遗其变。俱补出少阴主枢之义。今试再详之。第三十四节。谓少阴病下利。白通汤主之。示少阴下利以
此为专方。第三十五节。谓少阴病下利脉微者。与白通汤。利不止。厥逆无脉。干呕烦者。白通加猪胆汁
汤主之。服汤脉暴出者死。微续者生。此言寒盛骤投热药而拒格。必取热因寒用之法也。第三十六节。
谓少阴病二三日不已。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。此言水中无火。则土虚不能制水。此为有水气五字最重。为少阴
之侧面文章。非白通四逆之为正面文章也。第三十七节。谓少阴病下利清谷。里寒外热。手足厥逆。脉
微欲绝。身反不恶寒。其人面赤色。或腹痛。或干呕。或咽痛。或利止脉不出者。通脉四逆汤主之。此言内
真寒而外假热。为少阴之正面文章。又为四逆证之进一步文章也。自三十一节至此。承上第三十节
下利立论。为少阴证下水作一 也。
第三十八节。谓少阴四逆。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。此承四
逆不专主于虚寒。复设和解一法。以示变动不居之意。所以暗补出主枢之义也。第三十九节。谓少阴
下利六七日。咳而呕渴。心烦不得眠者。猪苓汤主之。此承下利虽属于下焦。至六七日寒变为热。而气
复上行。病见咳呕渴烦不眠等证。所谓下行极而上也。复设一清利法。遵经旨邪气自下而上者。仍须
从下引而出之。亦所以暗补出主枢之义也。跟上第三十节全节大意主枢作一 也。所以然者。少阴
为性命之根。病有水火之分。治若焚溺之救。稍迟则不可挽矣。
第四十节云。少阴病得之二三日。口燥舌干者。急下之。宜大承气汤。此言少阴君火亢于上。不戢将自
焚也。第四十一节云。少阴病。自利清水。色纯青。心下必痛。口干燥者。急下之。宜大承气汤。此言少阴君
火亢于上。加以木火煽之。一水不能胜二火而立竭矣。第四十二节云。少阴病六七日。腹胀不大便者。
急下之。宜大承气汤。此言少阴君火不能从枢而出。逆于地中而为胀。即内经所谓一息不运。则针机
穷。必急下以运少阴之枢而使转之。少阴三急下证。宜于浅注而熟玩之。又有二急温症。第四十三节
云。少阴病脉沉迟者。急温之。宜四逆汤。言少阴为性命之根。起首脉沉。预知已伏四逆吐利烦燥之机。
即易履霜坚冰至之义。盖于人所易忽者。独知所重而急治之也。第四十四节云。少阴病。饮食入口则
吐。心中温温欲吐。复不能吐。（阴寒拒格不纳露出枢象）始得之。手足寒。脉弦迟者。此胸中实。不可下也。
当吐之。（借胸中实可吐证叙出急温症。）若膈上有寒饮。干呕者。不可吐也。急温之。宜四逆汤。此少阴阴
气上 寒饮。不同于胸实。盖人所摇移者。得所独断而急治之也。究而言之。少阴重在救阳。而真阴亦不可伤。
第四十五节云。少阴病下利。脉微（阳虚）涩（阴虚）。呕而汗出。（阳虚则阴寒上逆而为呕。阴虚则阴不内守而汗出）
必数更衣。反少者。（七字是一节之眼目。阳虚则气下坠。阴虚则动努矣）当温其上灸之。
言当灸百会一穴。以温其上。不可偏温其下。以灼真阴。言外见对待之阴阳。分而为两。互根之阴阳。合
而为一也。少阴篇文本空灵幻变。不可方物。老子其犹龙矣乎。
遗漏了少阴病的变证。这里都补充说明了少阴作为“主枢”的意义。现在再详细论述一下。第三十四节说，少阴病出现下利，用白通汤主治。这是表明少阴下利以此方为专用方剂。第三十五节说，少阴病下利且脉象微弱的，给予白通汤；如果服药后下利不止，出现四肢厥冷、无脉、干呕、心烦的症状，用白通加猪胆汁汤主治。服药后如果脉搏突然暴出的是死证，脉搏微微续接的是生证。这是在说明寒邪极盛时骤然投用热药会导致格拒（排斥），必须采用“热因寒用”的方法。第三十六节说，少阴病两三天没有好转，到了四五天出现腹痛、小便不利、四肢沉重疼痛、自发性下利的症状，这是因为体内有水气。或者有的患者咳嗽，或者小便通畅，或者下利，或者呕吐的，用真武汤主治。这是在说明水中没有阳气（火），则脾土虚弱不能制约水湿，这就是所谓“有水气”。这五个字最为重要，是少阴病的侧面文章，不同于白通汤、四逆汤所代表的正面文章。第三十七节说，少阴病下利完谷不化，里有寒而外有假热，手足厥冷，脉微细几乎摸不到，身体反而不恶寒，病人面色发红，或者腹痛，或者干呕，或者咽痛，或者下利停止但脉搏不出来的，用通脉四逆汤主治。这是在说明内里是真寒而外表是假热，这是少阴病的正面文章，也是四逆证进一步发展的文章。从第三十一节到这里，承接上文第三十节关于下利的论述，为少阴证的水液代谢障碍做了一个总结。
第三十八节说，少阴病出现四肢厥冷，或者有的患者咳嗽，或者心悸，或者小便不利，或者腹中疼痛，或者泄利伴有肛门重坠感的，用四逆散主治。这是承接上文指出四肢厥冷并不专属于虚寒证，又设立了一种和解的方法，以显示病情变动不居的意思。所以暗中补充说明了少阴作为“主枢”的意义。第三十九节说，少阴病下利六七天，伴有咳嗽、呕吐、口渴、心烦不得睡眠的症状，用猪苓汤主治。这是承接上文指出下利虽然属于下焦病变，但到了六七天，寒邪转化为热邪，并且气机重新上行，病症表现为咳嗽、呕吐、口渴、心烦、失眠等。这就是所谓的“下行至极则转而向上”。又设立一种清利湿热的方法，遵循经旨中“邪气自下而上者，仍须从下引导而出之”的原则。这也是在暗中补充说明少阴作为“主枢”的意义。这与跟上文第三十节全节大意中的“主枢”相呼应。之所以这样，是因为少阴是性命之根本，疾病有水和火两种性质的区分，治疗若像救火或救人溺水一样紧急，稍一迟缓就无法挽回了。
第四十节说，少阴病得病两三天，出现口燥舌干的症状，应当急下，宜用大承气汤。这是在说明少阴君火亢盛于上，如果不加以遏制将会自焚。第四十一节说，少阴病，自利清水，颜色纯青，心下部必然疼痛，口干燥的，应当急下，宜用大承气汤。这是在说明少阴君火亢盛于上，再加上木火煽动，肾水不能胜二火而立刻枯竭。第四十二节说，少阴病六七天，腹部胀满且不大便的，应当急下，宜用大承气汤。这是在说明少阴君火不能通过枢机转出，逆乱于地中导致腹胀，即《内经》所说的“一息不运，则针机穷”，必须急下以运转少阴的枢机使其转动。少阴三急下证，应当在浅注中仔细玩味。又有二急温症。第四十三节说，少阴病脉象沉迟的，应当急温，宜用四逆汤。这是说少阴是性命之根本，起首脉沉，预先知道已经潜伏了四肢厥逆、呕吐下利、烦躁的机理，也就是《易经》中“履霜坚冰至”的含义。在于人们容易忽视的地方，唯独知道重视并急于治疗。第四十四节说，少阴病，饮食入口就吐，心中感觉温热想吐却又吐不出来。（这是阴寒格拒不纳，显露出枢机的象）刚得病时，手足寒冷，脉象弦迟的，这是胸中有实邪，不可用下法，应当用吐法。（借胸中实可吐的证候叙述出急温症）。如果膈上有寒饮，干呕的，不可用吐法，应当急温，宜用四逆汤。这是少阴阴气上逆伴有寒饮，不同于胸中实邪。在于人们动摇犹豫的时候，得到独到的决断而急于治疗。总而言之，少阴病重在挽救阳气，而真阴也不可损伤。第四十五节说，少阴病下利，脉象微（阳虚）、涩（阴虚），呕吐且出汗。（阳虚则阴寒上逆而为呕吐，阴虚则阴不内守而汗出）必定频繁上厕所，但排便量反而很少的。（这七个字是一节的重点，阳虚则气下坠，阴虚则产生努责感）。应当温灸上部穴位。说是应当灸百会这一穴，以温煦上部，不可偏重于温下部，以免灼伤真阴。言外之意体现了对待的阴阳分为两途，互根的阴阳合而为一的道理。少阴篇的文本空灵变幻，不可名状，老子大概就像龙一样吧。
The variations of Shaoyin disease are omitted. Here, the significance of Shaoyin as the "pivot" (Zhu Shu) is supplemented. Let us examine this in detail now. Section 34 states that for Shaoyin disease presenting with diarrhea, Baotong Tang (White Tongue Decoction) is the primary treatment. This indicates that Baotong Tang is the specific formula for Shaoyin diarrhea. Section 35 states that for Shaoyin disease with diarrhea and a faint pulse, Baotong Tang is administered; if diarrhea persists, accompanied by cold extremities, absence of pulse, dry retching, and irritability, Baotong Tang plus Porcine Bile Decoction (Baotong Jia Zhudan Huang Tang) is used. If the pulse suddenly emerges violently after taking the decoction, it indicates death; if the pulse slowly resumes, it indicates survival. This explains that when cold pathogenic factors are extreme, sudden administration of hot herbs causes rejection (Ge Ju), necessitating the method of "using heat for cold" (Re Yin Han Yong). Section 36 states that if Shaoyin disease does not improve after two or three days, and by the fourth or fifth day presents with abdominal pain, dysuria, heaviness and pain in the four limbs, and spontaneous diarrhea, this is due to the presence of water qi (Shui Qi). The patient may also have cough, clear urination, diarrhea, or vomiting; in such cases, Zhenwu Tang (True Warrior Decoction) is indicated. This describes a condition where there is no fire (Yang Qi) within the water, leading to Spleen Earth deficiency and an inability to control water dampness. The phrase "presence of water qi" is most critical; it represents the lateral aspect of Shaoyin disease, distinct from the frontal aspects represented by Baotong Tang and Sini Tang. Section 37 states that for Shaoyin disease with diarrhea of undigested food, internal cold with external false heat, cold extremities, and a pulse so faint it is nearly imperceptible, yet the body feels no aversion to cold and the face appears red, or if accompanied by abdominal pain, dry retching, sore throat, or cessation of diarrhea without pulse recovery, Tongmai Sini Tang (Pulse-Reviving Sini Decoction) is used. This describes true internal cold with false external heat, representing the frontal aspect of Shaoyin disease and a progression of the Sini syndrome. From Section 31 to here, following the discussion on diarrhea in Section 30, this serves as a summary for water-related disorders in Shaoyin syndrome.
Section 38 states that for Shaoyin disease presenting with cold extremities, and optionally cough, palpitations, dysuria, abdominal pain, or tenesmus during diarrhea, Sini San (Four Counterflow Powder) is used. This follows up by indicating that cold extremities are not exclusively due to deficiency-cold, thereby establishing a harmonizing method to demonstrate the dynamic nature of the disease. Thus, it implicitly supplements the significance of Shaoyin as the pivot. Section 39 states that for Shaoyin diarrhea persisting for six or seven days, accompanied by cough, vomiting, thirst, irritability, and insomnia, Zhu Ling Tang (Polyporus Decoction) is used. This follows the principle that although diarrhea originates in the lower jiao, after six or seven days the cold transforms into heat, and the qi moves upward again, manifesting as cough, vomiting, thirst, irritability, and insomnia—what is termed "descending to the extreme leads to ascending." A clearing and draining method is established, adhering to the classic principle that pathogens moving upward from below should still be guided out from below. This also implicitly supplements the significance of Shaoyin as the pivot, aligning with the main theme of Section 30 regarding the pivot. This is because Shaoyin is the root of life and destiny; diseases are divided into water and fire types, and treatment must be as urgent as rescuing someone from fire or drowning, for any delay renders it irretrievable.
Section 40 states: "For Shaoyin disease developing over two or three days, with dry mouth and tongue, immediate purgation is required, using Da Chengqi Tang (Major Order the Qi Decoction)." This explains that when Minister Fire (Jun Huo) of Shaoyin is hyperactive above, failure to restrain it will lead to self-burning. Section 41 states: "For Shaoyin disease with spontaneous discharge of clear watery stool, purely green in color, with必 (must) pain in the epigastrium and dry mouth/throat, immediate purgation is required, using Da Chengqi Tang." This explains that Shaoyin Minister Fire is hyperactive above, exacerbated by Wood-Fire stirring, causing Kidney Water to fail against the two Fires and collapse immediately. Section 42 states: "For Shaoyin disease lasting six or seven days, with abdominal distension and constipation, immediate purgation is required, using Da Chengqi Tang." This explains that Shaoyin Minister Fire fails to exit via the pivot, reversing into the earth element causing distension. As stated in the *Neijing*: "If movement ceases for a breath, the efficacy of acupuncture ends." One must urgently purge to move the Shaoyin pivot and restore its rotation. The three urgent purgation syndromes of Shaoyin should be carefully studied in shallow annotations. There are also two urgent warming syndromes. Section 43 states: "For Shaoyin disease with a deep and slow pulse, urgent warming is required, using Sini Tang." This emphasizes that Shaoyin is the root of life; a deep pulse at the onset predicts the latent mechanism of cold extremities, vomiting, diarrhea, and irritability, akin to the meaning of "treading on frost implies hard ice is coming." It highlights focusing on what others easily overlook and treating it urgently. Section 44 states: "For Shaoyin disease, if food is vomited upon entering the mouth, and there is a warm sensation in the heart with a desire to vomit but inability to do so... (indicating Yin-Cold rejection revealing pivot symptoms), and initially presenting with cold extremities and a string-taut, slow pulse, this is excess in the chest; purgation is contraindicated, but emesis is indicated. (Using the chest-excess emesis case to narrate the urgent warming syndrome.) If there is cold-fluid retention above the diaphragm causing dry retching, emesis is contraindicated; urgent warming is required, using Sini Tang." This describes Shaoyin Yin-Qi rising with cold-fluid retention, differing from chest excess. In moments of hesitation, one must make a unique decision to treat urgently. Ultimately, Shaoyin focuses on saving Yang, while True Yin must not be damaged. Section 45 states: "For Shaoyin disease with diarrhea, a faint (Yang deficiency) and choppy (Yin deficiency) pulse, vomiting and sweating... (Yang deficiency leads to Yin-Cold counterflow causing vomiting; Yin deficiency leads to insecure Yin causing sweating), frequent trips to the toilet but scant output... (these seven characters are the key: Yang deficiency causes Qi sinking; Yin deficiency causes straining). One should warm the upper part with moxibustion." This means moxa should be applied to Baihui (GV20) to warm the upper region, avoiding excessive warming of the lower part which could scorch True Yin. The implication is that opposing Yin and Yang divide into two, while mutually rooting Yin and Yang unite as one. The text of the Shaoyin chapter is ethereal and变幻 (transformative), indescribable; Laozi was perhaps like a dragon.