（此系仲景原文）
中寒之病。皆阴证也。故虽寒中太阳阳明之经腑。亦谓之阴证。犹之伤寒之邪。传入三阴。亦谓之阳证也。寒
中三阴。为真阴证。然惟太阴中寒。其证不似阳。若少阴中寒。则见心烦而渴。咽痛。干呕。面色赤反发热。欲去
衣被等。全似阳证。何也。盖少阴上本君火。下亦命门相火。少阴之火将绝。故真形毕见也。又厥阴中寒。亦有发
热。无汗而烦。咽中痛。干呕喉痹。便脓血。下利腹胀满。及小腹满。按之痛。其人躁。无暂安时。亦全似阳证。
何也。盖厥阴上即心包。下又风木。木火之气燥。故阴极。则真藏之形见也。学人必先于仲景伤寒热病论。逐条解
明。及诊视阳证。因人投剂。确有试验。心目豁然。后读此书。庶无误治之阴证云尔。
自利不渴者。属太阴。以其脏有寒故也。当温之。宜服四逆辈。此太阴中寒也。自利不渴为湿胜。方注云然
也。夫湿挟热则渴。今者寒邪直透阳明。入于太阴之经而干其脏。太阴主湿土。其脏本寒。又挟外寒。故不渴也。
是当急温其里。宜服四逆辈以救脏寒。脏气得温。则经中之寒亦解矣。武陵陈氏云。言四逆辈。则理中亦在其中。
○愚按上证。乃太阴经与脏皆有寒。若用理中。不如四逆之附子。为能行经矣。或其人自利脏寒且虚。经中无寒。
宜用理中。经中寒而脏虚者。宜理中加附子。下多者。仍加茯苓。此仲景活法也。
上条证（见原论中第六卷太阴病脉证并治法第十）
少阴病。欲吐不吐。心烦。但欲寐。五六日。自利而渴者。属少阴也。虚故引水自救。若小便色白者。少阴病
形悉具。小便白者。以下焦虚。有寒。不能制水。故令色白也。（此少阴中寒也。以全文观之。大似热证。惟于小
便色白细辩。知其为真寒之证无疑。少阴经脉贯膈。循喉咙。欲吐不吐者。寒中其经。肾火虚。不能纳气。以故冲
逆于咽膈之间。欲作吐也。少阴之支脉。从肺出络心。注胸中。寒气凌心。故心烦但欲寐。然此与热邪之但欲寐不
同。其寐必不昏浊。其呼吸必促而细也。如此等证若不急治。延至五六日。寒邪直入下焦。侵少阴之脏。肾家虚冷。
失其闭藏之令。故自利。自利则肾水下泄。兼之火。虚其气不能熏 以上润其经。故喉舌间反作渴也。曰属少阴者。
以别其非阳邪郁热之作渴也。肾气大虚。内无津液。甚至饮水自救。愚谓渴是假象。试以冷水饮之。必不能多也。
细察其小便。若色白者。此少阴虚寒之形证悉具也。下焦者。两肾也。惟下焦虚。故不能约束水液。惟下焦既虚且
有寒。故令便色白也。○愚按此条论。重在小便色白句。故篇中三言之成注以五六日。为邪传少阴之时。尚论条辩
等书。又以口燥咽干。注少阴热病之形证悉具。俱大误之极。○愚又按此条论。仲景无治法。补亡论常器之云。可
四逆汤。又甘草干姜汤。见金匮方。愚以五六日之前。宜四逆汤。加生姜二两。五六日后。宜茯苓四逆汤。即仲景
四逆汤中加人参茯苓也。）
病患脉阴阳俱紧。反汗出者。亡阳也。此属少阴。法当咽痛。而复吐利。（此少阴中寒也。病患脉阴阳俱紧。
此阴阳以尺寸言。紧为寒。腠理当闭密而无汗。今则反自汗出者。寒邪直透太阳而中少阴之经。经气虚寒。不能卫
护其表。故曰亡阳。尚论篇云。此邪不出而汗先出也。惟少阴中寒之证为然。寒中少阴之经。法当咽痛复吐。以其
脉贯膈循咽喉也。寒入少阴之脏。法当复利。以肾家无火。失其闭藏之令。故水无制而下泄也。后条辩云。由其人
肾阳素虚。一遇寒中其经。脏气辄不能自守。故见以上等证。使其人肾脏素温。当不有此。又无阳。直是亡阳。以
阴寒甚而相迸。阳遂出亡也。斯言实得仲景之旨。○愚按此条论。仲景无治法。补亡论常器之云。可猪肤汤。误以
咽痛为少阴传经燥热证。悖谬之极。又郭白云云。少阴有伏气病。亦如伤寒。法先咽痛。次必下利。与前证相似。
古人谓之肾伤寒。其病轻。不传经。治法不同。咽痛。可半夏桂枝甘草汤。下利。用四逆汤。一二日即愈。愚以半
夏桂枝甘草汤。此即仲景治客寒咽痛方也。曰下利。宜四逆汤。此本仲景治汗出复吐利之药。）
少阴病脉微。不可发汗。亡阳故也。阳已虚。尺脉弱涩者。复不可下之。（此言少阴中寒之禁法也。仲景法。
凡言少阴病。皆脉微细。但欲寐。夫微脉轻取而得。细脉重取而得。今但云微而不云细。此表气已虚。里气不守。
乃亡阳而欲脱之脉也。汗为阳气所化。岂有亡阳而可发汗者哉。此可见少阴亡阳。但脉微。虽无汗出之证。亦自不
可发汗。至亡阳而阳已虚矣。尺脉又弱。夫尺脉必沉取乃得。沉取脉弱。是里气又虚。兼之脉涩。则血亦不足矣。
故复有下之之禁。○愚按少阴中寒证。有汗法。麻黄附子细辛汤是也。其无下法者。推仲景之意。谓凡尺脉弱涩。
虽传经热证。尚不可下。况阴寒之证邪。此以明断不可下之戒。补亡论云。并宜附子汤。以补阳气。散阴邪。助营
血也。）
少阴病脉紧。至七八日。自下利。脉暴微。手足反温。脉紧反去者。为欲解也。虽烦下利。必自愈。（此条乃
少阴中寒自愈之证。少阴病脉紧者。寒邪盛也。至七八日失治。自下利。宜乎病加而寒将入脏矣。及诊其脉乃暴微。
则其微非亡阳之微。实阳气回而脉微也。故其手足不厥而反温。紧脉反去。此为寒邪欲解之候。虽烦且利。知其烦
非寒气凌心。乃阳复之烦。其利亦非肾气失于闭藏。成注云。寒气得泄。自愈可必也。）
少阴病下利。若利自止。恶寒而蜷卧。手足温者。可治。（此条并下条。乃少阴中寒可治之证。寒邪入少阴之
里。故下利。即前所云肾失闭藏之令也。若利自止者。少阴之里气复也。里气虽复。经中之寒邪未散。仍见恶寒而
蜷卧。蜷曲也。武陵陈氏云。少阴之脉。从然谷至俞府。皆行身之前。脉起足心。足恶冷。则足引起而蜷。身恶冷。
则身屈蠖而蜷少阴恶寒之象如此。四肢者。诸阳之本。手足温。虽经中之寒邪未尽去。而在里之阳气有足恃也。故
云可治。补亡论常器之云。可当归四逆汤。愚以温经散寒。还宜四逆汤主之。但不可过剂。）
少阴病恶寒而蜷。时自烦。欲去衣被者。可治。（少阴病恶寒而蜷。经中之寒邪甚也。时自烦。欲去衣被者。
少阴真阳之气与之相争。乃阳气欲复之兆也。故云可治。○愚按此条论。仲景无治法。补亡论常器之云。吴茱萸汤。
郭白云云。凡少阴病烦躁者。不可下。先服吴茱萸汤。以烦躁。非实热。且手足多逆冷也。愚以手足逆冷。亦有热
深而厥者。只据恶寒而蜷。明系是少阴真寒证。烦躁欲去衣被。是假热之象。学人如遇以上等证。宜细辩之。）
少阴病。吐利。手足不逆冷。反发热者。不死。脉不至。灸少阴七壮。（此条乃少阴中寒宜灸之法也。少阴病
吐利。为寒邪直中其里。手足逆冷。其常候也。今手足不逆冷。及反发热者。此与少阴病始得之反发热不同。乃真
藏之阳气未脱。犹能通于经络之间。故云不死。医人不可以其无脉。竟弃而不治。此由吐利而阴阳之气暴虚。以致
卒不相接。非脉绝之比也。宜急灸少阴七壮。以返其阳。斯脉至。而吐利亦将自止矣。○愚按此条论。仲景未言当
灸何穴。补亡论常器之云。是少阴太溪穴。庞安时云。发热。谓其身发热也。太溪二穴。在内踝后跟骨动脉陷中。
经曰。肾之原。出于太溪。药力尚缓。惟急灸其原。以温其脏。犹可挽其危也。）
\r太溪穴图\pt158a1.bmp\r
少阴病恶寒。身蜷而利。手足逆冷者。不治。（此条乃少阴中寒不治之证也。成注云。内外寒极。纯阴无阳。
故云不治。愚以外寒甚。则恶寒身蜷。手足厥冷。寒主收引故也。里寒甚。则肾失闭藏。不能禁固而利不止乃少阴
之气已绝也。○后条辩云。阳受气于四肢虽主于脾。实肾中生阳之气所奉。故手足之温与逆。关于少阴者最重。尚
论篇云。即用四逆等法。恐亦不能回其阳矣。）
少阴病。吐利躁烦。四逆者。死。（自此以下共三条。皆少阴中寒之死证也。成注云。吐利者。寒甚于里。四
逆者。寒甚于表。躁烦则阳气欲绝。是知死矣。愚以阴寒既甚。则水来侮土。故见吐利四逆。加之躁烦者。武陵陈
氏云。脏中阳虚。神气不能固守。故浮越而发为躁烦。躁出于肾。烦出于心。先躁而后至烦者。肾之神乱而又上干
于心也。此与阳经烦躁不同。阳经烦躁。因热邪从表而侵于内。乃形动其神。阴经躁烦。因寒邪从经而迫于脏。乃
神动其形。故知必死。）
少阴病。下利止而头眩。时时自冒者死。（成注云。下利止。则水谷竭。眩冒。则阳气脱。故死。○愚按下利
止。则病当愈。今者反为死候。非阳回而利止。乃阳脱而利尽也。肾开窍于二阴。下利止而眩冒。为肾气下绝。无
根之阳气泛上。故头眩。无时而不昏冒。即条辩云。神气散乱。谓非死候而何。）
少阴病。四逆恶寒。而身蜷。脉不至。不烦而躁者死。（条辩云。四肢温和为顺。故以厥冷为逆。逆不顺也。
恶寒身蜷。注已见前。此条虽不利。然脉不至。则阳气已绝。以故不烦而躁。盖肾藏志。阴寒直入于里。迫其神志
欲脱。故作躁也。成注以灯将灭而暴明为喻。愚以但躁不烦。其灯并不能暴明矣。谓非死证而何。）
少阴病。脉微细沉。但欲卧。汗出不烦。自欲吐。至五六日。自利复烦躁。不得卧寐者死。（此条病。乃少阴
中寒。失于温而致死之证。脉微细但欲寐。此少阴经热病亦然。今则加沉。则寒中少阴矣。但欲卧者。卧与寐等耳。
此与欲吐。皆少阴经真寒证。注已见前第一条中。汗出不烦者。此阳亡于表。不能作烦热也。此等病皆当急温。失
此不治。延至五六日。经中寒邪。遂尔入脏。甚至自利。烦躁不得卧寐。乃真阳之气不能关守。顷刻奔散而扰乱不
宁。焉得不死。○后条辩云。凡此诸证。语以少阴失温。医家必且哄然曰。病患不手足厥冷。不恶寒蜷卧。而烦躁
如是。不得卧如是。又何阴证之有。可见少阴一经病。为最难识。凡我同人。宜细辩之。）
少阴病。始得之。反发热。脉沉者。麻黄附子细辛汤主之。（此条乃少阴病温发之一法也。条辩云。少阴位北
而居里。故脉沉。当不发热。今者始得病便在少阴。此系寒邪直中其经。非太阳经逗留而传来者。故以发热为反也。
要之少阴发热。与太阳较异。太阳当见头项强痛。今者太阳证皆不见而脉沉。由其人肾经素寒。真阳之气。不能辟
邪而出。故脉沉。然其发热处。仍在太阳部分愚以用麻黄附子细辛汤者。内以温少阴之里。使邪仍从太阳之表而出
也。○愚按仲景法。凡云少阴病。必兼脉微细但欲寐而言。上文云少阴病始得之。必脉微细沉而但欲寐。只多反发
热证。故知其为直中少阴无疑。）
（这是张仲景的原文）
中寒病，都属于阴证。所以即使是寒邪侵袭太阳、阳明的经络和脏腑，也称为阴证。这就像伤寒的病邪传入三阴经，却被称为阳证一样。寒邪直中三阴经，属于真正的阴证。然而只有太阴中寒，其症状不像阳证；如果少阴中寒，则会出现心烦口渴、咽痛、干呕、面色发红甚至发热、想要脱去衣被等症状，完全像阳证。为什么呢？因为少阴上部本属君火，下部又是命门相火。当少阴之火即将衰竭时，所以真脏脉象就会显露出来。另外，厥阴中寒，也会出现发热、无汗而烦躁、咽喉疼痛、干呕喉痹、大便脓血、腹泻腹胀满以及小腹胀满、按压疼痛、病人躁动不安、片刻不得安宁等症状，也完全像阳证。为什么呢？因为厥阴上部即心包络，下部又属风木，木火之气燥烈，所以当阴极之时，真脏之形就会显现。学习中医的人必须先对张仲景《伤寒论》中的热病论述逐条解析明白，并且在临床诊视阳证时，根据病人的具体情况投药，确有疗效验证，心中豁然开朗后，再读这本书，才不会有误治阴证的错误。
自发性腹泻且不口渴的，属于太阴病。这是因为内脏有寒的缘故。应当用温法治疗，适宜服用四逆汤类方剂。这是太阴中寒的表现。“自利不渴”是因为湿邪偏盛，方剂注释中也是这样说的。湿邪挟带热邪则会导致口渴，现在寒邪直接穿透阳明，进入太阴经脉并侵犯其脏腑。太阴主司湿土，其脏腑本性为寒，又夹杂外来的寒邪，所以不口渴。此时应当紧急温补里虚，适宜服用四逆汤类方剂来救治脏腑之寒。脏腑之气得到温煦，那么经脉中的寒邪也就解除了。武陵陈氏说：提到“四逆辈”，那么理中汤也在其中了。○我认为上述证候，是太阴经与脏都有寒。如果使用理中汤，不如四逆汤中的附子，能够通行经脉。或者如果病人自发性腹泻，脏腑寒冷且虚弱，但经脉中没有寒邪，适宜使用理中汤。如果是经脉有寒而脏腑虚弱，适宜使用理中汤加附子。如果腹泻严重，仍然要加茯苓。这是张仲景的灵活用法。
上一条证候（见原论第六卷太阴病脉证并治法第十）
少阴病，想吐却吐不出来，心烦，只想睡觉。过了五六天，出现自发性腹泻且口渴的，属于少阴病。因为正气虚弱，所以引水来自救。如果小便颜色发白的，少阴病的形态就全部具备了。小便发白，是因为下焦虚寒，不能制约水液，所以使小便颜色发白。（这是少阴中寒。纵观全文，非常像热证，只有在小便颜色发白这一点上仔细辨别，才知道这是真正的寒证无疑。少阴经脉贯穿膈肌，沿着喉咙。想吐却吐不出来，是因为寒邪中伤经脉，肾火虚弱，不能纳气，所以冲逆于咽喉膈膜之间，想要作吐。少阴的支脉，从肺出络于心，注入胸中。寒气凌犯心脏，所以心烦只想睡觉。然而这与热邪导致的只想睡觉不同，其睡眠一定不清醒浑浊，呼吸一定急促而细微。像这样的证候如果不紧急治疗，拖延到五六天，寒邪直接深入下焦，侵扰少阴之脏。肾家虚冷，失去闭藏的功能，所以自发性腹泻。自发性腹泻则肾水下泄，加上火气虚弱，其气不能熏蒸以上滋润经脉，所以咽喉舌间反而感到口渴。说“属于少阴”，是为了区别于阳邪郁热导致的口渴。肾气大虚，内部没有津液，甚至饮水来自救。我认为口渴是假象，试着给病人喝冷水，一定喝不了多少。仔细观察其小便，如果颜色发白，这说明少阴虚寒的形证全部具备。下焦指两肾。正因为下焦虚，所以不能约束水液。正因为下焦既虚又有寒，所以使小便颜色发白。○我认为这一条论述，重点在于“小便色白”一句，所以篇中三次强调它作为注解。以“五六日”为邪气传入少阴的时候，《尚论篇》、《条辩》等书，又将口燥咽干注解说成是少阴热病的形证全部具备，都错得极其离谱。○我又认为这一条论述，张仲景没有给出治法。《补亡论》常器之说：可以用四逆汤，还有甘草干姜汤，见于《金匮要略》方。我认为在五六日之前，适宜用四逆汤加生姜二两。五六日之后，适宜用茯苓四逆汤，即在张仲景的四逆汤中加入人参、茯苓。）
病人脉象寸关尺三部都紧，反而出汗的，是亡阳。这属于少阴病，依法应当出现咽痛，并且伴有呕吐和下利。（这是少阴中寒。病人脉象寸关尺三部都紧，这里的阴阳是指尺寸脉。紧脉主寒，腠理应当闭合致密而无汗。现在反而自发出汗，是因为寒邪直接穿透太阳而中伤少阴经脉。经脉之气虚寒，不能卫护体表，所以说亡阳。《尚论篇》说：这是邪气不出而汗先出的情况。只有少阴中寒的证候才会这样。寒邪中伤少阴经脉，依法应当咽痛并呕吐，因为其经脉贯穿膈肌循行咽喉。寒邪进入少阴之脏，依法应当腹泻，因为肾家没有火气，失去闭藏的功能，所以水液无法制约而下泄。《后条辩》说：由于这个人肾阳素来虚弱，一旦遇到寒邪中伤经脉，脏气就不能自我固守，所以见到以上等证候。如果这个人的肾脏素来温暖，应当不会有这种情况。又说“无阳”，其实就是亡阳，因为阴寒极盛而相互逼迫，阳气于是外出消亡。这番话确实得到了张仲景的宗旨。○我认为这一条论述，张仲景没有给出治法。《补亡论》常器之说：可以用猪肤汤。这是错误地把咽痛当作少阴传经的燥热证，悖谬到了极点。还有郭白云说：少阴有伏气病，也像伤寒一样，依法先咽痛，其次必然下利，与前证相似。古人称之为肾伤寒。这种病较轻，不传经，治法不同。咽痛，可用半夏桂枝甘草汤。下利，用四逆汤。一两天就好了。我认为半夏桂枝甘草汤，这就是张仲景治疗客寒咽痛的方子。说下利，宜用四逆汤，这本就是张仲景治疗汗出后又呕吐下利的药物。）
少阴病，脉象微弱，不可发汗，因为会亡阳。阳气已经虚弱，尺脉弱涩的，也不可以再攻下。（这是在讲少阴中寒的禁忌疗法。张仲景的法度，凡是说少阴病，都是脉微细，只想睡觉。微脉轻取就能得到，细脉重取才能得到。现在只说微而不说细，这是表气已虚，里气不守，是亡阳欲脱的脉象。汗是由阳气化生的，哪有亡阳还可以发汗的呢？由此可见少阴亡阳，只要脉微，即使没有出汗的症状，也不可发汗。到了亡阳而阳气已经虚弱的地步，尺脉又弱。尺脉必须沉取才能得着，沉取脉弱，说明里气又虚，再加上脉涩，那么血液也不足了。所以又有攻下的禁忌。○我认为少阴中寒证，有汗法，麻黄附子细辛汤就是。其没有下法的原因，推究张仲景的意思，是说凡是尺脉弱涩，即使是传经的热证，尚且不可攻下，何况是阴寒的证候呢？这是为了明确断言不可攻下的戒律。《补亡论》说：都适宜用附子汤，以补益阳气，驱散阴邪，助养营血。）
少阴病，脉紧，到了七八天，自发性腹泻，脉突然变微，手足反而温暖，脉紧反而消失的，是病情将要解除。虽然烦躁且腹泻，必定自愈。（这一条是少阴中寒自愈的证候。少阴病脉紧，说明寒邪盛。到了七八天失治，自发性腹泻，按理说是病情加重且寒邪将入脏了。及至诊察其脉突然变微，那么这个微不是亡阳的微，实际上是阳气回复而脉微。所以其手足不厥冷反而温暖，紧脉反而消失，这是寒邪将要解除的征候。虽然烦躁且腹泻，知道其烦躁不是寒气凌犯心脏，而是阳气回复的烦躁。其腹泻也不是肾气失去闭藏功能。成注说：寒气得泄，自愈是可以肯定的。）
少阴病腹泻，如果腹泻自行停止，恶寒且蜷缩而卧，手足温暖的，可以治愈。（这一条及下一条，是少阴中寒可治的证候。寒邪进入少阴之里，所以腹泻，就是前面所说的肾失去闭藏功能。如果腹泻自行停止，说明少阴的里气恢复了。里气虽然恢复，但经脉中的寒邪未散，仍然见恶寒且蜷缩而卧。蜷曲。武陵陈氏说：少阴的经脉，从然谷穴到俞府穴，都行走于身体前面。脉起于足心，足部怕冷，所以脚引起而蜷曲；身体怕冷，所以身体屈曲如尺蠖而蜷曲。少阴恶寒的景象就是这样。四肢，是诸阳之本。手足温暖，虽然经脉中的寒邪未尽去除，但在里的阳气有足以依仗的。所以说可以治愈。《补亡论》常器之说：可用当归四逆汤。我认为温经散寒，还是适宜用四逆汤为主方。只是不可过量。）
少阴病恶寒且蜷缩，时常自己烦躁，想要脱去衣被的，可以治愈。（少阴病恶寒且蜷缩，说明经脉中的寒邪很盛。时常自己烦躁，想要脱去衣被，说明少阴真阳之气与之相争，是阳气将要回复的征兆。所以说可以治愈。○我认为这一条论述，张仲景没有给出治法。《补亡论》常器之说：吴茱萸汤。郭白云说：凡是少阴病烦躁的，不可攻下。先服用吴茱萸汤。因为烦躁，不是实热，而且手足多逆冷。我认为手足逆冷，也有热深而厥的情况。只依据恶寒而蜷缩，明显是少阴真寒证。烦躁想要脱去衣被，是假热的现象。学习中医的人如果遇到以上等证候，应当仔细辨别。）
少阴病，呕吐下利，手足不逆冷，反而发热的，不会死。脉不至，灸少阴穴七壮。（这一条是少阴中寒适宜用灸法的证候。少阴病呕吐下利，是寒邪直接中伤其里。手足逆冷，是常规征候。现在手足不逆冷，反而发热，这与少阴病刚开始得的反发热不同，是真脏的阳气未脱，还能够通达于经络之间，所以说不会死。医生不可以因为没有脉搏，就放弃不治疗。这是由于呕吐下利导致阴阳之气暴虚，以致突然不相接续，并不是脉绝的情况。应当紧急灸少阴穴七壮，以回复阳气。这样脉搏就会恢复，呕吐下利也将自行停止。○我认为这一条论述，张仲景没有说明应当灸哪个穴位。《补亡论》常器之说：是少阴太溪穴。庞安时说：发热，是指身体发热。太溪二穴，在内踝后方跟骨动脉凹陷中。经书说：肾的原穴，出于太溪。药力还缓慢，只有紧急灸其原穴，以温煦其脏，还可以挽回危局。）
少阴病恶寒，身体蜷缩且腹泻，手足逆冷的，不治。（这一条是少阴中寒不治的证候。成注说：内外寒极，纯阴无阳，所以说不治。我认为外寒甚，则恶寒身蜷，手足厥冷，因为寒主收引。里寒甚，则肾失去闭藏功能，不能禁固而腹泻不止，这是少阴之气已经绝灭。○《后条辩》说：阳气受气于四肢，虽然主要归属于脾，实际上是肾中生阳之气所奉养。所以手足的温与逆，关系到少阴的最为重要。《尚论篇》说：即使使用四逆等法，恐怕也不能回复其阳气了。）
少阴病，呕吐下利，躁烦，四肢逆冷的，死。（自此以下共三条，都是少阴中寒的死证。成注说：呕吐下利，是寒邪甚于里；四肢逆冷，是寒邪甚于表。躁烦则是阳气欲绝，由此可知必死。我认为阴寒既已极盛，则水来侮土，所以见呕吐下利四肢逆冷。加之躁烦，武陵陈氏说：脏中阳虚，神气不能固守，所以浮越而发为躁烦。躁出于肾，烦出于心。先躁而后烦的，是肾的神乱而又上干于心。这与阳经的烦躁不同。阳经烦躁，因热邪从表侵入于内，是形体扰动神志；阴经躁烦，因寒邪从经脉逼迫于脏，是神志扰动形体。所以知道必死。）
少阴病，腹泻停止但头眩，时常自觉昏冒的，死。（成注说：腹泻停止，则水谷竭尽；眩晕昏冒，则阳气脱失，所以死。○我认为腹泻停止，病应当痊愈。现在反而是死候，不是因为阳气回复而腹泻停止，而是因为阳气脱失而腹泻穷尽。肾开窍于二阴，腹泻停止而眩晕昏冒，是肾气下绝，无根的阳气泛溢向上，所以头眩，无时而不昏冒。即《条辩》所说：神气散乱，谓不是死候又是什么呢？）
少阴病，四肢逆冷，恶寒，且身体蜷缩，脉不至，不烦躁而躁动的，死。（《条辩》说：四肢温和为顺，所以以厥冷为逆。逆就是不顺。恶寒身蜷，注解已在前面见过。这一条虽然不下利，但是脉不至，说明阳气已绝。所以不烦躁而躁动。盖肾藏志，阴寒直接入里，逼迫其神志欲脱，所以作躁。成注以灯将灭而突然明亮为比喻。我认为只是躁动不烦躁，那盏灯甚至连突然明亮都没有了。谓不是死证又是什么呢？）
少阴病，脉微细沉，只想睡觉，出汗不烦躁，自己想吐，到了五六天，自发性腹泻又烦躁，不能卧睡的，死。（这一条病，是少阴中寒，失于温补而导致死亡的证候。脉微细但想睡觉，这也是少阴经热病的表现。现在加上沉脉，则是寒中少阴。只想睡觉，睡与寐等同。这与想吐，都是少阴经真寒证，注解已在前面第一条中见过。出汗不烦躁，这是阳气亡于表，不能产生烦热。这些病都应当紧急温补。错过此时不治疗，拖延到五六天，经脉中的寒邪，于是进入脏。甚至自发性腹泻，烦躁不能卧睡，是真阳之气不能关守，顷刻奔散而扰乱不宁，焉能不死亡。○《后条辩》说：凡是这些证候，告诉他们是少阴失温，医家一定会哄然大笑说：病患不手足厥冷，不恶寒蜷卧，而烦躁如此，不能卧睡如此，又有什么阴证呢？可见少阴一经病，是最难识别的。凡是我同道中人，应当仔细辨别。）
少阴病，刚开始得病，反而发热，脉沉的，用麻黄附子细辛汤主治。（这一条是少阴病温发的一个方法。《条辩》说：少阴位处北方而居里，所以脉沉，应当不发热。现在刚开始得病就在少阴，这是寒邪直接中伤其经脉，不是太阳经逗留而传来的，所以以发热为反常。总之少阴发热，与太阳不同。太阳应当见头项强痛。现在太阳证都不见而脉沉，是由于这个人肾经素来寒冷，真阳之气，不能辟邪而出，所以脉沉。然而其发热之处，仍在太阳部分。我认为用麻黄附子细辛汤，是在内温少阴之里，使邪气仍从太阳之表而出。○我认为张仲景的法度，凡是说少阴病，必须兼有脉微细但想睡觉而言。上文说少阴病刚开始得病，必然脉微细沉而但想睡觉，只是多了反发热证，所以知道其为直中少阴无疑。）
(This is the original text of Zhang Zhongjing)
The disease of Zhonghan (Cold Strike) all belongs to Yin syndromes. Therefore, even if cold pathogen invades the meridians and zang-fu organs of Taiyang (Greater Yang) and Yangming (Bright Yang), it is still called a Yin syndrome. This is similar to how the pathogen of Shanghan (Cold Damage) transmitting into the Three Yin meridians is referred to as a Yang syndrome. Cold striking the Three Yin meridians constitutes a true Yin syndrome. However, only in Zhonghan of Taiyin (Lesser Yin) are the symptoms unlike Yang syndromes; whereas in Zhonghan of Shaoyin (Lesser Yin), symptoms such as mental restlessness, thirst, sore throat, dry retching, flushed complexion, fever, and a desire to remove clothing and bedding appear, resembling Yang syndromes completely. Why? Because Shaoyin originates with Ministerial Fire at the top and Mingmen (Gate of Life) Ministerial Fire at the bottom. When the fire of Shaoyin is about to extinguish, the true Zang pulse manifests. Furthermore, in Zhonghan of Jueyin (Terminal Yin), there may also be fever, anhidrosis with irritability, sore throat, dry retching with throat obstruction, pus and blood in stool, diarrhea with abdominal fullness, lower abdominal fullness with tenderness upon pressure, patient agitation with no moment of rest, all resembling Yang syndromes completely. Why? Because Jueyin connects to the Pericardium above and governs Wind-Wood below; the Qi of Wood and Fire is dry and hot. Thus, when Yin reaches its extreme, the form of the True Zang appears. Students must first clarify item by item the discussions on heat diseases in Zhang Zhongjing's *Shanghan Lun*, and after having verified clinical efficacy in diagnosing and treating Yang syndromes according to individual conditions, achieving sudden clarity, they can then read this book without making errors in treating Yin syndromes.
Spontaneous diarrhea without thirst indicates involvement of the TAIYIN. This is due to cold within the viscera. Treatment should employ warming methods, preferably using decoctions similar to Sini Tang (Four Reversal Decoction). This represents Zhonghan of Taiyin. "Spontaneous diarrhea without thirst" implies dampness predominance, as noted in the commentary. Dampness combined with heat causes thirst; here, cold pathogen penetrates directly through Yangming, entering the Taiyin meridian and affecting its organ. Taiyin governs wet earth, and its organ is inherently cold, compounded by external cold, hence no thirst. Urgent warming of the interior is required; Sini Tang class decoctions are suitable to rescue visceral cold. Once visceral Qi is warmed, the cold in the meridians will also resolve. Chen of Wuling stated: mentioning "Sini Tang class" includes Lizhong Tang (Regulate the Middle Decoction). ○ I opine that the above syndrome involves cold in both Taiyin meridian and organ. If using Lizhong Tang, it is inferior to Fuzi (Aconite Lateralis Radix Preparata) in Sini Tang for circulating through the meridians. Or, if the patient has spontaneous diarrhea with visceral cold and deficiency but no cold in the meridians, Lizhong Tang is appropriate. If there is cold in the meridians and deficiency in the viscera, Lizhong Tang plus Fuzi is suitable. For severe diarrhea, add Poria (Poria Cocos). This is the flexible application of Zhang Zhongjing.
(The previous syndrome is found in Volume 6, Chapter 10: Pulse, Symptoms, and Treatment Methods of Taiyin Disease of the Original Treatise.)
SHAoyin disease characterized by the urge to vomit but inability to do so, mental restlessness, and a desire to sleep. After five or six days, spontaneous diarrhea accompanied by thirst indicates SHAoyin involvement. Due to deficiency, the patient draws water to self-rescue. If the urine is white, the manifestations of Shaoyin disease are fully present. White urine results from deficiency and cold in the Lower Jiao (Lower Burner), which fails to control water metabolism, causing the color to turn white. (This is Zhonghan of Shaoyin. The entire text resembles a heat syndrome, but careful differentiation regarding white urine confirms it is undoubtedly a true cold syndrome. The Shaoyin meridian passes through the diaphragm and follows the throat. The urge to vomit without success occurs because cold strikes the meridian; Kidney Fire is deficient and cannot grasp Qi, leading to rebellious Qi rushing between the pharynx and diaphragm, inducing vomiting. The branch meridian of Shaoyin emerges from the lung, connects to the heart, and pours into the chest. Cold pathogen harasses the heart, causing mental restlessness and a desire to sleep. However, this differs from the desire to sleep caused by heat pathogens; the sleep is not confused/turbid, and respiration is rapid and fine. If these syndromes are not treated urgently, delaying to five or six days allows cold pathogen to enter the Lower Jiao and invade the Shaoyin organ. Kidney deficiency and cold lead to loss of closure and storage functions, causing spontaneous diarrhea. Spontaneous diarrhea leads to downward leakage of Kidney Water; coupled with deficient Fire Qi failing to steam upwards to moisten the meridians, thirst arises in the throat and tongue. Stating "belongs to Shaoyin" distinguishes it from thirst caused by Yang pathogen stagnation and heat. Severe Kidney Qi deficiency and lack of internal fluids lead to drinking water for self-rescue. I consider thirst here a false sign; attempting to give cold water would result in inability to drink much. Careful observation of urine: if white, the signs of Shaoyin deficiency-cold are complete. The Lower Jiao refers to the two Kidneys. Only due to Lower Jiao deficiency can water fluids not be constrained. Only due to Lower Jiao being both deficient and cold does urine become white. ○ I note this discussion emphasizes "white urine," mentioned three times in the chapter as annotation. Viewing "five or six days" as the time for pathogen transmission to Shaoyin, texts like *Shanglun Pian* and *Tiaobian* incorrectly annotate "dry mouth and throat" as the full presentation of Shaoyin heat disease, which is extremely erroneous. ○ I further note Zhang Zhongjing provides no treatment method for this clause. *Buwang Lun* Chang Qizhi suggests Sini Tang or Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) from *Jingui Yaolue*. I suggest before day five or six, Sini Tang plus 2 liang of Shengjiang (Fresh Ginger Rhizome); after day five or six, Fuling Sini Tang (Poria and Four Reversal Decoction), i.e., adding Renshen (Ginseng Radix) and Fuling (Poria Cocos) to Zhang Zhongjing's Sini Tang.)
If a patient's pulse is tight at all positions (Cun, Guan, Chi) but paradoxically sweats, this indicates Wangyang (Loss of Yang). This belongs to Shaoyin disease. According to the law, it should present with sore throat, followed by vomiting and diarrhea. (This is Zhonghan of Shaoyin. "Pulse tight at all positions" refers to Cun and Chi pulses. Tight pulse indicates cold; pores should be closed and anhidrotic. Paradoxical sweating occurs because cold pathogen penetrates Taiyang and strikes the Shaoyin meridian. Meridian Qi is deficient and cold, failing to protect the exterior, hence "Wangyang." *Shanglun Pian* states: "Pathogen does not exit, yet sweat appears first." This is specific to Zhonghan of Shaoyin. Cold striking Shaoyin meridian legally causes sore throat and vomiting because the meridian passes through the diaphragm and circulates the throat. Cold entering Shaoyin organ legally causes diarrhea because Kidney Fire is absent, losing closure/storage function, allowing water to leak downward. *Hou Tiaobian* states: Due to inherent Kidney Yang deficiency, once cold strikes the meridian, Zang Qi cannot guard itself, producing these syndromes. If Kidney were inherently warm, this would not occur. "No Yang" essentially means Loss of Yang; extreme Yin-Cold forces mutual expulsion, causing Yang to flee. This statement truly captures Zhang Zhongjing's intent. ○ I note Zhang Zhongjing provides no treatment method. *Buwang Lun* Chang Qizhi suggests Zhufu Tang (Swan Skin Decoction), erroneously treating sore throat as a Shaoyin transmitted dry-heat syndrome, which is extremely absurd. Guo Baiyun states: Shaoyin has latent Qi disease, similar to Shanghan; legally starts with sore throat, then inevitably diarrhea, resembling the previous syndrome. Ancients called this "Kidney Shanghan." It is mild, does not transmit, and has different treatment. For sore throat, Banxia Guizhi Gancao Tang (Pinellia, Cinnamon Twig, and Licorice Decoction); for diarrhea, Sini Tang. Recovery in one or two days. I consider Banxia Guizhi Gancao Tang to be Zhang Zhongjing's formula for exogenous cold sore throat. For diarrhea, Sini Tang is appropriate, which is originally Zhang Zhongjing's medicine for sweating followed by vomiting and diarrhea.)
Shaoyin disease with a faint pulse contraindicates sweating therapy due to the risk of Wangyang. If Yang is already deficient and the Chi pulse is weak and choppy, purgative therapy is also contraindicated. (This discusses contraindications for Zhonghan of Shaoyin. Zhang Zhongjing's rule: whenever Shaoyin disease is mentioned, it implies faint and thin pulse with a desire to sleep. Faint pulse is felt lightly; thin pulse requires heavy pressure. Here, only "faint" is mentioned, not "thin," indicating exterior Qi is deficient and interior Qi is unguarded, a pulse of Wangyang and impending collapse. Sweat is transformed from Yang Qi; how can one induce sweat when Yang is lost? Thus, in Shaoyin Wangyang, even without sweating symptoms, if the pulse is faint, sweating is contraindicated. When Yang is lost and deficient, and the Chi pulse is weak, it must be felt deeply. Deep weak pulse indicates further interior deficiency. Combined with a choppy pulse, Blood is also insufficient. Hence, purgatives are forbidden. ○ I opine that Zhonghan of Shaoyin has a sweating method: Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction). The reason for no purgative method, inferring Zhang Zhongjing's intent, is that whenever Chi pulse is weak and choppy, even in transmitted heat syndromes, purgatives are contraindicated, let alone Yin-cold syndromes. This clarifies the strict prohibition against purgatives. *Buwang Lun* suggests Fuzi Tang (Aconite Decoction) for all cases to tonify Yang Qi, disperse Yin Evil, and assist Ying Blood.)
Shaoyin disease with a tight pulse, progressing to seven or eight days, presenting with spontaneous diarrhea, sudden faintness of pulse, warmth of hands and feet, and disappearance of the tight pulse, indicates the condition is resolving. Although there is irritability and diarrhea, it will heal spontaneously. (This clause describes the self-healing pattern of Zhonghan of Shaoyin. Tight pulse in Shaoyin disease indicates abundant cold pathogen. By day seven or eight, if untreated, spontaneous diarrhea suggests worsening condition and cold entering the Zang. However, the sudden faint pulse is not the faintness of Wangyang, but rather Yang Qi returning, manifesting as a faint pulse. Thus, hands and feet are not cold but warm, and the tight pulse disappears. This is a sign of resolving cold pathogen. Irritability and diarrhea persist, but the irritability is not cold harassing the Heart, but rather Yang returning. Diarrhea is not due to Kidney losing closure, as Cheng Zhu notes: "Cold Qi is vented, self-healing is certain.")
Shaoyin disease with diarrhea that stops spontaneously, accompanied by aversion to cold, curling up while lying, and warm hands and feet, is treatable. (This clause and the next describe treatable patterns of Zhonghan of Shaoyin. Cold pathogen enters the interior of Shaoyin, causing diarrhea, as previously described as Kidney losing closure function. If diarrhea stops spontaneously, it indicates recovery of Shaoyin interior Qi. Although interior Qi recovers, cold pathogen in the meridians remains, so aversion to cold and curling posture persist. Curling. Chen of Wuling states: The Shaoyin meridian runs along the anterior body from Ranggu to Shufu. The pulse originates from the sole of the foot. Cold feet cause curling; cold body causes curling like a measuring worm. This is the manifestation of Shaoyin aversion to cold. The four limbs are the root of all Yang. Warm hands and feet indicate that although meridian cold is not fully expelled, interior Yang Qi is sufficient support. Hence, "treatable." *Buwang Lun* Chang Qizhi suggests Danggui Sini Tang (Angelica Sinensis and Four Reversal Decoction). I believe for warming meridians and dispersing cold, Sini Tang is still primary, but dosage must not be excessive.)
Shaoyin disease with aversion to cold, curling up, occasional spontaneous irritability, and a desire to remove clothing and bedding, is treatable. (Aversion to cold and curling in Shaoyin disease indicates severe cold in the meridions. Occasional irritability and desire to remove clothing indicate Shaoyin True Yang Qi struggling against the pathogen, a sign of Yang Qi attempting to return. Hence, "treatable." ○ I note Zhang Zhongjing provides no treatment method. *Buwang Lun* Chang Qizhi suggests Wuzhuyu Tang (Evodia Decoction). Guo Baiyun states: In Shaoyin disease with irritability, purgatives are forbidden. First administer Wuzhuyu Tang. Irritability is not excess heat, and hands/feet are often cold. I consider that cold extremities can also result from deep heat causing reversal cold. Based solely on aversion to cold and curling, this is clearly a Shaoyin true cold syndrome. Irritability and desire to remove clothing are false heat signs. Students encountering such syndromes must differentiate carefully.)
Shaoyin disease with vomiting and diarrhea, non-reversed cold hands and feet, and paradoxical fever indicates survival. If the pulse is absent, moxa seven moxibustion cones on Shaoyin points. (This clause describes the indication for moxibustion in Zhonghan of Shaoyin. Vomiting and diarrhea in Shaoyin disease result from cold pathogen directly striking the interior. Reversed cold hands and feet are the usual sign. Now, non-reversed cold and paradoxical fever differ from the initial "paradoxical fever" in Shaoyin disease; it indicates True Zang Yang has not collapsed and can still communicate with the meridians. Hence, "survival." Physicians should not abandon treatment due to absent pulse. This results from sudden deficiency of Yin and Yang Qi due to vomiting/diarrhea, causing temporary discontinuity, not pulse extinction. Urgent moxibustion on Shaoyin points (seven cones) is needed to restore Yang. Once pulse returns, vomiting and diarrhea will cease. ○ I note Zhang Zhongjing does not specify the acupoint. *Buwang Lun* Chang Qizhi identifies Taixi (KI3). Pang Anshi states: Fever refers to body heat. Taixi points are located in the depression behind the medial malleolus, where the posterior tibial artery beats. The Classic states: The Yuan-Source point of the Kidney is Taixi. Medicinal action is slow; urgent moxibustion on the Source point warms the Zang and can salvage the crisis.)
[Image: Taixi Acupoint Diagram]
Shaoyin disease with aversion to cold, curling up, diarrhea, and reversed cold hands and feet is untreatable. (This clause describes untreatable patterns of Zhonghan of Shaoyin. Cheng Zhu states: Extreme cold inside and out, pure Yin without Yang, hence "untreatable." I opine: Severe exterior cold causes aversion to cold, curling, and cold extremities because cold governs contraction. Severe interior cold causes Kidney to lose closure, unable to contain, leading to incessant diarrhea, indicating extinction of Shaoyin Qi. ○ *Hou Tiaobian* states: Yang receives Qi in the four limbs; although governed by Spleen, it is actually supported by the generating Yang Qi of the Kidney. Thus, warmth vs. cold of hands/feet is most critical regarding Shaoyin. *Shanglun Pian* states: Even using Sini methods, it may be impossible to restore Yang.)
Shaoyin disease with vomiting, diarrhea, agitation/restlessness, and reversed cold hands and feet indicates death. (The following three clauses are all fatal patterns of Zhonghan of Shaoyin. Cheng Zhu states: Vomiting/diarrhea indicates severe cold in the interior; reversed cold indicates severe cold in the exterior. Agitation/restlessness indicates impending Yang extinction, thus death. I opine: With extreme Yin-Cold, Water insults Earth, causing vomiting, diarrhea, and reversed cold. Added agitation/restlessness: Chen of Wuling states: Visceral Yang deficiency causes Shen (Spirit) Qi to fail to guard itself, floating outward causing agitation/restlessness. Agitation originates from Kidney, restlessness from Heart. Agitation preceding restlessness indicates Kidney Spirit disorder affecting Heart. This differs from Yang meridian agitation/restlessness caused by heat invading from exterior disturbing Form affecting Spirit. Yin meridian agitation/restlessness is caused by cold forcing from meridian to Zang, disturbing Spirit affecting Form. Hence, death is certain.)
Shaoyin disease with cessation of diarrhea but dizziness and frequent sensations of blackout indicates death. (Cheng Zhu states: Cessation of diarrhea means exhaustion of water and grain; dizziness/blackout means Yang Qi collapse, hence death. ○ I opine: Cessation of diarrhea usually implies recovery. Here, however, it is a death sign. It is not Yang returning stopping diarrhea, but Yang collapsing ending diarrhea. Kidney opens into the two yin openings. Cessation of diarrhea with dizziness/blackout indicates descending extinction of Kidney Qi. Rootless Yang floats upward, causing dizziness and constant blackout. As *Tiaobian* states: "Shen Qi scattered," how could this not be death?)
Shaoyin disease with reversed cold, aversion to cold, curling up, absent pulse, no irritability but only agitation indicates death. (*Tiaobian* states: Warm limbs are smooth/compliant, so cold reversal is adverse. Adverse is not compliant. Aversion to cold and curling explained previously. Although no diarrhea here, absent pulse indicates Yang extinction. Hence, no irritability but only agitation. Kidney stores Zhi (Will); Yin-Cold enters directly, forcing Shen-Zhi to collapse, causing agitation. Cheng Zhu uses the metaphor of a lamp about to go out flashing brightly. I consider that mere agitation without irritability means the lamp doesn't even flash brightly. How could this not be a death sign?)
Shaoyin disease with faint, thin, deep pulse, desire to sleep, sweating without irritability, and desire to vomit. By five or six days, spontaneous diarrhea followed by irritability and inability to sleep indicates death. (This disease is Zhonghan of Shaoyin leading to death due to failure to warm. Faint/thin pulse and desire to sleep are also seen in Shaoyin heat disease. Adding deep pulse indicates cold striking Shaoyin. Desire to sleep is equivalent to desire to slumber. These and desire to vomit are true cold signs of Shaoyin meridian, explained in Clause 1. Sweating without irritability indicates Yang collapsing at the exterior, unable to generate heat/irritability. Such diseases require urgent warming. Failure to treat leads to pathogen entering Zang by day five or six, causing spontaneous diarrhea, irritability, and insomnia. True Yang Qi cannot guard, scattering instantly in turmoil. How can one survive? ○ *Hou Tiaobian* states: Regarding these syndromes, telling physicians it is Shaoyin loss of warmth, they will laugh: "Patient has no cold extremities, no aversion to cold/curling, yet irritability and insomnia are so severe. Where is the Yin syndrome?" Thus, Shaoyin disease is hardest to identify. Colleagues must differentiate carefully.)
Shaoyin disease, upon onset, presents with paradoxical fever and deep pulse. Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) is indicated. (This clause describes a warming-and-releasing method for Shaoyin disease. *Tiaobian* states: Shaoyin is North and interior, so pulse is deep and should not have fever. Onset directly in Shaoyin indicates cold pathogen directly striking the meridian, not transmitted from Taiyang lingering. Hence, fever is considered "paradoxical." Shaoyin fever differs from Taiyang. Taiyang presents with head/neck stiffness. Here, Taiyang signs are absent, pulse is deep, due to inherent Kidney meridian cold preventing True Yang from expelling pathogen outward. However, the site of fever remains in the Taiyang region. I believe Mahuang Fuzi Xixin Tang warms the interior of Shaoyin internally, allowing pathogen to exit via the exterior of Taiyang. ○ I note Zhang Zhongjing's rule: Shaoyin disease must include faint/thin pulse and desire to sleep. The previous clause says "onset of Shaoyin disease," implying faint/thin/deep pulse and desire to sleep, merely adding paradoxical fever. Thus, it is undoubtedly direct strike to Shaoyin.)