黄芩 芍药（俱酒炒） 生姜（各一两）
水二升。煎八合。去滓。热服。不愈。再作服。
（上方乃手足太阴泄热散邪之剂。兼入手足阳明。仲景虽云。脉弱。要之脉弦数。而腹痛者。更宜用此方也。）
（琥）总按上方论乃治太阴病活变之法也。可以佐仲景方论之未备者。要之人病多端。并上方论亦不足以尽其变。
在学人推展而通之耳。
（此系仲景原文）
少阴之为病脉微细。但欲寐也。（此少阴病热困极之状也。少阴者。肾经也。肾为水藏。主寒。其脉当沉。今曰脉微
细者。与沉相类之脉也。邪在三阳。脉皆洪大。传入少阴。则变微细者。此热邪深而脉内伏也。成注云。邪传少阴。则
气行于阴而不行于阳。故但欲寐。愚以此非真寐。乃热极而神志昏愦。若欲寐然。条辩谬以欲寐为静。若果静。则邪去
而无病矣。此与仲景立论之意大悖。愚按少阴病但欲寐。此仅举病热之端。以故不及治法。）
少阴病欲吐不吐。心烦。但欲寐。五六日。自利而渴者。属少阴也。虚故引水自救。若小便色白者。少阴病形悉具。
小便白者。以下焦虚。有寒。不能制水。故令色白也。（此条少阴病。非自三阳经传来者。乃少阴经自中之寒气已深。内
迫于脏故见以上等证。正文与注俱见中寒论中）
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。（此亦少阴真寒证也。注见中寒论中）
（见后例）少阴病咳。而下利谵语者。被火气劫故也小便必难以强责少阴汗也。（此火逆证也。正文与注见第十二卷
救逆论中）
少阴病。脉细沉数。病为在里。不可发汗。（此条乃阳邪传入少阴之证。夫曰少阴病者。此承首条但欲寐。而申言治
法之不可误也。诊其脉于细沉之中带数。可见热邪虽伏而终不可掩。乃热入于里之征也。里指胃府而言。仲景云三阴经
受病。已入于府者。可下而已。病热在里。正当议下。故云不可发汗。）
少阴病脉微不可发汗亡阳故也。阳已虚。尺脉弱涩者。复不可下之。（此条少阴病。乃寒邪直中之阴证。故不可汗而
并无可下之理。正文与注见中寒论中）
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（此条病。亦寒邪直
中少阴之证。脉暴微。为阳气得回故为欲解。可见脉微不但指阴证而言。则是首条云。脉微细。为阳热传阴之证。无疑
矣。正文与注见中寒论中）
少阴病下利若利自止恶寒而 卧手足温者。可治少阴病恶寒而 时自烦。欲去衣被者。可治。
上二条皆真寒证。（正文与注见中寒论中）
少阴中风脉阳微阴浮者。为欲愈（此条言少阴中风。虽不明指其证。要之辩其脉。可以知其证之轻矣。少阴中风。
风为阳邪。其初必自太阳经传来者。但邪在太阳。脉本阳浮阴弱。传至少阴。又自有微细之本脉。曰微细者。其脉于尺
寸之间。浮沉取之俱微而细。乃阴阳皆微细也。夫微细之脉。为表邪已缓。里邪深伏。兹者。阳脉虽不细而见微。此在
表之风邪已解也。阴脉不微细而反浮。此在里之正气自和也。尚论篇云。阳微则外邪不复内入。阴浮。则内邪尽从外出。
故为欲愈。）
少阴病欲解时从子至寅上（注已见前第三卷太阳上编）
少阴病。吐利。手足不逆冷反发热者。不死。脉不至者。灸少阴七壮。（此条系真寒证。故宜用艾灸法。正文与注见
中寒论中）
少阴病八九日。一身手足尽热者。以热在膀胱。必便血也。（此条乃少阴经邪热。传入太阳府证也。少阴肾经也。与
太阳膀胱经为表里。少阴病八九日。寒邪郁而变热。热势已极。有不入阳明胃府而入本经之府者。故云热在膀胱也。一
身手足尽热者。言其热自内达外。与表热不同。膀胱为多血之经。肾又开窍于二阴。热在膀胱。则下焦之血受伤故从前
后便而出也。按此条论。仲景无治法。补亡论常器之云。可桃仁承气汤。芍药地黄汤。愚以桃仁承气汤。仲景用以治太
阳病不解。热结膀胱。下焦有蓄血者。此条证。成注云。血散下行。上汤断难借用。如欲用药。还宜芍药地黄汤。郭白
云云。未见方。愚意云。想即是芍药地黄二味药。煎汤服也。）
少阴病但厥无汗而强发之。必动其血。未知从何道出。或从口鼻。或从目出。是名下厥上竭。为难治。（此条少阴病
乃传经热证。厥冷也。热深者。厥亦深。热邪深入。表虽发厥而无汗。成注所云。热行于里者是也。医人不知。不攻其
里。而反用麻桂等药。以强发其汗。汗不得出。则在内燥热已极。必击动。少阴之血而出于上窍。错经妄行。故从口鼻。
或目中出也。条辩云下厥者。以少阴居下而热深也。上竭者。以血妄逆而几尽也。汗与血一而已。得汗固非易治。得血
其治尤难。此为最逆之候。愚按此条论。仲景但云。难治其非必死之证明矣。补亡论常器之云。可芍药地黄汤。）
少阴病恶寒。身 而利手足逆者。不治。少阴病吐利躁烦。四逆者死。
少阴病下利止而头眩。时时自冒者死。
少阴病四逆恶寒。而身 脉不至不烦而躁者死。
以上四条皆中寒死证（正文与注俱见中寒论中）
少阴病六七日。息高者死。（少阴病至六七日。传经之热已深。少阴属水。水生气。成注云。肾为呼吸之门。息高。
则邪热甚而水将涸。肾虚不能纳气归源。其鼻息但呼出。而声甚高。故主死也。或云。此亦中寒死证。殊不知少阴经中
寒者。乃命门火衰而阳虚也。阳虚则气馁。而鼻不能报息矣。今云息高。明系热证无疑。）
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。
少阴病始得之。反发热脉沉者麻黄附子细辛汤主之。
麻黄附子细辛汤方
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。
麻黄附子甘草汤方
以上证三条方二首（俱见中寒论中）
少阴病得之二三日以上。心中烦。不得卧。黄连阿胶汤主之。（此条少阴病虽得之二三日。当是三阳经传来者。少阴
之脉。出络心。注胸中。肾经邪热。上凌于心。故发烦也。第少阴病热。当但欲寐兹则不得卧者。何也。盖热微则昏沉
而欲寐热甚则反扰乱而不得卧也。成注云。与黄连阿胶汤以扶阴散热。或问云。心中烦。不得卧。非少阴独有之证。何
以知其为少阴病邪。余答云。此条少阴病。必口燥舌本干而渴者。否则心烦不得卧。几与阳明病无别矣。学人临证。宜
细诊之。）
Huangqin (Scutellariae Radix), Shaoyao (Paeoniae Radix) (both stir-fried with wine), Shengjiang (Fresh Zingiberis Rhizoma) (each 1 liang).
Add two sheng of water, decoct to obtain eight ge. Remove the dregs, and take warm. If not cured, prepare and administer again.
(The above formula is an agent for draining heat and dispersing pathogens in the Hand and Foot Taiyin meridians, also affecting the Hand and Foot Yangming meridians. Although Zhang Zhongjing mentions a weak pulse, the key lies in a wiry and rapid pulse; it is especially suitable for cases accompanied by abdominal pain.)
(Wang Hu) General Comment: The discussion of the above formulas represents the method for treating dynamic changes in Taiyin disease, supplementing what is incomplete in Zhang Zhongjing's treatise on formulas. However, human diseases are manifold, and the discussion of the above formulas alone cannot exhaust all variations.
This requires students to deduce, expand, and integrate these principles.
(This is the original text by Zhang Zhongjing)
The manifestation of Shaoyin disease is a faint and fine pulse, with a desire only to sleep. (This describes the state where Shaoyin disease heat is extremely constrained. Shaoyin refers to the Kidney meridian. The Kidney is a Water organ, governs cold, and its pulse should be deep. Now, saying the pulse is faint and fine indicates a pulse similar to the deep pulse. When pathogens are in the Three Yang meridians, the pulse is typically surging and large; upon transmission to Shaoyin, it becomes faint and fine because the heat pathogen is deep and the pulse qi is internalized. Cheng Wuji noted: "When pathogens transmit to Shaoyin, qi moves in Yin and does not move in Yang, hence the desire only to sleep." I believe this is not true sleep, but rather extreme heat causing mental confusion, resembling sleep. Tiaobian erroneously interpreted "desire to sleep" as stillness. If it were truly still, the pathogen would have departed and there would be no disease. This contradicts Zhang Zhongjing's intent. My analysis suggests that "desire only to sleep" in Shaoyin disease merely lists the onset of heat illness, thus omitting treatment methods.)
In Shaoyin disease, if one desires to vomit but cannot, feels vexed, and desires only to sleep. After five or six days, spontaneous diarrhea accompanied by thirst indicates involvement of the Shaoyin. Due to deficiency, the patient draws water to save themselves. If the urine is white, the manifestations of Shaoyin disease are fully present. White urine results from lower Jiao deficiency and cold, which fails to control water, causing the color to be white. (This clause of Shaoyin disease is not transmitted from the Three Yang meridians but arises from deep cold pathogens directly invading the Shaoyin meridian and pressing inward on the zang organs. The main text and annotations are found in *Zhonghan Lun* [Treatise on Cold Damage].)
If a patient's pulse is tight at all positions (Yin and Yang), yet sweat appears, this indicates loss of Yang. This belongs to Shaoyin disease, manifesting as sore throat, followed by vomiting and diarrhea. (This is also a True Cold syndrome of Shaoyin. Annotation is found in *Zhonghan Lun*.)
(See following example) In Shaoyin disease, if there is cough, diarrhea, and delirium, it is due to劫夺 (robbery/depletion) by fire therapy. Urination will certainly be difficult, caused by forcing sweat from the Shaoyin. (This is a Fire Reversal syndrome. Main text and annotation are found in Volume 12, *Jiuni Lun* [Treatise on Rescue from Reversal].)
In Shaoyin disease, if the pulse is fine, deep, and rapid, the disease is in the interior, and sweating should not be induced. (This clause refers to Yang pathogens transmitting into Shaoyin. The term "Shaoyin disease" follows the first clause "desire only to sleep" to clarify that treatment must not be mistaken. Examining the pulse, the presence of rapidity within the fine and deep quality reveals that although heat pathogens are hidden, they cannot be concealed; this is a sign of heat entering the interior. "Interior" refers to the Stomach fu. Zhang Zhongjing stated that when Three Yin meridians are affected and the disease enters the fu, purgation may be used. Since the heat is in the interior, purgation should be considered; therefore, sweating is contraindicated.)
In Shaoyin disease, if the pulse is faint, sweating is contraindicated because it causes loss of Yang. If Yang is already deficient and the Chi position pulse is weak and choppy, purgation is also contraindicated. (This Shaoyin disease is a Yin syndrome caused by direct invasion of Cold pathogens. Therefore, sweating is contraindicated, and there is no rationale for purgation. Main text and annotation are found in *Zhonghan Lun*.)
In Shaoyin disease, if the pulse is tight, and after seven or eight days, spontaneous diarrhea occurs, the pulse suddenly becomes faint, hands and feet become warm, and the tightness disappears, the condition is about to resolve. Although irritability is present, the diarrhea will heal itself. (This case is also a syndrome of Cold pathogens directly invading Shaoyin. The sudden faintness of the pulse indicates the return of Yang qi, hence "about to resolve." This shows that a faint pulse does not solely indicate Yin syndromes; thus, the first clause's "faint and fine" pulse confirms Yang-heat transmitting to Yin without doubt. Main text and annotation are found in *Zhonghan Lun*.)
In Shaoyin disease with diarrhea, if the diarrhea stops spontaneously, the patient fears cold and curls up, but hands and feet are warm, the condition is treatable. In Shaoyin disease, if the patient fears cold and curls up, occasionally feels irritable, and desires to remove clothing and blankets, the condition is treatable.
The above two clauses describe True Cold syndromes. (Main text and annotation are found in *Zhonghan Lun*.)
In Shaoyin Wind Strike, if the exterior pulse is faint and the interior pulse is floating, recovery is imminent. (This clause discusses Shaoyin Wind Strike. Although symptoms are not explicitly listed, observing the pulse allows one to gauge the mildness of the condition. Shaoyin Wind Strike involves Wind, a Yang pathogen, which initially transmits from the Taiyang meridian. While in Taiyang, the pulse is typically exterior-floating and interior-weak. Upon transmission to Shaoyin, the inherent faint and fine pulse emerges. "Faint and fine" means that at both Cun and Chi positions, superficial and deep palpations reveal faint and fine qualities, indicating both Yin and Yang are faint and fine. A faint and fine pulse signifies that exterior pathogens have eased and interior pathogens are deeply hidden. At this stage, the exterior pulse is faint but not fine, indicating resolved exterior wind pathogens. The interior pulse is not faint and fine but instead floating, indicating harmonization of interior righteous qi. *Shanglun Pian* states: "Exterior faintness prevents external pathogens from re-entering; interior floating allows internal pathogens to exit completely," hence "about to recover.")
The time when Shaoyin disease resolves is from Zi hour to Yin hour. (Annotation is found in Volume 3, *Taiyang Shang Bian*.)
In Shaoyin disease, if there is vomiting and diarrhea, but hands and feet are not cold and instead are warm, death is avoided. If the pulse is absent, moxa should be applied to the Shaoyin meridian seven moxibustions. (This is a True Cold syndrome, thus moxibustion is appropriate. Main text and annotation are found in *Zhonghan Lun*.)
In Shaoyin disease, after eight or nine days, if the entire body and hands and feet are hot, it is because heat resides in the Bladder, and hematochezia or hematuria will likely occur. (This clause describes Shaoyin meridian heat pathogens transmitting to the Taiyang Fu level. Shaoyin is the Kidney meridian, exterior-interior related to the Taiyang Bladder meridian. After eight or nine days of Shaoyin disease, Cold pathogens stagnate and transform into heat. With extreme heat intensity, instead of entering the Yangming Stomach Fu, it enters the Fu of the meridian itself, hence "heat in the Bladder." Heat throughout the body and extremities indicates heat radiating from interior to exterior, distinct from exterior heat. The Bladder is a meridian abundant in blood, and the Kidney opens into the two yin orifices. Heat in the Bladder injures blood in the lower Jiao, causing bleeding from either anterior or posterior orifices. Regarding treatment, Zhang Zhongjing provides none. Chang Qizhi in *Buwang Lun* suggests Taoren Chengqi Tang or Shaoyao Dihuang Tang. I argue that Taoren Chengqi Tang is used by Zhang Zhongjing for Taiyang disease unresolved with heat binding the Bladder and blood stasis in the lower Jiao. For this case, Cheng Wuji notes: "Blood scatters downward," making the aforementioned decoction unsuitable. If medication is desired, Shaoyao Dihuang Tang is preferable. Guo Baiyun mentioned seeing no such formula. My opinion is that it likely consists of just Shaoyao and Dihuang decocted together.)
In Shaoyin disease, if there is only cold limbs without sweat, and sweating is forcibly induced, blood will certainly be disturbed. It is unknown from which orifice it will emerge; it may come from the mouth or nose, or from the eyes. This is called Lower Reversal and Upper Exhaustion, and is difficult to treat. (This Shaoyin disease is a transmitted heat syndrome. Cold limbs indicate that deeper heat causes deeper reversal. Heat pathogens have penetrated deeply; although the surface presents with cold limbs and no sweat, as Cheng Wuji stated: "Heat moves in the interior." Physicians unaware of this do not attack the interior heat but instead use Mahuang and Guizhi to force sweating. Since sweat cannot be produced, internal dryness and heat become extreme, striking the Shaoyin blood and forcing it out through upper orifices, causing erratic flow from mouth, nose, or eyes. Tiaobian explains: "Lower Reversal" means Shaoyin is located below and heat is deep; "Upper Exhaustion" means blood rebels and is nearly depleted. Sweat and blood share the same origin. Obtaining sweat is difficult to treat; obtaining blood is even more difficult. This is the most adverse prognosis. I note that Zhang Zhongjing only said "difficult to treat," proving it is not necessarily fatal. Chang Qizhi in *Buwang Lun* suggests Shaoyao Dihuang Tang.)
In Shaoyin disease, if there is fear of cold, curling up, diarrhea, and cold limbs, it is untreatable. In Shaoyin disease, if there is vomiting, diarrhea, restlessness, irritability, and cold limbs, death ensues.
In Shaoyin disease, if diarrhea stops but dizziness occurs, with frequent sensations of head cloudiness, death ensues.
In Shaoyin disease, if there are cold limbs, fear of cold, curling up, absent pulse, no irritability but only restlessness, death ensues.
The above four clauses describe fatal Cold Damage syndromes. (Main text and annotations are found in *Zhonghan Lun*.)
In Shaoyin disease, after six or seven days, if respiration is shallow and high-pitched, death ensues. (By six or seven days of Shaoyin disease, transmitted heat is deep. Shaoyin belongs to Water, which generates Qi. Cheng Wuji noted: "The Kidney is the gate of respiration." High-pitched respiration indicates severe pathogenic heat depleting Water, and Kidney deficiency failing to grasp Qi, resulting in exhalation only with high-pitched sound, hence fatal. Some claim this is also a fatal Cold syndrome. However, Cold in the Shaoyin meridian implies Mingmen fire decline and Yang deficiency. Yang deficiency leads to Qi exhaustion, preventing inhalation. High-pitched respiration clearly indicates a Heat syndrome.)
In Shaoyin disease, if the pulse is faint, fine, and deep, with a desire to lie down, sweating without irritability, and a desire to vomit, and after five or six days, spontaneous diarrhea occurs with renewed irritability and inability to lie down or sleep, death ensues.
At the onset of Shaoyin disease, if there is contrary fever and a deep pulse, Mahuang Fuzi Xixin Tang should be administered.
Mahuang Fuzi Xixin Tang Formula
If Shaoyin disease has persisted for two or three days, Mahuang Fuzi Gancao Tang should be used to induce slight sweating, as there are no interior symptoms after two or three days.
Mahuang Fuzi Gancao Tang Formula
The above three conditions involve two formulas. (All found in *Zhonghan Lun*.)
If Shaoyin disease persists for more than two or three days, with vexation in the heart and inability to lie down, Huanglian Ejiao Tang should be administered. (Although this Shaoyin disease has lasted two or three days, it likely transmitted from the Three Yang meridians. The Shaoyin meridian connects to the Heart and pours into the Chest. Heat pathogens in the Kidney meridian ascend to oppress the Heart, causing vexation. Normally, Shaoyin heat presents with a desire to sleep; here, the inability to lie down raises the question: Mild heat causes drowsiness and desire to sleep; severe heat causes disturbance and inability to lie down. Cheng Wuji noted: "Administer Huanglian Ejiao Tang to support Yin and dissipate heat." A question was raised: Vexation and inability to lie down are not exclusive to Shaoyin; how do we know this is Shaoyin pathology? I answer: This Shaoyin case must be accompanied by dry mouth, dry tongue root, and thirst. Otherwise, vexation and inability to lie down would be indistinguishable from Yangming disease. Students should examine carefully during clinical practice.)