葱白（四茎） 干姜（一两） 附子（一枚生去皮破八片） 人尿（一合味苦寒）
猪胆汁（一合味苦寒）
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。
内经曰。若调寒热之逆。冷热必行。则热物冷服。下嗌之后。冷体既消。热性便发。
由是病气随愈。呕哕皆除。情且不达。而致大益。此和人尿猪胆汁咸苦寒物于白通汤热
剂中。要其气相从。则可以去格拒之寒也。
张兼善云。白通汤用附子。凡四证。惟真武汤一证熟用。余皆生用。何也。凡附子
生用则温经散寒。炮熟则益阳除湿。干姜辛热。故佐生附为用。生姜辛温。少资熟附之
功。然白通等汤。以下利为重。其真武汤证。以寒湿为先。故用药有轻重之殊耳。
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。
少阴病二三日。则邪气犹浅。至四五日。邪气已深。肾主水。肾病不能制水。水饮
停为水气。腹痛者。寒湿内甚也。四肢沉重疼痛。寒湿外甚也。小便不利。自下利者。
湿胜而水谷不别也。内经曰。湿胜则濡泄。与真武汤。益阳气。散寒湿。
茯苓（三两味甘平） 芍药（三两味酸平） 生姜（三两切味辛温） 白术（二两
味甘温） 附子（一枚炮去皮破八片味辛热）
上五味。以水八升。煮取三升。去滓。温服七合。日三服。
脾恶湿。甘先入脾。茯苓白术之甘。以益脾逐水。寒淫所胜。平以辛热。湿淫所胜。
佐以酸平。附子芍药生姜之酸辛。以温经散湿。
后加减法。
若咳者。加五味半升。细辛干姜各一两。
气逆咳者。五味之酸。以收逆气。水寒相搏则咳。细辛干姜之辛。以散水寒。
若小便利者。去茯苓。
小便利。则无伏水。故去茯苓。
若下利者。去芍药。加干姜二两。
芍药之酸泄气。干姜之辛散寒。
若呕者。去附子。加生姜。足前成半斤。
气逆则呕。附子补气。生姜散气。千金曰。呕家多服生姜。此为呕家圣药。
论云。真武、北方水神也。水气在心下。外带表而属阳。必应发散。故治以真武汤。
青龙汤主太阳病。真武汤主少阴病。
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。
下利清谷。手足厥逆。脉微欲绝。为里寒。身热不恶寒。面色赤。为外热。此阴甚
于内。格阳于外。不相通也。与通脉四逆汤。散阴通阳。
葱白（四根） 干姜（一两） 附子（一枚，生用，去皮，破成八片） 人尿（一合，味苦寒）
猪胆汁（一合，味苦寒）
以上三味药。用水三升。煮取一升。去渣。加入胆汁和人尿。调和均匀。分两次温服。如果
没有胆汁，也可以用（其他方法替代）。
《内经》说。如果要调理寒热错杂的逆乱之气。冷热之气必然各行其道。那么就用热药冷服。咽下之后。冷的性状既然消失。热的性质便发作出来。
因此病气随之痊愈。呕吐呃逆都消除了。药性不致格拒不受。而达到很大的疗效。这就是将人尿和猪胆汁这些咸苦寒的药物加入白通汤这种热剂中。关键在于气味相从。那么就可以去除格拒之寒邪。
张兼善说。白通汤中使用附子。共有四种证候。只有真武汤这一证候是用熟附子。其余都是生用。为什么呢。凡是附子
生用则能温经散寒。炮制成熟则能益阳除湿。干姜辛热。所以辅助生附子发挥作用。生姜辛温。稍微资助熟附子的
功效。然而白通等汤。以下利为重症。其真武汤证。以寒湿为先。所以用药有轻重之分罢了。
少阴病。两三天没有好。到了四五天。腹痛。小便不利。四肢沉重疼痛。自发性腹泻。这
是因为有水气。其中有的人咳嗽。或者小便通畅。或者腹泻。或者呕吐。真武汤主治。
少阴病二三天。则邪气尚浅。到了四五天。邪气已深。肾主水。肾病不能制约水液。水饮
停滞成为水气。腹痛。是寒湿内盛。四肢沉重疼痛。是寒湿外盛。小便不利。自发性腹泻。是
湿胜而水谷不分。《内经》说。湿胜则导致濡泄。给予真武汤。补益阳气。散寒湿。
茯苓（三两，味甘平） 芍药（三两，味酸平） 生姜（三两，切，味辛温） 白术（二两
味甘温） 附子（一枚，炮制，去皮，破成八片，味辛热）
以上五味药。用水八升。煮取三升。去渣。温服七合。每日三次服用。
脾恶湿。甘味先入脾。茯苓白术的甘味。用来补益脾气驱逐水湿。寒淫所胜。用辛热来平抑。湿淫所胜。
用酸平来佐助。附子芍药生姜的酸辛。用来温经散湿。
后续加减法。
如果咳嗽。加五味子半升。细辛干姜各一两。
气逆咳嗽。五味子的酸味。用来收敛逆气。水寒相互搏结则咳嗽。细辛干姜的辛味。用来散水寒。
如果小便通畅。去掉茯苓。
小便通畅。则没有伏留的水湿。所以去掉茯苓。
如果腹泻。去掉芍药。加干姜二两。
芍药的酸味泄气。干姜的辛味散寒。
如果呕吐。去掉附子。加生姜。补足前量至半斤。
气逆则呕吐。附子补气。生姜散气。《千金方》说。呕吐患者多服生姜。这是治疗呕吐的圣药。
论中说。真武。是北方水神。水气在心下。外带表证而属阳。必须应当发散。所以用真武汤治疗。
青龙汤主治太阳病。真武汤主治少阴病。
少阴病。腹泻。完谷不化。里寒外热。手足厥冷。脉微欲绝。身体反而不恶寒。其人面色发红。
或者腹痛。或者干呕。或者咽痛。或者腹泻停止。脉不出者。通脉四逆汤主治。
腹泻完谷不化。手足厥冷。脉微欲绝。为里寒。身热不恶寒。面色赤。为外热。这是阴寒极
盛于内。格拒阳气于外。不相通。给予通脉四逆汤。散阴通阳。
Scallion white (four stalks) Dried ginger (one liang) Aconitum carmichaelii radix preparata (one raw piece, peeled, broken into eight slices) Human urine (one he, bitter and cold in nature) Pig bile (one he, bitter and cold in nature)
The above three ingredients. Use three sheng of water. Boil to obtain one sheng. Remove the dregs. Add bile and human urine. Mix well. Divide into two warm doses. If
bile is unavailable, it may be omitted or substituted.
The *Neijing* states: "To regulate the reversal of cold and heat, when cold and hot qi act separately, take hot medicine cold." After swallowing, as the cold nature dissipates, the hot nature emerges.
Thus, the pathogenic qi resolves, vomiting and hiccups cease. The medicinal properties do not face rejection, thereby achieving significant benefit. This involves adding salty, bitter, and cold substances like human urine and pig bile to the hot formula Baicon Tang. The key lies in the harmony of flavors, which can overcome the rejection by cold pathogenic factors.
Zhang Jianshan stated: In Baicon Tang, Aconitum carmichaelii radix preparata is used in four conditions. Only in the condition treated by Zhenwu Tang is cooked aconite used; in others, raw aconite is used. Why? Generally, raw aconite warms the meridians and dispels cold, while cooked aconite benefits yang and removes dampness. Dried ginger is acrid and hot, thus assisting raw aconite. Fresh ginger is acrid and warm, slightly supporting the efficacy of cooked aconite. However, in Baicon Tang and similar formulas, diarrhea is the primary severity. In the Zhenwu Tang condition, cold-dampness is paramount. Hence, there are differences in the weight and dosage of herbs.
Shaoyin disease persisting for two to three days, progressing to four or five days, presents with abdominal pain, difficult urination, heaviness and pain in the four limbs, and spontaneous diarrhea. This indicates the presence of fluid retention (Shui Qi). Some patients may have cough, clear urination, diarrhea, or vomiting. Zhenwu Tang is indicated.
In Shaoyin disease lasting two to three days, the pathogenic factor is still shallow. By four or five days, it has penetrated deeply. The Kidney governs water. When the Kidney fails to control water, fluid retention accumulates as Shui Qi. Abdominal pain indicates severe internal cold-dampness. Heaviness and pain in the four limbs indicate severe external cold-dampness. Difficult urination and spontaneous diarrhea result from excessive dampness causing failure to separate water and grain. The *Neijing* states: "Excessive dampness leads to loose stools." Zhenwu Tang is administered to tonify Yang qi and disperse cold-dampness.
Poria cocos (three liang, sweet and neutral in nature) Paeonia lactiflora radix (three liang, sour and neutral in nature) Zingiberis Rhizoma Recens (three liang, sliced, acrid and warm in nature) Atractylodis Macrocephalae Rhizoma (two liang, sweet and warm in nature) Aconitum carmichaelii radix preparata (one prepared piece, peeled, broken into eight slices, acrid and hot in nature)
The above five ingredients. Use eight sheng of water. Boil to obtain three sheng. Remove the dregs. Take seven he warm, three times daily.
The Spleen dislikes dampness. Sweet flavors enter the Spleen first. The sweetness of Poria cocos and Atractylodis macrocephalae rhizoma tonifies the Spleen and expels water. When cold excess prevails, pacify with acrid-hot herbs. When damp excess prevails, assist with sour-neutral herbs. The sour-acrid nature of Aconitum carmichaelii radix preparata, Paeonia lactiflora radix, and Zingiberis Rhizoma Recens warms the meridians and disperses dampness.
Subsequent modifications:
If cough occurs, add Schisandrae chinensis fructus (half sheng), Asari Radix et Rhizoma, and Dried ginger (one liang each).
For rebellious Qi causing cough, the sourness of Schisandrae chinensis fructus astringes rebellious Qi. Water-cold binding causes cough. The acridity of Asari Radix et Rhizoma and Dried ginger disperses water-cold.
If urination is clear and frequent, remove Poria cocos.
Clear urination indicates no retained water, so Poria cocos is removed.
If diarrhea occurs, remove Paeonia lactiflora radix, add Dried ginger (two liang).
The sourness of Paeonia lactiflora radix drains Qi, while the acridity of Dried ginger disperses cold.
If vomiting occurs, remove Aconitum carmichaelii radix preparata, add Zingiberis Rhizoma Recens, sufficient to make half jin total.
Rebellious Qi causes vomiting. Aconitum carmichaelii radix preparata tonifies Qi, while Zingiberis Rhizoma Recens disperses Qi. The *Qianjin Fang* states: Vomiting patients should take much Zingiberis Rhizoma Recens; it is the sacred herb for vomiting.
The Treatise states: Zhenwu is the Water Deity of the North. Fluid retention in the epigastrium extends outward to the exterior and belongs to Yang. It must be diffused. Therefore, Zhenwu Tang is used.
Qinglong Tang treats Taiyang disease; Zhenwu Tang treats Shaoyin disease.
Shaoyin disease with diarrhea, undigested food in stool, interior cold with exterior heat, cold extremities, faint pulse nearly imperceptible, body feeling no aversion to cold, facial redness,
or abdominal pain, dry heaving, sore throat, cessation of diarrhea with absent pulse. Tongmai Sini Tang is indicated.
Diarrhea with undigested food, cold extremities, faint pulse nearly imperceptible indicate interior cold. Fever without aversion to cold, red face indicate exterior heat. This is extreme Yin cold internally rejecting Yang externally, lacking communication. Tongmai Sini Tang is administered to scatter Yin and unblock Yang.