少阴但厥身无汗。强发之时血不安。或从口鼻或目出。下厥上竭实难全。
按伤寒传入少阴而身厥者。乃荣卫俱虚。不当发汗也。若强发其汗。致血妄行。或从口
鼻。或从目出。此名为下厥上竭。主不治也。
过汗亡阳症不轻。三焦上下及周身。桂枝加减苓甘附。真武汤兼附泻心。
亡阳者。谓发汗过多而汗不止也。然有卫外之阳。为周身荣卫之主。此阳虚遂有汗
漏不
止。恶寒身痛之症。宜桂枝加附子汤主之。有膻中之阳。为上焦心肺之主。此阳虚遂有叉手
冒心。及奔豚之症。宜桂枝甘草汤及茯苓桂枝甘草汤主之。有肾中之阳。为下焦真元之主。此
阳虚遂有发热眩悸。 振擗地之症。宜真武汤主之。有胃中之阳。为中焦水谷生化之主。此
阳虚遂有腹胀满。胃不和。而成心下痞之症。宜生姜泻心汤主之。大抵伤寒亡阳。病本不轻
。救误者须观脉症。知犯何逆以法治之。
真武汤中芍药煨。云苓浙术炙甘随。附子炮来加减用。生姜五片总相宜。
伤寒下利多般数。要识阴阳勿差误。三阳利时身必热。三阴但温无热俱。合病自利
汤。或用黄芩汤可愈。自利不渴属太阴。少阴必渴身虚故。外审证兮内凭脉。内外并观斯两
得。脉大由来却是虚。脉滑而数有宿食。协热而利脐下热。谵语而利燥屎结。少阴心痛口燥
烦。却与利之斯要诀。
按利与痢不同。利者。泻也。不因攻下而泄泻也。此即伤寒自利之症。俗名漏底伤
矣。凡伤寒自利。有因三阳传阴经而下利者。为协热利。协热利者。曰肠垢。脐下必热。宜
黄芩汤葛根汤主之。有因阴寒直中阴经而下利者。必协寒利。协寒利者。曰 溏。脐下必寒
。宜理中四逆汤主之。原病式曰。泻白为寒。青黄红黑皆热也。大抵阳热之利。与阴寒不同
。宜细辨而详治之。凡自利不可发汗。以下利为邪气内攻。走津液而胃虚也。
黄芩汤用甘芍并。伤寒自利枣和烹。此方遂为治痢祖。后人加味或更名。
少阴病仅见四肢厥冷而身体无汗。若强行发汗，则血液不得安宁。血可能从口鼻或眼睛流出。这种下焦厥逆、上焦血竭的证候确实难以救治。
按语：伤寒传入少阴经而出现四肢厥冷的情况，是由于营气和卫气都虚弱，不应当使用发汗法。如果强行发汗，导致血液妄行，或者从口鼻流出，或者从眼睛流出，这被称为“下厥上竭”，属于主治困难的危重证候。
过汗导致亡阳的病症并不轻微，涉及三焦上下及全身各处。治疗可用桂枝汤加减配合茯苓、甘草、附子，以及真武汤兼用附子泻心汤。
所谓亡阳，是指发汗过多而导致汗出不止。然而，有护卫体表的阳气，它是周身营卫的主宰。此阳气虚衰便出现汗漏不止、恶寒、身体疼痛的症状，宜用桂枝加附子汤主治。有位于膻中的阳气，它是上焦心肺的主宰。此阳气虚衰便出现双手交叉按压心胸部位，以及奔豚气的症状，宜用桂枝甘草汤及茯苓桂枝甘草汤主治。有位于肾中的阳气，它是下焦真元的主宰。此阳气虚衰便出现发热、眩晕、心悸、战栗扑倒于地的症状，宜用真武汤主治。有位于胃中的阳气，它是中焦水谷生化之源的主宰。此阳气虚衰便出现腹部胀满、胃气不和，从而形成心下痞塞的症状，宜用生姜泻心汤主治。大抵而言，伤寒导致的亡阳，病根本来就不轻。救治误治者必须观察脉象和症状，了解犯了什么错误，然后依法治疗。
真武汤中芍药需煨制，云苓（茯苓）、浙术（白术）炙甘草相随。附子炮制后根据情况加减使用，生姜五片总是适宜。
伤寒下利多般多样，要识别阴阳切勿出错。三阳经下利时身体必然发热，三阴经下利只是温而无热。合病自利的情况可用黄芩汤治愈。自利且不口渴的属于太阴病，少阴病下利必定口渴且身体虚弱。外在审察症状，内在凭借脉象，内外并观才能两全其美。脉象宏大由来却是虚证，脉滑而数表示有宿食停滞。协热下利伴有脐下发热，谵语且下利表示燥屎内结。少阴病伴有心痛、口燥、烦躁，此时却给予止利之法，这是关键诀窍。
按语：利与痢不同。“利”指的是泄泻，不是因攻下药物引起的泄泻。这就是伤寒自利的症状，俗名漏底伤。凡是伤寒自利，有因为三阳经传入阴经而下利的，称为协热利。协热利，也称为肠垢，脐下必然发热，宜用黄芩汤或葛根汤主治。有因为阴寒之邪直中阴经而下利的，必为协寒利。协寒利，也称为溏泄，脐下必然寒冷，宜用理中汤或四逆汤主治。《原病式》说：大便色白为寒证，青、黄、红、黑皆为热证。大抵阳热性质的下利，与阴寒性质的不同，应当仔细辨别并详细治疗。凡是自利不可发汗，因为下利是邪气向内攻伐，耗损津液导致胃气虚弱。
Shaoyin disease presents only with cold extremities and no sweating on the body. If forced diaphoresis is applied, the blood becomes unsettled. Bleeding may occur from the mouth, nose, or eyes. This condition of lower jiao cold reversal (Xia Jue) and upper jiao blood exhaustion (Shang Jie) is indeed difficult to save.
Commentary: When Taiyang syndrome transmits to Shaoyin meridian resulting in cold extremities, it is due to deficiency of both Ying (Nutrient Qi) and Wei (Defensive Qi), and diaphoresis should not be used. If forced diaphoresis is applied, causing blood to flow recklessly, bleeding may occur from the mouth or nose, or from the eyes. This is named "Lower Cold Reversal and Upper Blood Exhaustion" (Xia Jue Shang Jie), a critical condition that is difficult to treat.
Excessive sweating leading to Yang collapse (Wang Yang) is a serious condition affecting the upper and lower jiao as well as the whole body. Treatment may involve Guizhi Tang (Cinnamon Twig Decoction) modified with Fuling (Poria), Gancao (Licorice), and Fuzi (Aconite), combined with Zhenwu Tang (True Warrior Decoction) and Fuzi Xixin Tang (Aconite and Asarum Heart-Purging Decoction).
"Wang Yang" refers to continuous sweating due to excessive diaphoresis. There is the exterior-protecting Yang, which is the master of the whole body's Ying and Wei. Deficiency of this Yang leads to leakage of sweat, aversion to cold, and body pain; Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite) is indicated. There is the Yang located in the Danzhong (Chest Center), which is the master of the upper jiao Heart and Lung. Deficiency of this Yang leads to crossing hands over the heart and Ben Tun (Running Piglet) syndrome; Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction) and Fuling Guizhi Gancao Tang (Poria, Cinnamon Twig, and Licorice Decoction) are indicated. There is the Yang located in the Kidney, which is the master of the lower jiao True Yuan (True Origin). Deficiency of this Yang leads to fever, dizziness, palpitations, and tremors causing collapse; Zhenwu Tang (True Warrior Decoction) is indicated. There is the Yang located in the Stomach, which is the master of the transformation and production of water and grain in the middle jiao. Deficiency of this Yang leads to abdominal fullness, stomach disharmony, and formation of Xin Xia Pi (epigastric stuffiness); Shengjiang Xiexin Tang (Fresh Ginger Heart-Purging Decoction) is indicated. Generally speaking, Yang collapse caused by Taiyang syndrome is fundamentally serious. To correct errors, one must observe the pulse and symptoms, understand what mistake was made, and treat accordingly.
In Zhenwu Tang, Shaoyao (Peony Root) should be roasted; Fuling (Poria), Baizhu (Atractylodes Macrocephala Rhizome), and Gancao (Licorice Root) should be processed with honey or heat. Paozhi Fuzi (Prepared Aconite Lateral Root) is added or subtracted as needed; five slices of Shengjiang (Fresh Ginger) are always appropriate.
Taiyang syndrome diarrhea is diverse; one must distinguish Yin and Yang to avoid error. Diarrhea in the Three Yang meridians is accompanied by fever; diarrhea in the Three Yin meridians is warm without fever. For spontaneous diarrhea in He Bing (Combined Disease), Huangqin Tang (Scutellaria Decoction) can cure it. Spontaneous diarrhea without thirst belongs to Taiyin; Shaoyin diarrhea necessarily involves thirst and body weakness. Externally examine symptoms, internally rely on the pulse; observing both internal and external yields success. A large pulse indicates deficiency; a slippery and rapid pulse indicates retained food. Heat-colluding diarrhea features heat below the umbilicus; delirium with diarrhea indicates dry stool accumulation. Shaoyin disease with heart pain, dry mouth, and irritability requires stopping diarrhea; this is the key principle.
Commentary: Li (diarrhea) differs from Li (dysentery). "Li" refers to purging/diarrhea, not caused by cathartic drugs. This is the symptom of spontaneous diarrhea in Taiyang syndrome, commonly known as "Leaking Bottom Injury." All spontaneous diarrhea in Taiyang syndrome includes cases where transmission from the Three Yang to the Yin meridians causes diarrhea, called Xie Re Li (Heat-Colluding Diarrhea). Xie Re Li is also called Chang Gou (Intestinal Mucus), with heat below the umbilicus; Huangqin Tang (Scutellaria Decoction) or Gegen Tang (Kudzu Decoction) is indicated. Cases where cold pathogens directly strike the Yin meridians cause diarrhea, called Xie Han Li (Cold-Colluding Diarrhea). Xie Han Li is also called Tang Xie (Loose Stool), with cold below the umbilicus; Lizhong Tang (Regulate the Middle Decoction) or Sini Tang (Frigid Extremities Decoction) is indicated. *Yuan Bing Shi* states: White stool indicates cold; green, yellow, red, and black indicate heat. Generally, Yang-heat type diarrhea differs from Yin-cold type; careful differentiation and detailed treatment are required. Spontaneous diarrhea must not be treated with diaphoresis, as diarrhea indicates pathogenic factors attacking inward, consuming fluids and weakening the Stomach.
Huangqin Tang uses Gancao (Licorice Root) and Shaoyao (Peony Root). For Taiyang spontaneous diarrhea, it is decocted with Dazao (Jujube). This formula became the ancestor for treating dysentery; later generations added ingredients or renamed it.