少阴之为病。脉微细。但欲寐也。
〔鉴〕少阴肾经。阴盛之脏也。少阴受邪。则阳气微。故脉微细也。卫气行阳则寤。行阴则寐。少阴受
邪。则阴盛而行阴者多。故但欲寐也。此少阴病之提纲。后凡称少阴病者。皆指此脉证而言也。〔程〕前太阴。
后厥阴。俱不出脉象。以少阴一经。可以该之也。少阴病六七日前。多与人以不觉。但起病喜浓衣近火。善瞌
睡。凡后面亡阳发躁。诸剧证。便伏于此处矣。最要堤防。
案太阳中篇。三十七条云。太阳病。十日以去。脉浮细而嗜卧者。外已解也。此当以脉浮沉。而别阴阳也。
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。（具下。小便白。玉函。作所以然三字。水。
玉函。作溲。）
〔程〕人身阴阳中分。下半身属阴。上半身属阳。阴盛于下。则阳扰于上。欲吐不吐。心烦证尚模糊。
以但欲寐征之。则知下焦寒而胸中之阳被壅。治之不急。延至五六日。下寒甚。而闭藏彻矣。故下利。上热甚
而津液亡矣。故渴。虚故引水自救。非徒释渴字。指出一虚字来。明其别于三阳证之实邪作渴也。然则此证也。
自利为本病。溺白。正以征其寒。故不但烦与渴以寒断。即从烦渴。而悉及少阴之热证。非戴阳即格阳。无不
可以寒断。而从温治。（肾水欠温。则不能纳气。气不归元。逆于膈上。故欲吐不吐。肾气动膈。故心烦也。）
〔汪〕此与热邪之但欲寐不同。其寐必不昏浊。其呼吸必促。而细也。常器之云。可四逆汤。又甘草干姜汤。
愚以五六日之前。宜四逆汤。加生
姜二两。五六日后。宜茯苓四逆汤。〔魏〕引水自救。以理论之。虽渴未必能多饮水。或多饮多尿。尿色淡白。
则少阴肾脏为真寒。附子汤主之。少阴肾脏为病。内素虚寒者。十之六七。外寒乘入者。十之三四。无内寒。
则不能召外寒。君子平日。宁可不以命门之火为宝。而用啬道乎。〔舒〕经络考云。舌下有二隐窍。名曰廉泉。
运动开张。津液涌出。然必藉肾中真阳。为之熏腾。乃是以上供。若寒邪侵到少阴。则真阳受困。津液不得上
潮。故口渴。与三阳经之邪热。烁干津液者。大相反也。
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。（亡。脉经作无。）
〔方〕阴阳俱紧。伤寒也。伤寒不当有汗。故谓汗为反出。〔周〕案脉至阴阳俱紧。阴寒极矣。寒邪入里。
岂能有汗。乃反汗出者。则是真阳素亏。无阳以固其外。遂致腠理疏泄。不发热而汗自出也。此属少阴。正用
四逆急温之。时庶几真阳骤回。里证不作。否则阴邪上逆。则为咽痛。为吐。阴寒下泄。而复为利。种种危候。
不一而足也。〔魏〕利者。少阴本证。吐而咽痛。则孤阳飞越。欲自上脱也。可不急回其阳。镇奠其肾脏阴寒。
以救欲亡之阳乎。真武四逆附子等汤。斟酌用之可也。
案亡阳之亡。程氏魏氏为出亡之亡。以讥无阳之解。然太阳上编。桂枝二越婢一汤条。有无阳字。此条亡
字。脉经作无字。则必不出亡之义也。
柯氏云。上焦从火化。而咽痛呕吐。下焦从阴虚。而下利不止也。宜八味肾气丸主之。○案柯氏所论。于
杂病往往有如此者。此条证。决非肾气丸所主也。
少阴病。咳而下利谵语者。被火气劫故也。小便必难。
以强责少阴汗也。（以。玉函。作为。）
〔锡〕此三节。俱论少阴不可发汗。平脉篇云。肾气微。少精血。奔气促迫。上入胸膈。是咳者。少阴
精血少。奔气上逆也。下利者。少阴肾气微。津液下注也。复以火劫其汗。则少阴精气妄泄。神气浮越。水不
胜火。则发谵语。故曰。谵语者。被火气劫故也。然不特谵语。小便必难。以强责少阴肾脏之精。而为汗。竭
其津液之源故也。蒋宾侯曰。少阴下利极多。何曾皆是被火。且被火。未必下利。惟谵语。乃是被火。经云。被
火者必谵语。故咳而下利谵语者。当分看为是。〔程〕少阴病咳而下利。真武中有此证。〔方〕强责。谓过求也。
案汪引补亡论云。常器之。用救逆汤。猪苓汤。五苓散。以通小便。金鉴曰。白虎猪苓二汤。择而用之。
可耳。并误也。盖因喻氏热邪挟火力之解。而袭其弊耳。当是茯苓四逆证矣。
少阴病。脉细沉数。病为在里。不可发汗。
〔程〕何谓之里。少阴病脉沉是也。毋论沉细沉数。俱是脏阴受邪。与表阳是无相干。法当固密肾根为
主。其不可发汗。从脉上断。非从证上断。麻黄附子细辛汤。不可恃为常法也。薛慎庵曰。人知数为热。不知
沉细中见数为寒甚。真阴寒证。脉常有一息七八至者。尽概此一数字中。但按之无力而散耳。宜深察也。
案此条。方喻诸家。以热邪入里为解。乃与经旨乖矣。
少阴病。脉微。不可发汗。亡阳故也。阳已虚。尺脉弱涩者。复不可下之。（亡。脉经千金翼。作无。
钱云。亡。音无。）
〔钱〕微者。细小软弱。似有若无之称也。脉微则阳气大虚。卫阳衰弱。故不可发汗以更竭其阳。以汗
虽阴液。为阳
气所蒸。而为汗。汗泄而阳气亦泄矣。今阳气已虚。故曰亡阳故也。若阳已虚。而其尺脉又弱涩者。如命门之
真火衰微。肾家之津液不足。不惟不可发汗。复不可下之又竭其阴精阳气也。此条本为少阴禁汗禁下而设。故
不言治。然温经补阳之附子汤之类。即其治也。〔程〕拈出尺脉弱涩字。则少阴之有大承气汤证。其尺脉必强而
滑。已伏见于此处矣。
汪云。补亡论。并宜附子汤。以补阳气。散阴邪。助营血也。周云。不可汗。用四逆加人参汤。不可下者。
用蜜煎导。
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。
〔钱〕脉紧。见于太阳。则恶热恶寒。而为寒邪在表。见于少阴。则无热恶寒。而为寒邪在里。至七八日。
则阴阳相持已久。而始下利。则阳气耐久。足以自守矣。虽至下利而以绞索之紧。忽变而为轻细软弱之微。脉
微则恐又为上文不可发汗之亡阳脉矣。为之如何。不知少阴病。其脉自微。方可谓之无阳。若以寒邪极盛之紧
脉。忽见暴微。则紧峭化。而为宽缓矣。乃寒邪弛解之兆也。曰手足反温。则知脉紧下利之时。手足已寒。若
寒邪不解。则手足不当温。脉紧不当去。因脉本不微。而忽见暴微。故手足得温。脉紧得去。是以谓之反也。
反温反去。寒气已弛。故为欲解也。虽其人心烦。然烦属阳。而为暖气已回。故阴寒之利。必自愈也。
少阴病下利。若利自止。恶寒而蜷卧。手足温者可治。（柯本。删下利二字。蜷。方本。作倦。）
〔程〕少阴病下利。而利自止。则阴寒亦得下祛。而又不致于脱。虽有恶寒蜷卧不善之证。但使手足温者。
阳气有挽回之机。虽前此失之于温。今可尚温而救失也。〔钱〕大凡热
者偃卧。而手足弛散。寒则蜷卧。而手足敛缩。下文恶寒蜷卧。而手足逆冷者。即为真阳败绝。而成不治矣。
若手足温。则知阳气未败。尚能温暖四肢。故曰可治。〔汪〕温经散寒。宜四逆汤主之。
活人书释音曰。蜷。具员切。蜷 不伸也。
少阴病。恶寒而蜷。时自烦。欲去衣被者可治。（千金翼。作不可治。）
〔钱〕但恶寒而不发热。为寒邪所中也。蜷卧者。蜷曲而卧。诸寒收引。恶寒之甚也。〔程〕少阴病。不必
尽下利也。只恶寒而蜷。已知入藏深矣。烦而去衣被。阳势尚肯力争也。而得之。时与欲。又非虚阳暴脱者比。
虽前此失之于温。今尚可温而救失也。〔喻〕后条云。不烦而躁者死。对看便知。
案总病论。活人书。并云。宜大柴胡汤。可疑。
少阴中风。脉阳微阴浮者。为欲愈。
〔钱〕太阳中风。阳浮而阴弱。盖以浮候沉候。分阴阳也。此所谓阳微阴浮者。是以寸口尺中。分阴阳也。
若以浮沉二候。分阴阳。则沉候岂有浮脉邪。此不辨自明也。夫少阴中风者。风邪中少阴之经也。脉法。浮则
为风。风为阳邪。中则伤卫。卫受风邪。则寸口阳脉当浮。今阳脉已微。则知风邪欲解。邪入少阴。唯恐尺部
脉沉。沉则邪气入里。今阴脉反浮。则邪不入里。故为欲愈也。
少阴病欲解时。从子至寅上。（至。玉函。作尽。无上字。）
〔成〕阳生于子。子为一阳。丑为二阳。寅为三阳。少阴解于此者。阴得阳则解也。〔喻〕各经。皆解于
所王之时。而少阴独解于阳生之时。阳进则阴退。阳长则阴消。正所谓阴得阳则解也。即是推之。而少阴所重
在真阳。不可识乎。
少阴病。吐利。手足不逆冷。反发热者。不死。脉不至
者。（【原注】至。一作足。）灸少阴七壮。（脉经。千金翼。吐上。有其人二字。千金翼。至。作足。）
〔程〕少阴病。吐而且利。里阴胜矣。以胃阳不衰。故手足不逆冷夫手足逆冷之发热。为肾阳外脱。手足
不逆冷之发热。为卫阳外持。前不发热。今反发热。自非死候。人多以其脉之不至。而委弃之。失仁人之心与
术矣。不知脉之不至由吐利。而阴阳不相接续。非脉绝之比。灸少阴七壮。治从急也。嗣是而用药。自当从事
于温。〔魏〕灸其少阴本穴七壮者。就其经行之道路。扶其阳气使宣通。则吐利不止。自止。脉不至。亦必至
矣。七壮必非一穴。凡少阴之经。起止循行之处。皆可灸也。仍须温中扶阳。又不待言。
汪云。常器之云。是少阴太溪二穴。在内踝后。跟骨动脉陷中。庞安常云。发热。谓其身发热也。经曰。
肾之原。出于太溪。药力尚缓。惟急灸其原。以温其脏。犹可挽其危也。○案活人书。亦云太溪穴。
少阴病。八九日。一身手足尽热者。以热在膀胱。必便血也。
〔钱〕大凡寒邪入少阴。必恶寒逆冷。故以反发热者。为阳回阴解。而不死。此因邪气入少阴。至八九日
之久。一身手足尽热者。盖以足少阴肾邪。传归足太阳膀胱也。肾与膀胱。一表一里。乃脏邪传腑。为自阴还
阳。以太阳主表。故一身手足尽热也。热邪在膀胱。迫血妄行。故必便血也。必便血三字。前注家。俱为必出
一阴之窍。（方。喻。并同。）恐热邪虽在膀胱。而血未必从小便出也。
案汪引常器之云。可桃仁承气汤。芍药地黄汤。愚以还宜芍药地黄汤。柯氏云。轻则猪苓汤。重则黄连阿
胶汤。盖柯说为的对矣。
少阴病。但厥无汗。而强发之。必动其血。未知从何道出。或从口鼻。或从目出者。是名下厥上竭。为难
治。（成本。无者字。）
〔锡〕此论少阴生阳衰于下。而真阴竭于上也。少阴病。但厥无汗者。阳气微也。夫汗虽血液。皆由阳气之
熏蒸宣发。而出也。今少阴生阳衰微。不能蒸发。故无汗。强发之。不能作汗。反动其经隧之血。从空窍而出
也。然未知从何道之窍而出。少阴之脉。循喉咙。挟舌本。系目系。故或从口鼻。或从目出。阳气厥于下。而
阴血竭于上。少阴阴阳气血俱伤矣。故为难治。〔程〕难治者。下厥非温不可。而上竭则不能用温。故为逆中
之逆耳。
案汪氏云。案此条。仲景但云难治。其非必死之证明矣。补亡论。常器之云。可芍药地黄汤。成氏方氏喻
氏魏氏金鉴。并以此条证。为热厥。盖袭常氏之谬耳。
案喻氏云。后人随文读去。总置不讲。不知下厥者。阴气逆于下也。上竭者。阴血竭于上也。盖气与血两
相维附。气不得血。则散而无统。血不得气。则凝而不流。故阴火动。而阴气不得不上奔。阴气上奔。而阴血
不得不从之上溢而竭矣。血既上溢。其随血之气。散于胸中。不得复反于本位。则下厥矣。阴既逆于下。势必
龙雷之火应之。血不尽竭不止也。仲景所以断为难治者。非直不治也。吾为大辟其扃。则以健脾中之阳气。为
第一义。健脾之阳。一举有三善。一者脾中之阳气旺。而龙雷之火潜伏也。一者脾中之阳气旺。而胸中窒塞。
如太空不留纤翳也。一者脾中之阳气旺。而饮食运化精微。复生其竭之血也。出医门法律。以此推之。下厥上
竭。唯景岳六味回阳饮。滋阴回阳两全。以为合剂矣。
少阴病。恶寒身蜷。而利。手足逆冷者。不治。
〔钱〕前恶寒而蜷。因有烦而欲去衣被之证。为阳气犹在。故为可治。又下利自止。恶寒而蜷。以手足
温者。亦为阳气未败。而亦曰可治。此条恶寒身蜷。而利。且手足逆冷。则四肢之阳气已败。故不温。又无烦
与欲去衣被之阳气尚存。况下利又不能止。是为阳气已竭。故为不治。虽有附子汤。及四逆白通等法。恐亦不
能挽回既绝之阳矣。〔舒〕案此证尚未至汗出息高。犹可为治。急投四逆汤加人参。或者不死。
少阴病。吐利躁烦。四逆者死。
〔喻〕上吐下利。因至烦躁。则阴阳扰乱。而竭绝可虞。更加四肢逆冷。是中州之土先败。上下交征。中
气立断。故主死也。使蚤用温中之法。宁至此乎。〔张〕此条。与吴茱萸汤一条不殊。何彼可治。而此不可治
少阴病的提纲证是：脉象微细，精神萎靡只想睡觉。
〔鉴〕少阴肾经，是阴气极盛的脏腑。少阴经受邪，阳气就会微弱，所以脉象微细。卫气行于阳分则人清醒，行于阴分则人入睡。少阴受邪，阴气盛而卫气行于阴分的时间多，所以病人只想睡觉。这是少阴病的提纲，后面凡是提到“少阴病”的，都是指这种脉证而言。〔程〕前文太阴病、后文厥阴病，都没有单独列出脉象，因为少阴一经的脉证可以概括它们。少阴病发病六七天以前，往往让人察觉不到，只是起病时喜欢穿厚衣服靠近火源，容易打瞌睡。凡后面出现的亡阳发躁等危重证候，其实都潜伏在此处了。必须高度警惕。
案《伤寒论》太阳篇第三十七条说：太阳病，过了十天，脉浮细而想睡觉的，说明表邪已解。这里应当通过脉象的浮沉来辨别阴阳。
少阴病，想吐又吐不出来，心烦，只想睡觉。过了五六天，出现自发性腹泻且口渴的，属于少阴病。这是因为虚，所以喝水来自救。如果小便颜色清白，那么少阴病的特征就完全具备了。小便清白的缘故，是因为下焦虚寒，不能制约水液，所以使小便颜色变白。（在“具”字之下，《玉函经》作“所以然”三字；“水”字，《玉函经》作“溲”。）
〔程〕人体阴阳分为上下两半，下半身属阴，上半身属阳。阴气盛于下，则阳气扰动于上。想吐又吐不出来，心烦，这些症状尚且模糊不清，用“只想睡觉”这一征象来验证，就知道是下焦寒冷而胸中的阳气被壅滞。治疗如果不及时，拖延到五六天，下焦寒气更甚，闭藏功能彻底失常，所以发生下利；上焦热势更盛而津液耗伤，所以口渴。因为虚，所以喝水自救。这不仅仅是解释“渴”字，更是指出一个“虚”字，以明确区别于三阳证的实邪作渴。既然这样，这个证候中，自利是本病，小便白正是用来验证寒性的。所以不仅烦与渴断为寒证，即使从烦渴来看，也全部涉及少阴的热证，不是戴阳证就是格阳证，没有不可以断为寒证而从温法治疗的。（肾水不够温暖，就不能纳气，气不归元，逆冲于膈上，所以想吐又吐不出来；肾气动扰膈部，所以心烦。）
〔汪〕这与热邪导致的只想睡觉不同。那种睡眠一定不昏沉浑浊，呼吸一定急促而细微。常器之说可以用四逆汤，或者甘草干姜汤。我认为在发病五六日之前，宜用四逆汤加生姜二两；五六日之后，宜用茯苓四逆汤。〔魏〕喝水自救，从理论上分析，虽然口渴未必能喝很多水，或者多喝多尿，如果尿色淡白，则是少阴肾脏为真寒，应用附子汤主治。少阴肾脏生病，体内素来虚寒的占十分之六七，外寒乘虚而入的占十分之三四。如果没有内寒，就不能招致外寒。君子平日，难道可以不把命门之火当作宝贝，而吝惜保养吗？〔舒〕《经络考》说，舌下有两个隐窍，名叫廉泉，运动张开时，津液涌出。但这必须借助肾中的真阳来熏蒸腾跃，才能向上供给。如果寒邪侵袭少阴，则真阳受困，津液不得上潮，所以口渴。这与三阳经的邪热灼烧干燥津液的情况，大相径庭。
病人脉象寸关尺三部都紧，反而出汗的，是亡阳。这属于少阴病，按规定应当咽喉疼痛并且呕吐腹泻。（“亡”字，《脉经》作“无”。）
〔方〕阴阳三部脉都紧，是伤寒。伤寒不应当有汗，所以说汗是反常而出。〔周〕案脉象至寸关尺三部都紧，阴寒至极。寒邪入里，怎么会有汗？反而出汗的，则是真阳素来亏虚，没有阳气来固护体表，导致腠理疏松泄越，不发热而汗自出。这属于少阴病，正应当用四逆汤急温。时机得当或许真阳能骤然回复，里证就不会发作。否则阴邪上逆，就会咽喉痛、呕吐；阴寒下泄，就会腹泻。种种危候，不胜枚举。〔魏〕下利是少阴的本证，呕吐和咽痛，则是孤阳飞越，想要从上脱失。怎能不急回其阳气，镇奠其肾脏阴寒，以挽救将要亡失的阳气呢？真武汤、四逆汤、附子汤等，斟酌使用即可。
案关于“亡阳”的“亡”，程氏、魏氏解释为出亡之亡，以此讥讽将“亡”解释为“无阳”的观点。然而《伤寒论》太阳上编桂枝二越婢一汤条中有“无阳”字样，此条“亡”字，《脉经》作“无”字，那么必定不出“出亡”的含义。
柯氏说，上焦从火化，出现咽痛呕吐；下焦从阴虚，出现下利不止。宜用八味肾气丸主治。○案柯氏所论述的，对于杂病往往有这样的情况。此条证候，绝对不是肾气丸所能主治的。
少阴病，咳嗽且腹泻并说胡话的，是被火攻劫夺所致。小便一定困难。
这是因为强行逼迫少阴病发汗。（“以”字，《玉函经》作“为”。）
〔锡〕这三节，都在论述少阴不可发汗。《平脉篇》说：肾气微弱，精血不足，奔豚之气急促迫促，上入胸膈，这就是咳嗽。少阴精血少，奔气上逆。下利，是少阴肾气微弱，津液下注。又用火攻劫取汗，则少阴精气妄泄，神气浮越，水不胜火，就会发说胡话。所以说，说胡话，是被火气劫夺的缘故。然而不仅说胡话，小便一定困难，这是因为强行索取少阴肾脏的精气作为汗源，竭尽了津液的源头。蒋宾侯说：少阴下利极多，何曾都是被火攻？而且被火攻，未必都下利。只有说胡话，才是被火攻。经文说：被火攻的必定说胡话。所以“咳嗽而下利谵语者”，应当分开来看才是正确的。〔程〕少阴病咳嗽而下利，真武汤证中有这种情况。〔方〕强责，意思是过分追求。
案汪氏引用《补亡论》说：常器之用救逆汤、猪苓汤、五苓散来通利小便。《医宗金鉴》说：白虎汤、猪苓汤二方，择一使用即可。这都是错误的。大概是沿袭喻氏热邪挟火力的解释，从而犯了同样的弊病。应当是茯苓四逆汤证才对。
少阴病，脉细沉数，病位在里，不可发汗。
〔程〕什么叫里？少阴病脉沉就是里。不论沉细还是沉数，都是脏阴受邪，与表阳没有关系。治法应当以固密肾根为主。不可发汗，是从脉象上判断的，不是从症状上判断的。麻黄附子细辛汤，不可视为常规法则。薛慎庵说：人们知道数为热，不知道沉细中见数为寒甚。真正的阴寒证，脉象常有一息七八至的，都概括在这个数字中，只是按下去无力而散罢了。应当仔细体察。
案此条，方氏、喻氏等各家，以热邪入里来解释，乃与经文旨意违背。
少阴病，脉微，不可发汗，因为会亡阳。阳气已经虚弱，尺脉弱涩的，也不可攻下。（“亡”字，《脉经》、《千金翼方》作“无”。钱潢说：“亡”，音同“无”。）
〔钱〕微，是细小软弱，似有若无的说法。脉微则阳气大虚，卫阳衰弱，所以不可发汗以更竭尽阳气。因为汗虽然是阴液，但由阳气蒸腾而成汗，汗泄出则阳气也随之泄出。现在阳气已经虚弱，所以说亡阳。如果阳气已经虚弱，而其尺脉又弱涩的，如命门的真火衰微，肾家的津液不足，不仅不可发汗，也不可不攻下，以免再次竭尽阴精阳气。此条本是为少阴禁汗禁下而设，所以不言治法。然而温经补阳的附子汤之类，就是其治法。〔程〕拈出“尺脉弱涩”四字，则少阴有大承气汤证的情况，其尺脉必定强而滑，已经隐含伏见于此处了。
汪氏说：《补亡论》并宜用附子汤，以补阳气，散阴邪，助营血。周氏说：不可发汗，用四逆加人参汤；不可攻下的，用蜜煎导。
少阴病，脉紧，到了七八天，自发下利，脉突然变微，手足反而温和，脉紧反而消失的，是病欲愈。虽然心烦下利，必定自愈。
〔钱〕脉紧，见于太阳病，则恶热恶寒，为寒邪在表；见于少阴病，则无热恶寒，为寒邪在里。到了七八天，则阴阳相持已久，才开始下利，说明阳气耐久，足以自守。虽然到了下利的时候，原本如绞索般的紧脉，忽然变为轻细软弱的微脉。脉微则恐怕又是上文所说的不可发汗的亡阳脉了。该怎么办呢？不知少阴病，其脉本来微，才可以称为无阳。如果是以寒邪极盛的紧脉，忽然见到暴微，则是紧峭化为宽缓，这是寒邪弛解的征兆。说“手足反温”，则知道在脉紧下利之时，手足已经是冷的。如果寒邪不解，则手足不应当温，脉紧不应当去。因为脉本来不微，而忽然见到暴微，所以手足得温，脉紧得去。因此称之为“反”。反温反去，寒气已弛，所以叫欲解。虽然其人心烦，但烦属阳，是暖气已回的表现，所以阴寒之利，必定自愈。
少阴病下利，如果利自止，恶寒而蜷卧，手足温的，可治。（柯韵伯本，删去“下利”二字。蜷，方有执本，作“倦”。）
〔程〕少阴病下利，而利自止，则阴寒也能下行祛除，而不至于脱失。虽然有恶寒蜷卧不善的证候，只要手足温，说明阳气有挽回之机。虽然此前失于温治，现在尚可温而补救过失。〔钱〕大凡热证则仰卧而手足弛散，寒证则蜷卧而手足敛缩。下文提到的恶寒蜷卧而手足逆冷的，就是真阳败绝，成为不治之症。如果手足温，则知阳气未败，尚能温暖四肢，所以说可治。〔汪〕温经散寒，宜用四逆汤主治。
《活人书》释音说：蜷，具员切，蜷曲不伸也。
少阴病，恶寒而蜷，时常自己心烦，想脱去衣被的，可治。（《千金翼方》作“不可治”。）
〔钱〕只恶寒而不发热，是寒邪中伤。蜷卧，是蜷曲而卧。诸寒收引，恶寒得很厉害。〔程〕少阴病，不一定都有下利。只恶寒而蜷，已知病邪入脏很深。心烦而去衣被，说明阳气势力尚肯力争。而且“时”与“欲”，又不是虚阳暴脱的情况相比。虽然此前失于温治，现在尚可温而补救过失。〔喻〕后条说：不烦而躁的，死。对照看就知道了。
案《总病论》、《活人书》都说：宜用大柴胡汤。值得怀疑。
少阴中风，脉象寸部微、尺部浮的，为欲愈。
〔钱〕太阳中风，阳浮而阴弱，是以浮候、沉候分阴阳。这里所说的阳微阴浮，是以寸口、尺中分阴阳。如果以浮沉二候分阴阳，则沉候怎么会有浮脉呢？这不辨自明。所谓少阴中风，是风邪中伤少阴之经。脉法说：浮则为风。风为阳邪，中则伤卫。卫受风邪，则寸口阳脉当浮。现在阳脉已微，则知风邪欲解。邪入少阴，唯恐尺部脉沉。沉则邪气入里。现在阴脉反浮，则邪不入里，所以为欲愈。
少阴病欲解时，从子时至寅时。（“至”字，《玉函经》作“尽”，无上字。）
〔成〕阳生于子，子为一阳，丑为二阳，寅为三阳。少阴病解于此，是因为阴得阳则解。〔喻〕各经，都解于所旺之时，而少阴独解于阳生之时。阳进则阴退，阳长则阴消，正所谓阴得阳则解也。由此推之，少阴所重在真阳，不可不认识清楚。
少阴病，吐利，手足不逆冷，反发热者，不死。脉不至的。（【原注】至，一作足。）灸少阴七壮。（《脉经》、《千金翼方》，吐上有“有其人”二字。《千金翼方》，至，作足。）
〔程〕少阴病，吐而且利，里阴胜了。因为胃阳不衰，所以手足不逆冷。手足逆冷的发热，是肾阳外脱；手足不逆冷的发热，是卫阳外持。先前不发热，现在反发热，自然不是死候。很多人因为其脉不至，就放弃治疗，失去了仁人的心与术。不知脉之不至是由于吐利而导致阴阳不相接续，并非脉绝之比。灸少阴七壮，治法从急。此后用药，自然应当从事于温法。〔魏〕灸其少阴本穴七壮，顺着其经络运行的道路，扶助其阳气使其宣通，则吐利不止，自然停止。脉不至，也必然恢复。七壮必非一穴。凡是少阴经起止循行的地方，都可以灸。仍须温中扶阳，这就不必再说了。
汪氏说：常器之说：是少阴太溪二穴，在内踝后，跟骨动脉陷中。庞安常说：发热，谓其身发热也。经文说：肾之原，出于太溪。药力尚缓，只有急灸其原穴，以温其脏，还可以挽回其危局。○案《活人书》也说太溪穴。
少阴病，过了八九天，一身手足都热的，因为热在膀胱，必定便血。
〔钱〕大凡寒邪入少阴，必恶寒逆冷，所以以反发热者，为阳回阴解，而不死。这是因为邪气入少阴，到了八九天之久，一身手足都热，是因为足少阴肾邪，传归足太阳膀胱。肾与膀胱，一表一里，乃是脏邪传腑，为自阴还阳。因为太阳主表，所以一身手足都热。热邪在膀胱，迫血妄行，所以必定便血。“必便血”三字，前代注家，都认为必出一阴之窍。（方有执、喻昌，都相同。）恐怕热邪虽在膀胱，而血未必从小便出。
案汪氏引用常器之说：可用桃仁承气汤、芍药地黄汤。我认为还应当用芍药地黄汤。柯氏说：轻则猪苓汤，重则黄连阿胶汤。大概柯氏的说法是对的。
少阴病，但厥无汗，而强行发汗的，必定动其血。未知从哪个孔窍流出，有的从口鼻，有的从眼睛流出的，这叫下厥上竭，为难治。（成本，无“者”字。）
〔锡〕这是在论述少阴生阳衰于下，而真阴竭于上。少阴病，但厥无汗，是阳气微。汗虽然是血液，都由阳气的熏蒸宣发而出。现在少阴生阳衰微，不能蒸发，所以无汗。强行发汗，不能作汗，反而动其经隧之血，从空窍而出。然而不知从哪个孔窍而出。少阴之脉，循喉咙，挟舌本，系目系，所以或从口鼻，或从目出。阳气厥于下，而阴血竭于上，少阴阴阳气血俱伤，所以为难治。〔程〕难治，是因为下厥非温不可，而上竭则不能用温，所以是逆中之逆。
案汪氏说：案此条，仲景只说难治，这就证明它不是必死之症。《补亡论》常器之说：可用芍药地黄汤。成氏、方氏、喻氏、魏氏、《医宗金鉴》，都以此条证为热厥，大概是沿袭常氏的错误。
案喻氏说：后人随文读去，总是放置不讲。不知下厥者，阴气逆于下也；上竭者，阴血竭于上也。盖气与血两相维系依附，气不得血，则散而无统；血不得气，则凝而不流。所以阴火动，而阴气不得不往上奔；阴气上奔，而阴血不得不随之而上溢而竭。血既上溢，其随血之气，散于胸中，不得复返于本位，则下厥了。阴既逆于下，势必龙雷之火应之，血不尽竭不止。仲景所以断为难治，并非直说不治。我大大开辟其门户，则以健脾中之阳气为第一义。健脾之阳，一举有三善：一是脾中之阳气旺，而龙雷之火潜伏；二是脾中之阳气旺，而胸中窒塞，如太空不留纤翳；三是脾中之阳气旺，而饮食运化精微，复生其竭之血。出自《医门法律》。以此推之，下厥上竭，唯有张景岳的六味回阳饮，滋阴回阳两全，作为合剂。
少阴病，恶寒身蜷，而利，手足逆冷的，不治。
〔钱〕前文恶寒而蜷，因为有烦而欲去衣被的证候，为阳气犹在，所以为可治。又下利自止，恶寒而蜷，以手足温的，也为阳气未败，而亦曰可治。此条恶寒身蜷，而利，且手足逆冷，则四肢的阳气已败，所以不温。又没有烦与欲去衣被的阳气尚存，何况下利又不能止，这是阳气已竭，所以为不治。虽有附子汤，及四逆、白通等法，恐怕也不能挽回既绝之阳。〔舒〕案此证尚未至汗出息高，犹可为治。急投四逆汤加人参，或许不死。
少阴病，吐利躁烦，四逆的，死。
〔喻〕上吐下利，因至烦躁，则阴阳扰乱，而竭绝可虞。更加四肢逆冷，是中州之土先败，上下交征，中气立断，所以主死。如果早用温中之法，岂会至此呢？〔张〕此条，与吴茱萸汤一条不殊，为何彼可治，而此不可治？
The general manifestation of Shaoyin disease is: a pulse that is faint and fine, with a desire only to sleep.
[Jian] The Shaoyin Kidney meridian is an organ where Yin qi is extremely abundant. When the Shaoyin channel is invaded by pathogenic factors, Yang qi becomes weak, hence the pulse is faint and fine. Wei Qi (Defensive Qi) moves in the Yang aspect causing wakefulness, and moves in the Yin aspect causing sleep. When Shaoyin is invaded, Yin qi is abundant and Wei Qi spends more time moving in the Yin aspect, so the patient desires only to sleep. This is the outline of Shaoyin disease; whenever "Shaoyin disease" is mentioned subsequently, it refers to this specific pulse and symptom pattern. [Cheng] Neither the preceding Taiyin disease nor the subsequent Jueyin disease lists its pulse separately, because the pulse and symptoms of the Shaoyin channel can encompass them. Before six or seven days after the onset of Shaoyin disease, it often goes unnoticed, with the patient preferring to wear thick clothes and stay near fire, and prone to dozing off. All the severe conditions appearing later, such as Yang collapse with restlessness, are actually latent here. One must be highly vigilant.
Note: Article 37 of the Taiyin chapter in *Shanghan Lun* states: In Taiyang disease, if ten days have passed, the pulse is floating and fine, and the patient desires to lie down, it indicates that the exterior pathogen has resolved. Here, one should distinguish between Yin and Yang based on whether the pulse is floating or sunken.
In Shaoyin disease, if there is a desire to vomit but nothing comes up, irritability, and a desire only to sleep, and after five or six days, spontaneous diarrhea occurs accompanied by thirst, this belongs to Shaoyin disease. This is due to deficiency, leading the patient to drink water to self-rescue. If the urine is clear and white, then the characteristics of Shaoyin disease are fully present. The reason for clear white urine is deficiency-cold in the Lower Jiao (Lower Burner), which fails to control water metabolism, thus resulting in pale urine. (Below the character "ju" [complete], *Yuhan Jing* reads "suoyiran" [the reason being]; below the character "shui" [water], *Yuhan Jing* reads "sou" [urine].)
[Cheng] The human body's Yin and Yang are divided into upper and lower halves; the lower half belongs to Yin, and the upper half to Yang. When Yin is abundant in the lower part, Yang is disturbed in the upper part. The desire to vomit without success and irritability are somewhat ambiguous symptoms; verifying them with the sign of "desiring only to sleep" reveals cold in the Lower Jiao and obstruction of Yang Qi in the chest. If treatment is not prompt, delaying to five or six days will cause the Lower Jiao cold to intensify and the storage function to fail completely, resulting in diarrhea. Meanwhile, heat in the Upper Jiao intensifies, consuming body fluids, causing thirst. Because of deficiency, the patient drinks water to self-rescue. This does not merely explain the word "thirst," but points out the character "deficiency," clearly distinguishing it from the thirst caused by excess pathogens in the Three Yang channels. Thus, in this condition, spontaneous diarrhea is the root disease, and white urine serves to verify the cold nature. Therefore, not only irritability and thirst are diagnosed as cold, but even considering irritability and thirst, all heat signs of Shaoyin are involved; these are either Dai Yang syndrome (floating false Yang) or Ge Yang syndrome (repelling false Yang), none of which cannot be diagnosed as cold and treated with warming methods. (When Kidney Water lacks warmth, it cannot grasp Qi; Qi fails to return to its origin and rebels upward to the diaphragm, causing the desire to vomit without success; Kidney Qi agitates the diaphragm, causing irritability.)
[Wang] This differs from the "desire only to sleep" caused by Heat pathogens. In that case, sleep is not confused or turbid, and breathing is necessarily rapid and fine. Chang Qizhi stated that Sini Tang (Four Reversal Decoction) or Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) could be used. I believe that before five or six days, Sini Tang with two taels of fresh ginger should be used; after five or six days, Fuling Sini Tang (Poria Four Reversal Decoction) should be used. [Wei] Drinking water to self-rescue, theoretically speaking, although thirsty, the patient may not be able to drink much, or may drink much and urinate much. If the urine color is pale white, it indicates true cold in the Shaoyin Kidney, and Fuzi Tang (Aconite Decoction) should be the primary treatment. Diseases of the Shaoyin Kidney involve internal deficiency-cold in six or seven out of ten cases, and external cold taking advantage of weakness in three or four out of ten cases. Without internal cold, external cold cannot be summoned. Should a gentleman not treasure the Fire of the Gate of Vitality (Mingmen) daily and practice conservation? [Shu] *Jingluo Kao* states that there are two hidden apertures under the tongue named Lianquan. When they move and open, body fluids surge forth. However, this must rely on the True Yang of the Kidney to steam and ascend to supply the upper parts. If Cold pathogens invade Shaoyin, True Yang is constrained, and body fluids cannot ascend, causing thirst. This is vastly different from the drying of body fluids by Heat pathogens in the Three Yang channels.
If a patient's pulse is tight in all three positions (Cun, Guan, Chi), yet sweat appears, this is Yang collapse. This belongs to Shaoyin disease. By standard protocol, there should be sore throat accompanied by vomiting and diarrhea. ("Wang" [collapse/loss] is written as "Wu" [no] in *Mai Jing*.)
[Fang] A pulse tight in all three positions indicates Cold Damage (Shanghan). Cold Damage should not present with sweating, hence sweating is described as occurring contrary to expectation. [Zhou] Note that when the pulse is tight in all three positions, Yin cold is extreme. How can there be sweat if Cold pathogens enter the interior? The fact that sweat appears indicates that True Yang was originally deficient, lacking the Yang Qi to secure the exterior, leading to loose pores and spontaneous sweating without fever. This belongs to Shaoyin disease and requires urgent warming with Sini Tang. If timed correctly, True Yang may suddenly return, preventing interior syndromes from developing. Otherwise, Yin pathogens rebelling upward will cause sore throat and vomiting; Yin cold draining downward will cause diarrhea. Various critical conditions are too numerous to list. [Wei] Diarrhea is the fundamental symptom of Shaoyin; vomiting and sore throat indicate lone Yang flying away, attempting to escape from above. One must urgently restore Yang, stabilize the Yin cold of the Kidneys, and rescue the collapsing Yang. Zhenwu Tang, Sini Tang, and Fuzi Tang should be used judiciously.
Regarding the character "wang" in "Yang collapse," Cheng and Wei interpret it as "fleeing/losing," criticizing the interpretation of "wang" as "absence." However, in the Taiyang Upper Chapter under Guizhi Er Yuebi Yi Tang, the term "wu yang" (no Yang) appears. Since *Mai Jing* writes "wang" as "wu" in this passage, it certainly does not imply "fleeing."
Ke Shi says: The Upper Jiao transforms into Fire, causing sore throat and vomiting; the Lower Jiao involves Yin deficiency, causing persistent diarrhea. Bawei Shenqi Wan (Eight-Ingredient Rehmannia Pill) should be used. ○ Note: Ke Shi's discussions often apply this way to miscellaneous diseases. However, this syndrome is definitely not indicated for Shenqi Wan.
In Shaoyin disease, if there is cough, diarrhea, and delirium, it is due to coercion by Fire therapy. Urination will certainly be difficult.
This is because excessive effort was made to induce sweating in Shaoyin disease. ("Yi" [because] is written as "wei" [as] in *Yuhan Jing*.)
[Xi] These three sections discuss why Shaoyin disease should not be treated with sweating. *Ping Mai Pian* states: When Kidney Qi is weak and essence-blood is scant, Ben Qi (rushing Qi) presses urgently, entering the chest and diaphragm, causing cough. In Shaoyin, scant essence-blood leads to rebellious rushing Qi. Diarrhea occurs because Shaoyin Kidney Qi is weak, and body fluids drain downward. Further coercing sweat with Fire causes Shaoyin essence and Qi to leak recklessly, and Spirit Qi to float outward. Water fails to control Fire, leading to delirium. Hence, delirium is caused by Fire coercion. Not only delirium occurs, but urination will also be difficult, because forcing Shaoyin Kidney essence to become sweat exhausts the source of body fluids. Jiang Binhou said: There are many cases of Shaoyin diarrhea, not all caused by Fire. Moreover, Fire coercion does not always cause diarrhea. Only delirium is caused by Fire. The classic states: Those coerced by Fire will surely deliriate. Therefore, "cough, diarrhea, and delirium" should be analyzed separately. [Cheng] Shaoyin disease with cough and diarrhea is present in Zhenwu Tang syndrome. [Fang] "Qiang ze" means seeking excessively.
Note: Wang cites *Buwang Lun*, stating Chang Qizhi used Jiuni Tang, Zhuling Tang, and Wuling San to promote urination. *Yizong Jinjian* suggested choosing between Baihu Tang and Zhuling Tang. Both are errors. They likely followed Yu Shi's explanation of Heat pathogens carrying Fire force, inheriting the same flaw. It should be Fuling Sini Tang syndrome.
In Shaoyin disease, if the pulse is fine, sunken, and rapid, the disease is in the interior, and sweating is contraindicated.
[Cheng] What constitutes the interior? A sunken pulse in Shaoyin disease constitutes the interior. Whether fine-sunken or rapid-sunken, it indicates Zang-Yin invasion, unrelated to Exterior-Yang. The method should focus on securing the Kidney root. The contraindication of sweating is determined from the pulse, not the symptoms. Mahuang Fuxi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) should not be relied upon as a routine method. Xue Shengan said: People know that rapid pulse indicates Heat, but do not know that rapid pulse within a fine-sunken context indicates extreme Cold. In true Yin-Cold syndromes, the pulse may beat seven or eight times per breath, all falling under this description, but feeling weak and scattered upon pressure. One must observe deeply.
Note: Fang, Yu, and other families interpreted this as Heat pathogens entering the interior, which contradicts the intent of the Classic.
In Shaoyin disease, if the pulse is faint, sweating is contraindicated because it causes Yang collapse. If Yang is already deficient, and the Chi pulse is weak and choppy, purging is also contraindicated. ("Wang" [collapse] is written as "Wu" [no] in *Mai Jing* and *Qianjin Yifang*. Qian Huang notes: "Wang" sounds like "Wu".)
[Qian] "Faint" describes a pulse that is small, thin, soft, and seemingly present yet absent. A faint pulse indicates severe Yang deficiency and weak Defensive Yang, so sweating is contraindicated to avoid further exhausting Yang. Although sweat is Yin fluid, it is formed by Yang Qi steaming it; when sweat exits, Yang Qi also exits. Now that Yang is already deficient, it is called Yang collapse. If Yang is deficient and the Chi pulse is also weak and choppy, indicating decline of the True Fire of the Gate of Vitality and insufficiency of Kidney fluids, not only is sweating contraindicated, but purging is also forbidden to avoid further exhausting Yin essence and Yang Qi. This section is set to prohibit sweating and purging in Shaoyin disease, hence no treatment is specified. However, warming meridians and tonifying Yang formulas like Fuzi Tang constitute the treatment. [Cheng] Highlighting "Chi pulse weak and choppy" implies that when Shaoyin disease presents with Dachengqi Tang syndrome, the Chi pulse must be strong and slippery, a hint foreshadowed here.
Wang said: *Buwang Lun* suggests using Fuzi Tang to tonify Yang Qi, disperse Yin pathogens, and assist Ying-Blood. Zhou said: For contraindicated sweating, use Sini Tang plus Renshen (Ginseng); for contraindicated purging, use honey suppositories.
In Shaoyin disease, if the pulse is tight, and after seven or eight days, spontaneous diarrhea occurs, the pulse suddenly becomes faint, hands and feet become warm, and the tightness of the pulse disappears, this indicates the disease is resolving. Although there is irritability and diarrhea, it will surely heal itself.
[Qian] A tight pulse in Taiyang disease indicates aversion to heat and cold, with Cold pathogens in the exterior; in Shaoyin disease, it indicates absence of fever and aversion to cold, with Cold pathogens in the interior. After seven or eight days, Yin and Yang have been in stalemate for a long time, leading to diarrhea, showing that Yang Qi is durable enough to defend itself. Even with diarrhea, if the tight pulse like a绞索 (gallows rope) suddenly changes to a light, fine, soft faint pulse, one might fear it is the Yang-collapse pulse mentioned earlier prohibiting sweating. What to do? One must realize that in Shaoyin disease, the pulse is naturally faint, which can be called "no Yang." But if an extremely盛 (abundant) tight pulse from severe Cold suddenly becomes faint, the tightness transforms into looseness, signaling the relaxation and resolution of Cold pathogens. Saying "hands and feet become warm" implies that during the tight-pulse diarrhea, hands and feet were cold. If Cold did not resolve, hands and feet would not warm, and the pulse would not lose its tightness. Because the pulse was not originally faint, but suddenly became faint, hands and feet warmed, and tightness disappeared. Hence termed "reverse" (fan). Reverse warming and reverse disappearance mean Cold Qi has relaxed, hence "resolving." Although the person is irritable, irritability belongs to Yang, indicating returning warmth, so Yin-Cold diarrhea will surely heal itself.
In Shaoyin disease with diarrhea, if the diarrhea stops spontaneously, there is aversion to cold and curling up in bed, but hands and feet are warm, it is treatable. (Ke Renbo's edition deletes "diarrhea"; Fang Youzhi's edition writes "juan" [tired] instead of "quan" [curling].)
[Cheng] In Shaoyin disease with diarrhea, if diarrhea stops spontaneously, Yin Cold is expelled downward without collapsing. Although there are adverse signs like aversion to cold and curling up, if hands and feet are warm, it shows Yang Qi has the potential to recover. Although previous treatment lacked warming, current warmth allows for remedial warming. [Qian] Generally, Heat syndromes involve lying flat with relaxed limbs; Cold syndromes involve curling up with contracted limbs. Later, aversion to cold, curling up, and cold extremities indicate failure of True Yang and incurability. If hands and feet are warm, it shows Yang Qi has not failed and can still warm the limbs, hence "treatable." [Wang] To warm meridians and dispel Cold, Sini Tang should be used.
*Huren Shu* phonetic annotation says: Quan, pronounced ju yuan qie, means curling up without extending.
In Shaoyin disease, if there is aversion to cold and curling up, occasional spontaneous irritability, and a desire to remove clothing and blankets, it is treatable. (*Qianjin Yifang* writes "incurable".)
[Qian] Aversion to cold without fever indicates invasion by Cold pathogens. Curling up means lying curled. All Cold contracts and draws in, indicating severe aversion to cold. [Cheng] Shaoyin disease does not necessarily involve diarrhea. Only aversion to cold and curling up indicates deep penetration into the Zang organs. Irritability and desire to remove clothing show that Yang Qi still strives against the pathogen. Furthermore, "occasional" and "desire" differ from sudden collapse of deficient Yang. Although previous treatment lacked warming, current conditions allow for remedial warming. [Yu] The next article states: "No irritability but restlessness indicates death." Comparing them makes it clear.
Note: *Zong Bing Lun* and *Huren Shu* both state: Da Chaihu Tang should be used. This is doubtful.
In Shaoyin Wind Strike, if the Cun pulse is faint and the Chi pulse is floating, recovery is imminent.
[Qian] In Taiyang Wind Strike, the Yang pulse is floating and the Yin pulse is weak, distinguishing Yin and Yang by Floating and Sunken palpation. Here, "Yang faint, Yin floating" distinguishes Yin and Yang by Cun (inch) and Chi (cubit) positions. If distinguished by Floating/Sunten palpation, how could a Sunken position have a Floating pulse? This is self-evident. Shaoyin Wind Strike means Wind pathogens strike the Shaoyin meridian. Pulse theory states: Floating indicates Wind. Wind is a Yang pathogen; striking injures Wei Qi. If Wei Qi is invaded by Wind, the Cun Yang pulse should be floating. Now that the Yang pulse is faint, Wind pathogens are resolving. When pathogens enter Shaoyin, one fears the Chi pulse sinking. Sinking means pathogens enter the interior. Now that the Yin pulse floats, pathogens do not enter the interior, hence "recovery imminent."
The time when Shaoyin disease resolves is from Zi hour to Yin hour. ("Zhi" [to] is written as "jin" [end] in *Yuhan Jing*; no "shang" [above] character.)
[Cheng] Yang is born at Zi; Zi is First Yang, Chou is Second Yang, Yin is Third Yang. Shaoyin resolves here because Yin resolves when it obtains Yang. [Yu] Each meridian resolves during its prosperous time, but Shaoyin alone resolves during the time of Yang birth. As Yang advances, Yin retreats; as Yang grows, Yin declines. This is precisely "Yin resolves when it obtains Yang." Inferring from this, Shaoyin emphasizes True Yang; one cannot fail to recognize this.
In Shaoyin disease, with vomiting and diarrhea, if hands and feet are not cold, but rather feverish, the patient will not die. If the pulse is absent, moxa seven moxibustion cones on Shaoyin points. (Original note: "Zhi" [arrive] is alternatively "Zu" [foot]. *Mai Jing* and *Qianjin Yifang* add "you qi ren" [there is a person] before "tu" [vomit]. *Qianjin Yifang* writes "zu" [foot] for "zhi" [arrive].)
[Cheng] In Shaoyin disease, vomiting and diarrhea indicate prevailing Interior Yin. Because Stomach Yang is not exhausted, hands and feet are not cold. Fever with cold extremities indicates External collapse of Kidney Yang; fever with non-cold extremities indicates External support by Wei Yang. Previously no fever, now reverse fever, naturally not a death omen. Many abandon treatment due to absent pulse, losing benevolence and skill. Absent pulse results from vomiting/diarrhea causing discontinuity of Yin and Yang, distinct from pulse cessation. Moxa seven cones on Shaoyin points for urgent treatment. Subsequent medication should focus on warming. [Wei] Moxa seven cones on the primary Shaoyin points, following the meridian pathway to boost Yang Qi and promote circulation. Vomiting and diarrhea will stop spontaneously. Absent pulse will also return. Seven cones are not limited to one point; any point along the Shaoyin meridian's start, end, and course can be moxa-ed. Warming the Middle and supporting Yang is implied.
Wang said: Chang Qizhi stated: These are the two Shaoyin Taixi points, located behind the medial malleolus in the depression of the posterior tibial artery. Pang Anchang said: Fever refers to body heat. The Classic states: The Source point of the Kidney is Taixi. Medicinal action is slow; urgently moxa-ing the Source point to warm the Zang organ can still save the crisis. ○ Note: *Huren Shu* also mentions Taixi point.
In Shaoyin disease, after eight or nine days, if the entire body and hands and feet are hot, because Heat is in the Bladder, hematochezia (blood in stool) or hematuria will occur.
[Qian] Generally, Cold pathogens entering Shaoyin cause aversion to cold and cold extremities, so reverse fever indicates Yang return and Yin resolution, sparing death. This is because pathogens entered Shaoyin, and after eight or nine days, whole-body and limb heat indicates transmission of Foot-Shaoyin Kidney pathogens to Foot-Taiyang Bladder. Kidney and Bladder are interior-exterior pairs; Zang-pathogen transmitting to Fu organ represents returning from Yin to Yang. Since Taiyang governs the exterior, the entire body and hands and feet become hot. Heat pathogens in the Bladder force blood to move recklessly, causing bleeding. The phrase "must bleed" was interpreted by previous commentators as bleeding from a Yin orifice (Fang Youzhi and Yu Chang agree). Perhaps although Heat is in the Bladder, blood may not necessarily exit via urine.
Note: Wang cites Chang Qizhi: Tao Ren Chengqi Tang and Shaoyao Dihuang Tang can be used. I believe Shaoyao Dihuang Tang is appropriate. Ke Shi said: Mild cases use Zhuling Tang; severe cases use Huanglian Ejiao Tang. Ke's view seems correct.
In Shaoyin disease, if there is only cold extremities without sweat, and forced sweating is applied, blood will surely be disturbed. Unknown from which orifice it flows, some from mouth/nose, some from eyes, this is called Lower Jue and Upper Exhaustion, and is difficult to treat. (Cost edition omits "zhe" [particle].)
[Xi] This discusses declining Sheng Yang in the Lower Jiao and exhaustion of True Yin in the Upper Jiao. Shaoyin disease with only cold extremities and no sweat indicates weak Yang Qi. Sweat, though blood-derived, is released by Yang Qi steaming and dispersing. Now, weak Sheng Yang cannot evaporate, hence no sweat. Forced sweating fails to produce sweat but disturves blood in the collaterals, causing it to exit through apertures. Unknown which aperture: Shaoyin meridian follows the throat, flanks the tongue base, and connects to the eye system, hence bleeding from mouth/nose or eyes. Yang Jue (reversal) in the Lower Jiao and Yin Blood exhaustion in the Upper Jiao injure Shaoyin Yin, Yang, Qi, and Blood, hence difficult to treat. [Cheng] Difficult to treat because Lower Jue requires warming, while Upper Exhaustion forbids warming, making it a reversal within a reversal.
Note: Wang said: Zhang Zhongjing only states "difficult to treat," proving it is not inevitably fatal. *Buwang Lun* Chang Qizhi said: Shaoyao Dihuang Tang can be used. Cheng Shi, Fang Shi, Yu Shi, Wei Shi, and *Yizong Jinjian* all interpreted this as Heat Jue, likely inheriting Chang's error.
Note: Yu Shi said: Later readers follow the text literally and ignore deeper meanings. Lower Jue means Yin Qi rebelling in the Lower Jiao; Upper Exhaustion means Yin Blood exhausted in the Upper Jiao. Qi and Blood mutually support each other; Qi without Blood scatters without control; Blood without Qi coagulates without flow. Thus, when Yin Fire moves, Yin Qi must rush upward; as Yin Qi rushes up, Yin Blood must overflow and exhaust. Once Blood overflows, accompanying Qi scatters in the chest and cannot return to its origin, causing Lower Jue. Since Yin rebels in the Lower, Long-Lei Fire responds, and bleeding continues until exhaustion. Zhang Zhongjing judged it "difficult to treat," not strictly "untreatable." I greatly expand the door: strengthening Spleen-Middle Yang is the first principle. Strengthening Spleen Yang has three benefits: 1. Strong Spleen Yang subdues Long-Lei Fire; 2. Strong Spleen Yang clears chest stagnation like empty sky; 3. Strong Spleen Yang aids digestion and generates exhausted Blood. From *Yimen Falü*. Inferring from this, for Lower Jue and Upper Exhaustion, Zhang Jingyue's Liuwei Huiyang Yin (Six-Ingredient Return-Yang Drink), balancing Yin tonification and Yang restoration, is the suitable compound formula.
In Shaoyin disease, with aversion to cold, body curling, diarrhea, and cold extremities, it is incurable.
[Qian] Previous aversion to cold and curling up was treatable due to irritability and desire to remove clothing, indicating remaining Yang. Diarrhea stopping with curling up and warm hands/feet was treatable due to unfailed Yang. This case, with aversion to cold, curling, diarrhea, and cold extremities, indicates failure of Limb Yang, hence cold. No irritability or desire to remove clothing remains, and diarrhea persists, indicating exhausted Yang, hence incurable. Although Fuzi Tang, Sini Tang, and Baitong Tang exist, they may not restore collapsed Yang. [Shu] Note: This syndrome has not reached sweating and high-pitched breathing, so it is still treatable. Urgently administer Sini Tang plus Renshen; perhaps survival is possible.
In Shaoyin disease, with vomiting, diarrhea, restlessness, and cold extremities, death ensues.
[Yu] Vomiting and diarrhea leading to irritability/restlessness indicates chaotic Yin and Yang, fearing exhaustion. Added cold extremities indicate failure of Central Earth (Spleen/Stomach), with upper and lower attacking each other, severing Middle Qi, hence death. Had warming of the Middle been applied early, would it have come to this? [Zhang] This section is similar to the Wuzhuyu Tang section; why is that treatable while this is not?