治少阴病, 下痢脉微者, 与白通汤. 痢不止, 厥逆无脉, 干呕烦者,
白通加猪胆汁汤主之. 服汤脉暴出者死, 脉微续者生.
葱白四茎 干姜一两 附子 ( 生用, 去皮, 破八片 ) 一枚, 右三味
,以水三升, 煮取一升, 去滓, 分温再服.
葱白四茎 干姜一两 附子 ( 生用, 去皮, 破八片 ) 一枚 人尿五
合 猪胆汁一合以上三味, 以水三升, 煮取一升, 去滓, 纳猪胆汁人
尿,和令相得, 分温再服. 若无胆汁亦可.
【注】是方也, 即四逆汤减甘草加葱白也, 而名之曰白通者, 以葱白
能通阳气也. 减甘草者, 因其缓也; 加尿胆者, 从其类也. 下咽之后
,冷体既消, 热性便发, 情且不违而致大益, 则二气之拒格可调, 上
下之阴阳可通矣.
治少阴水气为患, 腹痛下痢, 四肢沉重疼痛, 小便不
利,其人或咳或呕, 或小便利而下痢者, 用此加减.
白术二两 茯苓二两 白芍二两 大附子 ( 炮 ) 一枚 生姜 ( 切
)三两,, 右五味, 以水八升, 煮取三升, 去滓, 温服七合, 日三服.
若咳者, 加五味子半升, 细辛, 干姜各一两. 若小便利者, 去茯苓.
若下痢, 去芍药加干姜二两. 若呕, 去附子加生姜, 足成半斤.
【注】小青龙汤治表不解有水气, 中外皆寒实之病也. 真武汤治表已
解有水气, 中外皆寒虚之病也. 真武者, 北方司水之神也, 以之名汤
者,借以镇水之义也. 夫人一身制水者脾也, 主水者肾也, 肾为胃关
,聚水而从其类, 倘肾中无阳, 则脾之枢机虽运, 而肾之关门不开,
水即欲行, 以无主制, 故泛溢妄行而有是证也. 用附子之辛热, 壮肾
之元阳, 则水有所主矣. 白术之苦燥创建中土, 则水有所制矣. 生姜
之辛散, 佐附子以补阳, 于主水中寓散水之意. 茯苓之淡渗, 佐白术
以健土, 于制水中寓利水之道焉. 而尤妙在芍药之酸收, 仲景之旨微
矣.盖人之身阳根于阴, 若徒以辛热补阳, 不稍佐以酸收之品, 恐真
阳飞越矣. 用芍药者, 是亟收阳气归根于阴也. 于此推之, 则可知误
服青龙致发汗亡阳者, 所以于补阳药中必需芍药也. 然下利减芍药者
,以其阳不外散也; 加干姜者, 以其温中胜寒也. 水寒伤肺则咳, 加
细辛, 干姜者, 散水寒也; 加五味子者, 收肺气也. 小便利者, 去茯
苓,以其虽寒而水不能停也. 呕者, 去附子倍生姜, 以其病非下焦,
水停于胃也, 所以不须温肾以行水, 只当温胃以散水, 且生姜功能止
呕也.
Treatment of Shaoyin disease presenting with diarrhea and a faint pulse, administer Baitong Tang (White Tong Decoction). If the diarrhea persists, accompanied by cold extremities, absence of pulse, dry retching, and irritability, Baitong Jia Zhuzhitan Tang (White Tong Decoction plus Porcine Bile and Human Urine) is the primary treatment. If after taking the decoction the pulse suddenly emerges violently (floating and rootless), death ensues; if the pulse remains faint but gradually recovers, life is preserved.
Scallion white (Congbai) four stalks, Dried Ginger (Ganjiang) one tael, Aconite Root (Fuzi) (used raw, skin removed, broken into eight pieces) one piece. The above three ingredients are boiled in three sheng of water to obtain one sheng. Strain the dregs, and divide into two doses for warm administration.
Scallion white (Congbai) four stalks, Dried Ginger (Ganjiang) one tael, Aconite Root (Fuzi) (used raw, skin removed, broken into eight pieces) one piece, Human Urine (Renao) five he, Porcine Bile (Zhuzhitan) one he. The above ingredients (note: text implies boiling the first three, then adding the last two) are boiled in three sheng of water to obtain one sheng. Strain the dregs, add Porcine Bile (Zhuzhitan) and Human Urine (Renao), mix well, and divide into two doses for warm administration. If porcine bile is unavailable, it may be omitted.
[Annotation] This formula is essentially Sini Tang (Four Reversal Decoction) with Glycyrrhiza (Gancao) removed and Scallion White (Congbai) added. It is named "Baitong" because Scallion White (Congbai) can unblock and transmit Yang Qi. Glycyrrhiza (Gancao) is removed because its nature is slow/mild; Human Urine (Renao) and Porcine Bile (Zhuzhitan) are added to follow their respective affinities. After ingestion, the cold nature dissipates, and the hot efficacy arises immediately. Since the drug action does not conflict with the pathology, great benefit is achieved, thereby regulating the rejection between Yin and Yang Qi, and allowing the communication of Yin and Yang between the upper and lower parts.
For Shaoyin disease where Water-Qi causes pathology, manifesting as abdominal pain and diarrhea, heaviness and pain in the four limbs, and dysuria; or if there is cough or vomiting, or clear urination accompanied by diarrhea, this formula should be used with modifications.
Atractylodes Macrocephala Rhizome (Baizhu) two taels, Poria (Fuling) two taels, White Peony Root (Baishao) two taels, Large Aconite Root (Dafuzi) (processed) one piece, Fresh Ginger (Shengjiang) (sliced) three taels. The above five ingredients are boiled in eight sheng of water to obtain three sheng. Strain the dregs, and take seven ge per dose warm, three times daily.
If coughing occurs, add Schisandra Fruit (Wuweizi) half sheng, Liatris Rhizome (Xixin) and Dried Ginger (Ganjiang) one tael each.
If urination is clear/profuse, remove Poria (Fuling).
If diarrhea occurs, remove White Peony Root (Baishao) and add Dried Ginger (Ganjiang) two taels.
If vomiting occurs, remove Aconite Root (Fuzi) and increase Fresh Ginger (Shengjiang), totaling half jin.
[Annotation] Xiao Qinglong Tang (Minor Blue Dragon Decoction) treats exterior syndrome unresolved with Water-Qi, representing an excess-cold condition affecting both interior and exterior. Zhenwu Tang (True Warrior Decoction) treats exterior syndrome resolved with Water-Qi, representing a deficiency-cold condition affecting both interior and exterior. "Zhenwu" refers to the deity governing water in the North; naming the decoction after him borrows the meaning of suppressing water. In the human body, the Spleen controls water, and the Kidney governs water. The Kidney acts as the gatekeeper of the Stomach; water gathers and follows its kind. If there is no Yang Qi in the Kidney, although the pivot mechanism of the Spleen functions, the gate of the Kidney remains closed. Water attempts to move but lacks control, leading to overflow and erratic movement, causing these symptoms. The pungent-hot nature of Aconite Root (Fuzi) strengthens the Primordial Yang of the Kidney, thus providing a master for the water. The bitter-drying nature of Atractylodes Macrocephala Rhizome (Baizhu) establishes the Middle Earth (Spleen/Stomach), thus providing a constraint for the water. The pungent-dispersing nature of Fresh Ginger (Shengjiang) assists Aconite Root (Fuzi) in tonifying Yang, embedding the intent of dispersing water within the governance of water. The light-penetrating nature of Poria (Fuling) assists Atractylodes Macrocephala Rhizome (Baizhu) in strengthening Earth, embedding the method of promoting diuresis within the constraint of water. Most ingeniously, the sour-astringent nature of White Peony Root (Baishao) reflects the profound intent of Zhang Zhongjing. Generally, Yang Qi in the body is rooted in Yin Essence. If only pungent-hot herbs are used to tonify Yang without assisting with sour-astringent herbs, there is a risk that True Yang will fly away and dissipate. Using White Peony Root (Baishao) is to urgently gather Yang Qi and return it to Yin. From this, we can infer why, in cases of Yang collapse due to excessive sweating from misusing Xiao Qinglong Tang, White Peony Root (Baishao) is necessary among Yang-tonifying herbs. However, when reducing Baishao for diarrhea, it is because Yang is not scattering outward; adding Ganjiang is to warm the middle and overcome cold. When Cold-Water injures the Lung causing cough, Xixin and Ganjiang are added to disperse Cold-Water; Wuweizi is added to astringe Lung Qi. When urination is clear, Fuling is removed because although there is cold, water cannot stagnate. When vomiting occurs, Fuzi is removed and Shengjiang is doubled because the pathology is not in the Lower Jiao, but Water-Stagnation is in the Stomach; thus, warming the Kidney to move water is unnecessary, and instead, warming the Stomach to disperse water is required, and Shengjiang has the function of stopping vomiting.