渴者，盖先呕后渴，为邪欲解；先渴后呕，多为水停，况又有水寒射肺为咳之可兼察乎？以是知必有挟饮于内耳。
沈明宗曰∶黄连阿胶汤之心烦不得眠，较此条颇同而治异，何也？盖此条乃少阴风热，转入阳明而致下利，
故以猪苓汤驱导水邪，还从膀胱而去，急救胃中津液为主；彼条之心烦不得眠而无下利，乃肾水枯少，故用黄
连阿胶汤滋阴清火，急救肾阴为主也。
魏荔彤曰∶咳而咽不痛，渴而口不干，则知邪虽为传经而入之热，惟其有水饮相混，故热势不能甚肆。其
猛烈虽上冲为咳呕，而不致咽痛，隔阻正津为口渴，而不致干燥，兼以心烦不得眠，于少阴但欲寐，阴证中见
阳证，岂非传经之热兼水湿者乎？其所以不发黄者，以少阴病原有下利，湿不能留，热不能蓄故也。由此观之，
热邪兼水饮昭然矣。
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。
【注】凡少阴四逆，虽属阴盛不能外温，然亦有阳为阴郁，不得宣达而令四肢逆冷者，故有或咳、或悸、
或小便不利，或腹中痛、泄利下重诸证也。今但四逆而无诸寒热证，是既无可温之寒，又无可下之热，惟宜疏
畅其阳，故用四逆散主之。
【集注】李中梓曰∶按少阴用药，有阴阳之分，如阴寒而四逆者，非姜、附不能疗。此证虽云四逆必不甚
冷，或指头微温，或脉不沉微，乃阴中涵阳之证。惟气不宣通是以逆冷，故以柴胡凉表，芍药清中。此本肝胆
之剂，而少阴用之者，为水木同源也。以枳实利七冲之门，以甘草和三焦之气，气机宣通，而四逆可痊矣。
程知曰∶盖伤寒以阳为主，四逆有阴进之象，下之则阳益亏陷而不出。故经谓诸热邪传经至于手足逆冷最
难辨认，谓为寒深于里，则无脉微欲绝之象；谓为热深于里，则无烦渴之证。盖只是热邪入结于里，而阳气不
得顺行四肢也。此证当用和解，不当用寒下，故经中用剂之轻少者，无如此方，则其轻缓解散之义可见矣。
程应旄曰∶初得之四逆，固非热证，亦非深寒。咳悸而或小便不利，既似乎水蓄，腹痛泄利，又似乎寒凝，
其中更兼下重一证，得毋气滞在趺阳，而经络失宣通也耶！
汪琥曰∶四逆散，乃阳邪传变而入阴经，是解传经之邪，非治阴寒也。凡阳热之极，六脉细弱，语言轻微，
神色懒静，手足清温，有似阴证，而大便结小便数，齿燥舌苔，其热已伏于内，必发热也。若用热药，则内热
愈炽；用凉药，则热被寒束而不得散。法惟宜和表解肌，疏通气血，而里热自除。此仲景
四逆散所由设也。
四逆散方
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。
咳者，加五味子、干姜各五分，并主下利。悸者，加桂枝五分。小便不利者，加茯苓五分。腹中痛者，
加附子一枚，炮令折。泻利下重者，先以水五升，煮薤白三升，煮取三升，去滓，以散三方寸匕，纳汤中，煮
取一升半，分温再服。
【方解】方名四逆散，与四逆汤均治手足逆冷，但四逆汤治阴邪寒厥，此则治阳邪热厥。热厥者，三阳
传厥阴合病也。太阳厥阴，麻黄升麻汤、甘草干姜汤证也；阳明厥阴，白虎汤、大承气汤证也。此则少阳厥阴，
故君柴胡以疏肝之阳，臣芍药以泻肝之阴，佐甘草以缓肝之气，使枳实以破肝之逆，三物得柴胡，能外走少阳
之阳，内走厥阴之阴，则肝胆疏泄之性遂，而厥可通也。或咳或下利者，邪饮上下为病，加五味子、干姜，温
中以散饮也。或悸者，饮停侮心，加桂枝通阳以益心也。或小便不利者，饮蓄膀胱，加茯苓利水以导饮也。或
腹中痛者，寒凝于里，加附子温中以定痛也。或泻利下重者，寒热郁结，加薤白开结以疏寒热也。
【集解】方有执曰∶人之四肢，温和为顺，故以不温和为逆。但不温和而未至于厥冷，则热犹未深入也，
故用柴胡以解之，枳实以泻之，芍药以收之，甘草以和之也。
少阴病，下利，若利自止，恶寒而蜷卧，手足温者，可治。
【注】少阴病，恶寒厥冷下利不止者，阴寒盛也。今下利能自止，手足能自温，虽见恶寒蜷卧，乃阴退
阳回之兆，故曰可治。
【集注】程应旄曰∶少阴病，下利而利自止，则阴寒亦得下祛，而又不致于脱，虽有恶寒蜷卧不善之证，
但使手足温者，阳气有挽回之机，故可温而救之也。
沈明宗曰∶手足温者，乃真阳未离，急用白通、四逆之类，温经散寒，则邪退而真阳复矣，故曰可治。
少阴病，恶寒而蜷，时自烦，欲去衣被者，可治。
【注】少阴病，恶寒而蜷，阴寒证也。若时自烦欲去衣被者，此阳回阴退之征，故曰可治。
少阴病，得之二三日以上，心中烦，不得卧，黄连阿胶汤主之。
【注】此承上条以出其治也。少阴病，得之二三日以上，谓或四五日也。言以二三日，少阴之但欲寐，至
四五日，反变为心中烦不得卧，且无下利清谷咳而呕之证，知非寒也，是以不用白通汤；非饮也，亦不用猪苓
汤；乃热也，故主以黄连阿胶汤，使少阴不受燔灼，自可愈也。
【集注】程知曰∶二三日邪在少阴，四五日已转属阳明，故无呕利厥逆诸证。而心烦不得卧者，是阳明之
热内扰少阴，故不欲寐也，当以解热滋阴为主治也。
黄连阿胶汤方
黄连（四两） 黄芩（二两） 芍药（二两） 鸡子黄（二枚） 阿胶（三两）
上五味，以水六升，先煮三物，取二升，去滓，纳胶烊尽，小冷，纳鸡子黄，搅令相得，温服七合，日三服。
【集解】柯琴曰∶此少阴之泻心汤也。凡泻心必藉连、芩，而导引有阴阳之别。病在三阳，胃中不和，
而心下痞硬者，虚则加参、甘补之，实则加大黄下之。病在少阴，而心中烦不得卧者，既不得用参、甘以助阳，
亦不得用大黄以伤胃也。故用芩、连以直折心火；用阿胶以补肾阴；鸡子黄佐芩、连，于
泻心中补心血；芍药佐阿胶，于补阴中敛阴气，斯则心肾交合，水升火降，是以扶阴泻阳之方，而变为滋阴和
阳之剂也。是则少阴之火，各归其部，心中之烦、不得眠可除矣。经曰∶阴平阳秘，精神乃治。斯方之谓欤！
少阴病，下利咽痛，胸满心烦，猪肤汤主之。
【注】身温腹满下利，太阴证也；身寒欲寐下利，少阴证也。身热不眠咽痛，热邪也；身寒欲寐咽痛，寒
邪也。今身寒欲寐，下利咽痛，与胸满心烦之证并见，是少阴热邪也。少阴之脉，循喉咙，其支者，从肺出络
心注胸中，是以少阴之热邪上逆，则所过之处无不病也。以猪肤汤主之，解少阴上焦之热，兼止下焦之利也。
【集解】喻昌曰∶下利咽痛，胸满心烦，此少阴热邪充斥上下中间，无所不到，寒下之药，不可用矣，故
立猪肤汤一法也。盖阳微者，用附子温经；阴竭者，用猪肤润燥，温经润燥中，同具散邪之义也。
猪肤汤方
猪肤（一斤）
上一味，以水一斗，煮取五升，去滓，加白蜜一升，白粉五合，熬香，和令相得，温分六服。
【方解】猪肤者，乃革外之肤皮也。其体轻，其味咸，轻则能散，咸则入肾，故治少阴咽痛，是于解热中
寓散之意也。
【集解】成无己曰∶猪，水畜也。其气先入肾，解少阴之客热。加蜜以润燥除烦，白粉以益气断利也。
少阴病二三日，咽痛者，可与甘草汤；不瘥，与桔梗汤。
【注】少阴病二三日，咽痛无他证者，乃少阴经客热之微邪，可与甘草汤缓泻其少阴之热也。若不愈者，
与桔梗汤，即甘草汤加桔梗以开郁热。不用苦寒者，恐其热郁于阴经也。
【集注】喻昌曰∶用甘草者，和缓其势；用桔梗者，开提其邪也。此在二三日，他证未具，故可用之。若
五六日，则少阴之下利、呕逆诸证皆起，此法又未可用矣。
甘草汤方
甘草（二两）
上一味，以水三升，煮取一升半，去滓，温服七合，日二服。
桔梗汤方
桔梗（一两） 甘草（二两）
上二味，以水三升，煮取一升，去滓，温分再服。
少阴病，咽中痛，半夏散及汤主之。
【注】少阴病咽痛者，谓或左或右，一处痛也。咽中痛者，谓咽中皆痛也。较之咽痛而有甚焉。甚则涎缠
于咽中，故主以半夏散，散风邪以逐涎也。
【集注】方有执曰∶此以风邪热甚，痰上壅而痹痛者言也。故主之以桂枝祛风也，佐之以半夏消痰也，和
之以甘草除热也。三物者，是又为咽痛之一治法也。
半夏散及汤方
半夏（洗） 桂枝 甘草（炙，各等分）
上三味，各别捣筛已，合治之，白饮和服方寸匕，日三服。若不能散服者，以水一升，煎七沸，纳散两方
寸匕，更煮三沸，下火令小冷，少少咽之。半夏有毒，似不当散服。
少阴病，咽中伤，生疮，不能语言，声不出者，苦酒汤主之。
【注】少阴病，咽痛不愈，若剧者，咽中为痛所伤，渐乃生疮，不能言语，声音不出，
所必然也。以苦酒汤主之，用半夏涤涎，蛋清敛疮，苦酒消肿。则咽清而声出也。
【集注】程知曰∶咽痛忌汗、忌寒下，故甘草、桔梗、苦酒三方，皆用和解之法。惟半夏散及汤，在前条
为辛散温解之法也。
苦酒汤方
半夏（洗，破如枣核大，十四枚） 鸡子（去黄，纳上苦酒，着鸡子壳中，一枚）
上二味，纳半夏，着苦酒中，以鸡子壳置刀环中，安火上，令三沸，去滓，少少含咽之，不瘥，更作三剂。
【集解】李杲曰∶大抵少阴多咽伤、咽痛之证，古方用醋煮鸡子，主咽喉失音，取其酸收，固所宜也。半
夏辛燥，何为用之？盖少阴多寒证，取其辛能发散，一发一敛，遂有理咽之功也。
程知曰∶按卵白象天，卵黄象地。前黄连阿胶汤用鸡子黄，义取入肾滋阴；此苦酒汤用鸡子白，义取入肺
润疮也。
少阴病八九日，一身手足尽热者，以热在膀胱，必便血也。
【注】邪传少阴，不从阴化而见寒证，亦不从阳化而见热证，是其人肾气素充，所以脏虽受邪，留连八九
日，仍复传腑外散也。太阳主表，故一身手足尽热。若热还卫分，非汗不解；热还营分，非衄不解。热甚于上，
则头痛、目瞑、衄血；热甚于下，则腹痛、尿难、便血，理必然也。凡热少血多，瘀成血蓄；热多血少，热迫
其血，血不得蓄。今为少阴邪热，复转膀胱而伤营分，迫走下窍，故便血也。
【集注】程知曰∶前少阴病，手足不逆冷，反发热者不死，阳未全亏也；此八九日，一身及手足热，阴盛
于里也。
张璐曰∶少阴病，难于得热，热则阴尽阳复，故少阴篇中谓手足不逆冷，反发热者不死。然病至八九日，
阴邪内解之时，反一身手足尽热，少阴必无此证，当是脏邪转腑，肾移热于膀胱，以膀胱主表，故一身及手足
尽热也。膀胱之血，为少阴之热所逼，其趋必出阴窍，以阴主降故也。
少阴病，二三日至四五日，腹痛，小便不利，下利不止，便脓血者，桃花汤主之。
【注】少阴病二三日无阴邪之证，至四五日始腹痛、小便不利，乃少阴阳邪攻里也。若腹痛、口燥、咽干
而从燥化，则为可下之证矣。今腹痛、小便不利，是热瘀于里，水无出路，势必下迫大肠而作利也。倘利久热
伤其营，营为火化，血腐为脓，则为可清之证也。今下利昼夜不止，而便脓血，则其热已随利减，而下焦滑脱
可知矣，故以桃花汤主之，益中以固脱也。
【集注】成无己曰∶《要略》云∶阳证内热，则溢出鲜血；阴证内寒，则下紫黑如豚肝也。
喻昌曰∶治下必先固中，中气不下坠，则滑脱无源，而自止。注家见用干姜，谓是寒邪伤胃，不知热邪挟
少阴之气填塞胃中，故少佐干姜之辛以散之也。
程知曰∶此下利脓血之治法也。腹痛、小便不利，少阴热邪也，而下利不止，便脓血，则证为伤血，且有
中气下脱之虞矣，故用桃花汤固肠止利也。
魏荔彤曰∶此证乃热在下焦，而熏蒸中焦，使气化因热郁而不行，大便因热盛而自利也。久而下利不止，
将肠胃秽浊之物，如脓带血，尽随大便而下，热一日不消，利一日不止也。
沈明宗曰∶此邪挟内湿凝滞血分，则便脓血也。
桃花汤方
赤石脂（一半全用，一半筛末，一斤） 干姜（一两） 糯米（一升）
上三味，以水七升，煮米令熟，去滓，温
服七合，纳赤石脂末方寸匕，日三服。若一服愈，余勿服。
【方解】少阴寒邪，多利清谷；少阴热邪，多便脓血，日久不止，关门不固，下焦滑脱矣。此方君以体膏
性涩之石脂，养肠以固脱；佐以味甘多液之糯米，益气以滋中。则虽下利日久，中虚液枯，未有不愈者也。其
妙尤在用干姜少许，其意不在温而在散火郁，借此以开脓血无由而化也。若一服愈，余勿服，以其粘涩之性甚也。
少阴病，下利便脓血者，桃花汤主之。
【注】少阴病，诸下利用温者，以其证属虚寒也。此少阴下利便脓血者，是热伤营也。而不径用苦寒者，
盖以日久热随血去，肾受其邪，关门不固也，故以桃花汤主之。
少阴病，下利便脓血者，可刺。
Thirst: Thirst occurring after vomiting indicates that the pathogenic factor is about to resolve. However, thirst preceding vomiting usually suggests fluid retention. Furthermore, one can observe concurrent cough caused by cold-fluid attacking the lungs. Thus, it is known that there must be fluid retention within.
Shen Mingzong stated: The restlessness and insomnia treated by Huanglian Ejiao Tang are quite similar to this clause but differ in treatment. Why? This clause involves Shaoyin wind-heat transforming into Yangming, leading to diarrhea. Therefore, Zhuling Tang is used to guide out the water pathogen via the Bladder, prioritizing the urgent rescue of Stomach fluids. In contrast, the other clause (Huanglian Ejiao Tang) presents restlessness and insomnia without diarrhea, indicating dried-up Kidney water. Hence, Huanglian Ejiao Tang is used to nourish Yin and clear fire, prioritizing the urgent rescue of Kidney Yin.
Wei Litong stated: Cough with a non-painful throat, and thirst with a non-dry mouth, indicate that although the pathogen is heat transmitted through the meridians, its intensity is restrained because it mixes with fluid retention. Although the fierce Qi rushes upward causing cough and vomiting, it does not cause throat pain; although it obstructs normal fluids causing thirst, it does not cause dryness. Coupled with restlessness and insomnia appearing amidst the "desire to sleep" (Yin syndrome) of Shaoyin, isn't this heat transmitted through the meridians combined with dampness and fluid? The reason for no jaundice is that Shaoyin disease originally involves diarrhea, preventing dampness from staying and heat from accumulating. Thus, it is evident that heat pathogens combine with fluid retention.
Shaoyin disease presenting with cold extremities (Nizhi), where the patient may have cough, palpitations, difficult urination, abdominal pain, or tenesmus during diarrhea, should be primarily treated with Sini San.
[Note] Generally, Shaoyin cold extremities belong to excessive Yin failing to warm the exterior. However, there are cases where Yang is constrained by Yin, unable to circulate freely, causing cold extremities. Thus, symptoms like cough, palpitations, difficult urination, abdominal pain, and tenesmus occur. Since there are only cold extremities without other cold or heat signs, neither warming for cold nor purging for heat is applicable. Only unblocking and circulating Yang is suitable; hence, Sini San is used.
[Collected Notes] Li Zhongzi stated: Medication for Shaoyin differs between Yin and Yang syndromes. For Yin-cold causing cold extremities, only Ginger (Shengjiang/Ganjiang) and Aconite (Fuzi) work. This case, though called cold extremities, is not severely cold; fingers may be slightly warm, and the pulse is not deep and faint. It is a syndrome containing Yang within Yin. The coldness is due to Qi stagnation. Chaihu cools the exterior, and Shaoyao clears the interior. Though originally a Liver-Gallbladder formula, it is used for Shaoyin because Water and Wood share the same source. Zhishi unblocks the seven gates, and Gancao harmonizes the Sanjiao Qi. Once Qi mechanism circulates, cold extremities heal.
Cheng Zhi stated: In Shanghan, Yang is paramount. Cold extremities suggest advancing Yin. Purging would further deplete Yang. The Classic states that heat transmitted causing cold extremities is hardest to identify. If considered deep internal cold, there is no pulse fading away. If considered deep internal heat, there is no irritability or thirst. It is merely heat binding internally, preventing Yang from reaching the limbs. This case requires harmonization, not cold purgation. Among light formulas in the Classic, none is lighter than this, revealing its meaning of gentle resolution.
Cheng Yingmao stated: Initial cold extremities are neither heat nor deep cold. Cough, palpitations, and possible difficult urination resemble water accumulation; abdominal pain and diarrhea resemble cold coagulation. With added tenesmus, could Qi be stagnant at the Fuyang pulse, losing meridian circulation?
Wang Hu stated: Sini San treats Yang pathogen transmitting into Yin meridians, resolving transmitted heat, not treating Yin cold. When Yang heat is extreme, pulses may be fine and weak, speech quiet, spirit listless, and extremities cool/warm, resembling Yin syndrome. Yet constipation and frequent urination, dry teeth and coating indicate heat hidden inside, likely causing fever. Hot herbs intensify internal heat; cold herbs bind heat. The method is to harmonize and release the muscle layer, unblock Qi and Blood, eliminating internal heat. This is why Zhang Zhongjing established Sini San.
Sini San Formula
Gancao (Zhi/Roasted), Zhishi (Poaked, soaked in water, roasted dry), Chaihu, Shaoyao.
Four ingredients, each ten parts. Pound and sift. Mix with rice water, take one Fangcunbi, three times daily.
For cough, add Wuweizi and Ganjiang, five parts each, also treating diarrhea.
For palpitations, add Guizhi, five parts.
For difficult urination, add Fuling, five parts.
For abdominal pain, add Fuzi, one piece, prepared until breakable.
For tenesmus during diarrhea, boil Xiebai (Scallion white) in five sheng of water with three sheng of Xiebai to obtain three sheng. Strain. Add three Fangcunbi of the powder to the decoction. Boil to obtain one and a half sheng. Divide into two warm doses.
[Formula Analysis] Named Sini San, it treats cold extremities like Sini Tang, but Sini Tang treats Yin-cold Jue, while this treats Yang-heat Jue. Heat Jue is a combined disease of Three Yang transmitting to Jueyin. Taiyang-Jueyin involves Mahuang Shengma Tang or Gancao Ganjiang Tang; Yangming-Jueyin involves Baihu Tang or Dachengqi Tang. This case is Shaoyang-Jueyin. Chaihu (Monarch) disperses Liver Yang; Shaoyao (Minister) drains Liver Yin; Gancao (Assistant) moderates Liver Qi; Zhishi (Envoy) breaks Liver rebellion. Together with Chaihu, they move outward to Shaoyang Yang and inward to Jueyin Yin, restoring Liver-Gallbladder excretion and resolving Jue. For cough or diarrhea, pathogen and fluid affect upper and lower; Wuweizi and Ganjiang warm middle and scatter fluid. For palpitations, fluid stops harassing Heart; Guizhi unblocks Yang to benefit Heart. For difficult urination, fluid accumulates in Bladder; Fuling promotes urination to guide fluid. For abdominal pain, cold congeals inside; Fuzi warms middle to stop pain. For tenesmus, cold and heat knot; Xiebai opens knots to disperse cold and heat.
[Jie] Fang Youzhi stated: Limbs being warm is smooth; not warm is reverse. If not cold enough to be Jue, heat has not deeply entered. Use Chaihu to resolve, Zhishi to drain, Shaoyao to collect, Gancao to harmonize.
Shaoyin disease with diarrhea, if diarrhea stops spontaneously, accompanied by aversion to cold and curling up, but hands and feet are warm, is treatable.
[Note] Shaoyin disease with aversion to cold, cold extremities, and unremitting diarrhea indicates excessive Yin-cold. Now, spontaneous cessation of diarrhea and warming of hands/feet, despite aversion to cold and curling, signifies Yin retreating and Yang returning. Thus, it is treatable.
[Collected Notes] Cheng Yingmao stated: Spontaneous cessation of diarrhea removes Yin-cold downward without collapse. Despite bad signs like cold and curling, warm hands/feet show Yang recovery potential, allowing warming rescue.
Shen Mingzong stated: Warm hands/feet mean True Yang is not departed. Urgently use Baotong or Sini type formulas to warm meridians and scatter cold. Pathogen retreats, True Yang recovers. Treatable.
Shaoyin disease with aversion to cold and curling, occasionally feeling irritable and wanting to remove clothes/blankets, is treatable.
[Note] Aversion to cold and curling is Yin-cold. Occasional irritability and desire to remove coverings signify Yang returning and Yin retreating. Treatable.
Shaoyin disease, after two to three days or more, presenting with vexation in the heart and inability to lie down, should be primarily treated with Huanglian Ejiao Tang.
[Note] Following the previous clause to explain treatment. Shaoyin disease after two-three days implies four-five days. At two-three days, Shaoyin shows desire to sleep; by four-five days, it changes to heart vexation and insomnia, without diarrhea of undigested food, cough, or vomiting. Knowing it is not cold, Baotong Tang is not used; knowing it is not fluid, Zhuling Tang is not used. It is heat, so Huanglian Ejiao Tang is used to prevent Shaoyin from being scorched, ensuring recovery.
[Collected Notes] Cheng Zhi stated: Two-three days pathogen is in Shaoyin; by four-five days it transfers to Yangming. No vomiting, diarrhea, or Jue. Heart vexation and insomnia result from Yangming heat disturbing Shaoyin. Treatment should focus on clearing heat and nourishing Yin.
Huanglian Ejiao Tang Formula
Huanglian (4 liang), Huangqin (2 liang), Shaoyao (2 liang), Ji Zi Huang (Egg Yolk, 2 pieces), Ejiao (3 liang).
Five ingredients. Boil first three in six sheng of water to obtain two sheng. Strain. Dissolve Ejiao. Cool slightly. Add egg yolk, stir well. Take seven ge warm, three times daily.
[Jie] Ke Qin stated: This is the Xiexin Tang of Shaoyin. Xiexin requires Lian and Qin, but guidance differs by Yin/Yang. In Three Yang, Stomach disharmony with chest fullness/hardness: deficiency adds Renshen/Gancao; excess adds Dahuang. In Shaoyin, heart vexation/insomnia: cannot use Renshen/Gancao to aid Yang, nor Dahuang to injure Stomach. Use Qin/Lian to curb Heart Fire; Ejiao to tonify Kidney Yin; Egg Yolk assists Qin/Lian to nourish Heart Blood while draining; Shaoyao assists Ejiao to gather Yin while tonifying. Heart-Kidney interact, Water rises, Fire descends. Transforming Fu-Yin/Xie-Yang into Zi-Yin/Huo-Yang agent. Fire returns to its place, vexation/insomnia removed. Classic says: "When Yin is balanced and Yang is firm, Spirit is governed." This formula embodies this.
Shaoyin disease with diarrhea, sore throat, chest fullness, and heart vexation should be primarily treated with Zhufu Tang.
[Note] Warm body, abdominal fullness, diarrhea = Taiyang. Cold body, desire to sleep, diarrhea = Shaoyin. Fever, insomnia, sore throat = Heat pathogen. Cold body, desire to sleep, sore throat = Cold pathogen. Now cold body, desire to sleep, diarrhea, sore throat, plus chest fullness/vexation = Shaoyin Heat pathogen. Shaoyin meridian runs along throat; branch from Lung connects to Heart, enters chest. Shaoyin heat reversing upward causes pathology along its path. Zhufu Tang resolves Shaoyin Upper Jiao heat and stops Lower Jiao diarrhea.
[Jie] Yu Chang stated: Diarrhea, sore throat, chest fullness, vexation indicate Shaoyin heat filling upper, lower, and middle. Cold purgatives are contraindicated. Zhufu Tang is established. For weak Yang, use Fuzi to warm; for exhausted Yin, use Zhufu to moisten. Both warm/moisten and scatter pathogen.
Zhufu Tang Formula
Zhufu (Pig skin, 1 jin).
One ingredient. Boil in ten dou of water to obtain five sheng. Strain. Add Baimi (White honey) one sheng, Baifen (Rice flour) five he. Stir-fry until fragrant, mix well. Divide into six warm doses.
[Formula Analysis] Zhufu is outer pig skin. Light texture, salty taste. Light scatters; Salt enters Kidney. Treats Shaoyin sore throat, implying scattering within clearing heat.
[Jie] Cheng Wuji stated: Pig is Water animal. Its Qi enters Kidney first, resolving Shaoyin guest heat. Honey moistens/dries vexation; Rice flour benefits Qi/stops diarrhea.
Shaoyin disease, two-three days, sore throat: give Gancao Tang. If not healed, give Jiegeng Tang.
[Note] Two-three days, sore throat without other signs = mild guest heat in Shaoyin meridian. Gancao Tang gently drains Shaoyin heat. If unresolved, Jiegeng Tang (Gancao + Jiegeng) opens depressed heat. Avoid bitter-cold to prevent heat trapping in Yin meridians.
[Collected Notes] Yu Chang stated: Gancao moderates momentum; Jiegeng lifts pathogen. Applicable at two-three days before other symptoms arise. By five-six days, Shaoyin diarrhea/vomiting arise, making this method unusable.
Gancao Tang Formula
Gancao (2 liang).
One ingredient. Boil in three sheng water to obtain one and a half sheng. Strain. Take seven ge warm, twice daily.
Jiegeng Tang Formula
Jiegeng (1 liang), Gancao (2 liang).
Two ingredients. Boil in three sheng water to obtain one sheng. Strain. Divide into two warm doses.
Shaoyin disease, pain in the throat center: Banxia San and Decoction primarily treat.
[Note] Shaoyin sore throat refers to unilateral pain. Pain in throat center refers to diffuse pain, more severe. Severe cases involve saliva entangling throat. Banxia San disperses Wind pathogen and drives out saliva.
[Collected Notes] Fang Youzhi stated: Wind-heat severe, phlegm obstructing causing bi-pain. Guizhi dispels wind; Banxia eliminates phlegm; Gancao clears heat. Another method for sore throat.
Banxia San & Decoction Formula
Banxia (Washed), Guizhi, Gancao (Roasted, equal parts).
Three ingredients. Pound/sift separately, mix. Take one Fangcunbi with rice water, three times daily. If powder is intolerable, boil one sheng water seven times, add two Fangcunbi powder, boil three times. Cool slightly. Swallow slowly. Banxia is toxic, seemingly unsuitable for powder.
Shaoyin disease, injury to throat, sores forming, inability to speak, voice loss: Kujiu Tang primarily treats.
[Note] Unresolved sore throat worsening leads to throat injury, sores, aphonia. Kujiu Tang uses Banxia to wash saliva, Egg White to contract sores, Kujiu (Vinegar) to reduce swelling. Throat clears, voice returns.
[Collected Notes] Cheng Zhi stated: Sore throat forbids sweating and cold purgation. Gancao, Jiegeng, Kujiu formulas all use harmonization. Only Banxia San uses acrid-warm resolution.
Kujiu Tang Formula
Banxia (Washed, broken like jujube pit, 14 pieces), Ji Dan (Egg, remove yolk, add Kujiu, keep in shell, 1 piece).
Two ingredients. Place Banxia in Kujiu. Put eggshell in knife ring over fire. Boil three times. Strain. Hold and swallow slowly. If not healed, make three more doses.
[Jie] Li Gao stated: Shaoyin often has throat injury/pain. Ancient formulas use vinegar-boiled egg for aphonia, using sour-astringency. Banxia is acrid-dry; why use it? Shaoyin often has cold. Acrid disperses. One dispersing, one astringing, regulating throat.
Cheng Zhi stated: Egg white represents Heaven, yolk Earth. Huanglian Ejiao Tang uses yolk to enter Kidney/nourish Yin. Kujiu Tang uses white to enter Lung/moisten sores.
Shaoyin disease, eight-nine days, whole body and extremities hot: Heat is in Bladder,必定 (must) cause hematochezia/blood in stool.
[Note] Pathogen entering Shaoyin transforms neither to Yin-cold nor Yang-heat initially, indicating robust Kidney Qi. Pathogen lingers 8-9 days, then transmits to Fu and disperses externally. Taiyang governs exterior, causing whole-body/extremity heat. If heat remains in Wei level, sweat resolves it; if in Ying level, epistaxis resolves it. Heat above causes headache, eye closing, epistaxis; heat below causes abdominal pain, difficult urination, hematochezia. Less heat/more blood causes blood stasis; more heat/less blood forces blood flow. Here, Shaoyin heat transfers to Bladder, injuring Ying level, forcing blood down the orifice, causing hematochezia.
[Collected Notes] Cheng Zhi stated: Previous clause: extremities not cold, fever = not fatal, Yang not fully depleted. This clause: 8-9 days, whole body/extremity heat = Yin excess internally.
Zhang Lu stated: Shaoyin rarely gets heat; heat means Yin ends, Yang returns. "Extremities not cold, fever" is not fatal. But at 8-9 days, when Yin pathogen should resolve, sudden whole-body/extremity heat is impossible for pure Shaoyin. Likely Zang-Fu transmission, Kidney heat transferring to Bladder. Bladder governs exterior, causing whole-body/extremity heat. Bladder blood, forced by Shaoyin heat, exits via Yin orifices due to Yin descending nature.
Shaoyin disease, two-three to four-five days, abdominal pain, difficult urination, unremitting diarrhea, pus and blood in stool: Taohua Tang primarily treats.
[Note] Shaoyin 2-3 days without Yin-cold signs, developing abdominal pain/difficult urination at 4-5 days = Shaoyin Yang-heat attacking interior. If pain/dry mouth/throat dryness transformed to dryness, purgation would apply. Now pain/difficult urination = heat stasis inside, water no outlet, pressing Large Intestine causing diarrhea. If prolonged heat injures Ying, blood rots to pus, clearing would apply. Now day/night unremitting pus/blood diarrhea = heat reduced with diarrhea, Lower Jiao slipping/debilitated. Taohua Tang tonifies Middle and secures leakage.
[Collected Notes] Cheng Wuji stated: Jingui YaoLue: Yang syndrome internal heat -> bright red blood; Yin syndrome internal cold -> purple-black like pig liver.
Yu Chang stated: Treat diarrhea by securing Middle first. If Middle Qi doesn't drop, slipping stops. Commentators see Ganjiang and think Cold damages Stomach. Actually, Heat pathogen with Shaoyin Qi fills Stomach; slight Ganjiang acridity disperses it.
Cheng Zhi stated: Treatment for pus/blood diarrhea. Pain/difficult urination = Shaoyin heat. Unremitting pus/blood = blood injury, risk of Middle Qi collapse. Taohua Tang secures intestine/stops diarrhea.
Wei Litong stated: Heat in Lower Jiao steams Middle Jiao, blocking Qi transformation. Heat causes spontaneous diarrhea. Prolonged diarrhea expels turbid matter (pus/blood). Heat persists, diarrhea continues.
Shen Mingzong stated: Pathogen combines with internal dampness, stagnating Blood level, causing pus/blood stool.
Taohua Tang Formula
Chishizhi (Half whole, half powdered, 1 jin), Ganjiang (1 liang), Nuomi (Glutinous Rice, 1 sheng).
Three ingredients. Boil rice in seven sheng water until cooked. Strain. Take seven ge warm. Add one Fangcunbi of Chishizhi powder. Three times daily. If cured after one dose, stop remaining.
[Formula Analysis] Shaoyin Cold -> undigested diarrhea; Shaoyin Heat -> pus/blood. Prolonged -> gate insecure, Lower Jiao slipping. Chishizhi (Monarch) is sticky/astringent, nourishes intestine/secures leakage. Nuomi (Assistant) is sweet/fluid-rich, benefits Qi/nourishes Middle. Even with prolonged diarrhea/Middle deficiency/fluid depletion, it heals. Key is slight Ganjiang: intent not warming, but dispersing Fire depression, aiding pus/blood resolution. Stop if cured due to strong astringency.
Shaoyin disease, diarrhea with pus/blood: Taohua Tang primarily treats.
[Note] Shaoyin diarrhea treated with warmth implies deficiency-cold. This pus/blood diarrhea is Heat injuring Ying. Bitter-cold is avoided because prolonged heat leaves with blood, Kidney affected, gate insecure. Taohua Tang is used.
Shaoyin disease, diarrhea with pus/blood: Acupuncture may be used.