赤石脂(一半全用，一半筛末)一斤 干姜一两 糯米一升
右三味，以水七升，煮米令熟，去滓，温服七合，内赤石脂末方寸匕，日三服，若一
服愈，余勿服。
【方解】
少阴寒邪，多利清谷；少阴热邪，多便脓血；日久不止，关门不固，下焦滑脱矣。此
方君以体膏性涩之石脂，养肠以固脱；佐以味甘多液之糯米，益气以滋中，则虽下利
日久，中虚液枯，未有不愈者也。其妙尤在用干姜少许，其意不在温而在散火郁，借
此以开脓血无由而化也。若一服愈，余勿服，以其粘涩之性甚也。
@@@
少阴病下利，便脓血者，桃花汤主之。
【注】
少阴病诸下利，用温者，以其证属虚寒也。此少阴下利便脓血者，是热伤荣也，而不
径用苦寒者，盖以日久热随血去，肾受其邪，关门不固也，故以桃花汤主之。
@@@
少阴病下利，便脓血者，可刺。
【注】
少阴病下利，便脓血用桃花汤不止者，热瘀于阴分也，则可刺本经之穴，以泄其热，
热去则脓血自止矣。
【集注】
张璐曰：先下利日久，而后便脓血，则用桃花汤。若不先下利，而下利，便脓血，则
可刺经穴。若刺经穴不愈，则当从事白头翁汤；设更咽干心烦不得眠，则又须黄连阿
胶汤为合法也。
林澜曰：刺者泻其经气而宣通之也。下利便脓血，既主桃花汤矣，此复云可刺者，如
痞证利不止，复利其小便，与五苓散，以救石脂禹余粮之穷；故此一刺，亦以辅桃花
汤之所不逮也。
@@@
少阴病得之二三日，口燥咽干者，急下之，宜大承气汤。
【注】
邪至少阴二三日，即口燥咽干者，必其人胃火素盛，肾水素亏，当以大承气汤，急泻
胃火以救肾水。若复迁延时日，肾水告竭，其阴必亡，虽下无及矣。
【集注】
成无己曰：与大承气汤急下之，以全肾何也？经云：三阴经受病已入于府者，可下而
已。则是上条少阴病乃入府证也，少阴邪热已转属府胃，府实热消灼肾水，故口燥咽
干，用大承气以泻府，而实热自除。且少阴之藏本肾属水，胃府属土，泻土所以救水
也。
方有执曰：口燥咽干者，少阴之脉循喉咙挟舌本，邪热客于其经，而肾水为之枯竭也
。然水干则土燥，土燥则水愈干，所以急于下也。
张璐曰：按少阴急下三证，一属传经热邪亢极，一属热邪转入胃府，一属温热发自少
阴，皆刻不容缓之证。故当急救欲绝之肾水，与阳明急下三法，同源异派。
汪琥曰：少阴病得之二三日者，非才得病二三日，即口燥咽干；谓少阴口燥咽干之病
，已得之二三日也。
@@@
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。
【注】
少阴病自利清水，谓下利无糟粕也。色纯青，谓所下者皆污水也。下无糟粕，纯是污
水，此属少阴实热；所以心下必痛，口燥咽干，其为少阴急下之证无疑矣，故当急下
之，宜大承气汤。
【集注】
程知曰：阳邪热结，口必干燥；设系阴邪，口中和而不燥矣。故宜急下之以救阴也。
沈明宗曰：邪传阳明，必俟大便坚□而攻下者，迺未伤胃中津液之谓。此利清水，因
少阴邪热炽盛，乘逼胃中津液，顷刻势已濒危，不得不以通；因通用急夺，而救胃肾
将绝之阴也。
@@@
少阴病六七日，腹胀不大便者，急下之，宜大承气汤。
【注】
少阴病六七日，腹胀不大便者，盖因其人阳气素盛，胃有宿食故也。所以传邪已入少
阴，复转属阳明，而成胃实，故宜大承气汤急下之也。
【集注】
张璐曰：少阴之证自利者最多，虚寒则下利清谷，虚热则下利脓血，故多用温补传经
。阳邪内结，则自利纯青水；温热病，则自利烦渴；并宜下夺清热。此以六七日不大
便而腹胀，可见邪热转归阳明，而为胃实之证，所以宜急下也。
@@@
少阴中风脉，阳微阴浮者，为欲愈。
【注】
少阴中风脉，若见阳浮阴弱，乃风邪传入少阴，则是其势方盛，未易言愈。今阳脉反
微，阴脉反浮，阳微则外邪散而表气和，阴浮则里气胜而邪外出，故为欲愈也。
@@@
少阴病欲解时，从子至寅上。
【注】
子丑寅阳生渐长之候也，病在少阴而解于阳生之际，所谓阳进则阴退，阴得阳而邪自
解也。少阴所重在真阳，从可见矣。
音切
蜷音拳
【方解】
少阴经受寒邪，多表现为腹泻且排出未消化的食物；少阴经受热邪，多表现为大便带脓血；若病程日久不止，导致下焦固摄功能丧失，出现滑脱不禁。此方以质地如膏、性味涩滞的赤石脂为君药，滋养肠道以固涩滑脱；佐以味甘汁多的糯米，益气以滋养中焦，那么即使下利日久，导致中气虚弱、津液枯竭，也没有不痊愈的道理。其妙处更在于使用少量的干姜，其用意不在于温补，而在于发散郁火，借此促使脓血得以化解。如果服用一次后病愈，剩余的药就不要服用了，因为该药粘涩之性很强。
【注】
少阴病的各种下利，采用温法治疗的，是因为证候属于虚寒。此处少阴病下利且大便带脓血，是热邪损伤了营血，而不直接使用苦寒药物的原因，是因为日久之后热邪随血液流失，肾受邪气侵袭，关门（指下焦固摄功能）不固，所以用桃花汤主治。
【注】
少阴病下利，大便带脓血，服用桃花汤无效时，说明热邪瘀结在阴分，此时可以针刺本经的穴位，以泄除热邪，热邪去除则脓血自然停止。
【集注】
张璐说：先长期下利，随后才出现大便带脓血，则使用桃花汤。如果不先下利，而是直接出现下利并伴有大便带脓血，则可以针刺经络穴位。如果针刺经络穴位无效，则应当采用白头翁汤；如果再加上咽干、心烦、不得睡眠的症状，则又必须使用黄连阿胶汤才是合适的治法。
林澜说：所谓刺，是泻除经气而使其宣通。下利便脓血，既然已经用桃花汤主治，这里又说可以针刺，就像痞证下利不止，再次通过利小便的方法，配合五苓散，来补救赤石脂、禹余粮等固涩药的不足；所以这一针，也是辅助桃花汤所不能达到的效果。
@@@
少阴病发病两三天，出现口燥咽干的，应当急下，宜用大承气汤。
【注】
邪气传入少阴仅两三天，就出现口燥咽干的，必定是此人胃火素来旺盛，肾水素来亏虚，应当用大承气汤，急泻胃火以救肾水。如果再拖延时日，肾水枯竭，阴液必将亡失，即使再下也来不及了。
【集注】
成无己说：给大承气汤急下，是为了保全肾水，为什么呢？经文说：三阴经受病，如果已传入腑，就可以用下法。那么上一条所说的少阴病就是传入腑的证候，少阴的邪热已经转属到胃腑，腑实热邪消灼肾水，所以出现口燥咽干，用大承气汤泻去腑实，实热自然消除。而且少阴的脏本是肾，属水；胃腑属土，泻土就是为了救水。
方有执说：口燥咽干，是因为少阴经脉循行喉咙挟持舌根，邪热客居在该经，导致肾水枯竭。然而水干则土燥，土燥则水更加干涸，所以急于用下法。
张璐说：按少阴急下证的三种情况，一种属于传经热邪亢盛到了极点，一种属于热邪转入胃腑，一种属于温热病发自少阴，都是刻不容缓的证候。所以应当急救将绝的肾水，这与阳明急下三法，同源而异派。
汪琥说：少阴病得之二三日，不是说刚得病二三天，就出现口燥咽干；是说少阴病出现口燥咽干的症状，已经持续了两三天。
@@@
少阴病，自行排出清水样便，颜色纯青，心下部必定疼痛，口干燥的，应当急下，宜用大承气汤。
【注】
少阴病自行排出清水样便，是指腹泻没有糟粕（粪便残渣）。颜色纯青，是指排出的都是污水。下利没有糟粕，全是污水，这属于少阴实热证；所以心下部必定疼痛，口燥咽干，这是少阴急下证无疑，所以应当急下，宜用大承气汤。
【集注】
程知说：阳邪热结，口必然干燥；如果是阴邪，口中应该是和润而不干燥的。所以应当急下以救阴液。
沈明宗说：邪气传入阳明，通常要等到大便坚硬才攻下，那是还没有损伤胃中津液的情况。这里是下利清水，因为少阴邪热炽盛，逼迫胃中的津液，顷刻间形势已濒危，不得不以通为用；因为通下的方法需要急夺，以挽救胃肾即将断绝的阴液。
@@@
少阴病六七天，腹部胀满且不大便的，应当急下，宜用大承气汤。
【注】
少阴病六七天，腹部胀满且不大便，大概是因为此人阳气素来旺盛，胃中有宿食积滞。所以邪气传入少阴后，又转属阳明，形成胃实证，所以宜用大承气汤急下。
【集注】
张璐说：少阴病的证候中自利的情况最多，虚寒则下利清谷，虚热则下利脓血，所以多用温补法治疗传经之邪。阳邪内结，则自利纯青色水；温热病，则自利且烦渴；都适宜用下法夺热清热。此处因六七天不大便而腹胀，可见邪热转归阳明，成为胃实证，所以宜急下。
@@@
少阴中风脉象，尺部脉微而寸部脉浮的，是快要痊愈的表现。
【注】
少阴中风的脉象，如果见到阳脉（寸脉）浮而阴脉（尺脉）弱，乃是风邪传入少阴，此时病势正盛，不容易说痊愈。现在阳脉反而微，阴脉反而浮，阳微则外邪消散而表气和顺，阴浮则里气胜而邪气外出，所以说是快要痊愈。
@@@
少阴病欲解的时间，从子时到寅时。
【注】
子、丑、寅三个时辰是阳气逐渐生长的时刻，病在少阴而在阳气生长之际解除，这就是所谓的阳进则阴退，阴得到阳的帮助则邪气自然解除。少阴病重在真阳，由此可见。
音切
蜷字读音同“拳”。
[Formula Analysis]
Shaoyin disease (Disease of the Shaoyin channel) caused by cold pathogen often presents with diarrhea and passage of undigested food; Shaoyin disease caused by heat pathogen often presents with pus and blood in the stool; if the condition persists for a long time, it leads to loss of control in the Lower Jiao (Lower Burner), resulting in sliding and uncontrolled discharge. This formula uses Chishizhi (Red Halloysite) as the Sovereign herb, which has a paste-like texture and astringent nature, to nourish the intestines and secure against sliding; it is assisted by Nuomi (Glutinous Rice), which is sweet in flavor and rich in fluid, to benefit Qi and nourish the Middle Jiao (Middle Burner). Thus, even if diarrhea persists for a long time leading to deficiency of the Middle and depletion of fluids, recovery is assured. Its subtlety lies particularly in the use of a small amount of Ganjiang (Dried Ginger); its intent is not primarily warming but rather to dissipate constrained fire, thereby facilitating the transformation of pus and blood. If the illness resolves after one dose, the remaining medicine should not be taken, due to the strong adhesive and astringent properties of the formula.
@@@
In Shaoyin disease, if there is diarrhea with pus and blood in the stool, Taohua Tang (Peach Blossom Decoction) is the primary treatment.
[Annotation]
For various types of diarrhea in Shaoyin disease, warm methods are used because the syndrome belongs to deficiency-cold. In this case of Shaoyin diarrhea with pus and blood, it is due to heat damaging the Ying (Nutrient) level. The reason for not directly using bitter-cold herbs is that after a long duration, the heat dissipates along with the blood, the Kidney is affected by the pathogen, and the "gate" (referring to the securing function of the Lower Jiao) is not firm. Therefore, Taohua Tang is used.
@@@
In Shaoyin disease, if there is diarrhea with pus and blood in the stool, acupuncture may be employed.
[Annotation]
When Shaoyin disease presents with diarrhea and pus/blood in the stool, and Taohua Tang fails to stop it, it indicates that heat is stasis-bound in the Yin levels. In such cases, acupoints on the relevant channel can be needled to drain the heat; once the heat is removed, the pus and blood will naturally cease.
[Collected Annotations]
Zhang Lu stated: If prolonged diarrhea precedes the appearance of pus and blood in the stool, Taohua Tang is used. If there is no prior diarrhea, but instead immediate onset of diarrhea with pus and blood, needling the channel acupoints is appropriate. If needling the channel acupoints is ineffective, Baitouweng Tang (Pulsatilla Decoction) should be adopted; if accompanied by dry throat, irritability, and insomnia, Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) would be the suitable prescription.
Lin Lan stated: "Needling" refers to draining the Qi of the channels to promote circulation. Although Taohua Tang is indicated for diarrhea with pus and blood, the mention of needling here serves a similar purpose to treating persistent diarrhea in Pi syndrome (glomus disorder) by promoting urination with Wuling San (Five-Ingredient Poria Pill) to compensate for the limitations of astringents like Chishizhi and Yuyuliang. Thus, this needling technique assists where Taohua Tang falls short.
@@@
In Shaoyin disease, if dry mouth and dry throat appear within two or three days of onset, urgent purgation is required, preferably using Dachengqi Tang (Major Order the Qi Decoction).
[Annotation]
If dry mouth and dry throat appear only two or three days after the pathogen enters the Shaoyin stage, it implies that the person inherently has excessive Stomach Fire and deficient Kidney Water. Dachengqi Tang should be used to urgently purge Stomach Fire to rescue Kidney Water. If time is delayed until Kidney Water is exhausted, Yin will perish, and purgation at that point would be too late.
[Collected Annotations]
Cheng Wuji stated: Why give Dachengqi Tang for urgent purgation to preserve Kidney Water? The Classic states: When diseases of the Three Yin channels enter the Fu organs, purgation is applicable. Thus, the aforementioned Shaoyin disease represents an entry into the Fu organ stage. The Shaoyin heat pathogen has transferred to the Stomach Fu; Fu excess heat consumes Kidney Water, causing dry mouth and throat. Dachengqi Tang clears the Fu, eliminating excess heat. Furthermore, the Zang organ of Shaoyin is the Kidney (Water), while the Stomach Fu is Earth; purging Earth saves Water.
Fang Youzhi stated: Dry mouth and throat occur because the Shaoyin channel circulates through the throat and surrounds the root of the tongue; pathogenic heat lodging in this channel causes Kidney Water to dry up. However, when Water dries, Earth becomes dry; when Earth is dry, Water dries further. Hence, urgent purgation is necessary.
Zhang Lu stated: Regarding the three indications for urgent purgation in Shaoyin disease: one involves extreme hyperactivity of transmitted heat pathogen, another involves heat transferring to the Stomach Fu, and the third involves warm-heat originating from Shaoyin. All are critical conditions requiring immediate attention. Thus, rescuing the nearly exhausted Kidney Water parallels the three methods of urgent purgation in Yangming, sharing the same origin but differing in manifestation.
Wang Hu stated: "Two or three days" in "Shaoyin disease getting two or three days" does not mean dry mouth and throat appear immediately upon contracting the disease for two or three days; rather, it means the symptoms of dry mouth and throat in Shaoyin disease have persisted for two or three days.
@@@
In Shaoyin disease, if there is spontaneous passage of clear water, purely green in color, with必 pain in the epigastrium and dry mouth/throat, urgent purgation is required, preferably using Dachengqi Tang (Major Order the Qi Decoction).
[Annotation]
"Spontaneous passage of clear water" in Shaoyin disease refers to diarrhea without solid fecal matter. "Purely green" means the discharged material is all turbid fluid. Diarrhea consisting solely of turbid fluid without residue indicates Shaoyin Excess Heat; consequently, there must be pain in the epigastrium and dry mouth/throat. This is undoubtedly a Shaoyin indication for urgent purgation, so Dachengqi Tang should be used urgently.
[Collected Annotations]
Cheng Zhi stated: Yang pathogenic heat accumulation causes dry mouth; if it were Yin pathogen, the mouth would feel moist and not dry. Therefore, urgent purgation is needed to save Yin.
Shen Mingzong stated: Typically, when pathogens transmit to Yangming, purgation waits until the stool is hard, implying the Stomach fluids have not yet been damaged. Here, passing clear water occurs because Shaoyin heat pathogen is blazing, forcing out Stomach fluids. The situation is critically endangered in moments, necessitating unblocking via purgation. This urgent draining method aims to rescue the nearly extinct Yin of the Stomach and Kidney.
@@@
In Shaoyin disease, if abdominal distension and constipation persist for six or seven days, urgent purgation is required, preferably using Dachengqi Tang (Major Order the Qi Decoction).
[Annotation]
In Shaoyin disease, abdominal distension and constipation lasting six or seven days likely stem from the patient's inherent robust Yang Qi and accumulated food stagnation in the Stomach. Thus, the pathogen entering Shaoyin transfers to Yangming, forming Stomach Excess, warranting urgent purgation with Dachengqi Tang.
[Collected Annotations]
Zhang Lu stated: Among Shaoyin syndromes, spontaneous diarrhea is most common: deficiency-cold causes diarrhea of undigested food, deficiency-heat causes diarrhea with pus and blood, so warm tonification is often used for transmitted pathogen. Yang pathogen internal binding causes pure green watery diarrhea; warm-heat disease causes diarrhea with vexation and thirst; both are suitable for purgative heat-clearing methods. Here, constipation and abdominal distension after six or seven days indicate heat pathogen has returned to Yangming, forming Stomach Excess, hence urgent purgation is indicated.
@@@
In Shaoyin wind-strike, if the pulse shows weak Yang (cun position) and floating Yin (chi position), it indicates impending recovery.
[Annotation]
In Shaoyin wind-strike, if the pulse shows floating Yang (cun) and weak Yin (chi), it signifies the wind pathogen has entered Shaoyin, indicating the pathogen is still strong and recovery is unlikely. However, if the Yang pulse is unexpectedly weak and the Yin pulse is unexpectedly floating, weak Yang indicates external pathogen dispersal and harmonious exterior Qi, while floating Yin indicates superior interior Qi and outward expulsion of pathogen. Thus, it indicates impending recovery.
@@@
The time when Shaoyin disease tends to resolve is from Zi hour to Yin hour.
[Annotation]
Zi, Chou, and Yin hours represent the gradual growth of Yang Qi. When Shaoyin disease resolves during this period of Yang generation, it exemplifies "as Yang advances, Yin retreats"; Yin benefits from Yang, and the pathogen naturally resolves. Shaoyin disease focuses on True Yang, as can be seen here.
Phonetics
Quan sounds like "Quan" (fist).