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。
邪传厥阴。则热已深也。邪自太阳。传至太阴。则腹满而嗌干。未成渴也。邪至少
阴者。口燥舌干而渴。未成消也。至厥阴成消渴者。热甚。能消水故也。饮水多而小便
少者。谓之消渴。木生于火。肝气通心。厥阴客热。气上撞心。心中疼热。伤寒六七日。
厥阴受病之时。为传经尽。则当入腑。胃虚客热。饥不欲食。蛔在胃中。无
食则动。闻食嗅而出。得食吐蛔。此热在厥阴经也。若便下之。虚其胃气。厥阴木邪相
乘。必吐下不止。
张卿子云。素问阴证三条。皆指传邪。故云已满三日可下而已。仲景三阴首条。皆
言病气。所谓伤寒本自寒下也。太阴少阴易明。唯厥阴条。种种似热。故成氏注为热已
深。不知太阳篇中。微热消渴者五苓散则桂术也。又气上冲胸。身为振振摇。则大虚也。
厥阴寒疝。亦气上冲心。又膈中阳气微。心中饥而烦。平脉篇云。气微者心内饥。饥而
不欲食也。又胃中冷则吐蛔。脾胃论虚劳。则热气熏胸中。又杂病心中疼热。多成膈气。
宜吴茱萸汤。盖皆以不能化热成阴。玩下之利不止一句。爽然矣。成注未渴而渴消。渴
分浅深。故云渴而至消为热甚。试玩少阴渴本文云。虚故引水自救。何曾较太阴不渴为
浸热耶。尝见厥阴消渴数证。舌尽红赤。厥冷。脉微。渴甚。服白虎黄连等汤。皆不救。
厥阴中风。脉微浮。为欲愈。不浮为未愈。
经曰。阴病见阳脉而生。浮者阳也。厥阴中风。脉微浮。为邪气还表向汗之时。故
云欲愈。
厥阴病欲解时从丑至卯上。
厥阴木也。王于卯。丑寅向王。故为解时。
厥阴病。渴欲饮水者。少少与之愈。
邪至厥阴。为传经尽。欲汗之时。渴欲得水者。少少与之。胃气得润则愈。
诸四逆厥者。不可下之。虚家亦然。
四逆者。四肢不温也。厥者。手足冷也。皆阳气少而阴气多。故不可下。虚家亦然。
下之是为重虚。金匮玉函曰。虚者十补。勿一泻之。
伤寒先厥。后发热。而利者必自止。见厥复利。
阴气胜。则厥逆而利。阳气复。则发热。利必自止。见厥。则阴气还胜而复利也。
张兼善云。三阴伤寒。太阴为始。则手足温。少阴则手足清。厥阴则手足厥逆。然
病至厥阴。乃阴之极也。故反有发热之理。盖阳极则阴生。阴极则阳生。此阴阳推荡。
必然之理也。易云。穷则变。穷者。至极之谓也。阳至极而生阴。故阳病有厥冷之证。
阴至极而生阳。则厥逆者有发热之条。凡言厥深热亦深者。乃事之极而变之常。经曰。
亢则害。承乃制也。
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。
始发热。邪在表也。至六日邪传厥阴。阴气胜者。作厥而利。厥反九日。阴寒气多。
当不能食。而反能食者。恐为除中。除、去也。中、胃气也。言邪气大甚。除去胃气。
胃欲引食自救。故暴能食。此欲胜也。食以索饼试之。若胃气绝。得面则必发热。若不
发热者。胃气尚在也。恐是寒极变热。因暴热来而复去。使之能食。非除中也。金匮要
略曰。病患素不能食。而反暴思之。必发热。后三日脉之。其热续在者。阳气胜也。期
之旦日夜半愈。若旦日不愈。后三日。脉数而热不罢者。为热气有余。必发痈脓。经曰。
数脉不时。则生恶疮。
伤寒脉迟。六七日。而反与黄芩汤彻其热。脉迟为寒。今与黄芩汤。复除其热。腹
中应冷。当不能食。今反能食。此名除中。必死。
伤寒脉迟。六七日。为寒气已深。反与黄芩汤寒药。两寒相搏。腹中当冷。冷不消
谷。则不能食。反能食者。除中也。四时皆以胃气为本。胃气已绝。故云必死。
伤寒先厥后发热。下利必自止。而反汗出。咽中痛者。其喉为痹。发热无汗。而利
必自止。若不止。必便脓血。便脓血者。其喉不痹。
伤寒先厥而利。阴寒气胜也。寒极变热。后发热。下利必自止。而反汗出。咽中痛。
其喉为痹者。热气上行也。发热无汗。而利必自止。利不止。必便脓血者。热气下行者。
热气下而不上。其喉亦不痹也。
王宇泰云。厥而利。发热则利必止。反汗出者。亡阳也。咽中痛。热上冲也。亡阳。
则阴独复会于热。则阴阳结而为喉痹也。内经曰。一阴一阳。结为喉痹。
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。
前厥后发热者。寒极生热也。前热后厥者。阳气内陷也。厥深热深。厥微热微。随
阳气陷之深浅也。热之伏深。必须下去之。反发汗者。引热上行。必口伤烂赤。内经曰。
火气内发。上为口糜。
吴氏云。伤寒一二日。至四五日。而厥者。必发热。是传经之邪。前热后厥者。亦
传经之邪。当以厥之微甚。辨热之深浅。若厥热入腑而实者。须下去之。若反发汗。则
胃中津液。愈燥竭而热。故必口伤烂赤。然经云。诸四逆者不可下之。至此又云应下。
最宜详审。先贤谓热厥。手足虽厥冷而或有温时。手足虽逆冷而手足掌心必暖。戴院使又
以指甲之暖冷。别寒热二厥。临病之工慎之。
伤寒病厥五日。热亦五日。设六日当复厥。不厥者自愈。厥终不过五日。以热五日。
故知自愈。
阴胜则厥。阳胜则热。先厥五日。为阴胜。至六日。阳复胜。热亦五日。后复厥者。
阴复胜。若不厥。为阳全胜。故自愈。经曰。发热四日。厥反三日。复热四日。厥少热
多。其病为愈。
凡厥者。阴阳气不相顺接。便为厥。厥者。手足逆冷是也。
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。阳不与
阴相顺接。故手足为之厥冷也。
伤寒脉微而厥。至七八日肤冷。其人躁。无暂安时者。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。蛔上入膈故烦。须臾复止。得食而
呕。又烦者。蛔闻食臭出。其人当自吐蛔。蛔厥者。乌梅丸主之。又主久利方。
脏厥者死。阳气绝也。蛔厥。虽厥而烦。吐蛔已。则静。不若脏厥而躁。无暂安时
也。
病患脏寒。胃虚。蛔动上膈。闻食臭出。因而吐蛔。与乌梅丸。温脏安虫。
厥阴病的典型症状是：口渴多饮，气向上冲撞心脏，心中感觉疼痛且灼热，虽有饥饿感但不想吃东西，进食后则呕吐蛔虫。如果误用攻下法治疗，会导致腹泻不止。
邪气传入厥阴经，说明热邪已经深入。邪气从太阳经传至太阴经时，会出现腹部胀满和咽喉干燥的症状，但尚未形成口渴；邪气传至少阴经时，会出现口燥舌干而渴的症状，但尚未形成消渴（饮水多而小便少）；到了厥阴经形成消渴，是因为热势极盛，能够消耗水分。饮水多而小便少的情况，称为消渴。肝属木，心属火，木生火，故肝气通于心。厥阴经受客热侵袭，导致气上撞心，心中疼热。伤寒病经过六七天，正值厥阴经受病之时，这是传经的最后一环，邪气应当入腑。此时胃气虚弱而有客热停留，所以感到饥饿却不想吃东西。蛔虫在胃中，没有食物时就会躁动，闻到食物的气味就会出来，吃到食物就会引发呕吐蛔虫。这是热邪在厥阴经的表现。如果此时立即使用攻下法，会进一步损伤胃气，导致厥阴木邪乘虚克制脾土，必然出现吐泻不止的后果。
张卿子说，《素问》中的三条阴证论述，都是指邪气传变，所以说发病满三天就可以用下法治愈。张仲景《伤寒论》中三阴篇的第一条条文，都是描述病气状况，所谓伤寒本来就有寒下的性质。太阴、少阴的病证容易明白，唯独厥阴篇的条文，种种表现似热，所以成无己将其注释为“热已深”。殊不知在《伤寒论·太阳篇》中提到微热消渴的情况，是用五苓散，其中包含桂枝和白术；又有气上冲胸、身体振摇不定的情况，那是正气大虚的表现。厥阴寒疝也会出现气上冲心的症状；膈中阳气微弱，心中感觉饥饿且烦躁，《平脉篇》说：“脉气微弱的人心里觉得饿，饿了却不想吃东西。”还有胃中寒冷则会呕吐蛔虫。李东垣《脾胃论》提到虚劳时，有热气熏蒸胸中的说法；杂病中心中疼热，多发展为膈气，适宜用吴茱萸汤治疗。这些情况都是因为不能化热成阴。仔细玩味“下之利不止”这一句，就能豁然开朗了。成无己的注释认为未渴而渴、消渴分为深浅，所以说渴发展到消的程度是热势很盛。试着研读少阴篇关于渴的原文，说是因为虚所以引水自救，哪里曾比较过太阴不渴是否浸染热邪呢？我曾经见到厥阴消渴的几种证候，舌头完全红赤，四肢厥冷，脉象微弱，口渴严重，服用白虎汤、黄连汤等清热药，都不能挽救。厥阴中风，脉象微浮，表示将要痊愈；如果不浮，则表示未愈。
经典记载：阴病见到阳脉就会生还。浮脉属于阳脉。厥阴中风，脉象微浮，是邪气回归体表准备发汗的时候，所以说将要痊愈。
厥阴病欲解的时间是从丑时到卯时。
厥阴属木，旺于卯时，丑时和寅时趋向于旺，所以这是病欲解的时间。
厥阴病，如果口渴想喝水的，少量给予饮水即可痊愈。
邪气到达厥阴，是传经的尽头，也是想要发汗的时候。如果口渴想喝水，少量给予饮水，胃气得到滋润就会痊愈。
凡是出现四逆厥冷的情况，不可使用攻下法。体质虚弱的人也是如此。
四逆是指四肢不温暖。厥是指手脚冰冷。这都是因为阳气少而阴气多，所以不可攻下。体质虚弱的人也是如此。攻下会导致更加严重的虚损。《金匮玉函经》说：“虚证应当十次补益，不要一次泻下。”
伤寒先出现厥冷，后来发热，而下利（腹泻）必然会自行停止。如果再次出现厥冷，下利也会复发。
阴气胜则厥逆并伴有下利。阳气恢复则发热，下利必然自止。如果再次出现厥冷，说明阴气重新占优势，下利也会复发。
张兼善说，三阴伤寒，太阴为首，所以手足温暖；少阴则手足清冷；厥阴则手足厥逆。然而病至厥阴，已是阴气的极点，所以反而会有发热的道理。盖阳极则阴生，阴极则阳生，这是阴阳推移激荡的必然规律。《易经》说：“穷则变。”穷，就是至极的意思。阳至极点而生阴，所以阳病有厥冷的证候；阴至极点而生阳，所以厥逆者有发热的条文。凡是说“厥深热亦深”的，乃是事物发展到极致而发生变化的常理。经典说：“亢盛则有害，承制才能平衡。”
伤寒开始发热六天，厥冷反而九天，并伴有下利。凡是厥冷下利的病人，通常不能吃东西。现在反而能吃东西，恐怕是“除中”（胃气将绝的回光返照）。给病人吃索饼（面条），如果不发热，就知道胃气还在，病一定会好。担心的是突然发热来去匆匆。三天后再诊察，如果热度持续存在，预计在第二天半夜痊愈。之所以这样，是因为原本发热六天，厥冷反九天，后来又发热三天，加上之前的六天，总共也是九天，与厥冷的天数相应，所以预计在第二天半夜痊愈。如果三天后再诊察，脉象数，热度不退，这是因为热气有余，一定会发生痈脓。
开始发热，说明邪气在表。到了第六天邪气传入厥阴，阴气胜则出现厥冷和下利。厥冷反而九天，说明阴寒气多，按理应该不能吃东西，而反而能吃的，恐怕是除中。“除”，去除；“中”，胃气。意思是邪气太盛，去除了胃气，胃为了自救想引食，所以突然能吃。这是邪气欲胜的表现。用索饼来试探。如果胃气已绝，吃到面食必然发热；如果不发热，说明胃气尚在。担心的是寒极变热，因暴热来临又离去，导致能吃东西，并非除中。《金匮要略》说：“病人平时不能吃，反而突然想吃，必定发热。三天后诊察，如果热度持续，说明阳气胜，预计在第二天半夜痊愈。如果第二天没好，三天后脉数且热不退，说明热气有余，一定会发生痈脓。经典说：‘脉数而不按时休止，会产生恶疮。’”
伤寒脉迟，经过六七天，反而给予黄芩汤清除其热。脉迟主寒，现在给予黄芩汤，又除去其热，腹中应当寒冷，应当不能吃东西。现在反而能吃东西，这名叫除中，必死。
伤寒脉迟，六七天，说明寒气已深，反而给予黄芩汤这种寒药，两寒相搏，腹中应当寒冷。寒冷不能消化谷物，则不能吃东西。反而能吃的，是除中。四季都以胃气为本，胃气已绝，所以说必死。
伤寒先厥冷后发热，下利必然会自行停止。如果反而出汗，咽喉疼痛，这就是喉痹。如果发热无汗，下利必然会自行停止。如果下利不止，一定会便脓血。便脓血的人，其咽喉不会痹痛。
伤寒先厥冷而下利，是阴寒气胜。寒极变热，后来发热，下利必然自止。如果反而出汗，咽喉疼痛，导致喉痹，这是热气上行。发热无汗，下利必然自止。如果下利不止，一定便脓血，这是热气下行。热气下行而上行不足，其咽喉也不会痹痛。
王宇泰说：厥冷而下利，发热则下利必止。反而出汗，是亡阳。咽喉疼痛，是热上冲。亡阳，则阴独复聚于热，阴阳结聚而为喉痹。《内经》说：“一阴一阳结，谓之喉痹。”
伤寒一二天，到四五天出现厥冷的，必定会发热。先前发热的，后来必定厥冷。厥冷深的，热也深；厥冷轻的，热也微。厥冷应当用下法，如果反而发汗，必定导致口腔糜烂红肿。
先前厥冷后来发热的，是寒极生热。先前发热后来厥冷的，是阳气内陷。厥深热深，厥微热微，随阳气内陷的深浅而定。热伏藏得深，必须用下法祛除。如果反而发汗，会引热上行，必定导致口腔糜烂红肿。《内经》说：“火气内发，上为口糜。”
吴氏说：伤寒一二天，到四五天出现厥冷的，必定会发热，这是传经之邪。先前发热后来厥冷的，也是传经之邪。应当根据厥冷的轻重，辨别热的深浅。如果厥热入腑而成实证，须用下法。如果反而发汗，胃中津液会更加干燥枯竭而热，所以必定口腔糜烂红肿。然而经典说“诸四逆者不可下之”，到这里又说“应下”，最宜详细审察。先贤认为热厥，手足虽然厥冷，但有时会有温暖的时候；手足虽然逆冷，但手心必定暖和。戴院使又以指甲的冷暖，来区别寒热两种厥冷。临证医生务必谨慎。
伤寒病厥冷五天，发热也五天。假设第六天应当再次厥冷，如果不厥冷，病就会自愈。厥冷终不过五天，因为发热五天，所以知道会自愈。
阴胜则厥，阳胜则热。先厥冷五天，是阴胜。到第六天，阳复胜，发热也五天。之后如果再次厥冷，是阴复胜。如果不厥冷，是阳全胜，所以自愈。经典说：“发热四天，厥冷反三天，又发热四天，厥少热多，病为愈。”
凡是厥证，都是阴阳之气不相顺接，就会导致厥。厥，就是手足逆冷。
手部的三阴三阳经脉，交接于手指十端；足部的三阴三阳经脉，交接于脚趾十端。阳气内陷，阳不与阴相顺接，所以手足为之厥冷。
伤寒脉微而厥冷，到了七八天皮肤也冷，其人烦躁，没有片刻安宁的时候，这是脏厥，不是蛔厥。
蛔厥的病人，应当呕吐蛔虫。让病人安静下来，却又时不时烦躁，这是因为脏寒，蛔虫上行进入膈部所以烦躁。过了一会儿又停止。吃东西就呕吐，又烦躁，是因为蛔虫闻到食物气味而出，病人应当自己吐出蛔虫。蛔厥，用乌梅丸主治。乌梅丸也主治久利。
脏厥者死，因为阳气绝灭。蛔厥，虽然厥冷且烦躁，但吐出蛔虫后就安静了，不像脏厥那样烦躁，没有片刻安宁。
病人脏腑寒冷，胃虚，蛔虫扰动上行至膈，闻到食物气味而出，因而呕吐蛔虫。给予乌梅丸，温补脏腑，安伏蛔虫。
The typical manifestations of Jueyin disease are: excessive thirst (Xiao Ke, a condition characterized by excessive drinking and urination due to heat consuming fluids), sensation of Qi rushing up to strike the heart, pain and burning sensation in the heart region, hunger without desire to eat, and vomiting of roundworms (Hui) after eating. If purgatives are mistakenly used, it will lead to unceasing diarrhea.
When pathogenic factors transmit to the Jueyin channel, the heat has already penetrated deeply. When pathogens transmit from the Taiyang channel to the Taiyin channel, symptoms include abdominal fullness and dry throat, but thirst has not yet formed. When pathogens reach the Shaoyin channel, there is dry mouth and tongue with thirst, but Xiao Ke has not yet formed. At the Jueyin stage, Xiao Ke forms because the heat is extremely severe and consumes water. The condition of drinking much water but producing little urine is called Xiao Ke. Liver belongs to Wood, Heart belongs to Fire; Wood generates Fire, so Liver Qi connects with Heart. When external heat invades the Jueyin channel, it causes Qi to rush up to strike the heart, resulting in pain and burning in the heart region. In Shanghan disease, after six or seven days, when the Jueyin channel is affected, this marks the completion of the transmission through the channels, and the pathogen should enter the Fu organs. At this time, Stomach Qi is deficient while external heat remains, causing hunger but no desire to eat. Roundworms reside in the stomach; without food, they become active, and upon smelling food, they emerge. Eating triggers the vomiting of roundworms. This indicates heat in the Jueyin channel. If purgatives are immediately used, Stomach Qi is further damaged, allowing Jueyin Wood pathogen to overact on Spleen Earth, inevitably leading to unceasing vomiting and diarrhea.
Zhang Qingzi stated that the three Yin syndrome entries in *Suwen* all refer to transmitted pathogens, hence stating that after three days, purgation can cure it. Zhang Zhongjing’s first entries in the Three Yin chapters of *Shanghan Lun* all describe the nature of the pathogenic Qi, referring to the inherent cold nature of Shanghan. Taiyin and Shaoyin syndromes are easy to understand; only the Jueyin entries present various heat-like symptoms, which Cheng Wuji annotated as "heat has penetrated deeply." However, one should not overlook that in the *Taiyang* chapter of *Shanghan Lun*, mild heat with Xiao Ke is treated with Wuling San, containing Guizhi (Cinnamon Twig) and Baizhu (Atractylodis Macrocephalae Rhizoma); also, Qi rushing up to the chest and body trembling indicate severe deficiency. Cold hernia of Jueyin also presents with Qi rushing up to the heart; slight Yang Qi in the Diaphragm causes hunger and irritability. The *Pingmai Pian* states: "Those with weak pulse feel hungry inside, but having hunger, they do not wish to eat." Furthermore, cold in the Stomach leads to vomiting roundworms. Li Dongyuan’s *Piwei Lun* mentions heat steaming the chest in deficiency consumptive diseases; miscellaneous diseases involving pain and burning in the heart often develop into Ge Qi (Diaphragmatic Qi stagnation), suitable for treatment with Wuzhuyu Tang. These cases arise because heat fails to transform into Yin. Carefully pondering the phrase "purging leads to unceasing diarrhea" brings clarity. Cheng Wuji’s annotation suggests that thirst progressing to Xiao Ke indicates varying depths, claiming that reaching Xiao Ke signifies severe heat. Studying the original text of Shaoyin regarding thirst reveals it says "due to deficiency, it draws water to save itself," never comparing Taiyin's lack of thirst to infiltrating heat. I have observed several cases of Jueyin Xiao Ke where the tongue was entirely red, limbs were cold, pulse was faint, and thirst was severe; treating with Baihu Tang (White Tiger Decoction) or Huanglian Tang (Coptis Decoction) failed to save them. In Jueyin wind-stroke, a slightly floating pulse indicates impending recovery; non-floating indicates no recovery.
Classics state: Yin diseases presenting with Yang pulses lead to survival. Floating pulse is Yang. In Jueyin wind-stroke, a slightly floating pulse indicates pathogen returning to the exterior preparing for sweating, hence "impending recovery."
Jueyin disease tends to resolve between Chou hour (01:00-03:00) and Mao hour (05:00-07:00).
Jueyin belongs to Wood, flourishing at Mao hour; Chou and Yin hours trend towards flourishing, thus constituting the resolution time.
In Jueyin disease, if the patient desires water, giving small amounts allows recovery.
Pathogen reaching Jueyin marks the end of channel transmission, a time when sweating is desired. If thirsty for water, giving small amounts moistens Stomach Qi, leading to recovery.
For all cases of Si Ni (Four Extremities Cold) and Jue (Cold Reversal), purgation is contraindicated. This applies equally to patients with deficiency constitution.
Si Ni refers to limbs not being warm. Jue refers to cold hands and feet. Both result from scant Yang Qi and abundant Yin Qi, hence purgation is contraindicated. Deficient patients are similarly treated. Purgation would cause double deficiency. *Jinkui Yufan Jing* states: "For deficiency, tonify ten times; do not purge once."
In Shanghan, initial cold reversal followed by fever implies diarrhea will stop spontaneously. If cold reversal reappears, diarrhea recurs.
Yin dominance causes cold reversal and diarrhea. Yang recovery causes fever, and diarrhea stops. Appearance of cold reversal indicates Yin dominance returns, causing diarrhea recurrence.
Zhang Jianshan said: Among Three Yin Shanghan, Taiyin starts with warm hands and feet; Shaoyin presents with cool hands and feet; Jueyin presents with cold reversal of hands and feet. However, reaching Jueyin represents the extreme of Yin, hence the possibility of fever. Extreme Yang generates Yin; extreme Yin generates Yang. This is the inevitable law of Yin-Yang interaction. *I Ching* states: "At the limit, change occurs." Limit means extremity. Extreme Yang generates Yin, so Yang diseases have cold reversal signs; extreme Yin generates Yang, so cold reversal cases have fever entries. Statements like "deeper cold reversal, deeper heat" refer to the normal change at extremes. Classics say: "Excess causes harm; control follows."
Shanghan begins with fever for six days, then cold reversal for nine days with diarrhea. Patients with cold reversal and diarrhea usually cannot eat. If they suddenly can eat, it may be Chu Zhong (Elimination of Middle, a sign of failing Stomach Qi). Feed them Suobing (noodles). If no fever ensues, Stomach Qi remains, and recovery is certain. One must fear sudden brief heat. After three days, if pulse shows sustained heat, recovery is expected at midnight of the next day. This is because initial fever was six days, cold reversal nine days, plus subsequent three days of fever equals nine days total, matching the cold reversal duration, hence recovery at midnight. If after three days pulse is rapid and heat persists, it indicates excess heat, likely leading to carbuncles and pus.
Initial fever indicates pathogen in the exterior. By day six, pathogen transmits to Jueyin. Yin dominance causes cold reversal and diarrhea. Nine days of cold reversal indicate abundant Yin-cold,理应 inability to eat. Sudden ability to eat suggests Chu Zhong. "Chu" means remove; "Zhong" means Stomach Qi. Severe pathogen eliminates Stomach Qi; Stomach seeks self-rescue by craving food, appearing as sudden appetite. This is pathogen dominance. Testing with noodles: if Stomach Qi is exhausted, eating causes fever; if no fever, Stomach Qi remains. Fear is that extreme cold transforms to heat, causing transient ability to eat, not Chu Zhong. *Jinkui Yaolue* states: "Patient unable to eat normally suddenly craves food,必定 fever. After three days, if heat persists, Yang dominates, expecting recovery at midnight. If not recovered, and after three days pulse is rapid with persistent heat, it is excess heat, leading to carbuncles. Classics say: 'Rapid pulse not stopping produces foul sores.'"
Shanghan with slow pulse for six to seven days, wrongly treated with Huangqin Tang (Scutellaria Decoction) to clear heat. Slow pulse indicates cold. Giving Huangqin Tang removes heat, causing abdominal cold and inability to eat. Sudden ability to eat is named Chu Zhong, indicating death.
Shanghan with slow pulse for six to seven days indicates deep cold. Wrongly giving cold medicine Huangqin Tang creates two colds clashing, causing abdominal cold. Cold cannot digest grain, leading to inability to eat. Sudden ability to eat is Chu Zhong. All seasons rely on Stomach Qi as root. Exhausted Stomach Qi means death.
Shanghan initial cold reversal then fever implies diarrhea stops. If sweating occurs instead, with sore throat, it becomes Hou Bi (Throat Obstruction). If fever without sweating, diarrhea stops. If diarrhea persists, pus and blood in stool occur. Those with pus/blood stool do not have throat obstruction.
Initial cold reversal and diarrhea indicate Yin-cold dominance. Extreme cold transforms to heat; subsequent fever stops diarrhea. Sweating and sore throat indicate rising heat causing Hou Bi. Fever without sweating stops diarrhea. Persistent diarrhea leads to pus/blood stool, indicating descending heat. Descending heat without ascending component spares the throat.
Wang Yutai said: Cold reversal with diarrhea stops upon fever. Sweating indicates Yang collapse. Sore throat indicates heat rushing up. Yang collapse allows Yin to gather with heat, knotting into Hou Bi. *Neijing* states: "One Yin and One Yang knot, called Hou Bi."
Shanghan days 1-2 progressing to days 4-5 with cold reversal必定 fever. Previous fever followed by cold reversal indicates Yang Qi sinking internally. Deeper cold reversal means deeper heat; shallower means shallower heat, depending on depth of Yang sinking. Deeply latent heat requires purgation. Wrongly using sweating pulls heat upward, causing oral ulceration and redness. *Neijing* states: "Fire Qi internal emission causes oral ulcers above."
Wu Shi said: Shanghan days 1-2 to 4-5 with cold reversal必定 fever indicates transmitted pathogen. Previous fever then cold reversal is also transmitted pathogen. Assess heat depth via severity of cold reversal. If cold/heat enters Fu organ becoming excess, purgation is needed. Wrong sweating dries Stomach fluids, increasing heat, causing oral ulcers. Although classics say "all Si Ni contraindicate purgation," here it says "should purge." Careful examination is vital. Ancients noted Heat Jue: hands/feet cold but occasionally warm; palms warm despite cold reversal. Dai Yuan Shi distinguished cold/heat Jue by nail temperature. Clinicians must be cautious.
Shanghan cold reversal five days, fever five days. If day six brings reversal again, no reversal means self-healing. Reversal does not exceed five days; since fever lasted five days, self-healing is known.
Yin dominance causes cold; Yang dominance causes heat. Initial five days cold indicates Yin dominance. Day six, Yang recovers dominance, fever lasts five days. Subsequent reversal indicates Yin resurgence. No reversal means Yang complete dominance, hence healing. Classics say: "Fever four days, reversal three days, fever four days more; less reversal, more fever, disease heals."
All Jue syndromes result from failure of Yin and Yang Qi to connect smoothly, causing Jue. Jue is cold reversal of hands and feet.
Hand Three Yin/Yang meridians connect at ten fingers; Foot Three Yin/Yang meridians connect at ten toes. Yang Qi sinks internally, failing to connect smoothly with Yin, causing cold hands and feet.
Shanghan with faint pulse and cold reversal, progressing to day 7-8 with cold skin, restlessness without respite, is Zang Jue (Organ Cold Reversal), not Hui Jue (Roundworm Cold Reversal).
Hui Jue patients vomit roundworms. Patient quiet but intermittently irritable indicates Cold Zang; roundworms ascend to Diaphragm causing irritation. Rest soon resumes. Vomiting and irritability after eating occur because roundworms emerge smelling food; patient vomits roundworms. Hui Jue is treated with Wumei Wan (Mume Pill), also for chronic diarrhea.
Zang Jue is fatal due to Yang Qi exhaustion. Hui Jue, though cold and irritable, quiets after vomiting roundworms, unlike Zang Jue's constant restlessness.
Patient with Cold Zang, deficient Stomach, roundworms agitated ascending to Diaphragm, emerging smelling food, vomiting roundworms. Administer Wumei Wan to warm Zang and calm worms.