芍药，加桔梗一两。利止脉不出者，加人参二两。
【注】论中扶阳抑阴之剂，中寒阳微不能外达，主以四逆。中外俱寒，阳气虚甚，主
以附子。阴盛于下，格阳于上，主以白通。阴盛于内，格阳于外，主以通脉。是则可知四
逆营运阳气者也，附子温补阳气者也，白通宣通上下之阳气者也，通脉通达内外之阳气
者也。今脉微欲绝，里寒外热，是肾中阴盛，格阳于外，故主之也。倍干姜加甘草佐附子，
易名通脉四逆汤者，以其能大壮元阳，主持中外，共招外热反之于内。盖此时生气已离，
亡在俄顷，若以柔缓之甘草为君，岂能疾呼外阳耶？故易以干姜。然必加甘草与干姜等
分者，恐涣漫之余，姜、附之猛不能安养元气，所谓有制之师也。若面赤者，加葱以通
格上之阳。腹痛者，加芍药以和在里之阴。呕逆者，加生姜以止呕。咽痛者，加桔梗以利
咽。利止脉不出气少者，俱倍人参，以生元气而复脉也。
白通汤 治少阴病，下利脉微者，与白通汤。利不止，厥逆元脉，干呕烦者，白通
加猪胆汁汤主之。服汤脉暴出者死，脉微续者生。
葱白（四茎） 干姜（一两） 附子（生用，去皮，破八
片，一枚）
上三味，以水三升，煮取一升，去滓，分温再服。
白通加猪胆汁汤
葱白（四茎） 干姜（一两） 附子（生用，去皮，破八片，一枚） 人尿（五合） 猪胆汁（一合）
以上三味，以水三升，煮取一升，去滓，内猪胆汁、人尿，和令相得，分温再服。若
无胆汁亦可。
【注】是方也，即四逆汤减甘草加葱白也，而名之曰白通者，以葱白能通阳气也。减甘
草者，因其缓也；加尿胆者，从其类也。下咽之后，冷体既消，热性便发，情且不违而
致大益，则二气之拒格可调，上下之阴阳可通矣。
真武汤 治少阴水气为患，腹痛下利，四肢沉重疼痛，小便不利，其人或咳或呕，或
小便利而下利者，用此加减。
白术（二两） 茯苓（二两） 白芍（二两） 大附子（炮，一枚） 生姜（切，三两）
上五味，以水八升，煮取三升，去滓，温服七合，日三服。
若咳者，加五味子半升，细辛、干姜各一两。若小便利者，去茯苓。若下利，去芍
药加干姜二两。若呕，去附子加生姜，足成半斤。
【注】小青龙汤治表不解有水气，中外皆寒实之病也。真武汤治表已解有水气，中外
皆寒虚之病也。真武者，北方司水之神也，以之名汤者，借以镇水之义也。夫人一身制水
者脾也，主水者肾也，肾为胃关，聚水而从其类，倘肾中无阳，则脾之枢机虽运，而肾
之关门不开，水即欲行，以无主制，故泛溢妄行而有是证也。用附子之辛热，壮肾之元
阳，则水有所主矣。白术之苦燥创建中土，则水有所制矣。生姜之辛散，佐附子以补阳，于
主水中寓散水之意。茯苓之淡渗，佐白术以健土，于制水中寓利水之道焉。而尤妙在芍
药之酸收，仲景之旨微矣。盖人之身阳根于阴，若徒以辛热补阳，不少佐以酸收之品，恐
真阳飞越矣。用芍药者，是亟收阳气归根于阴也。于此推之，则可知误服青龙致发汗亡
阳者，所以于补阳药中之必需芍药也。然下利减芍药者，以其阳不外散也；加干姜者，以
其温中胜寒也。水寒伤肺则咳，加细辛、干姜者，散水寒也；加五味子者，收肺气也。小
便利者，去茯苓，以其虽寒而水不能停也。呕者，去附子倍生姜，以其病非下焦，水停于
胃也。所以不须温肾以行水，只当温胃以散水，且生姜功能止呕也。
当归四逆汤 手足厥冷，脉细欲绝者，主之。若其人内有久寒，加吴茱萸、生姜。
当归（三两） 桂枝（三两） 芍药（三两） 细辛（二两） 通草（二两） 甘草（炙，二两）
大枣（擘，二十五枚）
上七味，以水八升，煮取三升，去滓，温服一升，日三服。
当归四逆加吴茱萸生姜汤
于前汤内加吴茱萸半斤，生姜三两。
上九味，以水六升，清酒六升和煮，取五升，去滓，分温五服。
【注】凡厥阴病则脉微而厥，以厥阴为三阴之尽，阴尽阳生，若受其邪，则阴阳之气
不相顺接，故脉微而厥也，然厥阴之脏，相火游行其间，经虽受寒，而脏不即寒，故先
厥者后必发热。所以伤寒初起，见其手足厥冷，脉细欲绝者，不得遽认为虚寒而用姜、附
也。此方取桂枝汤，君以当归者，厥阴主肝为血室也。佐细辛味极辛，能达三阴，外温
经而内温脏。通草其性极通，善开关节，内通窍而外通营。倍加大枣，即建中加饴用甘
之法。减去生姜，恐辛过甚而迅散也。肝之志苦急，肝之神欲散，甘辛并举，则志遂而
神悦，未有厥阴神志遂悦，而脉微不出，手足不温者也。不须参、苓之补，不用姜、附
之峻，此厥阴厥逆与太少不同治也。若其人内有久寒，非辛温之品所能兼治，则加吴茱
萸、生姜之辛热，更用酒煎，佐细辛直通厥阴之脏，迅散内外之寒，是又救厥阴内外两
伤于寒之法也。
吴茱萸汤 治厥阴病干呕吐涎沫、头痛者，少阴证吐利手足厥冷、烦躁欲死者，阳
明食谷欲呕者。
吴茱萸（一升） 人参（三两） 生姜（六两） 大枣（擘，十二枚）
上四味，以水七升，煮取二升，温服七合，日三服。
【集注】罗谦甫曰∶仲景救阳诸法，于少阴四逆汤必用姜附；通脉四逆汤倍加干姜，其
附子生用；附子汤又加生附至二枚。所以然者，或壮微阳使之外达，或招飞阳使之内返，
此皆少阴真阳失所，故以回阳为亟也。至其治厥阴，则易以吴茱萸，而并去前汤诸药，独
用人参、姜、枣者，盖人身厥阴肝木虽为两阴交尽，而一阳之真气实起其中，此之生气
一虚，则三阴浊气直逼中上，不惟本经诸证悉具，将阳明之健运失职，以至少阴之真阳
浮露而吐利，厥逆烦躁欲死，食谷欲呕，种种丛生矣。吴茱萸得东方震气，辛苦大热，能
达木郁，直入厥阴，降其盛阴之浊气，使阴翳全消，用以为君。人参秉冲和之气，甘温
大补，能接天真，挽回性命，升其垂绝之生气，令阳光普照，用以为臣。佐姜、枣和胃
而行四末。斯则震坤合德，木土不害，一阳之妙用成，而三焦之间无非生生之气矣。诸
证有不退者乎？盖仲景之法，于少阴则重固元阳，于厥阴则重护生气。学人当深思而得
之矣。
乌梅丸 治厥阴病消渴，气上撞心，心中疼热，饥而不欲食，食即吐蛔。又主久痢。
乌梅（三百个） 细辛（六两） 干姜（十两） 黄连（一斤） 当归（四两） 附子（六两）
蜀椒（去汗，四两） 桂枝（六两） 人参（六两） 黄柏（六两）
上十味，异捣筛，合治之。以苦酒浸乌梅一宿，去核蒸之五升米下，饭熟捣成泥，和
药令相得，内臼中，与蜜杵二千下，九如梧桐子大。先食饮服十丸，日三，稍加至二十
丸，禁生冷滑物臭食等。
【集注】柯琴曰∶六阴惟厥阴为难治。其本阴，其标热，其体木，其用火，必伏其所
主而先其所因，或收、或散、或逆、或从，随所利而行之，调其中气使之和平，是治厥阴
法也。厥阴当两阴交尽，又名阴之绝阳，宜无热矣。第其具合晦朔之理，阴之初尽即阳
之初生，所以厥阴病热，是少阳使然也。火王则水亏，故消渴气上撞心，心中疼热；气
有余便是火也。木胜则克土，故饥不欲食。虫为风化，饥则胃中空虚，蛔闻食臭出，故吐
蛔也。仲景立方，皆以甘辛苦味为君，不用酸收之品，而此用之者，以厥阴主肝木耳。
《洪范》曰∶木曰曲直作酸。《内经》曰∶木生酸，酸入肝。君乌梅之大酸，是伏其所主
也。配黄连泻心而除疼，佐黄柏滋肾以除渴，先其所因也。连、柏治厥阴阳邪则有余，不
足以治阴邪也。椒、附、辛、姜大辛之品并举，不但治厥阴阴邪，且肝欲散，以辛散之
也。又加桂枝、当归，是肝藏血，求其所属也。寒热杂用，则气味不和，佐以人参，调
其中气。以苦酒浸乌梅，同气相求，蒸之米下，资其谷气。加蜜为丸，少与而渐加之，缓
则治其本也。蛔，昆虫也，生冷之物与湿热之气相成，故药亦寒热互用，且胸中烦而吐
蛔，则连、柏是寒因热用也。蛔得酸则静，得辛则伏，得苦则下，信为治虫佳剂。久痢则
虚，调其寒热，酸以收之，下痢自止。
赤石脂禹余粮汤 治久利不止，大肠虚脱，服理中丸而利益甚者。
赤石脂（捣碎，一斤） 禹余粮（捣碎，一斤）
上二味，以水六升，煮取二升，去滓，分温三服。
【集注】柯琴曰∶甘、姜、参、术可以补中宫元气之虚，而不足以固下焦脂膏之脱。此
利在下焦，故不得以理中之剂收功矣。然大肠之不固，无责在胃，关门之不闭，无责在
脾，二石皆土之精气所结，实胃而涩肠，急以治下焦之标者，实以培中宫之本也。要知
此证土虚而火不虚，故不宜于姜、附。若湿甚而虚不甚，复利不止者，故又当利小便也。
白头翁汤 治厥阴热利，下重，脉沉弦，渴欲饮水者。
白头翁（三两） 黄连（三两） 黄柏（三两） 秦皮（三两）
上四味，以水七升，煮取三升，去滓，温服一升。不愈更服一升。
【注】三阴俱有下利证，自利不渴者，属太阴也；自利而渴者，属少阴也。惟厥阴下
利属于寒者，厥而不渴，下利清谷；属于热者，消渴下重，下利脓血。此热利下重，乃
火郁湿蒸，秽气奔迫广肠魄门，重滞而难出。《内经》云暴注下迫者是矣。君以白头翁寒而
苦辛，臣以秦皮寒而苦涩。寒能胜热，苦能燥湿，辛以散火之郁，涩以收下重之利也。佐
黄连清上焦之火，则渴可止。使黄柏泻下焦之热，则利自除也。治厥阴热利有二，初利
用此方，以苦燥之，以辛散之，以涩固之，是谓以寒治热之法；久利则用乌梅丸之酸以收
火，佐以苦寒，杂以温补，是谓逆之从之，随所利而行之，调其气使之平也。
芍药，加桔梗一两。如果腹泻停止但脉搏仍然摸不到，加入人参二两。
【注释】论述中扶阳抑阴的方剂：对于中寒导致阳气微弱不能外达的情况，主治用四逆汤；对于内外俱寒、阳气极度虚弱的情况，主治用附子；对于阴气盛于下、格拒阳气于上的情况，主治用白通汤；对于阴气盛于内、格拒阳气于外的情况，主治用通脉四逆汤。由此可知，四逆汤是营运阳气的，附子是温补阳气的，白通汤是宣通上下阳气的，通脉四逆汤是通达内外阳气的。如今脉象微弱几乎消失，里有寒而外有热，这是肾中阴气盛极，格拒阳气于外，所以主治用此方。倍用干姜并加入甘草辅助附子，改名为通脉四逆汤，是因为它能大壮元阳，主持内外，共同招引外部的热气返回体内。大概此时生气已经离散，死亡只在顷刻之间，如果用柔缓的甘草作为君药，怎么能迅速呼唤回外部的阳气呢？所以改用干姜。然而必须加入与干姜等量的甘草，是担心在元气涣散之后，干姜、附子的猛烈药性不能安养元气，这就是所谓“有节制的军队”。如果面色发红，加入葱白以通达格拒在上部的阳气。如果腹痛，加入芍药以调和内部的阴气。如果呕吐逆气，加入生姜以止呕。如果咽喉痛，加入桔梗以利咽。如果腹泻停止但脉搏不出且气短，都加倍使用人参，以生发元气并恢复脉搏。
白通汤 治疗少阴病，出现腹泻、脉微的症状，给予白通汤。如果腹泻不止，四肢厥冷、无脉，伴有干呕、心烦，主治用白通加猪胆汁汤。服药后脉搏突然暴出的会死，脉搏微微持续存在的会生。
葱白（四茎） 干姜（一两） 附子（生用，去皮，破成八片，一枚）
以上三味药，用水三升，煮取一升，去渣，分两次温服。
白通加猪胆汁汤
葱白（四茎） 干姜（一两） 附子（生用，去皮，破成八片，一枚） 人尿（五合） 猪胆汁（一合）
以上五味药，用水三升，煮取一升，去渣，加入猪胆汁和人尿，混合均匀，分两次温服。如果没有胆汁也可以不用。
【注释】这个方子，就是四逆汤减去甘草加上葱白，之所以命名为白通，是因为葱白能通达阳气。减去甘草，是因为它药性缓滞；加入尿和胆汁，是因为顺从其同类属性。药液咽下之后，冷体既然消除，热性随即发作，药情不违背病情而能产生巨大的益处，那么阴阳二气的格拒就可以调和，上下的阴阳就可以通畅了。
真武汤 治疗少阴水气为患，出现腹痛、腹泻，四肢沉重疼痛，小便不利，或者有人咳嗽或呕吐，或者小便自利但仍有腹泻的，用此方加减治疗。
白术（二两） 茯苓（二两） 白芍（二两） 大附子（炮制，一枚） 生姜（切片，三两）
以上五味药，用水八升，煮取三升，去渣，温服七合，每日三次服用。
如果咳嗽，加五味子半升，细辛、干姜各一两。如果小便自利，去掉茯苓。如果腹泻，去掉芍药，加干姜二两。如果呕吐，去掉附子，增加生姜，总量达到半斤。
【注释】小青龙汤治疗表证未解且有水气，属于内外皆寒实的病证。真武汤治疗表证已解但有水气，属于内外皆寒虚的病证。真武，是北方掌管水的神祇，用它来命名汤剂，是借用镇压水邪的含义。人的身体中制约水的是脾，主宰水的是肾，肾是胃的关口，水聚积而跟随其同类，如果肾中没有阳气，那么脾的枢机虽然运转，但肾的关门不开，水想要流动，因为没有主宰制约，所以泛滥妄行而出现这些症状。使用附子的辛热，壮大肾的元阳，那么水就有了主宰。白术的苦燥建立中土，那么水就有了制约。生姜的辛散，辅助附子以补阳，在主宰水中寓含散水的意思。茯苓的淡渗，辅助白术以健运脾胃，在制约水中寓含利水的方法。尤其巧妙之处在于芍药的酸收，张仲景的旨意微妙啊。大概人体的阳气根源于阴，如果只用辛热补阳，不稍加酸收的药物，恐怕真阳会飞越散失。使用芍药，是急切地收敛阳气使其归根于阴。由此推论，就知道误服小青龙汤导致发汗亡阳的人，所以在补阳药中必需加入芍药。然而腹泻时减去芍药，是因为阳气不外散；加干姜，是因为要温中胜寒。水寒伤肺则咳嗽，加细辛、干姜，是为了散水寒；加五味子，是为了收敛肺气。小便自利者，去掉茯苓，因为虽然寒但水不能停聚。呕吐者，去掉附子加倍生姜，因为病不在下焦，水停在胃里。所以不需要温肾以行水，只应当温胃以散水，而且生姜的功能就是止呕。
当归四逆汤 治疗手足厥冷，脉细欲绝的症状，主治用此方。如果其人内部有久寒，加吴茱萸、生姜。
当归（三两） 桂枝（三两） 芍药（三两） 细辛（二两） 通草（二两） 甘草（炙，二两） 大枣（掰开，二十五枚）
以上七味药，用水八升，煮取三升，去渣，温服一升，每日三次服用。
当归四逆加吴茱萸生姜汤
在前一方中加入吴茱萸半斤，生姜三两。
以上九味药，用水六升，清酒六升混合煎煮，取五升，去渣，分五次温服。
【注释】凡是厥阴病则脉微而厥冷，因为厥阴是三阴的尽头，阴尽阳生，如果受到邪气侵袭，则阴阳之气不相顺接，所以脉微而厥冷。然而厥阴之脏，相火游行其间，经脉虽然受寒，但脏腑不立即变寒，所以先厥冷的后来必定发热。因此伤寒初起，见到手足厥冷，脉细欲绝的，不能立刻认为是虚寒而使用干姜、附子。此方选取桂枝汤，以当归为君药，因为厥阴主肝，肝为血室。佐以细辛，味道极辛，能通达三阴，外温经脉而内温脏腑。通草性质极通利，善于开通关节，内通窍道而外通营气。倍加大枣，就是建中汤加饴糖用甘缓之法。减去生姜，是担心辛散太过而迅疾耗散。肝的志趣苦于急迫，肝的神气欲求疏散，甘味与辛味并举，则志趣遂愿而神气愉悦，没有厥阴神志遂悦而脉微不出、手足不温的。不需要人参、茯苓的补益，不使用干姜、附子的峻烈，这是厥阴厥逆与太阳、少阴不同治法的原因。如果其人内部有久寒，不是辛温药物所能兼治的，则加入吴茱萸、生姜的辛热，更用酒煎煮，辅助细辛直通厥阴之脏，迅速消散内外的寒邪，这又是救治厥阴内外两伤于寒的方法。
吴茱萸汤 治疗厥阴病干呕吐涎沫、头痛的，少阴证吐利、手足厥冷、烦躁欲死的，阳明病进食后想呕吐的。
吴茱萸（一升） 人参（三两） 生姜（六两） 大枣（掰开，十二枚）
以上四味药，用水七升，煮取二升，温服七合，每日三次服用。
【集注】罗谦甫说：张仲景救治阳气的各种方法，在治疗少阴的四逆汤中必用干姜、附子；通脉四逆汤倍加干姜，其附子生用；附子汤又加生附子至两枚。之所以这样，或者是为了壮大微弱的阳气使其外达，或者是为了招引飞越的阳气使其内返，这都是因为少阴真阳失守，所以以回阳为紧急。至于治疗厥阴，则改用吴茱萸，并去掉前汤的各种药物，独用人参、姜、枣，大概人身厥阴肝木虽然是两阴交尽，但一阳的真气实在其中兴起，这个生气一旦虚弱，则三阴浊气直逼中上部，不仅本经各种症状全部具备，还将导致阳明健运失职，以至于少阴真阳浮露而出现吐利、厥逆、烦躁欲死、食谷欲呕等各种病症丛生。吴茱萸得东方震卦之气，辛苦大热，能通达木郁，直入厥阴，降下盛阴的浊气，使阴翳全消，用作君药。人参秉承冲和之气，甘温大补，能接续天真，挽回性命，升发垂绝的生气，令阳光普照，用作臣药。佐以姜、枣和胃而行于四肢末端。这样则是震坤合德，木土不相害，一阳的妙用成就，而三焦之间无非生生之气。各种症状有不消退的吗？大概张仲景的法度，在少阴则重在固护元阳，在厥阴则重在保护生气。学习者应当深思而领悟其中的道理。
乌梅丸 治疗厥阴病消渴，气上撞心，心中疼热，饥饿但不想吃东西，吃东西就吐蛔虫。又主治久痢。
乌梅（三百个） 细辛（六两） 干姜（十两） 黄连（一斤） 当归（四两） 附子（六两） 蜀椒（去汗，四两） 桂枝（六两） 人参（六两） 黄柏（六两）
以上十味药，分别捣碎过筛，混合处理。用醋浸泡乌梅一夜，去核蒸于五升米下，饭熟后捣成泥，与药混合均匀，放入臼中，与蜜杵两千下，制成如梧桐子大小的丸药。饭前饮服十丸，每日三次，逐渐增加到二十丸，禁止吃生冷、滑腻、臭秽食物等。
【集注】柯琴说：六经中只有厥阴难治。其本是阴，其标是热，其体属木，其用属火，必须伏其所主而先究其所因，或收、或散、或逆、或从，随其有利之处而行，调其中气使之和平，这是治疗厥阴的方法。厥阴当两阴交尽之时，又名阴之绝阳，应该没有热了。但它的机理符合晦朔之理，阴之初尽即阳之初生，所以厥阴病热，是少阳所致。火旺则水亏，所以消渴、气上撞心、心中疼热；气有余便是火。木胜则克土，所以饥不欲食。虫由风化而生，饥饿时胃中空虚，蛔闻到食臭而出，所以吐蛔。张仲景立方，都以甘辛苦味为君，不用酸收之品，而此处使用，是因为厥阴主肝的缘故。《洪范》说：木曰曲直作酸。《内经》说：木生酸，酸入肝。君药使用乌梅的大酸，是伏其所主。配伍黄连泻心而除痛，佐以黄柏滋肾而除渴，是先究其所因。连、柏治疗厥阴阳邪则有余，不足以治阴邪。椒、附、辛、姜大辛之品并举，不但治疗厥阴阴邪，而且肝欲散，以辛散之。又加桂枝、当归，是因为肝藏血，求其所属。寒热杂用，则气味不和，佐以人参，调其中气。用苦酒（醋）浸乌梅，同气相求，蒸于米下，资助谷气。加蜜为丸，少量给予而逐渐增加，缓则治其本。蛔，是昆虫，生冷之物与湿热之气相成，所以药也寒热互用，且胸中烦而吐蛔，则连、柏是寒因热用。蛔得酸则静，得辛则伏，得苦则下，确实是治虫的好方剂。久痢则虚，调其寒热，酸以收之，下痢自然停止。
赤石脂禹余粮汤 治疗久痢不止，大肠虚脱，服用理中丸后腹泻反而加重的。
以上两味药，用水六升，煮取二升，去渣，分三次温服。
【集注】柯琴说：甘、姜、参、术可以补中宫元气之虚，但不足以固摄下焦脂膏之脱。此利在下焦，所以不能用理中之剂收功。但是大肠的不固，责任不在胃，关门之不闭，责任不在脾，二石都是土之精气所结，实胃而涩肠，紧急治疗下焦之标，实际上是培补中宫之本。要知道此证是土虚而火不虚，所以不宜于姜、附。如果湿甚而虚不甚，复利不止的，则又应当利小便。
以上四味药，用水七升，煮取三升，去渣，温服一升。不好再服一升。
【注释】三阴都有下利的症状，自利不渴的，属于太阴；自利而渴的，属于少阴。只有厥阴下利属于寒的，厥而不渴，下利清谷；属于热的，消渴下重，下利脓血。此热利下重，乃是火郁湿蒸，秽气奔迫广肠魄门，重滞而难出。《内经》说的暴注下迫就是这种情况。君药用白头翁，寒而苦辛；臣药用秦皮，寒而苦涩。寒能胜热，苦能燥湿，辛以散火之郁，涩以收下重之利。佐黄连清上焦之火，则渴可止。使黄柏泻下焦之热，则利自除。治疗厥阴热利有两种，初利用此方，以苦燥之，以辛散之，以涩固之，这叫以寒治热的方法；久利则用乌梅丸之酸以收火，佐以苦寒，杂以温补，这叫逆之从之，随其有利之处而行，调其气使之平。
Shao Yao (Radix Paeoniae Alba), add Jie Geng (Radix Platycodonis) one liang. If diarrhea stops but the pulse is not palpable, add Ren Shen (Radix Ginseng) two liang.
[Annotation] In the discussion regarding formulas that support Yang and suppress Yin: for cases of cold injury in the middle where Yang Qi is weak and cannot reach the exterior, Si Ni Tang (Cinnamon Twig, Aconite, and Licorice Decoction) is the primary treatment; for cases where both interior and exterior are cold with extreme deficiency of Yang Qi, Fu Zi (Prepared Radix Aconiti Lateralis Preparata) is the primary treatment; for cases where Yin is excessive below and repels Yang to the upper part, Bai Tong Tang (Scallion White Decoction) is the primary treatment; for cases where Yin is excessive inside and repels Yang to the outside, Tong Mai Si Ni Tang (Pulse-Returning Cinnamon Twig, Aconite, and Licorice Decoction) is the primary treatment. From this, it can be known that Si Ni Tang circulates and operates Yang Qi; Fu Zi warms and tonifies Yang Qi; Bai Tong Tang unblocks and communicates Yang Qi between the upper and lower parts; Tong Mai Si Ni Tang unblocks and communicates Yang Qi between the interior and exterior. Now, the pulse is faint and nearly absent, with cold in the interior and heat in the exterior; this indicates that Yin in the Kidney is excessively strong, repelling Yang to the exterior, hence this formula is indicated. By doubling Gan Jiang (Rhizoma Zingiberis Recens) and adding Gan Cao (Radix Glycyrrhizae Uralensis) to assist Fu Zi, and renaming it Tong Mai Si Ni Tang, it is because it greatly strengthens the Primordial Yang, governs both interior and exterior, and jointly attracts external heat back into the interior. At this time, the vital Qi has already dispersed, and death may occur in an instant; if soft and slow Gan Cao were used as the sovereign drug, how could it quickly call back the external Yang? Therefore, Gan Jiang is substituted. However, Gan Cao must be added in equal proportion to Gan Jiang, out of fear that after the dispersion of Yuan Qi, the fierce nature of Gan Jiang and Fu Zi cannot nourish and stabilize the Yuan Qi; this is what is meant by a "disciplined army." If there is facial flushing, add Cong Bai (Scallion White) to unblock the Yang repelled to the upper part. If there is abdominal pain, add Shao Yao to harmonize the Yin within. If there is vomiting or rebellious Qi, add Sheng Jiang (Fresh Rhizoma Zingiberis) to stop vomiting. If there is a sore throat, add Jie Geng to benefit the throat. If diarrhea stops but the pulse does not appear and Qi is deficient, double the dosage of Ren Shen to generate Yuan Qi and restore the pulse.
Bai Tong Tang treats Shaoyin disease presenting with diarrhea and a faint pulse; administer Bai Tong Tang. If diarrhea persists, accompanied by cold extremities, absence of pulse, dry heaving, and irritability, treat with Bai Tong Jia Zhu Dan Ji Tang (Scallion White Decoction plus Porcine Bile and Human Urine). If the pulse suddenly becomes prominent after taking the decoction, the patient will die; if the pulse gradually and continuously returns, the patient will survive.
Cong Bai (Scallion White) (4 stalks) Gan Jiang (Dried Ginger) (1 liang) Fu Zi (Raw Aconite Root, peeled, broken into eight pieces, 1 piece)
The above three ingredients are boiled in 3 sheng of water until 1 sheng remains. Strain the dregs and divide into two warm doses.
Bai Tong Jia Zhu Dan Ji Tang
Cong Bai (Scallion White) (4 stalks) Gan Jiang (Dried Ginger) (1 liang) Fu Zi (Raw Aconite Root, peeled, broken into eight pieces, 1 piece) Ren Niao (Human Urine) (5 he) Zhu Dan Zhi (Porcine Bile) (1 he)
The above five ingredients are boiled in 3 sheng of water until 1 sheng remains. Strain the dregs, add Zhu Dan Zhi and Ren Niao, mix well, and divide into two warm doses. If bile is unavailable, it may be omitted.
[Annotation] This formula is essentially Si Ni Tang with Gan Cao removed and Cong Bai added. It is named Bai Tong because Cong Bai can unblock Yang Qi. Gan Cao is removed because its action is slow; Ren Niao and Zhu Dan Zhi are added to follow their similar natures. After swallowing, the cold nature dissipates, and the hot nature immediately acts. The medication does not conflict with the condition but brings great benefit, thereby adjusting the rejection between Yin and Yang Qi and allowing the communication of Yin and Yang between the upper and lower parts.
Zhen Wu Tang treats Shaoyin disorders caused by Water-Qi, presenting with abdominal pain, diarrhea, heaviness and pain in the four limbs, and difficulty in urination. For patients who may also have cough or vomiting, or who have spontaneous urination but still suffer from diarrhea, this formula should be used with modifications.
Bai Zhu (Rhizoma Atractylodis Macrocephalae) (2 liang) Fu Ling (Poria) (2 liang) Bai Shao (Radix Paeoniae Alba) (2 liang) Da Fu Zi (Large Prepared Aconite Root, processed, 1 piece) Sheng Jiang (Fresh Ginger) (3 liang, sliced)
The above five ingredients are boiled in 8 sheng of water until 3 sheng remain. Strain the dregs and take 7 ge warm, three times daily.
If there is a cough, add Wu Wei Zi (Fructus Schisandrae Chinensis) half sheng, Xi Xin (Herba Asari) and Gan Jiang each 1 liang. If urination is spontaneous, remove Fu Ling. If there is diarrhea, remove Shao Yao and add Gan Jiang 2 liang. If there is vomiting, remove Fu Zi and increase Sheng Jiang so that the total amount reaches half jin.
[Annotation] Xiao Qing Long Tang treats exterior conditions unresolved with Water-Qi, representing a syndrome of Cold-Excess in both interior and exterior. Zhen Wu Tang treats conditions where the exterior is resolved but Water-Qi remains, representing a syndrome of Cold-Deficiency in both interior and exterior. Zhen Wu refers to the deity governing water in the North; naming the decoction after him implies the meaning of suppressing water. In the human body, the Spleen controls water, and the Kidney masters water. The Kidney is the gate of the Stomach; when water gathers, it follows its kind. If there is no Yang in the Kidney, although the pivot mechanism of the Spleen functions, the gate of the Kidney does not open. Although water desires to flow, lacking mastery and control, it overflows and moves recklessly, causing these symptoms. Using the pungent and hot nature of Fu Zi to strengthen the Primordial Yang of the Kidney ensures that water has a master. The bitter and drying nature of Bai Zhu establishes the Central Earth, ensuring that water has constraints. The pungent and dispersing nature of Sheng Jiang assists Fu Zi in tonifying Yang, embedding the intent of dispersing water within mastering water. The light and permeating nature of Fu Ling assists Bai Zhu in strengthening Earth, embedding the method of promoting urination within constraining water. Most ingeniously, the sour and astringent nature of Shao Yao reveals Zhang Zhongjing's subtle intent. Generally, Yang Qi in the body is rooted in Yin. If only pungent and hot herbs are used to tonify Yang without assisting with sour and astringent substances, there is a risk that True Yang may fly away and disperse. Using Shao Yao is to urgently gather Yang Qi and return it to Yin. From this, we can understand why, for those who mistakenly took Xiao Qing Long Tang leading to sweating and loss of Yang, Shao Yao is essential in Yang-tonifying formulas. However, Shao Yao is reduced in diarrhea because Yang does not scatter outward; Gan Jiang is added to warm the middle and overcome cold. When cold-water injures the Lung causing cough, Xi Xin and Gan Jiang are added to disperse cold-water; Wu Wei Zi is added to collect Lung Qi. If urination is spontaneous, Fu Ling is removed because although there is cold, water does not stagnate. If there is vomiting, Fu Zi is removed and Sheng Jiang is doubled because the pathology is not in the Lower Jiao but water stagnates in the Stomach. Thus, warming the Kidney to move water is unnecessary; instead, warming the Stomach to disperse water is appropriate, and Sheng Jiang functions to stop vomiting.
Dang Gui Si Ni Tang treats cold extremities and a fine pulse nearly absent; this formula is indicated. If the person has chronic cold within, add Wu Zhu Yu (Fructus Evodiae Officinalis) and Sheng Jiang.
Dang Gui (Radix Angelicae Sinensis) (3 liang) Gui Zhi (Ramulus Cinnamomi Cassiae) (3 liang) Shao Yao (Radix Paeoniae Alba) (3 liang) Xi Xin (Herba Asari) (2 liang) Tong Cao (Medulla Tetrapanacis) (2 liang) Gan Cao (Honey-fried Radix Glycyrrhizae Uralensis) (2 liang) Da Zao (Fructus Jujubae, split) (25 pieces)
The above seven ingredients are boiled in 8 sheng of water until 3 sheng remain. Strain the dregs and take 1 sheng warm, three times daily.
Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang
To the previous decoction, add Wu Zhu Yu half jin and Sheng Jiang 3 liang.
The above nine ingredients are boiled in 6 sheng of water and 6 sheng of clear wine until 5 sheng remain. Strain the dregs and divide into five warm doses.
[Annotation] In all Jueyin diseases, the pulse is faint and there is cold extremities, because Jueyin is the end of the Three Yin meridians. When Yin ends, Yang begins to generate. If affected by pathogenic factors, the Qi of Yin and Yang do not connect smoothly, resulting in a faint pulse and cold extremities. However, in the Jueyin organ, Ministerial Fire roams between them. Although the meridians are affected by cold, the organs do not immediately become cold; thus, those who first experience cold extremities will later develop fever. Therefore, at the initial stage of Cold Damage, when cold extremities and a fine pulse nearly absent are seen, one should not hastily diagnose it as Deficiency-Cold and use Gan Jiang and Fu Zi. This formula selects Gui Zhi Tang, with Dang Gui as the sovereign herb, because Jueyin governs the Liver, which is the Blood Chamber. Assisting with Xi Xin, which is extremely pungent, allows it to reach the Three Yin meridians, warming the meridians externally and the organs internally. Tong Cao is extremely penetrating, good at opening joints, connecting orifices internally and Ying-Qi externally. Doubling Da Zao follows the method of Jian Zhong Tang adding Yi Tang using sweet flavors. Removing Sheng Jiang prevents excessive pungency from rapidly scattering Qi. The will of the Liver dislikes urgency, and the spirit of the Liver desires dispersion. Combining sweet and pungent flavors satisfies the will and pleases the spirit. There is no case where the Jueyin spirit and will are satisfied yet the pulse remains faint and extremities remain cold. There is no need for the tonification of Ren Shen and Fu Ling, nor the harshness of Gan Jiang and Fu Zi. This distinguishes the treatment of Jueyin cold extremities from Taiyang and Shaoyin. If the person has chronic cold within, simple pungent-warm herbs cannot treat it simultaneously; therefore, add the pungent-hot Wu Zhu Yu and Sheng Jiang, and decoct with wine to assist Xi Xin in directly reaching the Jueyin organ, rapidly dispersing internal and external cold. This is another method for rescuing Jueyin from dual cold injury.
Wu Zhu Yu Tang treats Jueyin disease with dry heaving, vomiting of saliva/foam, and headache; Shaoyin syndrome with vomiting, diarrhea, cold extremities, and severe irritability; and Yangming disease with desire to vomit after eating.
Wu Zhu Yu (Evodia Fruit) (1 sheng) Ren Shen (Ginseng Root) (3 liang) Sheng Jiang (Fresh Ginger) (6 liang) Da Zao (Jujube, split) (12 pieces)
The above four ingredients are boiled in 7 sheng of water until 2 sheng remain. Take 7 ge warm, three times daily.
[Collected Annotations] Luo Qianfu said: Among Zhang Zhongjing's methods for rescuing Yang, Si Ni Tang for Shaoyin must use Gan Jiang and Fu Zi; Tong Mai Si Ni Tang doubles Gan Jiang and uses raw Fu Zi; Fu Zi Tang adds two raw Fu Zi. The reason is either to strengthen weak Yang to reach the exterior or to attract flying Yang to return inward. These are all because the True Yang of Shaoyin has lost its residence, making the restoration of Yang urgent. When treating Jueyin, however, Wu Zhu Yu is substituted, and previous herbs are removed, using only Ren Shen, Jiang, and Zao. This is because although Jueyin Liver Wood is the convergence of Two Yins, the True Qi of One Yang actually arises within it. If this vital Qi becomes deficient, the turbid Qi of the Three Yin meridians directly presses upon the Middle and Upper Jiao. Not only do all symptoms of the meridian manifest, but the healthy function of Yangming fails, leading to floating True Yang of Shaoyin, causing vomiting, diarrhea, cold extremities, severe irritability, and vomiting after eating. Wu Zhu Yu obtains the Qi of the East (Zhen Trigram), is pungent, bitter, and very hot, capable of reaching Liver depression, entering Jueyin directly, and descending the turbid Qi of excessive Yin, eliminating all Yin obscurity; it serves as the sovereign herb. Ren Shen possesses balanced Qi, is sweet, warm, and strongly tonifying, capable of connecting True Essence, saving life, and raising declining vital Qi, allowing sunlight to shine universally; it serves as the minister herb. Ginger and Jujube assist in harmonizing the Stomach and circulating to the four extremities. Thus, Zhen and Kun harmonize, Wood and Earth do not harm, the subtle function of One Yang is achieved, and the San Jiao is filled with generative Qi. How could any symptoms not recede? Zhang Zhongjing's methodology emphasizes consolidating Primordial Yang in Shaoyin and protecting Vital Qi in Jueyin. Students should ponder deeply to understand this.
Wu Mei Wan treats Jueyin disease with excessive thirst, sensation of Qi rushing up to the heart, burning pain in the heart, hunger without desire to eat, and vomiting roundworms after eating. It also treats chronic dysentery.
Wu Mei (Mume Fruit) (300 pieces) Xi Xin (Asarum Herb) (6 liang) Gan Jiang (Dried Ginger) (10 liang) Huang Lian (Coptis Rhizome) (1 jin) Dang Gui (Angelica Root) (4 liang) Fu Zi (Aconite Root) (6 liang) Shu Jiao (Sichuan Pepper, dried) (4 liang) Gui Zhi (Cinnamon Twig) (6 liang) Ren Shen (Ginseng Root) (6 liang) Huang Bo (Phellodendron Bark) (6 liang)
The above ten ingredients are separately pounded and sifted, then mixed. Soak Wu Mei in vinegar (Ku Jiu) overnight, remove pits, steam over rice (5 sheng of rice), pound into paste when cooked, mix with herbs, place in a mortar, and pound with honey 2,000 times until pills are the size of Sophora seeds. Take 10 pills before meals with water, three times daily, gradually increasing to 20 pills. Avoid cold, slippery, and foul-smelling foods.
[Collected Annotations] Ke Qin said: Among the Six Meridians, Jueyin is the most difficult to treat. Its root is Yin, its branch is Heat, its substance is Wood, and its function is Fire. One must subdue its dominant nature and address its cause, using astringents, dispersants, inverses, or followers as appropriate, regulating Middle Qi to achieve harmony. This is the method for treating Jueyin. Jueyin occurs when Two Yins converge, also called the Absolute Yin of Yang, and should theoretically have no Heat. However, its mechanism follows the logic of new moon and full moon; the end of Yin is the beginning of Yang. Thus, Heat in Jueyin disease is caused by Shaoyang. When Fire is prosperous, Water is deficient, causing excessive thirst, Qi rushing to the heart, and burning pain; excess Qi becomes Fire. When Wood overacts on Earth, there is hunger without desire to eat. Worms arise from Wind transformation; when hungry, the Stomach is empty, and roundworms emerge smelling food, causing vomiting of worms. Zhang Zhongjing's formulas generally use Sweet, Pungent, Bitter, and Sour as sovereigns, avoiding astringents, but here they are used because Jueyin governs the Liver. The *Hong Fan* states: "Wood is bending and straightening, producing Sour." The *Neijing* states: "Wood generates Sour, Sour enters the Liver." Using the highly sour Wu Mei as sovereign subdues its dominant nature. Pairing Huang Lian clears Heart Heat and removes pain; assisting with Huang Bo nourishes Kidney Yin and removes thirst, addressing the cause. Coptis and Phellodendron treat Jueyin Yang pathogens but are insufficient for Yin pathogens. Piper, Aconite, Asarum, and Ginger are all highly pungent; combined, they not only treat Jueyin Yin pathogens but also disperse Liver Qi, as the Liver desires dispersion. Adding Gui Zhi and Dang Gui addresses the Liver's storage of Blood. Mixing Cold and Hot creates disharmony in flavor and nature; Ren Shen is added to regulate Middle Qi. Soaking Wu Mei in vinegar seeks similar Qi; steaming with rice provides grain Qi. Making pills with honey and administering small amounts gradually treats the root slowly. Roundworms are insects formed by cold-damp and damp-heat; thus, the medicine mixes Cold and Hot. For chest irritability and vomiting worms, Coptis and Phellodendron are used according to the principle of "treating heat with heat" (using cold herbs in a specific context). Roundworms become quiet with Sour, subdued with Pungent, and descend with Bitter; this is indeed an excellent formula for expelling parasites. Chronic dysentery involves deficiency; regulating Cold and Heat and using Sour to astringe will stop dysentery naturally.
Chi Shi Zhi Yu Liang Tang treats persistent dysentery not stopping due to Large Intestine deficiency collapse, where taking Li Zhong Wan worsens the diarrhea.
Chi Shi Zhi (Halloysitum Rubrum, crushed) (1 jin) Yu Liang (Pyritum, crushed) (1 jin)
The above two ingredients are boiled in 6 sheng of water until 2 sheng remain. Strain the dregs and divide into three warm doses.
[Collected Annotations] Ke Qin said: Gan, Jiang, Ren, and Zhu can tonify the deficiency of Yuan Qi in the Middle Palace but are insufficient to secure the collapse of essence in the Lower Jiao. Since this diarrhea is in the Lower Jiao, Li Zhong Tang cannot achieve success. However, the insecurity of the Large Intestine is not the fault of the Stomach, and the failure of the gate to close is not the fault of the Spleen. Both stones are結 (condensed) from the essence of Earth; they solidify the Stomach and astringe the Intestines. Urgently treating the branch of the Lower Jiao actually cultivates the root of the Middle Palace. Note that this syndrome involves Earth deficiency but not Fire deficiency, so Gan Jiang and Fu Zi are unsuitable. If Dampness is severe and deficiency is not significant, and diarrhea persists, promoting urination is appropriate.
Bai Tou Weng Tang treats Jueyin Heat Dysentery with tenesmus, deep and string-taut pulse, and thirst with desire to drink water.
Bai Tou Weng (Pulsatilla Root) (3 liang) Huang Lian (Coptis Rhizome) (3 liang) Huang Bo (Phellodendron Bark) (3 liang) Qin Pi (Ash Bark) (3 liang)
The above four ingredients are boiled in 7 sheng of water until 3 sheng remain. Strain the dregs and take 1 sheng warm. If not cured, take another 1 sheng.
[Annotation] All Three Yin meridians have diarrhea syndromes. Spontaneous diarrhea without thirst belongs to Taiyin; spontaneous diarrhea with thirst belongs to Shaoyin. Only Jueyin diarrhea belonging to Cold presents with cold extremities without thirst and passing undigested food; diarrhea belonging to Heat presents with excessive thirst, tenesmus, and pus/blood in stool. This Heat Dysentery with tenesmus is caused by Fire stagnation and Dampness steaming, with foul Qi rushing to the Large Intestine and Anus, causing heaviness and difficulty in expulsion, as described in the *Neijing* as sudden pouring and urgent straining. The sovereign herb is Bai Tou Weng, Cold, Bitter, and Pungent; the minister herb is Qin Pi, Cold, Bitter, and Astringent. Cold overcomes Heat; Bitter dries Dampness; Pungent disperses Fire stagnation; Astringent secures diarrhea with tenesmus. Assisting with Huang Lian clears Upper Jiao Fire to stop thirst. Directing Huang Bo to drain Lower Jiao Heat removes diarrhea. There are two treatments for Jueyin Heat Dysentery: for early stages, use this formula to dry with Bitter, disperse with Pungent, and secure with Astringent, which is the method of treating Heat with Cold; for chronic cases, use Wu Mei Wan's Sour to gather Fire, assist with Bitter-Cold, and mix with Warm-Tonics, which is the method of opposing and following, acting according to advantage, regulating Qi to achieve balance.