葱白（四茎） 干姜（一两） 附子（一枚生去皮破八片） 人尿（五合） 猪胆汁（一合）
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。
成注引内经曰。若调寒热之逆。令热必行。则热物冷服。下嗌之后。冷体既消。热性便发。由是病气随愈。呕
烦皆除。情且不违。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。
琥按上方后云。若无胆亦可用。则知所重在人尿。方当名白通加人尿汤始妥。人尿咸寒。内汤中。和令相得饮
之。即成注云热物冷服之意。
内台方议云。少阴病下利脉微者。与白通汤服之。利当止。若利不止。厥逆无脉。干呕烦者。乃寒气大甚。内
为格拒。使阳气逆乱也。故加猪胆汁童便二物。以和其阴。内经曰。逆而从之。则格拒因解也。
武陵陈氏云。下利。则寒甚于下。干呕。则寒甚于上。以反见虚烦。乃火无根失守之象。夫姜附之力。不得达
于下焦。而虚阳上浮。其死可立而待非用人尿猪胆汁。以为向导。不可葱白之通阳气。乃正治之法。二物之通阳气。
乃反治之法。人尿咸寒。取其降下。水畜惟胆苦寒。取其同气相求也。
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。（此条系少阴中寒。寒气积结。变为水气之证。少阴二三日。寒邪犹浅。
至四五日。寒邪已深。成注云。肾主水。肾病不能制水。水寒之气内甚。则腹痛。小便不利。及自下利。外甚。则
四肢沉重。疼痛。其人或咳者。水寒气逆也。或小便利者。即下焦虚。有寒。不能制水。小便色白之意。或下利者。
谓前自下利。系二三日之证。此必是前未尝下利。指四五日后。始下利者而言。或呕者。水寒之气上壅也。故与真
武汤。以益阳气。散寒水。）
葱白（四根） 干姜（一两） 附子（一枚，生用，去皮，破成八片） 人尿（五合） 猪胆汁（一合）
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，也可以使用（单用人尿）。
成无己注引《内经》说：如果要调理寒热错杂的逆乱情况，让热性药物发挥作用，可以采用“热药冷服”的方法。药液咽下之后，冷的性状已经消散，热的药性随即发挥。因此病气随之痊愈，呕吐和烦闷都消除了。患者情志不抵触，从而获得大的益处。这是利用人尿、猪胆汁这些咸苦寒性质的药物，在白通汤这种热剂中，寻求气味相从，这样就可以消除格拒之寒邪。
琥按：上方后注明“若无胆亦可用”，则可知重点在于人尿。方名应当叫“白通加人尿汤”才妥当。人尿咸寒，加入汤剂中，调和均匀服用，就是成注所说的“热物冷服”的意思。
《内台方议》说：少阴病出现下利、脉微的情况，给予白通汤服用。下利应当停止。如果下利不止，四肢厥冷、无脉、干呕、烦闷，这是寒气极盛，内部产生格拒，使阳气逆乱。所以加入猪胆汁和童便两味药，来调和其阴。《内经》说：逆着病势而治，那么格拒就会解除。
武陵陈氏说：下利，说明下部寒气极盛；干呕，说明上部寒气极盛。如果反而出现虚烦，这是火无根基、失守的表现。姜、附子的药力，不能到达下焦，而虚阳上浮，死亡可以立刻等待到。如果不使用人尿、猪胆汁作为向导，就不能引导药力。葱白通达阳气，是正治之法；这两味药（人尿、猪胆汁）通达阳气，是反治之法。人尿咸寒，取其降下的作用；水畜惟胆苦寒，取其同气相求的作用。
少阴病。二三天没有好，到了四五天。腹痛。小便不利。四肢沉重。疼痛。自发性下利的，这是有水气。或者有人咳嗽。或者小便通畅。或者下利。或者呕吐的，用真武汤主治。（此条属于少阴中寒证，寒气积结，变为水气证。少阴病二三天，寒邪尚浅。到了四五天，寒邪已深。成注说：肾主水，肾病不能制约水，水寒之气内盛，则腹痛、小便不利及自发性下利；外盛，则四肢沉重、疼痛。其人若咳嗽，是水寒气逆；若小便利，即下焦虚寒，不能制水，小便色白的意思；若下利，谓之前的自发性下利，是二三天时的证候，这里必定是指之前未曾下利，指四五天之后才开始下利的情况；若呕吐，是水寒之气上壅。所以给予真武汤，以益阳气，散寒水。）
Scallion White (four stalks) Dried Ginger (one liang) Aconite Root (one piece, raw, peeled, broken into eight slices) Human Urine (five he) Pig Bile (one he)
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 doses and take warm. If bile is unavailable, it may also be used [referring to using human urine alone].
Cheng Wuji's commentary cites the *Neijing* (Classic of Internal Medicine): "If one wishes to regulate the reversal of cold and heat, allowing the heat nature to act, then hot substances should be taken cold. After swallowing, the cold physical state dissipates, and the hot nature emerges. Thus, the pathogenic qi resolves, and vomiting and vexation are eliminated. The patient's disposition remains compliant, resulting in great benefit." This explains the use of human urine and pig bile, which are salty, bitter, and cold substances, within the hot formula of Baitong Tang. By seeking compatibility in their qi, the rejecting cold can be dispelled.
Hu notes: The postscript of the above formula states, "If bile is unavailable, it may also be used," indicating that the emphasis lies on human urine. The formula name should properly be "Baitong Jia Ren Nao Tang" (Baitong Decoction plus Human Urine). Human urine is salty and cold; when added to the decoction and mixed well for consumption, it aligns with Cheng's commentary on "taking hot substances cold."
*Neitai Fangyi* states: In Shaoyin disease presenting with diarrhea and a faint pulse, administer Baitong Tang. The diarrhea should cease. If diarrhea persists, accompanied by cold extremities, absence of pulse, dry retching, and vexation, this indicates extreme cold causing internal rejection, leading to chaotic reversal of yang qi. Therefore, add pig bile and child's urine to harmonize the yin. As the *Neijing* states: "Treating against the trend resolves the rejection."
Chen from Wuling states: Diarrhea indicates extreme cold in the lower part; dry retching indicates extreme cold in the upper part. If false vexation appears instead, this is a sign of rootless fire losing its station. The power of Ginger and Aconite cannot reach the lower jiao, while deficient yang floats upward; death could follow immediately. Without using human urine and pig bile as guides, treatment is ineffective. Scallion White unblocking yang qi is the orthodox method; these two substances [urine and bile] unblocking yang qi is the contrary method. Human urine is salty and cold, utilizing its descending action; Pig Bile is bitter and cold, utilizing the principle of similar qi attracting each other.
Shaoyin disease. If not resolved after two or three days, progressing to four or five days, abdominal pain, difficulty urinating, heaviness and pain in the four limbs, and spontaneous diarrhea indicate the presence of fluid retention. Some patients may cough, have free urination, experience diarrhea, or vomit. Zhenwu Tang is the primary treatment. (This clause pertains to Cold Damage affecting Shaoyin, where accumulated cold qi transforms into fluid retention. At two or three days of Shaoyin disease, the cold pathogen is still shallow. By four or five days, the cold pathogen has deepened. Cheng's commentary states: The Kidney governs water. When Kidney disease fails to control water, excessive cold-water qi internally causes abdominal pain, difficulty urinating, and spontaneous diarrhea; externally it causes heaviness and pain in the four limbs. Coughing indicates reverse flow of cold-water qi. Free urination implies deficiency-cold in the lower jiao failing to control water, resulting in pale urine. Diarrhea here refers to cases where spontaneous diarrhea did not occur in the first two or three days but started after four or five days. Vomiting indicates congestion of cold-water qi upwards. Therefore, Zhenwu Tang is administered to tonify yang qi and disperse cold-water.)