【纲】仲景曰。少阴之为病。脉微细。但欲寐也。
【目】朱肱曰。足少阴肾之经。其脉起于小指之下。斜趋足心。别行者。入足跟中。上至股内
后廉。贯肾。络膀胱。直行者。从肾上贯肝膈。入肺中。络舌本。伤寒热气入脏。流于少阴之经。
少阴主肾。肾恶燥。故渴而引饮入经。发汗吐下后。脏腑空虚。津液枯竭。肾有余热。亦渴。故病
人口燥舌干而渴。其脉尺寸俱沉者。知少阴经受病也。
问。伤寒何以须诊太溪脉耶。答曰。太溪穴。是足少阴肾之经。男子以右肾为命门。女子以左
肾为命门。主生死之要。病患有命门脉者活。无者死。仲景云。少阴手足逆冷。发热者不死。脉不
至者。灸太溪七壮。故伤寒必诊太溪。以察其肾之盛衰也。太溪二穴。在足内踝后跟骨上动脉陷中。
问。脉微细。欲吐不吐。心烦。但欲寐。五六日自利而渴。答曰。此名少阴也。少阴为病。欲吐
不吐。心烦。但欲寐。五六日自利而渴者。虚故引水自救。若小便色白者。以下焦虚。有寒。不能
制水。故令色白也。四逆汤。少阴肾之经。主脉微细。心烦。但欲寐。或自利而渴。问。经云。一
二日少阴病者。何也。谓国中病时。腠理寒。便入阴经。不经三阳也。伤寒虽是三阴三阳。大抵发
于阳。则太阳也。发于阴。则少阴也。此二经为表里。其受病最多。阳明太阴。受病颇稀。至于少
阳厥阴肝胆之经。又加少焉。凡病一日至十二三日。太阳症不罢者。但治太阳。有初得病便见少阴
症者。直攻少阴。亦必先自太阳次传而至。盖寒气入太阳。即发热而恶寒。入少阴。但恶寒而不发
热也。三阴中寒。微则理中汤。稍厥。或中寒下利。即干姜甘草汤。手足指微寒冷。谓之清。此未
须服四逆。盖疾轻故也。只可服理中干姜之类。大段重者。用四逆汤。无脉者。用通脉四逆汤。
【纲】仲景曰。少阴病。脉沉细数。病为在里。不可发汗。少阴病。脉微。不可发汗。亡阳故
也。阳已虚。尺中弱涩者。复不可下之。
【目】危亦林曰。发汗则动其经气。便有夺血亡阳之灾。故所戒也。
韩祗和曰。亡阳无阳。亡与无同。无阳则其邪为阴邪。阴邪本宜下。然阳已虚。尺脉弱涩者。
复不可下。宜用温矣。
魏荔彤曰。此乃申明少阴病。应审之于脉。而知其经病脏病。为直中寒邪。为传经热邪。而分
应汗不应汗。应下不应下也。盖少阴为病。直感乎外邪者。有经受脏受之不同。其连及乎太阴者。
又有传经为热。直感为寒之不同。皆不容不辨。如脉不紧而微。此经邪欲愈乎。再手足温。必自愈。
而无俟发汗也。不然。是脏邪初感。即见阳微之象。更无事于发汗伤正也。此无论其邪在经在脏。
发汗。阳必随汗而亡。少阴阳亡。必难治矣。此应审其经邪脏邪而禁误汗者也。再或阳本虚。尺
脉弱涩。或为传经热邪乎。是少阴大承气症也。然见此脉不可下也。况为直感肾脏之寒邪耶。方用
附子四逆等汤温之不暇。顾可下乎。此又就传经热邪直感寒邪谛审之而不可误下也。吾曾言六经皆发汗。
今仲师言不可汗。何也。盖少阴病。阴阳俱紧。审其为在经之寒邪。则附子麻黄甘草汤。原为发少
阴之汗而设。如不紧而微。在经邪欲愈。尚不可汗。况脏邪乎。至于别条阴阳俱紧而反汗出者。
则是阴邪逼出之汗。与发汗无与。是又为少阴脏病。故愈不可发汗也。
六经原俱可汗。五脏原俱不可汗。何疑焉。然六经见阳微之脉。俱不可发汗。不止少阴见微脉。
方不可发法也。又何疑焉。
【纲】仲景曰。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。
脉阴阳俱紧者。口中气出。唇口燥干。鼻中涕出。蜷卧足冷。舌上苔滑者。勿妄治也。到七八
日以来。其人微发热。手足温者。此为欲解。或到八日以上。反大发热者。此为难治。设使恶寒者。
必欲呕也。腹内痛者。必欲利也。
脉阴阳俱紧。至于吐利。其脉独不解。紧去人安。此为
欲解。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。
【目】朱肱曰。问阴症有发热者乎。答曰。太阴厥阴。皆不发热。只少阴发热有二症。仲景谓
之反发热也。少阴病初得之。发热脉沉者。麻黄附子细辛汤。少阴病脉沉。发汗则动经。此大略之
言耳。脉应里而发热在表。亦当以小辛之药泄汗而温散也。仲景云。伤寒之病。从风寒得之。表中
风寒。入里则不消。须用温药少汗而解。
杨士瀛曰。有咽痛复吐利见症。方是少阴病。不然是风寒两伤之脉紧汗出矣。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。
庞安常曰。阴阳俱紧。伤寒脉也。伤寒本无汗。反汗出者。无阳以卫其外。所以邪不出而汗反
出也。少阴之邪不出。所以咽痛吐利。皆少阴本症也。于此而可不用少阴温经散邪之法乎。脉紧。
寒邪也。自下利脉暴微。阴寒内泄也。手足反温。阳回也。阳回则阴退。故紧反去。为欲解也。
夫寒邪在阴。而脉紧得自利。脉暴微。手足温。紧去欲解者。犹之邪在阳。脉数而热。得汗出。脉
和身凉数去。为欲愈也。
柯琴曰。少阴脉络肺。肺主鼻。故涕出。少阴脉络舌本。故舌苔滑。少阴大络注诸络以温足胫。
故足冷诸症。全似亡阳。口气出。唇口燥干。涕出。此为内热。脉紧蜷卧。舌苔足冷。又是内寒。
此少阴为枢。故见寒热相持。病虽发于阴。而口舌唇鼻之半表里。恰与少阳口咽目之半表里相应
也。治之却与少阳不同。紧去则吐利止。其人可安。此据脉辨症之法。
三条。亡阳脉症。四条。阳回脉症。玩反温。前此已冷可知。微为少阴本脉。烦利为少阴本症。
至七八日。阳尽阴复之时。紧去微见。所谓谷气之来也徐而和矣。
【纲】仲景曰。少阴中风。脉阳微阴浮者。为欲愈。
【目】魏荔彤曰。少阴病。不外直中。传经寒热二邪。然于其入也。分寒热必清。于其出。则
不必分寒热。竟言出而得愈
而已。然症脉必明辨之。而后临事不惑。如本少阴病。何忽类太阳之中风。少阴有直中之寒。必无
直中之风。如有直中之风。则为风中肾脏之症。与伤寒中传经热邪。固不相涉。即与伤寒中直中寒
邪。亦不相涉也。盖少阴症。忽变为似乎太阳之中风也。何以见之。以其热自发。汗自出定之也。
少阴之反热。反汗出。乃内真寒外假热。直中寒邪内所有之症也。本文未尝发热汗出。吾以为本文
所有也。何言之。以脉见阳微阴浮。而知其人必发热汗出也。在少阴直中寒邪之脉。见沉紧。是阳
紧而阴沉也。在少阴传经热邪之脉。见沉数。是阳沉而阴数也。今阳见微。是不紧也。原为直中之
寒邪将散。故变紧为微。且不沉也。原为传经之热邪将散。故变沉为微也。再阴脉见浮。是不沉也。
原为直中之寒邪将散。故变沉为浮。且不数也。原为传经之热邪将散。故变量为浮也。此足见少
阴病。不论寒邪热邪。见此阳微阴浮之脉。俱为欲愈之几矣。又何以知其发热汗出也。于太阳原文
知之。太阳中风原文云。阳浮者热自发。阴弱者汗自出。少阴见阳微。即太阳之浮脉也。再阴脉浮
而不沉。非弱之义乎。于此知其阴病转阳。里邪透表。必发热汗出。见欲愈之神理也。发热则阴寒
已微。况脉不见沉紧。则非内阴逼阳于外之反发热也。汗出则里病已除。脉又不见沉细。则非阴盛
逼阳出亡之汗自出也。此皆辨析于毫厘。而虚实寒热。进退真假之理。跃如也。
【纲】仲景曰。少阴病。四逆。恶寒而身蜷。脉不至。不烦而躁者。死。
【目】方中行曰。不伸曰蜷。阴主屈故也。症俱见而脉不至。阳已绝矣。不烦而躁。孤阴亦欲
自尽也。
【纲】仲景曰。少阴病。吐利。手足不逆冷者。不死。脉不至者。灸少阴七壮。
【目】朱震亨曰。手足不逆冷。阳足拒阴也。阳虽微。尚能内拒。正阳犹存于中。而阳气犹充
于四肢。阴病中得此。岂有死理哉。设或脉有不至。不过阳气衰微。不能快行于经隧间耳。非脉绝
也。灸少阴本穴者。就其经行之道路。扶其阳气。使得宣通。则脉必自至。而吐利亦自止矣。曰七
壮者。不必定在一处。凡少阴之经。起止循行处。皆可灸也。
【纲】仲景曰。少阴病。下利。脉微涩。呕而汗出。大便数而少者。宜温其上灸之。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。
【目】朱肱曰。少阴不得有汗。而少阴亦有反自汗出之症。盖阴症四肢逆冷。额上及手背冷汗
者。亡阳也。
【纲】仲景曰。病六七日。手足三部脉皆至。大烦。而口噤不能言。其人躁扰者。必欲解也。
若脉和。其人大烦。目重。睑内际黄者。此欲解也。
【目】柯琴曰。脉者。资始于肾。朝会于肺。肾气绝。则脉不至。三部手足皆至。是脉道大通。
根本俱足。非暴出可知。故所致之脉和调。虽大烦不解。亦不足虑也。
【纲】仲景曰。少阴病。始得之。无汗。恶寒。反发热。脉沉者。麻黄附子细辛汤主之。
【目】朱肱曰。少阴病。始得。发热脉沉者。固用本汤矣。若二三日常见少阴无阳症者。亦须
微发汗。麻黄附子甘草汤。此不可不知也。若少阴病恶寒而蜷。时时自烦。不欲浓衣者。大柴胡去
大黄。
张介宾曰。太阳症似少阴者。以其发热恶寒而脉反沉也。少阴症似太阳者。以其恶寒脉沉而反
发热也。如仲景曰。太阳病。发热头痛。脉反沉。身体疼痛。若不瘥者。当救其里。宜四逆汤。以
及本条。此二症。谓在太阳。其脉当浮而反沉者。因正气衰弱。里虚而然。故当用四逆。以里虚不
得不救也。病在少阴。当无热而反热者。因寒邪在表。犹未传里。故用本汤。以表邪不得不散也。
此二症者。均属脉沉发热。但其有头痛。故为太阳病。无头痛。故为少阴病。但在少阴而反发热者。
以表邪浮浅。可以汗解。其反犹轻。在太阳而反脉沉。以正气衰微。虽施汗下。其反为重。由此观
之。可见阳经有当温里者。故以生附配干姜。补中自有散意。阴经有当发表者。故以熟附配麻黄。
发中亦有补焉。此仲景求本之治。其他从可知矣。
【纲】仲景曰。少阴病。身体痛。手足寒。骨节痛。脉沉者。附子汤主之。
【目】黄仲理曰。此乃少阴肾脏病也。骨属肾。肾寒故骨俱痛也。即此一端。盒饭急救其脏中
之阳。宜用本汤也。
【纲】仲景曰。脉浮而迟。表热里寒。下利清谷者。四逆汤主之。病发热头疼。脉反沉。若不
瘥。身体疼痛。当救其里。宜四逆汤。呕而脉弱。小便复利。身有微热。见厥者。难治。四逆汤主
之。既吐且利。小便复利。而大汗出。下利清谷。内寒外热。脉微欲绝者。四逆汤主之。少阴病。
脉沉者。急温之。宜四逆汤。
【目】庞安常曰。五条。不言症。非无症也。少阴之症自具。不必言也。独云脉沉。则寒邪坚
实凝固。脏中将有灭阳之势。可知。是即脉一端。盒饭急温以救阳也。
柯琴曰。首条。浮为在表。迟为在脏。浮中见迟。是浮为表虚。迟为脏寒。未经妄下而利清谷。
是表为虚热。里有真寒矣。
仲景凡治虚症。以里为主。此是伤寒症。然脉浮表热。亦是病发于阳。世所云漏底伤寒也。二
条。诸症皆麻黄。是病为在表矣。其脉当浮。今反沉。此为逆也。当凭脉之沉而为在里。阳症见阴
脉。是阳消阴长之兆也。热虽发于表而为阳。虚寒反据于里。是真阴也。三条。脉弱而微热。非相
火也。膈上有寒饮。故呕也。四条。脉微欲绝而见吐利交作。下利清谷之症。是气血丧亡矣。
【纲】仲景曰。少阴病。下利清谷。里寒外热。手足厥逆。脉微欲绝。身反不恶寒。其人面色
赤。或腹痛。或干呕。或咽痛。或利止。脉不出者。通脉四逆汤主之。
【目】朱肱曰。大抵阴症发热。终是不同。脉须沉。或下利。手足厥也。病患尺寸脉俱沉细欲
寐者。少阴症也。急作四逆汤复其阳。不可缓也。
少阴病。口燥舌干而渴。急下之。不可缓。大承气汤。若脉沉而迟。四逆汤温之。盖以口燥而
渴者。知其热。脉沉而迟者。别其寒也。
少阴属肾。古人谓之肾伤寒。其口燥舌干而渴。固当急下。大抵肾伤寒。亦多表
里无热。但苦烦愦。默默而极不欲见光明。有时腹痛。其脉沉细。旧用四顺汤。古人恨其热不堪用。
云肾病而体犹有热。可服仲景四逆散。若已十余日。下利不止。手足厥冷。乃无热候。可增损四顺
汤。
少阴症。口燥咽干。即云急下之。盖少阴主肾。系舌本。伤寒热气入于藏。流于少阴之经。肾
汁干。咽络焦。故口燥咽干而渴。即宜急下。非若阳明宜下而可缓也。虽然。阳明亦有一症。发热
汗出多。急下之。阳明属胃。汗多则胃汁干。故亦须急急下之也。
【纲】仲景曰。下利清谷。里寒外热。汗出而厥者。通脉四逆汤主之。脉沉而迟。其人面少赤。
[General Principle] Zhang Zhongjing stated: The characteristic of Shaoyin disease is a pulse that is faint and fine, accompanied by a desire to sleep.
[Commentary] Zhu Gong said: The Foot-Shaoyin Kidney Meridian originates below the little toe, slants towards the sole of the foot. Its branch enters the heel, ascends to the posterior medial aspect of the thigh, penetrates the Kidney, and connects with the Bladder. The main trunk ascends from the Kidney, passes through the Liver and diaphragm, enters the Lung, and connects with the root of the tongue. When pathogenic heat from cold damage invades the zang organs and flows into the Shaoyin meridian, since Shaoyin governs the Kidney and the Kidney detests dryness, thirst and a desire to drink occur. After sweating, vomiting, or purging, the zang-fu organs become empty, and body fluids are depleted; residual heat in the Kidney also causes thirst. Thus, the patient presents with dry mouth and tongue and thirst. If the pulse at the cun, guan, and chi positions is deep in all three, it indicates disease of the Shaoyin meridian.
Question: Why must the Taixi (KI3) pulse be examined in the treatment of cold damage? Answer: Taixi (KI3) belongs to the Foot-Shaoyin Kidney Meridian. In men, the right Kidney is the Gate of Vitality (Mingmen); in women, the left Kidney is the Gate of Vitality. This is the key to life and death. If the Gate of Vitality pulse (Taixi) can be felt in a patient, they will live; if not, they will die. Zhang Zhongjing said: In Shaoyin disease, if there is cold reversal of the hands and feet but fever is present, death does not ensue; if the pulse cannot be felt, moxa should be applied to Taixi (KI3) for seven moxibustion cones. Therefore, in treating cold damage, one must examine Taixi (KI3) to assess the prosperity or decline of the Kidney Qi. There are two Taixi (KI3) acupoints, located in the depression above the ankle bone behind the medial malleolus, where the arterial pulse can be felt.
Question: How to explain faint and fine pulse, nausea without vomiting, irritability, desire to sleep, and spontaneous diarrhea with thirst after five or six days? Answer: This is called Shaoyin disease. In Shaoyin disease, symptoms such as nausea without vomiting, irritability, and desire to sleep, followed by spontaneous diarrhea and thirst after five or six days, occur because of deficiency, leading the body to draw water to save itself. If the urine is clear and white, it is due to lower jiao deficiency-cold, which fails to control water metabolism, resulting in clear urine. Si Ni Tang (Cinnamon Twig, Aconite, Licorice Decoction) treats Shaoyin Kidney meridian pathology, characterized by faint and fine pulse, irritability, desire to sleep, or spontaneous diarrhea with thirst. Question: The classic states "Shaoyin disease appearing on the first or second day," what is the reason? Answer: This occurs when the interstices are cold during the onset of illness, allowing pathogens to enter the Yin meridians directly without passing through the Three Yang meridians. Although cold damage is categorized into Three Yin and Three Yang, it mostly manifests in the Yang meridians, specifically Taiyang (Greater Yang). Manifestation in the Yin meridians refers to Shaoyin (Lesser Yin). These two meridians are exterior-interior partners and are most frequently affected. Yangming (Bright Yang) and Taiyin (Greater Yin) are less frequently affected. ShaoYang (Lesser Yang) and Jueyin (Terminal Yin), involving the Liver and Gallbladder, are even less frequently affected. For any illness lasting one to twelve or thirteen days, if Taiyang symptoms persist, treat only Taiyang. If Shaoyin symptoms appear immediately upon onset, attack Shaoyin directly, though this usually follows transmission from Taiyang. Cold qi entering Taiyang causes fever and aversion to cold; entering Shaoyin causes only aversion to cold without fever. For cold invasion in the Three Yin meridians, if mild, use Li Zhong Tang (Regulate the Middle Decoction); if slightly cold-reversed or with cold-induced diarrhea, use Gan Jiang Gan Cao Tang (Dried Ginger and Licorice Decoction). Slight coldness in the fingers and toes is termed "Qing" (Clear/Cool); at this stage, Si Ni Tang (Cinnamon Twig, Aconite, Licorice Decoction) is not yet needed because the disease is light. Only Li Zhong Tang or Dried Ginger should be used. For severe cases, use Si Ni Tang (Cinnamon Twig, Aconite, Licorice Decoction). For absent pulse, use Tong Mai Si Ni Tang (Pulse-Returning Cinnamon Twig, Aconite, Licorice Decoction).
[General Principle] Zhang Zhongjing stated: In Shaoyin disease, a deep, fine, and rapid pulse indicates the disease is in the interior; sweating is contraindicated. In Shaoyin disease, a faint pulse indicates sweating is contraindicated because it would lead to collapse of Yang. If Yang is already deficient and the chi position pulse is weak and choppy, purgation is also contraindicated.
[Commentary] Wei Yilin said: Sweating disturbs the meridian Qi, leading to disaster of blood loss and Yang collapse; therefore, it is prohibited.
Han Zhihe said: Wang Yang (collapse of Yang) and Wu Yang (absence of Yang) mean the same. Absence of Yang means the pathogen becomes Yin-pathogen. Although Yin-pathogens generally require purgation, if Yang is already deficient and the chi pulse is weak and choppy, purgation is again contraindicated; warming is appropriate.
Wei Litong said: This further elucidates Shaoyin disease, emphasizing the need to distinguish between meridian and zang diseases, and between direct invasion of cold pathogens and transmitted heat pathogens, to determine whether sweating or purgation is indicated. In Shaoyin disease, direct external invasion differs depending on whether it affects the meridian or the zang organ. Involvement of Taiyin also differs between transmitted heat and direct cold. These distinctions are crucial. For instance, if the pulse is not tight but faint, is the meridian pathogen resolving? If the hands and feet are warm, it will heal spontaneously without sweating. Otherwise, if the zang pathogen is newly contracted and shows signs of Yang deficiency, sweating should certainly not be used to injure healthy Qi. Regardless of whether the pathogen is in the meridian or zang, sweating will cause Yang to collapse with the sweat. Collapse of Shaoyin Yang is difficult to treat. Thus, one must examine meridian vs. zang pathogens to prohibit erroneous sweating. Furthermore, if Yang is originally deficient with a weak and choppy chi pulse, or if it is a transmitted heat pathogen, it might resemble a Shaoyin Da Cheng Qi Tang (Major Order the Yellow Decoction) syndrome. However, with this pulse, purgation is contraindicated. Especially so for direct invasion of Kidney cold. One should use Fu Zi Si Ni Tang (Aconite Cinnamon Twig Licorice Decoction) to warm, let alone purge. This clarifies why purgation is contraindicated for both transmitted heat and direct cold. I previously stated that all Six Meridians can be sweated; now Master Zhong says sweating is contraindicated. Why? If Shaoyin disease presents with tight pulses at both Yin and Yang positions, indicating cold in the meridian, Fu Zi Ma Huang Gan Cao Tang (Aconite Ephedra Licorice Decoction) was originally designed to induce sweating in Shaoyin. If the pulse is not tight but faint, indicating resolving meridian pathogen, sweating is still contraindicated, let alone zang pathogen. Regarding other clauses mentioning tight pulses with spontaneous sweating, this is sweat forced out by Yin pathogens, unrelated to therapeutic sweating; this is Shaoyin zang disease, making sweating even more contraindicated.
All Six Meridians can theoretically be sweated; all Five Zang organs should not be sweated. Is there doubt? However, if any of the Six Meridians show a faint Yang pulse, sweating is contraindicated, not just in Shaoyin with a faint pulse. Is there doubt?
[General Principle] Zhang Zhongjing stated: If a patient has tight pulses at both Yin and Yang positions but spontaneously sweats, this indicates collapse of Yang. This belongs to Shaoyin. According to the law, it should present with sore throat accompanied by vomiting and diarrhea.
With tight pulses at both Yin and Yang positions, if the person breathes heavily, has dry lips and mouth, runsny nose, curls up in bed, has cold feet, and a slippery tongue coating, do not treat rashly. After seven or eight days, if the person has slight fever and warm hands and feet, this indicates impending resolution. If after eight or more days, there is sudden high fever, this is difficult to treat. If there is aversion to cold, vomiting will likely occur. If there is abdominal pain, diarrhea will likely occur.
If tight pulses persist until vomiting and diarrhea occur, but the pulse alone does not resolve, and the tightness disappears while the person feels comfortable, this indicates impending resolution. In Shaoyin disease, if the pulse is tight, and after seven or eight days, spontaneous diarrhea occurs, the pulse suddenly becomes faint, the hands and feet become warm, and the tightness disappears, this indicates impending resolution. Although there is irritability and diarrhea, it will heal spontaneously.
[Commentary] Zhu Gong said: Question: Are there febrile cases in Yin syndromes? Answer: Taiyin and Jueyin do not feature fever. Only Shaoyin fever has two presentations, which Zhang Zhongjing calls "counter fever." In early Shaoyin disease with fever and deep pulse, use Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, Asarum Decoction). In Shaoyin disease with deep pulse, sweating disturbs the meridian; this is a general statement. The pulse reflects interior conditions, while fever is in the exterior; thus, mild acrid herbs should be used to induce slight sweating and disperse warmth. Zhang Zhongjing said: Cold damage arises from wind-cold. Wind-cold in the exterior, if it enters the interior, will not dissipate; mild acrid-warm herbs must be used to induce slight sweating for resolution.
Yang Shiying said: Sore throat accompanied by vomiting and diarrhea defines Shaoyin disease. Otherwise, it is wind-cold injuring both exterior and interior, causing tight pulse and sweating. Sore throat occurs because the Shaoyin meridian circulates around the throat. The zang belongs to Water; thus, not only sore throat but also vomiting and diarrhea occur due to uncontrolled Water.
Pang Anchang said: Tight pulses at Yin and Yang positions are typical of cold damage. Cold damage normally has no sweat; spontaneous sweating indicates lack of Yang to guard the exterior, so the pathogen remains inside while sweat comes out. Because Shaoyin pathogens do not exit, sore throat, vomiting, and diarrhea occur, which are original Shaoyin symptoms. Here, one must not fail to use Shaoyin methods to warm the meridian and scatter pathogens. Tight pulse indicates cold pathogen. Spontaneous diarrhea with sudden faint pulse indicates internal leakage of Yin-cold. Warm hands and feet indicate return of Yang. Return of Yang drives back Yin, so tightness disappears, indicating resolution. Just as cold pathogen in Yang meridians with rapid pulse and fever resolves with sweating, smooth pulse, cool body, and disappearance of rapid pulse indicating healing, so too does cold pathogen in Yin meridians with tight pulse resolving via spontaneous diarrhea, sudden faint pulse, warm hands and feet, and disappearance of tightness indicate resolution.
Ke Qin said: The Shaoyin meridian connects to the Lung, which governs the nose, hence nasal discharge. It connects to the root of the tongue, hence slippery tongue coating. The great Luo vessel of Shaoyin nourishes the lower legs, hence cold feet. These symptoms resemble Yang collapse. Heavy breathing, dry lips/mouth, and nasal discharge indicate internal heat. Tight pulse, curling up, slippery coating, and cold feet indicate internal cold. Shaoyin acts as a pivot, hence holding between cold and heat. Although originating in Yin, the semi-exterior/semi-interior nature of the mouth, tongue, lips, and nose corresponds to the semi-exterior/semi-interior nature of the mouth, throat, and eyes in Shaoyang. Treatment differs from Shaoyang. Disappearance of tightness stops vomiting/diarrhea, bringing comfort. This is a method of distinguishing symptoms by pulse.
The first three clauses describe Yang collapse pulses and symptoms. The fourth describes Yang return pulses and symptoms. Note "counter warm," implying previous coldness. "Faint" is the original Shaoyin pulse; "irritability and diarrhea" are original Shaoyin symptoms. By seven or eight days, a time of Yang exhaustion and Yin restoration, tightness disappears and faintness appears, representing the gentle arrival of Grain Qi.
[General Principle] Zhang Zhongjing stated: In Shaoyin wind-stroke, if the Yang pulse is faint and the Yin pulse is floating, recovery is imminent.
[Commentary] Wei Litong said: Shaoyin disease involves either direct invasion or transmitted cold/heat pathogens. Upon entry, cold and heat must be distinguished clearly; upon exit, distinction is unnecessary, simply stating resolution. However, symptoms and pulses must be clearly differentiated to avoid confusion in practice. For example, why does a Shaoyin case suddenly resemble Taiyang wind-stroke? Shaoyin has direct cold invasion but no direct wind invasion. If wind directly invaded, it would be wind striking the Kidney, unrelated to transmitted heat or direct cold in cold damage. Essentially, Shaoyin symptoms suddenly mimic Taiyang wind-stroke. How is this known? By spontaneous fever and spontaneous sweating. Counter-fever and counter-sweating in Shaoyin represent true internal cold with false external heat, characteristic of direct cold invasion. The text does not explicitly state fever and sweating, but I infer they are present. Why? Because the pulse shows faint Yang and floating Yin, indicating inevitable fever and sweating. In direct cold invasion, the pulse is deep and tight (Yang tight, Yin deep). In transmitted heat, the pulse is deep and rapid (Yang deep, Yin rapid). Now, Yang is faint (not tight), indicating resolving direct cold (tight changing to faint) or resolving transmitted heat (deep changing to faint). Yin is floating (not deep), indicating resolving direct cold (deep changing to floating) or resolving transmitted heat (rapid changing to floating). Thus, regardless of cold or heat pathogen in Shaoyin, faint Yang and floating Yin pulse indicate impending resolution. How do we know fever and sweating occur? From the Taiyang text: "Floating Yang means spontaneous fever; weak Yin means spontaneous sweating." Faint Yang in Shaoyin corresponds to floating pulse in Taiyang. Floating Yin (not deep) corresponds to weakness. Thus, Yin disease turning to Yang, interior pathogen penetrating to exterior, inevitably causes fever and sweating, revealing the divine mechanism of resolution. Fever indicates Yin cold is mild; absence of deep/tight pulse rules out counter-fever caused by Yin forcing Yang outward. Sweating indicates interior disease is removed; absence of deep/fine pulse rules out sweating caused by Yin excess forcing Yang to escape. These subtle distinctions clarify truth/falsehood and advancement/retreat of cold/heat and deficiency/excess.
[General Principle] Zhang Zhongjing stated: In Shaoyin disease, with cold reversal, aversion to cold, and curling up, absent pulse, and irritability without vexation, the prognosis is fatal.
[Commentary] Fang Zhongxing said: Curling up implies inability to extend, governed by Yin's nature of flexion. With all symptoms present and absent pulse, Yang is exhausted. Irritability without vexation indicates lone Yin attempting to exhaust itself.
[General Principle] Zhang Zhongjing stated: In Shaoyin disease, with vomiting and diarrhea but warm hands and feet (no cold reversal), death does not ensue. If the pulse is absent, moxa should be applied to the Shaoyin meridian for seven cones.
[Commentary] Zhu Zhenheng said: Warm hands and feet indicate sufficient Yang resisting Yin. Although Yang is weak, it can resist internally, meaning righteous Yang remains within and nourishes the limbs. Such a sign in Yin disease precludes death. If the pulse is absent, it is merely due to weak Yang failing to circulate rapidly through the meridians, not pulse extinction. Moxibustion at the primary Shaoyin acupoints supports Yang along its pathway, promoting circulation, thereby restoring the pulse and stopping vomiting/diarrhea. "Seven cones" implies application anywhere along the Shaoyin meridian's course, not necessarily a single point.
[General Principle] Zhang Zhongjing stated: In Shaoyin disease, with diarrhea, faint and choppy pulse, vomiting, sweating, frequent but scanty stools, warming the upper part and moxibustion are appropriate. In Shaoyin disease, with faint, deep, and fine pulse, desire to sleep, sweating without vexation, and desire to vomit, progressing to spontaneous diarrhea, renewed irritability, and inability to sleep or lie down after five or six days, the prognosis is fatal.
[Commentary] Zhu Gong said: Shaoyin disease should not have sweating, but counter-sweating can occur. Generally, Yin syndrome with cold reversal, cold sweat on the forehead and back of hands indicates Yang collapse.
[General Principle] Zhang Zhongjing stated: After six or seven days of illness, if pulses at hand, foot, and head positions are all palpable, and the patient is extremely vexed, jaw locked unable to speak, and restless, this indicates impending resolution. If the pulse is harmonious, the patient is very vexed, and the inner eyelids are yellow, this also indicates impending resolution.
[Commentary] Ke Qin said: The pulse originates in the Kidney and convenes in the Lung. If Kidney Qi is exhausted, the pulse is absent. Palpable pulses at hand, foot, and head positions indicate free flow of pulse vessels and sufficient root, not a sudden false emergence. Thus, the pulse is harmonious. Even with extreme vexation, there is no cause for concern.
[General Principle] Zhang Zhongjing stated: In early Shaoyin disease, with no sweat, aversion to cold, counter-fever, and deep pulse, Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, Asarum Decoction) is indicated.
[Commentary] Zhu Gong said: Early Shaoyin disease with fever and deep pulse requires this decoction. If after two or three days, Shaoyin Yang-deficiency symptoms appear, mild sweating with Ma Huang Fu Zi Gan Cao Tang (Ephedra, Aconite, Licorice Decoction) is necessary. This must be known. If Shaoyin disease presents with aversion to cold, curling up, occasional self-vexation, and dislike for heavy clothing, use Da Chai Hu Tang (Major Bupleurum Decoction) without Da Huang (Rhubarb).
Zhang Jiebin said: Taiyang symptoms resembling Shaoyin occur due to fever, aversion to cold, and paradoxically deep pulse. Shaoyin symptoms resembling Taiyang occur due to aversion to cold, deep pulse, and paradoxical fever. As Zhang Zhongjing stated: In Taiyang disease with fever, headache, paradoxically deep pulse, and body pain, if unresolved, rescue the interior with Si Ni Tang (Cinnamon Twig, Aconite, Licorice Decoction) due to interior deficiency. Similarly, in the current clause, although it is Shaoyin, the presence of fever indicates exterior cold not yet transmitted inward, requiring Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, Asarum Decoction) to scatter exterior pathogen. Both involve deep pulse and fever. Headache distinguishes Taiyang; absence distinguishes Shaoyin. Paradoxical fever in Shaoyin indicates shallow exterior pathogen resolvable by sweating (paradox is mild). Paradoxical deep pulse in Taiyang indicates severe Zhengqi decline (paradox is severe). Thus, Yang meridians may require warming the interior (using raw Aconite with Dried Ginger, where tonification contains dispersal). Yin meridians may require releasing the exterior (using processed Aconite with Ephedra, where dispersal contains tonification). This is Master Zhongjing's fundamental treatment principle.
[General Principle] Zhang Zhongjing stated: In Shaoyin disease, with body pain, cold hands and feet, bone/joint pain, and deep pulse, Fu Zi Tang (Aconite Decoction) is indicated.
[Commentary] Huang Zhongli said: This is Shaoyin Kidney disease. Bones belong to the Kidney; Kidney cold causes bone pain. Based on this, urgent warming of Kidney Yang is required using this decoction.
[General Principle] Zhang Zhongjing stated: With floating and slow pulse, exterior heat and interior cold, and diarrhea with undigested food, Si Ni Tang (Cinnamon Twig, Aconite, Licorice Decoction) is indicated. In disease with fever, headache, paradoxically deep pulse, if unresolved and body pain persists, rescue the interior with Si Ni Tang (Cinnamon Twig, Aconite, Licorice Decoction). With vomiting, weak pulse, free urination, slight fever, and cold reversal, the condition is difficult to treat; treat with Si Ni Tang (Cinnamon Twig, Aconite, Licorice Decoction). With simultaneous vomiting and diarrhea, free urination, profuse sweating, diarrhea with undigested food, interior cold and exterior heat, and faint pulse nearly extinct, Si Ni Tang (Cinnamon Twig, Aconite, Licorice Decoction) is indicated. In Shaoyin disease with deep pulse, urgently warm with Si Ni Tang (Cinnamon Twig, Aconite, Licorice Decoction).
[Commentary] Pang Anchang said: The five clauses omit symptoms because Shaoyin symptoms are inherent. Mentioning only deep pulse indicates solidified cold pathogen threatening to extinguish Yang in the zang. Urgent warming to rescue Yang is required based on this pulse alone.
Ke Qin said: Clause 1: Floating indicates exterior, Slow indicates interior. Floating with Slow suggests exterior deficiency and interior cold. Diarrhea with undigested food without prior purgation indicates exterior deficiency-heat and interior true cold.
Master Zhongjing prioritizes the interior in treating deficiency. This is cold damage, yet floating pulse and exterior heat suggest onset in Yang, known as "leaky bottom cold damage." Clause 2: Symptoms involve Ma Huang, indicating exterior disease. Pulse should be floating but is deep, an inversion. Deep pulse indicates interior location. Yang symptom with Yin pulse signifies Yang decline and Yin growth. Heat originating in exterior is Yang, but deficiency-cold occupying interior is True Yin. Clause 3: Weak pulse with slight fever is not Ministerial Fire. Cold-fluid in the diaphragm causes vomiting. Clause 4: Nearly extinct pulse with vomiting/diarrhea and undigested food indicates loss of Qi and Blood.
[General Principle] Zhang Zhongjing stated: In Shaoyin disease, with diarrhea of undigested food, interior cold and exterior heat, cold reversal, faint pulse nearly extinct, body not averse to cold, flushed face, or abdominal pain, dry heaving, sore throat, or cessation of diarrhea with absent pulse, Tong Mai Si Ni Tang (Pulse-Returning Cinnamon Twig, Aconite, Licorice Decoction) is indicated.
[Commentary] Zhu Gong said: Generally, fever in Yin syndrome is distinct. Pulse is deep, or accompanied by diarrhea and cold reversal. Patient with deep, fine pulses at all positions and desire to sleep has Shaoyin syndrome. Urgently prepare Si Ni Tang (Cinnamon Twig, Aconite, Licorice Decoction) to restore Yang; do not delay.
In Shaoyin disease, with dry mouth, tongue, and thirst, urgent purgation is required using Da Cheng Qi Tang (Major Order the Yellow Decoction). If pulse is deep and slow, warm with Si Ni Tang (Cinnamon Twig, Aconite, Licorice Decoction). Dry mouth/thirst indicates heat; deep/slow pulse distinguishes cold.
Shaoyin belongs to the Kidney, historically called Kidney Cold Damage. Dry mouth, tongue, and thirst require urgent purgation. Generally, Kidney Cold Damage lacks exterior/interior heat, featuring only vexation, silence, aversion to light, occasional abdominal pain, and deep/fine pulse. Historically, Si Shun Tang (Four Smooth Decoction) was used, but ancients disliked its heat. If Kidney disease retains some heat, use Zhongjing's Si Ni San (Cinnamon Twig, Rhubarb, Bupleurum, Licorice Powder). If after ten-plus days, persistent diarrhea and cold reversal occur (no heat signs), modify Si Shun Tang (Four Smooth Decoction).
In Shaoyin syndrome, dry mouth and throat mandate urgent purgation. Shaoyin governs the Kidney and connects to the tongue root. Pathogenic heat entering the zang and flowing into Shaoyin dries Kidney fluids and scorches throat collaterals, causing dry mouth/thirst/throat. Urgent purgation is required, unlike Yangming where purgation can be delayed. Although Yangming also has a case of profuse sweating requiring urgent purgation (due to stomach fluid depletion), Shaoyin urgency is distinct.
[General Principle] Zhang Zhongjing stated: With diarrhea of undigested food, interior cold and exterior heat, sweating, and cold reversal, Tong Mai Si Ni Tang (Pulse-Returning Cinnamon Twig, Aconite, Licorice Decoction) is indicated. With deep and slow pulse, the person has a slightly red face.