35. 阴毒寒极色青黑, 咽痛通身厥冷寒, 重强身疼如被杖, 腹中纹痛
若石坚, 或呕或痢或烦躁, 或出冷汗温补先, 无汗还阳退阴汗, 急灸
气海及关元.
【注】阴毒, 谓阴寒至极之证也. 血脉受阴毒邪, 故面色青黑也. 阴
毒内攻于里, 故咽痛腹中绞痛也. 阴毒外攻于表, 故厥冷通身, 重强
疼痛如被杖也, 独阴无阳不化, 故阴凝腹若石之坚硬也. 或呕吐、 或
下痢, 或烦躁, 或冷汗出, 皆阳虚不足或有之证, 均以温补为先, 宜
四逆汤倍加人参. 若有是证, 其人无汗, 宜还阳散, 退阴散, 温而汗
之,使寒毒散而阳伸也. 凡遇此证, 俱宜急灸气海, 关元二, 三百壮,
随服药饵, 未有不生者也.
1.发热无时热翕翕, 炊笼腾越热蒸蒸, 表热尿白里热赤, 外需麻桂内
凉承, 燥干烦渴为阳热, 厥痢外热属阴经, 阳热宜清白虎辈, 阴热四
逆与白通.
【注】发热无时热翕翕, 谓发热无休止之时, 若合羽外复之表热也.
炊笼腾越热蒸蒸, 谓发热如炊笼蒸蒸内越之里热也. 表热, 热不在里,
故尿白也; 里热, 故尿赤也. 外需麻桂, 谓表热无汗宜麻黄汤, 有汗
宜桂枝汤. 内凉承, 谓里热轻者宜凉膈散, 重者宜三承气汤. 发热兼
口燥, 舌干, 烦渴者, 为阳经之热也. 发热兼厥冷, 下痢清谷者, 属
阴经之热也. 阳热宜清, 白虎解毒辈也. 阴热宜温, 四逆白通汤也.
【按】翕翕, 蒸蒸发热, 俱有汗, 二证相类. 若以翕翕之表热, 误为
蒸蒸之里热, 下之则逆; 若以蒸蒸里热, 误为翕翕表热, 汗之转伤.
翕翕之汗热虽同蒸蒸, 扪之自温, 不似蒸蒸之汗热、 扪之自有热气透
手也. 其间或有疑似难辨, 又当审小便之白赤, 舌胎之润燥, 自可决
也.
35. 阴毒证表现为寒邪极盛，面色青黑，咽喉疼痛，全身四肢厥冷且畏寒，身体沉重僵硬疼痛，感觉如同被棍棒殴打一般，腹部绞痛坚硬如石头。或者出现呕吐、腹泻或烦躁不安，或者出冷汗，治疗应首先采用温补法。若无汗，宜用还阳散以退阴寒；急灸气海穴和关元穴。
【注】所谓阴毒，是指阴寒之气达到极致的病证。血脉受到阴毒邪气的侵袭，所以面色呈现青黑色。阴毒向内攻伐脏腑，所以导致咽喉疼痛和腹部绞痛。阴毒向外攻伐体表，所以导致全身四肢厥冷，身体沉重僵硬，疼痛如同被棍棒击打一样。只有阴气而没有阳气来化生，所以阴气凝滞，腹部坚硬如石头。或者呕吐、或者下痢、或者烦躁、或者出冷汗，这些都是阳气虚弱不足可能出现的症状，都应当以温补为先，适宜使用四逆汤并加倍加入人参。如果具备这些症状，患者无汗，适宜使用还阳散、退阴散，通过温法发汗，使寒毒消散而阳气伸展。凡是遇到这种病症，都应当紧急艾灸气海、关元两个穴位，各三百壮，随后服用药物，没有不痊愈的。
1. 发热无定时，热度轻微如羽毛覆盖般的翕翕发热，热气蒸腾如炊笼般的蒸蒸发热。表热证小便清白，里热证小便赤黄，表热需用麻黄汤或桂枝汤，里热需用凉膈散或承气汤类方剂。燥渴烦闷为阳热证，四肢厥冷下痢伴外热属阴经证。阳热证适宜用白虎汤等清热，阴热证适宜用四逆汤与白通汤。
【注】“发热无时热翕翕”，是指发热没有休止的时候，就像羽毛覆盖在体表一样的表热。“炊笼腾越热蒸蒸”，是指发热像炊笼中热气向上蒸腾一样的里热。表热，说明热邪不在体内，所以小便清白；里热，所以小便赤黄。外需麻桂，是说表热无汗适宜用麻黄汤，有汗适宜用桂枝汤。内凉承，是说里热轻的适宜用凉膈散，重的适宜用三承气汤。发热兼有口燥、舌干、烦渴的，属于阳经的热证。发热兼有四肢厥冷、下痢清谷（完谷不化）的，属于阴经的热证。阳热证适宜清热，可用白虎汤解毒之类。阴热证适宜温阳，可用四逆汤、白通汤。
【按语】翕翕发热、蒸蒸发热，二者都有汗出，两种证候相似。如果把翕翕发热的表热证，误认为是蒸蒸发热的里热证，使用泻下法就会导致逆证；如果把蒸蒸发热的里热证，误认为是翕翕发热的表热证，使用发汗法反而会损伤正气。虽然翕翕发热也有汗出，但触摸皮肤只是自感温和，不像蒸蒸发热那样，触摸皮肤自有热气透出手掌。其间如果有疑似难以辨别的情况，又应当审视小便的清浊颜色，舌苔的润燥情况，自然可以决断。
35. Yin poison (Yin Du, a syndrome characterized by extreme yin-cold pathogen) presents with extreme cold, cyanotic and black complexion, sore throat, cold limbs throughout the body, and aversion to cold. The body feels heavy, stiff, and painful, as if beaten by a club, with abdominal cramping that is hard as stone. There may be vomiting, dysentery, or irritability, or cold sweating. Treatment should prioritize warming and tonifying. If there is no sweat, use Huanyang San (Restore Yang Powder) to dispel yin-cold; urgently moxa Qihai (CV6) and Guanyuan (CV4).
[Note] "Yin poison" refers to a syndrome where yin-cold reaches its extreme. The blood vessels are invaded by yin-poison pathogens, hence the cyanotic and black complexion. Yin-poison attacks inwardly into the interior, causing sore throat and abdominal cramping pain. Yin-poison attacks outwardly on the exterior, causing cold limbs throughout the body, heaviness, stiffness, and pain as if beaten by a club. With only yin and no yang to transform it, yin stagnates, making the abdomen hard as stone. Vomiting, dysentery, irritability, or cold sweating are all signs potentially arising from deficiency of yang qi. Warming and tonifying should be prioritized in all cases. Si Ni Tang (Frigid Extremities Decoction) with added Ginseng Radix et Rhizoma (Renshen, 人参) is appropriate. If these symptoms are present and the patient has no sweat, Huanyang San (Restore Yang Powder) and Tuiyin San (Retract Yin Powder) are suitable. Use warming methods to induce sweating, thereby dispersing cold pathogens and extending yang qi. For any such case, urgent moxibustion on Qihai (CV6) and Guanyuan (CV4), three hundred moxa cones each, followed by herbal medication, will invariably lead to recovery.
1. Fever without fixed timing: mild fever like feathers covering the body (Xi Xi Re, 翕翕热); steaming fever rising like a cooking steamer (Zheng Zheng Re, 蒸蒸热). Exterior heat presents with clear urine; interior heat presents with dark urine. Exterior heat requires Mahuang Tang (Ephedra Decoction) or Guizhi Tang (Cinnamon Twig Decoction); interior heat requires Liangge San (Cool the Diaphragm Powder) or Chengqi Tang (Assist the Qi Decoctions). Dryness, thirst, and irritability indicate Yang heat; cold limbs and dysentery with external heat belong to the Yin meridians. Yang heat is treated with clearing methods, such as Baihu Tang (White Tiger Decoction). Yin heat is treated with warming methods, using Si Ni Tang (Frigid Extremities Decoction) and Baitong Tang (White Through Decoction).
[Note] "Fever without fixed timing, Xi Xi heat" means fever without cessation, resembling the mild warmth of feathers covering the body, indicating exterior heat. "Cooking steamer rising, Zheng Zheng heat" means fever rising internally like steam from a cooking steamer, indicating interior heat. In exterior heat, the pathogen is not in the interior, so urine is clear; in interior heat, urine is dark. "Exterior requires Ma Gui" means for exterior heat with no sweat, Mahuang Tang (Ephedra Decoction) is indicated; with sweat, Guizhi Tang (Cinnamon Twig Decoction) is indicated. "Interior cooling uses Cheng" means for mild interior heat, Liangge San (Cool the Diaphragm Powder) is indicated; for severe interior heat, the three Chengqi Tangs (Assist the Qi Decoctions) are indicated. Fever accompanied by dry mouth, dry tongue, irritability, and thirst belongs to Yang meridian heat. Fever accompanied by cold limbs and dysentery with undigested food belongs to Yin meridian heat. Yang heat should be cleared, using Baihu Tang (White Tiger Decoction) and similar detoxifying formulas. Yin heat should be warmed, using Si Ni Tang (Frigid Extremities Decoction) and Baitong Tang (White Through Decoction).
[Commentary] Xi Xi heat and Zheng Zheng heat both involve sweating and are similar syndromes. Mistaking Xi Xi exterior heat for Zheng Zheng interior heat and using purgation leads to adverse reactions; mistaking Zheng Zheng interior heat for Xi Xi exterior heat and using diaphoresis damages healthy qi. Although Xi Xi heat involves sweating, palpation reveals only mild warmth, unlike Zheng Zheng heat where palpation reveals heat penetrating the hand. If differentiation is difficult due to similarity, examine whether the urine is clear or dark, and whether the tongue coating is moist or dry, to make a determination.