玄参 生地黄（各四两） 大黄（酒浸一两）
上三味。蒸一伏时。合捣。令相得。如膏。每用取两许。投百沸汤中。热绞取汁一升。作一服。腹胀者。加浓朴枳
实各五钱。
上方。乃入手足。少阴兼走阳明之药也。阴虚人及老人血少者。大宜服之。
（琥）总按以上方论。乃治少阴经热病。通变之法也。少阴热病所急者。止一下证。所难者。亦止一下证耳。学人
苟能临证切脉。神而明之。则旧论新方。何一非济人之良法哉。
（此系仲景原文）
厥阴之为病。消渴。气上撞心。心中疼热。饥而不欲食。食则吐蛔。下之利不止。（此条厥阴病。乃总言病热之大纲
也。成注云。邪传厥阴。则热已深而成消渴。消渴者。饮水多而小便少也。厥阴属木。肝木过旺。则肾水不足以滋之。
故水易消。而渴不止。气上撞心。心中疼热者。火生于木。气即是火。火性急速。以故上逆之势如撞。肝相火也。心君
火也。以火犯火。火热亢极。心中则疼。饥不欲食者。胃属土。火热。则土偏燥。故饥。木强。则土受制。故不欲食也。
食则吐蛔者。蛔胃中长虫也。蛔居胃中。因人不食。则饥而上膈。故一闻食臭。即上逆而吐出也。厥阴经邪热。横逆于
脏腑之间。故见以上诸证。实则胃中空虚。无物可下。若漫下之。则木乘所胜。利遂不止。而成土崩之势矣。愚按此条
论。乃仲景约言病热之大纲。以故不及治法。设误下之而利不止者。宜以理中汤救之。）
厥阴中风脉微浮。为欲愈不浮。为未愈（未言伤寒。而先言中风者。亦犹太阳病例。先出中风条也。论例中原云。
厥阴受病。尺寸脉俱微缓。愚已校正当是沉弦之误。盖寒为沉。而风为弦也。兹者风已传入。脉见微浮。成注云。此邪
气还表向汗之时。故云。欲愈。不浮则邪气深入。正多变证。故云。未愈也。或问仲景但云。脉微浮。不言中风形证。
何以知。为厥阴病。余答云。病患必见消渴。或气上撞心。心中疼热一二证。而后谓之厥阴病也。王宇泰云。仲景立法。
凡曰厥阴病者。皆气上撞。心痛吐蛔也。言虽如此。亦不可拘。）
厥阴病欲解时从丑至卯上。（注已见前第三卷太阳上编）
厥阴病。渴欲饮水者。少少与之愈（厥阴病渴。传经之邪热已深。欲饮水。则邪热有向外之机。盖木火亢盛。得水
济之。则阴阳气和。而病自愈。或问厥阴原有消渴一候。不言自愈。此条渴。何以与之水即愈也。余答云武陵陈氏云。
消渴者。热甚而津液消烁。虽饮水。不能胜其燥烈。乃邪气深入。未愈之征也。此渴欲饮水。其热非消渴之比。乃邪气
向外。欲解之象也。两者自是不同。）
诸四逆厥者。不可下之。虚家亦然（此言厥阴逆厥之端也。成注云。四逆者。四肢不温。厥者。手足冷也。邪传厥
阴阳气内陷。阴气已微阳气内陷。则外不与四肢相接。故逆而厥。阴气已微。则内不能守于脏腑。故不可下。若轻下之。
则内陷之阳热未去。将几微之真阴。反随之而亡矣。在仲景于后条。虽云热厥者应下之。然方其逆厥之时。下之一法。
不轻试也。诸字。是该下文诸厥之条而言。虚家亦然者。言人于未病之前。气血本虚家。虽病热厥。亦不可下。成注引
金匮云。虚者十补。勿一泻之。此是言其平日。若病伤寒。不可取以为例也。愚按此条论。仲景无治法。补亡论常器之
云可当归四逆汤误矣。当先以四逆散调之。）
伤寒先厥后发热而利者。必自止。见厥复利。（先厥后热。乃阴寒也。发热。是阳气自复。故利止。见厥是阴气还胜。
故复利。此条病。名为伤寒。而实中寒证。正文与注见中寒论中。）
伤寒始发热六日。厥反九日而利。凡厥利者。当不能食。今反能食者。恐为除中。食以索饼不发热者。知胃气尚在。
必愈。恐暴热来。出而复去也。后三日脉之。其热续在者。期之旦日夜半愈。所以然者。本发热六日。厥反九日。复发
热三日。并前六日。亦为九日。与厥相应。故期之旦日夜半愈后三日脉之。而脉数其热不罢者。此为热气有余。必发痈
脓也。（索苏故切当作素。此条病。先发热而后厥。乃伤寒传经邪热伏匿之证也。始发热者。邪自三阳经起也。热至六日。
邪传厥阴。阳气内陷。因而见厥。协热下利反九日之久者。邪热伏于里。不能还于表也。凡厥利者。多胃气下陷。当不
能食。今反能食者。恐是除中之证。除中者。胃中之真气。所余无几。将欲尽除。求救于食。如灯将灭。而复明之意。
当以索饼试与食之。以观其发热与否。其不骤发热者。此非除中。知胃中真气尚在。其厥与利。必渐自愈。其发热者。
是为暴热。恐其骤来。则能食。出即来也。既来而复骤去者。此胃中真气。得食而尽泄于外。即名除中而必死矣。若然。
则是厥利之人。食以索饼。但虑其热之暴耳。使其于九日之后。其热悠悠。又三日脉之。而热续在者。此言诊之。而前
已发热六日矣。兹则复热三日。故云续也。此其人。内陷之阳气渐还。而复于四肢之间。可期之于旦日前。夜半后。病
当向愈盖自丑至卯。为厥阴欲解之时也。所以然者。以热与厥期。无太过不及而相应。故当愈也。如愈后。又三日。脉
之。而脉数仍不罢。此为邪热之气。尚有余留。条辩云。厥阴主血。血热持久。则壅瘀腐化而为痈脓。所不免耳。愚按
此条论。仲景无治法。补亡论郭白云云。可服千金漏芦汤。盖此汤即漏芦连翘汤也。治时行热毒。变作赤色痈疽者。若
未发痈脓之前。厥利发热。还宜以白头翁汤主之。）
伤寒脉迟。六七日而反与黄芩汤彻其热。（云云至）腹中应冷。当不能食。今反能食。此名除中。必死。（此条病。
虽名伤寒。实则中寒证也。上条除中是热邪。此条是寒邪。正文与注见中寒论中。）
伤寒先厥后发热。下利必自止。而反汗出。咽中痛者。其喉为痹。（云云至）便脓血者。其喉不痹。（此条伤寒亦中
寒之证。盖先厥后热为真寒。但寒极亦能变热。热气上行。则为喉痹。热气下行。则便脓血。后条辩云。此得毋辛温过
剂所致。亦犹热病过用凉药而变成寒证也。愚以既变之后。虽从中寒例。当以治杂病法治之。注详中寒论中。）
伤寒一二日。至四五日而厥者。必发热。前热者。后必厥厥深者。热亦深。厥微者。热亦微。厥应下之。而反发汗
者必口伤烂赤。（此条乃传经邪热。阳极似阴之证。伤寒一二日。至四五日而厥者。言伤寒在一二日之时。本发热。至四
五日后而厥者。乃邪传厥阴之候也。必发热者。言病患四肢及肌表虽厥。而躯壳以内。必发热也。前热者。后必厥。乃
申明一二日为前。四五日为后。以见热极必发厥也。成注云。此为阳气内陷。厥深热深。厥微热微。随阳气内陷之深浅
也。阳邪深伏。应须以苦寒之药。下去其热。使阴气得伸。则阴阳平四肢和顺而不厥矣。粗工见厥。认以为寒。而反用
辛温之药。以强发其汗。辛温皆升。引热上行。必口伤烂赤。以厥阴之脉循颊里。环唇内故也。补亡论郭白云云。仲景
言厥应下之者。谓有当下之厥而误汗。非谓厥皆可下也。故仲景又曰。诸四逆厥者。不可下。或问厥证应下。当用何药。
余答云。尚论篇举厥阴篇末下利谵语条。而用小承气汤。因本篇中别无下药故耳。殊不知此条系阳明篇错简。若审证用
药。厥时四肢冰冷。过乎肘膝。甚至有肌表皆凉。脉伏匿者。用四逆散。热回脉沉数。大便难者。方宜小承气。如脉沉
实。大便不通者。还宜大承气汤下之。口伤烂赤者。宜黄连解毒汤。）
伤寒病。厥五日。热亦五日。设六日。当复厥。不厥者。（云云至）故知自愈（此条伤寒。先厥后热。是亦中寒证也。
正文与注见中寒论中）
凡厥者。阴阳气不相顺接。便为厥厥者。手足逆冷是也。（以上数条。皆言厥证。而未详其厥之义。故于此节特申明
之。成注云。手之三阴三阳。相接于手十指。足之三阴三阳。相接于足十指。阳气内陷。不与阴气相顺接。故手足为之
厥冷也。愚以人之肢体。皆属阴。气附则温而生。气离则冷而死。阳气主外。阴气主内。成注云。阳气内陷而厥。乃阴
气已微。阳热用事。当是热厥。若寒厥。则阴寒用事。阳气将外脱矣。何由而反内陷邪。学人。其试思之。）
伤寒脉微而厥。至七八日肤冷（云云至）此为藏厥。非为蛔厥也。蛔厥者。其人当吐蛔。令病者静。而复时烦。此
为藏寒。蛔上入膈。（云云至）乌梅丸主之。又主久利方。（按上条伤寒曰藏厥。曰蛔厥。藏厥固系无阳证。即蛔厥。亦
为藏寒。此非首条厥阴病。心中疼热吐蛔比也。正文与注并。）
玄参、生地黄（各四两）、大黄（用酒浸泡一两）。
以上三味药。蒸制一个时辰（约两小时）。混合捣碎，使其均匀融合。制成如膏状。每次取适量。投入滚开的水中。加热绞取汁液一升。作为一次服用量。若伴有腹胀症状。加入厚朴、枳实各五钱。
上方药物。是进入手少阴心经和足少阴肾经，兼走阳明胃经的药物。阴虚体质的人以及老年人血虚者。非常适合服用。
（琥）总评：以上的方剂论述。是治疗少阴经热病的通变之法。少阴热病所急需治疗的。只是一下证（里实证）。所难处理的。也是一下证罢了。学者如果能够临证切脉。神而明之地运用。那么旧有的理论和新的方剂。哪一个不是救人的良法呢？
（此系张仲景原文）
厥阴病的病症表现。口渴多饮。气向上冲撞心脏。心中疼痛且有灼热感。感觉饥饿但不想吃东西。吃东西则会吐出蛔虫。如果误用攻下法。会导致腹泻不止。（这条关于厥阴病的论述。是总括热病的大纲。成无己注解说。邪气传入厥阴。则热邪已深入而形成消渴。消渴是指喝水多而小便少。厥阴属木。肝木过旺。则肾水不足以滋养它。所以水容易消耗。而口渴不止。气上撞心。心中疼热。是因为火生于木。气即是火。火性急速。因此上逆的势头如同撞击。肝相火也。心君火也。以火犯火。火热亢盛到了极点。心中就会疼痛。饥而不欲食。是因为胃属土。火热则土偏燥。所以感到饥饿。木强则克制土。所以不想吃东西。吃东西则吐蛔。蛔是胃中的长虫。蛔居住在胃中。因为人不进食。它就饥饿而上行至膈部。所以一闻到食物的气味。就向上逆行并吐出来。厥阴经的邪热。横逆于脏腑之间。所以出现以上各种症状。实际上是胃中空虚。没有实物可下。如果盲目攻下。则木乘其所胜（脾土）。腹泻就会不止。从而形成土崩之势。我认为这条论述。是张仲景简要概括热病的大纲。所以没有涉及治法。假设误用攻下法导致腹泻不止的。应该用理中汤来救治。）
厥阴中风。脉象微浮。表示快要痊愈。不浮。表示未愈（这里没有提伤寒。而是先提中风。也就像太阳病篇。先列出中风条文一样。论例中原话云。厥阴受病。尺寸脉俱微缓。我已校正认为这是沉弦之误。因为寒脉为沉。风脉为弦。如今风邪已传入。脉象见微浮。成无己注解说。这是邪气还表向汗出的时候。所以说。欲愈。如果不浮。则邪气深入。正气多变生他证。所以说。未愈。有人问张仲景只说脉微浮。没说中风的具体形证。怎么知道是厥阴病。我回答说。患者必定见到消渴。或气上撞心。心中疼热中的一两个症状。然后才称之为厥阴病。王宇泰说。张仲景立法。凡是说厥阴病的。都是气上撞心。心痛吐蛔。话虽然这么说。也不可拘泥。）
厥阴病想要缓解的时间是从丑时到卯时。（注解已见于前第三卷太阳上编）
厥阴病。想喝水的人。少量给予饮水即可痊愈（厥阴病口渴。是传经的热邪已深。想喝水。说明邪热有向外透发的机转。因为木火亢盛。得到水的济助。则阴阳气和。而病自愈。有人问厥阴原有消渴这一候。没说自愈。这条说的渴。为什么给水喝就能好。我回答说。武陵陈氏说。消渴是热甚而津液消烁。即使喝水。也不能胜过其燥烈。是邪气深入。未愈的迹象。这种渴欲饮水。其热势不如消渴那样严重。是邪气向外。欲解的征象。两者自然是不同的。）
各种四肢逆冷的厥证。不可用攻下法。体虚的人也是如此（这是说厥阴逆厥的开端。成无己注解说。四逆是指四肢不温。厥是指手足冷。邪气传入厥阴。阴阳之气内陷。阴气已微弱。阳气内陷。则外部不能与四肢相接。所以逆冷。阴气已微弱。则内部不能守于脏腑。所以不可攻下。如果轻率攻下。则内陷的阳热未去。将几微的真阴。反而随之亡失。在张仲景的后条文中。虽然说过热厥应当攻下。但在其逆厥之时。攻下这一法。不可轻试。“诸”字。是指下文各种厥的条文而言。虚家亦然。是说人在未病之前。气血本虚的人。即使病热厥。也不可用攻下法。成无己引用《金匮要略》说。虚者十补。勿一泻之。这是说平日。如果病伤寒。不可以此为例。我认为这条论述。张仲景没有给出治法。《补亡论》常器之说可用当归四逆汤是错误的。应当先用四逆散调理。）
伤寒先出现厥冷。后发热并且腹泻的。腹泻必定自行停止。再次出现厥冷则腹泻又发。（先厥后热。是阴寒证。发热。是阳气自复。所以利止。见厥是阴气还胜。所以复利。这条病。名为伤寒。而实为中寒证。正文与注见中寒论中。）
伤寒开始发热六天。厥冷反而九天并且腹泻。凡是厥冷腹泻的。应当不能进食。现在反而能进食的。恐怕是除中证。给吃索饼（面条）。如果不发热。知道胃气尚在。必定痊愈。恐怕是暴热来临。出现后又消失。三天后诊脉。如果热度持续存在。预期在第二天半夜痊愈。之所以这样。本来发热六天。厥冷反而九天。再次发热三天。加上前面的六天。也是九天。与厥冷天数相应。所以预期在第二天半夜痊愈。三天后诊脉。如果脉数且热度不退。这是热气有余。必定发生痈脓。（“索苏故切”当作“素”。这条病。先发热而后厥。是伤寒传经邪热伏匿的证候。始发热。是邪气自三阳经起。热至六天。邪传厥阴。阳气内陷。因而见厥。协热下利反长达九日之久。是邪热伏于里。不能还于表。凡是厥利者。多胃气下陷。应当不能食。现在反而能食。恐怕是除中证。除中是指胃中的真气。所剩无几。将要尽除。求救于食物。如灯将灭。而复明的意思。应当给吃索饼试探。以观察是否发热。如果不骤发热。这不是除中。知道胃中真气尚在。其厥与利。必定渐渐自愈。如果发热。是为暴热。恐怕其骤来。则能食。出即来也。既来而复骤去。这是胃中真气。得食而尽泄于外。即名除中而必死。如果是这样。则是厥利之人。给吃索饼。只需担心其热之暴耳。如果在九日之后。其热悠悠。又三天诊脉。而热续在。这是说诊脉。而前已发热六天。此时又复热三天。所以说续。此人内陷的阳气渐还。而复于四肢之间。可以预期在第二天前。夜半后。病当向愈。盖自丑至卯。为厥阴欲解之时。之所以这样。是以热与厥期。无太过不及而相应。故当愈。如愈后。又三天。诊脉。而脉数仍不罢。这是邪热之气。尚有余留。条辩说。厥阴主血。血热持久。则壅瘀腐化而为痈脓。在所难免。我认为这条论述。张仲景没有给出治法。《补亡论》郭白云说。可服千金漏芦汤。这个汤即漏芦连翘汤。治时行热毒。变作赤色痈疽者。若未发痈脓之前。厥利发热。还宜以白头翁汤主治。）
伤寒脉迟。六七天却反而用黄芩汤彻其热。（云云至）腹中应冷。应当不能进食。现在反而能进食。这叫除中。必死。（这条病。虽名伤寒。实则中寒证。上一条除中是热邪。这条是寒邪。正文与注见中寒论中。）
伤寒先厥后发热。腹泻必定自行停止。却反而出汗。咽喉痛的。其喉为痹。（云云至）便脓血的。其喉不痹。（这条伤寒亦中寒之证。盖先厥后热为真寒。但寒极亦能变热。热气上行。则为喉痹。热气下行。则便脓血。后条辩说。这莫非是辛温过剂所致。也犹热病过用凉药而变成寒证。我认为既变之后。虽从中寒例。应当以治杂病法治之。注详中寒论中。）
伤寒一二天。至四五天而出现厥冷的。必定发热。前面的热。后面的必定厥。厥深的。热亦深。厥微的。热亦微。厥应当用攻下法。却反而发汗的。必定口舌生疮溃烂发红。（这条乃传经邪热。阳极似阴的证候。伤寒一二天。至四五天而厥。是说伤寒在一二天时。本发热。至四五日后而厥。是邪传厥阴的候象。必发热。是说患者四肢及肌表虽厥。而躯壳以内。必发热。前热者。后必厥。乃申明一二日为前。四五日为后。以见热极必发厥。成无己注解说。此为阳气内陷。厥深热深。厥微热微。随阳气内陷的深浅。阳邪深伏。应用苦寒的药。下去其热。使阴气得伸。则阴阳平四肢和顺而不厥。粗工见厥。认以为寒。而反用辛温的药。以强发其汗。辛温皆升。引热上行。必口伤烂赤。因厥阴之脉循颊里。环唇内。故也。《补亡论》郭白云说。张仲景言厥应下之者。谓有当下之厥而误汗。非谓厥皆可下。故张仲景又说。诸四逆厥者。不可下。有人问厥证应下。当用什么药。我回答说。《尚论篇》举厥阴篇末下利谵语条。而用小承气汤。因本篇中别无下药故耳。殊不知此条系阳明篇错简。若审证用药。厥时四肢冰冷。过乎肘膝。甚至有肌表皆凉。脉伏匿者。用四逆散。热回脉沉数。大便难者。方宜小承气。如脉沉实。大便不通者。还宜大承气汤下之。口伤烂赤者。宜黄连解毒汤。）
伤寒病。厥五天。热亦五天。设第六天。应当再厥。不厥的。（云云至）故知自愈（这条伤寒。先厥后热。是亦中寒证。正文与注见中寒论中）
凡是厥证。阴阳气不相顺接。便为厥。厥。是指手足逆冷。（以上数条。皆言厥证。而未详其厥之义。故于此节特申明之。成无己注解说。手之三阴三阳。相接于手十指。足之三阴三阳。相接于足十指。阳气内陷。不与阴气相顺接。故手足为之厥冷。我认为人之肢体。皆属阴。气附则温而生。气离则冷而死。阳气主外。阴气主内。成无己注解说。阳气内陷而厥。乃阴气已微。阳热用事。应当是热厥。若寒厥。则阴寒用事。阳气将外脱矣。何由而反内陷邪。学者。其试思之。）
伤寒脉微而厥。至七八天肤冷（云云至）此为脏厥。非为蛔厥也。蛔厥者。其人当吐蛔。令病者静。而复时烦。此为脏寒。蛔上入膈。（云云至）乌梅丸主之。又主久利方。（按上条伤寒曰藏厥。曰蛔厥。藏厥固系无阳证。即蛔厥。亦为脏寒。此非首条厥阴病。心中疼热吐蛔比也。正文与注并。）
Shenxuan (Scrophulariae Radix), Shengdihuang (Rehmanniae Radix) (each 4 liang), Dahuang (Rhei Radix et Rhizoma) (1 liang, soaked in wine).
The above three herbs. Steamed for one fu period (approximately two hours). Mixed and pounded until well combined. Prepared into a paste-like consistency. Each time, take an appropriate amount. Throw into boiling water. Heat and squeeze to extract one sheng of juice. Take as a single dose. If abdominal distension is present, add Houpo (Magnoliae Officinalis Cortex) and Zhishi (Aurantii Fructus) each 5 qian.
The above formula enters the Hand Shaoyin Heart Meridian and Foot Shaoyin Kidney Meridian, and also acts on the Yangming Stomach Meridian. It is highly suitable for individuals with Yin deficiency and elderly people with blood deficiency.
(Hu) General Comment: The above prescription discussion is a flexible method for treating heat diseases of the Shaoyin meridian. What is urgent in Shaoyin heat disease is only the "Xia" syndrome (interior excess syndrome); what is difficult to handle is also only the "Xia" syndrome. If scholars can palpate the pulse during clinical practice and apply it with divine clarity, then whether old theories or new formulas, which one is not a good method for saving lives?
(This is the original text of Zhang Zhongjing)
The manifestations of Jueyin disease include excessive thirst (Xiao Ke), sensation of Qi rushing up to strike the heart, pain and burning sensation in the heart, hunger without desire to eat, and vomiting of roundworms upon eating. If purgatives are misused, diarrhea will not stop. (This clause on Jueyin disease summarizes the general outline of heat diseases. Cheng Wuji's commentary states: When pathogenic factors transmit to Jueyin, the heat has already deepened to form Xiao Ke. Xiao Ke refers to drinking much water but having little urine. Jueyin belongs to Wood. If Liver Wood becomes overly vigorous, Kidney Water is insufficient to nourish it. Thus, water is easily consumed, and thirst does not cease. Qi rushing up to strike the heart, pain and burning in the heart occur because Fire is born from Wood; Qi is Fire. Fire nature is rapid, hence the upward counterflow momentum resembles striking. Liver Xiang Fire and Heart Jun Fire interact; when Fire attacks Fire, heat-fire becomes extremely hyperactive, causing heart pain. Hunger without desire to eat occurs because the Stomach belongs to Earth; heat-fire makes Earth dry, causing hunger. Strong Wood controls Earth, causing lack of desire to eat. Vomiting roundworms upon eating happens because roundworms are long worms in the stomach. Roundworms reside in the stomach; when humans do not eat, they become hungry and move up to the diaphragm. Thus, upon smelling food odor, they counterflow upward and are vomited out. Pathogenic heat of the Jueyin meridian counterflows between Zang-Fu organs, resulting in the aforementioned symptoms. Actually, the stomach is empty with no substance to purge. Blind purging causes Wood to overact on its conquered element (Spleen Earth), leading to unceasing diarrhea and a collapse-like state. I believe this discussion is Zhang Zhongjing's concise summary of the heat disease outline, hence treatment methods are omitted. If misusing purgatives leads to unceasing diarrhea, Lizhong Tang should be used to rescue.)
Jueyin wind-strike presents with a slightly floating pulse. This indicates impending recovery. A non-floating pulse indicates no recovery. (Although Cold Damage is not mentioned, Wind Strike is discussed first, similar to the Taiyang chapter listing Wind Strike clauses first. The original discussion example states: For Jueyin disease, both Cun and Chi pulses are slightly slow. I have corrected this as a mistake for Chen-Xian [deep-wiry]. Cold pulse is Chen, Wind pulse is Xian. Now that Wind pathogen has transmitted, the pulse shows slight floating. Cheng Wuji comments: This is when pathogenic qi returns to the exterior towards sweating, hence "impending recovery." Non-floating means pathogenic qi has penetrated deeply, and Zheng Qi may generate various complications, hence "no recovery." Someone asks: Zhang Zhongjing only mentions slightly floating pulse, not specific Wind Strike symptoms. How do we know it is Jueyin disease? I answer: The patient must exhibit one or two symptoms such as Xiao Ke, Qi rushing up to strike the heart, or pain/burning in the heart before it is called Jueyin disease. Wang Yutai says: Zhang Zhongjing's legislation states that all cases referred to as Jueyin disease involve Qi rushing up, heart pain, and vomiting roundworms. Although stated thus, one should not be rigidly bound by it.)
Jueyin disease tends to resolve from Chou hour to Mao hour. (Note seen previously in Volume 3, Taiyang Upper Compilation)
In Jueyin disease, if the patient desires to drink water, giving small amounts allows recovery. (Jueyin thirst indicates transmitted pathogenic heat has deepened. Desire to drink suggests pathogenic heat has a tendency to move outward. Since Wood-Fire is hyperactive, receiving water assistance harmonizes Yin and Yang, leading to spontaneous recovery. Someone asks: Jueyin originally has the symptom of Xiao Ke, which is not said to resolve spontaneously. Why does this thirst resolve with water intake? I answer: Chen Shi of Wuling states: Xiao Ke involves severe heat consuming body fluids; even drinking water cannot overcome the dryness and烈ness, indicating deep pathogen invasion and unresolved disease. This thirst-desire-to-drink differs from Xiao Ke; its heat is less severe, indicating pathogen moving outward and impending resolution. The two are naturally different.)
For various types of Si Ni (Four Extremities Reversal/Cold) and Jue (Cold Limbs), purgation is contraindicated. This also applies to patients with deficiency constitutions. (This discusses the onset of Jueyin Si Ni/Jue. Cheng Wuji comments: Si Ni refers to cold extremities; Jue refers to cold hands and feet. Pathogen transmitting to Jueyin causes Yin-Yang Qi to sink inward. With deficient Yin Qi and sinking Yang Qi, the exterior cannot connect with the limbs, causing reversal cold. Deficient Yin Qi cannot guard the interior Zang-Fu, so purgation is contraindicated. Light purgation would fail to remove sinking Yang-heat and cause the remaining true Yin to perish. In later clauses, Zhang Zhongjing mentions heat-Jue should be purged, but during the phase of reversal cold, purgation should not be lightly attempted. The word "Zhu" (all/various) refers to subsequent Jue clauses. "Xu Jia Yi Ran" means those with pre-existing Qi-Blood deficiency, even if suffering heat-Jue, should not be purged. Cheng Wuji cites Jin Gui Yao Lue: "Deficiency requires ten parts tonification, never one part draining." This refers to daily maintenance; for Cold Damage, this rule does not apply. I note Zhang Zhongjing provides no treatment here. Bu Wang Lun by Chang Qizhi suggests Danggui Sini Tang, which is incorrect. One should first use Sini San to regulate.)
In Cold Damage, if there is initial Jue followed by fever and diarrhea, the diarrhea must stop spontaneously. If Jue reappears, diarrhea recurs. (Initial Jue then fever indicates Yin-Cold. Fever indicates self-recovery of Yang Qi, hence diarrhea stops. Appearance of Jue indicates Yin Qi regaining dominance, hence diarrhea recurs. This disease is named Cold Damage but is actually a Cold Injury pattern. Text and notes see Cold Injury Treatise.)
In Cold Damage, initial fever lasts six days, but Jue lasts nine days with diarrhea. Generally, those with Jue and diarrhea cannot eat. Now, if the patient can eat, fear this is Chu Zhong (Elimination of the Middle/False Appetite). Feed Su Bing (plain noodles). If no fever ensues, it indicates Stomach Qi remains, and recovery is certain. Fear sudden heat coming and going. Three days later, palpate the pulse. If heat continues, expect recovery at dawn/midnight. The reason is: originally fever for six days, Jue for nine days, recurring fever for three days, totaling nine days with Jue, matching the cycle, hence expected recovery at dawn/midnight. Three days later, if pulse is rapid and heat persists, this indicates excess heat, likely leading to carbuncles/pus. ("Su Su Gu Qie" should be "Su". This case involves initial fever then Jue, representing latent transmitted heat in Cold Damage. Initial fever starts in San Yang meridians. Heat for six days, pathogen transmits to Jueyin, Yang sinks inward causing Jue. Diarrhea accompanying heat lasting nine days indicates heat latent in interior, unable to return to exterior. Generally, Jue/Diarrhea implies sinking Stomach Qi and inability to eat. Current ability to eat fears Chu Zhong. Chu Zhong means remaining true Qi in Stomach is nearly exhausted, seeking salvation through food, like a lamp flickering before extinction. Testing with Su Bing observes fever response. No sudden fever means not Chu Zhong, true Qi remains, Jue/Diarrhea will gradually resolve. Fever indicates sudden heat, fearing recurrence. If heat comes suddenly and leaves, true Qi leaks out upon eating, named Chu Zhong, leading to death. Thus, for Jue/Diarrhea patients given Su Bing, worry only about sudden heat. If after nine days heat is gentle, and three days later pulse shows continued heat, this means diagnosed after previous six days fever, now recurring three days, hence "continued". Internal sinking Yang Qi gradually returns to limbs, expecting recovery before dawn/midnight. From Chou to Mao is Jueyin resolution time. Reason: Heat and Jue cycles match without excess or deficiency, hence recovery. If after recovery, three days later pulse remains rapid without heat subsiding, this indicates residual pathogenic heat. Tiao Bian states: Jueyin governs Blood; prolonged blood heat causes stasis and putrefaction into carbuncles/pus inevitably. I note Zhang Zhongjing gives no treatment. Bu Wang Lun by Guo Baiyun suggests Qianjin Loulu Tang (Loulu Lianqiao Tang), treating epidemic heat-toxin turning into red carbuncles. Before carbuncle formation, with Jue/Diarrhea/Fever, Baitouweng Tang is appropriate.)
Cold Damage with slow pulse. After six-seven days, mistakenly using Huangqin Tang to clear heat... Abdomen should be cold, patient should not eat. Now able to eat, this is Chu Zhong, definitely fatal. (This disease, though named Cold Damage, is actually Cold Injury. Previous Chu Zhong was due to Heat Pathogen; this is Cold Pathogen. Text and notes see Cold Injury Treatise.)
Cold Damage initial Jue then fever, diarrhea stops, but instead sweating occurs, throat pain results in Bi obstruction... If pus/blood in stool, throat is not Bi obstructed. (This Cold Damage is also Cold Injury. Initial Jue then fever is true cold, but extreme cold can transform into heat. Heat rising causes throat Bi; heat descending causes pus/blood stool. Later Tiao Bian suggests this might result from excessive warm-acrid dosage, similar to heat disease becoming cold pattern from excessive cooling meds. I believe after transformation, treat as Cold Injury using miscellaneous disease methods. Notes see Cold Injury Treatise.)
Cold Damage day one-two, progressing to day four-five with Jue, must have fever. Previous fever leads to subsequent Jue. Deep Jue means deep heat; mild Jue means mild heat. Jue should be purged, but if mistakenly sweated, mouth injuries and red ulcers occur. (This is transmitted heat, extreme Yang resembling Yin. Cold Damage day one-two fever, progressing to day four-five Jue indicates pathogen transmitting to Jueyin. "Must have fever" means although limbs/skin are cold, interior trunk is hot. "Previous fever leads to Jue" clarifies day one-two is previous, day four-five is subsequent, showing extreme heat generates Jue. Cheng Wuji comments: Yang sinks inward; depth of Jue matches depth of heat. Deep Yang pathogen requires bitter-cold herbs to purge heat, allowing Yin Qi to extend, balancing Yin-Yang and smoothing limbs. Crude physicians see Jue, mistake for cold, use acrid-warm herbs to force sweat. Acrid-warm rise, guiding heat upward, causing mouth ulcers/redness due to Jueyin meridian circling lips/cheeks. Bu Wang Lun Guo Baiyun says: "Jue should be purged" refers to Jue requiring purgation mistaken for sweating, not that all Jue can be purged. Hence Zhang says: All Si Ni Jue cannot be purged. Question: What medicine for purging Jue? Answer: Shanglun Pian cites end of Jueyin chapter diarrhea/delirium clause using Xiaochengqi Tang, as no other purgative exists in this chapter. Unknowingly, this clause is misplaced from Yangming chapter. Clinical application: If Jue limbs cold past elbows/knees, surface cool, pulse hidden, use Sini San. If heat returns, pulse deep-rapid, difficult stool, use Xiaochengqi. If pulse deep-solid, constipation, use Dachengqi. Mouth ulcers/redness: Huanglian Jiedu Tang.)
Cold Damage Jue five days, fever five days. If sixth day, Jue should recur. If no Jue... therefore knows self-recovery. (This Cold Damage, initial Jue then fever, is also Cold Injury. Text and notes see Cold Injury Treatise.)
All Jue cases involve failure of Yin and Yang Qi to connect smoothly, resulting in Jue. Jue refers to reverse cold of hands and feet. (Previous clauses discuss Jue symptoms but not the meaning of Jue. Here specifically clarified. Cheng Wuji comments: Hand/San Yin/Yang connect at ten fingers; Foot/San Yin/Yang connect at ten toes. Yang sinks inward, failing to connect smoothly with Yin, causing cold limbs. I believe limbs belong to Yin; Qi attachment brings warmth/life, detachment brings cold/death. Yang governs exterior, Yin interior. Cheng Wuji comments: Yang sinking causing Jue implies deficient Yin and active Yang-heat, suggesting Heat Jue. If Cold Jue, Yin-Cold dominates, Yang is about to escape exterior, how could it sink inward? Scholars, consider this.)
Cold Damage pulse micro and Jue. By seven-eight days, skin cold... This is Zang Jue, not Wei Jue. Wei Jue patients vomit roundworms. Patient quiet but occasionally restless, this is Zang Cold, roundworms moving up to diaphragm... Wumei Wan is the main formula. Also treats chronic diarrhea. (Regarding previous clause: Cold Damage mentions Zang Jue and Wei Jue. Zang Jue lacks Yang signs; Wei Jue also involves Zang Cold. This differs from the first Jueyin clause involving heart pain/burning and roundworm vomiting. Text and notes combined.)