叔和脉经曰。阴毒为病。身重背强。腹中绞痛。咽喉不利。毒瓦斯
攻心。心下坚强。短气不得息。呕逆。唇青面黑。四肢厥冷。其脉沉细
紧数。身如被杖。五六日可治。至七日不可治也。或伤寒病一二日。
便结成阴毒。或服药六七日以上至十日。变成阴毒。甘草汤主之。雍
曰。要略有咽喉痛字。千金二毒。并同脉经。金匮要略阳毒之为病。
面赤斑斑如锦文。咽喉痛。吐脓血。阴毒之为病。面目青。身痛如被
杖。咽喉痛。此与脉经证同语异。第语简而易明。故重录之。
庞氏曰。阴毒之为病。因汗下药性冷所变。多在四五日也。或素
来阳气虚冷。始得病便成阴毒。或始因伤寒冷物。便成阴毒。服甘草
汤。仍作返阴丹。喘促吐逆者。入口便定。服药三五服不退。便于脐
下一寸半灸之。大炷百壮。未愈。可至二百壮。若手足极冷。小便涩。
小腹硬痛。囊缩。即须于脐下四寸。如前灸之。仍用当归四逆加吴茱
萸汤。同返阴丹。频频与服。内外逼逐。亦可解。稍缓则死矣。其阴毒
气结在小腹。故小便涩。切不可用利小便药。有以炒盐及热药熨脐
下者。其冷气在少腹之间。被热物所熨。无处通出。即冲上奔心。其
死尤速也。当须预服温剂。然后熨之。非不当熨也。
又曰。阴毒。脉沉微欲绝。四肢逆冷。大躁而渴不止。宜服附子
饮子。仍下硫黄丸。尤妙。
活人书曰。阴毒之为病。初得病。手足冷。背强咽痛。糜粥不下。
毒瓦斯攻心。腹痛短气。四肢逆冷。呕吐不利。身如被打。宜服阴毒甘
草汤、白术散、附子散、正阳散、肉桂散、回阳丹、返阴丹、天雄散、正
元散、退阴散之类。可选用之。雍曰。升麻甘草二汤。观其用药。性甚
缓。然诸家必先用之者。以古人治阴阳二毒者惟此二汤。故须用之
以去其毒势。而后辅之以他药也。
又曰。阴毒本因肾气虚寒。或因冷物伤脾。外伤风寒。内既伏
阴。外又感寒。或先感外寒而内伏阴。内外皆阴。则阳气不守。遂发
头疼腰重。
又曰。阴毒伤寒。心间烦躁。四肢逆冷。白术散、返阴丹皆主之。
雍曰。朱氏返阴丹。比之庞氏加附子干姜桂心为六物。其灸法。先灸
脐下一寸间。若其人手足冷。少腹硬。即更于脐下两边各一寸。三处
齐灸之。仍与四逆返阴二药频服。方可解退。若加以小便不通。及阴
囊缩入。少腹绞痛欲死者。更于脐下二寸石门穴火灸之。仍可服二
药。切不可与寻常利小便药也。
雍曰。从兄盛年恃健。不善摄生。因极饮冷酒食。内外有所感。
初得疾。即便身凉自利。手足厥。额上冷汗不止。遍身痛。呻吟不绝。
偃卧不能转侧。心神俱无。昏愦恍惚。呼医视之。治不效。予言兄曰。
此疾证甚重。而病患甚静。又觉昏愦身重不能起。自汗自利。四肢
厥。此阴病无疑也。又遍身痛。不知处所。出则身如被杖。阴毒证也。
安得不急治。医者之言。缪误不可听。乃急令服四逆汤。灸关元及三
阴交。未知。加服九炼金液丹。利厥汗皆少止。稍缓药艾。则诸证复
出。再救急治。如此进退者三。比三日两夜。灸十余壮。服金液六十
余粒。四逆汤一二斗。方能住火灸汤药。阳气虽复。而汗不出。证复
如太阳证。未敢服药以待汗。二三日后。大烦躁饮水。次则谵语。斑
出热甚。无可奈何。复与调胃承气汤。得利。大汗而解。阴阳反复有
如此者。前言烦躁不可投凉药。此则可下证具。非止小烦躁而已。故
不可同也。
《脉经》记载：阴毒这种病，身体沉重、背部僵硬，腹部剧烈绞痛，咽喉不畅，毒气攻心，心下部位坚硬胀满，呼吸短促无法顺畅喘息，呕吐逆气，嘴唇发青、面色发黑，四肢冰冷。其脉象沉细、紧数，身体感觉像被棍棒打过一样疼痛。发病五六天还可以治疗，到了第七天就无法治愈了。有的伤寒病人在发病一两天内，就结成了阴毒；有的服药六七天以上甚至十天，变成了阴毒。应当用甘草汤主治。郭雍说：这里简要提到了咽喉痛的症状。《千金方》中提到的两种毒证，与《脉经》相同。《金匮要略》记载阳毒的病证，面部红赤，斑纹如锦缎般交错，咽喉痛，吐脓血；阴毒的病证，面目青紫，身体疼痛像被棍棒打过，咽喉痛。这与《脉经》的证候相同但文字表述不同，只是文字更简练易懂，所以重新记录在这里。
庞安时（庞氏）说：阴毒这种病，是因为使用了发汗或泻下药后，药性寒冷所导致的，多在发病四五天时出现。或者患者素来阳气虚弱寒冷，刚得病就形成了阴毒；或者起初因为受寒凉食物伤害，就形成了阴毒。服用甘草汤后，再配合服用返阴丹。如果气喘急促、呕吐逆气的，服药入口症状就会安定。如果服药三五次后症状不退，就在脐下一寸半处施灸，用大艾炷灸一百壮。如果还没痊愈，可以增加到二百壮。如果手脚极度冰冷，小便涩滞，小腹部硬痛，阴囊收缩，就必须于脐下四寸处，像前面那样施灸。同时使用当归四逆加吴茱萸汤，配合返阴丹，频繁给予服用。通过内外逼迫驱逐邪气，也可以解除病症。如果稍微迟缓就会死亡。阴毒之气结聚在小腹部，所以小便涩滞，千万不可使用利小便的药物。有人用炒盐及热药熨烫脐下部位，寒气在少腹之间，被热物熨烫后，无处排出，就会冲上直逼心脏，这样死亡速度更快。应当预先服用温补药物，然后再进行熨烫。不是说不应该熨烫，而是强调顺序和前提。
又说：阴毒，脉象沉微几乎摸不到，四肢逆冷，极度烦躁且口渴不止，适宜服用附子饮子，同时服用硫黄丸，尤其妙效。
《活人书》说：阴毒这种病，初得病时，手脚冰冷，背部僵硬，咽喉痛，连稀粥都咽不下，毒气攻心，腹痛，呼吸短促，四肢逆冷，呕吐不利，身体感觉像被打过一样。适宜服用阴毒甘草汤、白术散、附子散、正阳散、肉桂散、回阳丹、返阴丹、天雄散、正元散、退阴散等药物，可以选择其中一种使用。郭雍说：升麻甘草二汤，观察其用药，性质非常缓和。然而各家医家必定先使用它的原因，是因为古人治疗阴阳二毒只使用这两首汤剂，所以必须用它来去除毒势，然后再辅以其他药物。
又说：阴毒本因肾气虚寒，或因冷物损伤脾胃，外伤风寒，体内既潜伏阴寒，体外又感受寒邪，或者先感受外寒而体内潜伏阴寒，内外皆属阴，则阳气不能固守，于是引发头痛、腰部沉重。
又说：阴毒伤寒，心胸间烦躁不安，四肢逆冷，白术散、返阴丹都可以主治。郭雍说：朱氏的返阴丹，相比庞氏的版本增加了附子、干姜、桂心，共六味药。其灸法，先灸脐下一寸处。如果其人手脚冰冷，少腹部坚硬，就在脐下两边各一寸处，三处同时施灸。同时频繁服用四逆汤和返阴丹这两种药，才可以解除退热。如果加上小便不通，以及阴囊缩入，少腹部绞痛欲死，就在脐下二寸的石门穴用火灸之。仍然可以服用那两种药，千万不可给予寻常的利小便药物。
郭雍说：我的堂兄盛年时身体健壮，不善于保养身体，因为大量饮用冷酒冷食，内外受到感邪。刚得病时，身体发凉，自行腹泻，手脚厥冷，额头冷汗不止，全身疼痛，呻吟声不绝，躺卧不能翻身，心神恍惚，昏沉迷糊。请医生诊治，治疗效果不佳。我对兄长说：这个疾病证候很重，但病人表现得很安静，又觉得昏沉身体沉重不能起身，自汗、自利，四肢厥冷，这无疑是阴病。而且遍身疼痛，不知具体痛点，出门则身体像被棍棒打过，这是阴毒的证候。怎么能不紧急治疗？医生的话谬误不可听。于是急忙令服用四逆汤，灸关元穴和三阴交穴。病情未见明显好转，加服九炼金液丹，腹泻、厥冷、出汗都稍微停止了一些。稍微减缓药物和艾灸的力度，各种证候又复发。再次紧急救治。如此进退反复三次，经过三天两夜，灸了十余壮，服用了六十多粒金液丹，喝了一二斗四逆汤，才能停止艾灸和汤药的治疗。虽然阳气恢复，但是不出汗，证候又类似太阳病。不敢立即服药等待出汗。两三天后，出现大烦躁、想喝水，接着说胡话（谵语），身上出斑，发热严重，无可奈何，再次给予调胃承气汤，得到腹泻，大汗出而病解。阴阳反复变化竟然如此。前言说烦躁不可投用凉药，此时则是可下的证候具备，不仅仅是轻微烦躁而已。所以情况不可等同看待。
The *Mai Jing* (Pulse Classic) states: Yin poison disease is characterized by a heavy body, stiff back, severe colicky pain in the abdomen, difficulty in the throat, toxic qi attacking the heart, hardness and fullness below the heart, shortness of breath with inability to breathe smoothly, vomiting and regurgitation, cyanosis of the lips, blackish complexion, and cold limbs. The pulse is deep, fine, tight, and rapid. The body feels as if beaten with a stick. It can be treated within five or six days; after seven days, it becomes incurable. Some patients with Shanghan (Cold Damage) develop Yin poison within one or two days of onset. Others may transform into Yin poison after taking medicine for six or seven days up to ten days. Gancao Tang (Licorice Decoction) is the primary prescription. Guo Yong stated: This briefly mentions sore throat. The "Two Poisons" mentioned in *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold) are consistent with the *Mai Jing*. In *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet), Yang poison disease presents with a red face, mottled rash like brocade, sore throat, and expectoration of pus and blood. Yin poison disease presents with blue-green complexion, body pain as if beaten with a stick, and sore throat. This matches the symptoms in the *Mai Jing* but differs in wording, being more concise and clear, so it is recorded again here.
Pang Anshi (Pang Shi) stated: Yin poison disease results from the cold nature of sweating or purgative medicines used previously, often appearing around the fourth or fifth day. Or, if the patient has always had deficient and cold Yang qi, Yin poison forms immediately upon contracting the disease. Or, if initially injured by cold food, Yin poison forms. After administering Gancao Tang, Fanyin Dan (Return-Yin Pill) should still be taken. For those with panting, urgency, vomiting, and regurgitation, symptoms stabilize upon ingestion. If symptoms do not recede after three to five doses, moxibustion should be applied 1.5 cun below the umbilicus using large moxa cones, 100 cones. If not cured, this can be increased to 200 cones. If hands and feet are extremely cold, urination is difficult, the lower abdomen is hard and painful, and the scrotum is retracted, moxibustion must be applied at 4 cun below the umbilicus, as described above. Simultaneously, Danggui Sini Jia Wuzhuyu Tang (Cinnamon Twig Decoction Modified with Evodia) should be administered frequently along with Fanyin Dan. By driving out pathogens from both inside and outside, the condition can be resolved. Delay leads to death. Since the Qi of Yin poison knots in the lower abdomen, causing difficult urination, diuretics must absolutely not be used. Some people use fried salt and hot medicines to iron the area below the umbilicus. If cold Qi is trapped in the lower abdomen and is heated by external warmth without an outlet, it rushes upward to attack the heart, leading to even faster death. One must pre-administer warming agents before ironing. It is not that ironing is inappropriate, but rather emphasizes sequence and prerequisites.
It is also stated: In Yin poison, the pulse is deep, minute, and nearly imperceptible; limbs are cold; there is extreme restlessness and unquenchable thirst. Fuzi Yinzi (Aconite Drink) is suitable, combined with Xiuhuang Wan (Sulfur Pill), which is especially effective.
The *Huo Ren Shu* (Book That Saves Lives) states: In the early stage of Yin poison disease, hands and feet are cold, the back is stiff, the throat hurts, and even gruel cannot be swallowed. Toxic qi attacks the heart, causing abdominal pain, shortness of breath, cold limbs, vomiting, and difficulty in defecation. The body feels as if beaten. Suitable prescriptions include Yindu Gancao Tang (Yin Poison Licorice Decoction), Baizhu San (Atractylodes Powder), Fuzi San (Aconite Powder), Zhengyang San (Upright-Yang Powder), Rougui San (Cinnamon Bark Powder), Huiyang Dan (Restore-Yang Pill), Fanyin Dan (Return-Yin Pill), Tianxiong San (Aconite Root Powder), Zhengyuan San (Upright-Origin Powder), Tuiyin San (Push-Yin-Away Powder), etc. One may select from these. Guo Yong stated: Regarding Shengma Gancao Er Tang (Ephedra and Licorice Two Decoctions), observing their ingredients, their nature is very mild. However, various schools insist on using them first because ancients only used these two decoctions to treat Yin and Yang poisons. Thus, they must be used to dissipate the toxic pathogenic factor before assisting with other medicines.
It is also stated: Yin poison originates from deficiency-cold of Kidney Qi, or injury to the Spleen by cold substances, external invasion of Wind-Cold. Internally, Yin cold lies dormant; externally, Cold is contracted. Or, external Cold is contracted first, followed by internal latent Yin. When both interior and exterior are Yin, Yang Qi fails to guard, leading to headache and heaviness in the waist.
It is also stated: In Yin poison Shanghan, there is irritability and restlessness in the chest, and cold limbs. Baizhu San and Fanyin Dan both govern this condition. Guo Yong stated: Zhu's Fanyin Dan adds Fuzi (Prepared Aconite Root), Ganjiang (Dried Ginger), and Guixin (Cinnamon Twig Heart) to Pang's version, totaling six herbs. Its moxibustion method involves first moxibusting 1 cun below the umbilicus. If the person has cold limbs and a hard lower abdomen, moxibustion should also be applied 1 cun to the left and right of the umbilicus, treating all three points simultaneously. Frequent administration of Sizni Tang (Four Reversal Decoction) and Fanyin Dan is required for resolution. If accompanied by urinary retention, retraction of the scrotum, and severe colicky pain in the lower abdomen threatening death, fire moxibustion should be applied at Shimen (CV5), located 2 cun below the umbilicus. The two medicines can still be taken. Diuretics commonly used for such conditions must absolutely not be given.
Guo Yong said: My cousin, in his prime and robust health, did not practice proper self-care. Due to excessive consumption of cold wine and food, he was affected internally and externally. Upon initial onset, his body became cool, he suffered spontaneous diarrhea, his limbs were cold, sweat poured from his forehead continuously, his whole body ached, he groaned incessantly, could not turn over while lying down, felt mentally blank, confused, and dazed. Physicians were called, but treatment was ineffective. I told my brother: This disease is severe, yet the patient appears quiet. He feels confused, heavy-bodied, unable to rise, with spontaneous sweating and diarrhea, and cold limbs. This is undoubtedly a Yin disease. Furthermore, the diffuse body pain without a specific location, resembling being beaten when moving outdoors, indicates Yin poison. Why not treat it urgently? The physician's advice was erroneous and should not be heeded. I urgently ordered the administration of Sizni Tang and moxibustion on Guanyuan (CV4) and Sanyinjiao (SP6). Without significant improvement, Jiuling Jin Ye Dan (Nine-Refined Metal Liquid Pill) was added. Diarrhea, cold limbs, and sweating decreased slightly. If the dosage and moxibustion were relaxed, symptoms recurred. Emergency treatment was repeated. This cycle of advance and retreat occurred three times. Over three days and two nights, over ten moxa cones were burned, sixty-plus pills of Jin Ye Dan were taken, and one to two dou of Sizni Tang were consumed, finally allowing cessation of moxibustion and herbal decoctions. Although Yang Qi recovered, no sweat appeared, and symptoms resembled Taiyang disease (Taiyang Disease). I dared not administer medicine to induce sweating immediately. Two or three days later, severe irritability and thirst developed, followed by delirium, appearance of macules, and high fever. Helpless, I administered Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction). Diarrhea ensued, followed by profuse sweating and resolution. The reversal of Yin and Yang can be thus. Previously stated that irritability contraindicates cooling medicines, but here, the indications for purgation are complete, not merely slight irritability. Therefore, the situations cannot be equated.