氏云。言发热者。谓其身发
热也。太溪穴。在内踝后跟骨上动脉陷中。
又曰。少阴病八九日。一身手足尽热者。以热在膀胱。必便血
也。常氏云。可桃仁承气汤、芍药地黄汤。（未见方）
又曰。少阴病。但厥无汗。而强发之。必动其血。未知从何道出。
或从口鼻。或从目出。是名下厥上竭。为难治。常氏云。可芍药地黄
汤。雍曰。仍灸太溪。三阴交。及涌泉穴。
又曰。少阴病。恶寒。身蜷而利。手足逆冷者。不治。雍曰。灸太
溪等穴。仍服四逆汤。
又曰。少阴病。吐利躁烦。四逆者死。庞氏云。烦躁者。内烦躁
也。与吴茱萸汤。正宜细审其生死也。
又曰。凡少阴四逆者。宜温之。
雍曰。此正仲景吴茱萸汤证。不当不治。仍灸太溪。
又曰。少阴病。下利止而头眩。时时自冒者死。庞氏云。此当是
少阳冒昧。汗 然出。脉匀小浮者。少阴无眩冒之证。雍日。千金翼
作少阴。
又曰。少阴病。四逆恶寒而身蜷。脉不至。不烦而躁者死。（千金
翼同。一作吐利而躁逆者死。）庞氏详定云。吐利烦躁者死。雍曰。吐
利烦躁四逆者死。已见前证。不应重出。此正谓不烦而躁。属利证
也。更宜吴茱萸汤、当归四逆加吴茱萸汤。仍灸太溪穴。
又曰。少阴病。六七日。息高者死。
又曰。少阴病。脉微细沉。但欲卧。汗出不烦。自欲吐。至五六日
自利。复烦躁。不得卧寐者死。
又曰。少阴病。始得之。反发热。脉沉者。麻黄附子细辛汤主之。
庞氏曰。少阴病脉沉。不知何沉也。且沉紧发汗则动经。沉数为病在
里。不可发汗。此脉或沉而濡。或沉而微。是表中寒而里不消。脉应
里而发在表。故以细辛之药温散而取汗也。
又曰。少阴病。得之二三日。麻黄附子甘草汤微发汗。以二三日
无里证。故微发汗也。庞氏曰。谓初得病二三日。常见少阴证无阳
者。须发小汗也。
又曰。少阴病。得之二三日以上。心中烦。不得卧。黄连阿胶汤
主之。
又曰。少阴病。得之一二日。口中和。其背恶寒者。当灸之。附子
汤主之。常氏云。当灸膈俞关元穴。背俞第三行。雍曰。此有漏字。当
是灸膈俞及关元穴也。膈俞是背俞第二行穴。
又曰。少阴病。身体痛。手足寒。骨节痛。脉沉者。附子汤主之。
又曰。少阴病。下利便脓血者。桃花汤主之。
又曰。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。
又曰。少阴病。下利便脓血者。可刺。常云。刺幽门交信。雍曰。
宜灸。
又曰。少阴病。吐利。手足厥冷。烦躁欲死者。吴茱萸汤主之。雍
曰。凡少阴病。四逆而烦躁者。未问其余证。先宜服吴茱萸汤。四逆
而无烦躁证者。先宜服四逆汤。四逆下利脉不出者。先宜服通脉四
逆汤。此三者。治少阴证大要药也。
又曰。少阴病。下利咽痛。胸满心烦者。猪肤汤主之。
又曰。少阴病二三日。咽痛者。可与甘草汤。不瘥者。与桔梗汤。庞氏云。半夏散亦主之。
又曰。少阴病。咽中痛。半夏散及汤主之。
又曰。少阴病。咽中伤生疮。不能语言。声不出者。苦酒汤主之。
又曰。少阴病。下利。白通汤主之。
又曰。少阴病。下利脉微者。与白通汤。利不止。厥逆无脉。干呕烦者。白通加猪胆汁汤主之。服汤。脉暴出者死。
微续者生。
又曰。少阴病。二三日不已。至四五日。腹痛。小便不利。四肢沉重疼痛。自下利者。此为有水气。其人或咳。或
小便利。或下利。或呕者。真武汤主之。雍曰。真武汤不愈者。小青龙汤。
又曰。少阴病。下利清谷。里寒外热。手足厥逆。脉微欲绝。身反不恶寒。其人面赤色。或腹痛。或干呕。或咽痛。
或利止脉不出者。通脉四逆汤主之。
又曰。少阴病。四逆。其人或咳。或悸。或小便不利。或腹中痛。或泄利下重者。四逆散主之。
又曰。少阴病。下利六七日。咳而呕渴。心烦不得眠者。猪苓汤主之。
又曰。少阴病。得之二三日。口燥咽干者。急下之。宜大承气汤。
又曰。少阴病。自利清水。色纯青。心下必痛。口干燥者。急下
之。宜大承气汤。（一法用大柴胡）雍曰。惟口干燥一证见热。更当细详其余证。方敢用。
又曰。少阴病六七日。腹胀不大便者。急下之。宜大承气汤。
又曰。少阴病。脉沉者。急温之。宜四逆汤。
又曰。少阴病。饮食入口则吐。心中温温欲吐。复不能吐。始得
之。手足寒。脉弦迟者。此胸中实。不可下也。当吐之。若膈上有寒
饮。干呕者。不可吐也。急温之。宜四逆汤。
又曰。少阴病。下利。脉微涩。呕而汗出。必数更衣。反少者。当
温其上。灸之。脉经云。灸厥阴可五十壮。常氏云。可灸大冲穴。雍
曰。仍灸太溪。
问曰。自利者。三阴证也。仲景以自利不渴者属太阴。渴者属少
阴。何也。雍曰。太阴。脾之经也。其脉布胃中。与胃为表里。脾本恶
湿。加以胃中寒。故不渴也。少阴。肾之经也。肾属水。故恶燥。经中
有邪。则肾当大燥。于是引饮自救。故渴也。是以太阴无渴证。少阴
有渴证也。
Zhang Zhongjing stated: When both the cun (inch) and chi (foot) pulses are deep, it indicates that the Shaoyin channel has been affected. Symptoms typically manifest on the fifth or sixth day. This is because the Shaoyin channel penetrates the Kidney, connects with the Lung, and attaches to the root of the tongue; therefore, symptoms such as dryness of the mouth, dry tongue, and thirst occur. Pang Anshi suggested the use of Dachengqi Tang (Major Order the Qi Decoction). Guo Yong argued that purgation should not be used at this stage; one must carefully examine other syndromes and only apply purgation if indicated.
He further stated: The hallmark of a Shaoyin disease is a faint and fine pulse, accompanied by a desire to sleep (Dan Yu Mei).
He also stated: In Shaoyin disease, if the patient feels the urge to vomit but cannot, experiences mental restlessness, and has a desire to sleep, and after five or six days develops spontaneous diarrhea with thirst, it belongs to the Shaoyin syndrome. The thirst arises from internal deficiency, leading the patient to drink water to save themselves. If the urine is clear in color, the manifestations of Shaoyin disease are complete. The clarity of the urine is due to deficiency-cold in the Lower Jiao, which fails to control water metabolism, resulting in clear urine. Chang Qizhi suggested using Sini Tang (Frigid Extremities Decoction) and Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) (a formula from *Jingui Yaolue*).
He further stated: If a patient’s pulses are tight in both the Yin and Yang positions but sweats profusely, this indicates the loss of Yang energy (Wang Yang). This belongs to Shaoyin disease. By standard protocol, it should present with sore throat accompanied by vomiting and diarrhea. Chang Qizhi suggested Fuzhu Tang (Pig Skin Decoction). Guo Yong noted that Shaoyin disease can involve latent heat (Fu Qi), presenting similarly to Cold Damage (Shanghan). It typically begins with sore throat followed by diarrhea, resembling the previous syndrome. Ancient texts refer to this as "Kidney Cold Damage." The condition is mild and does not transmit to other channels. The treatment method differs. For sore throat, Banxia Guizhi Gancao Tang (Pinellia, Cinnamon Twig, and Licorice Decoction) is used; for diarrhea, Sini Tang is used. Recovery occurs within two to three days.
He further stated: In Shaoyin disease, if coughing is accompanied by diarrhea and delirium (Zhanyu) occurs, it is caused by the劫夺 (robbery/depletion) of fluids by fire therapy. Urination will certainly be difficult due to the forced sweating of the Shaoyin channel. Chang Qizhi suggested using Guizhi Qu Shaoyao Jia Shujie Longgu Muli Jiuni Tang (Cinnamon Twig Decoction without Peony plus Chinese Tallow Tree Root Bark, Dragon Bone, and Oyster Shell to Rescue from Reversal) to treat fire-induced reversal, and Zhuling Tang (Polyporus Decoction) or Wuling San (Five-Ingredient Powder with Poria) to promote urination.
He further stated: In Shaoyin disease, if the pulse is fine, deep, and rapid, the disease is interior, and sweating should not be induced.
He further stated: In Shaoyin disease, if the pulse is faint, sweating should not be induced, as it leads to the loss of Yang. If Yang is already deficient and the Chi pulse is weak and choppy, purgation is strictly contraindicated. Guo Yong suggested using Fuzi Tang (Aconite Decoction).
He further stated: In Shaoyin disease, if the pulse is tight, and after seven or eight days, spontaneous diarrhea occurs, the pulse suddenly becomes faint, the hands and feet become warm, and the tightness of the pulse disappears, this indicates that the disease is about to resolve. Although there may be irritability and diarrhea, the patient will recover spontaneously.
He further stated: In Shaoyin disease with diarrhea, if the diarrhea stops spontaneously, the patient feels cold and curls up in bed, but the hands and feet remain warm, the condition is treatable. Chang Qizhi suggested Danggui Sini Tang (Angelica Sinensis Decoction to Warm the Extremities).
He further stated: In Shaoyin disease, if the patient feels cold, curls up, occasionally feels irritable, and desires to remove clothing and blankets, the condition is treatable. Chang Qizhi suggested Wuzhuyu Tang (Evodia Decoction). Guo Yong stated that for any Shaoyin disease presenting with irritability, purgation is contraindicated. One should first administer Wuzhuyu Tang, as this irritability is not due to excess heat, and the extremities are usually cold.
He further stated: In Shaoyin Wind Strike, if the Yang pulse is faint and the Yin pulse is floating, recovery is imminent.
He further stated: The time when Shaoyin disease resolves is from Zi hour to Yin hour (11:00 PM to 5:00 AM).
He further stated: In Shaoyin disease, if vomiting and diarrhea occur, but the hands and feet are not cold and the patient instead has a fever, death is not inevitable. If the pulse is absent, moxibustion should be applied to the Shaoyin channel with seven moxa cones. Chang Qizhi identified the Shaoyin acupoint as Taixi (KI3). Pang Anshi clarified that "fever" refers to whole-body fever. Taixi is located in the depression anterior to the medial malleolus and posterior to the Achilles tendon.
He further stated: In Shaoyin disease lasting eight or nine days, if the entire body and hands and feet become hot, it indicates heat in the Bladder, which will likely result in hematochezia (blood in stool). Chang Qizhi suggested Tao Ren Chengqi Tang (Peach Kernel Major Order the Qi Decoction) or Shaoyao Dihuang Tang (Peony and Rehmannia Decoction) (formula not found in extant texts).
He further stated: In Shaoyin disease, if there is only cold extremities without sweat, and forced sweating is attempted, it will disturb the blood. The source of bleeding is unknown; it may exit from the mouth or nose, or from the eyes. This is called "Lower Reversal and Upper Exhaustion" (Xia Jue Shang Jie) and is considered difficult to treat. Chang Qizhi suggested Shaoyao Dihuang Tang. Guo Yong added that moxibustion should still be applied to Taixi (KI3), Sanyinjiao (SP6), and Yongquan (KI1).
He further stated: In Shaoyin disease, if the patient feels cold, curls up, has diarrhea, and cold extremities, the prognosis is poor (incurable). Guo Yong suggested moxibustion on Taixi and other points, along with oral administration of Sini Tang.
He further stated: In Shaoyin disease, if vomiting and diarrhea are accompanied by restlessness and cold extremities, the prognosis is fatal. Pang Anshi noted that "restlessness" refers to internal agitation. Comparing with Wuzhuyu Tang, careful differentiation of life and death prognoses is essential.
He further stated: For all Shaoyin diseases presenting with cold extremities, warming treatment is appropriate.
Guo Yong commented: This corresponds exactly to the indication for Zhang Zhongjing’s Wuzhuyu Tang. It should not be left untreated. Moxibustion on Taixi should still be performed.
He further stated: In Shaoyin disease, if diarrhea stops but dizziness occurs, and the patient frequently feels a sensation of being covered or obscured (Mao), the prognosis is fatal. Pang Anshi believed this might be a Shaoyang symptom of dizziness, where sweat pours out and the pulse is uniform, small, and floating, noting that Shaoyin disease does not typically present with dizziness. Guo Yong noted that *Qianjin Yi Fang* records this as Shaoyin disease.
He further stated: In Shaoyin disease, if there are cold extremities, aversion to cold, curling up, an absent pulse, no irritability but only restlessness, the prognosis is fatal. (*Qianjin Yi Fang* agrees; another version states vomiting, diarrhea, restlessness, and reversal are fatal.) Pang Anshi detailed that vomiting, diarrhea, and restlessness indicate death. Guo Yong stated that vomiting, diarrhea, restlessness, and cold extremities indicate death, which was previously mentioned and should not be repeated. Here, it refers to restlessness without irritability, belonging to the category of diarrhea syndromes. Wuzhuyu Tang or Danggui Sini Tang plus Wuzhuyu Tang is more appropriate, along with moxibustion on Taixi.
He further stated: In Shaoyin disease, if after six or seven days the breathing becomes shallow and high (Xi Gao), the prognosis is fatal.
He further stated: In Shaoyin disease, if the pulse is faint, fine, and deep, the patient desires to sleep, sweats without irritability, feels the urge to vomit, and after five or six days develops spontaneous diarrhea, followed by renewed irritability and inability to lie down or sleep, the prognosis is fatal.
He further stated: In Shaoyin disease, if upon initial onset there is fever despite a deep pulse, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) is the primary treatment. Pang Anshi explained: Regarding the deep pulse in Shaoyin disease, one must distinguish the type. A deep-tight pulse requires caution with sweating as it may damage the channels; a deep-rapid pulse indicates interior disease where sweating is contraindicated. If the pulse is deep and soggy or deep and faint, it indicates exterior cold with unresolved interior conditions. The pulse reflects the interior, but the treatment acts on the exterior. Therefore, Xixin (Asarum) is used to warm and disperse to induce sweating.
He further stated: In Shaoyin disease, if two or three days have passed, Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction) is used to induce slight sweating. This is because after two or three days, there are no interior syndromes, so only slight sweating is required. Pang Anshi noted that in the early stages of Shaoyin disease, where Yang is often absent, a slight sweat must be induced.
He further stated: In Shaoyin disease, if two or more days have passed and the patient experiences mental restlessness and inability to sleep, Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is the primary treatment.
He further stated: In Shaoyin disease, if one or two days have passed, the mouth feels normal (not bitter or dry), but the back feels cold, moxibustion should be applied, and Fuzi Tang is the primary treatment. Chang Qizhi suggested moxibustion on Ge Shu (BL17) and Guan Yuan (CV4), located in the third row of Back-Shu points. Guo Yong noted a textual omission; it should read "moxibustion on Ge Shu and Guan Yuan." Ge Shu is in the second row of Back-Shu points.
He further stated: In Shaoyin disease, if there is body pain, cold hands and feet, bone and joint pain, and a deep pulse, Fuzi Tang is the primary treatment.
He further stated: In Shaoyin disease, if there is diarrhea with pus and blood in the stool, Taohua Tang (Peach Seed Decoction) is the primary treatment.
He further stated: In Shaoyin disease, from two or three days to four or five days, if abdominal pain, difficulty urinating, persistent diarrhea, and pus/blood in stool occur, Taohua Tang is the primary treatment.
He further stated: In Shaoyin disease with diarrhea and pus/blood in the stool, acupuncture may be used. Chang Qizhi suggested puncturing Haimen (KI14) and Jiaoxin (KI8). Guo Yong suggested moxibustion instead.
He further stated: In Shaoyin disease, if vomiting and diarrhea are accompanied by cold extremities and severe restlessness approaching death, Wuzhuyu Tang is the primary treatment. Guo Yong stated that for any Shaoyin disease with cold extremities and irritability, regardless of other symptoms, Wuzhuyu Tang should be administered first. For cold extremities without irritability, Sini Tang is appropriate first. For cold extremities, diarrhea, and absent pulse, Tongmai Sini Tang (Pulse-Returning Frigid Extremities Decoction) is appropriate first. These three are the major formulas for treating Shaoyin syndromes.
He further stated: In Shaoyin disease, if there is diarrhea, sore throat, chest fullness, and mental restlessness, Fuzhu Tang is the primary treatment.
He further stated: In Shaoyin disease, if after two or three days a sore throat occurs, Gancao Tang (Licorice Decoction) may be given. If it does not improve, Jiegeng Tang (Platycodon Decoction) is given. Pang Anshi noted that Banxia San (Pinellia Powder) is also indicated.
He further stated: In Shaoyin disease, if there is pain in the throat, Banxia San and Tang (Pinellia Powder and Decoction) are the primary treatments.
He further stated: In Shaoyin disease, if the throat is injured and ulcers form, preventing speech and voice production, Kujiu Tang (Bitter Wine Decoction) is the primary treatment.
He further stated: In Shaoyin disease with diarrhea, Baitong Tang (White Onion Decoction) is the primary treatment.
He further stated: In Shaoyin disease with diarrhea and a faint pulse, Baitong Tang is given. If diarrhea persists, cold extremities develop, the pulse becomes absent, and dry heaving and irritability occur, Baitong Jia Zhu Dan Jiang Tang (White Onion Decoction plus Pig Bile) is the primary treatment. If the pulse suddenly emerges after taking the decoction, death ensues; if the pulse gradually returns, survival is possible.
He further stated: In Shaoyin disease, if after two or three days the condition persists until the fourth or fifth day, presenting with abdominal pain, difficulty urinating, heavy and painful limbs, and spontaneous diarrhea, this indicates the presence of Water-Qi (fluid retention). If the patient also has cough, frequent urination, diarrhea, or vomiting, Zhenwu Tang (True Warrior Decoction) is the primary treatment. Guo Yong noted that if Zhenwu Tang is ineffective, Xiao Qinglong Tang (Minor Green Dragon Decoction) may be used.
He further stated: In Shaoyin disease, if there is diarrhea with undigested food, interior cold with exterior heat, cold extremities, a faint pulse nearly imperceptible, aversion to cold is absent, the face is red, and there may be abdominal pain, dry heaving, sore throat, or cessation of diarrhea with absent pulse, Tongmai Sini Tang is the primary treatment.
He further stated: In Shaoyin disease with cold extremities, if the patient has cough, palpitations, difficulty urinating, abdominal pain, or a feeling of heaviness in the anus during diarrhea, Sini San (Frigid Extremities Powder) is the primary treatment.
He further stated: In Shaoyin disease, if after six or seven days of diarrhea, cough, vomiting, thirst, mental restlessness, and insomnia occur, Zhuling Tang is the primary treatment.
He further stated: In Shaoyin disease, if after two or three days dry mouth and throat occur, urgent purgation is required, and Dachengqi Tang is appropriate.
He further stated: In Shaoyin disease, if there is spontaneous diarrhea of clear water, pure green in color,必 (certainly) pain in the epigastrium, and dry mouth/throat, urgent purgation is required, and Dachengqi Tang is appropriate. (Another method uses Da Chaihu Tang). Guo Yong noted that only when dry mouth/throat indicates heat should one carefully examine other symptoms before daring to use it.
He further stated: In Shaoyin disease, if after six or seven days abdominal distension and constipation occur, urgent purgation is required, and Dachengqi Tang is appropriate.
He further stated: In Shaoyin disease, if the pulse is deep, urgent warming is required, and Sini Tang is appropriate.
He further stated: In Shaoyin disease, if food is vomited immediately upon entry, the heart feels warm with an urge to vomit but inability to do so, and upon onset, the hands and feet are cold with a string-tight and slow pulse, this indicates excess in the Chest (Thorax). Purgation is contraindicated; emesis should be induced. If there is cold-fluid in the Diaphragm causing dry heaving, emesis is contraindicated; urgent warming is required, and Sini Tang is appropriate.
He further stated: In Shaoyin disease with diarrhea, a faint and choppy pulse, vomiting, sweating, frequent urges to defecate but scant output, the upper part should be warmed with moxibustion. *Mai Jing* states moxibustion on the Jueyin channel up to fifty cones. Chang Qizhi suggested moxibustion on Dachong (LR2). Guo Yong added that moxibustion on Taixi should still be performed.
Question: Spontaneous diarrhea is a syndrome of the Three Yin channels. Zhang Zhongjing classifies spontaneous diarrhea without thirst as Taiyin, and with thirst as Shaoyin. Why? Guo Yong answered: Taiyin is the Spleen channel, which spreads into the Stomach, forming an interior-exterior relationship. The Spleen naturally dislikes dampness; combined with cold in the Stomach, thirst does not occur. Shaoyin is the Kidney channel. The Kidney belongs to Water and thus dislikes dryness. When pathogens invade the channel, the Kidney becomes excessively dry, leading the patient to drink water to自救 (save themselves), hence thirst. Therefore, Taiyin presents without thirst, while Shaoyin presents with thirst.