太阴厥阴，皆以里症为提纲。太阴为阴中之阴而主寒，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，则开折，胸下痞硬者，开折反 也；厥阴为 ，气上
逆而下之，则 折，利不止者， 折反开也。
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，而胆藏肝内，则厥阴热症，皆少阳相
火内发也。要知少阳厥阴，同一相火。相火入于内，是厥阴病；相火出于表，为少阳病。少阳咽干，即厥阴消渴
之机；胸胁痞满，即气上撞心之兆；心烦，即邪热之初；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，至数日热除，欲得食，
其病愈者是已。
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之旨
也。诸经伤寒无渴症，太阳不恶寒而渴，即是温病也。惟厥阴伤寒，肝木郁而不得出，热甚于内，盗窃母气以克
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，此正其类也。
厥阴消渴，即以水饮之，所谓顺其欲，然少与之可以平。凡水多与之，反以益阴邪，当量其消与不消，恐水
渍入胃也。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。夫阴寒如此而不用姜、附者，以
相火寄于肝经，外虽寒而脏不寒。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，厥深热亦深，厥微热亦微，此四证是厥
阴伤寒之定局。先热后厥，厥热往来，厥多热少，热多厥少，此四证是厥阴伤寒之变局。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词也。
《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，是肾火起涌泉之下也。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。厥阴有晦朔具合之理，阴极阳生，故厥阴伤寒，反以阳为主。热多
厥少，是为生阳，故病当愈；厥多热少，是为死阴，故病为进。其热气有余者，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，气血调和，营卫以行，则阴阳相贯，如环之无端也。厥阴无阳，厥
阴病则阴阳不相顺接，故手足厥冷。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。若脉微烦躁，灸厥阴，厥不还者死，是阴阳之气绝矣。
本篇云∶“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
矣。盖诸四逆不可下，是指伤寒脉微欲绝，此时外寒切迫，内热未起。此当发汗，是指虚寒症言，故曰虚家亦然。
应下之者，是脉滑而厥，内热闭郁，故曰厥深热亦深。若发汗只能引火上升，不能逐热外散，故令口伤。所谓下
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。
诊厥阴脉，以阳为主，而治厥阴病，以阴为主。故当归四逆不去芍药，白头翁重用芩、连，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，虽是阴盛，亦未阳虚，
故可表散外邪，不可固里。脉结代心动悸者，似乎阳虚，实为阴弱，只可大剂滋阴，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，壮火食气。”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，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
冲心，心不受邪，因而越之，故咽中痛而喉为痹。若发热而利，汗出不止者死，是虚阳外亡，为有阴无阳，与少
阴亡阳同义。若肝火内行而入脾，火土合德，必无汗而利自止。若发热而利不止，此肝火内行，血室不宁，故便
脓血。若发热下利，甚至厥不止者死，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。一曰伤寒腹满谵语，寸口脉浮而紧，此肝乘脾也，名曰纵，刺期门。夫腹满谵语，似胃家实，然脉浮紧
而不潮热，非阳明脉也。《脉法》曰∶“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。”是腹满由于肝火，而谵语乃肝气所发也。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，断非三经症矣。
然知发热恶寒是肺病，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
原清则气皆顺，表里尽解矣。此非汗吐下清火诸法所可治，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
枝汤倍加芍药以平木加饴糖以缓急，为厥阴驱邪发表、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，先建中后柴胡，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。此方是化水为汗，发散内邪之剂，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。此本由阴虚，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。故以白头翁汤
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，是风火
势微，故为自止。虽发热不死者，阴出之阳也。下利有微热，汗出，见中风本症，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，热伤阴络，肝血不藏，必便脓血也。
厥阴中风热利，是里有热；伤寒亦有协热利，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，故为有阴无阳。要知《内经》之舌卷囊 ，是有阳无阴，故热虽甚而可治。
厥阴下利，有因厥而利者，有协热而利者，有内热而利者，总属于热，乃相火挟风木而为患也。
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
以少腹里急，阴中拘挛，热上冲胸，眼中生花，身重少气，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。此即瘟疫传染，遗祸他人之一症也。
太阴病和厥阴病，都是以里证作为提纲。太阴属于阴中之阴，主要表现寒象，所以口不渴；厥阴属于阴中之阳，主要表现热象，所以出现消渴（口渴多饮）。太阴主司湿土，土脏生病则气机下陷，湿邪侵入胃腑，所以腹痛且自发性腹泻；厥阴主司相火，火脏生病则气机上逆，火邪侵入心包，所以心中疼痛且有灼热感。太阴病表现为腹部胀满且呕吐，饮食难进；厥阴病表现为感觉饥饿但不想进食，吃了就吐蛔虫。同样是饮食难进，太阴是腹胀，厥阴是饥饿感。同样都是呕吐，太阴是吐出食物，厥阴是吐出蛔虫。这又是属土与属木的区别。太阴主“开”，本有自利症状，如果误用攻下法，则“开”的功能折损，导致胸下痞塞坚硬，这是“开折”的反常现象；厥阴主气上逆，如果误用攻下法，则气机折损，导致腹泻不止，这是“折”反而导致“开”的功能失常。
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象了。然而厥阴主肝，而胆藏于肝内，所以厥阴的热证，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。相火入于体内，就是厥阴病；相火出于体表，就是少阳病。少阳病的咽干，就是厥阴病消渴的机理；胸胁痞满，就是气上撞心的征兆；心烦，就是邪热初起的表现；不想吃饭，是饥不欲食的根源；喜欢呕吐，就是吐蛔虫的渐进过程。所以少阳病不解，转属到厥阴就会病情危重；厥阴病衰退，转属到少阳就会想要痊愈。比如伤寒热势轻微、四肢厥冷轻微，指尖发凉不想吃饭，过了几天热退去，想要吃东西，这就是病愈的情况。
太阴病的提纲是内伤寒，不是外感病。厥阴病的提纲是温病，而不是伤寒。要知道六经各有主症，这是张仲景将伤寒与杂病合论的宗旨。各经伤寒一般没有口渴症状，太阳病如果不恶寒而口渴，就是温病。只有厥阴伤寒，因肝木郁结而不能疏泄，热势在体内很盛，盗取母气（肾水）来克制火气，所以口渴想喝水。如果不恶寒，应当按温病治疗。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一类，这正是其类别。
厥阴病的消渴，可以用饮水来缓解，所谓顺应病人的欲望，但应少量给予以平复病情。如果大量给水，反而助长阴邪，应当衡量病人是否还能喝水，担心水液浸渍入胃。渴欲饮水与饥不欲食对照来看，才能穷尽厥阴病的病情。
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药。阴寒如此严重却不用干姜、附子，是因为相火寄居于肝经，外表虽然寒冷但内脏并不寒。所以先出现厥冷的，后来必定发热，手足越冷，肝胆内部越热，所以说厥冷越深，内热也越深。因此伤寒初起，脉症如此者，不能立刻认定为虚寒证，妄投干姜、附子以免留下后患。
厥冷必定伴随发热，发热与厥冷相应，厥冷深内热也深，厥冷浅内热也浅，这四种情况是厥阴伤寒的定局。先发热后厥冷，厥冷与发热交替出现，厥冷多发热少，发热多厥冷少，这四种情况是厥阴伤寒的变局。这都是因为人体阳气多少不同所致，就像太阳伤寒也有已发热和未发热的互文说法一样。
《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，是肾火从涌泉穴发起。本论的热厥，是因为热在肝脏，而手足反而寒冷，所以说厥冷越深，内热也越深。《内经》的寒厥，只有寒没有热；本论的寒厥，先出现厥冷，后来必定发热。热胜则生，寒胜则死，这是内伤与外感的区别。厥阴有晦朔盈亏的道理，阴极则阳生，所以厥阴伤寒，反而以阳气为主。发热多厥冷少，是为生阳，所以病应当痊愈；厥冷多发热少，是为死阴，所以病会进展。如果有热气有余的情况，或者大便脓血，或者发生痈脓，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，厥阴病时阴阳不相顺接，所以手足厥冷。如果热势轻微、厥冷轻微且仅指尖发凉，知道病可痊愈，手足反温的，即使腹泻也必自愈，这是阴阳自我调和而顺接。如果脉微细且烦躁，灸治厥阴经穴位，厥冷不回的则死，这是阴阳之气断绝了。
本篇说：“各种四肢逆冷厥逆的病，不可用泻下法。”又说：“厥逆应当用泻下法却误用发汗法，必然导致口腔糜烂发红。”这两种说法意思不同，应当理解上下文的差异。大概各种四肢逆冷不可下，是指伤寒脉微细欲绝，此时外寒紧迫，内热尚未兴起。这种情况应当发汗，是指虚寒证而言，所以说体虚的人也是如此。应当用下法的，是脉滑而厥逆，内热闭郁，所以说厥深热亦深。如果发汗只能引火上升，不能驱散内热，所以导致口腔损伤。所谓下法，是下其内热，而非下其实邪。泄利下重的，用四逆散；想喝几升水的，用白虎汤。这是厥阴病用下法的方药，所以下的是无形的邪气。如果用承气汤类攻下，腹泻就不会停止了。
诊察厥阴脉，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掉芍药，白头翁汤重用黄芩、黄连，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。要知道脉微细欲绝、手足厥冷，虽然是阴盛，但也未至阳虚，所以可以发散外邪，不可固守里气。脉结代、心动悸的，似乎阳虚，实为阴弱，只可大剂量滋阴，不可温补。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。《内经》说：“阳给予正气，阴作为主宰。”又说：“阴虚则无气。”又说：“少火生气，壮火食气。”审视这些道理，就知道治疗厥阴的原理了。
中州四肢，都由脾所主。厥阴伤寒，手足逆冷，而又腹泻，这是木克土。如果再发热，腹泻必定自止，这是火生土。如果肝火上行使之心包受逼，所以反而出汗、气上冲心，心不受邪，因而邪气上越，所以咽喉痛且喉部痹阻。如果发热且腹泻，出汗不止的则死，这是虚阳外亡，为有阴无阳，与少阴亡阳意义相同。如果肝火内行而入脾，火土合德，必定无汗且腹泻自止。如果发热且腹泻不止，这是肝火内行，血室不安宁，所以大便脓血。如果发热下利，甚至厥冷不止的则死，这是土败木贼，诸阳之本断绝了。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，似胃家实证，但脉浮紧而不潮热，不是阳明脉。《脉法》说：“浮而紧的，名叫弦。”这是弦脉，为肝脉。《内经》说：“各种腹胀大，都归属于热。”又说：“肝气盛则多言。”所以腹满是因肝火，谵语乃肝气所发。木旺则侮其所胜，直犯脾土，所以名叫纵。另一种叫伤寒发热，啬啬恶寒，大渴欲饮水，腹部必定胀满，这是肝乘肺，名叫横，刺期门穴。发热恶寒，似太阳表证；未经大汗而大渴，非转属阳明；未经误下而腹满，非转属太阴。且头不痛，胃不实，不下利，绝非三经病症。然而知道发热恶寒是肺病，肺虚而肝火乘之。脾畏木邪，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、寡于畏惧，所以名叫横。一纵而乘脾，一横而乘肺，总是肝有亢火，应当泻不可补，必须刺期门穴，随其实而泻之。募原清则气皆顺，表里尽解。这不是汗、吐、下、清火诸法所能治疗的，所以宜用针刺。
伤寒阳脉涩，阴脉弦，腹中急痛的，这也是肝乘脾。所以先与小建中汤安脾，继与小柴胡汤疏木。要知道小建中汤是桂枝汤加倍芍药以平木，加饴糖以缓急，是厥阴驱邪发表、和中止痛的神剂。不愈的，是中气虚而不振作，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，先麻黄后桂枝，是先外后内法；在厥阴病，先建中后柴胡，是先内后外法，也是令厥阴转属少阳的契机。
伤寒厥逆且心下悸动的，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。此方是化水为汗，发散内邪的方剂，也就是厥阴治厥的方剂。
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，是厥阴中风，脉反而沉。这本来由阴虚，风入地中，木郁不舒，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。
这种热利下重，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。所以以白头翁汤为主以治风，黄芩、黄连为辅以清火，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，是沉为在里，弦为风脉。弦而大，是风因火动，所以利未止。微弱数者，是风火势微，所以为自止。虽发热不死者，是阴出之阳。下利有微热，汗出，见中风本症，里症出表，则风从外散，所以令自愈。欲愈的脉，当微浮。若寸脉反浮数，风去而热不去，尺中自涩的，热伤阴络，肝血不藏，必便脓血。
厥阴中风热利，是里有热；伤寒也有协热利，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，故为有阴无阳。要知道《内经》的舌卷囊缩，是有阳无阴，所以热虽甚而可治。
厥阴下利，有因厥而利的，有协热而利的，有内热而利的，总属于热，乃是相火挟风木而为患。
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；继而少阴之精不藏，厥阴之火不羁。所以少腹里急，阴中拘挛，热上冲胸，眼中生花，身重少气，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。这就是瘟疫传染，遗祸他人的一种病症。
Taiyin and Jueyin diseases both use interior syndromes as their guiding principles. Taiyin belongs to Yin within Yin and governs cold, therefore there is no thirst; Jueyin belongs to Yang within Yin and governs heat, therefore there is Xiao Ke (polydipsia/excessive thirst). Taiyin governs damp earth; when the earth organ is diseased, Qi sinks downward, and damp pathogen enters the stomach, causing abdominal pain and spontaneous diarrhea; Jueyin governs Ministerial Fire (Xiang Huo); when the fire organ is diseased, Qi rebels upward, and fire pathogen enters the Heart, causing pain and burning sensation in the heart region. Taiyin presents with abdominal fullness and vomiting, inability to eat; Jueyin presents with hunger but no desire to eat, and vomiting roundworms upon eating. Both involve inability to eat, yet Taiyin has fullness while Jueyin has hunger. Both involve vomiting, yet Taiyin vomits food while Jueyin vomits roundworms. This distinguishes those belonging to Earth from those belonging to Wood. Taiyin governs "opening"; it naturally has diarrhea, and if purged incorrectly, the "opening" collapses, leading to epigastric stiffness and fullness, which is a reversal of "opening collapse"; Jueyin governs rebellious Qi, and if purged incorrectly, the Qi collapses, leading to unceasing diarrhea, which is a reversal where "collapse" leads to abnormal "opening".
When two Yins intersect and exhaust, it is named Jueyin, also called the extreme Yang of Yin; theoretically, Jueyin should have no heat. However, Jueyin governs the Liver, and the Gallbladder resides within the Liver; thus, Jueyin heat syndromes all originate from the internal activation of Shaoyang Ministerial Fire (Xiang Huo). It must be understood that Shaoyang and Jueyin share the same Ministerial Fire. When Ministerial Fire enters the interior, it is Jueyin disease; when it emerges to the exterior, it is Shaoyang disease. The dry throat of Shaoyang is the mechanism for Jueyin's polydipsia; chest and hypochondriac stuffiness is the precursor to Qi rushing up to strike the heart; irritability is the initial stage of evil heat; lack of desire to eat is the root of hunger without desire to eat; preference for vomiting is the gradual progression to vomiting roundworms. Therefore, if Shaoyang disease does not resolve, it transfers to Jueyin and becomes critical; if Jueyin disease declines, it transfers to Shaoyang and tends toward recovery. For example, in Shanghan (Cold Damage) with slight heat and mild cold extremities, cold fingertips, and lack of desire to eat, if after several days the heat subsides and the patient desires food, this indicates recovery.
The guiding principle of Taiyin is internal Cold Damage, not external contraction. The guiding principle of Jueyin is Warm Disease (Wen Bing), not Cold Damage. It must be known that each of the Six Channels has its principal syndrome, which is Zhang Zhongjing's intent in combining Cold Damage and miscellaneous diseases in his discussion. Cold Damage in various channels generally lacks thirst; if Taiyin disease lacks aversion to cold but has thirst, it is a Warm Disease. Only in Jueyin Cold Damage, due to Liver Wood stagnation unable to disperse, heat becomes severe internally, stealing Mother Qi (Kidney Water) to control Fire, causing thirst and desire to drink water. If there is no aversion to cold, it should be treated as a Warm Disease. It must be known that Wen is the pathogen of Wind-Wood, which is the primary disease of Jueyin; Xiao Ke (polydipsia) is the root of Warm Disease, and Jue-Li (cold extremities and diarrhea) is the variation of Warm Disease. As stated in *Neijing*, "All heat diseases belong to the category of Cold Damage," which precisely fits this category.
For Jueyin's polydipsia, allowing water intake soothes the condition, following the patient's desire, but it should be given in small amounts to calm the situation. Giving large amounts of water instead exacerbates the Yin pathogen; one must assess whether the patient can still drink, fearing water flooding into the stomach. Comparing "thirst and desire to drink" with "hunger but no desire to eat" allows one to fully understand the pathology of Jueyin.
Cold extremities and a faint pulse nearly imperceptible are external symptoms of Jueyin Cold Damage; Danggui Sini Tang (Angelica Decoction for Nourishing Blood and Unblocking Collaterals) is the formula for the exterior aspect of Jueyin Cold Damage. Despite such severe Yin-cold, Ginger and Aconite are not used because Ministerial Fire resides in the Liver channel; although the exterior is cold, the viscera are not cold. Thus, those who first experience cold extremities will subsequently develop fever; the colder the extremities, the hotter the Liver and Gallbladder interior, hence "the deeper the Jue, the deeper the heat." Therefore, at the onset of Shanghan, when pulse and symptoms present thus, one must not hastily diagnose it as Deficiency-Cold and recklessly administer Ginger and Aconite, lest it cause future harm.
Jue always involves fever; fever and Jue correspond, "the deeper the Jue, the deeper the heat; the shallower the Jue, the shallower the heat." These four conditions constitute the fixed pattern of Jueyin Cold Damage. Fever preceding 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 abundance or scarcity of the person's Yang Qi, similar to how Taiyin Cold Damage uses "already febrile" and "not yet febrile" as interchangeable terms.
The cold and heat Jue in *Neijing* result from internal injury, differing from the external pathogens discussed in this treatise. *Neijing*'s heat Jue occurs only in the soles of the feet, arising from Kidney Fire at Yongquan (KI-1). This treatise's heat Jue results from heat in the Liver, causing cold hands and feet, hence "the deeper the Jue, the deeper the heat." *Neijing*'s cold Jue has cold but no heat; this treatise's cold Jue features initial Jue followed by subsequent fever. Heat prevailing leads to life, cold prevailing leads to death; this distinguishes internal injury from external contraction. Jueyin follows the logic of lunar phases; when Yin reaches its extreme, Yang is born. Thus, in Jueyin Cold Damage, Yang is prioritized. More fever and less Jue indicates generating Yang, so the disease should recover; more Jue and less fever indicates dying Yin, so the disease progresses. If there is excess heat, it may manifest as pus and blood in stool or carbuncles/pus, differing from *Neijing*'s heat Jue.
Yin Qi originates from the inner side of the five toes, Yang Qi from the outer side. When Qi and Blood harmonize, Ying and Wei circulate, Yin and Yang interconnect like a circle without end. In Jueyin, Yang is absent; in Jueyin disease, Yin and Yang do not connect smoothly, causing cold extremities. If heat is slight and Jue is mild with only cold fingertips, recovery is anticipated; if hands and feet become warm, even with diarrhea, it will self-resolve due to self-harmonization and smooth connection of Yin and Yang. If the pulse is faint with irritability, moxa applied to Jueyin channels with no return of warmth indicates death, signifying the severance of Yin and Yang Qi.
This chapter states: "In cases of various Si Ni (four-finger coldness/Jue), purgatives are contraindicated." It also says: "If Jue requires purgation but sweating is used instead, oral ulcers and redness will occur." These two meanings differ and must be understood contextually. Generally, Si Ni cannot be purged when the pulse is faint and nearly imperceptible in Shanghan, indicating external cold pressing tightly with internal heat not yet arisen. Sweating is indicated for deficiency-cold syndromes, hence "even for the deficient." Cases requiring purgation feature a slippery pulse with Jue, indicating internal heat closure, hence "the deeper the Jue, the deeper the heat." Sweating only draws fire upward and cannot dispel internal heat, causing oral damage. "Purgation" here means purging heat, not solid excrement. For heaviness in defecation, Sini San (Four Counterflow Powder) is used; for intense thirst drinking several liters, Baihu Tang (White Tiger Decoction) is used. These are purgative formulas for Jueyin to eliminate formless pathogens. Using Chengqi Tang would lead to unceasing diarrhea.
Diagnosing Jueyin pulses prioritizes Yang, but treating Jueyin disease prioritizes Yin. Thus, Danggui Sini Tang retains Shao Yao (Peony), Baitouweng Tang heavily uses Huang Qin (Scutellaria) and Huang Lian (Coptis), Wumei Wan (Mume Pill) uses Jin (catty) of Huang Lian plus 6 liang of Huang Bo (Phellodendron), and Fumai Tang (Restore Pulse Decoction) uses Jin of Di Huang (Rehmannia) plus 8 liang of Mai Dong (Ophiopogon). Note that faint pulse and cold extremities, though indicating Yin excess, do not necessarily mean Yang deficiency; thus, dispersing external pathogens is possible, but securing the interior is not. For knotted/intermittent pulse and palpitations, which seem like Yang deficiency, it is actually Yin weakness; large-dose Yin tonification is suitable, 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. *Jing* states: "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 extremities and diarrhea indicate Wood overcoming Earth. Subsequent fever implies diarrhea will stop, as Fire generates Earth. If Liver Fire rises and presses on the Heart, sweating and Qi rushing up to the heart occur; since the Heart rejects evil, the pathogen ascends, causing sore throat and bi-syndrome. If fever, diarrhea, and unceasing sweating occur, it is fatal, indicating floating Yang escaping, having Yin but no Yang, equivalent to Shaoyin Yang exhaustion. If Liver Fire moves inward to the Spleen, Fire and Earth harmonize, resulting in no sweating and self-resolving diarrhea. If fever and diarrhea persist, Liver Fire disturbs the Blood Chamber, causing pus and blood in stool. If fever, diarrhea, and unceasing Jue occur, it is fatal, indicating Earth failure and Wood aggression, severing the root of all Yang. Jueyin Cold Damage has two confusing symptoms involving Spleen and Lung invasion, requiring careful differentiation. One is abdominal fullness and delirium with floating-tight pulse at Cun, indicating Liver invading Spleen, named Zong (Vertical), treat by puncturing Qimen (LR-14). Abdominal fullness and delirium resemble Stomach excess, but floating-tight pulse without tidal fever is not Yangming. *Mai Fa* states: "Floating and tight is named Xian (Wiry)." This is the Liver pulse. *Neijing* states: "All abdominal distensions belong to heat." And: "Excess Liver Qi causes excessive talking." Thus, fullness stems from Liver Fire, delirium from Liver Qi. Excess Wood insults what it conquers, directly attacking Spleen Earth, hence named Zong. Another is fever, shivering aversion to cold, extreme thirst, and abdominal fullness, indicating Liver invading Lung, named Heng (Horizontal), treat by puncturing Qimen. Fever and aversion to cold resemble Taiyang exterior; extreme thirst without heavy sweating is not Yangming transfer; abdominal fullness without mistaken purgation is not Taiyin transfer. No headache, no Stomach excess, no diarrhea rules out these three channels. Knowing fever/aversion to cold is Lung disease, Lung deficiency allows Liver Fire to invade. Splee fears Wood, Water Essence fails to ascend to Lung, causing thirst; Lung fails to regulate water passages, causing fullness. This insults the unconquered and shows fearlessness, hence named Heng. Whether Zong (invading Spleen) or Heng (invading Lung), it is always Liver hyperactive fire, requiring draining not tonifying, puncturing Qimen to drain excess. Once the Mu Yuan clears, Qi flows smoothly, resolving exterior and interior. This cannot be treated by sweating, vomiting, purging, or cooling methods, hence acupuncture is appropriate.
Shanghan with Yang pulse choppy, Yin pulse wiry, and acute abdominal pain also indicates Liver invading Spleen. First give Xiaojianzhong Tang (Minor Construct the Middle Decoction) to calm Spleen, then Xiaochaihu Tang (Minor Bupleurum Decoction) to soothe Wood. Note that Xiaojianzhong Tang is Guizhi Tang doubled Shao Yao to pacify Wood, plus Yitang (Maltose) to relieve urgency, a divine formula for Jueyin to expel evil, release exterior, harmonize middle, and stop pain. If unresolved, Middle Qi is weak and stagnant, pathogen lingers; follow with Xiaochaihu Tang to tonify middle and release exterior, directing Wood pathogen to Shaoyang for an exit, meaning "Yin emerging to Yang leads to recovery." Zhang Zhongjing uses two formulas for one syndrome: in Taiyang, Mahuang then Guizhi is exterior-then-interior method; in Jueyin, Xiaojianzhong then Chaihu is interior-then-exterior method, also facilitating Jueyin's transfer to Shaoyang.
Shanghan with Jue and palpitation below the heart also indicates Liver invading Lung. Though no fever/aversion to cold, it is Wood excess and Metal deficiency causing unfavorable Water Qi. The abdominal fullness case has water in Middle Jiao, treated by puncturing Qimen to drain excess. This case has water in Upper Jiao, treated by Fuling Gancao Tang (Poria and Licorice Decoction) to induce sweating. This formula transforms water into sweat, dispersing internal pathogens, serving as the Jueyin treatment for Jue.
The pulse of Jueyin Fengzhong (Wind Strike) differs from other channels. Usually floating pulse indicates Wind; here, non-floating indicates non-recovery, meaning Jueyin Wind Strike pulse is sinking. This originates from Yin deficiency, Wind entering the earth, Wood stagnation failing to舒展, hence non-recovery; slight floating indicates Wind moving on earth, vegetation renewing, restoring Jueyin Wind-Wood normalcy, hence recovery.
Generally, floating pulse indicates Exterior, sinking indicates Interior. Jueyin Wind Strike, with sinking pulse, has interior symptoms.
This heat diarrhea with heaviness is Jueyin Wind Strike. Taiyang Wind Strike with diarrhea and vomiting involves Water Qi; Jueyin Wind Strike with heat diarrhea and heaviness involves Fire Qi. Thus, Baitouweng Tang is main to treat Wind, Huang Qin and Huang Lian assist to clear Fire, plus Qin Pi to lift Wind from deep earth, allowing Liver Wood to flourish. Diarrhea with thirst is Jueyin's Xiao Ke, caused by Wind Strike irritability. Diarrhea with sinking-wiry pulse: sinking is interior, wiry is Wind. Wiry-large indicates Wind moved by Fire, so diarrhea persists. Weak-rapid indicates Wind-Fire power waning, so diarrhea stops. Fever without death indicates Yin emerging to Yang. Diarrhea with slight fever and sweating, showing Wind Strike symptoms, means interior symptoms emerge to exterior, Wind scatters externally, leading to self-recovery. Recovery pulse should be slightly floating. If Cun pulse is floating-rapid, Wind gone but Heat remains, Chi pulse choppy indicates Heat injuring Yin collaterals, Liver Blood failing to store, leading to pus/blood in stool.
Jueyin Wind Strike heat diarrhea indicates interior Heat; Shanghan also has Xie Re Li (collateral heat diarrhea) indicating interior Cold. This differs from Jue Li; Jue Li stops diarrhea when fever appears. Here, no diarrhea for 6-7 days, then fever and diarrhea with unceasing sweating, indicates exterior heat and interior cold, having Yin but no Yang. Note *Neijing*'s curled tongue and contracted testicles indicate Yang excess and Yin deficiency, so severe heat is treatable.
Jueyin diarrhea includes cases due to Jue, collateral heat, and internal heat, all belonging to Heat, namely Ministerial Fire carrying Wind-Wood as pathology.
Yin Yang Yi (Exchange of Yin and Yang) disease originates from Jueyin lust/fire. Initially, Liver Fire movement injures Shaoyin Essence; subsequently, Shaoyin Essence fails to store, and Jueyin Fire runs wild. Thus, lower abdominal tension, genital cramping, heat rushing to chest, visual spots, body heaviness, shortness of breath, heavy head unwilling to lift, are all disasters of Jueyin Ministerial Fire. Suddenly changing the sinews, vessels, form, and Qi of a healthy person. This is a symptom of plague contagion, bringing disaster to others.