22.少阴脉沉反发热 , 麻黄附子细辛汤, 若二三日无里证, 减辛加草
用之良.
【注】少阴病脉沉, 为阴寒之证, 当无热, 今反发热, 是兼有太阳表
也.宜麻黄附子细辛汤, 急温而散之. 若二、 三日热仍不解, 亦无里
寒吐痢之证, 去细辛易甘草, 缓温而和之. 详少阴篇. 厥阴篇.
23. 厥阴阴邪微细厥, 肤冷脏厥躁难安, 囊缩舌短胎滑黑, 四逆当归
四逆先, 少满痛厥姜萸入, 蛔厥静而复时烦, 得食而呕蛔闻臭, 烦因
蛔动乌梅圆.
【注】厥阴阴邪, 谓邪从阴化之寒证也. 微细, 厥阴阴邪脉也. 厥,
谓四肢厥冷也. 肤冷, 谓肌肤冷也. 脏厥, 谓寒阴脏厥也. 躁难安,
谓烦躁无有安时也. 囊缩, 谓外肾为寒收引缩入腹也, 妇人则乳缩阴
收也. 舌短, 谓舌缩短也. 胎滑黑, 谓舌胎不干而色黑也. 四逆, 谓
四逆汤也. 当归四逆, 谓当归四逆汤也. 先者, 谓先服当归四逆汤也.
少满痛, 谓少腹满按之痛心也. 厥, 谓厥冷也. 姜萸入, 谓当归四逆
汤加入吴茱萸、 生姜也. 蛔厥, 谓厥而吐蛔也. 静而复时烦, 谓烦时
止时烦也. 得食而呕蛔闻臭, 谓呕因蛔闻食臭而始呕也. 烦因蛔动,
谓烦因蛔动而始烦也. 乌梅圆蛔厥, 谓宜用乌梅丸也. 详厥阴篇.
22. 少阴病脉象沉，反而出现发热症状，应使用麻黄附子细辛汤；若发病两三天后没有里证，则减少细辛用量并加入甘草，这样使用效果良好。
【注】少阴病的脉象沉，属于阴寒性质的病证，应当没有发热，现在反而发热，说明兼有太阳经表证。适宜使用麻黄附子细辛汤，急需温阳散寒。如果两三天后热势仍未解除，同时也没有里寒导致的呕吐、下痢等证候，则去掉细辛改用甘草，以缓和的方式温补调和。详见《少阴篇》和《厥阴篇》。
23. 厥阴经受阴邪侵袭，脉象微细，四肢厥冷，肌肤寒冷，内脏虚寒躁动不安难以安宁，阴囊收缩，舌体短缩，舌苔滑润且色黑，应先服用四逆汤或当归四逆汤；若见少腹部胀满疼痛且伴有厥冷，则在方中加入吴茱萸和生姜；若是蛔虫引起的厥逆，表现为安静时突然心烦，进食后因闻到食物气味而呕吐，心烦是因为蛔虫扰动所致，适宜使用乌梅丸。
【注】厥阴经的阴邪，指的是邪气从阴化生而成的寒证。“微细”，是厥阴经阴邪的典型脉象。“厥”，指四肢厥冷。“肤冷”，指肌肤寒冷。“脏厥”，指内脏因寒阴而厥逆。“躁难安”，指烦躁不安，没有片刻安宁之时。“囊缩”，指外肾（睾丸）因寒气收引而缩入腹中，女性则表现为乳房收缩、阴户收紧。“舌短”，指舌体缩短。“胎滑黑”，指舌苔不干燥且颜色发黑。“四逆”，指四逆汤。“当归四逆”，指当归四逆汤。“先者”，指先服用当归四逆汤。“少满痛”，指少腹部胀满，按压时感到疼痛并伴有厥冷。“姜萸入”，指在当归四逆汤中加入吴茱萸和生姜。“蛔厥”，指因蛔虫引起的厥逆，伴有吐蛔。“静而复时烦”，指有时安静，时而心烦。“得食而呕蛔闻臭”，指因闻到食物气味而引发呕吐，吐出蛔虫。“烦因蛔动”，指心烦是因为蛔虫扰动所致。“乌梅圆蛔厥”，指适宜使用乌梅丸治疗蛔厥。详见《厥阴篇》。
22. In Shaoyin disease, the pulse is deep but fever is present; this should be treated with Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction). If after two or three days there are no interior syndromes, reduce the dosage of Xixin (Asari Radix) and add Gancao (Licorice Root); this method yields good results.
[Annotation] A deep pulse in Shaoyin disease indicates a Yin-cold syndrome, which typically presents without fever. The presence of fever indicates a concurrent Taiyang exterior syndrome. It is appropriate to use Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) to urgently warm and disperse the cold. If the fever persists after two or three days, and there are no interior cold symptoms such as vomiting or dysentery, remove Xixin (Asari Radix) and substitute it with Gancao (Licorice Root) to gently warm and harmonize. For details, refer to the "Shaoyin Chapter" and the "Jueyin Chapter".
23. In Jueyin Yin-pathogen conditions, the pulse is faint and thin, accompanied by cold extremities, cold skin, visceral coldness, and restlessness that prevents comfort. Symptoms may include retraction of the scrotum, shortening of the tongue, and a slippery black coating. Initially, treat with Sini Tang (Frigid Extremities Decoction) or Danggui Sini Tang (Angelica Sinensis Decoction for Cold Extremities). If there is distension and pain in the lower abdomen with cold extremities, add Wuzhuyu (Evodiae Fructus) and Shengjiang (Zingiberis Rhizoma Recens) to the formula. If the condition is Jueyin due to roundworms (Hui Jue), characterized by periods of calmness alternating with sudden irritability, vomiting upon smelling food, and irritability caused by worm movement, Wumei Wan (Mume Pill) is indicated.
[Annotation] "Jueyin Yin-pathogen" refers to cold syndromes generated from the transformation of pathogens into Yin. "Faint and thin" describes the pulse characteristic of Jueyin Yin-pathogens. "Jue" refers to cold extremities. "Skin cold" refers to coldness of the skin and muscles. "Visceral Jue" refers to visceral coldness leading to Jue. "Restlessness preventing comfort" refers to irritability with no time of peace. "Scrotal retraction" refers to the external genitalia retracting into the abdomen due to cold contraction; in women, this manifests as breast and vaginal retraction. "Short tongue" refers to a shortened tongue body. "Slippery black coating" refers to a moist, non-dry tongue coating that is black in color. "Sini" refers to Sini Tang (Frigid Extremities Decoction). "Danggui Sini" refers to Danggui Sini Tang (Angelica Sinensis Decoction for Cold Extremities). "Initially" means to administer Danggui Sini Tang first. "Lower abdominal distension and pain" refers to distension and tenderness upon pressure in the lower abdomen accompanied by cold. "Add Ginger and Evodia" means adding Wuzhuyu (Evodiae Fructus) and Shengjiang (Zingiberis Rhizoma Recens) to Danggui Sini Tang. "Hui Jue" refers to Jueyin due to roundworms, characterized by vomiting roundworms. "Calm then intermittently irritable" refers to alternating states of calmness and irritability. "Vomiting upon smelling food" refers to vomiting triggered by the smell of food, often expelling roundworms. "Irritability due to worm movement" refers to irritability caused by the movement of roundworms. "Wumei Wan for Hui Jue" indicates that Wumei Wan (Mume Pill) is suitable for treating Jueyin due to roundworms. For details, refer to the "Jueyin Chapter".