【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。下利清谷。里寒外热。汗出而厥者。通脉四逆汤主之。下利脉沉而
迟。其人面少赤。身有微热。下利清谷者。必郁冒。汗出而解。病患必微厥。所以然者。其面戴阳。
下虚故也。
【目】王肯堂曰。此阴寒内竭。逼其浮火上行于面。故发赤色。非热也。若误投寒凉之剂。即
死。又夹阴伤寒。虚阳泛上者。亦面赤也。但足冷脉沉者。是又烦躁面赤。足冷脉沉。不能饮水者。
此阴极也。宜温。
柯琴曰。上条。是寒热相半症。下利清谷。阴盛于里也。手足厥冷。寒盛于外也。身不恶寒面
赤。阳郁于表也。咽痛利止。阳回于内也。腹痛干呕。寒热交争也。温里通脉。乃扶阳之法。脉出
则从阳而生。厥逆则从阴而死。下条。脉症较轻。热微厥亦微。故面亦少赤。此阴阳相等。寒热自
和。故易愈。
鳌按。诸家面色之说。详在少阳经症。互参之可也。
【纲】仲景曰。少阴病。下利止而头眩。时时自冒者死。
【目】李杲曰。内症头痛。有时而作。有时而止。外症头痛。常常有之。直须传入里方罢。此
又内外症之不同者也。
王肯堂曰。下利则水谷竭。眩冒则阳气脱。故死。
陈士铎曰。少阴症。下利虽止。而头眩晕。亦是死症。盖阳虽回而阴已绝。下多亡阴。竟致阴
绝。而诸阳之上聚于头者。纷然乱动。所以眩冒。此阳欲脱而未脱。补其阳而阳气生。阳生则阴之
绝者。可以重续。阴生于阳也。方用参桂汤。人参二两。肉桂二钱。参能返阳气。桂能走肝肾。兼
补阴也。
【纲】仲景曰。病发热头疼。脉反沉。若不瘥。身体疼痛。当救其里。宜四逆汤。
【目】鳌按。发热头痛。病在表。本太阳麻黄症也。脉当浮而反沉。故为逆。
【纲】仲景曰。干呕。吐涎沫。头痛者。吴茱萸汤主之。
【目】柯琴曰。呕而无物。胃虚可知。吐惟涎沫。胃寒可知。头痛者。阳气不足。阴寒得以乘
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。下利脉沉而迟。其人面
少赤。身有微热。下利清谷者。必郁冒。汗出而解。病患必微厥。所以然者。其面戴阳。下虚故也。
【目】寇宗 曰。此条脉症皆轻。故能自作郁冒。汗出而自解也。
[General Principle] Zhang Zhongjing stated: In Shaoyin disease, if there is diarrhea with undigested food in the stool (Xiali Qinggu), internal cold and external heat (Lihan Waire), cold limbs (Shoujue Ni), a pulse that is faint and nearly imperceptible (Mai Wei Yu Jue), the body does not feel aversion to cold, and the patient's face appears red. Alternatively, there may be abdominal pain, dry heaving, sore throat, or cessation of diarrhea with an absent pulse. In such cases, Tongmai Sini Decoction (Pulse-Reviving Four Reversals Decoction) should be administered. If there is diarrhea with undigested food, internal cold and external heat, sweating, and cold limbs, Tongmai Sini Decoction should also be administered. If diarrhea is accompanied by a deep and slow pulse, the patient's face is slightly red, the body has slight fever, and there is diarrhea with undigested food, the patient will inevitably experience dizziness and mental confusion (Yumao), which will resolve through sweating. The patient will likely have mild cold limbs. This occurs because the face shows floating yang (Mian Daiyang), due to deficiency in the lower jiao.
[Commentary] Wang Kentang said: This condition arises from extreme depletion of yin-cold internally, forcing floating fire to ascend to the face, resulting in redness; it is not a heat syndrome. If cold-natured medicines are mistakenly administered, death will ensue. Additionally, in typhoid complicated by yin-deficiency (Jia Yin Shanghan), where deficient yang floats upward, facial redness also occurs. However, if the feet are cold and the pulse is deep, this indicates irritability and facial redness with cold feet and a deep pulse, along with an inability to drink water; this represents extreme yin excess and is suitable for warming treatment.
Ke Qin said: The previous clause describes a syndrome where cold and heat are balanced. Diarrhea with undigested food indicates yin excess in the interior; cold limbs indicate cold excess in the exterior; lack of aversion to cold and facial redness indicate yang constrained in the exterior; sore throat and cessation of diarrhea indicate yang returning to the interior; abdominal pain and dry heaving indicate the struggle between cold and heat. Warming the interior and unblocking the vessels is a method of supporting yang. When the pulse returns, life follows yang; when limbs are cold, death follows yin. The subsequent clause presents milder pulse and symptomatology, with slight heat and mild cold limbs, hence only slight facial redness. Here, yin and yang are equal, and cold and heat naturally harmonize, making recovery easier.
Shen Jin'ao noted: Discussions on facial coloration by various authors are detailed in the symptoms of the Shaoyang meridian and can be cross-referenced.
[General Principle] Zhang Zhongjing stated: In Shaoyin disease, if diarrhea ceases but is followed by dizziness and frequent sensations of vertigo or clouding of consciousness (Shishi Zimao), the prognosis is fatal.
[Commentary] Li Gao said: Headache caused by internal factors occurs intermittently, sometimes appearing and sometimes subsiding; headache caused by external factors is persistent and only ceases when the pathogen transmits inward. This distinguishes internal from external syndromes.
Wang Kentang said: Diarrhea depletes water and grain essences; dizziness and vertigo indicate the collapse of yang qi; therefore, it is a fatal condition.
Chen Shiduo said: In Shaoyin syndrome, although diarrhea stops, the presence of dizziness and vertigo indicates a fatal condition. Although yang qi returns, yin fluids are exhausted. Profuse diarrhea leads to loss of yin, ultimately causing yin exhaustion. The yang qi gathering at the head becomes chaotic and agitated, causing dizziness and vertigo. This represents yang attempting to escape but not yet fully collapsed. By tonifying yang, yang qi generates; as yang generates, the exhausted yin can be restored, for yin is born from yang. The formula used is Renshen Guizhi Tang (Ginseng and Cinnamon Twig Decoction): Ren Shen (Ginseng Radix et Rhizoma) two liang, Rou Gui (Cinnamomi Cortex) two qian. Ren Shen restores yang qi, while Rou Gui circulates through the Liver and Kidney, simultaneously tonifying yin.
[General Principle] Zhang Zhongjing stated: In a disease presenting with fever and headache, if the pulse is unexpectedly deep, and if the condition does not improve, accompanied by body pain, one should urgently treat the interior with Sini Decoction (Four Reversals Decoction).
[Commentary] Shen Jin'ao noted: Fever and headache indicate a superficial disease, originally a Taiyang Ma Huang Tang (Ephedra Decoction) syndrome. The pulse should be floating but is instead deep, thus constituting an adverse sign.
[General Principle] Zhang Zhongjing stated: For dry heaving, vomiting of saliva and froth, accompanied by headache, Wuzhuyu Tang (Evodia Decoction) should be administered.
[Commentary] Ke Qin said: Vomiting without material expulsion indicates stomach deficiency; vomiting only saliva and froth indicates stomach cold. Headache occurs because yang qi is insufficient, allowing yin-cold to invade.
[General Principle] Zhang Zhongjing stated: In cases of diarrhea with undigested food, internal cold and external heat, sweating, and cold limbs, Tongmai Sini Decoction (Pulse-Reviving Four Reversals Decoction) should be administered. In cases of diarrhea with a deep and slow pulse, slightly red face, slight body fever, and diarrhea with undigested food, the patient will inevitably experience dizziness and mental confusion (Yumao), resolving through sweating. The patient will have mild cold limbs. This is due to floating yang on the face (Mian Daiyang) caused by lower deficiency.
[Commentary] Kou Zongshi said: The pulse and symptoms in this clause are relatively mild, allowing the patient to spontaneously experience Yumao and resolve through sweating.