少阴病，始得之，无汗恶寒，反发热脉沉者，麻黄附子细
辛汤主之。
太阳主表，病发于阳，故当发热；少阴主里，病发于阴，只当内热。今始得寒邪，即便发热，似乎太阳，而
属之少阴者何？《内经》曰∶“逆冬气则少阴不藏，肾气独沉。”故反热而脉则沉也。肾为坎象，二阴不藏，则
一阳无蔽，阴邪始得而内侵，孤阳因得以外散耳。病在表脉浮者，可发汗可知；病在表脉沉者，亦不可不汗矣。
然沉为在里，而反发其汗，津液越出，亡阳则阴独矣。故用麻黄开腠理，细辛散浮热，而无附子固元阳，则热去
寒起，亡可立待也。其人不知养藏之道，逆冬气而伤肾，故有此证。能不扰乎阳，无泄皮肤，去寒就温，讵有
此患哉？本条当有无汗恶寒证。
少阴病，始得之二三日，麻黄附子甘草汤微发汗。以二三日无里证，故微发汗也。
言无里证，则有表证可知。以甘草易细辛，故曰微发汗。要知此条是微恶寒、微发热，故微发汗也。《皮部论》
云∶“少阴之阴，其入于经也，从阳部注于经；其出者，从阴内注于骨。”此证与附子汤证，皆是少阴表证。发
热脉沉无里证者，从阳部注于经也；身体骨节痛，手足寒，背恶寒，脉沉者，从阴内注于骨也。从阳注经，故用麻
黄、细辛；从阴注骨，故用参、苓、术、芍。口中和，枢无热，皆可用附子。
麻黄附子细辛汤∶
麻黄 细辛（各三两） 附子（一枚，炮去皮）
水一斗，先煮麻黄，减二升，去沫沸，内诸药，煮取三升，去滓，温服一升，日三服。
麻黄附子甘草汤∶
前方去细辛加甘草二两，水七升，煎法同。亦见微发汗之意。
少阴病八九日，一身手足尽热者，以热在膀胱，必便血也。
此藏病传府，阴乘阳也，气病而伤血，阳乘阴也，亦见少阴中枢之象。发于阴者六日愈，到七日其人微发
热手足温者，此阴出之阳则愈
也。到八日以上，反大发热者，肾移热于膀胱，膀胱热则太阳经皆热。太阳主一身之表，为诸阳主气。手足者
诸阳之本，故一身手足尽热。太阳经多血，血得热则行。阳病者，上行极而下，故尿血也。此里传表证，是自阴
转阳则易解，故身热虽甚不死。轻则猪苓汤，重则黄连阿胶汤可治。与太阳热结膀胱血自下者，证同而来因则异。
少阴传阳证者有二∶六七日腹胀不大便者，是传阳明；八九日一身手足尽热者，是传太阳。
下利便脓血，指大便言；热在膀胱而便血，是指小便言。
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。
上咳下利，津液丧亡，而谵语非转属阳明。肾主五液，入心为汗。少阴受病，液不上升，所以阴不得有汗也。
少阴发热，不得已用麻黄发汗，即用附子以固里，岂可以火气劫之而强发汗也？少阴脉入肺，出络心。肺主声，
心主言，火气迫心肺，故咳而谵语也。肾主二便，治下焦，济泌别汁，渗入膀胱。今少阴受邪，复受火侮，枢
机无主，大肠清浊不分，膀胱水道不利，故下利而小便难也。小便利者，其人可治。此阴虚，故小便难。
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。
阳气不达于四肢，故厥。厥为无阳，不能作汗，而强发之。血之与汗，异名同类，不夺其汗，必动其血矣。
上条火劫发汗，上伤心肺，下竭膀胱，犹在气分，其害尚轻。峻剂发汗，伤经动血。若阴络伤而下行，犹或可救；
若阳络伤而上溢，不可复生矣。妄汗之害如此。
少阴病，初起时，无汗、怕冷，反而出现发热、脉象沉的，用麻黄附子细辛汤主治。
太阳主司体表，病发于阳经，所以应当发热；少阴主司体内，病发于阴经，只应当有内热。现在刚感受寒邪，就立即发热，看似太阳病，却归属于少阴病，这是为什么呢？《内经》说：“违背冬季闭藏之气，则少阴不藏，肾气独陷。”所以反而发热而脉象沉。肾对应坎卦之象，二阴（指少阴中的阴精）不固藏，则一阳（指命门之火）失去遮蔽，阴邪才得以侵入体内，孤阳因此得以向外发散。病在表且脉浮的，可以发汗，这是显而易见的；病在表但脉沉的，也不可不用发汗法。然而沉脉主里，如果反而发汗，津液外泄，导致亡阳而阴独存，那就危险了。所以用麻黄开泄腠理，细辛散除浮热，如果没有附子固护元阳，那么热去寒起，死亡就在眼前了。这个人不懂得养藏的道理，违背冬气而损伤肾脏，所以出现这种证候。如果能不扰动阳气，不使皮肤开泄出汗，远离寒冷趋向温暖，怎会有这种祸患呢？本条应当有无汗、恶寒的症状。
少阴病，初起二三天，用麻黄附子甘草汤微发汗。因为二三天没有里证，所以只是微发汗。
说没有里证，那么有表证就可以知道了。用甘草代替细辛，所以说微发汗。要知道此条是微恶寒、微发热，所以才微发汗。《素问·皮部论》说：“少阴之阴，进入经脉，是从阳部注入经脉；它外出，是从阴内部注入骨骼。”此证与附子汤证，都是少阴表的证候。发热、脉沉、无里证的，是从阳部注入经脉；身体骨节疼痛、手足寒冷、背部怕冷、脉沉的，是从阴内部注入骨骼。从阳注入经脉，所以用麻黄、细辛；从阴注入骨骼，所以用人参、茯苓、白术、芍药。口中平和，枢机无热，都可以使用附子。
麻黄附子细辛汤：
麻黄、细辛（各三两）、附子（一枚，炮制去皮）
用水一斗，先煮麻黄，减少二升，撇去沫沸，加入其他药物，煮取三升，去渣，温服一升，每日三次。
麻黄附子甘草汤：
前方去掉细辛，加甘草二两，用水七升，煎煮方法相同。也体现了微发汗的意思。
少阴病八九天，全身和手足都发热的，是因为热在膀胱，一定会便血。
这是脏病传腑，阴乘阳位，气病伤血，阳乘阴位，也显示出少阴中枢的象。病发于阴经者六天痊愈，到第七天其人微发热、手足温暖的，这是阴出之阳则愈。到八日以上，反而大发热的，是肾移热于膀胱，膀胱热则太阳经都热。太阳主一身之表，为诸阳主气。手足是诸阳之本，所以全身和手足都发热。太阳经多血，血得热则运行加速。阳病者，上行至极则下行，所以尿血。这是里传表的证候，是自阴转阳则容易解除，所以身热虽然很甚也不死。轻症用猪苓汤，重症用黄连阿胶汤可治。这与太阳热结膀胱血自下的情况，证候相同但病因不同。
少阴传阳证有两种：六七天腹胀不大便的，是传阳明；八九天全身手足尽热的，是传太阳。
少阴病，咳嗽且下利谵语的，是被火气劫迫所致；小便一定困难，因为强行要求少阴发汗。
上咳下利，津液丧亡，而谵语并非转属阳明。肾主五液，入心为汗。少阴受病，液不上升，所以阴不得有汗。少阴发热，不得已用麻黄发汗，即用附子以固护里气，岂可以用火气劫迫而强行发汗呢？少阴脉入肺，出络心。肺主声，心主言，火气迫心肺，所以咳嗽且谵语。肾主二便，治下焦，济泌别汁，渗入膀胱。现在少阴受邪，又受火侮，枢机无主，大肠清浊不分，膀胱水道不利，所以下利而小便难。小便利的人，还可以治疗。这是阴虚，所以小便难。
少阴病，只有四肢厥冷无汗，而强行发汗的，必定动其血。不知道血从何道而出，或从口鼻，或从眼睛流出，这叫做下厥上竭，属于难治。
阳气不能达于四肢，所以厥。厥就是无阳，不能作汗，而强行发汗。血与汗，名称不同但同类，不夺取其汗，必定动其血了。
上一条是火劫发汗，上伤心肺，下竭膀胱，还在气分，危害尚轻。峻剂发汗，伤经动血。如果阴络受伤而下溢，或许还可救；如果阳络受伤而上溢，不可复生矣。妄用汗法的危害如此。
Shaoyin disease, when it first occurs, presents with no sweating, aversion to cold, and conversely fever with a deep pulse; Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) is the primary treatment.
Taiyang governs the exterior; diseases originating in Yang channels typically present with fever. Shaoyin governs the interior; diseases originating in Yin channels should typically present only with internal heat. Now, upon initially contracting cold pathogenic factors, fever appears immediately. Although this resembles Taiyang disease, why is it classified under Shaoyin? The *Neijing* states: "Violating the Qi of winter storage causes Shaoyin to fail to store, leading to the solitary sinking of Kidney Qi." Thus, there is conversely fever and a deep pulse. The Kidney corresponds to the Kan trigram image. When the two Yins (Yin essence within Shaoyin) fail to store, the one Yang (Mingmen fire) loses its cover, allowing Yin pathogens to invade internally, causing the isolated Yang to scatter externally. When the disease is in the exterior and the pulse is floating, diaphoresis (inducing sweating) is indicated, which is evident. When the disease is in the exterior but the pulse is deep, diaphoresis cannot be omitted. However, a deep pulse indicates an interior condition. If one were to induce sweating contrary to this, body fluids would escape, leading to the loss of Yang and leaving Yin alone, which is perilous. Therefore, Ma Huang (Ephedrae Herba) opens the interstices (cou li), Xi Xin (Asari Radix et Rhizoma) disperses floating heat, but without Fu Zi (Aconiti Lateralis Radix Praeparata) to secure the Primordial Yang, once the heat dissipates, the cold will rise, and death will follow immediately. This person did not understand the principles of nourishing and storing, violated the Qi of winter, and injured the Kidneys, resulting in this syndrome. If one could avoid disturbing Yang, prevent the skin from opening and sweating, and shun cold for warmth, how could such a disaster occur? This clause implies symptoms of no sweating and aversion to cold.
In Shaoyin disease, after two or three days, if treated with Ma Huang Fu Zi Gan Cao Tang (Ephedra, Aconite, and Licorice Decoction) to induce slight sweating, it is because there are no interior syndromes after two or three days, hence only slight sweating is induced.
Stating that there are no interior syndromes implies the presence of exterior syndromes. By replacing Xi Xin with Gan Cao (Glycyrrhizae Radix et Rhizoma), it is described as inducing slight sweating. It must be understood that this clause involves slight aversion to cold and slight fever, hence slight sweating is induced. The *Suwen: Pi Bu Lun* states: "The Yin of Shaoyin, when entering the meridians, flows from the Yang portion into the meridians; when exiting, it enters the bones from the interior Yin." This syndrome and the Fuzi Tang syndrome are both exterior syndromes of Shaoyin. Fever with a deep pulse and no interior syndrome indicates flow from the Yang portion into the meridians; body and joint pain, cold hands and feet, aversion to cold on the back, and a deep pulse indicate entry from the interior Yin into the bones. Flowing from Yang into the meridians warrants the use of Ma Huang and Xi Xin; entering from Yin into the bones warrants the use of Ren Shen (Ginseng Radix), Fu Ling (Poria), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Shao Yao (Paeoniae Radix). With a harmonious mouth and no heat at the pivot, Fu Zi can be used.
Ma Huang Fu Zi Xi Xin Tang:
Ma Huang (Ephedrae Herba), Xi Xin (Asari Radix et Rhizoma) [each 3 liang]; Fu Zi (Aconiti Lateralis Radix Praeparata) [1 piece, processed and peeled].
Boil in 10 dou of water. First boil Ma Huang, reduce by 2 dou, remove the foam, then add the other herbs. Boil until 3 sheng remain, strain, and take 1 sheng warm, three times daily.
Ma Huang Fu Zi Gan Cao Tang:
Take the above formula, remove Xi Xin, and add Gan Cao (Glycyrrhizae Radix et Rhizoma) 2 liang. Use 7 sheng of water. The decoction method is the same. This also reflects the intent of inducing slight sweating.
In Shaoyin disease, after eight or nine days, if the whole body and hands and feet are hot, it is because the heat is in the Bladder, and hematochezia or hematuria (bleeding from the lower orifices) will certainly occur.
This is a transmission from Zang (organ) to Fu (hollow organ), where Yin overcomes Yang. Qi pathology injuring Blood represents Yang overcoming Yin. This also shows the image of the Shaoyin pivot. Diseases originating in Yin heal in six days. On the seventh day, if the patient has slight fever and warm hands and feet, this indicates Yin emerging into Yang, signifying recovery. On the eighth day or later, if there is conversely high fever, it is because heat transfers from the Kidney to the Bladder. Bladder heat causes heat throughout the Taiyang meridians. Taiyang governs the exterior of the whole body and is the master of all Yang Qi. Hands and feet are the roots of all Yang Qi, hence the whole body and hands and feet become hot. The Taiyang meridians have abundant blood; when blood encounters heat, it moves rapidly. Yang diseases, rising to the extreme, descend; thus, bleeding from the urine occurs. This is a syndrome transmitting from interior to exterior, turning from Yin to Yang, which is easy to resolve; therefore, even with severe body heat, death does not ensue. Mild cases may be treated with Zhu Ling Tang (Polyporus Decoction), and severe cases with Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction). This differs from Taiyang heat binding in the Bladder with spontaneous bleeding, although the symptoms are similar, the etiology is different.
There are two types of Shaoyin transmitting to Yang syndromes: Abdominal distension with constipation after six or seven days indicates transmission to Yangming; whole body and hand-foot heat after eight or nine days indicates transmission to Taiyang.
"Diarrhea with pus and blood" refers to the stool; "heat in the Bladder causing bleeding" refers to urination.
In Shaoyin disease, cough with diarrhea and delirium results from being coerced by Fire Qi; urination will certainly be difficult due to the forced induction of sweating in Shaoyin.
Upper cough and lower diarrhea deplete body fluids, yet delirium does not indicate transmission to Yangming. The Kidney governs the five fluids, which enter the Heart to become sweat. In Shaoyin disease, fluids do not ascend, so Yin cannot produce sweat. When Shaoyin fever necessitates sweating with Ma Huang, Fu Zi must be used to secure the interior. How can one coerce sweating using Fire Qi? The Shaoyin meridian enters the Lung and emerges to connect with the Heart. The Lung governs voice, and the Heart governs speech. Fire Qi forcing the Lung and Heart causes cough and delirium. The Kidney governs the two lower orifices, manages the Lower Jiao, separates clear from turbid fluids, and渗 (seeps) them into the Bladder. Now, Shaoyin is invaded by pathogens and further harassed by Fire. The pivot lacks direction, the Large Intestine fails to separate clear from turbid, and the Bladder's water pathways are obstructed, resulting in diarrhea and difficult urination. If urination is smooth, the patient is treatable. This is due to Yin deficiency, hence difficult urination.
In Shaoyin disease, if there is only cold extremities without sweating, and one forcibly induces sweating, the blood will certainly be disturbed. It is unknown from which orifice the blood will exit; it may come from the mouth and nose, or from the eyes. This is called "Lower Cold and Upper Exhaustion," which is difficult to treat.
Yang Qi fails to reach the four limbs, causing cold extremities. Cold extremities indicate a lack of Yang, preventing sweat production. Forcibly inducing sweating affects the blood. Blood and sweat share the same origin but have different names. If sweat is not extracted, blood will be disturbed.
The previous case involved coercive sweating by Fire, damaging the Lung and Heart above and exhausting the Bladder below, remaining in the Qi level, so the harm was relatively light. Harsh diaphoretic agents damage the meridians and disturb the blood. If the Yin collaterals are damaged and bleeding flows downward, it might still be salvageable; if the Yang collaterals are damaged and bleeding flows upward, life cannot be restored. Such is the harm of reckless sweating.