庞安时云。尺寸俱微缓者。厥阴受病也。当六七日发。以其脉循阴器。络于肝。故烦满而囊缩。微缓者。囊必不缩。
若尺寸俱沉短者。囊必缩。宜承气汤下之。
琥按上庞氏云云即仲景论例中语也。其言微缓者。囊必不缩。此以见论例中。凡言脉处。皆不可拘也。其言沉短者。
囊必缩。宜承气汤下之。愚以沉短囊缩。恐非是下证。若论脉。当沉中带弦。或带数疾。按之有力。斯为下证悉具。当
以小承气汤微利之。
王海藏云。厥阴证。烦满囊缩。大小便不通。发热引饮。腹满。脉尺寸俱微缓。又云。脉沉疾。按之有力者。为阳。
阳则当下。宜大承气汤。
琥按王氏云。厥阴证烦满囊缩。大小便不通。发热引饮。腹满。则脉不当微缓矣。其曰尺寸俱微缓者。此仲景论
例中语也。其曰脉沉疾。按之有力。是为脉证相符。决当议下。但其用大承气。亦太峻厉。盖热传厥阴。阳邪久郁。真
阴内消。若用峻厉之药。则阳邪虽得外泄。而几微之阴气。亦随之而脱矣。故余立议云。若用下药。止须以小承气汤微
利之。
活人书问手足逆冷。而大便秘。小便赤。或大便黑色。脉沉而滑。答曰。此名阳证似阴也。重阳必阴。重阴必阳。
寒暑之变也。假令前证。其脉沉而滑者。皆阳证也。轻者。白虎汤。甚者。承气汤。伤寒失下。血气不通。令四肢逆冷。
此是伏热深。故厥亦深。速用大承气。加分剂下之。汗出立瘥。（仲景所谓热厥应下之者此也。）
琥按上朱氏论。因仲景云。热厥应下。伤寒论有法无方。故采仲景之方而补之也。其言轻者。白虎汤此是仲景云。
伤寒脉滑而厥者。里有热也。宜白虎汤主之。愚以此条当是阳明篇错简。盖白虎汤。乃解肌散热之药。热病服之。有汗
出而解者。独不闻仲景云。热厥应下。不可反发汗邪。兹用白虎汤。虽非辛热发散之比。据上朱氏云。加分剂下之。汗
出立瘥。则是热厥不但应下。并宜使出汗矣。倘后学观之。更用他药。反发其汗。岂不大误。故余于仲景热厥应下之条
云。厥深者。用小承气缓下。厥微者。宜四逆散调之。
庞安时说：寸脉和尺脉都呈现微缓之象，这是厥阴经受邪。这种病通常在发病后六七天出现。因为厥阴经脉循行经过生殖器，并联络肝脏，所以会出现心中烦闷、腹部胀满以及睾丸收缩的症状。如果脉象是微缓的，那么睾丸一定不会收缩。
如果寸脉和尺脉都呈现沉短之象，那么睾丸一定会收缩，适宜用承气汤攻下。
王琥按语：上面庞氏所说的内容，其实就是张仲景《伤寒论》论述体例中的话语。他说“如果是微缓脉，睾丸一定不收缩”，这可以看出在《伤寒论》的论述体例中，凡是提到脉象的地方，都不能拘泥死板地理解。他说“如果是沉短脉，睾丸一定收缩，适宜用承气汤攻下”。我认为“沉短脉伴睾丸收缩”恐怕不属于应当使用下法的证候。如果从脉象来看，应当是沉脉中带弦象，或者带数疾之象，且按之有力，这才是下法证候完全具备的表现，此时应当用小承气汤轻微通利大便。
王海藏说：厥阴病的症状包括心中烦闷、腹部胀满、睾丸收缩、大小便不通、发热且想喝水、腹部胀满，脉象寸尺俱微缓。他又说：如果脉象沉而急疾，按之有力，属于阳证，阳证就应当使用下法，适宜用大承气汤。
王琥按语：王氏所说的厥阴病症状有烦满囊缩、大小便不通、发热引饮、腹满，那么脉象就不应当是微缓的了。他所说的“寸尺俱微缓”，这是张仲景《伤寒论》论述体例中的话。他所说的“脉沉疾，按之有力”，这才是脉证相符，确实应当考虑使用下法。但是，他主张使用大承气汤，这也过于峻猛猛烈了。因为热邪传入厥阴，阳邪久郁体内，真阴在内消耗，如果使用峻猛的药物，虽然阳邪得以向外宣泄，但几近枯竭的阴气也会随之脱失。所以我提出建议：如果使用下药，只需用小承气汤轻微通利即可。
《活人书》问：手足逆冷，且大便秘结，小便色赤，或者大便呈黑色，脉象沉而滑。回答是：这叫做“阳证似阴”。重阳必转为阴，重阴必转为阳，这是寒暑变化的规律。假设上述症状，其脉象沉而滑的，都是阳证。轻症的，用白虎汤；重症的，用承气汤。伤寒若失于攻下，导致血气不通，致使四肢逆冷，这是因为伏热深重，所以厥逆也深重，必须迅速使用大承气汤，增加剂量攻下，汗出后立即痊愈。（这就是张仲景所说的“热厥应当使用下法”的情况。）
王琥按语：上面朱氏的论述，是因为张仲景说“热厥应当使用下法”，而在《伤寒论》中只有治法没有方剂，所以朱氏采集张仲景的方剂来补充。朱氏说“轻症用白虎汤”，这是引用张仲景的话：“伤寒脉滑而厥者，里有热也，宜白虎汤主之。”我认为这一条应当是阳明篇的错简（文字顺序错乱）。因为白虎汤是解肌散热的药物，热病服用后，会有汗出而愈的情况。难道没听说过张仲景说“热厥应当使用下法，不可反而发汗”吗？这里使用白虎汤，虽然不像辛温发散药那样，但根据朱氏所说，“增加剂量攻下，汗出立即痊愈”，这意味着热厥不仅应当使用下法，还适宜通过出汗来治疗。如果后世学者看到此处，再使用其他药物去发汗，岂不是大错特错？所以我对于张仲景“热厥应当使用下法”的条文认为：厥逆严重的，用小承气汤缓慢攻下；厥逆轻微的，宜用四逆散调理。
Pang Anshi stated: When both the cun (inch) and chi (foot) pulses are moderate and slow (wei huan), it indicates that the Jueyin meridian is affected. This condition typically manifests after six or seven days of onset. Since the Jueyin meridian courses through the genitalia and connects with the Liver, symptoms such as vexation, fullness in the chest and hypochondrium, and retraction of the scrotum may occur. If the pulse is moderate and slow, the scrotum will certainly not retract.
If both the cun and chi pulses are deep and short (chen duan), the scrotum will certainly retract. In this case, Chengqi Tang (Gastrointestinal Releasing Decoction) should be used to purge the interior.
Wang Hu's commentary: The above statements by Pang are actually derived from the general principles found in Zhang Zhongjing’s *Shanghan Lun* (Treatise on Cold Damage). His statement that "if the pulse is moderate and slow, the scrotum will not retract" demonstrates that one cannot rigidly adhere to pulse descriptions in the general principles of the text. His statement that "if the pulse is deep and short, the scrotum will retract, and Chengqi Tang should be used to purge" is also cited. However, I believe that a deep and short pulse accompanied by scrotal retraction does not necessarily constitute an indication for purgation. Regarding the pulse, it should present as deep with a wiry (xian) quality, or rapid and hurried (shu ji), and forceful upon palpation. Only then are all indications for purgation fully present, at which point Xiao Chengqi Tang (Minor Gastrointestinal Releasing Decoction) should be used to gently promote bowel movement.
Wang Haizang stated: Symptoms of Jueyin disease include vexation, fullness, scrotal retraction, obstruction of both large and small intestines, fever with thirst, abdominal fullness, and a moderate and slow pulse in both cun and chi positions. He further stated: If the pulse is deep and rapid (chen ji) and forceful upon palpation, it belongs to Yang patterns. Yang patterns require purgation, and Da Chengqi Tang (Major Gastrointestinal Releasing Decoction) is appropriate.
Wang Hu's commentary: Wang described Jueyin disease symptoms including vexation, fullness, scrotal retraction, obstruction of bowels and urine, fever with thirst, and abdominal fullness; therefore, the pulse should not be moderate and slow. The mention of "moderate and slow pulse in both cun and chi" refers to the general principles of Zhang Zhongjing. The mention of "deep, rapid pulse, forceful upon palpation" represents a correspondence between pulse and symptoms, definitely indicating the need for purgation. However, using Da Chengqi Tang is too harsh and severe. When heat transmits to the Jueyin, Yang pathogens stagnate for a long time, consuming true Yin internally. If harsh medications are used, although Yang pathogens may be expelled outward, the nearly depleted Yin Qi will also escape with them. Therefore, my proposal is: if purgation is necessary, only Xiao Chengqi Tang should be used to gently promote bowel movement.
The *Huoren Shu* (Book for Saving Lives) asks: What if there is cold reversal of the hands and feet, constipation, red urine, or black stools, with a deep and slippery pulse? The answer is: This is named "Yang pattern resembling Yin." Extreme Yang transforms into Yin, and extreme Yin transforms into Yang; this is the variation of cold and heat. Assuming the aforementioned symptoms, if the pulse is deep and slippery, they are all Yang patterns. For mild cases, Baihu Tang (White Tiger Decoction) is used; for severe cases, Chengqi Tang is used. If Shanghan (Cold Damage) fails to use purgation, blood and Qi become obstructed, causing cold reversal of the four limbs. This occurs because latent heat is deep, so the cold reversal is also deep. One must quickly use Da Chengqi Tang, increasing the dosage to purge, and recovery will follow immediately upon sweating. (This corresponds to what Zhang Zhongjing said: "Heat cold reversal should be treated with purgation.")
Wang Hu's commentary: Zhu’s discussion above was prompted by Zhang Zhongjing’s statement that "heat cold reversal should be treated with purgation," yet the *Shanghan Lun* provided methods without specific formulas. Thus, Zhu collected Zhang’s formulas to supplement this gap. Zhu mentioned "mild cases use Baihu Tang," citing Zhang Zhongjing: "In Shanghan, if the pulse is slippery and there is cold reversal, there is heat in the interior; Baihu Tang should be administered." I believe this clause is likely a textual error misplaced in the Yangming chapter. Baihu Tang is a formula for releasing muscle-layer heat and clearing heat; when taken for heat diseases, it induces sweating leading to resolution. Have we not heard Zhang Zhongjing say that "heat cold reversal requires purgation and should not be treated with diaphoresis"? Although Baihu Tang is not a pungent-warm diaphoretic, Zhu’s statement about "increasing the dosage to purge, with immediate recovery upon sweating" implies that heat cold reversal requires not only purgation but also induction of sweating. If later students observe this and use other drugs to induce sweating, it would be a grave error. Therefore, regarding Zhang Zhongjing’s principle that "heat cold reversal requires purgation," I propose: for severe cold reversal, use Xiao Chengqi Tang to gently purge; for mild cold reversal, use Sini San (Four Counterflow Powder) to regulate.