葱白（四茎） 干姜（二两） 附子（一枚生去皮破八片） 人尿（五合） 猪胆汁（一合）
以上三味。以水三升。煮取一升。去滓。内胆汁人尿。和令相得。分温再服。若无胆汁
亦可用。
尿。与溺同。奴吊切。此承上条复以其甚者言。脉微。阳虚也。厥逆无脉干呕烦者。热药治
寒。寒甚者。格拒而不入。汤不为用。反争而逆乱也。人尿性寒。胆汁微寒。以之为向导者。经
曰。逆者从之。此之谓也。暴出。烛欲烬而焱烈也。微续。真阳回而渐复也。然属加减耳。成方
疑后人所增。
（三十六）少阴病。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。
此为有水气。其人或咳。或小便利。或下利。或呕者。真武汤主之。
真武汤方
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。
腹痛。小便不利。阴寒内甚。湿甚而水不行也。四肢沉重疼痛。寒湿内渗。又复外薄也。自
下利者。湿既甚而水不行。则与谷不厘清。故曰此为有水气也。或为诸证。大约水性泛滥。无所
不之之故也。真武者。北方阴精之宿。职专司水之神。以之名汤。义取之水。然阴寒甚而水泛滥。
由阳困弱而土不能制伏也。是故术与茯苓燥土胜湿。芍药附子利气助阳。生姜健脾以燠土。则水
有制而阴寒退。药与病宜。理至必愈。
后加减法。（或为诸证之治。）
若咳者。加五味子半升。细辛干姜各一两。（水寒相搏则咳。细辛干姜之辛。散水寒也。既
散矣。肺主咳。而欲收。五味子者。酸以收之也。）若小便利者。去茯苓。（茯苓淡渗而利窍。
小便既利。不须渗也。）若下利者。去芍药。加干姜二两。（芍药收阴而停液。非下利者所宜。
故去之。干姜散寒而燠土。土燠则水有制。故加之。）若呕者。去附子。加生姜。足成半斤。
（呕。气逆也。去附子。以其固气也。加生姜以其散气也。）
（三十七）少阴病。下利清谷。里寒外热。手足厥逆。脉微欲绝。身反不恶寒。其人面赤色。
或腹痛。或干呕。或咽痛。或利止脉不出者。通脉四逆汤主之。
通脉四逆汤方
甘草（二两炙） 干姜（三两强人可四两） 附子（大者一枚生去皮破八片）
上三味。以水三升。煮取一升二合。去滓。分温。再服。其脉即出者愈。
下利清谷。手足厥冷。脉微欲绝而里寒者。阴甚于内也。身反不恶寒。面
色赤而外热者。格阳于外也。阴阳不相通。所以逆乱而有或为诸多证。利虽止邪欲
罢也。脉仍不出。阳气未复也。夫脉者血气之道路。血。阴也。非阳不行。姜附
辛热。助阳也。甘草甘平。益气也。汤本四逆而分两殊。通脉则加姜之谓。
后加减法。（同前。）
面色赤者。加葱九茎。（面色赤。阳格甚也。加葱。通阳气也。）腹中痛者。
去葱。加芍药二两。（腹中痛。真阴不足也。去葱。恶其顺阳也。加芍药。收阴也。）
呕者。加生姜二两。（见前）咽痛者。去芍药加桔梗一两。（咽痛。气结也。去芍
药。聚气也。加桔梗。利咽也。）利止。脉不出者。去桔梗。加人参二两。（利止脉不
出见上。去桔梗者。嫌其载而少畅通也。加人参者。生其阳而和其阴也。）
（三十八）少阴负趺阳者为顺也。
此承上文自利而言。以示人通诊吉凶利害之大意。盖谓少阴属水。其自利者以阴寒甚。
土弱而水无制也。趺阳主胃而属土。负谓趺阳有脉。土尚强。土强则水有制。而少阴反
为输负矣。顺言不以受制为拘也。盖水惟其有制。则卒遵道。不得终于泛滥而成大害。且
万物资生于土。而百骸藉养于胃。水土平成。物类又安。非天下之至顺乎。古今谓趺阳有
脉者不死。有以哉。
（三十九）少阴病。四逆。其人或咳。或悸。或小便不利。或腹中痛。或泄利下重者。四逆
散主之。
四逆散方
甘草（炙） 枳实（破水渍炙干） 柴胡 芍药
上四味。各十分。捣筛。白饮和服方寸匕。日三服。
分。去声。上同。人之四肢。温和为顺。故以不温和为逆。但不温和而未至于厥冷。则热犹
为未入深也。故用柴胡解之也。枳实。泄之也。然热邪也。邪欲解本阴也。阴欲收。芍药收之也。
甘草和之也。分。今之二钱五分也。
后加减法。（同前。）
咳者加五味子干姜各五分。并主下痢。（咳见前。并主下利。亦散水寒收泄气之意。）悸者。
加桂枝五分。（心主悸。桂枝通心气也。）小便不利者。加茯苓五分。（见前）腹中痛者。加附子一枚。炮令坼。
（腹中痛。寒甚也。附子。温之也。）
泄利下重者。先以水五升。煮薤白三升。煮取三升。去滓。以散三方寸匕。内汤中。煮取一升半。
分。温。再服。（下重。气滞也。薤白。疏泄也。）
（四十）少阴病。下利六七日。咳而呕渴心烦。不得眠者。猪苓汤主之。
下利。固乃阴寒甚而水无制。六七日咳而呕渴心烦。不得眠者。水寒相搏。蓄积不行。内闷而
不宁也。猪苓汤者。泻利以
厘清其水谷之二道也。二道清则利无有不止者。利止。则呕渴心烦。不待治而自愈矣。方见阳明篇。
（四十一）少阴病。得之二三日。口燥咽干者。急下之。宜大承气汤。
口燥咽干者。少阴之脉。循喉咙。挟舌本。邪热客于经。而肾水为之枯竭也。然水干则土燥。
土燥则水愈干。所以急于下也。方见阳明篇。下同。
（四十二）少阴病。自利清水。色纯青。心下必痛。口干燥者。急下之。宜大承气。
水。肾邪。青。肝色。肾邪传肝也。心下必痛者。少阴之脉。其支别者。从肺出络心。注胸
中也。口干燥见上。故治同。
（四十三）少阴病。六七日。腹胀。不大便者。急下之。宜大承气汤。
腹胀不大便。胃实可知。急下者。少阴属水。恶土实也。
（四十四）少阴病。脉沉者。急温之。宜四逆汤。
脉沉。寒邪深入于里也。温之不容以不急也。方见太阳中篇。下同。
（四十五）少阴病。饮食入口则吐。心中温温欲吐。复不能吐。始得之手足寒。脉弦迟者。
此胸中实。不可下也。当吐之。若膈上有寒饮。干呕者。不可吐也。急温之。宜四逆汤。
饮食入口则吐。少阴主喉咙而寒邪客之也。少阴之脉。络心。注胸中。实。谓痰壅而上塞也。
寒。以虚言。温。有补意。
（四十六）少阴病。下利。脉微涩。呕而汗出。必数更衣反少者。当温其上。灸之。
数。音朔。更平声。反少之少。上声。微。阳虚也。涩。血少也。汗出。阳虚不能外固。阴
弱不能内守也。更衣见阳明篇。反少者。
阳虚则气下坠。血少所以勤努责而多空坐也。上。谓顶。百会是也。灸。升举其阳以调养夫阴也。
Scallion White (four stalks) Dried Ginger (two liang) Aconite Root (one piece, raw, skin removed, broken into eight pieces) Human Urine (five he) Pig Bile (one he)
The above three ingredients [Note: Text says "three ingredients" but lists five items including urine and bile added later; context implies the base decoction ingredients or a specific preparation step]. Use three sheng of water. Boil to obtain one sheng. Remove the dregs. Add the bile and human urine. Mix well until harmonious. Divide into two doses and take warm. If bile is unavailable, it may be omitted or substituted.
"Niao" (urine) is the same as "Niao". Pronounced "Nu Diao Qie". This follows the previous clause to further discuss more severe conditions. A faint pulse indicates Yang deficiency. Cold limbs, absence of pulse, dry heaving, and irritability occur because when treating cold with hot medicines, if the cold pathogen is extremely severe, it causes rejection, preventing the medicine from entering the body. The decoction becomes ineffective and instead causes chaotic reversal of qi. Human urine is cold in nature, and pig bile is slightly cold. Using them as guides aligns with the classic saying: "Follow the contrary," which refers to this situation. "Sudden emergence" is like a candle flame flaring up just before extinguishing; "gradual continuation" signifies the return and gradual recovery of True Yang. However, this belongs to the category of modifications. It is suspected that this formula entry was added by later authors.
(36) Shaoyin disease (disease of the Shaoyin channel), persisting for two to three days without resolution, progressing to four or five days, presenting with abdominal pain, difficulty in urination, heaviness and pain in the four limbs, and spontaneous diarrhea. This is due to the presence of retained fluid (Shui Qi). Some patients may also experience cough, or clear urination, or diarrhea, or vomiting. Zhenwu Tang (True Warrior Decoction) should be used as the primary treatment.
Zhenwu Tang Formula:
Poria (three liang) Paeonia Root (three liang) Fresh Ginger (three liang, sliced) Atractylodes Macrocephala Rhizome (two liang) Prepared Aconite Root (one piece, processed, skin removed, broken into eight pieces)
The above five ingredients. Use eight sheng of water. Boil to obtain three sheng. Remove the dregs. Take seven ge warm per dose, three times daily.
Abdominal pain and difficulty in urination result from severe internal Yin-cold and excessive dampness causing stagnation of fluids. Heaviness and pain in the four limbs are caused by cold-dampness infiltrating internally and pressing outwardly on the exterior. Spontaneous diarrhea occurs because excessive dampness and stagnant fluids prevent the proper separation of food and fluids, hence described as "retained fluid." Other symptoms arise largely because water properties tend to overflow and affect all areas. Zhenwu refers to the deity of water in the North (associated with the Black Tortoise constellation), whose duty is specifically managing water. Naming the decoction after him implies its function in regulating water. However, when Yin-cold is extreme and water overflows, it is because Yang is constrained and weak, failing to control the water via Spleen Earth. Therefore, Atractylodes and Poria dry the earth and overcome dampness; Paeonia and Aconite promote Qi and assist Yang; Fresh Ginger strengthens the Spleen and warms the Earth. Thus, water is controlled, and Yin-cold recedes. The medication suits the pathology, and according to principle, cure is certain.
Subsequent Modification Method (Treatment for various accompanying symptoms):
If coughing, add Schisandra Berry (Ban Sheng) and Fineleaf Asarum and Dried Ginger (each one liang). (Water and cold fighting each other causes cough; the pungency of Fineleaf Asarum and Dried Ginger disperses water-cold. Once dispersed, since the Lung governs cough and requires consolidation, the sourness of Schisandra Berry consolidates it.) If urination is clear/profuse, remove Poria. (Poria is bland and promotes diuresis; if urination is already clear, diuresis is unnecessary.) If diarrhea, remove Paeonia Root and add Dried Ginger (two liang). (Paeonia Root consolidates Yin and retains fluids, unsuitable for diarrhea, so it is removed. Dried Ginger disperses cold and warms the Earth; warmed Earth controls water, so it is added.) If vomiting, remove Aconite Root and add Fresh Ginger, totaling half a jin. (Vomiting is rebellious Qi. Aconite Root is removed because it secures Qi; Fresh Ginger is added because it disperses Qi.)
(37) Shaoyin disease, characterized by diarrhea with undigested food (Wan Gu Bu Hua), internal cold with external heat, cold limbs, faint pulse nearly imperceptible, yet the body does not feel aversion to cold, and the face appears red. Alternatively accompanied by abdominal pain, dry heaving, sore throat, or cessation of diarrhea with no pulse emerging. Tongmai Sini Tang (Pulse-Restoring Four Reversal Decoction) should be used as the primary treatment.
Tongmai Sini Tang Formula:
Licorice Root (two liang, honey-fried) Dried Ginger (three liang, four liang for robust individuals) Large Raw Aconite Root (one piece, skin removed, broken into eight pieces)
The above three ingredients. Use three sheng of water. Boil to obtain one sheng and two he. Remove the dregs. Divide into two warm doses. If the pulse emerges, the patient will recover.
Diarrhea with undigested food, cold limbs, and faint pulse with internal cold indicate severe Yin-cold within. The body not feeling aversion to cold, with a red face and external heat signs, indicates Yang being rejected to the exterior. Yin and Yang fail to communicate, leading to chaotic Qi and various symptoms. Although diarrhea stopping might suggest the evil is subsiding, if the pulse still does not emerge, it means Yang has not recovered. The pulse is the pathway of Blood and Qi. Blood is Yin and cannot move without Yang. Dried Ginger and Aconite are pungent and hot, assisting Yang; Licorice is sweet and neutral, benefiting Qi. This decoction is essentially Sini Tang but with different dosages; "restoring the pulse" refers to increasing the amount of Ginger.
Subsequent Modification Method (Same as before):
For red face, add nine stalks of Scallion White. (Red face indicates severe Yang rejection; adding Scallion White unblocks Yang Qi.) For abdominal pain, remove Scallion White and add Paeonia Root (two liang). (Abdominal pain indicates insufficiency of True Yin; removing Scallion White avoids promoting Yang dispersion; adding Paeonia Root consolidates Yin.) For vomiting, add Fresh Ginger (two liang). (See previous explanation.) For sore throat, remove Paeonia Root and add Platycodon Root (one liang). (Sore throat indicates Qi knotting; removing Paeonia Root avoids gathering Qi; adding Platycodon Root benefits the throat.) For cessation of diarrhea with no pulse, remove Platycodon Root and add Ginseng Root (two liang). (Cessation of diarrhea with no pulse seen above; removing Platycodon Root is to avoid its upward bearing lacking smooth flow; adding Ginseng Root generates Yang and harmonizes Yin.)
(38) When the Shaoyin pulse is weaker than the Fuyang pulse, it is considered a favorable condition (Shun).
This follows the discussion on spontaneous diarrhea to illustrate the general principles of diagnosing auspicious and inauspicious outcomes. It means that Shaoyin belongs to Water; spontaneous diarrhea occurs due to severe Yin-cold where weak Earth fails to control Water. Fuyang pulse governs the Stomach and belongs to Earth. "Fu" (defeat/loss) here means the Fuyang pulse is still present, indicating Earth is still strong. Strong Earth can control Water, making Shaoyin relatively subordinate. "Shun" (favorable) means not being constrained by subordination. Because only when Water is controlled can it eventually follow the Dao and not cause disaster through flooding. Moreover, all things are born from Earth, and the body relies on the Stomach for nourishment. When Water and Earth are balanced, all classes of things are at peace. Is this not the greatest favorableness in the world? Since ancient times, it has been said that if the Fuyang pulse exists, death does not occur, which is reasonable.
(39) Shaoyin disease, with cold limbs (Si Ni). Accompanying symptoms may include cough, palpitations, difficulty in urination, abdominal pain, or diarrhea with a sensation of rectal tenesmus (Xie Li Xia Zhong). Sixni San (Four Reversal Powder) should be used as the primary treatment.
Sixni San Formula:
Licorice Root (honey-fried) Immature Bitter Orange (broken, soaked in water, then dried and fried) Bupleurum Root Paeonia Root
The above four ingredients, each taken in equal parts ("fen"). Pound and sift. Mix with rice water and take one fang cun bi per dose, three times daily.
"Fen" is pronounced with the departing tone. The four limbs of humans are favorable when warm; thus, lack of warmth is called "Ni" (reversal/cold). However, if they are merely cool and not yet cold, the heat pathogen has not penetrated deeply. Therefore, Bupleurum Root is used to resolve it. Immature Bitter Orange is used to drain/descend. Since it is a heat pathogen, resolving it relies on Yin; Yin tends to consolidate, so Paeonia Root is used to consolidate. Licorice Root harmonizes. "Fen" corresponds to approximately 2.5 qian today.
Subsequent Modification Method (Same as before):
For cough, add Schisandra Berry and Dried Ginger (each 5 fen), also primarily treating dysentery. (Cough seen previously. Also treating dysentery reflects the intent to disperse water-cold and consolidate/restrict Qi.) For palpitations, add Cinnamon Twig (5 fen). (The Heart governs palpitations; Cinnamon Twig unblocks Heart Qi.) For difficulty in urination, add Poria (5 fen). (See previous explanation.) For abdominal pain, add one Aconite Root, processed until cracked. (Abdominal pain indicates severe cold; Aconite Root warms it.)
For diarrhea with rectal tenesmus, first boil Leek Allium (three sheng) in five sheng of water to obtain three sheng. Remove dregs. Add three fang cun bi of the powder to the decoction. Boil to obtain one sheng and half. Divide into two warm doses. (Tenesmus indicates Qi stagnation; Leek Allium has a draining/dispersing effect.)
(40) Shaoyin disease, diarrhea lasting six to seven days, accompanied by cough, vomiting, thirst, irritability, and inability to sleep. Zhuling Tang (Polyporus Decoction) should be used as the primary treatment.
Diarrhea is indeed due to severe Yin-cold and loss of fluid control. However, the appearance of cough, vomiting, thirst, irritability, and insomnia after six to seven days indicates that water and cold are fighting and accumulating, causing internal stifling and restlessness. Zhuling Tang functions to clarify the two pathways of water and grain separation. Once these pathways are clear, diarrhea will inevitably stop. Once diarrhea stops, vomiting, thirst, and irritability will heal spontaneously without further treatment. See Yangming Chapter for the formula.
(41) Shaoyin disease, developing mouth dryness and throat dryness within two to three days. Urgent purgation is required. Da Chengqi Tang (Major Order the Qi Decoction) is suitable.
Mouth and throat dryness occur because the Shaoyin meridian runs along the throat and surrounds the root of the tongue. Pathogenic heat lodging in the meridian depletes Kidney Water. When Water is dry, Earth becomes dry; when Earth is dry, Water becomes even drier. Hence, urgent purgation is necessary. See Yangming Chapter for the formula, same below.
(42) Shaoyin disease, passing pure green watery stool,必有 (must have) pain in the epigastrium, and mouth dryness. Urgent purgation is required. Da Chengqi Tang is suitable.
Water represents Kidney evil; Green represents Liver color. This indicates Kidney evil transmitting to the Liver. Pain in the epigastrium occurs because a branch of the Shaoyin meridian emerges from the Lung, connects to the Heart, and enters the chest. Mouth dryness is seen above; thus, the treatment is the same.
(43) Shaoyin disease, after six to seven days, presenting with abdominal distension and constipation. Urgent purgation is required. Da Chengqi Tang is suitable.
Abdominal distension and constipation indicate Stomach excess (Wei Shi). Urgent purgation is needed because Shaoyin belongs to Water and dislikes Earth excess.
(44) Shaoyin disease, with a deep pulse (Mai Chen). Urgent warming is required. Sini Tang (Four Reversal Decoction) is suitable.
A deep pulse indicates cold pathogen penetrating deeply into the interior. Warming cannot be delayed; it must be urgent. See Taiyang Middle Chapter for the formula, same below.
(45) Shaoyin disease, vomiting immediately after food enters the mouth, feeling warm and wanting to vomit but unable to do so. At onset, cold hands and feet, with a string-tight (Xuan) and slow (Chi) pulse. This is excess in the chest (Xiong Zhong Shi); purgation is contraindicated. Vomiting induction should be used. If there is cold-fluid retention above the diaphragm causing dry heaving, vomiting induction is contraindicated. Urgent warming is required. Sini Tang is suitable.
Vomiting upon ingestion occurs because Shaoyin governs the throat and cold pathogen lodges there. The Shaoyin meridian connects to the Heart and enters the chest. "Excess" refers to phlegm turbidity obstructing upwards. "Cold" refers to deficiency-cold. "Warm" implies tonification.
(46) Shaoyin disease, diarrhea, with a faint and choppy (Se) pulse, vomiting and sweating. Frequent trips to the toilet but scant output. Warm the upper part and moxibustion should be applied.
"Shu" is pronounced "Shuo". "Geng" is pronounced with the level tone. "Shao" in "Fan Shao" is pronounced with the rising tone. Faint pulse indicates Yang deficiency; Choppy pulse indicates Blood deficiency. Sweating indicates Yang deficiency failing to secure the exterior and Yin deficiency failing to guard the interior. "Geng Yi" (changing clothes/toilet) is explained in the Yangming Chapter. Frequent visits with scant output occur because Yang deficiency causes Qi to sink, and Blood deficiency leads to frequent straining with empty sitting. "Upper" refers to the top of the head, Baihui (GV20). Moxibustion raises Yang to nourish Yin.