沉。已为在里。则此条当是初起属太阳。及既入里。虚阳之浮于表者虽仍发热。而寒邪据里。实属
真阴难解。故脉沉。而必治以四逆也。曰反者。见得初起之时。头痛发热。脉宜浮而反沉。其非专
属太阳明矣。故虽治以麻黄而终不瘥。必当以四逆救其里也。夫四逆者。少阴之剂。则此条当属少
阴经症。不得以初起之太阳。遂列太阳篇中。并以为太阳脉似少阴也。至少阴病始得而无头痛。宜
属少阴症矣。曰反热者。以寒邪尚在于表。但皮肤腠理郁闭为热。故用麻黄细辛以发表间之热。而
尤必用附子以温少阴之经。其所以必温之者。以寒邪尚未入里。内未作热也。若寒入里。则必内热
而外不热。当见吐利厥逆等症。不曰反发热矣。
【纲】仲景曰。厥阴之为病。消渴。气上冲心。心中疼热。饥而不欲食。食即吐蛔。下之。利
不止。
【目】李杲曰。阳中之阳水。太阳是也。为三阳之首。能循经传。亦能越经传。阳中之阳土。
阳明是也。夫阳明为中州之土。主纳而不出。如太阳传至此。名曰循经传也。阳中之阳木。少阳是
也。上传阳明。下传太阴。如太阳传至此。为越经传也。阴中之阴土。太阴是也。上传少阳为顺。
下传少阴为逆。此为上下传也。如太阴传太阳。为误下传也。阴中之阳水。少阴是也。上传太阴为
顺。下传厥阴为生。如太阳传至此。乃表传里也。阴中之阴木。厥阴也。上传少阴为实。再传
太阳。为自愈也。太阳者。巨阳也。为诸阳之首。膀胱经病。若渴者。自入于本也。名曰传本。太
阳传阳明胃土者。名曰循经传。为发汗不彻。利小便。余邪不尽。透入于里也。太阳传少阳胆木者。
名曰越经传。为元受病。脉浮无汗。当用麻黄而不用之故也。太阳传少阴肾水者。名曰表传里。
为得病。急当发汗而反下。汗不出。所以传也。太阳传太阴脾土者。名曰误下传。为元受病。脉缓有
汗。当用桂枝。而反下之所致也。当时腹痛。四肢沉重。太阳传厥阴肝木者。为三阴脉不至于首。
惟厥阴与督脉上行。与太阳相接。名曰循经得度传。
李 曰。厥阴。阴尽则变。而厥逆生。盖传经至此已尽。无复可传。再传则逆于首经矣。脉尺
寸俱沉。沉实有力。当下。沉迟无力。当温。浮缓。病自愈。厥阴受病。当六七日发。以其脉循阴
器。络于肝。故唇青舌卷而烦满者。胸中气满急也。或囊拳者。阴囊缩也。在女子则阴户急痛引小
腹。此传经厥阴风热毒深于内也。肝木移热克脾。脾受贼邪。五脏六腑皆困。荣卫不通。耳聋囊缩
而厥。水浆不入。不知人。则死。速下以救。五死一生。或下利谵语者。内有燥屎也。仍宜下之。
或呕而发热者。和之。或发热恶寒如疟。囊不缩。脉微浮。微缓。胃之脉。脾气既全不受贼邪。
荣卫将复。水升火降。寒热作而大汗解矣。或下利腹胀身疼者。当先救表。而后温里。若下利清谷。
大汗出而厥。四肢疼。小腹拘急。或干呕吐沫。或气冲心痛。吐蛔发热消渴。皆厥阴寒症也。宜
温之。以上正文六言。乃万病之祖。非得之内经。不能六言包括无遗如此。凡言六经所见之症。即
此三阳三阴经症也。凡杂病亦然。
柯琴曰。太阴厥阴。皆以里症为提纲。太阴主寒。厥阴主热。太阴为阴中之至阴。厥阴为阴中
之阳也。
鳌按。厥者。绝也。厥阴者。阴绝阳也。阴既绝阳。则本经所发。自无热症。其或有之者。厥
阴之脉络于胆。皆少阳相火所化令也。
脉象沉。说明病邪已在里。那么这一条应当是初起时属于太阳病，等到病邪入里后，虚阳浮越于体表虽然仍然发热，但寒邪占据在里，实际上属于真阴难以化解的情况。所以脉象沉，必须用四逆汤来治疗。说“反”字，是为了表明初起之时，头痛、发热，脉象本应浮而反而沉，这就明显不是专属于太阳病了。所以虽然用麻黄汤治疗但最终不愈，必须用四逆汤来救里。夫四逆汤，是少阴经的方剂，那么这一条应当属于少阴经病症，不能因为初起时的太阳病，就将其列在太阳篇中，并认为这是太阳脉象类似少阴。至于少阴病，刚得病时没有头痛，应当属于少阴症了。说“反发热”，是因为寒邪尚且在表，只是皮肤腠理郁闭导致发热，所以用麻黄、细辛来发表间的热，而且必须用附子来温通少阴经。之所以必须温补，是因为寒邪尚未入里，体内还没有产生内热。如果寒邪入里，则必然出现内热而体表不热，应当见到呕吐、下利、四肢厥逆等症状，就不会说是“反发热”了。
【纲】张仲景说：厥阴病的提纲症状是：口渴，气向上冲撞心脏，心中疼痛且有灼热感，饥饿但不想吃东西，吃了就会吐出蛔虫。如果用攻下法治疗，会导致腹泻不止。
【目】李杲说：阳中的阳水，指的是太阳经。它是三阳经的首位，能沿着经络传变，也能跨越经络传变。阳中的阳土，指的是阳明经。阳明作为中州的土，主受纳而不排出。如太阳病传变至此，称为循经传。阳中的阳木，指的是少阳经。上传至阳明，下传至太阴。如太阳病传变至此，称为越经传。阴中的阴土，指的是太阴经。上传至少阳为顺证，下传至少阴为逆证。这叫做上下传变。如太阴病传变至太阳，称为误下传。阴中的阳水，指的是少阴经。上传至太阴为顺证，下传至厥阴为生机之象。如太阳病传变至此，是从表传入里。阴中的阴木，指的是厥阴经。上传至少阴为实证，再传回太阳，为自愈之象。太阳经，又称巨阳，是诸阳经之首，对应膀胱经病变。如果出现口渴，是病邪自传入本经，称为传本。太阳病传变至阳明胃土，称为循经传，这是因为发汗不彻底，利小便，余邪未尽，透入到里所致。太阳病传变至少阳胆木，称为越经传，这是因为原本患病，脉浮无汗，应当用麻黄汤而没有使用的缘故。太阳病传变至少阴肾水，称为表传里，这是因为得病后，急当发汗却反而用了攻下法，汗不出，所以发生传变。太阳病传变至太阴脾土，称为误下传，这是因为原本患病，脉缓有汗，应当用桂枝汤，却反而用了攻下法所致。当时会出现腹痛、四肢沉重。太阳病传变至厥阴肝木，是因为三阴经的脉气不到达头部，只有厥阴经与督脉上行，与太阳经相接，称为循经得度传。
李杲又说：厥阴，阴气尽则变化，从而产生厥逆。大概传经到此已经尽头，不再有可传之处，再传则逆乱于首经（太阳）。脉象寸部和尺部都沉，沉实有力，应当用攻下法；沉迟无力，应当用温法；浮缓，病会自愈。厥阴经受病，应当在六七日发作，因为其经脉循行经过阴器，联络于肝，所以出现嘴唇青紫、舌头卷缩、烦闷胀满的，是胸中气机满急所致。或者出现阴囊收缩的，是阴囊缩入腹中。在女子则是阴户急痛牵引小腹。这是传经导致的厥阴风热毒邪深伏于内。肝木移热克制脾土，脾受到贼邪侵害，五脏六腑都困顿，营卫不通，出现耳聋、阴囊收缩和厥逆，水浆不能入口，神志不清，则会死亡，需速用攻下法以急救，此时五死一生。或者出现下利伴谵语的，是内有燥屎，仍宜用攻下法。或者出现呕吐且发热的，应用和解法。或者出现发热恶寒像疟疾一样，阴囊不收缩，脉微浮、微缓，这是胃的脉象，脾气既全不受贼邪侵害，营卫即将恢复，水升火降，寒热发作而出大汗则病解。或者出现下利、腹胀、身体疼痛的，应当先救表，而后温里。如果下利完谷不化，大汗出且四肢厥冷，身体疼痛，小腹拘急，或者干呕吐沫，或者气上冲心痛，吐蛔虫、发热、口渴，这些都是厥阴寒症，应当用温法。以上正文六句话，乃是万病的根源，如果不是出自《内经》，不能仅用六句话就概括得如此完备。凡是说六经所见的症状，就是这三阳三阴经的症状。凡是杂病也是如此。
柯琴说：太阴和厥阴，都是以里症作为提纲。太阴主寒，厥阴主热。太阴是阴中之至阴，厥阴是阴中之阳。
沈金鳌按语：厥，意思是断绝。厥阴，意思是阴绝而阳存。既然阴已绝阳，那么本经所发的病，自然没有热症。其中如果有热症的，是因为厥阴的脉络联络于胆，都是少阳相火所化生和令行的结果。
Pulse is deep (Chen). This indicates the pathogen is in the interior. Therefore, this clause should be understood as initially belonging to Taiyang disease, but after entering the interior, although deficient Yang floating on the exterior still causes fever, the cold pathogen occupies the interior, actually representing a true Yin condition that is difficult to resolve. Thus, the pulse is deep, and treatment must employ Sini Tang (Four Reversal Decoction). The term "counter" (Fan) is used to indicate that at the onset, with headache and fever, the pulse should have been floating but was instead deep, clearly showing it does not exclusively belong to Taiyang. Hence, although treated with Mahuang Tang (Ephedra Decoction), it ultimately fails to heal; one must use Sini Tang to rescue the interior. Sini Tang is a formula for Shaoyin disease; thus, this clause belongs to Shaoyin meridian symptoms and should not be listed in the Taiyang chapter merely because of the initial Taiyang presentation, nor should it be considered as Taiyang pulse resembling Shaoyin. As for Shaoyin disease, if there is no headache upon initial onset, it should be classified as Shaoyin syndrome. The term "counter fever" (Fan Re) is used because the cold pathogen remains in the exterior, causing heat due to the stagnation and closure of skin and pores; therefore, Mahuang (Ephedrae Herba) and Xixin (Asari Radix et Rhizoma) are used to release the heat between the exterior, and Fuzi (Aconiti Lateralis Radix Praeparata) must be used to warm the Shaoyin meridian. The reason warming is necessary is that the cold pathogen has not yet entered the interior, so internal heat has not yet formed. If the cold enters the interior, there will necessarily be internal heat without external heat, presenting symptoms such as vomiting, diarrhea, and cold limbs (Jue Ni); it would not be described as "counter fever."
[Gang] Zhang Zhongjing states: The guiding symptoms of Jueyin disease are: excessive thirst (Xiao Ke), Qi rushing up to the heart, pain and burning sensation in the heart region, hunger without desire to eat, and vomiting roundworms upon eating. If purgatives are used, it leads to unceasing diarrhea.
[Mu] Li Gao states: Water among Yang within Yang is Taiyang. It is the head of the Three Yang meridians and can transmit along the meridians or skip meridians. Earth among Yang within Yang is Yangming. Yangming, as the Earth of the Central State, governs reception and does not discharge. If Taiyang transmits here, it is called transmission along the meridian (Xun Jing Chuan). Wood among Yang within Yang is Shaoyang. It transmits upward to Yangming and downward to Taiyin. If Taiyang transmits here, it is called skipping meridian transmission (Yue Jing Chuan). Earth among Yin within Yin is Taiyin. Upward transmission to Shaoyang is favorable; downward transmission to Shaoyin is unfavorable. This is referred to as vertical transmission. If Taiyin transmits to Taiyang, it is called erroneous purgative transmission (Wu Xia Chuan). Water among Yin within Yang is Shaoyin. Upward transmission to Taiyin is favorable; downward transmission to Jueyin represents vitality. If Taiyang transmits here, it is transmission from exterior to interior. Wood among Yin within Yin is Jueyin. Upward transmission to Shaoyin indicates excess; further transmission back to Taiyang indicates spontaneous recovery. Taiyang, also known as Ju Yang, is the head of all Yang meridians and corresponds to Bladder meridian pathology. If thirst occurs, the pathogen has entered its root, called transmission to the root (Chuan Ben). Transmission of Taiyang to Yangming Stomach Earth is called transmission along the meridian, caused by incomplete sweating, diuresis, residual pathogens penetrating inward. Transmission of Taiyang to Shaoyang Gallbladder Wood is called skipping meridian transmission, caused by the original illness where the pulse was floating without sweat, and Mahuang Tang should have been used but was not. Transmission of Taiyang to Shaoyin Kidney Water is called exterior-to-interior transmission, caused by the need for urgent sweating being met with purgation instead, resulting in no sweat and subsequent transmission. Transmission of Taiyang to Taiyin Spleen Earth is called erroneous purgative transmission, caused by the original illness where the pulse was slow with sweat, requiring Guizhi Tang (Cinnamon Twig Decoction), but purgation was wrongly applied. This results in abdominal pain and heavy limbs. Transmission of Taiyang to Jueyin Liver Wood occurs because the Three Yin meridians do not reach the head; only Jueyin and the Du Meridian ascend to connect with Taiyang, called transmission according to degree along the meridian.
Li Gao further states: Jueyin implies the end of Yin leading to change, generating Jue Ni (Reversal Cold). Transmission reaching here is complete, with nowhere left to transmit; further transmission reverses into the first meridian. If the pulse is deep at both Cun and Chi positions, deep and solid with force, purgation is indicated; deep and slow without force, warming is indicated; floating and slow indicates spontaneous recovery. When Jueyin is affected, symptoms typically appear on the sixth or seventh day, as its meridian circulates through the genitalia and connects to the Liver. Thus, blue lips, curled tongue, irritability, and fullness indicate Qi stagnation in the chest. Or testicular retraction (Nang Quan) indicates shrinking of the scrotum. In women, it manifests as acute pain in the vaginal opening radiating to the lower abdomen. This is deep-seated Wind-Heat-Toxin in Jueyin due to meridian transmission. Liver Wood transferring heat to attack Spleen Earth subjects the Spleen to thief-pathogens, distressing all Zang-Fu organs, blocking Ying and Wei, leading to deafness, testicular retraction, and Jue Ni. If food and drink cannot enter and consciousness is lost, death ensues; rapid purgation is needed to save life, with five deaths for every one survival. If diarrhea accompanied by delirium occurs, indicating dry stool inside, purgation is still appropriate. If vomiting with fever occurs, harmonization is indicated. If fever and aversion to cold resemble malaria, with no testicular retraction, and pulse slightly floating and slightly slow (Stomach pulse), indicating Spleen Earth is fully protected from thief-pathogens, Ying and Wei are recovering, Water rises and Fire descends, cold and heat manifest, and profuse sweating resolves the disease. If diarrhea, abdominal distension, and body pain occur, the exterior should be rescued first, then the interior warmed. If diarrhea with undigested food, profuse sweating, cold limbs, body pain, lower abdominal tension, dry retching with froth, Qi rushing causing heart pain, vomiting roundworms, fever, and thirst occur, these are all Jueyin Cold syndromes, requiring warming therapy. The above six sentences of the main text are the ancestors of all diseases; only derived from Neijing can they encompass everything so concisely. Any mention of symptoms seen in the Six Meridians refers to these Three Yang and Three Yin meridian syndromes. This applies equally to miscellaneous diseases.
Ke Qin states: Both Taiyin and Jueyin use interior syndromes as their guiding principles. Taiyin governs Cold, while Jueyin governs Heat. Taiyin is the Extreme Yin within Yin, whereas Jueyin is Yang within Yin.
Shen Jin'ao comments: "Jue" means severance. Jueyin means Yin is severed and Yang remains. Since Yin is severed, the manifestations of this meridian naturally lack Heat syndromes. If Heat syndromes do occur, it is because the Jueyin meridian connects to the Gallbladder, which is governed by the transforming and commanding functions of Shaoyang Ministerial Fire (Xiang Huo).