19. 腹满时减复如故, 此是寒虚气上从, 腹满不减不大便, 转属阳明
乃可攻.
【注】腹满时减, 减复如故, 谓腹时满时不满, 而减复如常, 此为太
阴寒邪寒虚之气上逆之满, 乃可温之证也, 宜厚朴生姜甘草半夏人参
汤. 腹满不减, 谓常常而满, 终日不减, 或不大便, 此为转属阳明实
热内壅之满, 乃可攻之证也, 宜大承气汤. 详太阴篇.
20. 少阴阴邪脉沉细, 背寒欲寐口中和, 咽痛腹痛骨节痛, 厥痢清谷
四逆瘥.
【注】少阴阴邪, 谓邪从阴化之寒证也. 脉沉细, 少阴阴邪之脉也.
背寒, 谓背恶寒, 阳气虚也. 欲寐, 谓但欲寐, 阴气盛也. 口中和,
口中不干燥也. 咽痛腹痛, 下痢清谷, 寒盛于中也. 骨节疼痛, 四肢
厥冷, 寒淫于外也, 宜四逆汤, 温中散寒也. 详少阴篇.
21. 少阴阳邪沉细数, 口燥咽干大承汤, 少阴心烦不得卧, 黄连阿胶
是主方.
【注】阳邪, 谓少阴邪从阳化之热证也. 少阴病但欲寐, 阴邪则脉沉
细无力, 阳邪则脉加数而有力矣. 始病即口燥咽干, 水不上升, 热之
甚也. 宜大承气汤急下之, 泻阳救阴也. 少阴病但欲寐, 二、 三日已
上变生心烦不得眠, 是阳邪乘阴, 阴不能静也, 宜黄连阿胶汤, 清阳
益阴也. 详少阴篇.
19. 腹部胀满有时减轻，但不久又恢复原状，这是太阴寒邪与虚气上逆所致；若腹部胀满持续不减且伴有大便不通，则属于转属阳明病，此时才可以采用攻下法。
【注】腹部胀满时轻时重，减轻后又像往常一样（复发），意思是腹部有时胀满有时不胀满，减轻后症状如常再现，这属于太阴寒邪和虚寒之气上逆引起的胀满，属于可以用温法治疗的证候，适宜使用厚朴生姜甘草半夏人参汤。腹部胀满持续不减，意思是整天都感到胀满，终日不缓解，或者伴有不大便，这属于转属阳明实热内结壅滞引起的胀满，属于可以采用攻下法治疗的证候，适宜使用大承气汤。详细情况参见太阴篇。
20. 少阴病感受阴邪（寒邪）时，脉象表现为沉细，背部恶寒，精神萎靡只想睡觉，口中感觉平和（不燥不渴），出现咽痛、腹痛、骨节疼痛，四肢厥冷、下利清谷等症状，使用四逆汤治疗可痊愈。
【注】少阴阴邪，指的是病邪从阴化生为寒证的状况。脉象沉细，是少阴病感受阴邪的典型脉象。背寒，指背部怕冷，说明阳气虚弱。欲寐，指总是想睡觉，说明阴气旺盛。口中和，指口中不干燥。咽痛、腹痛、下利清谷（大便中有未消化的食物），是因为寒邪盛于中焦。骨节疼痛、四肢厥冷，是因为寒邪淫溢于体表，适宜使用四逆汤，以温中散寒。详细情况参见少阴篇。
21. 少阴病感受阳邪（热邪）时，脉象沉细而数，若病情严重需急下存阴，可用大承气汤；若少阴病出现心烦、无法入睡，黄连阿胶汤是主要方剂。
【注】阳邪，指的是少阴病邪从阳化生为热证的状况。少阴病通常表现为只想睡觉，若是阴邪，则脉象沉细无力；若是阳邪，则脉象在沉细的基础上兼见数脉且有力。发病初期即出现口干咽燥，是因为肾水不能上济，说明热势很盛，适宜使用大承气汤急下，以泻火救阴。少阴病原本只想睡觉，过了两三天以上转变为心烦、无法入睡，这是因为阳邪乘袭阴分，导致阴液不能宁静，适宜使用黄连阿胶汤，以清泄阳热、滋养阴液。详细情况参见少阴篇。
19. Abdominal fullness that decreases intermittently but returns to its original state indicates fullness caused by the upward reversal of cold pathogenic factors and deficiency qi in the Taiyin stage; if abdominal fullness persists without reduction accompanied by constipation, it has transferred to the Yangming stage, and purgative therapy may then be applied.
[Annotation] "Fullness that decreases intermittently but returns" means the abdomen is sometimes full and sometimes not, with symptoms recurring as usual after subsiding. This type of fullness results from the upward reversal of cold pathogenic factors and deficiency-cold qi in the Taiyin stage, constituting a syndrome suitable for warming treatment; Houpo Shengjiang Gancao Banxia Renshen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction) is appropriate. "Fullness that does not decrease" implies constant fullness throughout the day without relief, or accompanied by inability to defecate. This constitutes fullness due to internal accumulation of excess heat in the Yangming stage, representing a syndrome suitable for purgation; Dachengqi Tang (Major Order the Qi Decoction) is appropriate. For details, refer to the Taiyin chapter.
20. When Shaoyin disease involves Yin pathogens (cold), the pulse is deep and fine, there is aversion to cold in the back, drowsiness, a neutral sensation in the mouth, along with sore throat, abdominal pain, bone and joint pain, cold extremities, and diarrhea with undigested food. Sini Tang (Frigid Extremities Decoction) can cure these conditions.
[Annotation] "Shaoyin Yin pathogen" refers to a cold syndrome where the pathogen transforms according to Yin characteristics. A deep and fine pulse is characteristic of Shaoyin disease with Yin pathogens. Back cold indicates aversion to cold in the back, signifying deficiency of Yang qi. Drowsiness (wanting to sleep) indicates abundance of Yin qi. A neutral mouth sensation means the mouth is not dry. Sore throat, abdominal pain, and diarrhea with undigested food indicate excessive cold in the Middle Jiao. Bone and joint pain and cold extremities indicate cold pathogens overflowing into the exterior. Sini Tang (Frigid Extremities Decoction) should be used to warm the middle and dissipate cold. For details, refer to the Shaoyin chapter.
21. In Shaoyin disease involving Yang pathogens (heat), the pulse is deep, fine, and rapid; if urgent purgation is required to preserve Yin, Dachengqi Tang (Major Order the Qi Decoction) may be used. If Shaoyin disease manifests as irritability and insomnia, Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is the primary formula.
[Annotation] "Yang pathogen" refers to a heat syndrome where the Shaoyin pathogen transforms according to Yang characteristics. Shaoyin disease typically presents with drowsiness; with Yin pathogens, the pulse is deep, fine, and forceless; with Yang pathogens, the pulse becomes rapid and forceful in addition to being deep and fine. Dry mouth and throat appearing at the onset indicate that Kidney water fails to ascend, signifying severe heat. Dachengqi Tang (Major Order the Qi Decoction) should be used for urgent purgation to drain fire and save Yin. If Shaoyin disease, initially presenting with drowsiness, progresses after two to three days to irritability and insomnia, it indicates that Yang pathogens have invaded the Yin aspect, preventing Yin from remaining tranquil. Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) should be used to clear Yang heat and nourish Yin. For details, refer to the Shaoyin chapter.