少阴病脉细沉数病在里。不可发汗。
沉细中加之以数。正邪热入里之征邪热入里即不可发汗。发汗则动其经。而有夺血亡阳之变故示戒也。
少阴病四逆。其人或咳或悸。或小便不利。或腹中痛或泄利下重者。四逆散主之。
四肢为诸阳之本阳邪传至少阴陷下于里而不能交通阳分。乃至四逆下利其中土之阳气亦伤所以亟用柴胡升陷内之阳
邪。枳实破内滞之结热甘草助脾胃之阳运芍药收失位之阴津。允为利解少阴。阴阳痞膈之定法慎不可以其阳热结内而用
下法也。盖伤寒以阳为主四逆有阴进之象。若复用苦寒攻之。则阳益亏所以有诸四逆者。不可下之之戒。
咳者加五味子干姜各五分。并主下利。悸者加桂枝五分。小便不利者。加茯苓五分。腹中痛者加附子一枚。泡令折。
泄利下重者。先以水五升。煮薤白三升。煮取三升去滓。以散三方寸匕内。汤中煮取一升半。分温再服。
此证虽属少阴。而实脾胃不和。故尔清阳之气。不能通于四末是用四逆散清理脾胃。而散阴分之热滞乃正治也。至
于腹中痛者。加附子。于此不能无疑。盖阳邪内陷之腹痛。只宜小建中和之。而此竟用附子者。以其证虽属阳邪。必其
人内有沉寒结滞不散。更兼形体素丰。可受阳药。方可加热药于清理脾胃剂中。仍是用和之法而非温经助阳之义。观下
文即云泄利下重者。加薤白。则知热滞虽得下利。究竟不能速通所以急行涤垢为务。即咳加五味子干姜总是从治之法慎
勿以其用热治热而致感也。
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。
少阴之脉从足入腹。上循喉咙萦绕舌本。故多咽痛之证。则支别出肺。故间有咳证。今以火气强迫其汗。则热邪挟
火力上攻。必为咳。以肺金恶火故也下攻必为利。以火势逼迫。而走空窍故也。内攻必谵语。以火势燔灼而乱神识故也。
小便必难者。见三证皆妨小便。盖肺为火热所伤。则膀胱气化不行。大肠奔迫无度。则水谷并趋一路。心包燔灼不已。
则小肠枯涸必至耳。少阴可强责其汗乎。
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。
强责少阴汗而动其 血势必逆行而上出阳窍以发汗皆阳药故也。或口鼻或耳目。较之从阴窍出者。则倍危矣下厥者。
少阴居中。不得汗而热深也。上竭者。少阴之血。尽从上而越竭矣。少阴本少血。且从上逆。故为难治。然则热在膀胱。
必便血者。岂非以多血。且从便出为顺乎。
少阴病咽中痛。半夏散及汤主之。
少阴病。咽中伤生疮不能言语。声不出者。苦酒汤主之。
太阳之热邪薄于少阴。则阴火挟痰攻咽。所以作痛当用半夏以涤饮。兼桂枝以散邪。甘草以缓急也。若剧者。则咽
伤生疮。音声不出为阴邪上结。复与寒下不宜。故用半夏以开结。鸡子以润咽更藉苦酒消肿敛疮。以胜阴热也。胜阴热
者。正所以存阴也。饮散则热解。即内经流湿润燥之意。与厥阴喉痹麻黄升麻汤证例同。
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。少阴热邪也。而下利不止。便脓血。则下焦滑脱矣。滑脱即不可用寒药。故取干姜石脂之辛涩。以
散邪固脱而加粳米之甘。以益中虚盖治下必先固中。中气不下坠则滑脱无源而自止。此从治之法也。故注及内台方。谓
其用干姜而曰里寒谬矣。
少阴病。下利便脓血者。桃花汤主之。少阴病。便脓血者可刺。
先下利而后便脓血。则用桃花汤。若不下利。而但便脓血。则可刺经穴以散其热。今不用刺法。当从事白头翁汤。
设更兼咽干心烦不得卧。又须黄连阿胶汤为合法耳。
少阴病。自利清水。色纯清心下必痛。口干燥者急下宜大承气汤。
热邪传入少阴逼迫津水注为自利质清而无滓秽相杂。色青而无黄赤相间。可见阳邪炎威之极反与阴邪无异。但阳邪
传自上焦。其人心下必痛口必干燥设系阴邪。则心下满而不痛。口中和而不渴必无此枯槁之象故宜急下以救其阴也。
以上少阴传经热证。
少阴病六七日腹胀不大便者。急下之宜大承气汤。
少阴之症自利者。最多虚寒则下利清谷滑脱。则下利脓血。故多用温药传经阳邪内结则自利纯清水温热病则自利作
渴并宜下夺清热。此以六七日不大便而腹胀可见邪热。转归阳明。而为胃实之证。所以宜急下也。然六七日腹胀不大便
何得目之少阴。必在先曾见咽痛。自利烦渴至五六日。
□□□□□□□□□□□□无边际是□热则少阴必无此证当是藏庶学人易于□膀胱之候以膀胱主表故一身。
厥阴之为病消渴气之血为少阴之热所逼其趋必出二阴之窍以阴主降故也。宜当归四逆和营透表兼疏利膀胱为合法
也。
上条少阴热邪转膀胱腑证。
少阴病，脉象细、沉、数，说明病位在里。此时不可使用发汗法。
在沉细的脉象中加上数的特征，正是邪热入里的征象；邪热入里便不可发汗。如果发汗，就会扰动经络，导致耗伤血液和亡失阳气的变故，因此发出警告以示警戒。
少阴病出现四肢厥冷。病人有的咳嗽，有的心悸，有的小便不通畅，有的腹痛，有的腹泻且伴有肛门重坠感。这些情况都用四逆散主治。
四肢是诸阳经的根本。阳邪传入少阴，陷入体内而不能与阳气交通，从而导致四肢厥冷和下利，其中脾胃（土）的阳气也受到了损伤。所以急需使用柴胡来升举陷入体内的阳邪，枳实来破除内部的滞结之热，甘草来辅助脾胃的阳气运行，芍药来收敛失去位置的阴津。这确实是解除少阴病阴阳痞塞阻隔的定法。千万不要因为它是阳热结聚在内就使用攻下法。大概伤寒病以保护阳气为主，四肢厥冷有阴气进逼的迹象。如果再使用苦寒药物攻伐，阳气会更加亏损，所以有“凡是出现四肢厥冷的，不可使用下法”的告诫。
咳嗽的，加五味子、干姜各五分，这两味药同时也主治下利。
心悸的，加桂枝五分。
小便不利的，加茯苓五分。
腹痛的，加附子一枚，先浸泡后折断。
腹泻且伴有肛门重坠感的，先用五升水，煮三升薤白，煮取三升药液，去掉药渣。将四逆散三方寸匕的药粉放入汤中，再煮取一升半，分两次温服。
这个证候虽然属于少阴病，但实际上是脾胃不和。因此清阳之气不能通达四肢末端。使用四逆散清理脾胃，并疏散阴分的郁热，这才是正治法。至于腹痛加附子这一点，对此我不能不有所怀疑。一般来说，阳邪内陷引起的腹痛，只适宜用小建中汤调和，而这里竟然使用附子，是因为这个证候虽然属于阳邪，但病人内部一定有沉寒结滞不散，再加上病人身体素来丰腴，能够承受阳热药物，才可以在清理脾胃的方剂中加入热药。这仍然是使用调和的方法，而不是温经助阳的意思。看下文说“腹泻且伴有肛门重坠感的，加薤白”，就知道热滞即使通过下利排出，终究不能迅速通畅，所以急务在于迅速涤除垢浊。至于咳嗽加五味子、干姜，总是顺从病势的治疗法，千万不要因为用热药治疗热证而导致误感。
少阴病，咳嗽并且腹泻，还出现谵语，这是被火劫迫所致。强行索取少阴病的汗液，必然导致小便困难。
少阴经脉从足部进入腹部，向上沿喉咙，环绕舌根，所以多有咽痛的证候。其支脉别出联系肺脏，所以间或有咳嗽的证候。现在用火气强迫出汗，那么热邪挟带火势向上攻冲，必然引起咳嗽，因为肺金厌恶火邪的缘故。向下攻冲必然引起腹泻，因为火势逼迫，使水谷走空窍的缘故。向内攻冲必然引起谵语，因为火势焚烧灼烧而扰乱神识的缘故。小便必然困难的原因，是因为这三个证候都妨碍了小便的正常排泄。大概肺被火热所伤，则膀胱的气化功能不行；大肠奔迫无度，则水谷并趋一路；心包焚烧灼热不已，则小肠枯涸必至。少阴病怎么可以强行发汗呢？
少阴病，只有四肢厥冷而没有汗，如果强行发汗，必然会动血。不知道血会从哪个孔道流出，或者从口鼻流出，或者从眼睛流出。这叫做“下厥上竭”，属于难治之证。
强行索取少阴汗而扰动血液，势必导致血液逆行而上从阳窍流出，因为发汗用的都是阳药。或者从口鼻，或者从耳目流出，比起从阴窍流出来说，更加危险。所谓“下厥”，是指少阴居中，不得汗出而热邪深伏。所谓“上竭”，是指少阴的血液尽从上窍外越而枯竭。少阴本就不多血，且血液从上逆出，所以难以治疗。然而，如果热在膀胱，必然导致便血，难道不是因为血多，且从大便排出为顺吗？
少阴病，咽喉疼痛，用半夏散及汤主治。
少阴病，咽喉受伤生疮，不能说话，声音发不出来的，用苦酒汤主治。
太阳的热邪侵薄于少阴，则阴火挟带痰饮攻击咽喉，所以产生疼痛。应当用半夏来涤除饮邪，兼用桂枝来发散邪气，甘草来缓解急迫。如果病情严重，则咽喉受伤生疮，声音发不出来，这是阴邪上结，再用寒下法就不适宜了。所以用半夏来开结，鸡蛋清来润喉，更借助苦酒（醋）来消肿敛疮，以战胜阴热。战胜阴热，正是为了保存阴液。饮邪散去则热解，这就是《内经》所说的“流湿润燥”的意思。这与厥阴病喉痹的麻黄升麻汤证例相同。
少阴病，两三天到四五天的时间，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。
腹痛、小便不利，是少阴热邪的表现。而下利不止、大便带脓血，则是下焦滑脱不禁了。滑脱不禁就不可使用寒凉药物，所以选取干姜、赤石脂的辛涩之性，以散邪固脱，并加入粳米的甘味，以补益中气的虚弱。大概治疗下利必须先固护中气，中气不下坠，则滑脱没有源头而自然停止。这是从治之法。所以注释及《内台方》中说它用干姜是因为里寒，这是错误的。
少阴病，腹泻且大便带脓血的，用桃花汤主治。少阴病，大便带脓血的，可以针刺治疗。
先腹泻而后大便带脓血的，就用桃花汤。如果不腹泻，只是大便带脓血，就可以针刺经络穴位以疏散热邪。现在不使用刺法，应当从事白头翁汤的治疗。
如果更兼有咽干、心烦、不得卧的症状，又必须用黄连阿胶汤才是合法的治法。
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，宜用大承气汤。
热邪传入少阴，逼迫津液注为自利，质地清澈而没有秽浊杂质混杂，颜色青而没有黄赤相间。可见阳邪炎威之极，反而与阴邪无异。但是阳邪是从上焦传下来的，其人心中必定疼痛，口中必定干燥。如果是阴邪，则心下满而不痛，口中平和而不渴，必定不会有这种枯槁的现象。所以应当急下以救阴液。
以上是少阴病传经的热证。
少阴病，六七天，腹胀且不大便的，应当急下，宜用大承气汤。
少阴病的症状，自利的最多见的是虚寒，则下利清谷滑脱，则下利脓血，所以多用温药。传经的阳邪内结则自利纯清水，温热病则自利作渴，都适宜用下法夺热清热。这里因为六七天不大便且腹胀，可见邪热转归阳明，成为胃实的证候。所以适宜急下。然而六七天腹胀不大便，怎么能说是少阴病呢？一定是在先前曾出现过咽痛、自利、烦渴等症状，到了五六天，
[此处原文缺字] 无边际是 [此处原文缺字] 热则少阴必无此证 当是 [此处原文缺字] 庶学人易于 [此处原文缺字] 膀胱之候 以膀胱主表故一身。
厥阴的病表现为消渴，气之血被少阴的热邪所逼迫，其趋向必然出于二阴的孔窍，因为阴主降的缘故。适宜用当归四逆汤调和营卫透达表邪，兼疏利膀胱，才是合法的治法。
上一条是少阴热邪转属膀胱腑的证候。
Shaoyin disease characterized by a fine, deep, and rapid pulse indicates that the pathogen is in the interior. Sweating therapy should not be used.
The presence of rapidity within the deep and fine pulse is a sign of evil heat entering the interior. Once evil heat enters the interior, sweating is contraindicated. If sweating is induced, it will disturb the meridians, leading to depletion of blood and loss of Yang Qi; this serves as a warning.
In Shaoyin disease presenting with cold extremities (Si Ni), the patient may experience cough, palpitations, difficulty urinating, abdominal pain, or diarrhea with a sensation of heaviness in the anus. These conditions are primarily treated with Si Ni San (Four Counterflow Powder).
The four limbs are the root of all Yang meridians. When Yang pathogenic factors transmit to Shaoyin and sink into the interior, failing to communicate with Yang, it leads to cold extremities and diarrhea, damaging the Yang Qi of the Spleen and Stomach (Earth element). Therefore, Chai Hu (Bupleuri Radix) is urgently needed to raise the sunken Yang pathogen; Zhi Shi (Aurantii Fructus Immaturus) to break internal stagnation and heat; Gan Cao (Glycyrrhizae Radix et Rhizoma) to assist the Spleen and Stomach Yang in its transformation; and Bai Shao (Paeoniae Radix Alba) to gather the displaced Yin fluids. This is indeed the definitive method for resolving Shaoyin disease involving Yin-Yang obstruction. One must not use purgation methods simply because there is internal Yang-heat accumulation. Generally, in Shang Han (Cold Damage) diseases, preserving Yang is paramount. Cold extremities indicate an advance of Yin. If bitter-cold purgatives are used again, Yang will be further depleted. Hence, the warning: "For those with cold extremities, do not use purgation."
If there is cough, add Wu Wei Zi (Schisandrae Fructus) and Gan Jiang (Zingiberis Rhizoma) each at 5 fen; these also treat diarrhea.
If there are palpitations, add Gui Zhi (Cinnamomi Ramulus) at 5 fen.
If there is difficulty urinating, add Fu Ling (Poria) at 5 fen.
If there is abdominal pain, add Fu Zi (Aconiti Lateralis Radix Praeparata) one piece, soaked and broken.
If there is diarrhea with anal heaviness, first boil Xie Bai (Allii Macrostemonis Bulbus) in five sheng of water until reduced to three sheng. Strain the dregs. Add three square-inch spoons of Si Ni San powder to the decoction and boil until reduced to one and a half sheng. Divide into two doses and take warm.
Although this syndrome belongs to Shaoyin, it is essentially disharmony of the Spleen and Stomach. Thus, Clear Yang cannot reach the four extremities. Using Si Ni San to regulate the Spleen and Stomach and dissipate heat-stagnation in the Yin aspect is the correct treatment. Regarding the addition of Fu Zi for abdominal pain, I have doubts. Typically, abdominal pain caused by sunken Yang pathogen should only be harmonized with Xiao Jian Zhong Tang (Minor Construct the Middle Decoction). The use of Fu Zi here implies that although the syndrome involves Yang pathogen, the patient internally has deep cold and stagnation, and due to a robust physique capable of tolerating Yang-warming drugs, hot herbs can be added to the Spleen-Stomach regulating formula. This remains a harmonizing method, not warming the meridians to assist Yang. As stated later, adding Xie Bai for diarrhea with anal heaviness shows that even if heat-stagnation is expelled via diarrhea, it does not quickly clear; thus, the urgent task is to rapidly cleanse turbidity. Adding Wu Wei Zi and Gan Jiang for cough follows the principle of treating according to the manifestation; one must not fear using hot herbs to treat heat syndromes.
In Shaoyin disease, cough combined with diarrhea and delirium results from coercion by fire therapy. Forcing sweat in Shaoyin disease inevitably leads to difficult urination.
The Shaoyin meridian enters the abdomen from the foot, ascends along the throat, and surrounds the tongue base, hence often causing sore throat. Its branch connects to the Lung, so cough occasionally occurs. Now, forcing sweat with fire causes heat pathogen to attack upward with fire power, resulting in cough, as Metal dislikes Fire. Attacking downward causes diarrhea due to fire forcing fluids through orifices. Attacking inward causes delirium as fire burns and disturbs the Shen (Spirit). Urination becomes difficult because all three symptoms obstruct urinary function. Lung injury by fire impairs Bladder Qi transformation; excessive Large Intestine urgency causes water and grain to mix; Heart Pericardium burning dries the Small Intestine. How can Shaoyin be forcibly sweated?
In Shaoyin disease, if there is cold extremities without sweat, forcing sweat will inevitably move the blood. It is unknown which orifice it will exit from: either mouth and nose, or eyes. This is called "Lower Jue and Upper Exhaustion," a difficult-to-treat condition.
Forcibly inducing sweat in Shaoyin moves blood, causing it to reverse and exit through Yang orifices, as sweating agents are Yang-natured. Exit via mouth/nose or eyes is more critical than exit via Yin orifices. "Lower Jue" refers to Shaoyin being central, unable to sweat, with deep heat. "Upper Exhaustion" refers to Shaoyin blood exhausting by flowing out from above. Since Shaoyin naturally has little blood, and it flows upward reversely, it is hard to treat. However, if heat is in the Bladder causing hematochezia, is it not because there is abundant blood and exiting via stool is favorable?
Shaoyin disease with sore throat in the throat is primarily treated with Ban Xia San Ji Tang (Pinellia Powder and Decoction).
Shaoyin disease where the throat is injured, sores form, speech is impossible, and voice is lost is primarily treated with Ku Jiu Tang (Bitter Wine Decoction).
Sun Tai heat pathogen invading Shaoyin causes Yin fire to attack the throat with phlegm, causing pain. Ban Xia (Pinelliae Rhizoma) clears phlegm, Gui Zhi (Cinnamomi Ramulus) disperses pathogen, and Gan Cao (Glycyrrhizae Radix et Rhizoma) relieves urgency. In severe cases, throat injury and sores prevent speech; this is Yin pathogen knotting upward, making cold purgation unsuitable. Ban Xia opens knots, Egg White moistens the throat, and Ku Jiu (Vinegar) reduces swelling and heals sores to overcome Yin-heat. Overcoming Yin-heat preserves Yin. Clearing phlegm resolves heat, following the Nei Jing principle of "moistening dryness with flow." This parallels the Ma Huang Sheng Ma Tang (Ephedra and Ligusticum Decoction) pattern for Liver Jue throat bi.
Shaoyin disease progressing from two to four or five days, presenting with abdominal pain, difficulty urinating, incessant diarrhea, and pus-blood in stool is primarily treated with Tao Hua Tang (Peach Blossom Decoction).
Abdominal pain and difficulty urinating indicate Shaoyin heat pathogen. Incessant diarrhea with pus-blood indicates Lower Jiao slipping and sliding (incontinence). Slipping precludes cold herbs. Gan Jiang (Zingiberis Rhizoma) and Shi Li (Kaolinitum) use acrid-astringent properties to disperse pathogen and secure leakage; Jing Mi (Oryzae Semen) adds sweetness to tonify middle deficiency. Treating lower disorders requires securing the middle first. If Middle Qi does not sink, slipping stops spontaneously. This is a conforming treatment method. Notes claiming Gan Jiang indicates interior cold are incorrect.
Shaoyin disease with diarrhea and pus-blood in stool is primarily treated with Tao Hua Tang (Peach Blossom Decoction). Shaoyin disease with pus-blood in stool can be treated with acupuncture.
If diarrhea precedes pus-blood, use Tao Hua Tang. If no diarrhea but only pus-blood, acupuncture can disperse heat. Without acupuncture, consider Bai Tou Weng Tang (Pulsatillae Decoction).
If accompanied by dry throat, irritability, and inability to sleep, Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is appropriate.
Shaoyin disease with spontaneous discharge of clear water, pure green color, epigastric pain, and dry mouth requires urgent purgation with Da Cheng Qi Tang (Major Order the Qi Decoction).
Heat pathogen transmitting to Shaoyin forces fluids into spontaneous discharge. The substance is clear without turbidity, color green without yellow/red, showing extreme Yang heat resembling Yin pathogen. However, Yang pathogen transmits from Upper Jiao, causing epigastric pain and dry mouth. Yin pathogen would cause fullness without pain and a neutral mouth without thirst, lacking this withered appearance. Urgent purgation saves Yin.
These are Shaoyin transmitted heat syndromes.
Shaoyin disease persisting six to seven days with abdominal distension and constipation requires urgent purgation with Da Cheng Qi Tang (Major Order the Qi Decoction).
Shaoyin diarrhea is mostly deficiency-cold (clear grains, slipping) or pus-blood, treated with warm herbs. Transmitted Yang pathogen internal knotting causes clear water diarrhea; warm-heat disease causes thirst with diarrhea; both suit purgation to clear heat. Here, six-seven days of constipation and distension show heat transforming to Yang Ming, becoming Stomach Excess. Hence urgent purgation. But why call this Shaoyin after six-seven days of distension/constipation? It likely followed prior sore throat, diarrhea, irritability, and thirst up to day five or six.
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Jue Yin disease presents with Xiao Ke (Wasting-Thirst). Qi and Blood are forced by Shaoyin heat to exit via the two Yin orifices, as Yin descends. Dang Gui Si Ni Tang (Angelica Four Counterflow Decoction) harmonizes Ying and disperses exterior, plus unblocking Bladder, is appropriate.
The previous paragraph describes Shaoyin heat pathogen transferring to the Bladder Fu organ.