桃仁（十个） 大黄（二钱五分） 芒硝（一钱五分） 甘草（一钱） 桂枝（五分）
水煎服。
水蛭 虻虫（去翅，各十枚） 桃仁（十枚） 大黄（五钱）
水煎服。
伤寒传经热症，渐至手足厥冷，是为热极而反见厥，所谓热深厥亦深，热微厥亦微是也
医者不识，误投热药，以火济火，迫血妄行，其血或从耳目，或从目鼻，一拥而出，名曰
动阴血，又名下厥上竭，为难治。大抵伤寒初起，即发厥者、寒厥也；初起发热燥渴，渐次
而厥者，热厥也。寒厥者，必下利清谷，口鼻气冷，口舌常润，脉沉迟。热厥者，必便闭谵
语，或下利肠垢，口渴唇焦，或舌黑而燥，脉滑数。寒热之际，朗然明白，则无动阴血之祸
矣。
鼻鼾者，鼻中发声，如鼾睡也，此为风热壅闭。鼻鸣者，鼻气不清，言响如从瓮中出也
多属风寒壅塞，须按兼症治之。
不能言及语言难出者，有表里之分。其一、太阳证，发汗已，身犹灼热者，名曰风温。
其脉尺寸俱浮，自汗身重，多眠鼻息鼾，语言难出，此表邪蕴其内热也。治用葳蕤汤，去麻
黄，加秦艽主之。其一、少阴病，咽中伤，生疮，不能言，古方治以苦酒汤。然苦酒汤，恐
传写之讹，宜用甘桔汤，加蒡子、薄荷、元参、白前之属，以清之。复有风寒客于肺中，声
哑不能言者，当用半夏、生姜、荆、防等辛温以散之。更有中寒之证，口鼻气冷，口噤难言
者，当用温热之剂。大抵唇焦齿燥，舌干口渴者，热也；唇清口和，口鼻气冷者，寒也。伤
寒辨证，莫先于此，学人宜致思焉。
桃仁（十个） 大黄（二钱五分） 芒硝（一钱五分） 甘草（一钱） 桂枝（五分）
用水煎煮后服用。
水蛭 虻虫（去掉翅膀，各十只） 桃仁（十只） 大黄（五钱）
用水煎煮后服用。
伤寒病邪传入经络化热，逐渐发展到手足冰冷，这是热邪极盛反而出现厥冷，也就是所说的“热邪越深，厥冷越深；热邪轻微，厥冷也轻微”。
医生如果不认识这种病症，错误地投用热性药物，如同火上浇油，迫使血液妄行，血液有时从耳朵和眼睛流出，有时从眼睛和鼻子涌出，一齐出来，名叫动阴血，又叫做下厥上竭，属于难治之症。大抵来说，伤寒初起就发生厥冷的，是寒厥；初起发热、烦躁口渴，逐渐发展为厥冷的，是热厥。寒厥的症状，必定伴有腹泻排出未消化的食物，口鼻呼出的气寒冷，口舌经常湿润，脉象沉迟。热厥的症状，必定伴有便秘、胡言乱语，或者腹泻排出污浊黏液，口渴嘴唇焦裂，或者舌头黑而干燥，脉象滑数。在寒证与热证的辨别之间，如果朗然明白，就不会有动阴血的祸患了。
鼻鼾，是指鼻中发出声音，像打呼噜睡觉一样，这属于风热壅塞闭阻。鼻鸣，是指鼻气不通畅，说话的声音像从瓮中传出来一样，大多属于风寒壅塞阻滞，必须按照兼夹症状进行治疗。
不能说话及语言困难的情况，有表证和里证的区别。其一，太阳证，发汗之后，身体仍然灼热，名叫风温。其脉象寸关尺三部都浮，自汗出、身体沉重，嗜睡、鼻息打鼾、语言困难，这是表邪蕴结导致内热。治疗使用葳蕤汤，去掉麻黄，加入秦艽为主药来治疗。其二，少阴病，咽喉受伤，生疮，不能说话，古方用苦酒汤治疗。然而苦酒汤，恐怕是传抄书写时的讹误，适宜使用甘桔汤，加上牛蒡子、薄荷、玄参、白前这类药物，以清利咽喉。又有风寒客居于肺中，导致声音嘶哑不能说话的，应当使用半夏、生姜、荆芥、防风等辛温药物来发散。更有中寒的证候，口鼻呼出的气寒冷，牙关紧闭难以说话的，应当使用温热性质的药剂。大抵来说，嘴唇焦裂牙齿干燥，舌头干渴想喝水的，是热证；嘴唇清爽口中和缓，口鼻呼出的气寒冷的，是寒证。伤寒辨证，没有比这更优先的了，学习的人应该深入思考。
Peach Kernel (Ten seeds) Rhubarb (2.5 qian) Mirabilite (1.5 qian) Licorice Root (1 qian) Cinnamon Twig (0.5 qian)
Decoct in water and take orally.
Hirudo (Leech) Ophiorrhiza? No, *Ophiorrhiza* is not correct here. The text says "Meng Chong" which refers to Horseflies. So: Hirudo (Leech) Oestrus? No, *Musca* or *Tabanus*. WHO term for Meng Chong is often translated as Horsefly. Let's use *Hirudo* and *Horsefly*. Wait, standard Latin for Meng Chong is often just described as the insect. I will use the English common name with Latin if available, but for insects, it's tricky. I'll stick to English names as per instruction "herbs... Latin". For non-herbs, English is fine. But let's look at the prompt: "Herb names priority use Latin". These are animal drugs. I will provide English and Latin where applicable or standard English.
*Hirudo nipponica* (Shuizhi, 水蛭) *Tabanus* species (Mengchong, 虻虫) (Remove wings, ten each) Peach Kernel (Ten seeds) Rhubarb (5 qian)
Decoct in water and take orally.
In *Shanghan* (Cold Damage) disease, when pathogenic heat transmits through the meridians and gradually leads to coldness of the hands and feet, this is referred to as "extreme heat presenting with reversal coldness" (Re Jie Fan Jue). This is what is meant by "the deeper the heat, the deeper the reversal coldness; the slighter the heat, the slighter the reversal coldness."
If physicians fail to recognize this condition and mistakenly administer hot-natured medicines, it is like adding fire to fire, forcing blood to flow recklessly. The blood may erupt from the ears and eyes, or gush out from the eyes and nose. This is named "disturbing Yin blood" (Dong Yin Xue), also known as "reversal coldness below and exhaustion above" (Xia Jue Shang Jie), which is difficult to treat. Generally speaking, if reversal coldness occurs right at the onset of *Shanghan*, it is Cold Reversal (Han Jue); if fever, restlessness, and thirst occur initially and gradually progress to reversal coldness, it is Heat Reversal (Re Jue). Symptoms of Cold Reversal must include diarrhea with undigested food, cold breath from the mouth and nose, a moist tongue and lips, and a deep, slow pulse. Symptoms of Heat Reversal must include constipation and delirious speech, or diarrhea with foul mucus, thirst with cracked lips, a black and dry tongue, and a slippery, rapid pulse. If the distinction between cold and heat is clear, the disaster of disturbing Yin blood can be avoided.
Snoring (Bi Han) refers to sounds emitted from the nose, similar to snoring during sleep; this indicates obstruction by Wind-Heat. Nasal congestion/noise (Bi Ming) refers to unclear nasal airflow and a resonant voice, as if speaking from a jar; this mostly belongs to obstruction by Wind-Cold. Treatment must be based on accompanying symptoms.
Inability to speak or difficulty in articulation involves a distinction between Exterior and Interior patterns. First, in Taiyang syndrome, after sweating therapy, if the body remains burning hot, it is named Wind-Warmth (Feng Wen). The pulse is floating at all three positions (Cun, Guan, Chi); accompanied by spontaneous sweating, heaviness of the body, somnolence, snoring, and difficulty in speech. This indicates exterior pathogens trapping interior heat. The treatment uses Zhen Zhu Tang (Jade Yucca Decoction), removing Ephedrae Herba (Mahuang, 麻黄) and adding Kochiae Radix (Qinjiao, 秦艽) as the principal herb. Second, in Shaoyin disease, if the throat is injured and sores form, causing inability to speak, ancient formulas prescribe Ku Jiu Tang (Bitter Wine Decoction). However, Ku Jiu Tang is likely a transcription error; it is advisable to use Gan Jie Tang (Licorice and Platycodon Decoction), added with Fructus Armeniacae Amarum (Niang Xing Ren? No, Bang Zi is Fructus Arctii/Burdock Seed), Fructus Arctii (Bangzi, 牛蒡子), Folium Menthae (Bohe, 薄荷), Radix Scrophulariae (Yuanshen, 玄参), and Radix Stemonae (Baiqian, 白前) to clear the area. Furthermore, if Wind-Cold invades the Lungs causing hoarseness and inability to speak, one should use Pinelliae Rhizoma (Banxia, 半夏), Zingiberis Rhizoma (Shengjiang, 生姜), Schizonepetae Spica (Jingsai, 荆芥), and Saposhnikoviae Radix (Fangfeng, 防风) etc., warm-natured acrid herbs to disperse it. Additionally, in cases of Middle-Jiao Cold, where breath from the mouth and nose is cold and the jaw is locked making speech difficult, warm-natured formulas should be used. Generally, scorched lips, dry teeth, a dry tongue, and thirst indicate Heat; clear lips, a harmonious mouth, and cold breath from the mouth and nose indicate Cold. In diagnosing *Shanghan*, nothing is more primary than this; students should reflect deeply upon it.