有阴热亢极而成阴毒者。金匮云。阴毒之为病。面目青。身痛如被杖。咽喉痛。五日
可治。七日不可治。升麻鳖甲去雄黄蜀椒主之。活人用本方加桂枝。名阴毒甘
草汤。
复有阴寒极盛而成阴毒者。自是两种。不可混也。惟阴寒至极。反大热躁渴。四肢
厥逆。脉沉细而疾。或尺部短而寸口大。额上手背冷。汗不止。或因入房而后着
寒。或内伤生冷而犯房室。内既伏阴。复加外寒。积寒伏于下。微阳消于上。遂成
阴盛格阳。阳气上脱之候。后五六日。胸前发出红斑。其色淡。其点小。是为阴斑。
虽盛夏宜附子理中汤。甚至身重眼睛疼。额冷汗出。呕哕呃逆。或爪甲青。或腹
绞痛。或面赤足冷厥逆。躁渴不欲饮。身发青黑色斑。目鼻灰色。舌黑而卷。茎与
囊俱缩。脉沉细而迟。或伏而不出。或疾至七八至而不可数者。急用葱饼于脐
上熨之。随用附子散。或人参三白汤。合四逆汤。熨后服汤已。手足不和暖者不治。
刘守真曰。世俗所言阴毒。皆阳热亢极。蓄热深于内。身表似有阴寒。此特指仲景
升麻鳖甲汤去雄黄、蜀椒阴热亢极之证。若后世所言阴寒极盛之阴毒。非用
回阳退阴之药。内温正气。逼邪外出。乌能起死回生耶。
王安道曰。阴阳二毒。与阴阳二证迥异。仲景书虽有阴毒之名。其所叙证。不过面
目青。身如被杖。咽喉痛而已。并不言阴寒极盛之证也。沉所治之方。不过升麻、
甘草、当归、鳖甲而已。并不用大温大热之药。故知仲景所谓阴毒。非阴寒之病。
乃是感天地恶毒之气。入于阴经。故名阴毒。而非纯阴冱寒。可用热药之比也。
赵以德曰。按古方书谓阳毒者。阳气独盛。阴气暴衰。内外皆阳。故成阳毒。阴毒者。
阴气独盛。阳气大衰。内外皆阴。故成阴毒。二者或伤寒初得。便有是证。或服药
后变而成者。阳毒治以寒凉。阴毒治以温热。药剂如冰炭之异。何仲景以一方
治之乎。且治阴毒去雄黄、蜀椒。则反去其温热者矣。岂非一皆热毒伤于阴阳
二经乎。在阳经络。则面赤如锦纹。唾脓血。在阴经络。则面青身如被杖。此皆阴
阳水火动静之本象也。其曰七日不可治者。阴阳之津气血液。皆消减矣。伤寒
七日。经气已尽。而此加之以毒。至七日不惟消灭其阴。且火抑亦自减矣。
有一种因阴热亢盛至极而形成的阴毒。《金匮要略》中说：阴毒这种病，表现为面目发青，身体疼痛如同被棍棒打过一样，咽喉疼痛。发病五天内可以治疗，七天后则难以治愈。用升麻鳖甲汤去掉雄黄和蜀椒来主治。《活人书》使用这个方子加上桂枝，命名为阴毒甘草汤。
另外还有一种因阴寒极盛而形成的阴毒。这是两种不同的情况，不能混淆。只有当阴寒达到极点时，反而会出现大热、烦躁、口渴的症状，四肢厥冷逆乱，脉象沉细且快速，或者尺部脉短而寸口脉大，额头和手背发冷，汗出不止。这可能是因为行房事后感受寒邪，或者内伤生冷饮食又犯了房事。体内既有潜伏的阴寒，外面又加上外寒侵袭，积寒伏于下部，微弱的阳气消亡于上部，于是形成了阴盛格阳、阳气上脱的证候。过了五六天，胸前发出红斑，颜色淡，斑点小，这就是阴斑。即使在盛夏时节也应当使用附子理中汤。甚至出现身体沉重、眼睛疼痛、额头冷汗出、呕吐呃逆、指甲发青、腹部绞痛、面赤脚冷四肢厥逆、烦躁口渴但不想喝水、身上发出青黑色的斑、眼睛和鼻子周围呈灰色、舌头发黑且卷缩、阴茎和阴囊都收缩、脉象沉细而迟，或者脉伏隐不出，或者脉搏疾速达到七八次一息而无法计数的情况。紧急时用葱饼在肚脐上熨烫，随后服用附子散，或者人参三白汤，合用四逆汤。熨烫后服药，如果手脚仍然不能温暖调和的，属于不治之症。
刘守真说：世俗所说的阴毒，都是阳热亢盛到极点，蓄积的热邪深在于内，体表似乎有阴寒的表现。这特指张仲景《伤寒论》中升麻鳖甲汤去雄黄、蜀椒所治疗的阴热亢盛至极的证候。如果是后世所说的阴寒极盛的阴毒，不用回阳退阴的药物，在内温补正气，逼迫邪气外出，怎么能起死回生呢？
王安道说：阴阳二毒与阴阳二证截然不同。张仲景的书里虽然有名目为“阴毒”，但其所描述的证候，不过是面目发青、身体像被棍棒打过、咽喉痛罢了，并没有提到阴寒极盛的证候。他所治疗的方剂，不过是升麻、甘草、当归、鳖甲而已，并没有使用大温大热的药物。因此知道张仲景所说的阴毒，不是阴寒的病，而是感受了天地间恶毒之气，侵入阴经，所以叫阴毒，而不是纯阴凝冻寒冷、可以用热药治疗的类型。
赵以德说：查阅古方书称阳毒是阳气独盛，阴气突然衰败，内外都是阳，所以形成阳毒。阴毒是阴气独盛，阳气大衰，内外都是阴，所以形成阴毒。这两种病，要么是伤寒初得时就有的证候，要么是服药后变成的。阳毒用寒凉药物治疗，阴毒用温热药物治疗，药剂性质如同冰炭差异那么大，为什么张仲景用同一个方子来治疗呢？而且治疗阴毒去掉雄黄、蜀椒，反而是去掉了温热药了。这难道不是一样是热毒伤害了阴阳二经吗？在阳经络，就表现为面赤如锦纹，唾脓血；在阴经络，就表现为面青身体像被棍棒打过。这都是阴阳水火动静的基本现象。所谓七天不可治，是因为阴阳的津液、气、血、液都消耗减少了。伤寒到了第七天，经气已经耗尽，而这个病又加上了毒邪，到了第七天不仅消灭了阴气，而且火邪也会自行减少。
There is a type of Yin Toxicity (Yin Du) formed due to extreme hyperactivity of Yin-Heat. The *Jingui Yaolue* states: In the disease of Yin Toxicity, the face and eyes appear blue/green, body pain feels as if beaten with a club, and there is sore throat. It can be treated within five days; after seven days, it becomes difficult to treat. The main treatment is Shengma Biejia Tang (Coptis and Softshell Turtle Shell Decoction) with Xionghuang (Realgar) and Shujiao (Sichuan Pepper) removed. The *Huo Ren Shu* uses this formula adding Guizhi (Cinnamon Twig), naming it Yin Du Gancao Tang (Yin Toxicity Licorice Decoction).
Furthermore, there is another type of Yin Toxicity formed due to extreme abundance of Yin-Cold. These are two distinct conditions and must not be confused. Only when Yin-Cold reaches its extreme does it paradoxically present with intense heat, restlessness, thirst, cold limbs (Jue Ni), a deep and fine yet rapid pulse, or a short pulse at the Chi position and a large pulse at the Cun position, cold forehead and back of hands, and unceasing sweating. This may occur after sexual intercourse followed by exposure to cold, or due to internal injury from raw/cold food combined with sexual excess. Internally, Yin-Cold lies latent; externally, Cold invades. Accumulated Cold hides in the lower part, while slight Yang Qi dissipates in the upper part, resulting in a syndrome of Yin Excess repelling Yang (Yin Sheng Ge Yang) and Yang Qi escaping upwards. After five or six days, red spots appear on the chest; their color is pale and spots are small; this is called Yin Spots (Yin Ban). Even in midsummer, Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) should be used. In severe cases presenting with heavy body, eye pain, cold sweat on the forehead, vomiting and hiccupping, cyanotic nails, abdominal colic, red face with cold feet and limb reversal, restlessness and thirst without desire to drink, dark green-black spots on the body, grayish hue around eyes and nose, black and curled tongue, retraction of penis and scrotum, deep fine and slow pulse, or hidden pulse not palpable, or rapid pulse reaching 7-8 beats per breath and uncountable, urgently apply a warm compress of scallion cake on the navel. Subsequently administer Fuzi San (Aconite Powder), or Renshen Sanbai Tang (Ginseng Three Whites Decoction), combined with Sini Tang (Frigid Extremities Decoction). After warming and taking the decoction, if the hands and feet remain cold and unharmonized, the condition is incurable.
Liu Shouzhen said: What the secular world calls Yin Toxicity is actually Yang-Heat hyperactive to the extreme, with accumulated heat deep inside, making the body surface appear to have Yin-Cold symptoms. This specifically refers to the syndrome of extreme Yin-Heat hyperactivity treated by Zhang Zhongjing’s Shengma Biejia Tang with Xionghuang and Shujiao removed. If it is the Yin-Toxicity of extreme Yin-Cold as described in later generations, without using herbs that restore Yang and retreat Yin, internally warming the righteous Qi and forcing pathogens outward, how could one revive the dying?
Wang Andao said: Yin-Yang Two Toxicities are radically different from Yin-Yang Two Syndromes. Although Zhang Zhongjing’s texts mention the name "Yin Toxicity," the symptoms described are merely blue-green face and eyes, body pain like being beaten, and sore throat. There is no mention of extreme Yin-Cold abundance. The formulas he treated with consisted only of Shengma (Cimicifugae Rhizoma), Gancao (Glycyrrhizae Radix), Danggui (Angelicae Sinensis Radix), and Biejia (Trionycis Carapax); no strongly warming or hot herbs were used. Thus, we know that Zhang Zhongjing’s "Yin Toxicity" is not a disease of Yin-Cold, but rather caused by absorbing the malignant toxic Qi of Heaven and Earth into the Yin Meridians, hence named Yin Toxicity. It is not comparable to pure Yin freezing cold which can be treated with hot herbs.
Zhao Yi-de said: According to ancient medical books, Yang Toxicity occurs when Yang Qi is exclusively abundant and Yin Qi suddenly declines, resulting in Yang both inside and outside, thus forming Yang Toxicity. Yin Toxicity occurs when Yin Qi is exclusively abundant and Yang Qi greatly declines, resulting in Yin both inside and outside, thus forming Yin Toxicity. These two conditions either exist upon the initial onset of Shanghan (Cold Damage) or develop after medication. Yang Toxicity is treated with cold-cooling agents, and Yin Toxicity with warm-heating agents; the medicinal properties differ as much as ice and charcoal. Why did Zhang Zhongjing use one formula to treat them? Moreover, treating Yin Toxicity by removing Xionghuang and Shujiao removes the warming herbs. Does this not imply that both are Heat Toxins injuring the Yin and Yang meridians? When affecting the Yang meridians, it presents as a red face like brocade patterns and spitting pus and blood; when affecting the Yin meridians, it presents as a blue-green face and body pain as if beaten. These are the fundamental images of Yin-Yang, Water-Fire, Motion, and Stillness. The statement "untreatable after seven days" implies that the fluids, Qi, and Blood of Yin-Yang have been depleted. By the seventh day of Shanghan, the meridian Qi is exhausted, and with the addition of toxicity, by the seventh day, not only is Yin destroyed, but the Fire pathogen also naturally diminishes.