论
《内经》曰∶阳气衰于下，则为寒厥；阴气衰于下，则为热厥。又曰∶寒厥者，此人质壮，以秋冬夺于所用，下气
上争，不能复，精气溢下，邪气因从之而上也，气因于中，由阳衰不能渗营其经络，阳气日损，阴气独在，故手足为之
寒也。热厥者，此人必醉饱入房，精气中虚，酒入于胃，则络脉满而经脉虚，脾主为胃行其津液者也，阴气虚则阳气入，
阳气入则胃不和，胃不和则精气竭，精气竭则不能渗营其四肢也。气聚于脾中不得散，酒气与谷气相薄，热盛于中，故
热遍于身内热而溺赤也。肾气日衰，阳气独盛，故手足为之热也。又阴气盛于上则下虚，下虚则腹胀满，腹满则下气重
上而邪气厥，厥则阳气乱，阳气乱则令人暴仆不知人，或至半日远至一日乃知人也，名曰尸厥。考之张仲景伤寒论，阴
阳二厥之证，皆指手足逆冷而言也。河间《原病式》曰∶阴厥者，原病脉候皆为阴证，身凉不渴，脉迟而微。阳厥者，
原病脉候皆为阳证，烦渴谵妄，身热而脉数。若阳厥极深，或失下而至于身冷，反见阴证，脉微欲绝而死者，此为极热
而然。俗医妄谓变成阴证，急用热药助其阳气，以致十无一生也。愚按∶内经曰寒热二厥者，皆常病虚损证也，并宜补
益之法，但热厥补阴，寒厥当补阳耳，正经所谓壮水之主，以镇阳光，益火之原，以消阴翳也。若夫《伤寒论》所谓阴
阳二厥者，冰炭殊途，治法亦异，诊察之间，死生反掌，医者其可不尽心乎。
脉法
《脉经》曰∶寸口沉大而滑，沉则为实，滑则为气，实气相搏，血气入于脏则死，入于腑则愈，此为卒厥。不知人，
唇青身冷，为入脏即死；如身温和，汗自出，为入腑而后自愈。
《活人书》云∶阳厥脉滑而沉实，阴厥脉细而沉伏。
方法
丹溪曰∶厥因气虚、血虚者多。气虚脉细，血虚脉大如葱管，热厥脉数，外感脉浮而实，有痰者脉弦。热用承气汤，
痰用白术、竹沥，外感宜解散药中加姜汁服。
（以上丹溪方法凡一条）
《活人书》曰∶初得病身热头痛，大便秘，小便赤，或畏热，或饮水，或扬手掷足，烦躁不得安卧，谵语昏愦而厥，
此阳厥也，大柴胡汤、大小承气汤治之，渴者白虎汤妙。手足厥冷，脉乍结，此邪气结在胸，心下烦满，饥不能食，瓜
蒂散吐之。寒热而厥，面色不泽，冒昧，两手忽无脉或一手无脉，必是有正汗也。多用绵衣包手足，急服五味子汤，或
兼与桂枝麻黄各半汤，须臾大汗而解。伤寒厥逆，心下怔忡者，宜先治水，茯苓甘草汤主之。如得病后，四肢逆冷，脉
沉而细，足挛卧而恶寒，引衣盖复，不饮水，或下利清谷而厥逆者，阴厥也，四逆汤、白通汤。厥逆脉不至者，通脉四
逆汤。手足指头微寒者谓之清，理中汤。无热证而厥，当归四逆加茱萸生姜汤。喘促脉伏而厥，五味子汤。吐利，手足
厥冷，烦躁欲死，吴茱萸汤。
五味子汤（活人） 治阳厥脉伏，手足厥冷。
五味子（一两） 人参 麦门冬 杏仁 陈皮（以上各五钱）
上细切，用水三盏，生姜十片，枣二枚，煎至一盏半，去渣分作二服。
桂枝麻黄各半汤（方见伤寒门。）
茯苓甘草汤 治阳厥怔忡，手足厥逆，心下有水气。
茯苓 桂枝（各二钱） 甘草（一钱） 生姜（三钱）
上细切，作一服，水一盏半，煎至一盏，去渣温服。
通脉四逆汤（活人） 治阴厥，下利清谷，四肢逆冷，脉微。
甘草（六钱五分） 附子（一枚，生用） 干姜（一两，炮）
如面赤者，加葱九茎。呕者，加生姜。咽痛，加桔梗。利止脉不出，加人参。
上用水三大盏，煎至一盏半，去渣分作二服。
当归四逆加茱萸生姜汤（活人） 治无热证而厥。
当归 芍药 桂枝 细辛（各一两） 甘草 通草（各六钱五分） 吴茱萸（三钱） 生姜（六钱）
上细切，水三升，煮至一升半，分三服。
吴茱萸汤（活人） 治阴厥吐利，手足逆冷，烦躁欲死。
吴茱萸 生姜（各五钱） 人参（三钱五分）
上细切，作一服，水二盏，大枣一枚，煎至一盏半，温服，忌生冷物。
苏合香丸（局方） 治卒厥不知人，未详风痰气厥，先与此药极妙。每用一丸，以汤调化灌之即醒，醒后察脉
而用他药。
（丹溪活套）云∶热厥四肢烦热，盖湿热郁于脾土之中，治用东垣升阳散火汤、火郁汤之类。寒厥手足逆冷者，多
是气血不足，补气血药加附子。饮酒人或体肥盛人手足热者，湿痰郁火盛也，二陈汤加芩、连、栀子之类。若忽然手足
逆冷、卒厥不知人者，多属痰火，亦有阴先亏而阳暴热者，宜多用参膏，兼竹沥、姜汁与之。人瘦弱者，虽无痰而火亦
盛也，服竹沥亦能养血而降火。
论
《黄帝内经》说：阳气在下部衰弱，就会发生寒厥；阴气在下部衰弱，就会发生热厥。又说：所谓寒厥，这种人体质强壮，在秋冬季节因过度使用精气（如房劳等），导致下部的正气向上争竞而不能恢复，精气从下部外泄，邪气便随之上行。气郁结在中焦，由于阳气衰弱不能渗透滋养其经络，阳气日益损耗，只有阴气独存，所以手足因此发冷。所谓热厥，这种人必定是在醉酒饱食后行房事，导致精气中虚。酒进入胃中，则络脉充盈而经脉空虚。脾的功能是为胃传输津液，阴气虚弱则阳气内入，阳气内入则胃气不和，胃气不和则精气枯竭，精气枯竭则不能渗透滋养四肢。气聚积在脾中不得疏散，酒气与谷气相互搏结，热气盛于中焦，所以热遍全身，体内发热且小便色赤。肾气日益衰弱，阳气独盛，所以手足因此发热。另外，如果阴气盛于上部则下部虚，下部虚则腹部胀满，腹满则下部之气沉重而上逆，邪气导致厥逆，厥逆则阳气紊乱，阳气紊乱使人突然仆倒不省人事，有的半天到一天后才苏醒，名叫尸厥（一种因气机逆乱导致的昏厥）。考察张仲景的《伤寒论》，阴阳二厥的病证，都是指手足逆冷而言。刘河间在《原病式》中说：阴厥，其病因、脉象和症状都属于阴证，身体凉爽不口渴，脉象迟而微弱。阳厥，其病因、脉象和症状都属于阳证，烦渴谵语妄动，身体发热且脉象数急。如果阳厥极深，或者因误治未用攻下法而导致身体冰冷，反而出现阴证，脉微欲绝甚至死亡，这是极热所致。庸医错误地认为变成了阴证，急忙使用热药助长阳气，以致十人中没有一人能存活。我认为：《内经》所说的寒热二厥，都是常见的虚损病证，都适宜用补益的方法治疗，只是热厥应当补阴，寒厥应当补阳罢了。这正是经典所说的“壮水之主，以镇阳光”（滋补肾阴以抑制亢盛的阳热），“益火之原，以消阴翳”（温补肾阳以消散阴寒之邪）。至于《伤寒论》所说的阴阳二厥，如同冰炭殊途，治疗方法也不同，诊断察辨之间，生死只在反掌之间，医生怎能不尽心竭力呢？
脉法
《脉经》说：寸口脉沉大而滑，沉主实邪，滑主气滞，实邪与气滞相搏结，血气侵入脏则死，侵入腑则愈，这叫做卒厥（突然发生的厥逆）。如果不省人事，嘴唇青紫身体寒冷，是血气入脏即死；如果身体温和，汗自出，是血气入腑而后自愈。
方法
朱丹溪说：厥逆多因气虚、血虚引起。气虚脉细，血虚脉大如葱管，热厥脉数，外感引起的厥逆脉浮而实，有痰者脉弦。热厥用承气汤，痰厥用白术、竹沥，外感宜在解散药中加入姜汁服用。
（以上为丹溪关于厥逆的治疗方法共一条）
《活人书》说：初得病时身体发热头痛，大便秘结，小便色赤，或怕热，或想喝水，或扬手掷足，烦躁不能安卧，谵语昏愦而厥逆，这是阳厥，用大柴胡汤、大小承气汤治疗，口渴的用白虎汤效果妙。手足厥冷，脉象乍现乍止（结脉），这是邪气结在胸中，心下烦闷胀满，饥饿但不能进食，用瓜蒂散催吐。寒热交替而厥逆，面色无光泽，头目昏眩，两手突然无脉或一手无脉，必定会有正汗（正常出汗）出现。多用绵衣包裹手足，急服五味子汤，或者兼服桂枝麻黄各半汤，不久大汗出而病解。伤寒引起的厥逆，伴有心下悸动的，宜先治水，用茯苓甘草汤主治。如果得病后，四肢逆冷，脉沉而细，脚挛缩卧床且恶寒，拉衣服遮盖身体，不想喝水，或者下利清谷（泻下未消化的食物）而厥逆的，是阴厥，用四逆汤、白通汤。厥逆脉象摸不到的，用通脉四逆汤。手足指尖微冷的叫作清厥，用理中汤。没有热证而厥逆的，用当归四逆加茱萸生姜汤。喘促脉伏而厥逆的，用五味子汤。呕吐腹泻，手足厥冷，烦躁欲死的，用吴茱萸汤。
五味子汤（出自《活人书》） 治疗阳厥脉伏，手足厥冷。
五味子（一两） 人参 麦门冬 杏仁 陈皮（以上各五钱）
将药材细细切碎，用水三盏，生姜十片，大枣二枚，煎至一盏半，去渣分成两份服用。
茯苓甘草汤 治疗阳厥怔忡，手足厥逆，心下有停饮。
茯苓 桂枝（各二钱） 甘草（一钱） 生姜（三钱）
将药材细细切碎，作为一服，用水一盏半，煎至一盏，去渣温服。
通脉四逆汤（出自《活人书》） 治疗阴厥，下利清谷，四肢逆冷，脉微。
甘草（六钱五分） 附子（一枚，生用） 干姜（一两，炮制）
如果面色发红，加葱九茎。呕吐的，加生姜。咽痛，加桔梗。腹泻停止但脉搏不出，加人参。
用水三大盏，煎至一盏半，去渣分成两份服用。
当归四逆加茱萸生姜汤（出自《活人书》） 治疗无热证而厥逆。
当归 芍药 桂枝 细辛（各一两） 甘草 通草（各六钱五分） 吴茱萸（三钱） 生姜（六钱）
将药材细细切碎，水三升，煮至一升半，分三次服用。
吴茱萸汤（出自《活人书》） 治疗阴厥呕吐腹泻，手足逆冷，烦躁欲死。
吴茱萸 生姜（各五钱） 人参（三钱五分）
将药材细细切碎，作为一服，用水二盏，大枣一枚，煎至一盏半，温服，忌食生冷食物。
苏合香丸（出自《局方》） 治疗卒厥不省人事，若不清楚是风、痰还是气厥，先用此药极好。每次用一丸，用开水化开灌服即可苏醒，醒后根据脉象再用其他药物。
（丹溪的灵活变通之法）说：热厥四肢烦热，是因为湿热郁结在脾土之中，治疗用李东垣的升阳散火汤、火郁汤之类。寒厥手足逆冷的，多是气血不足，在补气血药中加入附子。饮酒的人或体形肥胖的人手足发热的，是湿痰郁火旺盛，用二陈汤加黄芩、黄连、栀子之类。如果突然手足逆冷、卒厥不省人事的，多属于痰火，也有阴精先亏损而阳气暴热的，宜多用参膏，并配合竹沥、姜汁给予。人瘦弱的，即使没有痰，火也旺盛，服用竹沥也能养血而降火。
Treatise
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When Yang Qi (vital energy associated with warmth and activity) is deficient in the lower part of the body, Cold Jue (a condition characterized by cold extremities due to Yang deficiency) occurs; when Yin Qi (vital energy associated with cooling and substance) is deficient in the lower part, Heat Jue (a condition characterized by hot extremities due to Yin deficiency) occurs. It further states: Regarding Cold Jue, this type of person has a robust constitution but squanders their essence during autumn and winter (e.g., through excessive sexual activity). The Qi below contends upward but cannot recover; essence overflows from below, and pathogenic factors follow it upward. Qi becomes stagnant in the middle jiao. Due to Yang deficiency, it fails to permeate and nourish the meridians. Yang Qi diminishes daily, leaving only Yin Qi present, hence the hands and feet become cold. Regarding Heat Jue, such a person must have engaged in sexual intercourse after being drunk and full. This leads to emptiness of essence within. Wine enters the stomach, filling the collaterals while emptying the main meridians. The Spleen is responsible for transporting and transforming fluids for the Stomach. When Yin Qi is deficient, Yang Qi enters inwardly. Once Yang Qi enters inwardly, the Stomach becomes disharmonious. When the Stomach is disharmonious, essence is exhausted. When essence is exhausted, it cannot permeate and nourish the four limbs. Qi gathers in the Spleen and cannot disperse. The qi of wine and the qi of grain contend with each other, causing intense heat in the center. Thus, heat pervades the whole body, internal heat arises, and urine becomes red. Kidney Qi declines daily, while Yang Qi becomes excessively strong, hence the hands and feet become hot. Furthermore, if Yin Qi is excessive in the upper part, the lower part becomes deficient. Lower deficiency leads to abdominal distension. Abdominal distension causes Qi in the lower part to become heavy and reverse upward, leading to Jue where pathogenic factors cause reversal. In Jue, Yang Qi becomes chaotic. Chaotic Yang Qi causes sudden collapse and loss of consciousness. Some may regain consciousness after half a day or even up to a day; this is named Shi Jue (Corpse Jue, a type of syncope caused by chaotic Qi mechanism). Examining Zhang Zhongjing’s *Shanghan Lun* (Treatise on Cold Damage), the syndromes of Yin and Yang Jue both refer to coldness reversing from the extremities inward. Liu Hejian, in his *Yuanbing Shi* (Original Causes of Diseases), states: For Yin Jue, the etiology, pulse, and symptoms all belong to Yin syndromes: the body is cool, there is no thirst, and the pulse is slow and thready. For Yang Jue, the etiology, pulse, and symptoms all belong to Yang syndromes: there is irritability, thirst, delirium, restlessness, the body is hot, and the pulse is rapid. If Yang Jue is extremely deep, or if failure to use purgatives leads to a cold body, presenting falsely as a Yin syndrome with a faint pulse nearing extinction and death, this is caused by extreme heat. Quack physicians mistakenly believe it has transformed into a Yin syndrome and urgently administer hot medicines to assist Yang Qi, resulting in no survivors out of ten. I observe: The Cold and Heat Jue described in the *Neijing* are common deficiency and exhaustion syndromes. Both are suitable for tonification methods, but Heat Jue requires tonifying Yin, while Cold Jue requires tonifying Yang. This aligns with the classic saying: "Strengthen the master of Water to suppress the flaring Sun" (nourish Kidney Yin to restrain hyperactive Yang heat), and "Benefit the source of Fire to dissipate the shade" (warm Kidney Yang to dispel Yin-cold pathogens). However, the Yin and Yang Jue described in the *Shanghan Lun* are as different as ice and charcoal, and their treatment methods differ. Between diagnosis and observation, life and death can reverse in the turning of a palm. How can physicians not exert themselves fully?
Pulse Diagnosis
The *Maijing* (Pulse Classic) states: At the Cun Kou (radial artery) position, if the pulse is deep, large, and slippery, "deep" indicates excess, and "slippery" indicates Qi stagnation. When excess and Qi stagnation clash, if Blood and Qi enter the Zang organs, death ensues; if they enter the Fu organs, recovery occurs. This is called Cu Jue (Sudden Jue). Loss of consciousness, blue lips, and cold body indicate entry into the Zang organs leading to death; if the body is warm and sweat comes spontaneously, it indicates entry into the Fu organs followed by self-recovery.
The *Huren Shu* (Book Saving Lives) states: The pulse of Yang Jue is slippery and deep-excess; the pulse of Yin Jue is fine and deep-hidden.
Methods
Zhu Danxi states: Jue is mostly caused by Qi deficiency or Blood deficiency. Qi deficiency presents with a fine pulse; Blood deficiency presents with a large pulse like an onion stalk; Heat Jue presents with a rapid pulse; Exogenous Jue presents with a floating and excess pulse; Phlegm-related cases present with a wiry pulse. For Heat, use Chengqi Tang (Gut-Purging Decoction); for Phlegm, use Baizhu (Atractylodis Rhizoma) and Zhuli (Bamboo Sap); for exogenous factors, add Jiangzhi (Ginger Juice) to dispersing formulas.
(Above is one rule of Zhu Danxi’s methods regarding Jue.)
The *Huren Shu* states: Initially contracting the disease with fever, headache, constipation, dark urine, aversion to heat, desire for water, waving hands and throwing legs about, irritability preventing peaceful lying down, delirium, confusion, and Jue—this is Yang Jue, treated with Da Chaihu Tang (Major Bupleurum Decoction) or Xiao/Chengqi Tangs (Minor/Major Gut-Purging Decoctions). If thirsty, Baihu Tang (White Tiger Decoction) is excellent. Cold hands and feet with a knotted pulse (intermittent pulse) indicates pathogenic factors knotting in the chest, oppression and fullness below the heart, hunger but inability to eat; treat with Gouti San (Melon Seed Powder) to induce vomiting. Alternating chills and fever with Jue, lusterless complexion, dizziness, sudden absence of pulse in both hands or one hand—this indicates normal sweating will occur. Wrap hands and feet in cotton cloth, urgently administer Wuweizi Tang (Schisandra Decoction), or alternatively Guizhi Mahuang Ge Ban Tang (Half-Dose Combination of Cinnamon Twig and Ephedra Decoction). After a short while, profuse sweating will resolve the condition. For Shanghan-induced Jue with palpitations below the heart, first treat the water retention using Fuling Gancao Tang (Poria and Licorice Decoction). If after contracting the disease, there is coldness reversing in the four limbs, deep and fine pulse, leg cramping while lying down, aversion to cold, pulling clothes to cover oneself, no desire for water, or diarrhea with undigested food and Jue—this is Yin Jue, treated with Sini Tang (Recover the Extremities Decoction) or Baitong Tang (White Through Decoction). For Jue with absent pulse, use Tongmai Sini Tang (Unblocking the Mai Sini Decoction). For slight coldness in the fingertips, termed Qing Jue (Clear/Cold Jue), use Lizhong Tang (Regulate the Middle Decoction). For Jue without heat signs, use Danggui Sini Jia Zhuyu Shengjiang Tang (Angelica Sinensis Decoction to Nourish the Extremities plus Cornus and Ginger). For panting, hidden pulse, and Jue, use Wuweizi Tang. For vomiting and diarrhea, cold hands and feet, and irritability wishing to die, use Wuzhuyu Tang (Evodia Decoction).
Wuweizi Tang (from *Huren Shu*) treats Yang Jue with hidden pulse and cold hands and feet.
Wuweizi (Schisandra Fructus, 1 liang), Renshen (Ginseng Radix), Maidong (Ophiopogonis Tuber), Xingren (Prunus Semen), Chenpi (Citri Reticulatae Pericarpium) (each 5 qian).
Finely chop, add 3 zhan of water, 10 slices of Shengjiang (Fresh Ginger), and 2 dates. Decoct to 1.5 zhan, remove dregs, and divide into two doses.
Guizhi Mahuang Ge Ban Tang (See Shanghan section for formula.)
Fuling Gancao Tang treats Yang Jue with palpitations, cold hands and feet, and fluid retention below the heart.
Fuling (Poria), Guizhi (Cinnamomi Ramulus) (each 2 qian), Gancao (Licorice Radix, 1 qian), Shengjiang (Fresh Ginger, 3 qian).
Finely chop, prepare as one dose, add 1.5 zhan of water, decoct to 1 zhan, remove dregs, and take warm.
Tongmai Sini Tang (from *Huren Shu*) treats Yin Jue, diarrhea with undigested food, cold hands and feet, and faint pulse.
Gancao (Licorice Radix, 6.5 qian), Fuzi (Aconiti Lateralis Radix Preparata, 1 piece, raw), Ganjiang (Zingiberis Rhizoma, 1 liang, processed).
If the face is red, add 9 stems of Congbai (Allii Cepae Bulbus). If vomiting, add Shengjiang. If sore throat, add Jiegeng (Platycodon Radix). If diarrhea stops but pulse does not return, add Renshen.
Add 3 large zhan of water, decoct to 1.5 zhan, remove dregs, and divide into two doses.
Danggui Sini Jia Zhuyu Shengjiang Tang (from *Huren Shu*) treats Jue without heat signs.
Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix Alba), Guizhi (Cinnamomi Ramulus), Xixin (Asari Radix et Rhizoma) (each 1 liang), Gancao (Licorice Radix), Tongcao (Tetrapanacis Medulla) (each 6.5 qian), Wuzhuyu (Evodiae Fructus, 3 qian), Shengjiang (Fresh Ginger, 6 qian).
Finely chop, add 3 sheng of water, boil to 1.5 sheng, divide into three doses.
Wuzhuyu Tang (from *Huren Shu*) treats Yin Jue with vomiting and diarrhea, cold hands and feet, and irritability wishing to die.
Wuzhuyu (Evodiae Fructus), Shengjiang (Fresh Ginger) (each 5 qian), Renshen (Ginseng Radix, 3.5 qian).
Finely chop, prepare as one dose, add 2 zhan of water and 1 date. Decoct to 1.5 zhan, take warm. Avoid raw and cold foods.
Suhexiang Wan (Styrax Pill, from *Jufang*) treats sudden Jue with loss of consciousness. If the cause (Wind, Phlegm, or Qi) is unclear, this medicine is excellent initially. Use one pill each time, dissolve in warm water, and administer to induce awakening. After awakening, examine the pulse and use other medicines accordingly.
(Danxi’s Flexible Methods) states: Heat Jue with vexing heat in the four limbs is due to damp-heat stagnating in the Spleen Earth. Treat with Li Dongyuan’s Shengyang Sanhuo Tang (Raising Yang and Dispersing Fire Decoction) or Huoyu Tang (Depressed Fire Decoction). Cold Jue with cold hands and feet is mostly due to insufficiency of Qi and Blood; add Fuzi to Qi and Blood tonifying formulas. For drinkers or obese individuals with hot hands and feet, it is due to abundant damp-phlegm and depressed fire; use Erchen Tang (Two-Aged Phlegm Resolving Decoction) plus Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Zhizi (Gardeniae Fructus). If sudden cold reversal in hands and feet and sudden Jue with loss of consciousness occur, it mostly belongs to Phlegm-Fire, or sometimes initial Yin deficiency with sudden Yang heat; use lots of Shen Gao (Ginseng Paste) combined with Zhuli (Bamboo Sap) and Jiangzhi (Ginger Juice). For thin and weak persons, even without phlegm, fire is often abundant; taking Zhuli can also nourish Blood and descend Fire.