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。（成注引内经曰。热淫于内。佐以甘苦。以酸收之。以苦发之。
枳实甘草之苦甘。以泄里热。芍药之酸。以收阴气。柴胡之苦。以发表热。琥按上方。虽云。治少阴。实阳明少阳药也。）
内台方议曰。四逆者手足不温也。四厥者。寒冷之甚也。四厥为阴寒之邪。四逆为传经之邪。乃阳热已退。邪气
不散。将欲传阴而未入也。此只属阳。故与凉剂以治之。用甘草为君。以和其中而行四末。以枳实为臣。而行结滞。以
芍药为佐。而行营气。以柴胡为使。而通散表里之邪也。琥按上云。阳热已退。言阳经之邪热。敛而退入于里。以故外
不热而四逆。仲景用四逆散者。乃和解邪热。兼消里实之剂。
后加减法
咳者。加五味子干姜各五分。并主下利。（成注云。肺寒气逆则咳。五味子之酸。收逆气。干姜之辛散肺寒。并主下
利者。肺与大肠为表里。上咳下利。治则颇同。愚意云。亦有肺热而咳者不可拘也。下利亦然。）悸者。加桂枝。五分。
（内台方注云。气虚不能通行于心。则心下筑筑而动悸也。桂枝入心。故加之。愚意云。亦有邪热乘于心包而动悸者。
不可以气虚例。治之。）小便不利者。加茯苓五分。（条辩云。茯苓味淡渗而利窍。故宜加之。）腹中痛者。加附子一枚。
炮令拆。（成注云。里虚遇邪则痛。加附子以补虚。愚按前成注于方后云。热淫于内云云。枳实甘草之苦甘。以泄里热。
盖里热宜泄。虽腹痛。未必是虚。若用炮附子。必致大害条辩顺文作解。其误甚矣。建安许氏云。古金镜方中倍加芍药
五分。以其能止痛也。后人改作附子。此岂从治之法邪。）泄利下重者。先以水五升。煮薤白三升。煮取三升去滓。以散
三方寸七。内汤。中煮取一升半。分温再服。（成注云泄利下重者。下焦气滞也。加薤白以泄气滞。）
少阴病下利六七日。咳而呕。渴心烦。不得眠者。猪苓汤主之。（此治少阴热利分理之法也。成注云。下利不渴者。
里寒也。此以下利而渴。知非里寒。至六七日。正当热邪传里之时。经云足。少阴之脉。其直者入肺中。其支者。从肺
出络心。注胸中。下利本有水渍。经中之热。与水搏结。侵于肺。则咳逆于胸。则呕。凌于心。则烦。少阴之病本欲寐。
今者反不得眠。其为热甚而躁动。明矣。与猪苓汤以清降邪热。通调水道。斯利止而呕渴等候自平矣。
或问下利咳而呕渴。心烦不得眠。焉知非少阳阳明病。余答云。少阳阳明。若见此证为里实。其脉必弦大而长。此
条病。脉必微细。故知其为少阴下利之证无疑。猪苓汤方见前第六卷阳明篇中。）
内台方议曰。少阴下利不渴者。为寒。今此下利渴。又咳而呕。心烦不得眠。知非里寒。乃里热者。故用猪苓为
君。茯苓为臣轻淡之味。而理虚烦。行水道。泽泻为佐而泄伏水。阿胶滑石为使。镇下而利水道者也。
琥按阿胶之用。不但利水。其气平而味甘微咸。上以益肺气而清化源。则咳止。下以滋肾阴而除经热则利平。此成
氏未悉之义。学人不可不知。
琥又按上方。乃治阳明病。热渴引饮。小便不利之剂。上条病亦借用之。何也。盖阳明病。发热。渴欲饮水。小便
不利者。乃水热相结而不行。兹则少阴病。下利咳而呕渴。心烦不得眠者。亦水热搏结而不行也。病名虽异。而病源则
同。故仲景法。同用猪苓汤主之。不过是清热利水。兼润燥滋阴之义。
少阴病得之二三日。口燥咽干者。急下之宜大承气汤。（此条系邪传少阴。热入于府之证。少阴病得之二三日者。非
才得病二三日。即口燥咽干。谓少阴口燥咽干之病。已得之二三日也。少阴之脉。循喉咙挟舌本邪热传于经。以故口燥
咽干。成注云邪热已甚。肾水将干。急与大承气汤下之。以全肾也。汤见前第六卷阳明篇中。或问大承气汤。乃下胃府
实热之药。与少阴病热。肾水干之证无与。成注云与。大承气汤。急下之以全肾。何也。余答云。仲景于论例中原云。
三阴经受病。已入于府者。可下而已。则是上条少阴病乃入府证也。少阴邪热。已入于府。胃府实热。以故口燥咽干。
用大承气汤以泄府实。而经中之邪热自除。且少阴之藏本肾属水。胃府属土。泻土所以救水。故成注云然也。）
少阴病。自利清水。色纯青心下必痛。口干燥者急下之。宜大承气汤。（此条少阴病。亦热邪入府。所当急下之证。
少阴之藏本水。经中热极。则迫其水液下流。而肾燥。肾愈燥。则肠中之物愈坚。以故下利。止清水耳。色纯青者。肾
将竭而肝木反来侮之。故色青也。心下痛为实。口干燥为热。故与大承气汤。以下实热之邪。）
少阴病六七日腹胀不大便者。急下之。宜大承气汤。（此条病。虽系少阴。实则阳明。实热证之显见者也。少阴邪热。
传入阳明胃府。成注云。阳明内热壅甚。腹满不大便。阳明病土胜肾水则干。急与大承气汤。以救肾水。或问少阴之邪。
既传阳明而见腹胀等证。何以不入阳明篇中。余答云。此条病实承上二条。口燥咽干之证而言。以故系之为少阴病。否
则与阳明病。实无以别矣。学人宜细诊之。）
（附例）少阴负趺阳者。为顺也。（此条自厥阴篇移附于此。愚意云。少阴病可下者。亦当于脉候决之。少阴者。两
手尺中之脉也。趺阳者。两足跗上高骨间动脉也。少阴主肾水。趺阳主胃土。兹者。少阴脉弱。趺阳脉强。是为负于趺
阳。则肾水已亏。胃土太旺。故宜用大承气汤。以泻土救水。虽下之。亦为顺候也。）
琥按趺阳脉。图经原名冲阳。脉在足跗中指端。上行五寸。去陷谷穴三寸。足阳明脉之所过也。为原。故一名会原。
诊法。病重者。切此以决死生。伤寒。以胃气为本。趺阳之脉不衰。知胃气尚在病虽危。犹可治也。
少阴病。脉沉者。急温之。宜四逆汤。少阴病。饮食入口则吐。心中温温欲吐。（云云至）干呕者。不可吐也。急温
之宜四逆汤。
上二条证并汤方（俱见中寒论中）
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。（此条系真阴证之宜用灸法者。正文与
注详中寒论中）
（琥）按以上方论。乃仲景治少阴病法也。少阴之经有真寒。有热病。今止就少阴热病。从阳经传来者。一十七条
悉为解说于前。又考昔贤治少阴热病法。与仲景论稍有异旨者。复为详辩于后。务使学人临证施方。略知通变云耳。
Licorice (Zhi, roasted), Zhi Shi (broken, soaked in water, roasted dry), Chai Hu, Shao Yao.
The above four ingredients. Each taken ten parts. Crushed and sifted. Mixed with rice water and administered as one cubic inch dose per intake. Taken three times a day. (Cheng Wuji's commentary cites the *Nei Jing*: "When heat is rampant within, assist with sweet and bitter [agents], gather it with sour, and disperse it with bitter."
The bitter and sweet properties of Zhi Shi and Licorice are used to drain interior heat; the sour property of Shao Yao is used to gather Yin Qi; the bitter property of Chai Hu is used to release exterior heat. Hu notes: Although the above formula is said to treat Shaoyin disease, it is actually a formula for Yangming and Shaoyang diseases.)
*Neitai Fangyi* states: "Sini" refers to cold hands and feet that are not warm; "Sijue" refers to extreme cold. "Sijue" is caused by Yin-cold pathogenic factors, whereas "Sini" is due to pathogenic factors transmitted through the meridians. This indicates that Yang-heat has receded, but the pathogen remains unresolved, about to transmit into the Yin meridians but not yet having entered. This belongs solely to Yang patterns, thus cool formulas are given to treat it. Licorice is used as the Sovereign herb to harmonize the Middle Jiao and circulate to the extremities; Zhi Shi is used as the Minister herb to move stagnation; Shao Yao is used as the Assistant herb to circulate Ying-Qi; Chai Hu is used as the Envoy herb to unblock and scatter pathogenic factors in both the exterior and interior. Hu notes: The aforementioned statement "Yang-heat has receded" refers to the heat of the Yang meridians敛 (contracting) and retreating inward, hence the exterior is not hot while the extremities are cold. Zhongjing uses Sini San to harmonize pathogenic heat and simultaneously resolve interior excess.
Subsequent Modifications
For cough: Add Wuweizi and Ganjiang, each five fen. Also indicated for diarrhea. (Cheng Wuji's commentary states: "Cold qi in the Lung causing rebellious Qi leads to cough. The sourness of Wuweizi gathers rebellious Qi; the pungency of Ganjiang disperses Lung cold. It also treats diarrhea because the Lung and Large Intestine are exterior-interior pairs; upper cough and lower diarrhea share similar treatment principles. My opinion is that there are also cases of Lung-heat cough, so one should not be rigid. The same applies to diarrhea.")
For palpitations: Add Guizhi, five fen. (*Neitai Fangzhu* states: "Qi deficiency prevents smooth circulation to the Heart, causing a fluttering sensation in the heart region. Guizhi enters the Heart meridian, hence its addition." My opinion is that there are also cases where pathogenic heat invades the Pericardium causing palpitations; these should not be treated merely as Qi deficiency.)
For difficult urination: Add Fuling, five fen. (*Tiaobian* states: "Fuling has a light, leaching taste that opens orifices, hence it is suitable for addition.")
For abdominal pain: Add Fuzi, one piece. (Pao, broken apart.) (Cheng Wuji's commentary states: "Interior deficiency encountering pathogenic factors causes pain; add Fuzi to tonify deficiency." I note: In Cheng's previous commentary on the formula postscript, he stated: 'Heat rampant within... the bitter-sweet nature of Zhi Shi and Licorice drains interior heat.' Since interior heat should be drained, abdominal pain may not necessarily be due to deficiency. Using Pao Fuzi would likely cause great harm. *Tiaobian* interprets this text literally, which is a significant error. Xu Jian'an states: In the ancient *Jinjing Fang*, Shao Yao was doubled by five fen because it can relieve pain. Later generations changed it to Fuzi; is this truly a method of following the disease trend?)
For dysentery with a sensation of heaviness in the rectum: First, boil Xiebai in five sheng of water until reduced to three sheng, then strain. Add three cubic inches of the powder from the main formula to the decoction, boil again until one and a half sheng remains. Divide into two doses and take warm. (Cheng Wuji's commentary states: "Dysentery with rectal heaviness indicates Qi stagnation in the Lower Jiao. Adding Xiebai helps drain Qi stagnation.")
In Shaoyin disease, if there is diarrhea for six or seven days, accompanied by cough, vomiting, thirst, irritability, and inability to sleep, Zhu Ling Tang is the primary treatment. (This is the method for treating Shaoyin heat-dysentery by separating clear from turbid. Cheng Wuji's commentary states: "Diarrhea without thirst indicates interior cold. Here, diarrhea with thirst indicates it is not interior cold. By the sixth or seventh day, it is precisely when heat pathogens transmit inward. The Classic states: The straight branch of the Foot-Shaoyin meridian enters the Lung; the branch emerges from the Lung, connects with the Heart, and pours into the chest. Diarrhea originally involves water dampness. Heat from the meridions binds with water, invading the Lung, causing cough and rebellious Qi in the chest; invading the Heart, causing irritability. Shaoyin disease naturally desires sleep; now, the inability to sleep clearly indicates severe heat and agitation. Zhu Ling Tang is given to clear and descend pathogenic heat and regulate water passages, thereby stopping diarrhea and resolving vomiting and thirst.)
A question arises: How do we know that diarrhea, cough, vomiting, thirst, irritability, and insomnia are not Yangming or Shaoyang diseases? I answer: If Yangming or Shaoyang diseases present with these symptoms, they constitute interior excess, and the pulse must be wiry, large, and long. In this case, the pulse must be faint and fine, confirming beyond doubt that this is Shaoyin diarrhea. See Zhu Ling Tang formula in Volume 6, Yangming Chapter.)
*Neitai Fangyi* states: "Shaoyin diarrhea without thirst is cold. Now, this case involves diarrhea with thirst, cough, vomiting, irritability, and insomnia, indicating it is not interior cold but interior heat. Therefore, Zhu Ling is used as the Sovereign herb; Fuling as the Minister, with its light and bland taste to regulate empty irritability and promote water flow; Zexie as the Assistant to drain retained water; Ejiao and Huashi as the Envoys to anchor the lower jiao and promote water passage."
Hu notes: The function of Ejiao is not limited to promoting diuresis; its nature is neutral, taste sweet and slightly salty. Upward, it benefits Lung Qi and clears the source, stopping cough; downward, it nourishes Kidney Yin and clears meridian heat, stopping diarrhea. This is a meaning Cheng Wuji did not fully elucidate, which students must understand.
Hu further notes: The above formula is originally for Yangming disease with heat-thirst and desire to drink, and difficult urination. Why is it borrowed for the previous clause? Generally, Yangming disease with fever, thirst, desire to drink, and difficult urination involves water-heat binding and stagnation. Here, Shaoyin disease with diarrhea, cough, vomiting, thirst, irritability, and insomnia also involves water-heat binding and stagnation. Although the disease names differ, the pathology is the same. Thus, Zhongjing's method similarly uses Zhu Ling Tang. The principle is clearing heat, promoting diuresis, and moistening dryness/nourishing Yin.
In Shaoyin disease, if mouth dryness and throat dryness occur within two or three days of onset, urgent purgation is required using Da Chengqi Tang. (This clause refers to pathogenic transmission to Shaoyin and heat entering the Fu organs. "Two or three days" does not mean immediate onset, but rather that the symptoms of mouth and throat dryness have persisted for two or three days. The Shaoyin meridian circles the throat and attaches to the root of the tongue; pathogenic heat transmitting along the meridian causes mouth and throat dryness. Cheng Wuji's commentary states: "Pathogenic heat is severe, and Kidney Water is nearly exhausted. Urgently administer Da Chengqi Tang to purge and preserve the Kidney." See Da Chengqi Tang in Volume 6, Yangming Chapter. A question arises: Da Chengqi Tang purges stomach-Fu excess heat; how does it relate to Shaoyin heat exhausting Kidney Water? Cheng says: "Urgently purge with Da Chengqi Tang to preserve the Kidney." I answer: Zhongjing's general rules state: 'When Three-Yin meridians are diseased and have entered the Fu organs, purgation is applicable.' Thus, this Shaoyin case is a Fu-organ syndrome. Shaoyin pathogenic heat has entered the Fu, causing stomach-Fu excess heat, leading to mouth and throat dryness. Da Chengqi Tang drains Fu-excess, thereby removing meridian heat. Furthermore, the Shaoyin organ is the Kidney (Water), while the Stomach-Fu is Earth. Draining Earth saves Water, hence Cheng's commentary.)
In Shaoyin disease, if there is spontaneous diarrhea of clear water, pure green in color,必定 (must) pain in the epigastrium, and mouth dryness, urgent purgation is required using Da Chengqi Tang. (This Shaoyin case is also heat entering the Fu organs, requiring urgent purgation. The Shaoyin organ is Water; extreme heat in the meridians forces fluid downward, causing Kidney dryness. As the Kidney dries, intestinal contents become harder, resulting in diarrhea of only clear water. Pure green color indicates Kidney essence is nearly exhausted and Liver Wood is counter-attacking. Epigastric pain indicates excess; mouth dryness indicates heat. Hence, Da Chengqi Tang is given to purge excess heat.)
In Shaoyin disease, if abdominal distension and constipation persist for six or seven days, urgent purgation is required using Da Chengqi Tang. (Although labeled Shaoyin, this is essentially an obvious Yangming excess-heat syndrome. Shaoyin pathogenic heat transmits to the Yangming Stomach-Fu. Cheng Wuji's commentary states: "Severe internal heat in Yangming causes fullness and constipation. When Yangming Earth overcomes, Kidney Water dries. Urgently give Da Chengqi Tang to save Kidney Water." A question arises: If Shaoyin pathogenic factors transmit to Yangming showing distension, why is it not in the Yangming chapter? I answer: This clause follows the previous two regarding mouth/throat dryness, hence listed under Shaoyin. Otherwise, it would be indistinguishable from Yangming disease. Students should examine this carefully.)
(Attached Example) If the Shaoyin pulse is weaker than the Fuyang pulse, it is a favorable sign. (Moved here from the Jueyin chapter. My opinion: For Shaoyin cases suitable for purgation, diagnosis should rely on pulse. Shaoyin pulse refers to the Chi position at both wrists. Fuyang pulse is the arterial pulse between the high bone on the dorsum of the foot. Shaoyin governs Kidney Water; Fuyang governs Stomach Earth. If Shaoyin pulse is weak and Fuyang pulse is strong, Shaoyin is inferior to Fuyang, indicating depleted Kidney Water and hyperactive Stomach Earth. Thus, Da Chengqi Tang is appropriate to drain Earth and save Water. Even with purgation, it is a favorable prognosis.)
Hu notes: The Fuyang pulse, originally named Chongyang in *Tu Jing*, is located at the end of the middle toe on the dorsum of the foot, ascending five cun, three cun from Xangu. It is the pathway of the Foot-Yangming meridian and serves as the Yuan-Source point, hence also called Huiyuan. Diagnostic method: In severe illness, palpating this pulse determines life or death. In Shanghan, Stomach Qi is fundamental. If the Fuyang pulse does not weaken, Stomach Qi remains; although critical, the disease is treatable.
In Shaoyin disease, if the pulse is deep, urgent warming is required using Sini Tang. In Shaoyin disease, if food/vomit is rejected immediately upon entry, with a feeling of nausea in the heart (continuing to)... dry retching, vomiting methods are contraindicated; urgent warming is required using Sini Tang.
(The above two clauses and formulas are found in *Zhong Han Lun*.)
In Shaoyin disease, if there is diarrhea, faint and choppy pulse, vomiting with sweating, frequent defecation attempts but scant output, warmth should be applied to the upper body via moxibustion. (This clause describes a true Yin pattern suitable for moxibustion. Details are in *Zhong Han Lun*.)
Hu notes: The above formulas and discussions represent Zhongjing's methods for treating Shaoyin disease. The Shaoyin meridian presents with both true cold and heat patterns. Previously, I explained seventeen clauses regarding Shaoyin heat patterns transmitted from Yang meridians. I have also examined past sages' treatments for Shaoyin heat, noting differences from Zhongjing's论述 (discussions), and clarified them below. The aim is to enable students to adapt their clinical prescriptions appropriately.