2e. 六经辩证-少阴病

2e. Six Jing diagnosis –Shaoyin stage

少阴之为病，脉微细，但欲寐, 自利而渴者也。

If a patient’s pulse is tiny-thin and he/she desires to lie down, has diarrhea and thirsty, we will say that his/her condition belongs to Shaoyin stage of the Shanghan disease. The whole body, from physical, emotional to spiritual part, shows as the person is in deep winter: cold and quiet.

诊断少阴病最主要的依据是脉细微，但欲寐，可以有自利也可以没有自利，如果有，则为伴口渴的自利。在此基础上，病人可以有不同的其它的突出症状，或发热，或恶寒，或身痛关节痛手足寒，或脉搏极沉，或下利，或欲吐不吐，或食谷即吐，或腹痛，小便不利，四肢沉重疼痛，自下利，或吐利，手足逆冷，烦躁欲死，或下利六、七日，咳而呕渴，心烦不得眠；或咽痛，或口燥咽干，腹胀不大便。

The key words to diagnose Shaoyin stage is the thin-tiny pulse and desire to lie down. The patient has or has no diarrhea. If there is diarrhea, there will also have thirsty. Under such condition, the patient can have other symptoms, such as fever; or chilly; or pain in the body, in the joints, or have cold hands and feet; or has deep pulse; or has diarrhea; or has nausea but no vomit; or vomit whenever eat; or pain in stomach, difficulty in urination, pain and heavy feeling in the arms and legs, diarrhea; or vomit, irritated feeling to die; or diarrhea for six to seven days, cough and nausea and thirsty, irritated and hard to fall into sleep; or sour throat, or dry mouth and throat, stomach bloating and no bowel movement…  

仲景先生举出了这些例子，也对每一种少阴病夹症的治疗给出了方案。临床上，少阴病的兼症绝不会只是这里列举的症型，所以，我们必须时刻记住，对于神情淡漠的病人，默默无语的病人，白天安静而晚上难受的病人，注意是否为少阴病。如果脉细微，诊断就可以确定。另外在诊断太阳病，阳明病，太阴病，和厥阴病时，注意区别少阴病。伤寒论在论述少阴病时，其死证最多。也就是说少阴病是最凶险的阶段。如果在太阳，阳明，少阳阶段治疗有误，基本上是导致变症出现，尚不至于危及生命（见这些阶段误治部分 – 后叙），但如果少阴病误治，当用温阳却用了寒冷，无疑將是落井下石，病情会急剧恶化，有导致死亡的可能。

Master Zhongjing Zhang gave us those examples. He also introduced the herbal formulae for the treatment of those accompanying conditions. In clinic, the accompanying syndromes of the Shaoyin stage are not only these examples. Therefore, we must always remember if the patient is in Shaoyin stage, whenever we see a patient, who looks silent, quiet, feels worse more at night but better during the day time. If the pulse feels tiny and thin, the diagnosis can be set and confirmed. In addition, whenever we diagnose Taiyang, Yangming, Shaoyao, Taiyin and Jueyin stage of the Shanghan disease, the Taiyin stage must be always distinguished. In the introduction of Taiyin stage in the book Shanghan Lun, there are many conditions that may lead to a death, e.g. the Shaoyin stage is a very dangerous stage in the Shanghan disease. If there is a improper treatment in the Taiyang, Yangming and Shaoyang stage, the outcome may not lead to a death, but if the treatment is improper or wrong in the Shaoyin stage, the patient might die. For example, the main principle in the treatment of Shaoyin stage is the use of warming herbs or herbal formulae, if a cooling herb or herbal formula is applied, the body condition could turn worse very soon and the patient might die.   

(1). 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。

(1).  Patient in the Shaoyin stage for two to three days, and there is no any other symptoms inside the body, e.g. the patient only feels desire to lie down silently and has thin and weak pulse, use Mahuang Fuzi Gancao Tang for the treatment (to create little sweat).

(2). 少阴病，脉沉者，急温之，宜四逆汤。

(2). If the patient is in the Shaoyin stage and the pulse is deep, use Si Ni Tang for the treatment urgently.  

(3). 少阴病，始得之，反发热，脉沉者，麻黄附子细辛汤主之。

(3). If the patient is in the Shaoyin stage not for a long time and has fever (typically there should have no fever in Shaoyin stage) and the pulse is deep, use Mahuang Fuzi Xixin Tang for the treatment.

(4). 少阴病，得之一、二日，口中和，其背恶寒者，当灸之，附子汤主之。

(4). If patient is in Shaoyin stage for one or two days, no special taste in mouth, but feels chilly on back, moxibustion therapy, or Fuzi Tang, should be used for the treatment.

(5). 少阴病，身体痛，手足寒，骨节痛，脉沉者，附子汤主之。

(5). If patient is in the Shaoyin stage, feels pain in the body and joints, feels cold in hands and feet, and has deep pulse, use Fuzi Tang for the treatment.

(6). 少阴病，下利，白通汤主之。利不止，厥逆无脉，干呕烦者，白通加猪胆汁汤主之。服汤脉暴出者死，微续者生。

(6). If patient in Shaoyin stage has diarrhea, use Bai Tong Tang for the treatment. If the diarrhea continues, and the hands and feet feel reversely cold, the pulse is hardly to feel, the patient has nausea (no vomit) and feels annoyed, use the Bai Tong Tang plus pig gall bladder juice for the treatment.

(7). 少阴病，欲吐不吐，心烦，但欲寐，五、六日，自利而渴者，属少阴也。 若小便色白者，少阴病形悉具。

(7). Shaoyin stage, the patient has desire to vomit but do no vomit, feels annoyed and has desire to lie down. After five or six days, the patient has diarrhea and thirsty. It indicates that the condition is in the Shaoyin stage. If the urine is pure as water, it further more confirms the diagnosis.

(8). 少阴病，饮食入口则吐，心中温温欲吐，复不能吐，始得之，手足寒，脉弦迟者，此胸中实，不可下也，当吐之，若膈上有寒饮，干呕者，不可吐也，当温之，宜四逆汤。

(8). Shaoyin stage, the patient has vomits whenever he/she eats. When does not eat, the patient still has tend to vomit, but nothing can be vomited out. The situation in which the Shaoyin stage lasts no long time yet, the patient feels cold in hands and feet, and the pulse feels string and slow, suggests that the patient has overwhelming (no weak) condition in the chest. Colon-cleansing therapy should not be used, but vomiting therapy (Gua Di San) should. If the condition belongs to cold-water in above the diaphragm, the vomiting therapy should not be used, but the Si Ni Tang should.

(9). 少阴病，二、三日不已，至四、五日，腹痛，小便不利，四肢沉重疼痛，自下利者，此为有水气。其人或咳，或小便不利，或下利，或呕者，真武汤主之。

(9). The Shaoyin stage lasts for two to three days without getting better. Upon the fourth or fifty day, the patient feels pain in belly, difficulty in urination, pain and heaviness in arms and legs, and has diarrhea. This condition suggests that there is Water-Qi in the body. The person may have cough, or hard in urination, or diarrhea, or nausea. In either case, use Zhen Wu Tang for the treatment.

(10). 少阴病，吐利，手足逆冷，烦躁欲死者，吴茱萸汤主之。

(10). The Shaoyin stage, the patient has vomit and diarrhea, feels reversely cold in hands and feet, and feels extremely annoyed as to die, use Wuzhuyu Tang for the treatment.

(11). 少阴病，下利清谷， 里寒外热，手足厥逆，脉微欲绝，身反不恶寒，其人面色赤，或腹痛，或干呕，或咽痛，或利止脉不出者，通脉四逆汤主之。

(11). The Shaoyin stage, the patient has diarrhea with non-digestive food in the stool, has cold inside the body but hotness outside, has reversely cold feeling in the hands and feet, has very weak pulse as it is hardly to feel. The patient however has no cold-dislike feeling, has red color on face. The patient may have pain in belly, or nausea, or pain in throat, or there is pulse after stop of the diarrhea. In this case, use Tong Mai Si Ni Tang for the treatment.

(12). 少阴病，下利六、七日，咳而呕渴，心烦不得眠者，猪苓汤主之。

(12). The Shaoyin stage, the patient has diarrhea for six to seven days, has cough, nausea and thirsty, has annoyed feeling and feels hard to fall into sleep. In this case, use Zhuling Tang for the treatment.

(13). 少阴病，得之二、三日以上，心中烦，不得卧，黄连阿胶汤主之。

(13). The Shaoyin stage lasts for two to three days more. The patient feels annoyed in heart, and has difficult to sleep. In this case, use Huanglian Ajiao Tang for the treatment.

(14). 少阴病二三日，至四五日腹痛小便不利，八、九日，一身手足尽热者，以热在膀胱，必便血. 下利不止便脓血者，桃花汤主之。

(14). The Shaoyin stage lasts for two to three days. Upon the fourth or fifty day, the patient has pain in belly and has difficulty in urination. Upon the eighth or ninth day, the patient feels hot in whole body including hands and feet. This is a hotness in urine bladder syndrome. The patient will have bleeding in stool. If the diarrhea continues and there is pus and blood in stool, use Taohua Tang for the treatment (Taohua here means peach flower).

(15). 少阴病，下利咽痛，胸满心烦，猪肤汤主之。

(15). If patient in the Shaoyin stage has diarrhea, pain in throat, fullness in chest and annoyed in heart, use Zhufu Tang for the treatment.

(16). 少阴病二、三日，咽痛者，可与甘草汤，不差，与桔梗汤。

(16). If the Shaoyin stage lasted for two to three days, and the patient has pain in throat, try Gancao Tang for the treatment. If it does not work, try Jigen Tang,or Banxia San or Banxia Tang. (San here means powder form of herbs). 

(17). 少阴病，咽中伤，生疮，不能语言，声不出者，苦酒汤主之。

(17). If the patient is in the Shaoyin stage, has hurt and ulcer in throat, has difficult to speech and has no voice, use Kujiu Tang for the treatment.

(18). 少阴病得之二三日，口燥咽干者，急下之，宜大承气汤。

(18). The Shaoyin stage lasts for two to three days, and the patient feels dry in mouth and throat, it is a urgent condition. Use Da Chenqi Tang to save the life (to save the Kidney Water by reducing Heart Fire).

(19). 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。

(19). In the Shaoyin stage, the patient has water-like bowel movement. The patient will also have pain in upper stomach area and have dry in mouth. This is also an urgent condition. Use Da Chenqi Tang for the treatment. 

(20). 少阴病六七日，腹胀不大便者, 急下之，宜大承气汤。

(20). The Shaoyin stage lasts for six to seven days, the patient has fullness and bloating in belly, and has no any bowel movement. This is urgent condition. Use Da Chenqi Tang for the treatment.

注意事项和解释：

Notice and explanation:

1. 少阴病整体表现为新陈代谢水平低下，病人精神萎靡，无精打采，生活兴趣低下，嗜睡，疲乏无力，所以相应的脉细而微。

1. The Shaoyin stage expresses as overall low level of metabolism. The patient feels less ambition to action, no strong interest in life, feels drowsiness, tired. The pulse so feels thin and tiny.

如果不伴有吐，利，不大便，口燥咽干，咽痛等，单用麻黄附子甘草汤，或麻黄附子细辛汤效果就很好。恶寒身痛者，用附子汤；下利者，白通汤；呕吐烦躁者，吴茱萸汤；有水饮潴留者，真武汤；下利而不眠者，猪苓汤；不下利而心烦不眠者，黄连阿胶汤；里寒（下利）外热（面赤）有厥，用通脉四逆汤；咽痛者，轻则甘草汤，桔梗汤，重则苦酒汤；口燥咽干者，或腹胀不大便者，急用大承气汤。

If the patient has no vomit, no diarrhea, no constipation, no dry mouth or throat, and no sour throat, the herbal formula Mahuang Fuzi Gancao Tang alone, or Mahuang Fuzi Xixin Tang will work well. If there is chilly and pain in the body, use Fuzi Tang. If there is diarrhea, use Bai Tong Tang. If there is vomit and annoyed feeling, use Wuzhuyu Tang. If there is water retention syndrome, use Zheng Wu Tang. If the diarrhea is with poor sleep, use Zhu Ling Tang. If there is no diarrhea, but still hard to fall into sleep, use Huanglian Ajiao Tang. If there is inside cold (as diarrhea), but outside hot (as red face), and also cold hands and feet, use Tong Mai Si Ni Tang. If there is sour throat, use either Gancao Tang , or Jiegen Tang. For severe sour throat, use Ku Jiu Tang. If there is dryness in the mouth and throat, or bloating belly without bowel movement, use Da Cheng Qi Tang.  

2. 心烦者，需要和少阳病鉴别。少阳病者脉不细不微，精神不萎靡，不嗜睡。这里的脉细微需要和脉沉紧相区别。脉沉紧者，把脉处皮肤多绷紧。少阴病脉细弱者，把脉处皮肤多软弱松弛。脉沉紧者多见于长期情感不畅的病人，多属于少阳病。少阴病有心烦者多伴有躁症，而少阳病者烦而少有躁症。躁症者，手脚乱动，躁动不安。少阳病者易有牙关紧张症或颈项强紧感。

2. The annoyed feeling needs to be distinguish with Shaoyang stage. In the Shaoyang stage, the patient’s pulse is not thin, not tiny. The person does not look tired or tend to have nap. Here the thin-tiny pulse should be distinguished with deep-tight pulse. For the deep-tight pulse, the wrist where we feel the pulse feels also tight. For the thin-tiny pulse, that place usually does not feel tight. The deep-tight pulse can be seen usually in those of persons who have long term of stress and anxiety. It in most case belongs to Shaoyang stage (Shaoyang disease). For patient in Shaoyin stage tends to have restless arms or legs (Huanglian Ajiao Tang condition), or shacking of arms or hands or legs (Zheng Wu Tang condition). Patient in the Shaoyang stage tends to have spasm (TMJ syndrome or tight on neck).  

3. 下利：太阴病下利，下利不渴，手足温，脉不细微；少阴病下利，下利而渴，脉细微，精神萎靡。阳明中寒下利，下利而小便不利，病情因进食则加剧。

3. Diarrhea. Diarrhea in Taiyin stage is without thirsty in mouth and the hands and feet are warm. Diarrhea in Shaoyin stage is with thirsty and the pulse is thin and tiny. Diarrhea in Cold-attack Yangming stage is with difficulty in urination. The symptoms could become worse with eating.

4. 咽痛：少阳病和少阴病都有咽干，但少阳病者脉不细微，精神不萎靡。阳明中风者也有咽痛，但如不咳嗽就无咽痛。而少阴病的咽痛为持续性，咳嗽与不咳嗽都痛。温病者也会出现咽干和咽痛，但脉浮数有力。

4. Sour throat or dryness in throat. There is dry throat in both Shaoyang and Shaoyin stages. In the Shaoyang stage with dry throat, the throat feels more as tightness or as a foreign mass in the throat. In Wind-attack Yangming stage, there could be dryness and sour in throat, which are worse with cough. If there is no cough, there would have no sour in the throat. The sour throat in Shaoyin stage is continuous, regardless of cough or not. In Wen disease, there would also be dry and sour in throat, but the pulse is floating-frequent too. The person with the Wen disease dislikes hot, but likes cold.

5. 这里列举的通脉四逆汤证当属于厥阴病。因为厥阴病的主要特点具备：厥，寒热错杂（里寒外热）。

5. The Tong Mai Si Ni Tang introduced here should belong to Jueyin stage (see later chapter), since the characteristics of the Jueyin stage is the cold hands and feet, and the mixture of the Cold and Fire syndrome (inside cold and outside hot). The Tong Mai Si Ni Tang is used for the treatment of such condition.

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