麻黄附子细辛汤。麻黄附子甘草汤。附子汤。四逆汤。通脉四逆加人参汤。真武汤。猪苓
汤。黄连阿胶汤。四逆散。大承气汤。
但欲寐。口燥咽干。咽痛。吐。吐利。下利。
少阴症。仲景以脉微细、但欲寐为主病。此指正气之虚。非示邪气之实也。凡舌干口燥。心
烦。泄利下重。是少阴实邪见象。引衣蜷卧。下利清谷。腹痛吐泻。是少阴虚寒见证。脉以沉实有
力为实热。沉细无力为虚寒。须分属之。又烦为阳。躁为阴。少阴以烦为生机。躁为死兆。
邵评∶此辨少阴虚寒实热之见症脉象。分际极清
凡初起发热身痛。而头不痛。脉沉而微细。无里症。但欲寐者。此少阴感寒之表症
也。宜麻黄附子细辛汤峻汗之。若发热在二三日后。麻黄附子甘草汤微汗之。盖少阴与太
阳为表里。故发热。即可发汗。是假太阳为出路也。
邵评∶三阴无表热见症。少阴病反发热。是外连太阳之表也。故用麻附细辛发
汗温经。在二三日后。见症稍缓。方内去细辛而用甘草者。用药亦缓也。
若恶寒身痛。手足冷。骨节痛。口中和。而脉沉者。是表里俱寒也。附子汤大温大补之。
邵评∶寒伤肾阳。阳气大虚。故专用温补。
若下利清谷。里寒表热。手足厥冷。脉微欲绝。但欲寐者。此太阴转少阴也。四逆汤主之。
邵评∶寒邪转入少阴。而阳大虚。不能内守。治以扶阳散寒。此即俗名漏底伤寒症之正法。
若反不恶寒。或咽痛。干呕腹痛。面赤。或利止。脉不出。此下元虚极。阴症似阳也。通
脉四逆加人参主之。盖葱体空味辛。能入肺以行营卫之气。姜、附、参、甘。得此以奏捷于经络之间。
而脉自通矣。
邵评∶寒中少阴。阴盛格阳。阳被寒郁。故见此假热之症。用通阳散寒之法。
若腹痛下利。四肢沉重疼痛。小便不利者。此坎中阳虚。不能以制阴水。致阴浊停蓄。宜真武汤。
壮元阳以消阴翳。培阳土以泄阴水。则开阖得宜。小便自利。腹痛诸
症自除矣。
以上诸条。皆少阴虚寒之证。
邵评∶肾阳虚弱。水气浊阴凝蓄。用壮阳泄浊。以利水气一法。
按手足厥冷。专指指掌言。四逆兼胫臂言。故少阴下利。手足厥冷。犹为可治。四肢逆冷则死。
少阴病。下利六七日。咳而呕。心烦不眠。小水不利者。此少阴阳邪停水也。宜猪苓汤主之。使热
邪从小便而出。诸症自解矣。
邵评∶此少阴阳邪挟水气上逆为病。用滋阴利水。导热下行一法。
少阴病。得之二三日以上。心中烦。不得卧。黄连阿胶汤主之。此传经热邪扰动少阴之阴。肾水亏。
则君火旺。故以芩连泻心。胶黄育阴。且鸡子黄色赤而通心。阿胶色黑而通肾。坎离合治。自然热清而烦解。
少阴病。四逆。泄利下重。或咳或悸。或小便不利。或腹中痛。四逆散主之。此阳经热邪扰于阴
分而厥也。盖四逆。有寒热之分。胃阳不敷于四肢为寒厥。阳邪内扰于
阴分为热厥。寒则下利清谷。热则泄利下重。故用芍药枳实以清泄之。柴胡以升
散之。则升降利。而厥逆诸症自解矣。
以上三条。皆阳经热邪传里。但不转属阳明。故不用承气。
邵评∶此阳邪传里。少阴热厥证。因阳邪陷入阴中。阳内而阴反外。以致阴阳脉气。不相顺接。而为四逆。
此热厥也。或咳或悸等症。皆因水气为患也。少阴枢机无主。故有此或然之症。用四逆散以敛阴泄热。
以散四逆之热邪。后随症加味。以治或然之症。此少阴气分之下剂也。
少阴病。有大承气急下者三症。一曰得二三日。口燥咽干。急下之。一曰自利清水。
色纯青。心下痛。口干燥。急下之。一曰六七日。腹胀不大便者。急下之。此皆阳经
热邪传里。销烁肾液。以致胃中大实。病已转属阳明。故用承气急下。
邵评∶少阴用承气急下三症。此是阳经热邪。传入少阴。脏不能容。则还而转属
阳明胃腑。腑实燥热。灼耗肾精胃液。而见口燥咽干。下水便秘腹胀等症。故急下之。以救阴液。
麻黄附子细辛汤。麻黄附子甘草汤。附子汤。四逆汤。通脉四逆加人参汤。真武汤。猪苓汤。黄连阿胶汤。四逆散。大承气汤。
只想睡觉（但欲寐）。口干咽燥。咽喉疼痛。呕吐。上吐下泻。腹泻。
少阴病（少阴经受邪所致的病证）。张仲景以脉象微细、只想睡觉作为主要病症特征。这是指正气虚弱，并非显示邪气实盛。凡是舌干口燥、心烦、泄泻且伴有肛门重坠感，是少阴实证邪气的表现。喜欢蜷缩身体躺卧、腹泻排出未消化的食物、腹痛呕吐，是少阴虚寒证的表现。脉象以沉取有力为实热，沉取细弱无力为虚寒，必须加以区分。另外，“烦”属于阳，“躁”属于阴，少阴病中以“烦”为生机，“躁”为死兆。
邵评：此处辨析少阴病虚寒与实热的症状和脉象，界限非常清晰。
凡是初起时发热身痛，但头部不痛，脉象沉而微细，没有里证，只是只想睡觉的，这是少阴感受寒邪的表证。适宜用麻黄附子细辛汤峻猛发汗。如果发热在发病二三天后出现，用麻黄附子甘草汤轻微发汗。因为少阴与太阳互为表里，所以发热就可以发汗，这是借助太阳经作为出路。
邵评：三阴经通常没有表热症状，少阴病反而发热，说明外连太阳之表。所以用麻黄、附子、细辛发汗并温通经脉。在发病二三天后，症状稍缓，方剂中去掉细辛而改用甘草，用药也变得缓和。
如果恶寒身痛，手脚冰冷，骨节疼痛，口中感觉正常（口中和），且脉象沉的，这是表里俱寒。适宜用附子汤大力温补。
邵评：寒邪损伤肾阳，阳气极度虚弱，所以专门使用温补之法。
如果腹泻排出未消化的食物，里有寒而表有热，手脚厥冷，脉象微弱几乎摸不到，只想睡觉的，这是太阴病转化为少阴病。用四逆汤主治。
邵评：寒邪转入少阴，导致阳气极度虚弱，不能内守，治疗以扶助阳气、驱散寒邪为主。这就是俗称的“漏底伤寒症”的正治法。
如果反而不恶寒，或者咽喉疼痛，干呕腹痛，面色发红，或者腹泻停止但脉搏摸不到，这是下元极度虚弱，阴证似阳证。用通脉四逆加人参汤主治。葱白中空味辛，能入肺经以运行营卫之气，生姜、附子、人参、甘草得到葱白的帮助，能在经络间迅速奏效，脉搏自然通畅。
邵评：寒邪中于少阴，阴盛格拒阳气，阳气被寒邪郁遏，所以出现这些假热的症状。采用通阳散寒的方法。
如果出现腹痛腹泻，四肢沉重疼痛，小便不利的，这是肾中阳气虚弱，不能制约阴水，导致阴浊停滞蓄积。适宜用真武汤。壮大元阳以消除阴翳，培补脾土以排泄阴水，那么开阖功能得当，小便自然通利，腹痛等症状自然消除。
以上各条，都是少阴虚寒的证候。
邵评：肾阳虚弱，水气与浊阴凝滞蓄积，采用壮阳泄浊、以利水气的方法。
按：手足厥冷专指手指和脚趾发冷，四逆兼指小腿和手臂发冷。所以少阴病腹泻，如果只是手足厥冷，还可以治疗；如果是四肢逆冷，则预后不良（死亡）。
少阴病，腹泻六七天，咳嗽且呕吐，心烦失眠，小便不利的，这是少阴阳热邪气与水饮停聚。适宜用猪苓汤主治，使热邪从小便排出，各种症状自然解除。
邵评：这是少阴阳热邪气挟带水气上逆致病，采用滋阴利水、引导热邪下行的一法。
少阴病，得病二三天以上，心中烦躁，无法入睡的，用黄连阿胶汤主治。这是传经的热邪扰动少阴之阴，肾水亏虚，则心火旺盛，所以用黄芩、黄连清泻心火，阿胶、鸡子黄滋养阴液，而且鸡子黄色赤通心，阿胶色黑通肾，坎离交合治疗，自然热清烦解。
少阴病，四肢逆冷，泄泻且伴有肛门重坠感，或者咳嗽或者心悸，或者小便不利，或者腹中疼痛的，用四逆散主治。这是阳经的热邪扰乱阴分导致的厥逆。四逆有寒热之分，胃阳不足不能敷布于四肢为寒厥，阳热邪气内扰阴分为热厥。寒证则腹泻排出未消化的食物，热证则泄泻且伴有肛门重坠感，所以用芍药、枳实清泄，柴胡升散，那么升降功能协调，厥逆等症状自然解除。
以上三条，都是阳经热邪传入里部，但不转属阳明经，所以不用承气汤。
邵评：这是阳邪传入里部，少阴热厥证。因阳邪陷入阴中，阳气在内而阴气反在外，导致阴阳脉气不相顺接，从而出现四肢逆冷。这是热厥。咳嗽或心悸等症状，都是因为水气为患。少阴枢机无主，所以有这些或然症。用四逆散收敛阴气、泄除热邪，以疏散四肢逆冷的热邪，随后根据症状加减，以治疗或然症。这是少阴气分的下剂。
少阴病，有大承气汤急下的三种情况。第一种是得病二三天，口燥咽干，急下之。第二种是自利清水，颜色纯青，心下疼痛，口干燥，急下之。第三种是六七天，腹胀不大便，急下之。这些都是阳经热邪传入里部，消烁肾液，导致胃中大实，病已转属阳明经，所以用承气汤急下。
邵评：少阴病用承气汤急下的三种情况，这是阳经热邪传入少阴，脏气不能容纳，则返还转属阳明胃腑。腑实燥热，灼耗肾精胃液，而出现口燥咽干、下水便秘腹胀等症状，所以急下，以救阴液。
Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction). Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction). Fuzi Tang (Aconite Decoction). Sini Tang (Frigid Extremities Decoction). Tongmai Sini Jia Renshen Tang (Decoction to Restore the Pulse with Sini Tang plus Ginseng). Zhenwu Tang (True Warrior Decoction). Zhuling Tang (Polyporus Decoction). Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction). Sini San (Frigid Extremities Powder). Dachengqi Tang (Major Order the Qi Decoction).
Somnolence (desire to sleep only). Dry mouth and throat. Sore throat. Vomiting. Vomiting and diarrhea. Diarrhea.
Shaoyin disease (disease pattern of the Shaoyin channel). Zhang Zhongjing takes a faint and fine pulse, along with somnolence, as the main pathological features. This indicates deficiency of healthy qi, not excess of pathogenic factors. Whenever there is dry tongue and mouth, irritability, and diarrhea with a sensation of heaviness in the anus, these are manifestations of excess pathogens in Shaoyin. Lying curled up, diarrhea with undigested food, abdominal pain, and vomiting are manifestations of deficiency-cold in Shaoyin. Regarding the pulse, deep and forceful indicates excess-heat, while deep, fine, and weak indicates deficiency-cold; these must be distinguished. Furthermore, "fan" (restlessness/irritability) belongs to Yang, and "zao" (agitation) belongs to Yin. In Shaoyin disease, "fan" signifies vitality, whereas "zao" signifies a fatal sign.
Shao's Commentary: This section distinguishes the symptoms and pulse images of deficiency-cold and excess-heat in Shaoyin disease, with very clear boundaries.
Whenever there is fever and body ache at the onset, but without headache, a deep and faint-fine pulse, no interior syndrome, and only somnolence, this is an exterior syndrome of Shaoyin contracting cold. It is appropriate to use Mahuang Fuzi Xixin Tang for vigorous sweating. If fever appears after two or three days, use Mahuang Fuzi Gancao Tang for mild sweating. Since Shaoyin and Taiyang are exterior-interior counterparts, fever allows for sweating; this utilizes Taiyang as an exit route.
Shao's Commentary: The Three Yin channels typically do not present with exterior heat. Shaoyin disease presenting with fever indicates connection to the exterior of Taiyang. Therefore, Mahuang, Fuzi, and Xixin are used to induce sweating and warm the channels. After two or three days, when symptoms slightly ease, Xixin is removed and Gancao is used in the formula, making the medication milder.
If there is aversion to cold, body ache, cold hands and feet, bone and joint pain, a normal sensation in the mouth (kou zhong he), and a deep pulse, this is cold affecting both exterior and interior. It is appropriate to use Fuzi Tang for strong warming and tonification.
Shao's Commentary: Cold damages Kidney Yang, causing severe Yang deficiency; thus, specific warming and tonifying methods are employed.
If there is diarrhea with undigested food, interior cold with exterior heat, cold extremities, a faint pulse almost imperceptible, and somnolence, this is Taiyin disease transforming into Shaoyin disease. Sini Tang is the primary treatment.
Shao's Commentary: Cold pathogens enter Shaoyin, causing severe Yang deficiency that cannot remain within. Treatment focuses on supporting Yang and dispersing cold. This is the correct method for what is commonly known as "Lou Di Shang Han" (leaky bottom cold damage).
If there is contrary absence of aversion to cold, or sore throat, dry retching with abdominal pain, flushed face, or cessation of diarrhea with absent pulse, this is extreme deficiency of the lower origin, where Yin syndrome mimics Yang. Tongmai Sini Jia Renshen Tang is the primary treatment. Scallion white is hollow and pungent, entering the Lung to circulate Ying and Wei Qi. Ginger, Fuzi, Renshen, and Gancao, aided by scallion white, achieve rapid results in the collaterals, and the pulse naturally becomes accessible.
Shao's Commentary: Cold strikes Shaoyin, causing Yin excess to repel Yang, with Yang constrained by cold, resulting in these false-heat symptoms. The method of unblocking Yang and dispersing cold is used.
If there is abdominal pain and diarrhea, heavy and painful limbs, and difficult urination, this is deficiency of Yang in Kan (Kidney), unable to control Yin water, leading to stagnation of Yin turbidity. Zhenwu Tang is appropriate. It strengthens Yuan Yang to dispel Yin shadows and nourishes Spleen Earth to drain Yin water, thereby regulating opening and closing, allowing normal urination, and naturally resolving abdominal pain and other symptoms.
The above items all describe Shaoyin deficiency-cold syndromes.
Shao's Commentary: Kidney Yang is weak, with water qi and turbid Yin coagulating and accumulating. The method involves strengthening Yang to drain turbidity and promoting diuresis.
Note: "Cold extremities" (shou zu jue leng) specifically refers to coldness of fingers and toes. "Si Ni" (four reversals) includes calves and arms. Therefore, in Shaoyin disease with diarrhea, if only hands and feet are cold, it is still treatable; if all four limbs are cold, it is fatal.
In Shaoyin disease, if diarrhea persists for six or seven days, accompanied by cough and vomiting, irritability, insomnia, and difficult urination, this is Yang heat pathogen combined with water retention in Shaoyin. Zhuling Tang is appropriate to allow heat pathogens to exit via urine, resolving all symptoms.
Shao's Commentary: This is Shaoyin Yang heat pathogen carrying water qi upward. The method involves nourishing Yin, promoting diuresis, and guiding heat downward.
In Shaoyin disease, if two or more days have passed since onset, with mental irritability and inability to sleep, Huanglian Ejiao Tang is the primary treatment. This is transmitted heat disturbing Shaoyin Yin. Deficiency of Kidney Water leads to hyperactivity of Ministerial Fire. Thus, Huangqin and Huanglian clear Heart fire, while Ejiao and Ji Zi Huang nourish Yin. Ji Zi Huang is red and connects to the Heart; Ejiao is black and connects to the Kidney. Through the interaction of Kan and Li, heat clears and irritability resolves.
In Shaoyin disease, with cold extremities, diarrhea with anal heaviness, or cough, palpitations, difficult urination, or abdominal pain, Sini San is the primary treatment. This is Jue (reversal) caused by Yang channel heat pathogens disturbing the Yin aspect. Si Ni has cold and heat distinctions: insufficient Stomach Yang failing to reach limbs causes cold Jue; internal disturbance by Yang heat pathogens in Yin causes heat Jue. Cold presents with diarrhea of undigested food; heat presents with diarrhea and anal heaviness. Therefore, Shaoyao and Zhishi are used to clear and drain, and Chai Hu to ascend and disperse. With regulated ascending and descending functions, Jue and related symptoms resolve.
The above three items involve Yang channel heat pathogens transmitting to the interior, but not transferring to Yangming, hence Chengqi formulas are not used.
Shao's Commentary: This is Yang pathogen transmitting to the interior, constituting Shaoyin heat Jue syndrome. Because Yang pathogen sinks into Yin, Yang is inside while Yin is outside, causing Yin-Yang pulse qi to fail connecting smoothly, resulting in cold extremities. This is heat Jue. Cough or palpitations are due to water pathology. The Shaoyin pivot lacks mastery, causing these optional symptoms. Sini San is used to astringe Yin, drain heat, and disperse heat pathogens causing cold extremities. Subsequent modifications treat optional symptoms. This is a purgative formula for Shaoyin Qi level.
Shaoyin disease has three indications for urgent purgation with Dachengqi Tang. First, after two or three days, dry mouth and throat require urgent purgation. Second, spontaneous discharge of clear water, purely green in color, epigastric pain, and dry mouth require urgent purgation. Third, abdominal distension and constipation after six or seven days require urgent purgation. These all involve Yang channel heat pathogens transmitting to the interior, consuming Kidney fluids, leading to significant excess in the Stomach, and transferring to Yangming. Thus, Chengqi is used for urgent purgation.
Shao's Commentary: The three indications for using Chengqi urgently in Shaoyin disease occur when Yang channel heat transmits to Shaoyin. The Zang cannot contain it, so it returns and transfers to the Yangming Stomach Fu. Fu excess and dry-heat burn Kidney essence and Stomach fluids, presenting as dry mouth/throat, watery stool, constipation, and abdominal distension. Urgent purgation is used to save Yin fluids.