按厥逆、厥冷、四逆，一也。阴阳二病，皆能发厥。然阴厥易明。惟阳厥有阳邪内传阴经，
脉数沉细，误认阴寒者。有阳邪内传阳经，冷汗时出，误认阴寒者。有表邪内伏，身冷无
汗，脉伏不出，误认阴寒者。不知阴寒起病，身不发热，口不作渴，二便清利，神气清爽，
手足厥冷，不能举动，六脉沉迟不数，此阴经寒厥之症。《伤寒论》以四逆汤、干姜甘草汤、
吴茱萸汤等，治气分火虚厥冷。于恶寒门，有当归四逆汤，治血分冒寒。又立芍药甘草附子
汤，治血分恶寒。类于厥冷，即可推此以治彼。以上治阴经阴厥之法也。若初起发热恶寒，
热久不凉，渐至手足皆冷，又或热片时，神昏不语，或独语谵妄，身虽厥冷，手足仍能举
动，大便或闭或泻，小便赤涩，甚至自遗不觉，其脉沉细而数，此阳热传入三阴，乃阴经阳
厥之症，用寒药则碍厥冷，用热药则碍阳邪，故仲景用四逆散疏通胃阳，阳气外达，待厥愈
足温，再清其热。若初起发热，自汗烦躁，至八九日忽然四肢厥冷，口燥唇焦，烦渴引饮，
神昏不语，扬手掷足，身虽厥冷不欲衣被，冷汗常出，脉大沉数，或数时一止，此阳邪传入
三阳，乃阳经阳厥之症，宜河间凉膈散、白虎汤、黄连解毒汤。清内伏之热外发，则手足温
暖。然后看里有结热者，再清之。有下症者，二承气汤选用。若初起恶寒发热，六脉或浮
大，或沉伏，烦躁呻吟，忽尔手足皆冷，此表汗不出，表邪内伏之厥冷，宜升阳散火汤、羌
独败毒散发散表邪，则汗出厥愈。以上三条治阳厥之法也。另有夹痰、夹食、夹食气，填塞
中脘，升降不通，胃阳不得四布，亦令人手足厥冷，宜用消导痰食，导痰汤、保和散再加开豁之药。
升阳散火汤
升麻 葛根 羌活 独活 柴胡 白芍药 防风 甘草
里热见厥，用凉膈散等。表邪内伏厥冷，以此方升散。
羌独败毒散
三阳表邪内伏，用升阳散火汤。太阳表邪内伏，则用此方。
黄连解毒汤
黄连 黄芩 黄柏 山栀
热在上焦而厥，用凉膈散。热在中焦，用白虎汤。若三焦皆热，则用此方。
大承气汤 见大便秘结。
甘草干姜汤
甘草 干姜
此条本是阳症，因表虚脉浮，卫虚自汗，又误汗复亡其阳，故使厥。误下复竭其阴，故咽
中干，烦躁。若用温复阳，则碍咽干烦躁。用寒，则碍厥冷。故此方以干姜暖中。甘草缓
急，待其胃阳敷布，厥愈足温，然后作芍药甘草汤，调和阴血。
芍药甘草汤
芍药 甘草 石膏 荆芥
此方妙法，妙在石膏、荆芥辛凉上焦，润其咽干烦躁；又藉其辛凉入血，助芍药、甘草下
缓肝急，使其脚伸；脱去干姜辛热，以防胃热谵语，微露下文用调胃承气汤，复清胃热。
调胃承气汤
大黄 枳壳 浓朴 甘草
复阳太过，不耐辛温，胃热谵语，暂用此方。
四逆散
柴胡 白芍药 枳实 甘草
三阳表邪内伏，四肢厥冷，升阳散火汤等发之。热邪内传，四肢厥冷，凉膈散等清之。三
阴脏寒而厥冷，以四逆汤等温之。今本是阳症，因热邪内传阴经而厥冷，故以柴胡、白芍药
疏通肝胆，伸阳气外达，则肝主四末而四肢自暖。又以枳实、甘草疏通阳明里气，伸胃阳外
布，则胃主手足而手足自温。此方分治阴经阳厥，与阳经阳厥不同者。
凉膈散 见发狂。
白虎汤 见潮热。
吴茱萸汤 见恶寒。
白通猪胆汤
厥冷有脉，用四逆汤。脉伏，加葱白以通阳气。阴极发躁，加胆汁以监制。家秘恐凝浊，
易川连少许，宗连理汤法。
当归四逆汤
当归 白芍药 桂枝 细辛 通草 甘草 大枣
此治血虚冒邪，不能发汗外出。例如气虚冒邪，而用人参败毒散、参苏饮。
麻黄升麻汤 麻黄 升麻 知母 石膏 当归 芍药 黄芩 甘草
此治误下邪伏，故用升散法从表发出。以知母、石膏、黄芩清里热，以归、芍引入血分至
深之处。家秘加羌活，去麻黄，以其咽喉不利吐脓血耳。
按：厥逆、厥冷、四逆，名称虽异，实为同一病证。阴证与阳证两种病机，都能引发厥证。然而，阴厥（阴寒内盛所致的厥冷）容易辨识。唯有阳厥（阳热内郁所致的厥冷），有的因阳邪内传至阴经，脉象数而沉细，容易被误认为是阴寒证；有的因阳邪内传至阳经，冷汗不时渗出，容易被误认为是阴寒证；有的因表邪内伏于体内，身体寒冷无汗，脉象潜伏不出，容易被误认为是阴寒证。
不知道阴寒起病时，身体不发热，口不渴，大小便清长通畅，精神清爽，手足厥冷且不能举动，六脉沉迟而不数，这是阴经寒厥的症状。《伤寒论》用四逆汤、干姜甘草汤、吴茱萸汤等，治疗气分火衰导致的厥冷。在恶寒门中，有当归四逆汤，治疗血分受寒。又设立芍药甘草附子汤，治疗血分恶寒。这类属于厥冷的病症，即可由此类推来治疗其他类似情况。以上所述是治疗阴经阴厥的方法。
如果初起时发热恶寒，热久不退，逐渐发展到手足皆冷；或者发热片刻后，神志昏迷不语，或独自胡言乱语，身体虽然厥冷，但手足仍能举动，大便或闭结或泄泻，小便赤涩，甚至失禁不知，脉象沉细而数，这是阳热传入三阴经，属于阴经阳厥的症状。此时用寒药则会阻碍厥冷的缓解，用热药则会助长阳邪，所以张仲景使用四逆散疏通胃阳，使阳气外达，等待厥愈足温后，再清除其热。
如果初起发热，自汗烦躁，到了第八九日忽然四肢厥冷，口燥唇焦，烦渴引饮，神志昏迷不语，扬手掷足，身体虽然厥冷但不想盖衣被，冷汗常出，脉象大沉数，或数时有间歇，这是阳邪传入三阳经，属于阳经阳厥的症状，适宜使用河间凉膈散、白虎汤、黄连解毒汤。清除内伏之热使其外发，则手足温暖。然后看里有结热的，再行清热。有下症者，选用大承气汤或小承气汤。
如果初起恶寒发热，六脉或浮大，或沉伏，烦躁呻吟，忽然手足皆冷，这是表汗不出，表邪内伏导致的厥冷，适宜使用升阳散火汤、羌独败毒散发散表邪，则汗出厥愈。以上三条是治疗阳厥的方法。
另有夹痰、夹食、夹食气，填塞中脘，升降不通，胃阳不得四布，也令人手足厥冷，适宜使用消导痰食的药物，如导痰汤、保和散再加开豁之药。
升阳散火汤
升麻、葛根、羌活、独活、柴胡、白芍药、防风、甘草。
里热见厥，用凉膈散等方。表邪内伏厥冷，用此方升散。
羌独败毒散
三阳表邪内伏，用升阳散火汤。太阳表邪内伏，则用此方。
黄连解毒汤
黄连、黄芩、黄柏、山栀。
热在上焦而厥，用凉膈散。热在中焦，用白虎汤。若三焦皆热，则用此方。
甘草干姜汤
甘草、干姜。
此条本是阳症，因表虚脉浮，卫虚自汗，又误汗复亡其阳，故使厥。误下复竭其阴，故咽中干，烦躁。若用温复阳，则碍咽干烦躁。用寒，则碍厥冷。故此方以干姜暖中。甘草缓急，待其胃阳敷布，厥愈足温，然后作芍药甘草汤，调和阴血。
芍药甘草汤
芍药、甘草、石膏、荆芥。
此方妙法，妙在石膏、荆芥辛凉上焦，润其咽干烦躁；又藉其辛凉入血，助芍药、甘草下缓肝急，使其脚伸；脱去干姜辛热，以防胃热谵语，微露下文用调胃承气汤，复清胃热。
调胃承气汤
大黄、枳壳、浓朴、甘草。
复阳太过，不耐辛温，胃热谵语，暂用此方。
四逆散
柴胡、白芍药、枳实、甘草。
三阳表邪内伏，四肢厥冷，升阳散火汤等发之。热邪内传，四肢厥冷，凉膈散等清之。三阴脏寒而厥冷，以四逆汤等温之。今本是阳症，因热邪内传阴经而厥冷，故以柴胡、白芍药疏通肝胆，伸阳气外达，则肝主四末而四肢自暖。又以枳实、甘草疏通阳明里气，伸胃阳外布，则胃主手足而手足自温。此方分治阴经阳厥，与阳经阳厥不同者。
白通猪胆汤
厥冷有脉，用四逆汤。脉伏，加葱白以通阳气。阴极发躁，加胆汁以监制。家秘恐凝浊，易川连少许，宗连理汤法。
当归四逆汤
当归、白芍药、桂枝、细辛、通草、甘草、大枣。
此治血虚冒邪，不能发汗外出。例如气虚冒邪，而用人参败毒散、参苏饮。
麻黄升麻汤 麻黄、升麻、知母、石膏、当归、芍药、黄芩、甘草。
此治误下邪伏，故用升散法从表发出。以知母、石膏、黄芩清里热，以归、芍引入血分至深之处。家秘加羌活，去麻黄，以其咽喉不利吐脓血耳。
Translation:
Note: Jue Ni (Jue Reversal/Cold Extremities), Jue Leng (Cold Extremities), and Si Ni (Four Extremities Cold) are different names for the same pathological condition. Both Yin syndromes and Yang syndromes can induce Jue. However, Yin Jue (cold extremities due to Yin-cold excess) is easy to identify. It is only Yang Jue (cold extremities due to Yang-heat constraint) that presents diagnostic challenges: some cases involve Yang pathogenic factors transmitting internally to the Yin meridians, with a rapid, deep, and thin pulse, easily mistaken for a Yin-cold syndrome; some involve Yang pathogenic factors transmitting internally to the Yang meridians, with cold sweat appearing intermittently, easily mistaken for a Yin-cold syndrome; some involve exterior pathogens lying latent within, with a cold body, no sweat, and a hidden, imperceptible pulse, easily mistaken for a Yin-cold syndrome.
One must not fail to recognize that when an illness originates from Yin-cold, the body is not feverish, there is no thirst in the mouth, urination and defecation are clear and profuse, mental spirit is clear and refreshed, hands and feet are cold and immobile, and the six pulses are deep, slow, and not rapid. These are symptoms of Cold Jue in the Yin meridians. *Shanghan Lun* (Treatise on Cold Damage) employs Sini Tang (Four Reversals Decoction), Ganjiang Gancao Tang (Dried Ginger and Licorice Decoction), and Wuzhuyu Tang (Evodia Decoction) to treat cold extremities caused by fire deficiency in the Qi level. In the section on aversion to cold, Danggui Sini Tang (Angelica Sinensis Decoction for Reversing Cold) is used to treat cold invading the Blood level. Additionally, Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) is established to treat aversion to cold in the Blood level. For conditions similar to cold extremities, one can infer treatments for others based on these principles. The above describes the methods for treating Yin Jue in the Yin meridians.
If at the onset there is fever and aversion to cold, which persists without cooling down, gradually progressing to coldness in both hands and feet; or if after a brief period of fever, the patient becomes comatose and silent, or speaks deliriously alone; although the body is cold, the hands and feet remain movable; stool may be constipated or loose; urine is red and difficult; or even incontinence occurs without awareness; and the pulse is deep, thin, and rapid—this indicates Yang-heat transmitting into the Three Yin meridians, constituting Yang Jue in the Yin meridians. Using cold medicines would hinder the resolution of cold extremities, while using hot medicines would exacerbate the Yang pathogen. Therefore, Zhang Zhongjing uses Sini San (Four Reversals Powder) to unblock Stomach Yang, allowing Yang Qi to reach the exterior. Once the reversal resolves and feet become warm, the heat is then cleared.
If at the onset there is fever, spontaneous sweating, and irritability, which suddenly progresses to cold limbs on the eighth or ninth day, with dry mouth and scorched lips, extreme thirst prompting drinking, coma and silence, flinging hands and kicking feet, body cold but unwilling to cover with clothes or quilts, frequent cold sweat, and a large, deep, rapid pulse, or a rapid pulse with intermittent pauses—this indicates Yang pathogenic factors transmitting into the Three Yang meridians, constituting Yang Jue in the Yang meridians. He Jian’s Liangge San (Cool the Diaphragm Powder), Baihu Tang (White Tiger Decoction), and Huanglian Jiedu Tang (Coptis Decoction to Resolve Toxicity) are appropriate. Clearing the latent internal heat allows it to manifest outwardly, warming the hands and feet. Subsequently, if there is accumulated heat in the interior, clear it further. If there are purgative indications, choose between Dachengqi Tang (Major Order the Qi Decoction) or Xiaochengqi Tang (Minor Order the Qi Decoction).
If at the onset there is aversion to cold and fever, with pulses that are either floating and large or deep and hidden, accompanied by irritability and groaning, followed suddenly by coldness in all four limbs—this is cold extremities caused by failure of perspiration and latent exterior pathogens. Shengyang Sanhuo Tang (Raise Yang and Disperse Fire Decoction) or Qiangduo Baidu San (Notopterygium and Angelica Decoction to Overcome Toxins) should be used to disperse the exterior pathogens. Perspiration will occur, and the reversal will resolve. The above three points describe the methods for treating Yang Jue.
Additionally, cases complicated by phlegm, food stagnation, or food-Qi obstruction blocking the Zhongwan (Middle Epigastrium), leading to impaired ascending and descending functions and inability of Stomach Yang to distribute widely, also cause cold extremities. These should be treated with herbs that resolve phlegm and digest food, such as Daotan Tang (Phlegm-Resolving Decoction) or Baohe San (Preserve Harmony Powder), added with herbs that open and scatter obstructions.
Shengyang Sanhuo Tang (Raise Yang and Disperse Fire Decoction):
Shengma (Rhizoma Cimicifugae), Gegen (Radix Puerariae), Qianghuo (Rhizoma et Radix Notopterygii), Duhuo (Radix Angelicae Pubescentis), Chaihu (Radix Bupleuri), Baishao (Radix Paeoniae Alba), Fangfeng (Radix Saposhnikoviae), Gancao (Radix Glycyrrhizae).
For Jue with interior heat, use Liangge San etc. For cold extremities due to latent exterior pathogens, use this formula to raise and disperse.
Qiangduo Baidu San (Notopterygium and Angelica Decoction to Overcome Toxins):
For latent exterior pathogens in the Three Yang meridians, use Shengyang Sanhuo Tang. For latent exterior pathogens in the Taiyang (Greater Yang) meridian, use this formula.
Huanglian Jiedu Tang (Coptis Decoction to Resolve Toxicity):
Huanglian (Rhizoma Coptidis), Huangqin (Radix Scutellariae), Huangbai (Cortex Phellodendri), Shanzhi (Fructus Gardeniae).
For Jue with heat in the Upper Jiao, use Liangge San. For heat in the Middle Jiao, use Baihu Tang. If heat exists in all three Jiaos, use this formula.
Dachengqi Tang (Major Order the Qi Decoction): See entry for Constipation.
Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction):
Gancao (Radix Glycyrrhizae), Ganjiang (Rhizoma Zingiberis).
This case originally belongs to a Yang syndrome. Due to exterior deficiency with a floating pulse and Wei (Defensive) deficiency causing spontaneous sweating, erroneous sweating further depleted Yang, causing Jue. Erroneous purging further exhausted Yin, causing dryness in the throat and irritability. Using warming methods to restore Yang would aggravate throat dryness and irritability. Using cold medicines would aggravate cold extremities. Therefore, this formula uses Ganjiang to warm the center and Gancao to relieve urgency. Wait until Stomach Yang distributes, Jue resolves, and feet warm, then prepare Shaoyao Gancao Tang to harmonize Yin blood.
Shaoyao Gancao Tang (Peony and Licorice Decoction):
Shaoyao (Radix Paeoniae Alba), Gancao (Radix Glycyrrhizae), Shigao (Gypsum Fibrosum), Jingjie (Herba Schizonepetae).
The subtle method of this formula lies in Shigao and Jingjie being acrid-cool to the Upper Jiao, moistening throat dryness and irritability; furthermore, their acrid-cool nature enters the Blood level, assisting Shaoyao and Gancao to soften Liver tension below, allowing the legs to extend. Removing the acrid-hot Ganjiang prevents Stomach heat-induced delirium, subtly hinting at the subsequent use of Tiaowei Chengqi Tang to clear Stomach heat.
Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction):
Dahuang (Radix et Rhizoma Rhei), Zhike (Fructus Aurantii), Houpo (Cortex Magnoliae Officinalis), Gancao (Radix Glycyrrhizae).
Used temporarily when excessive restoration of Yang leads to intolerance of acrid-warmth, resulting in Stomach heat and delirium.
Sini San (Four Reversals Powder):
Chaihu (Radix Bupleuri), Baishao (Radix Paeoniae Alba), Zhishi (Fructus Aurantii), Gancao (Radix Glycyrrhizae).
For latent exterior pathogens in the Three Yang meridians causing cold limbs, use Shengyang Sanhuo Tang etc. to release them. For heat pathogens transmitting internally causing cold limbs, use Liangge San etc. to clear them. For cold extremities due to cold in the Three Yin organs, use Sini Tang etc. to warm them. This case originally belongs to a Yang syndrome, but due to heat pathogens transmitting internally to the Yin meridians causing cold limbs, Chaihu and Baishao are used to unblock the Liver and Gallbladder, extending Yang Qi outward, so that since the Liver governs the four extremities, they naturally warm. Zhishi and Gancao are used to unblock the interior Qi of the Yangming, extending Stomach Yang outward, so that since the Stomach governs the hands and feet, they naturally warm. This formula treats Yang Jue in the Yin meridians differently from Yang Jue in the Yang meridians.
Liangge San (Cool the Diaphragm Powder): See entry for Mania.
Baihu Tang (White Tiger Decoction): See entry for Tidal Fever.
Wuzhuyu Tang (Evodia Decoction): See entry for Aversion to Cold.
Baitong Zhudan Tang (Arisaema with Pig Bile Decoction):
For cold extremities with a palpable pulse, use Sini Tang. If the pulse is hidden, add Congbai (Scallion White) to unblock Yang Qi. If extreme Yin causes restlessness, add bile to control it. My family's secret modification fears turbidity congealing, substituting a small amount of Chuanlian (Rhizoma Coptidis), following the method of Lianli Tang.
Danggui Sini Tang (Angelica Sinensis Decoction for Reversing Cold):
Danggui (Radix Angelicae Sinensis), Baishao (Radix Paeoniae Alba), Guizhi (Ramulus Cinnamomi), Xixin (Herba Asari), Tongcao (Medulla Tetrapanacis), Gancao (Radix Glycyrrhizae), Dazao (Fructus Jujubae).
This treats Blood deficiency exposed to pathogens, unable to perspire outwardly. Similarly, for Qi deficiency exposed to pathogens, Renshen Baidu San (Ginseng Decoction to Overcome Toxins) or Shen Su Yin (Ginseng and Perilla Drink) are used.
Mahuang Shengma Tang (Ephedra and Cimicifuga Decoction): Mahuang (Herba Ephedrae), Shengma (Rhizoma Cimicifugae), Zhimu (Rhizoma Anemarrhenae), Shigao (Gypsum Fibrosum), Danggui (Radix Angelicae Sinensis), Shaoyao (Radix Paeoniae Alba), Huangqin (Radix Scutellariae), Gancao (Radix Glycyrrhizae).
This treats pathogens lying latent due to erroneous purging, thus using a raising and dispersing method to expel them from the exterior. Zhimu, Shigao, and Huangqin clear interior heat; Danggui and Shaoyao guide the action deep into the Blood level. My family adds Qianghuo and removes Mahuang because of throat discomfort and expectoration of pus and blood.