绝引食以自救也。中，以胃言。死，谓万物无土不生也。
程知曰∶言脉迟为寒，不宜更用寒药，以致有除中之变也。中气为阴寒革除，则胃中无根之阳气将欲尽除，
而求救于食，故为死证。
伤寒，先厥后发热而利者，必自止，见厥复利。
【注】厥逆，阴也。发热，阳也。先厥后发热，而利必自止者，是阴退而阳进也。见厥复利者，是阳退而
阴进也。热多厥少，病虽甚者亦可愈；厥多热少，病虽微者亦转甚。可知厥热，乃阴阳进退生死之机也。
【集注】汪琥曰∶厥阴者，阴之尽。厥阴之经，阳气甚微，故不论阴阳二证，寒热之邪，但至其经，无有
不发厥者。盖厥即为逆，起于手足，今曰先厥者，此初起便厥。厥即下利发热者，则阳气复而利必自止也。
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。
【注】此承上条而详辨之，以出其证也。先厥后发热，下利必自止，厥回利止，其热若退，为欲愈也。若
厥回利止，其热不退，而反汗出者，是厥阴病从阳化热，其邪上循本经之脉，故咽喉痛痹也。若厥回发热，无
汗利不止者，是厥阴邪热因利下迫，伤及脉中之血，故必便脓血也。便脓血者，其喉不痹，谓热邪下利，而不
复上病咽痛也。可知下利止，其喉为痹者，谓热邪已上，病咽痛，即不复病下利也。
【集注】喻昌曰∶先厥后热下利止，其病为欲愈矣。乃反汗出咽中痛，是热邪有余，上攻咽喉而为痹也。
既发热虽无汗，为其阳已回，所以利亦必自止，若不止，则无汗明系邪不外出，热郁在里，必主便脓血也。便
脓血者，其喉不痹，见热邪在里，即不复在表，在下，即不复在上也。
汪琥曰∶咽中痛者，此热伤上焦气分也。痹者，闭也。咽中痛甚，其喉必闭而不通，以
厥阴经循喉咙之后，上入颃颡故也。无汗利不止，便脓血者，此热伤下焦血分也。热邪注下，则不干上，故曰∶
其喉不痹。
下利脉数，有微热，汗出，令自愈。设复紧，为未解。
【注】厥阴下利脉数，热利也。若热微汗出，知邪微欲解，下利必自止，故令自愈也。设脉复紧，为表邪
犹盛，未能解也。
【集注】成无己曰∶下利，阴病也。脉数，阳脉也。阴病见阳脉者生。微热汗出，阳气得通也，利必自愈。
诸紧为寒，设复脉紧，寒邪犹盛，故云∶未解。
沈明宗曰∶数条乃指厥而下利便脓血者。或见实大、浮数、微弱、沉涩、弦紧、洪长诸脉，当分虚、实、
寒、热，即知欲愈未愈，真为察病之微旨也。
下利有微热而渴，脉弱者，令自愈。
【注】厥阴下利，有大热而渴，脉强者，乃邪热俱盛也。今下利有微热而渴，脉弱者，是邪热衰也，邪热
既衰，故可令自愈也。
【集注】方有执曰∶微热，阳渐回也。渴，内燥未复也。脉弱，邪退也。令自愈，言不须治也。
程知曰∶下利以阳复邪微为愈。微热而渴，证已转阳，脉弱则邪气已退，故不治自愈。若下利大热脉盛，
又是逆候矣。
下利脉数而渴者，令自愈。设不瘥，必圊脓血，以有热故也。
【注】此承上条互言，以详其变也。下利脉数而渴者，是内有热也，若身无热，其邪已衰，亦可令自愈也。
设下利脉数而渴，日久不瘥，虽无身热，必圊脓血，以内热伤阴故也。
【集注】方有执曰∶脉数与上文微热互相发明。
程应旄曰∶脉数而渴，阳胜阴矣，故亦令自愈。若不瘥，则阴虚热入，经所云脉数不解而下利不止，必协
热而便脓血是也。
下利，寸脉反浮数，尺中自涩者，必圊脓血。
【注】厥阴热利，寸脉当沉数，今寸脉反浮数，是热在外而不在内也。尺中自涩者，是在外之热不解，乘
下利入里，伤及其阴，热与血瘀，必圊脓血也。
【集注】喻昌曰∶脉见浮数，若是邪还于表，则尺脉自和，今尺中自涩，乃热邪抟结于阴分，虽寸口得阳
脉，究竟阴邪必走下窍，而便脓血也。
汪琥曰∶此条乃下利变脓血之候也。热利而得数脉非反也，得浮脉则为反矣。此条论无治法，宜以仲景黄
芩汤代之。
下利脉沉弦者，下重也。脉大者，为未止；脉微弱数者，为欲自止，虽发热，不死。
【注】此详申上条，下利圊脓血之证脉也。脉沉，主里。脉弦，主急。下重，后重也。下利、脉沉弦，故
里急后重也。凡下利之证，发热脉大者，是邪盛，为未止也。脉微弱数者，是邪衰，为欲自止，虽发热不死也。
由此可知滞下脉大身热者，必死也。
【集注】喻昌曰∶下利而脉沉弦，主里急后重，成滞下之证，即今所称痢证也。脉大者，即沉弦中之大，
脉微弱数者，即沉弦中之微弱数也。
下利欲饮水者，以有热故也，白头翁汤主之。热利下重者，白头翁汤主之。
【注】此承上条以出其治也。下利欲饮水者，热利下夺津液，求水以济干也。热利下重者，热伤气滞，里
急后重，便脓血也。二者皆以白头翁汤主之者，以其大苦大寒，寒能胜热，苦能燥湿也。
【集注】程知曰∶按少阴自利而渴，亦有虚而引水自救者。犹当以小便之赤白，脉之
迟数辨之。此言热邪内结者也。热邪内结而致下重，故纯用苦寒以胜热而浓肠也。
白头翁汤方
白头翁（三两） 黄连（去须，三两） 黄柏（去皮，三两） 秦皮（三两）
上四味，以水七升，煮取三升，去滓，温服一升，不愈，更服一升。
【方解】三阴俱有下利证。自利不渴者，属太阴也；自利而渴者，属少阴也。惟厥阴下利，属于寒者，厥
而不渴，下利清谷；属于热者，消渴下利，下重便脓血也。此热利下重，乃火郁湿蒸，秽气奔逼广肠，魄门重
滞而难出，即《内经》所云∶暴注下迫者是也。君白头翁，寒而苦辛；臣秦皮，寒而苦涩。寒能胜热，苦能燥
湿，辛以散火之郁，涩以收下重之利也。佐黄连清上焦之火，则渴可止；使黄柏泻下焦之热，则利自除也。治
厥阴热利有二∶初利用此方之苦以泻火，以苦燥之，以辛散之，以涩固之，是谓以寒治热之法；久利则用乌梅
丸之酸以收火，佐以苦寒，杂以温补，是谓逆之从之，随所利而行之，调其气使之平也。
伤寒下利，日十余行，脉反实者，死。
【注】伤寒下利，日十余利，正气虚也，其脉当虚，今反实者，邪气盛也。正虚邪盛，故主死也。
【集注】成无己曰∶下利里虚也，脉当微弱，反实者，病胜脏也，故死。脉不应病，此之谓也。
郑重光曰∶脉实则胃气失和缓之状，而真脏之脉独见，邪盛正脱矣。
伤寒六七日不利，便发热而利，其人汗出不止者，死，有阴无阳故也。
【注】伤寒六七日，邪传厥阴之时也，厥而不利，是阴邪未盛，若便发热，尚在不死。今六七日不利，忽
而下利，发热汗出不止者，是阴盛于中，而阳亡于外，故为有阴无阳也，其死可知矣。
【集注】方有执曰∶发热而利，里阴内盛也，故曰有阴。汗出不止，表阳外绝也，故曰无阳。
程知曰∶言暴下利汗出，为亡阳死证也。六七日不利，忽发热而利下，至于汗出不止，浑是外阳内阴，真
阳顷刻无存矣。
汪琥曰∶寒中厥阴至六七日，当亦厥六七日矣，不言厥者，省文也。厥则当利不利者，阳气未败，犹能与
邪相支吾也，若至发热，即利者亦当止。今则发热与利，骤然并至，加之汗出不止，则知其热非阳回而热，乃
阳脱而热，故兼下利而汗出不止也。
张令韶曰∶厥阴病发热不死，发热亦死者有三证∶一在躁不得卧，一在厥不止，一在汗出不止。
发热而厥，七日下利者，为难治。
【注】此详申上条，发热而厥之义也。发热而厥至七日，若厥回利止，则可以自解矣。今发热而厥至七日，
下利不止者，为难治也。盖上条有阴无阳故主死，此条阴盛而阳不复，故为难治也。
【集注】方有执曰∶厥七日而下利，阴盛而阳不复也。
张璐曰∶厥利与热不两存之势也。发热而厥七日，是热者自热，厥利者自厥利，阴阳两造其偏，漫无相协
之期，故虽未见烦躁，已为难治。盖治其热则愈厥愈利，治其厥利则愈热，不至阴阳两绝不止耳。
下利脉沉而迟，其人面少赤，身有微热，下利清谷者，必郁冒汗出而解，病患必微厥，所以然者，其面戴
阳，下虚故也。
【注】脉沉而迟，下利清谷，是里有阴寒也。若其人面有少赤色，身有微热，又属表有阳热也。夫内有里
阴之寒，外有表阳之热，则阴得阳化而解者有之，但其未解之先，病
人必郁冒汗出而后解。所以然者，面戴之虚阳，与下利之虚阴，两相和顺，故作解也。此非在下之阴，格在上
之阳，所以病患虽冒而厥必微，必不似不解之冒厥而甚也。
【集注】喻昌曰∶下利脉沉迟，里寒也。面少赤有微热，是仍兼外邪，必从汗解。但戴阳之证，必见微厥，
此中大伏危机，其用法当迥异常法矣。六经皆有下利之证，惟少阴、厥阴为难治。盖邪气入里，利深则必致厥，厥
深亦必致利，故下利一证，经于少阴、厥阴，皆详言之。盖以伤寒下利，则无论少阴、厥阴，其治法皆可会通也。
汪琥曰∶郁冒者，头目之际郁然昏冒，乃阳气能胜寒邪，里阳回而表和顺，故解。汗出而解，是阳回里寒
散而营卫和，故汗出，非攻表而使之汗出也。
下利清谷，里寒外热，汗出而厥者，通脉四逆汤主之。
【注】此承上条互详其义，以出其治也。下利清谷，里寒也；身有微热，外热也。上条有无汗怫郁面赤之
表，尚可期其冒汗而解；此条汗出而厥，则已露亡阳之变矣。故主以通脉四逆汤，救阳以胜阴也。
【集注】方有执曰∶下利故曰里寒，阴不守也；外热故汗出，阳不固也。通脉四逆救表里、通血气而复阴
阳者也。
喻昌曰∶上条辨证，此条用药，互相发明。然不但此也，少阴病下利清谷，面色赤者，已用此法矣。
吴人驹曰∶有协热下利者，亦完谷不化，乃邪热不杀谷，其别在脉之阴阳、虚实之不同。
大汗出，热不去，内拘急，四肢疼，又下利厥逆而恶寒者，四逆汤主之。
【注】通身大汗出，热当去矣。热仍不去，而无他证，则为邪未尽而不解也。今大汗出，热不去，而更见
拘急肢疼，且下利厥逆而恶寒，是阳亡于表，寒盛于里也，故主四逆汤，温经以胜寒，回阳而敛汗也。
【集注】方有执曰∶大汗出，阳虚而表不固也；热不去，言邪不除也；内拘急四肢疼者，亡津液而骨气不
利也；下利厥逆，恶寒亡阳，而阴寒内甚也。
程知曰∶言大汗后下利厥逆，急宜回阳也。大汗出而热不去，正恐真阳飞越，若内拘急，四肢痛，更加下
利，厥逆，恶寒，则在里，纯是阴寒矣。
程应旄曰∶此证大汗出热不去，何为不在亡阳死证之列？不知亡阳由于汗不止而阳亡，此证内拘急，四肢
疼，是汗已止，阳未亡而恶寒，故可行温法也。
大汗，若大下利而厥冷者，四逆汤主之。
【注】大汗出汗不收者，桂枝加附子汤证也。大下利，利不止者，理中加附子汤证也。今大汗出，又大下
利不止，而更见厥冷，乃阳亡于外，寒盛于中，非桂枝理中之所能治矣，当与四逆汤急回其阳，以胜其阴，使
汗利止而厥冷还，则犹可生也。以上三条，皆厥阴少阴同病，因少阴寒甚，故俱从少阴主治也。
【集注】喻昌曰∶此证无外热相错，其为阴寒易明，然既云大汗大下，则阴津亦亡，但此际不得不以救阳
为急，阳回方可徐救其阴也。
下利，手足厥冷，无脉者，灸之不温，若脉不还，反微喘者，死。下利后脉绝，手足厥冷， 时脉还，手
足温者，生；脉不还者死。
【注】下利手足厥冷无脉者，有阴无阳也。虽用附子四逆辈，恐阳不能急回，宜急灸厥阴以通其阳。若脉
还、手足温者生；脉不还、手足不温反微喘者，乃无气以续之喘，是阳
气上脱也，故主死。
【集注】方有执曰∶其喘必息短而声不续，乃阳气衰绝也。
程知曰∶少阴下利，厥逆无脉，服白通汤，脉暴出者死，微续者生。厥阴下利，厥逆脉绝，用灸法， 时
脉还者生，不还者死。可见求阳气者，非泛然求之于无何有之乡也。必两肾之中有几微可续，然后可借温灸为
鸾胶耳！
伤寒发热，下利厥逆，躁不得卧者，死。伤寒发热，下利至甚，厥不止者，死。
【注】伤寒发热下利而厥，反烦躁不得卧者，乃寒盛于中，孤阳扰乱也。或发热下利至甚，厥逆不止，即
不烦躁，亦为表阳外散，里阳内脱，故均死也。
【集注】成无己曰∶伤寒发热，邪在表也；下利厥逆，阳气虚也；躁不卧，病胜脏也，故死。《金匮要略》
云∶六腑气绝于外者，手足寒；五脏气绝于内者，下利不禁。伤寒发热，为邪独甚，下利至甚，厥不止，为腑
脏气绝，故死。
程知曰∶厥阴病，但发热即不死，以发热则邪出于表，而里证自除。若外发热而内厥逆，下利不止，且至
烦躁不解，则发热又为阳气外散之候，而主死矣。
（原文）绝引食以自救也。中，以胃言。死，谓万物无土不生也。
译文：断绝饮食来引取食物以自救。这里的“中”，是指胃气而言。“死”，是说万物没有土壤就不能生长（比喻胃气绝则生机亡）。
程知说：脉迟表示有寒，不应当再用寒凉药，以免导致“除中”的变证。如果中气被阴寒之气革除殆尽，那么胃中无根的阳气也将被完全清除，从而求救于食物，所以这是死证。
伤寒病，先出现四肢厥冷，后来发热且伴有下利，下利必定会自行停止；如果再次出现四肢厥冷，下利就会复发。
【注】四肢厥逆属于阴证。发热属于阳证。先厥冷后发热，且下利必定自行停止，这是因为阴邪退却而阳气进复。再次出现厥冷并伴随下利，是因为阳气退却而阴邪进盛。发热多而厥冷少，即使病情严重也可以痊愈；厥冷多而发热少，即使病情轻微也会加重。由此可知，厥冷与发热的交替，是阴阳进退、决定生死的关键机制。
【集注】汪琥说：厥阴经是阴气的尽头。厥阴经的阳气非常微弱，所以无论是阴证还是阳证，寒邪还是热邪，只要侵犯到这条经脉，没有不发生厥冷的。所谓“厥”就是逆乱，起于手足。这里说“先厥”，是指初起时就发生厥冷。如果是厥冷同时伴有下利和发热，说明阳气恢复，下利必定自行停止。
伤寒先厥冷后发热，下利必定自行停止，但如果反而出现汗出、咽喉疼痛的，喉部会发生痹阻不通；如果发热无汗，且下利不能停止，必定会出现大便带脓血的情况。出现大便带脓血的，喉部就不会发生痹阻。
【注】这一段承接上一条详细辨析以揭示其证候。先厥冷后发热，下利必定自行停止，厥冷回温、下利停止，如果热度消退，说明病将要痊愈。如果厥冷回温、下利停止，但热度不退，反而出现汗出的，这是厥阴病从阳化热，邪气顺着本经经脉上行，所以导致咽喉疼痛痹阻。如果厥冷回温后发热，无汗且下利不止的，这是厥阴邪热因下利而下迫，损伤了脉中的血液，所以必定出现大便带脓血的情况。出现大便带脓血的，喉部就不会痹阻，意思是热邪向下利泄，就不再向上侵犯咽喉引起疼痛。由此可知，下利停止、喉部发生痹阻的，意思是热邪已经上行，病在咽喉疼痛，就不再病在下利的部位了。
【集注】喻昌说：先厥冷后发热且下利停止，病势是想要痊愈了。却反而汗出、咽喉疼痛，这是热邪有余，向上攻冲咽喉导致痹阻。既然发热虽然无汗，但因为阳气已经回复，所以下利也必定自行停止，如果不停止，那么无汗明确显示邪气不能外出，热邪郁结在体内，必定会导致大便带脓血。出现大便带脓血的，喉部不会痹阻，说明热邪在体内，就不在体表；在下部，就不在上部。
汪琥说：咽喉疼痛，这是热邪损伤上焦气分。痹，就是闭塞的意思。咽喉疼痛剧烈，喉部必然闭塞不通，因为厥阴经脉循行经过喉咙后方，向上进入颃颡（鼻咽部）。无汗且下利不止、大便带脓血的，这是热邪损伤下焦血分。热邪注于下部，就不干扰上部，所以说：“喉部不会痹阻”。
下利脉象数，伴有轻微发热、汗出，将会自愈。如果脉象又变得紧，说明病未解除。
【注】厥阴下利脉数，属于热利。如果热势轻微且汗出，说明邪气微弱想要解除，下利必定自行停止，所以能自愈。如果脉象又变紧，说明表邪仍然强盛，未能解除。
【集注】成无己说：下利是阴病。脉数是阳脉。阴病见到阳脉者生。微热汗出，说明阳气得以通畅，下利必定自愈。各种紧脉主寒，如果脉象又变紧，说明寒邪仍然强盛，所以说：“未解”。
沈明宗说：这几条是指厥冷伴下利、大便带脓血的情况。或者见到实大、浮数、微弱、沉涩、弦紧、洪长等各种脉象，应当分辨虚、实、寒、热，就能知道是欲愈还是未愈，这真是洞察疾病细微奥旨的方法。
下利伴有轻微发热且口渴，脉象弱的，将会自愈。
【注】厥阴下利，如果有大热且口渴，脉象强的，那是邪热都强盛。现在下利伴有轻微发热且口渴，脉象弱的，说明邪热衰退了，邪热既然衰退，所以可以自愈。
【集注】方有执说：微热，说明阳气逐渐回复。口渴，说明体内津液燥热尚未恢复。脉弱，说明邪气退去。说“令自愈”，意思是无需治疗。
程知说：下利以阳气回复、邪气微弱为痊愈标志。微热而渴，证候已转为阳证，脉弱则邪气已退，所以不治自愈。如果下利大热脉盛，又是逆证的征候了。
下利脉数且口渴的，将会自愈。如果不好转，必定大便带脓血，因为有内热的原因。
【注】这一段承接上一条互文见义，以详细说明其变化。下利脉数且口渴，说明体内有热，如果身体没有发热，说明邪气已衰，也可以自愈。如果下利脉数且口渴，日久不好转，即使身体没有发热，必定大便带脓血，因为内热损伤阴液的原因。
【集注】方有执说：脉数与上文微热互相阐明。
程应旄说：脉数而渴，是阳胜阴衰，所以也能自愈。如果不好转，则是阴虚热入，经文中所说“脉数不解而下利不止，必定协热而便脓血”就是这个意思。
下利，寸脉反而浮数，尺脉自涩的，必定大便带脓血。
【注】厥阴热利，寸脉应当沉数，现在寸脉反而浮数，说明热在表而不在里。尺脉自涩的，说明在表的热邪未解，乘下利之机入里，损伤了其阴液，热与血瘀结，必定大便带脓血。
【集注】喻昌说：脉见浮数，如果是邪气还归于表，则尺脉应当调和，现在尺脉自涩，乃是热邪搏结于阴分，虽然寸口得阳脉，终究阴邪必走下窍，而大便带脓血。
汪琥说：这一条是下利变为脓血的征候。热利得到数脉并不反常，得到浮脉才是反常。这一条论述中没有治疗方法，适宜用仲景的黄芩汤代替。
下利脉象沉弦的，有里急后重感。脉象大的，病未停止；脉象微弱数的，病将自行停止，即使发热，也不会死。
【注】这一段详细阐述上一条，下利大便带脓血的证候和脉象。脉沉，主里证。脉弦，主急迫。下重，即后重感。下利、脉沉弦，所以是里急后重。凡下利的证候，发热脉大的，是邪气强盛，病未停止。脉微弱数的，是邪气衰退，病将自行停止，即使发热也不会死。由此可知，痢疾脉大身热的，必定死亡。
【集注】喻昌说：下利而脉沉弦，主里急后重，形成滞下的证候，就是现在所称的痢疾证。脉大，即沉弦之中的大脉；脉微弱数，即沉弦之中的微弱数脉。
下利想喝水的，是因为有热，用白头翁汤主治。热利伴有里急后重的，用白头翁汤主治。
【注】这一段承接上一条以揭示治法。下利想喝水的，是热利下夺津液，寻求水来滋润干燥。热利伴有里急后重的，是热伤气机阻滞，里急后重，大便带脓血。这两种情况都用白头翁汤主治，因为它味大苦大寒，寒能胜热，苦能燥湿。
【集注】程知说：按少阴自利而渴，也有因虚而引水自救的。还应当根据小便的赤白、脉的迟数来辨别。这里说的是热邪内结的情况。热邪内结导致下重，所以纯用苦寒药来胜热厚肠。
白头翁汤方
白头翁（三两） 黄连（去须，三两） 黄柏（去皮，三两） 秦皮（三两）
以上四味药，用水七升，煮取三升，去渣，温服一升，若不好，再服一升。
【方解】三阴经都有下利的证候。自利且不渴的，属于太阴；自利而渴的，属于少阴。只有厥阴下利，属于寒证的，厥冷且不渴，下利完谷不化；属于热证的，消渴下利，里急后重，大便带脓血。这个热利下重，是火郁湿蒸，秽气奔逼广肠，魄门（肛门）重滞而难出，也就是《内经》所说的“暴注下迫”。君药白头翁，性寒味苦辛；臣药秦皮，性寒味苦涩。寒能胜热，苦能燥湿，辛以散火之郁结，涩以收敛下利之重坠。佐药黄连清上焦之火，则口渴可止；使药黄柏泻下焦之热，则下利自然消除。治疗厥阴热利有两种方法：初起利用此方的苦味以泻火，以苦燥之，以辛散之，以涩固之，这叫以寒治热的方法；久利则用乌梅丸的酸味以收火，佐以苦寒，杂以温补，这叫逆之从之，随所利而行之，调其气使之平的方法。
伤寒下利，一天十多次，脉象反而实的，死。
【注】伤寒下利，一天十多次，正气虚弱，其脉应当虚，现在反而实，说明邪气强盛。正虚邪盛，所以主死。
【集注】成无己说：下利是里虚，脉应当微弱，反而实，是病胜脏气，所以死。脉不应病，说的就是这个道理。
郑重光说：脉实则胃气失去和缓之状，而真脏之脉单独显现，邪盛正脱了。
伤寒六七天，原本不下利，突然发热且下利，其人汗出不止的，死，因为有阴无阳的缘故。
【注】伤寒六七天，是邪气传入厥阴的时候，厥冷而不下利，说明阴邪不盛，如果发热，尚在不死。现在六七天原本不下利，忽然下利，发热汗出不止的，这是阴盛于中，而阳亡于外，所以是有阴无阳，其死可知了。
【集注】方有执说：发热而利，是里阴内盛，所以说有阴。汗出不止，是表阳外绝，所以说无阳。
程知说：说暴下利汗出，是亡阳的死证。六七天不下利，忽然发热而下利，以至于汗出不止，完全是外阳内阴，真阳顷刻间无存了。
汪琥说：寒中厥阴至六七天，应当也是厥冷六七天了，不说厥冷，是省略写法。厥冷时应当下利却不下利，说明阳气未败，还能与邪气相抵抗，如果到了发热，即使是下利也应当停止。现在却是发热与下利骤然并至，加上汗出不止，就知道这个热不是阳气回复的热，而是阳脱的热，所以兼有下利而汗出不止。
张令韶说：厥阴病发热不死，发热也死的有三种证候：一是在躁动不得卧，一是在厥冷不止，一是在汗出不止。
发热而厥冷，七日下利的，为难治。
【注】这一段详细阐述上一条，发热而厥冷的含义。发热而厥冷至七日，如果厥冷回温、下利停止，就可以自行解除了。现在发热而厥冷至七日，下利不止的，是难治。上一条是有阴无阳所以主死，这一条是阴盛而阳不复，所以为难治。
【集注】方有执说：厥冷七日而下利，是阴盛而阳不复。
张璐说：厥利与热是不两存之势。发热而厥冷七日，是热者自热，厥利者自厥利，阴阳两造其偏，漫无相协之期，所以即使未见烦躁，也已难治。治疗热则更厥更利，治疗厥利则更热，不到阴阳两绝不止罢了。
下利脉沉而迟，其人面部微红，身体有微热，下利完谷不化的，必定会出现郁冒汗出而后解，病人必定轻微厥冷，之所以这样，是因为他面部戴阳，下部虚的缘故。
【注】脉沉而迟，下利完谷不化，是里有阴寒。如果其人面部有少许红色，身体有微热，又属于表有阳热。内有里阴之寒，外有表阳之热，那么阴得阳化而解的情况是有的，但在未解之前，病人必定郁冒汗出而后解。之所以这样，是因为面部的戴阳之虚阳，与下利的虚阴，两者相互和顺，所以作解。这不是在下之阴格拒在上之阳，所以病人虽然昏冒但厥冷必定轻微，必定不像不解时的昏冒厥冷那样严重。
【集注】喻昌说：下利脉沉迟，是里寒。面部微红有微热，是仍兼外邪，必定从汗解。但戴阳的证候，必定见微厥，这其中潜伏着危机，其用法应当迥异常法。六经都有下利的证候，只有少阴、厥阴为难治。邪气入里，利深则必致厥，厥深亦必致利，所以下利一证，经文在少阴、厥阴，都详细论述。因为伤寒下利，无论少阴、厥阴，其治法皆可会通。
汪琥说：郁冒，是头目之际郁然昏冒，乃阳气能胜寒邪，里阳回而表和顺，所以解。汗出而解，是阳回里寒散而营卫和，所以汗出，不是攻表而使之汗出。
下利完谷不化，里寒外热，汗出而厥冷的，用通脉四逆汤主治。
【注】这一段承接上一条互详其义，以揭示治法。下利完谷不化，是里寒；身体有微热，是外热。上一条有无汗怫郁面赤的表证，还可以期待其冒汗而解；这一条汗出而厥冷，则已显露亡阳的变证了。所以用通脉四逆汤，救阳以胜阴。
【集注】方有执说：下利故曰里寒，阴不守也；外热故汗出，阳不固也。通脉四逆救表里、通血气而复阴阳。
喻昌说：上一条辨证，这一条用药，互相发明。然而不仅于此，少阴病下利完谷不化，面色赤的，已经用过此法了。
吴人驹说：有协热下利的，也完谷不化，是邪热不杀谷，区别在于脉的阴阳、虚实不同。
大汗出，热不去，内部拘急，四肢疼痛，又下利厥逆而恶寒的，用四逆汤主治。
【注】全身大汗出，热应当退了。热仍不退，而没有其他证候，则是邪未尽而不解。现在大汗出，热不退，而又见拘急肢疼，且下利厥逆而恶寒，这是阳亡于表，寒盛于里，所以用四逆汤，温经以胜寒，回阳而敛汗。
【集注】方有执说：大汗出，阳虚而表不固；热不去，言邪不除；内拘急四肢疼，是亡津液而骨气不利；下利厥逆，恶寒亡阳，而阴寒内甚。
程知说：说大汗后下利厥逆，急宜回阳。大汗出而热不去，正恐真阳飞越，如果内拘急，四肢痛，更加下利，厥逆，恶寒，则在里，纯是阴寒了。
程应旄说：此证大汗出热不去，为什么不在亡阳死证之列？不知道亡阳是由于汗不止而阳亡，此证内拘急，四肢疼，是汗已止，阳未亡而恶寒，所以可行温法。
大汗，或大下利而厥冷的，用四逆汤主治。
【注】大汗出汗不收的，是桂枝加附子汤证。大下利，利不止的，是理中加附子汤证。现在大汗出，又大下利不止，而又见厥冷，乃阳亡于外，寒盛于中，不是桂枝汤、理中汤所能治疗的，当给四逆汤急回其阳，以胜其阴，使汗利止而厥冷还，则还可以生。以上三条，都是厥阴少阴同病，因少阴寒甚，所以俱从少阴主治。
【集注】喻昌说：此证无外热相错，其为阴寒易明，然而既云大汗大下，则阴津亦亡，但此时不得不以救阳为急，阳回方可徐救其阴。
下利，手足厥冷，无脉的，灸之不温，如果脉不还，反而微喘的，死。下利后脉绝，手足厥冷，一时脉还，手足温的，生；脉不还的，死。
【注】下利手足厥冷无脉的，是有阴无阳。虽然用附子四逆之类，恐怕阳气不能急回，宜急灸厥阴以通其阳。如果脉还、手足温的，生；脉不还、手足不温反微喘的，乃无气以续之喘，是阳气上脱，所以主死。
【集注】方有执说：其喘必定息短而声不续，乃阳气衰绝。
程知说：少阴下利，厥逆无脉，服白通汤，脉暴出者死，微续者生。厥阴下利，厥逆脉绝，用灸法，一时脉还者生，不还者死。可见求阳气者，不是泛然求之于虚无缥缈之乡。必须在两肾之中有几微可续，然后可借温灸为鸾胶！
伤寒发热，下利厥逆，躁不得卧的，死。伤寒发热，下利至甚，厥不止的，死。
【注】伤寒发热下利而厥，反烦躁不得卧的，乃寒盛于中，孤阳扰乱。或者发热下利至甚，厥逆不止，即使不烦躁，也为表阳外散，里阳内脱，所以均死。
【集注】成无己说：伤寒发热，邪在表；下利厥逆，阳气虚；躁不卧，病胜脏，所以死。《金匮要略》说：六腑气绝于外者，手足寒；五脏气绝于内者，下利不禁。伤寒发热，为邪独甚，下利至甚，厥不止，为脏腑气绝，所以死。
程知说：厥阴病，但发热即不死，因为发热则邪出于表，而里证自除。如果外发热而内厥逆，下利不止，且至烦躁不解，则发热又为阳气外散之候，而主死。
(Original) "Jue" (extinction/abandonment) refers to drawing in food to save oneself. "Zhong" (middle) speaks of the stomach. "Si" (death) means that all things cannot grow without soil.
Translation: The patient abandons normal intake and draws in food to sustain life. Here, "Zhong" refers to Stomach Qi. "Death" implies that just as all things cannot grow without soil, life cannot persist without Stomach Qi.
Cheng Zhi stated: A slow pulse indicates cold; it is inappropriate to use cold-natured medicines further, lest it lead to the complication of "Chu Zhong" (false recovery). If the Middle Qi is eradicated by Yin-cold, the rootless Yang Qi in the Stomach will be completely cleared, leading the patient to seek relief through food. Thus, this is a death sign.
In Shaoyang disease, if there is initial Jue (cold extremities) followed by fever and diarrhea, the diarrhea must stop spontaneously. If Jue returns, the diarrhea will recur.
[Annotation] Cold extremities (Jue) belong to Yin. Fever belongs to Yang. Initial Jue followed by fever, with spontaneous cessation of diarrhea, indicates that Yin pathogen recedes while Yang advances. Recurrence of Jue with diarrhea indicates that Yang recedes while Yin advances. If heat predominates over cold extremities, even severe illness may heal; if cold extremities predominate over heat, even mild illness may worsen. Thus, the alternation of Jue and fever is the mechanism of Yin-Yang advance and retreat, determining life and death.
[Collected Notes] Wang Hu stated: Jueyin represents the end of Yin. The Yang Qi in the Jueyin channel is very weak. Therefore, regardless of whether the syndrome is Yin or Yang, or whether the pathogen is cold or heat, once it invades this channel, Jue invariably occurs. "Jue" means reversal, starting from the hands and feet. Here, "initial Jue" means Jue occurring at the onset. If Jue is accompanied by diarrhea and fever, it indicates Yang recovery, and diarrhea must stop spontaneously.
In Shaoyang disease, initial Jue followed by fever leads to spontaneous cessation of diarrhea. However, if sweating occurs instead, accompanied by throat pain, Bi obstruction of the throat will ensue. If there is fever without sweating, and diarrhea does not stop, pus and blood will inevitably appear in the stool. If pus and blood appear in the stool, the throat will not be obstructed.
[Annotation] This section elaborates on the previous clause to reveal the syndromes. Initial Jue followed by fever leads to spontaneous cessation of diarrhea. When Jue resolves and diarrhea stops, if the heat subsides, the disease is about to heal. If Jue resolves and diarrhea stops, but heat persists with sweating, this indicates that the Jueyin disease has transformed into heat from Yang. The pathogen follows its own channel upward, causing throat pain and Bi obstruction. If Jue resolves with fever, no sweating, and persistent diarrhea, this indicates that Jueyin heat pathogen, driven downward by diarrhea, damages the blood in the vessels, inevitably leading to pus and blood in the stool. If pus and blood appear in the stool, the throat is not obstructed, meaning the heat pathogen moves downward via diarrhea and no longer attacks the throat causing pain. Conversely, if diarrhea stops and the throat becomes obstructed, it means the heat pathogen has moved upward, attacking the throat, and thus no longer causes diarrhea below.
[Collected Notes] Yu Chang stated: Initial Jue followed by fever and cessation of diarrhea indicates the disease is about to heal. Instead, sweating and throat pain occur, indicating excess heat pathogen attacking the throat causing Bi obstruction. Although there is fever without sweating, since Yang has returned, diarrhea should stop spontaneously. If it does not stop, the absence of sweating clearly shows the pathogen cannot exit outward; heat is constrained inside, inevitably leading to pus and blood in the stool. If pus and blood appear, the throat is not obstructed, showing that heat constrained inside does not manifest on the exterior; located below, it does not manifest above.
Wang Hu stated: Throat pain indicates heat damaging the Qi aspect of the Upper Jiao. "Bi" means closure. Severe throat pain causes the throat to close and become obstructed because the Jueyin channel passes behind the throat and enters the nasopharynx. No sweating, persistent diarrhea, and pus/blood in stool indicate heat damaging the Blood aspect of the Lower Jiao. Heat pouring downward does not affect the upper part, hence "the throat is not obstructed."
Diarrhea with a rapid pulse, slight fever, and sweating indicates spontaneous healing. If the pulse becomes tight again, the disease is unresolved.
[Annotation] Diarrhea in Jueyin with a rapid pulse indicates heat diarrhea. If the heat is slight and sweating occurs, it indicates the pathogen is weak and resolving; diarrhea will stop spontaneously, leading to self-healing. If the pulse becomes tight again, it indicates the exterior pathogen remains strong and unresolved.
[Collected Notes] Cheng Wuji stated: Diarrhea is a Yin disease. A rapid pulse is a Yang pulse. Yin disease presenting with a Yang pulse indicates survival. Slight fever and sweating indicate Yang Qi is unblocked; diarrhea will heal spontaneously. All tight pulses indicate cold. If the pulse becomes tight again, cold pathogen remains strong, hence "unresolved."
Shen Mingzong stated: These clauses refer to cases of Jue with diarrhea and pus/blood in stool. Observing various pulses such as Excess-Large, Floating-Rapid, Weak, Deep-Slippery, Wiry-Tight, or Surging-Long allows differentiation of Deficiency, Excess, Cold, and Heat, revealing whether healing is imminent. This is truly the subtle essence of disease examination.
Diarrhea with slight fever and thirst, and a weak pulse, indicates spontaneous healing.
[Annotation] In Jueyin diarrhea, great heat with thirst and a strong pulse indicates both pathogen and heat are exuberant. Now, diarrhea with slight fever and thirst, and a weak pulse, indicates the pathogenic heat has declined. Since the heat has declined, spontaneous healing is expected.
[Collected Notes] Fang Youzhi stated: Slight fever indicates gradual return of Yang. Thirst indicates internal dryness has not yet recovered. Weak pulse indicates pathogen retreat. "Spontaneous healing" means no treatment is required.
Cheng Zhi stated: Diarrhea heals when Yang returns and pathogen weakens. Slight fever and thirst show the syndrome has turned Yang; weak pulse shows pathogen has retreated, so it heals without treatment. If diarrhea presents with great heat and surging pulse, it is an adverse sign.
Diarrhea with a rapid pulse and thirst indicates spontaneous healing. If it does not improve, pus and blood will inevitably appear in the stool due to internal heat.
[Annotation] This clause complements the previous one to detail variations. Diarrhea with rapid pulse and thirst indicates internal heat. If there is no body heat, the pathogen has weakened, allowing for spontaneous healing. If diarrhea with rapid pulse and thirst persists for a long time without improvement, even without body heat, pus and blood will appear in the stool because internal heat damages Yin fluids.
[Collected Notes] Fang Youzhi stated: Rapid pulse elucidates the preceding text regarding slight fever.
Cheng Yingmao stated: Rapid pulse and thirst indicate Yang overcoming Yin, hence spontaneous healing. If it does not improve, Yin deficiency allows heat to enter. As the Classic states: "If pulse remains rapid and diarrhea persists, it will certainly involve heat and produce pus and blood in stool."
Diarrhea, with the Cun (inch) pulse surprisingly floating and rapid, and the Chi (cubit) pulse naturally slippery/choppy, will inevitably produce pus and blood in the stool.
[Annotation] In Jueyin heat diarrhea, the Cun pulse should be Deep-Rapid. Now, the Cun pulse is surprisingly Floating-Rapid, indicating heat is on the exterior rather than interior. The Chi pulse being naturally Choppy indicates that the exterior heat has not resolved; taking advantage of diarrhea, it enters the interior, damaging Yin. Heat and blood stasis combine, inevitably leading to pus and blood in the stool.
[Collected Notes] Yu Chang stated: Floating-Rapid pulse, if it were pathogen returning to the exterior, the Chi pulse would be harmonious. Now, the Chi pulse is naturally Choppy, indicating heat pathogen knotting in the Yin aspect. Although the Cun position yields a Yang pulse, ultimately the Yin pathogen will exit via the lower orifice, producing pus and blood in stool.
Wang Hu stated: This clause describes the manifestation of diarrhea transforming into pus and blood. Heat diarrhea with a rapid pulse is not abnormal; a Floating pulse is abnormal. This clause discusses the condition without specifying treatment; it is appropriate to substitute Zhang Zhongjing's Huangqin Decoction.
Diarrhea with a Deep-Wiry pulse indicates tenesmus. A Large pulse indicates the disease has not stopped; a Weak-Rapid pulse indicates it is about to stop spontaneously. Even with fever, death will not occur.
[Annotation] This elaborates on the previous clause regarding diarrhea with pus and blood. Deep pulse indicates Interior. Wiry pulse indicates tension/urgency. "Xia Zhong" (lower heaviness) refers to tenesmus. Diarrhea with Deep-Wiry pulse causes Li Ji Hou Zhong (tenesmus). Generally, in diarrhea, fever with a Large pulse indicates strong pathogen, meaning the disease has not stopped. Weak-Rapid pulse indicates declining pathogen, meaning it is about to stop; even with fever, death will not occur. From this, we know that dysentery with Large pulse and body heat will result in death.
[Collected Notes] Yu Chang stated: Diarrhea with Deep-Wiry pulse indicates Li Ji Hou Zhong, forming the syndrome of "Zhi Xia" (dysentery), now called Li syndrome. Large pulse refers to the Large quality within the Deep-Wiry; Weak-Rapid refers to the Weak-Rapid quality within the Deep-Wiry.
Diarrhea with desire to drink water indicates heat; Baitouweng Tang is indicated. Heat diarrhea with tenesmus is treated with Baitouweng Tang.
[Annotation] This follows the previous clause to reveal the treatment. Desire to drink water in diarrhea indicates heat diarrhea depletes fluids, seeking water to moisten dryness. Heat diarrhea with tenesmus indicates heat damages Qi stagnation, causing Li Ji Hou Zhong and pus/blood in stool. Both are treated with Baitouweng Tang because it is greatly bitter and cold; cold overcomes heat, and bitterness dries dampness.
[Collected Notes] Cheng Zhi stated: In Shaoyin spontaneous diarrhea with thirst, there are also cases of deficiency drawing water to save oneself. One must distinguish based on urine color and pulse speed. This clause refers to internal knotting of heat pathogen. Internal heat knotting causes tenesmus, so purely bitter-cold herbs are used to overcome heat and thicken the intestines.
Baitouweng Tang Formula
Baitouweng (3 liang), Huanglian (remove whiskers, 3 liang), Huangbai (remove bark, 3 liang), Qinpi (3 liang).
These four ingredients are boiled in 7 sheng of water to obtain 3 sheng. Strain and take 1 sheng warm. If not improved, take another 1 sheng.
[Formula Analysis] All three Yin channels have diarrhea syndromes. Spontaneous diarrhea without thirst belongs to Taiyin; spontaneous diarrhea with thirst belongs to Shaoyin. Only Jueyin diarrhea differs: cold types present with Jue, no thirst, and undigested food in stool; heat types present with excessive thirst, diarrhea, tenesmus, and pus/blood in stool. This heat diarrhea with tenesmus is caused by fire constraint and damp steaming, foul qi rushing to the large intestine, causing heavy, difficult defecation, as described in the *Neijing* as "sudden purging with urgent pressure." The Sovereign herb Baitouweng is cold, bitter, and acrid; the Minister herb Qinpi is cold, bitter, and astringent. Cold overcomes heat, bitterness dries dampness, acridity disperses fire constraint, and astringency arrests tenesmus. Assistant herb Huanglian clears Upper Jiao fire, stopping thirst; Envoy herb Huangbai drains Lower Jiao heat, eliminating diarrhea. There are two methods for treating Jueyin heat diarrhea: early stage uses this formula's bitterness to drain fire, dry with bitterness, disperse with acridity, and secure with astringency—this is the method of treating heat with cold. Chronic diarrhea uses Wumei Wan's sourness to gather fire, assisted by bitter-cold, mixed with warm-tonics—this is the method of counteracting and following, acting according to what is beneficial, regulating Qi to achieve balance.
Shaoyang diarrhea, occurring more than ten times a day, with a surprisingly Excess pulse, indicates death.
[Annotation] Shaoyang diarrhea occurring many times a day indicates deficient Righteous Qi; the pulse should be Deficient. Now it is surprisingly Excess, indicating Exuberant Pathogen. Deficient Righteous Qi and Exuberant Pathogen indicate death.
[Collected Notes] Cheng Wuji stated: Diarrhea is Interior Deficiency; pulse should be Weak-Fine. Surprisingly Excess means the disease overcomes the Zang organs, hence death. Pulse not corresponding to disease is what is meant here.
Zheng Zhongguang stated: An Excess pulse shows Stomach Qi has lost its gentle quality, and only the True Zang pulse appears. Pathogen is exuberant, Righteous Qi has collapsed.
Shaoyang disease after six or seven days, initially no diarrhea, suddenly develops fever, diarrhea, and incessant sweating indicates death, due to having Yin but no Yang.
[Annotation] Six or seven days into Shaoyang disease is when pathogen transmits to Jueyin. Initially Jue without diarrhea indicates Yin pathogen is not strong; if fever occurs, it is not fatal. Now, after six or seven days without diarrhea, sudden onset of diarrhea, fever, and incessant sweating indicates Yin exuberance in the Interior and Yang collapse on the Exterior. Thus, there is Yin but no Yang, and death is certain.
[Collected Notes] Fang Youzhi stated: Fever with diarrhea indicates Interior Yin exuberance, hence "having Yin." Incessant sweating indicates Exterior Yang extinction, hence "no Yang."
Cheng Zhi stated: Sudden profuse diarrhea with sweating is a Yang-collapse death sign. After six or seven days without diarrhea, sudden fever and diarrhea leading to incessant sweating indicates complete Exterior Yang and Interior Yin, with True Yang vanishing instantly.
Wang Hu stated: Cold invading Jueyin for six or seven days should imply Jue for six or seven days; omitting "Jue" is ellipsis. If Jue occurred with diarrhea, it would stop; Yang has not failed and can resist pathogen. If fever occurs, even with diarrhea, it should stop. Now fever and diarrhea arrive suddenly together, plus incessant sweating, indicating this heat is not Yang return but Yang collapse. Hence, diarrhea and sweating occur together.
Zhanglingshao stated: Jueyin disease fever is not fatal. Fever leading to death has three signs: restlessness unable to lie down, unremitting Jue, and incessant sweating.
Fever with Jue, and diarrhea after seven days, is difficult to treat.
[Annotation] This elaborates on the meaning of fever with Jue. Fever with Jue for seven days, if Jue resolves and diarrhea stops, can resolve spontaneously. Now, fever with Jue for seven days with persistent diarrhea is difficult to treat. The previous clause had Yin but no Yang, hence fatal; this clause has Yin exuberance with Yang failing to return, hence difficult to treat.
[Collected Notes] Fang Youzhi stated: Jue for seven days with diarrhea indicates Yin exuberance and Yang failing to return.
Zhang Lu stated: Jue/Diarrhea and Heat are mutually exclusive forces. Fever with Jue for seven days means heat stays hot, Jue/diarrhea stay cold. Yin and Yang deviate excessively with no hope of coordination. Thus, even without restlessness, it is difficult to treat. Treating heat worsens Jue/diarrhea; treating Jue/diarrhea worsens heat, until both Yin and Yang are exhausted.
Diarrhea with Deep-Slow pulse, slightly red face, slight body heat, and undigested food in stool will inevitably lead to Yu Mao (depression/dizziness) and sweating before resolution. The patient will have slight Jue. This is because the face shows Dai Yang (floating Yang), and the lower part is deficient.
[Annotation] Deep-Slow pulse and undigested food in stool indicate Interior Yin-Cold. Slightly red face and slight body heat indicate Exterior Yang-Heat. With Interior Yin-Cold and Exterior Yang-Heat, Yin can transform and resolve with Yang's help. However, before resolution, the patient will experience Yu Mao and sweating. This is because the floating Yang on the face and the deficient Yin from diarrhea harmonize, leading to resolution. This is not Yin rejecting Yang above; thus, although dizzy, Jue is slight, unlike severe dizziness and Jue in unresolved cases.
[Collected Notes] Yu Chang stated: Diarrhea with Deep-Slow pulse is Interior Cold. Slightly red face and slight heat indicate concurrent exterior pathogen, resolving via sweating. But Dai Yang syndrome must present with slight Jue; this hides a critical danger, requiring unusual treatment methods. All six channels have diarrhea; Shaoyin and Jueyin are difficult. Pathogen entering interior causes deep diarrhea leading to Jue; deep Jue causes diarrhea. Thus, the Classic details diarrhea in Shaoyin and Jueyin. Treatment principles can be integrated for both.
Wang Hu stated: Yu Mao is dizziness in the head/eyes, indicating Yang can overcome cold pathogen, Inner Yang returns, and Exterior-Harmony is achieved, leading to resolution. Sweating indicates Yang return, Interior-Cold disperses, and Ying-Wei harmonize. It is not induced by exterior-releasing drugs.
Undigested food in stool, Interior-Cold with Exterior-Heat, sweating, and Jue are treated with Tongmai Sini Tang.
[Annotation] This complements the previous clause to reveal treatment. Undigested food in stool is Interior-Cold; slight body heat is Exterior-Heat. The previous clause had no-sweat, flushed face, allowing expectation of resolution via sweating. This clause has sweating and Jue, revealing Yang-collapse complication. Thus, Tongmai Sini Tang is used to rescue Yang to overcome Yin.
[Collected Notes] Fang Youzhi stated: Diarrhea indicates Interior-Cold, Yin not guarding; Exterior-Heat causes sweating, Yang not securing. Tongmai Sini rescues Exterior/Interior, unblocks Blood/Qi, and restores Yin/Yang.
Yu Chang stated: Previous clause differentiates syndrome; this clause prescribes medicine, elucidating each other. Also, Shaoyin diarrhea with undigested food and red face already used this method.
Wu Renju stated: Xie Re (collateral heat) diarrhea also presents with undigested food, due to pathogen heat failing to digest grains. Distinction lies in pulse Yin/Yang and Deficiency/Excess.
Profuse sweating, heat not abating, internal cramping, limb pain, plus diarrhea, Jue, and aversion to cold are treated with Sini Tang.
[Annotation] Profuse whole-body sweating should abate heat. If heat persists without other symptoms, pathogen is incomplete and unresolved. Now, profuse sweating, heat persists, plus cramping, limb pain, diarrhea, Jue, and aversion to cold, indicates Yang collapse on Exterior and Cold exuberance in Interior. Thus, Sini Tang is used to warm meridians to overcome cold, restore Yang, and arrest sweating.
[Collected Notes] Fang Youzhi stated: Profuse sweating indicates Yang deficiency and insecure Exterior; heat not abating means pathogen not removed; internal cramping and limb pain indicate fluid loss and bone-Qi obstruction; diarrhea, Jue, aversion to cold indicate Yang collapse and severe Interior Yin-Cold.
Cheng Zhi stated: Post-profuse sweating with diarrhea and Jue requires urgent Yang restoration. Profuse sweating with persistent heat fears True Yang flying away. Internal cramping, limb pain, plus diarrhea, Jue, aversion to cold, indicates pure Interior Yin-Cold.
Cheng Yingmao stated: Why is this not in the Yang-collapse death category? Yang collapse results from incessant sweating. Here, internal cramping and limb pain indicate sweating has stopped, Yang has not collapsed, but aversion to cold exists, so warming method is applicable.
Profuse sweating, or profuse diarrhea with cold extremities, are treated with Sini Tang.
[Annotation] Profuse sweating with inability to retain sweat is Guizhi Jia Fuzi Tang syndrome. Profuse diarrhea with persistence is Lizhong Jia Fuzi Tang syndrome. Now, profuse sweating plus profuse persistent diarrhea with cold extremities indicates Yang collapse on Exterior and Cold exuberance in Middle. Guizhi and Lizhong cannot treat this; Sini Tang is needed urgently to restore Yang, overcome Yin, stop sweating/diarrhea, and resolve Jue, offering a chance of survival. The above three clauses are concurrent Jueyin-Shaoyin diseases; due to severe Shaoyin cold, they are treated according to Shaoyin principles.
[Collected Notes] Yu Chang stated: No conflicting Exterior-Heat makes Interior Yin-Cold clear. However, profuse sweating and diarrhea deplete Yin fluids. At this moment, rescuing Yang is urgent; only after Yang returns can Yin be slowly restored.
Diarrhea with cold extremities and absent pulse: if moxibustion fails to warm, and pulse does not return, but slight panting occurs, death ensues. After diarrhea, absent pulse and cold extremities: if pulse temporarily returns and extremities warm, survival; if pulse does not return, death.
[Annotation] Diarrhea with cold extremities and absent pulse indicates Yin without Yang. Even with Fuzi/Sini formulas, Yang may not return quickly; urgent moxibustion on Jueyin is needed to unblock Yang. If pulse returns and extremities warm, survival; if pulse does not return, extremities remain cold with slight panting, indicating Qi exhaustion and Yang collapsing upward, hence death.
[Collected Notes] Fang Youzhi stated: Panting is short-breathed and discontinuous, indicating Yang Qi decay and extinction.
Cheng Zhi stated: Shaoyin diarrhea, Jue, absent pulse, taking Baitong Tang: sudden pulse emergence is death, gradual continuation is survival. Jueyin diarrhea, Jue, absent pulse, using moxibustion: temporary pulse return is survival, non-return is death. Seeking Yang requires finding the faintest trace in the Kidneys to use warm moxibustion as a bridge!
Shaoyang fever, diarrhea, Jue, restlessness unable to lie down indicates death. Shaoyang fever, severe diarrhea, unremitting Jue indicates death.
[Annotation] Shaoyang fever, diarrhea, and Jue with restlessness unable to lie down indicates Cold exuberance in Interior disturbing solitary Yang. Or, fever with severe diarrhea and unremitting Jue, even without restlessness, indicates Exterior Yang scattering and Interior Yang collapsing, hence both are fatal.
[Collected Notes] Cheng Wuji stated: Shaoyang fever, pathogen on Exterior; diarrhea and Jue, Yang deficiency; restlessness unable to lie, disease overcomes Zang, hence death. *Jingui Yaolue* states: Six Fu organs Qi failure on Exterior causes cold hands/feet; Five Zang organs Qi failure on Interior causes uncontrollable diarrhea. Shaoyang fever indicates pathogen dominance; severe diarrhea and unremitting Jue indicate Fu/Zang Qi failure, hence death.
Cheng Zhi stated: Jueyin disease fever is not fatal because fever expels pathogen to Exterior, resolving Interior symptoms. If Exterior fever with Interior Jue, persistent diarrhea, and restlessness, fever indicates Yang scattering on Exterior, hence fatal.