乌梅（三百个） 细辛（六两） 干姜（十两） 黄连（一斤） 当归（四两） 附子（六两炮） 蜀椒（四
两去汗） 桂枝（六两） 人参（六两） 黄柏（六两）
上十味。异捣筛合治之。以苦酒渍乌梅一宿。去核。 之五升米下。饭熟。捣成泥。和药。令相得内臼中。与
蜜杵二千下。丸如梧桐子大。先食。饮服十丸。日三服。稍加至二十丸。禁生冷滑物臭食等。
成注云肺主气肺欲收急食酸以收之乌梅之酸以收肺气脾欲缓急食甘以缓之人参之甘以缓脾气寒淫于内以辛润
之以苦坚之当归桂椒细辛之辛以润内寒寒淫所胜予以辛热姜附之辛热以胜寒蛔得甘则动得苦则安黄连黄柏之苦以
安蛔。
琥按上成注。殊非紧要语。删之可也。
内台方议云。蛔厥者。乃多死也。其人阳气虚微。正元衰败。则饮食之物不化精气。反化而为蛔虫也。蛔为阴
虫。故知阳微而阴胜。阴胜则四肢多厥也。若病者时烦时静。得食而呕。或口常吐苦水。时又吐蛔者。乃蛔证也。
又腹痛脉反浮大者。亦蛔证也。有此当急治。不治杀人。故用乌梅为君。其味酸能胜蛔。以川椒细辛为臣。辛以杀
虫。以干姜桂枝附子为佐。以胜寒而温其中。以黄连黄柏之苦以安蛔。以人参当归之甘而补缓其中为使。且此蛔虫
为患。难比寸白等虫。剧用下杀之剂。故用胜制之方也。
琥按上议于理极是。但其云腹痛脉浮大者。此系胃中热而吐蛔。戴元礼曾记一人。阳毒发黄口疮咽痛吐蛔。皆
以冷剂取效。此等证。不宜溷入中寒吐蛔之中。
武陵陈氏云。乌梅丸专治蛔厥。方名乌梅。是合方中之药。而皆以乌梅统之矣。曷故哉。寒气从一阴直上而冲
心胃。蛔有不得不上膈。不得不吐之势。非用酸温之药。则逆气不可得而敛。逆气不敛。则蛔不可得而伏也。气逆
由于脏寒。必群队之辛热以胜之。附子蜀椒干姜桂枝细辛皆辛热。而其用不同。附子退阴回阳。蜀椒杀虫益火。干
姜不炮。取其热胜寒。而辛散逆也。细辛取其泄阴经之寒邪。使不由经而入脏。木得桂而枯。故用桂枝。然何不竟
用肉桂。盖厥阴风木。其病发惊骇。其性从九原之下上升。其状急暴。皆风象也。桂枝能治诸风。脏寒。则元气极
微。方中自当用人参以补配温。而又用当归者。当归入厥阴。养肝血。辛温能散内寒。乃引经之药也。连柏苦以伏
蛔。用为从治。备温补反佐之法。而统之以酸敛之乌梅。所谓节制之师也。
病者手足厥冷。言我不结胸。小腹满。按之痛者。此冷结在膀胱关元也。（此条乃厥阴中寒。冷结少腹之证。
厥阴之脉抵少腹。病者手足厥冷。乃阴寒之邪。直中于里也。不结胸者。非阳热也。小腹满。按之痛者。成注云。
下焦冷结也。膀胱关元。正当小腹之部分。○按此条论。仲景无治法。补亡论庞安时云宜灸关元穴。据图经云。关
元一穴。系腹部中行。在脐下三寸。足三阴任脉之会治脐下 痛。灸之良。可百壮。愚以灸关元而膀胱之冷结自解
矣。）
\r关元穴图\pt158a5.bmp\r
伤寒厥四日。热反三日。复厥五日。其病为进。寒多热少。阳气退。故为进也。（此条乃厥阴中寒。阳气欲复。
不胜阴邪之证。寒中厥阴。为阴之极。阴极。则阳当复。今者真阳之气。不能胜阴寒之邪。是以先厥后热。热后复
厥。厥之日多。其病为进。武陵陈氏云。邪与正不两立。邪为寒。正为热。邪为阴。正为阳。阳胜则热。阴胜则寒。
寒多热少。非阳气退而何。阳气退而阴邪进去死不远。可不畏哉。○按此条论。仲景无治法。补亡论常器之云。可
四逆汤。待其热退寒进。厥不复热者。始可用之。）
伤寒六七日。脉微。手足厥冷。烦躁。灸厥阴。厥不还者死。（此条乃寒厥之死证。寒中厥阴。所忌者厥。所
喜者热。伤寒脉微。手足厥冷。至四五日。阳回当热。今者六七日而阳不回。反加烦躁。成注云。阳虚而争。乃脏
中之真阳欲脱。而神气为之浮越。故作烦躁是皆为厥冷之兼证也。此时药力不足恃。宜急灸厥阴以回其阳。如灸之
而终厥。阳气不还者死。○此条论。仲景不言当灸何穴。补亡论常器之云。可灸太冲穴。以太冲二穴。为足厥阴脉
之所注。凡病诊太冲脉。可诀男子死生。穴在足大趾下。后二寸。或一寸半陷中。可灸三壮。武陵陈氏云。灸厥阴
如关元气海之类。关元穴已见前。气海一穴。在脐下一寸五分。治脐下冷气上冲。夫气海者。是男子生气之海也。
治脏气虚惫。真气不足。一切气疾久不瘥。悉皆灸之。）
\r太冲气海穴图\pt158a6.bmp\r
伤寒六七日。不利。便发热而利。其人汗出不止者死。有阴无阳故也。（此亦厥阴中寒之死证也。愚以伤寒六
七日下。当有脱简。寒中厥阴。至六七日。当亦厥六七日矣。不言厥者。阙文也。厥则当利。其不利者。武陵陈氏
云。阳气未败。犹能与邪相枝梧也。若至发热。即利者。亦当止。今则发热与利。特然并至。加之汗出不止。则知
其热非阳回而热。乃阳脱而热。故兼下利而汗出不止也。阴寒之邪中于里。为有阴。真阳之气脱于外。为无阳。有
阴无阳。焉得不死。）
伤寒脉促。手足厥逆者。可灸之。（此条乃厥阴中寒。阴极脉促。宜灸之证。促脉者。脉来数时。一止复来是
也。本阳极之脉。殊不知阴寒之极。迫其阳气欲脱。脉亦见促。况外证。又手足厥逆。此时即用汤药。恐亦无济。
可急灸之。以助阳气。○按此条论。仲景不言当灸何穴补亡论常器之云。灸太冲穴。穴注已见前。○或问阴寒之极。
脉当迟代。何以反数而促。余答云。王海藏武陵陈氏曰。四逆之名多矣。此当归四逆汤。固不如四逆汤。及通脉之
热。亦不若四逆散之凉。盖四逆之故不同。有因寒而逆。有因热而逆。此则因风寒中于血脉而逆。当归四逆所由立
也。风寒中于血脉。则已入营气之中。阴阳虽欲相顺接而不可得。邪涩于经。营气不流。非通其血脉不可。当归辛
温。血中气药。能散内寒而和血。故以为君。然欲通血脉。必先散血中之邪。桂枝散厥阴血分之风者也。细辛泄厥
阴血分之寒者也。故以二物为辅。芍药大枣甘草。调和营卫者也。未有营不与卫和而脉能通者。桂枝汤治卫不与营
和谐。此方治营不与卫和谐。而大枣之用。多于桂枝汤一倍有奇以大枣能助经脉和阴阳而调营卫也。且邪并肝经。
木盛则侮土。甘草大枣之用。倘兼有浓脾土而御侮之意邪。通草者。本经称其通利九窍血脉关节。盖邪气阻塞于血
分。吾以通草之入血分而破阻塞者治之。即众药亦藉通草之力而无不通矣。制方之神奇有如是哉。）
若其人内有久寒者。宜当归四逆。加吴茱萸生姜汤主之。（此承上条而言。若其人内有久寒者。以其人平日间
脏腑之内有寒积也。即用前汤。加吴茱萸之辛热以散积寒。生姜之辛温以行阳气。）
当归四逆加吴茱萸生姜汤方（此方自仲景论中第十卷集入于此）
于前汤方内加吴茱萸二升生姜半斤
上九味。以水六升。清酒六升。和煮取五升。去滓。温分五服。（一方。水酒各四升。）
琥按上汤内加清酒和煮者。酒之性大热。味甘而辛。海藏云其能引诸经。不止与附子相同。其力能润肝燥。通
血脉。散寒邪。病患内有久寒者。汤中大宜用之。
或问内有久寒。何以不用四逆汤。余答云。上条证本系血虚。厥阴经中风寒。在少阴并无兼证有云。阴毒沉困
之候。六脉附骨。取之方有。按之即无。一息八至以上。或不可数。非促而何。愚以真阳之气本动。为寒所迫。则
数而促。此理势之必然。人但知阴证之脉。微迟或绝不至。此其常。今特言脉促者。此其变。合常与变而能通之。
始可以言医矣。
手足厥寒。脉细欲绝者。当归四逆汤主之。（此条乃寒中厥阴血分之证。手足厥寒。与厥逆厥冷略异。逆冷者。
寒深入脏。故手足不顺利而如冰。斯为厥逆厥冷。厥寒者。手足厥而自觉畏寒之甚。乃寒中于经。成注所云。阳气
外虚。不温四末是也。脉细欲绝者。寒伤营。成注所云阴血内弱。脉行不利也。与当归四逆汤。助阳生阴也。）
乌梅（三百个） 细辛（六两） 干姜（十两） 黄连（一斤） 当归（四两） 附子（炮制过的，六两） 蜀椒（去汗的，四两） 桂枝（六两） 人参（六两） 黄柏（六两）
以上十味药。分别捣碎后过筛混合均匀。用醋浸泡乌梅一整夜。去掉核。拌入五升米中一起煮。饭煮熟后，捣成泥状。将药粉与饭泥混合，使其融合后放入臼中。加入蜂蜜杵捣两千下。制成如梧桐子大小的丸剂。饭前服用，每次十丸，每日三次。逐渐增加至每次二十丸。禁止食用生冷、滑腻、变质等食物。
成无己注解说：肺主气，肺气欲收敛，故急食酸味以收敛之，乌梅的酸味能收敛肺气；脾欲缓和，故急食甘味以缓急，人参的甘味能缓和脾气。寒邪淫溢于内，需用辛味滋润、苦味坚阴。当归、桂枝、蜀椒、细辛的辛味能滋润内寒；对于寒邪偏胜的情况，给予辛热药物，干姜、附子的辛热能战胜寒邪。蛔虫遇到甘味则躁动，遇到苦味则安静，黄连、黄柏的苦味能安定蛔虫。
琥按：上述成无己的注解，并非紧要关键之语，可以删去。
《内台方议》说：蛔厥证，往往是死证。患者阳气虚弱微细，正气元气衰败，导致饮食之物不能化为精气，反而化为蛔虫。蛔虫属阴虫，所以知道是阳微而阴盛。阴盛则四肢多出现厥冷。如果病人时而烦躁时而安静，进食后呕吐，或者口中常吐苦水，有时又吐出蛔虫，这是蛔虫病。又有腹痛且脉象反见浮大的，也是蛔虫病。有此症状应当紧急治疗，不治疗会致死。所以用乌梅作为君药，其味酸能克制蛔虫；以川椒、细辛为臣药，辛味能杀虫；以干姜、桂枝、附子为佐药，以战胜寒邪并温补中焦；以黄连、黄柏的苦味来安定蛔虫；以人参、当归的甘味来补益和缓和中焦，作为使药。况且这种蛔虫为患，难以比得上寸白虫等寄生虫那样剧烈，不宜使用猛烈的攻下杀虫药剂，所以使用以克制为主的方剂。
琥按：上述议论在理论上非常正确。但其说“腹痛脉浮大者”，这属于胃中有热而吐蛔。戴元礼曾记载一人，患阳毒发黄、口疮、咽痛并吐蛔，都用冷剂取得疗效。这类证候，不应混杂在中寒吐蛔的论述中。
武陵陈氏说：乌梅丸专门治疗蛔厥。方名乌梅，是因为方中的药物都以乌梅统领。为什么呢？寒气从一阴经直上冲犯心胃，蛔虫有不得不向上膈部、不得不呕吐的趋势。不用酸温的药物，逆气就无法收敛；逆气不收敛，蛔虫就无法伏藏。气逆是由于脏寒引起的，必须用大队辛热药物来战胜它。附子、蜀椒、干姜、桂枝、细辛都是辛热药，但用法不同。附子退阴回阳；蜀椒杀虫并补益命门之火；干姜不炮制，取其热性胜过寒邪，且辛散逆气；细辛取其宣泄阴经的寒邪，使寒邪不由经脉而入脏腑。树木遇到桂枝就会枯萎（此处借喻桂枝通阳散寒之力），所以用桂枝。然而为什么不直接用肉桂呢？因为厥阴风木发病时惊骇，其性质从九原之下上升，其状急暴，都是风象。桂枝能治各种风病。脏寒则元气极微弱，方中自然应当用人参来补益配合温补；而又用当归的原因，是因为当归入厥阴经，滋养肝血，其辛温之性能散内寒，是引经报使之药。连翘、黄柏之苦能伏住蛔虫，用作从治之法，备齐温补反佐的方法，并用酸敛的乌梅统领全方，这就是所谓有节制的军队。
病人手足厥冷，说我不结胸，小腹胀满，按压疼痛的，这是冷结在膀胱关元部位。（这一条是厥阴中寒，冷结少腹的证候。厥阴经脉抵少腹，病人手足厥冷，是阴寒之邪直中于里。不结胸，说明不是阳热证。小腹胀满，按压疼痛，成无己注解说：这是下焦冷结。膀胱、关元正当小腹的部位。○按此条论述，张仲景没有给出治疗方法，《补亡论》庞安时说适宜灸关元穴。据《图经》记载，关元一穴，位于腹部正中线上，脐下三寸，是足三阴经与任脉的交会穴，主治脐下疼痛，灸之效果好，可灸一百壮。我认为灸关元穴，膀胱的冷结自然解除。）
关元穴图
伤寒病四肢厥冷四天，发热反而三天，再次厥冷五天，病情加重。寒多热少，阳气衰退，所以病情进展。（这一条是厥阴中寒，阳气想要恢复但不能胜过阴邪的证候。寒邪中于厥阴，是阴之极。阴极，则阳气应当恢复。现在真阳之气，不能胜过阴寒之邪，所以先厥冷后发热，发热后又复厥冷。厥冷的日子多，病情就加重。武陵陈氏说：邪气与正气不能共存，邪气为寒，正气为热；邪气为阴，正气为阳。阳胜则热，阴胜则寒。寒多热少，难道不是阳气衰退吗？阳气衰退而阴邪不去，离死就不远了，能不害怕吗？○按此条论述，张仲景没有给出治疗方法，《补亡论》常器之说：可用四逆汤。等到热退寒进，厥冷不再转热的情况下，才开始可以使用。）
伤寒六七天，脉微细，手足厥冷，烦躁，灸厥阴经穴位。如果厥冷不回还的，死亡。（这一条是寒厥的死证。寒邪中于厥阴，所忌讳的是厥冷，所希望的是发热。伤寒脉微，手足厥冷，到了四五日，阳气回复应当发热。现在六七天了阳气还不回复，反而加上烦躁。成无己注解说：阳虚而抗争，是脏中的真阳将要脱失，神气为之浮越，所以发生烦躁。这些都是厥冷的兼见证。此时药力不足以依靠，应当紧急灸厥阴经以回复阳气。如果灸后仍然厥冷，阳气不回复的，死亡。○此条论述，张仲景没说应当灸哪个穴位，《补亡论》常器之说：可灸太冲穴。因为太冲二穴，是足厥阴脉的气所注之处。凡是诊察太冲脉，可以决断男子的生死。穴位在足大趾下方，向后二寸或一寸半的凹陷处，可灸三壮。武陵陈氏说：灸厥阴经如关元、气海等穴位。关元穴已见前面。气海一穴，在脐下一寸五分，主治脐下冷气上冲。夫气海，是男子生气的海洋。治疗脏气虚惫，真气不足，一切气疾久不痊愈，都应当灸之。）
伤寒六七天，没有下利，突然发热并且下利，病人汗出不止的，死亡。这是因为有阴无阳的缘故。（这也是厥阴中寒的死证。我认为伤寒六七天以下，可能有脱简。寒中厥阴，到了六七天，应当也是厥冷六七天了。不说厥冷，是缺文。厥冷则应当下利。那不下利的，武陵陈氏说：阳气未败，还能与邪气相抗衡。如果到了发热，下利应当停止。现在却是发热与下利同时出现，再加上汗出不止，就知道这热不是阳气回复的热，而是阳气脱失的热。所以兼见下利和汗出不止。阴寒之邪中于里，是有阴；真阳之气脱于外，是无阳。有阴无阳，怎么能不死？）
伤寒脉促，手足厥逆的，可以灸之。（这一条是厥阴中寒，阴极脉促，适宜灸治的证候。促脉，是脉搏来数，偶尔停一下又来的脉象。这本是阳极的脉象，殊不知阴寒之极，逼迫阳气欲脱，脉象也见促。何况外证又是手足厥逆。此时即使使用汤药，恐怕也无济于事，可紧急灸之，以助阳气。○按此条论述，张仲景没说应当灸哪个穴位，《补亡论》常器之说：灸太冲穴。穴位注释已见前面。○有人问：阴寒之极，脉应当迟或代，为什么反而数而促？我回答说：王海藏、武陵陈氏说：四逆的名称很多了。这个当归四逆汤，固然不如四逆汤的热力，以及通脉的热力，也不若四逆散的凉。盖因四逆的原因不同，有因寒而逆，有因热而逆。此则是因风寒中于血脉而逆，当归四逆汤由此而立。风寒中于血脉，则已进入营气之中，阴阳虽然想顺接却不可得，邪气阻滞于经络，营气不流通，不通其血脉不行。当归辛温，是血中之气药，能散内寒而调和血液，所以作为君药。然而想要通血脉，必须先散血中之邪。桂枝散厥阴血分的风邪；细辛泄厥阴血分的寒邪。所以以这两味为辅。芍药、大枣、甘草，调和营卫。没有营不与卫和谐而脉能通的。桂枝汤治卫不与营和谐，此方治营不与卫和谐。而大枣的使用量多于桂枝汤一倍有余，因为大枣能助经脉和阴阳而调营卫。况且邪气并入肝经，木盛则侮土，甘草、大枣的使用，或许兼有厚脾土而抵御侮逆的意思吧。通草，本经称其通利九窍血脉关节。盖邪气阻塞于血分，我用通草入血分而破阻塞的方法来治疗它，即众药也借助通草的力量而无不通了。制方的神奇竟到如此程度啊。）
如果其人内有久寒的，适宜用当归四逆加吴茱萸生姜汤主治。（这一条承接上一条而言，如果其人内有久寒的，是因为此人平日脏腑之内有寒积。就用前面的汤方，加吴茱萸的辛热以散积寒，生姜的辛温以行阳气。）
当归四逆加吴茱萸生姜汤方（此方自张仲景论著第十卷收录于此）
以上九味药，用水六升，清酒六升，混合煮取五升，去渣滓。温服，分五次服用。（一方：水酒各四升。）
琥按：上述汤剂中加入清酒同煮的原因，酒的性质大热，味甘而辛。海藏说它能引导诸经，不止与附子相同。其力量能润肝燥，通血脉，散寒邪。病患内有久寒的，汤剂中非常适宜使用它。
有人问：内有久寒，为什么不用四逆汤？我回答说：上一条证候本来属于血虚，厥阴经受中风寒，在少阴并无兼证。有人说：阴毒沉困的证候，六脉重按至骨才有，轻按即无，一息八次以上，或者无法计数，这不是促脉吗？我认为真阳之气本是动的，被寒邪逼迫，则数而促。这是理势的必然。人们只知道阴证的脉象，微迟或绝不至，这是常态。现在特别说脉促的，这是变局。结合常与变而能通晓之，才可以谈论医学了。
手足厥寒，脉细欲绝的，用当归四逆汤主治。（这一条是寒中厥阴血分的证候。手足厥寒，与厥逆、厥冷略有不同。厥逆、厥冷，是寒深入脏腑，所以手足不顺利而像冰一样，这才是厥逆、厥冷。厥寒，是手足厥冷且自觉畏寒很甚，这是寒中于经脉。成无己注解说：阳气外虚，不能温煦四肢末端。脉细欲绝，是寒伤营血。成无己注解说：阴血内弱，脉道运行不利。给予当归四逆汤，助阳生阴。）
Wumei (300 fruits), Xixin (6 liang), Ganjiang (10 liang), Huanglian (1 jin), Danggui (4 liang), Fuzi (processed, 6 liang), Shujiao (de-sweated, 4 liang), Guizhi (6 liang), Renshen (6 liang), Huangbai (6 liang).
The above ten ingredients. Crush each separately, sift, and mix. Soak Wumei in vinegar overnight. Remove the pits. Mix with five sheng of rice and cook. Once the rice is cooked, pound it into a paste. Mix the medicinal powder with the rice paste until well combined, then place in a mortar. Add honey and pound two thousand times. Form pills the size of paulownia seeds. Take before meals, ten pills per dose with warm water, three times daily. Gradually increase to twenty pills per dose. Avoid raw, cold, slippery, and spoiled foods.
Cheng Wuji's commentary states: The Lung governs Qi. Lung Qi desires to consolidate, so sour flavors are urgently used to consolidate it; the sourness of Wumei consolidates Lung Qi. The Spleen desires relaxation, so sweet flavors are urgently used to relax tension; the sweetness of Renshen relaxes Spleen Qi. When Cold pathogen overflows internally, acrid flavors are used to moisten, and bitter flavors to firm. The acridity of Danggui, Guizhi, Shujiao, and Xixin moistens internal Cold. For excessive Cold pathogen, acrid-hot substances are given; the acrid-hot nature of Ganjiang and Fuzi defeats Cold. Roundworms move when encountering sweet flavors and settle when encountering bitter flavors; the bitterness of Huanglian and Huangbai settles the roundworms.
Hu notes: Cheng Wuji's commentary above is not crucial and may be deleted.
*Neitai Fangyi* states: Huijue (roundworm syncope) is often fatal. The patient's Yang Qi is weak and minute, and Zheng Yuan (vital energy) is depleted. Consequently, ingested food fails to transform into essence but instead transforms into roundworms. Roundworms are Yin insects; thus, we know that Yang is weak and Yin prevails. When Yin prevails, the limbs often become cold (Jue). If the patient is occasionally irritable and quiet, vomits after eating, or constantly spits bitter fluid and occasionally vomits roundworms, this is a roundworm syndrome. Additionally, abdominal pain with a floating and large pulse also indicates roundworm syndrome. Such cases require urgent treatment; failure to treat leads to death. Therefore, Wumei is used as the Sovereign herb; its sour taste subdues roundworms. Chuanjiao and Xixin are used as Ministers; their acridity kills parasites. Ganjiang, Guizhi, and Fuzi are used as Assistants to defeat Cold and warm the Middle Jiao. The bitterness of Huanglian and Huangbai settles the roundworms. The sweetness of Renshen and Danggui tonifies and moderates the Middle Jiao, serving as Envoys. Moreover, this roundworm affliction is more severe than Ascaris lumbricoides or other parasites; harsh purgative anthelmintics are unsuitable. Thus, a formula based on control and suppression is employed.
Hu notes: The above discussion is theoretically sound. However, the statement "abdominal pain with a floating and large pulse" refers to stomach heat causing vomiting of roundworms. Dai Yanli recorded a case of a patient with Yang toxicity, jaundice, mouth ulcers, sore throat, and vomiting of roundworms, who recovered using cold-natured medicines. Such syndromes should not be conflated with middle-Jiao Cold causing roundworm vomiting.
Chen of Wuling states: Wumei Wan specifically treats Huijue. The formula is named Wumei because all herbs in the formula are governed by Wumei. Why? Cold Qi rises directly from the Shaoyin/Yueyin level to rush against the Heart and Stomach. Roundworms have no choice but to rise to the diaphragm and vomit. Without acrid-warm herbs, the rebellious Qi cannot be gathered; if rebellious Qi is not gathered, roundworms cannot be subdued. Rebellious Qi stems from Zang Cold; therefore, a group of acrid-hot herbs must be used to overcome it. Fuzi, Shujiao, Ganjiang, Guizhi, and Xixin are all acrid-hot, but their functions differ. Fuzi dispels Yin and restores Yang; Shujiao kills parasites and benefits Fire; unprocessed Ganjiang is used for its heat to overcome Cold and its acridity to scatter rebellious Qi; Xixin is used to vent Cold pathogen from the Yin meridians, preventing it from entering the Zang via the meridians. Wood withers when meeting Guizhi; hence, Guizhi is used. But why not use Rougui (Cinnamon Bark)? Because Jueyin Wind-Wood diseases manifest with fright and terror; their nature rises from the depths of the Nine Origins, appearing urgent and violent—all characteristics of Wind. Guizhi treats various Wind conditions. Zang Cold implies extremely weak Yuan Qi; thus, Renshen is naturally included to tonify and assist warmth. Danggui is added because it enters the Jueyin meridian, nourishes Liver Blood, and its acrid-warm nature disperses internal Cold, serving as a guiding herb. The bitterness of Huanglian and Huangbai subdues roundworms, acting as a counter-treatment, completing the method of warming/tonifying with reverse assistance, all unified by the astringent Wumei. This is what is meant by a disciplined army.
If the patient has cold extremities, claims no chest binding (Jie Xiong), and has fullness and tenderness upon pressure in the lower abdomen, this is Cold Binding in the Bladder and Guanyuan area. (This clause describes Jueyin Middle-Cold with Cold Binding in the Lower Abdomen. The Jueyin meridian reaches the lower abdomen. Cold extremities indicate Yin-Cold pathogen striking directly inward. No chest binding rules out Yang-Heat. Lower abdominal fullness and tenderness: Cheng Wuji notes this is Lower Jiao Cold Binding. The Bladder and Guanyuan correspond to the lower abdominal region. ○ Note: Zhang Zhongjing provides no treatment method here. *Bu Wang Lun* by Pang Anshi suggests moxibustion at Guanyuan. According to *Tu Jing*, Guanyuan is located on the midline of the abdomen, three cun below the umbilicus, an intersection of the Three Foot Yin Meridians and Ren Mai. It treats pain below the umbilicus; moxibustion is effective, up to one hundred moxa cones. I believe moxibustion at Guanyuan will resolve the Cold Binding in the Bladder.)
[Image: Guanyuan Acupoint Diagram]
In Shanghan disease, if there is cold extremities for four days, followed by fever for three days, and then cold extremities again for five days, the disease progresses. There is more Cold than Heat, indicating declining Yang Qi, hence progression. (This clause describes Jueyin Middle-Cold where Yang Qi attempts to recover but fails to overcome Yin pathogen. Cold strikes Jueyin, the extreme of Yin. At the extreme of Yin, Yang should recover. Now, True Yang Qi cannot overcome Yin-Cold pathogen, resulting in initial cold extremities, then fever, then recurrence of cold extremities. More days of cold extremities mean disease progression. Chen of Wuling states: Pathogen and Healthy Qi cannot coexist. Pathogen is Cold/Yin; Healthy Qi is Heat/Yang. Yang dominance brings Heat; Yin dominance brings Cold. More Cold than Heat signifies Yang decline. If Yang declines and Yin pathogen remains, death is near. One should fear this. ○ Note: Zhang Zhongjing provides no treatment method here. *Bu Wang Lun* by Chang Qizhi suggests Si Ni Tang. It should only be used after Heat recedes, Cold advances, and cold extremities do not return to warmth.)
In Shanghan disease, after six or seven days, if the pulse is minute, extremities are cold, and there is irritability, moxa the Jueyin meridian. If cold extremities do not return, death ensues. (This is a fatal syndrome of Cold Jue. Cold strikes Jueyin; the taboo is cold extremities, the hope is warmth. A minute pulse and cold extremities in Shanghan should see Yang recovery and warmth by day four or five. By day six or seven, if Yang does not recover and irritability increases, Cheng Wuji notes: Yang deficiency leads to struggle; True Yang within the Zang is about to collapse, causing Shen Qi to float outward, resulting in irritability. These are accompanying symptoms of cold extremities. At this stage, herbal medicine is insufficient; urgent moxibustion on Jueyin is needed to restore Yang. If moxibustion fails to reverse cold extremities and Yang does not return, death occurs. ○ Note: Zhang Zhongjing does not specify the acupoint. *Bu Wang Lun* by Chang Qizhi suggests Taichong. Taichong is the Well/Ashu point of the Foot Jueyin meridian. Diagnosing Taichong pulse can determine life or death in men. The point is located two cun posterior to the first interdigital space, or one and a half cun in the depression. Moxa three cones. Chen of Wuling states: Moxa Jueyin points like Guanyuan and Qihai. Guanyuan was mentioned previously. Qihai is one and a half cun below the umbilicus, treating rising cold Qi below the umbilicus. Qihai is the sea of Qi for men. It treats deficient Zang Qi, insufficient True Qi, and chronic Qi disorders; all should be treated with moxibustion.)
[Image: Taichong and Qihang Acupoint Diagram]
In Shanghan disease, after six or seven days, if there is no diarrhea, but sudden fever accompanied by diarrhea occurs, and the patient sweats profusely without stopping, death ensues. This is due to having Yin but lacking Yang. (This is also a fatal syndrome of Jueyin Middle-Cold. I suspect missing text follows "six or seven days." Cold striking Jueyin by day six or seven should involve six or seven days of cold extremities. The omission of "cold extremities" is a textual gap. Cold extremities usually imply diarrhea. If absent, Chen of Wuling says: Yang Qi is not yet exhausted and can still resist the pathogen. If fever occurs, diarrhea should stop. Now, fever and diarrhea occur simultaneously, plus incessant sweating. We know this heat is not Yang recovery but Yang collapse. Hence, it accompanies diarrhea and sweating. Yin-Cold pathogen strikes inward (Yin); True Yang Qi collapses outward (No Yang). Having Yin but lacking Yang inevitably leads to death.)
In Shanghan disease, if the pulse is rapid with intermittent pauses (Cu Mai) and extremities are cold/reversed, moxibustion is indicated. (This clause describes Jueyin Middle-Cold where extreme Yin causes Cu Mai, suitable for moxibustion. Cu Mai is a rapid pulse with occasional pauses. This is typically a sign of extreme Yang. However, extreme Yin-Cold forces Yang Qi to collapse, also producing Cu Mai. Given the external symptom of cold extremities, even herbal decoctions may be ineffective. Urgent moxibustion is required to assist Yang Qi. ○ Note: Zhang Zhongjing does not specify the acupoint. *Bu Wang Lun* by Chang Qizhi suggests Taichong. Point details noted previously. ○ Question: At extreme Yin-Cold, the pulse should be slow or intermittent (Dai). Why is it rapid and Cu? Answer: Wang Haizang and Chen of Wuling state: There are many types of Si Ni (Four Extremities Cold). Dang Gui Si Ni Tang is certainly less hot than Si Ni Tang, and its warming power is less than Tong Mai, while being cooler than Si Ni San. The causes of Si Ni differ: some are Cold-induced, some Heat-induced. This case is Cold-Wind striking the blood vessels, leading to the establishment of Dang Gui Si Ni Tang. Cold-Wind striking blood vessels enters Ying Qi. Although Yin and Yang wish to connect smoothly, they cannot. Pathogen obstructs the meridians, Ying Qi does not flow; blood vessels must be unblocked. Danggui is acrid-warm, a Qi-moving herb in Blood, dispersing internal Cold and harmonizing Blood, thus serving as Sovereign. To unblock vessels, blood-borne pathogen must first be dispersed. Guizhi disperses Wind in Jueyin Blood aspect; Xixin vents Cold in Jueyin Blood aspect. They serve as Ministers. Shaoyao, Dazao, and Gancao harmonize Ying and Wei. No pulse can flow if Ying and Wei are not harmonized. Guizhi Tang treats Wei not harmonizing with Ying; this formula treats Ying not harmonizing with Wei. Dazao is used more than double the amount in Guizhi Tang because Dazao assists meridians to harmonize Yin/Yang and regulate Ying/Wei. Furthermore, pathogen merges into the Liver Meridian; Wood excess insults Earth. The use of Gancao and Dazao likely intends to strengthen Spleen Earth to resist insult. Tongcao, according to Ben Jing, unblocks the nine orifices, blood vessels, and joints. Since pathogen blocks the blood aspect, Tongcao enters the blood aspect to break obstruction. All other herbs rely on Tongcao's power to achieve unblocking. How magical is formula preparation!)
If the person has long-standing internal Cold, Dang Gui Si Ni Tang plus Wu Zhu Yu and Sheng Jiang Decoction is indicated. (This continues the previous clause. If the person has long-standing internal Cold, meaning chronic Cold accumulation within the Zang-Fu, use the previous formula adding Wu Zhu Yu (acrid-hot) to disperse accumulated Cold, and Sheng Jiang (acrid-warm) to circulate Yang Qi.)
Dang Gui Si Ni Tang Plus Wu Zhu Yu and Sheng Jiang Decoction Formula (This formula is collected from Volume Ten of Zhang Zhongjing's treatise here)
To the previous formula, add Wu Zhu Yu (2 sheng) and Sheng Jiang (half jin).
The above nine ingredients. Boil with six sheng of water and six sheng of clear wine to extract five sheng. Strain. Take warm, divided into five doses. (Alternative: four sheng water and four sheng wine each.)
Hu notes: The reason for adding clear wine to boil the above decoction is that wine is greatly hot in nature, sweet and acrid in taste. Haizang states it guides herbs through the meridians, similar to Fuzi. Its power moistens Liver dryness, unblocks blood vessels, and disperses Cold pathogen. For patients with long-standing internal Cold, it is highly suitable in the decoction.
Question: Why not use Si Ni Tang for long-standing internal Cold? Answer: The previous syndrome was essentially Blood Deficiency, with Wind-Cold striking the Jueyin meridian. In Shaoyin, there were no accompanying syndromes. Some say: In severe Yin Toxicity, the six pulses are only palpable deep to the bone, disappearing with light pressure, beating eight times or more per breath, or too fast to count—is this not Cu Mai? I believe True Yang Qi is inherently active; forced by Cold, it becomes rapid and Cu. This is inevitable logic. People only know that Yin syndrome pulses are minute, slow, or absent—this is the norm. Here, mentioning Cu Mai is the variation. Understanding both norm and variation allows one to speak of medicine.
If hands and feet are cold and the pulse is fine and nearly imperceptible, Dang Gui Si Ni Tang is indicated. (This clause describes Cold striking the Blood aspect of Jueyin. "Cold extremities" differs slightly from "Jue Ni" or "Jue Leng." Jue Ni/Leng implies Cold deeply entered the Zang, making extremities stiff and ice-cold. "Jue Han" means extremities are cold and the patient feels intense aversion to cold; this is Cold striking the meridians. Cheng Wuji notes: External deficiency of Yang Qi fails to warm the four extremities. Fine, nearly imperceptible pulse indicates Cold injuring Ying Blood. Cheng Wuji notes: Internal weakness of Yin Blood leads to poor pulse circulation. Dang Gui Si Ni Tang is given to assist Yang and generate Yin.)