茯苓（三两） 芍药（三两） 生姜（三两切） 白术（二两） 附子（一枚炮去皮破八片）
上五味以水八升。煮取三升。去滓。温服七合。日三服。
真武为北方司水之神。方名真武。主镇北方寒水之气。实与小青龙汤对峙。盖太阳膀胱
。
少阴肾。一脏一腑。同居北方寒水之位。伤寒表不解。心下有水气。干呕发热而咳。此水气
属
太阳府邪。太阳主表。宜小青龙发之。少阴病。腹痛。小便不利。四肢沉重疼痛。自下利者
。此水气属少阴藏邪。少阴主里。宜真武汤镇之。方中茯苓白术。培土以制水也。生姜附子
温中以散寒也。更加芍药敛少阴浮越之气。使水得坎止而归其故宅。此诚有合乎真武坐镇北
方。摄伏龙蛇之神力矣。但水邪泛溢。其病体恒变动不居。若咳者加五味子半斤。细辛干姜
各一两。以水邪射肺。法当兼散肺邪也。若小便利者去茯苓。以水道已通。无取再泄肾气也。
若
下利去芍药加干姜二两。以脾气下泄。用以醒脾也。若呕者去附子加生姜足前成半斤。以胃
气上逆。用以温胃也。随其逆而治之如法。其诸神之神者乎。
按真武主治少阴水气。固与小青龙对峙。而太阳病误服大青龙。致成厥逆筋惕肉 之变
者亦
用此以救逆。盖龙非得水不灵。当阳气郁蒸之时。但得龙升雨降。烦热顿除。若淫溢不止。
则龙适滋害。摄伏龙蛇。舍真武更向何处乞灵哉。
再按太阳病。发汗。汗出不解。其人仍发热。心下悸。头眩。身 动。振振欲擗地者。
亦主
此汤救逆。按汗多亡阳。何以不用四逆辈而用真武。盖四逆功在以热却寒。真武功在以土制
水。水气奔越。不宜火温而宜土制。用真武者。不宜混作回阳一例看。
Poria (San Liang), Paeoniae Radix Alba (San Liang), Zingiberis Rhizoma Recens (San Liang, sliced), Atractylodis Macrocephalae Rhizoma (Er Liang), Aconiti Lateralis Radix Praeparata (One piece, processed, skin removed, broken into eight pieces).
The above five herbs are boiled with eight sheng of water. Decoct to obtain three sheng. Remove the dregs. Take seven ge as a warm dose, three times daily.
Zhenwu is the deity governing water in the North. The formula is named Zhenwu, primarily to suppress the cold-water qi of the North. In essence, it stands in opposition to Xiao Qinglong Tang (Minor Blue Dragon Decoction). This is because the Taiyang Bladder and Shaoyin Kidney, one zang organ and one fu organ, reside together in the position of northern cold water. When exterior syndrome of Shanghan (Cold Damage) is not resolved, and there is fluid retention in the epigastrium, accompanied by dry retching, fever, and cough, this fluid retention belongs to Taiyang fu pathogen. Since Taiyang governs the exterior, it should be dispersed using Xiao Qinglong Tang. In Shaoyin disease, characterized by abdominal pain, difficulty in urination, heaviness and pain in the four limbs, and spontaneous diarrhea, this fluid retention belongs to Shaoyin zang pathogen. Since Shaoyin governs the interior, it should be suppressed using Zhenwu Tang. In the formula, Fuling (Poria) and Baizhu (Atractylodis Macrocephalae Rhizoma) strengthen Earth to control Water. Shengjiang (Zingiberis Rhizoma Recens) and Fuzi (Aconiti Lateralis Radix Praeparata) warm the middle and dissipate cold. Additionally, Shaoyao (Paeoniae Radix Alba) astringes the floating and overflowing qi of Shaoyin, allowing the water to remain still in Kan (Water trigram) and return to its original dwelling. This truly aligns with the divine power of Zhenwu sitting in the North to subdue dragons and snakes. However, when water pathogens overflow, the pathological condition often changes unpredictably. If there is cough, add Wuweizi (Schisandrae Fructus) half jin, and Xixin (Asari Radix et Rhizoma) and Ganjiang (Zingiberis Rhizoma) one liang each, because water pathogens shoot into the Lung; the treatment method should simultaneously disperse Lung pathogens. If urination is smooth, remove Fuling, because the water pathway is already open, and there is no need to further drain Kidney qi. If there is diarrhea, remove Shaoyao and add Ganjiang two liang, because Spleen qi is sinking; this is used to awaken the Spleen. If there is vomiting, remove Fuzi and increase Shengjiang to half a jin (total amount from previous ingredients), because Stomach qi is rebelling upward; this is used to warm the Stomach. Treating according to the rebellion of qi in this manner is indeed the most divine of methods.
Note: Zhenwu primarily treats Shaoyin water qi, which naturally opposes Xiao Qinglong Tang. However, if Taiyang disease is mistakenly treated with Da Qinglong Tang (Major Blue Dragon Decoction), leading to complications of jue ni (cold extremities) and jing ti rou yun (twitching of sinews and muscles), this formula is also used to rescue from adverse reactions. Dragons are not effective without water. When yang qi is stagnant and steaming, if the dragon rises and rain falls, vexation and heat are instantly removed. If water overflows continuously, the dragon becomes harmful instead. To subdue dragons and snakes, where else can one seek efficacy besides Zhenwu?
Furthermore: In Taiyang disease, after sweating therapy, if the sweat does not resolve the disease, and the patient still has fever, palpitations in the epigastrium, dizziness, body twitching, and trembling as if about to fall to the ground, this decoction is also indicated for rescue. Note: Profuse sweating leads to loss of yang qi. Why use Zhenwu Tang instead of Si Ni Tang (Four Reversal Decoction) or similar formulas? Si Ni Tang's function is to use heat to dispel cold, whereas Zhenwu Tang's function is to use Earth to control Water. When water qi surges and overflows, it is unsuitable for fire/warmth but suitable for Earth control. Using Zhenwu Tang should not be confused with the general category of restoring yang.