脏病连经 少阴病始得之反发热脉沉者(麻附细辛症)少阴病得之二三日麻黄附子甘草汤微发汗以二三日无里症故
也(麻附甘草症)
脏病 少阴之为病脉微细但欲寐也 少阴病脉细沉数病为在里不可发汗(脏病忌汗症)少阴病脉沉者急温之(四
逆症)少阴病身体疼手足寒骨节痛脉沉者(附子汤症)少阴病得之一二日口中和其背恶寒者当灸之附子汤主之(附子症)
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(咳利谵语症)少阴病脉微不可发汗亡阳故也阳已虚尺脉
微弱者复不可下之(发汗亡阳症)脉阴阳俱紧反汗出者亡阳也此属少阴法当咽痛而复吐利(咽痛吐利症)少阴病二三日
咽痛者可与甘草汤不瘥与桔梗汤(甘草桔梗症)少阴病咽中痛半夏散及汤主之(半夏散症)少阴病咽中痛伤生疮不能语
言声不出者(苦酒汤症)少阴病下利咽痛胸满心烦(猪肤汤症)少阴病饮食入口即吐心中温温欲吐复不能吐始得之手足
寒
脉弦迟者此胸中实不可下也当吐之若膈上有寒饮干呕者不可吐也急温之宜四逆汤(四逆症)少阴病欲吐不吐心烦但欲寐
五六日自利而渴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也(下利烦渴症)
少阴病吐利手足厥冷烦躁欲死(吴茱萸症)少阴病二三日至四五日腹疼小便不利四肢沉重疼痛自下利者此为有水气其人
或咳或小便利或不利或呕者真武汤主之(真武症)少阴病下利脉微涩呕而汗出必数更衣反少者当温其上灸之(呕利汗出
症)少阴病下利六七日咳而呕渴心烦不得眠(猪苓症)少阴病四逆或咳或悸或小便不利或腹中痛或泄利小重(四逆散症)
少阴病下利清谷里寒外热手足厥逆脉微欲绝身反不恶寒其人面色赤或腹痛干呕咽痛或利止脉不出者通脉四逆汤主之其脉
出即愈(通脉四逆症)少阴病下利(白通汤症)少阴病下利脉微者与白通汤利不止厥逆无脉干呕烦者白通加猪胆汁汤主
之微续者生(白通猪胆汁症)少阴病二三日至四五日腹痛小便不利下利不止便脓血(桃花汤症)少阴病下利便脓血可刺
(下利脓血症)少阴病八九日一身手足尽热者以热在膀胱必便血(身热便血症)少阴病吐利手足不厥冷反发热者不死脉
不至者灸少阴七壮(阳回不死症)少阴病下利便脓血(桃花汤症)少阴病恶寒而蜷时自烦欲去衣被者可治(阳回症)少
阴病下利若利自止恶寒而蜷卧手足温者可治(阳回症)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(阳回症)少阴负趺阳者为顺也(土盛水负症)少阴病得之二三日以上心烦不得卧(土胜水负黄连阿胶
症)少阴病得之二三日口燥咽干者急下之;宜大承气汤(土胜水负大承气症)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(土胜水负大承气症)少阴病六七日腹胀不大便者急下之宜大承气汤(土胜水负大承气症)少阴中风
脉阳微阴浮为欲愈(中风欲症)少阴病欲解时从子至寅上
不治病 少阴病但厥无汗而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(发汗动血症)少阴病下利
脉微与白通汤利不止厥逆无脉干呕烦者服白通加猪胆汁汤脉暴出者死微续者生 少阴病脉微沉细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(亡阳死症)少阴病吐利烦躁四逆者死 少阴病四逆恶寒而身蜷脉不至不烦而躁者死
少阴病恶寒身蜷而利手足逆冷者不治 少阴病下利止而头眩时时自冒者死 少阴病六七日息高者死
方药
麻黄附子细辛汤 麻黄附子甘草汤 附子汤
附子 茯苓 人参 白术 芍药
甘草汤 桔梗汤
桔梗 甘草
半夏散
半夏 桂枝 甘草 不能服散以散煎
苦酒汤
半夏 鸡子(去黄内苦酒半夏)
猪肤汤
猪皮加白蜜铅粉熬
真武汤
茯苓 白术 生姜 附子 芍药
四逆散
甘草 枳实 柴胡 芍药
通脉四逆汤
甘草 干姜 附子 加葱白
白通汤
葱白 干姜 附子
白通加猪胆汁汤
葱白 干姜 附子 煮去滓 内猪胆汁人尿
桃花汤
粳米 干姜 赤石脂
黄连阿胶汤
黄连 黄芩 芍药 阿胶 鸡子黄
【脏病连经】少阴病初起,反而出现发热、脉象沉的(麻黄附子细辛汤证);少阴病发病二三天,用麻黄附子甘草汤微发汗,是因为发病二三天没有里证的缘故(麻黄附子甘草汤证)。
【脏病】少阴病的典型表现是:脉象微细,只想睡觉。少阴病脉象细、沉、数,说明病在里,不可发汗(脏病忌汗证)。少阴病脉象沉的,应当急温之(四逆汤证)。少阴病身体疼痛、手足寒冷、骨节疼痛、脉象沉的(附子汤证)。少阴病发病一两天,口中和缓不苦不燥,背部怕冷的,应当施灸,并用附子汤主治(附子汤证)。少阴病咳嗽且下利,又出现谵语,这是被火劫迫所致,小便必定困难,这是因为强行索取少阴汗出的缘故(咳利谵语证)。少阴病脉象微弱的,不可发汗,因为会亡阳;阳气已虚,尺脉微弱的,也不可用攻下法(发汗亡阳证)。脉象寸关尺三部俱紧,反而出汗的,是亡阳的表现,这属于少阴病,法当咽痛并伴有呕吐下利(咽痛吐利证)。少阴病发病二三天咽痛的,可以给予甘草汤,若不好转,再给予桔梗汤(甘草汤、桔梗汤证)。少阴病咽喉疼痛,用半夏散及汤主治(半夏散证)。少阴病咽喉疼痛,生疮不能说话、声音出不来的(苦酒汤证)。少阴病下利、咽痛、胸满、心烦(猪肤汤证)。少阴病饮食入口即吐,心中泛泛欲吐却又吐不出来,刚发病时手足寒冷、脉象弦迟的,这是胸中有实邪,不可用攻下法,应当用涌吐法;如果是膈上有寒饮导致干呕的,不可用涌吐法,应当急温之,适宜用四逆汤(四逆汤证)。少阴病想吐却吐不出,心烦,只想睡觉,过了五六天出现自发性下利且口渴,这属于少阴病,是因为虚故引水自救;如果小便颜色发白的,少阴病的症状就具备了,小便白是因为下焦虚寒,不能制约水液的原故(下利烦渴证)。少阴病呕吐下利、手足厥冷、烦躁得快要死去(吴茱萸汤证)。少阴病两三天到四五天,腹痛、小便不利、四肢沉重疼痛、自发性下利的,这是有水气,其人或者咳嗽、或者小便通利、或者不通利、或者呕吐的,用真武汤主治(真武汤证)。少阴病下利、脉象微涩、呕吐且出汗、必然频繁更衣但排便量反而少的,应当温其上部的穴位并施灸(呕利汗出证)。少阴病下利六七天,咳嗽、呕吐、口渴、心烦、不得安眠(猪苓汤证)。少阴病四肢厥逆,或者咳嗽、或者心悸、或者小便不利、或者腹中痛、或者泄泻痢重(四逆散证)。少阴病下利完谷不化,里有寒而外有热,手足厥冷,脉象微弱几乎摸不到,身体反而不怕冷,面色发红,或者腹痛、干呕、咽痛,或者下利停止但脉搏摸不到的,用通脉四逆汤主治,如果脉搏复出就会痊愈(通脉四逆汤证)。少阴病下利(白通汤证)。少阴病下利、脉象微弱的,给予白通汤,如果下利不止、手足厥冷、无脉、干呕、心烦的,用白通加猪胆汁汤主治,脉象微微接续的是生证(白通加猪胆汁汤证)。少阴病两三天到四五天,腹痛、小便不利、下利不止、大便带脓血的(桃花汤证)。少阴病下利便脓血,可以针刺(下利脓血症)。少阴病八九天,全身和手足都发热的,因为热在膀胱,必定便血(身热便血症)。少阴病呕吐下利、手足不厥冷反而发热的,不会死;如果脉搏摸不到的,灸少阴穴七壮(阳回不死证)。少阴病下利便脓血(桃花汤证)。少阴病恶寒且蜷卧,时常自觉心烦想要脱去衣被的,可治(阳回证)。少阴病下利,如果下利自行停止,恶寒且蜷卧,手足温暖的,可治(阳回证)。少阴病脉紧,到了七八天,自发性下利,脉象突然变微,手足反而温暖,脉紧反而消失的,是病将要解除的表现,虽然心烦下利,也必定自愈(阳回证)。少阴脉弱于趺阳脉为顺证(土盛水负证)。少阴病发病二三天以上,心烦不得卧的(黄连阿胶汤证)。少阴病发病二三天,口燥咽干的,应当急下之;适宜用大承气汤(土胜水负大承气汤证)。少阴病自利清水,颜色纯青,心下部必定疼痛,口干燥的,应当急下之,适宜用大承气汤(土胜水负大承气汤证)。少阴病六七天,腹胀不大便的,应当急下之,适宜用大承气汤(土胜水负大承气汤证)。少阴中风,脉象寸微尺浮的,是病将要痊愈的表现(中风欲愈证)。少阴病欲解的时间是从子时到寅时。
【不治病/预后不良】少阴病只有厥冷而无汗,如果强行发汗,必定动其血,不知道从哪个孔窍出血,或者从口鼻出,或者从眼睛出,这叫下厥上竭,为难治之证(发汗动血证)。少阴病下利、脉象微弱,给予白通汤,如果下利不止、手足厥冷、无脉、干呕、心烦的,服用白通加猪胆汁汤后,脉象突然暴出的会死,脉象微微接续的是生证。少阴病脉象微、沉、细,只想睡觉,出汗且不心烦,自己觉得想吐,到了五六天出现自发性下利,又烦躁不得安眠的,死(亡阳死证)。少阴病呕吐下利、烦躁、四肢厥逆的,死。少阴病四肢厥逆、恶寒且身体蜷缩、脉搏摸不到、不心烦但躁动的,死。少阴病恶寒、身体蜷缩且下利、手足逆冷的,不治。少阴病下利停止但头晕目眩、时时感到头昏蒙的,死。少阴病六七天,呼吸浅表高促的,死。
【方药】
麻黄附子细辛汤 麻黄附子甘草汤 附子汤
附子 茯苓 人参 白术 芍药
甘草汤 桔梗汤
桔梗 甘草
半夏散
半夏 桂枝 甘草 不能服散剂则煎汤服
苦酒汤
半夏 鸡蛋(去黄留清,内入苦酒和半夏)
猪肤汤
猪皮加白蜜、铅粉熬制
真武汤
茯苓 白术 生姜 附子 芍药
四逆散
甘草 枳实 柴胡 芍药
通脉四逆汤
甘草 干姜 附子 加葱白
白通汤
葱白 干姜 附子
白通加猪胆汁汤
葱白 干姜 附子 煮去渣滓,加入猪胆汁和人尿
桃花汤
粳米 干姜 赤石脂
黄连阿胶汤
黄连 黄芩 芍药 阿胶 鸡子黄
[Pathology involving the Zang and Channels] When Shaoyin disease first occurs, if there is fever and a deep pulse (Mahuang Fuzi Xixin Tang syndrome); when Shaoyin disease has lasted for two or three days, Ma Huang Fu Zi Gan Cao Tang (Cinnamon Twig, Aconite, and Licorice Decoction) is used to induce slight sweating because there are no interior syndromes at this stage (Ma Huang Fu Zi Gan Cao Tang syndrome).
[Zang Disease] The characteristic of Shaoyin disease is a faint and thin pulse with a desire to sleep. If the pulse is fine, deep, and rapid, the disease is in the interior, and sweating should not be induced (Contraindication of sweating for Zang disease). If the pulse is deep, urgent warming is required (Sini Tang syndrome). If the body aches, hands and feet are cold, joints ache, and the pulse is deep (Fuzi Tang syndrome). If the disease has lasted one or two days, the mouth feels normal without bitterness or dryness, but the back feels cold, moxibustion should be applied, and Fuzi Tang (Aconite Decoction) should be administered (Fuzi syndrome). If coughing and diarrhea occur along with delirium, it is due to coercion by fire therapy; urination will certainly be difficult because sweat was forcibly extracted from the Shaoyin (Cough, Diarrhea, and Delirium syndrome). If the pulse is faint, sweating must not be induced as it leads to Yang collapse; if Yang is already deficient and the Chi (cun-guan-chi) pulse is weak, purgation must not be used (Syndrome of Yang Collapse from Sweating). If the pulses at all positions are tight but there is sweating, it indicates Yang collapse; this belongs to Shaoyin disease, and sore throat accompanied by vomiting and diarrhea is expected (Sore Throat, Vomiting, and Diarrhea syndrome). If sore throat occurs on the second or third day, Gancao Tang (Licorice Decoction) may be given; if ineffective, Jiegeng Tang (Platycodon Decoction) is used (Gancao and Jiegeng Tang syndromes). For sore throat, Banxia San Ji Tang (Pinellia Powder and Decoction) is indicated (Banxia San syndrome). For sore throat with sores, inability to speak, and loss of voice, Kujiu Tang (Vinegar Decoction) is used (Kujiu Tang syndrome). For diarrhea, sore throat, chest fullness, and irritability, Zhufu Tang (Pig Skin Decoction) is used (Zhufu Tang syndrome). If food is vomited immediately upon entering the mouth, there is a sensation of nausea without ability to vomit, and initially the hands and feet are cold with a string-tight and slow pulse, this indicates excess in the chest; purgation is contraindicated, and emesis should be used. If dry heaving is caused by cold fluid in the diaphragm, emesis is contraindicated, and urgent warming with Sini Tang (Four Reversal Decoction) is appropriate (Sini Tang syndrome). If there is a desire to vomit but cannot, irritability, and a desire to sleep, followed by spontaneous diarrhea and thirst after five or six days, this is Shaoyin disease due to deficiency leading to water intake for self-rescue; if urine is white, the Shaoyin syndrome is complete, indicating lower jiao deficiency-cold failing to control water (Diarrhea, Irritability, and Thirst syndrome). For vomiting, diarrhea, cold extremities, and severe irritability (Wuzhuyu Tang syndrome). If abdominal pain, difficulty urinating, heavy painful limbs, and spontaneous diarrhea occur between two to four days, this is water retention; symptoms may include cough, normal urination, difficulty urinating, or vomiting, treated with Zhenwu Tang (True Warrior Decoction) (Zhenwu Tang syndrome). For diarrhea with a faint and choppy pulse, vomiting, sweating, frequent bowel movements but small volume, warming the upper part via moxibustion is indicated (Vomiting, Diarrhea, and Sweating syndrome). After six or seven days of diarrhea, if cough, vomiting, thirst, irritability, and insomnia occur (Zhuling Tang syndrome). For cold extremities, possibly with cough, palpitations, difficulty urinating, abdominal pain, or heavy diarrhea (Sini San syndrome). For diarrhea with undigested food, interior cold with exterior heat, cold extremities, faint-to-absent pulse, aversion to cold absent, flushed face, possibly abdominal pain, dry heaving, sore throat, or cessation of diarrhea with absent pulse, Tongmai Sini Tang (Pulse-Returning Four Reversal Decoction) is used; recovery is indicated if the pulse returns (Tongmai Sini Tang syndrome). For diarrhea (Baitong Tang syndrome). For diarrhea with a faint pulse, Baitong Tang is given; if diarrhea persists, extremities become cold, pulse is absent, with dry heaving and irritability, Baitong Jia Zhuyedanhuang Tang (Baitong Decoction plus Pig Bile and Human Urine) is used; survival is indicated if the pulse slowly returns (Baitong Jia Zhuyedanhuang Tang syndrome). For abdominal pain, difficulty urinating, persistent diarrhea with pus and blood between two to four days (Taohua Tang syndrome). For diarrhea with pus and blood, acupuncture may be used (Diarrhea with Pus and Blood syndrome). After eight or nine days, if the whole body and limbs are hot, the heat is in the Bladder, and hematuria is likely (Body Heat and Hematuria syndrome). If vomiting and diarrhea occur without cold extremities but with fever, death is unlikely; if the pulse is absent, moxibustion on Shaoyin points seven times is performed (Yang Return and Non-Death syndrome). For diarrhea with pus and blood (Taohua Tang syndrome). If aversion to cold, curling up, and occasional irritability with a desire to remove covers occur, treatment is possible (Yang Return syndrome). If diarrhea stops, aversion to cold and curling up persist, but hands and feet are warm, treatment is possible (Yang Return syndrome). If the pulse is tight, and after seven to eight days spontaneous diarrhea occurs with a suddenly weak pulse, warm hands and feet, and disappearance of the tight pulse, resolution is expected despite irritability and diarrhea (Yang Return syndrome). If the Shaoyin pulse is weaker than the Duzi pulse, it is favorable (Earth Excess and Water Deficiency syndrome). If irritability and insomnia occur after two to three days (Huanglian Ejiao Tang syndrome). If dry mouth and throat occur after two to three days, urgent purgation with Dachengqi Tang (Major Order the Qi Decoction) is indicated (Earth Excess/Water Deficiency Dachengqi Tang syndrome). If spontaneous diarrhea of pure green water, epigastric pain, and dry mouth occur, urgent purgation with Dachengqi Tang is indicated (Earth Excess/Water Deficiency Dachengqi Tang syndrome). If abdominal distension and constipation occur after six to seven days, urgent purgation with Dachengqi Tang is indicated (Earth Excess/Water Deficiency Dachengqi Tang syndrome). In Shaoyin wind-strike, a faint superficial pulse and floating deep pulse indicate impending recovery (Wind-Strike Recovery syndrome). The time for Shaoyin disease to resolve is from Zi hour to Yin hour.
[Untreatable Conditions] If only cold extremities and no sweat occur, forced sweating will cause bleeding from unknown orifices (mouth, nose, or eyes), known as Lower Cold and Upper Exhaustion, which is difficult to treat (Bleeding from Forced Sweating syndrome). If diarrhea and faint pulse occur, Baitong Tang is given; if diarrhea persists, extremities become cold, pulse is absent, with dry heaving and irritability, and after taking Baitong Jia Zhuyedanhuang Tang, the pulse suddenly bursts out, death ensues; if the pulse slowly returns, life is preserved. If the pulse is faint, deep, and thin, with desire to sleep, sweating, no irritability, and a desire to vomit, progressing to spontaneous diarrhea, irritability, and insomnia after five to six days, death occurs (Yang Collapse Death syndrome). If vomiting, diarrhea, irritability, and cold extremities occur, death occurs. If cold extremities, aversion to cold, curling up, absent pulse, no irritability but restlessness occur, death occurs. If aversion to cold, curling up, diarrhea, and cold extremities occur, it is untreatable. If diarrhea stops but dizziness and periodic vertigo occur, death occurs. If shallow, high breathing occurs after six to seven days, death occurs.
[Formulas and Herbs]
Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction)
Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction)
Fuzi Tang (Aconite Decoction)
Fuzi (Aconiti Lateralis Radix Praeparata)
Fuling (Poria)
Renshen (Ginseng Radix et Rhizoma)
Baizhu (Atractylodis Macrocephalae Rhizoma)
Shaoyao (Paeoniae Radix Alba)
Gancao Tang (Licorice Decoction)
Jiegeng Tang (Platycodon Decoction)
Jiegeng (Platycodi Radix)
Gancao (Glycyrrhizae Radix et Rhizoma)
Banxia San (Pinellia Powder)
Banxia (Pinelliae Tuber)
Guizhi (Cinnamomi Ramulus)
Gancao (Glycyrrhizae Radix et Rhizoma)
If powder cannot be taken, decoct it.
Kujiu Tang (Vinegar Decoction)
Banxia (Pinelliae Tuber)
Jizi (Galli Ovi Ovum - Egg Yolk removed, vinegar and Pinellia added)
Zhufu Tang (Pig Skin Decoction)
Zhipi (Porci Cutis) with Baimit (Mel) and Qianfen (Lithargyrum) boiled.
Zhenwu Tang (True Warrior Decoction)
Fuling (Poria)
Baizhu (Atractylodis Macrocephalae Rhizoma)
Shengjiang (Zingiberis Rhizoma Recens)
Fuzi (Aconiti Lateralis Radix Praeparata)
Shaoyao (Paeoniae Radix Alba)
Sini San (Four Reversal Powder)
Gancao (Glycyrrhizae Radix et Rhizoma)
Zhishi (Aurantii Fructus Immaturus)
Chaihu (Bupleuri Radix)
Shaoyao (Paeoniae Radix Alba)
Tongmai Sini Tang (Pulse-Returning Four Reversal Decoction)
Gancao (Glycyrrhizae Radix et Rhizoma)
Ganjiang (Zingiberis Rhizoma)
Fuzi (Aconiti Lateralis Radix Praeparata)
Add Congbai (Allii Fistulosi Bulbus)
Baitong Tang (White Onion Decoction)
Congbai (Allii Fistulosi Bulbus)
Ganjiang (Zingiberis Rhizoma)
Fuzi (Aconiti Lateralis Radix Praeparata)
Baitong Jia Zhuyedanhuang Tang (White Onion Decoction plus Pig Bile and Human Urine)
Congbai (Allii Fistulosi Bulbus)
Ganjiang (Zingiberis Rhizoma)
Fuzi (Aconiti Lateralis Radix Praeparata)
Boil, strain, add Zhu Danhuang (Suis Fel) and Ren Niao (Urine).
Taohua Tang (Peach Kernel Decoction)
Jingmi (Oryzae Sativae Semen Glutinosa)
Ganjiang (Zingiberis Rhizoma)
Chishizhi (Halloysit Rubra)
Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction)
Huanglian (Coptidis Rhizoma)
Huangqin (Scutellariae Radix)
Shaoyao (Paeoniae Radix Alba)
Ejiao (Asini Corii Colla)
Jizi Huang (Galli Ovi Ovum - Egg Yolk)