少阴病。吐利。手足厥冷。烦躁欲死者。吴茱萸汤主之。干呕吐涎沫亦此汤。吐利
止而身痛不休者。当和解其外。宜桂枝汤。
少阴病。下利属于热者。四症。四逆泄利下重。四逆散。
邵评∶阳郁不达于四肢。故逆。下重者热之征也。此阳邪下陷而入阴中。用四逆散泄热散邪。
下利六七日。咳而呕渴。心烦不得眠者。猪苓汤。
邵评∶此虚热下焦有水。治以导水泄热。
自利清水。色纯青。心下痛。口干燥者。大承气。
邵评∶阳明燥实。热利旁流。故急下以存阴。
下利咽痛。猪肤汤。
邵评∶阳邪传入少阴。虚火上升。治以滋阴泄热。
少阴病。下利恶寒而蜷。手足温者可治。四逆汤。四肢逆者不治。少阴病。脉浮而
迟。表热里寒。下利清谷。四逆汤主之。大汗若大下利而厥逆者。四逆汤。
邵评∶大汗则亡阳。下利则亡阴。阴阳俱虚。厥冷而利。非清谷。急温之。阳回而生可望也。
少阴至四五日。腹痛。小便不利。四肢沉重疼痛。自下利者。此为有水气。真武汤。
邵评∶肾中阳虚。复受寒邪。肾火衰而不能化水。致水积下焦。用真武汤。壮元阳以消阴水。
少阴病。下利清谷。里寒外热。手足厥冷。脉微欲绝。身反不恶寒。其人面赤色。或腹
痛。或干呕。或咽痛。或利止脉不出者。通脉四逆汤主之。
邵评∶真阳之气。被阴寒所迫。不安其处。而游散于外。故显假热之象。而实非热也。
少阴病。二三日。至四五日。腹痛。小便不利。下利不止。便脓血者。桃花汤主之。
邵评∶阳邪入里。便脓血者。为协热下利。是白头翁汤症。此少阴病便脓血而下利。为下焦不约
而里寒也。因桃花汤固下而散寒。
少阴病。下利脉微者。与白通汤。
邵评∶用白通汤通阳散寒。姜附之辛温。破阴固里。葱白之辛通。入脉引阳也。此方最合。
利不止。厥逆无脉。干呕烦者。白通加猪胆汁汤主之。服后脉暴出者死。微续者生。
邵评∶白通汤中加人尿胆汁之咸、苦、寒、为反佐。从阴引阳。使不格拒。脉暴出。是
无根之阳。发露无遗。故死。脉微续者。被抑之阳。来复有渐。故生。
下利死证。少阴病。下利止而头眩。时时自冒者死。
邵评∶此肾气下绝。无根之阳泛上。神气散乱。阴阳俱脱。是以死也。
少阴病。自下利。汗出烦躁不得寐者死。少阴病。恶寒身蜷而利。手足逆冷者不治。
邵评∶躁不得寐。则阴阳尽虚。邪气独盛。正不胜邪。扰乱不宁。顷刻离散而死。下利发热。汗出不止者死。
邵评∶下利发热。阴不内守。汗出阳从外亡。是谓有阴无阳。故死。下利厥逆。躁不得卧者死。
邵评∶厥利不止。脏腑气绝矣。躁不得卧。精神不治矣。微阳不能久留。故死。下利十余日。脉反实者死。
邵评∶利十余日。正气受伤。其脉反实。邪未衰也。正虚邪盛。不克支撑。故死。
少阴病，出现呕吐、腹泻，手足冰冷，烦躁得快要死去的情况，用吴茱萸汤主治。干呕并吐出清稀涎沫的，也适用此方。如果呕吐和腹泻停止后，身体疼痛仍不缓解的，应当调和解除表邪，适宜用桂枝汤。
少阴病中，属于热证的腹泻，有四种情况：一是四肢厥冷且伴有泄泻肛门重坠感，用四逆散治疗。
邵评：阳气郁结不能通达于四肢，所以出现厥冷。肛门重坠是热象的表现。这是阳热之邪下陷进入阴分，使用四逆散来泄热散邪。
腹泻持续六七天，伴有咳嗽、呕吐、口渴、心烦无法入睡的，用猪苓汤治疗。
邵评：这是虚热在下焦导致有水饮停留，治疗以引导水饮排出并泄除热邪。
自行排泄清水样便，颜色纯青，心窝部疼痛，口干燥的，用大承气汤治疗。
邵评：这是阳明经燥屎内结，热利旁流（即燥屎阻滞，稀水从旁流出），故需急下以保存阴液。
腹泻伴有咽喉疼痛的，用猪肤汤治疗。
邵评：阳热之邪传入少阴，虚火上炎，治疗以滋阴泄热。
少阴病，腹泻且恶寒蜷卧，但手足温暖的，可以治愈，用四逆汤。如果四肢完全厥冷的，则难治。少阴病，脉象浮而迟，表现为表热里寒，腹泻排出未消化的食物残渣，用四逆汤主治。大汗出或者严重腹泻后出现四肢厥冷的，用四逆汤。
邵评：大汗出会亡失阳气，严重腹泻会亡失阴液。阴阳俱虚，出现厥冷和腹泻，并非单纯的清谷（完谷不化），需紧急温补。若阳气回复，则有生存希望。
少阴病发展到四五日，出现腹痛、小便不利、四肢沉重疼痛、自行腹泻的，这是因为体内有水气停留，用真武汤治疗。
邵评：肾中阳气虚弱，又受寒邪侵袭，肾火衰微不能气化水液，导致水积聚在下焦，使用真武汤壮元阳以消除阴水。
少阴病，腹泻排出未消化食物，里有寒而外有假热，手足冰冷，脉微细几乎摸不到，身体反而不觉得怕冷，面色发红，或者伴有腹痛，或者干呕，或者咽喉疼痛，或者腹泻停止但脉搏摸不到的，用通脉四逆汤主治。
邵评：真阳之气被阴寒逼迫，不安于本位而游散于外，所以显现出假热的现象，但实际上并不是热证。
少阴病，从二三天到四五天，出现腹痛、小便不利、腹泻不止、大便带有脓血的，用桃花汤主治。
邵评：阳热之邪入里，大便带脓血的是协热下利，那是白头翁汤的适应症。这里是少阴病大便带脓血且腹泻，是因为下焦约束无力且里寒所致，因用桃花汤固涩止泻并散寒。
少阴病，腹泻且脉象微弱的，给予白通汤治疗。
邵评：使用白通汤通阳散寒。干姜、附子的辛温之性，能破阴寒固守里气；葱白的辛通之性，能入脉引阳气回归。此方最为合适。
如果服药后腹泻不止，四肢厥冷，没有脉搏，干呕心烦的，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，脉搏逐渐微弱接续的是生证。
邵评：在白通汤中加入人尿、猪胆汁的咸、苦、寒性质，作为反佐，从阴引阳，防止药性与病性格拒不相受纳。脉搏突然暴出，是无根之阳彻底暴露无遗，所以死亡。脉搏逐渐微弱接续，是被压抑的阳气慢慢恢复，所以存活。
腹泻的死证：少阴病，腹泻停止但头晕目眩，经常感到头昏蒙的，为死证。
邵评：这是肾气下绝，无根之阳上浮，神气散乱，阴阳俱脱，所以死亡。
少阴病，自行腹泻，出汗，烦躁无法入睡的，为死证。少阴病，恶寒身体蜷缩且腹泻，手足逆冷的，为难治。
邵评：烦躁无法入睡，说明阴阳极度虚弱，邪气独盛，正气不胜邪气，扰乱不宁，顷刻间离散而死。腹泻伴有发热，汗出不止的，为死证。
邵评：腹泻发热，阴液不能内守，汗出导致阳气随之外亡，这叫有阴无阳，所以死亡。腹泻伴有四肢厥冷，烦躁无法躺卧的，为死证。
邵评：厥冷和腹泻不止，脏腑之气已绝。烦躁无法躺卧，精神已无法收敛。微弱的阳气不能久留，所以死亡。腹泻十余天，脉象反而实大的，为死证。
邵评：腹泻十余天，正气受损，脉象反而实大，说明邪气未衰。正虚邪盛，无法支撑，所以死亡。
Shaoyin disease (Disease of the Lesser Yin) presenting with vomiting and diarrhea, cold extremities, and severe restlessness bordering on death is primarily treated with Wuzhuyu Tang (Evodia Decoction). Dry retching accompanied by spitting out clear saliva also responds to this formula. If vomiting and diarrhea cease but body pain persists, the exterior should be harmonized and released; Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
In Shaoyin disease, diarrhea classified as heat-pattern presents in four scenarios: first, cold extremities with diarrhea and a sensation of heaviness/tenesmus at the anus, treated with Sini San (Frigid Extremities Powder).
Commentary by Shao: Yang qi is constrained and fails to reach the limbs, causing cold extremities. The sensation of heaviness indicates heat. This is yang-heat pathogen sinking into the yin level; Sini San is used to drain heat and disperse pathogens.
Diarrhea persisting for six or seven days, accompanied by cough, vomiting, thirst, irritability, and inability to sleep, is treated with Zhuling Tang (Polyporus Decoction).
Commentary by Shao: This involves deficient heat with water retention in the lower jiao (Lower Burner). Treatment guides out water and drains heat.
Spontaneous passage of pure green watery stool, pain in the epigastrium, and dry mouth indicate treatment with Dachengqi Tang (Major Order the Qi Decoction).
Commentary by Shao: This is yangming dryness and excess, where heat diarrhea flows around impactions (liangliu); urgent purgation is required to preserve yin fluids.
Diarrhea accompanied by sore throat is treated with Zhufu Tang (Pig Skin Decoction).
Commentary by Shao: Yang-heat pathogen has transmitted to shaoyin, causing deficiency fire to rise. Treatment nourishes yin and drains heat.
Shaoyin disease with diarrhea, aversion to cold, and curling up, yet with warm hands and feet, is curable and treated with Sini Tang (Frigid Extremities Decoction). If the four limbs are completely cold, it is difficult to treat. Shaoyin disease with a floating and slow pulse, manifesting as exterior heat and interior cold, with diarrhea passing undigested food, is primarily treated with Sini Tang. Profuse sweating or severe diarrhea followed by cold extremities is treated with Sini Tang.
Commentary by Shao: Profuse sweating leads to loss of yang; severe diarrhea leads to loss of yin. With both yin and yang deficient, cold extremities and diarrhea occur. Urgent warming is required. If yang returns, survival is possible.
On the fourth or fifth day of Shaoyin disease, abdominal pain, difficulty urinating, heavy/painful limbs, and spontaneous diarrhea indicate water accumulation (shuiqi). This is treated with Zhenwu Tang (True Warrior Decoction).
Commentary by Shao: Kidney yang is deficient and further invaded by cold pathogens. Diminished kidney fire fails to transform water, leading to water accumulation in the lower jiao. Zhenwe Tang strengthens primordial yang to dissipate yin-water.
Shaoyin disease with diarrhea passing undigested food, interior cold with exterior false-heat, cold extremities, faint pulse nearly imperceptible, body paradoxically not averse to cold, flushed face, possibly accompanied by abdominal pain, dry retching, sore throat, or cessation of diarrhea with absent pulse, is primarily treated with Tongmai Sini Tang (Pulse-Recovering Frigid Extremities Decoction).
Commentary by Shao: True yang qi is forced by yin-cold to abandon its proper location and scatter externally, creating an image of false heat, though it is not actual heat.
Shaoyin disease progressing from two-three days to four-five days, presenting with abdominal pain, difficulty urinating, unceasing diarrhea, and pus/blood in stool, is primarily treated with Taohua Tang (Peach Kernel Decoction).
Commentary by Shao: Yang-heat pathogen entering the interior with pus/blood in stool indicates heat-binding diarrhea, which is the indication for Baitouweng Tang. Here, shaoyin disease with pus/blood and diarrhea results from failure of the lower jiao to constrain and interior cold. Taohua Tang secures the intestines and disperses cold.
Shaoyin disease with diarrhea and a faint pulse is treated with Baitong Tang (White Connective Decoction).
Commentary by Shao: Baitong Tang unblocks yang and disperses cold. The acrid-warm nature of Shengjiang (Prepared Ginger) and Fuzi (Prepared Aconite Root) breaks yin-cold and consolidates the interior; the acrid-connective nature of Congbai (Scallion White) enters the vessels to guide yang back. This formula is most suitable.
If diarrhea continues, with cold extremities, absent pulse, dry retching, and irritability, Bai Tong Jia Zhu Dan Jiang Tang (Baitong Decoction plus Porcine Bile and Human Urine) is primarily used. If the pulse suddenly emerges after administration, it is a death sign; if the pulse gradually and weakly resumes, there is hope for life.
Commentary by Shao: Adding the salty, bitter, cold properties of Renao (Human Urine) and Zhuhuang (Porcine Gallstone/Bile) to Baitong Tang acts as a counter-agent (fan zuo), drawing yang from yin to prevent rejection. Sudden emergence of the pulse indicates rootless yang fully exposed, leading to death. Gradual resumption indicates suppressed yang slowly recovering, leading to life.
Death signs in diarrhea: In Shaoyin disease, if diarrhea stops but dizziness occurs, with frequent sensations of head clouding/fainting, it is a death sign.
Commentary by Shao: This indicates exhaustion of kidney qi downward, with rootless yang floating upward, scattering of spirit/qi, and exhaustion of both yin and yang, hence death.
Shaoyin disease with spontaneous diarrhea, sweating, irritability, and inability to sleep is a death sign. Shaoyin disease with aversion to cold, curled-up posture, diarrhea, and cold extremities is difficult to treat.
Commentary by Shao: Irritability and insomnia indicate extreme deficiency of yin and yang, with pathogens prevailing; righteous qi cannot overcome pathogens, causing chaotic disturbance and sudden dispersion/death. Diarrhea with fever and unceasing sweating is a death sign.
Commentary by Shao: Fever with diarrhea means yin cannot be retained internally; sweating causes yang to escape externally. This is "yin present, yang absent," hence death. Diarrhea with cold extremities and irritability preventing lying down is a death sign.
Commentary by Shao: Unceasing cold extremities and diarrhea indicate exhaustion of zang-fu qi. Irritability and inability to lie still indicate loss of mental control. Weak yang cannot remain long, hence death. Diarrhea lasting ten-plus days with a paradoxically full/excess pulse is a death sign.
Commentary by Shao: After ten-plus days of diarrhea, righteous qi is injured; a paradoxically full pulse indicates pathogens have not declined. Righteous qi is deficient while pathogens are strong, unable to sustain, hence death.