治少阴病下利清谷。里寒外热。手足厥逆。脉微欲绝。身反不恶寒。其人面色
痛。或干呕。或咽痛。或利止脉不出者。此方主之。
甘草（三两） 干姜（三两 强人四两） 附子（一枚 生用。）
上三味。以水三升。煮取一升二合。去滓。分温再服。其脉即出者愈。面色赤者。加葱
九茎
脉不出者。去桔梗加人参二两。
歌曰 一枚生附草姜三。招纳亡阳此指南。外热里寒面赤厥。脉微通脉法中探。（一本。
甘
加减歌曰 面赤加葱茎用九。腹痛去葱真好手。葱去换芍二两加。呕者生
痛去芍桔须加。桔梗一两循经走。脉若不出二两参。桔梗丢开莫掣肘。
参各家说 阳气不能营运。宜四逆汤。元阳虚甚。宜附子汤。阴盛于下格阳于上。宜白
通汤
岂能疾呼散阳而使返耶。故倍用干姜。而仍不减甘草者。恐散涣之余。不能当姜、附之猛。
还藉甘草以收全功也。若面赤者。虚阳上泛也。加葱白引阳气以下行。腹中痛者。脾络不和
也。去葱加芍药以通脾络。呕者。胃气逆也。加生姜以宣逆气。咽痛者。少阴循经上逆也。
去芍药之苦泄。加桔梗之开提。利止脉不出者。谷气内虚。脉无所禀而生。去桔梗加人参以
生脉。
治少阴病四逆。其人或咳。或悸。或小便不利。或腹中痛。或泄利下重者主之。
甘草 枳实 柴胡 芍药
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。加附子一枚炮令坼。泄
利下重者。
分温再服
歌曰 枳甘柴芍数相均。热厥能回察所因。白饮和匀方寸匕。阴阳顺接用斯神。
加减歌曰 咳加五味与干姜。五分（去声）平行为正路。下利之病照此加。辛温酸收两
相顾。
法度。腹中痛
三升。去薤纳散寸匕数。再煮一升有半成。分温两服法可悟。
张令韶曰。凡少阴病四逆。俱属阳气虚寒。然亦有阳气内郁不得外达而四逆者。又宜四
逆散主之。枳实形圆臭香。胃家之宜品也。所以宣通胃络。芍药疏泄经络之血脉。甘草调中。
柴胡启达阳气而外行。阳气通而四肢温矣。若咳者。肺寒气逆也。用五味、干姜。温敛肺气。
并主下利者。温以散之。酸以收之也。悸者。心气虚也。加桂枝以保心气。小便不利者。水
道不行也。加茯苓以行水。腹中痛者。里寒也。加附子以温寒。泄利下重者。阳气郁于下也。
用薤白以通阳气。
治疗少阴病，出现下利且排泄物中夹杂未消化的食物。体内寒冷而体表发热。手足冰冷逆冷。脉搏微弱几乎摸不到。身体反而不觉得怕冷。患者的面色发红。或者伴有干呕。或者伴有咽喉疼痛。或者腹泻停止但脉搏仍无法触及的。此方主治这些症状。
甘草（三两） 干姜（三两，体质强壮者用四两） 附子（一枚，生用。）
以上三味药。用水三升。煮取一升二合的药液。滤去药渣。分两次温服。如果脉搏随即恢复出现的，说明病情好转。面色发红的。加葱白九茎。
脉搏仍不出来的。去掉桔梗，加入人参二两。
歌诀说：一枚生附子、三两甘草、三两干姜。招纳亡失的阳气以此为指南。外热里寒、面色赤红、四肢厥冷。在通脉法中探寻治法。（另一版本记载：甘草）
加减歌诀说：面色赤红加葱白九茎。腹痛时去掉葱白真是好方法。去掉葱白换上加芍药二两。呕吐者加生姜。咽痛时去掉芍药必须加桔梗。桔梗一两循经而走。脉搏若不出来加二两人参。丢掉桔梗不要犹豫牵制。
各家医家解说：阳气不能正常运行营运。适宜用四逆汤。元阳极度虚弱。适宜用附子汤。阴寒盛于下部格拒阳气于上部。适宜用白通汤。难道能急速呼散阳气使其返回吗？所以加倍使用干姜。并且仍然不减去甘草的原因，是担心在阳气涣散之余，身体不能承受干姜、附子的猛烈药性。还要借助甘草来收束全功。如果面色赤红。这是虚阳上浮。加葱白引导阳气下行。腹中疼痛的。是脾络不和。去掉葱白加入芍药以疏通脾络。呕吐的。是胃气上逆。加生姜以宣散逆气。咽喉疼痛的。是少阴经脉之气上逆。去掉芍药的苦泄之性。加入桔梗的开提之性。腹泻停止但脉搏不出来的。是谷气内部虚弱。脉无所依附而生。去掉桔梗加入人参以生脉。
治疗少阴病四肢厥逆。其中有的人咳嗽。有的人心悸。有的人小便不利。有的人腹中疼痛。有的人泄泻且肛门有重坠感的。主治这些症状。
甘草 枳实 柴胡 芍药
以上四味药。各取十分。捣碎过筛。用米汤调和。服用一方寸匕的量。每天服用三次。咳嗽的。加五味子、干姜各五分。同时主治下利。心悸的加桂枝五分。小便不利的。加茯苓五分。腹中疼痛的。加附子一枚炮制至裂开。泄泻且肛门重坠的。
分两次温服。
歌诀说：枳实、甘草、柴胡、芍药数量相等。热厥能够挽回需察明原因。用白饮调和均匀一方寸匕。使阴阳顺接运用此方神奇。
加减歌诀说：咳嗽加五味子和干姜。五分平行为正路。下利的病症照此加减。辛温与酸收两者兼顾。
法度：腹中疼痛。水三升。去掉薤白纳入散剂一方寸匕的数量。再煮成一升半成。分两次温服的方法可以领悟。
张令韶说：凡是少阴病的四肢厥逆。都属于阳气虚寒。然而也有阳气内郁不得向外通达而导致四肢厥逆的。又适宜用四逆散主治。枳实形状圆气味香。是胃家的适宜品种。所以能宣通胃络。芍药疏泄经络中的血脉。甘草调理中焦。柴胡启动通达阳气而向外运行。阳气通畅而四肢温暖了。如果咳嗽的。是肺寒气逆。用五味子、干姜。温敛肺气。同时主治下利的。是用温药散寒。酸味药收敛。心悸的。是心气虚。加桂枝以保护心气。小便不利的。是水道不通行。加茯苓以行水。腹中疼痛的。是里寒。加附子以温散寒邪。泄泻且肛门重坠的。是阳气郁结在下部。用薤白以通达阳气。
Treat Shaoyin disease presenting with diarrhea of undigested food. Internal cold and external heat. Cold extremities (Ji Ni). Pulse is faint and nearly imperceptible. The body does not feel aversion to cold. The person's face appears red. Or accompanied by dry retching. Or accompanied by sore throat. Or where diarrhea has stopped but the pulse remains unobtainable. This formula (Tongmai Sini Tang, Pulse-Reviving Four Reversal Decoction) is indicated for these symptoms.
Gancao (Licorice Root, *Glycyrrhizae Radix et Rhizoma*) (3 liang), Ganjiang (Dried Ginger, *Zingiberis Rhizoma*) (3 liang, 4 liang for robust individuals), Fuzi (Prepared Aconite Root Lateralis, *Aconiti Lateralis Radix Praeparata*) (1 piece, used raw).
Take the above three ingredients. Add 3 sheng of water. Boil to obtain 1.2 sheng of liquid. Strain off the dregs. Divide into two doses and take warm. If the pulse returns, the patient will recover. For those with a red face, add 9 stalks of Congbai (Scallion White, *Allii Fistulosi Bulbus*).
For those whose pulse does not return, remove Jiegeng (Platycodon Root, *Platycodonis Radix*) and add Renshen (Ginseng Root, *Panacis Quinquefolii Radix* or *Panacis Ginseng Radix*) 2 liang.
Song says: One raw Fuzi, 3 liang Gancao, 3 liang Ganjiang. To recruit lost Yang, this serves as the guide. External heat, internal cold, red face, and cold extremities. Explore the method within Tongmai therapy. (Another version mentions: Gancao)
Modification Song says: Red face, add 9 stalks of Congbai. Abdominal pain, removing Congbai is truly effective. Remove Congbai, add 2 liang Shaoyao (Peony Root, *Paeoniae Radix Alba*). For vomiting, add Shengjiang (Fresh Ginger, *Zingiberis Rhizoma Recens*). For sore throat, remove Shaoyao and must add Jiegeng. Jiegeng 1 liang follows the meridian. If the pulse does not appear, add 2 liang Renshen. Discard Jiegeng without hesitation.
Commentaries by various physicians: When Yang Qi cannot circulate and operate, Sini Tang (Four Reversal Decoction) is suitable. When Yuan Yang (Primal Yang) is severely deficient, Fuzi Tang (Aconite Decoction) is suitable. When Yin excess at the lower jiao repels Yang to the upper jiao, Baitong Tang (White Passage Decoction) is suitable. How can one hastily disperse Yang to make it return? Therefore, double the amount of Ganjiang. The reason Gancao is not reduced is to fear that after the dispersion, the body cannot withstand the fierce nature of Ganjiang and Fuzi. It still relies on Gancao to complete the therapeutic effect. If the face is red, it is floating deficient Yang ascending. Add Congbai to guide Yang Qi downward. For abdominal pain, it is disharmony of the Spleen collaterals. Remove Congbai and add Shaoyao to unblock the Spleen collaterals. For vomiting, it is rebellious Stomach Qi. Add Shengjiang to disseminate rebellious Qi. For sore throat, it is Shaoyin meridian Qi rebelling upward. Remove the bitter-draining property of Shaoyao; add the lifting property of Jiegeng. For diarrhea stopping but pulse not appearing, it is deficiency of Grain Qi internally, so the pulse lacks foundation. Remove Jiegeng and add Renshen to generate the pulse.
Treat Shaoyin disease with cold extremities (Ji Ni). Among these patients, some have cough. Some have palpitations. Some have difficulty urinating. Some have abdominal pain. Some have diarrhea with a sensation of heaviness in the rectum. These are primarily treated with this formula (Sini San, Four Reversal Powder).
Gancao (Licorice Root, *Glycyrrhizae Radix et Rhizoma*), Zhishi (Immature Bitter Orange Fruit, *Citri Reticulatae Fructus Immaturus*), Chaihu (Bupleurum Root, *Bupleuri Radix*), Shaoyao (Peony Root, *Paeoniae Radix Alba*).
Take the above four ingredients. Each in equal parts (10 fen). Pound and sieve. Mix with white rice decoction (Baiyin). Take one cun bi (a square-inch measure) per dose. Take three times daily. For cough, add Wuweizi (Schisandra Berry, *Schisandrae Chinensis Fructus*) and Ganjiang (Dried Ginger, *Zingiberis Rhizoma*) each 5 fen. Also treats diarrhea. For palpitations, add Guizhi (Cinnamon Twig, *Cinnamomi Ramulus*) 5 fen. For difficulty urinating, add Fuling (Poria, *Polyporus Umbellatus*) 5 fen. For abdominal pain, add Fuzi (Prepared Aconite Root Lateralis, *Aconiti Lateralis Radix Praeparata*) 1 piece, processed until cracked. For diarrhea with rectal heaviness, divide into two warm doses.
Song says: Zhishi, Gancao, Chaihu, Shaoyao in equal numbers. Heat Ji Ni can be reversed by investigating the cause. Mix evenly with Baiyin, one cun bi. Using this is divine for connecting Yin and Yang smoothly.
Modification Song says: For cough, add Wuweizi and Ganjiang. Equal 5 fen is the correct path. For diarrhea diseases, modify according to this. Acrid-warm and sour-astringent should attend to each other.
Methodology: For abdominal pain. Use 3 sheng of water. Remove Xiebai (Macrostemon Bulb, *Allii Macrostemis Bulbus*) and add the powder in quantities of one cun bi. Boil again until 1.5 sheng remains. Dividing into two warm doses illustrates the method.
Zhanglingshao said: All cases of Shaoyin disease with Ji Ni belong to deficiency-cold of Yang Qi. However, there are also cases where Yang Qi is internally constrained and cannot reach the exterior, causing Ji Ni. In such cases, Sini San (Four Reversal Powder) is indicated. Zhishi is round and fragrant, a suitable item for the Stomach. Thus, it can disseminate and unblock the Stomach collaterals. Shaoyao drains and disperses blood vessels in the collaterals. Gancao regulates the Middle Jiao. Chaihu initiates and guides Yang Qi outward. When Yang Qi flows freely, the four limbs become warm. For cough, it is Lung cold with rebellious Qi. Use Wuweizi and Ganjiang to warm and astringe Lung Qi. To treat diarrhea simultaneously, use warm herbs to scatter cold and sour herbs to astringe. For palpitations, it is Heart Qi deficiency. Add Guizhi to protect Heart Qi. For difficulty urinating, it is obstruction of the Water pathways. Add Fuling to promote water metabolism. For abdominal pain, it is interior cold. Add Fuzi to warm and dispel cold. For diarrhea with rectal heaviness, it is Yang Qi constrained in the lower jiao. Use Xiebai to unblock Yang Qi.