白术（四两） 甘草（二两炙） 附子（三枚炮） 生姜（三两） 大枣（十二枚）
上五味。以水六升。煮取二升。去滓。分温三服。初服。其人身如痹。半日许。复服之
。三
服尽。其人如冒状。勿怪。此以附术并走皮内逐水气。未得除。故使之耳。法当加桂四两。
此本一方二法。以大便硬。小便自利。去桂也。以大便不硬。小便不利。当加桂。附子三枚
恐多也。虚弱家及产妇。宜减服之。
按前证若其人大便硬。小便自利者。去桂加白术汤主之。小便自利。无取桂枝开膀胱而
化气
。恐渗泄太过。重虚津液也。大便硬反用白术者。以白术能益脾而输精也。当察二便以与前
方相出入。
附术并走皮内逐水气。未得除之。先其人身如痹。继复如冒状。亦险绝矣。险而稳。此其立
方之所以圣也。藉非胸有把握。安能任用附子至三枚之多。而履险如夷哉。
甘草（二两炙） 干姜（一两半） 附子（一枚生用去皮破八片）
上三味。以水三升。煮取一升二合。去滓。分温再服。强人可用大附子一枚。干姜三两
。
四逆者。手足厥冷也。方以四逆名。用治三阴经吐利厥逆之寒证也。干姜温中散寒。生
附驱
阴复阳。二味合用。乃能彻上彻下。开辟群阴。而挽垂绝之阳。复以甘草者。正取其甘缓留
中。制雄锐之师。迅奏肤功。迎阳复辟。此三阴经中之第一方也。
经云。脉浮而迟。表热里寒。下利清谷者。四逆汤主之。盖下利清谷。里证已急。急当
救里
。若复瞻顾表热。恐阳随下利而亡矣。此表里缓急先后之界。失治即驷马难追。急当着眼。
自利不渴者属太阴。以其藏有寒故也。夫自利不皆属寒。自利不渴。则寒证可知。虽未
至手足厥逆。而温中散寒。当防于未然矣。此太阴用四逆之大法。
少阴病脉沉者。沉为在里。急当救里。若欲吐而膈上有寒饮干呕者。益属阴邪上逆之象
。尤
当从事于此汤之急温。此少阴用四逆之大法。诸四逆厥者不可下之。虚家亦然。凡厥者阴阳
气不相顺接便为厥。厥者手足逆冷是也。厥有寒有热。凡下利厥逆而恶寒者。大汗若大下
利而厥冷者。则属虚寒可知。皆主是汤。此厥阴宜四逆之大法。
又经云。吐利汗出。发热恶寒。四肢拘急。手足厥冷者。四逆汤主之。既吐且利。小便
复利
。而大汗出。下利清谷。内寒外热。脉微欲绝者。四逆汤主之。按此二条。乃寒邪直中三阴
而
成霍乱之证。汗出恶寒。手足厥冷。下利清谷。脉微欲绝。若不急温。瞬有转筋入腹之变。
此三阴通用四逆之大法。
四逆证具。若无脉沉微恶寒等阴象。虽下利而并非清谷。反下重者。既属转经之热邪。
不可误用。贻祸难挽。当须细辨。
Bai Zhu (4 liang) Gan Cao (2 liang, honey-fried) Fu Zi (3 pieces, processed) Sheng Jiang (3 liang) Da Zao (12 pieces)
The above five herbs. With water 6 sheng. Boil to obtain 2 sheng. Remove dregs. Divide into three warm doses. After the initial dose. The patient's body feels numb and unfeeling. About half a day later. Take again.
After all three doses are finished. The patient experiences dizziness as if covered by a haze. Do not be alarmed. This is because Fu Zi and Bai Zhu act together in the skin interior to drive out dampness-water qi. Which has not yet been completely eliminated. Thus causing this phenomenon. According to the method. Gui Zhi (Cinnamon Twig) 4 liang should be added.
This was originally one formula with two methods. Because the stool is hard and urination is spontaneous. Gui Zhi is removed. Because the stool is not hard and urination is difficult. Gui Zhi should be added. Using 3 pieces of Fu Zi might be too much. For weak individuals and postpartum women. It is appropriate to reduce the dosage.
Regarding the previous syndrome. If the patient has hard stool and spontaneous urination. Use Qu Gui Jia Bai Zhu Tang (Cinnamon Twig-Removed and Atractylodes Added Decoction) as the main treatment. Spontaneous urination means there is no need for Gui Zhi to open the Bladder Qi transformation. Worrying that excessive seepage would further deplete fluids. Hard stool instead uses Bai Zhu because Bai Zhu can tonify Spleen Qi and transport essence. One should observe bowel movements and urination to determine modifications to the preceding formula.
Fu Zi and Bai Zhu acting together in the skin interior to drive out dampness-water qi. Not immediately resolved. First appearing as body numbness. Followed by dizziness as if covered by a haze. This is also a perilous and profound situation. Peril but stable. This is why the formulation of this prescription is sage-like. Without confidence in one's knowledge. How could one dare use up to 3 pieces of Fu Zi. And tread on danger as if it were flat ground?
Gan Cao (2 liang, honey-fried) Gan Jiang (1.5 liang) Fu Zi (1 piece. Raw. Skin removed. Broken into 8 slices)
The above three herbs. With water 3 sheng. Boil to obtain 1 sheng 2 he. Remove dregs. Divide into two warm doses. Strong individuals may use a large Fu Zi (1 piece) and Gan Jiang (3 liang).
Si Ni (Four Reversals) refers to cold extremities. The formula is named Si Ni. Used to treat cold syndromes of vomiting, diarrhea, and reversals of cold in the Three Yin meridians. Gan Jiang warms the Middle and disperses cold. Raw Fu Zi drives away Yin evil and restores Yang. These two herbs combined can penetrate from top to bottom. Break through groups of Yin evils. And salvage nearly extinguished Yang. Adding Gan Cao. Precisely utilizes its sweet and slow nature to retain action in the Middle. Restraining the fierce power of the other herbs. To quickly achieve efficacy. Welcoming the restoration of Yang. This is the premier formula among the Three Yin meridians.
The Classic states. Pulse floating and slow. Exterior heat and Interior cold. Diarrhea with undigested food. Si Ni Tang is the main treatment. Generally. Diarrhea with undigested food indicates an urgent Interior syndrome. Urgently save the Interior. If one hesitates due to exterior heat. Yang may perish along with the diarrhea. This is the boundary of urgency between Exterior and Interior. Mismanagement cannot be追回 (caught up with). One must focus on this immediately.
Spontaneous diarrhea without thirst belongs to Tai Yin syndrome. Because the Zang organs have cold. Not all spontaneous diarrhea is due to cold. But spontaneous diarrhea without thirst indicates a cold syndrome. Although not yet reaching cold extremities. Warming the Middle and dispersing cold should be prevented beforehand. This is the general principle for using Si Ni Tang in Tai Yin syndrome.
Shaoyin disease with a sinking pulse. Sinking indicates the pathogen is in the Interior. Urgently save the Interior. If there is desire to vomit and dry retching due to cold fluid retention in the upper Jiao. This further indicates reversal of Yin evil upwards. Especially should one attend to the urgent warming of this decoction. This is the general principle for using Si Ni Tang in Shaoyin syndrome. Various Si Ni and Jue (reversal) syndromes must not be treated with purgation. Weak individuals are the same. Any Jue syndrome occurs when Yin and Yang Qi do not connect smoothly. Jue refers to cold extremities. Jue can be cold or hot. Any diarrhea with reversal and aversion to cold. Or profuse sweating or severe diarrhea with cold extremities. Indicates deficiency-cold. All are primarily treated with this decoction. This is the general principle for using Si Ni Tang in Jueyin syndrome.
Also the Classic states. Vomiting and diarrhea with sweating. Fever and aversion to cold. Limb stiffness and spasms. Cold extremities. Si Ni Tang is the main treatment. Both vomiting and diarrhea. Urination becomes frequent. Profuse sweating. Diarrhea with undigested food. Interior cold and exterior heat. Pulse faint and near extinction. Si Ni Tang is the main treatment. Regarding these two clauses. They represent Huoluan (cholera-like) syndromes caused by cold pathogens directly invading the Three Yin meridians. Sweating and aversion to cold. Cold extremities. Diarrhea with undigested food. Faint pulse near extinction. If not urgently warmed. There will soon be changes like muscle spasms entering the abdomen. This is the general principle for universally using Si Ni Tang in the Three Yin meridians.
If Si Ni symptoms are present. But without Yin signs such as sinking/faint pulse and aversion to cold. Although there is diarrhea. It is not undigested food. Instead there is tenesmus. This belongs to heat pathogens transmitted via meridians. Must not be mistakenly used. Causing irreparable harm. Must distinguish carefully.