（仲景）
治少阴伤寒，腹痛，小便不利，四肢沉重疼痛，自下利者，此为有水气。或咳或呕，或
小便利（伤寒脉沉细，欲吐不吐，心烦，但欲寐，五六日利而渴者，为少阴证。凡人寤则气
行于阳
周扬
水，
湿
筋惕肉 ，振振欲擗地，气虚恶寒（汗出过多则心悸，汗为心液，汗去心虚，如鱼失水则跃
也；水停心下亦心悸，心属火，火畏水，故悸也。虚阳内动，故头眩；汗多则液少，不能荣
养筋肉，故筋惕惕而跳，肉 而动也；振振欲擗地者，亡阳无奈，欲擗地而入也。程郊倩
曰∶汗多亡阳，夫人知之，然有卫外之阳，为周身营卫之主，此阳虚遂有汗漏不止，恶寒身
痛之证；有膻中之阳，为上焦心肺之主，此阳虚遂有叉手冒心及奔豚之证；有肾中之阳，为
下焦真元之主，此阳虚遂有发热眩悸、 振擗地之证；有胃中之阳，为中焦水谷生化之主，
此阳虚遂有腹胀满、胃不和而成心下痞之证。救误者须观脉证，知犯何逆，以法治之。肾之
真阳盛，则水皆内附，而与肾气同其收藏矣；肾之阳虚，不能制水，则泛滥为病，故上凌心
而成眩
附子（一枚。炮） 白术（二两。炒） 茯苓 白芍（炒） 生姜（三两。）水寒相搏，
咳者，加五味子、细辛、干姜（五味敛肺气，细辛、干姜散水寒）；小便利，去茯苓（茯苓
渗水）；下利，去芍药，加干姜（芍药酸寒，干姜辛热）；呕，去附子，加生姜一倍（附子补
气，生姜散逆）。
此足少阴药也。茯苓、白术补土利水，能伐肾邪而疗心悸；生姜、附子回阳益卫，能壮
真火而逐虚寒；芍药酸收，能敛阴和营而止腹痛（补阳必兼和阴，不欲偏胜。经曰∶寒淫所
胜，治以辛热；湿淫所胜，佐以酸平）。真武，北方之神，一龟一蛇，司水火者也，肾命象
之。此方济火而利水，故以名焉（程郊倩曰∶水气惟太阳与少阴有之，以二经同司夫水也。
然太阳从表得之，肤腠不宣，水气为玄府所遏，故以小青龙发之；少阴由下焦有寒，不能制
服本水，客邪得深入而动其本气，缘肾阳衰而提防不及也，故用真武汤温中镇水，收摄其阴
气。按∶青龙主太阳表水，十枣主太阳里水，真武主少阴里水。喻嘉言曰∶阳明少阳绝无用
附子法，惟太阳经有不得不用之证。盖太阳膀胱为肾之腑，肾中阳虚阴盛，势必传出于腑，
以故才见脉微恶寒、漏汗恶风、心悸头眩、筋惕肉 躁扰等证，纵有传经热邪，不得不用姜
附以消阴回
本方去生姜，加人参二两，名附子汤（仲景）∶治少阴病身体痛、手足寒、骨节痛、脉
沉者（肾主骨，寒淫则痛。此一身骨节尽痛，乃阳虚阴盛而生内寒所致，非外感也；若以外
感之痛治之则杀人矣。故用参附助阳而胜肾寒，加芍药敛阴以为阳之附也）；及少阴病得之
一二日，口中和，背恶寒者（背为胸中之府，诸阳受气于胸中，转行于背，背为阳，腹为阴，
阳气不足，阴寒内盛，则背为之恶寒。若风寒在表而恶寒，则一身尽寒矣。昂按∶背为太阳
部分，然少阴肾脉亦贯脊，与太阳相表里。又背居北方，与肾同位，故寒伤少阴而背恶寒，
亦其义也。又有阴气不足，阳气乘虚内陷，阴中表阳新虚，背微恶寒者，经所谓伤寒无大热，
口渴心烦，背微恶寒是也，白虎加人参汤主之。一为阴气内盛，一为阳气内陷，何以明之，
盖阴寒为病，内无燥热，则口中和；阳气内陷，则销烁津液，口燥舌干而渴也。欲辨阳明寒
热之不同，当以口中燥润详之。一法看小便之清赤∶清者为寒，赤者为热也）。
（张仲景）
治疗少阴伤寒，出现腹痛、小便不通畅、四肢沉重疼痛、自发性腹泻的症状，这是因为体内有水气。或者咳嗽，或者呕吐，或者小便通畅（伤寒脉象沉细，想吐又吐不出来，心烦，只想睡觉，过了五六天出现腹泻且口渴的，属于少阴证。人清醒时，阳气运行于体表），周扬指出这是水湿之邪。
筋惕肉瞤（肌肉跳动），身体震颤想要倒在地上，这是气虚怕冷（出汗过多会导致心悸，汗是心的液体，汗出多了心气虚弱，就像鱼离开了水就会跳跃一样；水停在心下也会导致心悸，因为心属火，火畏惧水，所以会悸动。虚阳在内扰动，所以头晕目眩；出汗多则津液减少，不能滋养筋肉，所以筋肉跳动，肌肉颤动。身体震颤想要趴在地上的原因，是因为亡阳无奈，想要趴地以寻求依托）。程郊倩说：出汗多导致亡阳，这是人们所知道的，但是有护卫体表的阳气，它是周身营卫的主宰，这种阳气虚就会导致汗漏不止、怕冷、身体痛的证候；有膻中的阳气，它是上焦心肺的主宰，这种阳气虚就会导致双手交叉护住心胸以及奔豚气的证候；有肾中的阳气，它是下焦真元的主宰，这种阳气虚就会导致发热、眩晕、悸动、身体震颤趴地的证候；有胃中的阳气，它是中焦水谷生化之源的主宰，这种阳气虚就会导致腹胀满、胃不和而形成心下痞塞的证候。救治误治者必须观察脉证，知道犯了什么错误，然后依法治疗。肾的真阳旺盛，则水都内附，与肾气共同发挥收藏作用；肾的阳气虚，不能制约水，则水泛滥成病，所以上凌于心导致眩晕。
附子（一枚，炮制）、白术（二两，炒）、茯苓、白芍（炒）、生姜（三两）。水寒相互搏结，如果咳嗽，加五味子、细辛、干姜（五味子收敛肺气，细辛和干姜散水寒）；如果小便通畅，去掉茯苓（茯苓渗利水湿）；如果腹泻，去掉白芍，加干姜（白芍酸寒，干姜辛热）；如果呕吐，去掉附子，加倍使用生姜（附子补气，生姜散逆气）。
这是足少阴经的药物。茯苓、白术补益脾土以利水，能祛除肾邪而治疗心悸；生姜、附子回阳益卫，能壮真火而驱逐虚寒；白芍酸收，能敛阴和营而止腹痛（补阳必须兼以和阴，不希望偏胜。经文说：寒邪过胜，用辛热药治疗；湿邪过胜，佐以酸平药）。真武是北方之神，形象为一龟一蛇，掌管水火，肾命门象征它。这个方剂济助心火而通利水湿，所以以此命名（程郊倩说：水气只有太阳经和少阴经会有，因为这两经共同主管水液。然而太阳经是从表感受的，肤腠不宣通，水气被玄府所遏制，所以用小青龙汤发散它；少阴经是由下焦有寒，不能制服本脏之水，客邪得以深入并触动本气，因为肾阳衰微而堤防不及，所以用真武汤温中镇水，收摄其阴气。按：青龙汤主治太阳经表水，十枣汤主治太阳经里水，真武汤主治少阴经里水。喻嘉言说：阳明经和少阳经绝没有使用附子的方法，只有太阳经有不得不用的情况。因为太阳膀胱是肾的腑，肾中阳虚阴盛，势必传变出于腑，所以刚见到脉微恶寒、漏汗恶风、心悸头眩、筋肉跳动躁扰等证候，即使有传经的热邪，也不得不使用姜、附来消除阴寒，回复阳气）。
本方去掉生姜，加入人参二两，名为附子汤（张仲景）：治疗少阴病身体痛、手足寒冷、骨节痛、脉沉的症状（肾主骨，寒邪过胜则痛。这一身骨节都痛，是由于阳虚阴盛而生内寒所致，不是外感；如果用治疗外感的方法治疗就会死人。所以用人参、附子助阳而战胜肾寒，加白芍敛阴作为阳气的辅助）；以及少阴病得之一两天，口中平和，背部怕冷的症状（背是胸中的府邸，诸阳之气受于胸中，转行于背部，背为阳，腹为阴，阳气不足，阴寒内盛，则背部感到怕冷。如果是风寒在表而怕冷，则全身都会寒冷。汪昂按：背属于太阳经部分，然而少阴肾脉也贯穿脊柱，与太阳经相表里。另外背居北方，与肾同位，所以寒伤少阴而背部怕冷，也是其中的道理。又有阴气不足，阳气乘虚内陷，阴中之表阳新近虚弱，背部轻微怕冷的，经文所说的伤寒没有大热，口渴心烦，背部轻微怕冷，是用白虎加人参汤主治。一种是阴气内盛，一种是阳气内陷，如何分辨呢？大概阴寒为病，内部没有燥热，则口中平和；阳气内陷，则会销烁津液，口燥舌干而渴。要辨别阳明经寒热的不同，应当根据口中干燥湿润来详细判断。另一种方法是看小便的清赤：清者为寒，赤者为热）。
(Zhang Zhongjing)
Treats Shaoyin Cold Damage (Shaoyin syndrome caused by cold pathogen), presenting with abdominal pain, difficult urination, heaviness and pain in the four limbs, and spontaneous diarrhea; this is due to water qi (pathogenic fluid accumulation). There may be cough or vomiting, or clear urination. (In Cold Damage, a deep and fine pulse, desire to vomit but unable to do so, irritability, and only wanting to sleep, along with diarrhea and thirst after five or six days, indicate a Shaoyin pattern. When awake, Qi circulates in the Yang aspect of the body.) Zhou Yang points out that this involves Water-Dampness.
Muscle twitching (Jinti Rourun), tremors causing the patient to want to fall to the ground, indicates Qi deficiency and aversion to cold (excessive sweating leads to palpitations; sweat is the fluid of the Heart. When sweat is lost excessively, Heart Qi becomes deficient, similar to a fish jumping when it loses its water; water stagnating below the Heart also causes palpitations because the Heart belongs to Fire, and Fire fears Water, hence palpitations. Deficient Yang moving internally causes dizziness; excessive sweating reduces fluids, which cannot nourish muscles and sinews, leading to muscle twitching and trembling. The reason for trembling and wanting to collapse onto the ground is the helplessness of Yang exhaustion, seeking support from the ground.) Cheng Jiaoqian states: Excessive sweating leading to Yang exhaustion is well known. However, there is the Defensive Yang that protects the exterior, which is the master of the body's Ying and Wei. Deficiency of this Yang leads to continuous leaking sweat, aversion to cold, and body pain. There is the Yang in the Danzhong (Chest), which is the master of the Upper Jiao Heart and Lungs. Deficiency of this Yang leads to crossing hands over the heart and Penetrating Pig (Ben Tun) syndrome. There is the True Yang in the Kidney, which is the master of the Lower Jiao's true Yuan. Deficiency of this Yang leads to fever, dizziness, palpitations, and tremors causing collapse. There is the Yang in the Stomach, which is the master of the transformation and production of water and grain in the Middle Jiao. Deficiency of this Yang leads to abdominal fullness, stomach disharmony, and epigastric glomus (Xia Pi). Those treating medical errors must observe the pulse and symptoms, understand what mistake was made, and treat according to the method. When the Kidney's True Yang is prosperous, water adheres internally, sharing the storage function with Kidney Qi; when Kidney Yang is deficient and cannot control water, water floods and causes disease, thus overwhelming the Heart and causing dizziness.
Fuzi (Aconiti Lateralis Radix Praeparata, one piece, processed), Baizhu (Atractylodis Macrocephalae Rhizoma, two liang, stir-fried), Fuling (Poria), Shaoyao (Paeoniae Radix Alba, stir-fried), Shengjiang (Zingiberis Rhizoma Recens, three liang). When Water and Cold contend, if there is cough, add Wuweizi (Schisandrae Fructus), Xixin (Asari Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma); Wuweizi astringes Lung Qi, while Xixin and Ganjiang disperse Water-Cold. If urination is clear/abundant, remove Fuling (which leaches out water). If there is diarrhea, remove Shaoyao and add Ganjiang (Shaoyao is sour and cold, Ganjiang is acrid and hot). If there is vomiting, remove Fuzi and double the amount of Shengjiang (Fuzi tonifies Qi, Shengjiang disperses rebellious Qi).
This is a formula for the Foot-Shaoyin meridian. Fuling and Baizhu tonify Earth to promote water metabolism, able to attack Kidney pathogens and treat palpitations; Shengjiang and Fuzi restore Yang and benefit Wei, strengthening True Fire to expel deficient cold; Shaoyao is sour and astringent, able to conserve Yin and harmonize Ying to stop abdominal pain (Tonifying Yang must simultaneously harmonize Yin, avoiding excess. The Classic states: For excess Cold, treat with Acrid-Hot; for excess Dampness, assist with Sour-Neutral). Zhenwu is the deity of the North, depicted as a turtle and a snake, governing Water and Fire, symbolizing the Kidney-Mingmen. This formula assists Fire and promotes water flow, hence named Zhenwu Tang (Cheng Jiaoqian says: Water qi exists only in the Taiyang and Shaoyin meridians because both govern water. However, Taiyang receives it from the exterior; when skin pores are not unobstructed, water qi is blocked by the Xu Fu (pores), so Xiao Qinglong Tang is used to release it. Shaoyin arises from cold in the Lower Jiao, failing to control its own Water, allowing external pathogens to penetrate deeply and disturb the root Qi due to Kidney Yang decline and failed defense. Thus, Zhenwu Tang is used to warm the interior and suppress water, gathering the Yin Qi. Note: Xiao Qinglong Tang governs Taiyang exterior water, Shizao Tang governs Taiyang interior water, and Zhenwu Tang governs Shaoyin interior water. Yu Jiayan says: There is absolutely no indication for using Fuzi in Yangming or Shaoyang meridians; only in Taiyang are there cases where it is indispensable. Because the Taiyang Bladder is the Fu organ of the Kidney, Kidney Yang deficiency and Yin excess inevitably transmit to the Fu organ. Therefore, upon seeing signs like faint pulse, aversion to cold, leaking sweat, aversion to wind, palpitations, dizziness, muscle twitching, and restlessness, even if there is transmitted heat pathogen, Jiang (Ginger) and Fu (Aconite) must be used to eliminate Yin and restore Yang).
Removing Shengjiang from this formula and adding Ren Shen (Ginseng Radix et Rhizoma, two liang) creates Fuzi Tang (Zhang Zhongjing): Treats Shaoyin disease with body pain, cold hands and feet, bone joint pain, and a deep pulse (The Kidney governs bones; excess Cold causes pain. Pain throughout all bone joints here is caused by Yang deficiency and Yin excess generating internal cold, not external contraction; treating it as an external contraction would be fatal. Therefore, Ren Shen and Fuzi are used to assist Yang and overcome Kidney cold, while Shaoyao is added to conserve Yin as an attachment to Yang); and Shaoyin disease occurring within one or two days, with a neutral mouth feeling and aversion to cold in the back (The back is the mansion of the chest; all Yang Qi receives energy in the chest and circulates to the back. The back is Yang, the abdomen is Yin. Insufficient Yang and盛 Yin-cold internally cause aversion to cold in the back. If aversion to cold were due to Wind-Cold in the exterior, the whole body would be cold. Wang Ang notes: The back belongs to the Taiyang region, yet the Shaoyin Kidney meridian also penetrates the spine, being exterior-interior related to Taiyang. Furthermore, the back is located in the North, corresponding to the Kidney's position. Thus, cold injuring Shaoyin causing back aversion to cold is consistent with this principle. There is also a case of insufficient Yin Qi, where Yang sinks inward vacuously, and the new deficiency of Yang on the surface within Yin causes slight back aversion to cold. The Classic mentions Cold Damage without significant fever, thirst, irritability, and slight back aversion to cold, treated with Baihu Jia Renshen Tang. One case is internal盛 Yin-cold; the other is internal sinking of Yang. How to distinguish? Generally, Yin-Cold disease has no internal dry-heat, so the mouth feels neutral; Yang sinking inward consumes fluids, causing dry mouth, dry tongue, and thirst. To distinguish between Yangming Cold and Heat, one should carefully examine whether the mouth is dry or moist. Another method is observing urine clarity and color: clear indicates Cold, red indicates Heat).