【闡釋】少陰病，當無熱惡寒，鄭氏曰：“反發熱三字，不可忽略”。反發熱者，邪在表也，脈沉為少陰裏證，此即太陽與少陰同病，故其治療方法，既不同於太陽，也不同于少陰，但又不離乎太陽和少陰。三陰必以溫經之藥為表，麻黃以解太陽少陰之寒，細辛、附子以溫少陰之經，俾外邪之深入者可出，而內陽亦不因之外越也。
麻黃附子細辛湯（校補）
麻黃二兩（去節）附子一枚（炮、去皮、破八片）細辛二兩上三味，以水一鬥，先煮麻黃，減去二升，去上沫，內諸藥，煮取三升，去渣，溫服一升，日三服
【方解及其應用範圍】惡寒發熱，無汗而脈沉，是表裏同病，故用麻黃以發汗解表，附子以溫經扶陽，麻附配伍，可使體力增強而表邪易解，並使汗出表解而無損于心陽；更益以細辛配麻黃，專走少陰，而助麻黃辛溫發散。三者合用，補散兼施，雖發微汗，無損于陽氣矣，故為溫經散寒之神劑。本方傷寒論治少陰病反發熱脈沉者。鄭氏用此方治忿嚏不已，治腰痛難於轉側，及周身皮膚浮腫、內冷身重三症，亦係取其溫經散寒的作用。筆者經驗認為本方治療慢性咽炎、喉炎有很好療效。因少陰經脈循於咽喉，挾舌本，故咽喉疼痛痹阻，屬少陰病者甚多，辨證無誤，皆藥到病除。又本方加乾薑、桂枝、甘草，可治寒邪入裏，表裏同病，惡寒發熱，口不渴，全身倦怠無力，但欲寐。時時背部惡寒，小便清長，咳甚痰多，全身骨節疼痛，項強，心累，手足酸軟無力之咳嗽、哮喘，傷寒虛弱之咳、喘，以及因傷寒引起之各種疾病數十種，屢獲顯效。
三、少陰病，得之一二日，口中和①，其背惡寒者，當灸之②，附子湯主之。原文304
②灸之：即將艾火放在薑片上來燒。當灸隔俞、關元穴。鄭論：按背惡寒，口中和，證似太陽，而非少陰，何也？太陽行身之背，惡寒乃太陽提綱，此以為少陰者，太陽底面即是少陰，少陰寒甚，溢於太陽地面，故惡寒而見於背，是亦裏病及表之驗也，故灸之，主以附子湯，皆是助陽祛陰之意也。
【闡釋】此節乃少陰陽虛寒盛的證狀和治法，採用艾灸之法與湯藥配合施用。灸法用於回陽救急，應灸膈俞、關元等穴，方劑用附子湯，亦取其溫經散寒，補益陽氣。
附子湯（校補）
附子二枚（炮去皮破八片）茯苓三兩人參二兩白朮四兩芍藥三兩上五味，以水八升，煮取三升，去渣，溫服一升，日三服。
【方解及其應用範圍】本方以附子名湯，目的在於溫補元陽以散寒邪，人參回生氣之源，再加茯苓、白朮健脾利濕，芍藥和血，同奏溫經逐寒，益氣健脾之功，為少陰固本禦邪之方也。本方推廣以治虛寒性之神經痛、肌肉痛、風寒或風濕性關節炎，或類風濕性關節炎，少腹寒涼隱痛等病證，都有療效。
四、少陰病，得之二三日，麻黃附子甘草湯微發汗，以二三日無裏證，故微發汗也。原文302
鄭論：按少陰病，雖雲二三日，並未現出病情，統以麻黃附子甘草〔湯〕微發汗。又雲無裏證，是邪在表分，而非少陰證也，明甚。原文含含糊糊，未知所從，不敢強解。
【闡釋】本條和前二條相互聯繫，相互發明，皆為少陰初病，未見吐利逆冷諸裏證，先行發汗，預防裏證之治法。後者病勢較輕較緩，故以甘草易細辛，去細辛之辛散，益以甘草之甘緩，相機施治耳。鄭氏謂：“原文含含糊糊，未知所從，不敢強解”。似非確切之論。
麻黃二兩（去節）附子一枚（炮去皮破八片）甘草二兩（炙）上三味，以水七升，先煮麻黃一兩沸，去上沫，內諸藥，煮取三升，去渣，溫服一升，日三服。
【方解及其應用範圍】本方即前麻黃附子細辛湯去細辛之辛散，加甘草之甘緩，此少陰感寒之微發汗法，也是溫經發表的方劑，用以微微發汗以治療病勢較輕的少陰兼太陽表症。
近人推廣以治陽虛體質之感冒，寒邪侵入少陰之咳嗽、咽喉痛等證。
五、少陰病，欲吐不吐①，心煩，但欲寐，五六日自利而渴者，屬少陰也。虛、故引水自救；若小便色白者，少陰〔病〕形悉具。小便白者，以下焦虛①，有寒，不能制水，故令色白也。原文282
①欲吐不吐：是指要吐而又不得吐出之狀態。
①下焦：這裏指腎臟。
鄭論：按陰邪上幹，故欲吐而不吐，以致心煩，但欲寐者，少陰之征，五六日，自利而渴者，氣機下泄，腎氣不充於上也。虛、故引水自救，學者于此，當以飲冷、飲熱判之，舌苔之幹、潤判之。因邪熱自利之渴者，當以救腎水為急，因虛自利之渴者，當以救腎陽為先。至小便白，下焦火化不足，虛寒之的候，可以無疑也。
【闡釋】久病之人，小便黃者，陽氣未絕於內也。至下焦虛寒，不能制陰寒之水，不受陽熱蒸化而小便反白，故知久病而小便白者，皆危候也。少陰病形悉具者，指脈微細而沉，利不止，厥逆，幹嘔而煩。上有虛熱，下有實寒，法當用白通湯治之。然遽投熱藥，上有虛熱相拒，則水藥必將傾吐而出，故需用苦寒之豬膽汁，及鹹寒之童便，引之下行，乃能盡白通湯之力而收其效。但令腎水得從溫化，蒸氣上行，則心煩燥渴可愈，下行之小便，亦將色變矣。
六、病人脈陰陽俱緊，反（出汗）〔汗出〕者，亡陽也，此屬少陰，法當咽痛，而複吐利。原文283
鄭論：按少陰乃封藏之所，脈現細微，乃是本象，今所現者緊，而反汗出，是陽亡於外，上逆而為吐，為咽痛，陽既上逆，而下部即寒，故見自利。
【闡釋】太陽傷寒，脈陰陽俱緊，是浮而緊；少陰病，則陰陽俱緊，是沉而緊，此為寒邪已直侵少陰。陰證本不當有汗，現在反見汗出，此陰寒太甚，陽虛不能固外而從外脫，則上為吐，下為利。由於陰寒極盛，虛陽上浮，故咽痛，此類咽痛，大多不紅不腫，和實證咽痛完全不同，此為假熱真寒證。治以白通加童便、豬膽汁以回陽固脫，則諸證自愈。
七、少陰病，脈微，不可發汗，亡陽故也；陽已虛，尺脈弱澀者，複不可下〔之〕。原文286
鄭論：按脈既微，本非可汗之證，汗之必亡陽，故曰不可發汗；陽己虛，而尺脈又見澀，澀為血少，更不可以言下，此係根本之地，明示人汗、下之非法，當慎之也。
【闡釋】此節指出少陰病不可汗、下。然僅以脈來定少陰病，似不妥當，必須結合少陰證其他證狀來判定。少陰病，其脈微，為陽虛，當溫之；尺脈弱澀者，尺主下焦，弱主氣不足，澀主陰不足，亦當溫。此條本為少陰禁汗禁下而設，故不言治。然溫經補陽之附子湯之類，即可治也。
八、少陰病，下利（者），若利自止（者），惡寒而踡臥①，手足溫者，可治。原文288
①踡臥：就是四肢斂縮而臥。
鄭論：按利止而手足溫，陽未盡也。若利止，手足逆冷不回，陽已絕矣，生死即在此處攸分。
【闡釋】下利、惡寒、踡臥是陰寒極盛，下利停止而手足轉溫，則中陽未絕，此乃陽氣回復陰寒去而裏和，所以說其病可治，但可治並不等於勿藥可愈，投以大劑四逆湯類，可以克日奏功。
九、少陰病，惡寒而踡，時自煩，欲去衣被者，可治。原文289
鄭論：按少陰惡寒而自煩，欲去衣被者，真陽擾亂，陽欲外亡、而尚未出軀殼，故為可治。若去衣被，而汗出昏暈者，陽已外亡，法在不治。
【闡釋】鄭氏謂：“欲去衣被者，真陽擾亂，陽欲外亡，而尚未出軀殼”。
實則此為陽氣來複與陰邪相爭，陽氣獲勝的現象，故曰可治。若再投以麻黃附子細辛湯，則諸證可早日告愈。
十、少陰病，脈緊，至七八日，自下利，脈暴微，手足反溫，脈緊反去者，為欲解也，雖煩下利，必自（止）〔愈〕。原文287
鄭論：按脈緊，是病進之征，至漸自利，脈暴微，手足反溫，是陽回之驗，陽回雖見下利，必自愈，所患者手足不溫，脈緊不退耳，既已退矣，又何患乎？
【闡釋】鄭氏謂：“手足反溫，是陽回之驗，陽回雖見下利，必自愈。”蓋少陰病脈緊為裏寒盛，自下利，脈暴微者，陰寒內瀉也，是邪氣從下而解；手足轉溫，是陽氣複。正複邪退，乃病有向愈之機矣。
十一、少陰病，身體痛，手足寒，骨節痛，脈沉者，附子湯主之。原文305
鄭論：按脈沉者，邪在裏也，其人身體骨節寒痛，是脈與病合也，主以附子湯，亦溫經祛寒之意也。
【闡釋】本條主要是陽氣虛弱，故脈沉，邪在裏也。陽氣虛衰，不能充達於四肢，所以手足寒；正由於陽氣虛弱，陰凝之氣，滯而不行，留著於經脈骨節之間，故身體痛、骨節痛。鄭氏曰：“脈與病合，主以附子湯，亦溫經祛寒之意也”，是正確的。
十二、少陰病，吐利，〔手足逆冷〕，煩（燥）〔躁〕欲死者，吳茱萸湯主之。原文309
鄭論：按吐利而致煩（燥）〔躁〕欲死，此中宮陰陽兩亡，不交之甚者也。夫吐則亡陽，利則亡陰，陰陽兩亡，故有此候，主以吳茱萸湯，降逆安中，是的確不易之法也。
【闡釋】陽明證的食穀欲嘔，厥陰病的幹嘔吐涎沫，和本條的吐利，都是屬於虛寒證，皆可用吳茱萸湯治之。吐利，手足逆冷，而煩躁欲死，誠如鄭氏所說：“陰陽兩亡，主以吳茱萸湯，降逆安中，是的確不易之法。”手足逆冷與煩躁，乃因嘔吐繁劇所致，與真陽欲絕之四逆煩躁，根本不同。嘔吐由於寒邪犯胃，胃中虛冷，故用吳茱萸湯以驅寒溫胃，降逆止嘔。
吳茱萸湯方（校補）
吳茱萸一升（洗）人參（三兩）生薑六兩（切）大棗十二枚（擘）上四味，以水七升，煮取二升，去渣，溫服七合，日三服。
【方解及其應用範圍】按吳茱萸湯一方，乃溫中、降逆、補肝之劑也。吳茱辛溫，乃降逆補肝之品，逆氣降而吐自不作，即能補中，肝得補而木氣暢達，即不侮土；生薑為治嘔之要藥，其辛溫與吳萸同聲相應，合大棗之甘，能調胃陽，複得人參甘寒，功專滋養脾陰，二土得補，皆具生機，轉運複行，煩躁自然立止。筆者曾用本方治厥陰乾嘔吐涎頭痛之症，屢用屢效。近人推廣用以治療胃腸炎、慢性胃炎和胃酸過多，都能使症狀緩解或痊癒。
十三、少陰病，下利，白通湯主之。原文314
鄭論：按少陰下利，下元火衰也。主以白通湯，亦溫腎助陽，陽回利止之意也。
【闡釋】鄭氏雲：“主以白通湯，亦溫腎助陽，陽回利止”。是正確的，但語焉不詳，特為之補出。此條屬少陰虛寒下利，從方治推測，用乾薑、附子，則知本證亦屬脾腎陽虛。腎中有真陽，為一身陽氣之本，脾胃為中陽之本，脾腎之陽俱虛，則陽氣不能達於四肢，所以必有脈微細、惡寒、四肢厥冷等候。加蔥白取其急通上下之陽氣，本證較四逆湯證嚴重，去甘草者，恐甘草緩薑、附之性，反掣急救回陽之肘，所以棄而不用。
白通湯方（校補）
蔥白四莖乾薑一兩附子一枚（生，去皮，破八片）上三味，以水三升，煮取一升，去渣，分溫再服。
【方解及其應用範圍】附子大辛大熱，火性迅發，無所不到，為回陽救逆第一藥品，能大補腎陽。
乾薑辛烈溫散，能蕩盡陰邪之阻滯，迎陽歸舍。用蔥白而曰白通湯者，能通陽氣以破陰，此扶陽散寒止利之劑也。本方能通調周身上下之陽氣，為治陽隔於上之要方。筆者曾用此方治療高燒不退，以及慢性咽喉炎，取得滿意療效。患者雖注射針藥而燒不退，蓋此乃真寒假熱，陽隔於上也。
十四、少陰病，下利，脈微者，與白通湯；利不止，厥逆無脈，幹嘔煩者，白通加豬膽汁湯主之。服（後）〔湯〕脈暴（脫）〔出〕者死，微續者生。原文315
鄭論：按下利而用白通，直救其陽也。其脈暴〔出〕者，脫之機也；其脈微續，生之兆也。
【闡釋】少陰病，下利脈微者，宜附子湯回陽以消陰。而用白通者，鄭氏說：“直救其陽也”。但服後利不止，厥逆無脈，幹嘔煩者，此陰盛陽虛的程度相當嚴重，陰盛隔陽，湯藥被陰邪所格拒，並非藥不對證，所以仍主白通湯，加入咸寒苦降之豬膽汁、人尿，取其反佐作用，使熱藥不致被陰寒所格拒，以達到回陽救逆目的。服藥後其脈暴出者，正氣因發洩而脫也，故死；脈微續者，陽氣漸複也，故生。
白通加豬膽汁方（校補）
蔥白四莖乾薑一兩附子一枚（生、破八片）人尿五合豬膽汁一合上五味，以水三升，煮取一升，去渣，內膽汁，人尿，和令相得，分溫再服。若無膽，亦可用。
【方解及其應用範圍】本方即白通湯加人尿、豬膽汁。白通湯之解見前。加人尿、豬膽汁，引陽藥達于至陰，而調二氣之格拒，通上下之陰陽，此方即《內經》反佐之法也。故證見寒極格熱，幹嘔而煩不受熱藥，下嚥即吐者，則為白通加豬膽汁湯證。推廣以治霍亂吐瀉之症、中風卒倒，其他暴卒及脫陽之症，皆建奇效。
十五、少陰病，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，此為有水氣，其人或咳、或小便利，或下利，或嘔者，真武湯主之。原文316
[Explanation] Shaoyin disease should manifest as aversion to cold without fever. Mr. Zheng said: "The three characters 'rebound fever' cannot be ignored." The so-called rebound fever indicates that the pathogen is still in the exterior. A deep pulse is a characteristic of Shaoyin interior syndrome; this represents simultaneous involvement of both Taiyang and Shaoyin meridians. Therefore, its treatment method differs from both pure Taiyang disease and pure Shaoyin disease, yet it does not deviate from the pathogenesis of Taiyang and Shaoyin. Diseases of the Three Yin must use warming meridian herbs as the basis for resolving the exterior. Ephedrae Herba (Mahuang) is used to resolve cold in Taiyang and Shaoyin; Asari Radix (Xixin) and Aconiti Lateralis Radix Praeparata (Fuzi) are used to warm the Shaoyin meridians, allowing deeply entrenched external pathogens to exit, while preventing internal Yang from dissipating outward.
Mahuang Fuzi Xixin Decoction (Corrected and Supplemented)
Ephedrae Herba (Mahuang), 2 liang (remove joints); Prepared Aconite Root (Fuzi), 1 piece (processed, skin removed, broken into eight pieces); Asari Radix (Xixin), 2 liang.
Take the above three ingredients, add 10 dou of water, first boil Ephedrae Herba until the volume reduces by 2 dou, remove the foam on the surface, then add the other herbs. Boil until 3 sheng of liquid remains, filter out the dregs, and take 1 sheng warm, three times daily.
[Formula Analysis and Scope of Application] Aversion to cold with fever, absence of sweating, and a deep pulse indicate simultaneous exterior and interior involvement. Therefore, Ephedrae Herba is used to induce sweating and release the exterior, while Prepared Aconite Root warms the meridians and supports Yang. The combination of Ephedrae Herba and Prepared Aconite Root enhances physical strength and facilitates the resolution of exterior pathogens, ensuring that sweating resolves the exterior without damaging Heart Yang. Adding Asari Radix to Ephedrae Herba specifically targets the Shaoyin meridian, assisting Ephedrae Herba in its acrid-warm dispersing action. The combined use of these three herbs applies both tonification and dispersion; although only slight sweating occurs, Yang Qi is not damaged. Thus, it is a divine formula for warming meridians and dispelling cold. In the *Shanghan Lun*, this formula treats Shaoyin disease presenting with rebound fever and a deep pulse. Mr. Zheng used this formula to treat incessant hiccups, severe lower back pain making turning difficult, and three symptoms of generalized skin edema, internal cold, and heavy body, also utilizing its warming meridian and dispelling cold properties. In my experience, this formula has excellent efficacy in treating chronic pharyngitis and laryngitis. Since the Shaoyin meridian circulates around the throat and attaches to the root of the tongue, many cases of throat pain and obstruction belong to Shaoyin disease. With accurate differentiation, the medicine acts effectively. Furthermore, adding Dried Ginger (Ganjiang), Cinnamon Twig (Guizhi), and Licorice Root (Gancao) to this formula can treat conditions where cold pathogens enter the interior, causing simultaneous exterior-interior involvement, characterized by aversion to cold and fever, no thirst, general fatigue and weakness, and a desire to sleep. It is effective for frequent aversion to cold in the back, clear and profuse urination, severe cough with copious sputum, generalized joint pain, neck stiffness, palpitations, and weak limbs in coughs and asthma caused by deficiency-cold in Shanghan, as well as dozens of various diseases induced by Shanghan, often achieving remarkable results.
3. In Shaoyin disease, if after one or two days the mouth feels neutral① and there is aversion to cold in the back, moxibustion should be applied②, and Fuzi Tang should be used as the primary treatment. Original Text 304
① Neutral mouth: Refers to a moist tongue surface, no bitter taste, non-crimson tongue body, non-dry-red lips, and no thirst.
② Moxibustion: Refers to burning moxa on slices of ginger. Points such as Geshu (BL17) and Guanyuan (CV4) should be moxibusted. Mr. Zheng commented: Regarding aversion to cold in the back and a neutral mouth, the presentation seems like Taiyang disease, not Shaoyin. Why? The Taiyang meridian runs along the back, and aversion to cold is the guiding symptom of Taiyang. Here it is attributed to Shaoyin because the posterior aspect of Taiyang is Shaoyin. When Shaoyin cold is severe, it overflows onto the Taiyang surface, causing aversion to cold manifested in the back. This is evidence of interior disease affecting the exterior. Hence, moxibustion is applied, and Fuzi Tang is prescribed, both aiming to assist Yang and dispel Yin.
[Explanation] This section describes the symptoms and treatment of Shaoyin Yang deficiency with excess cold, employing a combination of moxibustion and herbal decoctions. Moxibustion is used to restore Yang and rescue from critical states, targeting points like Geshu (BL17) and Guanyuan (CV4). The formula Fuzi Tang is chosen for its ability to warm meridians, dispel cold, and tonify Yang Qi.
Fuzi Tang (Corrected and Supplemented)
Prepared Aconite Root (Fuzi), 2 pieces (processed, skin removed, broken into eight pieces); Poria (Fuling), 3 liang; Ginseng Root (Renshen), 2 liang; Atractylodes Macrocephala Rhizome (Baizhu), 4 liang; Red Peony Root (Shaoyao), 3 liang.
Take the above five ingredients, add 8 sheng of water, boil until 3 sheng remains, filter out dregs, and take 1 sheng warm, three times daily.
[Formula Analysis and Scope of Application] Named after Prepared Aconite Root, this formula aims to warm and tonify Primordial Yang to dispel cold pathogens. Ginseng restores the source of vital Qi. Combined with Poria and Atractylodes to strengthen the Spleen and promote dampness drainage, and Red Peony to harmonize blood, the formula jointly achieves warming meridians, driving out cold, benefiting Qi, and strengthening the Spleen. It is a formula for consolidating the root and defending against pathogens in Shaoyin disease. It is extended to treat neuralgia, myalgia, wind-cold or rheumatoid arthritis, and hypogastric cold dull pain, showing efficacy.
4. In Shaoyin disease, after two or three days, Mahuang Fuzi Gancao Decoction should be used to induce slight sweating, because there are no interior signs after two or three days, hence only slight sweating is indicated. Original Text 302
Mr. Zheng commented: Although it says two or three days in Shaoyin disease, no specific condition has appeared. Uniformly using Mahuang Fuzi Gancao [Decoction] for slight sweating. It also states there are no interior signs, clearly indicating the pathogen is in the exterior branch, not a Shaoyin syndrome. The original text is vague, and I dare not force an interpretation.
[Explanation] This article connects with the previous two, elucidating that in early Shaoyin disease, before symptoms like vomiting, diarrhea, and cold extremities appear, sweating is initiated first to prevent interior syndromes. The latter case has a milder and slower progression, so Gancao replaces Xixin, removing the acrid-dispersing nature of Xixin and adding the sweet-moderating nature of Gancao, treating according to circumstances. Mr. Zheng’s statement that the text is vague and he dares not interpret it seems inaccurate.
Mahuang Fuzi Gancao Decoction Formula (Corrected and Supplemented)
Ephedrae Herba (Mahuang), 2 liang (remove joints); Prepared Aconite Root (Fuzi), 1 piece (processed, skin removed, broken into eight pieces); Honey-fried Licorice Root (Gancao), 2 liang.
Take the above three ingredients, add 7 sheng of water, first boil Ephedrae Herba for one boiling point, remove foam, add other herbs, boil until 3 sheng remains, filter dregs, and take 1 sheng warm, three times daily.
[Formula Analysis and Scope of Application] This formula is derived from Mahuang Fuzi Xixin Decoction by removing the acrid-dispersing Asari Radix and adding the sweet-moderating Licorice Root. It is a mild sweating method for Shaoyin cold invasion and a formula for warming meridians and releasing the exterior, used to induce slight sweating for treating mild Shaoyin disease with concurrent Taiyang exterior symptoms.
Contemporary practitioners extend its use to treat colds in individuals with Yang-deficient constitutions, and coughs or sore throats caused by cold pathogens invading Shaoyin.
5. In Shaoyin disease, if there is a desire to vomit but nothing comes up①, irritability, and a desire to sleep, and after five or six days spontaneous diarrhea with thirst occurs, it belongs to Shaoyin. Due to deficiency, the patient seeks water to save themselves; if the urine is white, the form of Shaoyin [disease] is complete. White urine indicates lower Jiao deficiency① and cold, inability to control water, hence the color is white. Original Text 282
① Desire to vomit but cannot: Refers to the state of wanting to vomit but being unable to do so.
① Lower Jiao: Here refers to the Kidneys.
Mr. Zheng commented: Yin pathogens attacking upward cause the desire to vomit without success, leading to irritability and a desire to sleep, which are signs of Shaoyin. After five or six days, spontaneous diarrhea with thirst indicates downward leakage of Qi mechanism and insufficient Kidney Qi ascending. Due to deficiency, the patient drinks water to自救 (save oneself). Scholars should judge whether to drink cold or hot water, and examine if the tongue coating is dry or moist. For thirst due to heat-induced diarrhea, saving Kidney Water is urgent; for thirst due to deficiency-induced diarrhea, saving Kidney Yang is priority. As for white urine, insufficient fire transformation in the lower Jiao confirms definite deficiency-cold, beyond doubt.
[Explanation] In chronic illness, yellow urine indicates that Yang Qi has not perished internally. However, when the lower Jiao is deficient and cold, failing to control Yin-cold water and lacking Yang-heat steaming, urine turns white. Thus, white urine in chronic illness is a critical sign. Complete Shaoyin disease manifests as a faint, fine, and deep pulse, unceasing diarrhea, cold extremities, dry retching, and irritability. There is deficient heat above and excess cold below. The method should use Baitong Tang. However, immediately administering hot medicines may cause rejection by the deficient heat above, leading to vomiting of the medicine. Therefore, bitter-cold Pig Gallbladder Juice and salty-cold Child’s Urine are needed to guide the medicine downward, fully utilizing Baitong Tang’s power. Once Kidney Water is warmed and vapor rises, irritability and thirst will resolve, and urine color will change.
6. If a patient’s pulses at all positions (Yin and Yang) are tight, but they sweat instead, this is loss of Yang, belonging to Shaoyin. The method should result in sore throat, accompanied by vomiting and diarrhea. Original Text 283
Mr. Zheng commented: Shaoyin is the storehouse of sealing and storing. A fine and faint pulse is its normal appearance. Now, a tight pulse appears with sweating, indicating Yang escaping externally. Upward rebellion causes vomiting and sore throat. Since Yang rebels upward, the lower part becomes cold, resulting in spontaneous diarrhea.
[Explanation] In Taiyang Cold Damage, pulses are tight and floating. In Shaoyin disease, pulses are tight and deep, indicating cold pathogens directly invading Shaoyin. Yin syndromes should not have sweating; now sweating appears, indicating extreme Yin-cold and Yang deficiency failing to secure the exterior, leading to collapse. This causes upper vomiting and lower diarrhea. Due to extreme Yin-cold and floating deficient Yang, sore throat occurs. This type of sore throat is usually non-red and non-swollen, completely different from excess-type sore throat, representing false heat and true cold. Treatment uses Baitong Tang plus Child’s Urine and Pig Gallbladder Juice to restore Yang and secure collapse, curing the symptoms.
7. In Shaoyin disease, if the pulse is faint, sweating should not be induced, as it would cause loss of Yang. If Yang is already deficient and the Chi (cun-guan-chi) pulse is weak and choppy, purging should not be used. Original Text 286
Mr. Zheng commented: A faint pulse is not suitable for sweating; inducing sweat will cause loss of Yang, hence sweating is contraindicated. If Yang is deficient and the Chi pulse is choppy (indicating blood deficiency), purging is further contraindicated. This concerns the root foundation, explicitly warning against improper sweating and purging methods. One must be cautious.
[Explanation] This section points out that Shaoyin disease prohibits sweating and purging. However, determining Shaoyin disease solely by pulse is inappropriate; it must be combined with other Shaoyin symptoms. A faint pulse in Shaoyin indicates Yang deficiency, requiring warming. A weak and choppy Chi pulse indicates deficiency of Qi (weak) and Yin (choppy) in the lower Jiao, also requiring warming. This article sets rules against sweating and purging for Shaoyin, hence no treatment is specified. Formulas like Fuzi Tang for warming meridians and tonifying Yang can be used.
8. In Shaoyin disease, if diarrhea stops, but there is aversion to cold and curling up in bed①, and hands and feet are warm, the disease is treatable. Original Text 288
① Curling up: Refers to lying with limbs contracted.
Mr. Zheng commented: Diarrhea stopping with warm hands and feet indicates Yang is not exhausted. If diarrhea stops but cold extremities do not return, Yang is exhausted, distinguishing life from death.
[Explanation] Diarrhea, aversion to cold, and curling up indicate extreme Yin-cold. If diarrhea stops and hands/feet become warm, Middle Yang is not exhausted. This signifies Yang recovery, removal of Yin-cold, and harmony in the interior, meaning the disease is treatable. However, "treatable" does not mean no medication is needed. Administering large doses of Si Ni Tang type formulas can achieve quick results.
9. In Shaoyin disease, if there is aversion to cold and curling up, occasional irritability, and a desire to remove clothes and blankets, the disease is treatable. Original Text 289
Mr. Zheng commented: In Shaoyin disease, aversion to cold with self-irritability and desire to remove coverings indicates disturbance of True Yang, with Yang attempting to escape but not yet leaving the body shell, hence treatable. If removing coverings leads to sweating and fainting, Yang has escaped externally, and it is untreatable.
[Explanation] Mr. Zheng stated: "Desire to remove coverings indicates disturbance of True Yang, with Yang attempting to escape but not yet leaving the body." Actually, this is a phenomenon of Yang recovering and fighting Yin pathogens, with Yang winning, hence treatable. Further administration of Mahuang Fuzi Xixin Decoction can lead to early recovery.
10. In Shaoyin disease, if the pulse is tight, and after seven or eight days, spontaneous diarrhea occurs, the pulse suddenly becomes faint, hands and feet become warm, and the tight pulse disappears, this indicates impending resolution. Although there is irritability and diarrhea, it will heal spontaneously. Original Text 287
Mr. Zheng commented: A tight pulse indicates disease progression. Gradual spontaneous diarrhea with a sudden faint pulse and warm hands/feet is evidence of Yang recovery. Although diarrhea occurs with Yang recovery, it will heal. The concern was lack of warmth and persistent tight pulse; since these have resolved, there is no worry.
[Explanation] Mr. Zheng said: "Warm hands and feet are evidence of Yang recovery; although diarrhea occurs with Yang recovery, it will heal." Tight pulse in Shaoyin indicates interior cold excess. Spontaneous diarrhea with a sudden faint pulse indicates internal draining of Yin-cold, meaning pathogens are exiting via the lower route. Warm hands and feet indicate Yang restoration. When righteous Qi recovers and pathogens retreat, the disease moves toward resolution.
11. In Shaoyin disease, if there is body pain, cold hands and feet, bone and joint pain, and a deep pulse, Fuzi Tang should be used. Original Text 305
Mr. Zheng commented: A deep pulse indicates pathogen in the interior. Body and bone/joint cold pain matches the pulse and disease. Using Fuzi Tang reflects the intent to warm meridians and dispel cold.
[Explanation] This article primarily addresses Yang Qi deficiency, causing a deep pulse and interior pathogen. Yang deficiency fails to reach the limbs, causing cold hands and feet. Due to Yang deficiency, stagnant Yin-Qi lodges in meridians and joints, causing body and joint pain. Mr. Zheng’s view that "pulse matches disease, using Fuzi Tang warms meridians and dispels cold" is correct.
12. In Shaoyin disease, if there is vomiting and diarrhea, [cold extremities], and severe restlessness/despair, Wuzhuyu Tang should be used. Original Text 309
Mr. Zheng commented: Vomiting and diarrhea leading to severe restlessness indicate extreme failure of Yin and Yang in the Middle Jiao to interact. Vomiting loses Yang, diarrhea loses Yin. With both lost, this syndrome occurs. Using Wuzhuyu Tang to descend rebellion and calm the middle is indeed an unchangeable method.
[Explanation] Food refusal vomiting in Yangming syndrome, dry retching and spitting saliva in Jueyin syndrome, and the vomiting/diarrhea in this article are all deficiency-cold syndromes treatable with Wuzhuyu Tang. Vomiting, diarrhea, cold extremities, and severe restlessness, as Mr. Zheng said, involve dual loss of Yin and Yang. Treating with Wuzhuyu Tang to descend rebellion and calm the middle is correct. Cold extremities and restlessness here are caused by severe vomiting, fundamentally different from the restlessness of Si Ni syndrome due to impending Yang exhaustion. Vomiting is due to cold pathogens attacking the Stomach and Stomach deficiency-cold. Wuzhuyu Tang dispels cold, warms the Stomach, descends rebellion, and stops vomiting.
Wuzhuyu Tang Formula (Corrected and Supplemented)
Evodia Fruit (Wuzhuyu), 1 sheng (washed); Ginseng Root (Renshen), 3 liang; Fresh Ginger (Shengjiang), 6 liang (sliced); Jujube (Dazao), 12 pieces (broken open).
Take the above four ingredients, add 7 sheng of water, boil until 2 sheng remains, filter dregs, and take 7 ge warm, three times daily.
[Formula Analysis and Scope of Application] Wuzhuyu Tang warms the middle, descends rebellion, and tonifies the Liver. Evodia is acrid-warm, descending rebellion and tonifying the Liver. Descending rebellion stops vomiting, tonifying the middle. Tonifying the Liver ensures smooth Wood Qi, preventing it from insulting Earth. Fresh Ginger is a key herb for vomiting; its acrid-warm nature resonates with Evodia. Combined with the sweetness of Jujube, it regulates Stomach Yang. Ginseng nourishes Spleen Yin. Both Earth organs are tonified, restoring transport function, and restlessness stops naturally. I have used this formula successfully for Jueyin dry retching, spitting saliva, and headache. Contemporary practitioners extend it to treat gastroenteritis, chronic gastritis, and hyperacidity, relieving or curing symptoms.
13. In Shaoyin disease, if there is diarrhea, Baitong Tang should be used. Original Text 314
Mr. Zheng commented: Shaoyin diarrhea indicates decline of Fire in the Lower Yuan. Using Baitong Tang warms the Kidney and assists Yang, leading to Yang recovery and cessation of diarrhea.
[Explanation] Mr. Zheng’s statement is correct but brief. This belongs to Shaoyin deficiency-cold diarrhea. Inferring from the formula using Dried Ginger and Aconite, the syndrome involves Spleen-Kidney Yang deficiency. Kidney contains True Yang, the root of whole-body Yang; Spleen/Stomach are the root of Middle Yang. Dual deficiency prevents Yang from reaching limbs, causing faint pulse, aversion to cold, and cold extremities. Scallion White (Congbai) is added to urgently connect Upper and Lower Yang. This syndrome is more severe than Si Ni Tang syndrome. Glycyrrhiza (Gancao) is omitted to avoid slowing the action of Ginger and Aconite, which might hinder emergency Yang restoration.
Baitong Tang Formula (Corrected and Supplemented)
Scallion White (Congbai), 4 stems; Dried Ginger (Ganjiang), 1 liang; Raw Aconite Root (Fuzi), 1 piece (raw, skin removed, broken into eight pieces).
Take the above three ingredients, add 3 sheng of water, boil until 1 sheng remains, filter dregs, and divide into two warm doses.
[Formula Analysis and Scope of Application] Aconite is extremely acrid and hot, rapidly acting everywhere, being the premier herb for restoring Yang and rescuing from collapse, greatly tonifying Kidney Yang. Dried Ginger is acrid, fierce, and warming, clearing Yin-cold obstruction and guiding Yang back. Scallion White penetrates Yang to break Yin. This is a formula for supporting Yang, dispelling cold, and stopping diarrhea. It regulates Yang throughout the body and is essential for treating Yang separation above. I have used this for persistent high fever and chronic pharyngitis with satisfaction. Patients with injections failing to reduce fever often have true cold/false heat with Yang separated above.
14. In Shaoyin disease, if there is diarrhea and a faint pulse, give Baitong Tang; if diarrhea continues, extremities are cold and pulseless, with dry retching and irritability, Baitong Tang plus Pig Gallbladder Juice should be used. If the pulse suddenly emerges after taking the [medicine], death ensues; if the pulse slowly returns, survival occurs. Original Text 315
Mr. Zheng commented: Using Baitong Tang for diarrhea directly saves Yang. Sudden emergence of pulse indicates collapse; slow return indicates life.
[Explanation] For Shaoyin diarrhea with faint pulse, Fuzi Tang restores Yang to eliminate Yin. Mr. Zheng says Baitong Tang "directly saves Yang." If after taking it, diarrhea continues, extremities are cold/pulseless, with dry retching/irritability, the Yin-excess/Yang-deficiency is severe. Yin separates Yang, rejecting the decoction. This is not wrong prescription but rejection by Yin pathogens. Thus, Baitong Tang is continued, adding salty-cold-bitter Pig Gallbladder Juice and Human Urine for counter-agent effect, preventing heat medicines from being rejected by Yin-cold, achieving Yang restoration. Sudden pulse emergence indicates righteous Qi collapsing due to expulsion, hence death. Slow pulse return indicates gradual Yang recovery, hence survival.
Baitong Tang plus Pig Gallbladder Juice Formula (Corrected and Supplemented)
Scallion White (Congbai), 4 stems; Dried Ginger (Ganjiang), 1 liang; Raw Aconite Root (Fuzi), 1 piece (raw, broken into eight pieces); Human Urine, 5 he; Pig Gallbladder Juice, 1 he.
Take the above five ingredients, add 3 sheng of water, boil until 1 sheng remains, filter dregs, add gallbladder juice and urine, mix well, and divide into two warm doses. If no gallbladder is available, substitute may be used.
[Formula Analysis and Scope of Application] This is Baitong Tang plus Human Urine and Pig Gallbladder Juice. Adding urine and gallbladder juice guides Yang medicines to the utmost Yin, regulating Qi rejection and connecting Upper/Lower Yin-Yang. This follows the *Neijing* principle of counter-agents. It treats extreme cold rejecting heat, dry retching, irritability, and inability to retain hot medicines. Extended to treat cholera-like vomiting/diarrhea, sudden stroke, and other acute collapse syndromes, it yields miraculous effects.
15. In Shaoyin disease, if after two or three days it persists to four or five days, with abdominal pain, difficulty urinating, heavy and painful limbs, and spontaneous diarrhea, this is water retention. If there is cough, free urination, diarrhea, or vomiting, Zhenwu Tang should be used. Original Text 316