葱白四茎 干姜一两 附子（生，去皮，破八片 ）一枚
右三味，以水三升，煮取一升，去滓，分温再服。
【集解】
汪琥曰：此方与四逆汤相类，独去甘草，盖驱寒欲其速，辛烈之性取其骤发，直达下
焦，故不欲甘以缓之也。而犹重在葱白，少阴之阴，天之寒气亦为阴，两阴相合而偏
于下利，则与阳气隔绝不通，姜、附之力，虽能益阳，不能使真阳之气必入于阴中，
惟葱白味辛，能通阳气，令阴得阳而利，庶可愈矣。盖大辛、大热之药，不过借以益
人阳气，非有以通之，令真阳和会，而何以有济也耶？
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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。
【注】
此承上条详申其脉，以明病进之义也。少阴病下利脉微者，与白通汤，下利当止。今
利不止，而转见厥逆无脉，更增干呕而烦者，此阴寒盛极，格阳欲脱之候也。若专以
热药治寒，寒既甚，必反格拒而不入，故于前方中加人尿、猪胆之阴，以引阳药入阴
。经曰：逆者从之，此之谓也。无脉者，言诊之而欲绝也。服汤后，更诊其脉，若暴
出者，如烛烬焰高，故主死。若其脉徐徐微续而出，则是真阳渐回，故可生也。故上
条所以才见下利，即用白通以治于未形，诚善法也。
【集注】
程知曰：此言阴盛格阳，用胆汁通阴法也。以白通与之，宜乎阳可救。今乃利不止，
反至厥逆无脉，则阴邪愈无忌矣。干呕而烦，则阳药在膈而不入阴矣。此非药不胜病
，乃无向导之力也。加人尿、猪胆之阴寒，则可引姜、附之温，入格拒之寒而调其逆
。此『内经』从治之法也。
程应旄曰：脉暴出者死，无根之阳骤迸诸外也。微续者生，阳气渐交，阴肯纳也。
葱白四根，干姜一两，附子（生用，去皮，破成八片）一枚。
以上三味药，用水三升，煮取一升药液，滤去药渣，分两次温服。
【集解】
汪琥说：此方与四逆汤相似，只是去掉了甘草，大概是因为驱寒希望见效快，利用其辛烈之性使其迅速发作，直达下焦，所以不希望用甘味药来缓和药性。而本方仍重在葱白，少阴经的阴气，与天之寒气同为阴，两阴相合且偏重于导致下利，就会与阳气隔绝不通。干姜、附子的力量，虽然能补益阳气，但不能使真阳之气必然进入阴中，只有葱白味辛，能够通达阳气，使阴得阳助而止利，才可以痊愈。大概大辛、大热的药物，不过是借以补益人的阳气，如果没有办法通达它，使真阳调和会合，那又怎么会有帮助呢？
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少阴病，出现下利且脉象微弱的，给予白通汤治疗；如果下利不止，出现四肢厥冷且无脉象，伴有干呕、心烦的，主治用白通加猪胆汁汤。服用汤药后，如果脉象突然暴出的，主死；如果脉象微微持续出现的，主生。
【注】
这是承接上一条详细阐述脉象，以说明病情进展的含义。少阴病下利且脉象微弱的，给予白通汤，下利应当停止。现在下利不止，反而出现四肢厥冷且无脉象，更增加干呕和心烦的症状，这是阴寒极盛，格拒阳气欲脱的征候。如果专门用热药治疗寒证，寒邪既然很盛，必定反过来格拒药力而不入体内，所以在前方中加入人尿、猪胆的阴性物质，用来引导阳药进入阴分。医经说：对于逆乱的病势要顺从治法，说的就是这个意思。所谓“无脉”，是指诊察时感觉脉搏将要断绝。服药后再诊察脉象，如果脉搏突然暴出，就像蜡烛烧尽火焰突然升高一样，所以主死。如果脉搏徐徐微弱地持续出现，则是真阳逐渐恢复，所以可以生还。所以上一条才说只要见到下利，就立即用白通汤在病形未完全显现之前进行治疗，这确实是良法。
【集注】
程知说：这里讲的是阴盛格阳，使用胆汁通达阴气的治法。给予白通汤，按理说阳气可以挽救。现在却下利不止，反而发展到四肢厥冷无脉，那么阴邪更加肆无忌惮了。干呕而心烦，说明阳药停留在膈部而不能进入阴分。这不是药力不能战胜病邪，而是缺乏向导的力量。加入人尿、猪胆的阴寒之性，就可以引导干姜、附子的温热之性，进入被格拒的寒邪之中以调理逆乱。这是《内经》从治的方法。
程应旄说：脉象突然暴出的会死，是无根之阳骤然迸发于外。脉象微微持续的会生，是阳气逐渐交接，阴气愿意接纳阳气。
Scallion white (Congbai) four stalks, Dried Ginger (Ganjiang) one tael, Aconite Root (Fuzi) (raw, peeled, broken into eight pieces) one piece.
The above three ingredients are boiled in three sheng of water to obtain one sheng of decoction. The dregs are removed, and the liquid is divided into two doses for warm administration.
[Collected Explanations]
Wang Hu said: This formula is similar to Sini Tang (Four Reversal Decoction), except that Licorice Root (Ganzhi) is omitted. This is likely because rapid expulsion of cold is desired; the pungent and acrid nature is utilized for its swift action to reach directly to the lower jiao (Lower Burner). Therefore, the sweet flavor, which tends to moderate and slow down effects, is avoided. However, the emphasis remains on Scallion white (Congbai). The yin of Shaoyin (Lesser Yin) and the cold qi of heaven are both yin. When these two yins combine and predominantly cause diarrhea, they cut off communication with yang qi. Although the power of Dried Ginger (Ganjiang) and Aconite Root (Fuzi) can benefit yang qi, it cannot ensure that the true yang qi necessarily enters the yin. Only Scallion white (Congbai), being pungent, can unblock and unblock yang qi, allowing yin to receive yang's assistance to stop diarrhea, thus achieving cure. Generally, drugs that are extremely pungent and hot merely serve to supplement human yang qi. Without a means to unblock them so that true yang may harmonize and converge, how could they be of assistance?
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In Shaoyin disease, if there is diarrhea and the pulse is faint, Baotong Tang (White Connective Decoction) should be administered. If the diarrhea does not cease, and symptoms progress to cold extremities (Jue) and absence of pulse, accompanied by dry retching and vexation, Baotong Jia Zhudan Chi Tang (Baotong Decoction plus Porcine Bile and Human Urine) is the primary treatment. After taking the decoction, if the pulse suddenly emerges violently, death is indicated; if the pulse continues slightly and gradually, survival is indicated.
[Annotation]
This passage follows up on the previous clause to elaborate on the pulse, thereby clarifying the meaning of disease progression. In Shaoyin disease with diarrhea and a faint pulse, Baotong Tang (White Connective Decoction) is given, and the diarrhea should stop. Now, however, the diarrhea does not cease, and instead, cold extremities (Jue) and absence of pulse appear, along with increased dry retching and vexation. This is a sign of extreme excess of yin-cold, repelling yang qi which is on the verge of collapse. If one treats the cold exclusively with hot medicines, the severe cold will inevitably repel the medicinal force, preventing it from entering the body. Therefore, the yin substances of Human Urine (Renyao) and Porcine Bile (Zhudan) are added to the previous formula to guide the yang-acting drugs into the yin level. The classic states: "Treat contrary conditions by following them," which refers to this principle. "Absence of pulse" here describes a pulse that feels as if it is about to vanish upon palpation. After administering the medicine, if the pulse is re-examined and found to emerge suddenly and violently, it is like the flame rising high when a candle burns out; thus, death is indicated. If the pulse emerges slowly, weakly, and continuously, it indicates that true yang is gradually returning, thus survival is possible. Hence, in the previous clause, it was stated that as soon as diarrhea is observed, Baotong Tang (White Connective Decoction) should be used to treat the condition before it fully manifests, which is indeed an excellent method.
[Collected Notes]
Cheng Zhi said: This discusses the method of using bile to unblock yin in cases of yin-excess repelling yang. Administering Baotong Tang (White Connective Decoction) should theoretically allow yang to be rescued. Yet now, diarrhea persists, progressing to cold extremities (Jue) and absence of pulse, indicating that yin-pathogenic factors have become even more unrestrained. Dry retching and vexation indicate that the yang-acting drugs remain stuck in the diaphragm and fail to enter the yin. This is not because the drug strength is insufficient to overcome the disease, but due to the lack of guiding agents. Adding the yin-cold properties of Human Urine (Renyao) and Porcine Bile (Zhudan) can guide the warming properties of Dried Ginger (Ganjiang) and Aconite Root (Fuzi) into the repelled cold to regulate the counterflow. This is the method of "following treatment" (Cong Zhi) described in the Neijing (Inner Canon).
Cheng Yingmao said: A sudden violent emergence of the pulse indicates death, representing rootless yang qi bursting forth externally. A slight and continuous pulse indicates survival, representing yang qi gradually interacting and yin willing to accept it.