伤寒邪在三阳太阳为首。邪在三阴。少阴为先。少阴虽居太阴厥阴之中。而实为阴经之表。以其与太阳表里。又与
阴维相附。且人肾气多虚受病最易。况原委不一人。但知少阴有传经。直中两岐救阴回阳之法。不知直中虽当回阳。而
有兼汗兼温之殊。传经虽宜救阴。复有补正攻邪之别。岂有一概混淆。能令读者无眩耶盖传经热邪。先伤经中之阴。甚
者邪未除而阴已竭。独是传入少阴。其急下之证。反十之三。急温之证。反十之七。而宜温之中。复有次第不同。毫厘
千里。粗工不解。必于曾犯房室之证始敢用温及用一切当温之证反不能用。讵知未病先劳其肾水者。不可因是遂认为当
温也。必其人肾中之真阳素亏。复因汗下后扰之外出。而不能内返。势必藉温药以回其阳。方可得生。所以伤寒门中。
亡阳之证最多。即在太阳。已有种种危候。至传少阴其证辨之际。仲景多少迟徊顾虑不得从正治之法清热夺邪以存阴为
先务也。今将直伤阴经之证。与夫汗下太过。元气受伤从权用温经之法者疏为上编。正治存阴之法疏为下编。其温热病
之发于少阴者。另自为篇。庶泾渭条分。根蔓不乱耳。
少阴之为病脉微细。但欲寐也。
此言少阴之总脉总证也。盖少阴属水主静。即使热邪传至此经。其在先之脉虽滑大。亦必变为微细故先之证。虽烦
热不宁。亦必变为昏沉嗜卧。但仍不得安卧为异耳。况夫少阴经自感之寒证耶但须以先见表证。至五六日。后变出脉细
沉数口燥。不得卧者。为热证始病便脉微细。口中中利但欲卧者为寒证。以此明辨万无差误耳。其所以但欲寐者。以卫
气行阳则寤。行阴则寐也。
少阴病。始得之反发热脉沉者。麻黄附子细辛汤主之。
脉沉发热。乃少阴兼太阳之表邪。当行表散。非少阴病。四五日后阴盛格阳。真阳发露之比。但三阴之表
法。与三阳
迥异。三阴必以温经之药。为表。而少阴尢为萦关。故麻黄与附子合用。使外邪出而真阳不出才是少阴表法之证也。
少阴得病之二三日。麻黄附子甘草汤微发汗。以二三日无里证。故微发汗也。
得病才二三日。无吐利躁烦口渴里证。其当从外解无疑。然少阴绝无发汗之法汗之必至亡阳。惟此一证其外发热。
无汗。甘内不吐利。躁烦呕渴乃可温经散寒。取其微似之汗。此义甚微。在太阳经但有桂枝加附子之法。并无麻黄加附
子之方。盖太阳病无脉微恶寒之证。即当不用附子。及见脉微恶寒吐利躁烦等证。亡阳已在顷刻又不当用麻黄。即此推
之。凡治阴寒厥病而用麻黄者。其杀人不转睫矣。
少阴病得之一二日口中和其背恶寒者。当炙之附子汤主之。
口中和者。不渴不躁。全无表热可知。况背为督脉统诸阳上行之地。他处不到。独觉其背恶寒者。则阳微阴盛之机。
已露一班。故炙之以火助阳而消阴主之以附子汤温经而散寒也。不知者谓伤寒才一二日外证且轻何反张皇若此。讵识仲
景正以一二日即显阳虚阴盛之证。早从暴病施治。若待三四日。势必极盛难返。不可救药矣。○按少阴自感之寒。有始
得之反发热脉沉者。有初入太阳不作郁热。便入少阴者。二证似不甚相远若详察病情。大相悬绝。一则阴经独困。而太
阳不至于失守。故脉虽沉。尚能发热。即延至二三日。热犹在表。而无吐利厥逆里证。可见尚有太阳经外垣可恃也。一
则太阳表气大虚。邪气即得入犯少阴。故得之二三日。尚肯恶寒不发热。此阴阳两亏较之两感更自不同。两感表里皆热。
热邪犹堪发表攻里。此则内外皆属虚寒。无邪热可以攻击。急当温经补阳温补不足。更炙关元以辅助之。其证虽似缓于
发热脉沉。而危殆尤甚若稍延缓或遇庸工不敢用大热峻补。多致不救也。
少阴病身体痛。手足寒。骨节痛。脉沉者附子汤主之。
一身骨节俱痛者。太阳经病也。若手足寒而脉沉。则肾中真阳之虚审矣。可见身体骨节之痛。皆阳虚所致而与外感
不相涉也。故用附子汤以助阳而胜肾寒。斯骨节之痛尽除也。若以其痛为外感之邪。宁不杀人耶。
少阴病脉沉者急温之。宜四逆汤。
外邪入少阴宜与肾气两相搏击。乃脉见沉而不鼓。即内经所谓肾气独沉之义。其人阳气衰弱可知。故当急温以助其
阳也。
少阴病下利白通汤主之。
下利无阳证者。纯阴之象。恐阴盛而隔绝其阳。最急之兆也。故于四逆汤中。去甘草之缓而加葱白于姜附之中以通
其阳。而消其阴遂名其方为白通取葱白通阳之义也。
少阴病下利脉微者。与白通利不止。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。
与白通汤反至厥逆无脉干呕而烦。此非药之不能胜病也。而无向导之力宜其不入耳。故复加人屎猪胆汁之阴以引阳
药深入然服汤药脉必微续者生暴出反死。甚哉虚阳之易出难回也。亦危矣。故上条才见下利早用白通图功于未着真良法
也。
少阴病二三日不已。至四五日腹满。小便不利四肢沉重疼痛。自不利者。此为有水气。其人或咳或小便利或下利。
或呕者真武汤主之。
阴寒盛而水泛滥。由阳虚不难摄水。复不能生土以制水。以故腹痛。小便不利四肢沉重疼痛自下利或小便亦利。或
咳或呕。水性泛滥无所不之。非刺真武坐镇北方之水。宁有底哉。太阳篇中。厥逆筋惕肉 而亡阳者。用真武汤之法以
表明之矣兹少阴之水湿上逆。仍用真武一法以镇摄之可见太阳膀胱与少阴肾。一脏一腑同居北方寒水之位。腑邪为阳邪。
藉用麻黄为青龙脏邪为阴邪藉用附子为真武得此二汤以涤痰导水。消阴摄阳。其神功妙济真有不可思议者。○按真武汤
方。本治少阴病水饮内结。所以首推术附兼茯苓生姜之运脾渗水为务。此人所易明也至用芍药之微旨非圣人不能盖此证。
虽曰少阴本病而实缘水饮内结。所以腹痛自利。四肢疼重而小便反不利也。若极虚极寒。则小便必清白无禁矣安有反不
利之理哉。则知其人不但真阳不足真阴亦已素亏。或阴中伏有阳邪所致。若不用芍药固护其阴岂能胜附子之雄烈乎。即
如附子汤。桂枝加附子汤芍药甘草附子汤皆芍药与附子并用其温经护营之法与保阴回阳不殊。后世用药能获仲景心法者
几人哉。
若咳者。加附子半升。细辛干姜各一两。若小便利者。去茯苓。若下利者。去芍药。加干姜二两若呕者去附子加生
姜。足前成半斤呕加生姜宜矣。乃水寒上逆为呕。正当用附子者。何以反去之耶盖真武中除去附子外。更用无热药。乃
为肺胃素有积热留饮惯呕。而去之又法外之法也。观后通脉四逆汤呕者但加生姜不去附子岂不甚明所以暴病之呕。即用
真武尚不相当也。
少阴病。下利清谷。里寒外热手足厥冷脉微欲绝。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。其脉即出者愈。
下利里寒种种危殆。其外反热其面反赤其身反不恶寒。而手足厥逆。脉微欲绝明系群阴格阳于外。不能内反也。故
于四逆汤中。倍用干姜。大温其里以胜外邪。更效白通之法。加葱白以入阴微阳而复其脉也。前条云脉暴出者死。此条
云脉即出者愈。其辨最细。盖暴出则脉已离根即出其脉已返舍。由是外反发热而不恶寒。真阳尚在躯壳。然必通其脉。
其脉即出。始为休征。设脉出艰迟。其阳已随热势外散。又主死矣。
面色赤者。加葱九茎腹中痛者。去葱。加芍药二两。呕者。加生姜二两。咽痛者去芍药。加桔梗一两。利止脉不出
者。去桔梗加人参二两。
面赤色者阳格于上。加葱以通阳气。故名通脉也。腹中痛真阴不足也。去葱。恶顺其阳。加芍药以收阴也。咽痛阴
气上结也。去芍药恶其敛阴。加桔梗以利咽也。利止脉不出阳气未复。兼阴血未充。故加人参。以补其气血。去桔梗者。
恶其上载而不四通也。
少阴病。吐利手足厥冷。烦躁欲死者。吴茱萸汤主之。
是少阴兼厥阴之候也。吐利厥冷而至于烦躁。欲死肾肝之阴气上逆。将成危候。故用吴茱萸以下其逆气。人参姜枣
以浓其脾土。乃温经而兼温中。则阴气不复上干矣。
少阴病吐利躁烦四逆者死。
上吐下利因致躁烦。则阴阳扰乱而竭绝可虞。更加四肢逆冷。中州之土先败。上下交征。中气立断故主死也。使早
用温中之法。宁至此乎。○上条言吐利手足厥冷。烦躁欲死者。用吴茱萸汤。此吐利躁烦厥逆与上条不殊。何彼可治。
而此不可治耶故此证用温中。转加躁烦。故为死耳。
少阴病。饮食入口即吐。心下温温欲吐。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。急温之宜四逆汤。
饮食入口即吐。犹曰胃中不能纳谷也。若不饮食之时。复欲吐而不能吐。明系阴邪上逆。此等处必加细察。若始得
之。便手足寒。而脉弦迟。即非传经邪热可拟。然阴邪固有是证而痰饮亦有其脉设思胃中痰实当行吐发提之。今见欲吐
不吐专为阴气上逆无疑。即使膈上有寒饮干呕。亦属阴邪用事非寻常祛痰之药可施。设误用吐法。必致转增其剧。计惟
急温之法。以助阳胜阴则寒饮亦得开散。一举而两得之也。
少阴病欲吐不吐心烦。但欲寐。五六日。自利而渴者。属少阴也。虚故引水自救。若小便色白者。少阴病形悉具小
便白者。以下焦虚有寒不能制水。故令色白也。
欲吐不吐心烦肾气上逆之征也。自利而渴。加以口燥舌干。引水自救似乎热证之形然肾热则水道黄赤。若小便色白。
又非肾热乃下焦虚寒。不能制水仍当从事温法不可误认为热。而轻投寒下也。○自此条而下凡十余例皆是传次少阴虚寒
坏证。仲景俱不立方者。以其阴阳两伤。血气并竭多死少生故也。
病患脉。阴阳俱紧反汗出者。亡阳也。此属少阴法当咽痛而复吐利。
阴阳俱紧。伤寒之脉也。伤寒无汗。反汗出者。无阳以固其外。所以邪不出而汗先出也。少阴之邪。不出则咽痛吐
利。即当用少阴温经散寒之法。不言可知也。
少阴病脉微不可发汗。亡阳故也。阳已虚。尺脉涩者。不可下之。
亡阳不可发汗。与上条互发。亡与无同。无阳则其邪为阴邪。阴邪本宜下。然其人阳已虚。尺脉弱涩者。复不可下。
其当急行温法。又可见矣。
厥而脉紧不可发汗。发汗则声乱咽嘶舌萎声不得前。
少阴之络入肺中。循喉咙系舌本。肺为之标本虚则标弱。故声乱咽嘶舌萎。语不得前也。
前四条皆少阴经虚寒坏证也。仲景虽不出方。然犹可治。详少阴病。欲吐不吐一条。宜真武汤救之。病患脉阴阳俱
紧一条。宜附子汤加桔梗赤石脂少阴病。脉微不可发汗一条。宜白通加人尿猪胆汁。此条厥而脉紧。则当用四逆汤温之。
反误发汗。致声乱咽嘶舌萎。不可救矣。
少阴病脉微细沉。但欲卧汗出不烦自欲吐。至五六日自利。复烦躁不得卧寐者死。
脉微细沉欲卧。少阴之本证也。汗出不烦。则阳证悉罢。而当顾虑其阴矣。乃于中间带欲吐一证。欲吐明系阴邪上
逆正当急温之时。失此不图至五六日自利有加。复烦躁不得卧寐。非外邪至此转增正少阴肾中之真阳扰乱。顷刻奔散即
温之亦无及矣。况始先不烦今更烦躁。始先欲寐。今更不得卧寐所存一线之阳。扰乱若此。可复收乎。
少阴病恶寒身蜷而利。手足厥冷者不治。
阴盛无阳。即用四逆等法。回阳气于无何有之乡其不能回者。多矣。故曰不治。
少阴病四逆恶寒。而身热脉不至不烦而躁者死。
脉不至阳已先绝。不烦而躁孤阴顷刻自尽矣。
少阴病。下利止而头眩。时时自冒者死。
下利既止。其人似可得生。乃头眩时时自冒者。复护也。
少阴病。吐利手足不逆冷。反发热者不死。脉不至者炙少阴七壮。
少阴病手足不逆冷。而反发热。似乎阴尽复阳之兆但吐利未止而脉不至。又似真阳发外。故于少阴本穴。用炙法以
引其阳内返斯脉至。而吐利亦得自止耳。○前条皆恶寒之证。炙后用附子汤者。阴寒内凝。定非一炙所能胜。此条手足
反热。止是阴内阳外。故炙本经以招之内入不必更用温药也。
以上少阴虚寒证。
少阴病。恶寒而蜷。时时自烦。欲去衣被者可治。
自烦欲去衣被。真阳扰乱不宁。尚未至出亡在外故可用温法然必微烦即止。神气不乱。手足渐温脉来沉微不绝。方
为可治。设见躁逆 。乱扰攘不宁手足厥冷。脉反躁急或散大无伦。皆死证也。
少阴病。下利若利自止。恶寒而蜷卧。手足温者可治。
恶寒蜷卧。证本虚寒。利止手足温则阳气渐复其阴寒亦易散。故可用温以助其阳之复也。
少阴病脉紧。至七八日。自下利脉暴微。手足反温。脉紧反去者。为欲解也虽烦下利必自愈。
少阴病脉本紧。至七八日自利。则阴寒得以下走故脉反和。而手足温暖。阳气将复也。虽烦而利必自愈。○三条互
见。此则邪解寒回。可勿药自愈之证即医去人安之互辞也。
少阴中风。脉阳微阴浮者。为欲愈。
伤寒病邪侵犯三阳经，以太阳经为首要；侵犯三阴经，以少阴经为先。少阴经虽然位于太阴和厥阴之间，但实际上是阴经的表证。因为它与太阳经互为表里，又与阴维脉相连结，而且人的肾气多虚弱，最容易受邪发病。况且病因复杂，人们只知道少阴病有传经和直中两种情况，以及救阴和回阳两种治法，却不知道直中虽需回阳，但有兼汗法和兼温法的区别；传经虽宜救阴，又有扶正祛邪的不同。怎么能一概混淆，让读者不感到困惑呢？大概传经的热邪，先损伤经脉中的阴液，严重的甚至邪气未除而阴液已枯竭。特别是传入少阴经，需要急下存的证候，反而占十分之三，需要急温的证候，反而占十分之七。而在适宜温补之中，又有先后次第的不同，毫厘之差，结果千里之别。粗疏的医生不理解这一点，必定等到患者曾经犯房室之劳的证候才敢用温法，而对于一切应当温补的证候反而不敢用。哪里知道未生病前因劳累耗伤肾水的人，不能因此就认为应当温补。必须是人肾中的真阳素来亏损，又在发汗、攻下之后，阳气被扰动外出而不能内返，势必借助温药来挽回阳气，才可以得生。所以在伤寒门中，亡阳的证候最多。即使在太阳经，已有种种危重证候，传到少阴经时，在辨证之际，张仲景往往迟疑顾虑，不敢从正治之法清热夺邪以保存阴液作为首要任务。现在将直接损伤阴经的证候，以及因发汗、攻下太过导致元气受伤而权宜使用温经之法的情况，梳理为上编；将正治保存阴液的方法，梳理为下编。至于温热病发于少阴的，另立一篇，以便泾渭分明，条理清晰，根蔓不乱。
少阴病的脉象微细，精神萎靡只想睡觉。
这是论述少阴病的总脉象和总证候。因为少阴属水，主静。即使热邪传到这一经，起初的脉象虽然是滑大，也必然变为微细；起初的证候，虽然是烦热不安，也必然变为昏沉嗜睡。但仍然不能安稳睡眠，这是与一般嗜睡不同的地方。何况是少阴经感受寒邪的证候呢？只要先看是否有表证，到了五六天后，出现脉细、沉数、口燥、不能卧的，才是热证；如果起病就是脉微细、口中润泽、只想睡觉的，才是寒证。以此明确辨别，万无差错。之所以只想睡觉，是因为卫气行于阳分则醒，行于阴分则睡。
少阴病，刚得病时反而发热，脉沉的，用麻黄附子细辛汤主治。
脉沉且发热，是少阴兼有太阳的表邪，应当进行解表发散。这不是少阴病四五日后阴盛格阳、真阳外越的情况。但是三阴经的解表法，与三阳经截然不同。三阴经必须以温经的药物作为解表的基础，而少阴经尤为关键。所以麻黄与附子合用，使外邪排出而真阳不致外泄，这才是少阴经解表法的证候。
少阴病得病二三天，用麻黄附子甘草汤微发汗。因为二三天没有里证，所以微发汗。
得病才二三天，没有呕吐、腹泻、烦躁、口渴等里证，其病势应当从外部解除，这是毫无疑问的。然而少阴经绝无单纯发汗的法度，发汗必然导致亡阳。只有这一种证候，外部发热，无汗，内部不吐利、不烦躁、不呕吐、不口渴，才可以温经散寒，取其微微似有汗出的效果。这其中的义理非常精微。在太阳经，只有桂枝加附子汤的法度，并没有麻黄加附子的方剂。因为太阳病没有脉微恶寒的证候，即当不用附子；等到见到脉微恶寒、吐利、烦躁等证候，亡阳已在顷刻之间，又不当用麻黄。由此推断，凡是治疗阴寒厥逆病而用麻黄的，那简直是杀人于眨眼之间了。
少阴病得病一两天，口中平和（不苦不燥），背部怕冷的，应当用灸法，并用附子汤主治。
口中平和，说明不渴不躁，完全没有表热。况且背部是督脉统领诸阳上行之地，其他部位阳气不到，唯独觉得背部怕冷，那么阳微阴盛的机转已经显露一斑。所以用灸法助阳消阴，用附子汤温经散寒。不了解的人认为伤寒才一两天，外证尚轻，何必如此惊慌失措。哪里知道张仲景正是因为在初得病一两天就显现出阳虚阴盛的证候，主张尽早针对暴病施治。如果等到三四天，势必阴寒极盛难以逆转，不可救药了。○按：少阴经自感寒邪，有刚得病时反而发热脉沉的，有初入太阳经不作郁热便转入少阴的。这两种证候看似不相远，若详细考察病情，则大相径庭。一种是阴经独自受困，而太阳经不至于失守，所以脉虽沉，尚能发热，即使拖延到二三天，热仍在表，而没有吐利厥逆等里证，可见还有太阳经这个外垣可以依靠。另一种则是太阳表气大虚，邪气得以侵入少阴，所以得病二三天，仍然只恶寒而不发热。这种阴阳两亏的情况，比两感病更为不同。两感病表里皆热，热邪还可以发表攻里；此证则内外皆属虚寒，没有邪热可以攻击，急需温经补阳，温补不足，再灸关元穴以辅助它。这种证候虽然看起来比发热脉沉稍缓，但危险程度更甚。如果稍微延缓，或者遇到庸医不敢用大热峻补之药，大多会导致死亡。
少阴病身体痛，手足寒冷，骨节痛，脉沉的，用附子汤主治。
一身骨节都痛的，是太阳经病。如果手足寒冷而脉沉，那么肾中真阳的虚弱就可以确定了。可见身体骨节的疼痛，都是阳虚所致，而与外感邪气无关。所以用附子汤来助阳战胜肾寒，这样骨节的疼痛就能全部消除。如果认为这种疼痛是外感邪气所致，岂不是会害死人吗？
少阴病脉沉的，急需温补，宜用四逆汤。
外邪侵入少阴，应与肾气相互搏击，如果脉见沉而不鼓动，就是《内经》所说的“肾气独沉”的意思。可知此人阳气衰弱，所以应当急温以助其阳。
少阴病下利的，用白通汤主治。
下利而没有阳证的，是纯阴的征象，担心阴寒过盛而隔绝阳气，这是最紧急的征兆。所以在四逆汤中去掉甘草的缓和之性，加入葱白于干姜、附子之中，以通达阳气，消除阴寒，于是将此方命名为白通，取葱白通阳的意义。
少阴病下利，脉微的，给予白通汤；如果下利不止，出现四肢厥冷、无脉、干呕、心烦的，用白通加猪胆汁汤主治。服药后脉象突然出现的死，脉象微微续接的活。
给予白通汤后反而出现四肢厥冷、无脉、干呕而心烦，这不是药力不能胜病，而是缺乏向导的力量，药力不宜进入体内。所以再加入人尿、猪胆汁的阴寒之品，以引导阳药深入。然而服药后脉象必须微微续接才能生，突然出现的反而死。虚阳易出难回，真是严重啊！也是危重之症。所以上一条刚见下利就早用白通汤，是在病势未显之前图谋功效，真是良法。
少阴病二三天不好，到了四五天，腹部胀满，小便不利，四肢沉重疼痛，自行下利的，这是有水气。其中有的人咳嗽，或小便通利，或下利，或呕吐的，用真武汤主治。
阴寒盛而水泛滥，由于阳虚不难摄水，但又不能生土以制水，因此腹痛、小便不利、四肢沉重疼痛、自行下利，或者小便也通利，或者咳嗽，或者呕吐。水性泛滥，无处不到，如果不像真武大帝坐镇北方之水，哪里有底止呢？在太阳篇中，对于厥逆、筋惕肉瞤而亡阳的，用真武汤的法度来表明。这里少阴的水湿上逆，仍用真武汤这一法度来镇摄它。可见太阳膀胱与少阴肾，一脏一腑同居北方寒水之位。腑邪属于阳邪，借麻黄为青龙汤；脏邪属于阴邪，借附子为真武汤。得到这两张方剂来涤痰导水，消阴摄阳，其神功妙济实在有不可思议之处。○按：真武汤方，原本治疗少阴病水饮内结，所以首先推崇白术、附子兼茯苓、生姜运脾渗水为主要目的，这是人们容易明白的。至于使用芍药的深意，不是圣人不能理解。因为这个证候，虽然说是少阴本病，但实际上是由于水饮内结，所以腹痛、自行下利、四肢疼重而小便反而不利。如果极度虚弱极度寒冷，那么小便必定清白不禁，哪里有反而不利的道理呢？就知道这个人不但真阳不足，真阴也已经素亏，或者是阴中潜伏有阳邪所致。如果不用芍药固护其阴，怎么能承受附子的雄烈呢？就像附子汤、桂枝加附子汤、芍药甘草附子汤，都是芍药与附子并用，其温经护营的法度与保阴回阳没有区别。后世用药能领悟张仲景心法的有几个人呢？
如果咳嗽的，加附子半升，细辛、干姜各一两。如果小便通利的，去茯苓。如果下利的，去芍药，加干姜二两。如果呕吐的，去附子，加生姜，足前成半斤。呕吐加生姜是适宜的，但水寒上逆导致呕吐，正当用附子的时候，为什么反而去掉它呢？大概真武汤中除去附子外，更没有用热药，这是为了肺胃素有积热、留饮、习惯性呕吐，而去掉附子，这是法外之法。看后面的通脉四逆汤，呕吐者只是加生姜，不去附子，难道不是很明显吗？所以暴病导致的呕吐，即用真武汤尚且不相当，何况去掉附子呢？
少阴病，下利清谷，里寒外热，手足厥冷，脉微欲绝，身体反而不怕冷，其人面色赤色，或腹痛，或干呕，或咽痛，或利止脉不出者，用通脉四逆汤主治。如果脉象随即出来的就好了。
下利、里寒种种危殆，外部反而发热，面部反而发红，身体反而不怕冷，而手足厥逆，脉微欲绝，明显是群阴格拒阳气于外，不能内返。所以在四逆汤中，倍用干姜，大温其里以战胜外邪，更效法白通汤的方法，加葱白以入阴微阳而复其脉。前条说脉突然出现的死，此条说脉随即出来的好，其辨别最细微。大概突然出现则脉已离根，随即出来则脉已返回舍藏。由是外部反而发热而不恶寒，真阳尚在躯壳，然而必须通畅其脉，脉随即出来，始为好转的征兆。假设脉出艰难迟缓，其阳已随热势外散，又主死矣。
面色赤色的，加葱九茎。腹中痛的，去葱，加芍药二两。呕吐的，加生姜二两。咽痛的，去芍药，加桔梗一两。利止脉不出者，去桔梗，加人参二两。
面色赤色，是阳气格拒于上，加葱以通阳气，所以名叫通脉。腹中痛，是真阴不足，去葱，厌恶顺其阳，加芍药以收敛阴。咽痛，是阴气上结，去芍药，厌恶其收敛阴，加桔梗以利咽喉。利止脉不出，是阳气未复，兼阴血未充，所以加人参，以补其气血。去桔梗的原因，是厌恶其上载而不四通。
少阴病，吐利，手足厥冷，烦躁欲死的，用吴茱萸汤主治。
这是少阴兼厥阴的证候。吐利、厥冷以至于烦躁欲死，肾肝的阴气上逆，将要形成危候。所以用吴茱萸以下降其逆气，用人参、姜、枣以厚其脾土，这是温经而兼温中，那么阴气就不再上干了。
少阴病，吐利，躁烦，四肢逆冷的，死。
上吐下利导致躁烦，则阴阳扰乱而竭绝，令人担忧。再加上四肢逆冷，中州的土气先败，上下交争，中气立断，所以主死。如果早用温中之法，岂会到这种地步呢？○上一条说吐利、手足厥冷、烦躁欲死的，用吴茱萸汤。这一条吐利、躁烦、厥逆与上一条没有不同，为什么那条可治，而这条不可治呢？因为这个证候用温中法，反而加重躁烦，所以为死证。
少阴病，饮食入口即吐，心中温温欲吐，但又不能吐，刚得病时手足寒冷，脉弦迟的，这是胸中实邪，不可下，应当用吐法。如果膈上有寒饮导致干呕的，不可吐，急需温补，宜用四逆汤。
饮食入口即吐，还说胃中不能纳谷。如果不饮食的时候，又想吐却又吐不出来，明显是阴邪上逆。这些地方必须仔细考察。如果刚得病，就手足寒冷，而脉弦迟，就不是传经邪热所能比拟的。然而阴邪固有这种证候，而痰饮也有这种脉象。设想胃中有痰实，应当行吐法提之。现在见想吐不吐，专为阴气上逆，毫无疑问。即使膈上有寒饮导致干呕，也属于阴邪作祟，不是寻常祛痰药可施。如果误用吐法，必然导致病情加重。计策唯有急温之法，以助阳胜阴，那么寒饮也能开散，一举两得。
少阴病想吐又吐不出来，心烦，只想睡觉，过了五到六天，自行下利且口渴的，属于少阴病。因为虚故引水自救。如果小便颜色白的，少阴病的形证完全具备。小便白，是因为下焦虚寒，不能制水，所以令其色白。
想吐又吐不出来，心烦，是肾气上逆的征象。自行下利且口渴，加上口燥舌干，引水自救，似乎是热证的形态。然而肾热则水道黄赤，如果小便色白，又不是肾热，乃是下焦虚寒，不能制水，仍应当从事温法，不可误认为热，而轻投寒下药。○从此条以下凡十余例，都是传变至少阴的虚寒坏证。张仲景都不出方子，是因为阴阳两伤，血气并竭，多死少生的缘故。
病人脉象，阴阳俱紧，反而出汗的，是亡阳。这属于少阴病，法当咽痛而又吐利。
阴阳俱紧，是伤寒的脉象。伤寒无汗，反而出汗的，是无阳以固护其外，所以邪气不出而汗先出。少阴的邪气，不出则咽痛、吐利，就应当用少阴温经散寒的法度，不言可知。
少阴病脉微的，不可发汗，因为会亡阳。阳气已虚，尺脉涩的，不可下。
亡阳不可发汗，与上条互相发明。亡与无同。无阳则其邪为阴邪，阴邪本宜下，然而其人阳已虚，尺脉弱涩的，又不可下。其应当急行温法，又可见了。
四肢厥冷而脉紧的，不可发汗。发汗则声音杂乱、咽喉嘶哑、舌萎软、声音发不出。
少阴的络脉入肺中，循喉咙，系舌本。肺为之标本，虚则标弱，所以声音杂乱、咽喉嘶哑、舌萎软、言语不能发出。
前四条都是少阴经虚寒坏证。张仲景虽然不出方，然而还可治。详细看少阴病“欲吐不吐”一条，宜用真武汤救治。病人脉阴阳俱紧一条，宜用附子汤加桔梗、赤石脂。少阴病脉微不可发汗一条，宜用白通加人尿、猪胆汁。此条“厥而脉紧”，则当用四逆汤温之。反误发汗，导致声音杂乱、咽喉嘶哑、舌萎软，不可救了。
少阴病脉微细沉，只想睡觉，出汗不心烦，自己想要呕吐，到了五到六天自行下利，又烦躁不得卧寐的，死。
脉微细沉，想睡觉，是少阴的本证。出汗不心烦，则阳证全罢，而应当顾虑其阴。乃在中间带有想吐一证，想吐明显是阴邪上逆，正当急温之时。失去这个机会不图谋，到了五到六天自行下利加重，又烦躁不得卧寐，不是外邪至此转而增加正气，就是少阴肾中的真阳扰乱，顷刻奔散，即使温补也来不及了。何况开始不烦，现在更烦躁；开始想睡，现在更不得卧寐，所存的一线之阳，扰乱到这种程度，还能收回来吗？
少阴病恶寒，身体蜷缩而下利，手足厥冷的，不治。
阴盛无阳，即用四逆等法，在虚无之乡挽回阳气，其不能挽回的，太多了。所以说不治。
少阴病四肢逆冷，恶寒，而身体热，脉不至，不烦而躁的，死。
脉不至，阳已先绝。不烦而躁，孤阴顷刻自尽了。
少阴病，下利停止而头眩，时时自觉头晕目眩的，死。
下利既然停止，其人似乎可得生，然而头眩、时时自冒的，是复护（阳气脱绝）之兆。
少阴病，吐利，手足不逆冷，反而发热的不死。脉不至的，灸少阴穴七壮。
少阴病手足不逆冷，而反而发热，似乎是阴尽复阳的征兆。但吐利未止而脉不至，又像是真阳发露于外。所以在少阴本穴，用灸法以引导其阳内返，这样脉至，而吐利也能自行停止。○前几条都是恶寒的证候，灸后用附子汤的，是阴寒内凝，绝非一灸所能胜任。这一条手足反热，只是阴在内阳在外，所以灸本经以招之内入，不必再用温药。
以上是少阴虚寒证。
少阴病，恶寒而蜷缩，时时自烦，想要脱去衣被的，可治。
自烦想要脱去衣被，是真阳扰乱不宁，尚未至出亡在外，所以可用温法。然而必须是微烦即止，神气不乱，手足渐温，脉来沉微不绝，方为可治。假设见到躁逆、乱扰攘不宁、手足厥冷、脉反躁急或散大无伦，都是死证。
少阴病，下利如果自行停止，恶寒而蜷卧，手足温暖的，可治。
恶寒蜷卧，证本虚寒。利止手足温，则阳气渐复，其阴寒也容易消散，所以可用温法以助其阳之复。
少阴病脉紧，到了七八天，自行下利，脉突然变微，手足反而温暖，脉紧反而消失的，为欲解。虽然烦而下利，必自愈。
少阴病脉本紧，到了七八天自行下利，则阴寒得以下走，所以脉反而调和，而手足温暖，阳气将复。虽然烦而利必自愈。○三条互见，此则是邪解寒回，可不药自愈的证候，即医去人安的互辞。
少阴中风，脉象阳微阴浮的，为欲愈。
In the pathogenesis of Cold Damage (Shanghan), when the pathogenic factor invades the Three Yang meridians, the Taiyang (Greater Yang) meridian is the primary site; when it invades the Three Yin meridians, the Shaoyin (Lesser Yin) meridian is the primary site. Although the Shaoyin meridian is located between the Taiyin and Jueyin meridians, it actually serves as the exterior aspect of the Yin meridians. This is because it shares an interior-exterior relationship with the Taiyang meridian and is connected to the Yin Linking Vessel (Yin Wei Mai). Furthermore, human Kidney Qi is often deficient, making one most susceptible to disease in this area. Moreover, the etiology is diverse. People generally only know that Shaoyin disease involves transmission from other meridians or direct invasion, along with methods to save Yin and restore Yang. They do not realize that although direct invasion requires restoring Yang, there are distinctions between methods involving sweating and those involving warming. Although transmission usually calls for saving Yin, there are differences between supporting healthy Qi and attacking pathogenic factors. How can one confuse these indiscriminately without causing confusion to the reader? Generally, heat pathogens transmitted via meridians first damage the Yin within the meridians. In severe cases, the pathogen remains while Yin fluids are exhausted. Specifically regarding transmission to the Shaoyin meridian, cases requiring urgent purgation account for three-tenths, while cases requiring urgent warming account for seven-tenths. Among those suitable for warming, there are further differences in sequence and priority. A slight error at the beginning can lead to a thousand-mile difference in outcome. Unskilled physicians fail to understand this; they dare to use warming methods only when they encounter cases involving prior sexual exhaustion, yet they hesitate to use them in all other cases where warming is indicated. They fail to realize that individuals who had previously labored and damaged their Kidney Water before falling ill cannot simply be assumed to require warming treatment. Warming is necessary only if the person’s True Yang within the Kidneys was originally deficient, and subsequently, after sweating or purging therapies, the Yang was disturbed and moved outward, unable to return inward. Only by employing warming medicines to restore Yang can life be saved. Therefore, among Cold Damage conditions, Yang collapse (Wang Yang) is most common. Even in the Taiyang stage, various critical signs exist. When the disease transmits to the Shaoyin, Zhang Zhongjing often hesitates during differentiation, reluctant to adopt standard treatments that clear heat and drain pathogens to preserve Yin as the primary task. Here, I organize the conditions of direct injury to the Yin meridians, as well as those where excessive sweating or purging has damaged Yuan Qi, requiring the expedient use of meridian-warming methods, into the Upper Compilation. The standard treatments for preserving Yin are organized into the Lower Compilation. Conditions of Warm-Heat diseases originating in the Shaoyin will be treated in a separate chapter, ensuring clear distinctions and orderly classification.
The pulse of Shaoyin disease is fine and faint, accompanied by a desire to sleep.
This describes the general pulse and syndrome of Shaoyin disease. Shaoyin belongs to Water and governs stillness. Even if a heat pathogen transmits to this meridian, the initial pulse, though slippery and large, must transform into a fine and faint pulse. Similarly, the initial symptoms, though restless and hot, must transform into drowsiness and lethargy. However, unlike normal drowsiness, the patient cannot rest comfortably. This applies especially to cold syndromes contracted directly by the Shaoyin meridian. One must look for initial exterior signs. If, after five or six days, the pulse becomes fine, deep, and rapid, with dry mouth and inability to lie down, it indicates a heat syndrome. If, from the onset, the pulse is faint and fine, the mouth feels moist, and there is a desire to sleep, it indicates a cold syndrome. Clear differentiation based on these criteria ensures no errors. The reason for the desire to sleep lies in the movement of Defensive Qi (Wei Qi): when it circulates in the Yang aspects, one is awake; when it circulates in the Yin aspects, one sleeps.
In Shaoyin disease, if fever appears upon initial onset despite a deep pulse, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) is indicated.
A deep pulse with fever indicates Shaoyin complicated by Taiyang exterior pathogens, requiring dispersal. This is distinct from the condition occurring four or five days into Shaoyin disease, where extreme Yin repels Yang, causing True Yang to surface. The method for treating the exterior of the Three Yin meridians differs significantly from that of the Three Yang. For the Three Yin, warming the meridians is the foundation for releasing the exterior, particularly crucial for Shaoyin. Thus, combining Mahuang (Ephedrae Herba) with Fuzi (Aconiti Lateralis Radix Praeparata) allows the exterior pathogen to exit while preventing True Yang from escaping. This constitutes the proper exterior-releasing method for Shaoyin.
For Shaoyin disease presenting on the second or third day, Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction) should be used to induce mild sweating. This is because there are no interior syndromes at this stage.
On the second or third day of illness, in the absence of vomiting, diarrhea, restlessness, or thirst (interior signs), the pathogen should undoubtedly be resolved from the exterior. However, Shaoyin disease generally prohibits sweating methods, as sweating leads to Yang collapse. This specific case—characterized by external fever, absence of sweat, and internally free of vomiting, diarrhea, restlessness, or thirst—allows for warming the meridians and dispelling cold to induce a mild, lingering sweat. This principle is subtle. In Taiyang disease, there is the formula Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite), but no formula combining Mahuang with Aconite. Taiyang disease does not present with a faint pulse and aversion to cold, so Aconite is unnecessary initially. Once a faint pulse, aversion to cold, vomiting, diarrhea, and restlessness appear, indicating imminent Yang collapse, Mahuang should not be used. From this, we infer that using Mahuang to treat Yin-cold Jue (reversal) conditions would be fatal.
In Shaoyin disease, if the mouth feels neutral (not bitter or dry) and there is aversion to cold in the back upon onset (one or two days), moxibustion should be applied, and Fuzi Tang (Aconite Decoction) administered.
A "neutral" mouth indicates no thirst or restlessness, ruling out exterior heat. The back is the pathway of the Du Meridian, governing the ascent of Yang Qi throughout the body. Aversion to cold specifically in the back, where Yang Qi does not readily reach, reveals the mechanism of deficient Yang and excess Yin. Moxibustion aids Yang and dissipates Yin, while Fuzi Tang warms the meridians and dispels cold. Critics might argue that early-stage Cold Damage presents lightly, warranting no alarm. However, Zhang Zhongjing emphasizes treating early signs of Yang deficiency and Yin excess to prevent progression. Waiting until the fourth or fifth day allows Yin cold to become extreme and irreversible. Note: Direct cold contraction in Shaoyin presents either with initial fever and deep pulse, or with immediate transition from Taiyang without generating stagnant heat. Though seemingly similar, they differ greatly. In the former, only the Yin meridian is affected, leaving Taiyang intact; thus, despite a deep pulse, fever persists, and interior signs like diarrhea or reversal cold are absent, indicating reliance on the Taiyang exterior barrier. In the latter, Taiyang exterior Qi is severely deficient, allowing pathogens to invade Shaoyin directly; thus, aversion to cold persists without fever. This state of dual deficiency is more critical than simultaneous exterior-interior involvement (Liang Gan). While Liang Gan involves heat treatable by releasing exterior and draining interior, this condition involves internal and external cold-deficiency, requiring urgent warming and tonification, supplemented by moxibustion at Guanyuan (CV 4). Though appearing less acute than fever with deep pulse, it is more dangerous. Delay or hesitation by unskilled physicians fearing strong warming herbs often leads to death.
In Shaoyin disease, if there is body pain, cold hands and feet, bone and joint pain, and a deep pulse, Fuzi Tang (Aconite Decoction) is indicated.
Pain throughout the body and joints typically indicates Taiyang disease. However, combined with cold extremities and a deep pulse, it confirms deficiency of True Yang in the Kidneys. Thus, the body and joint pain stem from Yang deficiency, unrelated to exterior pathogens. Fuzi Tang assists Yang to overcome Kidney cold, resolving the pain. Misidentifying this pain as exterior pathogenic would be lethal.
In Shaoyin disease, if the pulse is deep, urgent warming is required, preferably using Sini Tang (Frigid Extremities Decoction).
When exterior pathogens enter Shaoyin, they contend with Kidney Qi. A deep, non-pulsating pulse reflects the Neijing concept of "Kidney Qi sinking alone," indicating severe Yang deficiency. Urgent warming is needed to support Yang.
In Shaoyin disease with diarrhea, Baitong Tang (White Passages Decoction) is indicated.
Diarrhea without Yang signs indicates pure Yin. The urgency lies in preventing extreme Yin from blocking Yang. In Sini Tang, the moderating effect of Gancao (Glycyrrhizae Radix) is removed, and Congbai (Allii Tuberosi Bulbus) is added to Ganjiang (Zingiberis Rhizoma) and Fuzi to unblock Yang and dissipate Yin. Hence the name Baitong, signifying the unblocking power of Congbai.
In Shaoyin disease with diarrhea and a faint pulse, administer Baitong Tang. If diarrhea persists, leading to cold extremities, absent pulse, dry retching, and irritability, Bai Tong Jia Zhu Dan Huang Tang (Baitong Decoction plus Pig Bile and Human Excrement) is indicated. If the pulse suddenly emerges after administration, death ensues; if it slowly returns, survival occurs.
If symptoms worsen to cold extremities, absent pulse, dry retching, and irritability after taking Baitong Tang, it is not due to the medicine's ineffectiveness but lack of guidance for the medicinal energy to penetrate. Therefore, Yin-substances like Ren Shen Huang (Human Excrement) and Zhu Dan (Pig Bile) are added to guide the Yang-tonifying herbs deeper. Survival depends on the pulse returning gradually; sudden emergence indicates death. The difficulty of retaining floating Yang highlights the severity. Early use of Baitong Tang for diarrhea prevents deterioration, representing sound practice.
If Shaoyin disease persists for two to three days and progresses to four or five days with abdominal fullness, difficult urination, heavy/painful limbs, and spontaneous diarrhea, water retention is present. Depending on accompanying symptoms such as cough, frequent urination, diarrhea, or vomiting, Zhenwu Tang (True Warrior Decoction) is indicated.
Excessive Yin cold causes water flooding. Yang deficiency fails to control water and generate Earth to restrain water, leading to abdominal pain, difficult urination, heavy/painful limbs, and diarrhea. Water floods everywhere. Just as Zhenwu controls northern waters, this formula stabilizes the condition. In the Taiyang chapter, Zhenwu Tang treats Yang collapse with tremors. Here, it addresses Shaoyin water-dampness reversing upward. Bladder (Yang organ) and Kidney (Yin organ) share the Northern Water position. Bladder pathogens (Yang) are treated with Mahuang (Qinglong Tang); Kidney pathogens (Yin) are treated with Fuzi (Zhenwu Tang). These formulas cleanse phlegm, guide water, dissipate Yin, and secure Yang. Regarding Zhenwu Tang, its primary function is treating internal water retention in Shaoyin via Baizhu (Atractylodis Macrocephalae Rhizoma), Fuzi, Fuling (Poria), and Shengjiang (Zingiberis Rhizoma Recens) to transport Spleen and leach dampness. The subtle use of Shaoyao (Paeoniae Radix Alba) is profound. Although termed Shaoyin disease, the root is internal water retention causing pain, diarrhea, heaviness, and paradoxical urinary difficulty. In extreme cold-deficiency, urine would be clear and uncontrollable; difficulty implies concurrent Yin deficiency or latent Yang pathogen. Shaoyao protects Yin against the harshness of Fuzi. Other formulas like Fuzi Tang and Guizhi Jia Fuzi Tang also combine Shaoyao and Fuzi to warm meridians and protect Ying, akin to preserving Yin and restoring Yang. Few later physicians grasp this nuance.
Modifications for Zhenwu Tang: Add Ban Sheng of Fuzi, 1 liang each of Xixin (Asari Radix) and Ganjiang for cough. Remove Fuling if urination is frequent. Remove Shaoyao and add 2 liang of Ganjiang for diarrhea. Remove Fuzi and add Shengjiang (totaling half jin) for vomiting. Removing Fuzi for vomiting is counterintuitive since water-cold reversing upward warrants Fuzi. This modification applies only if there is pre-existing heat/phlegm in Lung/Stomach causing habitual vomiting—an exceptional case. Contrast this with Tongmai Sini Tang, where ginger is added without removing Fuzi. Thus, using Zhenwu Tang for acute vomiting is already questionable; removing Fuzi is inappropriate.
In Shaoyin disease, if there is diarrhea with undigested food, interior cold with exterior heat, cold extremities, faint/almost imperceptible pulse, aversion to cold is absent, and the face is red, possibly with abdominal pain, dry retching, sore throat, or cessation of diarrhea with absent pulse, Tongmai Sini Tang (Pulse-Restoring Frigid Extremities Decoction) is indicated. Recovery occurs if the pulse returns.
Severe interior cold with diarrhea, yet exhibiting exterior heat, red face, absence of aversion to cold, cold extremities, and faint pulse, indicates Yin pathogens repelling Yang outward. In Sini Tang, double the amount of Ganjiang to strongly warm the interior. Following the logic of Baitong Tang, add Congbai to enter Yin, restore Yang, and revive the pulse. The previous text states sudden pulse emergence means death; here, prompt pulse return means recovery. Sudden emergence implies root separation; prompt return implies restoration. If pulse return is sluggish, Yang has scattered with heat, leading to death.
Modifications for Tongmai Sini Tang: Add 9 stalks of Congbai for red face. Remove Congbai and add 2 liang of Shaoyao for abdominal pain. Add 2 liang of Shengjiang for vomiting. Remove Shaoyao and add 1 liang of Jiegeng (Platycodonis Radix) for sore throat. Remove Jiegeng and add 2 liang of Renshen (Ginseng Radix) if diarrhea stops but pulse remains absent.
Red face indicates Yang repelled upward; Congbai unblocks Yang. Abdominal pain indicates insufficient True Yin; removing Congbai avoids aiding Yang excessively, adding Shaoyao to gather Yin. Sore throat indicates Yin knotting upward; removing Shaoyao avoids constraining Yin, adding Jiegeng to benefit the throat. Cessation of diarrhea with absent pulse indicates incomplete Yang recovery and blood deficiency; Renshen tonifies Qi and Blood. Jiegeng is removed to avoid ascending action obstructing circulation.
In Shaoyin disease, if there is vomiting and diarrhea, cold extremities, and severe restlessness bordering on death, Wuzhuyu Tang (Evodia Decoction) is indicated.
This represents Shaoyin complicated by Jueyin. Vomiting, diarrhea, cold extremities, and severe restlessness indicate rising Yin Qi of Kidney and Liver, approaching crisis. Wuzhuyu (Evodiae Fructus) descends rebellious Qi, while Renshen, Ganjiang, Dazao (Jujubae Fructus), and Ginger thicken Spleen Earth. This warms meridians and middle jiao, preventing Yin Qi from disturbing upward.
In Shaoyin disease, if vomiting and diarrhea are accompanied by restlessness and cold extremities, the prognosis is fatal.
Vomiting and diarrhea leading to restlessness indicate chaotic and exhausted Yin-Yang. Combined with cold extremities, the central Earth collapses, cutting off connection between upper and lower, resulting in death. Early warming of the middle jiao could have prevented this. Note: The previous case described similar symptoms but was treatable with Wuzhuyu Tang. Why is this fatal? Because applying warming methods here exacerbates restlessness, signaling impending death.
In Shaoyin disease, if food is vomited immediately upon entry, there is a sensation of wanting to vomit but inability to do so, initial cold extremities, and string-tight/slow pulse, this indicates excess in the chest; purgation is contraindicated, vomiting induction is appropriate. If dry retching is caused by cold-fluid above the diaphragm, vomiting induction is contraindicated; urgent warming with Sini Tang is required.
Immediate vomiting suggests stomach rejection. Inability to vomit when not eating indicates rebellious Yin Qi. Initial cold extremities and string-tight/slow pulse rule out transmitted heat. While Yin pathogens present this way, phlegm-fluid also shows this pulse. If gastric phlegm-excess were suspected, emesis would be indicated. However, the inability to vomit points clearly to Yin rebellion. Even if dry retching stems from cold-fluid above the diaphragm, it is Yin pathology, unsuitable for typical phlegm-resolving drugs. Emesis would worsen the condition. Urgent warming supports Yang to overcome Yin, dispersing cold-fluid effectively.
In Shaoyin disease, if there is desire to vomit but inability to do so, irritability, and desire to sleep, progressing after five to six days to spontaneous diarrhea and thirst, it belongs to Shaoyin. Thirst arises from deficiency prompting self-rescue with water. If urine is white, Shaoyin syndrome characteristics are complete. White urine indicates lower-jiao deficiency-cold failing to control water.
Desire to vomit without emission and irritability signal Kidney Qi rebellion. Spontaneous diarrhea with thirst and dry mouth mimics heat. However, Kidney heat causes yellow/red urine. White urine confirms lower-jiao deficiency-cold, requiring warming, not cold-purgatives. Subsequent cases describe deteriorated Shaoyin deficiency-cold syndromes where Zhang Zhongjing provides no formulas due to dual Yin-Yang injury and blood-Qi exhaustion, leading to high mortality.
If a patient’s pulse is tight in both Cun and Chi positions but sweats, it indicates Yang collapse, belonging to Shaoyin. Symptoms include sore throat, vomiting, and diarrhea.
Tight pulse is typical of Cold Damage, which usually lacks sweating. Sweating indicates failure of Yang to secure the exterior, allowing pathogen retention and sweat release. Shaoyin pathogens, if retained, cause sore throat, vomiting, and diarrhea. Treatment follows Shaoyin warming and cold-dispelling principles.
In Shaoyin disease, if the pulse is faint, sweating is contraindicated as it causes Yang collapse. If Yang is deficient and the Chi pulse is choppy, purgation is contraindicated.
Yang collapse precludes sweating. "Wang" (collapse) equates to "Wu" (absence). Absence of Yang implies Yin pathogen, which might suggest purgation. However, with deficient Yang and weak/choppy Chi pulse, purgation is forbidden. Urgent warming is indicated.
If there is cold extremities with a tight pulse, sweating is contraindicated. Sweating causes voice disorder, hoarseness, tongue flaccidity, and inability to speak.
Shaoyin collaterals enter the Lung, traverse the throat, and attach to the tongue base. Lung deficiency leads to weak collateral manifestations: voice disorder, hoarseness, tongue flaccidity, and speech impairment.
The preceding four items are deficient-cold deteriorated Shaoyin conditions. Though Zhang Zhongjing offers no formulas, they are treatable. Specific recommendations: "Desire to vomit" case → Zhenwu Tang; "Pulse tight" case → Fuzi Tang plus Jiegeng and Chishizhi; "Faint pulse" case → Baitong Tang plus Ren Shen Huang and Zhu Dan; "Cold extremities with tight pulse" → Sini Tang. Mistaken sweating leads to irreversible speech/tongue issues.
In Shaoyin disease, if the pulse is faint, fine, and deep, with desire to sleep, sweating, absence of irritability, and desire to vomit, progressing after five to six days to spontaneous diarrhea, restlessness, and insomnia, the prognosis is fatal.
Faint, fine, deep pulse and somnolence are fundamental Shaoyin signs. Sweating without irritability eliminates Yang signs, shifting focus to Yin. The presence of desire to vomit indicates rebellious Yin, requiring urgent warming. Failure to act leads to worsening diarrhea, restlessness, and insomnia. This signifies disturbance of True Yang in the Kidney, scattering instantly. Even warming would be too late. The shift from non-irritability to irritability, and from somnolence to insomnia, indicates the last thread of Yang is disrupted beyond recovery.
In Shaoyin disease, if there is aversion to cold, curling up, diarrhea, and cold extremities, the condition is untreatable.
With extreme Yin and absent Yang, even Sini Tang may fail to restore Yang from nothingness. Hence, "untreatable."
In Shaoyin disease, if there are cold extremities, aversion to cold, body heat, absent pulse, and irritability without restlessness, the prognosis is fatal.
Absent pulse indicates premature Yang extinction. Irritability without restlessness signals instantaneous exhaustion of solitary Yin.
In Shaoyin disease, if diarrhea ceases but dizziness and occasional vertigo occur, the prognosis is fatal.
Cessation of diarrhea suggests potential recovery. However, dizziness and vertigo indicate collapsing Yang.
In Shaoyin disease, if there is vomiting and diarrhea, but extremities are not cold, and there is fever, survival is possible. If the pulse is absent, apply moxibustion to Shaoyin points seven times.
Absence of cold extremities and presence of fever suggest Yin transforming back to Yang. However, persistent vomiting/diarrhea with absent pulse suggests floating Yang. Moxibustion on Shaoyin points guides Yang inward, restoring pulse and stopping symptoms. Previous cases involved aversion to cold requiring Zhenwu Tang post-moxibustion due to internal Yin-cold coagulation. This case involves internal Yin/external Yang, so moxibustion alone suffices to draw Yang inward without additional warming herbs.
These constitute Shaoyin deficiency-cold syndromes.
In Shaoyin disease, if there is aversion to cold, curling up, occasional self-arising irritability, and desire to remove clothing/blankets, the condition is treatable.
Self-arising irritability and desire to uncover indicate disturbed True Yang, not yet fully escaped. Warming methods are applicable. Prognosis is favorable only if irritability subsides quickly, spirit remains calm, extremities warm, and pulse is faint/deep but continuous. Agitation, cold extremities, and rapid/scattered pulse indicate death.
In Shaoyin disease, if diarrhea stops, accompanied by aversion to cold, curling up, but warm extremities, the condition is treatable.
Aversion to cold and curling up indicate deficiency-cold. Cessation of diarrhea and warm extremities suggest gradual Yang recovery and Yin-cold dissipation. Warming aids Yang restoration.
In Shaoyin disease, if the pulse is tight, progressing to the seventh or eighth day with spontaneous diarrhea, sudden pulse softening, warm extremities, and disappearance of tightness, resolution is indicated. Despite irritability and diarrhea, self-healing is expected.
Initial tight pulse softens as Yin-cold exits downward via diarrhea. Warm extremities indicate Yang recovery. Self-healing occurs despite irritability. These cases represent pathogen resolution and cold retreat, requiring no medication.
In Shaoyin Wind-Strike, if the pulse is superficially faint and deeply floating, recovery is indicated.