麻黄（二两去节） 甘草（二两炙） 附子（一枚炮去皮）
上三味。以水七升。先煮麻黄一两沸。去上沫。内诸药。煮取三升。去滓。温服一升。日三服。
成注云。麻黄甘草之甘。以散表寒。附子之辛。以温经气。○愚意云。此即辛甘发散之义。必反发热。故宜用
此汤也。
琥按内台方议。但云二三日内。脉沉细蜷而卧。为少阴病。不及反发热三字。殊为脱略。条辩诸注皆云。方中
用甘草。以易细辛。曰微发汗者。乃少阴病和解之法。为温散之缓方也。
少阴病得之一二日。口中和。其背恶寒者。当灸之。附子汤主之。（此条乃少阴中寒。大宜温补之证。少阴病
得之一二日。与前条云始得之义相同。口中和者。为里无热。成注云。少阴客热。当口燥舌干而渴。今则皆无之也。
背者。太阳经之部分。少阴之脉。上股内后廉。贯脊属肾。脊居背之里。背恶寒者。成注云。阳气弱。阴气胜也。
灸以艾火。助阳而消阴。与附子汤。温中而补虚。要之散寒邪之用。亦在其中矣。○按此条论。仲景不言当灸何穴。
补亡论常器之云。当灸鬲俞。关元穴。背俞第三行。郭白云云。此有漏字。当是灸鬲俞关元穴也。鬲俞是背俞第二
行穴。愚按鬲俞。果系背俞部。第二行穴。然常氏所云第三行穴者。当是鬲关。非鬲俞也。图经云。鬲关二穴。在
第七椎下。两旁相去各三寸陷中。正坐取之。足太阳气脉所发。专治背恶寒。脊强。俯仰难。可灸五壮。盖少阴中
寒。必由太阳而入。故宜灸其穴也。又关元一穴。在腹部中行。脐下三寸。足三阴任脉之会。可灸百壮。图见后厥
阴病第六条证下。常云灸鬲关者。是温其表以散其外邪灸关元者是温其里以助其元气也。）
\r鬲关穴图\pt158a2.bmp\r
麻黄（二两，去节） 甘草（二两，炙） 附子（一枚，炮，去皮）
以上三味药。用水七升。先煮麻黄，煮沸一次后。去掉上面的浮沫。加入其余药物。煮取三升药液。滤去药渣。每次温服一升。每日服用三次。
成无己注解说：麻黄、甘草的甘味，用来发散表寒。附子的辛味，用来温通经气。○我认为：这就是辛甘发散的道理。必定有反发热（少阴病初起即见发热）的症状，所以适宜使用此汤剂。
琥按《内台方议》记载，只说发病二三日内，脉象沉细，身体蜷缩而卧，属于少阴病。没有提到“反发热”三个字，显得非常简略遗漏。条辩诸家注解都说，方中使用甘草，来替代细辛。说是微发汗，这是少阴病的和解治法，属于温散类的缓方。
少阴病得之一二日。口中平和（不苦不燥）。背部感觉恶寒的，应当施灸。用附子汤主治。（这一条论述的是少阴中寒，非常适合温补的证候。少阴病得之一二日，与前文所说的“始得”意义相同。“口中和”，是指体内没有热邪。成无己注解说：如果是少阴客热，应当出现口燥、舌干而渴的症状，现在这些症状都没有。背，是太阳经所主的部位。少阴经脉，上行于大腿内侧后缘，贯穿脊柱，归属于肾。脊柱位于背部里面。背部恶寒，成无己注解说：是因为阳气虚弱，阴气偏盛。用艾火施灸，可以助阳而消阴。配合附子汤，温中焦而补虚损。总之，其散寒邪的作用也包含在其中了。○按此条论述，张仲景没有说明应当灸哪个穴位。《补亡论》常器之说：应当灸膈俞穴、关元穴。背俞第三行。郭白云说：这里漏写了字，应当是灸膈俞、关元穴。膈俞是背俞第二行的穴位。我按：膈俞果真是背俞部的第二行穴位，然而常氏所说的第三行穴位，应当是膈关穴，而不是膈俞穴。《图经》记载：膈关二穴，在第七椎下，两旁相距各三寸的凹陷处。正坐时取穴。足太阳气脉所发之处。专门治疗背恶寒、脊强、俯仰困难。可灸五壮。大概少阴中寒，必定由太阳经传入，所以适宜灸这些穴位。另外关元一穴，在腹部正中线上，脐下三寸。是足三阴经与任脉的交会穴。可灸百壮。图见后文厥阴病第六条证候下。常氏说灸膈关穴，是温其体表以疏散外邪；灸关元穴，是温其体内以扶助元气。）
Ephedrae Herba (Mahuang, 麻黄) two liang, remove joints; Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) two liang, honey-fried; Aconiti Lateralis Radix Praeparata (Fuzi, 附子) one piece, processed, peel removed.
The above three ingredients. Use seven sheng of water. First decoct Mahuang until it boils once. Remove the foam on the surface. Add the remaining herbs. Decoct to obtain three sheng of liquid. Strain off the dregs. Take one sheng warm. Three times a day.
Cheng Wuji's commentary states: The sweetness of Mahuang and Gancao is used to dissipate exterior cold. The pungency of Fuzi is used to warm the meridians and qi. ○ My opinion is: This embodies the principle of pungent-sweet dispersing. Since there must be "rebound fever" (fever appearing in Shaoyin disease), this decoction is appropriate.
Hu notes that *Neitai Fangyi* only mentions that within two or three days of onset, with a deep and fine pulse and the body curled up lying down, it is Shaoyin disease. It omits the phrase "rebound fever," which is quite incomplete. Various commentators in *Tiaobian* state that Gancao is used in the formula instead of Xixin, saying that mild sweating is the harmonizing method for Shaoyin disease, making it a gentle warming-dispersing formula.
When Shaoyin disease develops after one or two days, if the mouth feels neutral (not bitter or dry) and the back feels aversion to cold, moxibustion should be applied. Treat with Fuzi Tang. (This clause describes a syndrome of Cold invading Shaoyin, highly suitable for warming and tonifying. "One or two days" here has the same meaning as "just acquired" mentioned earlier. "Mouth feels neutral" indicates no heat in the interior. Cheng Wuji comments: If there were guest-heat in Shaoyin, there would be dry mouth, dry tongue, and thirst; none of these are present now. The back is the region governed by the Taiyang meridian. The Shaoyin meridian ascends along the posterior medial aspect of the thigh, penetrates the spine, and connects to the Kidney. The spine resides inside the back. Back aversion to cold, according to Cheng Wuji, is due to weak Yang Qi and excess Yin Qi. Moxibustion with mugwort fire assists Yang and dispels Yin. Combined with Fuzi Tang, it warms the middle and tonifies deficiency. Ultimately, its function of dispersing cold pathogens is included. ○ Regarding this clause, Zhang Zhongjing does not specify which acupoint to moxa. Chang Qizhi in *Buwang Lun* says: One should moxa Ge Shu (BL17) and Guanyuan (CV4). Back Shu third row. Guo Baiyun says: There is an omission of characters; it should be moxa Ge Shu and Guanyuan. Ge Shu is the second row of Back Shu points. I note: Ge Shu is indeed in the second row of Back Shu points, but what Chang referred to as the third row point is likely Gai Guan (BL18), not Ge Shu. *Tu Jing* records: Gai Guan two points are located below the seventh thoracic vertebra, three cun lateral to the midline, in the depression. Take them while sitting upright. They are where the Qi of the Foot-Taiyang meridian emerges. They specifically treat back aversion to cold, stiff spine, and difficulty bending/straightening. Five moxa cones can be applied. Generally, Cold invading Shaoyin must enter via Taiyang, hence these points are appropriate. Additionally, Guanyuan one point is on the anterior midline, three cun below the umbilicus. It is the convergence of the Foot-Yin meridians and the Ren Mai. One hundred moxa cones can be applied. See the figure under Clause 6 of Jueyin Disease later. Chang says moxa Gai Guan to warm the exterior and disperse external pathogens; moxa Guanyuan to warm the interior and assist Yuan Qi.)