故多或为之症如真武也。通脉四逆。治少阴下利清谷里寒外热。手足厥逆脉微欲绝者。为里寒。身
热恶寒而面色赤。为外热。此阴甚于内。格阳于外。不能相通。与通脉四逆以散阴通阳。或为症。
根据法加减。以上四症。俱云下利。而兼有或为症。是以用药大同小异也。或谓白通用附子凡四症。
惟真武一症熟用。余皆生用。何也。附子生用则温经散寒。非干姜佐之不可。熟用则益阳除湿。惟
生姜相辅为宜。干姜辛热。故佐生附。生姜辛温。少资熟附之功。佐使之妙。无出此理。然白通等
汤。以下利为重。其真武症。以寒湿为先。故用药有轻重之殊耳。盖风湿寒湿。大概颇同。如太阳
桂枝附子汤。治寒湿相搏。附亦用熟。仍用生姜佐之。其生熟之用。轻
重之分。无过此理也。
因此，有时会出现类似真武汤证的症状。通脉四逆汤，用于治疗少阴病下利完谷不化、内寒外热的情况。对于手足厥冷、脉搏微弱几乎摸不到的患者，这是里寒的表现；身体发热、怕冷且面色发红，这是外热的表现。这是因为阴寒盛于体内，格拒阳气于体外，导致阴阳不能相通。此时给予通脉四逆汤以驱散阴寒、通达阳气。或者根据具体症状，依据法则进行加减调整。以上四种病症，都提到下利，并且兼有或有的症状，所以用药大体相同而小异。有人问白通汤等方剂中通用附子共有四种情况，只有真武汤证使用熟附子，其余都使用生附子，为什么呢？附子生用可以温经散寒，但如果没有干姜辅助是不行的；熟用则可以补益阳气、祛除湿气，只有生姜配合才适宜。干姜辛热，所以辅助生附子；生姜辛温，稍微资助熟附子的功效。佐使药的妙处，没有超出这个原理的。然而白通汤等方剂，以下利为重症，而真武汤证，以寒湿为先导，所以用药有轻重之分罢了。大概风湿和寒湿是相似的，比如太阳病的桂枝附子汤，治疗寒湿相搏，附子也用熟附，仍然用生姜辅助。其生熟的使用、轻重的区分，没有超过这个原理的。
Therefore, symptoms may occasionally resemble those of the Zhenwu Tang (True Warrior Decoction) pattern. Tongmai Sini Tang (Pulse-Reviving Cold-Reversing Decoction) is indicated for Shaoyin disease presenting with diarrhea containing undigested food, internal cold with external heat. In cases where the hands and feet are cold (cold extremities) and the pulse is faint and nearly imperceptible, this indicates internal cold. The presence of body heat, aversion to cold, and a red complexion indicates external heat. This occurs when Yin-cold is excessive within, repelling Yang-Qi to the exterior, preventing communication between them. In such instances, Tongmai Sini Tang is administered to disperse Yin-cold and unblock Yang-Qi. Alternatively, modifications may be made according to standard principles based on specific symptoms. Regarding the aforementioned four patterns, all mention diarrhea accompanied by occasional or alternative symptoms; thus, the medicinal prescriptions are largely similar with minor differences. It has been asked that in the Bai Tong Tang (White Pass Decoction) and other formulas, Fuzi (Aconite Lateral Root) is used in four different patterns, yet only in the Zhenwu Tang pattern is it processed (cooked), while in the others it is raw. Why is this? When Fuzi is used raw, it warms the meridians and dispels cold, but it cannot function effectively without the assistance of Ganjiang (Dried Ginger). When processed, it tonifies Yang-Qi and eliminates dampness, making it most suitable to be assisted by Shengjiang (Fresh Ginger). Ganjiang is pungent and hot, thus assisting raw Fuzi; Shengjiang is pungent and warm, slightly augmenting the efficacy of processed Fuzi. The subtlety of assistant and guide herbs lies in no other principle than this. However, in Bai Tong Tang and similar formulas, diarrhea is the primary severity, whereas in the Zhenwu Tang pattern, cold-dampness takes precedence; hence, there is a distinction in the weight and dosage of the ingredients. Generally, wind-dampness and cold-dampness are quite similar. For instance, in Taiyang disease, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) treats the binding of cold-dampness, using processed Fuzi and still assisting it with Shengjiang. The use of raw versus processed forms and the differentiation of light versus heavy dosages do not exceed this principle.