《伤寒论》原文∶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，
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】甘草二两炙，附子大者一枚生用去皮破八片，干姜三两。
上三味，以水三升，煮取一升二合，去滓，分温再服，其脉即渐而出者愈（非若暴出者之自无而忽有、
既有而仍无，如灯火之回焰也）。面赤色者，加葱九茎，腹中痛者，去葱，加芍药二两；呕者，加生姜二两；
咽痛者，去芍药，加桔梗一两；利止脉不出者，去桔梗，加人参二两。
太阳篇四逆汤中干姜两半，以治汗多亡阳之证。至通脉四逆汤药味同前，惟将干姜加倍，盖因寒盛
脉闭，欲借辛热之力开凝寒以通脉也。面赤者加葱九茎（权用粗葱白切上九寸即可），盖面赤乃阴寒在
下，逼阳上浮，即所谓戴阳证也。加葱以通其上下之气，且多用同于老阳之数，则阳可下归其宅矣。而愚
遇此等证，又恒加芍药数钱，盖芍药与附子并用，最善收敛浮越之元阳下降也。
《伤寒论》原文∶少阴病，自利清水，色纯青，心下必痛，口干燥者，急下之，宜大承气汤。
此证乃伏气之热窜入肝肾二经也。盖以肾主闭藏，肝主疏泄，肾为二便之关，肝又为肾行气，兹因
伏气之热，窜入肾兼窜入肝，则肝为热助疏泄之力太过，即为肾行气之力太过，致肾关失其闭藏之用，而下利
清水。且因肝热而波及于胆，致胆汁因热妄行，随肝气之疏泄而下纯青色之水。于斯，肾水因疏泄太过而
将竭，不能上济以镇心火，且肝木不得水气之涵濡，则在下既过于疏泄，在上益肆其横恣，是以心下作痛口
中干燥也。此宜急下之，泻以止泻，则肾中之真阴可回，自能上济以愈口中干燥、心下作痛也。
此节之前有“少阴病得之二，三日，口燥咽干者，急下之，宜大承气汤。”及后节“少阴病六、七日，
腹胀不大便者，急下之，宜大承气汤。”想此二节，仲师亦皆言急下，若不急下，当亦若纯下青水
者，其危险即在目前。若仲师者，宜其为医中之圣也。
按∶方书有奇恒痢，张隐庵谓，系三阳并至，三阴莫当，九窍皆塞，阳气旁溢，咽干喉塞痛，并于阴
则上下无常，薄为肠僻，其脉缓小迟涩，血温身热者死，热见七日者死。盖因阳气偏盛，阴气受伤，是以脉
小迟涩，此证宜急用大承气汤泻阳养阴，缓则无效。夫奇恒痢病，未知所下者奚似，而第即其脉象缓小迟
涩，固与少阴病之脉微细者同也。其咽干喉塞，痛并于阴，又与此节之心下痛、口中干燥者同也。隐庵谓宜急
服大承气汤，又与此节之急下之宜大承气者同也。是奇恒痢者，不外少阴下利之范
围，名之为奇恒痢可也，名之为少阴下利亦无不可也。
《伤寒论》原文∶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。
注家谓∶宜灸百会穴。
《伤寒论》原文：少阴病（少阴经受邪所致的病证），下利清谷（腹泻且排出未消化的食物），里寒外热（体内寒冷而体表发热），手足厥逆（手脚冰凉），脉微欲绝（脉搏微弱，几乎摸不到），身体反而不恶寒（不觉得怕冷），病人面色发红，腹痛，有时干呕，有时咽喉痛，有时腹泻停止但脉搏仍摸不到，用通脉四逆汤主治。
【通脉四逆汤】炙甘草二两，生附子（大附子，去皮破成八片）一枚，干姜三两。
以上三味药，用水三升，煮取一升二合药液，去掉药渣，分两次温服。如果服药后脉搏逐渐恢复显现，即为痊愈（不像那种突然从无到有、有了又消失的情况，就像灯火重新燃起火焰一样）。面色发红的，加葱白九茎；腹中痛的，去掉葱白，加芍药二两；呕吐的，加生姜二两；咽喉痛的，去掉芍药，加桔梗一两；腹泻停止但脉搏仍不出来的，去掉桔梗，加人参二两。
太阳篇中的四逆汤里干姜用量为一两半，用来治疗出汗过多导致亡阳的病症。到了通脉四逆汤，药物组成与之前相同，只是将干姜加倍，这是因为寒气太盛导致脉道闭塞，想要借助辛热药物的力量来开通凝滞的寒气以通达血脉。面色发红的，加葱白九茎（权宜之计可用粗葱白切成长九寸即可），因为面色发红是阴寒在下，逼迫阳气上浮，这就是所谓的戴阳证。加葱是为了通畅上下之气，而且多用葱符合老阳之数，这样阳气就可以回归其本位了。而我遇到这类病症时，常常加几钱芍药，因为芍药与附子配合使用，最善于收敛浮越的元阳使其下降。
《伤寒论》原文：少阴病，自发泄清水，颜色纯青，心下部必定疼痛，口干燥的，应当紧急攻下，适宜用大承气汤。
这种病症是由于伏气温热之邪窜入肝、肾两条经络所致。因为肾主闭藏，肝主疏泄，肾是大小便的关口，肝又为肾运行气机，现在因为伏气温热之邪，窜入肾脏并兼窜入肝脏，那么肝因热邪助长而疏泄之力太过，即为肾运行气机的力量太过，导致肾失去闭藏的功能，从而下利清水。并且因为肝热波及到胆，导致胆汁因热妄行，随着肝气的疏泄而下出纯青色的水。在此情况下，肾水因疏泄太过而即将枯竭，不能上行济助以镇摄心火，且肝木得不到肾水的滋润涵养，那么在下的疏泄过于过度，在上的肝气更加横逆肆虐，所以心下部作痛、口中干燥。这种情况应当紧急攻下，通过泻下来止住泻，那么肾中的真阴可以回复，自然能上行济助以治愈口中的干燥和心部的疼痛。
这一节前面有“少阴病得之二三日，口燥咽干的，紧急攻下，适宜用大承气汤。”以及后面一节“少阴病六七日，腹胀不大便的，紧急攻下，适宜用大承气汤。”猜想这两节，张仲景老师也都说是急下，如果不紧急攻下，应当也像下纯青色水那样，危险就在眼前了。像张仲景这样的人，确实应该被称为医中之圣啊。
按语：方书中有奇恒痢，张隐庵认为，这是三阳经邪气并至，三阴经无法抵挡，九窍都堵塞，阳气旁溢，咽喉干燥喉塞痛，并入阴经则上下无常，迫注肠道成为肠僻，其脉象缓小迟涩，血温身热的会死亡，热邪持续七天的会死亡。大概是因为阳气偏盛，阴气受伤，所以脉象小迟涩，这种病症应当紧急用大承气汤泻阳养阴，迟缓了就无效了。关于奇恒痢这个病，不知道排出的东西是什么样，仅就其脉象缓小迟涩来看，本来就和少阴病的脉微细相同。其咽喉干燥喉塞痛并入阴经，又和这一节的心下痛、口中干燥相同。张隐庵说应当紧急服用大承气汤，又和这一节的紧急攻下适宜用大承气汤相同。所以奇恒痢这个病，不外乎是在少阴下利的范围内，叫它奇恒痢可以，叫它少阴下利也没有不可以。
《伤寒论》原文：少阴病，下利，脉微涩，呕吐且出汗，必然多次更衣（排便），反而量少，应当温补上部，用艾灸治疗。
注家认为：适宜灸百会穴。
Original text from *Shanghan Lun* (Treatise on Cold Damage Disorders): Shaoyin disease (a syndrome caused by pathogenic invasion of the Shaoyin meridians), with diarrhea of undigested food, internal cold and external heat, coldness of the hands and feet, a faint pulse nearly imperceptible, yet the body does not feel aversion to cold, the patient's face is red, abdominal pain, occasional dry retching, occasional sore throat, or cessation of diarrhea with an unpalpable pulse; Tongmai Sini Decoction (Pulse-Reviving Four-Reversal Decoction) is the primary treatment.
[Tongmai Sini Decoction] Prepared Glycyrrhizae Radix et Rhizoma (Gancao, Licorice Root) 2 liang, raw Fuzi (Aconiti Lateralis Radix Preparata, prepared lateral root of Aconite) one large piece, peeled and broken into eight slices, dried Ginger Root (Ganjiang, Dried Ginger) 3 liang.
Take the above three ingredients, add three sheng of water, boil to obtain one sheng and two he of liquid, remove the dregs, and divide into two warm doses. If the pulse gradually becomes palpable after administration, recovery occurs (unlike a sudden appearance from nothing followed by disappearance again, like a lamp flame flaring up). For those with a red face, add nine stalks of Scallion White (Congbai, White part of Allium fistulosum); for abdominal pain, remove Scallion White and add Paeoniae Radix Alba (Baishao, White Peony Root) 2 liang; for vomiting, add fresh Ginger (Shengjiang, Fresh Ginger) 2 liang; for sore throat, remove Paeoniae Radix Alba and add Platycodonis Radix (Jiegeng, Balloon Flower Root) 1 liang; for cessation of diarrhea with an unpalpable pulse, remove Platycodonis Radix and add Ginseng Radix (Renshen, Ginseng Root) 2 liang.
In the Taiyang chapter, the Sini Decoction contains 1.5 liang of dried Ginger, used to treat conditions where excessive sweating leads to Yang collapse. In Tongmai Sini Decoction, the ingredients are the same as before, but the amount of dried Ginger is doubled. This is because severe cold causes pulse obstruction, and the pungent-hot power is needed to open congealed cold and unblock the vessels. For a red face, adding nine stalks of Scallion White (roughly cut white parts of thick scallions, each about nine cun long) is prescribed. The red face indicates Yin cold below forcing Yang to float upward, known as Daiyang syndrome (False Yang floating upwards). Adding Scallion White facilitates the circulation of Qi between the upper and lower bodies. Moreover, using a larger quantity aligns with the number of Old Yang, allowing Yang to return to its residence. In my experience with such cases, I often add a few qian of Paeoniae Radix Alba, as the combination of Paeoniae Radix Alba and Fuzi is most effective in converging floating Yuan Yang (Primordial Yang) and guiding it downward.
Original text from *Shanghan Lun*: Shaoyin disease, spontaneous purgation of clear water, purely green in color, accompanied by inevitable pain in the epigastrium and dryness of the mouth, requires urgent purgation; Da Chengqi Decoction (Great Order the Qi Decoction) is appropriate.
This condition arises from latent heat pathogens invading the Liver and Kidney meridians. The Kidney governs closure and storage, while the Liver governs dispersion and drainage. The Kidney acts as the gate for urination and defecation, and the Liver assists the Kidney in regulating Qi flow. Due to the latent heat pathogen invading the Kidney and simultaneously affecting the Liver, the Liver’s dispersive force becomes excessive due to the heat, thereby excessively assisting the Kidney’s Qi movement. This causes the Kidney to lose its function of closure and storage, resulting in the purgation of clear water. Furthermore, Liver heat affects the Gallbladder, causing bile to flow recklessly due to heat and exit as purely green water along with the Liver’s excessive dispersion. Consequently, Kidney Water is nearly exhausted due to excessive dispersion and cannot ascend to nourish and suppress Heart Fire. Additionally, Liver Wood fails to receive the moistening nourishment of Water, leading to excessive dispersion below and rampant aggression above, causing epigastric pain and oral dryness. Urgent purgation is indicated here; by purging to stop diarrhea, the True Yin within the Kidney can recover, naturally ascending to cure oral dryness and epigastric pain.
Prior to this section, there is: "Shaoyin disease, two to three days after onset, with dry mouth and throat, requires urgent purgation; Da Chengqi Decoction is appropriate." And in the following section: "Shaoyin disease, six to seven days after onset, with abdominal fullness and constipation, requires urgent purgation; Da Chengqi Decoction is appropriate." It is presumed that Master Zhang Zhongjing also emphasized urgent purgation in these sections. If urgent purgation is not performed, the danger would be imminent, similar to the case of passing purely green water. Such being Zhang Zhongjing, he truly deserves to be called the Sage of Medicine.
Note: Medical texts mention Qiheng Dysentery. Zhang Yinan stated that this occurs when pathogens of the Three Yang meridians converge, overwhelming the Three Yin meridians, blocking all nine orifices, and causing Yang Qi to overflow sideways. Symptoms include dry throat, blocked and painful throat, and erratic movement into the Yin meridians, leading to intestinal dysentery. The pulse is slow, small, delayed, and choppy. Death ensues if the blood feels warm and the body is hot, or if the heat persists for seven days. Generally, this is due to excessive Yang Qi injuring Yin Qi, resulting in a small, delayed, and choppy pulse. This condition requires urgent use of Da Chengqi Decoction to purge Yang and nourish Yin; delay renders it ineffective. Regarding Qiheng Dysentery, although the nature of the excrement is unknown, the pulse characteristics of being slow, small, delayed, and choppy are identical to the faint and fine pulse of Shaoyin disease. The symptoms of dry throat, blocked throat, and pain merging into the Yin correspond to the epigastric pain and oral dryness in this section. Zhang Yinan’s recommendation for urgent administration of Da Chengqi Decoction aligns with the urgent purgation indicated here. Thus, Qiheng Dysentery falls within the scope of Shaoyin diarrhea; it may be named Qiheng Dysentery or simply Shaoyin diarrhea without issue.
Original text from *Shanghan Lun*: Shaoyin disease, with diarrhea, a faint and choppy pulse, vomiting and sweating, frequent bowel movements but scant output, should be treated by warming the upper part with moxibustion.
Commentators suggest: Moxibustion at Baihui GV20 (Convergence of Yang) is appropriate.