葱白（四茎） 干姜（二两） 附子（一枚生去皮破八片） 人尿（五合） 猪胆汁（一合）
以上三味。以水三升。煮取一升。去滓。内胆汁人尿。和令相得。分温再服。若无胆汁
亦可用。
尿。与溺同。奴吊切。此承上条复以其甚者言。脉微。阳虚也。厥逆无脉干呕烦者。热药治
寒。寒甚者。格拒而不入。汤不为用。反争而逆乱也。人尿性寒。胆汁微寒。以之为向导者。经
曰。逆者从之。此之谓也。暴出。烛欲烬而焱烈也。微续。真阳回而渐复也。然属加减耳。成方
疑后人所增。
（三十六）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。
真武汤方
茯苓（三两） 芍药（三两） 生姜（三两切） 白术（二两） 附子（一枚炮去皮破八片）
上五味。以水八升。煮取三升。去滓。温服七合。日三服。
腹痛。小便不利。阴寒内甚。湿甚而水不行也。四肢沉重疼痛。寒湿内渗。又复外薄也。自
下利者。湿既甚而水不行。则与谷不厘清。故曰此为有水气也。或为诸证。大约水性泛滥。无所
不之之故也。真武者。北方阴精之宿。职专司水之神。以之名汤。义取之水。然阴寒甚而水泛滥。
由阳困弱而土不能制伏也。是故术与茯苓燥土胜湿。芍药附子利气助阳。生姜健脾以燠土。则水
有制而阴寒退。药与病宜。理至必愈。
后加减法。（或为诸证之治。）
若咳者。加五味子半升。细辛干姜各一两。（水寒相搏则咳。细辛干姜之辛。散水寒也。既
散矣。肺主咳。而欲收。五味子者。酸以收之也。）若小便利者。去茯苓。（茯苓淡渗而利窍。
小便既利。不须渗也。）若下利者。去芍药。加干姜二两。（芍药收阴而停液。非下利者所宜。
故去之。干姜散寒而燠土。土燠则水有制。故加之。）若呕者。去附子。加生姜。足成半斤。
（呕。气逆也。去附子。以其固气也。加生姜以其散气也。）
（三十七）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。
通脉四逆汤方
甘草（二两炙） 干姜（三两强人可四两） 附子（大者一枚生去皮破八片）
上三味。以水三升。煮取一升二合。去滓。分温。再服。其脉即出者愈。
下利清谷。手足厥冷。脉微欲绝而里寒者。阴甚于内也。身反不恶寒。面
色赤而外热者。格阳于外也。阴阳不相通。所以逆乱而有或为诸多证。利虽止邪欲
罢也。脉仍不出。阳气未复也。夫脉者血气之道路。血。阴也。非阳不行。姜附
辛热。助阳也。甘草甘平。益气也。汤本四逆而分两殊。通脉则加姜之谓。
后加减法。（同前。）
面色赤者。加葱九茎。（面色赤。阳格甚也。加葱。通阳气也。）腹中痛者。
去葱。加芍药二两。（腹中痛。真阴不足也。去葱。恶其顺阳也。加芍药。收阴也。）
呕者。加生姜二两。（见前）咽痛者。去芍药加桔梗一两。（咽痛。气结也。去芍
药。聚气也。加桔梗。利咽也。）利止。脉不出者。去桔梗。加人参二两。（利止脉不
出见上。去桔梗者。嫌其载而少畅通也。加人参者。生其阳而和其阴也。）
（三十八）少阴负趺阳者为顺也。
此承上文自利而言。以示人通诊吉凶利害之大意。盖谓少阴属水。其自利者以阴寒甚。
土弱而水无制也。趺阳主胃而属土。负谓趺阳有脉。土尚强。土强则水有制。而少阴反
为输负矣。顺言不以受制为拘也。盖水惟其有制。则卒遵道。不得终于泛滥而成大害。且
万物资生于土。而百骸藉养于胃。水土平成。物类又安。非天下之至顺乎。古今谓趺阳有
脉者不死。有以哉。
（三十九）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。
四逆散方
甘草（炙） 枳实（破水渍炙干） 柴胡 芍药
上四味。各十分。捣筛。白饮和服方寸匕。日三服。
分。去声。上同。人之四肢。温和为顺。故以不温和为逆。但不温和而未至于厥冷。则热犹
为未入深也。故用柴胡解之也。枳实。泄之也。然热邪也。邪欲解本阴也。阴欲收。芍药收之也。
甘草和之也。分。今之二钱五分也。
后加减法。（同前。）
咳者加五味子干姜各五分。并主下痢。（咳见前。并主下利。亦散水寒收泄气之意。）悸者。
加桂枝五分。（心主悸。桂枝通心气也。）小便不利者。加茯苓五分。（见前）腹中痛者。加附子一枚。炮令坼。
（腹中痛。寒甚也。附子。温之也。）
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。（下重。气滞也。薤白。疏泄也。）
（四十）少阴病。下利六七日。咳而呕渴心烦。不得眠者。猪苓汤主之。
下利。固乃阴寒甚而水无制。六七日咳而呕渴心烦。不得眠者。水寒相搏。蓄积不行。内闷而
不宁也。猪苓汤者。泻利以
厘清其水谷之二道也。二道清则利无有不止者。利止。则呕渴心烦。不待治而自愈矣。方见阳明篇。
（四十一）少阴病。得之二三日。口燥咽干者。急下之。宜大承气汤。
口燥咽干者。少阴之脉。循喉咙。挟舌本。邪热客于经。而肾水为之枯竭也。然水干则土燥。
土燥则水愈干。所以急于下也。方见阳明篇。下同。
（四十二）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。
水。肾邪。青。肝色。肾邪传肝也。心下必痛者。少阴之脉。其支别者。从肺出络心。注胸
中也。口干燥见上。故治同。
（四十三）少阴病。六七日。腹胀。不大便者。急下之。宜大承气汤。
腹胀不大便。胃实可知。急下者。少阴属水。恶土实也。
（四十四）少阴病。脉沉者。急温之。宜四逆汤。
脉沉。寒邪深入于里也。温之不容以不急也。方见太阳中篇。下同。
（四十五）少阴病。饮食入口则吐。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。
饮食入口则吐。少阴主喉咙而寒邪客之也。少阴之脉。络心。注胸中。实。谓痰壅而上塞也。
寒。以虚言。温。有补意。
（四十六）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。
数。音朔。更平声。反少之少。上声。微。阳虚也。涩。血少也。汗出。阳虚不能外固。阴
弱不能内守也。更衣见阳明篇。反少者。
阳虚则气下坠。血少所以勤努责而多空坐也。上。谓顶。百会是也。灸。升举其阳以调养夫阴也。
葱白（四茎） 干姜（二两） 附子（一枚，生用，去皮，破成八片） 人尿（五合） 猪胆汁（一合）
以上三味药。用水三升。煮取一升。去渣。加入胆汁和人尿。调和均匀。分两次温服。如果没有胆汁，也可以用其他方法替代。
“尿”与“溺”同义。读音为“奴吊切”。这是承接上一条条文，进一步阐述病情更严重的情况。脉象微细，是阳气虚弱的表现。四肢厥冷、无脉、干呕、心烦，是因为用热药治疗寒证时，若寒邪极盛，会导致格拒而药液无法进入体内，汤药不起作用，反而引起气机逆乱。人尿性寒，胆汁微寒，将它们作为向导，正如经文所说：“逆者从之”，说的就是这个道理。“暴出”，如同蜡烛即将燃尽时火焰突然猛烈；“微续”，则是真阳回归并逐渐恢复的表现。但这属于加减法范畴。成方中这一条怀疑是后人增补的。
（三十六）少阴病（少阴经受邪所致的病证），发病两三天未愈，到了四五日，出现腹痛、小便不利、四肢沉重疼痛、自发性腹泻等症状。这是因为体内有水气停留。有的患者还伴有咳嗽，或小便通畅，或腹泻，或呕吐的情况，均应以真武汤（True Warrior Decoction）为主治方剂。
真武汤方剂组成：
茯苓（三两） 芍药（三两） 生姜（三两，切片） 白术（二两） 附子（一枚，炮制后去皮，破成八片）
以上五味药。用水八升。煮取三升。去渣。每次温服七合。每日服用三次。
腹痛、小便不利，是由于阴寒内盛，湿气过重导致水液运行不畅。四肢沉重疼痛，是因为寒湿内侵，又向外逼迫肌表。自发性腹泻，是因为湿气过盛且水液不行，导致食物与水谷不能正常分清别浊，所以说这是体内有水气。至于其他各种症状，大都是因为水性泛滥，无处不到的缘故。真武，是北方属水的星宿之神，专门掌管水事，以此命名此汤，寓意在于治水。然而，阴寒极盛而水液泛滥，是因为阳气困弱，脾土不能制约水湿。因此，白术和茯苓能燥湿健脾以胜湿，芍药和附子能利气助阳，生姜能健脾暖土。这样水湿就有制约，阴寒得以退散，药物与病症相宜，道理上必然痊愈。
后续加减法。（针对上述各种兼症的治疗。）
如果咳嗽，加五味子半升、细辛和干姜各一两。（水寒之气相互搏结导致咳嗽，细辛和干姜的辛味可以发散水寒。既然已经发散，肺主咳嗽且需要收敛，五味子的酸味可以收敛肺气。）如果小便通畅，去掉茯苓。（茯苓淡渗利窍，小便既已通畅，就不需要再渗利了。）如果腹泻，去掉芍药，加干姜二两。（芍药收敛阴气并停滞津液，不适合腹泻患者，所以去掉它。干姜能散寒暖土，土暖则水有制约，所以加上它。）如果呕吐，去掉附子，加生姜，总量达到半斤。（呕吐是气机上逆。去掉附子，是因为附子固摄气机；加生姜，是因为生姜能疏散气机。）
（三十七）少阴病，下利排出未消化的食物残渣（完谷不化），里寒外热，手足厥冷，脉象微弱几乎摸不到，身体反而不恶寒，面色发红。或者伴有腹痛，或者干呕，或者咽痛，或者腹泻停止但脉搏仍不出来的情况，应以通脉四逆汤（Pulse-Restoring Four Reversal Decoction）为主治方剂。
通脉四逆汤方剂组成：
甘草（二两，炙烤） 干姜（三两，体质强壮者可增至四两） 附子（大者一枚，生用，去皮，破成八片）
以上三味药。用水三升。煮取一升二合。去渣。分两次温服。如果脉搏随即复出，即为痊愈。
下利完谷不化，手足厥冷，脉微欲绝且里有寒邪，说明阴寒在体内极盛。身体反而不恶寒，面色赤红且表现为外热，这是阳气被格拒于体外所致。阴阳之气不相交通，所以气机逆乱而出现多种症状。虽然腹泻停止看似邪气欲罢，但如果脉搏仍不出，说明阳气尚未恢复。脉是气血运行的道路，血属阴，没有阳气的推动就无法运行。干姜和附子辛热，能辅助阳气；甘草甘平，能益气。本汤即四逆汤，只是分量不同，所谓“通脉”就是指增加干姜的用量。
后续加减法。（同前文原则。）
面色发红的，加葱白九茎。（面色赤，说明阳气格拒严重。加葱白，旨在通达阳气。）腹中痛的，去掉葱白，加芍药二两。（腹中痛，是真阴不足。去掉葱白，是厌恶其顺阳发散；加芍药，是为了收敛阴气。）呕吐的，加生姜二两。（见前文解释。）咽痛的，去掉芍药，加桔梗一两。（咽痛，是气机郁结。去掉芍药，是因为它聚气；加桔梗，是为了利咽。）腹泻停止但脉搏不出来的，去掉桔梗，加人参二两。（腹泻停止脉搏不出见上文。去掉桔梗，是嫌其载药上行而缺乏畅通之力；加人参，是为了生发阳气并调和阴气。）
（三十八）少阴脉弱于趺阳脉的，属于顺证。
这是承接上文关于自发性腹泻的内容，向人们展示诊断吉凶利害的大意。意思是说，少阴属水，其发生自利是因为阴寒极盛，脾土虚弱而不能制约水湿。趺阳脉主胃，属土。所谓“负”，是指趺阳脉尚有脉象，说明脾土尚强。土强则能制水，而少阴反居输负之位。所谓“顺”，是指不以受制为拘束。因为水只有得到制约，才能最终遵循正道，不至于泛滥成大害。况且万物依靠土而生，人体骨骼肌肉依靠胃气滋养，水土平和，物类安宁，这不是天下最顺遂的状态吗？古今认为趺阳脉存在就不死的说法，是有道理的。
（三十九）少阴病，四肢厥冷，有的患者伴有咳嗽，或心悸，或小便不利，或腹中痛，或泄泻伴肛门重坠感，应以四逆散（Four Reversal Powder）为主治方剂。
四逆散方剂组成：
甘草（炙烤） 枳实（破碎，用水浸泡后炙干） 柴胡 芍药
以上四味药，各取十分。捣碎过筛，用米汤调和，每次服用一方寸匕。每日服用三次。
“分”，读作去声，同上字。人的四肢，温和为顺，所以将不温和称为“逆”。但只要不温和而未达到厥冷的程度，说明热邪尚未深入。因此用柴胡来解表透邪。枳实用来泄降。既然是热邪，邪气欲解本应依赖阴气，阴气主收敛，故用芍药来收敛。甘草用来调和诸药。“分”，相当于现在的二钱五分。
后续加减法。（同前文原则。）
咳嗽的，加五味子和干姜各五分，同时也主治下痢。（咳嗽见前文。同时主治下利，也是发散水寒、收敛泄气的意思。）心悸的，加桂枝五分。（心主悸动，桂枝能通心气。）小便不利的，加茯苓五分。（见前文解释。）腹中痛的，加附子一枚，炮制至裂开。（腹中痛，是寒邪极盛。附子能温煦散寒。）
泄泻伴肛门重坠感的，先用水五升，煮薤白三升，煮取三升。去渣。将四逆散三方寸匕放入药汤中，再煮取一升半。分两次温服。（肛门重坠，是气机阻滞。薤白具有疏泄作用。）
（四十）少阴病，腹泻六七天，伴有咳嗽、呕吐、口渴、心烦、无法入睡的症状，应以猪苓汤（Polyporus Decoction）为主治方剂。
腹泻，固然是阴寒极盛而水液失去制约所致。但六七天后来出现咳嗽、呕吐、口渴、心烦、不得眠，是因为水寒之气相互搏结，蓄积不行，导致内部烦闷而不安宁。猪苓汤的作用，是通过分清泌浊来清理水谷运行的两道通道。两道通道清澈，则腹泻没有不止的道理。腹泻停止后，呕吐、口渴、心烦等症状，无需特别治疗也会自愈。该方剂详见阳明篇。
（四十一）少阴病，发病两三天，出现口燥咽干的，应当紧急攻下，适宜使用大承气汤（Major Order the Qi Decoction）。
口燥咽干，是因为少阴经脉循行喉咙，挟持舌根。邪热客居于经脉，导致肾水枯竭。然而水干则脾土燥，土燥则水更加干枯，所以急于攻下。该方剂详见阳明篇，下同。
（四十二）少阴病，下利排出纯青色清水，心下部必定疼痛，口干燥的，应当紧急攻下，适宜使用大承气汤。
水，代表肾邪；青，代表肝色。这是肾邪传变至肝。心下部必定疼痛，是因为少阴经脉的分支，从肺出来联络心脏，注入胸中。口干燥见上文，所以治疗方法相同。
（四十三）少阴病，六七天，出现腹胀、不大便的，应当紧急攻下，适宜使用大承气汤。
腹胀且不大便，可知是胃腑实证。急于攻下，是因为少阴属水，厌恶土气壅实。
（四十四）少阴病，脉象沉伏的，应当紧急温阳，适宜使用四逆汤（Four Reversal Decoction）。
脉沉，说明寒邪深入体内。温阳不容迟缓，必须紧急进行。该方剂详见太阳中篇，下同。
（四十五）少阴病，饮食入口即吐，心中感觉温热想吐却又吐不出来，刚开始发病时手足寒冷，脉象弦迟的，这是胸中有实邪，不可攻下，应当采用催吐法。如果是膈上有寒饮，导致干呕的，不可催吐，应当紧急温阳，适宜使用四逆汤。
饮食入口即吐，是因为少阴主司喉咙，寒邪客犯所致。少阴经脉络心，注入胸中。“实”，指痰浊壅塞而上逆。“寒”，指虚寒而言。“温”，有补益之意。
（四十六）少阴病，腹泻，脉象微涩，呕吐且出汗，必然频繁上厕所但排便量反而很少的，应当温灸上部穴位。
“数”，音朔。“更”，读平声。“反少”的“少”，读上声。脉微，是阳气虚弱；脉涩，是血液亏少。出汗，是阳气虚弱不能固护于外，阴血虚弱不能守持于内。“更衣”见阳明篇解释。排便次数多但量少，是因为阳气虚弱导致气机下坠，血少所以频繁用力排便却只能空坐。所谓“上”，指的是头顶部的百会穴。灸法可以升举阳气以调养阴血。
Scallion White (four stalks) Dried Ginger (two liang) Aconite Root (one piece, raw, skin removed, broken into eight pieces) Human Urine (five he) Pig Bile (one he)
The above three ingredients [Note: Text says "three ingredients" but lists five items including urine and bile added later; context implies the base decoction ingredients or a specific preparation step]. Use three sheng of water. Boil to obtain one sheng. Remove the dregs. Add the bile and human urine. Mix well until harmonious. Divide into two doses and take warm. If bile is unavailable, it may be omitted or substituted.
"Niao" (urine) is the same as "Niao". Pronounced "Nu Diao Qie". This follows the previous clause to further discuss more severe conditions. A faint pulse indicates Yang deficiency. Cold limbs, absence of pulse, dry heaving, and irritability occur because when treating cold with hot medicines, if the cold pathogen is extremely severe, it causes rejection, preventing the medicine from entering the body. The decoction becomes ineffective and instead causes chaotic reversal of qi. Human urine is cold in nature, and pig bile is slightly cold. Using them as guides aligns with the classic saying: "Follow the contrary," which refers to this situation. "Sudden emergence" is like a candle flame flaring up just before extinguishing; "gradual continuation" signifies the return and gradual recovery of True Yang. However, this belongs to the category of modifications. It is suspected that this formula entry was added by later authors.
(36) Shaoyin disease (disease of the Shaoyin channel), persisting for two to three days without resolution, progressing to four or five days, presenting with abdominal pain, difficulty in urination, heaviness and pain in the four limbs, and spontaneous diarrhea. This is due to the presence of retained fluid (Shui Qi). Some patients may also experience cough, or clear urination, or diarrhea, or vomiting. Zhenwu Tang (True Warrior Decoction) should be used as the primary treatment.
Zhenwu Tang Formula:
Poria (three liang) Paeonia Root (three liang) Fresh Ginger (three liang, sliced) Atractylodes Macrocephala Rhizome (two liang) Prepared Aconite Root (one piece, processed, skin removed, broken into eight pieces)
The above five ingredients. Use eight sheng of water. Boil to obtain three sheng. Remove the dregs. Take seven ge warm per dose, three times daily.
Abdominal pain and difficulty in urination result from severe internal Yin-cold and excessive dampness causing stagnation of fluids. Heaviness and pain in the four limbs are caused by cold-dampness infiltrating internally and pressing outwardly on the exterior. Spontaneous diarrhea occurs because excessive dampness and stagnant fluids prevent the proper separation of food and fluids, hence described as "retained fluid." Other symptoms arise largely because water properties tend to overflow and affect all areas. Zhenwu refers to the deity of water in the North (associated with the Black Tortoise constellation), whose duty is specifically managing water. Naming the decoction after him implies its function in regulating water. However, when Yin-cold is extreme and water overflows, it is because Yang is constrained and weak, failing to control the water via Spleen Earth. Therefore, Atractylodes and Poria dry the earth and overcome dampness; Paeonia and Aconite promote Qi and assist Yang; Fresh Ginger strengthens the Spleen and warms the Earth. Thus, water is controlled, and Yin-cold recedes. The medication suits the pathology, and according to principle, cure is certain.
Subsequent Modification Method (Treatment for various accompanying symptoms):
If coughing, add Schisandra Berry (Ban Sheng) and Fineleaf Asarum and Dried Ginger (each one liang). (Water and cold fighting each other causes cough; the pungency of Fineleaf Asarum and Dried Ginger disperses water-cold. Once dispersed, since the Lung governs cough and requires consolidation, the sourness of Schisandra Berry consolidates it.) If urination is clear/profuse, remove Poria. (Poria is bland and promotes diuresis; if urination is already clear, diuresis is unnecessary.) If diarrhea, remove Paeonia Root and add Dried Ginger (two liang). (Paeonia Root consolidates Yin and retains fluids, unsuitable for diarrhea, so it is removed. Dried Ginger disperses cold and warms the Earth; warmed Earth controls water, so it is added.) If vomiting, remove Aconite Root and add Fresh Ginger, totaling half a jin. (Vomiting is rebellious Qi. Aconite Root is removed because it secures Qi; Fresh Ginger is added because it disperses Qi.)
(37) Shaoyin disease, characterized by diarrhea with undigested food (Wan Gu Bu Hua), internal cold with external heat, cold limbs, faint pulse nearly imperceptible, yet the body does not feel aversion to cold, and the face appears red. Alternatively accompanied by abdominal pain, dry heaving, sore throat, or cessation of diarrhea with no pulse emerging. Tongmai Sini Tang (Pulse-Restoring Four Reversal Decoction) should be used as the primary treatment.
Tongmai Sini Tang Formula:
Licorice Root (two liang, honey-fried) Dried Ginger (three liang, four liang for robust individuals) Large Raw Aconite Root (one piece, skin removed, broken into eight pieces)
The above three ingredients. Use three sheng of water. Boil to obtain one sheng and two he. Remove the dregs. Divide into two warm doses. If the pulse emerges, the patient will recover.
Diarrhea with undigested food, cold limbs, and faint pulse with internal cold indicate severe Yin-cold within. The body not feeling aversion to cold, with a red face and external heat signs, indicates Yang being rejected to the exterior. Yin and Yang fail to communicate, leading to chaotic Qi and various symptoms. Although diarrhea stopping might suggest the evil is subsiding, if the pulse still does not emerge, it means Yang has not recovered. The pulse is the pathway of Blood and Qi. Blood is Yin and cannot move without Yang. Dried Ginger and Aconite are pungent and hot, assisting Yang; Licorice is sweet and neutral, benefiting Qi. This decoction is essentially Sini Tang but with different dosages; "restoring the pulse" refers to increasing the amount of Ginger.
Subsequent Modification Method (Same as before):
For red face, add nine stalks of Scallion White. (Red face indicates severe Yang rejection; adding Scallion White unblocks Yang Qi.) For abdominal pain, remove Scallion White and add Paeonia Root (two liang). (Abdominal pain indicates insufficiency of True Yin; removing Scallion White avoids promoting Yang dispersion; adding Paeonia Root consolidates Yin.) For vomiting, add Fresh Ginger (two liang). (See previous explanation.) For sore throat, remove Paeonia Root and add Platycodon Root (one liang). (Sore throat indicates Qi knotting; removing Paeonia Root avoids gathering Qi; adding Platycodon Root benefits the throat.) For cessation of diarrhea with no pulse, remove Platycodon Root and add Ginseng Root (two liang). (Cessation of diarrhea with no pulse seen above; removing Platycodon Root is to avoid its upward bearing lacking smooth flow; adding Ginseng Root generates Yang and harmonizes Yin.)
(38) When the Shaoyin pulse is weaker than the Fuyang pulse, it is considered a favorable condition (Shun).
This follows the discussion on spontaneous diarrhea to illustrate the general principles of diagnosing auspicious and inauspicious outcomes. It means that Shaoyin belongs to Water; spontaneous diarrhea occurs due to severe Yin-cold where weak Earth fails to control Water. Fuyang pulse governs the Stomach and belongs to Earth. "Fu" (defeat/loss) here means the Fuyang pulse is still present, indicating Earth is still strong. Strong Earth can control Water, making Shaoyin relatively subordinate. "Shun" (favorable) means not being constrained by subordination. Because only when Water is controlled can it eventually follow the Dao and not cause disaster through flooding. Moreover, all things are born from Earth, and the body relies on the Stomach for nourishment. When Water and Earth are balanced, all classes of things are at peace. Is this not the greatest favorableness in the world? Since ancient times, it has been said that if the Fuyang pulse exists, death does not occur, which is reasonable.
(39) Shaoyin disease, with cold limbs (Si Ni). Accompanying symptoms may include cough, palpitations, difficulty in urination, abdominal pain, or diarrhea with a sensation of rectal tenesmus (Xie Li Xia Zhong). Sixni San (Four Reversal Powder) should be used as the primary treatment.
Sixni San Formula:
Licorice Root (honey-fried) Immature Bitter Orange (broken, soaked in water, then dried and fried) Bupleurum Root Paeonia Root
The above four ingredients, each taken in equal parts ("fen"). Pound and sift. Mix with rice water and take one fang cun bi per dose, three times daily.
"Fen" is pronounced with the departing tone. The four limbs of humans are favorable when warm; thus, lack of warmth is called "Ni" (reversal/cold). However, if they are merely cool and not yet cold, the heat pathogen has not penetrated deeply. Therefore, Bupleurum Root is used to resolve it. Immature Bitter Orange is used to drain/descend. Since it is a heat pathogen, resolving it relies on Yin; Yin tends to consolidate, so Paeonia Root is used to consolidate. Licorice Root harmonizes. "Fen" corresponds to approximately 2.5 qian today.
Subsequent Modification Method (Same as before):
For cough, add Schisandra Berry and Dried Ginger (each 5 fen), also primarily treating dysentery. (Cough seen previously. Also treating dysentery reflects the intent to disperse water-cold and consolidate/restrict Qi.) For palpitations, add Cinnamon Twig (5 fen). (The Heart governs palpitations; Cinnamon Twig unblocks Heart Qi.) For difficulty in urination, add Poria (5 fen). (See previous explanation.) For abdominal pain, add one Aconite Root, processed until cracked. (Abdominal pain indicates severe cold; Aconite Root warms it.)
For diarrhea with rectal tenesmus, first boil Leek Allium (three sheng) in five sheng of water to obtain three sheng. Remove dregs. Add three fang cun bi of the powder to the decoction. Boil to obtain one sheng and half. Divide into two warm doses. (Tenesmus indicates Qi stagnation; Leek Allium has a draining/dispersing effect.)
(40) Shaoyin disease, diarrhea lasting six to seven days, accompanied by cough, vomiting, thirst, irritability, and inability to sleep. Zhuling Tang (Polyporus Decoction) should be used as the primary treatment.
Diarrhea is indeed due to severe Yin-cold and loss of fluid control. However, the appearance of cough, vomiting, thirst, irritability, and insomnia after six to seven days indicates that water and cold are fighting and accumulating, causing internal stifling and restlessness. Zhuling Tang functions to clarify the two pathways of water and grain separation. Once these pathways are clear, diarrhea will inevitably stop. Once diarrhea stops, vomiting, thirst, and irritability will heal spontaneously without further treatment. See Yangming Chapter for the formula.
(41) Shaoyin disease, developing mouth dryness and throat dryness within two to three days. Urgent purgation is required. Da Chengqi Tang (Major Order the Qi Decoction) is suitable.
Mouth and throat dryness occur because the Shaoyin meridian runs along the throat and surrounds the root of the tongue. Pathogenic heat lodging in the meridian depletes Kidney Water. When Water is dry, Earth becomes dry; when Earth is dry, Water becomes even drier. Hence, urgent purgation is necessary. See Yangming Chapter for the formula, same below.
(42) Shaoyin disease, passing pure green watery stool,必有 (must have) pain in the epigastrium, and mouth dryness. Urgent purgation is required. Da Chengqi Tang is suitable.
Water represents Kidney evil; Green represents Liver color. This indicates Kidney evil transmitting to the Liver. Pain in the epigastrium occurs because a branch of the Shaoyin meridian emerges from the Lung, connects to the Heart, and enters the chest. Mouth dryness is seen above; thus, the treatment is the same.
(43) Shaoyin disease, after six to seven days, presenting with abdominal distension and constipation. Urgent purgation is required. Da Chengqi Tang is suitable.
Abdominal distension and constipation indicate Stomach excess (Wei Shi). Urgent purgation is needed because Shaoyin belongs to Water and dislikes Earth excess.
(44) Shaoyin disease, with a deep pulse (Mai Chen). Urgent warming is required. Sini Tang (Four Reversal Decoction) is suitable.
A deep pulse indicates cold pathogen penetrating deeply into the interior. Warming cannot be delayed; it must be urgent. See Taiyang Middle Chapter for the formula, same below.
(45) Shaoyin disease, vomiting immediately after food enters the mouth, feeling warm and wanting to vomit but unable to do so. At onset, cold hands and feet, with a string-tight (Xuan) and slow (Chi) pulse. This is excess in the chest (Xiong Zhong Shi); purgation is contraindicated. Vomiting induction should be used. If there is cold-fluid retention above the diaphragm causing dry heaving, vomiting induction is contraindicated. Urgent warming is required. Sini Tang is suitable.
Vomiting upon ingestion occurs because Shaoyin governs the throat and cold pathogen lodges there. The Shaoyin meridian connects to the Heart and enters the chest. "Excess" refers to phlegm turbidity obstructing upwards. "Cold" refers to deficiency-cold. "Warm" implies tonification.
(46) Shaoyin disease, diarrhea, with a faint and choppy (Se) pulse, vomiting and sweating. Frequent trips to the toilet but scant output. Warm the upper part and moxibustion should be applied.
"Shu" is pronounced "Shuo". "Geng" is pronounced with the level tone. "Shao" in "Fan Shao" is pronounced with the rising tone. Faint pulse indicates Yang deficiency; Choppy pulse indicates Blood deficiency. Sweating indicates Yang deficiency failing to secure the exterior and Yin deficiency failing to guard the interior. "Geng Yi" (changing clothes/toilet) is explained in the Yangming Chapter. Frequent visits with scant output occur because Yang deficiency causes Qi to sink, and Blood deficiency leads to frequent straining with empty sitting. "Upper" refers to the top of the head, Baihui (GV20). Moxibustion raises Yang to nourish Yin.