太阴厥阴。皆以里症为提纲。太阴为阴中之至阴而主寒。故不渴。厥阴为阴中之阳而主热。故消渴也。太阴主湿土。
土病则气陷下。湿邪入胃。故腹痛自利。厥阴主相火。火病则气上逆。火邪入心。故心中疼热也。太阴腹满而吐。食不
下。厥阴饥不欲食。食即吐蛔。同是食不下。太阴则满。厥阴则饥。同是一吐。太阴则吐食。厥阴则吐蛔。此又属土属
木之别也。太阴为开。本自利。而下之则开拆胸下结硬者。开拆反合也。厥阴为合。气上逆。而下之则合拆。利不止者。
合拆反开也。两阴交尽。名曰厥阴。又名阴之绝阳。是厥阴宜无热矣。然厥阴主肝。而胆藏内。则厥阴热症。皆少阳相
火内发也。要知少阳厥阴。同一相火。相火郁于内。是厥阴病。相火出于表。为少阳病。少阳咽干。即厥阴消渴之机。
胸胁苦满。即气上撞心之兆。心烦即疼热之初。不欲食。是饥不欲食之根。喜呕。即吐蛔之渐。故少阳不解。转属厥阴
而病危。厥阴病衰。转属少阳而欲愈。如伤寒热少厥微。指头寒。不欲食。至热除欲食。其病愈者是也。
太阴提纲。是内伤寒。不是外感。厥阴提纲。是温病而非伤寒。要知六经各有主症。是仲景伤寒杂病合论旨也。
诸经伤寒无渴症。太阳不恶寒而渴。是温病矣。杂症矣。惟厥阴伤寒。肝木郁而不得出。热甚于内。欲窃母气以克
火。故渴欲饮水。若不恶寒。当作温病治之。要知温乃风木之邪。是厥阴本病。消渴是温病之本。厥利是温病之变。内
经所谓热病。皆伤寒之类。此正其类矣。
厥阴消渴。即以水饮之。所以顺其欲。然少与之。可以平亢火。多与之。反以益阴邪。当量其消与不消。恐水渍入
胃耳。
渴欲饮水。与饥不欲食对看。始尽厥阴病情。
手足厥冷。脉微欲绝。是厥阴伤寒之外症。当归四逆。是厥阴伤寒之表药。夫阴寒如此。而不同姜附者。以相火寄
于肝位。虽寒而脏不寒。故先厥者。后必发热。手足愈冷。肝胆愈热。故厥深热亦深。所以伤寒初起脉症如此者。不得
遽认为虚寒。妄投姜附以遗患也。厥者必发热。热与厥相应。热深厥亦深。热微厥亦微。此四症。是厥阴伤寒之定局。
先热后厥。厥热往来。厥多热少。热多厥少。此四症。是厥阴伤寒之变局。皆因其人阳气多寡而然。如太阳伤寒。亦有
已发热未发热之互辞也。
内经之寒热二厥。因于内伤。与本论因外邪者不同。内经热厥。只在足心。是肾水起涌泉之下也。本论热厥。因热
在肝脏。而手足反寒。故曰厥深热亦深。内经之寒厥。有寒无热。本论之寒厥。先厥者。后必发热。热胜则生。寒胜
则死。此内伤外感之别。
厥阴有晦朔合具之理。阴极阳生。故厥阴伤寒反以阳为主。厥少热多。是为生阳。故病当愈。厥多热少。是为死阴。
故病为进。如热气有余者。或便脓血。或发痈脓。亦与内经热厥不同。
阴气起于五指之里。阳气起于五指之表。气血和调。营卫以行。则阴阳相贯。如环之无端也。厥阴无阳。厥阴病
则阴阳不顺接。故手足逆冷。若热少厥微而指头寒。知病可愈。手足反温者。虽下利必自愈。此阴阳自和而顺接也。盖
脉微烦躁灸厥阴。厥不还者死。是阴阳之气绝矣。
本论云。诸四逆厥者。不可下。又曰厥应下之。而反发汗者。必口伤烂赤二义不同。当理会上下文。盖诸四逆是指
虚寒症言。故曰虚家亦然。应下之。是单指热厥言。故曰厥深热亦深。盖发汗。只能引火上升。不能逐热外散。故令口
伤。若手足厥冷。脉微欲绝。此时外寒切迫。内热未起。又当发汗。
厥而脉微欲绝。是伤寒所起之脉。所谓不可下者是矣。脉滑而厥。是内热闭郁之脉。所谓厥应下之是已。下之是
下其热。非下其实。泄利下重者。四逆散。欲饮水数升者。白虎汤。此厥阴之下药。所以下无形之邪也。若以承气下之。
利不止矣。诊厥阴病以阳为主。而治厥阴病以阴为主。故当归四逆不去芍药。白头翁汤重用连柏。乌梅丸用黄连至一斤。
又佐黄柏六两。复脉汤用地黄至一斤。又佐麦冬八两。要知脉微欲绝。手足厥冷者。虽是阴盛。亦不阳虚。故即可表散
外邪。而不可固里。脉代结。心动悸者。似乎阳虚。实为阴弱。只可太剂滋阴。而不可温补。所以然者。肝之相火本少
阳之生气。而少阳实出于坎宫之真阴。经曰。阳予之正。阴为之主。又曰。阴虚则无气。又曰。少火生气。壮火实气。
审此。则知治厥阴之理矣。
中州。四肢。皆脾所主。厥阴伤寒。手足逆冷。而又下利。是木克土也。复发热者。下利必自止。火生土也。若肝
火上行逼心。故反汗出。气上撞心。心不受邪。因而越之。故咽中痛。而喉为痹耳。若发热而利。汗出不止者死。是阳
虚外亡。为有阴无阳。与少阴亡阳同义。若肝火内行而入脾。土火合德。必无汗而利自止。若发热而利不止。此肝火内
陷。血室不宁。故便脓血。若发热下利至甚。厥不止者死。是土败木贼。诸阳之本绝也。厥阴伤寒。有乘脾乘肺二症。
疑似难明。最当详辨。一曰伤寒腹满 语。寸口脉浮而紧。此肝乘脾也。名曰纵。刺期门。夫腹满 语。似胃家实。然
脉浮紧而不潮热。非阳明脉也。脉法曰。脉浮而紧者。名曰弦。此弦为肝脉矣。内经曰。诸腹胀大。皆属于热。又曰。
肝气盛则多言。是腹满由肝火。而 语乃肝气所发也。木旺则侮其所胜。直犯脾土。故名纵。一曰伤寒发热。啬啬恶寒。
大渴欲饮水。其腹必满。此肝乘肺也。名曰横。刺期门。夫发热恶寒。似太阳之表。未经大汗而大渴。非转属阳明。未
经妄下而腹满。非转属太阴。且头不痛。胃不实。不下利。断非三阴症矣。要知发热恶寒。是肺病。肺虚而肝火乘之。
脾畏木邪。水精不上归于肺。故大渴。肺不能通调水道。故腹满。是侮所不胜。寡于畏也。故名横。一纵而乘脾。一横
而乘肺。总是肝有亢火。当泻无补。必刺期门。随其实而泻之。募原清。则三气皆顺。表里尽解矣。此非汗吐下清利诸
法所可治。故宜针。
伤寒阳脉涩。阴脉弦。腹中急痛者。此亦肝乘脾也。故先与小建中安脾。继与小柴胡疏木。要知小建中。是桂枝汤。
加芍药以平肝。加饴糖以缓急。为厥阴伤寒驱邪发表和中止痛之神剂也。不瘥者。中气虚而不振。邪尚留连。继以小
柴胡补中发表。令木邪直走少阳。使有出路。所谓阴出之阳则愈也。仲景有一症而用两方者。在太阳先麻黄继桂枝。是
先外后内法。在厥阴先建中继柴胡。是先内后外法。亦是令厥阴转属少阳之机。
伤寒厥而心下悸者。此亦肝乘肺也。虽不发热恶寒。亦木实金虚。水气不利所致。彼腹满者。是水气在中焦。故刺
期门以泻其实。此水在上焦。故用茯苓甘草汤以发其汗。此方是代水为汗。发邪内散之剂。即厥阴治厥之剂也。
厥阴中风之脉。与他经不同。凡脉浮为风。此云不浮为未愈。是厥阴中风。脉反沉矣。此木犹阴处。风入地中。木
郁不舒。故未愈。微浮是风行地上。草木发陈。复厥阴风木之常。故愈也。
凡脉浮为在表。沉为在里。厥阴中风。其脉既沉。其症亦为在里。此热利下重。是厥阴中风也。太阳中风。下利呕
逆。是有水气。厥阴中风。热利下重。是有火气。故以白头翁为主以治风。芩连为辅以清火。佐秦皮以升九地之风。则
肝木欣欣向荣矣。下利而渴欲饮水。是厥阴之消渴。亦中风之烦所致也。下利脉沉弦。是沉为在里。弦为风脉。弦而大。
是风因火动。故利未止微弱数者。是风少火微。故为自止。虽发热不死者。阴出之阳也。下利有微热汗出。是中风本症。
里症出表。则风从外散。故令自愈。欲愈之脉当微浮。若寸脉反浮数。风去而热不去。尺中自涩者。热属阴络。肝血不
藏。必便脓血也。
厥阴中风之热利。是里有热。伤寒亦有热利。是里有寒。又与厥利不同。厥利见发热则利止。此六七日不利。便发
热而利。汗出不止。是外热内寒。故谓之有阴无阳。要知内经之舌卷囊缩。是有阳无阴。故热虽甚而可治。
阴阳易之为病。本于厥阴之欲火。始也因肝火之动。致伤少阴之精继也。少阴之精不藏。厥阴之火不羁。所以少阴
里虚。阴中拘挛。热上冲胸。眼中生花。头重不欲举。皆厥阴相火为眚。顿令无病之人。筋脉形气为之一变。此即温疫
传染。遗祸他人之一症也。
太阴病和厥阴病，都是以里证作为提纲。太阴是阴中之至阴，主要主管寒邪，所以患者不口渴。厥阴是阴中之阳，主要主管热邪，所以患者会出现消渴（大量饮水仍觉口干）的症状。太阴主司湿土，土发生病变则气机下陷，湿邪侵入胃中，所以出现腹痛和自发性腹泻。厥阴主司相火，火发生病变则气机上逆，火邪侵入心包，所以心中感觉疼痛且发热。太阴病表现为腹部胀满且呕吐，食物无法咽下；厥阴病表现为饥饿但不想吃东西，吃东西就会吐出蛔虫。同样是食物难以下咽，太阴病是腹胀，厥阴病是饥饿感；同样都是呕吐，太阴病是吐出食物，厥阴病是吐出蛔虫。这又是由于属土和属木的区别所致。
太阴病属于“开”的功能失常，本应有腹泻，如果误用攻下法，会导致原本该开的部位闭塞，胸下形成结硬，这是“开”变成了“合”。厥阴病属于“合”的功能失常，气机上逆，如果误用攻下法，会导致原本该合的部位拆散，导致腹泻不止，这是“合”变成了“开”。两阴相交尽处，称为厥阴，又被称为阴之绝阳，按理说厥阴应该没有热症。然而厥阴主肝，胆腑寄居于内，所以厥阴的热症，都是由少阳相火在内发动所致。要知道少阳和厥阴，同属相火。相火郁结在体内，就是厥阴病；相火发散到体表，就是少阳病。少阳病的咽干，就是厥阴病消渴的机理；胸胁苦满，就是气上撞心的征兆；心烦，就是心中疼热的初期表现；不想吃东西，是饥不欲食的根源；喜欢呕吐，是吐蛔的前兆。所以少阳病不解，转属到厥阴，病情就会危重；厥阴病衰退，转属到少阳，病情就会痊愈。例如伤寒热象轻微、四肢厥冷轻微，仅指尖发凉，不想吃东西，等到热退去、想要吃东西时，病就痊愈了，这就是例子。
太阴病的提纲，指的是内伤寒，不是外感病。厥阴病的提纲，指的是温病而不是伤寒。要知道六经各有其主症，这是张仲景将伤寒与杂病合并论述的宗旨。各经的伤寒通常没有口渴症状，太阳病如果不恶寒而口渴，那就是温病了，或者是杂病了。只有厥阴伤寒，是因为肝木郁结而不能疏泄，内部热势严重，想要借用母气（肾水）来克制火邪，所以口渴想喝水。如果不恶寒，就应当当作温病来治疗。要知道温病是风木之邪，是厥阴的本病，消渴是温病的根本表现，厥逆下利是温病的变证。《内经》所说的热病，都属于伤寒的类别，这正是其中的类证。
对于厥阴病的消渴，虽然给予水饮以顺应其欲望，但要少量给予，这样可以平抑亢盛的火邪；如果大量给予，反而会助长阴邪。应当根据患者喝水后是否缓解来判断，担心水液浸渍进入胃中。
口渴想喝水，要与饥饿但不想吃东西对照来看，这样才能完全了解厥阴病的病情。
手足厥冷，脉微细几乎摸不到，这是厥阴伤寒的外在症状。当归四逆汤，是治疗厥阴伤寒表证的方剂。阴寒如此严重，却不用干姜、附子，是因为相火寄居于肝脏之位，虽然外表寒冷，但脏腑内部并不寒。所以先出现厥冷的，后来必定会发热。手足越冷，肝胆内部的火就越热，所以说“厥深热亦深”。因此，伤寒初起出现这种脉症时，不能立刻认定为虚寒证，妄投姜、附等温热药物而留下后患。厥逆必然伴随发热，发热与厥冷相应，热深则厥深，热微则厥微。这四个症状，是厥阴伤寒的定局。先发热后厥冷，厥冷与发热交替出现，厥多热少，热多厥少，这四个症状，是厥阴伤寒的变局。这都是因为人体阳气多少不同而导致的。如太阳伤寒，也有已发热和未发热的互文说法。
《内经》中的寒热二厥，是由于内伤引起的，与本论中因外邪引起的不同。《内经》的热厥，只在足心发热，这是因为肾水从涌泉穴之下升起。本论的热厥，是因为热在肝脏，而手足反而寒冷，所以说“厥深热亦深”。《内经》的寒厥，只有寒而没有热；本论的寒厥，先出现厥冷，后来必定会发热，热胜则生，寒胜则死。这是内伤与外感的区别。
厥阴具有晦朔（农历每月最后一天和第一天）交替的道理，阴极则阳生，所以厥阴伤寒反而以阳气为主。厥少热多，这是生阳，所以病应当痊愈；厥多热少，这是死阴，所以病情会加重。如果热气有余，或者大便脓血，或者发生痈脓，这也与《内经》的热厥不同。
阴气起始于脚趾内侧，阳气起始于脚趾外侧。气血调和，营卫运行，则阴阳相互贯通，像圆环一样没有尽头。厥阴无阳，厥阴病时阴阳之气不顺接，所以手足逆冷。如果热象轻微、厥冷轻微，仅指尖发凉，知道病可以痊愈；手足反而温暖，即使有腹泻也必定自愈，这是阴阳自我调和而顺接的表现。如果说脉微烦躁，灸治厥阴穴后，厥冷不回者死，这是阴阳之气断绝了。
本论说：“诸四逆厥者，不可下。”又说：“厥应下之。”而反用发汗法，必定导致口舌生疮溃烂。这两种说法意义不同，应当结合上下文理解。大概“诸四逆”是指虚寒证而言，所以说“虚家亦然”。“应下之”，是单指热厥而言，所以说“厥深热亦深”。发汗只能引火上升，不能驱逐热邪向外散发，所以导致口舌受伤。如果手足厥冷，脉微欲绝，此时外寒紧迫，内热尚未产生，又应当发汗。
厥逆而脉微欲绝，是伤寒发作时的脉象，所谓“不可下”就是指这种情况。脉滑而厥，是内热闭郁的脉象，所谓“厥应下之”就是指这种情况。下法是用来下其热，不是下其实邪。泄利下重的，用四逆散；想喝几升水的，用白虎汤。这些是厥阴病用于下法的方药，所以下的是无形的邪气。如果用承气汤类攻下，腹泻就不会停止。诊断厥阴病以阳气为主，而治疗厥阴病以阴液为主。所以当归四逆汤不去芍药，白头翁汤重用黄连、黄柏，乌梅丸用黄连至一斤，又佐以黄柏六两，复脉汤用地黄至一斤，又佐以麦冬八两。要知道脉微欲绝、手足厥冷者，虽然是阴盛，但也不是阳虚，所以既可以表散外邪，也不可以固护里气。脉代结、心动悸者，似乎阳虚，实则是阴弱，只可大量滋阴，而不可以温补。之所以这样，是因为肝的相火本是少阳的生气，而少阳实际上出于坎宫的真阴。经书说：“阳予之正，阴为之主。”又说：“阴虚则无气。”又说：“少火生气，壮火食气。”审察这一点，就知道治疗厥阴病的道理了。
中州（脾胃）、四肢，都由脾所主。厥阴伤寒，手足逆冷，而又腹泻，这是木克土。如果重新发热，腹泻必定自行停止，这是火生土。如果肝火上行的逼迫心脏，所以反而出汗，气上撞心，心脏不受邪气侵袭，因而邪气上越，所以咽喉疼痛，喉部痹阻。如果发热而腹泻，出汗不止，就会死亡，这是阳虚外亡，为有阴无阳，与少阴亡阳的意义相同。如果肝火内行而入脾，土火合德，必定无汗而腹泻自止。如果发热而腹泻不止，这是肝火内陷，血室不安宁，所以大便脓血。如果发热下利非常严重，厥冷不止，就会死亡，这是土败木贼，诸阳的根本断绝了。厥阴伤寒，有乘脾和乘肺两种症状，疑似难辨，最应当详细辨别。一种叫伤寒腹满谵语，寸口脉浮而紧，这是肝乘脾，名叫纵，刺期门穴。腹满谵语，看似胃家实证，然而脉浮紧而不潮热，不是阳明脉。脉法说：脉浮而紧，名叫弦。这弦脉就是肝脉。《内经》说：各种腹胀大，都归属于热。又说：肝气盛则多言。所以腹满是肝火所致，谵语是肝气所发。木旺则侮其所胜，直接侵犯脾土，所以名叫纵。另一种叫伤寒发热，啬啬恶寒，大渴想喝水，腹部必定胀满，这是肝乘肺，名叫横，刺期门穴。发热恶寒，看似太阳表证，未经大汗而大渴，不是转属阳明；未经误下而腹满，不是转属太阴；且头不痛，胃不实，不下利，绝非三阴病。要知道发热恶寒，是肺病，肺虚而肝火乘袭之，脾畏惧木邪，水精不能上归于肺，所以大渴；肺不能通调水道，所以腹满。这是侮所不胜，寡于畏忌，所以名叫横。一纵而乘脾，一横而乘肺，总是肝有亢火，应当泻而不可补，必须刺期门穴，随其实证而泻之，募原清利，则三气皆顺，表里尽解。这不是汗、吐、下、清、利诸法所能治疗的，所以适宜用针刺。
伤寒阳脉涩，阴脉弦，腹中急痛，这也是肝乘脾。所以先给予小建中汤安脾，继而又给予小柴胡汤疏木。要知道小建中汤是桂枝汤加芍药以平肝，加饴糖以缓急，是厥阴伤寒驱邪发表、和中止痛的神剂。如果不愈，是中气虚弱而不能振奋，邪气尚留连，继用小柴胡汤补中发表，令木邪直走少阳，使有出路，所谓阴出之阳则愈。张仲景有一症而用两方的情况，在太阳病是先麻黄汤继桂枝汤，是先外后内的方法；在厥阴病是先小建中汤继小柴胡汤，是先内后外的方法，也是令厥阴转属少阳的契机。
伤寒厥逆而心下悸动，这也是肝乘肺。虽然不发热恶寒，也是木实金虚，水气不利所致。那个腹满的，是水气在中焦，所以刺期门以泻其实；这个水在上焦，所以用茯苓甘草汤以发其汗。此方是将水化为汗，发散内邪的方剂，也就是治疗厥阴厥逆的方剂。
厥阴中风的脉象，与其他经不同。凡是脉浮为中风，这里说不浮为未愈，说明厥阴中风，脉反而沉。这是因为木犹在阴处，风入地中，木气郁结不舒展，所以未愈。脉微浮是风行地上，草木发陈，恢复厥阴风木的常态，所以痊愈。
凡是脉浮为在表，沉为在里。厥阴中风，其脉既沉，其症也为在里。这里的“热利下重”，是厥阴中风。太阳中风，下利呕逆，是有水气；厥阴中风，热利下重，是有火气。所以以白头翁为主药以治风，芩、连为辅药以清火，佐秦皮以升九地之风，则肝木欣欣向荣。下利而渴欲饮水，是厥阴的消渴，也是中风之烦所致。下利脉沉弦，沉为在里，弦为风脉。弦而大，是风因火动，所以利未止。微弱数者，是风少火微，所以为自止。虽发热不死者，是阴出之阳。下利有微热汗出，是中风本症，里症出表，则风从外散，所以令自愈。欲愈之脉当微浮。若寸脉反浮数，风去而热不去，尺中自涩者，热属阴络，肝血不藏，必便脓血。
厥阴中风的热利，是里有热；伤寒也有热利，是里有寒。又与厥利不同。厥利见发热则利止，此六七日不利，便发热而利，汗出不止，是外热内寒，故谓之有阴无阳。要知道《内经》的舌卷囊缩，是有阳无阴，故热虽甚而可治。
阴阳易之为病，本于厥阴的欲火。开始时因肝火之动，致伤少阴之精；接着少阴之精不藏，厥阴之火不羁。所以少阴里虚，阴中拘挛，热上冲胸，眼中生花，头重不欲举，都是厥阴相火为害，顿令无病之人，筋脉形气为之一变。这就是温疫传染，遗祸他人的一种病症。
Taiyin and Jueyin diseases both take interior syndromes as their guiding principles. Taiyin is the extreme yin within yin and governs cold; therefore, there is no thirst. Jueyin is yang within yin and governs heat; therefore, xiaoke (polydipsia) occurs. Taiyin governs damp earth. When earth is diseased, qi sinks downward, and damp pathogen enters the stomach, causing abdominal pain and spontaneous diarrhea. Jueyin governs ministerial fire. When fire is diseased, qi rebels upward, and fire pathogen enters the heart, causing pain and heat in the heart. Taiyin presents with abdominal fullness and vomiting, with food unable to go down. Jueyin presents with hunger but no desire to eat, and vomiting roundworms upon eating. Both involve food failing to go down: Taiyin involves fullness, while Jueyin involves hunger. Both involve vomiting: Taiyin involves vomiting food, while Jueyin involves vomiting roundworms. This further distinguishes between those belonging to Earth and those belonging to Wood.
Taiyin belongs to "opening." It naturally has diarrhea; if purged, the opening collapses, leading to chest hardness, which is a reversal of opening into closing. Jueyin belongs to "closing." Qi rebels upward; if purged, the closing disintegrates, leading to unceasing diarrhea, which is a reversal of closing into opening. The convergence of two yins is named Jueyin, also known as the absolute yin of yang. Thus, Jueyin should theoretically have no heat. However, Jueyin governs the Liver, and the Gallbladder resides internally; therefore, all Jueyin heat syndromes originate from the internal activation of Shaoyang ministerial fire. One must understand that Shaoyang and Jueyin share the same ministerial fire. When ministerial fire is constrained internally, it is a Jueyin disease; when ministerial fire emerges externally, it is a Shaoyang disease. Shaoyang dry throat is the mechanism behind Jueyin polydipsia; chest and hypochondriac distress is the precursor to qi rushing up to strike the heart; mental irritability is the initial stage of heart pain and heat; lack of desire to eat is the root of hunger without desire to eat; preference for vomiting is the gradual progression toward vomiting roundworms. Therefore, if Shaoyang disease does not resolve and transfers to Jueyin, the condition becomes critical. If Jueyin disease wanes and transfers to Shaoyang, recovery is desired. For example, in Shanghan (Cold Damage), when heat is slight and cold limbs are minimal, with only the fingertips cold and no desire to eat, once the heat subsides and appetite returns, the disease heals. This is an illustration.
The guiding principle of Taiyin refers to internal cold damage, not external contraction. The guiding principle of Jueyin refers to warm disease, not cold damage. One must know that each of the six meridians has its own principal syndrome; this is Zhang Zhongjing's intent in combining Shanghan and miscellaneous diseases in his discussion. Cold damage in the various meridians typically lacks thirst. If Taiyin disease presents without aversion to cold but with thirst, it is a warm disease or a miscellaneous disease. Only in Jueyin cold damage does liver wood become constrained and unable to emerge, causing severe internal heat that seeks to borrow maternal qi (Kidney water) to control fire, resulting in thirst and desire to drink. If there is no aversion to cold, it should be treated as a warm disease. One must understand that warm disease is caused by wind-wood pathogen, which is the primary disease of Jueyin. Polydipsia is the root of warm disease, while jue-li (cold limbs with diarrhea) is a variation of warm disease. What the Neijing calls heat diseases all belong to the category of cold damage; this is precisely such a case.
For Jueyin polydipsia, water is given to accommodate the patient's desire. However, it should be given in small amounts to calm hyperactive fire; giving too much will instead augment yin pathogen. One must assess whether drinking alleviates the thirst, fearing water flooding into the stomach.
Thirst with desire to drink should be viewed in contrast to hunger without desire to eat to fully grasp the pathology of Jueyin disease.
Cold limbs and pulse faint to the point of disappearance are exterior symptoms of Jueyin cold damage. Danggui Sini Decoction is the exterior formula for Jueyin cold damage. Despite such severe yin-cold, Ginger and Aconite are not used because ministerial fire resides in the Liver position. Although the exterior is cold, the zang organs are not cold. Therefore, those who first experience jue will later develop fever. The colder the hands and feet, the hotter the Liver and Gallbladder. Hence, "the deeper the jue, the deeper the heat." Thus, at the onset of Shanghan, when pulse and symptoms present thus, one must not hastily diagnose deficiency-cold and recklessly administer Ginger and Aconite, thereby causing future harm. Jue must be accompanied by fever; fever and jue correspond. Deep heat leads to deep jue; slight heat leads to slight jue. These four presentations constitute the fixed pattern of Jueyin cold damage. Fever followed by jue, alternating jue and fever, more jue than fever, and more fever than jue constitute the variable patterns of Jueyin cold damage. All depend on the quantity of the person's yang qi. For instance, in Taiyin cold damage, there is also the reciprocal usage of "already febrile" and "not yet febrile."
The cold and hot jue in the Neijing result from internal injury, differing from the external pathogens discussed in this treatise. In the Neijing, hot jue is confined to the sole of the foot, arising from Kidney water below the Yongquan acupoint. In this treatise, hot jue results from heat in the Liver, causing cold hands and feet; hence, "the deeper the jue, the deeper the heat." In the Neijing, cold jue involves cold without heat. In this treatise, cold jue begins with cold limbs but is inevitably followed by fever; heat prevailing leads to life, cold prevailing leads to death. This distinguishes internal injury from external contraction.
Jueyin possesses the principle of the conjunction of new and full moons (extreme yin generating yang). Therefore, Jueyin cold damage prioritizes yang. Less jue and more heat indicates generating yang, so the disease should heal. More jue and less heat indicates dying yin, so the disease progresses. If heat qi is excessive, pus and blood may appear in stool, or carbuncles and pus may develop. This differs from the hot jue in the Neijing.
Yin qi originates from the interior of the five toes; yang qi originates from the exterior. When qi and blood harmonize, and Ying and Wei circulate, yin and yang interconnect like a circle without end. Jueyin lacks yang; in Jueyin disease, yin and yang do not connect smoothly, causing reverse cold in the hands and feet. If heat is slight and jue is minimal, with only fingertip cold, the disease can heal. If hands and feet become warm, even with diarrhea, it will self-resolve due to the self-harmonization and smooth connection of yin and yang. Conversely, if pulse is faint with irritability, and after moxibustion of Jueyin points, jue does not reverse, death ensues, indicating the exhaustion of yin and yang qi.
This treatise states: "All cases of Sini jue should not be purged," and also says: "Jue should be purged." Yet, if sweating is induced instead, mouth sores and redness will occur. These two statements differ in meaning and must be understood in context. "All Sini" refers to deficiency-cold syndromes, hence "deficient persons are also like this." "Should be purged" refers specifically to hot jue, hence "the deeper the jue, the deeper the heat." Sweating only draws fire upward and cannot expel heat outward, causing mouth injury. If hands and feet are cold with pulse faint to disappearance, when external cold is pressing and internal heat has not yet arisen, sweating is appropriate.
Jue with pulse faint to disappearance is the pulse of onset in Shanghan, corresponding to "should not be purged." Slippery pulse with jue indicates internal heat constraint, corresponding to "jue should be purged." Purging here targets heat, not excess solid matter. For heaviness in defecation, Six Reversal Powder (Sini San) is used. For intense thirst requiring several liters of water, White Tiger Decoction (Baihu Tang) is used. These are the purgative formulas for Jueyin, targeting formless pathogens. Using Chengqi Decoctions would lead to unceasing diarrhea. Diagnosing Jueyin disease prioritizes yang, but treating it prioritizes yin. Thus, Danggui Sini Decoction retains Peony; Baitouweng Decoction heavily uses Coptis and Phellodendron; Wumei Pill uses one jin of Coptis and adds six liang of Phellodendron; Fumai Decoction uses one jin of Rehmannia and adds eight liang of Ophiopogon. One must know that although faint pulse and cold limbs indicate yin excess, they do not necessarily imply yang deficiency. Exterior pathogens can be dispersed without consolidating the interior. Intermittent pulse and palpitations suggest yang deficiency but actually indicate yin weakness; massive yin-nourishing is required, not warming tonification. This is because the Liver's ministerial fire is the vital qi of Shaoyang, which originates from the true yin of Kan Palace. The Classics state: "Yang provides correctness, Yin serves as master." Also: "Yin deficiency leads to lack of qi." And: "Lesser fire generates qi, greater fire consumes qi." Understanding this reveals the principle of treating Jueyin.
The central region and limbs are governed by the Spleen. In Jueyin cold damage, cold limbs with diarrhea indicate Wood overcoming Earth. If fever returns, diarrhea stops, indicating Fire generating Earth. If Liver fire rises and presses the Heart, sweating occurs, qi rushes up to strike the heart, and since the Heart rejects evil, the pathogen ascends, causing sore throat and pharyngeal bi. If fever, diarrhea, and unceasing sweating occur, death results from yang collapse and external loss, having yin but no yang, equivalent to Shaoyin yang collapse. If Liver fire moves inward to the Spleen, Earth and Fire combine, sweat ceases, and diarrhea stops. If fever and persistent diarrhea occur, Liver fire has sunk inward, disturbing the Blood Chamber, leading to pus and blood in stool. If fever, severe diarrhea, and unceasing jue occur, death results from Earth failure and Wood aggression, severing the root of all yang. Jueyin cold damage has two suspected syndromes: attacking the Spleen and attacking the Lung, which require careful differentiation.
One type is Shanghan with abdominal fullness and delirious speech, floating and tight radial pulse. This is Liver attacking Spleen, named "Zong" (Vertical), treated by puncturing Qimen. Abdominal fullness and delirium resemble Stomach excess, but floating-tight pulse without tidal fever is not Yangming. Pulse theory states: floating and tight is called Xian (Wiry), which is the Liver pulse. The Neijing states: all abdominal distension belongs to heat. Also: Liver qi excess causes talkativeness. Thus, fullness stems from Liver fire, and delirium from Liver qi. Wood excess insults what it overcomes, directly invading Spleen Earth, hence named Zong.
Another type is Shanghan with fever, shivering aversion to cold, intense thirst, and abdominal fullness. This is Liver attacking Lung, named "Heng" (Horizontal), treated by puncturing Qimen. Fever and aversion to cold resemble Taiyang exterior, but intense thirst without heavy sweating is not transferring to Yangming. Abdominal fullness without mistaken purgation is not transferring to Taiyin. No headache, no Stomach excess, no diarrhea rules out Three Yin diseases. Fever and aversion to cold are Lung diseases. Lung deficiency allows Liver fire to invade. Spleen fears Wood, preventing fluid essence from ascending to the Lung, causing intense thirst. Lung fails to regulate water passages, causing abdominal fullness. This insults what it cannot overcome, lacking fear, hence named Heng. One vertical attacking Spleen, one horizontal attacking Lung; both stem from hyperactive Liver fire, requiring draining, not tonifying. Puncturing Qimen drains excess. Clearing the Mu-Yuan allows the three qi to flow smoothly, resolving exterior and interior. This cannot be treated by sweating, vomiting, purging, clearing, or draining methods; acupuncture is indicated.
Shanghan with choppy superficial pulse and wiry deep pulse, with acute abdominal pain, is also Liver attacking Spleen. First, give Xiao Jianzhong Decoction to stabilize Spleen, then Xiaochaihu Decoction to soothe Wood. Xiao Jianzhong Decoction is Guizhi Decoction plus Peony to calm Liver and Malt Sugar to relieve urgency. It is a divine formula for dispelling evil, releasing exterior, harmonizing middle, and relieving pain in Jueyin cold damage. If ineffective, middle qi is deficient and stagnant, with lingering pathogen. Follow with Xiaochaihu Decoction to tonify middle and release exterior, directing Wood pathogen to Shaoyang for an exit, allowing yin to emerge into yang for healing. Zhang Zhongjing uses two formulas for one syndrome: in Taiyang, Mahuang Decoction followed by Guizhi Decoction is exterior-then-interior; in Jueyin, Xiao Jianzhong followed by Xiaochaihu is interior-then-exterior, facilitating transfer from Jueyin to Shaoyang.
Shanghan with jue and epigastric palpitation is also Liver attacking Lung. Even without fever and aversion to cold, it results from Wood excess and Metal deficiency, causing unfavorable Water qi. The abdominal fullness case involves Water qi in the Middle Jiao, treated by puncturing Qimen to drain excess. Here, Water qi is in the Upper Jiao, treated by Fuling Ganjiang Decoction to induce sweating. This formula transforms water into sweat, dispersing internal evil, serving as a treatment for Jueyin jue.
The pulse of Jueyin Wind Strike differs from other meridians. Floating pulse indicates wind; here, non-floating indicates non-recovery. Jueyin Wind Strike features a sinking pulse because Wood remains in yin positions, wind enters the earth, and Wood qi is constrained, hence not recovered. Slight floating indicates wind moving on the ground, vegetation renewing, restoring normal Jueyin wind-wood, hence recovery.
Floating pulse indicates exterior; sinking indicates interior. Jueyin Wind Strike has sinking pulse and interior symptoms. "Hot diarrhea with tenesmus" is Jueyin Wind Strike. Taiyang Wind Strike with diarrhea and vomiting involves Water qi; Jueyin Wind Strike with hot diarrhea and tenesmus involves Fire qi. Thus, Baitouweng Decoction treats wind, Huangqin and Huanglian clear fire, and Qinpi lifts wind from the depths, allowing Liver Wood to flourish. Diarrhea with thirst is Jueyin polydipsia, caused by wind-strike irritability. Diarrhea with sinking-wiry pulse: sinking is interior, wiry is wind. Wiry and large indicates wind stirred by fire, so diarrhea persists. Weak-rapid pulse indicates less wind and slight fire, so it self-resolves. Fever without death indicates yin emerging into yang. Diarrhea with slight fever and sweating is the original wind-strike symptom; interior symptoms emerging to exterior allows wind to scatter outward, leading to self-healing. The pulse for recovery should be slightly floating. If cun pulse is floating-rapid, wind leaves but heat remains; chi pulse is choppy, indicating heat in yin collaterals and uncontained Liver blood, leading to pus and blood in stool.
The hot diarrhea of Jueyin Wind Strike indicates interior heat. Shanghan also has hot diarrhea, but with interior cold. This differs from jue-li. In jue-li, fever stops diarrhea. Here, after six or seven days without diarrhea, fever and diarrhea begin with unceasing sweating, indicating exterior heat and interior cold, termed "having yin but no yang." Note that Neijing's tongue curling and scrotal retraction indicate "having yang but no yin," so despite high heat, it is treatable.
Yin-Yang Exchange disease originates from Jueyin lust. Initially, Liver fire movement injures Shaoyin essence. Subsequently, Shaoyin essence fails to store, and Jueyin fire runs wild. Thus, Shaoyin interior deficiency causes genital cramping, heat rushing to the chest, visual spots, and heavy head unwilling to lift. All are disasters of Jueyin ministerial fire, suddenly altering the sinews, vessels, form, and qi of previously healthy individuals. This is a symptom of warm epidemic transmission, bringing disaster to others.