伤寒不仁。何以明之。仁、柔也。不仁。谓不柔和也。痒不知也。痛不知也。寒不知也。热
不知也。任其屈伸灸刺。不知所以然者。是谓不仁也。由邪气壅盛。正气为邪气闭
伏。郁而不发。荣卫血气虚少。不能通行。致斯然也。内经曰。荣气虚则不仁。针经曰。
卫气不行。则为不仁。经曰。荣卫不能相将。三焦无所仰。身体痹不仁。即是言之。知
荣卫血气虚少。不能通行。为不仁者明矣。经曰。诸乘寒者则为厥。郁冒不仁。言此
厥者。是正气为寒气所乘。为厥气也。非四肢逆冷之厥也。何者。盖以郁冒。为昏冒
不仁。为不知痛痒。得不为尸厥之厥耶。经曰。少阴脉不至。肾气微少。精血奔。气促
迫。上入胸膈。宗气反聚。血结心下。阳气退下。热归阴股。与阴相动。令身不仁。此为
尸厥。其乘寒之厥。郁冒不仁。即此尸厥可知矣。昔越人入虢诊太子为尸厥。以郁
冒不仁为可治。刺之而得痊济者。实神医之诊也。呜呼。设或脉浮而洪。身汗如油。
喘而不休。水浆不下。形体不仁。此又为命绝。虽越人其能起之欤。
伤寒直视。何以明之。直视者。视物而目精不转动者是也。若目精转者。非直视也。
水之精为志。火之精为神。目者心之使也。神所寓焉。肝之外候也。精神荣焉。针经
曰。五脏六腑之气。皆上注于目。而为之精。精之窠为眼之睛。精为瞳子。筋之精为
黑睛。血之精为络。气之精为白睛。肌肉之精为约束。裹撷筋骨。血气之精。与脉并
为系。上属于脑。五脏血气充荣。则目和而明矣。伤寒目直视者。邪气壅盛。冒其正
气。使神智不慧。藏精之气不上荣于目。则目为之直视。伤寒至于直视。为邪气已
极。证候已逆。多难治。经曰。衄家不可发汗。汗出则额上陷。脉急紧。直视不能 。不
得眠。以肝受血而能视。亡血家肝气已虚。目气已弱。又发汗亡阳。则阴阳俱虚所
致也。此虽错逆。其未甚也。逮乎狂言。反目直视。又为肾绝。直视摇头。又为心绝。皆
脏气脱绝也。直视谵语。喘满者死。下利者亦死。又剧者发则不识人。循衣摸床。惕
而不安。微喘直视。脉弦者生。涩者死。皆邪气盛而正气脱也。其或有目中不了了。
睛不和。无表里证。大便难。身微热者。是非直视也。此为内实也。可用大承气汤、大
柴胡汤下之。直视为不治之疾。目中不了了。为可治之候。二者形证相近。其为工
者。宜熟视之。
伤寒不仁。何以明之。仁、柔也。不仁。谓不柔和也。痒不知也。痛不知也。寒不知也。热
不知也。任其屈伸灸刺。不知所以然者。是谓不仁也。由邪气壅盛。正气为邪气闭
伏。郁而不发。荣卫血气虚少。不能通行。致斯然也。内经曰。荣气虚则不仁。针经曰。
卫气不行。则为不仁。经曰。荣卫不能相将。三焦无所仰。身体痹不仁。即是言之。知
荣卫血气虚少。不能通行。为不仁者明矣。经曰。诸乘寒者则为厥。郁冒不仁。言此
厥者。是正气为寒气所乘。为厥气也。非四肢逆冷之厥也。何者。盖以郁冒。为昏冒
不仁。为不知痛痒。得不为尸厥之厥耶。经曰。少阴脉不至。肾气微少。精血奔。气促
迫。上入胸膈。宗气反聚。血结心下。阳气退下。热归阴股。与阴相动。令身不仁。此为
尸厥。其乘寒之厥。郁冒不仁。即此尸厥可知矣。昔越人入虢诊太子为尸厥。以郁
冒不仁为可治。刺之而得痊济者。实神医之诊也。呜呼。设或脉浮而洪。身汗如油。
喘而不休。水浆不下。形体不仁。此又为命绝。虽越人其能起之欤。
Translation:
What is meant by "numbness" (Bu Ren) in cold damage? Let us clarify it. "Ren" means soft and flexible. "Bu Ren" refers to a lack of softness and flexibility. It means being unaware of itching, unaware of pain, unaware of cold, and unaware of heat. One allows the body to bend or straighten, undergo moxibustion or acupuncture, yet remains unaware of why this is happening; this is called "numbness". This condition arises because pathogenic qi is abundant and obstructing, while healthy qi is closed off and suppressed by the pathogenic qi, stagnating and unable to manifest. The defensive and nutritive blood and qi are deficient and insufficient, failing to circulate freely, leading to this state. The *Neijing* states: "When nutritive qi is deficient, there is numbness." The *Zhenjing* states: "When defensive qi does not flow, there is numbness." Another classic says: "When defensive and nutritive qi cannot support each other, and the Triple Burner has no reliance, the body becomes bi-syndrome and numb." From these statements, it is clear that when nutritive and defensive blood and qi are deficient and fail to circulate, numbness occurs. Another classic says: "Those affected by cold become Jue (cold extremities/stagnation), with depression, dizziness, and numbness." Regarding this type of Jue, it is caused by healthy qi being overwhelmed by cold qi, becoming Jue qi. It is not the Jue characterized by cold limbs. Why? Because "depression and dizziness" imply confusion, numbness, and unawareness of pain and itch. Could this not be the Jue of Corpse Jue (Shi Jue)? The classic states: "When the Shaoyin pulse is absent, kidney qi is weak and scant. Essence and blood surge, qi becomes urgent and pressing, ascending into the chest and diaphragm. Zongqi (Gathering Qi) gathers in reverse, blood congeals below the heart. Yang qi retreats downward, heat returns to the inner thighs, interacting with yin, causing the body to become numb. This is called Corpse Jue." Thus, the Jue caused by cold, with depression, dizziness, and numbness, can be understood through this Corpse Jue. In the past, Yue Ren (Bian Que) entered Guo to diagnose the Crown Prince with Corpse Jue. He considered the depression, dizziness, and numbness as treatable, and after acupuncture, he recovered. This was truly the diagnosis of a divine physician. Alas! If the pulse is floating and surging, sweat flows like oil, panting does not cease, fluids and food cannot be taken in, and the body is numb, this is another sign of life ending. Even if Yue Ren were here, could he revive him?
伤寒直视。何以明之。直视者。视物而目精不转动者是也。若目精转者。非直视也。
水之精为志。火之精为神。目者心之使也。神所寓焉。肝之外候也。精神荣焉。针经
曰。五脏六腑之气。皆上注于目。而为之精。精之窠为眼之睛。精为瞳子。筋之精为
黑睛。血之精为络。气之精为白睛。肌肉之精为约束。裹撷筋骨。血气之精。与脉并
为系。上属于脑。五脏血气充荣。则目和而明矣。伤寒目直视者。邪气壅盛。冒其正
气。使神智不慧。藏精之气不上荣于目。则目为之直视。伤寒至于直视。为邪气已
极。证候已逆。多难治。经曰。衄家不可发汗。汗出则额上陷。脉急紧。直视不能 。不
得眠。以肝受血而能视。亡血家肝气已虚。目气已弱。又发汗亡阳。则阴阳俱虚所
致也。此虽错逆。其未甚也。逮乎狂言。反目直视。又为肾绝。直视摇头。又为心绝。皆
脏气脱绝也。直视谵语。喘满者死。下利者亦死。又剧者发则不识人。循衣摸床。惕
而不安。微喘直视。脉弦者生。涩者死。皆邪气盛而正气脱也。其或有目中不了了。
睛不和。无表里证。大便难。身微热者。是非直视也。此为内实也。可用大承气汤、大
柴胡汤下之。直视为不治之疾。目中不了了。为可治之候。二者形证相近。其为工
者。宜熟视之。
Translation:
What is meant by "fixed gaze" (Zhi Shi) in cold damage? Fixed gaze refers to looking at objects without the eyeballs moving. If the eyeballs move, it is not fixed gaze. The essence of water is Zhi (Will). The essence of fire is Shen (Spirit). The eyes are the envoys of the Heart. Shen resides therein. They are the external manifestation of the Liver. Spirit and essence flourish there. The *Zhenjing* states: "The qi of the five zang and six fu organs all ascend to the eyes, forming their essence. The nest of essence forms the pupil of the eye. The essence forms the pupil. The essence of sinews forms the black part of the eye. The essence of blood forms the collaterals. The essence of qi forms the white part of the eye. The essence of muscles forms the eyelids/restraints. Wrapping and grasping sinews and bones, the essence of blood and qi, along with the vessels, form the meridians. These ascend and connect to the brain. When the blood and qi of the five zang organs are abundant and flourishing, the eyes are harmonious and bright. In cold damage, fixed gaze of the eyes occurs because pathogenic qi is abundant and obstructing, covering the healthy qi, causing spirit and intellect to become dull. The essence qi of the zang organs fails to ascend to nourish the eyes, resulting in fixed gaze. When cold damage progresses to fixed gaze, it means pathogenic qi is at its extreme, and the syndrome pattern is reversed; it is often difficult to treat. The classic states: "For those prone to nosebleeds, sweating therapy should not be used. If sweat occurs, the temples sink, the pulse is urgent and tight, there is fixed gaze, inability to blink, and insomnia." Since the liver receives blood to enable vision, for those who have lost blood, liver qi is already deficient, and eye qi is already weak. Furthermore, inducing sweating depletes yang, leading to deficiency of both yin and yang. Although this is disordered and reversed, it is not yet severe. However, when delirious speech occurs, eyes roll back and gaze is fixed, this indicates Kidney exhaustion. Fixed gaze with head shaking indicates Heart exhaustion. All are signs of organ qi depletion and exhaustion. Fixed gaze with delirium, panting, and fullness leads to death. Diarrhea also leads to death. More severely, upon onset, one does not recognize people, picks at clothes, touches the bed, is startled and uneasy, has slight panting and fixed gaze. If the pulse is wiry, there is survival; if choppy, there is death. All are due to abundant pathogenic qi and depleted healthy qi. If there is unclear vision ("Mu Zhong Liao Liao Bu"), unharmonious pupils, no exterior or interior syndromes, difficulty defecating, and slight fever, this is not fixed gaze. This is internal excess. Da Cheng Qi Tang (Major Order the Qi Decoction) or Da Chai Hu Tang (Major Bupleurum Decoction) can be used to purge it. Fixed gaze is an untreatable disease. Unclear vision is a treatable sign. The manifestations and symptoms of these two are similar. Practitioners should examine them carefully.
Cold Damage Numbness. How shall we elucidate it? "Ren" implies softness and flexibility. "Bu Ren" denotes a lack of such softness and flexibility. It signifies an insensitivity to itching, an insensitivity to pain, an insensitivity to cold, and an insensitivity to heat. One permits the body to flex or extend, or undergoes moxibustion and acupuncture, yet remains unaware of the reasons behind these sensations or actions; this is termed "Bu Ren" (numbness/loss of sensation). This condition arises from the abundance and obstruction of Pathogenic Qi (Xie Qi), which closes off and suppresses Healthy Qi (Zheng Qi), causing stagnation and failure to manifest. The Ying (Nutritive) and Wei (Defensive) blood and qi become deficient and scant, failing to circulate freely, thereby resulting in this state. The *Neijing* states: "When Ying Qi is deficient, there is numbness." The *Zhenjing* states: "When Wei Qi does not flow, there is numbness." Another classic states: "When Ying and Wei Qi cannot support each other, and the San Jiao (Triple Burner) has no reliance, the body suffers from Bi syndrome and numbness." From these statements, it is evident that when Ying and Wei blood and qi are deficient and fail to circulate, numbness occurs. Another classic states: "Those affected by cold develop Jue (cold extremities/stagnation), accompanied by depression, dizziness, and numbness." Regarding this specific type of Jue, it is caused by Healthy Qi being overwhelmed by Cold Qi, transforming into Jue Qi. It is not the Jue characterized by cold extremities. Why? Because "depression and dizziness" imply confusion, numbness, and insensitivity to pain and itch. Could this not be the Jue associated with Shi Jue (Corpse Jue)? The classic states: "When the Shao Yin pulse is absent, Kidney Qi is weak and scant. Essence and Blood surge, Qi becomes urgent and pressing, ascending into the chest and diaphragm. Zong Qi (Gathering Qi) gathers in reverse, Blood congeals below the heart. Yang Qi retreats downward, Heat returns to the inner thighs, interacting with Yin, causing the body to become numb. This is called Shi Jue." Thus, the Jue caused by cold, with depression, dizziness, and numbness, can be understood through the concept of Shi Jue. In antiquity, Yue Ren (Bian Que) entered the State of Guo to diagnose the Crown Prince with Shi Jue. He considered the depression, dizziness, and numbness as treatable, and after acupuncture, the patient recovered. This was indeed the diagnosis of a divine physician. Alas! If the pulse is floating and surging, sweat flows like oil, panting does not cease, fluids and food cannot be ingested, and the body is numb, this is another sign of life ending. Even if Yue Ren were present, could he revive him?
Cold Damage Fixed Gaze. How shall we elucidate it? Fixed gaze (Zhi Shi) refers to looking at objects without the movement of the eyeballs. If the eyeballs move, it is not fixed gaze. The essence of Water is Zhi (Will). The essence of Fire is Shen (Spirit). The eyes are the envoys of the Heart. Shen resides therein. They are the external manifestation of the Liver. Spirit and essence flourish there. The *Zhenjing* states: "The Qi of the Five Zang and Six Fu organs all ascends to the eyes, forming their essence. The nest of essence forms the pupil of the eye. The essence forms the pupil. The essence of Sinews forms the black part of the eye. The essence of Blood forms the collaterals. The essence of Qi forms the white part of the eye. The essence of Muscles forms the eyelid restraints. Wrapping and grasping sinews and bones, the essence of Blood and Qi, along with the vessels, form the meridians. These ascend and connect to the Brain. When the blood and qi of the Five Zang organs are abundant and flourishing, the eyes are harmonious and bright. In cold damage, fixed gaze of the eyes occurs because Pathogenic Qi is abundant and obstructing, covering the Healthy Qi, causing spirit and intellect to become dull. The essence Qi of the Zang organs fails to ascend to nourish the eyes, resulting in fixed gaze. When cold damage progresses to fixed gaze, it indicates that Pathogenic Qi is at its extreme, and the syndrome pattern is reversed; it is often difficult to treat. The classic states: "For those prone to epistaxis, sweating therapy should not be used. If sweat occurs, the temples sink, the pulse is urgent and tight, there is fixed gaze, inability to blink, and insomnia." Since the Liver receives blood to enable vision, for those who have lost blood, Liver Qi is already deficient, and Eye Qi is already weak. Furthermore, inducing sweating depletes Yang, leading to deficiency of both Yin and Yang. Although this is disordered and reversed, it is not yet severe. However, when delirious speech occurs, eyes roll back and gaze is fixed, this indicates Kidney Exhaustion. Fixed gaze with head shaking indicates Heart Exhaustion. All are signs of Organ Qi depletion and exhaustion. Fixed gaze with delirium, panting, and fullness leads to death. Diarrhea also leads to death. More severely, upon onset, one does not recognize people, picks at clothes, touches the bed, is startled and uneasy, has slight panting and fixed gaze. If the pulse is Wiry (Xian), there is survival; if Choppy (Se), there is death. All are due to abundant Pathogenic Qi and depleted Healthy Qi. If there is unclear vision ("Mu Zhong Liao Liao Bu"), unharmonious pupils, no Exterior or Interior syndromes, difficulty defecating, and slight fever, this is not fixed gaze. This is Internal Excess. Da Cheng Qi Tang (Major Order the Qi Decoction) or Da Chai Hu Tang (Major Bupleurum Decoction) can be used to purge it. Fixed gaze is an untreatable disease. Unclear vision is a treatable sign. The manifestations and symptoms of these two are similar. Practitioners should examine them carefully.