病患脉阴阳俱紧。反汗出者。亡（音无）阳也。此属少阴。法当咽痛而复吐利。
此言少阴里证也。太阳中篇第一条曰。脉阴阳俱紧者。名曰伤寒。其第二条曰。头痛发热。身疼腰痛。
恶风无汗而喘者。麻黄汤主之。此曰病患脉阴阳俱紧。则寒伤营之脉也。伤寒本无汗。今反汗出者。以寒邪不在
太阳之表。而在少阴之里。命门之真火衰微。不能升越其清阳而为卫气。卫阳不密。玄府不闭。故反汗出也。
盖太阳脉紧则寒邪在表。少阴脉紧则寒邪在里。以阴阳脉俱紧者当无汗。而此又汗出。故谓之反。阳气不能外固。
故曰无阳。然真阳藏于两肾之中。故又曰属少阴。少阴之脉循喉咙。挟舌本。盖少阴真火衰微。虚阳上泛。故咽痛
也。阴邪上逆。胃中虚寒则吐。
寒邪在里。中气不守则利。犹太阴之腹满而吐。自利益甚也。能不以温经复阳为治乎。
辨误 尚论云。无阳以护外。所以邪不出而汗先出。误矣。若太阳寒邪在表。则当有汗出邪出之论。
若少阴寒邪在里。但复其阳。阳回则阴寒自消。犹东风解冻。大气一至。坚冰自泮。又何邪出之有哉。
少阴病。欲吐不吐。心烦但欲寐。五六日自利而渴者。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。故令色白也。
欲吐不吐者。少阴真火衰微。寒在下焦。阴气上逆。寒邪犯胃。胃寒故也。心烦者。少阴之脉从肺
出络心。注胸中。寒盛于下。虚阳上迫。故心烦也。但欲寐。与前第一条同义。五六日。邪传少阴之候也。
自利而渴者。阴寒在里。则胃阳不守。
故自利。下焦无火。则津液不升。故渴也。素问热论云。五日少阴受之。少阴脉贯肾络于肺。系舌本。
故口燥舌干而渴。况又见欲吐心烦但欲寐之证。故云属少阴也。然渴非阳邪。因下焦无火。不能蒸动气液。
上焦无灌溉之润。且自利则水谷下趋。而津液消亡矣。夫肾者。水脏也。上古天真论云。肾者主水。聚五脏六腑
之精而藏之者也。上枯下竭。水脏虚涸。故引水自救。非热燥而渴也。如果热邪作渴。小盒饭赤。若小便色白。
而又有欲吐心烦但欲寐之少阴病形悉具。则其所以小便白者。以下焦命门火虚。但有寒气在下。无火不能制水。
故令色白也。如此者。急当以温经复阳为治。不可因渴生疑。误用寒凉。枉人生命也。
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。
阳气衰少则脉数。寒邪在经则脉涩。阴邪下走则利。上逆则呕也。肾脏之真阳衰微。不能升越而为卫气。卫气不密。
故汗出也。必数更衣。反少者。即里急后重之谓也。盖古之所谓滞下。今之所谓痢疾。利与痢同。盖古人
所通用也。此因寒邪下利。非湿热痢之可比。乃下焦阳虚。清阳不能升举。少阴寒甚。阴气内迫而下攻也。
阳气陷入阴中。阴阳两相牵掣。致阴邪欲下走而不得。故数更衣。阳气虽不得上行。犹能提吸而使之反少。
经云。清气在下。则生飧泄。清气者。下焦清阳之气也。皆寒在下焦。清阳不升之病也。当温其上。前
注皆谓灸顶上之百会穴。以升其阳。盖百会乃督脉之巅顶。为诸阳之总会。灸之亦足以提吸阳气。但未知
果合仲景立法之义否。或曰。仲景无明文。未可强解。以意测之。非必巅顶。然后谓之上也。盖肾居下焦
而胃虽居中。然亦在肾之上。胃脘之阳。为后天根本。故有胃气者生也。言数更衣而反少。则下利不快。
但因下焦无火。不得以苦寒之药攻其下。当以补暖升阳之药温其胃。且灸之。则下焦之清阳升越。胃中之
阳气流行。清阳升而浊阴降。水谷分消而下利自止矣。灸之者。灸少阴之脉穴。或更灸胃之三脘也。即前所
谓当灸之。附子汤主之之法。及下文灸少阴七壮之类也。
少阴病。下利便脓血者。桃花汤主之。
见少阴证而下利。为阴寒之邪在里。湿滞下焦。大肠受伤。故皮坼血滞。变为脓血。滑利下脱。故以
温中固脱之桃花汤主之。
桃花汤方
赤石脂（一斤一半全用一半筛末） 干姜（一两） 粳米（一升）
上三味。以水七升。煮米令熟。去滓。内赤石脂末方寸匕。温服七合。日三服。若一服愈。余勿服。
桃花汤。非湿热暴利。积多气实之所宜。盖所以治阴寒虚滑之剂也。李时珍云。赤石脂。手足阳明药也。
体重性涩。故能收湿止血而固下。味甘气温。故能益气生肌而调中。中者。肠胃肌肉。惊悸黄胆是也。下者。
肠泄利。崩带失精是也。白入气分。赤入血分。故仲景用桃花汤。治下利便脓血。取赤石脂之重涩。
入下焦血分而固脱。干姜之辛温。暖中焦气分而补虚。粳米之甘温。佐石脂干姜而润肠胃也。
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。
腹痛小便不利。下利不止而便脓血者。盖阴寒下利也。二三日至四五日。阴邪在里。气滞肠间。故腹痛也。
下焦无火。气化不行。故小便不利。且下利不止。则小便随大便而频去。不得潴蓄于膀胱而小便不得分利也。
下利不止。气虚不固而大肠滑脱也。便脓血者。邪在下焦。气滞不流而大肠伤损也。此属阴寒虚利。故以涩
滑固脱。温中补虚之桃花汤主之。
辨误 腹痛小便不利。下利不止便脓血者。痢疾也。盖夏秋时行疫痢。或湿热流行。或寒湿浸淫。皆六气
淫慝之所致。凡湿火所犯。从下而上。先伤手阳明大肠。使广肠肿溃。皮伤血瘀。变为脓血积滞。气道闭塞。
清阳不升。浊气下坠。肠肿路窄。时时欲便而不快。故少腹痛而下重。治宜清湿热。泻大肠。宜通不宜涩。
经所谓通因通用也。若不急治而邪气上行犯胃。则必至于胸满不食。恶心干呕。胃气伤败而死矣。今所谓噤
口痢者是也。更有时行厉气。随犯随禁者。皆难治之证也。至若寒湿阴邪。动则先犯阴经。中满腹痛。脾胃
受伤。小腹绞痛。下利脓血。气化不行。小便点滴。治之之法。宜温宜升。久则宜补宜涩。所谓治寒以热也。
其更甚者。大孔开张。血不成积。胃口败绝而殒矣。痢虽一证。而
阴阳虚实之治法不同。此条自成氏以来。凡注皆以腹痛为里寒。惟尚论以腹痛小便不利为少阴热邪。云注家见
用干姜。谓是寒邪伤胃。欠清。盖热邪挟少阴之气。填塞胃中。故用干姜之辛以散之。若混指热邪为寒邪。
宁不贻误后人耶。详推此论。未必能矫前人之失。盖腹痛为太阴本证。即有热邪。亦必有宿食积滞。方能作
痛。岂但有热邪在内。能作腹痛耶。况热邪挟少阴之气句。尤为难解。若果热邪填塞胃中。如何可用干姜之辛
热以散之。似属背理。窃恐指为寒邪者。未为大误。指为热邪者。反贻误后人不小矣。若以干姜为误。其误当
责之立法之仲景矣。但观痢证。有用大黄黄连而愈者。有用干姜肉果人参附子而愈者。岂非明证耶。
少阴病。二三日不已。至四五日。腹痛小便不利。四肢沉重疼痛。自下利者。此为有水气。其人或咳。或小
便利。或下利或呕者。真武汤主之。
少阴病者。即前脉微细。但欲寐。及恶寒脉沉足冷等证也。二三日不已。言少阴本经自感之邪。非三阳传邪也。若
自
阳经传来。内经热论云。五日少阴受之。则二三日犹在阳明少阳。岂得即称少阴病。而又云不已哉。至四五日。渐久
而寒邪愈深。故里寒而腹痛也。小便不利者。阴寒盛极。下焦无火。气化不行也。四肢为诸阳之本。阳气旺。
则清阳实四肢。阳太盛。则四肢实而能登高而歌。及弃衣而走也。此以阳衰阴盛。故四肢沉重疼痛也。寒邪已当自利。
若里热
而小便不利。则水为热邪所耗矣。以寒邪在里而小便不利。是气化不行。寒水停蓄。水谷不分而下利。故为有水气。
非水停心下。及肿胀之水也。然病无定情。证有不齐。非必以腹痛小便不利。四肢沉重为定证也。若其人或因少阴
脉贯肾络于肺。阴邪在下。虚火上迫。肺气上逆而咳者。或下焦火不能制水。小便利而色白者。或寒邪在里。胃阳败
损。肾不能司二阴之窍而下利者。或阴邪上逆。犯胃而呕者皆是也。夫阴邪纵肆。真阳不守。急宜恢复真阳。
消除阴翳。故宜以真武汤主之。（真武汤论见青龙汤下）
真武汤方。成氏旧本。原在此条之下。其方论前已移附大青龙汤下。此不重赘。然后加减法。为后世俗
医所增。察其文理纰缪。恶其紫之乱朱。故重附于此。并逐一指摘其误。使学人有所别识云。
后加减法
若咳者。加五味子半升。细辛干姜各一两。
此三味。小青龙汤证中。因心下有水气。干呕而咳。或利或喘。皆水寒伤肺。肺寒气逆所致。故用芍药
细辛干姜五味等药。以收肺气之逆。此条亦有水气。或咳或利或呕。当与小青龙证同治。故从彼方移入此方。
深得仲景之意。可称恰当。（升法见小柴胡汤注中）
若小便利者。去茯苓。
小便利则气化尚行。或水气去。未可知也。然茯苓虽淡渗。亦有补虚益气之功。故为君子之药。虽温补
下焦之八味丸。亦仍用之。此方既与附子白术芍药同用。留之何害。而必去之耶。
若下利者。去芍药加干姜二两。
下利加干姜。极为允当。但去芍药之说。其义未妥。张元素曰。白芍入脾经。补中焦。乃下利必用之药。
盖泻利皆太阴病。故不可缺。得甘草为佐。治腹中痛。热加黄芩寒加桂。此仲景神方也。李时珍云。白芍益脾。
能于土中泻木。何反去
芍药耶。
若呕者。去附子。加生姜足成半斤。
呕加生姜。固为稳当。而去附子之说。是属何意。少阴寒邪下攻则下利。上逆则呕吐。其用附子处。
如饮食入口即吐而用四逆汤。非吐而用附子耶。如下利清谷。里寒外热。手足厥逆。脉微欲绝。或腹痛。
或干呕而用通脉四逆汤者。非呕而用附子耶。如利不止。厥逆无脉。干呕而烦。用白通加猪胆汁汤者。
非呕而用附子耶。如此之类。不可枚举。岂加减家犹未之见。而独于真武汤去之耶。想但见千金方呕
家多服生姜之语。而忘其为少阴证之腹痛小便不利。四肢沉重疼痛。下利等证耶。其加减如此。谓非出
自后世俗医之手而何。
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。
脉紧见于太阳。则发热恶寒而为寒邪在表。见于少阴。则无热恶寒而为寒邪在里。至七八日。则阴阳
相持已久。而始下利。则阳气耐久。足以自守矣。虽至下利。而以绞索之紧。忽变而为轻细软弱之微脉。
微则恐又为上文不可发汗之亡阳脉矣。为之奈何。不知少阴病。其脉自微。方可谓之无阳。若以寒邪极
盛之紧脉忽见暴微。则紧峭化而为宽缓矣。乃寒邪弛解之兆也。曰手足反温。则知脉紧下利之时。手足已寒。
若寒邪不解。则手足不当温。脉紧不当去。因脉本不微。而忽见暴微。故手足得温。脉紧得去。是以谓
之反也。反温反去。寒气已弛。故为欲解也。虽其人心烦。然烦属阳而为暖气已回。故阴寒之利必自愈也。
少阴病。吐利。手足厥冷。烦躁欲死者。吴茱萸汤主之。
吐利。阴经之本证也。或但吐。或但利者犹可。若寒邪伤胃。上逆而吐。下攻而利。乃至手足厥冷。盖四肢皆
禀气于胃。而为诸阳之本。阴邪纵肆。胃阳衰败而不守。阴阳不相顺接而厥逆。阳受阴迫而烦。阴盛格阳而躁。
且烦躁甚而至于欲死。故用吴茱萸之辛苦温热。以泄其厥气之逆而温中散寒。盖茱萸气辛味辣。性热而臭臊。
气味皆浓。为厥阴之专药。然温中解寒。又为三阴并用之药。更以甘和补气之人参。以补吐利虚损之胃气。
又宣之以辛散止呕之生姜。和之以甘缓益脾之大枣。为阴经急救之方也。
少阴病。下利。若利自止。恶寒而蜷卧。手足温者可治。
阴寒在里。则胃阳不守而下利。若利自止。则知胃气复固。阳气复能自守。恶寒者。阳虚不能胜任外气也。
蜷卧者。身体四肢皆蜷曲而卧。恶寒之情状也。大凡热者。偃卧而手足弛散。寒则蜷卧而手足敛缩。下文恶寒蜷
卧而手足逆冷者。即为真阳败绝而成不治矣。若手足温。则知阳气未败。以其阳气尚能温暖四肢。故曰手足温
者可治。然治之之法。亦无外乎温经复阳之法也。方氏不知四肢为诸阳之本。而曰四肢属脾。温者。脾土和也。
土和则万物生。故曰可治。其谬殆甚。
少阴病。吐利。手足不逆冷。反发热者不死。脉不至者。灸少阴七壮。
前吴茱萸汤条内。言吐利手足厥冷。烦躁欲死。此虽吐利而手足不逆冷。则阳气未损。阴经当无热而恶寒。
今反发热。足见阳气已回。故曰不死。既有可生之机而脉不至。则是阳虽未绝。寒邪固闭。脉道郁伏而不通。
故灸少阴七壮。少阴穴。即前背恶寒所灸之穴。及井荥输经合也。可见吐利而手足逆冷。恶寒蜷卧。不发热而
脉不至者。即为不治
之证矣。
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。或干呕。或咽
患者脉象寸关尺三部皆紧。反而出现汗出的，这是亡阳的表现。此证属于少阴病，按照病情发展规律，应当出现咽痛并且伴有呕吐和下利。
这里论述的是少阴病的里证。《伤寒论》太阳中篇第一条说：“脉象寸关尺三部皆紧的，称为伤寒。”第二条说：“头痛、发热、身体疼痛、腰痛、恶风、无汗且喘息的，用麻黄汤主治。”这里说患者脉象寸关尺三部皆紧，这是寒邪损伤营分的脉象。伤寒本来是无汗的，现在反而汗出，是因为寒邪不在太阳之表，而在少阴之里。命门中的真火衰微，不能升发清阳之气作为卫气。卫阳不固密，玄府（汗孔）不闭合，所以反而汗出。大概太阳脉紧，说明寒邪在表；少阴脉紧，说明寒邪在里。按道理阴阳脉俱紧应当无汗，而这里却有汗出，所以称之为“反”。阳气不能在外固护，所以说无阳（亡阳）。然而真阳藏于两肾之中，所以又说属于少阴。少阴经脉循行经过喉咙，挟持舌根。大概因为少阴真火衰微，虚阳上浮，所以出现咽痛。阴邪上逆，胃中虚寒则呕吐。
寒邪在里，中气不能固守则下利。就像太阴病的腹满而吐，自利益甚一样。难道不能用温经复阳的方法来治疗吗？
【辨误】尚论派说：“无阳导致护卫体表的功能减弱，所以邪气不能外出而汗先出来。”这是错误的。如果太阳寒邪在表，应当有汗出邪出的论述。如果是少阴寒邪在里，只要恢复其阳气，阳气回复则阴寒自然消除，就像东风吹来冰雪融化一样，大气一到，坚冰自然消融，又有什么邪气外出的说法呢？
少阴病，想吐又吐不出来，心烦只想睡觉，过了五六天出现自发性下利且口渴的，属于少阴病。这是因为正气虚弱，所以引水来自救。如果小便颜色清白，那么少阴病的症状就全部具备了。小便颜色白，是因为下焦虚寒，不能制约水液，所以使小便颜色变白。
想吐又吐不出来，是因为少阴真火衰微，寒邪位于下焦，阴气上逆，寒邪侵犯胃部，导致胃寒。心烦，是因为少阴经脉从肺出发联络心脏，注入胸中。寒盛于下，虚阳被逼迫而上浮，所以心烦。只想睡觉，与前面第一条的意义相同。五六天，是邪气传入少阴的征候。自发下利且口渴，是因为阴寒在里，胃阳不能固守，所以自利；下焦没有火气，津液不能上升，所以口渴。《素问·热论》说：“第五日少阴经受邪。”少阴经脉贯穿肾脏并联络于肺，系连舌根，所以口燥舌干而渴。况且又见到想吐、心烦、只想睡觉的症状，所以说属于少阴病。然而这种口渴并非阳热邪气所致，而是因为下焦没有火气，不能蒸腾气化津液，上焦缺乏灌溉滋润，而且自利导致水谷向下流失，津液消亡。肾是水脏，《上古天真论》说：“肾主水，汇聚五脏六腑的精气而储藏它。”上面干枯下面枯竭，水脏虚涸，所以引水自救。这不是热燥引起的口渴。如果是热邪引起口渴，小便应当发红。如果小便颜色白，而又具备想吐、心烦、只想睡觉等少阴病的典型症状，那么小便白的缘故，是因为下焦命门之火虚弱，只有寒气在下，没有火气不能制约水液，所以使小便颜色变白。像这种情况，急当用温经复阳的方法治疗，不可因为口渴产生疑惑，误用寒凉药物，枉害人的性命。
少阴病，下利，脉象微涩，呕吐且汗出，必定频繁上厕所，但排便量反而很少的，应当在上部施以艾灸治疗。
阳气衰少则脉数（此处指脉来急促或微弱无力之象，原文语境下结合后文解释为阳气衰），寒邪在经脉则脉涩。阴邪向下走则下利，向上逆则呕吐。肾脏的真阳衰微，不能升发成为卫气，卫气不固密，所以汗出。必定频繁上厕所，但排便量反而很少，这就是所谓的“里急后重”。大概古代所说的“滞下”，就是今天所说的痢疾。“利”与“痢”同义，大概是古人通用的说法。这是因为寒邪导致的下利，不能与湿热痢疾相比，这是下焦阳虚，清阳不能升举，少阴寒邪严重，阴气在内逼迫而下攻。阳气陷入阴中，阴阳相互牵制，导致阴邪想要向下走却不得顺畅排出，所以频繁上厕所。阳气虽然不能上行，但仍能提吸作用使得排便量少。经文说：“清气在下，则生飧泄。”清气，指的是下焦的清阳之气。这都是寒邪在下焦，清阳不升的病证。应当在上方施治。以前的注解都认为灸头顶的百会穴，以升举阳气。大概百会是督脉的最高点，是诸阳经的总会，灸它足以提吸阳气。但不确定这是否合乎张仲景立法的本意。有人说：张仲景没有明文规定，不可以强行解释。凭意思推测，不一定非要是头顶才叫“上”。大概肾位于下焦，而胃虽然居中，但也位于肾之上。胃脘的阳气是后天的根本，所以有胃气就能生存。说频繁上厕所但排便量少，说明下利不畅。只是因为下焦没有火气，不能用苦寒的药物攻伐下部，应当用补暖升阳的药物温暖胃气，并且施以艾灸，那么下焦的清阳就能升发，胃中的阳气就能流行。清阳升而浊阴降，水谷分别消化排泄，下利自然停止。所谓“灸之”，是灸少阴经的穴位，或者再灸胃部的三脘穴（上脘、中脘、下脘）。就是前面所说的应当灸的方法，以及附子汤主治的法度，和下文灸少阴七壮之类的方法。
见到少阴证并且下利，这是阴寒邪气在里，湿气停滞在下焦，大肠受伤，所以肠壁破裂血液瘀滞，变为脓血，滑脱不禁地下利，所以用温中固脱的桃花汤主治。
桃花汤方
赤石脂（一斤，一半全用，一半研成细末） 干姜（一两） 粳米（一升）
以上三味药，用水七升，煮米至熟，去渣滓，加入赤石脂末一方寸匕，温服七合，每日三次。如果一次服药后病愈，剩下的药不要服用。
桃花汤，不是湿热暴注下迫、积滞多、气实者所适宜的。它是治疗阴寒滑脱不禁的方剂。李时珍说：赤石脂是手足阳明经的药。体重性涩，所以能收湿止血而固摄下部。味甘气温，所以能益气生肌而调和中焦。中焦，指的是肠胃肌肉，如惊悸、黄疸等病症。下部，指的是肠泄利、崩漏带下、失精等病症。白色入气分，红色入血分。所以张仲景使用桃花汤治疗下利便脓血，取赤石脂的重涩之性，进入下焦血分以固脱；干姜的辛温之性，温暖中焦气分以补虚；粳米的甘温之性，辅助石脂和干姜以滋润肠胃。
少阴病，二三天到四五天，腹痛，小便不利，下利不止，大便带有脓血的，用桃花汤主治。
腹痛，小便不利，下利不止且大便带有脓血，这是阴寒下利。二三天到四五天，阴邪在里，气机阻滞于肠道，所以腹痛。下焦没有火气，气化不行，所以小便不利。而且下利不止，小便随着大便频繁排出，不能在膀胱潴蓄，所以小便不能正常分利。下利不止，是气虚不固而导致大肠滑脱。大便带有脓血，是邪气在下焦，气机阻滞不通而导致大肠受损。这属于阴寒虚利，所以用涩滑固脱、温中补虚的桃花汤主治。
【辨误】腹痛、小便不利、下利不止且大便带有脓血，这是痢疾。大概夏秋季节流行的疫痢，或者是湿热流行，或者是寒湿浸淫，都是六气淫邪所致。凡是湿火所犯，从下而上，先伤害手阳明大肠，使广肠肿胀溃烂，皮伤血瘀，变为脓血积滞，气道闭塞，清阳不升，浊气下坠，肠肿路窄，时时想排便却不痛快，所以少腹痛且肛门重坠。治疗宜清湿热，泻大肠，宜通不宜涩。经文所说的“通因通用”就是这个意思。如果不紧急治疗，邪气上行侵犯胃，就会发展到胸满不食、恶心干呕，胃气伤败而死。这就是今天所说的噤口痢。更有时候遇到厉气，随犯随禁的，都是难治的证候。至于寒湿阴邪，发作时先侵犯阴经，导致中满腹痛，脾胃受伤，小腹绞痛，下利脓血，气化不行，小便点滴不出。治疗之法，宜温宜升，久则宜补宜涩。这就是所说的“治寒以热”。更严重的，肛门开张，血不成积，胃口败绝而死亡。痢疾虽然是一个证候，但阴阳虚实的治疗方法不同。这一条自从成无己以来，凡是注释都认为是里寒。只有尚论派认为腹痛小便不利是少阴热邪，说注家看到用干姜，就认为是寒邪伤胃，不够清晰。大概热邪挟带少阴之气，填塞胃中，所以用干姜的辛味来散之。如果把热邪混同为寒邪，岂不是贻误后人吗？详细推究这个论点，未必能纠正前人的失误。大概腹痛是太阴的本证，即使有热邪，也必须有宿食积滞，才能作痛。岂能有只有热邪在内就能作腹痛的道理？况且“热邪挟少阴之气”这句话，尤其难以理解。如果真的是热邪填塞胃中，怎么能用干姜的辛热来散之？似乎违背常理。我私下认为，指为寒邪的人，并没有大错；指为热邪的人，反而贻误后人不少。如果把干姜视为错误，那错误应当归咎于立法者张仲景了。只是看痢疾证，有用大黄黄连而痊愈的，有用干姜、肉果、人参、附子而痊愈的，这难道不是明证吗？
少阴病，二三天不好，到了四五天，腹痛，小便不利，四肢沉重疼痛，自发下利的，这是有水气。其中有的人咳嗽，或小便利，或下利，或呕吐的，用真武汤主治。
少阴病，就是前面说的脉微细、只想睡觉，以及恶寒脉沉、足冷等症状。二三天不好，说的是少阴本经自感的邪气，不是三阳传来的邪气。如果是从阳经传来，《内经·热论》说：“第五日少阴受邪。”那么二三天还在阳明、少阳，怎么能立即称为少阴病，又说“不好”呢？到了四五天，时间渐久，寒邪越深，所以里寒而腹痛。小便不利，是因为阴寒极盛，下焦无火，气化不行。四肢是诸阳的根本，阳气旺盛，则清阳充实四肢，阳气太盛，则四肢有力能登高而歌，及弃衣而走。这里是因为阳衰阴盛，所以四肢沉重疼痛。寒邪已经导致自利，如果是里热而小便不利，那么水会被热邪耗损。因为是寒邪在里而小便不利，这是气化不行，寒水停蓄，水谷不分而下利，所以说是“有水气”。这不是水停心下，也不是肿胀的水气。然而病情没有固定的情状，症状有不齐之处，不一定非要以腹痛、小便不利、四肢沉重作为定证。如果其人因为少阴经脉贯穿肾脏联络于肺，阴邪在下，虚火上迫，肺气上逆而咳嗽；或者下焦火不能制水，小便利且颜色白；或者寒邪在里，胃阳败损，肾不能司管二阴之窍而下利；或者阴邪上逆，侵犯胃而呕吐，都是可能的情况。既然阴邪放纵肆虐，真阳不能固守，急宜恢复真阳，消除阴翳，所以适宜用真武汤主治。（真武汤的论述见青龙汤之下）
真武汤方，成无己的旧本，原本在此条之下。其方论前面已经移附在大青龙汤之下，这里不再重复赘述。但是后面的加减法，是被后世世俗医生增加的，考察其文理纰缪，厌恶它像紫色扰乱朱色一样混淆视听，所以重新附在这里，并逐一指出其错误，使学习的人有所辨别认识。
【后加减法】
如果咳嗽的，加五味子半升，细辛、干姜各一两。
这三味药，在小青龙汤证中，因为心下有水气，干呕而咳，或利或喘，都是水寒伤肺，肺寒气逆所致。所以用芍药、细辛、干姜、五味子等药，来收敛上逆的肺气。这一条也有水气，或咳或利或呕，应当与小青龙证同样治疗，所以从那一方移入此方，深得张仲景的心意，可称为恰当。（升法见小柴胡汤注中）
如果小便利的，去掉茯苓。
小便利说明气化尚且运行，或者水气已去，未可知也。然而茯苓虽然淡渗，也有补虚益气之功，所以被称为君子之药。即使是温补下焦的八味丸，也仍然使用它。此方既然与附子、白术、芍药同用，留着它有什么妨害，而一定要去掉它呢？
如果下利的，去掉芍药，加干姜二两。
下利加干姜，极为妥当。但去掉芍药的说法，其义不妥。张元素说：白芍入脾经，补中焦，是下利必用的药。大概泻利都是太阴病，所以不可缺少。得到甘草作为佐使，治疗腹中痛，热加黄芩，寒加桂枝，这是张仲景的神方。李时珍说：白芍益脾，能在土中泻木，为什么反而去掉芍药呢？
如果呕吐的，去掉附子，加生姜足成半斤。
呕吐加生姜，固然稳妥。但去掉附子的说法，是什么用意？少阴寒邪下攻则下利，上逆则呕吐。使用附子的地方，比如饮食入口即吐而用四逆汤，不是呕吐而用附子吗？如下利清谷，里寒外热，手足厥逆，脉微欲绝，或腹痛，或干呕而用通脉四逆汤的，不是呕吐而用附子吗？如下利不止，厥逆无脉，干呕而烦，用白通加猪胆汁汤的，不是呕吐而用附子吗？像这样的例子，不可枚举。难道加减法的人还没有见过这些，而唯独对真武汤去掉附子呢？想必只是见到《千金方》中说呕吐家常服生姜的话，而忘记了这是少阴证的腹痛、小便不利、四肢沉重疼痛、下利等症状啊。这样的加减，说不是出自后世世俗医生之手，还能是什么呢？
少阴病，脉紧，到了七八天，自发下利，脉突然变得微弱，手足反而温暖，脉紧反而消失的，这是将要痊愈的表现。虽然心烦，下利必定自愈。
脉紧见于太阳，则发热恶寒，是寒邪在表；见于少阴，则无热恶寒，是寒邪在里。到了七八天，阴阳相持已久，才开始下利，说明阳气耐久，足以自守。即使到了下利，那原本如绞索般的紧脉，忽然变为轻细软弱之微脉。微脉恐怕又是上文所说的不可发汗的亡阳脉了。该怎么办呢？不知道少阴病，其脉自微，才可以称为无阳。如果是以寒邪极盛的紧脉，忽然见到暴微，那么紧峭化为宽缓，这是寒邪弛解的征兆。说“手足反温”，就知道在脉紧下利的时候，手足已经是冷的。如果寒邪不解，手足不应当温暖，脉紧不应当消失。因为脉原本不微，而忽然见到暴微，所以手足得以温暖，脉紧得以消失，所以称之为“反”。反温反去，寒气已经松弛，所以说是将要痊愈。虽然其人心中烦，然而烦属于阳，是暖气已回的表现，所以阴寒的下利必定自愈。
少阴病，呕吐下利，手足厥冷，烦躁得快要死的，用吴茱萸汤主治。
呕吐下利，是阴经的本证。或者只吐，或者只利的还可以。如果寒邪伤胃，上逆而吐，下攻而利，以至于手足厥冷。大概四肢都禀受胃气，是诸阳的根本。阴邪放纵肆虐，胃阳衰败而不能固守，阴阳不相顺接而发生厥逆。阳受阴逼迫而烦，阴盛格拒阳气而躁。而且烦躁厉害以至于想死，所以用吴茱萸的辛苦温热，来泄其厥气的逆乱而温中散寒。大概吴茱萸气辛味辣，性热而有臭臊味，气味都很浓厚，是厥阴经的专药。然而温中解寒，又是三阴经并用的药。再加上甘平和补气的人参，来补吐利虚损的胃气。再用辛散止呕的生姜来宣散，甘缓益脾的大枣来调和，这是救治阴经危急的方剂。
少阴病，下利，如果下利自行停止，恶寒而蜷卧，手足温暖的，可以治疗。
阴寒在里，胃阳不能固守而下利。如果下利自行停止，就知道胃气恢复固密，阳气恢复能够自守。恶寒，是阳虚不能胜任外气。蜷卧，是身体四肢都蜷曲而卧，是恶寒的情状。大凡热证，是仰卧而手足弛散；寒证则是蜷卧而手足敛缩。下文说恶寒蜷卧而手足逆冷的，就是真阳败绝而成不治之证了。如果手足温暖，就知道阳气未败，因为阳气尚能温暖四肢，所以说手足温暖的可治。然而治疗的方法，也无外乎温经复阳的方法。方氏不知道四肢是诸阳的根本，而说四肢属脾，温暖就是脾土调和。土和则万物生，所以说可治。他的谬误大概很严重。
少阴病，呕吐下利，手足不逆冷，反而发热的，不会死亡。脉不至的，灸少阴经七壮。
前面吴茱萸汤条内，说吐利手足厥冷，烦躁欲死。这里虽然吐利，但手足不逆冷，说明阳气未损。阴经应当无热而恶寒，现在反而发热，足见阳气已回，所以说不会死亡。既然有可生的生机而脉不至，那是阳气虽未绝，但寒邪固闭，脉道郁伏而不通，所以灸少阴经七壮。少阴穴，就是前面背恶寒所灸的穴位，以及井荥输经合穴等。可见吐利而手足逆冷，恶寒蜷卧，不发热而脉不至的，就是不治之证了。
The patient's pulse is tight in all three positions (cun, guan, chi). The presence of sweating is contrary to expectation and indicates the loss of Yang (Wang Yang). This condition belongs to Shaoyin disease. According to the progression of the disease, it should present with a sore throat accompanied by vomiting and diarrhea.
This passage discusses the interior syndrome of Shaoyin disease. In Chapter 2 of the Taiyang section of the *Shanghan Lun*, Article 1 states: "A pulse that is tight in all three positions is named Cold Damage (Shanghan)." Article 2 states: "Headache, fever, body ache, lower back pain, aversion to wind, absence of sweating, and wheezing are treated with Mahuang Tang." Here, the patient's pulse is tight in all three positions, which is the pulse sign for cold pathogen damaging the Ying (Nutrient) level. Cold damage typically presents without sweating; however, the current presence of sweating indicates that the cold pathogen is not at the exterior of the Taiyang channel but within the interior of the Shaoyin channel. The True Fire of the Mingmen (Gate of Life) is declining and unable to ascend the Clear Yang Qi to form Wei (Defensive) Qi. Because Wei Yang is not secure and the Xu Fu (pores) are not closed, sweating occurs. Generally, a tight pulse in Taiyang indicates cold pathogen at the exterior, while a tight pulse in Shaoyin indicates cold pathogen at the interior. Since a tight pulse in both Yin and Yang positions should normally result in no sweating, the occurrence of sweating here is termed "contrary" (Fan). Yang Qi fails to secure the exterior, hence it is said that there is "No Yang" (loss of Yang). However, since True Yang resides in the two Kidneys, it is further stated as belonging to Shaoyin. The Shaoyin meridian passes through the throat and flanks the root of the tongue. Due to the decline of Shaoyin True Fire and the floating up of Deficient Yang, a sore throat occurs. The counterflow of Yin pathogen leads to vomiting due to deficiency-cold in the Stomach.
With cold pathogen in the interior, the Middle Qi fails to maintain control, leading to diarrhea. This is similar to the fullness and vomiting in the Taiyin disease, where spontaneous diarrhea worsens. Should one not treat this by warming the meridians and restoring Yang?
[Correction of Misunderstandings] The *Shanglun* school states: "Because there is no Yang to protect the exterior, the pathogen cannot exit, so sweat comes out first." This is incorrect. If the cold pathogen were at the exterior of Taiyang, there would be discussions of sweat exiting along with the pathogen. If the cold pathogen is at the interior of Shaoyin, one need only restore its Yang; once Yang returns, the Yin cold will naturally dissipate, just as ice melts when the east wind blows and warm air arrives. What talk is there of the pathogen exiting?
In Shaoyin disease, if the patient feels the urge to vomit but cannot, experiences mental restlessness (Xin Fan), and desires only to sleep, and after five or six days develops spontaneous diarrhea with thirst, this belongs to Shaoyin disease. The thirst arises because the deficiency leads the patient to draw water to save themselves. If the urine is clear and white, the signs of Shaoyin disease are fully manifested. The whiteness of the urine is due to deficiency-cold in the Lower Jiao, which fails to control water metabolism, causing the urine to appear white.
The urge to vomit without success is caused by the decline of Shaoyin True Fire, with cold located in the Lower Jiao and Yin Qi counterflowing upward, invading the Stomach, resulting in Stomach cold. Mental restlessness occurs because the Shaoyin meridian originates from the Lung, connects with the Heart, and enters the chest. With severe cold below, Deficient Yang is forced upward, causing mental restlessness. The desire to sleep shares the same meaning as in the first article above. Five or six days represent the time frame for the pathogen transmitting to the Shaoyin stage. Spontaneous diarrhea with thirst occurs because Yin cold in the interior prevents Stomach Yang from maintaining control, leading to diarrhea; meanwhile, the lack of fire in the Lower Jiao prevents fluids from ascending, causing thirst. The *Suwen·Re Lun* states: "On the fifth day, the Shaoyin channel receives the pathogen." The Shaoyin meridian passes through the Kidney, connects to the Lung, and ties to the root of the tongue, causing dry mouth and tongue with thirst. Furthermore, seeing symptoms such as the urge to vomit, mental restlessness, and desire to sleep confirms the diagnosis of Shaoyin disease. However, this thirst is not caused by Yang heat pathogen but by the lack of fire in the Lower Jiao, which cannot vaporize and move fluids, leaving the Upper Jiao without irrigation and moisture. Additionally, spontaneous diarrhea causes water and grain to flow downward, depleting fluids. The Kidney is the Water Organ. The *Shanggu Tianzhen Lun* states: "The Kidney governs water and gathers the essence of the Zang-Fu organs to store it." With dryness above and depletion below, the Water Organ is deficient and dried up, prompting the patient to drink water to self-rescue. This is not thirst caused by heat-dryness. If thirst were caused by heat pathogen, the urine would be red. If the urine is white, and the patient exhibits the full picture of Shaoyin disease (urge to vomit, mental restlessness, desire to sleep), the reason for white urine is the deficiency of Mingmen Fire in the Lower Jiao, with only cold present below and insufficient fire to control water, thus making the urine white. In such cases, urgent treatment should focus on warming the meridians and restoring Yang. One must not hesitate due to thirst and mistakenly use cold-cooling herbs, which would wrongly cost lives.
In Shaoyin disease, if there is diarrhea with a faint and choppy pulse, vomiting, and sweating, and the patient defecates frequently but with little output (tenesmus), one should moxa the upper part.
When Yang Qi is deficient, the pulse may appear rapid (or weak); when cold pathogen is in the channels, the pulse is choppy. Yin pathogen moving downward causes diarrhea, while counterflow upward causes vomiting. The True Yang of the Kidney is declining and cannot ascend to become Wei Qi; because Wei Qi is not secure, sweating occurs. Frequent defecation with little output refers to tenesmus. Historically, what was called "Zhixia" (stagnant discharge) is now known as dysentery. "Li" (diarrhea) and "Li" (dysentery) were used interchangeably by ancients. This case involves diarrhea caused by cold pathogen, which differs from damp-heat dysentery. It results from Yang deficiency in the Lower Jiao, failure of Clear Yang to ascend, severe cold in Shaoyin, and internal pressure from Yin Qi attacking downward. Yang Qi sinks into Yin, and Yin and Yang pull against each other, preventing smooth downward expulsion of Yin pathogen, hence frequent urges to defecate. Although Yang Qi cannot ascend, it still has a lifting effect, resulting in small volume. The Classic states: "If Clear Qi is below, sunken diarrhea occurs." Clear Qi refers to the Clear Yang Qi of the Lower Jiao. These are diseases of cold in the Lower Jiao and failure of Clear Yang to ascend. Treatment should target the upper region. Previous commentators believed this referred to moxa application at Baihui (GV20) on the vertex to raise Yang. Baihui is the apex of the Du Meridian and the convergence of all Yang meridians; moxa here can lift Yang Qi. However, it is uncertain if this aligns with Zhang Zhongjing's legislative intent. Some argue that since Zhang Zhongjing provided no explicit text, one should not force an interpretation. Speculatively, "upper" does not necessarily mean the vertex. The Kidney resides in the Lower Jiao, while the Stomach, though central, is superior to the Kidney. The Yang Qi of the Stomach cavity is the foundation of Post-Heaven existence; thus, "having Stomach Qi means life." The phrase "frequent defecation with little output" implies incomplete evacuation due to Lower Jiao fire deficiency. One should not attack the lower region with bitter-cold herbs but should use warming and ascending herbs to warm the Stomach, combined with moxa. This allows the Clear Yang of the Lower Jiao to ascend and Stomach Yang to circulate. As Clear Yang ascends and Turbid Yin descends, food and water separate, and diarrhea stops. "Moxa" here refers to moxa points on the Shaoyin meridian or the Three Wangshu points of the Stomach (Shangwan, Zhongwan, Xiawan). This corresponds to the methods mentioned earlier regarding moxa application, the indication for Fuzi Tang, and the subsequent mention of moxa seven moxibustions on Shaoyin.
In Shaoyin disease, if there is diarrhea with pus and blood in the stool, Taohua Tang (Peach Blossom Decoction) is indicated.
Seeing Shaoyin syndrome accompanied by diarrhea indicates Yin cold pathogen in the interior, dampness stagnating in the Lower Jiao, and injury to the Large Intestine. Consequently, the intestinal lining cracks and blood stagnates, transforming into pus and blood, leading to slippery, uncontrollable diarrhea. Therefore, Taohua Tang, which warms the middle and secures collapse, is used.
**Taohua Tang Formula**
Chishizhi (Red Halloysite, 1 jin; half whole, half powdered)
Ganjiang (Dried Ginger, 1 liang)
Jingmi (Rice, 1 sheng)
Take the three ingredients, add seven sheng of water, and boil until the rice is cooked. Strain the dregs, add one cunbi (square-inch spoonful) of Chishizhi powder, and take warm. Dosage: 7 ge per administration, three times daily. If cured after one dose, do not take the remainder.
Taohua Tang is not suitable for acute violent diarrhea due to damp-heat, excessive accumulation, or excess Qi. It is a formula for treating deficiency-cold with slippery collapse. Li Shizhen stated: Red Halloysite is a herb for the Hand and Foot Yangming meridians. Its heavy nature and astringent property allow it to absorb dampness, stop bleeding, and secure the lower orifices. Its sweet taste and warm temperature allow it to benefit Qi, generate flesh, and regulate the middle. "Middle" refers to the stomach and intestines/muscles (e.g., palpitations, jaundice). "Lower" refers to intestinal diarrhea, uterine bleeding/leukorrhea, and seminal emission. White enters the Qi level; red enters the Blood level. Thus, Zhang Zhongjing uses Taohua Tang to treat diarrhea with pus and blood, utilizing the heavy astringency of Chishizhi to enter the Blood level of the Lower Jiao and secure collapse; Ganjiang's pungent-warm nature to warm the Qi level of the Middle Jiao and tonify deficiency; and Jingmi's sweet-warm nature to assist Chishizhi and Ganjiang in moistening the stomach and intestines.
In Shaoyin disease, from two to three days up to four to five days, if there is abdominal pain, difficult urination, unceasing diarrhea, and pus/blood in the stool, Taohua Tang is indicated.
Abdominal pain, difficult urination, unceasing diarrhea with pus/blood indicate Yin cold diarrhea. From two to three to four to five days, the Yin pathogen is in the interior, causing Qi stagnation in the intestines, leading to abdominal pain. Lack of fire in the Lower Jiao prevents Qi transformation, causing difficult urination. Furthermore, unceasing diarrhea causes urine to pass frequently with the stool, preventing accumulation in the Bladder and normal separation of fluids. Unceasing diarrhea indicates Qi deficiency failing to secure the Large Intestine, leading to slipping/collapse. Pus and blood in the stool indicate pathogen in the Lower Jiao, Qi stagnation, and injury to the Large Intestine. This belongs to Yin cold deficiency diarrhea; therefore, Taohua Tang, which astringes slipping, secures collapse, warms the middle, and tonifies deficiency, is indicated.
[Correction of Misunderstandings] Abdominal pain, difficult urination, unceasing diarrhea with pus/blood constitutes dysentery. Epidemic dysentery in summer and autumn, whether due to damp-heat prevalence or cold-damp infiltration, is caused by the perversion of the Six Qi. When attacked by damp-fire, the pathogen moves upward from below, first injuring the Hand Yangming Large Intestine, causing swelling and ulceration of the Houchang (rectum), skin injury, blood stasis, transformation into pus/blood/stagnation, obstruction of Qi channels, failure of Clear Yang to ascend, descent of Turbid Qi, intestinal swelling narrowing the passage, frequent urges to defecate without relief, leading to lower abdominal pain and heaviness in the anus. Treatment should clear damp-heat, purge the Large Intestine, and favor unblocking over astringing, following the principle of "treating obstruction with unblocking agents" (Tong Yin Yong Tong). If not treated urgently, the pathogen ascends to invade the Stomach, leading to chest fullness, anorexia, nausea, and dry retching, eventually causing Stomach Qi failure and death. This is known today as "Jinkou Li" (Closed-Mouth Dysentery). Cases involving epidemic toxic qi that restrict immediately upon infection are also difficult to treat. Regarding cold-damp Yin pathogen, attacks often begin by affecting Yin meridians, causing middle fullness, abdominal pain, Spleen/Stomach injury, severe lower abdominal cramping, diarrhea with pus/blood, failed Qi transformation, and scanty urination. Treatment should favor warming and ascending, and long-term treatment should favor tonifying and astringing, following the principle of "treating cold with heat." In severe cases, the anus opens, blood does not form stagnation, the stomach gate fails, and death ensues. Although dysentery is one syndrome, the treatments for Yin/Yang and Deficiency/Excess differ. Since Cheng Wuji, commentators have interpreted abdominal pain in this clause as Interior Cold. Only the *Shanglun* school interprets abdominal pain and difficult urination as Shaoyin Heat Pathogen, arguing that commentators seeing Ganjiang used assume it is Cold injuring the Stomach, which is unclear. They suggest Heat Pathogen carrying Shaoyin Qi fills the Stomach, requiring Ganjiang's pungency to disperse it. Claiming Heat Pathogen is actually Cold would mislead future generations. However, scrutinizing this argument, it may not correct previous errors. Abdominal pain is a primary symptom of Taiyin; even with Heat Pathogen, there must be retained food/stagnation to cause pain. Can Heat Pathogen alone cause abdominal pain? The phrase "Heat Pathogen carrying Shaoyin Qi" is particularly hard to explain. If Heat truly filled the Stomach, how could one use the pungent-hot Ganjiang to disperse it? This seems illogical. I suspect that identifying it as Cold is not a major error, whereas identifying it as Heat misleads future generations significantly. If Ganjiang is considered an error, the fault lies with the legislator Zhang Zhongjing. Observing dysentery cases, some are cured with Dahuang and Huanglian, others with Ganjiang, Rougu, Renshen, and Fuzi. Is this not clear evidence?
In Shaoyin disease, if the condition persists for two to three days and extends to four to five days, presenting with abdominal pain, difficult urination, heavy/painful limbs, and spontaneous diarrhea, this indicates the presence of Water Qi. Variations may include cough, free urination, diarrhea, or vomiting. Zhenwu Tang is indicated.
Shaoyin disease refers to the previously mentioned symptoms: faint/fine pulse, desire to sleep, aversion to cold, deep pulse, and cold feet. Persistence for two to three days indicates pathogen contracted directly by the Shaoyin channel, not transmitted from the Three Yang. If transmitted from Yang channels, the *Neijing·Re Lun* states: "On the fifth day, Shaoyin receives the pathogen." Thus, at two to three days, the pathogen would still be in Yangming or Shaoyang, and one could not yet call it Shaoyin disease nor say it persists. By four to five days, the duration increases, and the cold pathogen deepens, causing Interior Cold and abdominal pain. Difficult urination results from extreme Yin cold, lack of fire in the Lower Jiao, and failed Qi transformation. The limbs are the root of all Yang. When Yang Qi is vigorous, Clear Yang fills the limbs; excessive Yang leads to strength allowing climbing and singing. Here, Yang deficiency and Yin excess cause heavy, painful limbs. Cold pathogen already causes spontaneous diarrhea. If Interior Heat caused difficult urination, water would be consumed by heat. Here, difficult urination due to Interior Cold indicates failed Qi transformation, retention of cold-water, and failure to separate water/grain, leading to diarrhea; thus, it is termed "Water Qi." This is not water retained under the heart nor edematous water. Disease manifestations are not fixed; abdominal pain, difficult urination, and limb heaviness are not definitive signs. Variations may occur: cough due to Yin pathogen below forcing Deficient Fire up, reversing Lung Qi; free urination with white color due to Lower Jiao fire failing to control water; diarrhea due to Interior Cold damaging Stomach Yang and Kidney failing to control the two lower orifices; or vomiting due to Yin pathogen counterflow invading the Stomach. Since Yin pathogen runs rampant and True Yang is insecure, urgent restoration of True Yang and elimination of Yin shadows is required; thus, Zhenwu Tang is indicated. (Discussion of Zhenwu Tang is found under Qinglong Tang).
Zhenwu Tang formula, in Cheng Wuji's old edition, originally appeared below this clause. Its formula discussion was moved earlier under Da Qinglong Tang, so it is not repeated here. However, the subsequent modification rules were added by later secular physicians. Examining their textual inconsistencies, and detesting them for confusing truth with falsehood (like purple confusing vermilion), they are re-attached here with pointed-out errors to help students distinguish correctly.
[Subsequent Modification Rules]
If coughing: Add Wuweizi (Schisandra Berry) 0.5 sheng, Xixin (Asarum) and Ganjiang (Dried Ginger) 1 liang each.
These three herbs are used in Xiao Qinglong Tang syndrome where there is water-Qi under the heart, causing dry retching, cough, diarrhea, or wheezing due to water-cold injuring the Lung and reversing Lung Qi. Thus, Shaoyao, Xixin, Ganjiang, and Wuweizi are used to constrain reversed Lung Qi. This clause also involves Water Qi with cough, diarrhea, or vomiting, so it should be treated similarly to Xiao Qinglong Tang, transferring these herbs into this formula. This deeply captures Zhang Zhongjing's intent and is appropriate. (Lifting method is noted in Xiaochaihu Tang commentary).
If urination is free: Remove Fuling (Poria).
Free urination suggests Qi transformation is still functioning, or Water Qi has departed. Although Fuling is light and leaching, it also has benefits for tonifying deficiency and benefiting Qi, earning it the title "Junzi" (gentleman) herb. Even in Bawei Wan (Eight-Ingredient Pill) for warming/tonifying the Lower Jiao, it is still used. Since this formula is used with Fuzi, Baizhu, and Shaoyao, keeping it causes no harm; why remove it?
If diarrhea: Remove Shaoyao (Peony), add Ganjiang (Dried Ginger) 2 liang.
Adding Ganjiang for diarrhea is very appropriate. However, removing Shaoyao is questionable. Zhang Yuansu stated: Baishao (White Peony) enters the Spleen meridian and tonifies the Middle Jiao; it is essential for diarrhea. Diarrhea is generally a Taiyin disease, so it cannot be omitted. Combined with Gancao (Licorice) as an assistant, it treats abdominal pain; add Huangqin (Scutellaria) for heat, Guizhi (Cinnamon Twig) for cold. This is Zhang Zhongjing's divine formula. Li Shizhen stated: Baishao benefits the Spleen and drains Wood within Earth. Why remove it?
If vomiting: Remove Fuzi (Aconite), add Shengjiang (Fresh Ginger) to make up half a jin.
Adding Shengjiang for vomiting is steady. But what is the rationale for removing Fuzi? In Shaoyin disease, cold pathogen attacking downward causes diarrhea, counterflow upward causes vomiting. Fuzi is used in cases like immediate vomiting after eating (Si Ni Tang), not just for vomiting itself. In cases of diarrhea with undigested food, Interior Cold with Exterior Heat, cold limbs, faint pulse, abdominal pain, or dry retching (Tong Mai Si Ni Tang), Fuzi is used despite vomiting. In cases of unceasing diarrhea, cold limbs, absent pulse, dry retching, and irritability (Bai Tong Jia Zhu Dan Ye Tang), Fuzi is used. Such examples are countless. Did the modifiers not see these, and only remove Fuzi for Zhenwu Tang? Perhaps they only saw the statement in *Qianjin Fang* that vomiting patients often take Shengjiang, forgetting that this is a Shaoyin syndrome with abdominal pain, difficult urination, heavy/painful limbs, and diarrhea. Such modifications clearly originate from later secular physicians.
In Shaoyin disease, with a tight pulse, by the seventh or eighth day, spontaneous diarrhea occurs. The pulse suddenly becomes faint. The hands and feet become warm. The tightness of the pulse disappears. This indicates impending resolution. Although there is irritability, the diarrhea will likely resolve spontaneously.
A tight pulse in Taiyang indicates fever and aversion to cold (Cold at exterior). In Shaoyin, it indicates no fever and aversion to cold (Cold at interior). By the seventh or eighth day, Yin and Yang have been in stalemate for a long time. The onset of diarrhea then shows that Yang Qi has endured sufficiently to defend itself. Even with diarrhea, the pulse changes from tight like a绞索 (stranglehold) to faint, fine, and soft. A faint pulse might seem like the "loss of Yang" pulse mentioned earlier where sweating is contraindicated. How to interpret this? In Shaoyin disease, a naturally faint pulse signifies "No Yang." However, a sudden change from the extremely盛 (excessive) tight pulse of cold pathogen to faint indicates the tightness relaxing into looseness, a sign of cold pathogen resolving. "Hands and feet becoming warm" indicates that during the tight-pulse diarrhea, the hands and feet were previously cold. If the cold pathogen had not resolved, the hands and feet would not be warm, nor would the tight pulse disappear. Because the pulse was not originally faint but suddenly became faint, the hands and feet gained warmth, and the tightness vanished. Hence, it is called "fan" (contrary/reversal). Reversal of warmth and reversal of pulse tightness indicate the cold has relaxed, hence "impending resolution." Although the patient is irritable, irritability belongs to Yang, indicating the return of warm Qi; thus, the Yin cold diarrhea will likely resolve.
In Shaoyin disease, with vomiting and diarrhea, cold limbs, and severe irritability bordering on death, Wuzhuyu Tang is indicated.
Vomiting and diarrhea are primary syndromes of Yin meridians. Isolated vomiting or diarrhea may be manageable. However, if cold pathogen injures the Stomach, causing counterflow vomiting and downward attacking diarrhea, leading to cold limbs, this is serious. The limbs receive Qi from the Stomach and are the root of all Yang. Rampant Yin pathogen causes Stomach Yang to fail and lose control. Yin and Yang fail to connect smoothly, resulting in cold extremities. Yang is oppressed by Yin, causing irritability (Fan); Yin excess repels Yang, causing restlessness (Zao). Severe irritability and restlessness reaching the point of wanting to die necessitate Wuzhuyu Tang. Wuzhuyu (Evodia Fruit) is pungent, bitter, and hot, dispersing rebellious Jue Qi and warming the middle to scatter cold. Evodia is pungent, spicy, hot, and odorous, with strong aroma/flavor, serving as a specific herb for the Jueyin meridian. It also warms the middle and resolves cold, applicable to all Three Yin meridians. Combined with Ren Shen (Ginseng), sweet and neutral, to tonify Qi and repair Stomach Qi damaged by vomiting/diarrhea; Sheng Jiang (Fresh Ginger), pungent and dispersing, to stop vomiting; and Da Zao (Jujube), sweet and緩 (slackening), to harmonize and benefit the Spleen, this forms an emergency formula for Yin meridians.
In Shaoyin disease, with diarrhea, if the diarrhea stops spontaneously, and the patient has aversion to cold and curls up while lying down, but the hands and feet are warm, the prognosis is treatable.
Interior Yin cold prevents Stomach Yang from controlling, causing diarrhea. Spontaneous cessation of diarrhea indicates the recovery of Stomach Qi security and Yang Qi's ability to defend itself. Aversion to cold indicates Yang deficiency failing to withstand external conditions. Curling up while lying down indicates the body and limbs are curled, reflecting the state of aversion to cold. Generally, heat syndromes involve lying flat with relaxed limbs; cold syndromes involve curling up with contracted limbs. Later, it is stated that if aversion to cold, curling up, AND cold extremities occur, it indicates true Yang collapse and is untreatable. If the hands and feet are warm, it indicates Yang has not collapsed, as it can still warm the limbs. Hence, "warm hands and feet" means treatable. The treatment method remains warming the meridians and restoring Yang. Fang Shi did not know the limbs are the root of all Yang, claiming instead that limbs belong to the Spleen and warmth indicates Spleen Earth harmony. "Earth harmony generates all things," hence treatable. His error is significant.
In Shaoyin disease, with vomiting and diarrhea, if the hands and feet are NOT cold, but rather there is fever, the patient will not die. If the pulse is absent, moxa the Shaoyin meridian seven times (seven moxibustion cones).
In the previous Wuzhuyu Tang clause, vomiting/diarrhea with cold limbs and severe irritability was described. Here, although there is vomiting/diarrhea, the hands and feet are not cold, indicating Yang is not damaged. Yin meridians should present with heatlessness and aversion to cold. The presence of fever indicates Yang has returned, hence "not dying." Although there is a chance of survival, the absent pulse suggests that although Yang is not extinct, the cold pathogen is firmly closed, obstructing the pulse vessels. Therefore, moxa the Shaoyin meridian seven times. The Shaoyin points refer to those moxed for back aversion to cold earlier, including Jing-River-Shu-Well-He points. Thus, vomiting/diarrhea with cold limbs, aversion to cold, curling up, no fever, and absent pulse constitute an untreatable syndrome.
In Shaoyin disease, with diarrhea containing undigested food, Interior Cold with Exterior Heat, cold limbs, faint pulse nearly imperceptible, body seemingly without aversion to cold, and the patient's face appearing red, or abdominal pain, or dry retching, or throat...