葱白四茎 干姜一两 附子（生，去皮，破八片）一枚 人尿五合 猪胆汁一合
以上三味，以水三升，煮取一升，去滓；内胆汁、人尿，和令相得，分温再服。若无
胆，亦可用。
【方解】
是方即前白通汤加人尿猪胆汁也。加尿、胆者，从其类也。下咽之后，冷体既消，热
性便发，情且不违而致大益，则二气之格拒可调，上下之阴阳可通矣。
@@@
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。
【注】
少阴病欲吐不吐，心中烦，但欲寐，五、六日自利而渴者，此属少阴传邪，寒热俱有
之证也。若是少阴热而燥干，引水之渴，小便必色赤，乃少阴燥不能生津，下焦有热
也。今为少阴虚，而引水自救之渴，故小便则色白，是少阴虚冷，不能化液，下焦有
寒也。于此可知少阴病形悉具，而渴者有寒热二端之别也。
【集注】
成无己曰：欲吐不吐，心烦者，表邪传里也。若腹满痛，则属太阴，此但欲寐，则知
属少阴。五、六日邪传少阴之时，若自利不渴，寒在中焦，属太阴也；此自利而渴，
为寒在下焦，属少阴也。肾虚水燥，故渴欲引水自救。下焦虚寒，故小便色白。下利
而渴，小便色白，非里热可知矣。
方有执曰：此反复申明，晓人勿认烦渴均为热证，以致误之意。
程应旄曰：烦证不尽属少阴，故指出但欲寐来；渴证不尽属少阴，故指出小便白来。
结以下焦虚有寒，教人上病治在下也。盖上虚而无阴以济，总由下虚而无阳以温也。
二「虚」字皆由「寒」字得来。又曰：吐利而渴，与猪苓汤证同，其别在但欲寐。且
猪苓证，小便必不利而色赤饮水，与白头翁证同，彼曰：以有热故也，小便亦必不白
。
林澜曰：欲吐不吐，心烦，阳虚格越于上。但欲寐，自利，小便白，里之真寒已深。
要如此渴，与口燥舌干之渴不同。若兼腹满便闭谵语诸证，自当作阳邪传里治之。既
里虚自利小便白，其为虚寒明甚。特曰下焦者，足见阴既盛于下，阳必格于上，岂可
以烦渴而误攻其热哉！
汪琥曰：以全文观之大似热证，惟小便色白，知为真寒之证。此但欲寐与热邪不同，
其寐必不昏浊，其呼吸必促而细。曰属少阴者，以别其非阳邪之渴，乃内无津液引水
自救之渴，试以冷水饮之，必不多也。细察其小便，若色白者，此少阴虚寒之证悉具
也，非热邪可知矣。
沈明宗曰：此少阴虚寒，似乎热证之辨也。世但知四肢厥逆为虚寒证，讵知小便色白
，乃为的验乎？
吴人驹曰：阳明之欲吐则不得寐，在少阴则但欲寐，引此以为盛虚之别。
@@@
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，当温之，宜四逆汤
。
【按】
温温，当是「嗢嗢」。嗢嗢者，乃吐饮之状也。
【注】
此承上条欲吐不吐详别脉证，以明其治也。饮食入口即吐，且心中嗢嗢欲吐复不能吐
，恶心不已，非少阴寒虚吐也，乃胸中寒实吐也。故始得之脉弦迟。弦者饮也，迟者
寒也。而手足寒者，乃胸中阳气，为寒饮所阻，不能通于四肢也。寒实在胸，当因而
越之，故不可下也。若膈上有寒饮，但干呕有声而无物出，此为少阴寒虚之饮，非胸
中寒实之饮也，故不可吐，惟急温之，宜四逆汤或理中汤加丁香、吴茱萸亦可也。
【集注】
程知曰：此言少阴饮吐，为肾邪上逆，当温不当吐也。欲吐不吐，阴邪上逆之证也。
若始得病时，邪未深入，其手足但寒而不厥，脉但弦迟而不沉细，则为邪实胸中，寒
尚在表，属于阳分，当吐而不当下。吐者有物，呕则无物，两者须辨。若膈上有寒饮
，但见干呕而不能吐出，则是阴寒上逆，当温而不当吐也。曰急温者，明不温则见厥
逆无脉诸变证也。
程应旄曰：寒在胸中，法不可下，而属实邪，但从吐法一吐，而阳气得通，吐法便是
温法。若膈上有寒饮干呕者，虚寒从下而上，阻留其饮于胸中，究非胸中之病也，直
从四逆汤，急温其下可矣。
@@@
少阴病，脉微细沉，但欲卧，汗出不烦，自欲吐，至五、六日，自利，复烦燥不得卧
寐者，死。
【注】
此发明上条，互详脉证，失于急温致变之义也。脉微细沉但欲卧，少阴寒也。当无汗
，今反汗出不烦，乃少阴亡阳也。且自欲吐，阴寒之邪上逆，正当急温，失此不治，
因循至五、六日，加之自利，复烦燥不得卧寐者，此少阴肾中真阳扰乱，外越欲绝之
死证。此时即温之，亦无及矣。
【集注】
方有执曰：脉微沉细，但欲卧，少阴本病也。汗出而不作烦热，无阳也。欲吐，经中
之邪不退也。自利，藏病进也。更复烦躁不得卧寐者，阳欲绝而扰乱不宁也。
程应旄曰：今时论治者，不至于恶寒蜷卧，四肢逆冷等证叠见，则不敢温，不知证已
到此，温之何及？况诸证有至死不一见者，则盍于本论中之要旨，一一申详之：少阴
病，脉必沉而微细，论中首揭此，盖已示人以可温之脉矣。少阴病但欲卧，论中又已
示人以可温之证矣。汗出在阳经不可温，在少阴宜急温，论中又切示人以亡阳之故矣
。况复有不烦自欲吐，阴邪上逆之证乎？则真武、四逆，诚不啻三年之艾矣。乃不知
预为绸缪，延缓至五、六日，前欲吐，今且利矣；前不烦，今烦且躁矣；前欲卧，今
不得卧矣，阳虚扰乱，阴盛转加，焉有不死者乎？
@@@
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，或小便不利，或下利，或呕者，真武汤主之。
【注】
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
胃府，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。
【集注】
喻昌曰：太阳篇中，厥逆筋惕肉□而亡阳，用真武矣。兹少阴之水湿上逆，仍用真武
以镇摄之，可见太阳膀胱与少阴肾，一藏一府，同为寒水。府邪为阳邪，藉用麻桂为
青龙；藏邪为阴邪，藉用附子为真武。
【方解】
这个方子就是前面的白通汤加入人尿和猪胆汁。加入尿和胆汁，是顺应其同类之性。药液咽下之后，寒凉的本性已经消除，热性随即发挥，药性与病情不相违背从而产生巨大的疗效，那么阴阳二气的格拒就可以调和，上下的阴阳之气就可以通畅了。
@@@
少阴病，想吐却吐不出来，心烦，只想睡觉，到了第五、六天，出现自发性腹泻且口渴的，属于少阴病。因为正气虚弱所以引水来自救，如果小便颜色发白的，说明少阴病的症状全部具备。小便发白的原因，是因为下焦虚寒，不能制约水液，所以导致小便颜色发白。
【注】
少阴病想吐却吐不出来，心中烦闷，只想睡觉，五、六天后出现自发性腹泻且口渴的，这是属于少阴病传变而来的邪气，是寒证和热证都有的表现。如果是少阴热证导致的燥渴，想要喝水，小便一定颜色发红，这是少阴燥热不能生津液，下焦有热的表现。现在是少阴虚证，因想要喝水来自救而口渴，所以小便颜色发白，这是少阴虚冷，不能化生津液，下焦有寒的表现。从这里可以知道，少阴病症状全部具备时，口渴也有寒证和热证两类的区别。
【集注】
成无己说：想吐却吐不出来，心烦，是表邪传入里部。如果腹部胀满疼痛，就属于太阴病，这里只是只想睡觉，就知道属于少阴病。五、六天邪气传入少阴的时候，如果自发性腹泻且不口渴，是寒邪在中焦，属于太阴病；这里自发性腹泻且口渴，是寒邪在下焦，属于少阴病。肾气虚弱水液干燥，所以口渴想要引水自救。下焦虚寒，所以小便颜色发白。腹泻且口渴，小便颜色发白，这就不是里热证，可以知道了。
方有执说：这是反复申明，告诫人们不要误认为烦躁和口渴都是热证，从而导致误治的意思。
程应旄说：烦躁的症状不全都属于少阴病，所以指出“只想睡觉”来鉴别；口渴的症状不全都属于少阴病，所以指出“小便发白”来鉴别。归结于下焦虚而有寒，教导人们上部的病要从下部治疗。因为上部虚而无阴液来济助，总归是由于下部虚而无阳气来温煦。两个“虚”字都是由“寒”字得来的。又说：呕吐腹泻且口渴，与猪苓汤证相同，区别在于是否“只想睡觉”。而且猪苓汤证，小便一定不通利且颜色发红，饮水情况与白头翁汤证相同，那里说是因为有热，所以小便也一定不发白。
林澜说：想吐却吐不出来，心烦，是阳虚被格拒浮越于上。只想睡觉，自发性腹泻，小便发白，说明体内的真寒已经很深了。这种口渴，与口燥舌干的口渴不同。如果兼有腹部胀满、大便闭塞、胡言乱语等症状，自然应当作为阳邪传入里部来治疗。既然已经是里虚自发性腹泻且小便发白，其为虚寒是非常明显的。特别提到下焦，足见阴寒既盛于下部，阳气必然格拒于上部，怎么能因为烦躁口渴就错误地攻伐热邪呢！
汪琥说：从全文来看，很像热证，只有小便颜色发白，才知道是真寒证。这种“只想睡觉”与热邪不同，睡眠一定不清醒浑浊，呼吸一定急促而细微。说属于少阴病，是为了区别于非阳邪引起的口渴，这是内部没有津液而引水自救的口渴，试着给冷水喝，一定喝不了多少。仔细察看它的小便，如果颜色发白，这说明少阴虚寒的症状全部具备，不是热邪，可以知道了。
沈明宗说：这是辨别少阴虚寒证似乎像热证的情况。世人只知道四肢厥冷逆算是虚寒证，哪里知道小便颜色发白，才是确切的验证呢？
吴人驹说：阳明病的想吐则无法入睡，在少阴病则是只想睡觉，引用这个来说明盛实与虚弱的区别。
@@@
少阴病，饮食入口就吐，心中感觉恶心想要吐，却又吐不出来，刚得病时，手脚冰凉，脉象弦而迟缓的，这是胸中有实邪，不可用泻下法，应当用涌吐法。如果膈上有寒饮，干呕的，不可用涌吐法，应当用温补法，适宜用四逆汤。
【按】
“温温”，应当是“嗢嗢（wà）”。“嗢嗢”，是吐出饮邪时的状态。
【注】
这是承接上一条关于想吐却吐不出的详细辨别脉证，以明确治疗方法。饮食入口即吐，且心中恶心想要吐却又吐不出来，恶心不停，这不是少阴寒虚引起的呕吐，而是胸中寒实引起的呕吐。所以刚得病时脉象弦迟。弦脉主饮邪，迟脉主寒邪。而手脚冰凉，是因为胸中的阳气，被寒饮所阻滞，不能通达于四肢。寒实邪气在胸中，应当顺势通过涌吐法排出，所以不可用泻下法。如果膈上有寒饮，只是干呕有声而没有东西吐出，这是少阴寒虚引起的饮邪，不是胸中寒实的饮邪，所以不可用涌吐法，只能紧急温补，适宜用四逆汤，或者理中汤加丁香、吴茱萸也可以。
【集注】
程知说：这是说少阴病饮邪呕吐，是肾邪上逆，应当温补而不应当涌吐。想吐却吐不出来，是阴邪上逆的症状。如果刚得病时，邪气尚未深入，手脚只是寒冷而没有厥逆，脉象只是弦迟而没有沉细，那就是邪气实于胸中，寒邪尚在表，属于阳分，应当用涌吐法而不应当用泻下法。吐是有形之物，呕是无物有声，两者必须辨别。如果膈上有寒饮，只见干呕而不能吐出，那就是阴寒上逆，应当温补而不应当涌吐。说“急温”，是表明如果不温补就会出现四肢厥冷、无脉等各种变证。
程应旄说：寒邪在胸中，依法不可泻下，但属于实邪，只要通过涌吐法一吐，阳气就能通畅，涌吐法也就是温法。如果膈上有寒饮导致干呕，这是虚寒从下部向上，阻留饮邪在胸中，终究不是胸中的病，直接通过四逆汤，紧急温补下部就可以了。
@@@
少阴病，脉象微细沉，只想睡觉，出汗但不觉得烦，自己想要吐，到了第五、六天，出现自发性腹泻，又出现烦躁不得卧睡的症状，这是死证。
【注】
这是阐发上一条的内容，互相详细辨析脉证，说明未能及时温补而导致病变的道理。脉象微细沉，只想睡觉，是少阴寒证。应当没有汗出，现在反而出汗且不觉得烦，这是少阴亡阳。而且自己想要吐，是阴寒邪气上逆，正当紧急温补，错过此时不治疗，拖延到五、六天，加上自发性腹泻，又出现烦躁不得卧睡的症状，这是少阴肾中真阳扰乱，向外浮越即将断绝的死证。此时即使温补，也已经来不及了。
【集注】
方有执说：脉象微沉细，只想睡觉，是少阴本病。出汗而不产生烦热，是没有阳气。想要吐，是经中的邪气未退。自发性腹泻，是脏病加重。再加上烦躁不得卧睡，是阳气将要断绝而扰乱不宁。
程应旄说：现在的医生治病，不到恶寒蜷卧、四肢逆冷等症状接连出现，就不敢用温法，不知道证候已经到了这一步，温补还来得及吗？况且有些症状至死都不一定全出现的，为什么不把《伤寒论》中的要旨一一详细说明：少阴病，脉必沉而微细，论中首先揭示这一点，大概是告诉人们这是可以用温法的脉象。少阴病只想睡觉，论中又告诉人们这是可以用温法的症状。出汗在阳经不可温补，在少阴病宜紧急温补，论中又深切地告诉人们亡阳的缘故。何况还有不烦而自己想要吐，阴邪上逆的症状呢？那么真武汤、四逆汤，确实就像存放三年的艾草一样珍贵（意指急需）。然而不知道预先准备，拖延到五、六天，前面想要吐，现在且腹泻了；前面不烦，现在烦且躁了；前面想睡觉，现在不能睡觉了，阳虚扰乱，阴盛转加，怎么有不死的呢？
@@@
少阴病，两、三天不好，到了第四、五天，腹痛，小便不利，四肢沉重疼痛，自发性腹泻的，这是因为有水气。其中有的人咳嗽，或者小便不利，或者腹泻，或者呕吐的，用真武汤主治。
【注】
《伤寒论》中心下有停水，发热有汗，烦渴引水，小便不利的，属于太阳中风，是五苓散证。发热无汗，干呕不渴，小便不利的，属于太阳伤寒，是小青龙汤证。现在少阴病，两、三天不好，到了第四、五天腹痛下利，阴寒已经很深了，假如小便通利，这是纯寒而无水，是附子汤证。现在小便不利，或者咳或者呕，这是阴寒兼有水气的证候：所以水寒之气，外攻于体表，则四肢沉重疼痛；内盛于体内，则腹痛自发性腹泻；水气停在上焦胸肺，则咳嗽气喘而不能卧；停在中焦胃腑，则呕吐或者腹泻；停在下焦膀胱，则小便不利，或者小腹胀满。种种症状，总不外乎阴寒之水，而不用五苓散的，是因为不是表热的饮邪；不用小青龙汤的，是因为不是表寒的饮邪。所以唯独主张用真武汤，温散寒邪以制约水气。
【集注】
喻昌说：太阳篇中，出现四肢厥逆、筋惕肉瞤而亡阳，用了真武汤。这里少阴的水湿上逆，仍然用真武汤来镇摄它，可见太阳膀胱与少阴肾，一为腑一为脏，同为寒水。腑的邪气为阳邪，借助麻黄、桂枝成为青龙汤；脏的邪气为阴邪，借助附子成为真武汤。
[Formula Analysis]
This formula is the preceding Baitong Tang (White Connect Decoction) with the addition of human urine and pig bile. The addition of urine and bile follows their similar nature. After swallowing, the cold nature is eliminated, and the hot nature immediately takes effect. The medicinal properties do not conflict with the condition but bring great benefit, thereby regulating the rejection between Yin and Yang Qi and allowing the upper and lower Yin and Yang to communicate.
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Shaoyin disease (Disease of the Shaoyin channel/organ system), characterized by the desire to vomit but inability to do so, irritability, and a strong desire to sleep. By the fifth or sixth day, if spontaneous diarrhea accompanied by thirst occurs, it belongs to Shaoyin disease. Due to deficiency, the patient draws water for self-rescue. If the urine is white in color, the manifestations of Shaoyin disease are fully present. The whiteness of the urine is due to deficiency-cold in the Lower Jiao (Lower Burner: abdominal cavity below the umbilicus), which fails to control water metabolism, resulting in pale urine.
[Annotation]
Shaoyin disease presenting with the desire to vomit but inability to do so, mental restlessness, a desire to sleep, and spontaneous diarrhea with thirst after five or six days, belongs to the transmission pathogen of Shaoyin disease, representing a syndrome where both cold and heat signs may be present. If it were Shaoyin heat causing dryness and thirst, the desire to drink would result in red urine, indicating Shaoyin dryness-heat failing to generate body fluids and heat in the Lower Jiao. Here, however, the thirst from drawing water for self-rescue is due to Shaoyin deficiency-cold failing to transform fluids, indicating cold in the Lower Jiao. Thus, it can be seen that when Shaoyin disease manifestations are complete, thirst can be distinguished into two categories: cold and heat.
[Collected Annotations]
Cheng Wuji stated: The desire to vomit but inability to do so, along with irritability, indicates exterior pathogens transmitting inward. If there were abdominal fullness and pain, it would belong to Taiyin disease; since there is only a desire to sleep, it is known to belong to Shaoyin disease. When pathogens transmit to Shaoyin on the fifth or sixth day, spontaneous diarrhea without thirst indicates cold in the Middle Jiao, belonging to Taiyin; spontaneous diarrhea with thirst indicates cold in the Lower Jiao, belonging to Shaoyin. Kidney deficiency leads to dry water, causing thirst and the desire to draw water for self-rescue. Lower Jiao deficiency-cold causes white urine. Diarrhea with thirst and white urine clearly indicates this is not an interior heat syndrome.
Fang Youzhi stated: This repeatedly clarifies to warn people not to mistake irritability and thirst as solely heat syndromes, which would lead to misdiagnosis.
Cheng Yingmao stated: Irritability does not exclusively belong to Shaoyin disease, hence "desire to sleep" is pointed out for differentiation; thirst does not exclusively belong to Shaoyin disease, hence "white urine" is pointed out. It concludes with deficiency-cold in the Lower Jiao, teaching that diseases above should be treated from below. Upper deficiency without Yin nourishment stems from Lower deficiency without Yang warming. Both instances of "deficiency" derive from "cold." Furthermore, vomiting/diarrhea with thirst resembles Zhuling Tang syndrome, differentiated by the presence of "desire to sleep." In Zhuling Tang syndrome, urination is necessarily obstructed and urine red; drinking habits resemble Baitouweng Tang syndrome, where heat is cited as the cause, so urine is never white.
Lin Lan stated: Desire to vomit but inability, and irritability, indicate Yang deficiency with floating/rebellious Qi above. Desire to sleep, spontaneous diarrhea, and white urine indicate profound true cold within. Such thirst differs from thirst caused by dry mouth and tongue. If accompanied by abdominal fullness, constipation, and delirium, it should be treated as Yang pathogens transmitting inward. Since there is interior deficiency with spontaneous diarrhea and white urine, the deficiency-cold is evident. Mentioning the Lower Jiao shows that when Yin excess is below, Yang must be rejected above; one cannot mistakenly attack heat due to irritability and thirst.
Wang Hu stated: Viewed holistically, it resembles a heat syndrome, but white urine reveals it is a true cold syndrome. The "desire to sleep" differs from heat pathogens; sleep is likely not confused/cloudy, and respiration is rapid and fine. Stating it belongs to Shaoyin distinguishes it from non-Yang-pathogen thirst; this is thirst from internal fluid deficiency seeking self-rescue. Offering cold water would result in little intake. Careful observation of white urine confirms all Shaoyin deficiency-cold symptoms are present, ruling out heat pathogens.
Shen Mingzong stated: This differentiates Shaoyin deficiency-cold which appears like a heat syndrome. People generally know limb coldness indicates deficiency-cold, but few realize white urine is the definitive verification.
Wu Renju stated: Yangming disease's desire to vomit prevents sleep, whereas Shaoyin disease features a desire to sleep, illustrating the difference between excess and deficiency.
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Shaoyin disease, where food entering the mouth triggers immediate vomiting, a sensation of nausea in the heart/chest with desire to vomit but inability to do so. At the onset, if hands and feet are cold and the pulse is wiry and slow, this indicates excess in the Chest (Upper Jiao); purgation is contraindicated, and emesis should be induced. If there is cold-fluid retention above the diaphragm causing dry retching, emesis is contraindicated; warming is required, preferably using Sini Tang (Frigid Extremities Decoction).
[Note]
"Wenwen" should be read as "Wawa," describing the state of vomiting fluid.
[Annotation]
This elaborates on the previous case of "desire to vomit but inability," detailing pulse and symptoms to clarify treatment. Vomiting upon ingestion, chest nausea, and inability to vomit despite the urge, with persistent恶心 (nausea), is not Shaoyin deficiency-cold vomiting, but rather Cold-Excess vomiting in the Chest. Hence, the initial pulse is wiry and slow. Wiry indicates fluid retention; slow indicates cold. Cold hands and feet occur because Chest Yang is blocked by cold-fluid, preventing circulation to the limbs. Cold-excess in the Chest requires inducing vomiting to expel it upward; thus, purgation is forbidden. If there is cold-fluid above the diaphragm causing only dry retching without expulsion, this is Shaoyin deficiency-cold fluid, not Chest cold-excess fluid. Therefore, emesis is contraindicated; urgent warming is needed, suitable for Sini Tang, or Lizhong Tang with Dingxiang (Caryophylli Flos) and Wuzhuyu (Evodiae Fructus).
[Collected Annotations]
Cheng Zhi stated: This discusses Shaoyin fluid-retention vomiting caused by Kidney pathogens rebelling upward, requiring warming rather than emesis. "Desire to vomit but inability" is a sign of Yin pathogens rebelling upward. If at onset, pathogens have not deeply penetrated, and limbs are merely cold (not cold-extremities) with a wiry-slow pulse (not deep-fine), it indicates pathogen excess in the Chest, cold still in the Exterior/Yang aspect, requiring emesis, not purgation. Vomit involves matter; retching involves sound without matter; these must be distinguished. If cold-fluid above the diaphragm causes only dry retching, it is Yin-cold rebelling upward, requiring warming, not emesis. "Urgent warming" implies that failure to warm will lead to cold-extremities and pulseless conditions.
Cheng Yingmao stated: Cold in the Chest prohibits purgation. If it is excess pathogen, emesis allows Yang Qi to flow freely; thus, emesis acts as warming. If cold-fluid above the diaphragm causes dry retching, it is deficiency-cold rising from below, trapping fluid in the Chest, which is ultimately not a Chest disease itself. Directly warming the Lower Jiao with Sini Tang is appropriate.
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Shaoyin disease, with a faint, thin, and deep pulse, a desire only to lie down, sweating without irritability, and a subjective desire to vomit. By the fifth or sixth day, if spontaneous diarrhea occurs followed by irritability and agitation preventing sleep, death ensues.
[Annotation]
This expands on the previous section, detailing pulses and symptoms to explain the consequences of failing to warm urgently. A faint, thin, deep pulse with a desire to lie down indicates Shaoyin cold. Sweating without irritability indicates Shaoyin collapse of Yang. The subjective desire to vomit indicates Yin-cold pathogens rebelling upward, necessitating urgent warming. Neglecting this until the fifth or sixth day, compounded by spontaneous diarrhea, leads to irritability and agitation preventing sleep. This represents the disturbance and external floating of the True Yang in the Shaoyin Kidney, approaching extinction—a fatal syndrome. Even warming at this stage would be too late.
[Collected Annotations]
Fang Youzhi stated: Faint, deep, thin pulse and desire to lie down are the root Shaoyin disease. Sweating without feverish irritability indicates absence of Yang. Desire to vomit indicates unexpelled meridian pathogens. Spontaneous diarrhea indicates worsening organ disease. Further irritability and agitation preventing sleep indicate Yang nearing extinction and chaotic unrest.
Cheng Yingmao stated: Modern physicians hesitate to use warming methods until severe signs like aversion to cold, curling up, and cold extremities appear, unaware that warming is viable even at earlier stages. Some symptoms may not manifest fully before death. One must understand the core principles: Shaoyin disease always presents with a deep, faint, thin pulse—this signals the appropriateness of warming. Desire to lie down signals the appropriateness of warming. While sweating in Yang meridians prohibits warming, in Shaoyin it mandates urgent warming due to Yang collapse. Coupled with non-irritable desire to vomit (Yin rebellion), Zhenwu Tang and Sini Tang are as precious as three-year-old mugwort. Delaying treatment for five or six days transforms prior desire to vomit into diarrhea, prior lack of irritability into agitation, and prior desire to sleep into insomnia. Yang deficiency chaos and Yin excess intensify, leading inevitably to death.
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Shaoyin disease persisting for two or three days, progressing to the fourth or fifth day, presenting with abdominal pain, difficult urination, heavy/painful limbs, and spontaneous diarrhea, indicates water retention. If the patient also experiences cough, or difficult urination, or diarrhea, or vomiting, Zhenwu Tang (True Warrior Decoction) is the primary treatment.
[Annotation]
In the Treatise, Heart-area water retention with fever, sweating, irritability/thirst, and difficult urination belongs to Wind-strike of the Taiyang channel, treated with Wuling San. Fever without sweating, dry retching, no thirst, and difficult urination belongs to Cold-damage of the Taiyang channel, treated with Xiao Qinglong Tang. Here, Shaoyin disease persists for days, leading to abdominal pain and diarrhea, indicating profound Yin-cold. If urination were normal, it would be pure cold without water, treated with Fuzi Tang. However, difficult urination, cough, or vomiting indicates Yin-cold combined with water retention. Water-cold attacking the exterior causes heavy/painful limbs; accumulating internally causes abdominal pain and diarrhea; stagnating in the Upper Jiao (chest/lungs) causes cough/wheezing/inability to lie flat; stagnating in the Middle Jiao (stomach) causes vomiting/diarrhea; stagnating in the Lower Jiao (bladder) causes difficult urination/hypogastric fullness. All these stem from Yin-cold water. Wuling San is excluded as it treats exterior-heat fluid; Xiao Qinglong Tang is excluded as it treats exterior-cold fluid. Thus, Zhenwu Tang is used to warm cold and control water.
[Collected Annotations]
Yu Chang stated: In the Taiyang chapter, cold-extremities, muscle twitching, and Yang collapse were treated with Zhenwu Tang. Here, Shaoyin water-dampness rebelling upward is still treated with Zhenwu Tang to suppress it. This shows Taiyang Bladder and Shaoyin Kidney, though Fu and Zang respectively, both govern cold-water. Pathogens in the Fu are Yang pathogens, utilizing Mahuang/Guizhi to form Qinglong Tang; pathogens in the Zang are Yin pathogens, utilizing Fuzi to form Zhenwu Tang.