按宋元以后医书。皆谓邪从三阳传入。俱是热症。唯有下之一法。论中四逆白通理中等
方。
俱为
不然
有
非也。有谓递次传入三阴尽无寒症者。
亦非
何则。人
今试譬之
寒。第觉
寒。寒性
谓误药而变
凡汗下失宜。过之。则伤正而虚其阳。不及。则热炽而伤其阴。虚其阳。则从少阴阴化
之症
化热
疼痛
阴化
里寒外
阳从阴
（为湿土纯阴之脏也。病入太阴。从阴化者多。从阳化者少）
何谓太阴之邪从阴化。伤寒论云。腹满吐食。自利不渴。手足自温。时腹自痛是也宜理
中汤
何谓太阴之邪从阳化。伤寒论云。发汗复不解腹痛。急下之。宜大承气汤是也。又曰。
腹满
而痛。）桂枝加大黄汤主之。
（肾中水火同具邪伤其经或从水化而为寒。或从火化而为热。二症俱以脉沉细但欲寐为
何谓少阴之邪从水化而为寒。曰脉沉细而微但欲寐。背恶寒口中和腹痛下利清谷。小便
白是
少阴病寒邪始伤是当无热。而反发热。为太阳之 阳外呈。脉沉。为少阴之生气不升。
恐阴
太阳
以上交阴阳法。
少阴病。自始得以至于二三日。俱无里症。可知太阳之表热。非汗不解。而又恐伤汗以
伤肾
汤。
以上微发汗法。
手足厥冷吐利小便复利。下利清谷。内寒外热脉微欲绝者。宜四逆汤。
里寒外热。面赤。或腹痛或干呕或咽痛利止脉不出。汗出而厥。宜通脉四逆汤。少阴下
利。
微续
汗下后。不解烦躁者。茯苓四逆汤主之。少阴病。二三日不已。至四五日。腹痛小便不
利。
武汤。
少阴病。得之二三日。口中和。其背寒者。（太阳之阳虚。不与少阴之君火相合）当灸
之。
○
痛
（
辄
云
少阴病吐利。（神机不能交会于中土。）手足逆冷。（中上气虚。不能达于四肢。）烦躁欲
死者
吴
以上用温剂法。
何谓少阴之邪从火化而为热。曰脉沉细而数。仍欲寐而内烦外躁。或不卧口中热下利清
水小
少阴病。二三日咽痛者。可与甘草汤。不瘥。与桔梗汤。
少阴病。咽中伤生疮。不能言语声不出者。苦酒汤主之
少阴病。咽中痛。半夏散及汤主之
少阴病。下利咽痛胸满心烦者。猪肤汤主之。
少阴病。得之二三日以上。心中烦不得卧。黄连阿胶汤主之。
少阴病。下利六七日。咳而呕渴心烦不得眠者。朱苓汤主之。
少阴病。二三日至四五日。腹痛小便不利。
下利便脓血。桃花汤主之。
以上皆以补正为救阴法。
少阴病。得之二三日。口燥舌干者。急下之。宜大承气汤。柯注云。热淫于内。因而转
属阳
少阴病。六七日腹胀不大便者。急下之。宜大承气汤。柯注云。得病六七日。当解不解。
津
心
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。柯注云。是土燥
火炎
以上皆以攻邪为救阴法。
按语：宋代和元代以后的医书，都声称病邪从三阳经传入（三阴经），全都是热证。只有使用攻下这一种方法。《伤寒论》中的四逆汤、白通汤、理中汤等方剂，都是（治疗寒证的）。
有人说不然，认为病邪依次传入三阴经，完全没有寒证，这也是不对的。为什么呢？现在试着打个比方：人感受了寒邪，只觉得寒冷。寒邪的性质……（原文此处有缺漏或排版错乱，意指寒邪致病特点）说是误用药物导致的变证。凡是发汗和攻下不当，过度则损伤正气而使其阳气虚弱；不足则热势炽盛而损伤其阴液。使阳气虚弱，则表现为少阴经从阴化（转化为寒证）的症状；（若热盛伤阴）则转化为热证。疼痛……阴化……里寒外热……阳气随阴气转化。
（因为脾为湿土，是纯阴之脏。病邪侵入太阴经，从阴化（转化为寒证）的情况多，从阳化（转化为热证）的情况少。）
什么叫太阴经的病邪从阴化呢？《伤寒论》说：腹部胀满，呕吐饮食，自发性腹泻且不口渴，手足自然温暖，时常腹部自发疼痛，这就是太阴从阴化的表现。适宜使用理中汤。
什么叫太阴经的病邪从阳化呢？《伤寒论》说：发汗后腹痛仍未解除，应当急下，适宜使用大承气汤。又说：腹部胀满而且疼痛，由桂枝加大黄汤主治。
（肾中水火同具，邪气伤害其经脉，或者从水化而为寒证，或者从火化而为热证。这两种症状都以脉象沉细、只想睡觉为共同特征。）
什么叫少阴经的病邪从水化而为寒证呢？回答说：脉象沉细而微弱，只想睡觉，背部怕冷，口中平和（不苦不燥），腹部疼痛，腹泻排出未消化的食物，小便清白，这是少阴病寒邪初伤时的表现，应当没有发热，却反而发热，这是因为太阳之阳气外现。脉沉，是因为少阴的生发之气不能上升。恐怕阴……太阳……以上是用交通阴阳的方法。
少阴病，从开始到二三天，都没有里证，可知太阳表的发热，不是发汗不能解除，但又担心发汗会伤及肾脏……汤。（原文此处似有脱文，指代某方）以上是用微发汗的方法。
手足厥冷，呕吐腹泻，小便复利，腹泻排出未消化的食物，内寒外热，脉象微弱几乎摸不到，适宜使用四逆汤。
里寒外热，面色发红，或者腹痛或者干呕或者咽痛，腹泻停止但脉搏不出，出汗且四肢厥冷，适宜使用通脉四逆汤。少阴病腹泻……微续……
发汗和攻下后，病情未解且烦躁的，由茯苓四逆汤主治。少阴病，二三天未愈，到了四五天，腹部疼痛，小便不利……武汤（应为真武汤）。
少阴病，得病二三天，口中平和，背部寒冷的。（因为太阳之阳虚，不与少阴之君火相合）应当施灸。
○ 痛（原文此处可能有缺漏）
少阴病呕吐腹泻，（神机不能在中焦交会），手足逆冷，（中上焦气虚，不能到达四肢），烦躁想死……吴茱萸汤（推测，原文截断）。以上是用温补药剂的方法。
什么叫少阴经的病邪从火化而为热证呢？回答说：脉象沉细而数，仍然想睡觉但内心烦乱外部躁动，或者不睡觉，口中热，腹泻排出清水，小……
少阴病，二三天咽喉痛的，可以给予甘草汤。如果不痊愈，给予桔梗汤。
少阴病，得病二三天以上，心中烦乱不能躺卧的，由黄连阿胶汤主治。
少阴病，腹泻六七天，咳嗽且呕吐、口渴、心烦不能睡眠的，由猪苓汤主治（原文作朱苓汤，通猪苓汤）。
少阴病，二三天到四五天，腹部疼痛，小便不利……
腹泻排脓血，由桃花汤主治。
少阴病，得病二三天，口燥舌干的，应当急下，适宜使用大承气汤。柯韵伯注解说：热邪淫溢于内，因而转属阳……
少阴病，六七天腹部胀满不大便的，应当急下，适宜使用大承气汤。柯韵伯注解说：得病六七天，应当解表而未解，津……心……
Translation:
Commentary: Medical texts after the Song and Yuan dynasties all claim that pathogenic factors transmitted from the Three Yang meridians (Taiyang, Yangming, Shaoyang) into the Three Yin meridaries are exclusively heat syndromes. They assert that only the purgative method should be used. However, formulas in the *Shanghan Lun* (Treatise on Cold Damage) such as Sini Tang (Four Reversal Decoction), Baitong Tang (White Pass Decoction), and Lizhong Tang (Regulate the Middle Decoction) are [used for cold syndromes].
Some argue otherwise, claiming that as pathogens transmit sequentially into the Three Yin meridians, there are no cold syndromes at all. This is also incorrect. Why? Let us use an analogy: When a person contracts cold, they feel cold. The nature of cold... [text fragment] ...is sometimes mistaken for changes caused by erroneous medication. Whenever sweating or purging methods are misapplied, excessiveness damages righteous Qi and depletes Yang, while insufficiency allows heat to blaze and damage Yin. Depletion of Yang leads to symptoms transforming according to Yin (cold transformation) in Shaoyin; [excess heat] transforms into heat. Pain... Yin transformation... interior cold with exterior heat... Yang follows Yin transformation.
(Because the Spleen is the organ of damp earth and is purely Yin. When disease enters the Taiyin meridian, it transforms according to Yin [into cold] more often than according to Yang [into heat].)
What is meant by Taiyin pathogenic factors transforming according to Yin? The *Shanghan Lun* states: Abdominal fullness, vomiting food, spontaneous diarrhea without thirst, naturally warm hands and feet, and occasional spontaneous abdominal pain. This is appropriate for Lizhong Tang (Regulate the Middle Decoction).
What is meant by Taiyin pathogenic factors transforming according to Yang? The *Shanghan Lun* states: After sweating, abdominal pain remains unresolved; urgent purging is required, suitable for Dachengqi Tang (Major Order the Qi Decoction). It also states: Abdominal fullness and pain. Guizhi Jiadahuang Tang (Cinnamon Twig plus Rhubarb Decoction) is the primary treatment.
(The Kidney contains both Water and Fire. When pathogens injure its meridians, they may transform via Water into cold or via Fire into heat. Both syndromes share the characteristics of a deep, fine pulse and a desire to sleep.)
What is meant by Shaoyin pathogenic factors transforming via Water into cold? The answer is: A deep, fine, and faint pulse, desire to sleep, aversion to cold on the back, a neutral mouth (no bitterness or dryness), abdominal pain, diarrhea with undigested food, and clear white urine. This is when Shaoyin cold pathogens initially injure the body; there should be no fever, yet fever appears reversely because Taiyang Yang manifests externally. A deep pulse indicates that Shaoyin’s vital ascending energy cannot rise. Fear of Yin... Taiyang... Above is the method of communicating between Yin and Yang.
In Shaoyin disease, from onset up to two or three days, there are no interior symptoms. Thus, we know that the exterior heat of Taiyang cannot be resolved without sweating, yet we must fear that sweating will injure the Kidney... [Formula name missing]... Above is the method of mild sweating.
Cold extremities, vomiting and diarrhea, urination resumes, diarrhea with undigested food, interior cold with exterior heat, and a pulse so faint it is almost imperceptible: Sini Tang (Four Reversal Decoction) is suitable.
Interior cold with exterior heat, red face, or abdominal pain, or dry retching, or sore throat, cessation of diarrhea but absence of pulse, sweating with cold extremities: Tongmai Sini Tang (Pulse-Returning Four Reversal Decoction) is suitable. Shaoyin diarrhea... [fragment]...
After sweating and purging, if the condition is not resolved and irritability occurs: Fuling Sini Tang (Poria Four Reversal Decoction) is the primary treatment. In Shaoyin disease, if unrelieved after two or three days, progressing to four or five days, with abdominal pain and difficult urination: Zhenwu Tang (True Warrior Decoction) [text says Wu Tang, likely typo].
In Shaoyin disease, within two or three days, if the mouth is neutral and the back feels cold (because Taiyang Yang deficiency fails to combine with Shaoyin Minister Fire): Moxibustion should be applied.
○ Pain [fragment]
Shaoyin disease with vomiting and diarrhea (the Spirit Mechanism cannot intersect in the Middle Jiao), cold extremities (Middle and Upper Jiao Qi deficiency cannot reach the four limbs), irritability desiring death... Wuzhuyu Tang [inferred from context, text cuts off]. Above is the method of using warming agents.
What is meant by Shaoyin pathogenic factors transforming via Fire into heat? The answer is: A deep, fine, and rapid pulse, still desiring sleep but with internal vexation and external restlessness, or inability to sleep, heat in the mouth, diarrhea with clear water, small [fragment]...
In Shaoyin disease, if there is a sore throat after two or three days: Gancao Tang (Licorice Decoction) may be given. If not healed, Jiegeng Tang (Platycodon Decoction) is given.
In Shaoyin disease, if the throat is injured and ulcers form, preventing speech and voice: Kujiu Tang (Bitter Wine Decoction) is the primary treatment.
In Shaoyin disease, if there is a sore throat: Banxia San Ji Tang (Pinellia Powder and Decoction) is the primary treatment.
In Shaoyin disease, if there is diarrhea, sore throat, chest fullness, and vexation: Zhufu Tang (Swine Skin Decoction) is the primary treatment.
In Shaoyin disease, if after two or three days there is internal vexation and inability to lie down: Huanglian Ejiao Tang (Coptis and Ass-Hide Gelatin Decoction) is the primary treatment.
In Shaoyin disease, if after six or seven days of diarrhea there is cough, vomiting, thirst, vexation, and inability to sleep: Zhuling Tang (Polyporus Decoction) [text says Zhu Ling Tang, variant for Zhuling] is the primary treatment.
In Shaoyin disease, from two or three days to four or five days, with abdominal pain and difficult urination...
Diarrhea with pus and blood: Taohua Tang (Peach Blossom Decoction) is the primary treatment.
All of the above employ the method of tonifying righteousness to rescue Yin.
In Shaoyin disease, if after two or three days there is dry mouth and tongue: Urgent purging is required, suitable for Dachengqi Tang (Major Order the Qi Decoction). Ke’s commentary notes: Heat rampant internally, thereby transferring to Yang...
In Shaoyin disease, if after six or seven days there is abdominal fullness and constipation: Urgent purging is required, suitable for Dachengqi Tang (Major Order the Qi Decoction). Ke’s commentary notes: Having had the disease for six or seven days, failure to resolve... Jin... Heart...
In Shaoyin disease, if there is spontaneous diarrhea of pure green water,必 (must) have pain in the epigastrium, and dry mouth/throat: Urgent purging is required, suitable for Dachengqi Tang (Major Order the Qi Decoction). Ke’s commentary notes: This is dry Earth and blazing Fire...
All of the above employ the method of attacking pathogens to rescue Yin.