少阴之热，上为咽痛，以少阴同气之物而留连于上以除热，非猪肤莫任。故医家多用此
取效，而仲圣猪肤汤实开其先，今试以鄙说备一解焉。下利、咽痛、心烦，皆少阴病，惟胸
满疑涉少阳，不知少阴脉之支别，从肺出络心注胸中。下利既泄其肾阴，其虚阳之上乘者，
遂得因中土无权，纷扰于经气所到之处，而致咽痛与胸满心烦。以其虚而非实，故胸满不至
于痛，不必用攻陷之剂。此时伏邪初发，尚未由血及气，亦无事于苦寒伤正。猪水畜而肤甘
寒轻浮，自能从上引下而客热以平。然下利非湿也，非加白蜜，不足以润燥益阴。患见于上
下则宜建中，非加白粉熬香，不足以悦脾振困。此证无与于少阳固矣，而邹氏更以痉病用大
承气汤有胸满字，为涉阳明之据，又岂足为训欤。
羊之为物，古说至赜，或谓火畜（礼月令及周官庖人注），或谓土畜（淮南子时则训及
吕览孟春注），或谓西方之性（牲子胎教篇），或谓土木之母（淮南子时则训），五行已占其
四；而自愚思之，即谓之水畜亦何恧焉。羊以西北方产者为美，有长髯可当长髯主簿之目（古
今注）。又好登历山崖倾仄处，略无怖意，其肾气之充固，非他畜比。惟于五行咸具中，以
得火土之气为尤多。故仲圣用治寒疝腹痛与产后腹中 痛，取其气热味甘，足以温脾缓中。
而药之能温脾缓中者尚有之，兹何以非羊肉不可，则以证不独在脾，羊肉正不独治脾也。素
问病名心疝，少腹当有形，又任脉为病，男子内结七疝，寒疝即七疝之一，何能于肾无与，
即仲圣之大乌头煎、抵当乌头桂枝汤，皆治寒疝腹痛，皆用乌头。乌头者，外驱寒湿，内温
肾阳者也。外台乌头汤，且以治寒疝发作时令人阴缩。况胁痛里急，明是寒袭厥阴，产后血
虚，无不下寒。小建中汤虽治腹痛，岂能愈此大证。兑为羊，兑卦二阳在下，一阴居上，羊
盖具刚很之性（易大壮疏），而能于阴中化阳者。寒疝乃肝肾之阴，同受寒累。羊肉温脾缓
中，而肝肾之虚寒，亦得其温补之益，故用之是证，最为切当。其必与归姜协力以成功者，
羊肉能于阴中化阳，不能散阴中之寒邪，此归姜辛温之能事，谓为羊肉之前驱可也。
少阴经的热邪，向上导致咽喉疼痛，需要用与少阴经同气相求的药物停留在上部以清除热邪，除了猪肤没有谁能胜任。所以医家多使用此药取得疗效，而张仲景的猪肤汤实际上开创了先例，现在尝试用我浅陋的见解来提供另一种解释。下利、咽喉痛、心烦，都属于少阴病，唯独胸满似乎涉及少阳经，却不知道少阴脉的分支，从肺脏出来联络心脏注入胸中。下利已经泄掉了肾阴，那些乘虚上扰的虚阳，便得以因为中焦脾胃之气虚弱无力，在经络之气到达的地方纷扰，从而导致咽喉痛和胸满心烦。因为这是虚证而非实证，所以胸满不至于疼痛，不需要使用攻下泻实的方剂。此时伏邪刚刚发作，尚未由血分波及气分，也无需使用苦寒药物损伤正气。猪是水畜，其皮味甘性寒且质地轻浮，自然能从上焦引导热邪下行从而使客热平息。然而下利并非单纯湿邪所致，如果不加入白蜜，不足以滋润燥热并补益阴液。病症表现在上下两端，适宜建立中气，如果不加入炒香的米粉，不足以愉悦脾气并振奋困顿。这个证候确实与少阳经无关，而邹氏更引用痉病使用大承气汤时出现的“胸满”二字，作为涉及阳明经的依据，这哪里足以作为准则呢？
羊这种动物，古人的说法非常深奥，有人说它是火畜（《礼记·月令》及《周礼·天官·庖人》注），有人说它是土畜（《淮南子·时则训》及《吕氏春秋·孟春》注），有人说它具有西方的属性（《胎教篇》），有人说它是土木之母（《淮南子·时则训》），五行之中它已占了四种；而从我个人的思考来看，即使称它为水畜又有什么可羞愧的呢？羊以西北方出产的为佳，有长胡须可以对应古代“长髯主簿”的称号（《古今注》）。又好攀登山崖倾斜之处，完全没有恐惧之意，它的肾气充盛坚固，不是其他牲畜能比的。只是在五行具备的情况下，它以获得火土之气为最多。所以张仲景用它治疗寒疝腹痛以及产后腹中疼痛，是取其气热味甘，足以温补脾脏并缓和里急。虽然能温脾缓中的药物还有其他的，这里为什么非羊肉不可呢？是因为病症不仅仅在脾脏，羊肉也不仅仅治疗脾脏。《素问》中提到病名心疝，小腹部应当有肿块，又是任脉发病，男子内有七种疝气，寒疝就是七疝之一，怎么能说与肾脏无关呢？即使是张仲景的大乌头煎、抵当乌头桂枝汤，都是治疗寒疝腹痛，都使用了乌头。乌头，外能驱散寒湿，内能温补肾阳。《外台秘要》中的乌头汤，甚至用来治疗寒疝发作时使人阴囊收缩的情况。况且胁痛且里急，明显是寒邪侵袭厥阴经，产后血虚，无不伴有下焦虚寒。小建中汤虽然治疗腹痛，难道能治愈这样严重的证候吗？兑卦代表羊，兑卦二阳在下，一阴在上，羊大概具有刚烈之性（《易传·大壮疏》），并且能在阴中化生阳气。寒疝乃是肝肾之阴，一同受到寒邪拖累。羊肉温脾缓中，而肝肾的虚寒，也能得到它的温补益处，所以用在这个证候上，最为恰当。它必须与当归、生姜协力才能成功，是因为羊肉能在阴中化阳，但不能驱散阴中的寒邪，这是当归、生姜辛温的功效，可以说它们是羊肉的前驱向导。
The heat of the Shaoyin (Lesser Yin) channel ascends to cause sore throat. To retain substances with similar affinity to Shaoyin in the upper jiao to clear heat, nothing is more suitable than pig skin (Zhu Fu). Therefore, physicians often use this material to achieve efficacy, and Zhang Zhongjing's Pig Skin Decoction (Zhufu Tang) actually pioneered its use. Now, I will attempt to offer an interpretation based on my humble understanding. Diarrhea, sore throat, and irritability are all symptoms of Shaoyin disease. Although chest fullness seems to involve the Shaoyang (Lesser Yang) channel, one should not overlook that a branch of the Shaoyin pulse emerges from the Lung, connects with the Heart, and enters the chest. Since diarrhea drains Kidney Yin, the floating deficient Yang, taking advantage of the weakness of the Middle Jiao (Spleen/Stomach Qi), disturbs the areas where the channel qi flows, resulting in sore throat and chest fullness with irritability. Because this is deficiency rather than excess, chest fullness does not reach the point of pain, and there is no need for purgative formulas. At this stage, latent pathogens have just emerged and have not yet moved from the blood level to the qi level; thus, bitter-cold herbs that damage healthy qi are unnecessary. The pig is a water animal, and its skin is sweet, cold, light, and floating. It can naturally guide heat downward from the upper jiao, thereby pacifying exogenous heat. However, diarrhea is not merely caused by dampness; without adding white honey (Baimi), it is insufficient to moisten dryness and benefit Yin. Since the pathology manifests both above and below, it is appropriate to establish the Middle Jiao; without adding roasted rice flour (Baifen), it is insufficient to please the Spleen and invigorate fatigue. This syndrome has nothing to do with the Shaoyang channel. Furthermore, Zou cited the appearance of "chest fullness" when using Da Chengqi Decoction for spasm diseases as evidence of involvement of the Yangming channel. How can such reasoning serve as a standard?
Regarding sheep, ancient theories are profound. Some consider it a Fire animal (based on *Liji: Yueling* and *Zhouli: Paoren* annotations), some a Earth animal (*Huainanzi: Shize Xun* and *Lüshi Chunqiu: Mengchun* annotations), some possessing Western attributes (*Taijiao Pian*), and some as the mother of Wood and Earth (*Huainanzi: Shize Xun*). Thus, it encompasses four of the Five Elements. From my own perspective, even calling it a Water animal would not be shameful. Sheep produced in the northwest are considered superior; their long beards correspond to the title "Long-Bearded Registrar" (*Gujin Zhu*). They enjoy climbing steep cliffs without fear, indicating that their Kidney Qi is robust and solid, unlike other animals. Among the Five Elements they possess, they acquire the most Fire and Earth Qi. Therefore, Zhang Zhongjing used mutton to treat Cold Hernia abdominal pain and postpartum abdominal pain, utilizing its hot nature and sweet taste to warm the Spleen and relieve interior tension. Although other drugs can warm the Spleen and relieve tension, why must mutton be used here? Because the pathology is not solely in the Spleen, and mutton does not only treat the Spleen. The *Suwen* mentions "Heart Hernia," where masses appear in the lower abdomen, and Ren Mai pathology involves seven types of hernias in men. Cold Hernia is one of these seven; how can it be unrelated to the Kidney? Even Zhang Zhongjing's Da Wutou Decoction and Didang Wutou Guizhi Decoction, which treat Cold Hernia abdominal pain, both use Aconite Root (Wutou). Aconite Root expels cold-dampness externally and warms Kidney Yang internally. The Wutou Decoction in *Waitai Miyao* is even used to treat cases where Cold Hernia attacks cause retraction of the genitals. Moreover, hypochondriac pain and interior tension clearly indicate cold invading the Jueyin (Greater Yin) channel. Postpartum blood deficiency invariably leads to lower-jiao cold. Although Xiaojianzhong Decoction treats abdominal pain, can it cure such severe syndromes? Dui represents the sheep. In the Dui trigram, two yang lines are at the bottom, and one yin line is at the top. Sheep likely possess a stubborn nature (*Yi Zhuan: Dazhuang Shu*) but can transform yang within yin. Cold Hernia involves both Liver and Kidney yin suffering from cold. Mutton warms the Spleen and relieves tension, while also providing warming benefits to the deficiency-cold of the Liver and Kidney. Therefore, its use in this syndrome is highly appropriate. It must cooperate with Angelica Root (Guizhi/Danggui context implies Danggui here given "Gui Jiang", though text says Gui, usually Danggui or Guizhi, context suggests Danggui for blood/yin transformation support alongside Ginger) and Ginger to succeed because mutton can transform yang within yin but cannot disperse cold pathogens within yin. The pungent-warm properties of Angelica and Ginger fulfill this function; they can be regarded as the vanguard for mutton.