少阴病，得之二三日，心中烦，不得卧，黄连阿胶汤主之。
此病发于阴，热为在里，与二三日无里证，而热在表者不同。按少阴受病，当五六日发，然发于二三日居多。
二三日背恶寒者，肾火衰败也，必温补以益阳；反发热者，肾水不藏也，宜微汗以固阳。口燥咽干者，肾火上走
空窍，急下之以存津液。此心中烦不得卧者，肾火上攻于心也，当滋阴以凉心肾。
黄连阿胶汤∶
黄连（四两） 阿胶（三两） 黄芩 芍药（各二两） 鸡子黄（三枚）
上五味，以水六升，先煮三物，取二升，去滓，内阿胶，烊尽少冷，内鸡子黄搅令相得，温服七合，日三服。
鸡感巽化，得心之母气者也。黄禀南方火色，率芍药之酸，入心而敛神明，引芩、连之苦，入心而清壮火。
驴皮被北方水色，入通于肾，济水性急趋下，内合于心，与之相溶而成胶，是火位之下，阴精承之。凡位以内为
阴，外为阳，色以黑为阴，赤为阳。鸡黄赤而居内，驴皮黑而居外，法坎宫阳内阴外之象，因以制壮火之食气耳。
少阴病，下利六七日，咳而呕渴，心烦不得眠者，猪苓汤主之。
少阴病，但欲寐，心烦而反不得卧，是黄连阿胶证也。然二三日心烦是实热，六七日心烦是虚烦矣。且下利
而热渴，是下焦虚，不能制水之故，非芩、连、芍药所宜。咳呕烦渴者，是肾水不升；下利不眠者，是心火不降
耳。凡利水之剂，必先上升而后下降，故用猪苓汤主之，以滋阴利水而升津液。斯上焦如雾而咳渴除，中焦如沤
而烦呕静，下焦如渎而利自止矣。
猪苓汤∶
猪苓 泽泻 茯苓 滑石 阿胶（各一两）
上五味，以水四升，先煮四味，取二升，内阿胶烊尽，温服七合，日─服。
五味皆润下之品，为少阴枢机之剂。猪苓、阿胶，黑色通肾，理少阴之本也；茯苓、滑石，白色通肺，滋少
阴之源也。泽泻、阿胶，咸先入肾，壮少阴之体；二苓、滑石，淡渗膀胱，利少阴之用。故能升水降火，有治阴
和阳，通理三焦之妙。
阳明病。若脉浮发热。渴欲饮水。小便不利者。猪苓汤主之。
脉证全同五苓。彼以太阳寒水利于发汗，汗出则膀胱气化而小便行，故利水之中，仍兼发汗之味。此阳明燥
土最忌发汗，汗之则胃亡津液，而小便更不利，所以利水之中，仍用滋阴之品。二方同为利
水，太阳用五苓者，因寒水在心下，故有水逆之证，桂枝以散寒、白术以培土也。阳明用猪苓者，因热邪在胃中，
故有自汗证，滑石以滋土、阿胶以生津也。散以散寒，汤以润燥，用意微矣。
二方皆是散饮之剂。太阳转属阳明者，其渴尚在上焦，故仍用五苓入心而生津；阳明自病而渴者，本于中
焦，故又藉猪苓入胃而通津液。
阳明病，汗多而渴者，不可与猪苓汤。以汗多，胃中燥，猪苓汤复利其小便故也。
阳明病，重在亡津液。饮水多而汗不多、小便不利者，可与猪苓汤利之。若汗出多，以大便燥，饮水多，即
无小便，不可利之。不知猪苓汤本为阳明饮多而用，不为阳明利水而用也。不可与猪苓汤，即属腑者不令溲数之
意。以此见阳明之用猪苓，亦仲景不得已之意矣。汗多而渴，当白虎汤，胃中燥，当承气汤，俱在言外。
少阴病，发病两三天后，出现心中烦乱、无法入睡的症状，应当使用黄连阿胶汤治疗。
这种病症发于阴分，热邪位于体内，与发病两三天没有里证而热邪在表的情况不同。按照少阴经受邪的规律，通常在五六天发作，但在二三天发作的情况居多。
如果发病两三天后背恶寒，这是肾阳衰败的表现，必须用温补的方法来扶助阳气；如果反而发热，这是肾阴（水）不能内守的表现，宜用微汗的方法以固护阳气。口燥咽干，是肾中虚火上炎至空窍，急需用泻下法以保存津液。这里所说的“心中烦乱、无法入睡”，是肾中虚火上攻于心所致，应当采用滋阴并清降心肾之火的方法。
黄连阿胶汤方：
黄连（四两） 阿胶（三两） 黄芩 芍药（各二两） 鸡子黄（三枚）
以上五味药，用水六升，先煮前三味药，取药液二升，去渣，加入阿胶，待其完全溶化并稍冷却后，加入鸡子黄，搅拌均匀，每次温服七合，每日服用三次。
鸡蛋感应巽卦的变化，禀受心的母气（木生火）。蛋黄呈南方火之色，率领芍药的酸味，入心经以收敛神明；引导黄芩、黄连的苦味，入心经以清泄壮火。
驴皮被北方水之色所染，通达于肾，济水的性质急趋下行，内合于心，与水相溶而成胶，这正是“火位之下，阴精承之”的道理。凡是位置在内为阴，在外为阳；颜色以黑为阴，赤为阳。鸡黄色赤而在内，驴皮质黑而在外，符合坎卦（☵）阳在内、阴在外的象，因此用来制约壮火的食气。
少阴病，腹泻六七天，伴有咳嗽、呕吐、口渴、心烦不得眠的症状，应当使用猪苓汤治疗。
少阴病，通常表现为只想睡觉（但欲寐），如果心烦反而无法入睡，这是黄连阿胶汤证。然而，发病两三天的心烦属于实热，发病六七天的心烦则属于虚烦。况且伴有腹泻和热渴，这是下焦虚弱，不能制约水液的缘故，不适合使用黄芩、黄连、芍药。咳嗽、呕吐、心烦、口渴，是肾水不能上升；腹泻、失眠，是心火不能下降。凡是利水的药剂，必须先使气机上升而后下降，所以用猪苓汤主治，以滋阴利水并升发津液。这样上焦如雾般宣发，咳嗽口渴消除；中焦如沤般腐熟，心烦呕吐平静；下焦如渎般疏通，腹泻自然停止。
猪苓汤方：
猪苓 泽泻 茯苓 滑石 阿胶（各一两）
以上五味药，用水四升，先煮前四味药，取药液二升，加入阿胶使其完全溶化，温服七合，每日服用一次。（注：原文“日─服”据《伤寒论》通行本及上下文逻辑，多为日三服或日再服，此处依字面译为一日一服，但古籍校勘常存疑，此处忠实于提供文本的字面意思“日─服”即一日一次，或可能为衍文/误植，按字面直译。）
这五味药都是润下的药物，是调节少阴枢机的方剂。猪苓、阿胶色黑通肾，调理少阴的根本；茯苓、滑石色白通肺，滋助少阴的来源。泽泻、阿胶味咸先入肾，壮盛少阴的体用；二苓（猪苓、茯苓）、滑石味甘淡渗利膀胱，发挥少阴的作用。因此能够升水降火，具有调和阴阳、通理三焦的妙用。
阳明病，如果出现脉浮、发热、想喝水、小便不利的症状，应当使用猪苓汤治疗。
这些脉证与五苓散证完全相同。五苓散针对太阳寒水，利于发汗，汗出则膀胱气化功能恢复而小便通畅，所以在利水中兼有发汗的药物。阳明病属燥土，最忌讳发汗，发汗会导致胃中津液亡失，从而使小便更加不利，所以在利水中，仍使用滋阴的药物。两个方子同为利水剂，太阳病用五苓散，是因为寒水停聚在心下，所以有水逆的症状，用桂枝散寒、白术培土。阳明病用猪苓汤，是因为热邪在胃中，所以有自汗的症状，用滑石滋润土气、阿胶生津液。散剂用于散寒，汤剂用于润燥，用意微妙。
这两个方子都是消散水饮的药剂。太阳病转属阳明的，其口渴尚在上焦，所以仍用五苓散入心而生津；阳明病自发的口渴，根源在中焦，所以又借助猪苓汤入胃而通调津液。
阳明病，出汗多且口渴的，不可给予猪苓汤。因为出汗多，胃中干燥，猪苓汤再次利其小便，会进一步损伤津液。
阳明病的重点在于津液亡失。饮水多而汗不多、小便不利的，可以用猪苓汤利水。如果出汗多，因大便干燥，饮水多，即使没有小便，也不可用利水法。不知道猪苓汤本是针对阳明病饮水过多而设用的，不是专门为了利水而设用的。不可使用猪苓汤，就是属于腑证时不让小便频数的意思。由此可以看出，阳明病使用猪苓汤，也是张仲景不得已而为之的意思。出汗多且口渴的，应当用白虎汤；胃中干燥的，应当用承气汤，这些都在言外之意中。
Shaoyin disease, occurring two to three days after onset, presents with vexation in the heart and inability to sleep; it is primarily treated with Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction).
This condition originates from the Yin aspect, with heat located internally, which differs from cases where, after two to three days, there are no interior signs but heat remains in the exterior. According to the pattern of Shaoyin disease, onset typically occurs on the fifth or sixth day, yet occurrence on the second or third day is quite common.
If chills on the back occur within two to three days, it indicates failure of Kidney Fire (Kidney Yang), requiring warming and tonification to benefit Yang; conversely, if fever occurs, it indicates that Kidney Water (Yin) fails to store, warranting mild sweating to secure Yang. Dry mouth and throat suggest Kidney Fire ascending to the orifices, necessitating rapid purgation to preserve body fluids. In this case, "vexation in the heart and inability to sleep" results from Kidney Fire attacking the Heart, requiring nourishment of Yin and cooling of the Heart and Kidneys.
Huanglian Ejiao Tang Formula:
Huanglian (Coptidis Rhizoma) (4 liang) Ejiao (Donkey-Hide Gelatin) (3 liang) Huangqin (Scutellariae Radix) Shaoyao (Paeoniae Radix Alba) (each 2 liang) Ji Zi Huang (Egg Yolk) (3 pieces)
Take the above five ingredients, add six sheng of water, first decoct the first three ingredients to obtain two sheng of liquid, remove the dregs, add Ejiao, melt completely, let cool slightly, then add Egg Yolk and stir well to mix. Take seven ge warm, three times daily.
The egg responds to the transformation of Xun (Wind/Wood), receiving the mother qi of the Heart (Wood generates Fire). The yolk possesses the red color of Southern Fire, leading the sour nature of Shaoyao to enter the Heart and gather Shen (Spirit); it guides the bitter nature of Huangqin and Huanglian to enter the Heart and clear vigorous fire.
Donkey hide is dyed with the black color of Northern Water, connecting to the Kidney. The nature of Water flows downward rapidly, merging internally with the Heart, dissolving together to form gelatin. This exemplifies "below the position of Fire, Yin Essence supports it." Generally, positions inside are Yin, outside are Yang; colors black are Yin, red are Yang. Egg yolk is red and internal; donkey hide is black and external. This corresponds to the image of Kan Palace (Water trigram ☵), with Yang inside and Yin outside, thereby controlling the qi of vigorous fire.
In Shaoyin disease, diarrhea lasting six to seven days, accompanied by cough, vomiting, thirst, vexation, and insomnia, is primarily treated with Zhuling Tang (Polyporus Decoction).
In Shaoyin disease, drowsiness (Dan Yu Mei) is typical. If vexation occurs with an inability to sleep, it is a Huanglian Ejiao Tang syndrome. However, vexation appearing within two to three days indicates excess heat, whereas vexation appearing after six to seven days indicates deficiency vexation. Furthermore, diarrhea with heat and thirst indicates deficiency in the Lower Jiao, unable to control water, making it unsuitable for Huangqin, Huanglian, and Shaoyao. Cough, vomiting, vexation, and thirst indicate that Kidney Water fails to ascend; diarrhea and insomnia indicate that Heart Fire fails to descend. All diuretic agents must first promote ascent before descent. Therefore, Zhuling Tang is used to nourish Yin, promote urination, and ascend body fluids. Thus, the Upper Jiao becomes like mist, resolving cough and thirst; the Middle Jiao becomes like fermentation vat, calming vexation and vomiting; the Lower Jiao becomes like a ditch, stopping diarrhea naturally.
Zhuling Tang Formula:
Zhuling (Polyporus) Zexie (Alismatis Rhizoma) Fuling (Poria) Huashi (Talcum) Ejiao (Donkey-Hide Gelatin) (each 1 liang)
Take the above five ingredients, add four sheng of water, first decoct the first four ingredients to obtain two sheng of liquid, add Ejiao and melt completely. Take seven ge warm, once daily.
All five ingredients are moistening and descending herbs, serving as a formula to regulate the pivot of Shaoyin. Zhuling and Ejiao, being black, connect to the Kidney, regulating the root of Shaoyin; Fuling and Huashi, being white, connect to the Lung, nourishing the source of Shaoyin. Zexie and Ejiao, being salty, enter the Kidney first, strengthening the substance of Shaoyin; Er Ling (Zhuling and Fuling) and Huashi, being bland and penetrating, drain the Bladder, utilizing the function of Shaoyin. Thus, they can ascend water and descend fire, possessing the subtle effect of harmonizing Yin and Yang and regulating the Three Jiao.
In Yangming disease, if pulse is floating, fever is present, there is desire to drink water, and urination is difficult, Zhuling Tang is primarily indicated.
The pulse and symptoms are identical to those of Wuling San (Five-Ingredient Powder with Poria). Wuling San targets Taiyang Cold-Water, facilitating sweating; when sweat is released, Bladder Qi transformation restores, and urination proceeds, thus combining diuresis with sweating-inducing properties. Yangming disease involves Dry Earth, which strongly contraindicates sweating; sweating causes loss of Stomach fluids, worsening urination. Therefore, this formula combines diuresis with fluid-nourishing properties. Both formulas promote urination. For Taiyang disease, Wuling San is used because Cold-Water stagnates below the heart, causing water regurgitation; Guizhi (Cinnamon Twig) disperses cold, Baizhu (Atractylodis Macrocephalae Rhizoma) strengthens Earth. For Yangming disease, Zhuling Tang is used because Heat pathogen resides in the Stomach, causing spontaneous sweating; Huashi (Talcum) moistens Earth, Ejiao (Donkey-Hide Gelatin) generates fluids. Powder disperses cold; Decoction moistens dryness. The intent is subtle.
Both formulas are agents to dissipate retained fluids. When Taiyang disease transfers to Yangming, thirst remains in the Upper Jiao, so Wuling San is still used to enter the Heart and generate fluids. When Yangming disease arises spontaneously with thirst, the root is in the Middle Jiao, so Zhuling Tang is employed to enter the Stomach and circulate fluids.
In Yangming disease, if sweating is profuse and thirst is present, Zhuling Tang must not be administered. Because profuse sweating leads to dryness in the Stomach, administering Zhuling Tang would further deplete fluids through diuresis.
Yangming disease focuses on the loss of body fluids. If fluid intake is high, sweating is minimal, and urination is difficult, Zhuling Tang may be used to promote urination. If sweating is profuse, due to dry feces, and fluid intake is high resulting in no urine, diuresis is contraindicated. It is unknown that Zhuling Tang was originally designed for Yangming disease with excessive fluid intake, not specifically for diuresis. Contraindication of Zhuling Tang implies preventing frequent urination in Fu organ syndromes. This shows that using Zhuling Tang in Yangming disease was also a measure of last resort by Zhang Zhongjing. For profuse sweating and thirst, Baihu Tang (White Tiger Decoction) is indicated; for Stomach dryness, Chengqi Tang (Decoction of the Bowel-Unblocking Agents) is indicated, these being implied.