之后，冷体既消，热性便发，由是病气随愈，呕哕皆除，情且不违，而致大益。此和人尿、猪胆汁咸苦寒物
于白通汤热剂中，要其气相从，则可以去格拒之寒也。
以上三（赵本作“右五”）味，以水三升，煮取一升，去滓，内胆汁、人尿，和令相得，分温再服，若
无胆亦可用。
少阴病，二三日不已，至四五日，腹痛，小便不利，四肢沉重疼痛，自下利者，此为有水气，其人或
咳，或小便利，或下利，或呕者，真武汤主之。
少阴病二三日，则邪气犹浅，至四五日邪气已深。肾主水，肾病不能制水，水饮停为水气。腹痛者，寒湿
内甚也；四肢沉重疼痛，寒湿外甚也；小便不利，自下利者，湿胜而水谷不别
也。《内经》曰∶湿胜则濡泄。与真武汤，益阳气散寒湿。
真武汤方∶
茯苓（三两。甘平） 芍药（三两。酸平） 生姜（三两，切。辛温） 白术（二两。甘温）
附子（一枚，炮，去皮，破八片。辛热）
脾恶湿，甘先入脾。茯苓、白术之甘，以益脾逐水。寒淫所胜，平以辛热；湿淫所胜，佐以酸平。附子、
芍药、生姜之酸辛，以温经散湿。
上五味，以水八升，煮取三升，去滓，温服七合，日三服。
后加减法∶（赵本无“后加减法”四字）
若咳者，加五味（赵本医统本并有“子”字）半升，细辛、干姜各一两。（赵本作“细辛一两，干姜一两”）
气逆咳者，五味子之酸，以收逆气。水寒相搏则咳，细辛、干姜之辛，以散水寒。
若小便利者，去茯苓。
小便利，则无伏水，故去茯苓。
若下利者，去芍药，加干姜二两。
芍药之酸泄气，干姜之辛散寒。
若呕者，去附子，加生姜，足前成（赵本作“为”）半斤。
气逆则呕，附子补气，生姜散气。《千金》曰∶呕家多服生姜。此为呕家圣药。
少阴病，下利清谷，里寒外热，手足厥逆，脉微欲绝，身反不恶寒，其人面赤色，（赵本作“色赤”）
或腹痛，或干呕，或咽痛，或利止，脉不出者，通脉四逆汤主之。
下利清谷，手足厥逆，脉微欲绝，为里寒；身热，不恶寒，面色赤为外热。此阴甚于内，格阳于外，不
相通也，与通脉四逆汤，散阴通阳。
通脉四逆汤方∶
甘草（二两，炙） 附子（大者一枚，生用，去皮，破八片） 干姜（三两，强人可四两）
上三味，以水三升，煮取一升二合，去滓，分温再服。其脉即出者愈。
面色赤者，加葱九茎。
葱味辛，以通阳气。
腹中痛者，去葱，加芍药二两。
芍药之酸，通寒利。腹中痛，为气不通也。
呕者，加生姜二两。
辛以散之，呕为气不散也。
咽痛者，去芍药，加桔梗一两。
咽中如结，加桔梗则能散之。
利止脉不出者，去桔梗，加人参二两。（赵本有“病皆
与方相应者，乃服之”十字）
利止脉不出者，亡血也，加人参以补之。经曰∶脉微而利，亡血也。四逆加人参汤主之，脉（熊校记∶
□病皆与方相应者，乃可服之。汪本病上增脉字。按旧钞本赵本，此二句皆属正文，直接加人参二两
句下，惟乃下无可字，计凡十字，并非成氏注语也。元人开版时漏写，随改作小字，添入夹行，特于上空
格以区别之，初无缺字）病皆与方相应者，乃可服之。
少阴病，四逆，其人或咳，或悸，或小便不利，或腹中痛，或泄利下重者，四逆散主之。
四逆者，四肢不温也。伤寒邪在三阳，则手足必热；传到太阴，手足自温；至少阴则邪热渐深，故四肢逆
而不温也；及至厥阴，则手足厥冷，是又甚于逆。四逆散以散传阴之热也。
四逆散方∶
甘草（炙。甘平） 枳实（破，水渍炙干。苦寒） 柴胡（苦寒） 芍药（酸微寒）
《内经》曰∶热淫于内，佐以甘苦，以酸收之，以苦发之。枳实、甘草之甘苦，（医统本作“苦甘”）
以泄里热；芍药之酸，以收阴气；柴胡之苦，以发表热。
上四味，各十分，捣筛，白饮和，服方寸匕，日三服。
咳者，加五味子、干姜各五分，并主下痢。（赵本医统本并作“利”）
肺寒气逆则咳。五味子之酸，收逆气；干姜之辛，散肺寒。并主下痢者，肺与大肠为表里，上咳下痢，
治则颇同。
悸者，加桂枝五分。
悸者，气虚而不能通行，心下筑筑然悸动也。桂，犹圭也。
引导阳气，若热（熊校记∶若执以使，汪本执改热，于义不通。按注意，言加
桂以导阳，犹之执圭以为使，故上言桂犹圭也，此执字即根圭字来，使读去声，
明桂为散中之佐使药，主引导也）以使。
小便不利者，加茯苓五分。
茯苓味甘而淡，用以渗泄。
腹中痛者，加附子一枚，炮令坼。
里虚遇邪则痛，加附子以补虚。
泄利下重者，先以水五升，煮薤白三升，煮取三升，去滓，以散三方寸匕，内汤中，煮取一升半，分温再服。
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。（赵本有“猪苓汤方”详见卷五）
下利不渴者，里寒也。经曰∶自利不渴者，属太阴，以其脏寒故也。此下利呕渴，知非里寒；心烦不得
眠，知协热也。与猪苓汤渗泄小便，分别水谷。经曰∶复不止，当利其小便。此之谓欤？
少阴病，得之二三日，口燥咽干者，急下之，宜大承气汤。（赵本有“大承气汤方”详见卷五）
伤寒传经五六日，邪传少阴，则口燥舌干而渴，为邪渐深也。今少阴病得之二三日，邪气未深入之时，
便作口燥咽干者，是邪热已甚，肾水干也，急与大承气汤下之，以全肾也。
少阴病，自利清水，色纯青，心下必痛，口干燥者，急（赵本作“可”）下之，宜大承气汤。（赵本
注∶“一法用大柴胡”）
少阴，肾水也。青，肝色也。自利色青，为肝邪乘肾。《难经》曰∶从前来者为实邪。以肾蕴实邪，必
心下痛，口干燥也，与大承气汤以下实邪。
少阴病，六七日，腹胀不大便者，急下之，宜大承气汤。
此少阴入腑也，六七日，少阴之邪入腑之时，阳明内热壅甚，腹满，不大便也。阳明病，土胜肾水则干，
急与大承气汤下之，以救肾水。
少阴病，脉沉者，急温之，宜四逆汤。（赵本有“四逆汤方”详见卷二）
既吐且利，小便复利，而大汗出，下利清谷，内寒外热，脉微欲绝者，不云急温；此少阴病脉沉而云
急温者，彼虽寒甚，然而证已形见于外，治之则有成法；此初头脉沉，未有形证，不知
邪气所之，将发何病，是急与四逆汤温之。
少阴病，饮食入口则吐，心中温温欲吐，复不能吐，始得之，手足寒，脉弦迟者，此胸中实，不可下也，
当吐之。若膈上有寒饮，干呕者，不可吐也，急（赵本作“当”）温之，宜四逆汤。
伤寒表邪传里，至于少阴。少阴之脉，从肺出，络心注胸中。邪既留于胸中而不散者，饮食入口则吐，心
中温温欲吐，阳气受于胸中，邪既留于胸中，则阳气不得宣发于外，是以始得之，手足寒，脉弦迟，此是胸
中实，不可下，而当吐。其膈上有寒饮，亦使人心中温温而手足寒，吐则物出，呕则物不出，吐
与呕别焉。胸中实，则吐而物出；若膈上有寒饮，则但干呕而不吐也，此不可吐，可与四逆汤以温其膈。
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。（赵本注∶“《脉经》云∶
灸厥阴，可五十壮”）
脉微为亡阳，涩为亡血。下利呕而汗出，亡阳亡血也。津液不足，里有虚寒，必数更衣；反少者，
温其上，以助其阳也，灸
之以消其阴。
Afterward, the cold nature dissipates, and the heat nature emerges; thus, the pathogenic qi subsides, vomiting and hiccups are completely eliminated, the patient's condition remains harmonious, resulting in significant benefit. This is achieved by adding Ren Niao (Human Urine) and Zhu Dan Huang (Pig Bile), which possess salty, bitter, and cold properties, into Bai Tong Tang (White Pass Decoction), a hot-natured formula. The key lies in the mutual adherence of their qi (flavors/natures), thereby overcoming the rejection of cold pathogens against the medication.
The above three ingredients (Zhao edition states "the right five"), with three sheng of water, are boiled to obtain one sheng. The dregs are removed, and Dan Huang (Bile) and Ren Niao (Human Urine) are added and mixed well. The mixture is divided into two doses and taken warm. If bile is unavailable, it may be omitted.
In Shaoyin disease, if after two or three days there is no improvement, and by the fourth or fifth day abdominal pain, dysuria, heaviness and pain in the four limbs, and spontaneous diarrhea occur, this indicates the presence of fluid retention (Shui Qi). Among these patients, some may experience cough, clear urination, worsening diarrhea, or vomiting. Zhen Wu Tang (True Warrior Decoction) is indicated.
Shaoyin disease lasting two or three days suggests the pathogen is still shallow; by the fourth or fifth day, the pathogen has penetrated deeply. The Kidney governs water; when Kidney disease fails to control water, fluid accumulation occurs, forming fluid retention. Abdominal pain indicates severe internal cold-dampness; heaviness and pain in the four limbs indicate severe external cold-dampness; dysuria and spontaneous diarrhea result from dampness prevailing, causing the separation of water and grain to fail. As stated in *Nei Jing* (Inner Canon): "When dampness prevails, loose stools occur." Zhen Wu Tang (True Warrior Decoction) is administered to tonify Yang qi and disperse cold-dampness.
**Zhen Wu Tang (True Warrior Decoction) Formula:**
Fuling (Poria, 3 liang, sweet, neutral) Shaoyao (Peony Root, 3 liang, sour, neutral) Shengjiang (Fresh Ginger, 3 liang, sliced, pungent, warm) Baizhu (Atractylodes Macrocephala Rhizome, 2 liang, sweet, warm) Fuzi (Prepared Aconite Lateral Root, 1 piece, processed, skin removed, broken into eight pieces, pungent, hot)
The Spleen dislikes dampness, and sweet flavors enter the Spleen first. The sweetness of Fuling (Poria) and Baizhu (Atractylodes Macrocephala Rhizome) tonifies the Spleen and expels water. When Cold prevails, it is balanced with Pungent-Hot agents; when Dampness prevails, it is assisted with Sour-Neutral agents. The sour and pungent properties of Fuzi (Prepared Aconite Lateral Root), Shaoyao (Peony Root), and Shengjiang (Fresh Ginger) warm the meridians and disperse dampness.
The above five ingredients, with eight sheng of water, are boiled to obtain three sheng. The dregs are removed. Each dose of seven he is taken warm, three times daily.
**Subsequent Modifications:**
If coughing occurs, add Wuweizi (Schisandra Berry, half sheng), Xixin (Asarum), and Ganjiang (Dried Ginger), each one liang. For rebellious Qi causing cough, the sourness of Wuweizi (Schisandra Berry) astringes the rebellious Qi. Cough caused by the binding of Water-Cold is dispersed by the pungency of Xixin (Asarum) and Ganjiang (Dried Ginger).
If urination is free, remove Fuling (Poria). Free urination indicates no latent water, hence Fuling (Poria) is removed.
If diarrhea occurs, remove Shaoyao (Peony Root) and add Ganjiang (Dried Ginger), two liang. The sourness of Shaoyao (Peony Root) drains Qi, while the pungency of Ganjiang (Dried Ginger) disperses Cold.
If vomiting occurs, remove Fuzi (Prepared Aconite Lateral Root) and add Shengjiang (Fresh Ginger), sufficient to make up half a jin of the previous quantity. Rebellious Qi causes vomiting; Fuzi (Prepared Aconite Lateral Root) tonifies Qi, while Shengjiang (Fresh Ginger) disperses Qi. *Qian Jin Fang* states: "Vomiters should frequently take Shengjiang (Fresh Ginger)." It is the sacred medicine for vomiters.
In Shaoyin disease, if there is diarrhea with undigested food, interior Cold with exterior Heat, cold extremities, and a pulse that is faint and nearly imperceptible, yet the body does not feel aversion to cold, and the person's face is red, or if there is abdominal pain, dry retching, sore throat, or cessation of diarrhea with an absent pulse, Tong Mai Si Ni Tang (Pulse-Recovering Four-Inverse Decoction) is indicated.
Diarrhea with undigested food, cold extremities, and a faint, nearly imperceptible pulse indicate Interior Cold; fever, absence of aversion to cold, and red complexion indicate Exterior Heat. This represents Yin Cold prevailing internally and repelling Yang externally, leading to a lack of communication between them. Tong Mai Si Ni Tang (Pulse-Recovering Four-Inverse Decoction) is given to scatter Yin Cold and unblock Yang.
**Tong Mai Si Ni Tang (Pulse-Recovering Four-Inverse Decoction) Formula:**
Gancao (Licorice Root, 2 liang, honey-fried) Fuzi (Raw Aconite Lateral Root, one large piece, raw use, skin removed, broken into eight pieces) Ganjiang (Dried Ginger, 3 liang, 4 liang for robust individuals)
The above three ingredients, with three sheng of water, are boiled to obtain one sheng and two he. The dregs are removed. The decoction is divided into two warm doses. Recovery occurs if the pulse reappears.
If the face is red, add Cong Bai (Scallion White), nine stems. Scallion White is pungent and unblocks Yang Qi.
If there is abdominal pain, remove Cong Bai (Scallion White) and add Shaoyao (Peony Root), two liang. The sourness of Shaoyao (Peony Root) unblocks Cold and relieves pain. Abdominal pain indicates blocked Qi.
If vomiting occurs, add Shengjiang (Fresh Ginger), two liang. Pungency disperses; vomiting indicates stagnant Qi.
If there is a sore throat, remove Shaoyao (Peony Root) and add Jiegeng (Platycodon Root), one liang. A sensation of constriction in the throat is dissipated by Jiegeng (Platycodon Root).
If diarrhea ceases but the pulse does not appear, remove Jiegeng (Platycodon Root) and add Renshen (Ginseng Root), two liang. Cessation of diarrhea with an absent pulse indicates loss of Blood; Renshen (Ginseng Root) is added to tonify. The Classics state: "A faint pulse with diarrhea indicates loss of Blood." Si Ni Jia Ren Shen Tang (Four-Inverse Decoction plus Ginseng) is indicated. [Textual note regarding Zhao edition: "If the disease corresponds to the formula, then take it."] Diarrhea ceasing with an absent pulse indicates loss of Blood; Renshen (Ginseng Root) is added to tonify. The Classics state: "A faint pulse with diarrhea indicates loss of Blood." Si Ni Jia Ren Shen Tang (Four-Inverse Decoction plus Ginseng) is indicated. [Textual note: "If the disease corresponds to the formula, then take it."]
In Shaoyin disease, with cold extremities, where the patient may have cough, palpitations, dysuria, abdominal pain, or diarrhea with a feeling of rectal heaviness, Si Ni San (Four-Inverse Powder) is indicated.
"Si Ni" refers to cold extremities. In Taiyang, Yangming, and Shaoyang diseases, hands and feet are hot; in Taiyin disease, hands and feet are naturally warm; in Shaoyin disease, the pathogenic heat deepens, causing cold extremities; in Jueyin disease, hands and feet become completely cold, which is more severe than Si Ni. Si Ni San (Four-Inverse Powder) disperses heat transmitted to the Yin stages.
**Si Ni San (Four-Inverse Powder) Formula:**
Gancao (Licorice Root, honey-fried, sweet, neutral) Zhishi (Immature Bitter Orange, broken, soaked in water and dried, bitter, cold) Chaihu (Bupleurum Root, bitter, cold) Shaoyao (Peony Root, sour, slightly cold)
*Nei Jing* states: "When Heat prevails internally, assist with Sweet-Bitter, astringe with Sour, and diffuse with Bitter." The Sweet-Bitter nature of Zhishi (Immature Bitter Orange) and Gancao (Licorice Root) drains Interior Heat; the Sour nature of Shaoyao (Peony Root) astringes Yin Qi; the Bitter nature of Chaihu (Bupleurum Root) releases Exterior Heat.
The above four ingredients, each ten parts, are crushed and sifted. Mix with rice water and take one cun bi (square-inch measure) per dose, three times daily.
If coughing occurs, add Wuweizi (Schisandra Berry) and Ganjiang (Dried Ginger), each five fen, which also treats dysentery. Lung Cold with rebellious Qi causes cough. The sourness of Wuweizi (Schisandra Berry) astringes rebellious Qi; the pungency of Ganjiang (Dried Ginger) disperses Lung Cold. Treating both cough and dysentery is based on the exterior-interior relationship between Lung and Large Intestine; the treatment principles for upper cough and lower dysentery are similar.
If palpitations occur, add Guizhi (Cinnamon Twig), five fen. Palpitations result from Qi deficiency failing to circulate, causing a thumping sensation in the heart region. Gui (Cinnamon) sounds like Gui (Jade Tablet). It guides Yang Qi, acting as an envoy like holding a jade tablet. [Textual note clarifying the metaphor of guiding Yang].
If dysuria occurs, add Fuling (Poria), five fen. Fuling (Poria) is sweet and bland, used to leach out dampness.
If there is abdominal pain, add Fuzi (Prepared Aconite Lateral Root), one piece, processed until cracked. Pain due to Interior Deficiency encountering pathogenic factors is treated by adding Fuzi (Prepared Aconite Lateral Root) to tonify deficiency.
If diarrhea with rectal heaviness occurs, first boil Xiebai (Allium Macrostemon Bulb) in five sheng of water to obtain three sheng. Remove dregs. Add three cun bi of the powder to the decoction, boil to obtain one and a half sheng, divide into two warm doses. Rectal heaviness in diarrhea indicates Lower Jiao Qi stagnation; Xiebai (Allium Macrostemon Bulb) is added to drain Qi stagnation.
In Shaoyin disease, if diarrhea persists for six or seven days, accompanied by cough, vomiting, thirst, irritability, and insomnia, Zhu Ling Tang (Polyporus Decoction) is indicated.
Diarrhea without thirst indicates Interior Cold. The Classics state: "Spontaneous diarrhea without thirst belongs to Taiyin due to organ Cold." Here, diarrhea with vomiting and thirst indicates it is not Interior Cold; irritability and insomnia indicate accompanying Heat. Zhu Ling Tang (Polyporus Decoction) is given to promote diuresis and separate water and grain. The Classics state: "If it does not stop, promote urination." This is what is meant.
In Shaoyin disease, if after two or three days there is dry mouth and throat, immediate purgation is required using Da Cheng Qi Tang (Major Order the Qi Decoction). After five or six days of transmission in Shanghan, if the pathogen enters Shaoyin, causing dry mouth, tongue, and throat with thirst, the pathogen is deepening. However, if Shaoyin disease presents with dry mouth and throat after only two or three days, before the pathogen has deeply penetrated, it indicates severe pathogenic Heat and depletion of Kidney Water. Immediate purgation with Da Cheng Qi Tang (Major Order the Qi Decoction) is necessary to preserve Kidney Water.
In Shaoyin disease, if there is spontaneous diarrhea of pure green watery stool,必 (must) pain in the epigastrium, and dry mouth, immediate purgation is required using Da Cheng Qi Tang (Major Order the Qi Decoction). Shaoyin corresponds to Kidney Water; Green corresponds to Liver Color. Diarrhea of green color indicates Liver Pathogen attacking Kidney. *Nan Jing* states: "Coming from the preceding element is Excess Pathogen." Due to Excess Pathogen accumulating in the Kidney, there must be epigastric pain and dry mouth. Da Cheng Qi Tang (Major Order the Qi Decoction) is given to purge the Excess Pathogen.
In Shaoyin disease, if after six or seven days there is abdominal distension and constipation, immediate purgation is required using Da Cheng Qi Tang (Major Order the Qi Decoction). This represents Shaoyin entering the Fu organs. At six or seven days, Shaoyin pathogen enters the Fu stage; Yangming Internal Heat is severely congested, causing fullness and constipation. In Yangming disease, Earth excess depletes Kidney Water; immediate purgation with Da Cheng Qi Tang (Major Order the Qi Decoction) is needed to save Kidney Water.
In Shaoyin disease, if the pulse is deep, immediate warming is required using Si Ni Tang (Four-Inverse Decoction). Cases involving vomiting and diarrhea, frequent urination, profuse sweating, diarrhea with undigested food, Interior Cold with Exterior Heat, and faint, nearly imperceptible pulse are not described as requiring "immediate warming"; they have manifest symptoms and established treatments. Here, Shaoyin disease with a deep pulse at the onset, lacking manifest symptoms, makes the pathogen's location and progression uncertain. Therefore, Si Ni Tang (Four-Inverse Decoction) is immediately given to warm.
In Shaoyin disease, if food is vomited immediately upon entering the mouth, with a sense of nausea in the heart but inability to vomit, and initially cold hands and feet with a string-tight and slow pulse, this is Excess in the Chest. Purging is contraindicated; emesis is indicated. If there is Cold Fluid above the diaphragm causing dry retching, emesis is contraindicated; immediate warming is required using Si Ni Tang (Four-Inverse Decoction).
Taiyang pathogen transmitting inward reaches Shaoyin. The Shaoyin meridian originates from the Lung, connects to the Heart, and enters the Chest. If pathogen stays in the Chest and does not disperse, food is vomited upon entry, and there is nausea. Yang Qi is constrained in the Chest; unable to disseminate outward, hands and feet become cold, and the pulse is string-tight and slow. This is Chest Excess, contraindicating purging but indicating emesis. Cold Fluid above the diaphragm also causes nausea and cold hands. Vomiting expels material; retching does not. Chest Excess results in vomiting with expulsion of material; Cold Fluid results in dry retching without expulsion. Emesis is contraindicated here; Si Ni Tang (Four-Inverse Decoction) is given to warm the diaphragm.
In Shaoyin disease, if there is diarrhea, a faint and choppy pulse, vomiting with sweating, frequent desire to defecate but with little output, the upper part should be warmed with moxibustion. A faint pulse indicates Yang collapse; a choppy pulse indicates Blood collapse. Diarrhea, vomiting, and sweating indicate collapse of both Yang and Blood. Insufficient fluids and Interior Cold-Deficiency lead to frequent defecation attempts with little output. Warming the upper part with moxibustion assists Yang and dissipates Yin.