四、少陰病，咳而下利，譫語者，被火〔氣〕劫故也，小便必難，以強責少陰汗也①原文284
①強責：強責少陰汗是不當發汗而強用發汗的方法。
鄭論：按下利、譫語而咳，在陽明為胃火攻劫所致，在少陰為強責其汗，血液被奪，以致陰虧而火旺，亦有此候。
【闡釋】下利為少陰之本病，惟咳而譫語，則為少陰證所本無，所以致此變證者，如鄭氏所說：“在少陰為強責其汗，血液被奪，以致陰虧而火旺。”可用調胃承氣湯使腑滯下行，則燥熱之氣除，而咳與譫語可愈。
五、少陰病，八九日，一身手足盡熱者，以熱在膀胱，必便血也。原文293
①強責：強責少陰汗是不當發汗而強用發汗的方法。
鄭論：按膀胱有熱，必口渴飲冷，小便不利，或短赤等情，此以少陰病而延至八九日，一身手足盡熱，是邪在表，而並未在裏，又焉知非陽越於外乎？況又未見膀胱腑證情形，而曰熱在膀胱，必便血，不能無疑。
【闡釋】鄭氏曰：“未見膀胱腑證情形，而曰熱在膀胱，必便血，不能無疑。”夫病在少陰，一般是不發熱的，今少陰病至八九日，不見少陰虛寒證，而見一身手足盡熱，寒邪已化為熱，是為病由陰轉陽，腎移熱於膀胱，氣病及血，引起迫血妄行而見便血，此乃陽回太過之象，如此注釋，可解鄭氏之疑。以便血證治法，柯韻伯指出輕則豬苓湯，重則黃連阿膠湯，可供臨證參考。
六、少陰病，但厥無汗，而強發之，必動其血，未知從何道出，或從口鼻，或從目出〔者〕，是名（厥上竭下）〔下厥上竭〕①為難治。原文294
①下厥上竭：厥逆因于下焦陽虛，故稱下厥，陰血因上出而耗竭，故稱上竭。
鄭論：按少陰病，厥亦已重矣，無汗則幸矣，而強汗之，是逼陽於外，血即不動亦動矣。血或從上從下，原不可定，此名曰（厥上竭下），〔下厥上竭〕為難治，確乎不爽。
【闡釋】少陰病，若因其無汗而強發之，則既傷其陽，複竭其陰，勢必厥逆不除，更動其血，逼血上出，致陽亡於下而厥，陰涸於上而竭，下厥上竭，屬誤治危候，故曰難治。唯景岳六味回陽飲，滋陰回陽並用，或可治此危候。
七、少陰病，得之二三日以上，心中煩，不得（眠）〔臥〕，黃連阿膠湯主之。原文303
鄭論：按此條即少陰挾火而動之候，余於六經定法已言之，茲不贅。
【闡釋】此條鄭氏於《醫理真傳》六經定法已言之，可參閱。按此乃寒邪化熱，血液受傷之候。本證的心煩，與心、腎有密切關係，腎屬水，心屬火，腎水不足，心火有餘，水不升，火不降，心腎不交，故不得臥；又腎水不足，不能制其心火，故心煩，必得滋其腎陰，制其心火，斯為正治，黃連阿膠湯主之是也。
黃連阿膠湯方（校補）
黃連四兩黃芩二兩芍藥二兩雞子黃二枚阿膠三兩上五味，以水六升，先煮三物，取二升，去渣，內膠烊盡，小冷，內雞子黃，攪令相得，溫服七合，日三服。
【方解及其應用範圍】按黃連阿膠湯一方，乃交陰陽之方，實養陰清熱之方也。夫此方本為少陰熱化症而為心煩不得臥者立法。蓋心煩者，坎中之精不能上交於心；不得臥者，離中之陰不能下降於腎。方中芩、連、芍藥之苦，直清其熱；又得雞子黃以補離中之氣，阿膠以補坎中之精，坎、離得補，陰、陽之氣自調，升、降不乖，而水、火互為其根矣。因本方能育陰制陽，使心腎相交，升降協調，故能治多種失眠症。
筆者治陽虛陰盛之患者，用大劑扶陽藥品，病者服此等熱藥，服至周身發熱難安時，然後與以一劑滋陰之藥，以斂其所複之陽，陽得陰斂，而陽有所依，自然互根相濟，而病癒矣。所選用之方劑，即此黃連阿膠湯，屢用而效者。又治高血壓及卒中之陰虛火旺，手足心煩熱、面熱赤、或譫妄者。
八、少陰病，二三日至四五者，腹痛，小便不利，下利不止，便膿血者，桃花湯主之。原文307
鄭論：按腹痛、小便不利者，寒結於下也。下利不止者，是陰寒阻截膀胱運行之機也。便膿血者，下利過甚，而腸中之脂膏，亦與之俱下也。主以桃花湯者，溫中化氣，鎮塞海底之意，誠良法也。
【闡釋】本條敍述桃花湯的證狀較為詳細，當與下條合看，也是屬於虛寒性的下利。鄭氏謂：“主以桃花湯者，溫中化氣，鎮塞海底之意”。方與證合，不再贅述。
九、少陰病，下利，便膿血者，桃花湯主之。少陰病，〔下利〕，便膿血者，可刺①。原文306、308
①可刺：是可以用針刺的方法。
鄭論：按桃花湯，乃治少陰虛寒下利的方，若濕熱下利者，斷乎不可。
【闡釋】此屬少陰病虛寒性的下利便膿血證。脾腎陽氣不足，腸胃虛寒，下焦不能固攝所致。故本證下利，必定滑脫不禁，並有脈沉細或腹痛喜按等虛寒性的脈證，沒有裏急後重和肛門灼熱的感覺，色澤暗晦，或血色淺淡，其氣不臭等；而熱性下利便膿血，血色鮮明，氣味很臭，有裏急後重，肛門灼熱的感覺，兩者根本是不同的。故鄭氏說：“桃花湯乃治少陰虛寒下利的方，若濕熱下利者，斷乎不可”。此證也可採用針刺法治療，原文未言穴位。常器之雲：可刺足少陰幽門、交信二穴。刺以泄其邪，通行其經絡，則其病可愈。
桃花湯方（校補）
赤石脂一斤（一半全用，一半篩末）乾薑一兩粳米一升上三味，以水七升，煮米令熟，去渣，溫服七合，內赤石脂末方寸匕，日三服，若一服愈，餘勿服。
【方解及其應用範圍】李時珍曰：取赤石脂之重澀，入下焦血分而固脫；乾薑之辛溫，暖下焦氣分而補虛，粳米之甘溫，佐石脂、乾薑而潤腸胃也。”為溫中、澀腸、固脫之方。故廣泛用於虛寒滑脫之久痢、久泄有顯著療效。
鄭論：按少陰證，而用豬膚湯者，協火而動之的候也。若協水而動，斷不用此，學者務宜於六經定法上探求，協火協水病情，便得其要也。
【闡釋】鄭氏說：“少陰證，而用豬膚湯者，協火而動之的候也。”少陰協火而動者何？病人真陽素旺，客邪入而附之，即從陽化而為熱，邪熱下注則下利，利則陰氣更傷，因而虛火上炎，產生咽痛、胸滿心煩等證。且利久必傷脾，脾虛津亦難複，故用豬膚湯滋陰潤燥和中以治下利止咽痛。
豬膚湯方（校補）
豬膚一斤上一味，以水一鬥，煮取五升，去渣，加白蜜一升，白粉五合，熬香，和令相得，溫分六服。
【方解及其應用範圍】本方乃滋潤平補之劑，豬膚鹹寒入腎，滋腎水而清熱潤燥，白蜜甘寒潤肺，清上炎之虛火而利咽，白粉即白米粉甘緩和中，扶脾止利，使下利止，津液來複，虛火降斂，則咽痛、胸滿、心煩諸證均可消除，為治療少陰熱化，津液下泄，虛火上炎之良方。
十一、少陰病，二三日，咽痛者，可與甘草湯；不差（者）①，（宜）與（吉更）〔桔梗〕湯。原文311
①不差（chāi釵）：病勢減輕的意思。
鄭論：按甘草湯與（吉更）〔桔梗〕湯，二方皆苦甘化陰之方，實治少陰協火而動，上攻于咽之方也，不可概作此論。
【闡釋】咽痛一證，陰證陽證都有。此言咽痛者，蓋少陰客熱之咽痛，不兼及其它證狀，而豈病情較輕，所以只用一味甘草湯以清火解熱；如果服後不愈者，當為咽喉有痰熱交阻之故，桔梗湯開肺驅痰治之。若為陰症之咽痛，投以此方則無效。故鄭氏曰：“不可概作此論”矣。
甘草湯（校補）
甘草二兩上一味，以水三升，煮取一升半，去渣，溫服七合，日二服。
【方解及其應用範圍】本方僅生甘草一味，乃從長桑君以後相傳之神方。具清熱、潤燥、和偏、緩急、化毒、補中之力，應該重用才能發揮療效。《肘後方》以治“肺痿咳嗽吐涎沫，心中溫溫，煩躁而不渴者。”筆者常用此方治久病患者之中藥毒者，（包括西藥中毒，即產生抗藥性）必先解其藥毒，然後才有療效。但必需重其劑量，服後肚瀉，屙風泡沫涎，帶烏黑色，藥毒解矣。
桔梗湯方（校補）
桔梗一兩甘草二兩上二味，以水三升，煮取一升，去渣，溫分再服。
【方解及其應用範圍】本方即甘草湯內加桔梗，桔梗有宣肺豁痰，排膿消炎的作用，合之以治咽喉痛，為治咽喉痛之祖方。《金匱》用以治肺癰虛證。筆者常用本方治風熱為患之咽喉腫痛病者，屢用屢效，但劑量必重，否則無效。
十二、少陰病，咽中痛，半夏散及湯主之。少陰病，咽中傷，生瘡①，不能語言，聲不出者，苦酒湯主之②。原文313、312
①生瘡：是指喉部的瘡瘍，如喉蛾、喉癰等。
②苦酒：就是酸醋。
鄭論：按此條皆少陰協火而動，上攻咽喉所致，觀所主之方，純是苦甘之劑，則得此病之實據也。
【闡釋】本條前段咽中痛，乃陰寒外束，陽邪鬱聚不得伸達，鬱而化火，除咽痛之外，應伴有惡寒、氣逆、欲嘔等證狀。後段先言咽中傷，而後言生瘡，則因傷而成瘡可知，至於不能言語，風痰互結，咽部糜爛而有所阻滯，聲乃不出，此證較咽中痛為重。鄭氏說：“觀所主二方，純是苦甘之劑，則知此病是少陰協火而動，上攻咽喉所致”。所論極是。
總的來說，咽痛一證，陰證陽證都有，最難辨認。到于少陰咽痛，雖識之而用溫裏之劑，又多畏而不敢輕投，而溫法又各有別，不容概施。如少陰前篇6條之咽痛，此為假熱真寒證，白通湯加童便之證也。
16條之咽痛，此為陰盛於內，隔陽於外，通脈四逆湯證也。至於本篇10條之咽痛，為下利傷陰，虛火上亢，與11條之咽痛，皆少陰證協火而動之的候，前者治以豬膚湯，後者治以甘草湯，不差者，治以桔梗湯，此皆苦甘化陰之方。12條之咽中痛，治以半夏散及湯；咽中傷，生瘡，不能語言，聲不出者，又當以苦酒湯治之。此亦屬少陰協火而動，上攻咽喉所致。以上所述雖同為少陰病之咽痛，而證有輕重，方亦有緩急，其不取寒涼直折一也。筆者師鄭氏之意，凡遇此類患者，先以炮姜甘草湯合桔梗湯治之，然後視證之輕重，或用附子理中湯，或用白通湯、通脈四逆湯治之。但少陰腎經之脈，循喉嚨，挾舌本，故加補腎藥物，療效更佳。
半夏散及湯方（校補）
半夏（洗）桂枝（去皮）甘草（炙）上三味，等分，各別搗篩已，合治之。白飲和，服方寸匕，日三服。若不能服散者，以水一升，煎七沸，內散兩方寸匕，更煮三沸，下火令小冷，少少嚥之。半夏有毒，不當散服。
【方解及其應用範圍】本方以半夏開結降痰，桂枝疏風散寒，甘草止痛和中。凡咽痛由於風寒外束而痰多者，宜用本方。其取捨在於是否有表證，否則，縱然陰虛火動，亦不適合。
苦酒湯方（校補）
半夏（洗破如棗核）十四枚雞子一枚（去黃，內上苦酒，著雞子殼中）上二味，內半夏苦酒中，以雞子殼置刀環中，安火上，令三沸，去渣，少少含咽之。不差，更作三劑。
【方解及其應用範圍】半夏辛溫滑利，以開上焦痰熱之結邪；但半夏辛燥，故佐以雞子清之甘寒，潤燥止痛；更以苦酒消腫斂瘡。三者相合，可達散結祛痰，消腫止痛的作用。本方應注意“少少含咽之”服法，使藥效能持續作用於咽部。今人少有用此方者。
十三、少陰病，四逆，其人或咳、或悸、或小便不利，或腹中痛，或（上輕）〔泄利〕下重者，四逆散主之。原文318
鄭論：按少陰病，而至四逆，陽微陰盛也。其中或咳或悸者，水氣上幹也；小便不利者，陽不化陰也；腹痛下重，陰寒之極也。法宜大劑回陽為是，而此以四逆散主之，吾甚不解。
【闡釋】歷代諸家注解本條，皆謂本證四逆是由於肝氣鬱結，陽郁於裏，不能通達四肢，所以逆冷。對治以四逆散，亦為之曲解，使其符合條文。鄭氏則認為此條乃少陰虛寒證，法宜大劑回陽。根據原文之義，當以鄭說為是，筆者從之。
四逆散方（校補）
甘草（炙）枳實（破、水漬、炙幹）柴胡芍藥上四味，各十分，搗篩，白飲和服方寸匕，日三服。咳者，加五味子、乾薑各五分，並主下利。悸者，加桂枝五分。小便不利者，加茯苓五分。腹中痛者，加附子一枚，炮令坼①。泄利下重者，先以水五升，煮薤白三升，煮取三升，去渣，以散三方寸匕，內湯中，煮取一升半，分溫再服。
①坼（chè四聲撤）：分裂也。
【方解及其應用範圍】本方為宣達鬱滯之劑，亦和解之方。用柴胡宣陽解郁使陽氣外達，枳實破滯氣，芍藥和血，甘草緩中調胃以解鬱熱。柴胡甘草同用，和中疏鬱；枳實芍藥同用，通經散結。所治四逆，不屬於陰盛陽虛的少陰病範圍，而方中並無一味辛熱回陽之品可以概見。本方適用于肝鬱氣滯，肝胃失調所引起之多種疾病。後世乎肝諸方，如局方逍遙散，皆此方化裁。
4. Shaoyin disease, characterized by cough and diarrhea accompanied by delirium, results from the coercive action of fire therapy [qi]劫 (forcing). Urination will inevitably become difficult because sweat was forcibly extracted from the Shaoyin [channel/organ system]. Original Text 284
① Qiangze (Forcibly demanding): Forcibly demanding sweat from Shaoyin refers to inappropriately using sweating methods when they are not indicated.
Zheng's Commentary: Based on the symptoms of diarrhea, delirium, and cough, in Yangming disease, this is caused by stomach fire attacking and coercing; in Shaoyin disease, it is due to forcibly extracting sweat, which depletes blood, leading to yin deficiency and hyperactive fire, resulting in such manifestations.
[Elucidation]: Diarrhea is a fundamental symptom of Shaoyin disease. However, cough and delirium are not inherent to Shaoyin syndrome. The cause of these altered syndromes, as Zheng stated, is "forcibly extracting sweat in Shaoyin, depleting blood, leading to yin deficiency and hyperactive fire." Tiaowei Chengqi Tang (Modestly Regulating the Stomach Decoction) can be used to promote the downward movement of intestinal stagnation, thereby eliminating dry-heat qi and curing the cough and delirium.
5. In Shaoyin disease, after eight or nine days, if the entire body and hands and feet are hot, it is because heat resides in the Bladder, and hematochezia [bleeding from the rectum] or hematuria [blood in urine] will certainly occur. Original Text 293
Zheng's Commentary: According to standard principles, if there is heat in the Bladder, there must be thirst for cold drinks, dysuria [difficulty urinating], or short, red urine. Here, Shaoyin disease has persisted for eight or nine days, with heat throughout the body and extremities. This indicates pathogenic factors are in the exterior, not the interior. How can we know it is not yang floating outward? Moreover, since typical Bladder fu-organ syndrome signs are absent, claiming that heat in the Bladder necessarily causes bleeding is doubtful.
[Elucidation]: Zheng said, "Without seeing Bladder fu-organ syndrome signs, claiming heat in the Bladder necessarily causes bleeding is doubtful." Generally, Shaoyin disease does not present with fever. Now, in Shaoyin disease lasting eight or nine days, instead of typical Shaoyin deficiency-cold signs, heat throughout the body and extremities appears. This indicates cold pathogen has transformed into heat, representing a shift from yin to yang. Heat transfers from the Kidney to the Bladder, affecting qi and then blood, causing forced reckless bleeding manifesting as hematochezia/hematuria. This is a sign of excessive yang recovery. This interpretation resolves Zheng's doubts. Regarding treatment for bleeding syndromes, Ke Yunbo pointed out that mild cases use Zhuling Tang (Polyporus Decoction), while severe cases use Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction), providing clinical reference.
6. In Shaoyin disease, if there is only cold limbs without sweat, and one forcibly induces sweating, blood will inevitably be disturbed. It is unknown from which pathway it will exit; it may come from the mouth and nose, or from the eyes. This is called "Lower Jue and Upper Exhaustion," which is difficult to treat. Original Text 294
① Xiajue Shangjie (Lower Jue and Upper Exhaustion): Jue (cold limbs) stems from lower jiao yang deficiency, hence Lower Jue. Yin blood is exhausted due to upward hemorrhage, hence Upper Exhaustion.
Zheng's Commentary: In Shaoyin disease, Jue is already severe. The absence of sweat is fortunate, yet forcing sweat drives yang outward, disturbing blood even if not directly targeted. Whether blood exits upward or downward is unpredictable. Naming this "Lower Jue and Upper Exhaustion" as difficult to treat is accurate and unerring.
[Elucidation]: In Shaoyin disease, forcing sweat due to lack thereof damages both yang and exhausts yin. This inevitably leads to persistent Jue and further disturbs blood, forcing it upward. This causes yang collapse below (Jue) and yin depletion above (Exhaustion). Lower Jue and Upper Exhaustion is a critical condition caused by mis-treatment, hence termed difficult to treat. Only Zhang Jingyue's Liuwei Huiyang Yin (Six-Ingredient Decoction to Return Yang) combines yin-nourishing and yang-returning actions, potentially treating this critical state.
7. In Shaoyin disease, after two or three days, if there is vexation in the heart and inability to lie down, Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is indicated. Original Text 303
Zheng's Commentary: This clause describes Shaoyin disease complicated by fire agitation. I have discussed this in the Six Channels Fixed Methods, so no further elaboration is needed here.
[Elucidation]: This clause was discussed by Zheng in the Six Channels Fixed Methods of *Yili Zhenzhuan*; readers may refer to it. This represents cold pathogen transforming into heat and injuring blood. The vexation in this syndrome is closely related to the Heart and Kidney. The Kidney belongs to Water, the Heart to Fire. Insufficient Kidney water and excess Heart fire prevent water from ascending and fire from descending, resulting in Heart-Kidney non-interaction, hence the inability to lie down. Additionally, insufficient Kidney water fails to control Heart fire, causing vexation. The correct treatment must nourish Kidney yin and restrain Heart fire, which is achieved by Huanglian Ejiao Tang.
Huanglian Ejiao Tang Formula (Verified Supplement)
Huanglian (Coptidis Rhizoma) 4 liang, Huangqin (Scutellariae Radix) 2 liang, Shaoyao (Paeoniae Radix Alba) 2 liang, JiZihuang (Ovi Oophorum) 2 pieces, Ejiao (Colla Corii Asini) 3 liang. Take these five herbs, add six sheng of water, first decoct the first three herbs, obtain two sheng of liquid, remove dregs, dissolve Ejiao completely, let cool slightly, add JiZihuang, stir well until mixed. Warm dose: 7 ge, three times daily.
[Formula Analysis and Scope of Application]: Huanglian Ejiao Tang is a formula for communicating yin and yang, essentially nourishing yin and clearing heat. It was originally formulated for Shaoyin heat-transformation syndrome presenting with vexation and insomnia. Vexation occurs because Jing essence of Kan (Water/Kidney) cannot ascend to communicate with Xin (Fire/Heart). Insomnia occurs because Yin of Li (Fire/Heart) cannot descend to nourish the Kidney. The bitterness of Huangqin, Huanglian, and Shaoyao directly clears heat. JiZihuang supplements Qi of Li, and Ejiao supplements Jing essence of Kan. With Kan and Li supplemented, yin and yang qi naturally harmonize, ascent and descent remain regular, and water and fire root each other. Because this formula nurtures yin to control yang, facilitating Heart-Kidney interaction and coordinated ascent/descent, it treats various insomnia syndromes.
I treated patients with yang deficiency and yin abundance using large doses of yang-supporting drugs. When patients felt unbearable heat all over after taking these hot medicines, I administered one dose of yin-nourishing medicine to gather the recovering yang. Yang, gathered by yin, finds support, achieving mutual rooting and balance, leading to cure. The formula selected was Huanglian Ejiao Tang, which proved effective repeatedly. It is also used for hypertension and stroke due to yin deficiency with hyperactive fire, presenting with heat in palms and soles, facial flushing, or delirium.
8. In Shaoyin disease, progressing from two to three days to four or five days, if there is abdominal pain, dysuria, incessant diarrhea, and passage of pus and blood, Taohua Tang (Peach Kernel Decoction) is indicated. Original Text 307
Zheng's Commentary: Abdominal pain and dysuria indicate cold knotting in the lower jiao. Incessant diarrhea indicates yin-cold obstructing the transport function of the Bladder. Passage of pus and blood indicates that severe diarrhea expels intestinal mucus along with stool. Using Taohua Tang aims to warm the middle, transform qi, and secure the foundation, which is indeed an excellent method.
[Elucidation]: This clause details the symptoms for Taohua Tang and should be read together with the next clause; it belongs to deficiency-cold diarrhea. Zheng stated, "Using Taohua Tang aims to warm the middle, transform qi, and secure the foundation." The formula matches the syndrome, so no further elaboration is needed.
9. In Shaoyin disease, with diarrhea and passage of pus and blood, Taohua Tang (Peach Kernel Decoction) is indicated. In Shaoyin disease, with diarrhea and passage of pus and blood, acupuncture may be used. Original Text 306, 308
① Ke Ci (May be needled): Indicates acupuncture treatment is applicable.
Zheng's Commentary: Taohua Tang treats Shaoyin deficiency-cold diarrhea. It is absolutely contraindicated for damp-heat diarrhea.
[Elucidation]: This belongs to Shaoyin deficiency-cold diarrhea with pus and blood. It results from insufficiency of Spleen and Kidney yang, cold-deficiency of intestines and stomach, and failure of the lower jiao to consolidate. Therefore, this diarrhea is invariably slippery and incontinent, accompanied by pulse deep and fine, or abdominal pain relieved by pressure—typical deficiency-cold signs. There is no tenesmus or burning sensation in the anus. The color is dull or pale, and the odor is not foul. In contrast, heat-type diarrhea with pus and blood presents with bright red blood, foul odor, tenesmus, and anal burning. They are fundamentally different. Thus, Zheng said, "Taohua Tang treats Shaoyin deficiency-cold diarrhea; it is absolutely contraindicated for damp-heat diarrhea." Acupuncture can also be used for this syndrome. Although the original text does not specify acupoints, Chang Qizhi stated: One may needle Youmen (KI15) and Jiaoxin (KI8) of the Foot-Shaoyin Kidney channel. Needling drains pathogens and unblocks meridians, curing the disease.
Taohua Tang Formula (Verified Supplement)
Chishizhi (Halloysit Rubra) 1 jin (half whole, half powdered), Ganjiang (Zingiberis Rhizoma) 1 liang, Jingmi (Oryza Sativa) 1 sheng. Take these three herbs, add seven sheng of water, cook rice until soft, remove dregs. Warm dose: 7 ge. Add one cun-bi of Chishizhi powder. Three times daily. If cured after one dose, do not take the remainder.
[Formula Analysis and Scope of Application]: Li Shizhen said: "Taking the heavy and astringent nature of Chishizhi, it enters the lower jiao blood level to consolidate leakage; the pungent-warm nature of Ganjiang warms the lower jiao qi level and tonifies deficiency; the sweet-warm nature of Jingmi assists Shizhi and Ganjiang to moisten intestines and stomach." This is a formula for warming the middle, astringing intestines, and consolidating leakage. It is widely used with significant efficacy for chronic dysentery and chronic diarrhea due to deficiency-cold and slipping.
10. In Shaoyin disease, with diarrhea, sore throat, chest fullness, and vexation, Zhufu Tang (Swine Skin Decoction) is indicated. Original Text
Zheng's Commentary: For Shaoyin syndrome, using Zhufu Tang indicates a specific manifestation of fire-agitation. If it were water-agitation, this formula would definitely not be used. Scholars must explore the Fixed Methods of Six Channels to understand the conditions of fire-agitation versus water-agitation and grasp the essentials.
[Elucidation]: Zheng said, "Using Zhufu Tang for Shaoyin syndrome indicates a specific manifestation of fire-agitation." What is Shaoyin fire-agitation? When a patient's true yang is inherently strong, external pathogens attach to it and transform into heat following yang. Pathogenic heat pouring downward causes diarrhea. Diarrhea further injures yin qi, leading to deficient fire flaming upward, producing symptoms like sore throat, chest fullness, and vexation. Prolonged diarrhea damages the Spleen, making fluid recovery difficult. Thus, Zhufu Tang nourishes yin, moistens dryness, harmonizes the middle, stops diarrhea, and relieves sore throat.
Zhufu Tang Formula (Verified Supplement)
Zhufu (Cutis et Corium Porci) 1 jin. Take this single herb, add ten dou of water, decoct to obtain five sheng, remove dregs. Add one sheng of Baimi (Mel), five he of Baifen (Rice Flour), roast until fragrant, mix well. Warm dose: divided into six servings.
[Formula Analysis and Scope of Application]: This formula is a moistening and neutral-tonic agent. Zhufu is salty and cold, entering the Kidney to nourish Kidney water, clear heat, and moisten dryness. Baimi (Honey) is sweet and cold, moistening the Lung, clearing deficient fire flaming upward, and benefiting the throat. Baifen (Rice Flour) is sweet and moderate, harmonizing the middle, supporting the Spleen, and stopping diarrhea. Once diarrhea stops and fluids recover, deficient fire descends, resolving sore throat, chest fullness, and vexation. It is an excellent formula for Shaoyin heat-transformation with fluid loss and deficient fire flaming upward.
11. In Shaoyin disease, after two or three days, if there is a sore throat, Ganc Tang (Licorice Decoction) may be given. If not improved, Jiegeng Tang (Platycodon Decoction) should be given. Original Text 311
① Bu Cha (Not improved): Means the disease severity has lessened.
Zheng's Commentary: Both Ganc Tang and Jiegeng Tang are formulas where bitter and sweet generate yin. They actually treat Shaoyin fire-agitation attacking the throat. One cannot generalize this view.
[Elucidation]: Sore throat can be either yin or yang syndrome. Here, the sore throat refers to Shaoyin exogenous heat causing sore throat without other accompanying symptoms, indicating a milder condition. Hence, only Ganc Tang is used to clear fire and resolve heat. If ineffective after administration, it suggests phlegm-heat obstruction in the throat, requiring Jiegeng Tang to ventilate the Lung and drive out phlegm. If it is a yin-syndrome sore throat, this formula is ineffective. Thus, Zheng said, "One cannot generalize this view."
Ganc Tang Formula (Verified Supplement)
Gancao (Glycyrrhizae Radix et Rhizoma) 2 liang. Take this single herb, add three sheng of water, decoct to obtain one and a half sheng, remove dregs. Warm dose: 7 ge, twice daily.
[Formula Analysis and Scope of Application]: This formula contains only raw Gancao, a divine prescription passed down since Chang Sangjun. It has effects of clearing heat, moistening dryness, harmonizing, relieving urgency, detoxifying, and tonifying the middle. Heavy dosage is required for efficacy. *Zhouhou Fang* uses it to treat "pulmonary萎 (flaccidity) with cough and salivation, warm feeling in the heart, vexation without thirst." I often use this formula for long-term patients suffering from herbal toxicity (including Western medicine toxicity/resistance). One must first resolve drug toxicity before efficacy can be seen. Heavy dosage is essential; after ingestion, diarrhea occurs, expelling wind-like foam and saliva, dark black in color, indicating toxin resolution.
Jiegeng Tang Formula (Verified Supplement)
Jiegeng (Platycodonis Radix) 1 liang, Gancao (Glycyrrhizae Radix et Rhizoma) 2 liang. Take these two herbs, add three sheng of water, decoct to obtain one sheng, remove dregs. Warm dose: divided into two servings.
[Formula Analysis and Scope of Application]: This formula is Ganc Tang plus Jiegeng. Jiegeng ventilates the Lung, resolves phlegm, drains pus, and reduces inflammation. Combined, they treat sore throat, serving as the ancestral formula for throat disorders. *Jingui Yaolue* uses it for deficiency-type lung abscess. I frequently use this formula for sore throat and swelling caused by wind-heat, with repeated success, provided the dosage is heavy; otherwise, it is ineffective.
12. In Shaoyin disease, with pain in the throat, Banxia San Ji Tang (Pinellia Powder and Decoction) is indicated. In Shaoyin disease, with injury to the throat, formation of ulcers, inability to speak, and voice loss, Kujiu Tang (Bitter Wine Decoction) is indicated. Original Text 313, 312
① Sheng Chuang (Forming Ulcers): Refers to throat ulcers, such as tonsillitis or peritonsillar abscess.
② Kujiu (Bitter Wine): Refers to vinegar.
Zheng's Commentary: This clause describes Shaoyin fire-agitation attacking the throat. Observing the prescribed formulas, which are purely bitter and sweet agents, confirms the pathology.
[Elucidation]: The first part, throat pain, results from exterior cold binding, trapping yang pathogen which郁 (stagnates) and transforms into fire. Besides throat pain, it should be accompanied by aversion to cold, rebellious qi, and desire to vomit. The second part mentions throat injury followed by ulceration, implying injury leads to ulcers. Inability to speak results from wind-phlegm knotting, erosion of the throat causing obstruction, preventing voice production. This syndrome is heavier than simple throat pain. Zheng said, "Observing the two formulas, purely bitter and sweet, confirms this disease is Shaoyin fire-agitation attacking the throat." His discussion is highly accurate.
Generally, sore throat involves both yin and yang syndromes, making differentiation difficult. For Shaoyin sore throat, although recognized, physicians fear using interior-warming formulas and hesitate to administer them lightly. Warming methods vary and cannot be applied uniformly. For example, the sore throat in Clause 6 of the previous Shaoyin chapter is false heat and true cold, treated with Baotong Tang plus child's urine. The sore throat in Clause 16 is yin abundance internally blocking yang externally, treated with Tongmai Sini Tang. The sore throat in Clause 10 of this chapter is yin injury from diarrhea with deficient fire flaming up, and Clause 11 is also a specific manifestation of Shaoyin fire-agitation. Clause 10 is treated with Zhufu Tang, Clause 11 with Ganc Tang, and if unimproved, Jiegeng Tang. These are all bitter-sweet generating-yin formulas. The throat pain in Clause 12 is treated with Banxia San Ji Tang; throat injury with ulcers, inability to speak, and voice loss are treated with Kujiu Tang. These also belong to Shaoyin fire-agitation attacking the throat. Although all described are Shaoyin sore throats, syndromes vary in severity, and formulas vary in urgency. None use cold-cooling direct suppression. Following Zheng's intent, for such patients, I first treat with Paojiang Ganc Tang combined with Jiegeng Tang. Then, based on severity, I use Fuzi Lizhong Tang, or Baotong Tang, or Tongmai Sini Tang. Since the Shaoyin Kidney channel circulates around the throat and clamps the tongue base, adding Kidney-tonifying herbs improves efficacy.
Banxia San Ji Tang Formula (Verified Supplement)
Banxia (Pinelliae Rhizoma Preparatum, washed), Guizhi (Cinnamomi Ramulus, peeled), Gancao (Glycyrrhizae Radix et Rhizoma, roasted). These three herbs in equal parts, separately pounded and sifted, then mixed. Mix with white drink (rice water), dose one cun-bi, three times daily. If powder cannot be taken, add one sheng of water, boil seven times, add two cun-bi of powder, boil three more times, remove from fire, let cool slightly, swallow slowly drop by drop. Banxia is toxic and should not be taken as powder alone.
[Formula Analysis and Scope of Application]: This formula uses Banxia to open knots and descend phlegm, Guizhi to dispel wind and scatter cold, and Gancao to relieve pain and harmonize the middle. It is suitable for sore throat due to exterior wind-cold with abundant phlegm. Its use depends on the presence of exterior syndrome; otherwise, even with yin deficiency and fire agitation, it is unsuitable.
Kujiu Tang Formula (Verified Supplement)
Banxia (Pinelliae Rhizoma Preparatum, washed and broken like a date pit) 14 pieces, JiDan (Galli Ovo Oviparum, remove yolk, add Kujiu/vinegar, place in shell). Take these two ingredients, put Banxia and Kujiu in the eggshell, place the shell in a knife ring, set over fire, boil three times, remove dregs, hold and swallow slowly. If not improved, prepare three more doses.
[Formula Analysis and Scope of Application]: Banxia is pungent, warm, and slippery, opening upper jiao phlegm-heat knots. Since Banxia is pungent and drying, it is assisted by JiZiqing (egg white) which is sweet and cold to moisten dryness and relieve pain. Kujiu (vinegar) reduces swelling and heals ulcers. Together, they dissipate knots, resolve phlegm, reduce swelling, and relieve pain. Note the instruction "hold and swallow slowly" to ensure sustained effect on the throat. Few modern practitioners use this formula.
13. In Shaoyin disease, with Si Ni (cold limbs), if the patient also has cough, palpitations, dysuria, abdominal pain, or heaviness in defecation, Sini San (Four Counterflow Powder) is indicated. Original Text 318
Zheng's Commentary: In Shaoyin disease, reaching Si Ni indicates weak yang and abundant yin. Cough or palpitations suggest water qi invading upward. Dysuria indicates yang failing to transform yin. Abdominal pain and heaviness in defecation indicate extreme yin-cold. The method should be large-dose yang-returning. Why use Sini San here? I do not understand.
[Elucidation]:历代 commentators interpret Si Ni in this clause as caused by Liver qi stagnation, with yang constrained internally unable to reach the limbs, causing coldness. They also twist the indication of Sini San to fit the text. Zheng considers this a Shaoyin deficiency-cold syndrome, requiring large-dose yang-returning. Based on the original text, Zheng's view is correct, and I follow him.
Sini San Formula (Verified Supplement)
Gancao (Glycyrrhizae Radix et Rhizoma, roasted), Zhishi (Aurantii Fructus Immaturus, broken, soaked in water, roasted dried), Chaihu (Bupleuri Radix), Shaoyao (Paeoniae Radix Alba). Four herbs, each ten parts, pounded and sifted. Mix with white drink, dose one cun-bi, three times daily. For cough, add Wuweizi (Schisandrae Fructus) and Ganjiang (Zingiberis Rhizoma) five parts each, also treating diarrhea. For palpitations, add Guizhi (Cinnamomi Ramulus) five parts. For dysuria, add Fuling (Poria) five parts. For abdominal pain, add Fuzi (Aconiti Lateralis Radix Praeparata) one piece, roasted until cracked. For heaviness in defecation, first decoct Xiebai (Allii Macrostemonis Bulbus) three sheng in five sheng of water, obtain three sheng, remove dregs. Add three cun-bi of powder to the decoction, boil to obtain one and a half sheng. Warm dose: divided into two servings.
① Che (Crack): To split or crack.
[Formula Analysis and Scope of Application]: This formula promotes circulation of stagnant qi and acts as a harmonizing formula. Chaihu vents yang and resolves depression, allowing yang to reach the exterior. Zhishi breaks stagnation. Shaoyao harmonizes blood. Gancao moderates the middle and regulates the stomach to resolve depressed heat. Chaihu and Gancao together harmonize the middle and vent depression. Zhishi and Shaoyao together unblock meridians and dissipate knots. The Si Ni treated here does not belong to the scope of Shaoyin disease with yin-abundance and yang-deficiency, nor does the formula contain any pungent-hot yang-returning herbs. This formula is suitable for various diseases caused by Liver qi stagnation and disharmony between Liver and Stomach. Later formulas for soothing the Liver, such as Ju Fang Xiaoyao San, are derived from this formula.
14. In Shaoyin disease, with diarrhea for six or seven days, accompanied by cough, vomiting, thirst, vexation, and insomnia, Zhuling Tang (Polyporus Decoction) is indicated. Original Text 319
Zheng's Commentary: This clause is a specific manifestation of Shaoyin diarrhea complicated by heat. Cough and vomiting indicate heat obstructing upward. Thirst, vexation, and insomnia indicate internal heat causing restlessness. The method should prioritize clearing and moistening.