耶。必是已用温中诸汤不愈。转加躁烦。故主死耳。
总病论曰。与吴茱萸汤。宜细审其死生也。
舒氏云。案此条。与后吴茱萸汤证无异。彼证未言死。此证胡为乎不主吴茱萸汤。而断之曰死。是何理
也。于中疑有缺文。
少阴病。下利止。而头眩。时时自冒者死。
〔钱〕前条利自止。而手足温。则为可治。此则下利止。而头眩。头眩者。头目眩晕也。且时时自冒。
冒者。蒙冒昏晕也。虚阳上冒于巅顶。则阳已离根而上脱。下利无因而自止。则阴寒凝闭而下竭。于此可见阳
回之利止。则可治。阳脱之利止。则必死矣。正所谓有阳气则生。无阳气则死也。然既曰死证。则头眩自冒之
外。或更有恶寒四逆等证。及可死之脉。未可知也。但未备言之耳。
少阴病。四逆恶寒。而身蜷。脉不至。不烦而躁者死。（【原注】一作吐利而躁逆者苑。）
〔钱〕恶寒身蜷。而利。手足逆冷者。固为不治。此条但不利耳。上文吐利烦躁四逆者死。此虽不吐利。而
已不见阳烦。但见阴躁。则有阴无阳矣。其为死证无疑。况又脉不至乎。前已有脉不至者。因反发热。故云不
死。又有脉不出者。虽里寒。而犹有外热。身反不恶寒。而面赤。其阳气未绝。故有通脉四逆汤之治。此则皆
现阴极无阳之证。且不烦而躁。并虚阳上逆之烦。亦不可得矣。宁有不死者乎。
少阴病。六七日。息高者死。
〔程〕夫肺主气。而肾为生气之源。盖呼吸之门也。关系人之生死者最巨。息高者。生气已绝于下。而不
复纳。故游息仅呼于上。而无所吸也。死虽成于六七日之后。而机自兆于六七日之前。既值少阴受病。何不预
为固护。预为堤防。迨今真阳涣散。走而莫追。谁任杀人之咎。
少阴病。脉微细沉。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。
〔程〕今时论治者。不至于恶寒蜷卧。四肢逆冷等证叠见。则不敢温。不知证已到此。温之何及。况诸证有
至死不一见者。则盍于本论中之要旨。一一申详之。少阴病。脉必沉而微细。论中首揭此。盖已示人以可温之
脉矣。少阴病但欲卧。论中又已示人。以可温之证矣。汗出。在阳经不可温。在少阴宜急温。论中又切示人以
亡阳之故矣。况复有不烦自欲吐。阴邪上逆之证乎。则真武四逆。诚不啻三年之艾矣。乃不知预绸缪。延缓至
五六日。前欲吐。今且利矣。前不烦。今烦且躁矣。前欲卧。今不得卧矣。阳虚扰乱。阴盛转加。焉有不死者
乎。（原文烦冗。今采金鉴所改。）〔柯〕六经中。独少阴历言死证。他经无死证。甚者但曰难治耳。知少阴
病是生死关。
案他经。亦有死证。但不如此经之多端也。
少阴病。始得之。反发热。脉沉者。麻黄细辛附子汤主之。（千金翼。脉下。更有反字。成本。玉函。作
麻黄附子细辛汤。）
〔钱〕此言少阴之表证也。曰始得之者。言少阴初感之邪也。始得之。而即称少阴病。则知非阳经传邪。
亦非直入中脏。乃本经之自感也。始得之而发热。在阳经则常事耳。然脉沉。则已属阴寒。篇首云。无热而恶
寒者。发于阴也。发于阴。而又发热。是不当发之热。故云反也。察其发热。则寒邪在表。诊其脉沉。则阴寒
在里。表者。足太阳膀胱也。里者。足少阴肾也。肾与膀胱。一表一里。而为一合。表里兼治。〔程〕脉沉者。
由其人肾经素寒。虽表中阳邪。而里阳不能协应。故沉而不能浮也。〔周〕少阴与太阳。相为表里。故言少阴
表证。即太阳也。
麻黄细辛附子汤方
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。纳诸药。煮取三升。去滓。温服一升。日三服。（千金
翼。一斗。作二斗。二升。作一升。成本。脱诸字。）
〔钱〕麻黄。发太阳之汗。以解其在表之寒邪。以附子。温少阴之里。以补其命门之真阳。又以细辛之气温
味辛。专走少阴者。以助其辛温发散。三者合用。补散兼施。虽发微汗。无损于阳气矣。故为温经散寒之神剂云。
伤寒琐言曰。赵嗣真曰。仲景太阳篇云。病发热头痛。脉反沉。身体疼痛。当救其里。宜四逆汤。少阴篇
云。少阴病。始得之。反发热。脉沉者。麻黄附子细辛汤。均是发热脉沉。以其头痛。故属太阳。阳证脉当浮。
而反不能浮者。以里久虚寒。正气衰微。又身体疼痛。故宜救里使正气内强。逼邪外出。而干姜附子。亦能出
汗而散。假令里不虚寒而脉
浮。则正属太阳麻黄症矣。均是脉沉发热。以无头痛。故名少阴病。阴病当无热。今反热。寒邪在表。未全传
里。但皮肤郁闭为热。故用麻黄细辛。以发表热。附子以温少阴之经。假使寒邪入里。外必无热。当见吐利厥
逆等症。而正属少阴四逆汤症矣。由此观之。表邪浮浅。发热之反犹轻。正气衰微。脉沉之反为重。此四逆汤。
不为不重于麻黄附子细辛矣。又可见熟附配麻黄。发中有补。生附配干姜。补中有发。仲景之旨微矣。
十便良方。指迷方。附子细辛汤。头痛者。谓痛连脑户。或但额阁与眉相引。如风所吹。如水所湿。遇风
寒则极。常欲得热物熨。此由风寒客于足太阳之经。随经入脑。搏于正气。其脉微弦而紧。谓之风冷头痛。
于本方。加川芎生姜。
医贯曰。有头痛连脑者。此系少阴伤寒。宜本方。不可不知。
医经会解曰。若少阴证。脉沉欲寐。始得之。发热肢厥。无汗。为表病里和。当用正方。缓以汗之。若见二
便闭涩。或泻赤水。谓之有表复有里。宜去麻黄。名附子细辛汤。仍随各脏见证加药。房欲后伤寒者。多患前证。
张氏医通曰。暴哑声不出。咽痛异常。卒然而起。或欲咳而不能咳。或无痰。或清痰上溢。脉多弦紧。或
数疾无伦。此大寒犯肾也。麻黄附子细辛汤温之。并以蜜制附子噙之。慎不可轻用寒凉之剂。又云。香港脚。冷
痹恶风者。非术附麻黄并用。必不能开。麻黄附子细辛汤。加桂枝白术。
少阴病。得之二三日。麻黄附子甘草汤。微发汗。以二三日无证。故微发汗也。（玉函。全书。证上。有
里字。方本以下。并同。盖原文系于遗脱。当补入焉。）
〔周〕案此条。当与前条合看。补出无里证三字。知前条原无吐利躁渴里证也。前条已有反发热三字。而此
条专言无里证。知此条亦有发热表证也。少阴证见。当用附子。太阳热见。可用麻黄。已为定法。但易细辛。
以甘草。其义安在。只因得之二三日。津液渐耗。比始得者不同。故去细辛之辛散。益以甘草之甘和。相机施
治。分毫不爽耳。〔程〕既云微发汗矣。仍用以字故字推原之。足见郑重之意。〔柯〕要知此条是微恶寒微发热。
故微发汗也。〔鉴〕此二证皆未曰无汗。非仲景略之也。以阴不得有汗。不须言也。
麻黄附子甘草汤方
麻黄（二两去节） 甘草（二两炙） 附子（一枚炮去皮破八片）
上三味。以水七升。先煮麻黄一两沸。去上沫。纳诸药。煮取三升。去滓。温服一升。日三服。（玉函。
千金翼。三升。作二升半。一升。作八合）
〔周〕但言无里证。则有反发热之表在。可知矣。易细辛以甘草者。因二三日其势缓。故甘草亦取其缓也。
设兼见呕利一二里证。专主救里。在太阳已然。况少阴乎。
少阴病。得之二三日以上。心中烦不得卧。黄连阿胶汤主之。（千金翼。卧下。有者字。外台同。）
〔成〕脉经曰。风伤阳。寒伤阴。少阴受病。则得之于寒。二三日以上。寒极变热之时。热烦于内。心
中烦不得卧也。与黄连阿胶汤。扶阴散热。〔知〕二三日。邪在少阴。四五日。已转属阳明。故无呕利厥逆诸
证。而心烦不得卧者。是阳明之热。内扰少阴。故不欲寐也。当以解热滋阴为主治也。〔周〕气并于阴。则寐。
故少阴多寐。今反不得卧。明是热邪入里劫阴。故使心烦遂不卧也。二三日以上。该以后之日。而言之也。
〔舒〕外邪挟火而动者。心烦不眠。肌肤 燥。神
气衰减。小便短而咽中干。法主黄连阿胶汤。分解其热。润泽其枯。此条挈证未全。疑有缺文。
黄连阿胶汤方
黄连（四两） 黄芩（二两○成本。玉函。千金翼。外台。作一两。） 芍药（二两） 鸡子黄（三枚）
阿胶（三两一云三挺○千金翼。作三挺。外台。作三片。）
上五味。以水六升。先煮三物。取二升。去滓。纳胶烊尽。小冷。纳鸡子黄。搅令相得。温服七合。日三
服。（水六升。成本。玉函。作五升。）
〔柯〕此少阴之泻心汤也。凡泻心。必藉连芩而导引。有阴阳之别。病在三阳。胃中不和。而心下痞硬
者。虚则加参甘补之。实则加大黄下之。病在少阴。而心中烦不得卧者。既不得用参甘以助阳。亦不得用大黄
以伤胃也。故用芩连。以直折心火。用阿胶。以补肾阴。鸡子黄佐芩连。于泻心中补心血。芍药佐阿胶。于补
阴中敛阴气。斯则心肾交合。水升火降。是以扶阴泻阳之方。而变为滋阴和阳之剂也。〔吴〕此汤。本治少阴
温热之证。以其阳邪炎威。伤犯真阴。故二三日以上。便见心烦不得卧。所以始病之际。即用芩连大寒之药。
兼芍药阿胶鸡子黄。以滋养阴血也。然伤寒六七日后。热传少阴。伤其阴血者。亦可取用。与阳明腑实。用承
气汤法。虽虚实补泻悬殊。而祛热救阴之意。则一耳。
肘后方。时气瘥后。虚烦不得眠。眼中 疼。懊 。黄连四两。芍药二两。黄芩一两。阿胶三小挺。水
六升。煮取三升。分三服。亦可纳鸡子黄二枚。
少阴病。得之一二日。口中和。其背恶寒者。当灸之。附子汤主之。（脉经。无附子汤主之五字。）
〔魏〕少阴病三字中。该脉沉细而微之诊。见但欲寐之证。却不发热。而单背恶寒。此少阴里证之确据
也。〔成〕少阴客
热。则口燥舌干。而渴。口中和者。不苦不燥。是无热也。背为阳。背恶寒者。阳气弱。阴气胜也。经曰。无
热恶寒者。发于阴也。灸之。助阳消阴。与附子汤。温经散寒。〔王〕背恶寒者。阴寒气盛。此条是也。又或
阳气内陷。有背恶寒者。经所谓伤寒无大热。口燥渴。心烦背微恶寒。白虎加人参汤主之。是也。一为阴寒气
盛。一为阳气内陷。当于口中润燥辨之。
汪氏云。补亡论。常器之云。当灸膈俞关元穴。背俞第三行。案第三行者。当是膈关。非膈俞也。图经云。
膈关二穴。在第七椎下。两旁相去各三寸陷中。正坐取之。足太阳气脉所发。专治背恶寒。脊强俯仰难。可灸
五壮。盖少阴中寒。必由太阳而入。故宜灸其穴也。又关元一穴。在腹部中行。脐下三寸。足三阴任脉之会。
灸之者。是温其里。以助其元气也。钱氏云。灸之。谓灸少阴之脉穴。如涌泉然谷太溪复溜阴谷等井荣输经合。
即三部九候论之所谓。下部地。足少阴也。王注云。谓肾脉在足内踝后跟骨上陷中。太溪之分。动脉应手者是
也。灸之者。所以温少阴之经也。
附子汤方
附子（二枚炮去皮破八片○成本。方本。诸本。脱炮字。只志聪。锡驹本。有炮字。） 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。
〔柯〕此大温大补之方。乃正治伤寒之药。为少阴固本御邪第一之剂也。与真武汤。似同而实异。倍术附。
去姜加参。是温补以壮元阳。真武汤。还是温散。而利胃水也。〔汪〕武陵陈氏曰。四逆诸方。皆有附子。于
此独名附子汤。其义重在附子。他方皆附子一枚。此方两枚。可见也。附子之用不多。则其力岂能兼散表里之
寒哉。邪之所凑。其气必虚。参术茯苓。皆甘温。益气以补卫气之虚。辛热与温补相合。则
气可益。而邪可散矣。既用附子之辛烈。而又用芍药者。以敛阴气。使卫中之邪。不遽全进于阴耳。
千金方。附子汤。治湿痹缓风。身体疼痛。如欲折。肉如锥刺刀割。
于本方。加桂心甘草。○案此据下条证。转用者。
少阴病。身体痛。手足寒。骨节痛。脉沉者。附子汤主之。（玉函注。沉。一作微。）
〔钱〕身体骨节痛。乃太阳寒伤营之表证也。然在太阳。则脉紧。而无手足寒之证。故有麻黄汤发汗之治。
此以脉沉。而手足寒。则知寒邪过盛。阳气不流。营阴滞涩。故身体骨节皆痛耳。且四肢为诸阳之本。阳虚不
能充实于四肢。所以手足寒。此皆沉脉之见证也。故以附子汤主之。以温补其虚寒也。即此推之。太阳篇之发
汗病不解。虚故也。以芍药甘草附子汤。及发汗后。身疼痛。脉沉迟者。桂枝加芍药生姜人参新加汤主之者。
皆汗多亡阳。阴盛阳虚之证。即此义也。
少阴病。下利便脓血者。桃花汤主之。（方本。利。作痢。注云。古利无 。 。后人所加。）
〔成〕阳病下利。便脓血者。协热也。少阴病。下利便脓血者。下焦不约。而里寒也。与桃花汤。固下散
Indeed. This must be a case where warming-middle decoctions have already been used without success, and the condition has worsened with restlessness and irritability. Therefore, it is judged as a fatal syndrome.
*Zong Bing Lun* states: Administer Wuzhuyu Tang (Evodia Fruit Decoction), but carefully examine the patient's prognosis for life or death.
Shu Chi-yuan says: Regarding this clause, it is no different from the Wuzhuyu Tang syndrome described later. In that syndrome, death is not mentioned; why is this syndrome not treated with Wuzhuyu Tang but declared fatal? What is the rationale? It is suspected that there are missing characters in the text.
In Shaoyin disease, if diarrhea stops but is accompanied by dizziness and frequent sensations of vertigo or clouding of consciousness, it is a fatal syndrome.
[Qian] In the previous clause, diarrhea stopping with warm hands and feet indicates a treatable condition. Here, diarrhea stops but dizziness occurs. "Dizziness" refers to vertigo of the head and eyes. Furthermore, there is frequent sensation of clouding. "Clouding" refers to a state of mental confusion and dizziness. When deficient Yang floats upward to the vertex, it signifies that Yang has detached from its root and is escaping upward. The spontaneous cessation of diarrhea without cause indicates that Yin-cold is coagulated and closed, leading to exhaustion below. From this, we can see that diarrhea stopping due to the return of Yang is treatable, whereas diarrhea stopping due to Yang collapse is fatal. This precisely aligns with the principle: "Where there is Yang, there is life; where there is no Yang, there is death." Since it is stated as a fatal syndrome, besides dizziness and clouding, there may also be symptoms such as aversion to cold and cold extremities, as well as potentially fatal pulse signs, though these are not explicitly detailed.
In Shaoyin disease, characterized by cold extremities, aversion to cold, body curling up, absence of pulse, absence of irritability but presence of restlessness, is a fatal syndrome. ([Original Note]: Another version reads "vomiting, diarrhea, restlessness, and counterflow.")
[Qian] Aversion to cold, body curling, accompanied by diarrhea and cold extremities, is inherently difficult to treat. This clause notes the absence of diarrhea. The earlier text mentions that vomiting, diarrhea, irritability, and cold extremities indicate death. Although this case lacks vomiting and diarrhea, the absence of Yang-related irritability and the presence only of Yin-related restlessness indicate an excess of Yin and deficiency of Yang. This is undoubtedly a fatal syndrome. Moreover, the pulse is absent. Previously, cases with an absent pulse were considered non-fatal because of rebound fever. There were also cases where the pulse was imperceptible; although there was interior cold, there was still exterior heat, the body was not averse to cold, and the face was red, indicating that Yang had not yet perished, thus allowing treatment with Tongmai Sini Tang (Pulse-Returning Four Reversals Decoction). Here, however, the signs indicate extreme Yin and absence of Yang. The absence of irritability, with only restlessness, and even the absence of irritability caused by floating deficient Yang, makes survival impossible.
In Shaoyin disease, if after six or seven days the breathing becomes shallow and rapid (Xi Gao), it is a fatal syndrome.
[Cheng] The Lungs govern Qi, and the Kidneys are the source of Qi generation, serving as the gate of respiration. This factor is crucial to life and death. "Xi Gao" (high breathing) indicates that the vital Qi has been severed below and can no longer be grasped. Thus, respiration is merely exhalation from above without inhalation. Although death manifests after six or seven days, the mechanism has been foreshadowed before this period. Given that Shaoyin disease has occurred, why was preventive protection not undertaken earlier? Now that True Yang has scattered and cannot be retrieved, who bears the responsibility for this fatality?
In Shaoyin disease, with a pulse that is faint, fine, and deep, a desire to sleep, sweating without irritability, and a subjective urge to vomit; progressing to five or six days with spontaneous diarrhea, renewed irritability, and inability to lie down or sleep, is a fatal syndrome.
[Cheng] Contemporary practitioners hesitate to use warming methods unless they observe severe symptoms like aversion to cold, curling up, and cold extremities. They fail to realize that once the syndrome reaches this stage, warming therapy is urgently needed. Furthermore, some fatal syndromes do not present all typical symptoms. One should thoroughly understand the key principles of this treatise. Shaoyin disease pulses are invariably deep, faint, and fine; the text highlights this first to indicate a pulse amenable to warming. The symptom of "desire to sleep" in Shaoyin disease indicates a syndrome amenable to warming. Sweating is contraindicated for warming in Yang meridians but requires urgent warming in Shaoyin, signaling Yang collapse. Additionally, the absence of irritability combined with a urge to vomit indicates counterflow of Yin pathogenic factors. In such cases, Zhenwu Tang (True Warrior Decoction) and Sini Tang (Four Reversals Decoction) are as essential as aged moxa. However, failing to prepare in advance and delaying until five or six days leads to progression: the prior urge to vomit becomes diarrhea; the prior lack of irritability becomes irritability and restlessness; the prior desire to sleep becomes insomnia. Yang deficiency causes disturbance, and Yin excess intensifies, making death inevitable. (The original text is verbose; the revised version from *Yi Zong Jin Jian* [Golden Mirror of Medical Tradition] is adopted here.) [Ke] Among the Six Meridians, only Shaoyin extensively discusses fatal syndromes; other meridians describe conditions as merely "difficult to treat." This indicates that Shaoyin disease is the critical juncture of life and death.
Note: Other meridians also have fatal syndromes, but not as numerous as in this one.
At the onset of Shaoyin disease, if there is rebound fever and a deep pulse, Mahuang Xixin Fuzi Tang (Ephedra, Asarum, and Prepared Aconite Decoction) is indicated. (*Qianjin Yifang* adds "fan" [rebound/unexpected] after "pulse"; *Chengben* and *Yuhan Jing* read "Mahuang Fuzi Xixin Tang".)
[Qian] This describes the exterior syndrome of Shaoyin. "At onset" refers to the initial contraction of pathogenic factors in Shaoyin. Being called "Shaoyin disease" at onset indicates that the pathogen did not transmit from a Yang meridian nor directly invade the zang organs, but rather affected the meridian itself. Fever at onset is common in Yang meridians. However, a deep pulse indicates interior Yin-cold. The opening chapter states: "Absence of fever with aversion to cold indicates onset in Yin." Onset in Yin with fever is an unexpected fever, hence termed "rebound" (fan). Observing fever indicates cold pathogen in the exterior; diagnosing a deep pulse indicates Yin-cold in the interior. The exterior corresponds to the Foot-Taiyang Bladder Meridian; the interior corresponds to the Foot-Shaoyin Kidney Meridian. Kidney and Bladder form a interior-exterior pair. Thus, this formula treats both exterior and interior. [Cheng] A deep pulse occurs because the person's Kidney meridian is chronically cold. Although there is Yang pathogen in the exterior, the interior Yang cannot coordinate, resulting in a deep rather than floating pulse. [Zhou] Shaoyin and Taiyang are interior-exterior pairs; therefore, referring to Shaoyin exterior syndrome implies Taiyang.
**Mahuang Xixin Fuzi Tang Formula**
Mahuang (Ephedrae Herba, 2 liang, remove joints)
Xixin (Asari Radix et Rhizoma, 2 liang)
Fuzi (Aconiti Lateralis Radix Praeparata, 1 piece, processed, peel removed, broken into 8 pieces)
Take these three ingredients. Boil in 10 sheng of water. First boil Mahuang, reducing by 2 sheng, and skim off the foam. Add the remaining herbs. Boil to obtain 3 sheng. Strain. Warm and take 1 sheng, three times daily. (*Qianjin Yifang*: 10 sheng becomes 2 dou; 2 sheng becomes 1 sheng. *Chengben* omits "zhu" [all/remaining]).
[Qian] Mahuang induces sweating in Taiyang to resolve exterior cold. Fuzi warms the Shaoyin interior to tonify Mingmen True Yang. Xixin, with its warm temperature and pungent flavor, specifically enters Shaoyin to assist in pungent-warm dispersion. The combination of these three provides both tonification and dispersion. Although it induces slight sweating, it does not damage Yang Qi. Hence, it is regarded as a divine agent for warming meridians and dispersing cold.
*Shanghan Suoyan* cites Zhao Sizhen: In the Taiyang chapter, Zhang Zhongjing states: "Fever, headache, pulse reversely deep, body pain, should rescue the interior, suitable for Sini Tang." In the Shaoyin chapter: "Shaoyin disease, at onset, rebound fever, deep pulse, Mahuang Fuzi Xixin Tang." Both present fever and deep pulse. Headache assigns it to Taiyang. Yang syndrome pulses should be floating; the failure to float indicates chronic interior deficiency-cold and weak righteous Qi. Body pain necessitates rescuing the interior to strengthen righteous Qi internally, forcing pathogens out. Ganjiang and Fuzi can also induce sweating to disperse pathogens. If the interior were not deficient-cold and the pulse floating, it would be a standard Taiyang Mahuang syndrome. Both present deep pulse and fever; absence of headache names it Shaoyin disease. Yin syndrome should lack fever; rebound fever indicates cold pathogen in the exterior, not fully transmitted inward, causing heat via skin closure. Thus, Mahuang and Xixin release exterior heat, while Fuzi warms the Shaoyin meridian. If cold entered the interior, there would be no exterior heat, but rather vomiting, diarrhea, and cold extremities, fitting Sini Tang. Thus, superficial exterior pathogen with rebound fever is lighter; weak righteous Qi with deep pulse is heavier. This highlights the importance of Sini Tang relative to Mahuang Fuzi Xixin Tang. It also illustrates that prepared Fuzi with Mahuang offers tonification within dispersion, while raw Fuzi with Ganjiang offers dispersion within tonification. Zhang Zhongjing's principles are subtle.
*Shibian Liangfang* and *Zhimi Fang*: Fuzi Xixin Tang. For headache involving the brain (Naohu) or forehead and eyebrows, feeling like wind blowing or water wetting, worsening with cold wind, preferring hot compresses: this is Wind-Cold Headache caused by Wind-Cold invading the Foot-Taiyang meridian and entering the brain, obstructing righteous Qi. Pulse is faint, wiry, and tight. Add Chuanxiong and Shengjiang to this formula.
*Yi Guan* states: Headache extending to the brain is Shaoyin Cold Damage; use this formula.
*Yijing Huijie* states: If Shaoyin syndrome presents with deep pulse and desire to sleep, at onset with fever, cold extremities, and anhidrosis, it is exterior pathology with harmonious interior. Use the main formula to induce slow sweating. If constipation or bloody diarrhea occurs, it is exterior with interior involvement. Remove Mahuang, naming it Fuzi Xixin Tang, and add herbs based on organ manifestations. Post-coital Cold Damage often presents thus.
*Zhangshi Yitong* states: Sudden aphonia, severe sore throat, sudden onset, coughing difficulty, clear phlegm overflow, with wiry-tight or rapid-disordered pulse: this is Great Cold invading the Kidney. Treat with Mahuang Xuzi Xixin Tang to warm, and hold honey-processed Fuzi in the mouth. Avoid cold-cooling agents. Also, for gout, cold bi, and aversion to wind, using Baizhu, Fuzi, and Mahuang together is necessary. Add Guizhi and Baizhu to Mahuang Fuzi Xixin Tang.
In Shaoyin disease, after two or three days, if there are no interior symptoms, Ma Huang Fu Zi Gan Cao Tang (Ephedra, Prepared Aconite, and Licorice Decoction) is used to induce slight sweating. (*Yuhan Jing* and complete texts insert "li" [interior] before "zheng" [symptoms]. The formula follows. The omission is likely a textual loss and should be inserted.)
[Zhou] This clause should be read with the previous one. Inserting "no interior symptoms" clarifies that the previous clause lacked vomiting, diarrhea, restlessness, and thirst. The previous clause mentioned "rebound fever," implying this clause also has fever/exterior symptoms. Shaoyin symptoms require Fuzi; Taiyang heat allows Mahuang. This is established practice. Replacing Xixin with Gancao: After two or three days, fluids are depleted compared to onset. Thus, Xixin's pungent dispersion is removed, and Gancao's sweet moderation is added to adapt to the changing condition precisely. [Cheng] The use of "yi" (by means of) and "gu" (therefore) emphasizes caution. [Ke] This involves slight aversion to cold and slight fever, hence slight sweating. [Jian] Neither case mentions anhidrosis because Yin syndromes do not sweat; it is unnecessary to state.
**Mahuang Fuzi Gancao Tang Formula**
Mahuang (Ephedrae Herba, 2 liang, remove joints)
Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle, 2 liang, honey-fried)
Fuzi (Aconiti Lateralis Radix Praeparata, 1 piece, processed, peel removed, broken into 8 pieces)
Take these three ingredients. Boil in 7 sheng of water. First boil Mahuang for one boil, skim foam. Add remaining herbs. Boil to obtain 3 sheng. Strain. Warm and take 1 sheng, three times daily. (*Yuhan Jing*, *Qianjin Yifang*: 3 sheng becomes 2.5 sheng; 1 sheng becomes 8 he).
[Zhou] Stating "no interior symptoms" confirms the presence of rebound fever/exterior syndrome. Replacing Xixin with Gancao is because the condition slows after two or three days, and Gancao provides moderation. If vomiting or diarrhea (interior symptoms) appear, prioritize rescuing the interior, as in Taiyang, let alone Shaoyin.
In Shaoyin disease, after two or three days or more, if there is internal vexation and inability to lie down, Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is indicated. (*Qianjin Yifang* adds "zhe" [particle] after "wo" [lie down]; *Waitai Miyao* agrees.)
[Cheng] *Mai Jing* states: Wind injures Yang, Cold injures Yin. Shaoyin disease results from Cold. After two or three days, Cold極 transforms into Heat. Heat vexes internally, causing heart vexation and insomnia. Administer Huanglian Ejiao Tang to support Yin and dissipate heat. [Zhi] Two to three days: pathogen in Shaoyin. Four to five days: transmission to Yangming. Absence of vomiting, diarrhea, and cold extremities, but presence of heart vexation and insomnia, indicates Yangming heat disturbing Shaoyin, causing unwillingness to sleep. Treatment should focus on clearing heat and nourishing Yin. [Zhou] Qi merging with Yin leads to sleep; thus Shaoyin often features somnolence. Inability to sleep indicates Heat pathogen entering interior and consuming Yin, causing vexation. "Two to three days or more" includes subsequent days. [Shu] External pathogen carrying Fire causes heart vexation, insomnia, dry skin, diminished spirit, short urine, and dry throat. Standard treatment is Huanglian Ejiao Tang to separate heat and moisten dryness. This clause lists incomplete symptoms, suggesting missing text.
**Huanglian Ejiao Tang Formula**
Huanglian (Coptidis Rhizoma, 4 liang)
Huangqin (Scutellariae Radix, 2 liang ○ *Chengben*, *Yuhan Jing*, *Qianjin Yifang*, *Waitai Miyao* read 1 liang)
Shaoyao (Paeoniae Radix Alba, 2 liang)
Jizihuang (Ovi Oolum, 3 pieces)
Ejiao (Asini Corii Colla, 3 liang ○ *Qianjin Yifang* reads 3 ting; *Waitai Miyao* reads 3 pian)
Take these five ingredients. Boil in 6 sheng of water. First boil the first three ingredients to obtain 2 sheng. Strain. Add Ejiao and melt completely. Cool slightly. Add Jizihuang and stir well. Warm and take 7 he, three times daily. (Water 6 sheng, *Chengben*, *Yuhan Jing* read 5 sheng).
[Ke] This is the Xiexin Tang (Drain the Epigastrium Decoction) of Shaoyin. Xiexin formulas rely on Huanglian and Huangqin for guidance, differing in Yin/Yang. In Three Yang meridians, stomach disharmony with epigastric fullness/stiffness: deficiency adds Renshen and Gancao; excess adds Dahuang. In Shaoyin, with heart vexation and insomnia, neither Renshen/Gancao (to aid Yang) nor Dahuang (to injure Stomach) is suitable. Thus, Huangqin and Huanglian directly suppress Heart Fire; Ejiao tonifies Kidney Yin. Jizihuang assists Huangqin/Huanglian to nourish Heart Blood while draining; Shaoyao assists Ejiao to astringe Yin. This facilitates Heart-Kidney interaction, Water rising and Fire descending, transforming a Yin-supporting/Yang-draining formula into a Yin-nourishing/Yang-harmonizing agent. [Wu] This decoction originally treats Shaoyin Warm-Heat syndromes. Yang pathogen flares, injuring True Yin, causing heart vexation and insomnia after two to three days. Hence, immediately use cold Huanglian/Huangqin, combined with Shaoyao, Ejiao, and Jizihuang to nourish Yin and Blood. Even if Cold Damage heat transmits to Shaoyin after six-seven days, injuring Yin-Blood, this formula applies. Though vastly different from Chengqi Tang in deficiency/excess and tonification/draining, the intent to clear heat and save Yin is identical.
*Zhouhou Fang*: Post-epidemic deficiency vexation and insomnia, eye pain, agonizing discomfort. Huanglian 4 liang, Shaoyao 2 liang, Huangqin 1 liang, Ejiao 3 small ting. Boil in 6 sheng water to 3 sheng, divide into three doses. Can add 2 Jizihuang.
In Shaoyin disease, after one or two days, if the mouth feels normal (not bitter or dry) and there is aversion to cold in the back, moxibustion should be applied, and Fuzi Tang (Aconite Decoction) administered. (*Mai Jing* omits "Fuzi Tang zhu zhi" [Fuzi Tang is indicated]).
[Wei] "Shaoyin disease" implies deep, faint, fine pulse and somnolence. Absence of fever with isolated back aversion to cold is definitive evidence of Shaoyin interior syndrome. [Cheng] Shaoyin guest-heat causes dry mouth/tongue and thirst. "Normal mouth" (not bitter/dry) indicates no heat. Back is Yang; back aversion to cold indicates weak Yang and dominant Yin. Classic states: "No fever with aversion to cold indicates onset in Yin." Moxibustion aids Yang and dispels Yin. Fuzi Tang warms meridians and disperses cold. [Wang] Back aversion to cold indicates excessive Yin-cold (this case). Alternatively, internal sinking of Yang causes back aversion to cold, as in "Cold damage with no great heat, dry mouth/thirst, heart vexation, slight back aversion to cold, Baihu Jia Renshen Tang indicated." One is Yin-cold excess; the other is Yang sinking. Differentiate by moisture/dryness in the mouth.
Wang Shi cites *Buwang Lun* (Chang Qizhi): Moxibustion on Ge Shu and Guan Yuan points. Third row of Back-Shu points. Note: Third row is Ge Guan, not Ge Shu. *Tujing* states: Ge Guan (2 points) are below the 7th thoracic vertebra, 3 cun lateral. Sit upright. Foot-Taiyang Qi emerges here. Treats back aversion to cold and stiff spine. Moxa 5 cones. Shaoyin Cold Damage enters via Taiyang, hence these points. Guan Yuan (1 point) is 3 cun below umbilicus on midline, meeting Foot-Taiyin, Foot-Yangming, Foot-Jueyin, and Ren Mai. Moxibustion warms interior and boosts Yuan Qi. Qian Shi states: Moxibustion refers to Shaoyin meridian points like Yongquan, RanGu, Taixi, Fuliu, YingGu (Jing-River-Sea points). Wang Bing notes: Kidney pulse is behind the medial malleolus at Taixi. Moxibustion warms Shaoyin meridians.
**Fuzi Tang Formula**
Fuzi (Aconiti Lateralis Radix Praeparata, 2 pieces, processed, peel removed, broken into 8 pieces ○ *Chengben*, *Fangben*, and others omit "processed"; only Zhicong and Xiju versions include it)
Fuling (Poria, 3 liang)
Renshen (Ginseng Radix, 2 liang)
Baizhu (Atractylodis Macrocephalae Rhizoma, 4 liang)
Shaoyao (Paeoniae Radix Alba, 3 liang)
Take these five ingredients. Boil in 8 sheng of water to obtain 3 sheng. Strain. Warm and take 1 sheng, three times daily.
[Ke] This is a major warming and tonifying formula, the primary treatment for Cold Damage, the foremost agent for consolidating the root and resisting pathogens in Shaoyin. Unlike Zhenwu Tang, which warms and disperses to benefit stomach water, Fuzi Tang doubles Baizhu and Fuzi, removes Ganjiang, adds Renshen, to warm and tonify Yuan Yang. [Wang] Chen Wuling notes: All Sini formulas contain Fuzi, but this is named Fuzi Tang, emphasizing Fuzi. Others use one piece; this uses two. Insufficient Fuzi cannot disperse exterior and interior cold simultaneously. Where pathogen gathers, righteousness is deficient. Renshen, Baizhu, and Fuling are sweet-warm, boosting Qi and defending Qi deficiency. Pungent-hot combined with warm-tonifying boosts Qi and disperses pathogen. Shaoyao is used with pungent Fuzi to astringe Yin, preventing exterior pathogens from fully penetrating Yin.
*Qianjin Fang*: Fuzi Tang treats damp-bi and wind-paralysis, body pain as if breaking, muscle pain like needle刺 or knife cutting. Add Guizhi and Gancao to this formula. ○ Note: Adapted from the next clause's syndrome.
In Shaoyin disease, with body pain, cold hands and feet, bone joint pain, and deep pulse, Fuzi Tang is indicated. (*Yuhan Jing* note: Deep, alternatively Micro/Faint).
[Qian] Body and joint pain are Taiyang Cold damaging Ying (exterior syndrome). In Taiyang, pulse is tight without cold extremities, treated with Mahuang Tang to sweat. Here, deep pulse and cold extremities indicate excessive Cold, stagnant Yang, and sluggish Ying-Yin, causing pain. Limbs are the root of Yang; Yang deficiency fails to fill limbs, causing cold extremities. These are manifestations of the deep pulse. Thus, Fuzi Tang warms and tonifies deficiency-cold. By analogy, in Taiyang chapter, unresolved sweating due to deficiency uses Shaoyao Gancao Fuzi Tang; post-sweating body pain with deep-slow pulse uses Guizhi Jia Shaoyao Shengjiang Renshen Xinjia Tang. Both are due to excessive sweating causing Yang loss, Yin excess, and Yang deficiency, following this same principle.
In Shaoyin disease, with diarrhea and pus/blood in stool, Taohua Tang (Peach Seed Decoction) is indicated. (*Fangben* reads "Li" [dysentery] instead of "Li" [diarrhea]. Note: Ancient "Li" had no character for dysentery; added later.)
[Cheng] Yang disease diarrhea with pus/blood is heat-collateral diarrhea. Shaoyin disease diarrhea with pus/blood is lower jiao insecurity and interior cold. Administer Taohua Tang to secure the lower and disperse cold.