（咽痛 吐 吐利 下利 但欲寐嗜卧 口燥咽干）
少阴之为病但欲寐也又欲吐不吐心烦但欲寐五六日自利而渴者理中四逆辈阴证虽云不用麻黄如少阴病始得之反发
热脉沉者麻黄细辛附子汤于六经中但少阴证难辨本经但云脉沉细欲寐小便数而曰背恶寒四肢厥者可不审而知之或虽有
恶寒甚者不觉寒或但喜浓衣近火善瞌睡问之则不言怕寒殊不知浓衣即恶寒也善瞌睡即但欲寐也其脉微细或沉涩虽有阴
阳俱紧者盖其人素有热为表寒外袭故如此但当察其外证为主必以温药逐之其阳邪传入及夫少阴自受热证宜下宜吐宜和
解者多矣仲景虽不言脉滑实沉数诸可下之脉然于证则可知矣脉必相符虽或有反沉微细迟脉不应证者为不可下亦宜凉剂
滋阴退阳而愈者其不愈者必待脉有力而后下之可也其有证恶寒急下之者倘反有脉不应病亦宜微下之虽不敢大下亦不可
缓也临病应变之术妙自神会非俗工之所知良医之所自得六经同法惟少阴传变与太阳相同如通脉四逆汤四逆散真武汤证
俱有加减法谓有或为之证亦犹太阳小青龙小柴胡之类罕有能知斯妙者也
少阴经治法有汗下吐温和解灸刺
汗 麻黄附子细辛汤 麻黄附子甘草汤
下 大承气汤 抵当汤
吐 瓜蒂散
温 四逆汤 桂枝芍药汤 附子汤 桃花汤 吴茱萸汤 白通汤 白通加猪胆汁汤 真武汤 通脉四逆汤
和解 桂枝甘草龙骨牡蛎汤 黄连阿胶汤 猪肤汤 甘草汤 桔梗汤 苦酒汤 半夏散 猪苓汤 四逆汤
灸 灸少阴
经云尺寸俱沉者少阴受病也以其脉贯肾络于肺系舌本故口燥舌干而渴少阴之为病脉微细但欲寐也少阴病欲吐不吐
心烦但欲寐五六日自利而渴者属少阴也虚故引水自救若小便色白者少阴病形悉具小便白者以下焦虚有寒不能制水故令
色白也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少阴病始得之反发热脉沉者麻黄附子细辛汤主之（张
或云论传经之邪自三阳而传至太阴太阴则传少阴此不言传经而言始得之何也夫传经者古人明理立法之意如此安可执一
而论哉夫三阳伤寒多自太阳入次第而传至厥阴者固有也其三阴伤寒亦有自利不渴始自太阴而入者今少阴病始得之反发
热此自少阴而入者故云始得之缘少阴无身热而今有热故言反发热以不当发热而热也为初病邪浅故与麻黄附子细辛汤以
发散之）少阴病脉细沉数病为在里不可发汗（成 少阴病始得之反发热脉沉者为邪在经可与发汗若脉细沉数为病在里不
可发汗按阴脉沉细今带数恐人以为热故举以告人盖此数乃沉细之数如经曰数为虚者是也非热则烦数之数也成注欠发
明）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（脉微为亡阳表虚不可发汗脉弱涩为亡阴里虚复不可
下）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（谓初得病二三日常见少阴证以邪未深故须汗
以无阳证故微发之而已）
麻黄附子甘草汤方
麻黄（去节） 甘草（炙各二两） 附子（一枚炮去皮破八片） 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（麻黄甘草之甘以散表寒附子之辛以温寒气）
庞 少阴病脉沉不知何沉也且沉紧发汗则动经细沉数为病在里不可发汗详此脉或沉而喘或沉而微不甚小是表中
寒
而里不消脉应里而发热在表故以小辛之药温散而微微取汗也
少阴病得之一二日口中和其背恶寒者当灸之附子汤主之（背者胸中之府诸阳受气于胸中而转行于背内经曰人身之阴
阳者背为阳腹为阴阳气不足阴寒气盛则背为之恶寒若风寒在表而恶寒者则一身尽寒矣但背恶寒者阴寒气盛可知如此条
是也又或乘阴气不足阳气内陷入阴中表阳新虚有背微恶寒者经所谓伤寒无大热口燥渴心烦背微恶寒白虎加人参汤主之
是也一为阴寒气盛一为阳气内陷何以明之盖阴寒为病则不能消耗津液故于少阴病则其口中和及阳气内陷则热烁津液为
干故于太阳病则口燥舌干而渴也要辨阴阳寒热不同者当于口中润燥详之）
附子汤方
附子（二枚炮去皮破八片） 白术（四两） 茯苓 芍药（各三两） 人参（二两）上五味以水八升煮取三升去滓
温服一升日三服（辛以散之附子之辛以散寒甘以缓之茯苓人参白术之甘以补阳酸以收之芍药之酸以扶阴所以然者偏阴偏
阳则为病水欲实水当平之不欲偏胜也）
少阴病得之二三日以上心中烦不得卧黄连阿胶汤主之（方见不得卧）少阴病六七日腹胀不大便者急下之用大承气汤
少阴病四逆其人或咳或悸或小便不利或腹中痛或泄利下重者四逆散主之
四逆散方
甘草（炙） 枳实（破水浸炙干） 柴胡 芍药（各等分） 上四味各十分捣筛白饮和服方寸匕日三服咳者加五味
子干姜各五分并主下利悸者加桂枝五分小便不利者加茯苓五分腹中痛者加附子一枚炮令拆泄利下重者先以水五升煮薤
白三升煮取三升去滓以散三方寸匕纳汤中煮取一升半分温再服
少阴病手足逆冷其人若下利后重者此条四逆散加薤白汤若下利脉绝及无脉者通脉四逆汤白通加猪胆汁汤（方论见下
利）若身体骨节痛脉沉者宜附子汤少阴病脉沉者急温之宜四逆汤（方见下利）少阴病身体痛手足寒骨节痛脉沉者附子汤
主之少阴病脉沉发热者宜麻黄附子细辛汤少阴病欲解时从子至寅上少阴病恶寒而蜷时自烦欲去衣被者可治少阴病下利
止而头眩时时自冒者死少阴中风脉阳微阴浮者为欲愈少阴病脉微细沉但欲卧汗出不烦自欲吐至五六日自利复烦躁不得
寤寐者死少阴病六七日息高者死少阴病脉紧至七八日自利脉紧变暴微厥手足反温者欲解也（论见下利）少阴病八九日一
身手足尽热者以热在膀胱必便血也少阴病但厥无汗而强发之必动其血未知从何道出或从口鼻或从目出是名下厥上竭最
难治少阴病四逆恶寒而身蜷脉不至不烦而躁者死少阴病恶寒身蜷而利手足逆冷者不可治
戴 若兀兀欲吐心烦喜寐或自利口燥而渴或口中和而背恶寒此属少阴经但少阴用药有阴阳之分自利而渴者宜猪
苓
汤盖阳热传入肾少阴经肾系舌本故自利口燥而渴以猪苓汤利肾中之热不愈则当自大便去之古法合用大承气汤若难用大
承气汤则用小承气汤或且进白头翁汤上项诸药为阴中涵阳者也泄利下重其人四逆先以水盏半葱白二根煎一盏去葱煎四
逆散至七分咳加半五味子干姜各半钱悸加桂枝一钱小便不利加茯苓一钱腹痛加熟附半钱若审是下利清谷手足四逆其人
面戴赤或腹痛或干呕或咽痛四逆汤倍干姜面赤者加葱一根腹痛加芍药一钱半呕加生姜咽痛加桔梗一钱若口中和而背恶
寒宜正方四逆汤不必加减四逆散四逆汤俱治少阴下利四肢逆冷泄利下重者与下利清谷者一凉一温又自有阴有阳之别若
初得病便见少阴证其人发热恶寒身疼头不痛者宜麻黄细辛附子汤微汗之或五积散加熟附半钱或五积散加以顺元散
少阴病的典型症状是只想睡觉。又想吐又吐不出来，心烦意乱，只想睡觉。五六天后出现自发性腹泻且口渴的，属于理中汤、四逆汤之类的方剂主治范围。虽然阴证通常不使用麻黄，但如果少阴病初起反而发热、脉象沉的，可用麻黄细辛附子汤。在六经病中，唯独少阴证难以辨别。本经原文只说脉沉细、想睡觉、小便频数；如果说背部怕冷、四肢厥冷的，可以不通过详细审察就知道。或者虽然有严重的恶寒，但患者自己并不觉得冷，或者只是喜欢穿厚衣服靠近火源，容易打瞌睡，问起来却不说怕冷。殊不知穿厚衣服就是恶寒的表现，容易打瞌睡就是“但欲寐”的表现。其脉象微细或沉涩。虽然有阴阳俱紧的情况，但这可能是因为患者素体有热，被表寒外袭所致，所以如此。此时应当主要观察外在证候，必须用温药来驱逐邪气。如果是阳邪传入，以及少阴自身受热证，适宜用下法、吐法、和解法的很多。张仲景虽然没有明确列出脉滑实沉数等可下的脉象，但从证候上是可以推断出来的。脉象必然相符，虽然或有脉象反见沉微细迟而不符合证候的，这种情况不可下，也宜用凉剂滋阴退阳而痊愈。如果不愈，必须等到脉有力之后才可下。如果有证候显示需要急下，如果反而脉象与病情不符，也宜轻微攻下。虽然不敢大力攻下，也不可迟缓。临病应变的技巧，妙处在于神会，非庸医所能知晓，是良医所自得。六经治法相同，唯独少阴的传变与太阳相同。如通脉四逆汤、四逆散、真武汤等证都有加减法，谓若有兼证则为之加减，这也像太阳病的小青龙汤、小柴胡汤之类，很少有人能知晓其中的奥妙。
少阴经的治疗方法有汗、下、吐、温、和、解、灸、刺八种。
汗法：麻黄附子细辛汤、麻黄附子甘草汤。
下法：大承气汤、抵当汤。
吐法：瓜蒂散。
温法：四逆汤、桂枝芍药汤、附子汤、桃花汤、吴茱萸汤、白通汤、白通加猪胆汁汤、真武汤、通脉四逆汤。
和解法：桂枝甘草龙骨牡蛎汤、黄连阿胶汤、猪肤汤、甘草汤、桔梗汤、苦酒汤、半夏散、猪苓汤、四逆汤。
灸法：灸少阴经穴位。
经文说：尺寸脉俱沉的，是少阴受病。因为少阴经脉贯穿肾脏，联络肺系和舌根，所以会出现口燥、舌干而渴。少阴病的典型症状是脉微细，只想睡觉。少阴病想吐又吐不出来，心烦意乱，只想睡觉。五六天后出现自发性腹泻且口渴的，属于少阴病。因为虚，所以引水自救。如果小便颜色发白的，少阴病的形证就具备了。小便色白是因为下焦虚寒，不能制约水液，所以令其色白。患者脉象阴阳俱紧，反而出汗的，是亡阳。这属于少阴病，法当出现咽痛并伴有呕吐和下利。少阴病初起，反而发热、脉沉的，用麻黄附子细辛汤主治。（张氏注：有人说这是论述传经之邪，从三阳传到太阴，太阴再传到少阴。这里不说传经而说“始得之”，为什么呢？传经是古人阐明道理、确立法则的意思，怎能拘泥于一端而论呢？三阳伤寒多从太阳入，依次传到厥阴，这也是有的。三阴伤寒也有自利不渴，从太阴而入的。现在少阴病初起反而发热，这是邪气直接从少阴而入的，所以说“始得之”。因为少阴本无身热，现在有热，所以说“反发热”，即不当发热而发热。因为初病邪气浅，所以给予麻黄附子细辛汤以发散。）
少阴病脉细沉数，病在里，不可发汗。（成氏注：少阴病初起，反发热、脉沉，为邪在经，可与发汗；若脉细沉数，为病在里，不可发汗。按：阴脉沉细，今带数，恐怕人误以为热，所以举出来告诫人。这个“数”乃是沉细之中的数，如经文所说“数为虚”是也，并非热证的烦数之数。成注欠发明。）
少阴病脉微，不可发汗，因为亡阳的缘故。阳气已虚，尺脉弱涩的，也不可以再下。（脉微为亡阳、表虚，不可发汗；脉弱涩为亡阴、里虚，不可下。）
少阴病得之二三日，用麻黄附子甘草汤微发汗，因为二三日没有里证，所以微发汗。（意思是初得病两三天，常常见到少阴证，因为邪气未深，所以需要汗法；因为没有阳证，所以只是微微发汗而已。）
麻黄附子甘草汤方：
麻黄（去节）、甘草（炙，各二两）、附子（一枚，炮，去皮，破成八片）。以上三味，用水七升，先煮麻黄，沸后去掉上面的沫，加入其他药物，煮取三升，去滓，温服一升，每日三次。（麻黄、甘草的甘味以疏散表寒，附子的辛味以温散寒气。）
庞氏注：少阴病脉沉，不知是什么沉？若是沉紧，发汗则会动经。细沉数为病在里，不可发汗。详查此脉，或是沉而喘，或是沉而微，不甚小，这是表中有寒而里没有消解，脉应里而发热在表，所以用小辛的药物温散，微微取汗。
少阴病得之一二日，口中平和，背部怕冷的，应当施灸，并用附子汤主治。（背是胸中的府邸，诸阳之气受于胸中而转行于背。《内经》说：人身之阴阳，背为阳，腹为阴。阳气不足，阴寒气盛，则背部恶寒。如果风寒在表而恶寒，则一身尽寒。只有背部恶寒的，可知是阴寒气盛，正如本条所述。又或者乘阳气不足，阳气内陷入阴中，表阳新虚，有背部微恶寒者，即经文所说的伤寒无大热、口燥渴、心烦、背微恶寒，用白虎加人参汤主治。这是一为阴寒气盛，一为阳气内陷，如何分辨？盖阴寒为病，则不能消耗津液，所以在少阴病中口中平和；而阳气内陷，则热烁津液为干，所以在太阳病中口燥舌干而渴。要辨别阴阳寒热的不同，应当在口中润燥上详察。）
附子汤方：
附子（二枚，炮，去皮，破成八片）、白术（四两）、茯苓、芍药（各三两）、人参（二两）。以上五味，用水八升，煮取三升，去滓，温服一升，每日三次。（辛味以散之，附子的辛味以散寒；甘味以缓之，茯苓、人参、白术的甘味以补阳；酸味以收之，芍药的酸味以扶阴。之所以这样，是因为偏阴偏阳则为病，水欲实，水当平，不欲偏胜也。）
少阴病得之二三日以上，心中烦，不得卧，用黄连阿胶汤主治。（方见不得卧条）少阴病六七天，腹胀不大便的，急下之，用大承气汤。
少阴病四肢逆冷，其人或有咳嗽，或有心悸，或小便不利，或腹中痛，或泄利下重，用四逆散主治。
四逆散方：
甘草（炙）、枳实（破，水浸，炙干）、柴胡、芍药（各等分）。以上四味，各十分，捣筛，用白饮（米汤）和服方寸匕，每日三次。咳嗽者加五味子、干姜各五分，并主下利；心悸者加桂枝五分；小便不利者加茯苓五分；腹中痛者加附子一枚，炮令拆碎；泄利下重者，先以水五升，煮薤白三升，煮取三升，去滓，将四逆散三方寸匕纳入汤中，煮取一升半，分两次温服。
少阴病手足逆冷，其人若下利后重者，此条用四逆散加薤白汤。若下利脉绝及无脉者，用通脉四逆汤、白通加猪胆汁汤。（方论见下利条）若身体骨节痛，脉沉的，宜用附子汤。少阴病脉沉的，急温之，宜用四逆汤。（方见下利条）少阴病身体痛，手足寒，骨节痛，脉沉的，用附子汤主治。少阴病脉沉发热者，宜用麻黄附子细辛汤。
少阴病欲解时，从子时至寅时上。少阴病恶寒而蜷缩，时时自烦，想要脱去衣被的，可治。少阴病下利止而头眩，时时自冒的，死。少阴中风，脉阳微阴浮的，为欲愈。少阴病脉微细沉，只想卧，汗出不烦，自欲吐，至五六日自利，复烦躁不得寤寐的，死。少阴病六七天，息高的，死。少阴病脉紧，至七八日自利，脉紧变暴微，厥逆的手足反而温暖的，欲解也。（论见下利条）少阴病八九日，一身手足尽热的，因为热在膀胱，必便血。少阴病但厥无汗而强发之，必动其血，未知从何道出，或从口鼻，或从目出，这叫做下厥上竭，最难治。少阴病四肢逆冷，恶寒而身蜷，脉不至，不烦而躁的，死。少阴病恶寒身蜷而利，手足逆冷的，不可治。
戴氏注：若兀兀欲吐，心烦喜寐，或自利口燥而渴，或口中和而背恶寒，这属于少阴经。但少阴用药有阴阳之分。自利而渴的，宜用猪苓汤。盖因阳热传入肾，少阴经肾系舌本，故自利、口燥而渴，以猪苓汤利肾中之热。若不愈，则当从大便去之。古法合用大承气汤。若难用大承气汤，则用小承气汤，或者暂进白头翁汤。上述诸药为阴中涵阳者也。泄利下重，其人四肢逆冷，先以水一盏半，葱白两根，煎至一盏，去葱，再煎四逆散至七分。咳加半钱五味子、干姜；悸加一钱桂枝；小便不利加一钱茯苓；腹痛加半钱熟附子。若审是下利清谷，手足四逆，其人面戴赤，或腹痛，或干呕，或咽痛，用四逆汤倍干姜。面赤者加葱一根；腹痛加芍药一钱半；呕加生姜；咽痛加桔梗一钱。若口中和而背恶寒，宜正方四逆汤，不必加减。四逆散、四逆汤俱治少阴下利、四肢逆冷、泄利下重，与下利清谷者相比，一凉一温，又自有阴有阳之别。若初得病便见少阴证，其人发热恶寒，身疼，头不痛，宜用麻黄细辛附子汤微汗之。或用五积散加熟附子半钱，或五积散加以顺元散。
(Throat pain, vomiting, simultaneous vomiting and diarrhea, diarrhea, desire to sleep/listlessness, dry mouth and throat)
The typical manifestation of Shaoyin disease is a desire to sleep. The patient feels the urge to vomit but cannot, experiences mental restlessness (fanxin), and has a strong desire to sleep. After five or six days, spontaneous diarrhea accompanied by thirst occurs; this falls under the treatment scope of formulas such as Lizhong Tang (Center-Regulating Decoction) and Sini Tang (Frigid Extremities Decoction). Although Yin syndromes generally do not utilize Ephedrae Herba (Mahuang), if Shaoyin disease presents with fever upon onset and a deep pulse, Mahuang Xixin Fuzi Tang (Ephedra, Asarum, and Aconite Decoction) may be used. Among the Six Channels, the Shaoyin syndrome is particularly difficult to differentiate. The classic text states only that the pulse is deep and fine, there is a desire to sleep, and urination is frequent. If one observes aversion to cold in the back and cold extremities, the diagnosis can be made without extensive examination. Alternatively, although severe aversion to cold exists, the patient may not perceive it themselves, preferring instead to wear thick clothing or stay near fire, and prone to dozing off. When asked, they do not complain of cold. It should be understood that wearing thick clothing indicates aversion to cold, and dozing off corresponds to "desire to sleep." The pulse may be faint and fine or deep and choppy. Even if both Yin and Yang pulses are tight, this may be due to the patient having internal heat predisposition combined with external invasion by cold pathogens. In such cases, one must primarily observe the external manifestations and must use warm herbs to expel the pathogen. If Yang pathogens have transmitted inward, or if Shaoyin itself involves heat syndromes requiring purgation, emesis, or harmonization, there are many such cases. Zhang Zhongjing did not explicitly list pulses such as slippery, full, deep, or rapid as indications for purgation, but these can be inferred from the symptoms. The pulse and symptoms must correspond. However, if the pulse is paradoxically faint, micro, fine, or slow contrary to the symptoms, purgation is contraindicated; instead, cooling agents to nourish Yin and subdue Yang should be used for recovery. If recovery does not occur, purgation should only be considered after the pulse becomes forceful. If symptoms indicate urgent purgation but the pulse does not match the condition, mild purgation is appropriate. While heavy purgation is avoided, delay is also unacceptable. The art of adapting to clinical changes lies in spiritual comprehension, unknown to mediocre practitioners but inherent to skilled physicians. The principles of the Six Channels are similar, but the transmission of Shaoyin mirrors that of Taiyang. For instance, Tongmai Sini Tang (Pulse-Recovering Frigid Extremities Decoction), Sini San (Frigid Extremities Powder), and Zhenwu Tang (True Warrior Decoction) all possess modification methods for accompanying symptoms, akin to Xiao Qinglong Tang (Minor Green Dragon Decoction) and Xiao Chaihu Tang (Minor Bupleurum Decoction) in Taiyang, yet few understand this subtlety.
Treatment methods for the Shaoyin Meridian include sweating, purging, inducing vomiting, warming, harmonizing, resolving, moxibustion, and acupuncture.
Sweating method: Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction); Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction).
Purgative method: Dachengqi Tang (Major Order the Qi Decoction); Didang Tang (Worth Attacking Decoction).
Emetic method: Gouti San (Melon Seed Powder).
Warming method: Sini Tang (Frigid Extremities Decoction); Guizhi Shaoyao Tang (Cinnamon Twig and Peony Decoction); Fuzi Tang (Aconite Decoction); Taohua Tang (Peach Blossom Decoction); Wuzhuyu Tang (Evodia Decoction); Baitong Tang (White Passage Decoction); Baitong Jia Zhuyedan Tang (White Passage Decoction plus Pig Gallbladder Bile); Zhenwu Tang (True Warrior Decoction); Tongmai Sini Tang (Pulse-Recovering Frigid Extremities Decoction).
Harmonizing/Resolving method: Guizhi Gancao Longgu Muli Tang (Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction); Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction); Zhufu Tang (Pig Skin Decoction); Gancao Tang (Licorice Decoction); Jiegeng Tang (Platycodon Decoction); Kujiu Tang (Bitter Wine Decoction); Banxia San (Pinellia Powder); Zhuling Tang (Polyporus Decoction); Sini Tang (Frigid Extremities Decoction).
Moxibustion: Moxibustion on Shaoyin meridian points.
The classic states: When both Cun and Chi pulses are deep, it indicates Shaoyin disease. This is because the Shaoyin meridian passes through the Kidney, connects to the Lung system, and reaches the root of the tongue, leading to dry mouth, dry tongue, and thirst. The hallmark of Shaoyin disease is a faint and fine pulse with a desire to sleep. If a Shaoyin patient desires to vomit but cannot, feels restless, and wants to sleep, and after five or six days develops spontaneous diarrhea with thirst, it belongs to Shaoyin. Due to deficiency, the patient seeks water to self-rescue. If urine is white, the Shaoyin syndrome is fully manifested. White urine results from lower Jiao deficiency-cold failing to control water metabolism. If a patient has both Yin and Yang pulses tight but sweats spontaneously, it indicates loss of Yang. This belongs to Shaoyin, where throat pain, vomiting, and diarrhea are expected. If Shaoyin disease begins with fever and a deep pulse, Mahuang Fuzi Xixin Tang is indicated. (Zhang's commentary: Some argue this discusses transmitted pathogenic factors moving from the Three Yang to Taiyin, then to Shaoyin. Why does it say "just acquired" rather than "transmitted"? Transmission reflects the ancients' intent to clarify principles and establish laws; one should not interpret rigidly. While Yang diseases often transmit sequentially from Taiyang to Jueyin, Yin diseases can also enter via Taiyin with spontaneous diarrhea and no thirst. Here, Shaoyin disease presenting with fever at onset indicates direct entry into Shaoyin, hence "just acquired." Since Shaoyin typically lacks fever, its presence is termed "counterfeit fever." Because the pathogen is shallow at the start, Mahuang Fuzi Xixin Tang is given to disperse it.)
If Shaoyin disease presents with a fine, deep, and rapid pulse, the pathology is interior, and sweating is contraindicated. (Cheng's commentary: Early Shaoyin disease with counterfeited fever and deep pulse indicates exterior pathogen, allowing sweating. Fine, deep, rapid pulse indicates interior pathology, prohibiting sweating. Note: Yin pulses are deep and fine; the addition of "rapid" might mislead one to think of heat. Thus, it is clarified that this "rapid" refers to the rapidness within the deep/fine quality, as stated in the classic "rapid indicates deficiency," not the rapidness associated with heat-induced restlessness. Cheng's note lacks clarity here.)
If Shaoyin disease presents with a faint pulse, sweating is contraindicated due to Yang exhaustion. If Yang is already deficient and the Chi pulse is weak and choppy, purgation is also contraindicated. (Faint pulse indicates Yang loss/exterior deficiency, prohibiting sweating; weak/choppy pulse indicates Yin loss/interior deficiency, prohibiting purgation.)
For Shaoyin disease acquired two to three days prior, Mahuang Fuzi Gancao Tang is used for mild sweating, as there are no interior symptoms at this stage. (Meaning: Early Shaoyin signs appear within two to three days; since the pathogen is not deep, sweating is needed. However, lacking Yang-excess symptoms, only mild sweating is applied.)
Formula: Mahuang Fuzi Gancao Tang
Ingredients: Mahuang (remove joints), Gancao (honey-fried, 2 liang each), Fuzi (one piece, processed, skin removed, broken into eight pieces).
Preparation: Boil the three ingredients in seven sheng of water. First boil Mahuang until boiling, skim the foam, then add other herbs. Boil until three sheng remain, strain, and take one sheng warm, three times daily. (The sweetness of Mahuang and Gancao disperses exterior cold; the pungency of Fuzi warms internal cold.)
Pang's commentary: Regarding Shaoyin disease with a deep pulse, one must discern the type. If deep and tight, sweating disturbs the meridians. Fine, deep, rapid pulse indicates interior pathology, prohibiting sweating. Examining this pulse, if deep with wheezing or deep and micro but not extremely small, it suggests exterior cold with unresolved interior conditions. The pulse corresponds to the interior, but fever manifests in the exterior. Therefore, mildly pungent herbs are used to warm and disperse, inducing slight sweating.
If Shaoyin disease is acquired one or two days ago, and the mouth feels normal but there is aversion to cold in the back, moxibustion should be applied, and Fuzi Tang is indicated. (The back is the mansion of the chest; Yang Qi originates in the chest and circulates to the back. The Classic states: Back is Yang, abdomen is Yin. Insufficient Yang and abundant Yin-cold cause back aversion to cold. If wind-cold is in the exterior, whole-body cold ensues. Isolated back aversion to cold indicates abundant Yin-cold, as in this case. Alternatively, if Yang deficiency allows Yang to sink into Yin, causing new exterior Yang deficiency, mild back aversion to cold may occur, treated with Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) for symptoms like no high fever, dry mouth/thirst, restlessness, and mild back aversion. One case is Yin-cold excess; the other is Yang sinking. Differentiation relies on checking if the mouth is moist or dry. Yin-cold does not consume fluids, so the mouth remains normal in Shaoyin. Yang sinking generates heat that scorches fluids, causing dryness in Taiyang.)
Formula: Fuzi Tang
Ingredients: Fuzi (two pieces, processed, skin removed, broken into eight pieces), Baizhu (4 liang), Fuling, Shaoyao (3 liang each), Renshen (2 liang).
Preparation: Boil the five ingredients in eight sheng of water until three sheng remain, strain, and take one sheng warm, three times daily. (Pungent herbs disperse; Fuzi's pungency dispels cold. Sweet herbs moderate; Fuling, Renshen, and Baizhu's sweetness tonifies Yang. Sour herbs astringe; Shaoyao's sourness supports Yin. This balance prevents deviation into extreme Yin or Yang, ensuring water metabolism remains balanced without dominance.)
If Shaoyin disease persists beyond two to three days with mental restlessness and insomnia, Huanglian Ejiao Tang is indicated. (See "Insomnia" section.) If Shaoyin disease lasts six to seven days with abdominal distension and constipation, urgent purgation with Dachengqi Tang is required.
If Shaoyin disease presents with cold extremities, and the patient has cough, palpitations, dysuria, abdominal pain, or tenesmus (heavy sensation during defecation), Sini San is indicated.
Formula: Sini San
Ingredients: Gancao (fried), Zhishi (broken, soaked in water, fried dry), Chaihu, Shaoyao (equal parts).
Preparation: Grind the four ingredients into powder. Mix with rice water and take one cubic inch spoon, three times daily. Modifications: Add Wuweizi and Ganjiang (0.5 fen each) for cough/diarrhea; add Guizhi (1 fen) for palpitations; add Fuling (1 fen) for dysuria; add Fuzi (one piece, processed) for abdominal pain. For tenesmus: Boil Xiebai (3 sheng) in water (5 sheng) to obtain 3 sheng, strain, add Sini San powder (3 cubic inches), boil to 1.5 sheng, divide into two warm doses.
For Shaoyin disease with cold extremities and post-diarrhea tenesmus, use Sini San plus Xiebai. If diarrhea leads to absent pulse, use Tongmai Sini Tang or Baitong Jia Zhuyedan Tang. (See Diarrhea section.) If body/joint pain with deep pulse occurs, use Fuzi Tang. If Shaoyin disease presents with deep pulse, urgent warming with Sini Tang is required. (See Diarrhea section.) If Shaoyin disease presents with body pain, cold extremities, joint pain, and deep pulse, Fuzi Tang is indicated. If Shaoyin disease presents with deep pulse and fever, Mahuang Fuzi Xixin Tang is appropriate.
Shaoyin disease resolves between Zi and Yin hours (11 PM - 3 AM). If Shaoyin disease presents with aversion to cold, curling up, occasional restlessness, and desire to remove covers, prognosis is favorable. If diarrhea stops but dizziness and lightheadedness occur, prognosis is fatal. If Shaoyin wind-strike presents with superficial pulse micro and deep pulse floating, recovery is imminent. If Shaoyin disease presents with faint/fine/deep pulse, desire to sleep, sweating without restlessness, and urge to vomit, progressing to spontaneous diarrhea, restlessness, and insomnia after five to six days, prognosis is fatal. If Shaoyin disease lasts six to seven days with high breathing (gasping), prognosis is fatal. If Shaoyin disease presents with tight pulse, progressing to day seven/eight with spontaneous diarrhea, pulse becoming suddenly micro, and cold extremities turning warm, resolution is impending. (See Diarrhea section.) If Shaoyin disease lasts eight to nine days with whole-body and extremity heat, blood in stool will occur due to heat in the Bladder. If Shaoyin disease presents with cold extremities and no sweat, forcing sweating will disturb blood, potentially causing bleeding from mouth, nose, or eyes, known as "Lower Jiao Cold with Upper Jiao Exhaustion," which is difficult to treat. If Shaoyin disease presents with cold extremities, aversion to cold, curling up, absent pulse, restlessness without mental agitation, prognosis is fatal. If Shaoyin disease presents with aversion to cold, curling up, diarrhea, and cold extremities, it is incurable.
Dai's commentary: Symptoms like nausea, restlessness, preference for sleep, spontaneous diarrhea with dry mouth/thirst, or normal mouth with back aversion to cold belong to Shaoyin. Treatment differs by Yin/Yang nature. Spontaneous diarrhea with thirst suggests Yang-heat transmitting to Kidney; Shaoyin meridian connects to tongue root, causing thirst. Zhuling Tang drains Kidney heat. If ineffective, purge via bowels using Dachengqi Tang, or Xiaochengqi Tang, or temporarily Baitouweng Tang. These formulas contain Yang within Yin. For tenesmus and cold extremities, first decoct Congbai (green onion white) in water, strain, then decoct Sini San. Modify as needed: Add Wuweizi/Ganjiang for cough; Guizhi for palpitations; Fuling for dysuria; Shu Fuzi for abdominal pain. If clear undigested food diarrhea with cold extremities, facial redness, abdominal pain, dry heaving, or throat pain, use Sini Tang with doubled Ganjiang. Add Congbai for facial redness; Shaoyao for abdominal pain; Shengjiang for vomiting; Jiegeng for throat pain. If mouth is normal with back aversion to cold, use standard Sini Tang without modifications. Sini San and Sini Tang both treat Shaoyin diarrhea, cold extremities, and tenesmus, differing from clear undigested food diarrhea by being cooling vs. warming, and Yin vs. Yang distinctions. If early Shaoyin symptoms present with fever, aversion to cold, body pain, but no headache, use Mahuang Xixin Fuzi Tang for mild sweating. Alternatively, Wujisan (Five Accumulations Powder) with Shu Fuzi, or Wujisan combined with Yishunyuan San.