【歌】厥形有六要消详,痰气尸蛔阴共阳。故使四肢成厥逆,阴阳虚实各分张。
【论】夫阴厥者,始因泄利,身寒厥冷,足蜷卧,唇口青,自利溲白不渴,脉迟。阳厥者,身热四肢厥逆,大、小
便闭涩,脉数,热极反厥也。痰厥者,寒痰迷闷心胸,隧道不行,四肢厥冷,僵仆卒倒不知人事。厥者,气暴
逆也,故卒然厥逆不知人,僵仆身冷。蛔厥者,胃寒,蛔虫攻胃,手足厥冷,吐蛔。尸厥者,冒犯不正之气,
忽然手足厥冷,肌肤起粟,头面青黑,或妄言,或口噤,昏聩不知人,或因吊丧问病,入庙登 而得。丹溪云∶
有因气而厥者,身冷脉伏。有血虚而厥者,因血大损故也,脉必芤涩。有因痰滞而厥者,口中流涎,昏不知人,
脉沉滑。有气虚而厥者,有所劳伤,气弱不能营运故也。凡此之类,在乎细辨之。
阴、阳厥
阴厥,理中汤,重者四逆汤,(二方俱见中寒。)外灸关元穴五十壮。阳厥,四逆散。大便闭,热极反
厥,大承气汤下之。(方见伤食。)
四逆散
治阳厥轻者。
甘草(炙,一钱) 枳壳(炒,一钱) 柴胡(一钱) 白芍药(炒,一钱)
锉一帖,水二钟,煎八分,不拘时服。
气、血厥
气厥,四七汤、调气散,八味顺气散、(方见气证。)苏合香丸。(方见类中风。)妇人血厥,仓公
散、白薇汤。
仓公散
治血厥。
瓜蒂(一钱) 藜芦(一钱) 矾石(飞,一钱) 雄黄(一钱)
末之,每用少许,吹鼻中取嚏。
白薇汤
治血厥。
白薇(三钱) 当归(三钱) 人参(一钱半) 甘草(炙,七分)
锉一帖,水二盏,煎一盏,温服。
蛔厥
蛔厥,理中汤加槟榔、川椒,煎吞乌梅丸。(一方见中寒,一见心痛。)不止,用乌梅、川椒、黄柏煎服。
盖蛔闻酸、苦则安。
尸厥
尸厥,苏合香丸、(方见类中风证。)调气散、(方见气证。)或追魂汤。
追魂汤
治卒厥不知人。
麻黄(去节,三钱) 杏仁(二十五粒) 生甘草(一钱)
煎服。
痰厥
痰厥昏闷不醒,稀涎散、(方见中风。)导痰汤。(方见痰证。)
【歌诀】厥证的形态有六种,需要仔细分辨:痰厥、气厥、尸厥、蛔厥、阴厥和阳厥。因此导致四肢出现厥逆(手足冰冷),需根据阴阳虚实进行区分。
【论述】所谓阴厥,起初是因为腹泻,身体寒冷且四肢厥冷,双脚蜷缩而卧,嘴唇和口唇发青,自行下利且小便清白、口不渴,脉象迟缓。阳厥表现为身体发热但四肢厥逆,大小便闭塞涩滞,脉象数(快),这是热邪极盛反而导致厥逆的现象。痰厥是由于寒痰迷蒙心胸,经络通道不通,导致四肢厥冷,突然僵仆倒地且不省人事。厥证,是指气机暴逆,所以突然发生厥逆而不省人事,僵仆倒地且身体变冷。蛔厥是胃中寒冷,蛔虫攻冲胃部,导致手足厥冷,并吐出蛔虫。尸厥是因冒犯不正之气,突然手足厥冷,皮肤起鸡皮疙瘩,头面部青黑,或者胡言乱语,或者牙关紧闭,昏迷不省人事,有时是因为去吊丧探病,进入庙宇登堂时得病。丹溪说:有因气滞而厥的,身体冷而脉伏;有因血虚而厥的,因为血液大损所致,脉象必定芤(中空)或涩;有因痰滞而厥的,口中流涎沫,昏迷不省人事,脉象沉滑;有因气虚而厥的,由于劳力损伤,气弱不能运行所致。凡此种种,在于仔细辨别。
阴厥、阳厥
阴厥,用理中汤,重症用四逆汤,(这两方剂均见于中寒章节。)外部艾灸关元穴五十壮。阳厥,用四逆散。若大便闭结,热极反致厥逆,用大承气汤攻下。(方剂见于伤食章节。)
四逆散
治疗轻症的阳厥。
甘草(炙,一钱) 枳壳(炒,一钱) 柴胡(一钱) 白芍药(炒,一钱)
锉碎为一帖,加水二钟,煎至八分,不拘时间服用。
气厥、血厥
气厥,用四七汤、调气散、八味顺气散,(方剂见于气证章节。)苏合香丸。(方剂见于类中风章节。)妇人血厥,用仓公散、白薇汤。
仓公散
治疗血厥。
瓜蒂(一钱) 藜芦(一钱) 矾石(飞研,一钱) 雄黄(一钱)
研为末,每次取少许,吹入鼻中引发喷嚏。
白薇汤
治疗血厥。
白薇(三钱) 当归(三钱) 人参(一钱半) 甘草(炙,七分)
锉碎为一帖,加水两盏,煎至一盏,温服。
蛔厥
蛔厥,用理中汤加槟榔、川椒,煎好后吞服乌梅丸。(一方见于中寒章节,一方见于心痛章节。)若不止,用乌梅、川椒、黄柏煎服。因为蛔虫闻到酸味、苦味就会安静。
尸厥
尸厥,用苏合香丸,(方剂见于类中风证章节。)调气散,(方剂见于气证章节。)或者追魂汤。
[Song] The manifestations of Jue (Jue Syndrome) are sixfold, requiring careful differentiation: Phlegm Jue, Qi Jue, Corpse Jue, Ascaris Jue, Yin Jue, and Yang Jue. Thus, limb Ni (cold extremities) occurs; differentiation must be made according to Yin-Yang and Deficiency-Excess.
[Discussion] Yin Jue begins with diarrhea, cold body and cold extremities, curled legs while lying, cyanosis of lips and mouth, spontaneous diarrhea with clear urine and no thirst, and a slow pulse. Yang Jue presents with fever in the body but cold extremities, obstruction and dryness of urination and defecation, a rapid pulse, which is extreme heat reversing into Jue. Phlegm Jue involves cold phlegm clouding the chest and heart, blocking the meridians and collaterals, causing cold extremities, sudden collapse, and loss of consciousness. Jue refers to the violent reversal of Qi, hence sudden Jue with loss of consciousness, collapse, and cold body. Ascaris Jue involves cold in the stomach where ascarides attack the stomach, causing cold hands and feet and vomiting of ascarides. Corpse Jue results from exposure to pathogenic factors, suddenly causing cold hands and feet, gooseflesh on the skin, cyanosis and blackness of the head and face, or delirium, or locked jaws, coma and loss of consciousness; it may also occur when attending funerals or visiting the sick, entering temples or ascending halls. Danxi stated: There is Jue due to Qi stagnation, with cold body and hidden pulse; there is Jue due to Blood deficiency, caused by severe blood loss, with a Kou (hollow) or Se (choppy) pulse; there is Jue due to Phlegm stagnation, with salivation, coma and loss of consciousness, and a Chen (deep) and Hua (slippery) pulse; there is Jue due to Qi deficiency, caused by labor injury where weak Qi cannot circulate. All these require careful differentiation.
Yin Jue and Yang Jue
For Yin Jue, Lizhong Tang is used; for severe cases, Sini Tang is used (both formulas are seen in the chapter on Cold Damage to the Middle). External moxibustion is applied to Guanyuan (CV4) acupoint, fifty moxa cones. For Yang Jue, Sini San is used. If stool is obstructed and Jue is caused by extreme heat, Dachengqi Tang is used to purge (formula seen in the chapter on Food Stagnation).
Sini San
Treats mild cases of Yang Jue.
Gancao (Zhi, fried, 1 qian) Zhike (Chao, stir-fried, 1 qian) Chaihu (1 qian) Baishao (Chao, stir-fried, 1 qian)
Crush into one dose, add two zhong of water, decoct to eight fen, take at any time.
Qi Jue and Blood Jue
For Qi Jue, Siqi Tang, Tiaoqi San, Bawei Shunqi San are used (formulas seen in the chapter on Qi Syndromes), and Suhexiang Wan (formula seen in the chapter on Stroke-like Syndromes). For female Blood Jue, Cang Gong San and Baiwei Tang are used.
Cang Gong San
Treats Blood Jue.
Gua Di (1 qian) Lili (1 qian) Fanshi (Fei, flown/processed, 1 qian) Xionghuang (1 qian)
Grind into powder, use a small amount each time, blow into the nose to induce sneezing.
Baiwei Tang
Treats Blood Jue.
Baiwei (3 qian) Danggui (3 qian) Renshen (1.5 qian) Gancao (Zhi, fried, 0.7 qian)
Crush into one dose, add two zhan of water, decoct to one zhan, take warm.
Ascaris Jue
For Ascaris Jue, Lizhong Tang is used with Binglang and Chuanjiao, decocted and taken with Wumei Wan (one formula seen in Cold Damage to the Middle, one in Heart Pain). If it does not stop, use Wumei, Chuanjiao, and Huangbai decocted and taken. This is because ascarides are calmed by sour and bitter tastes.
Corpse Jue
For Corpse Jue, Suhexiang Wan (formula seen in Stroke-like Syndromes), Tiaoqi San (formula seen in Qi Syndromes), or Zhuihun Tang are used.
Zhuihun Tang
Treats sudden Jue with loss of consciousness.
Mahuang (remove joints, 3 qian) Xingren (25 grains) Sheng Gancao (1 qian)
Decoct and take.
Phlegm Jue
For Phlegm Jue with cloudiness and failure to wake up, Xixian San (formula seen in Stroke) and Daotan Tang (formula seen in Phlegm Syndromes) are used.