经云。厥之为病也。足暴清。胸将若裂。肠若以刀切之。烦而不能食。脉大小皆涩。寒热客于
五脏。厥逆上泄。阴气竭。阳气未入。故卒然痛死不知人。气复反则生矣。
按厥论云。厥之寒热者。何也。阳气衰于下。则为寒厥。阴气衰于下。则为热厥。曰阳厥者。因
善怒而得也。曰风厥者。手足搐搦。汗出而烦满不解也。曰痿厥者。痿病与厥杂合。而足弱痿无
力也。曰痹厥者。痹病与厥病杂合。而香港脚顽麻肿痛。世谓香港脚冲心者是也。曰厥痹者。卧出而
风吹之。血凝于肤者为痹。凝于脉者为泣。凝于足者为厥是也。今人又以忽然昏晕。不省人事。
手足冷者为厥。仲景论伤寒。则以阳证传阴。手足寒者为热厥。主以四逆散。阴证恶寒。手足寒
者为寒厥。主以四逆汤。内经厥论之义则不然。盖足之三阳。起于足五指之表。三阴起于足五指
之里。故阳气胜则足下热。阴气胜则从五指至膝上寒。其寒也不从外。皆从内也。论得寒厥之由。
以其人阳气衰。不能渗荣其经络。阳气日损。阴气独在。故手足为之寒也。附子理中汤。论得热
厥之由。则谓其人必数醉若饱以入房。气聚于脾中。
肾气日衰。阳气独胜。故手足为之热也。加减八味丸。
经云。阳气者。烦劳则张精绝。（张主也。烦劳则主精绝。）辟积于夏。使人煎厥。（夏暑
伤气而煎厥。气逆也。）目盲不可以视。耳闭不可以听。清暑益气汤。阳气者。大怒则形气绝。
而血菀于上。使人薄厥。（血积胸中不散。气道阻碍不行。故为暴逆。）犀角地黄汤。二阳一阴
发病。名曰风厥。（肝木克胃。风胜其湿。不制肾水。故令上逆。）地黄饮子。又骨痛爪枯为骨
厥。两手指挛急。屈伸不得。爪甲枯厥为臂厥。身立如椽为肝厥。此皆内虚气逆也。并宜八味丸。
喘而 。狂走登高。为阳明厥。此为邪实。承气汤下之。厥而腹满不知人。卒然闷乱者。皆因邪
气乱。阳气逆。是少阴肾脉不至也。名曰尸厥。卒中天地戾气使然。急以二气丹二钱。用陈酒煎。
如觉焰硝起。倾放盆内盖着温服。如人行五里许。又进一服。不过三服即醒。若膏粱本虚之人。
用附子一枚。人参三两。酒煎分三次服。并灸百会穴四十九壮。气海丹田三百壮。身温灸止。艾
炷止许绿豆大。粗则伤人。暴厥脉伏。不省人事。莫辨阴阳。急用鸡子三枚。煮熟乘热开豆大一
孔。衬粗纸一层。亦开孔对当脐。令热气透达于内即苏。然后按脉证疗之。如连换三枚不应。不
可救矣。
张介宾曰。厥证之起于足者。厥发之始也。甚至卒倒暴厥。忽不知人。轻则渐苏。重则即死。
最为急候。后世不能详察。但以手足寒热为厥。又有以香港脚为厥者。谬之甚也。虽仲景有寒厥热
厥之分。亦以手足为言。盖彼自辨伤寒之寒热耳。实非内经之所谓厥也。观大奇论曰。暴厥者。
不知与人言。调经论曰。血之与气。并走于上。则为大厥。厥则暴死。气复反则生。不反则死。
缪刺论曰。手足少阴太阴足阳明五络俱竭。令人身体皆重。而形无知也。其状若尸。或曰尸
厥。若此者。岂止于手足寒热及香港脚之谓耶。今人多不知厥证。而皆指为中风也。夫中风者。病
多经络之受伤。厥逆
者。直因精气之内夺。表里虚实。病情当辨。名义不正。无怪其以风治厥也。医中之害。莫此为甚。
〔诊〕脉沉微不数为寒厥。沉伏而数为热厥。沉细为气厥。芤大为血虚。浮滑为痰。弦数为热。
浮者外感。脉至如喘。名曰暴厥。寸脉沉而滑。沉为气。滑为实。实气相搏。血气入脏。唇口身
冷。死。如身和汗自出。为入腑。此为卒厥。
孙兆治一人。自汗。两足逆冷至膝下。腹痛不省人事。六脉小弱而急。问其所服之药。皆阳
药也。此非受病重。药能重病耳。遂以五苓散、白虎汤十余剂而安。凡阴厥胫冷则臂亦冷。今胫
冷臂不冷。则非下厥上行。所以知是阳厥也。
汪石山治一人卒厥。暴死不知人。先前因微寒数发热。面色痿黄。六脉沉弦而细。知为中气
久郁所致。与人参七气汤一服。药未熟而暴绝。汪令一人紧抱。以口接其气。徐以热姜汤灌之。禁
止喧闹移动。移动则气绝不返矣。有顷果苏。温养半月而安。不特此证为然。凡中风。中气。中
暑。中寒。暴厥。俱不得妄动以断其气。内经明言气复返则生。若不谙而扰乱其气。不得复返。
致夭枉者多矣。
《黄帝内经》中说：厥这种病，表现为双脚突然发凉，胸部感觉像要裂开一样，肠道如同被刀割一般疼痛，心中烦乱却无法进食，脉象无论大小都呈现涩象。这是因为寒邪侵袭五脏，导致气机逆乱向上宣泄，阴气耗竭，阳气未能入里，所以突然剧烈疼痛、昏死过去不省人事。如果气机能够恢复运行，患者就能存活。
按照《素问·厥论》的说法：厥证中的寒热现象是怎么回事呢？如果下焦阳气衰弱，就会发生寒厥；如果下焦阴气衰弱，就会发生热厥。所谓阳厥，是因为容易发怒而引发的。所谓风厥，表现为手足抽搐痉挛，出汗且心烦胀满不能缓解。所谓痿厥，是痿病与厥病夹杂，表现为足部软弱无力。所谓痹厥，是痹病与厥病夹杂，表现为脚气（香港脚）顽麻肿痛，世人所说的“脚气冲心”就是这类。所谓厥痹，是指睡觉时起床受风吹袭，血液凝滞于皮肤形成痹证，凝滞于血脉则血流不畅，凝滞于足部则发生厥冷。现在的人又把突然昏晕、不省人事、手脚冰凉的情况称为厥。张仲景在论述伤寒时，认为阳证传入阴经，出现手脚寒冷的属于热厥，主治用四逆散；阴证恶寒，出现手脚寒冷的属于寒厥，主治用四逆汤。但《内经·厥论》的意思并非如此。大概足部的三条阳经，起始于足趾外侧，三条阴经起始于足趾内侧。所以阳气胜则足底发热，阴气胜则从足趾到膝盖以上发凉。这种寒冷不是从外部侵入的，都是从内部产生的。论述寒厥的成因，是因为此人阳气衰弱，不能渗透滋养经络，阳气日渐损耗，只有阴气独存，所以手脚发凉，可用附子理中汤治疗。论述热厥的成因，则认为此人必定是在醉酒或饱食后行房事，气聚积在脾中，肾气日渐衰弱，阳气独盛，所以手脚发热，可用加减八味丸治疗。
《黄帝内经》说：人体的阳气，如果过度烦劳就会亢盛，导致精液枯竭。（“张”意为亢盛。过度烦劳就会导致精气枯竭。）如果在夏季积累暑热，就会使人发生煎厥。（夏季暑热伤气导致气逆而发生煎厥。）表现为眼睛失明无法视物，耳朵闭塞无法听声，可用清暑益气汤治疗。又说：人体阳气，如果大怒就会导致形体之气断绝，血液郁积在上部，使人发生薄厥。（血液积聚在胸中不散，气道阻碍不通，所以发生暴逆），可用犀角地黄汤治疗。阳明和少阴两经发病，名为风厥。（肝木克制胃土，风邪胜过湿气，不能制约肾水，所以上逆），可用地黄饮子治疗。另外，骨痛指甲枯槁称为骨厥，两手手指拘挛紧急，屈伸不得，指甲枯槁称为臂厥，身体僵硬如椽木般直立称为肝厥。这些都属于内虚气逆，都适宜使用八味丸。喘息狂躁、奔跑登高，这是阳明厥，属于邪气实证，应用承气汤攻下。厥逆且腹部胀满、不省人事，突然胸闷混乱的，都是因为邪气扰乱，阳气上逆，这是少阴肾脉不至的表现，名为尸厥。这是由于猝然遭受天地间的戾气所致。急救时用二气丹二钱，用陈年酒煎煮。如果觉得药液中硝石升起，就倒进盆里盖好温服。大约人行走五里的时间，再服用一次。不超过三次服药就能苏醒。如果是原本体质虚弱、饮食肥甘厚味的人，用附子一枚、人参三两，用酒煎煮分三次服用。同时艾灸百会穴四十九壮，气海丹田穴三百壮。直到身体温暖停止艾灸。艾炷只允许绿豆大小，粗大则会伤害人体。突发厥证脉象伏匿，不省人事，无法辨别阴阳。急救时用鸡蛋三个，煮熟后趁热剥开豆大一孔，垫一层粗纸，也对准肚脐，让热气透达体内即可苏醒。然后按照脉证进行治疗。如果连续更换三个鸡蛋无效，就无法救治了。
张介宾说：厥证起源于足部的，是厥发作的开始。甚至突然昏倒暴厥，忽然不省人事，轻则逐渐苏醒，重则立即死亡，是最为急重的候症。后世医生不能详细察辨，只是把手脚冷热作为厥证的标准，又有把脚气当作厥证的，错误非常严重。虽然张仲景有寒厥热厥之分，也是以手脚为言，大概那是为了辨析伤寒的寒热罢了，实际上并不是《内经》所说的厥证。看《素问·大奇论》说：暴厥的人，不能与人交谈。《素问·调经论》说：血与气，一起向上走，就会发生大厥，厥则暴死，气机恢复下行则生，不恢复下行则死。《素问·缪刺论》说：手足少阴、太阴及足阳明五条络脉都衰竭，使人身体沉重，形体无知觉，其状态像尸体一样，有的称之为尸厥。像这种情况，难道仅仅是手脚冷热及脚气所能概括的吗？现在的人大多不知道什么是厥证，而都将其指认为中风。中风这个病，多是经络受伤；厥逆这个病，直接是因为精气在内被剥夺。表里虚实，病情应当辨别。名义如果不正，难怪会用治风的方法来治厥证。医学中的危害，没有比这更严重的了。
【诊法】脉象沉微且不数的，属于寒厥；脉象沉伏且数的，属于热厥；脉象沉细的，属于气厥；脉象芤大的，属于血虚；脉象浮滑的，属于痰证；脉象弦数的，属于热证；脉象浮的，属于外感。脉来急促如喘息的，名为暴厥。寸脉沉而滑，沉主气滞，滑主实邪，实邪与气相搏结，血气进入脏腑，出现唇口身体冰冷，预后不良（死）。如果身体温和且自然出汗，说明病在腑，这是卒厥。
孙兆治疗一个人，自汗出，双脚逆冷直到膝盖以下，腹痛不省人事，六脉小弱而急。询问他所服用的药物，都是阳药。这不是病重，而是药物加重了病情。于是用五苓散、白虎汤十余剂而痊愈。凡是阴厥，小腿冷手臂也会冷。现在这个人小腿冷但手臂不冷，就不是下厥上行，所以知道这是阳厥。
汪石山治疗一个人突发厥证，暴死不省人事。先前因为轻微受寒多次发热，面色萎黄，六脉沉弦而细。知道是中气长期郁结所致。给人参七气汤一服，药还没煮好病人就突然断气。汪石山命令一人紧紧抱住病人，用口对接病人的气息，慢慢用热姜汤灌入。禁止喧闹移动，移动则气绝不返。过了一会儿果然苏醒。温养半个月后痊愈。不仅仅是这个病症如此，凡是中风、中气、中暑、中寒、暴厥，都不得妄动以断绝其气。《内经》明确说气复返则生，如果不熟悉这一点而扰乱其气，使其不能复返，导致夭折枉死者很多。
The *Classic of Difficult Issues* (Jing Yun) states: In the disease of Jue (Reversal), the feet suddenly become cold, the chest feels as if it is splitting, the intestines feel as if cut by a knife, there is irritability and an inability to eat, and the pulse is choppy regardless of its size. This occurs when cold pathogens invade the five Zang organs, causing rebellious Qi to ascend and dissipate, leading to the exhaustion of Yin Qi and the failure of Yang Qi to enter. Consequently, there is sudden severe pain, death-like coma, and loss of consciousness. If Qi returns to normal circulation, the patient will survive.
According to the *Treatise on Jue* in the *Suwen*: What causes the cold and heat manifestations in Jue? When Yang Qi is deficient in the lower part of the body, Cold Jue occurs; when Yin Qi is deficient in the lower part, Heat Jue occurs. "Yang Jue" arises from frequent anger. "Feng Jue" (Wind Jue) presents with spasms of the hands and feet, sweating, and persistent irritability and fullness. "Wei Jue" (Flaccidity Jue) is a combination of Wei syndrome (flaccidity) and Jue, characterized by weak and powerless legs. "Bi Jue" (Obstruction Jue) combines Bi syndrome (obstruction/painful obstruction) with Jue, presenting as numbness, swelling, and pain in the legs (Hong Kong foot/gouty arthritis); what the world calls "Hong Kong foot rushing to the heart" belongs to this category. "Jue Bi" refers to getting up from bed and being exposed to wind, causing blood to coagulate in the skin (forming Bi), stagnate in the vessels (causing sluggish flow), or coagulate in the feet (causing Jue). Modern people also refer to sudden fainting, loss of consciousness, and cold hands and feet as Jue. Zhang Zhongjing, in his discussion of Shanghan (Cold Damage), classifies cases where Yang syndrome transmits to Yin channels, resulting in cold hands and feet, as Heat Jue, treating them with Sini San (Four Reversal Powder). Cases of Yin syndrome with aversion to cold and cold hands and feet are classified as Cold Jue, treated with Sini Tang (Four Reversal Decoction). However, the meaning in the *Neijing's Treatise on Jue* is different. The three Yang meridians of the foot originate from the lateral side of the toes, and the three Yin meridians originate from the medial side. Therefore, excess Yang leads to heat in the soles, while excess Yin leads to cold from the toes up to the knees. This cold does not come from outside but originates internally. The cause of Cold Jue is described as a deficiency of Yang Qi, which fails to moisten and nourish the collaterals. As Yang Qi diminishes daily, only Yin Qi remains, causing coldness in the hands and feet; Fuzi Lizhong Tang (Aconite and Ginger Decoction for Regulating the Middle) is indicated. The cause of Heat Jue is described as occurring after excessive drinking or intercourse after a full meal, where Qi accumulates in the spleen. Kidney Qi declines daily, leaving Yang Qi in excess, causing heat in the hands and feet; Jiajian Bawei Wan (Modified Eight-Ingredient Pill) is indicated.
The *Classic* states: When the body's Yang Qi is subjected to excessive mental and physical labor, it becomes hyperactive, leading to the depletion of essence. ("Zhang" means hyperactivity/excess. Excessive labor leads to essence depletion.) If this condition accumulates during summer, it causes Jian Jue (Boiling Jue). (Summer heat injures Qi, causing Qi rebellion and Jian Jue.) Symptoms include blindness and deafness. Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction) is indicated. It also states: When Yang Qi is subjected to extreme anger, the form and Qi become severed, and blood stagnates in the upper body, causing Bo Jue (Thin/Forceful Jue). (Blood accumulates in the chest without dispersing, obstructing the airway and causing violent rebellion). Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is indicated. When the Yangming and Shaoyin meridians are affected together, it is named Feng Jue. (Liver Wood overacts on Stomach Earth, Wind overcomes Dampness, and fails to control Kidney Water, causing upward rebellion). Dihuang Yinzi (Rehmannia Infusion) is indicated. Additionally, bone pain and withered nails constitute Bone Jue; finger spasms preventing flexion and extension constitute Arm Jue; standing rigidly like a rafter constitutes Liver Jue. All these result from internal deficiency and Qi rebellion and are suitable for Bawei Wan (Eight-Ingredient Pill). Panting, mania, running, and climbing high indicate Yangming Jue, which is an excess pathogen pattern, treated with Chengqi Tang (Order the Qi Decoction) to purge. Jue accompanied by abdominal fullness and unconsciousness, or sudden confusion, results from pathogenic disturbance and rebellious Yang Qi, indicating that the Shaoyin Kidney pulse is absent. This is named Shi Jue (Corpse Jue), caused by sudden exposure to malignant Qi of heaven and earth. Emergency treatment involves Erqi Dan (Two-Qi Pill), 2 qian, decocted in aged wine. When ammonium nitrate crystals appear to rise, pour into a basin, cover, and take warm. After walking about five li, administer another dose. Within three doses, the patient should awaken. For patients with underlying deficiency due to rich diet, use one piece of Fuzi (Aconite Root) and 3 liang of Renshen (Ginseng Root), decocted in wine, divided into three doses. Also moxa Baihui (GV20) with 49 moxa cones and Qihai (CV6)/Dantian with 300 moxa cones. Stop moxibustion when the body warms. Moxa cones should be no larger than mung beans; larger ones will damage the tissue. For sudden Jue with hidden pulse and unconsciousness, where Yin and Yang cannot be distinguished, emergency treatment uses three eggs. Boil them, peel while hot, make a bean-sized hole, place a layer of coarse paper over the navel aligned with the hole, allowing heat to penetrate until the patient revives. Then treat according to pulse and symptoms. If three eggs fail to work, the case is incurable.
Zhang Jiebin stated: Jue originating in the feet marks the onset of the attack. It may progress to sudden collapse and violent Jue, with immediate loss of consciousness. Mild cases recover gradually; severe cases lead to immediate death. It is a critical emergency. Later physicians failed to examine it carefully, defining Jue merely by cold or hot hands and feet, or even confusing it with Hong Kong foot (gouty arthritis), which is a significant error. Although Zhang Zhongjing distinguished Cold and Heat Jue based on hands and feet, he was specifically distinguishing cold and heat in Shanghan, not referring to the Jue of the *Neijing*. The *Daqi Lun* states: In violent Jue, the patient cannot speak. The *Tiaojing Lun* states: When blood and Qi rush upward together, it causes Great Jue, leading to sudden death; if Qi returns downward, the patient lives; if not, they die. The *Miaoci Lun* states: When the five collaterals of the hand-foot Shaoyin, Taiyin, and Yangming are exhausted, the body becomes heavy and insensible, resembling a corpse, known as Shi Jue. Such conditions are certainly not limited to cold/hot extremities or gout. Today, most people do not understand Jue and mistake it for Zhongfeng (Wind Stroke). Zhongfeng usually involves injury to the meridians, whereas Jue is directly caused by the internal depletion of essence and Qi. Exterior/interior and deficiency/excess must be differentiated. Misnaming the condition explains why wind treatments are wrongly applied to Jue. No harm in medicine is greater than this.
[Diagnosis] A deep, faint, non-rapid pulse indicates Cold Jue; a deep, hidden, rapid pulse indicates Heat Jue; a deep, fine pulse indicates Qi Jue; a knotted, large pulse indicates Blood deficiency; a floating, slippery pulse indicates Phlegm; a wiry, rapid pulse indicates Heat; a floating pulse indicates external contraction. A pulse coming rapidly like panting is named Bao Jue (Violent Jue). A cun pulse that is deep and slippery: deep indicates Qi stagnation, slippery indicates Excess. When Excess and Qi contend, blood and Qi enter the Zang organs. If lips, mouth, and body become cold, it is fatal. If the body is warm and sweating spontaneously, the pathogen has entered the Fu organs; this is Cu Jue (Sudden Jue).
Sun Zhao treated a patient who sweated spontaneously, had cold feet extending below the knees, abdominal pain, and unconsciousness. The six pulses were small, weak, and rapid. Upon asking about previous medications, all were Yang-tonifying drugs. Sun Zhao concluded that the illness was not severe, but the medication aggravated it. He prescribed Wuling San (Five-Ingredient Powder with Poria) and Baihu Tang (White Tiger Decoction) for over ten doses, resulting in recovery. In Yin Jue, if the calves are cold, the arms are also cold. Here, the calves were cold but the arms were not, indicating it was not Lower Jue ascending, thus confirming it as Yang Jue.
Wang Shishan treated a patient with sudden Jue, appearing dead and unconscious. Previously, the patient had slight chills and recurrent fevers, with a sallow complexion. The six pulses were deep, wiry, and fine. Wang diagnosed long-term depression of Middle Qi. He administered Ren Shen Qi Qi Tang (Ginseng Seven-Qi Decoction). Before the medicine was ready, the patient suddenly ceased breathing. Wang ordered someone to hold the patient tightly, breathed into their mouth to transfer Qi, and slowly poured hot ginger soup down their throat. He prohibited noise and movement, stating that movement would prevent Qi from returning. Shortly after, the patient revived. After half a month of warming and nourishing care, the patient recovered. This applies not only to this case but to all instances of Zhongfeng, Zhong Qi, Zhong Shu (Heatstroke), Zhong Han (Cold Strike), and Bao Jue. One must not disturb the patient, as this severs the Qi. The *Neijing* clearly states that if Qi returns, life is preserved. Those who do not understand this and disturb the Qi, preventing its return, cause many premature deaths.