【注】少阴病下利，便脓血用桃花汤不止者，热瘀于阴分也，则可刺本经之穴，以泄其热，热去则脓血自止矣。
【集注】张璐曰∶先下利日久，而后便脓血，则用桃花汤；若不先下利，而下利便脓血，则可刺经穴。若
刺经穴不愈，则当从事白头翁汤。设更咽干、心烦不得眠，则又须黄连阿胶汤为合法也。
林澜曰∶刺者，泻其经气而宣通之也。下利便脓血，既主桃花汤矣，此复云可刺者，如痞证利不止，复利
其小便，与五苓散以救石脂禹余粮之穷，故此一刺，亦以辅桃花汤之所不逮也。
少阴病，得之二三日，口燥咽干者，急下之，宜大承气汤。
【注】邪至少阴二三日，即口燥咽干者，必其人胃火素盛，肾水素亏，当以大承气汤，急泻胃火以救肾水。
若复迁延时日，肾水告竭，其阴必亡，虽下无及矣。
【集注】成无己曰∶与大承气汤急下之以全肾，何也？经云∶三阴经受病已入于腑者，可下而已，则是上
条少阴病，乃入腑证也。少阴邪热已转属于腑，胃腑实热消灼肾水，故口燥咽干，用大承气以泻腑，而实热自
除。且少阴之脏本肾属水，胃腑属土，泻土所以救水也。
方有执曰∶口燥咽干者，少阴之脉，循喉咙挟舌本，邪热客于其经，而肾水为之枯竭也。然水干则土燥，
土燥则水愈干，所以急于下也。
张璐曰∶按少阴急下三证，一属传经热邪亢极，一属热邪转入胃腑，一属温热发自少阴，皆刻不容缓之证。
故当急救欲绝之肾水，与阳明急下三法，同源异派。
汪琥曰∶少阴病得之二三日者，非才得病二三日即口燥咽干，谓少阴口燥咽干之病，已得之二三日也。
少阴病，自利清水，色纯青，心下必痛，口干燥者，急下之，宜大承气汤。
【注】少阴病自利清水，谓下利无糟粕也。色纯青，谓所下者皆污水也。下无糟粕，纯是污水，此属少阴
实热，所以心下必痛，口燥咽干，其为少阴急下之证无疑矣。故当急下之，宜大承气汤。
【集注】程知曰∶阳邪热结，口必干燥，设系阴邪，口中和而不燥矣，故宜急下之以救阴也。
沈明宗曰∶邪传阳明，必俟大便坚硬而攻下者，乃未伤胃中津液之谓。此利清水，因少阴邪热炽盛，乘逼
胃中津液，顷刻势已濒危，不得不以通因通用急夺，而救胃、肾将绝之阴也。
少阴病六七日，腹胀不大便者，急下之，宜大承气汤。
【注】少阴病六七日，腹胀不大便者，盖因其人阳气素盛，胃有宿食故也。所以传邪已入少阴，复转属阳
明，而成胃实，故宜大
承气汤急下之也。
【集注】张璐曰∶少阴之证，自利者最多，虚寒则下利清谷，虚热则下利脓血，故多用温补。传经阳邪内
结，则自利纯青水，温热病，则自利烦渴，并宜下夺清热。此以六七日不大便而腹胀，可见邪热转归阳明，而
为胃实之证，所以宜急下也。
少阴中风，脉阳微阴浮者，为欲愈。
【注】少阴中风，脉若见阳浮阴弱，乃风邪传入少阴，则是其势方盛，未易言愈。今阳脉反微，阴脉反浮，
阳微则外邪散而表气和，阴浮则里气胜而邪外出，故为欲愈也。
少阴病欲解时，从子至寅上。
【注】子、丑、寅阳生渐长之候也。病在少阴而解于阳生之际，所谓阳进则阴退，阴得阳而邪自解也。少
阴所重在真阳，从可见矣。
【注释】少阴病出现下利，使用桃花汤治疗便脓血症状无效时，说明热邪瘀结在阴分，此时可以针刺本经的穴位，以泄除热邪，热邪去除后，脓血自然停止。
【集注】张璐说：如果是先长期下利，随后才出现便脓血，则使用桃花汤；如果不是先有下利，而是直接出现下利并伴有便脓血，则可以针刺经络穴位。如果针刺经络穴位后仍未痊愈，则应当采用白头翁汤。假如又出现咽干、心烦、无法入睡的症状，那么必须使用黄连阿胶汤才是正确的治法。
林澜说：所谓“刺”，是泻除经脉之气使其宣通。下利便脓血，既然主治用桃花汤，这里又说可以针刺，就像痞证导致下利不止，通过利小便的方法，配合五苓散来补救禹余粮石脂（赤石脂禹余粮汤）疗效不足的情况一样，所以这里的针刺，也是用来辅助桃花汤所不能达到的效果。
少阴病，发病两三天，出现口燥咽干的，应当紧急攻下，适宜用大承气汤。
【注释】邪气传入少阴经过两三天，就出现口燥咽干的，一定是因为此人胃火素来旺盛，肾水素来亏虚，应当用大承气汤，紧急泻除胃火以拯救肾水。如果再拖延时日，肾水枯竭，其阴液必然消亡，即使再攻下也来不及了。
【集注】成无己说：给予大承气汤紧急攻下以保全肾水，为什么呢？经文说：“三阴经受病，如果已经入腑，就可以用攻下法。”这说明上一条所述的少阴病，属于入腑的证候。少阴的邪热已经转属到腑，胃腑实热消灼肾水，所以出现口燥咽干，使用大承气汤泻除腑实，实热自然消除。而且少阴之脏本是肾，属水，胃腑属土，泻土（胃）就是为了救水（肾）。
方有执说：口燥咽干，是因为少阴经脉循行喉咙挟持舌根，邪热客居在该经脉，导致肾水枯竭。然而水干则土燥，土燥则水更加干枯，所以急于攻下。
张璐说：按少阴急下证的三种情况，一种属于传经热邪亢盛到了极点，一种属于热邪转入胃腑，一种属于温热病发自少阴，都是刻不容缓的证候。因此应当急救即将衰竭的肾水，这与阳明急下三法，源头相同而派别不同。
汪琥说：少阴病得之二三日，并不是刚得病两三天就出现口燥咽干，而是指少阴病出现口燥咽干的症状，已经持续了两三天。
少阴病，自利清水，颜色纯青，心下部必定疼痛，口干燥的，应当紧急攻下，适宜用大承气汤。
【注释】少阴病自利清水，是指下利没有未消化的食物残渣。颜色纯青，是指排出的都是污水。下利没有糟粕，全是污水，这属于少阴实热证，所以心下部必定疼痛，口燥咽干，这是少阴急下证无疑。因此应当紧急攻下，适宜用大承气汤。
【集注】程知说：阳邪热结，口必定干燥，如果是阴邪，口中应该是和润而不干燥的，所以宜紧急攻下以拯救阴液。
沈明宗说：邪气传入阳明，通常要等到大便坚硬才攻下，那是还没有损伤胃中津液的说法。这里是下利清水，因为少阴邪热炽盛，逼迫胃中的津液，顷刻间形势已濒危，不得不采用“通因通用”的方法紧急夺回邪气，以拯救胃、肾即将断绝的阴液。
【注释】少阴病六七天，出现腹胀不大便，大概是因为此人阳气素来旺盛，胃中有宿食的缘故。所以邪气传入少阴后，又转属阳明，形成胃实证，因此适宜用大承气汤紧急攻下。
【集注】张璐说：少阴的病证，自利的情况最多，虚寒则下利清谷，虚热则下利脓血，所以多用温补法。如果是传经阳邪内结，则自利纯青水；如果是温热病，则自利且烦渴，都适宜用攻下法清热。这里因为六七天不大便且腹胀，可见邪热转归阳明，成为胃实证，所以宜紧急攻下。
少阴中风，脉象寸部微、尺部浮的，是快要痊愈的表现。
【注释】少阴中风，脉象如果见寸部浮、尺部弱，那是风邪传入少阴，说明病势正盛，不容易说痊愈。现在寸脉反而微，尺脉反而浮，寸脉微说明外邪消散且表气调和，尺脉浮说明里气胜而邪气外出，所以说是快要痊愈。
少阴病想要解除的时间，是从子时到寅时这段时间。
【注释】子、丑、寅这三个时辰是阳气逐渐生长的时刻。病在少阴而在阳气生长的时候解除，这就是所谓的阳气进则阴气退，阴得到阳的帮助则邪气自然解除。少阴病重在真阳，从这里就可以看出来了。
[Annotation] In Shaoyin disease with diarrhea, if the discharge of pus and blood does not stop after using Taohua Decoction (Peach Blossom Decoction), it indicates that heat is stasis in the Yin aspect. In this case, one may puncture the acupoints of the meridian itself to drain the heat; once the heat is eliminated, the pus and blood will naturally cease.
[Collected Annotations] Zhang Lu stated: If long-term diarrhea precedes the discharge of pus and blood, Taohua Decoction should be used; if there is no prior diarrhea but rather immediate diarrhea with pus and blood, puncturing the meridian acupoints is appropriate. If puncturing the meridian acupoints fails to cure the condition, Baitouweng Decoction (Pulsatilla Decoction) should be employed. If dry throat, irritability, and insomnia are added, then Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is the correct treatment.
Lin Lan stated: "Puncturing" refers to draining the Qi of the meridians to promote their free flow. Although Taohua Decoction is the primary treatment for diarrhea with pus and blood, the mention of puncturing here serves a similar function to using diuresis (promoting urination) and Wuling San (Five-Ingredient Poria Pill) to address the limitations of Chishizhi Yuyuli Tang (Red Halloysite and Barium Sulfate Decoction) in cases of Pi syndrome with persistent diarrhea. Thus, this puncturing method also serves to assist where Taohua Decoction falls short.
In Shaoyin disease, if dry mouth and throat appear within two or three days of onset, urgent purgation is required, preferably using Dachengqi Tang (Major Order the Qi Decoction).
[Annotation] If dry mouth and throat appear within two or three days after pathogenic factors enter the Shaoyin stage, it implies that the patient's Stomach Fire has been inherently excessive and Kidney Water inherently deficient. One should use Dachengqi Tang to urgently purge Stomach Fire to save Kidney Water. If time is delayed until Kidney Water is exhausted, Yin will perish, and even purgation would be too late.
[Collected Annotations] Cheng Wuji stated: Why give Dachengqi Tang to urgently purge and preserve the Kidney? The Classic states: "When diseases of the Three Yin meridians enter the Fu organs, they can be treated by purgation." This indicates that the aforementioned Shaoyin disease belongs to the category of entering the Fu organs. When Shaoyin pathogenic heat transfers to the Fu organ, the excess heat in the Stomach Fu consumes Kidney Water, causing dry mouth and throat. Using Dachengqi Tang to purge the Fu organ eliminates the excess heat. Furthermore, since the Zang organ of Shaoyin is the Kidney (Water) and the Stomach Fu is Earth, purging Earth saves Water.
Fang Youzhi stated: Dry mouth and throat occur because the Shaoyin meridian runs along the throat and surrounds the root of the tongue; pathogenic heat lodging in this meridian causes Kidney Water to dry up. However, when Water dries, Earth becomes dry; when Earth is dry, Water dries further. Hence, urgent purgation is necessary.
Zhang Lu stated: Regarding the three indications for urgent purgation in Shaoyin disease: one belongs to extreme hyperactivity of transmitted heat pathogens, one to heat pathogens transferring to the Stomach Fu, and one to warm-heat diseases originating from Shaoyin. These are all critical conditions requiring immediate attention. Therefore, one must urgently rescue the nearly exhausted Kidney Water. This shares the same origin as the three methods of urgent purgation in Yangming disease but differs in application.
Wang Hu stated: "Shaoyin disease developing over two or three days" does not mean dry mouth and throat appear immediately upon contracting the disease for two or three days. Rather, it means the symptoms of dry mouth and throat in Shaoyin disease have persisted for two or three days.
In Shaoyin disease, spontaneous diarrhea of clear water, pure green in color, accompanied by pain in the epigastrium and dry mouth/throat, requires urgent purgation, preferably using Dachengqi Tang (Major Order the Qi Decoction).
[Annotation] "Spontaneous diarrhea of clear water" refers to diarrhea without undigested food residues. "Pure green color" refers to the discharge being entirely foul liquid. Diarrhea without residue, consisting only of foul liquid, belongs to Shaoyin excess-heat syndrome. Consequently, there is必定 pain in the epigastrium and dry mouth/throat. This is undoubtedly an indication for urgent purgation in Shaoyin disease. Therefore, urgent purgation is required, preferably using Dachengqi Tang.
[Collected Annotations] Cheng Zhi stated: Yang pathogenic heat accumulation causes dry mouth. If it were a Yin pathogen, the mouth would feel moist and not dry. Thus, urgent purgation is suitable to save Yin.
Shen Mingzong stated: When pathogens transmit to Yangming, purgation is typically reserved until the stool becomes hard, implying that the fluids in the Stomach have not yet been damaged. Here, however, there is diarrhea of clear water because Shaoyin pathogenic heat is blazing and forcing out the fluids in the Stomach. The situation is critical and imminent. One must employ the principle of "treating obstruction with unblocking agents" (Tong Yin Yong Tong) to urgently seize back the pathogen and save the nearly extinct Yin of the Stomach and Kidney.
In Shaoyin disease, if abdominal distension and constipation persist for six or seven days, urgent purgation is required, preferably using Dachengqi Tang (Major Order the Qi Decoction).
[Annotation] In Shaoyin disease, if abdominal distension and constipation occur after six or seven days, it is likely due to the patient's inherent strong Yang Qi and the presence of retained food in the Stomach. Thus, although the pathogen entered Shaoyin, it transferred to Yangming, forming a Stomach excess syndrome. Therefore, Dachengqi Tang should be used for urgent purgation.
[Collected Annotations] Zhang Lu stated: In Shaoyin disease, spontaneous diarrhea is most common. Deficiency-cold leads to diarrhea of undigested food, while deficiency-heat leads to diarrhea with pus and blood, so warming and tonifying methods are mostly used. If transmitted Yang pathogens accumulate internally, there is spontaneous diarrhea of pure green water; if it is a warm-heat disease, there is spontaneous diarrhea with irritability and thirst, both requiring purgation to clear heat. In this case, the absence of bowel movements for six or seven days with abdominal distension indicates that pathogenic heat has transferred to Yangming, forming a Stomach excess syndrome, hence urgent purgation is indicated.
In Shaoyin wind-stroke, if the pulse is superficially weak (Cun) and deeply floating (Chi), recovery is imminent.
[Annotation] In Shaoyin wind-stroke, if the pulse shows superficial floating and deep weakness, it indicates wind pathogens have transmitted into Shaoyin, meaning the pathogenic force is still strong and recovery is not yet expected. However, if the superficial pulse is instead weak and the deep pulse is floating, a weak superficial pulse indicates that external pathogens are dissipating and the exterior Qi is harmonized, while a floating deep pulse indicates that interior Qi is victorious and pathogens are moving outward. Therefore, this signifies impending recovery.
The time when Shaoyin disease is likely to resolve is from Zi hour to Yin hour.
[Annotation] Zi, Chou, and Yin hours are periods when Yang Qi gradually grows. When a disease in Shaoyin resolves during these times of Yang growth, it illustrates the principle that as Yang advances, Yin retreats; when Yin receives the assistance of Yang, pathogens naturally resolve. Shaoyin disease focuses on True Yang, which can be seen from this.