【纲】仲景曰。下利。手足逆冷。无脉者。灸之。不温。若脉不还。反微喘者死。
下利后。脉绝。手足厥逆。 时脉还。手足温者生。脉不还者死。少阴病。下利。六七日。咳
而呕。渴。心烦。不得眠者。猪苓汤主之。
【目】柯琴曰。下利而热渴。下焦虚不能制水也。咳呕烦渴。肾水不升也。下利不眠。心火不
降也。凡利水之剂。必先上升。而后下降。故主此汤。
【纲】仲景曰。少阴病。下利。咽痛。胸满。心烦者。猪肤汤主之。
少阴病。呕而咽中痛。生疮。不能语言。声不出者。苦酒汤主之。
【目】鳌按。首条下利。肾元虚也。次条呕逆。肾火冲也。
【纲】仲景曰。少阴病。四逆。泄利下重。其人或咳。或悸。或小便不利。或腹中痛者。四逆
散主之。
【目】朱肱曰。问。仲景少阴四逆汤。又有散。何也。答曰。大抵少阴病。不可便用热药。且
亦有表热者。名晚发热。用麻黄、细辛辈发汗。终不成少阴症便不得发汗耶。今少阴病四肢冷。亦
有内热者。故用四逆散也。汤用干姜、附子。而散则主热症也。
【纲】仲景曰。少阴病。下利止而头眩。时时自冒者死。
【目】柯琴曰。此症阳回利止。是水谷已竭。无物更行。头眩而时时自冒。清阳之气已脱也。
【纲】仲景曰。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。
【目】朱肱曰。寒毒入胃者。脐下必寒。腹胀满。大便黄白。或青黑。或下利清谷。宜四逆汤、
理中汤、白通加附子汤、四逆加薤白散。挟热利者。脐下必热。大便赤黄色。及肠间津液垢腻。宜
黄芩汤、白头翁汤、三黄熟艾汤、薤白汤、赤石脂丸。三黄熟艾汤。治伤寒四日而大下。热利时作。
白通诸药多不得止。宜服此。除热止利。薤白汤。治伤寒下利如烂肉汁。赤带下。伏气腹痛。诸热
症。悉皆主之。湿毒瓦斯甚者。下利腹痛。大便如脓血。或如烂肉汁。宜桃花汤、地榆散、黄连阿胶
汤。
柯琴曰。本症与真武大同。彼以四肢沉重疼痛。为有水气。此便脓血。是为有火气矣。此方不
清火。不利水。一惟培土。盖土得其养。则火退位也。水归其职。则腹痛自除。脓血自清。小便自
利。
【纲】仲景曰。少阴病。下利。便脓血者。桃花汤主之。少阴病。便脓血者。可刺。
【目】程郊倩曰。此言少阴传经热邪。移入下焦。近后而致便脓血。又热挟中焦。秽浊之物下
行也。
方中行曰。便脓血者。当亦热入血室之病。故可刺。刺者。刺期门也。期门为厥阴穴。病在少
阴而刺厥阴之穴以泻之。所谓实则泻其子也。
【纲要】张仲景说：患下利（腹泻），出现手足逆冷、无脉搏的情况，应当施以艾灸。如果灸后手足仍不回暖，脉搏仍未恢复，反而出现轻微喘息，则预后不良，属死证。
下利之后，脉搏消失，手足厥冷。若脉搏逐渐恢复，手足转温者，可生；若脉搏不恢复者，则死。少阴病，下利，经过六七天，出现咳嗽、呕吐、口渴、心烦、无法入睡的症状，用猪苓汤主治。
【注释】柯琴说：下利且伴有热渴，是因为下焦虚寒不能制约水液。咳嗽、呕吐、烦躁、口渴，是肾水不能上升。下利且失眠，是心火不能下降。凡是利水的方剂，必须先使气机上升，然后才能下降，所以主治此汤。
【纲要】张仲景说：少阴病，下利，咽喉疼痛，胸部胀满，心烦的，用猪肤汤主治。
少阴病，呕吐且咽喉疼痛，喉部生疮，不能说话，声音发不出来的，用苦酒汤主治。
【注释】沈金鳌按语：第一条所述的下利，是肾元虚损所致。第二条所述的呕逆，是肾中虚火上冲所致。
【纲要】张仲景说：少阴病，四肢厥逆，泄泻且肛门重坠感（泄利下重），或者兼有咳嗽，或者心悸，或者小便不利，或者腹中疼痛的，用四逆散主治。
【注释】朱肱说：问：张仲景的少阴病有四逆汤，又有四逆散，为什么呢？答：大抵少阴病，不可直接使用热药。况且也有表热的情况，称为“晚发热”，可用麻黄、细辛等发汗。难道成了少阴症就不能发汗了吗？现在少阴病四肢冰冷，也有内部有热的情况，所以使用四逆散。四逆汤用干姜、附子，而四逆散则主治热症。
【纲要】张仲景说：少阴病，下利停止但头晕目眩，经常感到头昏蒙如被物覆盖的，属死证。
【注释】柯琴说：此症阳气回复，下利停止，这是水谷精气已竭尽，没有东西可以再排泄了。头晕目眩且经常头昏蒙，说明清阳之气已经脱失。
【纲要】张仲景说：少阴病，从二三天到四五天，出现腹痛，小便不利，下利不止，大便带脓血的，用桃花汤主治。
【注释】朱肱说：寒毒侵入胃部的，脐下必然寒冷，腹部胀满，大便颜色黄白，或青黑，或下利完谷不化，适宜用四逆汤、理中汤、白通加附子汤、四逆加薤白散。挟带热邪的下利，脐下必然发热，大便呈赤黄色，以及肠道间津液垢腻，适宜用黄芩汤、白头翁汤、三黄熟艾汤、薤白汤、赤石脂丸。三黄熟艾汤，治疗伤寒第四天经过剧烈攻下后，热性下利时发时止，其他白通类药物多不能止住，适宜服用此方，以清除热邪并止利。薤白汤，治疗伤寒下利像烂肉汁一样，伴有赤色白带，伏气温病引起的腹痛，各种热症都主治。湿毒之气严重的，下利腹痛，大便像脓血，或像烂肉汁，适宜用桃花汤、地榆散、黄连阿胶汤。
柯琴说：本症与真武汤证大体相同，真武汤证以四肢沉重疼痛为有水气，此症便脓血，是为有火气。此方不清火，不利水，只专注于培补脾胃（土）。因为土得到滋养，则火气退位；水回归其职能，则腹痛自然消除，脓血自清，小便自利。
【纲要】张仲景说：少阴病，下利，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。
【注释】程郊倩说：这是说少阴病传经的热邪，移入下焦，靠近后阴而导致便脓血，又是热邪挟带中焦秽浊之物下行。
方中行说：便脓血，也应当是热入血室的病，所以可以针刺。所谓刺，是刺期门穴。期门穴是厥阴肝经的穴位，病在少阴却刺厥阴的穴位来泻实，这就是所谓的“实则泻其子”。
[General Principles] Zhang Zhongjing stated: In cases of diarrhea (Xia Li) accompanied by cold extremities and absence of pulse, moxibustion should be applied. If the extremities remain cold after moxibustion and the pulse does not return, but instead slight panting occurs, the prognosis is fatal.
After diarrhea, if the pulse vanishes and the extremities become cold, life can be saved if the pulse gradually returns and the extremities warm up; however, if the pulse does not return, death ensues. In Shaoyin disease, with diarrhea persisting for six or seven days, accompanied by cough, vomiting, thirst, irritability, and insomnia, Zhu Ling Tang (Polyporus Decoction) is the primary formula.
[Commentary] Ke Qin stated: Diarrhea accompanied by heat and thirst indicates deficiency in the lower jiao failing to control water. Cough, vomiting, irritability, and thirst indicate that Kidney Water fails to ascend. Diarrhea accompanied by insomnia indicates that Heart Fire fails to descend. Generally, formulas that promote diuresis must first facilitate the ascent of Qi before enabling descent; therefore, this decoction is indicated.
[General Principles] Zhang Zhongjing stated: In Shaoyin disease, with diarrhea, sore throat, chest fullness, and irritability, Zhu Fu Tang (Pig Skin Decoction) is the primary formula.
In Shaoyin disease, with vomiting, sore throat, ulceration in the throat, inability to speak, and loss of voice, Ku Jiu Tang (Bitter Wine Decoction) is the primary formula.
[Commentary] Shen Jin'ao noted: The first case of diarrhea stems from deficiency of Kidney Yuan (Original Qi). The second case of vomiting and reflux stems from defluxion of deficient Fire from the Kidney.
[General Principles] Zhang Zhongjing stated: In Shaoyin disease, with cold extremities, diarrhea with a sensation of heaviness and bearing down at the anus (Xie Li Xia Zhong), or accompanied by cough, palpitations, difficult urination, or abdominal pain, Si Ni San (Frigid Extremities Powder) is the primary formula.
[Commentary] Zhu Gong stated: Question: Why does Zhang Zhongjing mention both Si Ni Tang (Frigid Extremities Decoction) and Si Ni San (Frigid Extremities Powder) for Shaoyin disease? Answer: Generally, Shaoyin disease should not be treated immediately with hot herbs. There are also cases of exterior heat, termed "late-onset fever," which require sweating methods using herbs like Ma Huang (Ephedrae Herba) and Xi Xin (Asari Radix et Rhizoma). Does having Shaoyin syndrome preclude sweating therapy? Currently, some Shaoyin patients with cold extremities have internal heat; thus, Si Ni San is used. Si Ni Tang uses Gan Jiang (Zingiberis Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata), whereas Si Ni San treats heat syndromes.
[General Principles] Zhang Zhongjing stated: In Shaoyin disease, if diarrhea stops but dizziness occurs, and there is frequent sensation of being covered or obscured (Mao), it is a fatal condition.
[Commentary] Ke Qin stated: In this syndrome, the return of Yang Qi causes the diarrhea to stop, indicating that the essence of food and water has been exhausted, leaving nothing more to excrete. Dizziness and frequent sensation of head obscuration indicate the collapse of Clear Yang Qi.
[General Principles] Zhang Zhongjing stated: In Shaoyin disease, progressing from two or three days to four or five days, with abdominal pain, difficult urination, persistent diarrhea, and passage of pus and blood in the stool, Tao Hua Tang (Peach Blossom Decoction) is the primary formula.
[Commentary] Zhu Gong stated: When Cold Toxic enters the Stomach, the area below the umbilicus will be cold, with abdominal distension and fullness. Stool may be yellowish-white, bluish-black, or contain undigested food; Si Ni Tang, Li Zhong Tang, Bai Tong Jia Fu Zi Tang, or Si Ni Jia Xie Bai San are appropriate. For diarrhea with Heat, the area below the umbilicus will be hot, stool reddish-yellow, and intestinal fluids greasy; Huang Qin Tang, Bai Tou Weng Tang, San Huang Shu Ai Tang, Xie Bai Tang, or Chi Shi Zhi Wan are appropriate. San Huang Shu Ai Tang treats heat-diarrhea occurring intermittently after severe purgation on the fourth day of Shang Han, when other Bai Tong formulas fail to stop it; it clears heat and stops diarrhea. Xie Bai Tang treats diarrhea resembling rotten meat juice, accompanied by bloody leukorrhea, abdominal pain due to latent Qi, and various heat syndromes. For severe damp-toxic qi causing diarrhea with abdominal pain, stool resembling pus and blood or rotten meat juice, Tao Hua Tang, Di Yu San, or Huang Lian E Jiao Tang are appropriate.
Ke Qin stated: This syndrome is similar to Zhen Wu Tang syndrome. The latter presents with heavy and painful limbs due to Water Retention; this syndrome presents with pus and blood in stool due to Fire Pathogen. This formula does not clear fire or promote diuresis, but solely focuses on strengthening Earth (Spleen/Stomach). When Earth is nourished, Fire retreats; when Water resumes its function, abdominal pain resolves, pus and blood clear, and urination becomes normal.
[General Principles] Zhang Zhongjing stated: In Shaoyin disease, with diarrhea and passage of pus and blood in the stool, Tao Hua Tang (Peach Blossom Decoction) is the primary formula. In Shaoyin disease, with passage of pus and blood in the stool, acupuncture may be employed.
[Commentary] Cheng Jiaoqian stated: This refers to heat pathogen transmitted through the meridians in Shaoyin disease, moving into the lower jiao near the posterior orifice, causing pus and blood in the stool, driven downward by heat carrying turbid matter from the middle jiao.
Fang Xingzhong stated: Passage of pus and blood should also be considered a disease of Heat entering the Blood Chamber; hence, acupuncture is applicable. The term "acupuncture" here refers to needling Qi Men (Liv-14). Qi Men is an acupoint of the Jueyin Liver Meridian. Needling a Jueyin point to drain excess in a Shaoyin disease follows the principle of "draining the son in excess conditions."