经验秘方。治喉咽郁结。声音不闻。大名安提举神效方。
于桔梗汤内。加诃子。各等分。生熟亦各半。为细末。食后沸汤调服。又名铁叫子如圣汤。
施圆端效方。橘甘汤。治咽喉噎塞堵闭。咳咯脓或血。
于桔梗汤内。加橘皮。半夏。生姜。水煎服。
备预百要方。喉闭。饮食不通。欲死方。（即桔梗汤）兼治马喉痹。（马项长。故凡痹在项内。不见处。
深肿连 。壮热吐气数者。是也。）
医垒元戎。仲景甘桔汤例。仁宗御名如圣汤。治少阴咽痛。炙甘草一两。桔梗三两。上粗末。水煎。加生
姜煎亦可。一法。加诃子皮二钱。煎去渣饮清。名诃子散。治失音无声。如咳逆上气者。加陈皮。如涎嗽者。
加知母贝母。如酒毒者。加葛根。如少气者。加人参麦门冬。如唾脓血者。加紫菀。如疫毒肿者。加黍粘子大
黄。如咳渴者。加五味子。如呕者。加生姜半夏。如目赤者。加栀子大黄。如胸膈不利者。加枳壳。如不得眠
者。加栀子。如心胸痞者。加枳实。如肤痛者。加黄 。如面目肿者。加茯苓。如咽痛者。加黍粘子竹茹。如
肺痿者。加阿胶。能续气。如发狂者。加防风荆芥。如声不出者。加半夏。
薛氏医案。武选汪用之。饮食起居失宜。咳嗽吐痰。用化痰（发散）之药。时仲夏。脉洪数而无力。胸满
面赤。吐痰腥臭。汗出不止。余曰。水泛为痰之证。而用前剂。是谓重亡津液。得非肺痈乎。不信仍服前药。
翌日果吐脓。脉数左寸右寸为甚。始信用桔梗汤一剂。脓数顿止。再剂全止。面色顿白。仍以忧惶。余曰。此
证面白脉涩。不治自愈。又用前药一剂。佐以六味丸。治之而愈。
少阴病。咽中伤生疮。不能语言。声不出者。苦酒汤主之。
〔钱〕前人以一咽疮。而有治法三等之不同。遂至议论纷出。不知其一条咽痛。少阴之邪气轻微。故但以
甘桔和之而已。其一条。因经邪未解。痛在咽中。痰热锁闭。故以半夏开豁。桂枝解散。此条则咽已生疮。语
言不能。声音不出。邪已深入。阴火已炽。咽以损伤。不必治表。和之无益。故用苦酒汤。以半夏。豁其咽之
不利。鸡子白。以润咽滑窍。且能清气除伏热。皆用开豁润利。收敛下降而已。因终是阴经伏热。虽阴火上逆。
决不敢以寒凉用事也。〔汪〕或问。仲景言咽痛。咽以咽物。于喉何与。而云语声不出邪。余答云。喉与咽相
附。仲景言少阴病热咽痛。而喉咙即在其中。
苦酒汤方
半夏（洗破如枣核十四枚○玉函。成本。核下。有大字。神巧万全方。七个。洗。切。破作十四片。） 鸡
子（一枚去黄纳上苦酒着鸡子壳中○玉函。无上字。着。作于。千金翼。上下。有好字）
上二味。纳半夏。着苦酒中。以鸡子壳。置刀环中。安火上。令三沸。去滓。少少含咽之。不瘥更作三剂。
（玉函。无着字。成本。玉函。环。作 。少少。玉函。作细一字。玉函。无三剂二字。千金翼。剂下。有愈
字。全书。剂下。有服之二字。置刀环中。圣济总录。作放剪刀环中。）
〔钱〕半夏。开上焦痰热之结邪。卵白。清气治伏热。苦酒。味酸。使阴中热淫之气敛降。今之优人。每
遇声哑。即以生鸡子白啖之。声音即出。亦此方之遗意也。〔鉴〕半夏涤涎。蛋清敛疮。苦酒消肿。则咽清而
声出也。
案活人书。苦酒。米醋。是也。盖原于本草陶注。王氏云。案苦酒。本草注。曰醯。而成氏复云。苦酒
之酸。余则以为名义俱乖。安知酒之味苦者。不可以已咽痛邪。考本草。醋也。醯也。苦酒也。并为一物。陶
云以有苦味。俗呼苦酒。不知王氏何据有此说。又案王氏云。上苦酒。上字无着落矣。宜较正之。不知上是上
好之谓。千金翼。作上好苦酒。可见耳。
外台秘要。古今录验。鸡子汤。疗喉痹方。半夏末。方寸匕。上一味。开鸡子头。去中黄白。盛淳苦酒。
令小满。纳半夏末着中。搅令和鸡子。着刀子环令稳。炭上令沸。药成置杯中。及暖稍咽之。但肿即减。肘后
文仲同。此与仲景苦酒汤同。半夏不可作末。剖之可也。
圣惠方。治咽喉中如有物。咽唾不得。宜服此方。半夏一七枚。破如棋子大。汤洗七遍去滑。上以鸡子
一枚。打破其头。出黄白。纳半夏。并入醋。于壳中令满。微火煎。去半夏。候冷冻饮料之。即愈。
圣济总录。治狗咽。鸡子法。半夏一钱末。姜汁搜为饼子。焙干。研细。鸡子一枚。上二味。先开鸡子
头。去黄。又盛苦酒一半。入半夏末壳中。搅令匀。安鸡子。坐于 灰火中。慢煎沸熟。取出。后稍冷。就壳。
分温三服。
少阴病。咽中痛。半夏散及汤主之。（外台。咽中。作咽喉。）
〔鉴〕少阴病。咽痛者。谓或左或右。一处痛也。咽中痛者。谓咽中皆痛也。较之咽痛而有甚焉。甚则
涎缠于咽中。
故主以半夏散。散风邪。以逐涎也。
半夏散及汤方
半夏（洗） 桂枝（去皮） 甘草（炙）
上三味。等分。各别捣筛。已合治之。白饮和服方寸匕。日三服。若不能散服者。以水一升。煎七沸。纳
散两方寸匕。更煮三沸。下火令小冷。少少咽之。半夏有毒。不当散服。（上。成本。作已上。两字。玉函。
作一二二字。全书。作一两二字。更煮。玉函。成本。作更煎。玉函。成本。无半夏有毒不当散服八字。）
〔钱〕咽中痛。则阳邪较重。故以半夏之辛滑。以利咽喉。而开其粘饮。仍用桂枝。以解卫分之风邪。又
以甘草和之。
活人书曰。半夏桂枝甘草汤。治伏气之病。谓非时有暴寒中人。伏气于少阴经。始不觉病。旬月乃发。脉
便微弱。法先咽痛。似伤寒。非咽痹之病。次必下利。始用半夏桂枝甘草汤主之。次四逆散主之。此病只二日
便瘥。古方谓之肾伤寒也。
即本方作汤。入生姜四片煎服。
少阴病。下利。白通汤主之。
〔钱〕下利已多。皆属实在少阴。下焦清阳不升。胃中阳气不守之病。而未有用白通汤者。此条但云下利。
而用白通汤者。以上有少阴病三字。则知有脉微细。但欲寐。手足厥之少阴证。观下文下利脉微。方与白通汤。
则知之矣。利不止。而厥逆无脉。又加猪胆人尿。则尤知非平常下利矣。盖白通汤。即四逆汤。而以葱易甘草。
甘草所以缓阴气之逆。和姜附。而调护中州。葱则辛滑行气。可以通行阳气。而解散寒邪。二者相较。一缓
一速。故其治亦颇有缓急之殊也。
案柯氏。以此条症治疏略。删去。
白通汤方
葱白（四茎） 干姜（一两） 附子（一枚生去皮破八片○成本。玉函。生下有用字。）
上三味。以水三升煮取一升。去滓。分温再服。
〔方〕用葱白。而曰白通者。通其阳。则阴自消也。
肘后方。白通汤。疗伤寒泄利不已。口渴不得下食。虚而烦方。
即本方。用葱白十四茎。干姜半两。更有甘草半两炙。方后云。渴微呕。心下停水者。一方。加犀角半
两。大良。
少阴病。下利脉微者。与白通汤。利不止。厥逆无脉。干呕烦者。白通加猪胆汁汤主之。服汤。脉暴出者
死。微续者生。
〔印〕少阴病。下利。阴寒在下也。脉微。邪在下。而生阳气微也。故当用白通汤。接在表在上之阳。以下
济。如利不止。阴气泄而欲下脱矣。干呕而烦。阳无所附。而欲上脱矣。厥逆无脉。阴阳之气。不相交接矣。
是当用白通汤。以通阳。加水畜之胆。引阴中之阳气。以上升。取人尿之能行故道。导阳气以下接。阴阳和。
而阳气复矣。〔方〕暴出。烛欲烬而焰烈也。微续。真阳回而渐复也。
伤寒类方曰。暴出。乃药力所迫。药力尽则气仍绝。微续。乃正气自复。故可生也。前云其脉即出者愈。
此云暴出者死。盖暴出与即出不同。暴出。一时出尽。即出。言服药后。少顷即徐徐微续也。须善会之。
白通加猪胆汁汤方
葱白（四茎） 干姜（一两） 人尿（五合） 猪胆汁（一合） 附子（一枚生去皮破八片○生下。宗印。
及锡驹本。有用字。是。）
上五味。以水三升。煮取一升。去滓。纳胆汁人尿。和令相得。分温再服。若无胆。亦可用。（成本。
上。作已上二字。五味。作三味。并非也。）
〔志〕始焉下利。继则利不止。始焉脉微。继则厥逆无脉。更兼干呕心烦者。乃阴阳水火并竭。不相交济。
故以白通加猪胆汁汤。夫猪。乃水畜。胆具精汁。可以滋少阴。而济其烦呕。人尿。乃入胃之饮。水精四布。
五经并行。可以资中土。而和其厥逆。中土相济。则烦呕自除。〔汪〕案方后云。若无胆亦可用。则知所重在
人尿。方当名白通加人尿汤。始妥。
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。或呕者。真武汤主之。（自下利。玉函。作而利。利下。无者字。小便利。作小便自利千金。
及翼。真武汤。作玄武汤。）
〔鉴〕论中心下有水气。发热有汗。烦渴引饮。小便不利者。属太阳中风。五苓散证也。发热无汗。干呕
不渴。小便不利者。属太阳伤寒。小青龙汤证也。今少阴病。二三日不已。至四五日。腹痛下利。阴寒深矣。
设小便利。是纯寒而无水。乃附子汤证也。今小便不利。或咳或呕。此为阴寒兼有水气之证。故水寒之气。外
攻于表。则四肢沉重疼痛。内盛于里。则腹痛自利也。水气停于上焦胸肺。则咳喘而不能卧。停于中焦胃腑。
则呕而或下利。停于下焦膀胱。则小便不利。而或少腹满。种种诸证。总不外乎阴寒之水。而不用五苓者。以
非表热之饮也。不用小青龙者。以非表寒之饮也。故惟主以真武汤。温寒以制水也。〔汪〕或下利者。谓前自
下利。系二三日之证。此必是前未尝下利。指四五日后始下利者而言。
真武汤方
茯苓（三两） 芍药（三两） 白术（二两○外台。作三两。） 生姜（三两切） 附子（一枚炮去皮破八片）
上五味。以水八升。煮取三升。去滓。温服七合。日三服。若咳者。加五味子半升。细辛一两。干姜一两。
若小便利者。去茯苓。若下利者。去芍药。加干姜二两。若呕者。去附子。加生姜。足前为半斤。（外台。五
味下。有切字。成本。细辛下。无一两二字。干姜下。有各字。千金翼。半斤下。有利不止便脓血者。宜桃花
汤十一字。）
〔张〕此方。本治少阴病水饮内结。所以首推术附。兼茯苓生姜之运脾渗水为务。此人所易明也。至用
芍药之微旨。非圣人不能。盖此证。虽曰少阴本病。而实缘水饮内结。所以腹痛自利。四肢疼重。而小便反不
利也。若极虚极寒。则小便必清白无禁矣。安有反不利之理哉。则知其人不但真阳不足。真阴亦已素亏。若不
用芍药固护其阴。岂能胜附子之雄烈乎。即如附子汤。桂枝加附子汤。芍药甘草附子汤。皆芍药与附子并用。
其温经护营之法。与保阴回阳不殊。后世用药。获仲景心法者。几人哉。〔知〕白通通脉真武。皆为少阴下利而
设。白通四逆。附子皆生用。惟真武一证。熟用者。盖附子生用。则温经散寒。炮熟则温中去饮。白通诸汤。
以通阳为重。真武汤以益阳为先。故用药有轻重之殊。干姜能佐生附。以温经。生姜能资熟附。以散饮也。〔钱〕
加减法。为后世俗医所增。察其文理纰缪。恶其紫之乱朱。故逐一指摘其误。使学人有所别识云。（今以文HT 。
不录于斯。汪氏引武陵陈氏亦云。加减法。系后人所附。而非仲景原文矣。）
王氏易简方。此药不惟阴证伤寒可服。若虚劳人。憎寒壮热。咳嗽下利。皆宜服之。因易名固阳汤。增
损一如前法。今人每见寒热。多用地黄当归鹿茸辈。补益精血。殊不知此等药味多甘。却欲恋膈。若脾胃大段
充实。服之方能滋养。然犹恐因时致伤胃气。胃为仓廪之官。受纳水谷之所。五脏皆取气于胃。所谓精气血气。
皆由谷气而生。若用地黄等药。
未见其生血。谷气已先有所损矣。孙兆谓补肾不如补脾。正谓是也。故莫若以固阳汤。调其寒热。不致伤脾。
饮食不减。则气血自生矣。
直指方。治少阴肾证。水饮与里寒。合而作嗽。腹痛下利。
于本方。加干姜细辛五味子。凡年高气弱久嗽通用。仍间服养正丹。
医史。朱右撰撄宁生传云。宋可与外家。暑月身冷自汗。口干烦躁。欲卧泥水中。伯仁诊其脉。浮而数。沉
之豁然虚散。曰素问云。脉至而从。按之不鼓。诸阳皆然。此为阴盛隔阳。得之饮食生冷。坐卧风露。煎真武
汤冷冻饮料之。一进汗止。再进烦躁去。三进平复如初。余子元病恶寒战栗。持捉不定。两手皆冷汗浸淫。虽浓衣
炽火不能解。伯仁即与真武汤。凡用附子六枚。一日病者忽出。人怪之。病者曰。吾不恶寒。即无事矣。或以
问伯仁。伯仁曰。其脉两手皆沉微。余无表里证。此体虚受寒。亡阳之极也。初皮表气隧。为寒邪壅遏。阳不
得伸而然也。是故血隧热壅。须用硝黄。气隧寒壅。须用桂附。阴阳之用不同者。无形有形之异也。
经验秘方。治疗咽喉部气机郁结闭塞，导致声音嘶哑甚至失音。这是大名府安提举的神效方。
在桔梗汤的基础上，加入诃子，两者用量相等，生品和熟品各占一半，研磨成细末。饭后用沸水调服。这个方子又名“铁叫子如圣汤”。
施圆端的效方。橘甘汤，治疗咽喉噎塞堵闭感，咳嗽咯出脓液或血液。
在桔梗汤的基础上，加入橘皮、半夏、生姜，用水煎煮后服用。
《备预百要》中的方子。治疗喉闭（急性咽喉梗阻），饮食无法吞咽，痛苦欲死。（即桔梗汤）兼治马喉痹。（马的脖子长，所以凡是痹症发生在颈部内部、肉眼看不见的地方，出现深部肿胀连及周围，高热且呼吸急促的情况，就是这种病。）
《医垒元戎》中记载了仲景的甘桔汤范例，仁宗御名“如圣汤”，治疗少阴经咽痛。炙甘草一两，桔梗三两，切碎成粗末，用水煎煮。也可以加生姜一起煎煮。另一种方法，加入诃子皮二钱，煎煮后去渣，趁热饮用，名为“诃子散”，治疗失音无声。如果伴有咳嗽气逆上冲的症状，加入陈皮；如果有痰嗽症状，加入知母、贝母；如果是酒毒引起的，加入葛根；如果气短少气，加入人参、麦门冬；如果唾吐脓血，加入紫菀；如果是疫毒肿盛，加入黍粘子（牛蒡子）、大黄；如果咳嗽口渴，加入五味子；如果呕吐，加入生姜、半夏；如果眼睛发红，加入栀子、大黄；如果胸膈部感觉不畅利，加入枳壳；如果失眠，加入栀子；如果心胸痞闷，加入枳实；如果皮肤疼痛，加入黄芩；如果面目浮肿，加入茯苓；如果咽痛，加入黍粘子、竹茹；如果是肺痿，加入阿胶，能够接续肺气；如果发狂，加入防风、荆芥；如果声音出不来，加入半夏。
薛氏医案。武选官汪用之，饮食起居不规律，咳嗽吐痰，使用了化痰（发散）的药物。当时正值仲夏，脉象洪大而数但无力，胸部胀满，面色红赤，吐出的痰腥臭，出汗不止。我说：这是水泛为痰的证候，却使用前面的发散药物，这叫做再次耗伤津液，难道不是肺痈吗？他不相信，仍然服用前面的药。第二天果然吐出脓液，脉象数，左寸和右寸脉象尤为明显，这才信服，服用桔梗汤一剂，脓液迅速减少，再服一剂完全停止，面色顿时变白，但仍然忧愁惶恐。我说：这个证候面白脉涩，虽然看似不治，但会自愈。又用前面的药一剂，配合六味丸治疗，于是痊愈。
少阴病，咽喉受伤生疮，不能说话，声音发不出来的，用苦酒汤主治。
〔钱〕前人因为一个咽疮，就有三种不同的治疗方法，导致议论纷纷。不知道其中一条咽痛，是少阴经邪气轻微，所以只用甘桔汤调和而已。另一条，是因为经邪未解，疼痛在咽喉，痰热锁闭，所以用半夏开豁痰结，桂枝解散表邪。这一条则是咽喉已经生疮，语言不能，声音不出，邪气已经深入，阴火已经炽盛，咽喉受到损伤，不需要治疗表证，单纯调和没有益处，所以用苦酒汤。用半夏豁除咽喉的不利，鸡蛋清滋润咽喉滑利窍道，并且能清气清除伏热，都是采用开豁润利、收敛下降的方法。因为终究是阴经伏热，虽然是阴火上逆，也决不敢用寒凉药来主导治疗。〔汪〕有人问：仲景说咽痛，咽是用来吞咽食物的，与喉有什么关系，却说语声出不出来呢？我回答说：喉与咽相邻附，仲景说少阴病热性咽痛，喉咙就在其中。
苦酒汤方
半夏（洗净，破开如枣核大小，十四枚○《玉函》，《成本》，在“核”字下有“大”字，《神巧万全方》，七个，洗，切，破作十四片。） 鸡蛋（一枚，去掉蛋黄，将苦酒放入蛋壳中○《玉函》，无“上”字，“着”作“于”，《千金翼》，上下，有“好”字）
以上两味药，将半夏放入苦酒中，用鸡蛋壳作为容器，放在刀环中，置于火上，煮沸三次。去渣，少量含咽。如果不愈，再制作三剂。
（《玉函》，无“着”字。《成本》，《玉函》，“环”作“...”。《玉函》，“少少”作“细”一字。《玉函》，无“三剂”二字。《千金翼》，“剂”下有“愈”字。《全书》，“剂”下有“服之”二字。《圣济总录》，“置刀环中”作“放剪刀环中”。）
〔钱〕半夏，开通上焦痰热之结邪；卵白，清气治疗伏热；苦酒，味酸，使阴中热淫之气收敛下降。现在的戏曲演员，每次遇到声音嘶哑，就吃生鸡蛋清，声音就能发出，这也是此方的遗意。〔鉴〕半夏涤除涎沫，蛋清敛疮，苦酒消肿，则咽喉清爽而声音发出。
按《活人书》记载，苦酒就是米醋。大概源于本草陶弘景的注释，王氏说：按苦酒，本草注曰醯，而成氏又说苦酒的酸味。我认为名义都有偏差，怎么知道味道苦的酒，不可以治疗咽痛呢？考证本草，醋、醯、苦酒，并为一物。陶弘景说因为有苦味，俗呼苦酒。不知道王氏有什么依据这样说。又按王氏说：上苦酒，这里的“上”字没有着落，应该校正。不知道“上”是指上好的意思，《千金翼》作“上好苦酒”，由此可见。
《外台秘要》引《古今录验》鸡子汤，治疗喉痹方。半夏末，方寸匕。以上一味药，切开鸡子头，去掉里面的黄和白，盛入纯苦酒，让蛋壳小满，纳入半夏末在其中，搅拌混合鸡蛋，放在刀子环中使其稳固，在炭火上煮沸。药成后放在杯中，待温热时慢慢咽下。只要肿胀就会减轻。《肘后方》文仲版本相同。这与仲景的苦酒汤相同。半夏不可做成粉末，剖开即可。
《圣惠方》。治疗咽喉中如有异物，吞咽唾液不得，宜服此方。半夏一十七枚，破开如棋子大，汤洗七遍去滑。以上用鸡蛋一枚，打破其头，取出黄白，纳入半夏，并倒入醋，在壳中令满。微火煎煮，去半夏，候冷却后饮之，即愈。
《圣济总录》。治疗狗咽（类似喉痹），鸡子法。半夏一钱末，姜汁搜和为饼子，焙干，研细。鸡蛋一枚。以上两味药，先开鸡子头，去掉黄，又盛苦酒一半，入半夏末于壳中，搅令均匀，安放鸡蛋，坐于灰火中，慢煎沸熟。取出，稍冷，就壳分温三服。
少阴病，咽喉疼痛，用半夏散及汤主治。（《外台》，“咽中”作“咽喉”。）
〔鉴〕少阴病，咽痛者，谓或左或右，一处痛也。咽中痛者，谓咽中皆痛也。较之咽痛而有甚焉，甚则涎缠于咽中。
故主以半夏散，散风邪，以逐涎也。
半夏散及汤方
半夏（洗） 桂枝（去皮） 甘草（炙）
以上三味药，等分，分别捣筛，已经混合处理。用白饮（米汤）调和服用方寸匕，每日三次。如果不能散服，用水一升，煎煮七沸，纳入散剂两方寸匕，再煮三沸，熄火令稍冷，少量咽之。半夏有毒，不应当散服。（“上”，《成本》作“已上”两字。《玉函》作“一二”二字。《全书》作“一两”二字。“更煮”，《玉函》、《成本》作“更煎”。《玉函》、《成本》，无“半夏有毒不当散服”八字。）
〔钱〕咽中痛，则阳邪较重，所以用半夏的辛滑，以利咽喉，而开其粘饮。仍用桂枝，以解卫分之风邪。又以甘草调和它。
《活人书》说：半夏桂枝甘草汤，治疗伏气之病。谓非时有暴寒中人，伏气于少阴经，开始不觉病，旬月乃发，脉便微弱，法先咽痛，似伤寒，非咽痹之病。其次必下利，始用半夏桂枝甘草汤主治。其次四逆散主治。此病只二日便瘥，古方谓之肾伤寒也。
少阴病，下利，用白通汤主治。
〔钱〕下利已多，皆属实在少阴，下焦清阳不升，胃中阳气不守之病。而未有用白通汤者，此条但云下利，而用白通汤者，以上有少阴病三字，则知有脉微细，但欲寐，手足厥之少阴证。观下文下利脉微，方与白通汤，则知之矣。利不止，而厥逆无脉，又加猪胆人尿，则尤知非平常下利矣。盖白通汤，即四逆汤，而以葱易甘草。甘草所以缓阴气之逆，和姜附，而调护中州。葱则辛滑行气，可以通行阳气，而解散寒邪。二者相较，一缓一速，故其治亦颇有缓急之殊也。
按柯氏，以此条症治疏略，删去。
白通汤方
葱白（四茎） 干姜（一两） 附子（一枚生，去皮破八片○《成本》、《玉函》，生下有用字。）
以上三味药，用水三升，煮取一升，去渣，分两次温服。
〔方〕用葱白，而曰白通者，通其阳，则阴自消也。
《肘后方》白通汤，治疗伤寒泄利不已，口渴不得下食，虚而烦方。
即本方，用葱白十四茎，干姜半两，更有甘草半两炙。方后云：渴微呕，心下停水者，一方，加犀角半两，大良。
少阴病，下利脉微者，与白通汤。利不止，厥逆无脉，干呕烦者，白通加猪胆汁汤主治。服汤，脉暴出者死，微续者生。
〔印〕少阴病，下利，阴寒在下也。脉微，邪在下，而生阳气微也。故当用白通汤，接在表在上之阳，以下济。如利不止，阴气泄而欲下脱矣。干呕而烦，阳无所附，而欲上脱矣。厥逆无脉，阴阳之气，不相交接矣。是当用白通汤，以通阳，加水畜之胆，引阴中之阳气，以上升。取人尿之能行故道，导阳气以下接。阴阳和，而阳气复矣。〔方〕暴出，烛欲烬而焰烈也。微续，真阳回而渐复也。
《伤寒类方》曰：暴出，乃药力所迫，药力尽则气仍绝。微续，乃正气自复，故可生也。前云其脉即出者愈，此云暴出者死。盖暴出与即出不同。暴出，一时出尽。即出，言服药后，少顷即徐徐微续也。须善会之。
白通加猪胆汁汤方
葱白（四茎） 干姜（一两） 人尿（五合） 猪胆汁（一合） 附子（一枚生，去皮破八片○生下，《宗印》及锡驹本，有用字，是。）
以上五味药，用水三升，煮取一升，去渣，纳胆汁人尿，和令相得，分两次温服。若无胆，亦可用。（《成本》，“上”作“已上”二字。“五味”作“三味”，并非也。）
〔志〕始焉下利，继则利不止。始焉脉微，继则厥逆无脉。更兼干呕心烦者，乃阴阳水火并竭，不相交济。故以白通加猪胆汁汤。夫猪，乃水畜，胆具精汁，可以滋少阴，而济其烦呕。人尿，乃入胃之饮，水精四布，五经并行，可以资中土，而和其厥逆。中土相济，则烦呕自除。〔汪〕按方后云：若无胆亦可用，则知所重在人尿。方当名白通加人尿汤，始妥。
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，或呕者，真武汤主治。（“自下利”，《玉函》作“而利”，“利”下无“者”字。“小便利”作“小便自利”。《千金》及《翼》，“真武汤”作“玄武汤”。）
〔鉴〕论中心下有水气，发热有汗，烦渴引饮，小便不利者，属太阳中风，五苓散证也。发热无汗，干呕不渴，小便不利者，属太阳伤寒，小青龙汤证也。今少阴病，二三日不已，至四五日，腹痛下利，阴寒深矣。设小便利，是纯寒而无水，乃附子汤证也。今小便不利，或咳或呕，此为阴寒兼有水气之证。故水寒之气，外攻于表，则四肢沉重疼痛。内盛于里，则腹痛自利也。水气停于上焦胸肺，则咳喘而不能卧。停于中焦胃腑，则呕而或下利。停于下焦膀胱，则小便不利，而或少腹满。种种诸证，总不外乎阴寒之水。而不用五苓者，以非表热之饮也。不用小青龙者，以非表寒之饮也。故惟主以真武汤，温寒以制水也。〔汪〕或下利者，谓前自下利，系二三日之证。此必是前未尝下利，指四五日后始下利者而言。
真武汤方
茯苓（三两） 芍药（三两） 白术（二两○《外台》作三两。） 生姜（三两切） 附子（一枚炮，去皮破八片）
以上五味药，用水八升，煮取三升，去渣，温服七合，每日三次。若咳者，加五味子半升，细辛一两，干姜一两。若小便利者，去茯苓。若下利者，去芍药，加干姜二两。若呕者，去附子，加生姜，足前为半斤。（《外台》，“五味”下，有“切”字。《成本》，“细辛”下，无一两二字。“干姜”下，有“各”字。《千金翼》，“半斤”下，有利不止便脓血者，宜桃花汤十一字。）
〔张〕此方，本治少阴病水饮内结，所以首推术附，兼茯苓生姜之运脾渗水为务。此人所易明也。至用芍药之微旨，非圣人不能。盖此证，虽曰少阴本病，而实缘水饮内结，所以腹痛自利，四肢疼重，而小便反不利也。若极虚极寒，则小便必清白无禁矣。安有反不利之理哉。则知其人不但真阳不足，真阴亦已素亏。若不用芍药固护其阴，岂能胜附子之雄烈乎。即如附子汤，桂枝加附子汤，芍药甘草附子汤，皆芍药与附子并用，其温经护营之法，与保阴回阳不殊。后世用药，获仲景心法者，几人哉。〔知〕白通、通脉、真武，皆为少阴下利而设。白通、四逆，附子皆生用。惟真武一证，熟用者。盖附子生用，则温经散寒。炮熟则温中去饮。白通诸汤，以通阳为重。真武汤以益阳为先。故用药有轻重之殊。干姜能佐生附，以温经。生姜能资熟附，以散饮也。〔钱〕加减法，为后世俗医所增。察其文理纰缪，恶其紫之乱朱，故逐一指摘其误，使学人有所别识云。（今以文HT，不录于斯。汪氏引武陵陈氏亦云：加减法，系后人所附，而非仲景原文矣。）
王氏易简方。此药不惟阴证伤寒可服，若虚劳人，憎寒壮热，咳嗽下利，皆宜服之。因易名固阳汤，增损一如前法。今人每见寒热，多用地黄、当归、鹿茸辈，补益精血。殊不知此等药味多甘，却欲恋膈。若脾胃大段充实，服之方能滋养。然犹恐因时致伤胃气。胃为仓廪之官，受纳水谷之所，五脏皆取气于胃，所谓精气血气，皆由谷气而生。若用地黄等药，未见其生血，谷气已先有所损矣。孙兆谓补肾不如补脾，正谓是也。故莫若以固阳汤，调其寒热，不致伤脾。饮食不减，则气血自生矣。
《直指方》。治疗少阴肾证，水饮与里寒，合而作嗽，腹痛下利。
于本方，加干姜、细辛、五味子。凡年高气弱久嗽通用。仍间服养正丹。
《医史》。朱右撰撄宁生传云：宋可与外家，暑月身冷自汗，口干烦躁，欲卧泥水中。伯仁诊其脉，浮而数，沉之豁然虚散。曰：《素问》云：脉至而从，按之不鼓，诸阳皆然。此为阴盛隔阳，得之饮食生冷，坐卧风露。煎真武汤冷冻饮料之。一进汗止，再进烦躁去，三进平复如初。余子元病恶寒战栗，持捉不定，两手皆冷汗浸淫，虽浓衣炽火不能解。伯仁即与真武汤，凡用附子六枚。一日病者忽出，人怪之。病者曰：吾不恶寒，即无事矣。或以问伯仁。伯仁曰：其脉两手皆沉微，余无表里证，此体虚受寒，亡阳之极也。初皮表气隧，为寒邪壅遏，阳不得伸而然也。是故血隧热壅，须用硝黄。气隧寒壅，须用桂附。阴阳之用不同者，无形有形之异也。
Empirical Secret Recipe. Treats throat and pharynx qi stagnation and obstruction, leading to hoarseness or aphonia. This is the Divine Efficacy Formula from An Tiju of Daming Prefecture.
Add Hezi (Terminalia chebula) to Jiegeng Tang (Platycodon Decoction), with equal proportions of raw and processed herbs. Grind into a fine powder. Take after meals, mixed with boiling water. It is also known as "Tie Jiao Zi Ru Sheng Tang" (Iron Voice Like Sage Decoction).
Shi Yuanduan's Effective Formulas. Jugan Tang (Citrus and Licorice Decoction) treats a sensation of blockage in the throat, coughing up pus or blood.
Add Ju Pi (Citri Reticulatae Pericarpium), Ban Xia (Pinelliae Rhizoma), and Sheng Jiang (Zingiberis Rhizoma Recens) to Jiegeng Tang (Platycodon Decoction). Decoct in water and take.
From *Bei Yu Bai Yao* (Preparedness for a Hundred Emergencies). For Hou Bi (Acute Throat Obstruction), where food and drink cannot pass, causing extreme distress. (This is Jiegeng Tang [Platycodon Decoction]). Also treats Ma Hou Bi (Equine Throat Bi). (Horses have long necks; thus, any Bi syndrome occurring deep within the neck, invisible externally, characterized by deep swelling extending to surrounding areas, high fever, and rapid breathing, is this condition.)
From *Yi Lei Yuan Rong* (Source of Medical Fortresses). Zhang Zhongjing's example of Ganjie Tang (Licorice and Platycodon Decoction), also known as Emperor Renzong's Ru Sheng Tang (Like Sage Decoction), treats Shaoyin throat pain. Zhi Gancao (Processed Glycyrrhizae Radix et Rhizoma) 1 liang, Jiegeng (Platycodonis Radix) 3 liang. Coarsely powdered, decoct in water. Adding Sheng Jiang (Zingiberis Rhizoma Recens) during decoction is also acceptable. Another method: add He Zi Pi (Terminaliae Chebulae Pericarpium) 2 qian, decoct, remove dregs, and drink while warm. Named Hezi San (Terminalia Powder), treats aphonia. If accompanied by cough and rebellious Qi, add Chen Pi (Citri Reticulatae Pericarpium). If with phlegm-cough, add Zhi Mu (Anemarrhenae Rhizoma) and Bei Mu (Fritillariae Bulbus). If due to alcohol toxicity, add Ge Gen (Puerariae Lobatae Radix). If with shortness of breath, add Ren Shen (Ginseng Radix) and Mai Men Dong (Ophiopogonis Radix). If spitting pus and blood, add Zi Wan (Asteris Radix). If with epidemic toxin swelling, add Niu Bang Zi (Arctii Fructus) and Da Huang (Rhei Radix et Rhizoma). If with cough and thirst, add Wu Wei Zi (Schisandrae Fructus). If vomiting, add Sheng Jiang (Zingiberis Rhizoma Recens) and Ban Xia (Pinelliae Rhizoma). If eyes are red, add Zhi Zi (Gardeniae Fructus) and Da Huang (Rhei Radix et Rhizoma). If chest and diaphragm feel obstructed, add Zhi Ke (Aurantii Fructus). If insomnia, add Zhi Zi (Gardeniae Fructus). If chest and heart feel stifled, add Zhi Shi (Aurantii Fructus Immaturus). If skin pain, add Huang Qin (Scutellariae Radix). If face and eyes are swollen, add Fu Ling (Poria). If throat pain, add Niu Bang Zi (Arctii Fructus) and Zhu Ru (Bambusae Caulis in Taeniam). If Fei Wei (Lung Withering), add E Jiao (Colla Corii Asini), which can replenish Qi. If manic, add Fang Feng (Saposhnikoviae Radix) and Jing Jie (Schizonepetae Herba). If voice cannot emerge, add Ban Xia (Pinelliae Rhizoma).
Xue's Medical Cases. Wang Yongzhi, a military officer, had irregular diet and lifestyle, resulting in cough and expectoration. He used phlegm-resolving (dispersing) medicines. It was mid-summer; his pulse was surging and rapid but weak. His chest was full, face red, sputum foul-smelling, and sweating profusely. I said: This is a pattern of water overflowing transforming into phlegm. Using the previous dispersing agents constitutes a second loss of body fluids. Could it not be Fei Yong (Lung Abscess)? He did not believe me and continued taking the previous medicine. The next day, he indeed expectorated pus. The pulse was rapid, especially at the left and right Cun positions. Only then did he trust it. One dose of Jiegeng Tang (Platycodon Decoction) stopped the pus quickly; two doses stopped it completely. His complexion turned pale instantly, yet he remained anxious. I said: In this pattern, a pale complexion and choppy pulse indicate it will heal spontaneously even if untreated. I prescribed the previous medicine again, combined with Liu Wei Wan (Six-Ingredient Pill with Rehmannia), and he recovered.
Shaoyin disease, where the throat is injured and sores form, preventing speech and voice production, is primarily treated with Ku Jiu Tang (Bitter Wine Decoction).
[Qian] Predecessors noted three different treatment methods for a single throat sore, leading to much debate. They failed to realize that one type of throat pain involves mild Shaoyin pathogenic factors, so only Gan Jie Tang (Licorice and Platycodon Decoction) is used to harmonize. Another type involves unresolved meridian pathogens, pain in the throat, and lock-up by phlegm-heat, so Ban Xia (Pinelliae Rhizoma) is used to resolve phlegm and Gui Zhi (Cinnamomi Ramulus) to dissipate exterior pathogens. This case involves sores already formed in the throat, inability to speak or produce sound, indicating the pathogen has deeply penetrated, Yin fire is blazing, and the throat is damaged. Exterior treatment is unnecessary, and simple harmonization is ineffective. Therefore, Ku Jiu Tang (Bitter Wine Decoction) is used. Ban Xia (Pinelliae Rhizoma) resolves throat obstruction; Ji Zi Bai (Album Ovi Galli) moistens the throat and lubricates orifices, clearing Qi and removing latent heat. All employ methods to open, resolve, moisten, and guide downward. Since it is ultimately latent heat in the Yin meridians, even though Yin fire rebels upward, cold-natured drugs must absolutely not be used dominantly. [Wang] Someone asked: When Zhongjing says throat pain, the throat is for swallowing food; what does it have to do with the larynx, hence the statement about inability to speak? I answered: The larynx and throat are adjacent. When Zhongjing speaks of Shaoyin heat-type throat pain, the larynx is included within it.
Ku Jiu Tang (Bitter Wine Decoction) Formula
Ban Xia (Pinelliae Rhizoma) (Washed, broken like a jujube pit, 14 pieces. *Yuhan*, *Chengben*: character "Da" under "He". *Shenqiao Wanquan Fang*: 7 pieces, washed, cut, broken into 14 slices.) Ji Zi (Egg) (One piece, remove yolk, place Ku Jiu (Bitter Wine/Vinegar) into the eggshell. *Yuhan*: No "Shang" character. "Zhe" made "Yu". *Qianjin Yi*: Top and bottom, character "Hao".)
Take the above two ingredients, place Ban Xia (Pinelliae Rhizoma) in Ku Jiu (Bitter Wine/Vinegar). Place the eggshell in a knife ring, set on fire, boil three times. Remove dregs, hold small amounts in mouth and swallow slowly. If not healed, prepare three more doses.
(*Yuhan*: No "Zhe" character. *Chengben*, *Yuhan*: "Huan" made "...". *Yuhan*: "Shao Shao" made "Xi" character. *Yuhan*: No "San Ji" characters. *Qianjin Yi*: Under "Ji", character "Yu". *Quan Shu*: Under "Ji", characters "Fu Zhi". *Shengji Zonglu*: "Zhi Dao Huan Zhong" made "Fang Jian Dao Huan Zhong".)
[Qian] Ban Xia (Pinelliae Rhizoma) opens the knot of phlegm-heat in the Upper Jiao; Album Ovi Galli (Egg White) clears Qi and treats latent heat; Ku Jiu (Bitter Wine/Vinegar) is sour, causing the excessive heat Qi in Yin to converge and descend. Today, actors often eat raw egg white when hoarse, and their voice returns; this is the legacy of this formula. [Jian] Ban Xia (Pinelliae Rhizoma) washes away saliva; Egg White heals sores; Ku Jiu (Bitter Wine/Vinegar) reduces swelling. Thus the throat becomes clear and voice emerges.
Note from *Huo Ren Shu* (Book Reviving People): Ku Jiu (Bitter Wine) is Mi Cu (Rice Vinegar). It originates from Tao Hongjing's commentary in Ben Cao. Wang Shi says: Note Ku Jiu, Ben Cao notes say Xi (Vinegar), and Cheng Shi again says the acidity of Ku Jiu. I consider both names inaccurate. How do we know wine with a bitter taste cannot treat throat pain? Examining Ben Cao, Cu (Vinegar), Xi (Vinegar), and Ku Jiu (Bitter Wine) are all one substance. Tao says it is called Ku Jiu because of its bitter taste. I do not know on what basis Wang Shi has this theory. Also, Wang Shi says: "Shang Ku Jiu" (Superior Ku Jiu), the character "Shang" has no anchor here; it should be corrected. I do not know "Shang" means superior quality. *Qianjin Yi* writes "Shang Hao Ku Jiu" (Superior Good Ku Jiu), which proves this.
*Waitai Miyao* (Essential Prescriptions from the Golden Cabinet) citing *Gu Jin Lu Yan* (Recorded Experiences Through Generations) Ji Zi Tang (Egg Decoction), treating Hou Bi (Throat Bi). Ban Xia Mo (Pinelliae Rhizoma Powder), 1 Fang Cun Bi. Take the above one ingredient. Open the head of the egg, remove yolk and white inside. Fill with pure Ku Jiu (Bitter Wine/Vinegar) until slightly full. Add Ban Xia Mo (Pinelliae Rhizoma Powder) inside, stir to mix with egg. Place in a knife ring to stabilize. Boil over charcoal fire. When medicine is ready, place in cup. Swallow slowly when warm. Swelling will decrease immediately. *Zhou Hou Bei Ji Fang* (Handbook of Prescriptions for Emergencies) Wen Zhong version is identical. This is the same as Zhongjing's Ku Jiu Tang (Bitter Wine Decoction). Ban Xia (Pinelliae Rhizoma) should not be powdered; cutting it is sufficient.
*Sheng Hui Fang* (Holy Grace Formulas). Treats sensation of foreign body in throat, unable to swallow saliva. Should take this formula. Ban Xia (Pinelliae Rhizoma) 17 pieces, broken like chess pieces size. Wash seven times with hot water to remove slipperiness. Take one Ji Zi (Egg), break its head, remove yolk and white. Insert Ban Xia (Pinelliae Rhizoma), pour in vinegar, fill the shell. Simmer over low heat. Remove Ban Xia (Pinelliae Rhizoma). Wait until cold/frozen, then drink. Will heal.
*Sheng Ji Zong Lu* (General Records of Holy Emergency). Treating Gou Yan (Dog Throat/Severe Laryngeal Obstruction), Ji Zi Method. Ban Xia Mo (Pinelliae Rhizoma Powder) 1 qian. Mix with Jiang Zhi (Ginger Juice) to make pills, bake dry, grind fine. One Ji Zi (Egg). Take the above two ingredients. First open egg head, remove yolk. Fill half with Ku Jiu (Bitter Wine/Vinegar). Add Ban Xia Mo (Pinelliae Rhizoma Powder) into shell. Stir evenly. Place egg, sit in ash fire. Slowly boil until cooked. Remove. Let cool slightly. Drink in three warm portions from the shell.
Shaoyin disease, throat pain, is primarily treated with Ban Xia San (Pinellia Powder) and Tang (Decoction). (*Waitai*: "Yan Zhong" made "Yan Hou".)
[Jian] Shaoyin disease, Yan Tong (Throat Pain), refers to pain in one spot, either left or right. Yan Zhong Tong (Throat Center Pain) refers to pain throughout the throat. It is more severe than Yan Tong (Throat Pain); severe cases involve saliva entangling the throat.
Therefore, primarily use Ban Xia San (Pinellia Powder) to disperse wind pathogen and expel saliva.
Ban Xia San (Pinellia Powder) and Tang (Decoction) Formula
Ban Xia (Pinelliae Rhizoma) (Washed) Gui Zhi (Cinnamomi Ramulus) (Remove bark) Gan Cao (Glycyrrhizae Radix et Rhizoma) (Roasted)
Take the above three ingredients in equal parts. Sift separately, then mix. Combine with Bai Yin (Rice Decoction) and take 1 Fang Cun Bi, three times daily. If powder form cannot be taken, use 1 Sheng water, boil seven times, add two Fang Cun Bi of powder, boil three more times. Remove fire, let cool slightly. Hold small amounts in mouth and swallow slowly. Ban Xia (Pinelliae Rhizoma) is toxic; should not be taken as powder. ("Shang", *Chengben*: "Yi Shang" two characters. *Yuhan*: "Yi Er" two characters. *Quan Shu*: "Yi Liang" two characters. "Geng Zhu", *Yuhan*, *Chengben*: "Geng Jian". *Yuhan*, *Chengben*: No "Ban Xia You Du Bu Dang San Fu" eight characters.)
[Qian] Yan Zhong Tong (Throat Center Pain) indicates Yang pathogen is heavier. Therefore, use the acrid and slippery nature of Ban Xia (Pinelliae Rhizoma) to benefit the throat and open sticky fluid. Still use Gui Zhi (Cinnamomi Ramulus) to resolve Wind pathogen in the Wei level. Use Gan Cao (Glycyrrhizae Radix et Rhizoma) to harmonize.
*Huo Ren Shu* (Book Reviving People) states: Ban Xia Gui Zhi Gan Cao Tang (Pinellia, Cinnamon Twig, and Licorice Decoction) treats Fu Qi Bing (Latent Qi Disease). It refers to sudden cold invading unexpectedly, latent Qi in Shaoyin Meridian. Initially no symptoms appear; after ten days or a month, it manifests. Pulse becomes weak and thin. Legally, first throat pain appears, resembling Taiyang Cold Damage, but it is not Yan Bi (Throat Obstruction). Subsequently, diarrhea must occur. Start with Ban Xia Gui Zhi Gan Cao Tang (Pinellia, Cinnamon Twig, and Licorice Decoction). Then Si Ni San (Frigid Extremities Powder). This disease heals in two days. Ancient formulas call it Shen Shang Han (Kidney Cold Damage).
Make this formula into a Tang (Decoction), add four slices of Sheng Jiang (Zingiberis Rhizoma Recens), decoct and take.
Shaoyin disease, diarrhea, is primarily treated with Bai Tong Tang (White Pass Decoction).
[Qian] Diarrhea has occurred frequently, belonging essentially to Shaoyin. Lower Jiao Clear Yang fails to ascend; Stomach Yang Qi fails to guard. There were previously no uses of Bai Tong Tang (White Pass Decoction). This clause only mentions diarrhea, yet uses Bai Tong Tang (White Pass Decoction) because of the preceding three characters "Shaoyin Bing" (Shaoyin Disease). Thus we know there are Shaoyin patterns such as Wei Xi Mai (Weak and Thin Pulse), Dan Yu Mei (Only Desire to Sleep), and Shou Zu Jue (Cold Extremities). Observing the following text: "Diarrhea with Wei Mai (Weak Pulse), then give Bai Tong Tang (White Pass Decoction)," confirms this. If diarrhea does not stop, and there are cold extremities and no pulse, adding Zhu Dan (Pig Bile) and Ren Niao (Human Urine) further confirms it is not ordinary diarrhea. Essentially, Bai Tong Tang (White Pass Decoction) is Si Ni Tang (Frigid Extremities Decoction), but replacing Gan Cao (Glycyrrhizae Radix et Rhizoma) with Cong Bai (Allii Fistulosi Bulbus). Gan Cao (Glycyrrhizae Radix et Rhizoma) slows rebellious Yin Qi, harmonizes Ginger and Aconite, and protects the Middle Jiao. Cong Bai (Allii Fistulosi Bulbus) is acrid, promotes Qi movement, can circulate Yang Qi, and dissipate Cold pathogen. Comparing the two, one is slow, one is fast; thus their treatments differ significantly in urgency.
Note: Ke Shi deleted this clause due to sparse symptom-treatment description.
Bai Tong Tang (White Pass Decoction) Formula
Cong Bai (Allii Fistulosi Bulbus) (Four stems) Gan Jiang (Zingiberis Rhizoma) (1 liang) Fu Zi (Aconiti Lateralis Radix Praeparata) (One piece, raw, remove skin, break into eight pieces. *Chengben*, *Yuhan*: Character "You" under "Sheng".)
Take the above three ingredients, use 3 Sheng water, boil to obtain 1 Sheng. Remove dregs. Divide into two warm doses.
[Fang] Using Cong Bai (Allii Fistulosi Bulbus), named Bai Tong (White Pass), means passing Yang Qi, thus Yin naturally dissipates.
*Zhou Hou Bei Ji Fang* (Handbook of Prescriptions for Emergencies) Bai Tong Tang (White Pass Decoction), treats Chang Han Xie Li Bu Yi (Cold Damage Diarrhea Unceasing), Kou Ke Bu De Xia Shi (Thirst Unable to Eat), Xu Er Fan (Deficiency with Vexation) formula.
It is this formula: Use Cong Bai (Allii Fistulosi Bulbus) 14 stems, Gan Jiang (Zingiberis Rhizoma) 0.5 liang, plus Gan Cao (Glycyrrhizae Radix et Rhizoma) 0.5 liang roasted. Post-formula note: If thirsty, slight vomiting, Water retention in Xin Xia (Epigastrium), another formula adds Xi Jiao (Rhinocerotis Cornu) 0.5 liang, very effective.
Shaoyin disease, diarrhea with Wei Mai (Weak Pulse), give Bai Tong Tang (White Pass Decoction). If diarrhea does not stop, cold extremities, no pulse, dry vomiting, vexation, is primarily treated with Bai Tong Jia Zhu Dan Huang Tang (White Pass Decoction with Pig Bile and Human Urine). After taking the decoction, if Mai Bao Chu (Pulse suddenly emerges) death; Wei Xu (Gradually continues) life.
[Yin] Shaoyin disease, diarrhea, Yin-Cold is below. Wei Mai (Weak Pulse), pathogen is below, generating Yang Qi is weak. Thus should use Bai Tong Tang (White Pass Decoction) to connect Yang Qi from exterior and upper, descending to assist below. If diarrhea does not stop, Yin Qi leaks and desires to collapse downward. Dry vomiting and vexation, Yang has no attachment and desires to collapse upward. Cold extremities and no pulse, Yin and Yang Qi do not intersect. Thus should use Bai Tong Tang (White Pass Decoction) to pass Yang. Add Shui Chu Zhi Dan (Bile of Water Animal/Pig) to guide Yang Qi from Yin upward. Take Ren Niao (Human Urine) ability to follow old pathways, guiding Yang Qi down to connect. Yin and Yang harmonize, and Yang Qi recovers. [Fang] Bao Chu (Sudden emergence) is like a candle about to burn out but flame flares brightly. Wei Xu (Gradual continuation) is True Yang returning and gradually recovering.
*Shang Han Lei Fang* (Classification of Cold Damage Formulas) says: Bao Chu (Sudden emergence) is forced by medicinal power; when power ends, Qi still perishes. Wei Xu (Gradual continuation) is Zheng Qi (Upright Qi) self-recovering, thus life is possible. Previously said "Mai Ji Chu Zhe Yu" (Pulse immediately emerging indicates healing); here says "Bao Chu Zhe Si" (Sudden emergence indicates death). The difference between Bao Chu (Sudden emergence) and Ji Chu (Immediate emergence) is distinct. Bao Chu (Sudden emergence) empties out all at once. Ji Chu (Immediate emergence) means shortly after taking medicine, it slowly and gradually continues. Must understand well.
Bai Tong Jia Zhu Dan Huang Tang (White Pass Decoction with Pig Bile and Human Urine) Formula
Cong Bai (Allii Fistulosi Bulbus) (Four stems) Gan Jiang (Zingiberis Rhizoma) (1 liang) Ren Niao (Human Urine) (5 He) Zhu Dan Huang (Pig Bile) (1 He) Fu Zi (Aconiti Lateralis Radix Praeparata) (One piece, raw, remove skin, break into eight pieces. Under "Sheng", *Zongyin* and Xi Ju version have "You" character, correct.)
Take the above five ingredients, use 3 Sheng water, boil to obtain 1 Sheng. Remove dregs. Add Dan Huang (Bile and Urine), mix well. Divide into two warm doses. If no bile, also usable. (*Chengben*: "Shang" makes "Yi Shang" two characters. "Wu Wei" makes "San Wei", incorrect.)
[Zhi] Initially diarrhea, subsequently diarrhea unceasing. Initially Wei Mai (Weak Pulse), subsequently cold extremities and no pulse. Plus dry vomiting and mental vexation, indicates Yin-Yang and Water-Fire both exhausted, failing to interact and assist each other. Thus use Bai Tong Jia Zhu Dan Huang Tang (White Pass Decoction with Pig Bile and Human Urine). Pig is a Water Animal, Gallbladder contains essence juice, can nourish Shaoyin and assist dry vomiting. Ren Niao (Human Urine) is drink entering Stomach, Water Essence distributes four directions, Five Meridians run together, can supplement Middle Earth and harmonize cold extremities. Middle Earth assists each other, thus vexation and vomiting remove themselves. [Wang] According to post-formula note: "If no bile, also usable," indicates focus is on Ren Niao (Human Urine). Formula should be named Bai Tong Jia Ren Niao Tang (White Pass Decoction with Human Urine) to be appropriate.
Shaoyin disease, two to three days not resolving, reaching four to five days, Abdominal Pain, Xiao Bian Bu Li (Urination Difficult), Si Zhi Chong Zhong Teng Tong (Heavy and Painful Limbs), Zi Xia Li (Spontaneous Diarrhea), this is having Shui Qi (Water Pathogen). Some may have Ke (Cough), or Xiao Bian Li (Urination Frequent/Easy), or Xia Li (Diarrhea), or Ou (Vomiting), primarily treated with Zhen Wu Tang (True Warrior Decoction). ("Zi Xia Li", *Yuhan*: "Er Li". Under "Li", no "Zhe" character. "Xiao Bian Li" made "Xiao Bian Zi Li". *Qianjin* and *Yi*: "Zhen Wu Tang" made "Xuan Wu Tang".)
[Jian] In the discussion, Xin Xia (Epigastrium) has Shui Qi (Water Pathogen), Fa Re (Fever) with Han (Sweat), Fan Ke (Vexation and Thirst) drinking water, Xiao Bian Bu Li (Urination Difficult), belongs to Taiyang Feng Zhong (Wind Strike), Wu Ling San (Five-Ingredient Powder with Poria) pattern. Fa Re (Fever) without Han (Sweat), Gan Ou (Dry Vomiting) without Ke (Thirst), Xiao Bian Bu Li (Urination Difficult), belongs to Taiyang Shang Han (Cold Damage), Xiao Qing Long Tang (Minor Blue Dragon Decoction) pattern. Now Shaoyin disease, two to three days not resolving, reaching four to five days, Abdominal Pain and Xia Li (Diarrhea), Yin-Cold is deep. If Xiao Bian Li (Urination Frequent/Easy), it is Pure Cold without Water,乃 Fuzi Tang (Aconite Decoction) pattern. Now Xiao Bian Bu Li (Urination Difficult), or Ke (Cough) or Ou (Vomiting), this is Yin-Cold combined with Shui Qi (Water Pathogen). Thus Water-Cold Qi attacks exterior, causing Si Zhi Chong Zhong Teng Tong (Heavy and Painful Limbs). Accumulates internally, causing Abdominal Pain and Zi Xia Li (Spontaneous Diarrhea). Shui Qi (Water Pathogen) stops in Upper Jiao Chest-Lungs, causing Ke Chuan (Cough and Wheezing) inability to lie down. Stops in Middle Jiao Stomach, causing Ou (Vomiting) or Xia Li (Diarrhea). Stops in Lower Jiao Bladder, causing Xiao Bian Bu Li (Urination Difficult) and possibly Xiao Fu Man (Lower Abdominal Fullness). Various symptoms all stem from Yin-Cold Water. Not using Wu Ling San (Five-Ingredient Powder with Poria) because it is not Exterior-Heat Fluid. Not using Xiao Qing Long Tang (Minor Blue Dragon Decoction) because it is not Exterior-Cold Fluid. Thus only primarily use Zhen Wu Tang (True Warrior Decoction) to Warm Cold to Control Water. [Wang] "Or Xia Li (Diarrhea)" refers to previous Zi Xia Li (Spontaneous Diarrhea) being the two-to-three-day pattern. This must refer to previously no diarrhea, pointing to diarrhea starting after four-to-five days.
Zhen Wu Tang (True Warrior Decoction) Formula
Fu Ling (Poria) (3 liang) Shao Yao (Paeoniae Radix Alba) (3 liang) Bai Zhu (Atractylodis Macrocephalae Rhizoma) (2 liang. *Waitai*: 3 liang.) Sheng Jiang (Zingiberis Rhizoma Recens) (3 liang, sliced) Fu Zi (Aconiti Lateralis Radix Praeparata) (One piece, prepared, remove skin, break into eight pieces)
Take the above five ingredients, use 8 Sheng water, boil to obtain 3 Sheng. Remove dregs. Warm take 7 Ge, three times daily. If Ke (Cough), add Wu Wei Zi (Schisandrae Fructus) 0.5 Sheng, Xi Xin (Asari Radix et Rhizoma) 1 liang, Gan Jiang (Zingiberis Rhizoma) 1 liang. If Xiao Bian Li (Urination Frequent/Easy), remove Fu Ling (Poria). If Xia Li (Diarrhea), remove Shao Yao (Paeoniae Radix Alba), add Gan Jiang (Zingiberis Rhizoma) 2 liang. If Ou (Vomiting), remove Fu Zi (Aconiti Lateralis Radix Praeparata), add Sheng Jiang (Zingiberis Rhizoma Recens), sufficient to reach half jin before. (*Waitai*: Under "Wu Wei", character "Qie". *Chengben*: Under "Xi Xin", no "Yi Liang" two characters. Under "Gan Jiang", character "Ge". *Qianjin Yi*: Under "Ban Jin", characters "Li Bu Zhi Bian Nong Xue Zhe, Yi Tao Hua Tang" eleven characters.)
[Zhang] This formula originally treats Shaoyin disease with internal accumulation of Water-Fluid. Hence prioritizing Zhu (Atractylodes) and Fu (Aconite), combining Fu Ling (Poria) and Sheng Jiang (Zingiberis Rhizoma Recens) to transport Spleen and渗 Water. This is easily understood by people. The subtle purpose of using Shao Yao (Paeoniae Radix Alba) requires a sage. Although this pattern is called Shaoyin original disease, it actually arises from internal accumulation of Water-Fluid, hence Abdominal Pain, spontaneous diarrhea, heavy painful limbs, and conversely Xiao Bian Bu Li (Urination Difficult). If extremely deficient and extremely cold, Xiao Bian (Urination) must be clear white and uncontrollable. How could it conversely be difficult? Thus we know this person not only has insufficient True Yang, but also chronically deficient True Yin. If not using Shao Yao (Paeoniae Radix Alba) to protect Yin, how can it withstand the fierce nature of Fu Zi (Aconiti Lateralis Radix Praeparata)? Just like Fuzi Tang (Aconite Decoction), Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite), Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction), all use Shao Yao (Paeoniae Radix Alba) with Fu Zi (Aconiti Lateralis Radix Praeparata). Their method of warming meridians and protecting Ying is similar to preserving Yin and restoring Yang. How many in later generations obtained Zhongjing's heart method? [Zhi] Bai Tong (White Pass), Tong Mai (Pulse-Passing), Zhen Wu (True Warrior), all established for Shaoyin diarrhea. Bai Tong (White Pass), Si Ni (Frigid Extremities), Fu Zi (Aconiti Lateralis Radix Praeparata) all used raw. Only Zhen Wu (True Warrior) pattern uses prepared. Raw Fu Zi (Aconiti Lateralis Radix Praeparata) warms meridians and dissipates cold. Prepared Fu Zi (Aconiti Lateralis Radix Praeparata) warms middle and removes fluid. Bai Tong (White Pass) formulas prioritize passing Yang. Zhen Wu Tang (True Warrior Decoction) prioritizes benefiting Yang. Thus medication has differences in weight. Gan Jiang (Zingiberis Rhizoma) assists raw Fu Zi (Aconiti Lateralis Radix Praeparata) to warm meridians. Sheng Jiang (Zingiberis Rhizoma Recens) aids prepared Fu Zi (Aconiti Lateralis Radix Praeparata) to dissipate fluid. [Qian] Modification methods were added by later vulgar doctors. Observing their textual flaws, hating purple confusing red, thus pointing out errors one by one, making learners distinguish clearly. (Now based on text HT, not recorded here. Wang Shi cites Wuling Chen Shi also saying: Modification methods are attached by later people, not Zhongjing's original text.)
Wang Shi Yi Jian Fang (Simple Formulas by Wang). This medicine is not only suitable for Yin-pattern Cold Damage, but also for Xu Lao (Deficiency Consumption) patients with aversion to cold and high fever, cough, and diarrhea; all should take it. Hence renamed Gu Yang Tang (Solidify Yang Decoction), additions and subtractions exactly as previous methods. Nowadays, people seeing cold and heat mostly use Di Huang (Rehmanniae Radix), Dang Gui (Angelicae Sinensis Radix), Lu Rong (Cervi Cornu Pantotrichum) etc., tonifying essence and blood. Little do they know these medicines are mostly sweet, tending to linger in the chest. If Spleen and Stomach are substantially solid, taking them can nourish. However, still fear damaging Stomach Qi due to timing. Stomach is Official of Granaries, receiving grain and water. Five Zang organs all take Qi from Stomach. So-called essence, blood, and Qi all arise from Gu Qi (Grain Qi). If using Di Huang (Rehmanniae Radix) etc., not seeing blood generation, Gu Qi (Grain Qi) is already damaged first. Sun Zhao said tonifying Kidney is inferior to tonifying Spleen, precisely referring to this. Thus better to use Gu Yang Tang (Solidify Yang Decoction) to regulate cold and heat, not damaging Spleen. Diet not decreasing, then essence and blood generate themselves.
*Zhi Fang* (Directing Guide Formulas). Treating Shaoyin Kidney pattern, Water-Fluid combined with Interior Cold, acting together to cause cough, Abdominal Pain, and diarrhea.
On this formula, add Gan Jiang (Zingiberis Rhizoma), Xi Xin (Asari Radix et Rhizoma), Wu Wei Zi (Schisandrae Fructus). Generally applicable for elderly with weak Qi and chronic cough. Still intermittently take Yang Zheng Dan (Nourish Righteousness Pill).
*Yi Shi* (Medical History). Zhu You wrote Biography of Ying Ning Sheng: Song Keyu with maternal relatives, in summer month, body cold, spontaneous sweat, dry mouth, vexation, wanting to lie in mud water. Boren diagnosed his pulse, floating and rapid, sinking revealed empty and scattered. Said: *Su Wen* says: Pulse arrives following, pressing does not drum, all Yang are like this. This is Yin excess separating Yang. Caused by eating cold/raw foods, sitting/lying in wind/dew. Decoct Zhen Wu Tang (True Warrior Decoction), drink frozen/cold. First dose stops sweat, second dose removes vexation, third dose recovers as before. Yu Zi Yuan suffered aversion to cold and trembling, holding grasp uncertain, both hands soaked in cold sweat, even thick clothes and intense fire could not resolve. Boren immediately gave Zhen Wu Tang (True Warrior Decoction), using six pieces of Fu Zi (Aconiti Lateralis Radix Praeparata). One day patient suddenly exited, people wondered. Patient said: I am no longer averse to cold, then nothing wrong. Someone asked Boren. Boren said: Pulse both hands are Chen Wei (Deep and Weak), rest no exterior-interior patterns, this is body deficiency receiving cold, extreme loss of Yang. Initially skin surface Qi tunnels, blocked by Cold pathogen, Yang cannot extend, thus so. Therefore Blood tunnel Heat blockage, must use Xiao Huang (Mirabilite and Rhubarb). Qi tunnel Cold blockage, must use Gui Fu (Cinnamon and Aconite). Different uses of Yin and Yang are differences of formless and formed.