（少阴肾中水火同具。邪伤其经。或从水化而为寒。或
从火化而为热。二症俱以脉沉细但欲寐为提纲。）
何谓少阴之邪从水化而为寒。曰。脉沉细而微。但欲寐。背恶寒。口中和。腹痛。下利清谷。小便白是
也。宜用回阳法。而回阳中首重在温剂。又有交阴阳。微发汗。共成三法。
少阴病。寒邪始伤。是当无热。而反发热。为太阳之标阳外呈。脉沉为少阴之生气不升。恐阴阳内外不相
接。故以熟附助太阳之表阳而内合于少阴。细辛启少阴之水阴而外合于太阳。仲景麻黄附子细辛汤。
非发汗法。乃交阴阳法。以上言交阴阳法也。
少阴病。自始得以至于二三日。俱无里症。可知太阳之表热非汗不解。而又恐过汗以伤肾液。另出加减
法。取中焦水谷之津而为汗。则内不伤阴。邪从表解矣。仲景麻黄附子甘草汤。变交阴阳法而为微发汗
法。以上言微发汗法也。
手足厥冷。吐利。小便复利。下利清谷。内寒外热。脉微欲绝者。宜四逆汤。
里寒外热。面赤。或腹痛。或干呕。或咽痛。或利止脉不出。或出而厥。宜通脉四逆汤。
少阴下利。宜白通汤。利不止。厥逆无脉。干呕烦。白通加猪胆汁汤主之。服药后。脉暴出者死。微续者生。
汗下后不解。烦燥者。茯苓四逆汤主之。
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。此为水气。宜真武汤。
咳呕小便利下利四症。或有或无。因症下药。当于浅注细玩之。
少阴病。得之二三日。口中和。其背恶寒者。太阳之阳虚。不与少阴之君火相合。当灸之。又身体痛。君火之
气不能周遍于一身。手足寒。君火之气不能充达于四肢。骨节痛。君火之神机不能游行以出入。脉沉者。
君火之神机不能自下而上。一为阳虚。责在太阳之阳气虚。不能内合。一为阴虚。责在少阴之君火内虚。
神机不转。皆以附子汤主之。
少阴病吐利。神机不能交会于中土。手足逆冷。中土气虚不能达于四肢。烦躁欲死者。少阴神机挟寒而
逆于经脉。心脉不能下交于肾则烦。肾脉不能上通于心则躁。吴茱萸汤主之。
以上用温剂法也。
何谓少阴之邪从火化而为热。曰。脉沉细而数。但欲寐。而内烦外躁。或不卧。口中热。下利清水。小便赤是
也。宜用救阴法。而救阴中又有补正攻邪之异。
少阴病二三日。咽痛者。可与甘草汤。不瘥。与桔梗汤。
少阴病。咽中伤。生疮。不能语言。声不出者。苦酒汤主之。
少阴病。咽中痛。半夏散及汤主之。
少阴病。下利咽痛。胸满心烦者。猪肤汤主之。
少阴病。得之二三日以上。心中烦。不得卧。黄连阿胶汤主之。
少阴病。下利六七日。咳而呕渴。心烦不得眠者。猪苓汤主之。
少阴病二三日。至四五日腹痛小便不利。下利便脓血。桃花汤主之。
以上皆以补正为救阴法也。
少阴病。得之二三日。口燥舌干者。急下之。宜大承气汤。热淫于内。因而转属阳明。胃火上炎。故
口燥舌干。急下之。谷气下流。津液得升矣。
少阴病六七日。腹胀不大便者。急下之。宜大承气汤。得病六七日。当解不解。津液枯涸。因转属阳明。故腹
胀不大便。宜于急下者。六七日来阴虚已极。恐土实于中。心肾不交而死也。
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。是土燥火炎。脾气不濡。胃气反浓。
水去而谷不去。故宜急下。
以上皆以攻邪为救阴法也。
内经云。少阴之上。火气治之。所谓本也。本之下。中之见也。见之下。气之标也。又曰。少阴从标
从本。又曰。少阴为枢。又热病论曰。五日少阴受之。少阴脉贯肾。络于肺。系舌本。故口燥舌干而渴。
伤寒论曰。少阴之为病。脉微细。但欲寐也。微者。体薄而不浓也。为手少阴神病。细者形窄而不宽也。为足
少阴精病。病在阴则欲寐。在阳则不得寐。故曰但欲寐。此为枢象。少阴证之总纲也。柯韵伯云。少阳为阳
枢。少阴为阴枢。枢机不利。故欲寐。与少阳喜呕。呕者欲出。阳主外也。寐者主入。阴主内也。喜呕是不得呕。
欲寐是不得寐。皆在病患意中得枢机之象如此。又云。但欲寐即是不得眠。然但欲寐是病情。乃问而知
之。不得眠是病形。可望而知之。欲寐是阴虚。不得眠是烦躁。故治法不同。
按少阴本热而标寒。其病或从本而为热化。或从标而为寒化。与太阳一例。第一节言微细之病脉。但
欲寐之病情。兼水火阴阳标本寒热。而提其总纲也。以下共四十四节。皆本此而立论。然他经提纲。皆
是邪气盛则实。少阴提纲。俱指正气夺则虚。以少阴为人身之根本也。所以第二节即言上火下水。虚
而未济。第三节即言外阳内阴。虚而不交。第四节第五节。又言不可发汗。第六节又就脉而言不可下。
无非着眼于虚之一字。而以根本为重也。
今再详第二节。原文云。少阴病欲吐不吐。心中烦。但欲寐三句。指初病时水火不济。已具枢病之象。又
云。五六日自利而渴。属少阴也。虚故引水自救四句。方指出五六日为少阴主气之期。火不下交。则自
利。水不上交。而作渴。属少阴之虚。为寒热俱有之证。又云。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。故令色白也六句。分出小便色白。始为少阴阴寒之病形悉具。言外见少阴热
化之病。邪热足以消水。其小便必赤。此寒热之几微当辨也。其第三节原文云。病患脉阴阳俱紧。反汗
出者。亡阳也。此属少阴四句。以诸紧为寒。阴不得有汗。今反汗出。此属少阴阴盛于内。阳亡于外。阴阳
不交之故也。又云。法当咽痛而复吐利二句。以阴阳不交。则阳自阳而格绝于外。其咽痛为假热之象。
阴自阴而独行于内。其吐利为真寒之证。此寒热之真假当分也。其第四节原文云。少阴病。咳而下利。
谵语者。被火气劫故也。小便必难。以强责少阴汗也六句。言少阴上咳下利之证。被火则精竭神越而
谵语。小便必难。戒其勿发少阴汗。虑其虚也。其第五节原文云。少阴病。脉沉细数。病为在里。不可发汗
三句。言少阴自有表里。脉沉而发热。为少阴表有麻黄附子细辛汤法。脉细而沉。数而不发热。为少阴
里。不可发汗。其第六节云。少阴病脉微。不可发汗。亡阳故也。阳已虚。尺脉涩弱者。复不可下之六句。言
脉微为亡阳。不可发汗以伤阳。若兼见尺脉弱涩为亡阴。更不可复下以伤阴。自第二节至此。皆着眼
于虚之一字以立论也。
请再言欲愈之证。第七节大旨。以脉紧为寒。至七八日紧去。而发烦自下利。脉微手足温。此少阴之寒。
得阳明之热。为戊癸之合化而愈也。第八节大旨。下利自止。得手足温之吉候。虽恶寒蜷卧而可治。以
其得中土之气而愈也。第九节提出自烦欲去衣被。虽恶寒而蜷可治。以得君火之气而可治也。第十
节少阴中风。风为阳邪。阳寸应浮。阴尺应沉。大旨以阳得微而外邪不复入。阴得浮则内邪从外出而
欲愈。言外见中风。而可推及伤寒矣。第十一节言少阴病欲解时。从子至寅时。上二句。指出阳生于半
子而病解。并结上数节。少阴得阳则解之义也。
虽贵得阳。阳者太阳之标阳也。既知中标阳之热化则生。亦当知热化太过而亦成病。第十二节云。少
阴病吐利。手足不逆冷。反发热者不死。言少阴而得太阳之标阳也。又云。脉不至。灸少阴七壮。言不得
太阳标热之化而下陷。灸之以启在下之阳也。第十三节云。少阴病八九日。一身手足尽热者。以热在
膀胱。必动便血也。言少阴热化太过。移于膀胱。膀胱主外。为一身发热。膀胱为胞之室。胞为血海。热邪
内干而为便血也。第十四节云少阴病。但厥无汗。热化太过而行于里而为厥。若强发之。必动其血。未
知从何道出。或从口鼻。或从目出。是名下厥上竭。为难治。言少阴热化太过而厥。误汗反增其热。盖主
内经厥论起于足下。以阳气起于足五趾之里。今误发少阴汗。激动少阴热化之邪。自下逆上。名曰厥。
少阴原为少血之藏。动其阴血而脱出。名曰上竭。为难治之证。
若夫不得太阳标阳。则为阴寒之症。不止难治。而为不治之死证。自第十五节。以及第二十节。各有妙
义。第十五节云。少阴病。恶寒身蜷而利。手足逆冷者不治。盖以少阴之脉起足心。至俞府。行身之前。外
呈而为寒。内陷而为利。真阳绝不行于手足而为逆冷。此言少阴之寒。不得太阳标阳之死证也。第十
六节云。少阴病。吐利躁烦。四肢逆者死。盖少阴上下水火阴阳之气。全赖中土以交合。今吐利躁烦。阴
阳水火之气顷刻离决。四肢逆冷。土气已绝。此言少阴不得中土之交之死证也。第十七节云。少阴病。
下利止而头眩。时时自冒者死。盖以阴竭于下而利止。阳亡于上而眩冒。为死证。利不止而眩冒。更为
死证。言阴阳不得倚附也。第十八节云。少阴病。四逆恶寒而身蜷。脉不至。不烦而燥者死。此言少阴有
阴无阳之死证也。第十九节云。少阴病六七日。息高者死。此言少阴生气上脱之死证也。第二十节云。
少阴病脉微细沉。但欲卧。汗出。不烦。自欲吐。此十一字为一截。言少阴阴寒恒有之脉证也。其云至五
六日自利。复烦燥不得卧寐者死。此十五字又为一截。少阴病以五六日为生死之关。若至五六日云
云。是真寒反为假热。阳被阴迫而飞越。此言少阴阳气外脱之死证也。
自章首至此凡二十节。论少阴证之全体已备。但未详其标本。寒热。阴阳水火。神机枢转。上下出入之
理。自二十一节至四十三节发明其旨。而并出其方。读者不可一字放过。此又少阴之大用也。
曷言标本。少阴标寒而本热。与太阳本寒而标热。为雌雄表里之相应。二十一节云。少阴病。始得之。反
发热。脉沉者。麻黄附子细辛汤主之。言少阴脉沉不当发热。今反发热。是太阳标阳陷于少阴而为热。
宜以此汤交和其内外也。二十二节云。少阴病得之二三日。麻黄附子甘草汤微发汗。以二三日无里
证。故微发汗也。言二三日值少阳主气之期。阴枢藉阳枢之力。可用此汤微发其汗。又申之曰。以二三
日无少阴之里证。止见太阳之表证故也。要知太阳阳虚。不能主外。内伤少阴之气。便露出少阴底板。
少阴阴虚。不能主内。外伤太阳之气。便假借太阳之面目。所以太阳病而脉反沉。用四逆以急救其里。
少阴病而表反热。用麻辛以微解其表。此表里轻重两解法也。故始得之不发汗。得之二三日微发汗。
用细辛非发汗。用甘草乃发汗。此旨不可与浅人语也。然二十一节二十二节。合脏腑雌雄而浅深言
之。二十三节二十四节二十五节。就少阴本经分标本而对待言之。其云。少阴病得之二三日以上。心
中烦。不得卧。黄连阿胶汤主之。言少阴本热之病。二三日随三阳主气之期而化热。此少阴本热之证
也。其云少阴病。得之二三日。口中和。其人皆恶寒者。当灸之。附子汤主之。言少阴君火之用弗宣。病在
上焦阳中之阳。为阳虚。其云少阴病。身体痛。手足寒。骨节痛。脉沉者。附子汤主之。言少阴生阳之气不
用。病在下焦水中之阳。为阴虚。主以附子汤。面面俱到。此少阴标寒之证也。然亦本热之证。不病无形
之气化。而病有形之经脉者。二十六节云。少阴下利。便脓血者。桃花汤主之。二十七节云。少阴病二三
日至四五日。腹痛小便不利。便脓血者。桃花汤主之。二十八节云。少阴病。下利便脓血者可刺。此言本
热病在经脉者。宜用石药。而济以期门刺法。便脓血。亦热入血室之义也。又有标寒之证。病发于手足
之少阴。而实本于阳明之中土者。二十九节云。少阴病吐利。手足厥冷。烦躁欲死者。吴茱萸汤主之。此
从少阴而归重到阳明。以百病皆以胃气为本。伤寒证重之。少阴证尤重之。总结上文数节之义。少阴
证虽有标本寒热之不同。而着眼不离乎此。首节至此作一大段读。
然而少阴上火下水而主枢也。主枢则旋转无有止息。第三十节云。少阴病。下利（火不下交而下寒）咽痛。
（水不上交而上热。）胸满心烦者。（上下神机内郁而枢转不出为烦满）猪肤汤主之。此上下而合言也。第三十一节云。
少阴病二三日咽痛者。（少阴从心系之脉而挟咽）可与甘草汤。不瘥者与桔梗汤。此言水不上交而为痛也。第三十二节云。
少阴病咽中伤。生疮。不能语言。声不出者。苦酒汤主之。此言水不上交。甚则兼及于肺而宜敛也。第三
十三节云。少阴病咽中痛。半夏散及汤主之。此言水不上交。正治不愈者。宜用从治之法也。此数节承第三
十节咽痛立论。为少阴上火作一 也。
下利为少阴证下水之一 。自三十四节至三十七节。皆言水火不交。则水中无火。火失闭藏之职。至
三十八节。变回阳之法为和解。三十九节。变辛温之法为清利。而推言中焦不输之下利。言其常亦不
（少阴肾中同时具备水和火两种属性。邪气侵袭其经脉，或者从水化而为寒证，或者从火化而为热证。这两种病症都以脉象沉细、只想睡觉作为总纲。）
什么是少阴的邪气从水化而为寒证呢？回答说：脉象沉细而微弱，只想睡觉，背部怕冷，口中感觉平和不苦不燥，腹痛，腹泻排出未消化的食物，小便颜色清白，这就是寒证的表现。应当使用回阳法，而在回阳法中首要重在温补药剂。又有调和阴阳、微微发汗的方法，共同构成三种治法。
少阴病，寒邪刚开始侵袭时，本应该没有发热，却反而出现发热，这是太阳经的标阳外现。脉沉说明少阴的生发之气不能上升，担心阴阳内外不能相接，所以用熟附子帮助太阳经的表阳，使其向内与少阴相合；用细辛激发少阴的水阴，使其向外与太阳相合。张仲景的麻黄附子细辛汤，并不是发汗法，而是调和阴阳法。以上讲的是调和阴阳法。
少阴病，从开始到两三天内，都没有里证，可知太阳经的表热非发汗不能解除，但又担心过度发汗会损伤肾液，于是另出加减法，取中焦水谷的精微津液来作为汗源，这样内部就不会损伤阴液，邪气就能从体表解除了。张仲景的麻黄附子甘草汤，将调和阴阳法变为微微发汗法。以上讲的是微微发汗法。
手足冰冷，呕吐腹泻，小便反而通利，腹泻排出未消化的食物，体内寒冷体外发热，脉象微弱几乎摸不到的人，适宜用四逆汤。
体内寒冷体外发热，面色发红，或者腹痛，或者干呕，或者咽喉痛，或者腹泻停止但脉搏摸不到，或者脉搏摸到了但四肢厥冷，适宜用通脉四逆汤。
少阴病腹泻，适宜用白通汤。如果腹泻不止，四肢厥冷，脉搏摸不到，干呕心烦，用白通加猪胆汁汤主治。服药后，如果脉搏突然暴出的是死证，脉搏慢慢恢复的是生证。
发汗或攻下后病情仍未解除，出现烦躁不安的，用茯苓四逆汤主治。
少阴病，过了两三天还没好，到了四五天，出现腹痛，小便不利，四肢沉重疼痛，自行腹泻，这是水气病，适宜用真武汤。
咳嗽、呕吐、小便通利、腹泻这四种症状，或有或无，应根据具体症状用药，应当在《伤寒论浅注》中仔细研读。
少阴病，得病两三天，口中感觉平和，背部怕冷的，是太阳经阳气虚，不能与少阴经的君火相合，应当施灸。又身体疼痛，是君火之气不能周遍全身；手足寒冷，是君火之气不能充达四肢；骨节疼痛，是君火的神机不能游行出入；脉象沉，是君火的神机不能自下而上。一是阳气虚，责任在太阳经阳气虚，不能内合；一是阴气虚，责任在少阴经君火内虚，神机不转，都用附子汤主治。
少阴病呕吐腹泻，神机不能在脾胃中土交会，手足逆冷，中土气虚不能到达四肢，烦躁欲死的，是少阴神机挟带寒气逆乱于经脉，心脉不能下交于肾则烦，肾脉不能上通于心则躁，用吴茱萸汤主治。
以上是使用温补药剂的方法。
什么是少阴的邪气从火化而为热证呢？回答说：脉象沉细而数，只想睡觉，但内心烦躁外部躁动，或者无法入睡，口中发热，腹泻排出清水，小便赤红，这就是热证的表现。应当使用救阴法，而在救阴法中又有扶正祛邪的不同。
少阴病两三天，咽喉痛的，可以给予甘草汤，如果不愈，给予桔梗汤。
少阴病，咽喉受伤，生疮，不能说话，声音出不来的，用苦酒汤主治。
少阴病，得病两三天以上，心中烦躁，无法入睡的，用黄连阿胶汤主治。
少阴病，腹泻六七天，咳嗽呕吐口渴，心烦不得眠的，用猪苓汤主治。
少阴病两三天，到了四五天腹痛小便不利，腹泻便脓血的，用桃花汤主治。
以上都是以扶正为救阴法。
少阴病，得病两三天，口燥舌干的，必须急下，适宜用大承气汤。热邪充斥于内，因而转属阳明，胃火上炎，所以口燥舌干，必须急下，使谷气下行，津液得以升腾。
少阴病六七天，腹胀不大便的，必须急下，适宜用大承气汤。得病六七天，应当解表而未解，津液枯竭，因而转属阳明，所以腹胀不大便，适宜急下的原因，是因为六七日来阴虚已极，恐怕土实于中，心肾不交而死。
少阴病，自行腹泻清水，颜色纯青，心下部必定疼痛，口干燥的，必须急下，适宜用大承气汤。这是土燥火炎，脾气不濡润，胃气反而浓浊，水去而谷不去，所以宜急下。
《内经》说：少阴之上，由火气主司，这叫作“本”。本的下面，是“中见”之气。中见的下面，是“标”气。又说：少阴既可以从标也可以从本。又说：少阴为枢。又《热病论》说：第五天少阴受邪。少阴脉贯穿肾脏，联络肺脏，系连舌根，所以口燥舌干而渴。
《伤寒论》说：少阴病的表现，是脉微细，只想睡觉。“微”，是指形体薄而不浓厚，属于手少阴心神之病；“细”，是指形态窄而不宽，属于足少阴精血之病。病在阴则想睡觉，在阳则睡不着，所以说“只想睡觉”，这是枢机的象，也是少阴证的总纲。柯韵伯说：少阳为阳枢，少阴为阴枢。枢机不利，所以想睡觉。这与少阳喜欢呕吐不同，呕吐是想排出去，阳主外；睡觉是主入，阴主内。喜欢呕吐是吐不出来，想睡觉是睡不好，都在病患意念中体现出枢机的象。又说：只想睡觉就是不能安眠。然而“想睡觉”是病情，是通过询问得知的；“不能安眠”是病形，是通过观察得知的。“想睡觉”是阴虚，“不能安眠”是烦躁，所以治疗方法不同。
按：少阴本热而标寒，其病或者从本化为热证，或者从标化为寒证，与太阳经一样。第一节讲的是微细的病脉和想睡觉的病情，兼括水火阴阳标本寒热，提出总纲。以下共四十四节，都以此为基础立论。然而其他经络的提纲，都是邪气盛则实证，少阴提纲，都指正气夺则虚证，因为少阴是人身的根本。所以第二节即讲上火下水，虚而未济；第三节即讲外阳内阴，虚而不交；第四节第五节，又讲不可发汗；第六节又从脉象上讲不可攻下。无非着眼于“虚”字，而以根本为重。
现在再详细分析第二节。原文说：“少阴病欲吐不吐，心中烦，但欲寐”三句，指出初病时水火不济，已经具备枢机病的象。又说：“五六日自利而渴，属少阴也，虚故引水自救”四句，才指出五六日是少阴主气的时期，火不下交则自利，水不上交而作渴，属于少阴之虚，是寒热俱有的证候。又说：“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”六句，分出小便色白，才是少阴阴寒的病形完全具备。言外之意，少阴热化的病，邪热足以消水，其小便必赤，这是寒热细微之处应当辨别。
第三节原文说：“病患脉阴阳俱紧，反汗出者，亡阳也，此属少阴”四句，以诸紧脉为寒，阴证不应有汗，如今反而出汗，这是属于少阴阴盛于内，阳亡于外，阴阳不交的缘故。又说：“法当咽痛而复吐利”二句，因阴阳不交，则阳自阳而格拒绝于外，其咽痛为假热的象；阴自阴而独行于内，其吐利为真寒的证。这是寒热真假应当分辨。
第四节原文说：“少阴病，咳而下利，谵语者，被火气劫故也。小便必难，以强责少阴汗也”六句，讲少阴上咳下利的证候，被火疗则精竭神越而谵语，小便必难，告诫不要发少阴汗，顾虑其虚。
第五节原文说：“少阴病，脉沉细数，病为在里，不可发汗”三句，讲少阴自有表里，脉沉而发热，是少阴表有麻黄附子细辛汤法；脉细而沉，数而不发热，是少阴里，不可发汗。
第六节说：“少阴病脉微，不可发汗，亡阳故也。阳已虚，尺脉涩弱者，复不可下之”六句，讲脉微为亡阳，不可发汗以伤阳；若兼见尺脉弱涩为亡阴，更不可再攻下以伤阴。从第二节至此，都着眼于“虚”字立论。
请再讲欲愈的证候。第七节大意：以脉紧为寒，到了七八日紧脉去，而发烦自下利，脉微手足温，这是少阴之寒，得到阳明之热，为戊癸之合化而愈。第八节大意：下利自止，得到手足温的吉兆，虽然恶寒蜷卧也可治，因为其得到中土之气而愈。第九节提出自烦欲去衣被，虽然恶寒蜷卧也可治，因为其得到君火之气而可治。第十节少阴中风，风为阳邪，阳寸应浮，阴尺应沉，大意是阳得微而外邪不复入，阴得浮则内邪从外出而欲愈，言外之意中风，可推及伤寒了。第十一节讲少阴病欲解时，从子时至寅时，上两句，指出阳生于半子而病解，并总结上几节，少阴得阳则解的意义。
虽然贵在得阳，阳者是指太阳的标阳。既然知道中标阳的热化则生，也应当知道热化太过而亦成病。第十二节说：“少阴病吐利，手足不逆冷，反发热者不死”，讲少阴而得到太阳的标阳。又说：“脉不至，灸少阴七壮”，讲不得太阳标热之化而下陷，灸之以启在下之阳。第十三节说：“少阴病八九日，一身手足尽热者，以热在膀胱，必动便血也”，讲少阴热化太过，移于膀胱，膀胱主外，为一身发热，膀胱为胞之室，胞为血海，热邪内干而为便血。第十四节说：“少阴病，但厥无汗，热化太过而行于里而为厥，若强发之，必动其血，未知从何道出，或从口鼻，或从目出，是名下厥上竭，为难治”，讲少阴热化太过而厥，误汗反增其热。盖依据《内经·厥论》起于足下，以阳气起于足五趾之里，如今误发少阴汗，激动少阴热化之邪，自下逆上，名曰厥。少阴原为少血之藏，动其阴血而脱出，名曰上竭，为难治之证。
如果不能得到太阳标阳，则为阴寒之症，不止难治，而为不治的死证。从第十五节，以及第二十节，各有妙义。第十五节说：“少阴病，恶寒身蜷而利，手足逆冷者不治”，盖因少阴之脉起足心，至俞府，行身之前，外呈而为寒，内陷而为利，真阳绝不行于手足而为逆冷，此言少阴之寒，不得太阳标阳的死证。第十六节说：“少阴病，吐利躁烦，四肢逆者死”，盖因少阴上下水火阴阳之气，全赖中土以交合，今吐利躁烦，阴阳水火之气顷刻离决，四肢逆冷，土气已绝，此言少阴不得中土之交的死证。第十七节说：“少阴病，下利止而头眩，时时自冒者死”，盖因阴竭于下而利止，阳亡于上而眩冒，为死证，利不止而眩冒，更为死证，言阴阳不得倚附。第十八节说：“少阴病，四逆恶寒而身蜷，脉不至，不烦而燥者死”，此言少阴有阴无阳的死证。第十九节说：“少阴病六七日，息高者死”，此言少阴生气上脱的死证。第二十节说：“少阴病脉微细沉，但欲卧，汗出，不烦，自欲吐”，此十一字为一截，讲少阴阴寒恒有的脉证。其云“至五六日自利，复烦躁不得卧寐者死”，此十五字又一截，少阴病以五六日为生死之关，若至五六日云云，是真寒反为假热，阳被阴迫而飞越，此言少阴阳气外脱的死证。
从章首至此凡二十节，论述少阴证的全体已完备，但未详其标本、寒热、阴阳水火、神机枢转、上下出入的道理，自二十一节至四十三节发明其旨，并出其方，读者不可一字放过，这又是少阴的大用。
何谓标本？少阴标寒而本热，与太阳本寒而标热，为雌雄表里的相应。第二十一节说：“少阴病，始得之，反发热，脉沉者，麻黄附子细辛汤主之”，讲少阴脉沉不当发热，如今反发热，是太阳标阳陷于少阴而为热，宜以此汤交和其内外。第二十二节说：“少阴病得之二三日，麻黄附子甘草汤微发汗，以二三日无里证，故微发汗也”，讲二三日值少阳主气的时期，阴枢藉阳枢之力，可用此汤微发其汗，又申述说：以二三日无少阴之里证，只见到太阳之表证。要知道太阳阳虚，不能主外，内伤少阴之气，便露出少阴底板；少阴阴虚，不能主内，外伤太阳之气，便假借太阳之面目。所以太阳病而脉反沉，用四逆以急救其里；少阴病而表反热，用麻辛以微解其表。这是表里轻重两解法。所以始得之不发汗，得之二三日微发汗，用细辛并非发汗，用甘草乃是发汗，此意不可与浅薄之人谈论。然而第二十一节二十二节，合脏腑雌雄而深浅言之；第二十三二十四二十五节，就少阴本经分标本而对待言之。其云：“少阴病得之二三日以上，心中烦，不得卧，黄连阿胶汤主之”，讲少阴本热之病，二三日随三阳主气的时期而化热，这是少阴本热之证。其云：“少阴病，得之二三日，口中和，其人皆恶寒者，当灸之，附子汤主之”，讲少阴君火之用弗宣，病在上焦阳中之阳，为阳虚。其云：“少阴病，身体痛，手足寒，骨节痛，脉沉者，附子汤主之”，讲少阴生阳之气不用，病在下焦水中之阳，为阴虚，主以附子汤，面面俱到，这是少阴标寒之证，然也是本热之证。不病无形之气化，而病有形之经脉者，第二十六节说：“少阴下利，便脓血者，桃花汤主之”，第二十七节说：“少阴病二三日至四五日，腹痛小便不利，便脓血者，桃花汤主之”，第二十八节说：“少阴病，下利便脓血者可刺”，此言本热病在经脉者，宜用石药，而济以期门刺法，便脓血，也是热入血室的含义。又有标寒之证，病发于手足之少阴，而实本于阳明之中土者，第二十九节说：“少阴病吐利，手足厥冷，烦躁欲死者，吴茱萸汤主之”，此从少阴而归重到阳明，以百病皆以胃气为本，伤寒证重之，少阴证尤重之，总结上文数节的意义，少阴证虽有标本寒热之不同，而着眼不离乎此，首节至此作一大段读。
然而少阴上火下水而主枢也，主枢则旋转无有止息。第三十节说：“少阴病，下利（火不下交而下寒），咽痛（水不上交而上热），胸满心烦者（上下神机内郁而枢转不出为烦满），猪肤汤主之”，此上下而合言也。第三十一节说：“少阴病二三日咽痛者（少阴从心系之脉而挟咽），可与甘草汤，不瘥者与桔梗汤”，此言水不上交而为痛也。第三十二节说：“少阴病咽中伤，生疮，不能语言，声不出者，苦酒汤主之”，此言水不上交，甚则兼及于肺而宜敛也。第三十三节说：“少阴病咽中痛，半夏散及汤主之”，此言水不上交，正治不愈者，宜用从治之法也。此数节承第三十节咽痛立论，为少阴上火作一总结。
下利为少阴证下水之一部分，自三十四节至三十七节，皆言水火不交，则水中无火，火失闭藏之职，至三十八节，变回阳之法为和解，三十九节，变辛温之法为清利，而推言中焦不输之下利，言其常亦不……
(Kidney of Shaoyin possesses both Water and Fire. When pathogenic factors invade its meridians, they may transform into Cold from Water, or into Heat from Fire. Both conditions use "deep and fine pulse with desire to sleep" as the general outline.)
What is meant by Shaoyin pathogenic factors transforming into Cold from Water? It is answered: deep, fine, and faint pulse; desire to sleep; aversion to cold in the back; neutral sensation in the mouth; abdominal pain; diarrhea with undigested food; and clear urine. This is it. One should employ the method of restoring Yang, wherein the primary emphasis lies on warming agents. There are also methods of harmonizing Yin and Yang, and slight perspiration, constituting three methods together.
In Shaoyin disease, when Cold pathogen initially invades, there should be no fever. However, if fever appears, it indicates the superficial Yang of Taiyang manifesting externally. A deep pulse signifies that the vital Qi of Shaoyin cannot ascend. Fearing that Yin and Yang inside and outside cannot connect, Shu Fu Zi (Prepared Aconite Root) is used to assist the exterior Yang of Taiyang to internally combine with Shaoyin; Xi Xin (Asarum) is used to stimulate the Water-Yin of Shaoyin to externally combine with Taiyang. Zhang Zhongjing's Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite, and Asarum Decoction) is not a sweating method, but a method of harmonizing Yin and Yang. The above discusses the method of harmonizing Yin and Yang.
In Shaoyin disease, from onset up to two or three days, if there are no interior symptoms, it can be known that the exterior heat of Taiyang cannot be resolved without sweating. Yet, one must fear excessive sweating damaging Kidney fluids. Therefore, an added-reduction method is provided, utilizing the fluids from water and grain in the Middle Jiao to generate sweat, so that Yin inside is not damaged, and pathogens are resolved from the exterior. Zhang Zhongjing's Mahuang Fuzi Gancao Tang (Ephedra, Prepared Aconite, and Licorice Decoction) changes the method of harmonizing Yin and Yang into a slight sweating method. The above discusses the method of slight sweating.
For those with cold extremities, vomiting and diarrhea, frequent urination, diarrhea with undigested food, internal cold with external heat, and a faint pulse nearly imperceptible, Si Ni Tang (Frigid Extremities Decoction) is suitable.
For internal cold with external heat, red face, or abdominal pain, or dry retching, or sore throat, or cessation of diarrhea with absent pulse, or presence of pulse but cold extremities, Tong Mai Si Ni Tang (Pulse-Restoring Frigid Extremities Decoction) is suitable.
For Shaoyin diarrhea, Bai Tong Tang (White Pass Decoction) is suitable. If diarrhea does not stop, with cold extremities, absent pulse, dry retching, and irritability, Bai Tong Jia Zhu Dan Jiang Tang (White Pass Decoction plus Pig Bile) governs. After taking medicine, if the pulse suddenly emerges, it is a death sign; if it slowly continues, it is a survival sign.
If after sweating or purging the condition remains unresolved, with irritability, Fu Ling Si Ni Tang (Poria and Frigid Extremities Decoction) governs.
In Shaoyin disease, if after two or three days it persists until four or five days, with abdominal pain, difficult urination, heavy and painful limbs, and spontaneous diarrhea, this is Water Qi. Zhen Wu Tang (True Warrior Decoction) is suitable.
Cough, vomiting, free urination, and diarrhea—these four symptoms may or may not occur. Medication should be prescribed according to symptoms; one should carefully study this in Qian Zhu (Shallow Annotations).
In Shaoyin disease, after two or three days, with a neutral mouth and aversion to cold in the back, it is deficiency of Taiyang Yang, failing to combine with the Sovereign Fire of Shaoyin. Moxibustion should be applied. Also, body pain indicates Sovereign Fire Qi cannot circulate throughout the body; cold hands and feet indicate Sovereign Fire Qi cannot reach the limbs; joint pain indicates the Divine Mechanism of Sovereign Fire cannot move in and out; a deep pulse indicates the Divine Mechanism of Sovereign Fire cannot rise from below. One case is Yang deficiency, blamed on Taiyang Yang deficiency failing to internally combine; another is Yin deficiency, blamed on Shaoyin Sovereign Fire internal deficiency with stagnant Divine Mechanism. Both are governed by Fu Zi Tang (Aconite Decoction).
In Shaoyin disease with vomiting and diarrhea, the Divine Mechanism fails to meet in the Earth Center (Spleen/Stomach), with cold extremities, Middle Earth Qi deficiency failing to reach limbs, and severe irritability. This is Shaoyin Divine Mechanism carrying Cold reversing in the meridians. Heart vessels failing to descend to Kidney cause irritability (Fan); Kidney vessels failing to ascend to Heart cause restlessness (Zao). Wu Zhu Yu Tang (Evodia Decoction) governs.
The above describes the method of using warming agents.
What is meant by Shaoyin pathogenic factors transforming into Heat from Fire? It is answered: deep, fine, and rapid pulse; desire to sleep; yet internal irritability and external restlessness, or inability to sleep; hot mouth; diarrhea with clear water; and red urine. This is it. One should employ the method of saving Yin. Within saving Yin, there are differences between tonifying righteousness and attacking pathogens.
In Shaoyin disease for two or three days, with sore throat, Gan Cao Tang (Licorice Decoction) may be given. If not healed, Ge Geng Tang (Kudzu Decoction) is given.
In Shaoyin disease, with injury to the throat, sores formed, inability to speak, and voice loss, Ku Jiu Tang (Bitter Wine Decoction) governs.
In Shaoyin disease, with sore throat, Ban Xia San Ji Tang (Pinellia Powder and Decoction) governs.
In Shaoyin disease, with diarrhea, sore throat, chest fullness, and heart vexation, Zhu Fu Tang (Pig Skin Decoction) governs.
In Shaoyin disease, after two or more days, with heart vexation and inability to sleep, Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction) governs.
In Shaoyin disease, with diarrhea for six or seven days, cough, vomiting, thirst, heart vexation, and insomnia, Zhu Ling Tang (Polyporus Decoction) governs.
In Shaoyin disease for two or three days, progressing to four or five days, with abdominal pain, difficult urination, and diarrhea with pus and blood, Tao Hua Tang (Peach Blossom Decoction) governs.
The above all use tonifying righteousness as the method of saving Yin.
In Shaoyin disease, after two or three days, with dry mouth and tongue, urgent purging is required. Da Cheng Qi Tang (Major Order the Qi Decoction) is suitable. Heat rampant inside causes transformation to Yangming, with Stomach Fire flaming upward, causing dry mouth and tongue. Urgent purging allows Grain Qi to flow downward and Fluids to ascend.
In Shaoyin disease for six or seven days, with abdominal distension and constipation, urgent purging is required. Da Cheng Qi Tang (Major Order the Qi Decoction) is suitable. After six or seven days, if resolution fails, fluids dry up, leading to Yangming transformation, causing abdominal distension and constipation. Urgent purging is needed because Yin deficiency is extreme after six or seven days, fearing Earth excess in the middle preventing Heart-Kidney communication and death.
In Shaoyin disease, with spontaneous diarrhea of pure green water, pain in the epigastrium, and dry mouth, urgent purging is required. Da Cheng Qi Tang (Major Order the Qi Decoction) is suitable. This is Dry Earth and Blazing Fire, with Spleen Qi not moistening and Stomach Qi becoming thick. Water leaves but Grain remains, hence urgent purging is needed.
The above all use attacking pathogens as the method of saving Yin.
*Neijing* states: Above Shaoyin, Fire Qi governs, called the "Root". Below the Root is the "Middle Manifestation". Below the Middle Manifestation is the "Mark". It also says: Shaoyin follows both Mark and Root. It also says: Shaoyin is the Pivot. *Lue Bing Lun* states: On the fifth day, Shaoyin is affected. Shaoyin meridians penetrate the Kidney, connect to the Lung, and tie to the root of the tongue, causing dry mouth, tongue, and thirst.
*Shanghan Lun* states: The disease of Shaoyin is a faint and fine pulse with desire to sleep. "Faint" means thin and not dense, referring to Hand Shaoyin Spirit disease. "Fine" means narrow and not wide, referring to Foot Shaoyin Essence disease. Disease in Yin leads to desire to sleep; in Yang, inability to sleep. Hence "desire to sleep". This is the image of the Pivot, the general outline of Shaoyin syndromes. Ke Yunbo said: Shaoyang is the Yang Pivot, Shaoyin is the Yin Pivot. Pivot dysfunction leads to desire to sleep. Unlike Shaoyang's preference for vomiting (vomiting implies wanting to expel, Yang governs exterior), sleeping implies entering, Yin governs interior. Preference for vomiting is inability to vomit; desire to sleep is inability to sleep. Both reflect pivot images in the patient's mind. He also said: Desire to sleep is essentially inability to rest. However, "desire to sleep" is the condition known through inquiry; "inability to sleep" is the form known through observation. "Desire to sleep" is Yin deficiency; "inability to sleep" is irritability. Thus treatments differ.
Note: Shaoyin has Heat at the Root and Cold at the Mark. Its disease may transform into Heat from the Root, or into Cold from the Mark, similar to Taiyang. The first section discusses faint and fine pulses and the condition of desire to sleep, encompassing Water/Fire, Yin/Yang, Root/Mark, Cold/Heat, outlining the general principles. The following forty-four sections are based on this. However, outlines for other meridians describe Excess due to Pathogenic Abundance; Shaoyin outlines describe Deficiency due to Healthy Qi Depletion, because Shaoyin is the root of the body. Thus, Section 2 discusses Upper Fire and Lower Water, deficient and unconnected; Section 3 discusses Exterior Yang and Interior Yin, deficient and unconnected; Sections 4 and 5 discuss contraindications for sweating; Section 6 discusses contraindications for purging based on pulse. All focus on "Deficiency" and prioritize the Root.
Now detailing Section 2: The original text "Shaoyin disease, desire to vomit but cannot, heart vexation, desire to sleep" refers to initial Water-Fire non-connection, showing pivot disease signs. "Self-diarrhea and thirst on days 5-6, belonging to Shaoyin, deficiency draws water to save itself" points out that days 5-6 are the period of Shaoyin ruling Qi. Fire not descending causes diarrhea; Water not ascending causes thirst, belonging to Shaoyin deficiency, a syndrome with both Cold and Heat. "If urine is white, Shaoyin disease signs are complete. White urine is due to Lower Jiao deficiency with Cold, unable to control Water, hence white." This distinguishes that white urine marks complete Shaoyin Yin-Cold signs. Implicitly, Shaoyin Heat transformation involves pathogenic Heat consuming Water, so urine must be red. This subtle distinction between Cold and Heat must be recognized.
Section 3 original text: "Patient's pulse Yin and Yang both tight, yet sweating occurs, this is Yang collapse, belonging to Shaoyin." Tight pulses indicate Cold; Yin syndromes should not sweat. Sweating here indicates Shaoyin Yin excess inside, Yang collapse outside, due to Yin-Yang non-connection. "Normally sore throat followed by vomiting and diarrhea." Due to non-connection, Yang repels outward, making sore throat a false Heat sign; Yin moves alone inside, making vomiting/diarrhea true Cold signs. True vs. False Cold/Heat must be distinguished.
Section 4 original text: "Shaoyin disease, cough and diarrhea, delirium caused by Fire coercion. Urine will be difficult, due to forcing Shaoyin sweat." Cough and diarrhea in Shaoyin, coerced by Fire, lead to Essence depletion and Spirit scattering causing delirium; urine becomes difficult. Warning against forcing Shaoyin sweat due to deficiency.
Section 5 original text: "Shaoyin disease, pulse deep, fine, rapid, disease is in Interior, do not sweat." Shaoyin has its own Exterior/Interior. Deep pulse with fever indicates Shaoyin Exterior, using Mahuang Fuzi Xixin Tang method. Fine, deep, rapid pulse without fever indicates Shaoyin Interior, do not sweat.
Section 6: "Shaoyin disease, faint pulse, do not sweat, due to Yang collapse. Yang already deficient, if Chi pulse is choppy and weak, do not purge." Faint pulse indicates Yang collapse, do not sweat to damage Yang. Choppy/weak Chi pulse indicates Yin collapse, do not purge to damage Yin. From Section 2 to here, all arguments focus on "Deficiency".
Now discussing signs of recovery. Section 7 main idea: Tight pulse indicates Cold. By days 7-8, tightness goes, irritability and self-diarrhea appear, pulse faint, extremities warm. This is Shaoyin Cold receiving Yangming Heat,戊-Gui combination leading to recovery. Section 8 main idea: Diarrhea stops, extremities warm is auspicious. Though aversion to cold and curling up, it is treatable because it receives Middle Earth Qi. Section 9 mentions spontaneous irritability, desire to remove blankets; though aversion to cold and curling up, treatable because it receives Sovereign Fire Qi. Section 10: Shaoyin Wind Strike. Wind is Yang pathogen. Yang Cun should float, Yin Chi should sink. Main idea: Yang becoming mild prevents external pathogen entry; Yin becoming floating allows internal pathogen exit, indicating recovery. Implicitly, Wind Strike can be extended to Cold Damage. Section 11: Shaoyin disease resolves from Zi to Yin hours. First two sentences point out Yang born at half-Zi leads to resolution, summarizing previous sections that Shaoyin resolves with Yang.
Although valuing Yang acquisition, Yang refers to Taiyang's superficial Yang. Knowing superficial Yang Heat transformation brings life, one must also know excessive Heat transformation causes disease. Section 12: "Shaoyin disease vomiting/diarrhea, extremities not cold, yet fever, not fatal." Indicates Shaoyin receiving Taiyang superficial Yang. "Pulse absent, moxa Shaoyin seven moxibustions." Indicates failure to receive Taiyang Heat transformation leading to sinking; moxa stimulates lower Yang. Section 13: "Shaoyin disease days 8-9, whole body and extremities hot, heat in Bladder, likely bloody stool." Excessive Shaoyin Heat transformation shifts to Bladder. Bladder governs exterior, causing whole-body heat. Bladder is chamber of Bao (Uterus/Womb), Bao is Sea of Blood. Heat invading internally causes bloody stool. Section 14: "Shaoyin disease, only cold extremities, no sweat. Excessive Heat transformation moving inward causes cold extremities. Forcing sweat will disturb blood, unknown exit route, possibly nose/mouth or eyes. This is Lower Cold Upper Exhaustion, difficult to treat." Excessive Heat transformation causes cold extremities; mistaken sweating increases heat. Based on *Neijing*, Jue starts from sole, Yang Qi starts from toes. Mistaken Shaoyin sweating agitates Heat transformation, rising from below, named Jue. Shaoyin stores little Blood; disturbing Yin Blood causes exhaustion, named Upper Exhaustion, a difficult syndrome.
Without Taiyang superficial Yang, it is Yin-Cold syndrome, not just difficult but fatal. Sections 15-20 have profound meanings. Section 15: "Shaoyin disease, aversion to cold, curling up, diarrhea, cold extremities, untreatable." Shaoyin meridian starts at sole, goes to Shu Fu, runs front of body. Exterior presents as Cold, interior sinks as Diarrhea. True Yang fails to reach extremities causing cold. This is Shaoyin Cold without Taiyang superficial Yang, a fatal sign. Section 16: "Shaoyin disease, vomiting/diarrhea, irritability/restlessness, cold extremities, death." Shaoyin Water/Fire/Yin/Yang relies on Middle Earth for connection. Vomiting/diarrhea/irritability causes instantaneous separation of Water/Fire/Yin/Yang. Cold extremities indicate Earth Qi extinction. This is Shaoyin lacking Middle Earth connection, a fatal sign. Section 17: "Shaoyin disease, diarrhea stops, dizziness, occasional blackout, death." Yin exhausted below stops diarrhea; Yang collapses above causes dizziness/blackout, a death sign. Continued diarrhea with dizziness is even worse, indicating Yin/Yang lack support. Section 18: "Shaoyin disease, cold extremities, aversion to cold, curling up, absent pulse, no irritability but restlessness, death." This is Shaoyin having Yin without Yang, a fatal sign. Section 19: "Shaoyin disease days 6-7, high breathing, death." This is Shaoyin Vital Qi escaping upward, a fatal sign. Section 20: "Shaoyin disease, pulse faint/fine/deep, desire to lie down, sweating, no irritability, spontaneous desire to vomit." These eleven characters describe constant Shaoyin Yin-Cold signs. "By days 5-6, self-diarrhea, recurring irritability/restlessness, insomnia, death." These fifteen characters form another segment. Days 5-6 are the critical juncture for life/death in Shaoyin. If reaching days 5-6 with these signs, True Cold turns to False Heat, Yang forced by Yin flies away. This is Shaoyin Yang Qi external collapse, a fatal sign.
From chapter start to here, twenty sections cover the entirety of Shaoyin syndrome, but details on Root/Mark, Cold/Heat, Yin/Yang, Water/Fire, Divine Mechanism pivot, and Up/Down/In/Out principles are missing. Sections 21-43 elucidate these principles and provide formulas. Readers must not miss a word; this is the great utility of Shaoyin.
What are Root and Mark? Shaoyin Mark is Cold, Root is Heat, corresponding to Taiyang Root Cold and Mark Heat as Yin-Yang partners. Section 21: "Shaoyin disease, initially obtained, yet fever, deep pulse, Mahuang Fuzi Xixin Tang governs." Deep pulse should not have fever. Fever indicates Taiyang superficial Yang sinking into Shaoyin causing Heat. This decoction harmonizes Inside/Outside. Section 22: "Shaoyin disease obtained 2-3 days, Mahuang Fuzi Gancao Tang slight sweating. Because 2-3 days have no interior symptoms, slight sweating is used." Days 2-3 coincide with Shaoyang ruling Qi period; Yin Pivot borrows Yang Pivot power, allowing slight sweating. Restated: No Shaoyin interior symptoms, only Taiyang exterior symptoms. Note: Taiyang Yang deficiency cannot govern exterior, injuring Shaoyin Qi reveals Shaoyin foundation. Shaoyin Yin deficiency cannot govern interior, injuring Taiyang Qi borrows Taiyang appearance. Thus Taiyang disease with deep pulse uses Si Ni Tang to urgently rescue Interior; Shaoyin disease with exterior fever uses Ma-Xin to slightly resolve Exterior. This is simultaneous light/heavy resolution of Exterior/Interior. Initially no sweating; by 2-3 days slight sweating. Using Xi Xin is not sweating; using Gan Cao is sweating. This meaning cannot be discussed with shallow people. Sections 21-22 discuss depth via organ pairs; Sections 23-25 discuss Root/Mark within Shaoyin meridian. "Shaoyin disease 2-3+ days, heart vexation, insomnia, Huang Lian E Jiao Tang governs." Shaoyin Root Heat disease transforms to Heat during 2-3 days following Three Yang periods. This is Shaoyin Root Heat syndrome. "Shaoyin disease 2-3 days, neutral mouth, aversion to cold, moxibustion, Fu Zi Tang governs." Shaoyin Sovereign Fire function not expressed, disease in Upper Jiao Yang-within-Yang, Yang deficiency. "Shaoyin disease, body pain, cold extremities, joint pain, deep pulse, Fu Zi Tang governs." Shaoyin Vital Yang Qi not functioning, disease in Lower Jiao Water-within-Yang, Yin deficiency. Governed by Fu Zi Tang, comprehensive. This is Shaoyin Mark Cold syndrome, yet also Root Heat syndrome. Not disease of formless Qi transformation, but formless meridian disease. Section 26: "Shaoyin diarrhea, pus/blood stool, Tao Hua Tang governs." Section 27: "Shaoyin disease 2-3 to 4-5 days, abdominal pain, difficult urination, pus/blood stool, Tao Hua Tang governs." Section 28: "Shaoyin disease, diarrhea with pus/blood stool, can be needled." Root Heat disease in meridians should use stone needles, combined with Qi Men needling method. Pus/blood stool is also Heat entering Blood Chamber meaning. There are also Mark Cold syndromes originating in Hand/Foot Shaoyin but rooted in Yangming Middle Earth. Section 29: "Shaoyin disease vomiting/diarrhea, cold extremities, severe irritability, Wu Zhu Yu Tang governs." Returning from Shaoyin to emphasize Yangming, as all diseases rely on Stomach Qi as root. Shanghan emphasizes this, Shaoyin especially so. Summarizing previous sections: Although Shaoyin has different Root/Mark/Cold/Heat, focus remains here. Read sections 1-29 as one large segment.
However, Shaoyin has Upper Fire/Lower Water and governs the Pivot. Governing Pivot means rotation never stops. Section 30: "Shaoyin disease, diarrhea (Fire not descending causes Lower Cold), sore throat (Water not ascending causes Upper Heat), chest fullness/heart vexation (Upper/Lower Divine Mechanism internal stagnation, pivot rotation blocked causes vexation/fullness), Zhu Fu Tang governs." Discusses Upper/Lower together. Section 31: "Shaoyin disease 2-3 days sore throat (Shaoyin connects to throat via Heart vessel), Gan Cao Tang may be given, if not healed, Ge Geng Tang." Water not ascending causes pain. Section 32: "Shaoyin disease throat injury, sores, inability to speak/voice, Ku Jiu Tang governs." Water not ascending, severely involving Lung, requiring astringency. Section 33: "Shaoyin disease throat pain, Ban Xia San Ji Tang governs." Water not ascending, standard treatment fails, requires following-treatment method. These sections follow Section 30's sore throat argument, summarizing Shaoyin Upper Fire.
Diarrhea is one part of Shaoyin Lower Water. Sections 34-37 discuss Water-Fire non-connection, meaning Water lacks Fire, Fire loses closing/storage function. Section 38 changes Yang-restoring method to Harmonizing; Section 39 changes Acrid-Warm method to Clearing/Draining, deducing diarrhea from Middle Jiao failure to transport, discussing normality...