少阴病。得之二三日。口燥咽干者。急下之。宜大承气汤。
此少阴热并阳明之证。二三日。为病未久。而便口燥咽干。热气盛而阴气少矣。盖阳明、土。少
阴、水。热并
阳明。则土实而水虚。不特热气伤阴。即土气亦伤水也。故宜急下。以泻土而全水。不然。热盛
伤阴。土实亦伤阴。其干槁可立而待。然非心下痛。腹胀不大便。如下二条所云。亦未可以大承气
轻试也。
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。
此亦少阴热并阳明。而气复下注之证。然虽下注而邪实不去。但水液从旁下转。为自利清水而
已。故心下痛而口干燥也。色纯青者。土受水邪。玄黄合色。而色转纯青也。以大承气急下。则胃
实去而肾病亦已矣。
少阴病。六七日。腹胀不大便者。急下之。宜大承气汤。
腹胀不大便。土实之征也。土实则水干。故非急下不可。夫阳明居中。土也。万物所归。故无
论三阳三阴。其邪皆得还入于胃。而成可下之证。然太阴传阳明。脏邪还腑。为欲愈也。厥阴传阳
明者。木邪归土。不能复木也。惟少阴则肾邪入胃。而胃实复将消肾。故虽并用下法。而少阴之
法。视太阴厥阴为加峻矣。
少阴病。始得之。反发热。脉沉者。麻黄附子细辛汤主之。
此寒中少阴之经。而复外连太阳之证。以少阴与太阳为表里。其气相通故也。少阴始得本无热
。而外连太阳则反发热。阳病脉当浮而仍紧。少阴则脉不浮而沉。故与附子、细辛。专温少阴之经
。麻黄兼发
太阳之表。乃少阴经温经散寒。表里兼治之法也。
麻黄附子细辛汤方
麻黄（二两去节） 附子（一枚炮去皮破八片） 细辛（二两）
上二味。以水一斗。先煮麻黄。减二升。去上沫。纳诸药。煮取三升。去滓。温服一升。日三
服。
按阳证有在经不在腑者。阴病亦有在经不在脏者。太阳篇云、脉浮者。桂枝汤。少阴篇、始得
之、反发热脉沉者。麻黄附子细辛汤。及得之二三日。麻黄附子甘草汤。厥阴篇、厥阴中风。脉微
浮为欲愈。此皆阴病之在经。而未入于脏者。
少阴病。得之二三日。麻黄附子甘草汤微发汗。以二三日无里证。故微发汗也。
少阴中寒二三日。为脉沉恶寒无热之时。故可与麻黄附子甘草汤。以取微汗而散寒邪。无里证
者。无吐利心烦不得卧等证也。以二三日病未入脏。而寒亦未变热。故得用温经散邪之法。如麻黄
附子细辛之例。然去细辛之辛。而加甘草之甘。于法为较和矣。所以然者。寒邪不可不发。而阴病
又不可过发耳。
麻黄附子甘草汤方
麻黄（二两去节） 附子（一枚炮去皮） 甘草（二两炙）
上三味。以水七升。先煮麻黄一二沸。去上沫。纳诸药。煮取三升。去滓。温服一升。日三服
。
少阴病。得之一二日。口中和。其背恶寒者。当灸之。附子汤主之。
口中和者。不燥不渴。为里无热也。背恶寒者。背为阳。而阴乘之。不能通于外也。阳不通。
故当灸之以通阳。痹阳不足。故主附子汤以补阳虚。非如麻黄附子细辛之属。徒以温散为事矣。此
阳虚受寒。而虚甚于寒者之治法也。
按元和纪用经云、少阴中寒而背恶寒者。口中则和。阳明受热而背恶寒者、则口燥而心烦。一为
阴寒下乘。阳气受伤。一为阳热入里。津液不足。是以背恶寒虽同。而口中和与燥则异。此辨证之
要也。
附子汤方
附子（二枚炮去皮破八片） 茯苓 芍药（各三两） 人参（二两） 白术（四两）
上五味。以水八升。煮取三升。去滓。温服一升。日三服。
气虚者。补之必以甘。气寒者。温之必以辛。甘辛合用。足以助正气而散阴邪。人参、白术、
茯苓、附子是也。而病属阴经。故又须芍药以和阴气。且引附子入阴散寒。所谓乡导之兵也。
少阴病。身体痛。手足寒。骨节痛。脉沉者。附子汤主之。
身体痛。骨节痛。寒在阴也。手足寒。脉沉。病属阴也。若脉浮而手足热。则为太阳伤寒。
可与汗解者矣。此为少阴血气不足。而寒邪侵之之证。故亦宜附子汤。复阳散阴。益精气也。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。
少阴中寒。二三日不已。至四五日。邪气递深而脏受其病矣。脏寒故腹痛。寒胜而阳不行。故小便不利。于是水寒
相抟。浸淫内外。为四肢沉重疼痛。为自下利。皆水气乘寒气而动之故也。其人或咳。或小便利。或下利。或呕者。水
寒之气。或聚或散或上。
真武汤方 方见太阳斡旋法。三服后加减法。
若咳者。加五味子半升。细辛、干姜各一两。
咳者。水寒射肺。气逆而不下也。成氏曰。五味子之酸。以收逆气。细辛、干姜之辛。以散水寒。若小便利者。去
茯苓。
小便利者。水已下趋。不必更利其水。故去茯苓。
若下利者。去芍药。加干姜二两。
下利者。寒盛于内也。故去芍药加干姜。避寒而就温也。
若呕者。去附子加生姜。足前成半斤。
呕者。气逆于上也。故去附子。加生姜。二物辛热则同。而生姜善降逆。附子能行而不能下。则不同也。少阴病。
下利清谷。里寒外热。手足厥逆。脉微欲绝。身反不恶寒。其人面赤色。或腹痛。或干呕。或咽痛。或利
止脉不出者。通脉四逆汤主之。
此寒中少阴。阴盛格阳之证。下利清谷。手足厥逆。脉微欲绝者。阴盛于内也。身热不恶寒。
面赤色者。格阳于外也。真阳之气。被阴寒所迫。不安其处。而游散于外。故显诸热象。实非热也
。通脉四逆。即四逆加干姜一倍。为阴内阳外。脉绝不通。故增辛热以逐寒邪。寒去则阳复反。
而脉复出。故曰其脉即出者愈。
通脉四逆汤方
甘草（二两炙） 附子（大者一枚生用去皮破八片） 干姜（三两强人可四两）
上三味。以水三升。煮取一升二合。去滓。分温再服。其脉即出者愈。
加减法
面色赤者。加葱九茎。
面色赤。阳格于上也。葱中空。味辛。能通阳气。
腹中痛者。去葱。加芍药二两。
腹中痛。阴滞于里也。芍药味酸。能利阴气止腹痛。故加之。葱通阳而不利阴。故去之。
呕者。加生姜二两。
呕者。阴气上逆也。生姜之辛。可散阴而降逆。
咽痛者。去芍药。加桔梗一两。
咽痛者。阳气上结也。桔梗之辛。可开阳结。去芍药者。恶其收也。
利止脉不出者。去桔梗。加人参二两。
利止脉不出。亡血也。故不利桔硬之散。而利人参之甘而能补也。
少阴病。饮食入口则吐。心中温温欲吐。复不能吐。始得之。手足寒。脉弦迟者。此胸中实
。不可下也。当吐之。若膈上有寒饮。干呕者。不可吐也。急温之。宜四逆汤。
肾者。胃之关也。关门受邪。上逆于胃。则饮食入口即吐。或心中温温欲吐。而复不能吐也。
夫下气上逆而为吐者。原有可下之例。如本论之哕而腹满。视其前后。知何部不利者而利之。金
匮之食已即吐者。大黄甘草汤主之是也。若始得之。手足寒。脉弦迟者。胸中邪实而阳气不布也。
则其病不在下而在上。其治法不可下而可吐。所谓因其高者而越之也。若膈上有寒饮而致干呕者。
则复不可吐而可温。所谓病痰饮者。当以温药和之也。故实可下。而胸中实则不可下。饮可吐。而
寒饮则不可吐。仲景立法。明辨详审如此。
少阴病。脉沉者。急温之。宜四逆汤。
此不详何证。而但凭脉以论治曰、少阴病脉沉者。急温之。宜四逆汤。然苟无厥逆恶寒下利不
渴等证。未可急与温法。愚谓学人当从全书会通。不可拘于一文一字之间者。此又其一也。
少阴病。下利。脉微涩。呕而汗出。必数更衣。反少者。当温其上。灸之。
少阴病。下利脉微涩。阴伤于下也。呕而汗出。阳虚于上也。阴虚并伤。法必上下并温矣。若更衣虽数。
而所下无多。尤为阴亡之验。是但当温其上而不可温其下。即温上之法。亦不可以药伤其阴。而但
宜灸以引其阳也。灸法未详。
少阴病。吐利。手足厥冷。烦躁欲死者。吴茱萸汤主之。
此寒中少阴。而复上攻阳明之证。吐利厥冷。烦躁欲死者。阴邪盛极而阳气不胜也。故以吴茱
萸温里散寒为主。而既吐且利。中气必伤。故以人参、大枣。益虚安中为辅也。然后条云、少阴病。
吐利烦躁。四逆者死。此复以吴茱萸汤主之者。彼为阴极而阳欲绝。此为阴盛而阳来争也。病证则
同。而辨之于争与绝之间。盖亦微矣。或云、先厥冷而后烦躁者。阳欲复而来争也。先烦躁而四逆者
。阳不胜而欲绝也。亦通。郭曰云云、四逆而烦躁者。不问其余证。先宜服吴茱萸汤。四逆而不
烦躁者。先宜服四逆汤。四逆下利脉不出者。先宜服通脉四逆汤。此三者。治少阴之大法也。
少阴病。下利。白通汤主之。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。
少阴病。下利脉微者。寒邪直中。阳气暴虚。既不能固其内。复不能通于脉。故宜姜附之辛而
温者。破阴固里。葱白之辛而通者。入脉引阳也。若服汤已。下利不止。而反厥逆无脉。干呕烦
者。非药之不中病也。阴寒太甚。上为格拒。王太仆所谓甚大寒热。必能与违性者争雄。异气者
相格也。故即于白通汤中加
人尿之咸寒。猪胆汁之苦寒。反其佐。以同其气。使不相格而适相成。内经所谓寒热温凉。反从其
病是也。脉暴出者。无根之阳。发露不遗。故死。脉微续者。被抑之阳。来复有渐。故生。
白通汤方
葱白（四茎） 干姜（一两） 生附子（一枚去皮破八片）
上三味。以水三升。煮取一升。去滓。分温再服。
白通加猪胆汁汤方
葱白（四茎） 干姜（一两） 猪胆汁（一合） 人尿（五合） 生附子（一枚去皮破八片
）
以上三味。以水三升。煮取一升。去滓。纳人尿猪胆汁。和令相得。分温再服。若无胆。亦可
用。
少阴病。下利便脓血者。桃花汤主之。少阴病。二三日至四五日。腹痛。小便不利。下利不
止。便脓血者。桃花汤主之。少阴病。下利便脓血者。可刺。
少阴病。下利便脓血者。脏病在阴。而寒复伤血也。血伤故腹痛。阴病故小便不利。与阳经挟
热下利不同。故以赤石脂理血固脱。干姜温里散寒。粳米安中益气。用刺法者。以邪陷血中。刺之
以行血散邪耳。刺法未详。
桃花汤方
赤石脂（一斤一半全用一半筛末） 干姜（一两） 粳米（一升）
上三味。以水七升。煮米令熟。去滓。温服七合。纳赤石脂末方寸匕。日三服。若一服愈。余
勿服。
少阴病，发病二三天，出现口燥咽干的症状，应当紧急使用下法治疗，适宜用大承气汤。
这是少阴热邪并入阳明的证候。发病二三天，说明病程尚短，却出现口燥咽干，表明热气亢盛而阴液亏虚。阳明属土，少阴属水，热邪并入阳明，则土气实而水气虚。这不仅热气损伤阴液，而且土气亢盛也会克制水气。因此应当紧急攻下，以泻除阳明之实土来保全少阴之水。否则，热盛伤阴，土实亦伤阴，身体干枯槁竭的局面将立刻形成。然而，如果没有心下疼痛、腹部胀满且大便不通等症状，像下面两条所述那样，也不可以轻易尝试使用大承气汤。
少阴病，自发腹泻排出清水，颜色纯青，心下部必定疼痛，口干燥的，应当紧急使用下法治疗，适宜用大承气汤。
这也是少阴热邪并入阳明，且气机向下注泄的证候。虽然气机下注，但邪气实滞并未去除，只是水液从旁侧流下，表现为自利清水罢了。所以会出现心下痛和口干燥。颜色纯青，是因为土受到水邪的影响，玄色与黄色混合，从而呈现出纯青色。使用大承气汤紧急攻下，则胃中的实邪去除，肾病的根源也随之消除。
少阴病，发病六七天，出现腹部胀满且大便不通的，应当紧急使用下法治疗，适宜用大承气汤。
腹部胀满且大便不通，是土气实滞的表现。土气实滞则水液枯竭，所以非紧急攻下不可。阳明居中焦，属土，是万物归聚之处，所以无论三阳经还是三阴经的病邪，都可以传入胃中，形成可以使用下法的证候。然而，太阴病传变为阳明病，属于脏邪传还腑，是病情向愈的表现；厥阴病传变为阳明病，属于木邪归于土，不能恢复为木性。只有少阴病，是肾邪传入胃中，胃实反过来会消损肾精。所以虽然都使用下法，但少阴病的治疗法则，比太阴和厥阴更为峻猛。
少阴病，刚发病时，反而发热，脉象沉的，用麻黄附子细辛汤主治。
这是寒邪侵入少阴经脉，同时外连太阳经的证候。因为少阴与太阳互为表里，它们的气机是相通的。少阴病初起本不应发热，但因为外连太阳，所以反而发热。阳病脉象应当浮而紧，少阴病则脉不浮而沉。所以给予附子、细辛，专门温通少阴经脉；麻黄兼发太阳之表。这是少阴经温经散寒、表里兼治的方法。
麻黄附子细辛汤方
麻黄（二两，去节） 附子（一枚，炮制，去皮，破成八片） 细辛（二两）
以上三味药，用水一斗，先煮麻黄，减少二升水量，撇去上面的浮沫，加入其他药物，煮取三升药汁，滤去药渣，每次温服一升，每日服用三次。
按：阳证有在经不在腑的，阴病也有在经不在脏的。《伤寒论·太阳篇》说：“脉浮者，桂枝汤。”《少阴篇》说：“始得之，反发热，脉沉者，麻黄附子细辛汤。”以及“得之二三日，麻黄附子甘草汤。”《厥阴篇》说：“厥阴中风，脉微浮为欲愈。”这些都是阴病在经，而未入于脏的情况。
少阴病，发病二三天，用麻黄附子甘草汤微微发汗。因为二三天没有里证，所以只微微发汗。
少阴感受寒邪二三天，正是脉沉、恶寒、无发热的时候，所以可以用麻黄附子甘草汤，通过取微汗来散除寒邪。“无里证”，是指没有呕吐、腹泻、心烦、不得卧等里证。因为二三天病邪尚未入脏，寒邪也未化热，所以可以采用温经散邪的方法，如麻黄附子细辛汤的用法。但是去掉细辛的辛烈，加上甘草的甘缓，在治法上较为平和。之所以这样，是因为寒邪不可不发，但阴病又不可过度发汗。
麻黄附子甘草汤方
麻黄（二两，去节） 附子（一枚，炮制，去皮） 甘草（二两，炙）
以上三味药，用水七升，先煮麻黄一二沸，撇去上面的浮沫，加入其他药物，煮取三升药汁，滤去药渣，每次温服一升，每日服用三次。
少阴病，发病一两天，口中感觉平和（不燥不渴），背部怕冷的，应当施以艾灸，并用附子汤主治。
口中平和，是不燥不渴，说明里没有热邪。背部怕冷，是因为背为阳气汇聚之处，阴寒乘袭，导致阳气不能通达于外。阳气不通，所以应当艾灸以通阳。阳气不足，所以主用附子汤来补益阳气。这不像麻黄附子细辛汤之类，仅仅以温散为目的。这是阳虚受寒，且虚损程度重于寒邪的治疗方法。
按：《元和纪用经》说：“少阴中寒而背部怕冷的，口中则是平和的；阳明受热而背部怕冷的，则口燥且心烦。”一个是阴寒下乘，阳气受伤；一个是阳热入里，津液不足。所以虽然都有背部怕冷，但口中平和与干燥是不同的，这是辨证的关键。
附子汤方
附子（二枚，炮制，去皮，破成八片） 茯苓 芍药（各三两） 人参（二两） 白术（四两）
以上五味药，用水八升，煮取三升药汁，滤去药渣，每次温服一升，每日服用三次。
气虚的人，补益必须用甘味药；气寒的人，温煦必须用辛味药。甘味和辛味合用，足以助长正气而驱散阴邪。人参、白术、茯苓、附子就是这样的配伍。而且病属阴经，所以还需要芍药来调和阴气，并引导附子进入阴分散寒，这就是所谓的“向导之兵”。
少阴病，身体疼痛，手足寒冷，骨节疼痛，脉象沉的，用附子汤主治。
身体痛、骨节痛，是寒邪在阴分。手足寒、脉沉，说明病属阴证。如果脉浮且手足热，那就是太阳伤寒，可以用发汗法解除。这是少阴血气不足，寒邪侵袭的证候，所以也适宜用附子汤，以回复阳气、驱散阴邪、补益精气。
少阴病，二三天未愈，到了四五天，出现腹痛，小便不利，四肢沉重疼痛，自发腹泻的，这是有水气。有的人可能咳嗽，或小便利，或腹泻加重，或呕吐的，用真武汤主治。
少阴感受寒邪，二三天未愈，到了四五天，邪气逐渐深入，脏腑受到病变影响。脏腑寒冷所以腹痛；寒气胜而阳气不行，所以小便不利。于是水寒相互搏结，浸淫内外，导致四肢沉重疼痛，导致自发腹泻，这都是水气乘着寒气而动造成的。有的人咳嗽，或小便利，或腹泻，或呕吐，是水寒之气，有的聚集，有的散开，有的向上冲逆。
真武汤方 （见太阳斡旋法章节，三服后的加减法）
如果咳嗽的，加五味子半升，细辛、干姜各一两。
咳嗽，是水寒射肺，气机上逆而不能下行。成无己说：五味子的酸味，用来收敛逆气；细辛、干姜的辛味，用来散除水寒。
如果小便利的，去掉茯苓。
小便利，说明水气已经向下趋行，不必再利水，所以去掉茯苓。
如果腹泻的，去掉芍药，加干姜二两。
腹泻，说明内部寒气盛。所以去掉芍药加干姜，避开寒凉而趋向温热。
如果呕吐的，去掉附子，加生姜，足前量至半斤。
呕吐，是气机上逆于上。所以去掉附子，加生姜。这两味药虽然都是辛热的，但生姜善于降逆，附子能行气但不能下行，所以不同。
少阴病，腹泻排出未消化的食物，里有寒而外有热，手足冰冷，脉微弱几乎摸不到，身体反而不怕冷，病人面色发红，或者腹痛，或者干呕，或者咽痛，或者腹泻停止但脉搏不出来的，用通脉四逆汤主治。
这是寒邪侵入少阴，阴盛格阳的证候。腹泻排出未消化食物，手足冰冷，脉微弱几乎摸不到，是阴寒盛于内。身体发热不怕冷，面色发红，是阳气被格拒于外。真阳之气，被阴寒逼迫，不安于其位，而游散于外，所以显现出各种热象，实际上并不是热证。通脉四逆汤，就是在四逆汤基础上加干姜一倍。因为阴在内，阳在外，脉绝不通，所以增加辛热之品以驱逐寒邪。寒邪去除则阳气回复，脉搏重新出现，所以说“其脉即出者愈”。
通脉四逆汤方
甘草（二两，炙） 附子（大者一枚，生用，去皮，破成八片） 干姜（三两，体质强壮者可四两）
以上三味药，用水三升，煮取一升二合药汁，滤去药渣，分两次温服。脉搏重新出现的就会痊愈。
加减法
面色赤的，加葱九茎。
面色赤，是阳气被格拒于上。葱中空，味辛，能通阳气。
腹中痛的，去掉葱，加芍药二两。
腹中痛，是阴气阻滞于里。芍药味酸，能利阴气止腹痛，所以加上。葱通阳但不利阴，所以去掉。
呕吐的，加生姜二两。
呕吐，是阴气上逆。生姜的辛味，可散阴而降逆。
咽痛的，去掉芍药，加桔梗一两。
咽痛，是阳气郁结于上。桔梗的辛味，可开阳结。去掉芍药，是厌恶它的收敛作用。
腹泻停止但脉搏不出来的，去掉桔梗，加人参二两。
腹泻停止但脉搏不出，是亡血。所以不用桔梗的疏散，而用人参的甘味以补益。
少阴病，饮食入口就吐，心中觉得温温欲吐却又吐不出来，刚发病时，手足寒冷，脉象弦迟的，这是胸中有实邪，不可以用下法，应当用吐法。如果是膈上有寒饮，干呕的，不可以用吐法，应当紧急温补，适宜用四逆汤。
肾是胃的关口。关口受邪，上逆于胃，则饮食入口即吐，或者心中温温欲吐，却又吐不出来。
下气上逆而导致呕吐的，原本有可用下法的例子，如本论中的哕而腹满，观察前后二便，知道哪一部不利就用利法；《金匮要略》中食已即吐的，用大黄甘草汤主治。如果刚发病，手足寒冷，脉象弦迟，这是胸中邪实而阳气不能布散。那么病不在下而在上，治疗方法不可用下法而应用吐法。这就是所谓“因其高者而越之”。如果是膈上有寒饮导致干呕的，则又不可用吐法而应用温法。这就是所谓“病痰饮者，当以温药和之”。所以实证可用下法，但胸中实邪不可用下法；饮邪可用吐法，但寒饮不可用吐法。张仲景立法，明辨详审到了如此地步。
少阴病，脉象沉的，应当紧急温补，适宜用四逆汤。
这里不详述具体症状，仅凭脉象论述治疗说：“少阴病脉沉者，急温之，宜四逆汤。”然而如果没有四肢厥冷、恶寒、腹泻、不渴等症状，不可以急于使用温法。我认为学者应当从全书融会贯通，不可拘泥于一文一字之间，这也是其中之一例。
少阴病，腹泻，脉象微涩，呕吐且出汗，必然频繁上厕所，但排便量反而很少的，应当温补上部，施以艾灸。
少阴病，腹泻脉微涩，是阴液损伤于下。呕吐且出汗，是阳气虚弱于上。阴虚并伤，治法必然上下同温。如果虽然频繁上厕所，但排泄物不多，更是阴液亡失的验证。这时只应当温补上部而不可温补下部。即使是温上的方法，也不可以用药物损伤其阴，而只适宜用艾灸来引阳气上行。灸法的具体操作未详。
少阴病，呕吐腹泻，手足冰冷，烦躁得快要死去的，用吴茱萸汤主治。
这是寒邪侵入少阴，并且向上攻犯阳明的证候。呕吐腹泻、厥冷、烦躁欲死，是阴邪极盛而阳气不胜。所以以吴茱萸温里散寒为主，既然又吐又泻，中气必然受损，所以用人参、大枣，补益虚损、安定中焦为辅。然后条文又说：“少阴病，吐利烦躁，四逆者死。”这里又用吴茱萸汤主治，前者是阴极而阳欲绝，后者是阴盛而阳来争。病证相同，但在“争”与“绝”之间进行辨别，差别非常细微。有人说：先厥冷而后烦躁的，是阳气欲复而来争；先烦躁而后四逆的，是阳气不胜而欲绝。这也讲得通。郭曰云说：四逆而烦躁的，不问其他症状，先宜服用吴茱萸汤；四逆而不烦躁的，先宜服用四逆汤；四逆下利脉不出的，先宜服用通脉四逆汤。这三者，是治疗少阴病的大法。
少阴病，腹泻，用白通汤主治。少阴病，腹泻脉微的，给白通汤。如果腹泻不止，四肢厥冷，无脉，干呕心烦的，用白通加猪胆汁汤主治。服药后脉搏突然暴出的，死亡；脉搏微微续接的，存活。
少阴病，腹泻脉微的，是寒邪直中，阳气暴虚，既不能固守于内，也不能通达于脉，所以适宜用姜、附的辛温之性，破除阴寒、巩固里气；用葱白的辛通之性，入脉引导阳气。如果服药后，腹泻不止，反而四肢厥冷无脉，干呕心烦的，这不是药不对症。而是阴寒太甚，在上格拒。王太仆所说“甚大寒热，必能与违性者争雄，异气者相格也”。所以在白通汤中加入人尿的咸寒、猪胆汁的苦寒，作为反佐，以顺从其气，使药力不相格拒而相得益彰。这正是《内经》所说的“寒热温凉，反从其病”。脉搏突然暴出的，是无根之阳，暴露无遗，所以死。脉搏微微续接的，是被压抑的阳气，慢慢回复，所以生。
白通汤方
葱白（四茎） 干姜（一两） 生附子（一枚，去皮，破成八片）
以上三味药，用水三升，煮取一升药汁，滤去药渣，分两次温服。
白通加猪胆汁汤方
葱白（四茎） 干姜（一两） 猪胆汁（一合） 人尿（五合） 生附子（一枚，去皮，破成八片）
以上三味药（指葱白、干姜、附子），用水三升，煮取一升药汁，滤去药渣，加入人尿、猪胆汁，调和均匀，分两次温服。如果没有猪胆，也可以用其他替代品。
少阴病，腹泻伴有脓血的，用桃花汤主治。少阴病，两三天到四五天，腹痛，小便不利，腹泻不止，大便带脓血的，用桃花汤主治。少阴病，腹泻伴有脓血的，可以针刺治疗。
少阴病，腹泻伴有脓血，是脏病在阴分，而寒邪又伤了血。血伤所以腹痛，阴病所以小便不利。这与阳经挟热下利不同，所以用赤石脂理血固脱，干姜温里散寒，粳米安中益气。采用刺法，是因为邪气陷入血中，针刺可以行血散邪。刺法的具体操作未详。
桃花汤方
赤石脂（一斤，一半全用，一半筛成粉末） 干姜（一两） 粳米（一升）
以上三味药，用水七升，煮米至熟，滤去药渣，温服七合，同时吞服赤石脂末一方寸匕，每日服用三次。如果一次服药后痊愈，剩下的不要服用。
Shaoyin disease. After two or three days of onset, if there is dryness of the mouth and throat, urgent purgation is indicated. Da Cheng Qi Tang (Great Order the Qi Decoction) is appropriate.
This is a syndrome where Shaoyin heat merges with Yangming. Two or three days indicates a short duration of illness, yet dryness of the mouth and throat appears, signifying excessive heat and deficient yin. Yangming corresponds to Earth, and Shaoyin to Water. When heat merges with Yangming, Earth becomes excess and Water becomes deficient. Not only does heat damage yin, but excess Earth also damages Water. Therefore, urgent purgation is required to drain the excess Earth to preserve Water. Otherwise, excessive heat damaging yin and excess Earth further injuring yin will lead to immediate desiccation. However, without symptoms such as pain in the epigastrium, abdominal fullness, and constipation as described in the following two clauses, Da Cheng Qi Tang should not be lightly attempted.
Shaoyin disease. Spontaneous diarrhea of clear water, purely green in color, with inevitable pain in the epigastrium and dryness of the mouth, requires urgent purgation. Da Cheng Qi Tang (Great Order the Qi Decoction) is appropriate.
This is also a syndrome of Shaoyin heat merging with Yangming, with qi descending. Although there is downward flow, the pathogenic factor remains excess and unremoved; only fluid flows from the sides, resulting in spontaneous diarrhea of clear water. Hence, there is pain in the epigastrium and dryness of the mouth. The pure green color occurs because Earth is affected by Water pathogens, mixing black and yellow hues to turn purely green. Urgent purgation with Da Cheng Qi Tang (Great Order the Qi Decoction) removes gastric excess, thereby resolving the kidney pathology.
Shaoyin disease. After six or seven days, presenting with abdominal fullness and constipation, requires urgent purgation. Da Cheng Qi Tang (Great Order the Qi Decoction) is appropriate.
Abdominal fullness and constipation are signs of Earth excess. Earth excess leads to Water dryness, making urgent purgation indispensable. Yangming resides in the center and corresponds to Earth, the gathering place of all things. Thus, regardless of whether the pathogen originates from the Three Yang or Three Yin meridians, it can return to the Stomach, forming a condition suitable for purgation. However, when Taiyin transmits to Yangming, it is a transfer of Zang pathogen to Fu, indicating recovery. When Jueyin transmits to Yangming, Wood pathogen returns to Earth, preventing it from reverting to Wood. Only in Shaoyin does Kidney pathogen enter the Stomach, and gastric excess subsequently consumes Kidney essence. Therefore, although purgation is used in all cases, the method for Shaoyin is more severe than that for Taiyin and Jueyin.
Shaoyin disease. At the initial stage, presenting with fever and a deep pulse, is treated primarily with Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite, and Asarum Decoction).
This is a syndrome where cold invades the Shaoyin meridian and externally connects with the Taiyang meridian. Because Shaoyin and Taiyang are exterior-interior pairs, their qi is interconnected. Shaoyin disease initially has no fever; however, due to external connection with Taiyang, fever appears. Yang diseases typically present with floating pulses, often tight; Shaoyin presents with a deep rather than floating pulse. Therefore, Fuzi (Prepared Aconite Root) and Xixin (Asarum) are used to specifically warm the Shaoyin meridian, while Mahuang (Ephedra Herb) releases the Taiyang exterior. This is a method of warming the meridian and dispelling cold in Shaoyin, treating both interior and exterior simultaneously.
Mahuang Fuzi Xixin Tang Formula
Mahuang (Ephedrae Herba, 2 liang, remove nodes) Fuzi (Prepared Aconiti Lateralis Radix, one piece, processed, peel removed, broken into eight pieces) Xixin (Asari Radix et Rhizoma, 2 liang)
Take these three ingredients. Boil in ten dou of water. First boil Mahuang, reducing volume by two dou, and remove the foam on top. Add the other herbs. Boil to obtain three sheng of decoction. Strain. Take one sheng warm, three times daily.
Note: In Yang syndromes, pathogens may reside in the meridian without affecting the fu organs. In Yin diseases, pathogens may reside in the meridian without affecting the zang organs. The Taiyang chapter states: "If the pulse is floating, Gui Zhi Tang (Cinnamon Twig Decoction) is indicated." The Shaoyin chapter states: "At the beginning, with fever and deep pulse, Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite, and Asarum Decoction) is indicated," and "After two or three days, Mahuang Fuzi Gancao Tang (Ephedra, Prepared Aconite, and Licorice Decoction)." The Jueyin chapter states: "Jueyin wind-stroke, a faintly floating pulse indicates impending recovery." These are all examples of Yin diseases residing in the meridian without entering the zang organs.
Shaoyin disease. After two or three days, use Mahuang Fuzi Gancao Tang (Ephedra, Prepared Aconite, and Licorice Decoction) to induce slight sweating. Since there are no interior syndromes after two or three days, slight sweating is induced.
When Shaoyin contracts cold for two or three days, the pulse is deep, there is aversion to cold, and no fever. Thus, Mahuang Fuzi Gancao Tang (Ephedra, Prepared Aconite, and Licorice Decoction) can be used to induce slight sweating to disperse cold pathogens. "No interior syndrome" means absence of vomiting, diarrhea, vexation, and inability to lie down. Since the disease has not entered the zang organs after two or three days, and the cold has not transformed into heat, methods for warming the meridian and dispersing pathogens, such as Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite, and Asarum Decoction), can be employed. However, removing the pungency of Xixin (Asarum) and adding the sweetness of Gancao (Licoriae Radix) makes the method milder. This is because cold pathogens must be dispersed, but Yin diseases should not be over-sweated.
Mahuang Fuzi Gancao Tang Formula
Mahuang (Ephedrae Herba, 2 liang, remove nodes) Fuzi (Prepared Aconiti Lateralis Radix, one piece, processed, peel removed) Gancao (Licoriziae Radix et Rhizoma, 2 liang, honey-fried)
Take these three ingredients. Boil in seven sheng of water. First boil Mahuang for one or two boils, remove the foam on top. Add the other herbs. Boil to obtain three sheng of decoction. Strain. Take one sheng warm, three times daily.
Shaoyin disease. After one or two days, if the mouth feels neutral (not dry or thirsty) and there is aversion to cold on the back, moxibustion should be applied, and Fuzi Tang (Aconite Decoction) is indicated.
"Mouth neutral" means no dryness or thirst, indicating no heat in the interior. Aversion to cold on the back occurs because the back is the area of yang, invaded by yin-cold, preventing yang from circulating outward. Since yang is blocked, moxibustion is used to unblock yang. Due to yang deficiency, Fuzi Tang (Aconite Decoction) is used to tonify yang deficiency. This differs from Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite, and Asarum Decoction), which merely focuses on warming and dispersing. This is the treatment for yang deficiency with cold invasion, where deficiency exceeds the cold pathogen.
Note: The *Yuanhe Ji Yong Jing* states: "In Shaoyin cold invasion with aversion to cold on the back, the mouth is neutral. In Yangming heat invasion with aversion to cold on the back, the mouth is dry and there is vexation." One is caused by yin-cold descending and injuring yang; the other by yang-heat entering the interior and depleting fluids. Although both have aversion to cold on the back, the difference between a neutral and dry mouth is key to differentiation.
Fuzi Tang Formula
Fuzi (Prepared Aconiti Lateralis Radix, two pieces, processed, peel removed, broken into eight pieces) Fuling (Poria, 3 liang) Shaoyao (Paeoniae Radix Alba, 3 liang) Renshen (Ginseng Radix, 2 liang) Baizhu (Atractylodis Macrocephalae Rhizoma, 4 liang)
Take these five ingredients. Boil in eight sheng of water. Boil to obtain three sheng of decoction. Strain. Take one sheng warm, three times daily.
For qi deficiency, tonification must use sweet flavors. For cold qi, warming must use pungent flavors. Combining sweet and pungent flavors sufficiently assists righteous qi and disperses yin pathogens. Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), and Fuzi (Prepared Aconite Root) exemplify this. Since the disease belongs to the Yin meridians, Shaoyao (Paeoniae Radix Alba) is needed to harmonize yin qi and guide Fuzi (Prepared Aconite Root) into the yin to disperse cold, acting as a "guide troop."
Shaoyin disease. Body pain, cold hands and feet, joint pain, and a deep pulse are treated with Fuzi Tang (Aconite Decoction).
Body pain and joint pain indicate cold in the yin. Cold hands and feet and a deep pulse indicate a yin disease. If the pulse were floating and hands/feet hot, it would be Taiyang cold damage, treatable by sweating. This is a syndrome of Shaoyin blood and qi deficiency with cold pathogen invasion, so Fuzi Tang (Aconite Decoction) is also appropriate to restore yang, disperse yin, and benefit essence and qi.
Shaoyin disease. Unresolved after two or three days, progressing to four or five days, presenting with abdominal pain, difficult urination, heavy and painful limbs, and spontaneous diarrhea, indicates water qi retention. Some patients may cough, have free urination, worsened diarrhea, or vomiting. Zhen Wu Tang (True Warrior Decoction) is indicated.
Shaoyin cold invasion unresolved after two or three days, progressing to four or five days, implies the pathogen has deepened and affected the zang organs. Cold in the zang causes abdominal pain. Excessive cold prevents yang circulation, causing difficult urination. Water and cold then contend, infiltrating inside and out, causing heavy/painful limbs and spontaneous diarrhea. All result from water qi moving due to cold qi. Cough, free urination, diarrhea, or vomiting occur as water-cold qi gathers, scatters, or rises upward.
Zhen Wu Tang Formula (See Taiyang Manipulation Method section, modifications after three doses)
If coughing, add Wuweizi (Schisandrae Fructus, half sheng), Xixin (Asari Radix et Rhizoma, 1 liang), and Ganjiang (Zingiberis Rhizoma, 1 liang).
Coughing results from water-cold attacking the Lung, causing rebellious qi. Cheng Shi said: Wuweizi's (Schisandrae Fructus) sourness collects rebellious qi; Xixin's (Asari Radix et Rhizoma) and Ganjiang's (Zingiberis Rhizoma) pungency disperses water-cold.
If urination is free, remove Fuling (Poria).
Free urination indicates water has moved downward; no need to promote diuresis further, so remove Fuling (Poria).
If diarrhea, remove Shaoyao (Paeoniae Radix Alba), add Ganjiang (Zingiberis Rhizoma, 2 liang).
Diarrhea indicates excessive internal cold. Remove Shaoyao (Paeoniae Radix Alba) and add Ganjiang (Zingiberis Rhizoma) to avoid cold and favor warmth.
If vomiting, remove Fuzi (Prepared Aconite Root), add Shengjiang (Zingiberis Rhizoma Recens), totaling half a jin.
Vomiting indicates rebellious qi rising upward. Remove Fuzi (Prepared Aconite Root) and add Shengjiang (Zingiberis Rhizoma Recens). Both are pungent and hot, but Shengjiang (Zingiberis Rhizoma Recens) descends rebellion effectively, whereas Fuzi (Prepared Aconite Root) circulates but does not descend.
Shaoyin disease. Diarrhea with undigested food, interior cold with exterior heat, cold hands and feet, faint pulse nearly imperceptible, body seemingly without aversion to cold, red facial color, possibly abdominal pain, dry retching, sore throat, or diarrhea stopping with absent pulse, is treated with Tongmai Sini Tang (Pulse-Returning Four Reversals Decoction).
This is a syndrome of cold invading Shaoyin, with yin excess repelling yang. Diarrhea with undigested food, cold extremities, and faint pulse indicate yin excess internally. Fever, lack of aversion to cold, and red face indicate yang repelled externally. True yang qi, forced by yin-cold, leaves its residence and scatters externally, manifesting heat-like symptoms, though it is not actual heat. Tongmai Sini Tang (Pulse-Returning Four Reversals Decoction) is Sini Tang (Four Reversals Decoction) plus double the amount of Ganjiang (Zingiberis Rhizoma). Because yin is internal and yang external, with pulse obstruction, pungent-hot herbs are increased to drive out cold. Once cold is removed, yang returns, and the pulse reappears. Hence, "if the pulse returns, the patient recovers."
Tongmai Sini Tang Formula
Gancao (Licoriziae Radix et Rhizoma, 2 liang, honey-fried) Fuzi (Raw Aconiti Radix, large piece, one, peel removed, broken into eight pieces) Ganjiang (Zingiberis Rhizoma, 3 liang; strong persons may take 4 liang)
Take these three ingredients. Boil in three sheng of water. Boil to obtain one sheng and two he of decoction. Strain. Divide into two warm doses. Recovery occurs if the pulse returns.
Modifications
If red face, add Congbai (Allii Fistulosi Bulbus, nine stems).
Red face indicates yang repelled upward. Congbai (Allii Fistulosi Bulbus) is hollow and pungent, capable of unblocking yang qi.
If abdominal pain, remove Congbai (Allii Fistulosi Bulbus), add Shaoyao (Paeoniae Radix Alba, 2 liang).
Abdominal pain indicates yin stagnation internally. Shaoyao's (Paeoniae Radix Alba) sourness benefits yin qi and stops pain, so add it. Congbai (Allii Fistulosi Bulbus) unblocks yang but does not benefit yin, so remove it.
If vomiting, add Shengjiang (Zingiberis Rhizoma Recens, 2 liang).
Vomiting indicates yin qi rebelling upward. Shengjiang's (Zingiberis Rhizoma Recens) pungency disperses yin and descends rebellion.
If sore throat, remove Shaoyao (Paeoniae Radix Alba), add Jiegeng (Platycodonis Radix, 1 liang).
Sore throat indicates yang qi knotted upward. Jiegeng's (Platycodonis Radix) pungency opens yang knots. Remove Shaoyao (Paeoniae Radix Alba) due to its astringent nature.
If diarrhea stops but pulse is absent, remove Jiegeng (Platycodonis Radix), add Renshen (Ginseng Radix, 2 liang).
Stopped diarrhea with absent pulse indicates blood loss. Do not use Jiegeng's (Platycodonis Radix) dispersing action; instead, use Renshen's (Ginseng Radix) sweetness to tonify.
Shaoyin disease. Food vomited immediately upon entry, feeling of warmth and urge to vomit but inability to do so, initial cold hands and feet, and string-tight slow pulse indicate excess in the chest. Purgation is contraindicated; emesis is indicated. If there is cold-fluid retention above the diaphragm causing dry retching, emesis is contraindicated; urgent warming is indicated. Sini Tang (Four Reversals Decoction) is appropriate.
The Kidney is the gate of the Stomach. If the gate is invaded, rebellion occurs in the Stomach, causing immediate vomiting or the urge to vomit without success.
Rebellious qi causing vomiting usually has purgative indications, e.g., hiccups with abdominal fullness in this text, or eating followed by immediate vomiting treated with Dahuang Gancao Tang (Rhubarb and Licorice Decoction) in the *Jin Gui Yao Lue*. However, if initially presenting with cold hands/feet and string-tight/slow pulse, it indicates chest excess with blocked yang distribution. The pathology is upper, not lower; thus, purgation is contraindicated, and emesis is indicated ("treat high conditions by inducing vomiting"). If dry retching is caused by cold-fluid retention above the diaphragm, emesis is contraindicated, and warming is indicated ("for phlegm-fluid retention, harmonize with warm herbs"). Thus, excess allows purgation, but chest excess forbids it; fluid retention allows emesis, but cold-fluid retention forbids it. Zhang Zhongjing's legislation is clear and meticulous.
Shaoyin disease. With a deep pulse, urgent warming is indicated. Sini Tang (Four Reversals Decoction) is appropriate.
Here, specific symptoms are not detailed; treatment is based solely on the pulse: "Shaoyin disease with deep pulse, urgent warming, Sini Tang (Four Reversals Decoction)." However, without symptoms like cold extremities, aversion to cold, diarrhea, and lack of thirst, urgent warming should not be applied. Scholars should integrate knowledge from the entire book, not拘泥于 single passages. This is another example.
Shaoyin disease. Diarrhea, faint and choppy pulse, vomiting with sweating, frequent defecation attempts with little output, requires warming the upper part and moxibustion.
Shaoyin disease with diarrhea, faint/choppy pulse indicates yin injury below. Vomiting with sweating indicates yang deficiency above. With simultaneous yin and yang injury, both upper and lower should be warmed. Frequent attempts with little output confirm yin depletion. Thus, only the upper should be warmed, not the lower. Even for warming the upper, medicinal herbs should not injure yin; moxibustion is preferred to draw yang upward. Moxibustion details are unspecified.
Shaoyin disease. Vomiting and diarrhea, cold extremities, extreme restlessness bordering on death, is treated with Wuzhuyu Tang (Evodia Decoction).
This is cold invading Shaoyin and attacking Yangming upward. Vomiting/diarrhea, cold extremities, and extreme restlessness indicate extreme yin pathogen overwhelming yang. Wuzhuyu (Evodiae Fructus) warms the interior and disperses cold as the primary agent. Since vomiting and diarrhea damage middle qi, Renshen (Ginseng Radix) and Dazao (Jujubae Fructus) tonify deficiency and stabilize the middle as auxiliary agents. Another clause states: "Shaoyin disease, vomiting/diarrhea, restlessness, cold extremities indicates death." Here, Wuzhuyu Tang (Evodia Decoction) is used because the former represents yin extreme with yang about to perish, whereas this case is yin excess with yang struggling to return. The distinction between "struggle" and "perishing" is subtle. Some say: Cold extremities followed by restlessness indicates yang returning; restlessness followed by cold extremities indicates yang failing. This is also valid. Guo Yueyun stated: For cold extremities with restlessness, use Wuzhuyu Tang (Evodia Decoction) first; for cold extremities without restlessness, use Sini Tang (Four Reversals Decoction) first; for cold extremities, diarrhea, and absent pulse, use Tongmai Sini Tang (Pulse-Returning Four Reversals Decoction) first. These three are major methods for Shaoyin disease.
Shaoyin disease. Diarrhea is treated with Baitong Tang (White Onion Decoction). Shaoyin disease. Diarrhea with faint pulse is given Baitong Tang (White Onion Decoction). If diarrhea persists, cold extremities, absent pulse, dry retching, and vexation occur, Baitong Jia Zhu Dan Huang Tang (White Onion Decoction with Pig Bile and Human Urine) is indicated. If the pulse suddenly emerges after ingestion, death ensues; if the pulse slowly returns, survival occurs.
Shaoyin disease with diarrhea and faint pulse indicates direct cold invasion and sudden yang deficiency. Unable to secure the interior or connect to the pulse, pungent-warming Jiang (Zingiberis Rhizoma) and Fu (Aconiti Radix) break yin and consolidate the interior. Pungent-unblocking Congbai (Allii Fistulosi Bulbus) enters the pulse to guide yang. If, after ingestion, diarrhea persists, cold extremities develop, pulse vanishes, and dry retching/vexation appear, it is not incorrect medication, but excessive yin-cold causing rejection above. As Wang Taipu said, extreme cold/heat contends with contrary natures. Therefore, add salty-cold Ren Niao (Human Urine) and bitter-cold Zhu Dan (Suis Fellis) to Baitong Tang (White Onion Decoction) as reverse assistants, harmonizing with the pathogen's qi to prevent rejection. This follows the *Neijing* principle: "Cold, heat, warm, cool, follow the disease." Sudden pulse emergence indicates rootless yang exposing itself completely (death). Slow pulse return indicates suppressed yang gradually recovering (survival).
Baitong Tang Formula
Congbai (Allii Fistulosi Bulbus, four stems) Ganjiang (Zingiberis Rhizoma, 1 liang) Sheng Fuzi (Raw Aconiti Radix, one piece, peel removed, broken into eight pieces)
Take these three ingredients. Boil in three sheng of water. Boil to obtain one sheng of decoction. Strain. Divide into two warm doses.
Baitong Jia Zhu Dan Huang Tang Formula
Congbai (Allii Fistulosi Bulbus, four stems) Ganjiang (Zingiberis Rhizoma, 1 liang) Zhu Dan (Suis Fellis, one he) Ren Niao (Human Urine, five he) Sheng Fuzi (Raw Aconiti Radix, one piece, peel removed, broken into eight pieces)
Take the first three ingredients (Congbai, Ganjiang, Sheng Fuzi). Boil in three sheng of water. Boil to obtain one sheng of decoction. Strain. Add Ren Niao (Human Urine) and Zhu Dan (Suis Fellis), mix well. Divide into two warm doses. If bile is unavailable, alternatives may be used.
Shaoyin disease. Diarrhea with pus and blood is treated with Taohua Tang (Peach Flower Decoction). Shaoyin disease. From two to three days up to four or five days, with abdominal pain, difficult urination, persistent diarrhea, and pus/blood in stool, Taohua Tang (Peach Flower Decoction) is indicated. Shaoyin disease. Diarrhea with pus and blood may be treated with acupuncture.
Shaoyin disease with diarrhea and pus/blood involves zang pathology in yin, with cold injuring blood. Blood injury causes abdominal pain; yin disease causes difficult urination. This differs from yang meridian diarrhea with heat. Chishizhi (Halloysit Rubrum) regulates blood and secures collapse; Ganjiang (Zingiberis Rhizoma) warms the interior and disperses cold; Jingmi (Oryza Sativa Germen) stabilizes the middle and benefits qi. Acupuncture is used because the pathogen has sunk into the blood; needling promotes blood circulation and disperses pathogens. Acupuncture details are unspecified.
Taohua Tang Formula
Chishizhi (Halloysit Rubrum, one jin, half whole, half sifted to powder) Ganjiang (Zingiberis Rhizoma, 1 liang) Jingmi (Oryza Sativa Germen, one sheng)
Take these three ingredients. Boil in seven sheng of water until rice is cooked. Strain. Take seven he warm, simultaneously ingesting one cun bi of Chishizhi powder. Three times daily. If cured after one dose, stop taking the remainder.