（仲景）
治厥阴伤寒，手足厥寒，脉细欲绝（成氏曰∶手足厥寒者，阳气外虚，不温四末；脉细
欲
当归 桂枝 芍药 细辛（三两） 甘草（炙） 通草（即木通。二两） 大枣（二十
五枚。）
吴茱萸生姜汤。
此足厥阴药也。成无己曰∶脉者，血之府也。诸血皆属于心，通脉者必先补心益血，苦
先入
以缓之，大枣、甘草、通草以缓阴血（四逆之名多矣，而有因寒、因热之不同。此则因风寒
中血脉而逆，故以当归细辛血中之气药为君；通脉散逆，必先去血中之邪，故以桂枝散太阳
血分之风，细辛散少阴血分之寒，为辅；未有营卫不和而脉能通者，故以芍药、甘草、大枣
调和营卫；通草利九窍，通血脉关节，诸药藉之以破阻滞，而厥寒散矣。周扬俊曰∶四逆汤
全从回阳起见，四逆散全从和解表里起见，当归四逆全从养血通脉起见，不欲入辛热之味，
恐劫其
即遇
外足
（仲景。此和解之寒剂，因名四逆，附次于此。）
治伤寒少阴证，阳邪入里，四逆不温，或咳或悸，或小便不利，或腹中痛，或泄利下
重（阳邪
故小便
四肢
柴胡 芍药（炒） 枳实（麸炒） 甘草（炙，等分，为末。）水调饮。咳加五味子、
干姜，并主下利（五味收逆气，干姜散肺寒。肺与大肠相表里，上咳下利。治法颇同；悸加
桂枝引导阳气）；小便不利加茯苓（甘淡渗泄）；腹痛加附子（以补虚散寒）；泄利下重加薤
白（能通大肠以泄气滞）。
此足少阴药也，伤寒以阳为主，若阳邪传里而成四逆，有阴进之象，又不敢以苦寒下之
，恐
元阴
者，视加法为治（陶节庵曰∶病在一经，有用热药又用寒药者，如少阴证有用白虎汤、四逆
散寒药者，有用真武汤、四逆汤热药者。庸医狐疑，讵能措手。不知寒药治少阴，乃传经之
热证也；热药治少阴，乃直中之寒证也。昂按∶仲景《伤寒论》阳明证热药仅一茱萸汤；少
阳证药主和解，亦有加干姜者；其余四经用姜、附、萸、桂者不可胜数，岂必一一皆直中之
邪乎。阳明、少阳二经并无热剂，岂直中者独不中此二经乎。况仲景书中说传经者有矣，并
无直中字面，何所据而以寒热分之，故程郊倩以直中寒邪、传经热邪二说，虽古来相传之语，
要未可为
【当归四逆汤】
（张仲景）
治疗厥阴经伤寒，症状为手足寒冷，脉象细微几乎摸不到。
[成无己注：手足寒冷的原因是阳气在体表虚弱，无法温暖四肢末端；脉象细微欲绝是因为血虚不能充盈脉道。]
组成：当归、桂枝、芍药、细辛（各三两），甘草（炙用）、通草（即木通，各二两），大枣（二十五枚）。
这是足厥阴肝经的药物。成无己说：脉是血液汇聚的府库。所有的血液都归属于心，想要通畅血脉，必须先补益心脏、滋养血液。[方中药物配伍逻辑：] 用苦味药先入心以缓急，用大枣、甘草、通草来缓和阴血的凝滞。（“四逆”这个名称有很多情况，有因寒引起的，也有因热引起的。此方是因为风寒侵入血脉导致气血逆乱，所以用当归、细辛这类血分中的气药作为君药；要散除血脉中的逆乱之气，必须先去除血中的邪气，所以用桂枝疏散太阳经血分的风邪，用细辛疏散少阴经血分的寒邪，作为臣药；如果没有营卫调和而血脉能通畅的情况，所以用芍药、甘草、大枣来调和营卫；通草能利九窍，通畅血脉和关节，各种药物借助它来破除阻滞，于是手足寒冷就消散了。）周扬俊说：四逆汤完全是从回阳救逆的角度出发，四逆散完全是从和解表里的角度出发，当归四逆汤完全是从养血通脉的角度出发，不想加入辛热性质的药物，恐怕会劫伤阴液。[原文此处似有缺漏或错简，接“即遇外足”等字，语意不全，暂略]
【四逆散】
（张仲景。这是和解类的寒凉剂，因为名为四逆，附在此处。）
治疗伤寒少阴证，阳热邪气传入体内，导致四肢逆冷不温，或者咳嗽或者心悸，或者小便不利，或者腹痛，或者腹泻伴有肛门重坠感。
[病机分析：] 故小便... [原文此处有缺漏] 四肢... [原文此处有缺漏]
组成：柴胡、芍药（炒）、枳实（麸炒）、甘草（炙，以上四味等分，研为末）。用水调服。
如果咳嗽，加五味子、干姜，这两味药也主治下利（五味子收敛逆气，干姜散肺寒。肺与大肠相表里，上见咳嗽下见下利，治法颇为相似）；如果心悸，加桂枝引导阳气；如果小便不利，加茯苓（甘淡渗湿泄浊）；如果腹痛，加附子（以补虚散寒）；如果腹泻伴有肛门重坠感，加薤白（能通畅大肠以泄气滞）。
这是足少阴肾经的药物。伤寒病以阳气为主，如果阳热邪气传入体内形成四逆症，有阴气进逼的迹象，又不敢用苦寒药攻下，恐怕损伤... [原文此处有缺漏] 元阴... [原文此处有缺漏]
治疗方法，视具体的加法而定。（陶节庵说：病在一经，有用热药又用寒药的情况，比如少阴证有用白虎汤、四逆散这些寒药的，也有用真武汤、四逆汤这些热药的。庸医犹豫不决，怎么能下手治疗。不知道寒药治少阴，是治疗传经的热证；热药治少阴，是治疗直中的寒证。汪昂按语：张仲景《伤寒论》中阳明证用热药仅有一方茱萸汤；少阳证药物主和解，也有加干姜的；其余四经使用姜、附、萸、桂的不可胜数，难道一定都是直中的邪气吗？阳明、少阳二经并没有热剂，难道直中的邪气唯独不侵犯这两经吗？况且仲景书中只说有传经的，并没有“直中”这个词面，根据什么来区分寒热呢？所以程郊倩提出的直中寒邪、传经热邪两种说法，虽然是古来相传的话，但未必可以... [原文此处截断]
[Guizhi Shao Yao Zhi Gan Tang (Cinnamon Twig, Peony, and Licorice Decoction)]
(Zhang Zhongjing)
Treats Jueyin Cold Damage (Cold damage affecting the Jueyin channel), characterized by coldness of the hands and feet, and a fine pulse that is nearly imperceptible.
[Cheng Wuji's commentary: The coldness of the hands and feet is due to deficiency of Yang Qi on the exterior, failing to warm the four extremities; the fine pulse nearly vanishing is due to blood deficiency failing to fill the vessels.]
Composition: Danggui Radix Angelicae Sinensis (3 liang), Guizhi Ramulus Cinnamomi (3 liang), Shaoyao Radix Paeoniae Alba (3 liang), Xixin Herba Asari (3 liang), Zhigancao Radix Glycyrrhizae Preparata (2 liang), Tongcao Medulla Tetrapanacis (i.e., Mutong Caulis Akebiae, 2 liang), Dazao Fructus Jujubae (25 pieces).
This is a formula for the Foot-Jueyin Liver Channel. Cheng Wuji stated: The pulse is the residence of Blood. All Blood belongs to the Heart. To unblock the pulses, one must first tonify the Heart and nourish the Blood. [Formula logic:] Bitter flavors enter the Heart first to relieve tension; Dazao, Zhigancao, and Tongcao are used to moderate the stagnation of Yin Blood. ("Sini" or "Four Reversals" has many causes, some due to Cold, some due to Heat. This case is due to Wind-Cold invading the blood vessels causing reversal of Qi, so Danggui and Xixin, which are Qi-moving herbs within the Blood category, are used as the Sovereign herb; to scatter the reversal in the pulses, one must first remove pathogens from the Blood, so Guizhi is used to disperse Wind in the Taiyang Blood level, and Xixin to disperse Cold in the Shaoyin Blood level, serving as Ministers; without harmonying Ying and Wei, the pulse cannot be unblocked, so Shaoyao, Zhigancao, and Dazao are used to harmonize Ying and Wei; Tongcao benefits the nine orifices, unblocks the blood vessels and joints, and all other drugs rely on it to break stagnation, thus the coldness of the extremities dissipates.) Zhou Yangjun said: Sini Tang is entirely aimed at restoring Yang; Sini San is entirely aimed at harmonizing the exterior and interior; Guizhi Shao Yao Zhi Gan Tang is entirely aimed at nourishing Blood and unblocking the pulses. It avoids acrid-hot substances to prevent damaging Yin fluids. [The original text here appears incomplete or corrupted, ending with "Ji yu wai zu", omitted for translation.]
[Sini San (Four Reversals Powder)]
(Zhang Zhongjing. This is a harmonizing cold-natured formula, named Sini, attached here.)
Treats Shaoyin syndrome of Cold Damage, where Yang pathogenic factors have entered the interior, causing four reversals (cold extremities) that do not warm, or cough, or palpitations, or difficulty in urination, or abdominal pain, or diarrhea with a sensation of heaviness/tenesmus at the anus.
[Mechanism analysis:] Therefore urination... [Text missing] Four limbs... [Text missing]
Composition: Chaihu Radix Bupleuri, Shaoyao Radix Paeoniae Alba (stir-fried), Zhishi Fructus Aurantii Immaturus (bran-fried), Zhigancao Radix Glycyrrhizae Preparata (equal parts, ground into powder). Take with water.
If coughing, add Wuweizi Fructus Schisandrae and Ganjiang Rhizoma Zingiberis Recens; these also treat diarrhea (Wuweizi averts rebellious Qi, Ganjiang disperses Lung Cold. The Lung and Large Intestine are exterior-interior pairs; upper cough and lower diarrhea share similar treatment principles); if palpitations, add Guizhi Ramulus Cinnamomi to guide Yang Qi; if difficulty in urination, add Fuling Poria (sweet and bland to leach out dampness); if abdominal pain, add Fuzi Radix Aconiti Lateralis Preparata (to tonify deficiency and dispel Cold); if diarrhea with tenesmus, add Xieium Bulbus Allii Macrostemonis (to unblock the Large Intestine and drain Qi stagnation).
This is a medicine for the Foot-Shaoyin Kidney Channel. In Cold Damage, Yang is primary. If Yang pathogens transmit to the interior forming Sini syndrome, there is an image of Yin advancing, yet one dares not use bitter-cold purgatives, fearing damage to... [Text missing] Yuan Yin (Primal Yin)... [Text missing].
Treatment depends on the specific modifications. (Tao Jian'an said: When disease is in one channel, there are cases using both hot and cold medicines. For example, in Shaoyin syndrome, cold medicines like Baihu Tang and Sini San are used, while hot medicines like Zhenwu Tang and Sini Tang are also used. Unskilled doctors hesitate and do not know how to proceed. They do not understand that treating Shaoyin with cold medicines addresses heat syndromes transmitted via channels; treating Shaoyin with hot medicines addresses cold syndromes directly attacking the body. Wang Ang's note: In Zhang Zhongjing's *Shanghan Lun*, only one formula using hot medicines exists for Yangming syndrome (Zhuyu Tang); Shaoyang formulas focus on harmonization, sometimes adding Ganjiang; the other four channels frequently use Jiang, Fu, Yu, Gui, countless in number. Must they all be direct attacks? Yangming and Shaoyang channels have no hot formulas; would direct attacks spare these two channels? Moreover, Zhang Zhongjing mentions transmitted diseases but never uses the term "direct attack." On what basis is this distinction made? Thus, Cheng Jiaoqian's theory of direct-attack cold vs. transmitted heat, though traditionally passed down, may not be...) [Text cuts off]