【纲】仲景曰。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。或利止。脉不出者。通脉四逆汤主之。下利清谷。里寒外热。汗出而厥者。
通脉四逆汤主之。下利。脉沉而迟。其人面少赤。身有微热。下利清谷者。必郁冒。汗出而解。病
人必微厥。所以然者。其面戴阳。下虚故也。脉浮而迟。表热里寒。下利清谷者。四逆汤主之。
【目】朱肱曰。大抵阴症发热。终是不同。脉须沉。或下利。手足厥也。病患尺寸脉俱沉细。
但欲寐者。少阴症也。急作四逆汤复其阳。
柯琴曰。首条。寒热相半症。下利清谷。阴盛于里也。二条。比首条脉症皆轻。因其下虚。故
下利清谷而厥逆。此阴阳相等。寒热自和。故易愈。三条之脉。浮中见迟。未经妄下而利清谷。是
表为虚热。里有真寒也。仲景凡治虚症。以里为主。
【纲】仲景曰。下利清谷。不可攻表。汗出必胀满。
【目】张兼善曰。里气其既虚矣。其何能藏精而为阳之守乎。幸得表阳尚存。可以卫外。而犹不
致于坏也。若又攻之。则表亦必虚。表虚则汗泄。汗出亡阳。其脏必寒而生胀满矣。可不戒哉。
【纲】仲景曰。伤寒下之后。续得下利清谷不止。身疼痛者。急当救里。宜四逆汤。
【目】徐彬曰。病。医下之。续得下利清谷不止。身体疼痛者。急当救里。后身体疼痛。清便
自调者。急当救表。按此言医宜知缓急先后之序也。谓表里分治。常理也。乃有表而复有里。倘因
误下而来。不得如余邪未清。双解表里。虽身疼痛。不可治表。谓稍缓而表邪将尽入内。故曰。急
当救里。迨清便调而身仍痛。又不得以余邪而忽之。谓内既曾利。稍缓而里将复受表邪。下利不止
也。故又曰。急当救表。
【纲】仲景曰。既吐且利。小便复利。而大汗出。下利清谷。内寒外热。脉微欲绝者。四逆汤
主之。
【目】黄仲理曰。此乃气血丧亡。故完谷不化。脉微欲绝也。
【纲】张仲景说：少阴病（少阴经受邪所致的病证），出现下利清谷（腹泻且排出未消化的食物），体内寒冷而体表发热，手足冰冷逆冷，脉搏微弱几乎摸不到。身体反而不觉得怕冷，患者面色发红。或者伴有腹痛，或者干呕，或者腹泻停止但脉搏仍摸不到的情况，应当用通脉四逆汤（由附子、干姜、甘草组成，具有回阳救逆、通达血脉功效的方剂）主治。如果是下利清谷，体内寒冷而体表发热，出汗且四肢厥冷的情况，也用通脉四逆汤主治。如果是腹泻，脉搏沉而迟缓，患者面部稍微发红，身体有轻微发热，且下利清谷的，必然会出现郁冒（头晕目眩、意识模糊的症状），通过出汗而病解。病人必然会有轻微的厥冷。之所以这样，是因为其面部戴阳（虚阳上浮于面），这是下焦虚寒的缘故。如果是脉搏浮而迟缓，表热里寒，下利清谷的，用四逆汤（由附子、干姜、甘草组成，具有回阳救逆功效的方剂）主治。
【目】朱肱说：大抵阴症（阴经病变或阴寒性质的病症）发热，终究是不同的。脉象必须沉，或者伴有下利，手足厥冷。如果病患寸口和尺口的脉象都沉细，只想睡觉的，是少阴症。应当紧急制作四逆汤来恢复其阳气。
柯琴说：第一条所述，是寒热各半的症状，下利清谷，说明阴寒盛于体内。第二条相比第一条，脉症都比较轻。因为下焦虚弱，所以下利清谷并出现厥逆。这是阴阳相等，寒热自和，所以容易痊愈。第三条的脉象，浮中见迟，未经误下而导致下利清谷，这是表为虚热，里有真寒。张仲景凡是治疗虚症，都以调理里气为主。
【纲】张仲景说：下利清谷，不可攻表（使用发汗法解除表邪）。如果发汗，必然导致腹胀满。
【目】张兼善说：里气既然已经虚弱，怎么能固藏精气作为阳气的守备呢？幸好表阳尚存，可以护卫体外，而不至于病情恶化。如果又去攻表，那么表气也必然虚弱。表虚则汗泄，出汗导致亡阳，内脏必然寒冷而生胀满。能不警惕吗？
【纲】张仲景说：伤寒经过泻下治疗后，接着出现下利清谷不止，身体疼痛的，应当紧急救治里气，适宜用四逆汤。
【目】徐彬说：患病，医生误用泻下法，接着出现下利清谷不止，身体疼痛的，应当紧急救治里气。后来身体仍然疼痛，但大小便正常的，应当紧急救治表邪。按此说法，医生应当知道缓急先后的次序。表里分治是常理。但是如果有表证又有里证，如果是因误下引起的，就不能像其他余邪未清那样双解表里。虽然身体疼痛，也不可治表，因为稍一迟缓，表邪将全部入内。所以说“紧急当救里”。等到二便调畅而身体仍然痛，又不能因为有余邪而忽视它，因为内部曾经下利，稍一迟缓，里气将再次受表邪侵袭，导致下利不止。所以又说“紧急当救表”。
[General Principle] Zhang Zhongjing stated: In Shaoyin disease (a syndrome caused by pathogenic invasion of the Shaoyin meridians), characterized by diarrhea with undigested food, internal cold and external heat, cold extremities, and a faint pulse nearly imperceptible. The body may paradoxically feel no aversion to cold, and the patient's complexion may appear red. Alternatively, there may be abdominal pain, dry retching, or cessation of diarrhea while the pulse remains unpalpable. In such cases, Tongmai Sini Decoction (Cinnamon Twig and Aconite Decoction for Unblocking the Pulse) is indicated. If the presentation involves diarrhea with undigested food, internal cold and external heat, sweating, and cold extremities, Tongmai Sini Decoction is also indicated. If there is diarrhea, a deep and slow pulse, slight facial redness, mild body heat, and diarrhea with undigested food, the patient will inevitably experience dizziness and confusion (Yu Mao), which will resolve through sweating. The patient will likely exhibit mild cold extremities. This occurs because of "floating yang on the face" (Dai Yang), resulting from deficiency-cold in the lower jiao. If the pulse is floating and slow, indicating external heat and internal cold, accompanied by diarrhea with undigested food, Sini Decoction (Aconite Decoction) is indicated.
[Commentary] Zhu Gong stated: Generally, fever in Yin syndromes (syndromes of yin nature or involving yin meridians) is distinct. The pulse must be deep, possibly accompanied by diarrhea and cold extremities. If both the Cun (inch) and Chi (cubit) pulses are deep and fine, and the patient desires sleep, it is a Shaoyin syndrome. One should urgently prepare Sini Decoction to restore yang qi.
Ke Qin stated: The first clause describes a condition where cold and heat are equally present; diarrhea with undigested food indicates excess yin-cold within. The second clause presents milder symptoms and pulse compared to the first. Due to lower jiao deficiency, diarrhea with undigested food and cold extremities occur. Here, yin and yang are balanced, and cold and heat harmonize naturally, making recovery easier. In the third clause, the pulse is floating yet reveals slowness; diarrhea with undigested food occurs without prior erroneous purgation, indicating empty-heat at the exterior and true cold within. Whenever treating deficiency syndromes, Zhang Zhongjing prioritizes regulating the interior.
[General Principle] Zhang Zhongjing stated: In cases of diarrhea with undigested food, one must not attack the exterior (use diaphoresis). Sweating will inevitably lead to abdominal distension.
[Commentary] Zhang Jianshan stated: Since the interior qi is already deficient, how can it store essence and serve as the guardian of yang? Fortunately, if exterior yang remains, it can protect the exterior, preventing deterioration. However, if one again attacks the exterior, the exterior qi will become deficient. Exterior deficiency leads to sweat leakage; loss of sweat results in loss of yang, causing the zang organs to become cold and generate distension. How can one not be vigilant?
[General Principle] Zhang Zhongjing stated: After a Taiyang cold injury has been treated with purgation, if diarrhea with undigested food persists incessantly, accompanied by body pain, one must urgently rescue the interior. Sini Decoction is appropriate.
[Commentary] Xu Bin stated: When a patient suffers from illness and the physician erroneously uses purgation, leading to incessant diarrhea with undigested food and body pain, one must urgently rescue the interior. Later, if body pain persists but bowel movements normalize, one must urgently rescue the exterior. This illustrates that physicians must understand the order of urgency and priority. Treating exterior and interior separately is the general rule. However, when both exterior and interior syndromes exist, especially if caused by erroneous purgation, one cannot simply resolve both simultaneously as with residual pathogens. Even with body pain, the exterior should not be treated, as delaying might allow exterior pathogens to fully enter the interior. Hence, "urgently rescue the interior." Once bowels are regulated but pain persists, one must not ignore it as mere residual pathogen, because previous diarrhea implies the interior is vulnerable to re-invasion by exterior pathogens, potentially causing persistent diarrhea. Hence, "urgently rescue the exterior."
[General Principle] Zhang Zhongjing stated: In cases of simultaneous vomiting and diarrhea, frequent urination, profuse sweating, diarrhea with undigested food, internal cold and external heat, and a faint pulse nearly imperceptible, Sini Decoction is indicated.
[Commentary] Huang Zhongli stated: This results from the loss of qi and blood, leading to the excretion of undigested food and a faint, nearly imperceptible pulse.