少阴肾经，水火之藏，邪伤其经，随人虚实，或从水化以为寒，或从火化以为热。水化为阴寒之邪，是其
本也∶火化为阳热之邪，是其标也。阴邪其脉沉细而微，阳邪其脉沉细而数。至其见证，亦各有别。阴邪但欲寐
身无热，阳邪虽欲寐则多心烦。阴邪背恶寒口中和，阳邪背恶寒则口中燥。阴邪咽痛不肿，阳邪咽痛则肿。阴
邪腹痛下利清谷，阳邪腹痛下利清水或便脓血也。阴邪外热面色赤，里寒大便利，小便白；阳邪外寒手足厥，
里热大便秘，小便赤。此少阴标本寒热之脉证也。凡从本之治，均宜温寒回阳；从标之治，均宜攻热救阴。回
阳救阴，其机甚微，总在临证详究，辨别标本寒热，以急施其治，庶克有济，稍缓则不及矣。
少阴之为病，脉微细，但欲寐也。
【注】少阴肾经，阴盛之脏也。少阴受邪，则阳气微，故脉微细也。卫气行阳则寤，行阴则寐，少阴受邪，
则阴盛而行阴者多，故但欲寐也。此少阴病之提纲，后凡称少阴病者，皆指此脉证而言也。
【集注】方有执曰∶少阴肾经也，居于极下，其脉起于小趾之下。《灵枢》曰∶是主所生病者，嗜卧但欲
寐。盖人肖天地，天地之气行于阳则辟而晓，行于阴则阖而夜，故人之气行于阳则动而寤，行于阴则静而寐。
凡病患但欲寐者，邪客于阴故也。
张璐曰∶此言少阴之总脉总证也。盖少阴属水主静，即使热邪传至其经，在先之脉虽浮大，此时亦必变为
沉细；在先之证虽烦热不宁，此时亦必变为昏沉嗜卧。但须辨出脉细沉数、口中燥为热证；脉沉微细、口中
和为寒证，以此明辨，万无差误矣。
程应旄曰∶凡阴脉皆沉，异乎太阳之浮，不必言矣。阳明脉大，微者大之反；少阳脉弦，细者弦之反，沉
兼微细，阴证定矣。
少阴病，始得之，反发热，脉沉者，麻黄附子细辛汤主之，
【注】少阴病，谓但欲寐也。脉沉者，谓脉不微细而沉也。今始得之，当不发热而反发热者，是为少阴之
里寒，兼有太阳之表热也。故宜麻黄附子细辛汤，温中发汗，顾及其阳，则两感之寒邪，均得而解之矣。
【集注】方有执曰∶发热邪在表也，脉沉少阴位北而居里也，以其居里，邪在表而发热，故曰反也。以邪
在表不在里，故用麻黄以发之；以其本阴而标寒，故用附子以温之。细辛辛温通于少阴，用之以佐主治者，以
其专经而为向导也。
程知曰∶三阴表法与三阳不同，三阴必以温经之药为表，而少阴尤为紧关，故用散邪温经之剂，俾外邪之
深入者可出，而内阳亦不因之外越也。
程应旄曰∶一起病便发热，兼以阴经无汗，世有计日按证者，类能用麻黄而忌在附子。不知脉沉者，由其
人肾经素寒，里阳不能协应，故沉而不能浮也。沉属少阴，不可发汗，而始得病时即发热，则兼太阳，又不
得不发汗。须以附子附子（炮去皮，破八片，一枚）
上三味，以水一斗，先煮麻黄，减二升，去上沫，纳诸药，煮取三升，去滓，温服一升，日三服。
少阴病，得之二三日，麻黄附子甘草汤微发汗。以二三日无里证，故微发汗也。
【注】此详上条少阴病得之二三日，仍脉沉发热不解者，宜麻黄附子甘草汤微发其汗也。盖谓二三日不见
吐利里寒之证，知邪已衰，然热仍在外，尚当汗之，但不可过耳！故不用细辛而用甘草，盖于温散之中有和意
也。此二证，皆未曰无汗，非仲景略之也，以阴不得有汗，不须言也。
【集注】张璐曰∶少阴无发汗之法，汗之必至亡阳。惟此一证，其外有太阳发热无汗，其内不吐利躁烦呕
渴，乃可温经散寒，取其微似之汗也。
程应旄曰∶既云微发汗矣，仍用“以”字、“故”字推原之，足见郑重之意。按此二条，与太阳篇发热头
痛脉沉用四逆者同一证。彼以不差，则期过三日，可知病已入里，虽尚冒太阳头痛，直以少阴法律之。此少阴
病在初得二三日，虽无头痛证，不容竟作少阴治之，故仍兼太阳之法以律之。一出一入，不啻爰书。假令前条
得之二三日，后二条过二三日不瘥，则四逆之与麻黄，易地皆然矣。
汪琥曰∶上条反发热脉沉，此亦反发热脉沉，但上言始得之为急，此言得之二三日为缓。病势稍缓，治法亦缓。
麻黄附子甘草汤方
麻黄（去节，二两） 子（炮去皮，破八片，一枚） 甘草（炙，二两）
上三味，以水七升，先煮麻黄一两沸，去上沫，纳诸药，煮取三升，去滓，温服一升，日三服。
【集解】柯琴曰∶彼太阳病而脉反沉，便用四逆以急救其里，是里寒阴盛也。此少阴脉而表反热，便于表
剂中加附子以预固其阳，是表热阳衰也。夫以发热无汗，太阳之表脉沉，但欲寐，少阴之里，设用麻黄开腠理，细
辛散浮热，而无附子以固元阳，则太阳之微阳外亡。惟附子与麻黄并用，则寒邪散而阳不亡，此里病及表，脉
沉而当发汗者，与病在表，脉浮而发汗者径庭也。若表微热，则受寒亦轻，故以甘草易细辛而微发其汗，甘以
缓之，与辛以散之者，又少间矣。
少阴病，脉微，不可发汗，亡阳故也。阳已虚，尺脉弱涩者，复不可下之。
【注】少阴病，脉微，虽有发热，亦为少阴里寒外热，非太阳发热者可比，故不可发汗，发汗则亡阳。然
阳已虚，津液已涸，即见少阴口燥咽干可下之证，若尺脉弱涩者，复不可下之，又恐亡阴也。
【集注】方有执曰∶微者，阳气不充，故曰无阳，无阳则化不行，故汗不可发也。尺以候阴，弱涩者，阴
血不足也，故谓复不可下，其当亟行温补，又可知矣。
程应旄曰∶少阴多自利证，人固无肯轻下者。但拈出“尺脉弱涩”字，则少阴之有大承气汤证，其尺脉必
强而滑，已伏见于此处矣。
病患脉阴阳俱紧，反汗出者，亡阳也。此属少阴，法当咽痛，而复吐利。
【注】病患脉阴阳俱紧，发热无汗者，太阳伤寒证也；发热汗出不止者，太阳亡阳证也。今脉紧无热而反
汗出，此属少阴，然少阴证，法当咽痛而复吐利也。上条脉微无汗，不可发汗者，是以脉为主也；此条有汗脉
紧，不可发汗者，是以证为主也。从脉从证，不
可不察。
【集注】程知曰∶阴阳俱紧，伤寒之脉也，法当无汗，而反汗出，太阳之阳外亡也。若以少阴亡阳之证，
而认为太阳中风之证，则误矣。少阴之寒上逼，则咽痛而吐，下逼则下利也。
少阴病，脉紧，至七八日，自下利，脉暴微，手足反温，脉紧反去者，为欲解也，虽烦下利，必自愈。
【注】此承上条互发其义，以别阴阳寒热也。少阴病，脉沉微细，寒邪脉也；脉沉数细，热邪脉也。若脉
紧汗出，是少阴寒虚证也；今脉紧无汗，乃少阴寒实证也。因循至七八日之久，而自下利，若寒实解，则脉必紧
去而暴微，其证必手足由冷而反温，是知邪随利去，为欲解也。故此时虽烦下利，乃阴退阳回，故知其必自愈也。
【集注】方有执曰∶紧，寒邪也。自下利脉暴微者，阴寒内泻也。故谓手足为反温，言阳回也。阳回则阴
退，故谓紧反去，为欲解也。夫寒邪在阴而脉紧，得自利脉暴微，手足温，紧去为欲解者，犹之邪在阳脉数而
热，得汗出脉和身凉数去，为欲愈之意，同阴阳胜复之机也。
程应旄曰∶脉于利后顿变紧而为微，手足于利后变不温而为温，则微非诸微亡阳之微，乃紧去人安之微。
盖以从前之寒，已从下利而去，故阳气得回而欲解也，虽烦下利必自愈。
少阴病，得之一二日，口中和，其背恶寒者，当灸之，附子汤主之。
【注】背恶寒为阴阳俱有之证，如阳明病无大热，口燥渴，心烦背微恶寒者，乃白虎加人参汤证也。今少
阴病但欲寐，得之二三日，口中不燥而和，其背恶寒者，乃少阴阳虚之背恶寒，非阳明热蒸之背恶寒也。故当
灸之，更主以附子汤，以助阳消阴也。口燥、口和，诚二者之确征矣。
【集注】程知曰∶言初得之证，口中和，不渴、不燥，全无里热也。《内经》曰∶背为阳，背恶寒则阳虚
阴盛，寒深可知。若风寒在表而恶寒，则一身尽寒矣。灸之以助阳消阴，与附子汤以温经散寒。论中云∶伤寒
无大热口燥渴，心烦背微恶寒者，白虎汤加人参主之。彼是阳热乘阴虚而内陷之恶寒，与此之阴寒盛者不同。
阳入阴者，则口燥心烦，阴寒盛者，则不能销铄津液，故口中和。
张璐曰∶太阳表气大虚，邪气得入犯少阴，故得之一二日，尚背恶寒不发热，此阴阳两亏，较之两感，更
自不同。两感表里皆属热邪，犹堪发表攻里，此则内外皆属虚寒，无邪热可以攻击。惟当温经补阳，以温补其
不足，更灸关元以辅助之。虽其证似缓于发热脉沉，而危殆尤甚焉。
汪琥曰∶此条论仲景不言当灸何穴。常器之云∶当灸膈俞、关元穴，背俞第三行。郭雍云∶此有错字，当
是灸膈俞、关元穴也。膈俞是背俞第二行穴。按∶膈俞实系背俞部第二行穴，然常器之所云第三行穴者，当是
膈关，非膈俞也。《图经》云∶膈关二穴在第七椎下，两旁相去各三寸陷中，正坐取之，足太阳气脉所发，专
治背恶寒，脊强，俯仰难，可灸五壮。盖少阴中寒，必由太阳而入，故宜灸其穴。又关元一穴在腹部中行脐下
三寸，足三阴、任脉之会，可灸百壮。常器之所谓灸膈关者，是温其表以散外邪；灸关元者，是温其里以助其
元气也。
少阴病，身体痛，手足寒，骨节痛，脉沉者，附子汤主之。
【注】此承上条详举其证，互发其义，以出其治也。身体痛，表里俱有之证也，如太阳病脉浮发热，恶寒
身痛，手足热，骨节痛，是为表寒，当主麻黄汤，发表以散其寒。今
少阴病，脉沉无热，恶寒身痛，手足寒，骨节痛，乃是里寒，故主附子汤，温里以散寒也。
【集注】方有执曰∶少阴肾也，肾主骨，寒淫则痛。
程应旄曰∶身体痛，手足寒，骨节痛，太阳伤寒同有此证也。以脉沉辨之，沉属阴寒重着所致，里阴有余，
表阳不足，故以附子汤主之。
附子汤方
附子（去皮，生破八片，二枚） 茯苓（三两） 人参（二两） 白术（四两） 芍药（三两）
上五味，以水八升，煮取三升，去滓，温服一升，日三服。
【方解】少阴为寒水之脏，故寒伤之重者，多入少阴，所以少阴一经，最多死证。方中君以附子二枚者，
取其力之锐，且以重其任也；生用者，一以壮少火之阳，一以散中外之寒，则身痛自止，恶寒自除，手足自温
矣。以人参为臣者，所以固生气之原，令五脏六腑有本，十二经脉有根，脉自不沉，骨节可和矣。更佐白术以
培土，芍药以平木，茯苓以伐水，水伐火自旺，旺则阴翳消，木平土益安，安则水有制，制则生化，此诚万全
之术也。其有畏而不敢用，以致因循有误者，不诚可惜哉！
少阴病，脉沉者，急温之，宜四逆汤。
【注】少阴病，但欲寐，脉沉者，若无发热、口燥之证，则寒邪已入其脏，不须迟疑，急温之以四逆汤，
消阴助阳可也。
【集注】吴人驹曰∶脉沉须别虚实及得病新久，若得之多日及沉而实者，须从别论。
四逆汤方
甘草（炙，二两） 干姜（一两半） 附子（生用，去皮，破八片，一枚）
上三味，以水三升，煮取一升二合，去滓，分温再服。强人可大附子一枚，干姜三两。
【方解】方名四逆者，主治少阴中外皆寒，四肢厥逆也。君以甘草之甘温，温养阳气；臣以姜附之辛温，
助阳胜寒；甘草得姜附，鼓肾阳温中寒，有水中暖土之功；姜、附得甘草，通关节走四肢，有逐阴回阳之力，
肾阳鼓，寒阴消，则阳气外达而脉自升，手足自温矣。
【集解】汪琥曰∶少阴病，本脉微细，但欲寐。今轻取之，微脉不见，重取之，细脉几亡，伏匿而至于沉，
此寒邪深入于里，殆将入脏，温之不容以不急也。稍迟则恶寒身蜷，吐利烦躁，不得卧寐，手足逆冷，脉不
至，诸死证立至矣，四逆汤之用可稍缓乎？
少阴病，下利，白通汤主之。
【注】少阴病但欲寐，脉微细，已属阳为阴困矣。更加以下利，恐阴降极、阳下脱也。故君以葱白，大通
其阳而上升；佐以姜、附，急胜其阴而缓降，则未脱之阳可复矣。
【集注】方有执曰∶少阴病而加下利者，不独在经，而亦在脏，寒甚而阴盛也。治之以干姜、附子者，胜
其阴则寒自散也。用葱白而曰白通者，通其阳则阴自消也。
程知曰∶此言下利宜通其阳也。少阴病，谓有脉微细、欲寐证也。少阴下利，阴盛之极，恐致格阳，故用
姜、附以消阴，葱白以升阳。通云者，一以温之，而令阳气得入；一以发之，而令阴气易散也。
汪琥曰∶肾虚无火不能主水，故下利用白通汤者，温里以散寒也。
白通汤方
葱白（四茎） 干姜（一两） 附子（生，去皮，破八片，一枚）
上三味，以水三升，煮取一升，去滓，分温再服。
【集解】汪琥曰∶此方与四逆汤相类，独
去甘草，盖驱寒欲其速，辛烈之性取其骤发，直达下焦，故不欲甘以缓之也。而犹重在葱白，少阴之阴，天之
少阴肾经，是藏纳水火的地方。邪气侵袭这条经脉后，会根据患者体质的虚实不同，有的转化为水化而表现为寒证，有的转化为火化而表现为热证。由水化产生的阴寒之邪，是少阴病的本；由火化产生的阳热之邪，是少阴病的标。阴寒之邪的脉象沉细而微弱，阳热之邪的脉象沉细而数。至于临床表现，也各有区别。阴寒之邪表现为只想睡觉、身体没有发热；阳热之邪虽然也想睡觉，但多伴有心烦意乱。阴寒之邪表现为背部怕冷、口中感觉平和（不苦不燥）；阳热之邪表现为背部怕冷、口中干燥。阴寒之邪表现为咽痛但不红肿；阳热之邪表现为咽痛且红肿。阴寒之邪表现为腹痛、腹泻且大便中有未消化的食物；阳热之邪表现为腹痛、腹泻排出清水或脓血。阴寒之邪表现为体表发热、面色发红、内部寒冷、大便通畅、小便颜色清白；阳热之邪表现为体表发冷、手足厥冷、内部热盛、大便秘结、小便颜色红赤。这就是少阴病标本寒热的脉象和症状。凡是属于从本（寒化）治疗的，都适宜用温散寒邪、回阳救逆的方法；凡是属于从标（热化）治疗的，都适宜用攻逐热邪、救阴清热的方法。回阳救阴的治疗时机非常微妙，关键在于临证时仔细研究，辨别是标本寒热中的哪一种，以便紧急施治，这样才可能取得疗效，如果稍微迟缓就来不及了。
少阴病的典型表现是：脉象微细，只想睡觉。
【注释】少阴肾经，是阴气极盛的脏腑。少阴经受邪，阳气就会微弱，所以脉象微细。卫气运行于阳分人就清醒，运行于阴分人就入睡。少阴受邪，阴气盛而运行于阴分的时间多，所以只想睡觉。这是少阴病的提纲，后面凡是提到“少阴病”的，都是指这种脉象和症状而言。
【集注】方有执说：少阴肾经位于人体最下部，其经脉起于足小趾之下。《灵枢》说：少阴经主治它所生的疾病，表现为嗜睡、只想睡觉。大概人效法天地，天地之气运行于阳分则开启而为白天，运行于阴分则闭合而为黑夜，所以人的气运行于阳分则活动而清醒，运行于阴分则安静而入睡。凡是病人只想睡觉的，是因为邪气客居在阴分所致。
张璐说：这是论述少阴病的总脉象和总症状。少阴属水主静，即使热邪传变到这条经脉，之前的脉象虽然浮大，此时也必然变为沉细；之前的症状虽然烦躁发热不安，此时也必然变为昏沉嗜卧。只须辨别出脉象细沉数、口中干燥为热证；脉象沉微细、口中平和为寒证，如此明确辨别，绝不会出差错。
程应旄说：凡是阴脉都是沉的，不同于太阳病的浮脉，这不必再说了。阳明病的脉大，微是大脉的反面；少阳病的脉弦，细是弦脉的反面。脉象既沉又兼微细，阴证就确定了。
少阴病，刚得病时，反而发热，脉象沉的，用麻黄附子细辛汤治疗。
【注释】少阴病，是指只想睡觉的症状。脉沉，是指脉象不微细而是沉。现在刚得病，应当不发热却反而发热，这是少阴里的寒邪，兼有太阳表的发热。所以适宜用麻黄附子细辛汤，温补中焦并发汗解表，顾护阳气，这样两感（少阴与太阳同病）的寒邪都能得到解除。
【集注】方有执说：发热说明邪气在表，脉沉说明少阴位处北方而居于里。因为居于里，邪气在表却发热，所以叫“反”。因为邪气在表不在里，所以用麻黄来发散；因为本质是阴而标是寒，所以用附子来温补。细辛辛温，通达少阴经，用它作为辅助主要药物的向导，因为它专入本经。
程知说：三阴经的表证治法与三阳经不同，三阴经必须用温经的药来解表，而少阴经尤为关键，所以使用散邪温经的方剂，使深入的外邪能够外出，而内阳也不会因此外越。
程应旄说：一开始发病就发热，加上阴经无汗，世上有些按日子和症状计量的医生，往往能用麻黄却忌讳用附子。不知道脉沉的原因，是由于此人肾经素来虚寒，里阳不能协同响应，所以脉沉而不能浮。沉脉属于少阴，不可发汗，但刚得病时就发热，说明兼有太阳病，又不得不发汗。必须用附子……（原文此处有重复字“附子”，下文接药材）
上三味药，用水一斗，先煮麻黄，减少二升水，去掉上面的沫，加入其他药物，煮取三升，去渣，温服一升，每天服三次。
少阴病，得病二三天，用麻黄附子甘草汤微微发汗。因为二三天里没有里证，所以微微发汗。
【注释】这是详细解释上一条少阴病得病二三天，仍然脉沉发热不解的情况，适宜用麻黄附子甘草汤微微发汗。意思是说二三天不见呕吐、腹泻等里寒症状，知道邪气已衰，然而热仍在表，还应当发汗，只是不可以过猛！所以不用细辛而用甘草，这是在温散之中含有调和之意。这两个证候，都没有提到无汗，不是仲景省略了，而是因为阴证不得有汗，不需要说。
【集注】张璐说：少阴经没有发汗的法度，发汗必定导致亡阳。只有这一个证候，外部有太阳病的发热无汗，内部没有呕吐、腹泻、躁动、烦躁、呕吐、口渴等症状，才可以温经散寒，取其微微似有汗出的效果。
程应旄说：既然说了微微发汗，仍然用“以”字、“故”字来推究原因，足以见到郑重的意思。按这两条，与太阳篇中发热头痛脉沉用四逆汤的是同一个证候。那边因为没好，期限过了三天，可知病已入里，虽然还有太阳病的头痛，直接按照少阴的法律来治疗。这个少阴病在初得二三天，虽然没有头痛症状，不容许完全当作少阴病治疗，所以仍然兼用太阳病的方法来衡量它。一出一入，就像判词一样严谨。假如前一条得病二三天，后两条超过二三天没好，那么四逆汤与麻黄附子细辛汤的作用，互换位置也是一样的道理。
汪琥说：上一条是反发热脉沉，这一条也是反发热脉沉，但上一条说刚得病是急症，这一条说得病二三天是缓症。病势稍缓，治法也缓和。
麻黄附子甘草汤方
麻黄（去节，二两） 附子（炮制去皮，破成八片，一枚） 甘草（炙，二两）
上三味药，用水七升，先煮麻黄一两沸，去掉上面的沫，加入其他药物，煮取三升，去渣，温服一升，每天服三次。
【集解】柯琴说：那个太阳病而脉反沉，就用四逆汤来急救其里，这是里寒阴盛。这个少阴病而表反热，就在表剂中加入附子来预先固护其阳，这是表热阳衰。以发热无汗，是太阳的表证；脉沉，是少阴的里证。假使只用麻黄开泄腠理，细辛散发浮热，而没有附子来固护元阳，那么太阳的微阳就会外亡。只有附子与麻黄并用，才能散寒邪而不亡阳，这是里病及表、脉沉而应当发汗的情况，与病在表、脉浮而发汗的情况截然不同。如果表热轻微，说明受寒也轻，所以用甘草代替细辛来微微发汗，甘味药能缓和病情，与辛味药发散的方式，又稍有间隔了。
少阴病，脉微，不可发汗，因为会亡阳。阳气已经虚弱，尺脉弱涩的，也不可用泻下法。
【注释】少阴病，脉微，虽然有发热，也是少阴里寒外热，不能与太阳病发热相比，所以不可发汗，发汗就会亡阳。然而阳气已经虚弱，津液已经枯竭，即使出现少阴口燥咽干等可以用泻下法的症状，如果尺脉弱涩，也不可用泻下法，又恐怕亡阴。
【集注】方有执说：微脉，说明阳气不充盛，所以叫无阳，无阳则气化不行，所以汗不可发。尺部脉候阴，弱涩说明阴血不足，所以说也不可用泻下法，应当紧急进行温补，这也就可以知道了。
程应旄说：少阴病多有自利的症状，人们本来就不会轻易使用泻下法。但特意提出“尺脉弱涩”这几个字，那么少阴病有大承气汤证的，其尺脉必定强而滑，这一点已经隐含在这里了。
病人脉象寸关尺三部都紧，反而出汗的，是亡阳。这属于少阴病，按规定应当咽痛，并且伴有呕吐和下利。
【注释】病人脉象三部都紧，发热无汗的，是太阳伤寒证；发热汗出不止的，是太阳亡阳证。现在脉紧无热却反而出汗，这属于少阴病，然而少阴病的症状，按规定应当咽痛并且伴有呕吐和下利。上一条脉微无汗，不可发汗，是以脉象为主；这一条有汗脉紧，不可发汗，是以症状为主。从脉还是从证，不可不仔细考察。
【集注】程知说：阴阳三部脉都紧，是伤寒的脉象，按规定应当无汗，却反而出汗，这是太阳的阳气外亡。如果把少阴亡阳的症状，误认为是太阳中风的症状，那就错了。少阴的寒邪上逼，就会咽痛并呕吐；下逼就会下利。
少阴病，脉紧，到了七八天，自己发生下利，脉突然变微，手脚反而变暖，脉紧反而消失的，是快要痊愈了，虽然心烦下利，一定会自愈。
【注释】这是承接上一条互相发挥其含义，来辨别阴阳寒热。少阴病，脉沉微细，是寒邪的脉象；脉沉数细，是热邪的脉象。如果脉紧汗出，是少阴寒虚证；现在脉紧无汗，是少阴寒实证。拖延到七八天之久，而自己发生下利，如果是寒实解除，则脉必紧去而突然变微，症状必然是手脚由冷而反而变暖，这是知道邪气随着下利而去，是快要痊愈了。所以此时虽然心烦下利，这是阴退阳回，所以知道一定会自愈。
【集注】方有执说：紧脉，是寒邪。自己下利而脉突然变微，是阴寒在内排泄。所以说手脚为“反温”，是说阳气回复。阳气回复则阴气消退，所以说紧脉反去，是快要痊愈了。寒邪在阴分而脉紧，得到自利后脉突然变微、手脚温、紧脉去而欲解，就像邪气在阳分脉数而热，得到汗出后脉和身凉、数去而愈的意思，这是同样的阴阳胜复的机理。
程应旄说：脉在下利后顿时由紧变为微，手脚在下利后由不温变为温，那么这个微就不是各种微脉中亡阳的微，而是紧去人安的那种微。大概是从前的寒邪，已经通过下利而去了，所以阳气得以回复而欲解，虽然心烦下利也一定会自愈。
少阴病，得病一两天，口中平和，背部怕冷的，应当施灸，用附子汤治疗。
【注释】背部怕冷是阴阳都有可能出现症状，比如阳明病没有大热，口燥渴，心烦背微恶寒的，是白虎加人参汤证。现在少阴病只想睡觉，得病二三天，口中不燥而平和，背部怕冷的，是少阴阳虚的背部怕冷，不是阳明热蒸引起的背部怕冷。所以应当施灸，更用附子汤治疗，以助阳消阴。口燥、口和，确实是两者的确凿征象。
【集注】程知说：说的是初得病的症状，口中平和，不渴、不燥，完全没有里热。《内经》说：背为阳，背部怕冷则是阳虚阴盛，寒气深重可知。如果是风寒在表而恶寒，则全身都会寒冷。施灸以助阳消阴，用附子汤温经散寒。论中说：伤寒没有大热、口燥渴、心烦背微恶寒的，用白虎汤加人参主治。那是阳热乘阴虚而内陷引起的恶寒，与此处的阴寒盛者不同。阳入阴分，就会口燥心烦；阴寒盛者，就不能销铄津液，所以口中平和。
张璐说：太阳表气大虚，邪气得以侵入侵犯少阴，所以得病一两天，还背部怕冷不发热，这是阴阳两亏，较之两感病，更加不同。两感病表里都属热邪，还可以发表攻里，这里内外都属虚寒，没有邪热可以攻击。只应当温经补阳，以温补其不足，更灸关元穴来辅助它。虽然其症状似乎比发热脉沉要缓和，但危险程度尤其严重。
汪琥说：这一条论述仲景没有说要灸哪个穴位。常器之说：应当灸膈俞、关元穴，背俞第三行。郭雍说：这里有错字，应当是灸膈俞、关元穴。膈俞是背俞第二行穴。按：膈俞确实系背俞部第二行穴，然而常器之所说的第三行穴，应当是膈关，不是膈俞。《图经》说：膈关二穴在第七椎下，两旁各相距三寸的凹陷中，正坐取穴，是足太阳气脉所发，专门治疗背部怕冷、脊背僵硬、俯仰困难，可灸五壮。大概少阴中寒，必定由太阳传入，所以适宜灸这些穴位。另外关元一穴在腹部正中线上脐下三寸，是足三阴经、任脉的交会穴，可灸百壮。常器之所说的灸膈关，是温其表以散外邪；灸关元，是温其里以助元气。
少阴病，身体疼痛，手脚寒冷，骨节疼痛，脉沉的，用附子汤治疗。
【注释】这是承接上一条详细列举其症状，互相发挥其含义，以提出治疗方法。身体疼痛，是表里都有的症状，比如太阳病脉浮发热，恶寒身痛，手脚热，骨节疼痛，这是表寒，应当用麻黄汤，发表以散其寒。现在少阴病，脉沉无热，恶寒身痛，手脚寒冷，骨节疼痛，这是里寒，所以用附子汤，温里以散寒。
程应旄说：身体疼痛，手脚寒冷，骨节疼痛，太阳伤寒也有这些症状。通过脉象来辨别，沉脉属于阴寒重着所致，里阴有余，表阳不足，所以用附子汤主治。
附子汤方
附子（去皮，生用破成八片，二枚） 茯苓（三两） 人参（二两） 白术（四两） 芍药（三两）
上五味药，用水八升，煮取三升，去渣，温服一升，每天服三次。
【方解】少阴是寒水之脏，所以寒邪伤之严重的，多进入少阴，所以少阴一经，最多死证。方中以附子二枚为君药，取其药力锐利，且加重其责任；生用的目的，一是壮大少火的阳气，一是消散内外的寒邪，那么身体疼痛自然停止，恶寒自然消除，手脚自然温暖。以人参为臣药，是为了固护生气之源，令五脏六腑有根本，十二经脉有根，脉自然不沉，骨节可调和。更佐以白术来培土，芍药来平木，茯苓来伐水，水被伐则火自旺，火旺则阴翳消除，木平则土益安，土安则水有制约，制约则有生化，这确实是万全之术。那些因为害怕而不敢使用，以致因循延误的，难道不可惜吗！
【注释】少阴病，只想睡觉，脉沉的，如果没有发热、口燥等症状，则寒邪已进入其脏，不必迟疑，紧急用四逆汤温补，消除阴寒、助长阳气即可。
【集注】吴人驹说：脉沉需要辨别虚实及得病时间的长短，如果得病多天且脉沉实的，须从别论。
四逆汤方
甘草（炙，二两） 干姜（一两半） 附子（生用，去皮，破成八片，一枚）
上三味药，用水三升，煮取一升二合，去渣，分两次温服。体质强壮的人可用大附子一枚，干姜三两。
【方解】方名四逆，主治少阴内外皆寒，四肢厥逆。以甘草的甘温为君，温养阳气；以姜附的辛温为臣，助阳胜寒；甘草得姜附，鼓动肾阳、温中寒，有水中暖土的功效；姜、附得甘草，通关节走四肢，有驱逐阴寒、回阳的力量，肾阳鼓动，寒阴消退，则阳气外达而脉自升，手脚自然温暖。
【集解】汪琥说：少阴病，本脉微细，只想睡觉。现在轻取，微脉不见，重取，细脉几乎消失，伏匿而至于沉，这是寒邪深入于里，差不多要入脏，温补不容许不紧急。稍微迟缓则恶寒身蜷缩，呕吐下利烦躁，无法躺卧入睡，手足逆冷，脉不至，各种死证立刻到来，四逆汤的使用可以稍微延缓吗？
【注释】少阴病只想睡觉，脉微细，已经属于阳气被阴邪困阻。再加上以下利，恐怕阴降极、阳下脱。所以以葱白为君药，大通其阳而上升；佐以姜、附，急胜其阴而缓降，则未脱的阳气可恢复。
【集注】方有执说：少阴病而加下利的，不仅在于经，也在脏，寒甚而阴盛。用干姜、附子治疗，是胜其阴则寒自散。用葱白而叫白通，是通其阳则阴自消。
程知说：这是说下利宜通其阳。少阴病，指有脉微细、想睡觉的症状。少阴下利，阴盛之极，恐怕导致格阳，所以用姜、附以消阴，葱白以升阳。所谓“通”，一是用以温之，令阳气得以入；一是用以发之，令阴气易于散。
白通汤方
葱白（四茎） 干姜（一两） 附子（生，去皮，破成八片，一枚）
上三味药，用水三升，煮取一升，去渣，分两次温服。
【集解】汪琥说：此方与四逆汤相似，唯独去掉甘草，大概是驱寒想要快速，辛烈之性取其迅速发作，直达下焦，所以不希望用甘味药来缓和。而仍然重在葱白，少阴的阴，天的……
The Shaoyin Kidney Meridian is the repository of Water and Fire. When pathogenic factors invade this meridian, they transform according to the patient's deficiency or excess: either transforming into Water (manifesting as Cold) or transforming into Fire (manifesting as Heat). The Yin-Cold pathogen resulting from Water transformation constitutes the Root (Ben); the Yang-Heat pathogen resulting from Fire transformation constitutes the Branch (Biao). The pulse for Yin pathogens is deep, fine, and faint; the pulse for Yang pathogens is deep, fine, and rapid. Their clinical manifestations also differ. Yin pathogens present with a desire to sleep and absence of fever; Yang pathogens, although desiring to sleep, are often accompanied by mental restlessness. Yin pathogens present with aversion to cold in the back and a neutral sensation in the mouth; Yang pathogens present with aversion to cold in the back and dryness in the mouth. Yin pathogens present with sore throat without swelling; Yang pathogens present with sore throat accompanied by swelling. Yin pathogens present with abdominal pain and diarrhea with undigested food; Yang pathogens present with abdominal pain and diarrhea passing clear water or pus and blood. Yin pathogens present with external heat, red complexion, internal cold, free bowel movements, and white urine; Yang pathogens present with external cold, cold extremities, internal heat, constipation, and red urine. These are the pulses and symptoms of Cold and Heat in the Root and Branch of Shaoyin disease. For treatments following the Root (Cold transformation), warming Cold and restoring Yang are appropriate; for treatments following the Branch (Heat transformation), clearing Heat and preserving Yin are appropriate. The timing for restoring Yang and saving Yin is critical; it depends entirely on careful clinical investigation to distinguish between Root/Branch and Cold/Heat, allowing for urgent treatment. Only then can there be hope of success; any delay will render treatment ineffective.
Shaoyin disease is characterized by a faint and fine pulse and a desire to sleep.
[Annotation] The Shaoyin Kidney Meridian is a Zang organ of extreme Yin abundance. When Shaoyin is invaded by pathogens, Yang Qi becomes weak, hence the faint and fine pulse. Wei Qi (Defensive Qi) moves through Yang leading to wakefulness, and through Yin leading to sleep. When Shaoyin is invaded, Yin is abundant, and movement through Yin predominates, hence the desire to sleep. This is the outline of Shaoyin disease; subsequent mentions of "Shaoyin disease" refer to these specific pulses and symptoms.
[Collected Annotations] Fang Youzhi states: The Shaoyin Kidney Meridian is located at the lowest part of the body, and its pulse originates below the little toe. *Ling Shu* states: It governs diseases generated within itself, manifesting as drowsiness and a desire to sleep. Humans mirror Heaven and Earth; when the Qi of Heaven and Earth moves through Yang, it opens to become day; when it moves through Yin, it closes to become night. Thus, when human Qi moves through Yang, one is active and awake; when it moves through Yin, one is quiet and asleep. Patients who only desire to sleep do so because pathogens have lodged in Yin.
Zhang Lu states: This discusses the general pulse and symptom of Shaoyin. Shaoyin belongs to Water and governs stillness. Even if Heat pathogens transmit to this meridian, if the initial pulse was floating and large, it must now change to deep and fine; if the initial symptom was irritability and heat, it must now change to lethargy and drowsiness. One must distinguish: a fine, deep, and rapid pulse with a dry mouth indicates Heat; a deep, faint, and fine pulse with a neutral mouth indicates Cold. With such clear distinction, errors will be avoided.
Cheng Yingmao states: All Yin pulses are deep, differing from the floating pulse of Taiyang, which needs no further explanation. Yangming pulses are large; "faint" is the opposite of large. Shaoyang pulses are wiry; "fine" is the opposite of wiry. A pulse that is both deep and combined with faint and fine confirms a Yin syndrome.
In Shaoyin disease, upon initial onset, if there is contrary fever and a deep pulse, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) should be administered.
[Annotation] Shaoyin disease refers to the symptom of desiring to sleep. A deep pulse here means the pulse is not faint and fine but specifically deep. Upon initial onset, fever should not be present; the presence of contrary fever indicates Shaoyin interior Cold combined with Taiyang exterior Heat. Therefore, Mahuang Fuzi Xixin Tang is suitable to warm the interior and induce sweating, protecting Yang Qi, thereby resolving the Cold pathogens of both Taiyang and Shaoyin (dual invasion).
[Collected Annotations] Fang Youzhi states: Fever indicates the pathogen is in the exterior; a deep pulse indicates Shaoyin's position in the North and interior. Because it is interior, yet fever exists due to exterior pathogens, it is termed "contrary." Since the pathogen is in the exterior and not the interior, Mahuang is used to disperse it; because the root is Yin and the branch is Cold, Fuzi (Prepared Aconite Root) is used to warm it. Xixin (Asarum) is acrid and warm, connecting to Shaoyin, used as an assistant to guide the main treatment, as it specializes in entering this meridian.
Cheng Zhi states: The method for treating exterior syndromes in the Three Yin meridians differs from the Three Yang. In the Three Yin, warming meridian herbs must be used for exterior release, particularly crucial in Shaoyin. Thus, formulas that disperse pathogens and warm meridians are used, allowing deeply entrenched exterior pathogens to exit while preventing internal Yang from escaping outward.
Cheng Yingmao states: Onset with immediate fever, combined with anhidrosis in a Yin meridian, leads some physicians who count days and match symptoms to use Mahuang (Ephedra) while avoiding Fuzi. They do not realize that a deep pulse occurs because the person's Kidney meridian is inherently cold, and interior Yang cannot coordinate, causing the pulse to be deep rather than floating. A deep pulse belongs to Shaoyin, where sweating is generally contraindicated. However, fever at the very beginning indicates concurrent Taiyang involvement, necessitating sweating. One must use Fuzi...
The above three ingredients: Use ten sheng of water. First boil Mahuang (Ephedra Herb), reducing by two sheng, remove the foam on top, add the remaining herbs, boil to obtain three sheng, strain, and take one sheng warm, three times daily.
In Shaoyin disease, after two or three days, if Ma Huang Fu Zi Gan Cao Tang (Ephedra, Aconite, and Licorice Decoction) is used to induce slight sweating: Because there are no interior symptoms after two or three days, slight sweating is indicated.
[Annotation] This elaborates on the previous case where Shaoyin disease persists for two or three days with continued deep pulse and fever. Ma Huang Fu Zi Gan Cao Tang is suitable for slight sweating. If after two or three days there are no signs of vomiting, diarrhea, or interior cold, it indicates the pathogen has weakened. However, since heat remains in the exterior, sweating is still required, but it must not be excessive. Hence, Xixin is replaced by Gancao (Licorice Root), introducing a harmonizing element within the warming and dispersing action. Neither of these cases explicitly mentions anhidrosis; this is not an omission by Zhongjing, but because Yin syndromes do not typically involve sweating, so it need not be stated.
[Collected Annotations] Zhang Lu states: There is no method for inducing sweating in Shaoyin; doing so leads to loss of Yang. Only in this specific case, where there is exterior Taiyang fever and anhidrosis, but no interior vomiting, diarrhea, agitation, irritability, vomiting, or thirst, can one warm the meridians and disperse cold, seeking only a slight perspiration.
Cheng Yingmao states: The use of "because" and "therefore" after stating "slight sweating" emphasizes caution. These two clauses correspond to the Taiyang chapter's case of fever, headache, and deep pulse treated with Sini Tang. In that case, if unresolved after three days, the disease enters the interior, and even with residual Taiyang headache, it is treated according to Shaoyin principles. Here, in early Shaoyin disease (2-3 days), despite lacking headache, it cannot be treated solely as Shaoyin; thus, Taiyang methods are applied concurrently. One approach exits, one enters, akin to legal judgment. If the first clause applies to 2-3 days, and the latter clauses apply to >3 days without resolution, the roles of Sini Tang and Mahuang-based formulas would be interchangeable.
Wang Hu states: The previous clause describes contrary fever and deep pulse as urgent (initial onset); this clause describes it as slower (onset after 2-3 days). A slower disease progression warrants a milder treatment.
Ma Huang Fu Zi Gan Cao Tang Formula
Mahuang (Ephedrae Herba, removed nodes, 2 liang)
Fuzi (Prepared Aconiti Lateralis Radix, peeled, broken into eight pieces, 1 piece)
Gancao (Prepared Glycyrrhizae Radix et Rhizoma, honey-fried, 2 liang)
The above three ingredients: Use seven sheng of water. First boil Mahuang for one boiling, remove the foam, add other herbs, boil to obtain three sheng, strain, and take one sheng warm, three times daily.
[Collected Exegesis] Ke Qin states: In the Taiyang case with a contrary deep pulse, Sini Tang is used to urgently rescue the interior, indicating interior Cold and Yin abundance. In this Shaoyin case with a contrary exterior heat, Fuzi is added to the exterior formula to pre-emptively secure Yang, indicating exterior Heat with Yang deficiency. With fever and anhidrosis (Taiyang exterior) and deep pulse/desire to sleep (Shaoyin interior), if Mahuang were used to open pores and Xixin to scatter floating heat without Fuzi to secure primal Yang, the slight Yang of Taiyang would escape. Only with Mahuang and Fuzi together can Cold pathogens be scattered without losing Yang. This interior disease affecting the exterior, requiring sweating due to a deep pulse, is diametrically opposed to exterior diseases requiring sweating due to a floating pulse. If exterior heat is mild, cold invasion is light; thus, Gancao replaces Xixin for slight sweating. Gancao slows/harmonizes, contrasting with Xixin's dispersing nature.
In Shaoyin disease, if the pulse is faint, sweating is contraindicated due to the risk of Yang loss. If Yang is already deficient and the Chi (Cun-Chi) pulse is weak and choppy, purging is also contraindicated.
[Annotation] In Shaoyin disease, a faint pulse, even with fever, represents interior Cold with exterior Heat, distinct from Taiyang fever. Sweating is contraindicated as it causes Yang loss. If Yang is deficient and fluids exhausted, even if symptoms like dry mouth and throat suggest purging is needed, a weak and choppy Chi pulse indicates Yin/Blood deficiency, making purging contraindicated to avoid Yin loss.
[Collected Annotations] Fang Youzhi states: A faint pulse indicates insufficient Yang Qi ("No Yang"), meaning transformation and circulation fail, so sweating is impossible. The Chi position reflects Yin; weak and choppy indicates insufficient Yin Blood, hence purging is also contraindicated. Urgent warming and tonification are indicated.
Cheng Yingmao states: Shaoyin disease often involves spontaneous diarrhea, so physicians rarely use purgatives lightly. However, highlighting "weak and choppy Chi pulse" implies that Shaoyin cases suitable for Dachengqi Tang would present with a strong and slippery Chi pulse, a point foreshadowed here.
If a patient's pulse is tight in all positions (Yin-Yang俱紧) and sweats contrary to expectation, this is Yang loss belonging to Shaoyin. According to protocol, this should present with sore throat, vomiting, and diarrhea.
[Annotation] Tight pulses in all positions with fever and anhidrosis indicate Taiyang Cold Damage; fever with continuous sweating indicates Taiyang Yang loss. Now, tight pulses without fever but with contrary sweating belong to Shaoyin. Shaoyin protocol dictates sore throat, vomiting, and diarrhea. The previous clause (faint pulse, anhidrosis) contraindicated sweating based on the pulse; this clause (sweating, tight pulse) contraindicates sweating based on the symptom. One must carefully distinguish whether to follow the pulse or the symptom.
[Collected Annotations] Cheng Zhi states: Tight pulses in Yin and Yang positions are characteristic of Cold Damage, expecting anhidrosis. Contrary sweating indicates the escape of Taiyang Yang. Mistaking Shaoyin Yang loss for Taiyang Wind Strike is an error. Shaoyin Cold forcing upward causes sore throat and vomiting; forcing downward causes diarrhea.
In Shaoyin disease, if the pulse is tight, and after seven or eight days, spontaneous diarrhea occurs, the pulse suddenly becomes faint, hands and feet become warm, and the tight pulse disappears, the condition is resolving. Although there is irritability and diarrhea, it will heal spontaneously.
[Annotation] This expands on the previous clause to distinguish Yin/Yang and Cold/Heat. Shaoyin disease with deep, faint, fine pulses indicates Cold; deep, rapid, fine pulses indicate Heat. Tight pulse with sweating indicates Shaoyin Cold-Deficiency; tight pulse without sweating indicates Shaoyin Cold-Excess. After seven to eight days, spontaneous diarrhea occurs. If Cold-Excess resolves, the pulse changes from tight to suddenly faint, and symptoms shift from cold extremities to warmth. This indicates pathogens exiting via diarrhea, signaling resolution. Thus, despite irritability and diarrhea, this represents Yin retreating and Yang returning, ensuring spontaneous healing.
[Collected Annotations] Fang Youzhi states: Tight pulse indicates Cold Pathogen. Spontaneous diarrhea with sudden faintness of pulse indicates internal expulsion of Yin-Cold. Hence, "contrary warmth" of extremities indicates Yang return. Yang return means Yin retreat, so disappearance of tight pulse signals resolution. Just as exterior Heat with rapid pulse resolves with sweating and cooling, interior Cold with tight pulse resolves with diarrhea and warmth; both illustrate the mechanism of Yin-Yang victory and defeat.
Cheng Yingmao states: The pulse changing from tight to faint after diarrhea, and extremities becoming warm, indicates this "faintness" is not the fatal faintness of Yang loss, but the favorable faintness of "tightness gone, peace restored." The prior Cold has exited via diarrhea, allowing Yang to return and resolve. Thus, irritability and diarrhea will self-resolve.
In Shaoyin disease, upon onset of one or two days, if the mouth feels neutral and there is aversion to cold in the back, moxibustion should be applied, and Fuzi Tang (Aconite Decoction) administered.
[Annotation] Aversion to cold in the back can occur in both Yin and Yang syndromes. For example, Yangming disease with no significant fever, dry mouth/thirst, irritability, and slight back aversion to cold is treated with Baihu Jia Renshen Tang. Here, Shaoyin disease with desire to sleep, onset of 2-3 days, neutral mouth (not dry), and back aversion to cold indicates Shaoyin Yang deficiency, not Yangming Heat steaming. Therefore, moxibustion and Fuzi Tang are used to assist Yang and dissipate Yin. "Dry mouth" vs. "Neutral mouth" are definitive differentiators.
[Collected Annotations] Cheng Zhi states: Early onset with neutral mouth (no thirst/dryness) indicates no interior Heat. *Nei Jing* states: The back is Yang; back aversion to cold indicates Yang deficiency and Yin abundance, implying deep Cold. If exterior Wind-Cold caused aversion to cold, the whole body would be cold. Moxibustion assists Yang and dissipates Yin; Fuzi Tang warms meridians and disperses Cold. The text notes Yangming cases with Baihu Jia Renshen Tang involve Heat sinking due to Yin deficiency, distinct from this severe Yin-Cold. Heat entering Yin causes dry mouth/irritability; severe Yin-Cold does not consume fluids, hence neutral mouth.
Zhang Lu states: Severe deficiency of Taiyang Exterior Qi allows pathogens to invade Shaoyin. Thus, early back aversion to cold without fever indicates dual deficiency of Yin and Yang, more severe than dual invasion (both exterior and interior Heat). Dual invasion can still be treated with exterior-releasing and interior-purging methods; this case involves interior-exterior deficiency-Cold with no Heat to attack. Treatment must warm meridians and tonify Yang, supplemented by moxibustion at Guanyuan. Although symptoms seem milder than fever/deep pulse, the danger is greater.
Wang Hu states: Zhongjing does not specify which acupoint to moxa. Chang Qizhi suggests Ge Shu and Guanyuan, third row of Back-Shu points. Guo Yong suggests a textual error, correcting to Ge Shu and Guanyuan. Ge Shu is actually the second row. Chang's "third row" likely refers to Ge Guan. *Tu Jing* states: Ge Guan (2 points) are below the 7th thoracic vertebra, 3 cun lateral, in depressions, where Foot-Taiyang Qi emerges, treating back aversion to cold, stiff spine, and difficulty bending/straightening; 5 moxa cones are applicable. Shaoyin Cold enters via Taiyang, hence these points. Guanyuan (1 point) is 3 cun below the umbilicus on the midline, intersection of Foot-Yin meridians and Ren Mai; 100 moxa cones are applicable. Moxa Ge Guan warms exterior to disperse external pathogens; moxa Guanyuan warms interior to boost primal Qi.
In Shaoyin disease, if there is body pain, cold hands and feet, bone/joint pain, and a deep pulse, Fuzi Tang is administered.
[Annotation] This elaborates on the previous clause's symptoms and treatment. Body pain occurs in both exterior and interior syndromes. Taiyang disease with floating pulse, fever, aversion to cold, body pain, warm hands/feet, and joint pain is exterior Cold, treated with Mahuang Tang to release exterior and disperse Cold. Here, Shaoyin disease with deep pulse, no fever, aversion to cold, body pain, cold hands/feet, and joint pain is interior Cold, treated with Fuzi Tang to warm interior and disperse Cold.
[Collected Annotations] Fang Youzhi states: Shaoyin corresponds to Kidney; Kidney governs bones; Cold invasion causes pain.
Cheng Yingmao states: Body pain, cold extremities, and joint pain are also seen in Taiyang Cold Damage. Differentiation by deep pulse indicates heavy Yin-Cold; excess interior Yin and deficient exterior Yang. Hence, Fuzi Tang is used.
Fuzi Tang Formula
Fuzi (Raw Aconiti Radix, peeled, broken into eight pieces, 2 pieces)
Fuling (Poria, 3 liang)
Renshen (Ginseng Radix, 2 liang)
Baizhu (Atractylodis Macrocephalae Rhizoma, 4 liang)
Shaoyao (Paeoniae Radix Alba, 3 liang)
The above five ingredients: Use eight sheng of water, boil to obtain three sheng, strain, and take one sheng warm, three times daily.
[Formula Analysis] Shaoyin is the organ of Cold Water; severe Cold injury often enters Shaoyin, making it prone to fatal cases. Fuzi (2 pieces) is the Sovereign herb for its potent strength. Raw usage strengthens the Minor Fire (Yang) and disperses interior/exterior Cold, stopping body pain, eliminating aversion to cold, and warming extremities. Renshen is the Minister herb to secure the source of Life Qi, providing roots for the Zang-Fu and meridians, raising the pulse from deep, and harmonizing joints. Baizhu supports Earth (Spleen), Shaoyao soothes Wood (Liver), and Fuling drains Water. Draining Water allows Fire to flourish; flourishing Fire dissipates Yin shadows; soothing Wood stabilizes Earth; stable Earth controls Water. Control enables transformation and production. This is a comprehensive strategy. Those who fear using it and delay treatment commit a grave error.
In Shaoyin disease, if the pulse is deep, urgent warming is required, preferably with Sini Tang (Four Reversals Decoction).
[Annotation] Shaoyin disease with desire to sleep and deep pulse, absent of fever or dry mouth, indicates Cold pathogens have entered the Zang organ. Do not hesitate; urgently warm with Sini Tang to eliminate Yin and assist Yang.
[Collected Annotations] Wu Renju states: Deep pulses must be differentiated for deficiency/excess and duration. If chronic and solid/deep, treat differently.
Sini Tang Formula
Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma, 2 liang)
Ganjiang (Dried Zingiberis Rhizoma, 1.5 liang)
Fuzi (Raw Aconiti Radix, peeled, broken into eight pieces, 1 piece)
The above three ingredients: Use three sheng of water, boil to obtain 1.2 sheng, strain, and divide into two warm doses. Strong individuals may use a large Fuzi (1 piece) and Ganjiang (3 liang).
[Formula Analysis] Named "Four Reversals," it treats Shaoyin interior-exterior Cold and limb reversal (cold extremities). Gancao (sweet/warm) is Sovereign to nourish Yang. Ganjiang and Fuzi (acrid/warm) are Ministers to assist Yang against Cold. Gancao with Jiang/Fuzi stirs Kidney Yang and warms middle Cold (warming Earth in Water). Jiang/Fuzi with Gancao penetrates joints and limbs, driving out Yin and restoring Yang. Stirred Kidney Yang dissipates Cold Yin, allowing Yang to reach the exterior, raising the pulse, and warming extremities.
[Collected Exegesis] Wang Hu states: Shaoyin baseline is faint/fine pulse and desire to sleep. Here, light pressure reveals no faint pulse; heavy pressure barely finds fine pulse, hiding into deepness. This indicates Cold pathogens deeply entrenched, nearing the Zang. Urgent warming is essential. Delay leads to aversion to cold, curling up, vomiting/diarrhea, irritability, inability to sleep, cold extremities, and absent pulse—imminent death. Can the use of Sini Tang be delayed?
In Shaoyin disease with diarrhea, Baitong Tang (White Through Decoction) is administered.
[Annotation] Shaoyin disease with desire to sleep, faint/fine pulse, indicates Yang trapped by Yin. Added diarrhea risks extreme Yin descent and Yang collapse. Congbai (Scallion White) is Sovereign to freely unblock Yang and direct it upward; Ganjiang and Fuzi are Ministers to urgently overcome Yin and slow its descent, recovering non-collapsed Yang.
[Collected Annotations] Fang Youzhi states: Shaoyin with diarrhea involves both Meridian and Zang, indicating severe Cold and Yin abundance. Ganjiang/Fuzi overcome Yin to disperse Cold. Congbai ("White Through") unblocks Yang to dissipate Yin.
Cheng Zhi states: Diarrhea requires unblocking Yang. Shaoyin diarrhea indicates extreme Yin abundance, risking Yang rejection. Jiang/Fuzi eliminate Yin; Congbai raises Yang. "Through" means warming to allow Yang entry and dispersing to allow Yin exit.
Wang Hu states: Kidney deficiency without Fire cannot control Water, causing diarrhea. Baitong Tang warms interior and disperses Cold.
Baitong Tang Formula
Congbai (Scallion Stems, 4 stems)
Ganjiang (Dried Zingiberis Rhizoma, 1 liang)
Fuzi (Raw Aconiti Radix, peeled, broken into eight pieces, 1 piece)
The above three ingredients: Use three sheng of water, boil to obtain one sheng, strain, and divide into two warm doses.
[Collected Exegesis] Wang Hu states: This formula resembles Sini Tang but omits Gancao. To expel Cold quickly, the acrid/pungent nature acts swiftly to reach the Lower Jiao; thus, sweet/harmonizing Gancao is avoided. The emphasis remains on Congbai...