凡四十六条方十五
三阴先太阴者。太阴正位中宫。统仓廪也。少阴居下。而先于厥阴者。阴道逆。自下而上也。
（一）少阴之为病。脉微细。但欲寐也。
少。去声。下皆同。少阴。肾经也。脉微细者。少阴居于极下。其脉起于小趾之下也。灵枢
曰是主所生病者。嗜卧。但欲寐。嗜卧也。盖人肖天地。天地之气。行于阳则辟而晓。行于阴则
阖而夜。故人之气。行于阳。则动而寤。行于阴。则静而寐。然则病患但欲寐者。邪客于阴故也。
（二）少阴病。始得之。反发热。脉沉者。麻黄附子细辛汤主之。
麻黄附子细辛汤方
麻黄（二两去节） 细辛（二两） 附子（一枚炮去皮破八片）
上三味。以水一斗。先煮麻黄减二升。去上沫。内药。煮取三升。去滓。温服一升。日三服。
发热。邪在表也。脉沉。少阴位北而居里也。以其居里。邪在表而发热。故曰反也。以邪在
表不在里。故用麻黄以发之。以其本阴而标寒。故用附子以温之。细辛辛温。通于少阴。用之以佐
主治者。以其专经而向导也。
（三）少阴病。得之一二日。口中和。其背恶寒者。当灸之。附子汤主之。
附子汤方
附子（二枚去皮破八片） 茯苓（三两） 人参（二两） 白术（四两） 芍药（三两）
上五味。以水八升。煮取三升。去滓。温服一升。日三服。
口中和。谓不燥不渴。里无热也。少阴之脉。贯脊。脊。背吕也。背字从北从肉。北。天地之阴
方也。北肉为背。人身背阴之处也。阳脉在背。根阴之义也。经传谓背为阳者。其犹谓桂枝发汗。
与夫历家谓月行速之意欤。肾居北方。其行属水。生于天一。故曰少阴。然则阴寒凑于少阴。宜
乎背恶寒而他处不恶也。灸之以火者。火能助阳而阴自消也。主之以附子者。附子温经而寒自散
也。人参甘寒。补其气以扶阳于生。芍药酸平。收其阴而为阳之附。茯苓甘淡。淡以利窍。逐水
以消阴。甘以入心。顺火以从阳。术味甘苦。苦以燥湿。制水而燠土。甘以益脾。和中而固本也。
（四）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。
欲吐不吐心烦者。少阴之脉循喉咙。其支者从肺出络心。注胸中故也。自利者。肾气实。水
无制也。虚故引水自救。释上文之渴也。白。寒色也。病形悉具。以其本病之口燥舌干言也。小
便白者。至末。反复申明上文。所以晓人。勿认烦渴为热以致误之意。
（五）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。
阴阳俱紧。伤寒也。伤寒不当有汗。故谓汗为反出。亡与无同。古字通用。无阳者。汗乃血
之液。阴主血。寒为阴而伤血。阴邪凑于少阴。阴盛矣。故谓无阳以为之卫护。而汗所以反得自
出也。咽痛者。少阴之脉循喉咙也。其脏属水。所以不惟咽痛。而复吐利。水无制也。
（六）少阴病。脉细沉数。病为在里。不可发汗。
细沉而数。里热也。故曰病为在里。不可发汗。恶虚其表也。
（七）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。
微者气不充。故曰无阳。无阳则化不行。故汗不可发也。尺以候阴。弱涩者阴血不足也。故
谓复不可下。盖少阴藏寒。其官作强。有出无入。有虚无实。有补无泻。所以汗下皆不可行。而
反复叮咛以示禁止如此。
（八）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。
少阴之脉。从足走腹。循喉咙。其支别至肺。自下而上者也。受火之劫。火性炎上。循经而
蒸烁于肺。肺伤则气逆。所以咳也。下利者。少阴属水。其脏虚寒。劫迫则滑脱也。滑脱而虚。
故生热乱而谵语也。强责。谓过求也。小便与汗。皆血液也。少阴少血。劫汗夺血。则小便之涸
竭。故难也。
（九）少阴病。下利。若利自止。恶寒而 卧。手足温者。可治。
下利。阴寒盛也。自止。寒邪退也。恶寒而 卧。其脏本虚寒也。手足属脾。温者。脾土和
也。土和则万物生。故曰可治也。
（十）少阴病。恶寒而 。时自烦。欲去衣被者。可治。
恶寒而 。承上条而言也。时或自烦欲去衣被。阳热复也。犹之手足温。故亦曰可治也。
（十一）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。
紧。寒邪也。自下利。脉暴微者。阴寒内泄也。故谓手足为反温。言阳回也。阳回则阴退。
故谓紧反去为欲解也。夫寒邪在阴而脉紧。得自利。脉暴微。手足温。紧去为欲解者。犹之邪在
阳。脉数而热。得汗出。脉和身凉。数去为欲愈之意同。阴阳
胜复之理也。
（十二）少阴中风。阳微阴浮者。为欲愈。
阴阳详见二难三难。阳微。风邪散。而表气和也。阴浮者。里气胜而邪外出也。
（十三）少阴病。欲解时。从子至寅上。
子丑寅。阳生之时也。各经皆解于其所王之时。而少阴独如此而解者。阳进则阴退。阳长则
阴消。且天一生水于子。子者。少阴生王之地。故少阴之欲解。必于此时欤。
（十四）少阴病。八九日。一身手足尽热者。以热在膀胱。必便血也。
膀胱属太阳。太阳者。六经之长也。为诸阳主气。与少阴肾为合。阴从阳化。里热达表。故
一身手足尽热也。热在膀胱。太阳多血。肾司开阖。阴主下降。故热乱。则血出于二便也。
（十五）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。必动其血者。汗为血之液。不得汗则得血也。或从口鼻。或从目出者。
迫则错经而妄逆也。下厥。以少阴居下而热深言也。上竭。以妄逆言也。
（十六）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。
阴寒吐利。法当厥逆者。以无阳也。手足不逆冷。则阳自若而脾胃和。故以热为反发者。婉
词也。然阳自若。则阴为有制。脾胃和。则五脏六腑皆得以受其气而生也。灸之者。以其有可生
之道。所以通其经以遂其生也。
（十七）少阴病。恶寒。身 而利。手足逆冷者。不治。
阴盛则阳竭。故曰不治。
（十八）少阴病。吐利。燥烦。四逆者。死。
阴寒吐利而至于燥烦。津液内亡。而成枯竭也。加之四肢厥逆。脾土败绝也。
（十九）少阴病。下利止而头眩。时时自冒者。死。
头眩。俗谓昏晕是也。诸阳在头。然则下利止而头眩者。津液内亡。而阴已虚竭。阳无根据附。
浮越于外。而神气散乱。故时时自冒也。
（二十）少阴病。四逆恶寒而身 。脉不至。不烦而躁者。死。
四肢温和为顺。故以厥冷为逆。不顺也。 。不伸也。阴主屈故也。诸证具见而脉又不至。
则阳已先绝。可知矣。不烦而躁。孤阴亦欲自尽也。
（二十一）少阴病。六七日。息高者。死。
息。呼吸气也。叹声曰息。言叹息之声。高而散漫。无接续生息之意。盖阳气欲绝。故其声
息如此。
（二十二）少阴病。脉微沉细。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。
脉微沉细。但欲卧。少阴之本病也。汗出而不作烦热。无阳也。欲吐。经中之邪不退也。
自利。脏病进也。更复烦躁不得卧寐者。阳欲绝而扰乱不宁也。
（二十三）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。
麻黄附子甘草汤方
麻黄（二两） 甘草（二两炙） 附子（一枚炮去皮）
上三味。以水七升。先煮麻黄一两沸。去上沫。内诸药。煮取三升。去滓。温服一升。日三服。
无里证。谓不吐利燥烦呕渴也。以无里证。而表又不见。故用附子以佐麻黄。虽曰微发汗。
而用甘草以易细辛。盖亦和解之意也。
（二十四）少阴病。得之二三日以上。心中烦。不得卧。黄连阿胶汤主之。
黄连（四两） 黄芩（一两） 芍药（二两） 鸡子黄（二枚） 阿胶（三两）
上五味。以水五升。先煮三物。取二升。去滓。内胶。烊尽。小冷。内鸡子黄。搅令相得。温
服七合。日三服。
少阴本欲寐。反心中烦不得卧者。风邪客于里。热甚而里不和也。黄连黄芩。清膈。以除风
拥之里热。鸡黄阿胶。和血。以益不足之真阴。然阿胶者。黑驴皮之膏液也。故能逐阴经之邪风。
鸡黄者。巽木禽之诞卵也。故能定邪风于少阴。芍药下气以和阴。所以为少阴风热之佐使也。
（二十五）少阴病。身体痛。手足寒。骨节痛。脉沉者。附子汤主之。
少阴肾也。肾主骨。寒淫则痛。然则身体痛。手足寒。骨节痛者。伤寒也。沉为在里。是故
附子汤者。温里以散寒之要药也。
（二十六）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。
桃花汤方
赤石脂（一斤一半全用一半筛末） 干姜（一两） 粳米（一升）
上三味。以水七升。煮米令熟。去滓。温服七合。内赤石脂末方寸匕。日三服。若一服愈。
余勿服。
腹痛。寒伤胃也。小便不利。下利不止者。胃伤而土不能制水也。便脓血者。下焦滑脱也。
石脂之涩。固肠虚之滑脱。干姜之辛。散胃虚之里寒。粳米甘平。和中而益胃。故三物者。所以为
少阴下利便脓血之主治也。
（二十七）少阴病。下痢。便脓血者。桃花汤主之。
古利无 。 后人所加。此比上条差轻。以便脓血同。故治亦同。
（二十八）少阴病。下痢。便脓血者。可刺。
此承上二条而申着其辅治之意。刺。所以通其壅瘀也。壅瘀通。便脓血自愈。可者仅可之词。
（二十九）少阴病。吐利。手足厥冷。烦躁欲死者。吴茱萸汤主之。
吐则耗阳。利则损阴。厥冷者。阴损而逆也。烦躁。阳耗而乱也。茱萸辛温。散寒暖胃而止
呕。人参甘温益阳。固本而补中。大枣助胃益脾。生姜呕家圣药。故四物者。为少阴扶危之所须
也。（方见阳明篇。）
（三十）少阴病。下利咽痛。胸满。心烦者。猪肤汤主之。
猪肤（一斤）
上一味。以水一斗。煮取五升。去滓。加白蜜一升。白粉五合。熬香。和相得。温。分六服。
下利。寒甚而水无制也。咽痛。胸满。心烦。脏病与经病具见也。猪肤。本草不载。义不可考。
说者不一。用者不同。然既曰肤。则当以 猪时所起。皮外毛根之薄肤为是。但猪属亥。宜入少
阴。肤乃外薄。宜能解外。其性则凉。固能退热。邪散而热退。烦满可除也。白蜜润燥以和咽。
咽利而不燥。痛可愈也。白粉益土以胜水。土王水制。利可止也。猪肤汤义。意者其在于兹乎。
（三十一）少阴病。二三日。咽痛者。可与甘草汤。不瘥者。与桔梗汤。
甘草汤方
甘草（二两）
上一味。以水三升。煮取一升半。去滓。温服七合。日二服。
桔梗汤方
桔梗（一两） 甘草（二两）
上二味。以水三升。煮取一升半。去滓。分温。再服。
咽痛。邪热客于少阴之咽喉也。甘草甘平而阴阳。故能主除寒热。桔梗苦甘而任舟楫。故能
主治咽伤。所以微则与甘草。甚则加桔梗也。
（三十二）少阴病。咽中痛。半夏散及汤主之。
半夏散及汤方
半夏（洗） 桂枝（去皮） 甘草（炙以上各等分）
以上三味。各别捣筛。已。合治之。白饮和。服方寸匕。日三服。若不能散服者。以水一升。
煮七沸。内散一两方寸匕。更煎三沸。下火。令少冷。少少咽之。
咽痛与上同。而治不同者。此以风邪热甚。痰上壅而痹痛者言也。是故主之以桂枝。祛风也。
佐之以半夏。消痰也。和之以甘草。除热也。三物者。是又为咽痛之一治也。
（三十三）少阴病。咽中伤。生疮。不能语言。声不出者。苦酒汤主之。
苦酒汤方
半夏（洗破如枣核大十四枚） 鸡子（一枚去黄内上苦酒着鸡子壳中）
上二味。内半夏着苦酒中。以鸡子壳置刀 中。安火上。令三沸。去滓。少少咽下。不瘥。
更作三剂服之。
咽伤而生疮。则比痛为差重。可知也。不能语言者。少阴之脉。复入肺络心。心通窍于舌。
心热则舌不掉也。声不出者。肺主声而属金。金清则鸣。热则昏而塞也。半夏主咽而开痰络。苦
酒消肿而敛咽疮鸡子甘寒而除伏热。以上三条证同而治殊。盖各适其因之宜然尔。
（三十四）少阴病。下利。白通汤主之。
白通汤方
葱白（四茎） 干姜（一两） 附子（一枚生去皮破八片）
上三味。以水三升。煮取一升。去滓。分。温再服。
少阴病而加下利者。不独在经。而亦在脏。寒甚而阴胜也。治之以干姜附子者。胜其阴则寒
自散也。用葱白而曰白通者。通其阳。则阴自消也。
（三十五）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。
There are forty-six clauses and fifteen prescriptions in total.
Among the three Yin meridians, Taiyin precedes Shaoyin. Taiyin occupies the central position of the Middle Jiao, governing the spleen and stomach (the granaries). Shaoyin is located inferiorly, yet it precedues Jueyin because the Yin energy moves counter to the normal flow, ascending from below upwards.
(1) The general manifestation of Shaoyin disease: the pulse is faint and fine, and there is a desire to sleep.
"Shao" is pronounced with the departing tone, as in all subsequent instances. Shaoyin refers to the Kidney meridian. A faint and fine pulse occurs because Shaoyin resides at the lowest level, and its meridian originates from beneath the little toe. The *Ling Shu* states: "This meridian governs diseases arising from the organ." The symptoms include drowsiness and a constant desire to sleep. Essentially, humans mirror heaven and earth: when Qi circulates in Yang, it opens leading to daytime wakefulness; when it circulates in Yin, it closes leading to nighttime sleep. Thus, when human Qi circulates in Yang, one is active and awake; when it circulates in Yin, one is quiet and asleep. Therefore, a patient's constant desire to sleep indicates that pathogenic factors have invaded the Yin aspect.
(2) In Shaoyin disease, if upon initial onset there is fever accompanied by a deep pulse, Ma Huang Fu Zi Xi Xin Tang (Ephedra, Fried Aconite Root, and Asarum Decoction) should be administered.
Ma Huang Fu Zi Xi Xin Tang Prescription
Ma Huang (Ephedrae Herba, 2 liang, nodes removed) Xi Xin (Asari Radix, 2 liang) Fu Zi (Fried Aconiti Lateralis Radix Preparata, 1 piece, fried, skin removed, broken into eight pieces)
Take the above three ingredients, add ten dou of water, first boil Ma Huang until the volume reduces by two dou, remove the foam on the surface, then add the remaining herbs. Boil until three sheng of liquid remain, strain, and take one sheng warm, three times daily.
Fever indicates the pathogen is in the exterior. A deep pulse indicates Shaoyin's location in the North and its interior nature. Because the pathology is rooted in the interior, the presence of fever from an exterior pathogen is termed "contrary" (fan). Since the pathogen is in the exterior rather than the interior, Ma Huang is used to disperse it. Because the root is Yin and the branch manifests as Cold, Fu Zi is used to warm it. Xi Xin is acrid and warm, entering the Shaoyin meridian, used here to assist the principal herbs as a guide specifically targeting this meridian.
(3) In Shaoyin disease, after one or two days, if the mouth feels neutral (not dry or bitter) and the back feels aversion to cold, moxibustion should be applied, and Fu Zi Tang (Aconite Decoction) should be administered.
Fu Zi Tang Prescription
Fu Zi (Fried Aconiti Lateralis Radix Preparata, 2 pieces, skin removed, broken into eight pieces) Fu Ling (Poria, 3 liang) Ren Shen (Ginseng Radix et Rhizoma, 2 liang) Bai Zhu (Atractylodis Macrocephalae Rhizoma, 4 liang) Shao Yao (Paeoniae Radix Alba, 3 liang)
Take the above five ingredients, add eight sheng of water, boil until three sheng remain, strain, and take one sheng warm, three times daily.
"Neutral mouth" means no dryness or thirst, indicating no heat in the interior. The Shaoyin meridian passes through the spine; the spine is the back. The character for back (bei) contains 'North' and 'flesh'; North represents the Yin direction of heaven and earth. Flesh of the North constitutes the back, which is the Yin aspect of the human body. Yang meridians run along the back, rooting in Yin principles. Although classics refer to the back as Yang, this analogy is similar to saying Guizhi Tang induces sweating or astronomers noting the moon's rapid motion. The Kidney resides in the North, belongs to Water, and is born from the number One (Tian Yi Sheng Shui), hence called Shaoyin. Consequently, when Yin-Cold gathers in Shaoyin, it naturally causes aversion to cold in the back while other areas remain unaffected. Moxibustion uses fire to assist Yang, causing Yin to dissipate. Fu Zi Tang is used because Fu Zi warms the meridians, dispersing Cold. Ren Shen is sweet and slightly cold, tonifying Qi to support Yang generation; Shao Yao is sour and neutral, collecting Yin to serve as an attachment for Yang; Fu Ling is sweet and bland, promoting diuresis to drain water and eliminate Yin pathogens; its sweetness enters the Heart, aligning with Fire to follow Yang; Bai Zhu is sweet and bitter, drying dampness via bitterness to control Water and warm Earth, while its sweetness benefits the Spleen, harmonizing the middle and consolidating the root.
(4) In Shaoyin disease, if the patient desires to vomit but cannot, experiences mental irritability, and has a desire to sleep, and after five or six days develops spontaneous diarrhea with thirst, this belongs to Shaoyin. The thirst arises from deficiency, prompting the intake of water for self-rescue. If the urine is white, the manifestations of Shaoyin disease are fully present. White urine results from deficiency-cold in the Lower Jiao failing to control water metabolism.
Desire to vomit without success and irritability occur because the Shaoyin meridian circles the throat, and its branch emerges from the Lung, connects with the Heart, and pours into the chest. Spontaneous diarrhea occurs due to Kidney Qi deficiency allowing Water to flow uncontrolled. The intake of water for self-rescue explains the aforementioned thirst. White is the color of Cold. The full presentation of the disease form refers to the earlier mention of dry mouth and tongue. The emphasis on white urine throughout reiterates the warning not to mistake irritability and thirst for Heat, preventing misdiagnosis.
(5) If a patient's pulse is tight in all positions (Yin and Yang) but sweats spontaneously, this indicates Loss of Yang. This belongs to Shaoyin disease. According to protocol, there should be sore throat, accompanied by vomiting and diarrhea.
Tight pulses in all positions indicate Cold Damage (Shang Han). Sweating is abnormal in Cold Damage, hence termed "contrary sweating." Wang (loss) is synonymous with Wu (no) in ancient texts. No Yang implies that sweat, being the fluid of blood, escapes because Yin dominates Blood, and Cold (Yin) damages Blood. When Yin pathogens gather in Shaoyin, Yin becomes excessive, leaving no Yang to guard the exterior, thus causing spontaneous sweating. Sore throat occurs because the Shaoyin meridian traverses the throat. Since the organ belongs to Water, besides sore throat, vomiting and diarrhea occur due to uncontrolled Water.
(6) In Shaoyin disease, if the pulse is fine, deep, and rapid, the disease is in the interior, and sweating therapy is contraindicated.
A fine, deep, and rapid pulse indicates Interior Heat. Thus, the disease is in the interior, and sweating is prohibited to avoid further depleting the exterior Qi.
(7) In Shaoyin disease, if the pulse is faint, sweating is contraindicated due to the risk of Yang loss. If Yang is already deficient and the Chi (cun kou) pulse is weak and choppy, purgation is also contraindicated.
A faint pulse indicates insufficient Qi, termed "No Yang." Without Yang, transformation and movement cease, so sweating is impossible. The Chi pulse reflects Yin; weakness and choppi ness indicate insufficient Yin Blood. Therefore, purgation is forbidden. Generally, Shaoyin involves Cold in the Zang organs; its function is vigorous, characterized by output without input, emptiness without fullness, and requires tonification rather than draining. Hence, both sweating and purging are prohibited, necessitating repeated warnings.
(8) In Shaoyin disease, if cough, diarrhea, and delirium occur, it is due to coercion by Fire therapy. Urination will likely be difficult because of forcing sweat in Shaoyin disease.
The Shaoyin meridian travels from the foot to the abdomen, circles the throat, and branches to the Lung, moving upward. Coercion by Fire, whose nature is flaming upward, steams and scorches the Lung along the meridian. Lung injury causes Qi rebellion, resulting in cough. Diarrhea occurs because Shaoyin belongs to Water, and its organ is deficient and cold; coercion leads to slipping and loss of control. Slipping and deficiency generate false Heat and confusion, causing delirium. "Qiang Ze" (forcing) means over-exertion. Sweat and urine are fluids of Blood. Shaoyin has little Blood; coercing sweat steals Blood, leading to depletion of urine and difficulty urinating.
(9) In Shaoyin disease with diarrhea, if the diarrhea stops spontaneously, there is aversion to cold and curling up in bed, but the hands and feet are warm, the condition is treatable.
Diarrhea indicates excess Yin-Cold. Spontaneous cessation indicates the retreat of Cold pathogens. Aversion to cold and curling up indicate the underlying deficiency-cold of the organ. Hands and feet belong to the Spleen; warmth indicates Spleen Earth is harmonious. Harmonious Earth generates all things, hence "treatable."
(10) In Shaoyin disease, with aversion to cold and curling up, occasional mental irritability, and a desire to remove clothing and blankets, the condition is treatable.
Aversion to cold and curling up continues from the previous clause. Occasional irritability and desire to remove coverings indicate the return of Yang heat. Similar to warm hands and feet, this is also deemed "treatable."
(11) In Shaoyin disease with a tight pulse, if after seven or eight days spontaneous diarrhea occurs, the pulse suddenly becomes faint, the hands and feet become warm, and the tightness disappears, the disease is resolving.
Although there is irritability and diarrhea, it will heal itself.
A tight pulse signifies Cold pathogens. Spontaneous diarrhea and a sudden faint pulse indicate the internal drainage of Yin-Cold. Hence, the warming of hands and feet is termed "contrary," signifying the return of Yang. Return of Yang drives back Yin, so the disappearance of tightness indicates resolution. Just as Exterior Cold with a rapid pulse and fever resolves with sweating, normalization of pulse, and cooling of the body, so too does Interior Cold resolve with these signs. This illustrates the principle of Yin-Yang victory and recovery.
(12) In Shaoyin Wind Strike, if the Yang pulse is faint and the Yin pulse floats, the disease is resolving.
(Yin and Yang pulses are detailed in Difficulties 2 and 3). A faint Yang pulse indicates the dispersion of Wind pathogens and harmony of the exterior Qi. A floating Yin pulse indicates superior Interior Qi expelling pathogens outward.
(13) Shaoyin disease tends to resolve between Zi (11 PM - 1 AM) and Yin (3 AM - 5 AM) hours.
Zi, Chou, and Yin are times when Yang Qi begins to generate. Each meridian resolves during its prosperous time, but Shaoyin resolves specifically then because as Yang advances, Yin recedes, and as Yang grows, Yin diminishes. Furthermore, Heaven generates Water at Zi, making Zi the birthplace of Shaoyin's prosperity. Thus, Shaoyin disease likely resolves at this time.
(14) In Shaoyin disease, if after eight or nine days the entire body and hands/feet become hot, the Heat is in the Bladder, and hematochezia/hematuria will likely occur.
The Bladder belongs to Taiyang, the head of the Six Meridians, governing Yang Qi, and pairs with Shaoyin Kidney. Yin transforms according to Yang; Interior Heat reaches the exterior, causing whole-body and extremity heat. Heat in the Bladder (Taiyang is rich in Blood) combined with Kidney controlling opening/closing and Yin descending leads to Heat disturbance, causing blood to exit via urine or stool.
(15) In Shaoyin disease, if there is only cold limbs, no sweat, and forced sweating is attempted, bleeding will inevitably occur. It is unknown from which orifice the blood exits; it may come from the mouth/nose or eyes. This is called "Lower Cold and Upper Exhaustion," a difficult-to-treat condition.
Bleeding occurs because sweat is the fluid of blood; lack of sweat leads to hemorrhage. Exit from mouth/nose/eyes results from forced disruption of meridians and rebellious flow. "Lower Cold" refers to Shaoyin's lower position and deep heat/cold complexity; "Upper Exhaustion" refers to the reckless bleeding.
(16) In Shaoyin disease, with vomiting and diarrhea, if hands/feet are not cold and there is contrary fever, death is unlikely. If the pulse is absent, moxa should be applied to Shaoyin points seven moxibustions.
Cold-induced vomiting/diarrhea typically causes cold limbs due to Yang deficiency. Non-cold limbs indicate preserved Yang and harmonized Spleen/Stomach. "Contrary fever" is a euphemism for preserved Yang. Preserved Yang controls Yin; harmonized Spleen/Stomach nourishes all organs. Moxibustion is used to open the meridians and facilitate survival where a path exists.
(17) In Shaoyin disease, with aversion to cold, curling up, diarrhea, and cold limbs, the prognosis is poor (untreatable).
Excess Yin leads to Yang exhaustion, hence "untreatable."
(18) In Shaoyin disease, with vomiting, diarrhea, restlessness, and cold limbs, death ensues.
Cold-induced vomiting/diarrhea leading to restlessness indicates internal loss of fluids and exhaustion. Combined with cold limbs, it signifies the collapse of Spleen Earth.
(19) In Shaoyin disease, if diarrhea stops but dizziness occurs, with frequent sensations of fainting, death ensues.
Dizziness (vertigo) occurs because although Yang resides in the head, the cessation of diarrhea with dizziness indicates internal fluid loss and Yin exhaustion. Yang has no foundation, floats externally, and Spirit scatters, causing frequent fainting.
(20) In Shaoyin disease, with cold limbs, aversion to cold, curling up, absent pulse, no irritability but restlessness, death ensues.
Warm limbs are smooth; cold limbs are adverse. Curling up reflects Yin's nature of flexion. With all these signs and absent pulse, Yang has already perished. Lack of irritability but presence of restlessness indicates solitary Yin attempting to extinguish itself.
(21) In Shaoyin disease, if after six or seven days respiration becomes shallow and high (Xi Gao), death ensues.
"Xi" refers to breathing/sighing. High and scattered sound without continuity indicates impending Yang exhaustion.
(22) In Shaoyin disease, with faint/deep/fine pulse, desire to sleep, sweating, no irritability, desire to vomit, progressing to day five/six with spontaneous diarrhea, followed by irritability and inability to sleep, death ensues.
Faint/deep/fine pulse and desire to sleep are the root of Shaoyin. Sweating without irritability indicates No Yang. Desire to vomit means meridian pathogens persist. Spontaneous diarrhea indicates Zang disease progression. Subsequent irritability and insomnia indicate Yang about to perish and chaotic unrest.
(23) In Shaoyin disease, after two or three days, use Ma Huang Fu Zi Gan Cao Tang (Ephedra, Fried Aconite Root, and Licorice Decoction) for mild sweating. This is because there are no Interior signs after two or three days.
Ma Huang Fu Zi Gan Cao Tang Prescription
Ma Huang (Ephedrae Herba, 2 liang) Gan Cao (Licorice Radix et Rhizoma Preparata, 2 liang) Fu Zi (Fried Aconiti Lateralis Radix Preparata, 1 piece, fried, skin removed)
Take the above three ingredients, add seven sheng of water, boil Ma Huang briefly, remove foam, add other herbs, boil to three sheng, strain, take one sheng warm, three times daily.
"No Interior signs" means no vomiting, diarrhea, irritability, or thirst. With no Interior signs and mild Exterior presentation, Fu Zi assists Ma Huang. Using Gan Cao instead of Xi Xin suggests a harmonizing intent, achieving mild sweating.
(24) In Shaoyin disease, after two or more days, if there is mental irritability and inability to sleep, Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction) should be administered.
Huang Lian E Jiao Tang Prescription
Huang Lian (Coptidis Rhizoma, 4 liang) Huang Qin (Scutellariae Radix, 1 liang) Shao Yao (Paeoniae Radix Alba, 2 liang) Ji Zi Huang (Egg Yolk, 2 pieces) E Jiao (Donkey-Hide Gelatin, 3 liang)
Take the above five ingredients, add five sheng of water, first boil the first three, reduce to two sheng, strain, dissolve E Jiao, cool slightly, add egg yolks, mix well, take seven he warm, three times daily.
Shaoyin normally involves desire to sleep; contrary irritability and insomnia indicate Wind pathogens in the Interior with severe Heat and disharmony. Huang Lian and Huang Qin clear the膈 (chest/diaphragm) to remove Interior Heat from Wind stagnation. Egg yolk and E Jiao nourish Blood and replenish true Yin. E Jiao (from donkey hide) expels Wind pathogens in Yin meridians. Egg yolk (from Wood-associated bird) calms Wind in Shaoyin. Shao Yao directs Qi downward to harmonize Yin, serving as assistant/guide for Shaoyin Wind-Heat.
(25) In Shaoyin disease, with body pain, cold hands/feet, bone/joint pain, and deep pulse, Fu Zi Tang (Aconite Decoction) should be administered.
Shaoyin corresponds to the Kidney, which governs bones. Cold invasion causes pain. Body pain, cold extremities, and joint pain indicate Cold Damage. Deep pulse confirms Interior location. Thus, Fu Zi Tang is the essential formula for warming the Interior and dispersing Cold.
(26) In Shaoyin disease, from day two/four to five, with abdominal pain, difficult urination, persistent diarrhea, and pus/blood in stool, Tao Hua Tang (Peach Kernel Decoction) should be administered.
Tao Hua Tang Prescription
Chi Shi Zhi (Halloysit Rubrum, 1 jin, half whole/half powdered) Gan Jiang (Zingiberis Rhizoma, 1 liang) Jing Mi (Oryza Sativa Germ, 1 sheng)
Take the above three ingredients, add seven sheng of water, cook rice until soft, strain, take seven he warm, add one cun cube of Chi Shi Zhi powder, three times daily. Stop if cured.
Abdominal pain indicates Cold injuring Stomach. Difficult urination and persistent diarrhea indicate Stomach injury and Spleen Earth failing to control Water. Pus/blood in stool indicates Lower Jiao slipping. Chi Shi Zhi's astringency secures intestinal slipping. Gan Jiang's acridity disperses Stomach Cold. Jing Mi is sweet/neutral, harmonizing and benefiting Stomach. These three treat Shaoyin diarrhea with pus/blood.
(27) In Shaoyin disease, with diarrhea and pus/blood in stool, Tao Hua Tang (Peach Kernel Decoction) should be administered.
Ancient texts use "Li" without the "Li" radical; "Li" was added later. This is milder than the previous clause but shares the symptom of pus/blood, hence identical treatment.
(28) In Shaoyin disease, with diarrhea and pus/blood in stool, acupuncture may be used.
This supplements the previous two clauses with auxiliary treatment. Acupuncture unblocks stagnation and stasis. Once unblocked, diarrhea with pus/blood heals spontaneously. "Ke" (may) implies optional assistance.
(29) In Shaoyin disease, with vomiting, diarrhea, cold limbs, and severe irritability, Wu Zhu Yu Tang (Evodia Decoction) should be administered.
Vomiting consumes Yang; diarrhea damages Yin. Cold limbs result from Yin damage and rebellion. Irritability results from Yang consumption and chaos. Wu Zhu Yu is acrid/warm, dispersing Cold, warming Stomach, stopping vomiting. Ren Shen is sweet/warm, benefiting Yang, consolidating root, tonifying middle. Da Zao benefits Stomach/Spleen. Sheng Jiang is the sage herb for vomiting. These four ingredients are necessary for rescuing critical Shaoyin cases. (See Yangming Chapter for prescription details.)
(30) In Shaoyin disease, with diarrhea, sore throat, chest fullness, and irritability, Zhu Fu Tang (Pig Skin Decoction) should be administered.
Zhu Fu Tang Prescription
Zhu Fu (Pig Skin, 1 jin)
Take one ingredient, add ten dou of water, boil to five sheng, strain, add one sheng white honey, five he white flour, roast until fragrant, mix well, take warm, divided into six doses.
Diarrhea indicates severe Cold and uncontrolled Water. Sore throat, chest fullness, and irritability show both Zang and Meridian involvement. Pig Skin is not recorded in Materia Medias; its meaning is debated. Assuming it is the thin skin/root of hair from pig slaughter: Pig corresponds to Hai (Water), entering Shaoyin. Thin skin can release exterior. Its cool nature clears Heat. Dispelling pathogens and clearing Heat removes irritability/fullness. White honey moistens dryness, soothing the throat. White flour benefits Earth to overcome Water; strong Earth controls Water, stopping diarrhea. The rationale for Zhu Fu Tang lies herein.
(31) In Shaoyin disease, after two/three days, if there is sore throat, give Gan Cao Tang (Licorice Decoction); if ineffective, give Jie Geng Tang (Platycodon Decoction).
Gan Cao Tang Prescription
Gan Cao (Licorice Radix et Rhizoma, 2 liang)
One ingredient, add three sheng water, boil to one and a half sheng, strain, take seven he warm, twice daily.
Jie Geng Tang Prescription
Jie Geng (Platycodonis Radix, 1 liang) Gan Cao (Licorice Radix et Rhizoma, 2 liang)
Two ingredients, add three sheng water, boil to one and a half sheng, strain, divide warm, take twice.
Sore throat indicates Pathogenic Heat in Shaoyin throat. Gan Cao is sweet/neutral, harmonizing Yin/Yang, treating cold/heat. Jie Geng is bitter/sweet, acting as a boat/pilot to direct medicine upward, treating throat injury. Mild cases use Gan Cao; severe cases add Jie Geng.
(32) In Shaoyin disease, with pain in the throat, Ban Xia San Ji Tang (Pinellia Powder and Decoction) should be administered.
Ban Xia San Ji Tang Prescription
Ban Xia (Pinelliae Rhizoma, washed) Gui Zhi (Cinnamomi Ramulus, skin removed) Gan Cao (Licorice Radix et Rhizoma Preparata, equal parts)
Grind each separately, sieve, mix. Take one cun cube mixed with rice water, three times daily. If powder is hard to take, boil one sheng water seven times, add one cun cube powder, boil three more times, cool slightly, swallow slowly.
Throat pain differs from previous cases due to severe Wind-Heat and Phlegm obstruction causing bi-pain. Gui Zhi dispels Wind; Ban Xia eliminates Phlegm; Gan Cao clears Heat. This is another method for treating throat pain.
(33) In Shaoyin disease, with throat injury, ulceration, inability to speak, and voice loss, Ku Jiu Tang (Bitter Wine Decoction) should be administered.
Ku Jiu Tang Prescription
Ban Xia (Pinelliae Rhizoma, washed, broken like jujube pit, 14 pieces) Ji Zi (Egg, one, remove yolk, add Ku Jiu [vinegar] to shell)
Place Ban Xia in Ku Jiu, put eggshell in knife ring, heat over fire until three boils, strain, swallow slowly. Repeat three doses if ineffective.
Ulcers are heavier than simple pain. Inability to speak occurs because Shaoyin meridian enters Lung/Heart, Heart opens to tongue; Heart Heat stiffens tongue. Voice loss occurs because Lung governs sound/metal; Metal rings when clear but dulls when hot. Ban Xia opens phlegm collaterals; Ku Jiu reduces swelling/astringes ulcers; Egg is sweet/cool, clearing latent Heat. Different treatments for same symptoms adapt to specific etiologies.
(34) In Shaoyin disease, with diarrhea, Bai Tong Tang (White Through-Soluble Decoction) should be administered.
Bai Tong Tang Prescription
Cong Bai (Allii Fistulosus Bulbus, 4 stems) Gan Jiang (Zingiberis Rhizoma, 1 liang) Fu Zi (Raw Aconiti Lateralis Radix, 1 piece, raw, skin removed, broken into eight pieces)
Three ingredients, add three sheng water, boil to one sheng, strain, take warm in two doses.
Diarrhea in Shaoyin affects both meridian and Zang. Severe Cold and Yin excess require Gan Jiang and Fu Zi to overcome Yin and disperse Cold. Cong Bai is named "Bai Tong" (White Through) because it unblocks Yang, causing Yin to dissipate.
(35) In Shaoyin disease, with diarrhea and faint pulse, give Bai Tong Tang. If diarrhea persists, limbs become cold, pulse vanishes, with dry retching and irritability, Bai Tong Jia Zhu Dan Zhi Tang (Bai Tong Tang plus Pig Gallbladder Bile Decoction) should be administered. If pulse suddenly bursts out after taking medicine, death ensues; if pulse gradually returns, life is saved.