少阴病，身体痛，手足寒，骨节痛，脉沉者，附子汤主之。
少阴病，得之一二日，口中和，其背恶寒者，当灸之，附子汤主之。
少阴主水，于象为坎。一阳居其中，故多热证。是水中有火，阴中有阳也。此纯阴无阳，阴寒切肤，故身
疼。四肢不得禀阳气，故手足寒。寒邪自经入藏，藏气实而不能入，则从阴内注于骨，故骨节疼。此身疼骨痛，
虽与麻黄证同，而阴阳寒热彼此判然。脉沉者，少阴不藏，肾气独沉也。口中兼咽与舌言，少阴之脉循喉咙，挟
舌本，故少阴有口干、舌燥、咽痛等证。此云和者，不燥干而渴，火化几于息矣。人之生也，负阴而抱阳，故
五脏之俞，皆系于背。背恶寒者，俞气化薄，阴寒得以乘之也。此阳气凝聚而成阴，必灸其背俞，使阴气流
行而为阳。急温以附子汤，壮火之阳，而阴自和矣。
附子汤∶
附子（二枚，炮） 白术（四两） 人参（二两） 芍药 茯苓（各三两）
水八升，煮取三升，去滓，温服一升，日三服。
此伤寒温补第一方也，与真武汤似同而实异。倍术、附去姜加参，是温补以壮元阳，真武汤还是温散而利
肾水也。
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，呕者，真武汤主之。
为有水气，是立真武汤本意。小便不利是病根。腹痛下利，四肢沉重疼痛，皆水气为患，因小便不利所致。
然小便不利，实由坎中之无阳。坎中火用不宣，故肾家水体失职，是下焦虚寒，不能制水故也。法当壮元阳以
消阴翳，逐留垢以清水源，因立此汤。末句语意，直接有水气来。后三项是真武加减证，不是主证。若虽有水
气而不属少阴，不得以真武主之也。
真武汤∶
茯苓 芍药 生姜（各三两） 白术（二两） 附子（一枚，炮）
水八升，煮取三升，温服七合，日三服。咳者，加五味半
升，细辛一两。小便利而下利者，去芍药、茯苓，加干姜一两。呕者，去附子，加生姜，足前成半斤。
真武，主北方水也。坎为水，而一阳居其中，柔中之刚，故名真武。是阳根于阴，静为动本之义。盖水体
本静，动而不息者，火之用也。火失其位，则水逆行。君附子之辛温，以奠阴中之阳；佐芍药之酸寒，以收炎
上之用；茯苓淡渗，以正润下之体；白术甘苦，以制水邪之溢。阴平阳秘，少阴之枢机有主，开阖得宜，小
便自利，腹痛下利自止矣。生姜者，用以散四肢之水气，与肤中之浮热也。
咳者，是水气射肺所致。加五味子之酸温，佐芍药以收肾中水气；细辛之辛温，佐生姜以散肺中水气。小
便自利而下利者，胃中无阳。则腹痛不属相火，四肢困于脾湿，故去芍药之酸寒，加干姜之辛热，即茯苓之甘
平亦去之。此为温中之剂，而非利水之剂矣。呕者是水气在中，故中焦不治。四肢不利者，不涉少阴，由于太阴
湿化不宣也。与水气射肺不同，法不须附子之温肾，倍加生姜以散邪。此和中之剂，而非下焦之药矣。
附子、芍药、茯苓、白术，皆真武所重。若去一，即非真武汤。
太阳病发汗，汗出不解，其人仍发热，心下悸，头眩，身 动振振欲擗地者，真武汤主之。
肾液入心而为汗，汗出不能遍身，故不解。所以然者，太阳阳微，不能卫外而为固，少阴阴虚，不能藏精
而起亟也。仍发热而心下悸，坎阳外亡而肾水凌心耳。头眩身 ，因心下悸所致。振振欲擗地，形容身 动之
状。凡水从火发，肾火上炎，水邪因得上侵。若肾火归原，水气自然下降，外热因之亦解。此条用真武者，全
在降火利水，重在发热而心下悸，并不在头眩身 动也。如伤寒厥而心下悸，宜先治水，亦重在悸，不重在厥。
但彼本于太阳寒水内侵，故用桂枝；此则少阴邪水泛溢，故用附子。仲景此方，为少阴治水而设。附会三纲之
说者，本为误服青龙而设。不知服大青龙而厥逆筋惕肉 ，是胃阳外亡。轻则甘草干姜汤，重则建中理中辈，
无暇治肾。即欲治肾，尚有附子汤之大温补，而乃用真武耶？要知小便自利，心下不悸，便非真武汤证。
少阴病，出现身体疼痛、手足寒冷、骨节疼痛、脉象沉细的症状，应当使用附子汤治疗。
少阴病，发病一两天后，口中感觉平和（不苦不燥），背部感到恶寒的，应当施以艾灸，并服用附子汤治疗。
少阴经主司水液，在卦象上对应坎卦。坎卦中有一阳爻居于中间，所以多表现为热证。这是水中含有火，阴中蕴含阳的表现。而本条所述为纯阴无阳，阴寒之气刺入肌肤，因此导致身体疼痛。四肢无法得到阳气的温煦，所以手足寒冷。寒邪从经络传入脏腑，但脏腑之气充实，寒邪不能深入，便从阴分向内注入骨骼，因此导致骨节疼痛。这种身体疼痛和骨节疼痛，虽然与麻黄汤证的表实证相似，但阴阳寒热的性质截然不同。脉象沉细，说明少阴肾气不能固藏，肾气独自下沉。口中的“口”兼指咽喉和舌头，因为少阴经脉循行经过喉咙，挟持舌根，所以少阴病常有口干、舌燥、咽痛等症状。这里说“口中平和”，是指口不干燥也不口渴，说明体内的火化功能几乎已经熄灭。人的生存，背负阴而怀抱阳，所以五脏的背俞穴都联系于背部。背部感到恶寒，是因为背俞之处的气化功能薄弱，阴寒之气得以乘虚侵袭。这里的阳气凝聚转化为阴寒，必须灸治背部的俞穴，使阴气流动转化为阳气。急需使用附子汤进行温补，壮大命门之火以扶助元阳，阴寒自然调和。
附子汤方：
附子（两枚，炮制） 白术（四两） 人参（二两） 芍药 茯苓（各三两）
用水八升，煮取三升，滤去药渣，每次温服一升，每日服用三次。
这是伤寒论中温补的第一方，它与真武汤看似相同实则不同。附子汤比真武汤加倍了白术和附子的用量，去掉了生姜，加入了人参，目的是通过温补来壮大元阳；而真武汤则是通过温散来利导肾水。
少阴病，经过两三天没有好转，到了四五天，出现腹痛、小便不利、四肢沉重疼痛、自发性腹泻的症状，这是因为体内有水气停留。患者或者咳嗽，或者小便通利，或者腹泻，或者呕吐的，应当使用真武汤治疗。
设立真武汤的本意，正是针对体内有水气的情况。小便不利是疾病的根本原因。腹痛、腹泻、四肢沉重疼痛，都是水气为患所致，是由小便不利引起的。然而，小便不利实际上是由于坎卦中的阳气不足。坎卦中的火用（阳气功能）不能宣通，导致肾脏的水体功能失职，这是下焦虚寒，不能制约水液的原因。治疗方法应当是壮大元阳以消除阴寒阴影，驱逐滞留的污浊以澄清水源，因此制定了这个汤剂。原文末尾几句的意思，直接指向了“有水气”这一病机。后面提到的咳嗽、小便利、下利、呕吐这几种情况是真武汤的加减证候，而不是主证。如果虽然有水气但不属于少阴病范畴，就不能用真武汤来主治。
真武汤方：
茯苓 芍药 生姜（各三两） 白术（二两） 附子（一枚，炮制）
用水八升，煮取三升，每次温服七合，每日服用三次。如果咳嗽，加五味子半升，细辛一两。如果小便通利且伴有腹泻，去掉芍药、茯苓，加入干姜一两。如果呕吐，去掉附子，增加生姜用量，使其总量达到半斤。
真武神主掌北方的水。坎卦代表水，其中有一阳爻居于中间，象征柔中之刚，所以命名为真武。这体现了阳根源于阴，静为动之本的道理。水的本体本是静止的，能够运动不息的是火的作用。如果火失去了其正常位置，水就会逆流而上。君药附子味辛性温，用来奠定阴中之阳的基础；佐药芍药味酸性寒，用来收敛炎上的火势；茯苓味甘淡性平，具有渗湿作用，以纠正水润下的本性；白术味甘苦性温，用来制约水邪的泛滥。当阴平阳秘，少阴的枢机有了主宰，开阖功能得当，小便自然通利，腹痛和下泻自然停止。生姜的作用是疏散四肢间的水气和皮肤表面的浮热。
咳嗽，是水气射入肺部所致。加入五味子的酸温之性，配合芍药来收敛肾中的水气；配合细辛的辛温之性，配合生姜来疏散肺中的水气。如果小便通利且伴有腹泻，说明胃中无阳。那么腹痛就不属于相火的问题，四肢困重是由于脾湿所致，所以去掉芍药的酸寒之性，加入干姜的辛热之性，甚至连茯苓的甘平之性也去掉。这就变成了温中的方剂，而不是利水的方剂了。呕吐是因为水气停留在中焦，导致中焦失治。四肢不利，不涉及少阴，而是由于太阴湿化功能不能宣通所致。这与水气射肺不同，治疗方法不需要附子温肾，而是加倍生姜以发散邪气。这就变成了调和中焦的方剂，而不是治疗下焦的药物了。
附子、芍药、茯苓、白术，都是真武汤重视的药物。如果去掉其中一味，就不再是真武汤了。
太阳病发汗后，汗出后病仍未解除，患者仍然发热，心下悸动，头晕目眩，身体震颤动摇，想要跌倒在地，应当使用真武汤治疗。
肾中的津液进入心脏化为汗，汗出不能遍及全身，所以病不解。之所以这样，是因为太阳经阳气微弱，不能卫护体表而固密，少阴经阴精亏虚，不能藏精而起急应对外邪。仍然发热且心下悸动，是因为坎阳外亡，肾水凌犯心脏。头晕目眩和身体震颤，是由于心下悸动引起的。“振振欲擗地”，是形容身体震颤动摇的状态。凡是水随火而动，肾火上炎，水邪因此得以侵犯上部。如果肾火回归本源，水气自然下降，体表的发热也因此解除。这条文中使用真武汤，关键在于降火利水，重点在于发热和心下悸动，并不在于头晕目眩和身体震颤。如果是伤寒出现厥逆且心下悸动，适宜先治疗水气，也是重在悸动，不在于厥逆。但是那种情况是由于太阳寒水内侵，所以使用桂枝；这种情况则是少阴邪水泛溢，所以使用附子。张仲景的这个方剂，是为少阴病治水而设立的。那些牵强附会三纲学说的人，认为此方是为误服大青龙汤而设的。他们不知道服用大青龙汤后出现厥逆、筋惕肉瞤，是胃阳外亡的表现。轻症用甘草干姜汤，重症用建中汤、理中汤之类，无暇顾及治疗肾脏。即使想要治疗肾脏，还有附子汤这样的大温补方剂可用，怎么会用真武汤呢？要知道，如果小便通利，心下不悸动，那就不是真武汤的适应证。
Shaoyin disease, characterized by body pain, coldness in the hands and feet, bone and joint pain, and a deep pulse (Chen Mai), is primarily treated with Fuzi Tang (Aconite Decoction).
In Shaoyin disease, if after one or two days of onset, the mouth feels neutral (not bitter or dry) and there is aversion to cold specifically in the back, moxibustion should be applied, and Fuzi Tang (Aconite Decoction) should be administered.
The Shaoyin meridian governs water and corresponds to the Kan trigram (☵) in imagery. With one Yang line residing within, it often presents with heat syndromes. This represents fire within water, and Yang within Yin. However, this specific case involves pure Yin without Yang, where severe Yin-cold penetrates the skin, causing body pain. The four limbs fail to receive the warming influence of Yang Qi, resulting in cold hands and feet. When Cold pathogenic factors enter the Zang organs from the meridians, but the organ Qi is sufficient to prevent deep invasion, the pathogens may infiltrate inward from the Yin level into the bones, causing bone and joint pain. Although this body and bone pain resembles that seen in Mahuang Tang (Ephedra Decoction) syndrome, the nature of Yin/Yang and Cold/Heat are distinctly different. A deep pulse indicates that Shaoyin fails to store, and Kidney Qi sinks independently. The term "mouth" here encompasses both the throat and tongue, as the Shaoyin meridian runs along the throat and surrounds the root of the tongue; thus, Shaoyin diseases often present with dry mouth, dry tongue, or sore throat. Here, "neutral" means no dryness or thirst, indicating that the Fire transformation function is nearly extinguished. Human life carries Yin and embraces Yang; therefore, the Back-Shu points of the five Zang organs are connected to the back. Aversion to cold in the back occurs because the Qi transformation at the Shu points is weak, allowing Yin-cold to take advantage of this deficiency. Since Yang Qi has condensed into Yin-cold, moxibustion on the Back-Shu points is necessary to promote the flow of Yin Qi, transforming it into Yang. Urgent warming with Fuzi Tang (Aconite Decoction) strengthens the Mingmen Fire and Yuan Yang, thereby harmonizing the Yin.
Fuzi Tang (Aconite Decoction):
Fuzi (Prepared Aconiti Lateralis Radix, 2 pieces, processed) Baizhu (Atractylodis Macrocephalae Rhizoma, 4 liang) Renshen (Ginseng Radix et Rhizoma, 2 liang) Shaoyao (Paeoniae Radix) Fuling (Poria, each 3 liang)
Boil in 8 sheng of water until reduced to 3 sheng, remove the dregs, and take 1 sheng warm, three times daily.
This is the premier formula for warming and tonifying in Shanghan Lun (Treatise on Cold Damage). It appears similar to Zhenwu Tang (True Warrior Decoction) but is fundamentally different. By doubling the dosage of Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuzi (Prepared Aconiti Lateralis Radix), removing Shengjiang (Zingiberis Rhizoma Recens), and adding Renshen (Ginseng Radix et Rhizoma), the purpose is to warm and tonify to strengthen Yuan Yang. In contrast, Zhenwu Tang (True Warrior Decoction) focuses on warming and dispersing to promote diuresis of Kidney water.
If Shaoyin disease persists for two to three days and progresses to four or five days, presenting with abdominal pain, difficult urination, heavy and painful limbs, and spontaneous diarrhea, this indicates the presence of Water Qi (fluid retention). Patients may also experience cough, clear urination, diarrhea, or vomiting. In such cases, Zhenwu Tang (True Warrior Decoction) is indicated.
The primary intention of establishing Zhenwu Tang (True Warrior Decoction) is to address Water Qi. Difficult urination is the root of the pathology. Abdominal pain, diarrhea, and heavy/painful limbs are all manifestations of Water Qi pathology caused by difficult urination. However, difficult urination is actually due to the lack of Yang within the Kan trigram. When the Fire function within Kan cannot circulate freely, the Kidney's water metabolism fails, resulting in lower Jiao deficiency-cold and an inability to control water. The treatment principle is to strengthen Yuan Yang to dispel Yin shadows and purge stagnation to clarify the water source, hence this formula was created. The final sentences of the text directly point to the presence of Water Qi. The subsequent symptoms (cough, clear urination, diarrhea, vomiting) represent modifications of Zhenwu Tang (True Warrior Decoction) rather than the main syndrome. If Water Qi exists but does not belong to the Shaoyin category, Zhenwu Tang (True Warrior Decoction) should not be used.
Zhenwu Tang (True Warrior Decoction):
Fuling (Poria) Shaoyao (Paeoniae Radix) Shengjiang (Zingiberis Rhizoma Recens, each 3 liang) Baizhu (Atractylodis Macrocephalae Rhizoma, 2 liang) Fuzi (Prepared Aconiti Lateralis Radix, 1 piece, processed)
Boil in 8 sheng of water until reduced to 3 sheng, take 7 ge warm, three times daily. If coughing, add Wuweizi (Schisandrae Fructus, half sheng) and Xixin (Asari Radix et Rhizoma, 1 liang). If urination is clear accompanied by diarrhea, remove Shaoyao (Paeoniae Radix) and Fuling (Poria), and add Ganjiang (Zingiberis Rhizoma, 1 liang). If vomiting, remove Fuzi (Prepared Aconiti Lateralis Radix) and increase Shengjiang (Zingiberis Rhizoma Recens) so that the total amount reaches half jin.
Zhenwu (True Warrior) governs the Water of the North. Kan represents water, with one Yang line inside, symbolizing the剛 (firmness) within the 柔 (yielding); hence the name Zhenwu. This embodies the meaning that Yang is rooted in Yin, and stillness is the basis of movement. The nature of water is originally still; what moves it incessantly is the function of Fire. If Fire loses its proper position, water flows backward. The sovereign herb Fuzi (Prepared Aconiti Lateralis Radix) is acrid and warm, stabilizing Yang within Yin. The assistant herb Shaoyao (Paeoniae Radix) is sour and cold, restraining the flaming upward tendency. Fuling (Poria) is sweet and bland, promoting leaching to correct the downward moistening nature. Baizhu (Atractylodis Macrocephalae Rhizoma) is sweet and bitter, controlling the overflow of water pathogens. When Yin and Yang are balanced and secure, the pivot mechanism of Shaoyin has a master, opening and closing functions are appropriate, urination becomes smooth, and abdominal pain and diarrhea cease. Shengjiang (Zingiberis Rhizoma Recens) is used to disperse Water Qi in the four limbs and floating heat in the skin.
Cough is caused by Water Qi invading the Lung. Adding Wuweizi (Schisandrae Fructus) with its sour-warm property assists Shaoyao (Paeoniae Radix) to consolidate Kidney Water Qi; assisting Xixin (Asari Radix et Rhizoma) with its acrid-warm property helps Shengjiang (Zingiberis Rhizoma Recens) disperse Lung Water Qi. If urination is clear with diarrhea, it indicates a lack of Yang in the Stomach. Thus, abdominal pain is not related to Ministerial Fire, and limb heaviness is due to Spleen dampness. Therefore, remove the sour-cold Shaoyao (Paeoniae Radix) and add the acrid-hot Ganjiang (Zingiberis Rhizoma), even removing the sweet-neutral Fuling (Poria). This transforms the formula into a Middle-Jiao warming agent rather than a diuretic. Vomiting indicates Water Qi stagnating in the Middle Jiao, leading to Middle Jiao dysfunction. Limb stiffness does not involve Shaoyin but results from Taiyin dampness failing to circulate. This differs from Water Qi invading the Lung; treatment does not require Fuzi (Prepared Aconiti Lateralis Radix) to warm the Kidney, but rather doubles Shengjiang (Zingiberis Rhizoma Recens) to disperse pathogens. This becomes a Middle-Jiao harmonizing agent, not a Lower Jiao remedy.
Fuzi (Prepared Aconiti Lateralis Radix), Shaoyao (Paeoniae Radix), Fuling (Poria), and Baizhu (Atractylodis Macrocephalae Rhizoma) are crucial to Zhenwu Tang (True Warrior Decoction). Removing any one of them renders it no longer Zhenwu Tang (True Warrior Decoction).
In Taiyang disease, after sweating therapy, if the condition remains unresolved, the patient still has fever, palpitations in the epigastrium, dizziness, and tremulous body movements with a desire to fall to the ground, Zhenwu Tang (True Warrior Decoction) is indicated.
Kidney fluids entering the Heart transform into sweat. If sweating does not cover the whole body, the disease is not resolved. This is because Taiyang Yang is weak, failing to defend the exterior and maintain solidity, while Shaoyin Yin essence is deficient, unable to store essence and respond urgently to external pathogens. Persistent fever and epigastric palpitations indicate the loss of Kan Yang to the exterior and Kidney Water overwhelming the Heart. Dizziness and body tremors result from epigastric palpitations. "Tremulous desire to fall" describes the state of body shaking. Generally, when Water follows Fire, rising Kidney Fire allows Water pathogens to invade upwards. If Kidney Fire returns to its origin, Water Qi naturally descends, and exterior heat resolves accordingly. The use of Zhenwu Tang (True Warrior Decoction) in this clause lies entirely in descending Fire and promoting diuresis, focusing on fever and palpitations, not on dizziness or tremors. In cases of Cold Damage with厥逆 (cold extremities) and palpitations, treating Water Qi first is appropriate, again focusing on palpitations rather than cold extremities. However, that scenario stems from Taiyang Cold-Water invading internally, thus using Guizhi (Cinnamomi Ramulus). This scenario involves Shaoyin pathological Water overflowing, thus using Fuzi (Prepared Aconiti Lateralis Radix). Zhang Zhongjing's formula is designed for treating Water in Shaoyin disease. Those who force-fit the Three Guidelines theory argue it was set for errors from taking Da Qinglong Tang (Major Blue Dragon Decoction). They do not realize that after taking Da Qinglong Tang (Major Blue Dragon Decoction), if 厥逆 (cold extremities) and muscle twitching occur, it is due to Stomach Yang escaping outward. Mild cases use Gancao Ganjiang Tang (Licorice and Ginger Decoction), severe cases use Jianzhong Tang (Establish the Middle Decoction) or Lizhong Tang (Regulate the Middle Decoction), leaving no time to treat the Kidney. Even if one wishes to treat the Kidney, there is Fuzi Tang (Aconite Decoction) for major warming and tonification; why use Zhenwu Tang (True Warrior Decoction)? One must understand that if urination is clear and there are no palpitations, it is not a Zhenwu Tang (True Warrior Decoction) syndrome.