【纲】仲景曰。少阴脉沉细。手足冷。或时烦躁。作渴。欲漱水不欲咽者。宜四逆汤。
【目】吴绶曰。本条之外。又有下利。厥逆无脉。干呕烦渴。欲漱水不欲咽者。白通加猪胆汁
人尿主之。又有厥阴蛔厥。体寒烦躁吐蛔。口燥舌干。但欲凉水浸舌及唇。时不可离者。理中汤加
乌梅。大抵阴症发躁烦渴不能饮水。或有勉强饮下。良久复吐。或饮水而呕。或哕逆者。皆内寒也。
盖无根失守之火。游于咽嗌之间。假作燥渴。则不能饮。或有能饮不吐。复欲饮者。热也。
（附不能言）
【纲】仲景曰。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。
【目】朱肱曰。脉沉迟。手足厥冷。或吐利而咽中痛。此少阴症也。病源云。此为下部脉都不
至。阴阳隔绝。邪客于足少阴之络。毒瓦斯上冲。故咽喉不利。或痛而生疮也。伤寒脉阴阳俱紧。如本条
云云。此候汗下熏熨俱不可。汗出者。 本粉传之。咽喉痛者。甘草汤、桔梗汤、猪肤汤、通脉四
逆去芍加桔梗汤、麻黄升麻汤。选用。又有伏气之病。谓非时暴寒中人。伏气于少阴经。始不觉病。
旬月乃发。脉微弱。法先咽痛似伤寒。非喉痹之病。次必利。始用半夏桂枝汤。次四逆散。此病
只一二日便瘥。古方谓之肾伤寒也。
戴原礼曰。亦有初得病。头痛发热。无阳毒少阴诸症。而咽自痛者。此因感冒后。顿用浓衣被
堆壅。或用蛮法。服姜汤热酒即卧。遂成上壅。或先有壅热。欲取凉快。致为外邪所袭。既有风寒。
又有热壅。宜参苏饮。倍桔梗。加木香五分。或消风百解散。或五积散、败毒散各半帖。名交加
散。
闵芝庆曰。此寒邪在少阴本脏而非经病也。当咽痛而又吐利。利为少阴本症。吐而咽痛。则孤
阳欲飞脱于上矣。急救欲亡之阳。真武四逆附子等汤。可选用也。
【纲】仲景曰。少阴病。下利清谷。里寒外热。手足厥逆。脉微欲绝。身反不恶寒。其人面色
赤。或腹痛。或干呕。或咽痛。或利止。脉不出者。通脉四逆汤主之。
【目】王肯堂曰。太阳阳明咽痛各一症。悉属热也。太阳治以半夏散。阳明治以四逆散加桔梗。
少阴咽痛有六症。热症四。寒症二。热者治以猪肤汤、甘草汤、桔梗汤、苦酒汤、半夏散。寒者
治以桂枝干姜汤、真武汤、四逆汤。厥阴咽痛一症。亦热也。治以桔梗汤。咽痛皆属热。何独少阴
二症寒耶。其一以汗多亡阳。故用干姜、附子以复阳温经。其一以阴盛格阳。故用通脉四逆以散阴
通阳。
【纲】仲景曰。伤寒六七日。大下后。寸脉沉而迟。手足厥冷。下部脉不至。咽喉不利。吐脓
血。泄利不止者。为难治。
【目】王肯堂曰。此宜麻黄升麻汤。
柯琴曰。此为下厥上绝。阴阳离决之候。故咽痛不利。为水谷之道绝也。
【纲】仲景曰。少阴病。下利咽痛。胸满心烦者。猪肤汤主之。
【目】张元素曰。或云。六经皆不言咽痛。惟少阴有咽痛咽伤。何也。夫少阴咽痛。乃经络所
系。盖少阴脉循喉咙。系舌本。故有咽伤痛之患。内经曰。少阴所生病者。咽肿上气。干嗌及痛。
此经脉所系。邪气循行而致然也。
方中行曰。猪肤。本草不载。但猪属亥。宜入少阴。肤乃外皮。宜能解外。其性则凉。固能退
热。邪散而热退。烦满可除也。白蜜润燥以利咽。痛可愈也。白粉益土以胜水。利可止也。意者义
取于此乎。
魏荔彤曰。此申解少阴传经热耶。上下充满之症。立法以滋阴散热为义。盖少阴之邪。上冲为
咽痛。为心烦。热之性升也。为便血。为便脓。阴之性降也。又有上下充周。热邪弥漫者。如下利。
犹之阴之降也。咽痛胸满心烦。犹之热之升也。无非邪在少阴。既内耗其真。复交乱三焦使之然
也。法用猪肤。猪亥水。肾蓄也。其肤主太阳。能入肾滋阴。兼透表散邪之用。佐蜜甘寒。上炎之
焰熄。白粉淡渗。下利之路分。一剂而三善备焉。盖肾脏原无散法。散药又必用辛温。今热邪在内。
非散不可。辛温又不可。因另出此法。以甘寒之味。佐原属肾经之物。带太阳表性者。入其中以
导之出。肤乃肉外皮中之薄脂。浮而外发之性也。亦如石膏以辛凉为发散之义也。
【纲】仲景曰。少阴病。二三日咽痛者。可与甘草汤。不瘥者。与桔梗汤。少阴病。咽中痛。
半夏散及汤主之。
【目】苏颂曰。咽痛而无下利心烦胸满等症。但甘以缓之足矣。不瘥者。配以桔梗。辛以散之
也。其热微。故用轻剂。
魏荔彤曰。少阴之邪。惟其缘木而升。所以于其传也。必传厥阴。亦升降之理也。太阴降而
少阴。少阴升而厥阴。三阴中之升降也。比之三阳之表里亦然。盖气之行也。无论病气与正气。皆以往复
屈伸为义也。
鳌按。下条之症。比上条较重。故非甘草桔梗。甘缓辛开。轻清之物可治。必用半夏之苦。开
而兼泄。桂枝之辛。升散其热。甘草之缓。缓其炎焰。其义如此。喻氏谓半夏涤饮。桂枝散邪。犹
非的义。盖本方用桂枝半夏。并非发汗解肌之谓也。
【纲】仲景曰。少阴病。咽中伤生疮。不能语言。声不出者。苦酒汤主之。
【目】吴绶曰。少阴脉疾。可下。脉沉。附子汤加知、柏、五味子、麦冬、花粉。若虚热。病
后烦热不解者。竹叶石膏汤去半夏加花粉。凡汗吐下后。口燥咽干。此津液衰少。肾水不升。虚火
上炎也。生津益气汤。脉沉微。足冷舌燥。难治。其少阴有急下以救肾水之例。若虚人水竭火燥不
可下者。以补中益气汤。倍人参。加麦冬、五味、花粉、知、柏。以滋水也。
赵嗣真曰。活人谓脾脏有热。则津液枯少。故口燥咽干。然非独脾脏有热。脾主太阴。太阴腹
满而咽干。此可言脾热。特一症耳。余皆非也。如白虎加人参汤。口舌干燥者。表里俱热也。口苦
咽干者。少阳经热。或阳明中风也。口燥咽干。急下之。自利清水。色纯青。心下痛。口干燥者。
少阴经热也。咽干烦躁吐逆者。误汗。津液少。而欲作阳明内热者也。如上数症。岂亦脾脏有热哉。
鳌按。伤者。痛久而伤也。火灼则疮生。邪热壅于胸膈之上。故不能语言。声出于喉。咽病则
喉亦病。肺金为邪火所制。故声不出。其症较重于咽中痛。皆治之迟误也。半夏开散。鸡子清凉润。
故必治以本汤。甘草汤、桔梗汤、半夏散及汤、苦酒汤数方。皆为少阴热邪在经。上冲为咽痛而
立之法也。
【纲】仲景曰。少阴病。得之二三日。口燥咽干者。急下之。宜大承气汤。少阴病。自利清水。
色纯青。心下必痛。口干燥者。急下之。宜大承气汤。
【目】成无己曰。伤寒传经五六日。邪传少阴。则口燥舌干而渴。为邪渐深也。今少阴病得之二
三日。邪未深入之时。
便作口燥咽干者。是邪热已甚。肾水干也。急与大承气。以全肾也。正经自病。其邪深入。宜急下
之。若燥则死。肾水干燥之故也。
张元素曰。承气汤。阳明当下之症宜用。少阴亦用。何也。盖胃为水谷之海。主养四旁。四旁
有病。皆能传入胃。胃土燥则肾水干。以二三日则口燥咽干。是热之深。传之远也。故曰。急下之
以全肾水。夫土实则水清。谓水谷不相混。故自利清水。而口干燥。此胃土实热致然也。下利色青。
青者肝也。乃肝邪传肾。缘肾之经脉。从肺出络心。注胸中。由是而心下痛。故急下以去实热。
逐肾邪。其六七日腹胀不大便。以入腑之邪壅甚。胃土胜。则肾涸。故急下以逐胃热。滋肾水。盖
阳明与少阴。皆有急下之条。然而症虽不同。其入腑之理则一。是以皆用大承气也。
王肯堂曰。按舌干轻。咽干重者。盖咽舌虽皆通于少阴之络。而舌又为心之苗也。伤寒喜阳而
恶阴。故舌干轻。
喻昌曰。热邪传入少阴。逼迫津水。注为自利。质清而无渣滓相杂。色青而无黄赤相间。可见
阳邪炎威之极。反与阴邪无异。但阳邪传自上焦。其人心下必痛。口必干燥。设系阴邪。必心下满
而不痛。口中和而不燥。必无此枯槁之象。故宜急下以救其阴也。
【纲】张仲景说：少阴病的脉象沉而细，手足冰冷，有时烦躁，口渴想喝水，但只想含水漱口而不愿咽下，适宜使用四逆汤。
【目】吴绶说：除了上述条文的情况外，还有出现下利、四肢厥冷且无脉搏、干呕、心烦口渴，想含水漱口但不愿咽下的情况，应用白通加猪胆汁人尿汤主治。又有厥阴病蛔厥证，身体寒冷、烦躁、吐蛔虫，口燥舌干，只想用凉水浸湿舌头和嘴唇，片刻也不能离开凉水的，应用理中汤加乌梅。大抵阴寒证出现躁动、烦渴但不能饮水的，或者勉强喝下去，过一会儿又吐出来，或者喝水后呕吐，或者呃逆的，都是内寒所致。这是因为无根失守的虚火，游走在咽喉之间，假作燥渴之象，所以不能饮水；如果有能饮水且不呕吐，还想再喝的，则是热证。
（附注：不能说话）
【纲】张仲景说：病人脉象寸关尺三部都紧，反而出汗的，是亡阳证。这属于少阴病，按规定应当出现咽痛，并且伴有呕吐和下利。
【目】朱肱说：脉象沉迟，手足厥冷，或者呕吐下利且咽喉疼痛的，这是少阴病。《病源》说：这是因为下部脉象都不至，阴阳隔绝，邪气客居在足少阴经的络脉，毒气上冲，所以咽喉不利，或者疼痛甚至生疮。伤寒脉象寸关尺三部都紧，像本条所说的那样，这种证候汗法、下法、熏法、熨法都不可用。如果出汗，是本方传变而来。咽喉痛的，可选用甘草汤、桔梗汤、猪肤汤、通脉四逆去芍药加桔梗汤、麻黄升麻汤等治疗。又有伏气病，说的是非时节的暴寒侵袭人体，伏气潜伏在少阴经，开始不觉得有病，过了一个月才发作，脉象微弱，按规定先出现咽痛类似伤寒，但不是喉痹病，随后必然下利，开始用半夏桂枝汤，接着用四逆散。这种病只在一两天内就能痊愈，古方称之为肾伤寒。
戴原礼说：也有刚得病时，头痛发热，没有阳毒和少阴的各种症状，而咽喉自己疼痛的。这是因为感冒之后，突然用厚衣服被子堆叠覆盖，或者用蛮横的方法，喝了姜汤热酒就睡觉，于是造成上部壅滞。或者原本就有壅热，想要取凉快，导致被外邪侵袭，既有风寒，又有热壅，适宜用参苏饮，倍量桔梗，加木香五分，或者消风百解散，或者五积散、败毒散各半帖，名为交加散。
闵芝庆说：这是寒邪在少阴本脏而不是经络的病。应当咽痛而又呕吐下利，下利是少阴的本症，呕吐而咽痛，则是孤阳想要飞脱于上了。急救将要亡失的阳气，真武汤、四逆汤、附子汤等可选用。
【纲】张仲景说：少阴病，下利完谷不化，里寒外热，手足厥冷，脉微细几乎摸不到，身体反而不恶寒，病人面色发红，或者腹痛，或者干呕，或者咽痛，或者下利停止但脉搏不出，由通脉四逆汤主治。
【目】王肯堂说：太阳病和阳明病的咽痛各有一种症状，都属于热证。太阳病用半夏散治疗，阳明病用四逆散加桔梗治疗。少阴病咽痛有六种症状，热证四种，寒证两种。热证用猪肤汤、甘草汤、桔梗汤、苦酒汤、半夏散治疗；寒证用桂枝干姜汤、真武汤、四逆汤治疗。厥阴病咽痛一种症状，也是热证，用桔梗汤治疗。咽痛都属于热证，为什么唯独少阴有两种寒证呢？其中一种是因出汗多导致亡阳，所以用干姜、附子来恢复阳气、温通经脉；另一种是因为阴盛格阳，所以用通脉四逆汤来驱散阴寒、通达阳气。
【纲】张仲景说：伤寒六七天，经过猛烈攻下后，寸脉沉而迟，手足厥冷，下部脉象摸不到，咽喉不利，吐脓血，泄利不止的，为难治证。
柯琴说：这是下厥上绝，阴阳离决的证候，所以咽痛不利，是因为水谷之道断绝了。
【纲】张仲景说：少阴病，下利、咽痛、胸满、心烦的，由猪肤汤主治。
【目】张元素说：有人说，六经都不提咽痛，只有少阴有咽痛咽伤，为什么呢？少阴咽痛，是与经络相关的。因为少阴脉循行喉咙，系连舌本，所以有咽喉疼痛的病患。《内经》说：少阴经所生的病，有咽肿、气上逆、咽喉干燥及疼痛。这是经脉相连，邪气循行所致。
方中行说：猪肤，本草书中没有记载。但猪属亥时，适宜入少阴经。肤是外皮，适宜能解表邪。其性质凉，确实能退热。邪气散去而热退，烦闷胀满就可以消除了。白蜜滋润燥邪以利咽喉，疼痛就可以痊愈。白粉（米粉）补益脾土以制水，下利就可以停止。大概其中的义理在于此吧。
魏荔彤说：这是在阐述少阴传经热的情况吗？上下充满的症状，立法以滋阴散热为意义。少阴的邪气，上冲成为咽痛、心烦，这是热性上升的表现；成为便血、便脓，这是阴性下降的表现。又有上下充周，热邪弥漫的情况，如下利，犹如阴性的下降；咽痛、胸满、心烦，犹如热性的上升。无非是邪气在少阴，既内部耗损真阴，又扰乱三焦使之如此。法度用猪肤，猪属亥水，是肾脏蓄藏之物。其肤主太阳，能入肾滋阴，兼有透表散邪的作用。佐以蜂蜜甘寒，熄灭上炎之火焰；白粉淡渗，分流下利的路径。一剂药而三种好处具备。大概肾脏原本没有发散的方法，发散药又必须用辛温的。现在热邪在内，非发散不可，但又不能用辛温，因此另出此法，用甘寒的味道，佐助原本属于肾经的物品，带有太阳表性的药物，进入其中引导邪气外出。肤是肉外皮中的薄脂，具有浮而外发的性质。也如同石膏以辛凉作为发散的意义一样。
【纲】张仲景说：少阴病，发病两三天咽痛的，可以给予甘草汤；如果不愈的，给予桔梗汤。少阴病，咽喉疼痛，由半夏散及汤主治。
【目】苏颂说：咽痛而没有下利、心烦、胸满等症状，只用甘味药缓急止痛就够了。如果不愈的，配合桔梗，用辛味药发散邪气。因为热邪轻微，所以用轻剂。
魏荔彤说：少阴的邪气，正因为沿着经脉上升，所以在传变时，必然传到厥阴，这也是升降的道理。太阴降而少阴，少阴升而厥阴，这是三阴经中的升降关系。比起三阳经的表里关系也是如此。气的运行，无论病气与正气，都是以往复屈伸为意义的。
沈金鳌按：下条的症状，比上条较重，所以不是甘草、桔梗这样甘缓辛开、轻清的药物可以治疗的，必须用半夏的苦味，开泄兼施，桂枝的辛味，升散其热，甘草的缓急，缓解其炎势。道理就是这样。喻嘉言认为半夏涤除痰饮，桂枝发散邪气，还不是确切的义理。因为本方用桂枝、半夏，并不是指发汗解肌的意思。
【纲】张仲景说：少阴病，咽喉受伤生疮，不能说话，声音出不来的，由苦酒汤主治。
【目】吴绶说：少阴脉疾速，可以用下法；脉沉，用附子汤加知母、黄柏、五味子、麦冬、天花粉。如果是虚热，病后烦热不解的，用竹叶石膏汤去半夏加天花粉。凡是经过汗、吐、下法治疗后，口燥咽干的，这是津液衰少，肾水不升，虚火上炎。可用生津益气汤。脉沉微，脚冷舌燥的，难治。少阴病有急下以救肾水的例子。如果是虚人、水竭火燥不可下的，用补中益气汤，倍量人参，加麦冬、五味子、天花粉、知母、黄柏，以滋补肾水。
赵嗣真说：《活人书》说脾脏有热，则津液枯少，所以口燥咽干。然而不仅仅是脾脏有热，脾主太阴，太阴病腹满而咽干，这可以说是有脾热，但这只是一个症状罢了，其余都不是。比如白虎加人参汤证，口舌干燥的，是表里俱热。口苦咽干的，是少阳经热，或者是阳明中风。口燥咽干，需要急下，自利清水，颜色纯青，心下痛，口干燥的，是少阴经热。咽干烦躁吐逆的，是误用汗法，津液少，而想要形成阳明内热。像上述几种症状，难道也是脾脏有热吗？
沈金鳌按：伤，是指疼痛久了造成的损伤。火热灼烧则生疮。邪热壅滞在胸膈之上，所以不能说话。声音出于喉，咽病则喉也病。肺金被邪火克制，所以声音出不来。这种症状比咽中痛更重，都是因为治疗迟缓延误造成的。半夏开散，鸡蛋清清凉润，所以必须用这个汤治疗。甘草汤、桔梗汤、半夏散及汤、苦酒汤这几个方子，都是为了少阴热邪在经，上冲导致咽痛而设立的法度。
【纲】张仲景说：少阴病，得病两三天，口燥咽干的，应当急下，适宜用大承气汤。少阴病，自利清水，颜色纯青，心下必定疼痛，口干燥的，应当急下，适宜用大承气汤。
【目】成无己说：伤寒传经五六天，邪气传入少阴，则口燥舌干而渴，说明邪气逐渐深入。现在少阴病得病两三天，邪气尚未深入的时候，就出现口燥咽干，这是邪热已经很甚，肾水干枯。急需给予大承气汤，以保全肾水。正经自病，邪气深入，应当急下。如果干燥就会死亡，这是肾水干燥的缘故。
张元素说：承气汤，是阳明病应当用下法的症状适宜使用的。少阴病也用，为什么呢？胃是水谷之海，主要滋养四周。四周有病，都能传入胃。胃土燥热则肾水干枯。在两三天内出现口燥咽干，说明热邪深重，传变遥远。所以说，急下以保全肾水。土实则水清，指水谷不相混杂，所以自利清水而口干燥。这是胃土实热导致的。下利颜色青，青色属肝，是肝邪传肾。因为肾的经脉，从肺出来联络心，注入胸中，由此而心下痛，所以急下来去除实热，驱逐肾邪。六七天的腹胀不大便，是因为进入腑的邪气壅滞严重，胃土胜，则肾枯竭，所以急下来驱逐胃热，滋补肾水。大概阳明与少阴，都有急下的条文，然而症状虽然不同，其进入腑的道理是一样的，所以都用大承气汤。
王肯堂说：按舌干较轻，咽干较重的。大概咽和舌虽然都连通少阴的络脉，而舌又是心的苗窍。伤寒喜欢阳而厌恶阴，所以舌干较轻。
喻昌说：热邪传入少阴，逼迫津液，注为自利，质地清澈而无渣滓相杂，颜色青而无黄赤相间，可见阳邪炎威之极，反而与阴邪无异。但阳邪从上焦传来，其人心中必定疼痛，口中必定干燥。如果是阴邪，必定心下满而不痛，口中平和而不燥，必定没有这种枯槁的现象，所以应当急下以救其阴液。
[Outline] Zhang Zhongjing stated: In Shaoyin disease, the pulse is deep and fine, the hands and feet are cold, there is occasional irritability, thirst with a desire to rinse the mouth but not swallow (Shuishu Buyan), Si Ni Tang (Four Counterflow Decoction) is indicated.
[Commentary] Wu Shou stated: In addition to the above clause, there are cases presenting with diarrhea, cold extremities without a pulse, dry heaving, irritability, thirst with a desire to rinse the mouth but not swallow; these should be treated with Bai Tong Jia Zhu Dan Jiang Ren Nao Tang (Bai Tong Decoction plus Pig Bile and Human Urine). There are also cases of Jueyin disease with Hui Jue (Roundworm Syncope), characterized by cold body, irritability, vomiting roundworms, dry mouth and tongue, with a strong desire to immerse the tongue and lips in cool water continuously; these should be treated with Li Zhong Tang (Regulate the Middle Decoction) plus Wumei (Mume Fruit). Generally, in Yin syndromes, if restlessness and irritability with thirst prevent drinking, or if drinking is forced but vomited after some time, or if drinking leads to vomiting or hiccups, these are all due to internal cold. This is because rootless fire, having lost its foundation, wanders between the throat and pharynx, feigning dryness and thirst, thus preventing drinking. If one can drink without vomiting and desires more, it is a Heat syndrome.
(Attachment: Inability to speak)
[Outline] Zhang Zhongjing stated: When a patient's pulse is tight in all positions (Yin Yang Ju Jin), yet sweating occurs, this indicates Loss of Yang (Wang Yang). This belongs to Shaoyin disease. By protocol, it should present with sore throat, accompanied by vomiting and diarrhea.
[Commentary] Zhu Gong stated: A deep and slow pulse with cold extremities, or vomiting and diarrhea with throat pain, constitutes Shaoyin disease. The *Pathogenesis* states: This occurs when pulses at the lower part are absent, indicating separation of Yin and Yang. Pathogenic factors invade the collaterals of the Foot-Shaoyin meridian, and toxic qi rushes upward, causing throat obstruction, pain, or even sores. In Taiyang Cold Damage, if the pulse is tight in all positions as described, neither sweating, purging, fumigation, nor moxibustion熨 (ironing/warming) methods should be used. If sweating occurs, it is a transmission from the original formula. For sore throat, Gan Cao Tang (Licorice Decoction), Jie Geng Tang (Platycodon Decoction), Zhu Fu Tang (Pig Skin Decoction), Tong Mai Si Ni Qu Shao Yao Jia Jie Geng Tang (Tongmai Sini Decoction removing Peony and adding Platycodon), or Ma Huang Sheng Ma Tang (Ephedra and Cypertrachis Decoction) may be selected. There is also "Fu Qi" disease (Latent Pathogen Disease), caused by sudden cold at an improper season invading the body, where latent pathogens hide in the Shaoyin meridian. Initially asymptomatic, it manifests after a month with a weak pulse. Protocol dictates initial sore throat resembling Cold Damage, but distinct from Hou Bi (Throat Bi). Subsequently, diarrhea must occur. Treatment begins with Ban Xia Gui Zhi Tang (Pinellia and Cinnamon Twig Decoction), followed by Si Ni San (Four Counterflow Powder). This disease resolves within one or two days; ancient texts call it Shen Shang Han (Kidney Cold Damage).
Dai Yuanli stated: There are cases where, upon onset, there is headache and fever, without Yang toxicity or other Shaoyin symptoms, yet the throat hurts spontaneously. This results from wearing thick clothes and blankets immediately after a cold, or using harsh methods such as drinking ginger soup and hot wine before sleeping, leading to upper congestion. Or, if there was pre-existing heat congestion and one sought cooling, inviting external pathogens, resulting in both Wind-Cold and Heat congestion. Can Su Yin (Ginseng and Perilla Drink) with doubled Jie Geng (Platycodon) and 5 fen Mu Xiang (Aucklandia) is suitable. Alternatively, Xiao Feng Bai Jie San (Eliminate Wind Hundred-Release Powder), or half doses of Wu Ji San (Five Accumulations Powder) and Bai Du San (Hundred Toxin Release Powder), named Jiao Jia San (Intersecting Release Powder).
Min Zhiqing stated: This is Cold pathogen affecting the Shaoyin organ proper rather than the meridian. It presents with sore throat and diarrhea; diarrhea is a primary Shaoyin symptom. Vomiting with sore throat indicates solitary Yang attempting to fly off upwards. One must urgently rescue the perishing Yang. Zhen Wu Tang (True Warrior Decoction), Si Ni Tang, and Fu Zi Tang (Aconite Decoction) are selectable.
[Outline] Zhang Zhongjing stated: In Shaoyin disease, with diarrhea of undigested food, interior cold with exterior heat, cold extremities, a faint pulse nearly imperceptible, the body is paradoxically not aversive to cold, the person has a red complexion, and possibly abdominal pain, dry heaving, sore throat, or cessation of diarrhea with no palpable pulse, Tong Mai Si Ni Tang (Tongmai Sini Decoction) is the primary treatment.
[Commentary] Wang Kentang stated: Sore throat in Taiyang and Yangming diseases, each having one presentation, belongs to Heat. Taiyang is treated with Ban Xia San (Pinellia Powder); Yangming with Si Ni San plus Jie Geng. Shaoyin sore throat has six presentations: four Heat types and two Cold types. Heat types are treated with Zhu Fu Tang, Gan Cao Tang, Jie Geng Tang, Ku Jiu Tang (Bitter Wine Decoction), and Ban Xia San. Cold types are treated with Gui Zhi Gan Jiang Tang (Cinnamon Twig and Dried Ginger Decoction), Zhen Wu Tang, and Si Ni Tang. Jueyin sore throat is one presentation, also Heat, treated with Jie Geng Tang. Since sore throat generally belongs to Heat, why are there two Cold types in Shaoyin? One type involves excessive sweating leading to Yang loss, hence Gan Jiang (Dried Ginger) and Fu Zi (Aconite) are used to restore Yang and warm the meridians. The other involves Yin excess repelling Yang, hence Tong Mai Si Ni Tang is used to scatter Yin and unblock Yang.
[Outline] Zhang Zhongjing stated: After six or seven days of Cold Damage, following severe purging, if the Cun (inch) pulse is deep and slow, extremities are cold, pulses at the lower part are absent, throat is obstructed, pus and blood are expectorated, and diarrhea persists uncontrollably, this is difficult to treat.
[Commentary] Wang Kentang stated: This situation is suitable for Ma Huang Sheng Ma Tang.
Ke Qin stated: This represents "Lower Jue and Upper Absolute," a state of separation of Yin and Yang. Thus, sore throat and obstruction occur because the pathway for food and fluids is severed.
[Outline] Zhang Zhongjing stated: In Shaoyin disease, with diarrhea, sore throat, chest fullness, and irritability, Zhu Fu Tang (Pig Skin Decoction) is the primary treatment.
[Commentary] Zhang Yuansu stated: Some ask why the Six Meridians do not mention sore throat, except for Shaoyin which has sore and injured throat. Shaoyin sore throat is related to the meridians. The Shaoyin meridian circulates along the throat and connects to the root of the tongue, hence suffering from throat pain. The *Neijing* states: Diseases generated by Shaoyin include throat swelling, Qi rushing upward, dry throat, and pain. This is due to meridian connections and pathogenic factors circulating along them.
Fang Zhongxing stated: Zhu Fu (Pig Skin) is not recorded in Materia Medica. However, Pig corresponds to Hai (Water), suitable for entering Shaoyin. Skin is the outer layer, suitable for resolving exterior conditions. Its nature is cool, capable of reducing heat. As pathogens disperse and heat recedes, irritability and fullness are eliminated. Bai Mi (White Honey) moistens dryness to benefit the throat, curing pain. Bai Fen (Rice Flour) tonifies Earth to control Water, stopping diarrhea. Perhaps the meaning lies here.
Wei Litong stated: Is this explaining the transmission heat of Shaoyin? Symptoms of fullness above and below are addressed by laws establishing Yin-nourishing and Heat-dispersing principles. Shaoyin pathogens rush upward causing sore throat and irritability, reflecting the ascending nature of Heat. They cause bloody stool or pus in stool, reflecting the descending nature of Yin. There are also cases of fullness throughout above and below with diffuse Heat, such as diarrhea (descending like Yin), while sore throat, chest fullness, and irritability ascend like Heat. This is merely pathogens in Shaoyin consuming True Yin internally and disturbing the Triple Burner. The method uses Zhu Fu. Pig is Hai Water, stored in Kidney. Its skin governs Taiyang, enters Kidney to nourish Yin, and penetrates the exterior to scatter pathogens. Assisted by sweet-cold Honey, it extinguishes flaming Fire. White powder (rice flour) is light and penetrating, diverting the path of diarrhea. One dose achieves three benefits. Kidneys originally have no dispersing method, and dispersing drugs must be Acrid-Warm. Now Heat is internal, requiring dispersal, but Acrid-Warm is contraindicated. Hence this method is devised: using Sweet-Cold flavors assisted by Kidney-related substances carrying Taiyang exterior properties to guide them out. Skin is thin fat under the skin, possessing floating and outward-expanding properties. Similar to Shi Gao (Gypsum) using Acrid-Cool for dispersal.
[Outline] Zhang Zhongjing stated: In Shaoyin disease, if sore throat appears on the second or third day, Gan Cao Tang (Licorice Decoction) may be given. If not cured, give Jie Geng Tang (Platycodon Decoction). In Shaoyin disease, with throat pain, Ban Xia San Ji Tang (Pinellia Powder and Decoction) is the primary treatment.
[Commentary] Su Song stated: If sore throat occurs without diarrhea, irritability, or chest fullness, soothing with Sweet flavor is sufficient. If not cured, add Jie Geng to disperse with Acrid flavor. Since Heat is mild, light agents are used.
Wei Litong stated: Shaoyin pathogens, rising along the Wood meridian, must transmit to Jueyin during progression, following the principle of ascent and descent. Taiyin descends to Shaoyin; Shaoyin ascends to Jueyin. This is the ascent and descent among the Three Yin meridians. Similarly, this applies to the Exterior-Interior relationship of the Three Yang meridians. The movement of Qi, whether pathological or healthy, follows the principle of recurrence and flexion-extension.
Shen Jin'ao noted: The symptoms in the next clause are heavier than the previous one. Therefore, they cannot be treated with light, clear agents like Gan Cao and Jie Geng which soothe and open. Instead, the bitterness of Ban Xia is needed to open and drain, the acridity of Gui Zhi to ascend and scatter Heat, and the soothing nature of Gan Cao to calm inflammation. This is the rationale. Yu Chang claimed Ban Xia clears phlegm-fluids and Gui Zhi scatters pathogens, which is not the precise meaning. The use of Gui Zhi and Ban Xia in this formula does not refer to inducing sweating or releasing the muscle layer.
[Outline] Zhang Zhongjing stated: In Shaoyin disease, if the throat is injured and sores form, preventing speech and voice production, Ku Jiu Tang (Bitter Wine Decoction) is the primary treatment.
[Commentary] Wu Shou stated: If Shaoyin pulse is rapid, purging may be used. If deep, use Fu Zi Tang plus Zhi Mu, Huang Bo, Wu Wei Zi, Mai Dong, and Hua Fen. If it is Deficient Heat with persistent irritability after illness, use Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) removing Ban Xia and adding Hua Fen. After sweating, vomiting, or purging, if dry mouth and throat occur due to fluid depletion and failing Kidney Water rising with Deficient Fire flaming upward, use Sheng Jin Yi Qi Tang. If pulse is deep and faint with cold feet and dry tongue, it is difficult to treat. Shaoyin disease has examples of urgent purging to save Kidney Water. For deficient patients with exhausted Water and Dry Fire who cannot be purged, use Bu Zhong Yi Qi Tang with doubled Ren Shen, plus Mai Dong, Wu Wei Zi, Hua Fen, Zhi Mu, and Huang Bo to nourish Water.
Zhao Sizhen stated: *Huoren Shu* says Heat in the Spleen causes fluid depletion, leading to dry mouth and throat. However, it is not only Spleen Heat. Spleen governs Taiyin; Taiyin presents with abdominal fullness and dry throat, which can be called Spleen Heat, but this is just one symptom. Others are incorrect. For example, in Bai Hu Jia Ren Shen Tang, dry mouth and tongue indicate Heat in both Interior and Exterior. Bitter taste and dry throat indicate Shaoyang Heat or Yangming Wind Strike. Urgent purging is required for dry mouth/throat with pure green watery diarrhea, epigastric pain, and dry mouth, indicating Shaoyang Heat. Irritability, vomiting, and dry throat after mistaken sweating indicate fluid depletion and impending Yangming Internal Heat. Do these not imply Spleen Heat?
Shen Jin'ao noted: "Injury" refers to damage from prolonged pain. Fire burning generates sores. Pathogenic Heat congests above the chest and diaphragm, preventing speech. Voice originates from the larynx; throat disease affects the larynx. Lung Metal is constrained by Evil Fire, hence voice is lost. This condition is heavier than simple throat pain, usually due to delayed treatment. Ban Xia opens and disperses; egg white is cool and moistening. Hence this decoction is necessary. Gan Cao Tang, Jie Geng Tang, Ban Xia San Ji Tang, and Ku Jiu Tang are all methods established for Shaoyin Heat pathogens in the meridian rushing upward to cause sore throat.
[Outline] Zhang Zhongjing stated: In Shaoyin disease, if dry mouth and throat appear on the second or third day, urgent purging is required, preferably Da Cheng Qi Tang (Major Order the Qi Decoction). In Shaoyin disease, if there is spontaneous watery diarrhea with pure green color,必 (must) epigastric pain, and dry mouth, urgent purging is required, preferably Da Cheng Qi Tang.
[Commentary] Cheng Wuji stated: In Cold Damage transmission, around the fifth or sixth day, when pathogens enter Shaoyin, dry mouth, tongue, and thirst indicate deepening pathogens. Now, in Shaoyin disease, if dry mouth and throat appear within two or three days, before pathogens deeply penetrate, it means Pathogenic Heat is severe and Kidney Water is dried. Urgently administer Da Cheng Qi Tang to preserve Kidney Water. Primary disease with deep pathogens requires urgent purging. If dryness prevails, death ensues due to Kidney Water exhaustion.
Zhang Yuansu stated: Cheng Qi Tang is indicated for Yangming diseases requiring purging. Why is it used in Shaoyin? Stomach is the Sea of Water and Grain, nourishing the surroundings. Illness in surroundings transmits to Stomach. Dry Stomach Earth dries Kidney Water. Dry mouth and throat within two or three days indicate deep Heat and distant transmission. Thus, urgent purging preserves Kidney Water. Solid Earth clarifies Water, meaning water and grain do not mix, causing watery diarrhea and dry mouth. This is due to Stomach Earth Excess Heat. Green diarrhea indicates Liver Wood (Green belongs to Liver); Liver Pathogens transmit to Kidney. Kidney meridian exits Lung, connects Heart, enters Chest, causing epigastric pain. Urgent purging removes Excess Heat and drives out Kidney pathogens. Abdominal distension and constipation on the seventh day indicate severe pathogen congestion in the Fu organs. Overpowering Stomach Earth dries Kidney, necessitating urgent purging to drive Stomach Heat and nourish Kidney Water. Both Yangming and Shaoyin have urgent purging clauses. Although symptoms differ, the principle of entering Fu organs is identical, hence Da Cheng Qi Tang is used in both.
Wang Kentang stated: Tongue dryness is mild; throat dryness is severe. Although throat and tongue connect to Shaoyin collaterals, the tongue is the sprout of the Heart. Cold Damage favors Yang and dislikes Yin, hence tongue dryness is milder.
Yu Chang stated: When Heat pathogens enter Shaoyin, they force fluids into spontaneous diarrhea. The substance is clear without dregs, color is green without yellow or red, showing extreme Yang Heat power, resembling Yin pathogens. But Yang pathogens transmit from the Upper Jiao, causing epigastric pain and dry mouth. If Yin pathogens, there would be fullness without pain, and a neutral, non-dry mouth, lacking this withered appearance. Thus, urgent purging is needed to save Yin fluids.