（张介宾《新方八阵》） 治阴阳将脱垂危诸证。
人参（一二两或数钱） 制附子（二三钱） 炮姜（二三钱） 炙草（一钱） 熟地（五
钱或一两）
分，温服。
理阴（煎）归草干姜地，此是理中之变义。脾肾中虚阴又亏，忌投刚燥宜斯治。（景岳
自云“
用理阴
感寒，
若用寒凉攻
达，而寒邪
更加细辛，
温散，即以
一托于内，
肉桂，散
附子，
治少阴病下利清谷，里寒外热，手足厥冷，汗出而厥，及膈上有寒饮干呕者；又治
太阳发热，头痛脉沉，虽身疼痛，当救其里；又太阳病发汗后，大汗出，热不去，内拘急，
四肢疼，下利厥逆而恶寒者，均宜以此主之。
甘草（二两炙） 干姜（一两半） 附子（一枚生切） 水三升，煮取一升二合，去滓，
分温再服
治证同上，而脉微欲绝者宜此。
四逆汤原方干姜用三两，加葱九茎。
治阴盛格阳，手足厥冷，脉微欲绝，面赤咽疼烦躁者宜此。
通脉四逆汤加猪胆汁半合。（诸药煎成，去滓，纳胆汁和服。）
治发汗，若下之，病仍不解，烦躁者。
四逆加人参汤内更加茯苓四两。
四逆汤中姜附草，四肢逆冷急煎尝。（按∶方名“四逆”，必以之治厥逆。《伤寒论·厥
阴
细，口不渴，以其脏有寒故也，温之无疑。）饮邪干呕亦相当。（寒饮无实物，温之则寒散而
饮去呕止。凡治饮皆用温法。）身疼清谷先温里，（凡病皆当先表后里，惟下利清谷，则以扶
阳为急，而表证为缓，虽身疼痛，亦当先救其里，俟清谷止而身疼未除者，仍从表治可也。
）不论三阴与太阳。（王晋三《古方选注》曰∶四逆汤“凡三阴一阳证中有厥者皆用之，故
少
汗亡阳亦用之者，以太少为水火之主，非交通中土之气，不能内复真阳，故以生附子、生干姜
迎阳归舍，交接于十二经。反复以炙草监之者，亡阳不至于大汗，
则阳未必尽亡，故可缓制留中，而为外召阳气之良法。”）表热里寒多汗出，更兼烦躁厥须
防。（多汗烦躁，阳气外亡，最有厥脱之虑。）厥而脉绝加葱白，（名通脉四逆汤葱入营通脉）
面赤咽疼猪胆 。（名通脉四逆加猪胆汁汤 猪胆汁苦滑之极，能引阳药直达下焦，所谓“
热因寒用”也。）亦有加入人参者，（名四逆加人参汤）亡阳脱血此为良。（此亡阳而更脱血
，故加人参以生津益血。）更益茯苓疗肾躁，（肾躁，即阴躁也。必引肾水上泛，故加茯苓镇
之。）茯苓四逆汤名彰。（此即真武汤之变方，重用茯苓镇泄肾水。）
（出自张介宾《新方八阵》）治疗阴阳即将脱失、病情垂危的各种证候。
人参（一两至二两，或数钱） 制附子（二至三钱） 炮姜（二至三钱） 炙甘草（一钱） 熟地黄（五钱或一两）
分次温服。
理阴煎由当归、甘草、干姜、熟地组成，这是理中汤的变通之法。脾肾中气虚弱且阴液亏损，忌用刚燥之药，适宜用此法治疗。（张景岳自注：“若感受寒邪……若误用寒凉攻伐，则寒邪更甚……加入细辛以温散，即以……肉桂、附子……”）
治疗少阴病下利完谷不化，内寒外热，手足厥冷，出汗且四肢厥逆，以及胸膈上有寒饮导致干呕者；又治疗太阳病发热、头痛、脉沉，虽然身体疼痛，应当先救其里证；又治疗太阳病发汗后，大汗出，热不退，内部拘急，四肢疼痛，下利、四肢厥逆且恶寒者，均适宜以此方主治。
甘草（二两，炙） 干姜（一两半） 附子（一枚，生用，切） 水三升，煮取一升二合，去渣，分两次温服。
治疗证候同上，但脉象微细欲绝者，适宜用此方。
四逆汤原方中干姜用量为三两，加入葱九茎。
治疗阴盛格阳，手足厥冷，脉象微细欲绝，面赤、咽痛、烦躁者，适宜用此方。
通脉四逆汤中加入猪胆汁半合。（诸药煎成后，去渣，纳入胆汁调和服用。）
治疗恶寒、脉微且再次下利，下利停止是因为亡血所致。
四逆汤原方中加入人参一两。
治疗经过发汗或攻下治疗后，病仍未解除，出现烦躁者。
四逆加人参汤中再加入茯苓四两。
四逆汤由干姜、附子、甘草组成，治疗四肢厥冷需急煎服用。（按：方名“四逆”，必然用于治疗厥逆。《伤寒论·厥阴篇》指出……脉细微，口不渴，因为脏腑有寒，所以温补无疑。）寒饮导致的干呕也适用此法。（寒饮无实物，温之则寒散而饮去呕止。凡是治疗饮邪皆用温法。）身体疼痛、下利完谷不化时先温里证，（凡是疾病都应当先解表后治里，唯独下利完谷不化时，以扶助阳气为急务，而表证为缓，即使身体疼痛，也应当先救其里，等到下利完谷不化停止而身体疼痛未除时，仍从表证治疗即可。）不论属于三阴经还是太阳经。（王晋三在《古方选注》中说：四逆汤“凡三阴一阳证中有厥逆者皆用之，故少阴……汗出亡阳亦用之，因为少阴和太阴是水火之主，如果不交通中土之气，就不能在内恢复真阳，所以用生附子、生干姜迎接阳气回归舍宅，交接于十二经脉。反复使用炙甘草来监制，是因为亡阳不至于大汗淋漓，那么阳气未必完全亡失，所以可以缓制留中，作为在外召唤阳气的良法。”）表热里寒多汗出，更要兼防烦躁和厥逆。（多汗且烦躁，是阳气外亡的表现，最有厥脱的危险。）出现厥逆且脉绝者加入葱白，（名为通脉四逆汤，葱入营分通血脉）面赤咽痛者加入猪胆汁。（名为通脉四逆加猪胆汁汤，猪胆汁苦滑至极，能引导阳药直达下焦，所谓“热因寒用”也。）也有加入人参的，（名为四逆加人参汤），亡阳脱血以此为良。（这是亡阳而又脱血，所以加人参以生津益血。）再添加茯苓治疗肾躁，（肾躁，即阴躁。必须引肾水上泛，所以加茯苓镇摄它。）茯苓四逆汤之名显著。（这就是真武汤的变方，重用茯苓来镇泄肾水。）
(From Zhang Jiebin's *Xin Fang Ba Zhen*) Treats various critical conditions where Yin and Yang are on the verge of collapse.
Ren Shen (Ginseng Radix) [1-2 liang or several qian] Zhi Fu Zi (Prepared Aconiti Lateralis Radix) [2-3 qian] Pao Jiang (Prepared Zingiberis Rhizoma) [2-3 qian] Zhi Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) [1 qian] Shu Di Huang (Prepared Rehmanniae Radix) [5 qian or 1 liang]
Take in divided doses, warm.
Li Yin Jian (Decoction for Regulating Yin) consists of Dang Gui (Angelicae Sinensis Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Gan Jiang (Zingiberis Rhizoma), and Di Huang (Rehmanniae Radix). This is a variation of Li Zhong Tang (Decoction for Regulating the Middle). When there is deficiency of the Spleen and Kidney with concurrent Yin depletion, harsh and drying agents are contraindicated; this treatment is appropriate. (Zhang Jingyue notes: "If affected by cold... if cold-purging agents are mistakenly used, the cold pathogen will worsen... add Xi Xin (Asari Radix) to warm and disperse... Rou Gui (Cinnamomi Cortex) and Fu Zi (Aconiti Lateralis Radix Praeparata)...")
Treats Shaoyin disease characterized by diarrhea with undigested food, internal cold with external heat, cold limbs, sweating accompanied by cold extremities, and dry retching due to cold fluid retention above the diaphragm; also treats Taiyang disease with fever, headache, and deep pulse; although body pain exists, the interior should be rescued first; also treats cases after Taiyang disease sweating therapy where excessive sweating occurs, fever persists, internal tension arises, limb pain ensues, accompanied by diarrhea, cold extremities, and aversion to cold. All these are suitable for this formula as the primary treatment.
Gan Cao (Glycyrrhizae Radix et Rhizoma) [2 liang, honey-fried] Gan Jiang (Zingiberis Rhizoma) [1.5 liang] Fu Zi (Aconiti Lateralis Radix) [1 piece, raw, sliced] Water 3 sheng, decoct to obtain 1.2 sheng, remove dregs, take in two divided warm doses.
For the same indications but with a faint pulse nearly imperceptible, this formula is appropriate.
The original Si Ni Tang (Four Reversal Decoction) uses 3 liang of Gan Jiang (Zingiberis Rhizoma), adding 9 stalks of Cong Bai (Allii Fistulosi Bulbus).
For Yin excess repelling Yang, characterized by cold limbs, faint pulse nearly imperceptible, red face, sore throat, and irritability, this formula is appropriate.
Tong Mai Si Ni Tang (Pulse-Rescuing Four Reversal Decoction) adds Zhu Dan Zhi (Porci Bile) half he. (After decocting all herbs, remove dregs, mix in the bile, and take.)
For aversion to cold, faint pulse, and recurrent diarrhea, where the cessation of diarrhea indicates loss of blood essence.
The original Si Ni Tang (Four Reversal Decoction) adds Ren Shen (Ginseng Radix) 1 liang.
For cases where the disease persists despite sweating or purging therapies, accompanied by irritability.
Si Ni Jia Ren Shen Tang (Four Reversal Decoction plus Ginseng) further adds Fu Ling (Poria) 4 liang.
Si Ni Tang (Four Reversal Decoction) contains Gan Jiang (Zingiberis Rhizoma), Fu Zi (Aconiti Lateralis Radix), and Gan Cao (Glycyrrhizae Radix et Rhizoma); it must be decocted urgently for treating cold extremities. (Note: The name "Si Ni" implies its use for reversing cold extremities. In *Shang Han Lun · Jueyin Chapter*... pulse is fine and slight, mouth not thirsty, because the zang organs have cold, so warming is unquestionable.) Cold fluid-induced dry retching is also applicable. (Cold fluid has no solid substance; warming disperses the cold, eliminates the fluid, and stops retching. Generally, warming methods are used for treating fluid retention.) Body pain and diarrhea with undigested food require warming the interior first. (Generally, exterior syndromes should be treated before interior ones; however, for diarrhea with undigested food, supporting Yang is urgent while the exterior syndrome is secondary. Even with body pain, one must first rescue the interior. Once the diarrhea stops and body pain remains, treat from the exterior.) Regardless of whether it involves the Three Yin meridians or the Taiyang meridian. (Wang Jin San in *Gu Fang Xuan Zhu* states: "Si Ni Tang (Four Reversal Decoction) is used for any Jue reversal in Three Yin and One Yang syndromes, thus... It is also used for sweating leading to Yang collapse because Shaoyin and Taiyin are the masters of Water and Fire. Without communicating the Qi of the Central Earth, true Yang cannot be restored internally. Therefore, raw Fu Zi (Aconiti Lateralis Radix) and raw Gan Jiang (Zingiberis Rhizoma) are used to welcome Yang back to its residence, connecting with the twelve meridians. Honey-fried Gan Cao (Glycyrrhizae Radix et Rhizoma) is repeatedly used to monitor this process because if Yang collapse does not involve profuse sweating, Yang may not be completely lost. Thus, a slow preparation retaining action in the middle serves as a good method to summon Yang from the outside.") External heat with internal cold and profuse sweating, combined with irritability, requires vigilance against Jue reversal. (Profuse sweating and irritability indicate external loss of Yang, posing a high risk of Jue collapse.) For Jue reversal with absent pulse, add Cong Bai (Allii Fistulosi Bulbus) (Named Tong Mai Si Ni Tang (Pulse-Rescuing Four Reversal Decoction); Cong Bai enters the Ying level to unblock vessels). For red face and sore throat, add Zhu Dan Zhi (Porci Bile) (Named Tong Mai Si Ni Jia Zhu Dan Zhi Tang (Pulse-Rescuing Four Reversal Decoction plus Porcine Bile); Porcine Bile is extremely bitter and slippery, capable of guiding Yang-tonifying drugs directly to the Lower Jiao, known as 'treating heat with cold'). There are also cases adding Ren Shen (Ginseng Radix) (Named Si Ni Jia Ren Shen Tang (Four Reversal Decoction plus Ginseng)), which is excellent for Yang collapse and blood loss. (This is Yang collapse compounded by blood loss, so Ren Shen (Ginseng Radix) is added to generate fluids and benefit blood.) Adding Fu Ling (Poria) further treats Kidney restlessness (Kidney restlessness refers to Yin restlessness. It requires guiding Kidney water upward, so Fu Ling (Poria) is added to calm it). The name Fu Ling Si Ni Tang (Poria and Four Reversal Decoction) becomes prominent. (This is a variation of Zhen Wu Tang (True Warrior Decoction), using heavy doses of Fu Ling (Poria) to calm and drain Kidney water.)