庞安时云。尺寸俱沉者。少阴受病也。当五六日。发以其经。贯肾。络于肺系舌本。故口燥舌干而渴也。宜大承气
汤下之。补亡论常器之云。未可下也。更详余证。可下则下之。
琥按上庞氏云云。即仲景论例中语也。其用大承气汤者。又即仲景云。少阴病得之二三日。口燥咽干者。急下之。
宜大承气汤。其说同也。但一云。五六日。一云。二三日。若论传经之时。不止二三日矣。此必是口燥咽干之证。已得
之二三日。故云宜急下也。
琥又按常器之云。未可下者。以脉沉故也。殊不知少阴热病。可下之脉沉。必沉脉中兼数疾。或有力。此的系可
下之脉。昔人言不尽意。在学人以意会之而已。又少阴病。邪气传经之脉本微细。邪气入府之脉必沉实。愚尝诊之。最
为有准。
云岐子云。少阴经病。口燥舌干而渴者。胃中实热而有痛。脉沉而疾者。宜大承气汤。少阴经病。口干燥而渴。自
利清水。心下痛胃实也。脉沉而疾者。宜大承气汤。少阴经病贯肾。络于肺系舌本。故口干燥而渴。饮水。大便难者。
胃实也。脉沉而疾者。宜大承气汤。
琥按上云岐子云云。即仲景少阴病。所当急下之三证也。仲景原论中不言脉。而此独言脉。更觉详悉。
海藏老人云。少阴证口燥舌干而渴。脉尺寸俱沉。沉疾。则大承气汤。疾而无力者。不可下。如大热。而脉反细小。
不可下。宜泻心汤。
Pang Anshi stated: When both the Cun (inch) and Chi (cubit) pulses are deep (Chen), it indicates that the Shaoyin (Lesser Yin) channel has been affected. Typically, on the fifth or sixth day, the pathogenic factor transmits to its originating channel. Since the Shaoyin channel penetrates the Kidney, connects with the Lung, and attaches to the root of the tongue, symptoms such as dryness of the mouth, dry tongue, and thirst arise. In such cases, Dachengqi Tang (Major Order the Qi Decoction) should be used to purge the accumulation.
Chang Qizhi, in the *Bu Wang Lun* (Supplement to Lost Chapters), remarked: Purging is not yet indicated. One must carefully examine other syndromic manifestations; if purging is indeed appropriate, then proceed with it.
Wang Hu noted: The aforementioned statement by Pang is derived from the principles found in Zhang Zhongjing's treatise. The rationale for using Dachengqi Tang aligns with Zhang Zhongjing’s assertion: "In Shaoyin disease, if after two or three days there is dryness of the mouth and throat, urgent purging is required, and Dachengqi Tang is appropriate." The theories are consistent. The discrepancy lies only in the timing: Pang mentions the fifth or sixth day, whereas Zhang mentions the second or third day. Regarding the timeline of pathogenic transmission, more than two or three days would have passed. This implies that the symptoms of dry mouth and throat had already appeared within the first two or three days of onset, hence the recommendation for urgent purging.
Wang Hu further noted: Chang Qizhi’s caution against purging stems from the observation of a deep pulse. However, he overlooked that in Shaoyin heat diseases, although the pulse may be deep, it must simultaneously exhibit rapidity (Shu) or forcefulness to be suitable for purging. Ancient texts often leave implicit meanings for students to comprehend through insight. Furthermore, in Shaoyin disease caused by pathogenic transmission through channels, the pulse is typically faint and fine (Wei Xi); however, when the pathogen enters the Fu organs, the pulse becomes deep and solid (Chen Shi). My own clinical experience confirms the accuracy of this distinction.
Yun Qizi stated: In Shaoyin channel disease, if there is dryness of the mouth, dry tongue, and thirst, accompanied by excess heat and pain in the stomach, and a pulse that is deep and rapid, Dachengqi Tang is appropriate. In Shaoyin channel disease, if there is dryness of the mouth and thirst, spontaneous diarrhea of clear water, pain in the epigastrium, indicating excess in the Stomach (Wei Shi), and a pulse that is deep and rapid, Dachengqi Tang is appropriate. In Shaoyin channel disease, since the channel penetrates the Kidney, connects with the Lung, and attaches to the root of the tongue, dryness of the mouth and thirst occur. If drinking water does not relieve constipation, indicating excess in the Stomach, and the pulse is deep and rapid, Dachengqi Tang is appropriate.
Wang Hu noted: Yun Qizi’s statements correspond to the three syndromes in Zhang Zhongjing’s work that require urgent purging in Shaoyin disease. While Zhang Zhongjing’s original text did not mention the pulse, the inclusion of pulse diagnosis here provides greater detail and completeness.
Haizang Laoren (Zhang Yuansu) stated: In Shaoyin syndrome, if there is dryness of the mouth, dry tongue, and thirst, and the pulse at both Cun and Chi positions is deep and rapid, Dachengqi Tang may be used. However, if the rapid pulse is weak and powerless, purging is contraindicated. If there is high fever but the pulse is unexpectedly fine and small, purging is also contraindicated; instead, Xiexin Tang (Drain the Epigastrium Decoction) is appropriate.