张云。厥者。逆也。气逆则乱。故忽为眩仆脱绝。是名为厥。厥证之起于足者。厥发之始也。甚至猝倒暴
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。简按千金方凡例。以厥为香港脚。然王注已言及之。则唐时有为其说者。可知也。考灵寒热病篇曰。厥
痹者。厥气上及腹则死。此特似指香港脚冲心。虽仲景有寒厥热厥之分。亦以手足为言。盖彼以辨伤寒之寒热耳。
实非若内经之所谓厥也。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。令人身脉皆重。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。简按厥。尔雅作 。说文亦作 。云。HT 气也。从 从HT 从欠。又云。 。 。或省 。史
记扁仓传。作蹶。刘熙释名。厥。逆气也。颜师古注急就章云。 者。气从下起。上行叉心胁也。厥有气厥血
厥痰厥酒厥脏厥蛔厥色厥等。景岳全书论之详焉。
五指之表 张云。足指之端曰表。
集于足下而聚于足心 简按集聚同义。然集有止之意。国语。有隼集于陈侯之庭而死。是也。聚乃散之反。
皆从内也 张云。其寒也非从外入。皆由内而生也。故凡病阳虚者。必手足多寒。皆从指端始。
前阴 马云。前阴者。阴器也。外肾也。简按宁氏折骨分经云。睾丸。外肾也。属足厥阴肝经。又
韵会云。外肾为势。宫刑男子割势。据此则宦者去其宗筋者。割去睾丸也。
下气上争不能复 吴云。下气。身半以下之气也。上争者。阳搏阴激。身半以下之气。亦引而上争也。
马云。是在下之肾气。乃因强力。而遂与上焦之气相争。不能复如其旧。高云。在下之阴气。上争于阳。致阳
气不能复。复。内藏也。
精气溢下 吴云。阴精之气。涌溢泄出而下也。志云。阳气上出。则阴脏之精气。亦溢于下矣。简按
上古天真论。二八肾气盛。天癸至。精气溢泻。知是亦言精气漏泄。然彼由肾气有余。此因上盛下虚。义递异。
邪气因从之 张云。阳虚则阴胜为邪。简按吴云。邪气。阳气也。以其失所。目之为邪。此解太误。
若改阳字作阴。则才通。
气因于中 汪昂云。寒从内发。即前不从外之意。高云。阴寒之邪气因于中。而阳气日衰。简按此一
句。诸说参差。甲乙。于。作所。而吴则以此四字。移上文前阴者宗筋之所聚之上。马则改因作困。张则以气
为上文之精气邪气。志则为气因于中焦水谷之所生。并不甚清晰。考上下文意。汪高所释似允当。今姑从之。
渗营其经络 张兆璜云。渗者。渗于脉外。营者。营于脉中。营气宗气。皆精阳之气。营行于脉中。
诸阳之气。淡渗于脉外。非独卫气之行脉外也。
手足为之寒也 滑云。张子和曰。秋冬阴壮阳衰。人或恃赖壮勇。纵情嗜欲于秋冬之时。则阳夺于内。
阴气下溢。邪气上行。阳气既衰。真精又竭。阳不荣养。阴气独行。故手足寒。发为寒厥也。
络脉满而经脉虚 志云。灵枢经脉篇曰。饮酒者。卫气先行皮肤。先充络脉。夫卫气者。水谷之悍气
也。酒亦水谷悍热之液。故从卫气。先行皮肤。从皮肤而充于络脉。是不
从脾气。而行于经脉。故络脉满。而经脉虚也。
气聚于脾中 马云。下气上争。聚于脾中。志云。谷气聚于脾中。高同。
肾气日衰阳气独胜 宋本。日。作有。吴作自。甲乙。胜。作盛。（张氏医通云。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。加减肾气丸。）
腹胀满 甲乙。无胀字。马云。下气上争。而行之于上。则下虚。故气在腹。而不在足。所以腹中胀
满也。夫曰阴气盛于上则腹满者。上文之寒厥。高云。阴寒之气盛于上。则上下皆阴。而阳气虚于下。下虚则
腹胀满。以明腹满而为寒厥之意。简按张云。阴虚于下。则脾肾之气不化。故腹为胀满。恐非。
阳气盛于上 新校正。据甲乙。作腹满二字。详辨其义。滑亦从之。而马吴诸家。仍原文而解之。简
按帝问有二或字。故举阴气盛于上。阳气盛于上之两端而答之。则新校正似是而却非。马云。乃上文之热厥耳。
高云。阳热之气盛于上。则下气重上。而邪气逆。逆则阳气乱。乱则心神不宁。故暴不知人。以明暴不知人。
而为热厥之意。
下气重上而邪气逆 吴云。重。平声。并也。邪气。气失其常之名也。简按腹中论云。阳气重上。
有余于上。此亦论厥逆也。即是同义。
不知人也 志云。猝然昏 。或仆扑也。吴。此下。补逆之微者半日复。逆之甚者一日复。复则知
人矣十九字。简按经文未知旧如此否。要之不可定然矣。
厥状病能 马云。能。音耐。礼运篇云。圣人耐以天下为一家。则能耐同。吴云。能。犹形也。张
同。志云。病能者。能为奇恒之病也。简按吴近是。详见病能论篇首。
肿首头重 简按脉解篇。肿腰 痛。着至教论。干嗌喉塞。乃与论语迅雷风烈。楚辞吉月辰良。并同
字法。肿。志本作踵。非。
仆 甲乙。作眩仆。吴云。 。目眩乱也。仆。颠仆也。马云。 眩而仆倒。乃上重下轻之证也。
阳明之厥 汪昂云。按阳明多血多气。详本症病皆有余。与虚而厥者不同。
癫疾欲走呼 简按阴阳类论云。骂詈妄行。巅疾为狂。王注。以肾水不胜。故胃气盛。而颠为狂。盖
与此同证。详见宣明五气篇。
后不利 志云。食饮入胃。脾为转输。逆气在脾。故后便不利。脾不转运。则胃亦不和。是以食则呕。
而不得卧也。
口干溺赤 甲乙。口。作舌。志云。阴液不能上资。是以口干心痛。肺金不能通调于下。故溺赤。水
火阴阳之气。上下不爽。故腹满也。
泾溲 简按诸家不释。但张云。泾。音经。水名。义难通。调经论王注云。泾。大便也。溲。小便也。
杨上善云。泾作经。妇人月经也。吴云。泾。水行有常也。溲。溺KT 也。泾溲不利。言常行之小便不利也。数
说亦未稳当。灵本神篇。亦有腹胀经溲不利之文。经。甲乙作泾。盖泾溲是小溲。集韵。泾。去挺切。泉也。
刘熙释名。水直波曰泾。泾。径也。言道径也。溲者。二便之通称。（国语。少溲于豕牢。史记仓公传。有大
小溲语。吴越春秋。太宰 奉溲恶。注。溲。即便也。恶。大便也。）故加泾字。别于大便。脉要精微论。言
小便为水泉。此亦一证。
阴缩肿 甲乙。无肿字。是。
以经取之 吴云。难经曰。不盛不虚。以经取之者。是
正经自病。不中他邪也。当自取其经。（六十九难）正此谓也。马云。若不盛不虚。则在胆取胆。而不取之肝。
在肝取肝。而不取之胆。所谓自取其经也。即名之曰经治。又曰经刺。
太阴厥逆 张云。按六经之厥。已具上文。此复言者。考之全元起本。自本节之下。另在第九卷中。
盖彼此发明。原属两篇之文。乃王氏类移于此者。非本篇之重复也。
治主病者 张云。谓如本经之左右上下。及原输等穴。各有宜用。当审其所主而刺之。余准此。
虚满呕变下泄清 吴云。少阴。肾也。肾间命门之火虚衰。不足以生脾土。故令虚满。虚满者。中
虚而满也。呕变者。水谷已变。犹呕逆而出。盖少阴在下。故食至下焦。其色已变犹呕也。泄清。下泄澄澈清
冷也。志云。少阴之气。上与阳明相合。而主化水谷。少阴气厥。以致中焦虚满。而变为呕逆。上下水火之气
不交。故下泄清冷也。按呕变。当作变呕。灵五味篇云。若走骨。多食之令人变呕。与此篇大义相同。且有声
无物曰呕。故不当作呕出变异之物解。高云。有欲呕之变证。简按佛典有变吐之语。知是呕变变呕。乃呕逆之
谓。诸注恐属强解。
前闭 高云。前阴闭结。
谵言 吴云。肝藏魂。魂失其守。故谵言也。
不得前后 张云。或闭结不通。或遗失不禁。不得其常之谓也。三阴俱逆。则脏气绝。阳明脉解篇
曰。厥逆连经则生。连脏则死。此之谓也。志云。阴关于下也。简按此谓二便不通。张注。或遗失不禁。误。
僵仆 高云。即上文发为 仆之义。
呕血善衄 志云。阳气上逆则呕血。阳热在上则衄血。此太阳之气。厥逆于上。以致迫血妄行。高
云。阳热之气。
不行皮毛内伤络脉。阳络伤则血外溢。故呕血善衄。简按吴本。无呕血二字。义不相蒙。 僭去之。非也。
机关不利 张云。机关者。筋骨要会之所也。胆者。筋其应。少阳厥逆。则筋不利。故为此机关腰项之病。
发肠痈不可治 张云。肠痈发于少阳厥逆者。相火之结毒也。故不可治。高云。少阳经厥气逆。则
枢转有乖。故机关不利不能枢转。从外则发肠痈。发肠痈。则内郁之气。从痈而泄。不可治少阳之主病。当治
阳明之肠痈。此少阳厥逆病能。发于阳明。当治阳明。故不言治主病者。简按高。据仲景呕家有痈脓。不可治
呕。脓尽自愈之例而释之。未知于经旨何如。存备一说。
惊者死 马云。肝之病发为惊骇。而胆与之为表里。故惊则死矣。张云。其毒连脏。故当死。
喘咳身热 志云。阳明气厥则喘。上逆则咳也。阳明之气主肌肉。故厥则身热。
善惊衄呕血 志云。二阳发病。主惊骇。衄血呕血者。阳明乃悍热之气。厥气上逆。则迫血妄行。
此病在气。而及于经血。高云。闻水音则善惊。热迫于经则衄呕血。上文发肠痈。不可治少阳。当治阳明。是
治阳明之意。已寓于上。故此不言治主病者。简按肠痈治阳明。未见所据。其不言治主病者。恐是脱文。
呕沫 吴云。肺主治节。行下降之令。肺病则不能降。故虚满而咳。虚满之久。必有留沫。故呕沫。
高云。肺气满咳。不能四布其水津。故善呕沫。
手心主少阴 高云。手心主厥阴包络。手少阴心经。经厥气逆。皆有心痛之病。喉者。肺气也。心
痛引喉。则两火上炎而烁金。又兼身热如焚如焰。则死不可治。马云。邪客
篇言。心者。五脏六腑之大主也。精神之所舍也。其脏坚固。邪弗能容也。容之则心伤。心伤则精神去。神去
则死。此所以死不可治。
腰不可以俯仰 吴云。其脉属于小肠。小肠系腰之部分。故腰不可以俯仰。张云。四时气篇曰。邪在
小肠者。连睾系。属于脊。故腰不可以俯仰也。简按王以为错简文。吴张强为之解。似不切贴。
马云。按全元起本。 。作痉。 。音炽。伤寒论。有刚 柔 。痉。音敬。风强病也。此 当
以痉为是。后世互书者非。灵枢热病篇第二十七节。有风痉证。高云。经脉篇云。大肠手阳明之脉。是主津液。
今手阳明经气厥逆。津液不荣于经脉。故 当资手阳明经之津液。简按张云。 。谓手臂肩项强直也。此盖拘
泥于本经之所流注。故云尔。
张云：厥，就是逆乱的意思。气机逆乱就会导致紊乱，因此突然发生眩晕、仆倒甚至昏厥脱绝的现象，这就叫做厥。厥证起源于足部的，是厥气发作的开始。严重的会突然跌倒、暴然昏厥，忽然失去知觉；轻的会逐渐苏醒，重的则会立即死亡，这是最为急迫的病候。后世医生不能详细考察，只是把手足寒冷或发热当作厥。又有把香港脚（一种以足胫肿重疼痛为特征的疾病）当作厥的，这种错误太严重了。简按《千金方》凡例中，把厥解释为香港脚，但王冰注中已经提到过这一点，可知唐代时就有这种说法了。考证《灵枢·寒热病篇》说：“厥痹，厥气上及腹部则死。”这特别像是指香港脚冲心（香港脚毒气上攻心脏）。虽然张仲景有寒厥和热厥的区分，但也只是针对手足而言。大概他是用来辨别伤寒病的寒热罢了，实际上并不是像《内经》所说的厥。看《素问·大奇论》说：“暴厥者，不知与人言。”《调经论》说：“血与气并走于上，则为大厥。厥则暴死，气复反则生，不反则死。”《缪刺论》说：“手足少阴、太阴、足阳明五络都竭尽，使人全身经脉沉重，形体无知觉，其状像尸体，有人说这是尸厥。”像这样的情况，难道仅仅是手足寒热以及香港脚所能概括的吗？现在的人多不知道什么是厥证，而都把它指认为中风。中风这个病，多是经络受到损伤；厥逆这个病，直接是因为精气被内部耗夺。表里虚实，病情应当辨别。名义如果不正确，难怪会用治风的方法来治疗厥证。医学中的危害，没有比这更严重的了。简按“厥”字，《尔雅》写作“”，《说文解字》也写作“”。说：HT 气也。从 从HT 从欠。又说： 。 。或者省略 。《史记·扁鹊仓公列传》中写作“蹶”。刘熙《释名》说：厥，是逆气。颜师古注《急就章》说： 者，气从下起，上行叉心胁也。厥有气厥、血厥、痰厥、酒厥、脏厥、蛔厥、色厥等。《景岳全书》对此论述得很详细。
五指之表：张云：足趾的末端叫做表。
集于足下而聚于足心：简按“集”和“聚”意思相同。但“集”有停止的意思。《国语》说：“有隼集于陈侯之庭而死。”就是这个意思。“聚”是散的相反，都是从内部产生的。
皆从内也：张云：那种寒冷不是从外部侵入的，都是由内部产生的。所以凡是阳虚的病人，必定手足大多寒冷，都是从脚趾尖端开始的。
前阴：马云：前阴，就是阴器，也就是外肾。简按宁氏《折骨分经》说：睾丸，就是外肾，属于足厥阴肝经。又《韵会》说：外肾称为势，宫刑男子割势。据此，宦官去掉宗筋的人，就是割去了睾丸。
下气上争不能复：吴云：下气，是指身体下半部分的气。上争，是指阳搏动激惹阴，身体下半部分的气，也被牵引向上争夺。马云：这是在下的肾气，因为强力房事，于是与上焦之气相争，不能恢复如初。高云：在下的阴气，向上与阳争，导致阳气不能恢复。复，指内藏。
精气溢下：吴云：阴精之气，涌溢泄出而下。志云：阳气上出，那么阴脏的精气，也会溢于下。简按《上古天真论》说：“二八肾气盛，天癸至，精气溢泻。”知道这也是说精气漏泄。然而那是由于肾气有余，这是由于上盛下虚，意义依次不同。
邪气因从之：张云：阳虚则阴胜成为邪。简按吴云：邪气，指的是阳气。因为它失去了正常位置，称之为邪。这种解释太错误了。如果把“阳”字改为“阴”，才通顺。
气因于中：汪昂云：寒从内发，就是前面说的不从外来的意思。高云：阴寒的邪气因于中焦，而阳气日渐衰微。简按这一句，各家说法参差不一。《甲乙经》中，“于”作“所”。吴崐则把这四个字移到上文“前阴者宗筋之所聚”之上。马莳则改“因”为“困”。张介宾则以“气”为上文提到的精气邪气。张志聪则认为气因于中焦水谷所生。都不甚清晰。考上下文意，汪昂和高世栻的解释似乎恰当。现在暂且采纳他们的说法。
渗营其经络：张兆璜云：渗，是渗于脉外。营，是营于脉中。营气、宗气，都是精阳之气。营行于脉中，诸阳之气，淡渗于脉外，不仅仅是卫气行于脉外。
手足为之寒也：滑寿云：张子和说：秋冬时节阴壮阳衰，有人倚仗强壮勇武，在秋冬之时放纵情欲，那么阳气被掠夺于内，阴气下溢，邪气上行，阳气既已衰败，真精又枯竭，阳气不能荣养，阴气独行，所以手足寒冷，发为寒厥。
络脉满而经脉虚：张志聪云：《灵枢·经脉篇》说：饮酒的人，卫气先行于皮肤，先充盈络脉。夫卫气，是水谷悍气。酒也是水谷悍热之液，所以跟随卫气，先行于皮肤，从皮肤而充于络脉，这不经过脾气，而行于经脉，所以络脉满，而经脉虚。
气聚于脾中：马云：下气上争，聚于脾中。张志聪云：谷气聚于脾中。高世栻同。
肾气日衰阳气独胜：宋本中，“日”作“有”。吴崐作“自”。《甲乙经》中，“胜”作“盛”。（《张氏医通》说：论述得寒厥的原因，是因为其人阳气衰，不能渗荣其经络，阳气日渐损耗，阴气独在，所以手足为之寒冷。附子理中汤。论述得热厥的原因，则是说其人必然大醉，若饱食后入房，气聚于脾中，肾气日渐衰微，阳气独胜，所以手足为之发热。加减肾气丸。）
腹胀满：《甲乙经》中没有“胀”字。马云：下气上争，而行于上，则下部虚，所以气在腹，而不在足，所以腹中胀满。夫曰阴气盛于上则腹满者，是上文寒厥的情况。高云：阴寒之气盛于上，则上下皆阴，而阳气虚于下，下虚则腹胀满，以说明腹满是寒厥的意思。简按张云：阴虚于下，则脾肾之气不化，故腹为胀满。恐怕不对。
阳气盛于上：新校正：据《甲乙经》，作“腹满”二字。详细辨析其义，滑寿也采纳此说，而马莳、吴崐诸家，仍按原文解释。简按黄帝问中有两个“或”字，所以列举阴气盛于上、阳气盛于上的两端来回答，那么新校正似是而非。马云：这是上文的热厥。高云：阳热之气盛于上，则下气重上，而邪气逆，逆则阳气乱，乱则心神不宁，所以暴然不知人，以说明暴然不知人是热厥的意思。
下气重上而邪气逆：吴云：重，平声，并也。邪气，是气失其常的名称。简按《腹中论》说：阳气重上，有余于上。这也是论厥逆。即是同义。
不知人也：张志聪云：猝然昏 ，或者仆倒。吴崐在此下补入“逆之微者半日复，逆之甚者一日复，复则知人矣”十九字。简按经文未知旧时是否如此，总之不能确定。
厥状病能：马云：能，音耐。《礼运篇》说：“圣人耐以天下为一家。”则能耐同。吴云：能，犹形也。张介宾同。张志聪云：病能者，能为奇恒之病也。简按吴说接近正确，详见《病能论篇首》。
肿首头重：简按《脉解篇》有“肿腰 ”痛，《著至教论》有“干嗌喉塞”，乃与《论语》迅雷风烈、《楚辞》吉月辰良，并用同字法。“肿”，志本作“踵”，非。
仆：《甲乙经》作“眩仆”。吴云： 。目眩乱也。仆，颠仆也。马云： 眩而仆倒，乃上重下轻之证也。
阳明之厥：汪昂云：按阳明多血多气，详本症病皆有余，与虚而厥者不同。
癫疾欲走呼：简按《阴阳类论》说：骂詈妄行，巅疾为狂。王冰注：以肾水不胜，故胃气盛，而颠为狂。大概与此同证，详见《宣明五气篇》。
后不利：张志聪云：食饮入胃，脾为转输，逆气在脾，故后便不利。脾不转运，则胃亦不和，是以食则呕，而不得卧也。
口干溺赤：《甲乙经》中，“口”作“舌”。张志聪云：阴液不能上资，是以口干心痛。肺金不能通调于下，故溺赤。水火阴阳之气，上下不爽，故腹满也。
泾溲：简按诸家不解释。但张云：泾，音经，水名，义难通。《调经论》王冰注说：泾，大便也。溲，小便也。杨上善说：泾作经，妇人月经也。吴云：泾，水行有常也。溲，溺KT 也。泾溲不利，言常行之小便不利也。数说亦未稳当。《灵枢·本神篇》也有“腹胀经溲不利”的文句。经，《甲乙经》作泾。盖泾溲是小溲。《集韵》：泾，去挺切，泉也。刘熙《释名》：水直波曰泾。泾，径也，言道径也。溲者，二便之通称。（《国语》：少溲于豕牢。《史记·仓公列传》：有大、小溲语。《吴越春秋》：太宰 奉溲恶。注：溲，即便也。恶，大便也。）故加泾字，别于大便。《脉要精微论》说：小便为水泉。此也是一证。
阴缩肿：《甲乙经》中没有“肿”字，是正确的。
以经取之：吴云：《难经》说：不盛不虚，以经取之者，是正经自病，不中他邪也。当自取其经。（六十九难）正是此谓。马云：若不盛不虚，则在胆取胆，而不取之肝；在肝取肝，而不取之胆。所谓自取其经也。即名之曰经治，又曰经刺。
太阴厥逆：张云：按六经之厥，已具上文。此复言者，考之全元起本，自本节之下，另在第九卷中。盖彼此发明，原属两篇之文，乃王氏类移于此者，非本篇之重复也。
治主病者：张云：谓如本经之左右上下，及原输等穴，各有宜用，当审其所主而刺之。其余依此类推。
虚满呕变下泄清：吴云：少阴，肾也。肾间命门之火虚衰，不足以生脾土，故令虚满。虚满者，中虚而满也。呕变者，水谷已变，犹呕逆而出。盖少阴在下，故食至下焦，其色已变犹呕也。泄清，下泄澄澈清冷也。张志聪云：少阴之气，上与阳明相合，而主化水谷。少阴气厥，以致中焦虚满，而变为呕逆。上下水火之气不交，故下泄清冷也。按“呕变”，当作“变呕”。《灵枢·五味篇》说：若走骨，多食之令人变呕。与此篇大义相同。且有声无物曰呕，故不当作呕出变异之物解。高云：有欲呕之变证。简按佛典有“变吐”之语，知是呕变、变呕，乃呕逆之谓。诸注恐属强解。
前闭：高云：前阴闭结。
不得前后：张云：或闭结不通，或遗失不禁，不得其常之谓也。三阴俱逆，则脏气绝。《灵枢·阳明脉解篇》说：厥逆连经则生，连脏则死。此之谓也。张志聪云：阴关于下也。简按此谓二便不通，张注：或遗失不禁，误。
僵仆：高云：即上文发为 仆之义。
呕血善衄：张志聪云：阳气上逆则呕血，阳热在上则衄血。此太阳之气，厥逆于上，以致迫血妄行。高云：阳热之气，不行皮毛内伤络脉，阳络伤则血外溢，故呕血善衄。简按吴本，无“呕血”二字，义不相蒙。 僭去之，非也。
机关不利：张云：机关者，筋骨要会之所也。胆者，筋其应。少阳厥逆，则筋不利，故为此机关腰项之病。
发肠痈不可治：张云：肠痈发于少阳厥逆者，相火之结毒也。故不可治。高云：少阳经厥气逆，则枢转有乖，故机关不利不能枢转。从外则发肠痈。发肠痈，则内郁之气，从痈而泄，不可治少阳之主病，当治阳明之肠痈。此少阳厥逆病能，发于阳明，当治阳明，故不言治主病者。简按高，据张仲景“呕家有痈脓，不可治呕，脓尽自愈”之例而释之，未知于经旨何如。存备一说。
惊者死：马云：肝之病发为惊骇，而胆与之为表里，故惊则死矣。张云：其毒连脏，故当死。
喘咳身热：张志聪云：阳明气厥则喘，上逆则咳也。阳明之气主肌肉，故厥则身热。
善惊衄呕血：张志聪云：二阳发病，主惊骇。衄血呕血者，阳明乃悍热之气，厥气上逆，则迫血妄行。此病在气，而及于经血。高云：闻水音则善惊，热迫于经则衄呕血。上文发肠痈，不可治少阳，当治阳明，是治阳明之意，已寓于上，故此不言治主病者。简按肠痈治阳明，未见所据。其不言治主病者，恐是脱文。
呕沫：吴云：肺主治节，行下降之令。肺病则不能降，故虚满而咳。虚满之久，必有留沫，故呕沫。高云：肺气满咳，不能四布其水津，故善呕沫。
手心主少阴：高云：手心主厥阴包络，手少阴心经，经厥气逆，皆有心痛之病。喉者，肺气也。心痛引喉，则两火上炎而烁金。又兼身热如焚如焰，则死不可治。马云：《邪客篇》言：心者，五脏六腑之大主也，精神之所舍也。其脏坚固，邪弗能容也。容之则心伤，心伤则精神去，神去则死。此所以死不可治。
腰不可以俯仰：吴云：其脉属于小肠，小肠系腰之部分，故腰不可以俯仰。张云：《四时气篇》说：邪在小肠者，连睾系，属于脊，故腰不可以俯仰也。简按王以为错简文，吴、张强为之解，似不切贴。
：马云：按全元起本， 作痉。 音炽。《伤寒论》有刚 、柔 。痉，音敬，风强病也。此 当以痉为是。后世互书者非。《灵枢·热病篇》第二十七节，有风痉证。高云：《经脉篇》说：大肠手阳明之脉，是主津液。今手阳明经气厥逆，津液不荣于经脉，故 当资手阳明经之津液。简按张云： 。谓手臂肩项强直也。此盖拘泥于本经之所流注，故云尔。
Zhang Yun: Jue (Jue syndrome) means reversal or counterflow. When Qi reverses, it causes chaos; thus, sudden dizziness, collapse, or even syncope and loss of consciousness occur, which is named Jue. Jue syndromes originating in the feet represent the beginning of the onset of Jue Qi. In severe cases, there may be sudden collapse and violent Jue, with a sudden loss of consciousness; in mild cases, gradual recovery occurs, while in severe cases, death may follow immediately. This is the most urgent condition. Later physicians failed to examine it in detail, merely identifying Jue by cold or heat in the hands and feet. Some even identified Hongjiao (a disease characterized by swelling and pain in the lower legs and feet) as Jue, which is a grave error. According to the Preface of *Qianjin Fang*, Jue was interpreted as Hongjiao, but Wang Bing's commentary already mentioned this, indicating that such views existed during the Tang Dynasty. Examining *Ling Shu · Han Re Bing Pian* states: "In Jue Bi, if Jue Qi ascends to the abdomen, death ensues." This specifically seems to refer to Hongjiao attacking the heart (Hongjiao toxic Qi ascending to attack the heart). Although Zhang Zhongjing distinguished between Cold Jue and Heat Jue, he referred only to the hands and feet. Presumably, he used these to differentiate the cold and heat of Shanghan (Cold Damage). In reality, this is not what Nei Jing refers to as Jue. Observing *Su Wen · Da Qi Lun*: "In violent Jue, one cannot speak with others." *Tiao Jing Lun* states: "When blood and Qi rush upward together, it becomes Great Jue. In Jue, there is sudden death; if Qi returns, life is preserved; if it does not return, death occurs." *Miu Ci Lun* states: "When the five collaterals of Hand Shaoyin, Taiyin, and Foot Yangming are exhausted, the person's whole body feels heavy, and the form loses sensation, resembling a corpse; some call this Corpse Jue." Do such conditions amount to nothing more than cold/heat in the hands and feet, or Hongjiao? Nowadays, many people do not understand Jue syndrome and instead attribute it to Wind Stroke (Zhong Feng). Wind Stroke usually involves injury to the meridians, whereas Jue Ni (reversal Qi) is directly caused by the internal depletion of Essence and Qi. Exterior and interior, deficiency and excess must be differentiated. If the terminology is incorrect, no wonder they treat Jue with methods for Wind. Among medical harms, none is greater than this. Note: The character 'Jue' is written as '' in *Erya*, and also as '' in *Shuo Wen Jie Zi*. It says: HT Qi. Composed of components including HT and Qian. It also says: . . Or abbreviated. In *Records of the Grand Historian · Biography of Bian Que and Cang Gong*, it is written as 'Jue'. Liu Xi in *Shi Ming* states: Jue is reverse Qi. Yan Shigu's commentary on *Ji Jiu Zhang* says: 者, Qi rises from below and ascends to cross the heart and hypochondrium. There are types such as Qi Jue, Blood Jue, Phlegm Jue, Wine Jue, Zang Jue, Ascariasis Jue, and Sexual Depletion Jue. *Jing Yue Quan Shu* discusses these in detail.
Surface of the Five Toes: Zhang Yun: The distal end of the foot toes is called the surface (Biao).
Gather at the soles and accumulate at the sole center: Note: "Ji" (gather) and "Ju" (accumulate) have similar meanings. However, "Ji" implies stopping. *Guo Yu* states: "A falcon gathered in the courtyard of the Marquis of Chen and died." This is the meaning. "Ju" is the opposite of scattering, both arising from within.
All arise from within: Zhang Yun: The coldness is not invaded from the exterior but generated internally. Therefore, in all cases of Yang deficiency, the hands and feet are often cold, starting from the tips of the toes.
Anterior Yin: Ma Yin: Anterior Yin refers to the genital organ, also known as the external kidney. Note: Ning Shi's *Zhe Gu Fen Jing* states: The testicles are the external kidney, belonging to the Foot Jueyin Liver Meridian. Also, *Yun Hui* states: External kidney is called "Shi". Castration of men involves cutting "Shi". Based on this, eunuchs who remove their Zongjin (tendons/genitals) have had their testicles removed.
Lower Qi struggles upward and cannot recover: Wu Yun: Lower Qi refers to the Qi in the lower half of the body. Upward struggle refers to Yang pulsating and stimulating Yin, causing the Qi in the lower half to be drawn upward in struggle. Ma Yin: This is the Kidney Qi located below, which, due to excessive sexual activity, struggles with the Qi of the Upper Jiao and cannot return to its original state. Gao Yun: The Yin Qi below struggles upward against Yang, preventing Yang Qi from recovering. "Fu" (recover) refers to the internal viscera.
Essence and Qi overflow downward: Wu Yun: The Qi of Yin essence surges and leaks out downward. Zhi Yun: When Yang Qi exits upward, the essence and Qi of the Yin viscera also overflow downward. Note: *Shang Gu Tian Zhen Lun* states: "At age sixteen, Kidney Qi is abundant, Tian Gui arrives, and essence and Qi overflow and discharge." This indicates leakage of essence. However, that case was due to excess Kidney Qi, whereas this case is due to upper excess and lower deficiency; the implications differ sequentially.
Evil Qi follows accordingly: Zhang Yun: Yang deficiency leads to Yin excess, which becomes evil. Note: Wu Yun: Evil Qi refers to Yang Qi. Because it has lost its proper position, it is termed evil. This explanation is too erroneous. If "Yang" were changed to "Yin," it would make sense.
Qi is trapped in the middle: Wang Ang Yun: Cold originates from within, consistent with the previous statement that it does not come from outside. Gao Yun: Yin-cold evil Qi is trapped in the middle, causing Yang Qi to decline daily. Note: Interpretations of this sentence vary among scholars. *Jia Yi Jing* reads "Yu" as "Suo". Wu Kun moved these four characters to above "Anterior Yin is where Zongjin gathers." Ma Shi changed "Yin" to "Kun" (trap/confuse). Zhang Jiebin considered "Qi" to refer to the essence and evil Qi mentioned earlier. Zhi Cong believed Qi is produced in the Middle Jiao from food and water. None are very clear. Considering the context, Wang Ang and Gao Shishi's interpretations seem appropriate. I will tentatively adopt them.
Percolates and nourishes the meridians: Zhang Zhaohuang Yun: "Shen" (percolate) means percolating outside the vessels. "Ying" (nourish) means circulating within the vessels. Ying Qi and Zong Qi are both refined Yang Qi. Ying Qi circulates within the vessels, while various Yang Qi percolates lightly outside the vessels, not just Wei Qi.
Therefore, the hands and feet become cold: Hua Shou Yun: Zhang Hezi said: In autumn and winter, Yin is strong and Yang is weak. If one relies on physical strength and indulges desires during these seasons, Yang is captured internally, Yin Qi overflows downward, and evil Qi ascends. With Yang depleted and true essence exhausted, Yang fails to nourish, and Yin Qi acts alone, causing cold hands and feet, resulting in Cold Jue.
Collateral vessels are full while main vessels are deficient: Zhi Cong Yun: *Ling Shu · Jing Mai Pian* states: For those who drink wine, Wei Qi first moves through the skin and first fills the collateral vessels. Wei Qi is the fierce Qi of food and water. Wine is also a fierce and hot fluid of food and water, so it follows Wei Qi, moving first through the skin and filling the collateral vessels. It does not follow Spleen Qi to move through the main vessels; thus, collateral vessels are full, and main vessels are deficient.
Qi accumulates in the Spleen: Ma Yin: Lower Qi struggles upward and accumulates in the Spleen. Zhi Cong Yun: Grain Qi accumulates in the Spleen. Gao Shishi agrees.
Kidney Qi declines daily while Yang Qi stands alone: Song edition: "Ri" (daily) is written as "You" (have). Wu Kun writes "Zi" (self). *Jia Yi Jing*: "Sheng" (win/surplus) is written as "Sheng" (abundant). (*Zhang Shi Yi Tong* states: Discussing the cause of Cold Jue, it is because the person's Yang Qi is deficient and cannot percolate and nourish the meridians. Yang Qi is damaged daily, leaving Yin Qi alone, hence cold hands and feet. Fuzi Lizhong Tang. Discussing the cause of Heat Jue, it states the person likely drinks heavily and engages in sex after eating. Qi accumulates in the Spleen, Kidney Qi declines daily, and Yang Qi stands alone, hence hot hands and feet. Jiashen Shenqi Wan.)
Abdominal fullness and distension: *Jia Yi Jing* omits the character "Zhang" (distension). Ma Yin: Lower Qi struggles upward and moves upward, causing deficiency below. Thus, Qi is in the abdomen, not the feet, leading to abdominal distension. Regarding "Yin Qi excess above causes abdominal fullness," this refers to the Cold Jue mentioned earlier. Gao Yun: When Yin-cold Qi is excessive above, both upper and lower become Yin, while Yang Qi is deficient below. Deficiency below causes abdominal distension, clarifying that abdominal fullness indicates Cold Jue. Note: Zhang Yun: Yin deficiency below causes failure of Spleen and Kidney Qi transformation, leading to abdominal distension. This is likely incorrect.
Yang Qi is excessive above: Xin Zheng Jiao: Based on *Jia Yi Jing*, it should read "Abdominal fullness." Analyzing the meaning carefully, Hua Shou adopts this view, while Ma Shi, Wu Kun, and others still interpret according to the original text. Note: The Emperor's question contains two "Huo" (or), listing both Yin Qi excess above and Yang Qi excess above to answer. Thus, Xin Zheng Jiao's correction seems plausible but is actually incorrect. Ma Yin: This refers to the Heat Jue mentioned earlier. Gao Yun: When Yang-heat Qi is excessive above, lower Qi weighs down and ascends, and evil Qi reverses. Reversal causes Yang Qi chaos, chaos disturbs the Heart Spirit, leading to sudden unconsciousness, clarifying that sudden unconsciousness indicates Heat Jue.
Lower Qi weighs down and ascends while evil Qi reverses: Wu Yun: "Zhong" (weigh/heavy) is pronounced flat tone, meaning combined/together. "Xie Qi" (evil Qi) is the name for Qi deviating from normalcy. Note: *Fu Zhong Lun* states: Yang Qi weighs heavily above, having surplus above. This also discusses Jue Ni (reversal Qi), implying the same meaning.
Loss of consciousness: Zhi Cong Yun: Sudden fainting or collapsing. Wu Kun adds nineteen characters here: "For mild Jue, recovery occurs in half a day; for severe Jue, recovery occurs in one day; upon recovery, consciousness returns." Note: It is unknown if the original text contained this; certainly, it cannot be assumed.
Jue manifestations and disease capabilities: Ma Yin: "Neng" is pronounced like "Nai". *Li Yun Pian* states: "The sage can treat the world as one family." Thus, Neng is equivalent to Nai. Wu Yun: Neng means shape/form. Zhang Jiebin agrees. Zhi Cong Yun: Bing Neng refers to the ability to manifest strange and constant diseases. Note: Wu's interpretation is closer to the truth; see detailed discussion at the beginning of *Bing Neng Lun Pian*.
Swollen head and heavy head: Note: *Mai Jie Pian* mentions "swollen waist and back pain"; *Zhi Zhi Jiao Lun* mentions "dry throat and blocked larynx". These use the same character usage as *Analects* "thunder and violent wind" and *Chu Ci* "auspicious month and good day". "Zhong" (swell), Zhi Ben version writes "Zhong" (heel), which is incorrect.
Dizziness and collapse: *Jia Yi Jing* writes "Xuan Pu" (dizzy collapse). Wu Yun: , eyes dizzy and chaotic. Pu, falling/collapsing. Ma Yin: Dizzy and collapsing is a symptom of heaviness above and lightness below.
Yangming Jue: Wang Ang Yun: Yangming has abundant blood and Qi. Detailed symptoms show excess, differing from deficiency-induced Jue.
Manic illness wanting to run and shout: Note: *Yin Yang Lei Lun* states: Cursing and acting wildly, Dian Ji (manic illness) becomes Kuang (mania). Wang Bing's commentary: Kidney Water fails to overcome, so Stomach Qi is strong, leading to Dian becoming Kuang. Likely the same syndrome; see *Xuan Ming Wu Qi Pian*.
Difficulty with defecation: Zhi Cong Yun: Food and drink enter the Stomach, Spleen transports and transforms. Reverse Qi in the Spleen causes difficulty with bowels. If Spleen fails to transport, Stomach also fails to harmonize, leading to vomiting after eating and inability to lie down.
Dry mouth and dark urine: *Jia Yi Jing*: "Kou" (mouth) is written as "She" (tongue). Zhi Cong Yun: Yin fluids fail to nourish above, causing dry mouth and heart pain. Lung Metal fails to regulate below, causing dark urine. Fire and Water, Yin and Yang Qi fail to communicate smoothly above and below, causing abdominal fullness.
Jing Sou (Urination): Note: Various commentators do not explain. Zhang Yun: Jing, pronounced Jing, is a river name; meaning is hard to connect. *Tiao Jing Lun* Wang Bing commentary: Jing means stool; Sou means urine. Yang Shangshan: Jing written as Jing, refers to menstrual flow. Wu Yun: Jing means water flows constantly; Sou means urine. Jing Sou bu li means difficulty with normal urination. These explanations are unstable. *Ling Shu · Ben Shen Pian* also has "abdominal distension and Jing Sou bu li". Jing in *Jia Yi Jing* is written as Jing. Jing Sou refers to small urine. *Ji Yun*: Jing, qu ting qie, spring. Liu Xi *Shi Ming*: Straight flowing water is Jing. Jing is path/route. Sou is a general term for both stools and urine (*Guo Yu*: "shao sou on pig pen"; *Shi Ji · Cang Gong Zhuan*: "da xiao sou"; *Wu Yue Chun Qiu*: "tai zai bo feng sou e", commentary: Sou means stool, E means feces). Adding Jing distinguishes it from large stool. *Mai Yao Jing Wei Lun* states: Small urine is water spring. This is another syndrome.
Yin shrinkage and swelling: *Jia Yi Jing* omits "Zhong" (swelling), which is correct.
Treat by taking from the meridian: Wu Yun: *Nan Jing* states: "If neither excess nor deficiency, take from the meridian." This means the regular meridian is self-diseased, not affected by other evils. One should take from its own meridian. (Difficult Issue 69) This is exactly what is meant. Ma Yin: If neither excess nor deficiency, take from Gallbladder without taking from Liver; take from Liver without taking from Gallbladder. This is taking from the self-meridian, named Jing Zhi (Meridian Treatment) or Jing Ci (Meridian Acupuncture).
Taiyin Jue Ni: Zhang Yun: The Jue of the Six Meridians is already presented above. Why mention it again? Examining Quan Yuanqi's edition, from below this section, it is separately in Volume 9. They elucidate each other, originally belonging to two different texts, later categorized by Wang Bing here, not a repetition in this chapter.
Treat the primary diseased area: Zhang Yun: Such as points on the left/right, upper/lower of the affected meridian, and Yuan-Shu points, each has suitable applications. One must examine what it governs and needle accordingly. Others follow this principle.
Deficient fullness, vomiting with changes, clear diarrhea below: Wu Yun: Shaoyin is Kidney. The fire of Mingmen between Kidneys is deficient and weak, insufficient to generate Spleen Earth, causing deficient fullness. Deficient fullness means central deficiency with fullness. Vomiting with changes means food and water have transformed but are still vomited up. Since Shaoyin is below, when food reaches the Lower Jiao, its color has already changed, yet it is vomited. Clear diarrhea below means clear, cold, and transparent discharge. Zhi Cong Yun: Shaoyin Qi combines with Yangming above to transform food and water. Shaoyin Qi Jue causes central deficient fullness and vomiting. Fire and Water Qi above and below do not intersect, causing clear and cold lower discharge. Note: "Ou Bian" should be "Bian Ou". *Ling Shu · Wu Wei Pian* states: If it affects bones, eating too much causes bian ou (vomiting with changes). This aligns with the main idea. Also, vomiting with sound but no matter is called Ou, so it should not be interpreted as vomiting abnormal substances. Gao Yun: There is a change syndrome of wanting to vomit. Note: Buddhist texts mention "Bian Tu" (vomiting/changing vomit), knowing that Ou Bian/Bian Ou refers to retching/vomiting. Other annotations may be forced interpretations.
Anterior closure: Gao Yun: Closure of the anterior Yin.
Delirious speech: Wu Yun: Liver stores Hun (Ethereal Soul). If Hun loses its guard, delirious speech occurs.
Inability to pass urine or stool: Zhang Yun: Either blockage and obstruction, or incontinence and leakage, failing to maintain normal function. If all Three Yin meridians reverse, Zang Qi is exhausted. *Ling Shu · Yang Ming Mai Jie Pian* states: Jue Ni connecting to meridians results in survival; connecting to viscera results in death. This is what is meant. Zhi Cong Yun: Yin closes below. Note: This refers to obstruction of both urine and stool. Zhang's note: "Or incontinence and leakage" is incorrect.
Stiffness and collapse: Gao Yun: Same as the meaning of Fa Wei Pu mentioned earlier.
Vomiting blood and prone to epistaxis: Zhi Cong Yun: Yang Qi reversing upward causes vomiting blood; Yang heat above causes epistaxis. This is Taiyang Qi reversing upward, forcing blood to move recklessly. Gao Yun: Yang-heat Qi fails to circulate in skin and hair, injuring collaterals internally. Injury to Yang collaterals causes blood to overflow externally, hence vomiting blood and prone to epistaxis. Note: Wu's edition lacks "vomiting blood"; the meaning does not connect. Removing it arbitrarily is incorrect.
Joint dysfunction: Zhang Yun: Guan Jian (joints) are places where sinews and bones meet. Gallbladder corresponds to sinews. Shaoyang Jue Ni causes sinew dysfunction, hence joint, waist, and neck diseases.
Developing intestinal abscess, incurable: Zhang Yun: Intestinal abscess developing from Shaoyang Jue Ni is the結毒 (knotted toxin) of Minister Fire. Hence, it is incurable. Gao Yun: Shaoyang Meridian Jue Qi reverses, disrupting pivot rotation. Hence joint dysfunction prevents pivoting. Externally, it develops into intestinal abscess. Developing intestinal abscess allows internally stagnant Qi to drain through the abscess. One cannot treat the primary disease of Shaoyang; one must treat the intestinal abscess of Yangming. This Shaoyang Jue Ni disease capability manifests in Yangming, so treat Yangming; hence, it does not say "treat the primary diseased area." Note: Gao bases this on Zhang Zhongjing's example: "For those with vomiting and abscess pus, do not treat vomiting; let the pus heal itself." Unclear if this fits the classic's intent. Preserved as one theory.
Fright leads to death: Ma Yin: Liver disease manifests as fright and terror, and Gallbladder is its exterior-interior pair, hence fright leads to death. Zhang Yun: The toxin connects to the viscera, hence death ensues.
Wheezing, coughing, and body heat: Zhi Cong Yun: Yangming Qi Jue causes wheezing; reversing upward causes coughing. Yangming Qi governs muscles, so Jue causes body heat.
Prone to fright, epistaxis, and vomiting blood: Zhi Cong Yun: Er Yang (Yangming) disease onset governs fright and terror. Epistaxis and vomiting blood: Yangming is fierce-hot Qi. Jue Qi reversing upward forces blood to move recklessly. This disease is in Qi but affects Jing and Blood. Gao Yun: Hearing water sounds causes fright; heat pressing on meridians causes epistaxis and vomiting blood. The earlier mention of intestinal abscess, not treating Shaoyang but treating Yangming, implies treatment of Yangming is already embedded above; hence, it does not say "treat the primary diseased area." Note: Treating intestinal abscess via Yangming lacks basis. The omission of "treat primary diseased area" is likely a textual lacuna.
Vomiting foam: Wu Yun: Lung governs regulation and descends. Lung disease fails to descend, causing deficient fullness and cough. Prolonged deficient fullness leaves retained foam, hence vomiting foam. Gao Yun: Lung Qi is full and coughing, unable to distribute water fluids widely, hence prone to vomiting foam.
Hand Jueyin Pericardium and Hand Shaoyin: Gao Yun: Hand Jueyin Pericardium and Hand Shaoyin Heart Meridian, if Qi reverses, both cause heart pain. The throat belongs to Lung Qi. Heart pain radiating to the throat causes both Fires to flare upward and scorch Metal. Coupled with body heat burning like flames, death is incurable. Ma Yin: *Xie Ke Pian* states: Heart is the great master of the five viscera and six bowels, abode of Spirit. Its organ is solid, evil cannot accommodate. If accommodated, Heart is injured; if injured, Spirit departs; if Spirit departs, death occurs. This is why it is incurable.
Waist cannot bend or extend: Wu Yun: Its meridian belongs to Small Intestine. Small Intestine relates to the waist region, hence waist cannot bend or extend. Zhang Yun: *Si Shi Qi Pian* states: Evil in Small Intestine connects to testicle cords, belonging to spine, hence waist cannot bend or extend. Note: Wang considered this a misplaced text. Wu and Zhang's forced explanations seem inappropriate.
: Ma Yin: According to Quan Yuanqi's edition, is written as Jing (spasm). pronounced Chi. *Shang Han Lun* has Gang Jing and Rou Jing. Jing, pronounced Jing, is wind-strength disease. This should be Jing. Later generations interchanging them is incorrect. *Ling Shu · Re Bing Pian* Section 27 has Feng Jing syndrome. Gao Yun: *Jing Mai Pian* states: Large Intestine Hand Yangming Meridian governs fluids. Now Hand Yangming Meridian Qi reverses, fluids fail to nourish meridians, hence should nourish fluids from Hand Yangming Meridian. Note: Zhang Yun: . Refers to stiffness and straightening of arms, shoulders, and neck. This is likely constrained by the flow of the specific meridian, hence stated so.