娄全善曰∶王太仆云∶厥者，气逆上也。世谬传为香港脚，读此始知其病，上古称
之为香港脚也。经曰∶寒厥者，手足寒也。曰热厥者，手足热也。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也。曰厥逆者，
即前寒厥、热厥、痿厥、痹厥、风厥等气逆上，而或呕吐，或迷闷，或胀或气急，
或小腹不仁，或暴不知人，世所谓香港脚冲心者是也。今人又以忽然昏运不省人事为
厥。或问世以手足冷者名为厥，何如？曰非也。在张仲景论伤寒，则以手足热者为
热厥，手足冷者为寒厥，冷者曰逆。谓凡厥者，阴阳不相顺接便为厥，厥者手足逆
冷也。是故于阳虚而不接者则温之，于阳陷而伏深，不与阴相顺者则下之，于邪热
入而未深者，则散其传阴之热，随其浅深轻重以为治。此乃为伤寒之邪自表入里，
至太阴手足厥者，独归于二经也。盖自伤寒六经传邪者论，故厥阴是两阴交尽之经，
热传至此，乃极深之时，故曰厥阴。及《内经》厥论篇之义则不然，概以足之三阳
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。论得寒厥之由，则谓前阴者，宗筋之所聚，太阴阳明之所合也。此人质壮，
秋冬阴气盛，阳气衰之时也，夺于所用，下气上争不能复，精气溢下，邪气因从之
而上，阳气衰不能渗营其经络，阳气日损，阴气独在，故手足为之寒也。论得热厥
之由，则谓人必数醉，若饱以入房，气聚于脾中，肾气有衰，阳气独胜，故手足为
之热也。观其微旨，殆将为肾得先身生之精，元气从此而充，二脏相因，脉道乃行，
运阴阳于内外，各有所司，阳主表，其气温，阴主里，其气寒，表里之脉，循环相
接于四肢，是故举此脾胃伤于酒色，致阴阳二厥之大者为例，着于篇首，续叙十二
经之厥逆者，止出本经气逆病形，皆不言手足之厥，亦不及受病之由，亦非一言而
可足。既设二例在前，于此便可推而及之，故不复言也。虽然更以诸篇有关于厥者，
详陈以明之。如太阴阳明论曰∶阳明者，五脏六腑皆禀气于胃，今脾病不能与胃行
其津液于三阴，胃亦不能行津液于三阳，四肢不得禀水谷气，日以益衰，阴道不利，
筋骨肌肉皆无气以生。即此而言，脾胃有更实更虚，互相盛衰，衰者不行津液，盛
者独行，独行必寒，此脾胃之致厥一也。又十二经皆禀气于胃，受胃之寒，则经气
亦寒，受胃之热，则经气亦热。因之经脉不和，比流行相接之际，必有所遗寒热于四
末，此脾胃之致厥二也。更有脾胃是肾之胜脏，脾胃有邪，必乘于肾，肾乃治下，
主厥者也。肾受邪则厥，此脾胃之致厥三也。《灵枢》曰∶冲脉者，与少阴大络同出
于肾，为五脏六腑之海，故五脏六腑皆禀焉。其上者，渗诸阳，灌诸精，其下者，
并少阴之经，渗三阴，灌诸络，而温肌肉，其别络结则 上不动，不动则厥，厥则
寒矣。夫冲脉者，是行肾脏治内之阳者，阳即火也，故阳动之以正，则为生物温养
之少火，动之以妄，则为炎炽害物之壮火，火壮则元真之阳亦衰。李东垣谓火与元
气不两立，一胜则一负是也。如前厥论，谓下气上争，邪气因从之而上者，非别有
其邪，即此火所乱，阴阳之淫气起而上逆者也。故经以逆气为冲脉之病，病机亦言
诸逆冲上，皆属于火。诸厥皆属于下。然而在肾之阴阳和则下治，不和则下不治，
不治则寒热之厥生矣，此肾主厥之道也。至于冲脉与胃，皆以海名，故十二经禀气
而致厥病悉同。又若他篇论厥，有谓因阳气烦劳则张，精绝辟积于夏，使人煎厥者；
有二阳一阴发病，为风厥者；有志不足则厥者；有脏厥者；有暴不知人之厥者；有
五络俱竭而尸厥者。凡此诸因上逆之邪，皆相火与五火相扇而起，起则变乱其经气，
所以属风寒燥湿热之五气相从而起，五气多相兼化，风燥同热化，湿同寒化，病甚
则手足经从其所化之寒热以为厥。盖所逆之气自下而上者，非得之火炎之势而能之
乎。如三焦、足少阳、冲、任、督，皆自司相火在下者，然而统属乎肾。何则？足
少阴子与手少阴午对化者，寄于其间，如是则肾之元气安于治下。若相火妄动，须
当先救其肾，分正治从治，折其冲逆，辨五气所从之盛衰者，补泻之。虽然亦有不
因气逆而遽冷者，如《原病式》谓阴水主清净，故病寒则四肢冷是也。乃为阳虚而阴
独在故寒，即仲景所谓先厥后热，因寒邪外中，阳气未能胜之，故先厥也。虽邪有
内外之分，然在温之则一耳。
【寒热二厥】《素问》黄帝曰∶厥之寒热者，何也？岐伯对曰∶阳气衰于下则
为寒厥，阴气衰于下则为热厥。帝曰∶热厥之为热也，必起于足下者，何也？岐伯曰∶
阳气起于足五指之表，阴脉者，集于足下而聚于足心，故阳气胜则足下热也。帝曰∶
寒厥之为寒也，必从五指而上于膝者何也？岐伯曰∶阴气起于五指之里，集于膝下
而聚于膝上，故阴气胜则从五指至膝上寒，其寒也，不从外，皆从内也。帝曰∶寒
厥何为而然也？岐伯曰∶前阴者，宗筋之所聚，太阴阳明之所合也。春夏则阳气多
而阴气少，秋冬则阴气盛而阳气衰，此人者质壮，以秋冬夺于所用，下气上争不能
复，精气溢下，邪气因从之而上也。气因于中，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。帝曰∶热厥何如而然也？岐伯曰∶酒入于胃，则络脉
满而经脉虚，脾主为胃行其津液者也。阴气虚则阳气入，阳气入则胃不和，胃不和
则精气竭，精气竭则不荣其四肢也。此人必数醉，若饱以入房，气聚于脾中不得散，
酒气与谷气相搏，热盛于中，故热遍于身，内热而溺赤也。夫酒气盛而 悍，肾气
日衰，阳气偏胜，故手足为之热也。《灵枢·颠狂》篇，厥逆为病也，足暴清，胸若
将裂，肠若将以刀切之，烦而不能食，脉大小皆涩。暖取足少阴，清取足阳明。
清则补之，温则泻之。《儒门事亲》云∶西华李政之病寒厥，其妻病热厥，前后十余
年，其妻服逍遥散十余剂，终无效。一日命予诊之，二人脉皆浮大而无力。政之
曰∶吾手足之寒，时时渍以热汤，渍而不能止；吾妇手足之热，终日沃以冷水，沃
而不能已者，何也？予曰∶寒热之厥也。此皆得之贪饮食，纵嗜欲，遂出《内经·厥
论》证之。政之喜曰∶十年之疑，今而释然，纵不服药，愈过半矣。仆曰∶热厥者，
寒在上也。寒厥者，热在上也。寒在上者，以温剂补肺金。热在上者，以凉剂清心
火。分取二药，令服之不辍，不旬日，政之诣门谢曰，寒热厥者皆愈矣。《原病式》
谓厥者有阴阳之辨，阴厥者，原病脉候皆为阴证，身凉不渴；脉迟细而微也。阳厥
者，原病脉候皆为阳证，烦渴谵妄，身热而脉数也。若阳厥极深，或失下而至于身
冷，反见阴证，脉微欲绝而死者，正为热极而然也。王安道曰∶热极而成厥逆者，
阳极似阴也。寒极而成厥逆者，独阴无阳也。阳极似阴用寒药，独阴无阳用热药，
不可不辨也。叶氏曰∶《内经》所谓寒热二厥者，乃阴阳之气逆而为虚损之证也。寒
厥补阳，热厥补阴。正王太仆所谓壮水之主以镇阳光，益火之原以消阴翳，此补
其真水、火之不足耳。仲景、河间、安道所论厥证，乃伤寒手足之厥冷也。证既不
同，治法亦异。寒厥，表热里寒，下利清谷，食入即吐，脉沉伏，手足冷，四逆汤
主之。热厥，腹满身重，难以转侧，面垢谵语遗溺，厥冷自汗，脉沉滑，白虎汤主
之。热厥，手足热而游赤，宜升阳泄火汤。若大便结实，大柴胡汤主之。寒厥，手
足冷，以附子理中汤。指尖冷，谓之清，理中汤主之。
【寒厥手足冷】脉沉数实为热。东垣治中书贴合公脚膝尻腰背冷，脉沉数有力，用黄柏滋肾丸，
再服而愈。又治中书左丞姚公茂，上热下寒，用既济解毒汤良愈。丹溪治吕宗信，腹
有积块，足冷至膝，用大承气加减下之愈。此皆寒厥有热也。脉沉细微为寒。罗谦
甫治征南副元帅大忒木儿，年六十，秋七月征南，至仲冬，病自利完谷不化，脐腹
冷痛，足 寒，以手搔之不知痛痒，常烧石以温之，亦不得暖。诊之脉沉细而微，
此年高气弱，深入敌境，军务烦冗，朝夕形寒，饮食失节，多饮乳酪，履于卑湿，
阳不外固，由是清湿袭虚，病起于下，故 寒而逆。《内经》云∶感于寒而受病，微
则为咳，盛则为泄为痛，此寒湿相合而为病也。法当急退寒湿之邪，峻补其阳，非
灸不能病已。先以大艾炷于气海灸百壮，补下焦阳虚。次灸三里各三七壮，治 寒
而逆，且接引阳气下行。又灸三阴交，以散足受寒湿之邪。遂处方云∶寒淫所胜，
治以辛热，湿淫于外，平以苦热，以苦发之。以附子大辛热，助阳退阴，温经散寒
为君。干姜、官桂大热辛甘，亦除寒湿，白术、半夏苦辛温而燥脾湿，故以为臣。
人参、草豆蔻、甘草大温中益气，生姜大辛温，能散清湿之邪，葱白辛温，能通上
焦阳气，故以为佐。又云∶补下治下制以急，急则气味浓，故大作剂服之。不数服，
泻止痛减，足 渐温，调其饮食，十日平复。明年秋，过襄阳值霖雨，阅旬余前证
复作，再根据前灸，添阳辅各二七壮，再以前药投之，数服愈。《内经》寒厥，皆属
肾虚。云肾脏志，志不足则厥。又云∶肾虚则清厥，意不乐。又云∶下虚则厥。又
云∶诸厥固泄，皆属于下是也。《灵枢·逆顺肥瘦》篇，黄帝曰∶少阴之脉，独下
行何也？歧伯曰∶不然。夫冲脉者，五脏六腑之海也，五脏六腑皆禀焉。其上者，
出于颃颡，渗诸阳，灌诸精，其下者，注少阴之大络，出于气冲，循阴股内廉，入
中，伏行 骨内，下至内踝之后属而别。其下者，并于少阴之经，渗三阴，其前
者，伏行出跗属，下循跗，入大指间，渗诸络而温肌肉。故别络结则跗上不动，不
动则厥，厥则寒矣。（经云∶经络坚紧，火所治之。盖灸以治之，或汤酒渍之也。）运气寒厥有
二∶一曰寒。经云∶水准气曰静顺，静顺之纪，其病厥。又云∶岁水太过，寒气流行，邪害
心火，躁悸阴厥。又云∶岁金不及，炎火乃行，复则病阴厥且格是也。二曰寒湿。经云∶
太阴司天之政，天气下降，地气上腾，民病寒厥是也。《千金方》治丈夫腰脚冷不
随，不能行方，上醇酒三斗，水三斗，合著瓮中，温渍至膝，三日止。冷则瓮下常
着灰火，勿令冷。东垣云∶经云，厥在于足，宗气不下，脉中之血，凝而留止，非
火调弗能取之。洁古云∶身热如火，足冷如冰，可灸阳辅穴。又云∶ 酸冷，绝骨取之。
【热厥手足热】丹溪曰∶司丞叔平生脚自踝以下常觉热，冬不可加绵于上，尝自言曰，我资禀
壮不怕冷。予曰，此足三阴虚，宜断欲事，以补养阴血，庶乎可免，笑而不答，年
方十七患痿，半年而死。《千金方》手足烦者，小便三升，盆中温渍手足。《素问》
热厥，取足太阴、少阳，皆留之。
暴不知人之厥，已前见卒中暴厥门，但有轻而未至于卒仆者，难以诸中目之，
故复附见于此。厥有涎潮，如拽锯声在咽中，为痰厥。先用瓜蒂散，或稀涎散，或
人参芦煎汤探吐，随用导痰汤，多加竹沥，少加姜汁。暴怒气逆而昏运者，为气厥。
宜八味顺气散，或调气散，或四七汤。手足搐搦为风厥，宜小续命汤。因酒而得为
酒厥，宜二陈汤加干葛、青皮，或葛花解酲汤。又有骨枯爪痛为骨厥，身立如椽为
厥，喘而惋为阳明厥，此皆由气逆也。厥亦有腹满不知人者，一二日稍知人者，
皆卒然闷乱者，皆因邪气乱，阳气逆，是少阴肾脉不至也。肾气衰少，精血奔逸，使
气促迫，上入胸胁，宗气反结心下，阳气退下，热归股腹，与阴相助，令身不仁。
又五络皆会于耳，五络俱绝，则令人身脉皆动，而形体皆无知，其状如尸，故曰尸
厥。正由脏气相刑，或与外邪相忤，则气郁不行，闭于经络，诸脉伏匿，昏不知人。
唯当随其脏气而通之，寒则热之，热则寒之，闭则通之。仲景云∶尸厥脉动而无气，
气闭不通，故静而死也。菖蒲屑内鼻孔中吹之，令人以桂屑着舌下。又剔取左角发
方寸，烧灰末酒和灌之，立起。以竹管吹其两耳。还魂汤。奄忽死去，四肢逆冷，
不醒人事，腹中气走如雷鸣，此尸厥也。以焰硝五钱，硫黄二钱，研细作三服，每
服好陈酒一大盏煎，觉硝焰起，倾于盆内，盖着温服，如人行五里，又进一服，不
过三服即醒，灸百会四十九壮，气海、丹田三百壮，身温灸止。如无前药，用黑附
子一只炮制，人参一两，分作二服，酒三盏煎服，或生姜汁、酒合煎亦妙。灸百会，
艾炷止许如绿豆大，粗则伤人。
【诊】沉微不数为寒厥。沉伏而数为热厥。细为气虚。大如葱管为血虚。浮
数为痰。弦数为热。浮者外感。脉至如喘为气厥。寸沉大而滑，沉为实，滑为气，
娄全善说：王冰（王太仆）说：厥，是气机逆乱向上冲逆。世人错误地将其传称为“香港脚”（一种以足部肿痛为主的疾病），读了这段文字才知道这种病，上古时期称之为“香港脚”。《内经》说：寒厥，表现为手足寒冷；热厥，表现为手足发热；痿厥，是痿病与厥证混杂，导致足部软弱无力；痹厥，是痹病与厥证混杂，表现为足部顽固性麻木、肿胀疼痛；厥逆，即前述的寒厥、热厥、痿厥、痹厥、风厥等气机逆乱上冲，并伴有呕吐、神志昏闷、腹胀或气急、小腹感觉迟钝，或突然昏迷不省人事，这就是世人所说的“香港脚冲心”的情况。现在的人又把突然昏晕、不省人事称为厥。有人问：世人都把手足发冷称为厥，怎么样？回答说：不对。在张仲景论述伤寒时，将手足发热称为热厥，手足发冷称为寒厥，发冷的称为“逆”。他说凡是厥证，都是阴阳之气不能顺接所致，厥的表现就是手足逆冷。因此，对于阳虚而不能相接的，就用温法治疗；对于阳气下陷而深伏，不能与阴气顺接的，就用下法治疗；对于邪热初入而未深的，就疏散其传入阴经的热邪，根据病位的浅深和病情的轻重来施治。这是针对伤寒之邪由表入里，发展到太阴经出现手足厥冷的情况，专门归属于这两条经脉而言的。因为这是从伤寒六经传变的角度来论述的，所以厥阴经被称为两阴交尽之经，热邪传到此处，正是极深的时候，所以叫厥阴。至于《内经·厥论篇》的意思则不是这样，它总体认为足三阳经起于足五指外侧，足三阴经起于足五指内侧，所以阳气胜则足底发热，阴气胜则从五指到膝盖以上寒冷。论述寒厥的成因，就说前阴是宗筋汇聚之处，是太阴脾经和阳明胃经会合的地方。这种人身体壮实，在秋冬阴气盛、阳气衰的时候，因过度使用肾精，导致下焦之气上争而不能恢复，精气外泄，邪气便随之而上行，阳气衰败不能渗润滋养经络，阳气日渐损耗，阴气独存，所以手足为之寒冷。论述热厥的成因，就说人必须多次醉酒，或者饱食后行房事，导致气聚积在脾中，肾气衰弱，阳气独盛，所以手足为之发热。观察其中的微言大义，大概是为了说明肾得到先天之精，元气从此充盛，肾与脾胃两脏相互关联，脉道才能运行，运化阴阳于内外，各有职司，阳主表，其气温煦；阴主里，其气寒凉。表里之脉，循环相接于四肢，所以举出脾胃因酒色损伤，导致阴阳二厥的大例作为开头，接着叙述十二经的厥逆，只列出本经气逆的病状表现，都不提手足厥冷，也不涉及受病的缘由，也不是用一句话就能讲清楚的。既然在前面设立了两个例子，在这里就可以推演类推了，所以不再赘述。虽然如此，再详细陈述其他篇章中关于厥的内容以阐明它。如《素问·太阴阳明论》说：阳明胃经，五脏六腑都禀受胃气。现在脾有病，不能帮助胃将津液输送到三阴经，胃也不能将津液输送到三阳经，四肢得不到水谷精气的滋养，一天比一天衰弱，阴脉不利，筋骨肌肉都没有气以生养。就此而言，脾胃有实有虚，互相盛衰，虚者不能传输津液，实者独自运行，独自运行必然导致寒冷，这是脾胃导致厥的第一种情况。另外十二经都禀受胃气，受胃的寒气影响，经气也寒；受胃的热气影响，经气也热。因此经脉不和，在气血流行相接之际，必然会在四肢末端留下寒热之邪，这是脾胃导致厥的第二种情况。还有脾胃是肾的胜脏（相克之脏），脾胃有邪气，必定乘袭于肾，肾位于下焦，主管厥证。肾受邪则发生厥，这是脾胃导致厥的第三种情况。《灵枢》说：冲脉，与足少阴肾经的大络同出于肾，是五脏六腑的海，所以五脏六腑都禀受于此。它的上行部分，渗灌诸阳经，灌注精气；它的下行部分，并入足少阴经，渗灌三阴经，灌注各络脉，从而温养肌肉。如果它的别络结滞，则足背脉搏不动，不动则发生厥，厥则寒冷。夫冲脉，是运行肾脏治理内部的阳气者，阳即火，所以阳气正常发动，就是生化温养的少火；妄动，就是炎炽害物的壮火。火壮则元真之阳也衰败。李东垣说火与元气不两立，一胜则一负，就是这个道理。如前文《厥论》所说，下气上争，邪气随之而上，并非另有他邪，就是此火扰乱，阴阳的淫气兴起而上逆。所以经文以逆气为冲脉的病，病机十九条也说诸逆冲上，皆属于火；诸厥皆属于下。然而在肾的阴阳调和则下焦治理正常，不调和则下焦不治，不治则寒热之厥就产生了，这就是肾主厥的道理。至于冲脉与胃，都以“海”命名，所以十二经禀受胃气而导致厥病的情况完全相同。又如其他篇章论述厥，有的说因阳气烦劳则张越，精绝耗散积累于夏季，使人发生煎厥；有的说二阳（胃、大肠）和一阴（肝）发病，为风厥；有的说志不足则厥；有的说脏厥；有的说突然不知人的厥；有的说五络俱竭而致的尸厥。凡这些原因导致的上逆之邪，都是相火与五火相互煽动而起，起来就扰乱经气，所以属于风寒燥湿热五气相随而起，五气多兼化，风燥同热化，湿同寒化，病重则手足经脉随着所化的寒热而发生厥。大概所逆之气自下而上，不是凭借火炎之势能做到的吗？如三焦、足少阳胆经、冲脉、任脉、督脉，都各自主管在下部的相火，然而统属于肾。为什么呢？足少阴肾经（子）与手少阴心经（午）对化，寄寓其间，这样肾的元气就能安于下焦治理。如果相火妄动，应当先救肾，区分正治和从治，折服其冲逆之势，辨别五气所从的盛衰，进行补泻。虽然也有不因气逆而突然寒冷的，如《原病式》说阴水主清净，所以生病时寒冷则四肢冷，这是因为阳虚而阴独存所以寒冷，即仲景所说的先厥后热，因寒邪外中，阳气未能战胜它，所以先厥。虽然邪气有内外之分，但在温补方面是一致的。
【寒热二厥】《素问》黄帝问：厥证的寒热表现，是怎么回事？岐伯回答：阳气衰于下部则为寒厥，阴气衰于下部则为热厥。帝问：热厥之所以发热，一定从足下开始，为什么呢？岐伯说：阳气起于足五指的外侧，阴脉聚集于足下并汇聚于足心，所以阳气胜则足下发热。帝问：寒厥之所以寒冷，一定从五指向上蔓延至膝盖，为什么呢？岐伯说：阴气起于足五指的内侧，汇聚于膝下并聚于膝上，所以阴气胜则从五指到膝盖以上寒冷，这种寒冷，不是从外部感受的，都是从内部产生的。帝问：寒厥为什么会产生这种情况？岐伯说：前阴是宗筋汇聚之处，是太阴脾经和阳明胃经会合的地方。春夏时节阳气多而阴气少，秋冬时节阴气盛而阳气衰，这种人身体壮实，在秋冬季节因过度使用肾精，导致下焦之气上争而不能恢复，精气外泄，邪气便随之而上行。气郁结在中焦，阳气衰败不能渗润荣养经络，阳气日渐损耗，阴气独存，所以手足为之寒冷。帝问：热厥为什么会产生这种情况？岐伯说：酒进入胃中，则络脉满盈而经脉空虚，脾主为胃传输津液。阴气虚则阳气内入，阳气内入则胃不和，胃不和则精气枯竭，精气枯竭则不能荣养四肢。这种人必定经常醉酒，或者饱食后行房事，气聚积在脾中不得消散，酒气与谷气相互搏结，热盛于中，所以热遍全身，内热且小便赤黄。酒气盛大而剽悍，肾气日渐衰败，阳气偏胜，所以手足为之发热。《灵枢·癫狂》篇说，厥逆作为疾病，表现为足部突然清冷，胸部像要裂开一样，肠道像被刀切一样疼痛，烦躁不能进食，脉象大小都涩。温暖取足少阴经穴，清凉取足阳明经穴。寒证用补法，热证用泻法。《儒门事亲》说：西华县李政之患寒厥，他的妻子患热厥，前后十多年，他的妻子服用逍遥散十多剂，始终无效。有一天让我诊治，两人的脉象都浮大而无力的。李政之说：“我手足寒冷，时时用热水浸泡，浸泡也不能停止；我妻子手足发热，整天用冷水浇淋，浇淋也不能止住，为什么呢？”我说：“这是寒热厥证。这都是因为贪饮食、纵情嗜欲所致。”于是引用《内经·厥论》来验证。李政之高兴地说：“十年的疑惑，今天解开了，即使不服药，也好了一半了。”我说：“热厥，是寒在上焦；寒厥，是热在上焦。寒在上焦的，用温剂补肺金；热在上焦的，用凉剂清心火。分别选取这两种药，让他们不停服用，不到十天，李政之登门感谢说，寒热厥都痊愈了。”《原病式》说厥证有阴阳的区别，阴厥者，原本病症脉候都是阴证，身凉口不渴；脉迟细而微。阳厥者，原本病症脉候都是阳证，烦渴谵语妄动，身热脉数。如果阳厥极深，或者失于攻下而导致身冷，反而出现阴证，脉微欲绝而死，这正是热极所致。王安道说：热极而成厥逆的，是阳极似阴；寒极而成厥逆的，是独阴无阳。阳极似阴用寒药，独阴无阳用热药，不可不辨别。叶氏说：《内经》所说的寒热二厥，是阴阳之气逆乱而为虚损的证候。寒厥补阳，热厥补阴。正是王冰所谓“壮水之主以镇阳光，益火之原以消阴翳”，这是补其真水、真火的不足罢了。仲景、河间、安道所论述的厥证，是伤寒所致的手足厥冷。证候既然不同，治法也不同。寒厥，表热里寒，下利清谷，食入即吐，脉沉伏，手足冷，用四逆汤主治。热厥，腹满身重，难以转侧，面垢谵语遗尿，厥冷自汗，脉沉滑，用白虎汤主治。热厥，手足热且游走性发红，宜用升阳泄火汤。如果大便结实，用大柴胡汤主治。寒厥，手足冷，用附子理中汤。指尖冷，称为“清”，用理中汤主治。
【寒厥手足冷】脉沉数实为热证。李东垣治疗中书贴合公脚膝尻腰背冷，脉沉数有力，用黄柏滋肾丸，再服而愈。又治疗中书左丞姚公茂，上热下寒，用既济解毒汤良愈。朱丹溪治疗吕宗信，腹部有积块，足冷至膝，用大承气汤加减攻下而愈。这些都是寒厥中有热的情况。脉沉细微为寒证。罗谦甫治疗征南副元帅大忒木儿，六十岁，七月出征，到仲冬时节，患病自利完谷不化，脐腹冷痛，足胫寒冷，用手搔抓不知痛痒，常烧石头来温暖，也不能暖和。诊其脉沉细而微，这是年高气弱，深入敌境，军务繁杂，早晚受寒，饮食失节，多饮乳酪，处于卑湿之地，阳气不能外固，因此清湿侵袭虚弱之处，病起于下，所以足胫寒冷而逆冷。《内经》说：感于寒而致病，轻微则咳嗽，严重则泄泻疼痛，这是寒湿相合而致病。治法应当急退寒湿之邪，峻补其阳，非艾灸不能治愈。先用大艾炷在气海穴灸一百壮，补下焦阳虚。其次灸足三里各三七壮，治疗足胫寒冷而逆，并且引导阳气下行。又灸三阴交，以散去足部受寒湿之邪。于是处方说：寒淫所胜，治以辛热；湿淫于外，平以苦热，以苦味发散。用附子大辛热，助阳退阴，温经散寒为君药。干姜、官桂大热辛甘，也能除寒湿；白术、半夏苦辛温而燥脾湿，所以作为臣药。人参、草豆蔻、甘草大温中益气，生姜大辛温，能散清湿之邪，葱白辛温，能通上焦阳气，所以作为佐药。又说：补下治下，制剂要急，急则气味浓厚，所以要制成大剂量服用。没吃几服，腹泻止痛减，足胫逐渐温暖，调理饮食，十天康复。第二年秋天，经过襄阳遇到连绵阴雨，过了十几天前证复发，再次按照前面的方法艾灸，增加阳辅穴各二七壮，再用前面的药投服，几服而愈。《内经》寒厥，都属于肾虚。说肾脏主志，志不足则厥。又说：肾虚则清厥，意志不乐。又说：下虚则厥。又说：诸厥固泄，皆属于下，就是这个道理。《灵枢·逆顺肥瘦》篇，黄帝问：少阴之脉，唯独向下行走，为什么呢？岐伯说：不是这样的。夫冲脉，是五脏六腑的海，五脏六腑都禀受于此。它的上行部分，出于颃颡，渗灌诸阳经，灌注精气；它的下行部分，注入足少阴的大络，出于气冲穴，沿大腿内侧廉，进入阴部，伏行于骨骼内，下至内踝之后分支。它的下行部分，并入足少阴经，渗灌三阴经，它的前行部分，伏行出于跗属，向下沿足背，入大趾间，渗灌各络脉而温养肌肉。所以别络结滞则足背上脉搏不动，不动则发生厥，厥则寒冷。（经文说：经络坚紧，用火法治之。大概是艾灸治疗，或者用药汤酒浸泡。）运气学说中的寒厥有两种：一是寒。经文说：水准气曰静顺，静顺之纪，其病厥。又说：岁水太过，寒气流行，邪害心火，躁悸阴厥。又说：岁金不及，炎火乃行，复则病阴厥且格。二是寒湿。经文说：太阴司天之政，天气下降，地气上腾，民病寒厥。《千金方》治疗男子腰脚冷不能随动，不能行走的方子，用上好的酒三斗，水三斗，混合放在瓮中，温热浸泡至膝盖，三天为止。冷了就在瓮下常放灰火，不要让水冷。李东垣说：经文说，厥在于足，宗气不下，脉中之血，凝而留止，非火调不能取之。洁古说：身热如火，足冷如冰，可灸阳辅穴。又说：足胫酸冷，取绝骨穴。
【热厥手足热】朱丹溪说：司丞叔平生脚从脚踝以下常觉得热，冬天不能在上面加棉絮，曾自己说，我体质壮实不怕冷。我说，这是足三阴虚，应该断绝房事，以补养阴血，或许可以免除，他笑着不答应，十七岁时患痿证，半年后死亡。《千金方》手足烦热的，用小便三升，在盆中温热浸泡手足。《素问》热厥，取足太阴、足少阳经穴，都留针。
突然不知人的厥，之前已在卒中暴厥门见过，但这里有轻症而未至于突然仆倒的，难以用诸中风口目之，所以再次附录在此。厥伴有痰涎如潮，喉咙里有拉锯声，为痰厥。先用瓜蒂散，或稀涎散，或人参芦煎汤探吐，随后用导痰汤，多加竹沥，少加姜汁。暴怒导致气逆而昏晕的，为气厥。宜用八味顺气散，或调气散，或四七汤。手足抽搐为风厥，宜用小续命汤。因饮酒而得的为酒厥，宜用二陈汤加干葛、青皮，或葛花解酲汤。又有骨枯爪痛的为骨厥，身体直立如椽木的为厥，喘促而心中懊恼的为阳明厥，这些都是由于气逆所致。厥也有腹胀不知人的，有一两天稍知人的，都是突然闷乱的，都是因为邪气扰乱，阳气逆乱，是少阴肾脉不至。肾气衰少，精血奔逸，使气促迫，上入胸胁，宗气反结于心下，阳气退下，热归股腹，与阴相助，令身体不仁。另外五络都交会于耳，五络都绝，则令人周身脉搏跳动，而形体都无知觉，其状如尸体，所以叫尸厥。正是因为脏气相刑，或与外邪相忤，则气郁不行，闭于经络，诸脉伏匿，昏不知人。只应当随其脏气而通之，寒则热之，热则寒之，闭则通之。仲景说：尸厥脉动而无气，气闭不通，所以静而死。将菖蒲屑纳入鼻孔中吹入，让人将桂屑放在舌下。又剔取左侧角头发方寸大小，烧成灰末，用酒调和灌服，立即苏醒。用竹管吹其两耳。还魂汤。忽然死去，四肢逆冷，不醒人事，腹中气走如雷鸣，这是尸厥。用焰硝五钱，硫黄二钱，研细分为三服，每服用好陈酒一大盏煎煮，感觉到硝焰升起，倾倒在盆内，盖好温热服用，如人行走五里的时间，再进一服，不超过三服即醒，灸百会穴四十九壮，气海、丹田三百壮，身体温暖后停止艾灸。如果没有前面的药，用黑附子一只炮制，人参一两，分为二服，酒三盏煎服，或者生姜汁、酒合煎也很好。灸百会穴，艾炷只允许如绿豆大小，粗了会伤人。
【诊法】脉沉微不数为寒厥。脉沉伏而数为热厥。脉细为气虚。脉大如葱管为血虚。脉浮数为痰。脉弦数为热。脉浮者为外感。脉至如喘为气厥。寸脉沉大而滑，沉为实，滑为气，
Lou Quanshan said: Wang Bing (Wang Taipu) stated: Jue (Jue syndrome, characterized by cold or hot extremities due to Qi counterflow) is Qi counterflowing upward. The world erroneously transmits it as "Hong Kong Foot" (a disease primarily characterized by swelling and pain in the feet), but reading this text reveals that this disease was called "Hong Kong Foot" in ancient times. The Classics state: Cold Jue presents with cold hands and feet; Hot Jue presents with hot hands and feet; Wei Jue (Atrophic Jue) is a combination of Atrophy syndrome and Jue syndrome, resulting in weak and powerless legs; Bi Jue (Obstruction Jue) is a combination of Obstruction syndrome and Jue syndrome, presenting as stubborn numbness, swelling, and pain in the feet; Jue Ni (Counterflow Jue) refers to the aforementioned Cold Jue, Hot Jue, Wei Jue, Bi Jue, Feng Jue (Wind Jue), etc., where Qi counterflows upward, accompanied by vomiting, mental confusion, abdominal distension or shortness of breath, insensitivity of the lower abdomen, or sudden unconsciousness. This is what the world calls "Hong Kong Foot rushing to the heart." Nowadays, people also refer to sudden fainting and loss of consciousness as Jue. Someone asked: The world names hand and foot coldness as Jue, how is this? I replied: Incorrect. In Zhang Zhongjing's discussion on Shanghan (Cold Damage), he termed hand and foot heat as Hot Jue, and hand and foot coldness as Cold Jue, with coldness specifically called "Ni" (counterflow). He stated that any Jue syndrome occurs when Yin and Yang Qi fail to connect smoothly, and the manifestation of Jue is cold extremities. Therefore, for those with Yang deficiency failing to connect, warming methods are used; for those with Yang sinking and lying deep, unable to connect with Yin, purgative methods are used; for those with pathogenic heat entering but not yet deep, the heat transmitting to the Yin meridians is dispersed, and treatment is administered according to the depth and severity of the condition. This specifically refers to Shanghan pathogenic factors moving from the exterior to the interior, reaching the Taiyin stage with cold extremities, attributing it solely to these two meridians. Since this discussion is based on the transmission of pathogens through the Six Meridians of Shanghan, the Jueyin meridian is described as the convergence of two Yins. When heat transmits to this point, it is at its deepest, hence named Jueyin. However, the meaning in the *Neijing* chapter on Jue is different. It generally states that the Three Yang meridians of the foot originate from the lateral side of the five toes, and the Three Yin meridians originate from the medial side. Thus, when Yang Qi prevails, the sole of the foot becomes hot; when Yin Qi prevails, coldness extends from the toes to above the knee. Discussing the cause of Cold Jue, it says: The anterior yin is the gathering place of the Zongjin (tendons), and the meeting point of the Taiyin (Spleen) and Yangming (Stomach) meridians. For a person of robust constitution, during autumn and winter when Yin Qi is abundant and Yang Qi is declining, excessive exertion depletes the lower Qi, causing it to contend upward without recovery, essence spills out, and pathogenic factors follow upward. Yang Qi declines and cannot moisten and nourish the collaterals, leading to daily depletion of Yang Qi and predominance of Yin Qi, thus causing coldness in the hands and feet. Discussing the cause of Hot Jue, it says: A person must frequently drink alcohol or engage in sexual activity after full meals, causing Qi to accumulate in the Spleen, weakening Kidney Qi, leading to predominant Yang Qi, thus causing heat in the hands and feet. Observing its subtle implications, it likely aims to illustrate that the Kidney receives the pre-heavenly essence, from which Yuan Qi is filled. The two Zang organs (Kidney and Spleen/Stomach) interact, allowing the pulse channels to function, transporting Yin and Yang inside and outside, each having its duties. Yang governs the exterior and provides warmth; Yin governs the interior and provides coldness. The exterior and interior pulse channels circulate and connect at the four limbs. Therefore, taking the example of Spleen and Stomach damage due to alcohol and lust, leading to major Yin-Yang Jue syndromes, placed at the beginning of the chapter, followed by the narration of Jue Ni of the Twelve Meridians, only listing the manifestations of Qi counterflow in the respective meridians, without mentioning hand/foot Jue or the causes of disease, as one sentence cannot suffice. Since two examples are set beforehand, inference can be made here, so no further words are needed. Nevertheless, let us detail other chapters regarding Jue to clarify them. As stated in the *Taiyin Yangming Lun*: Yangming (Stomach) is where the Five Zang and Six Fu organs receive Qi. Now, if the Spleen is diseased and cannot transport fluids to the Three Yin meridians along with the Stomach, and the Stomach cannot transport fluids to the Three Yang meridians, the four limbs do not receive water and grain Qi, becoming increasingly deficient day by day. The Yin channels become obstructed, and bones, sinews, muscles lack Qi for generation. From this perspective, Spleen and Stomach have excess and deficiency, alternating in dominance. The deficient cannot transport fluids, while the excess acts alone; acting alone leads to coldness. This is the first way Spleen and Stomach cause Jue. Furthermore, all twelve meridians receive Qi from the Stomach. Receiving Stomach cold makes meridian Qi cold; receiving Stomach heat makes meridian Qi hot. Consequently, meridian Qi becomes disordered, and during circulation and connection, cold and heat are inevitably left in the four extremities. This is the second way Spleen and Stomach cause Jue. Additionally, Spleen and Stomach are the controlling organs of the Kidney. If Spleen and Stomach have pathogens, they must attack the Kidney. The Kidney resides in the lower jiao and governs Jue. If the Kidney is affected by pathogens, Jue occurs. This is the third way Spleen and Stomach cause Jue. The *Lingshu* states: The Chong Mai (Penetrating Vessel) emerges from the Kidney together with the great Luo vessel of Shaoyin, serving as the Sea of the Five Zang and Six Fu organs, so all organs receive from it. Its upper branch seeps into the Yang meridians and irrigates essence; its lower branch joins the Shaoyin channel, seeps into the Three Yin meridians, irrigates the collaterals, and warms the muscles. If its collateral branches knot, the dorsum of the foot becomes immobile; immobility leads to Jue, and Jue leads to coldness. The Chong Mai conducts the Yang Qi governing the interior of the Kidney. Yang is Fire. When Yang moves correctly, it is the mild fire that generates and warms life; when it moves recklessly, it is the fierce fire that damages things. Fierce fire causes the original true Yang to decline. Li Dongyuan said that Fire and Yuan Qi cannot coexist; when one wins, the other loses. As mentioned in the previous Jue Lun, lower Qi contending upward and pathogenic factors following upward is not another pathogen, but this Fire causing chaos, with chaotic Yin and Yang Qi rising and counterflowing. Hence, the Classics attribute counterflow Qi to the Chong Mai disease, and the Pathogenesis principles state that all counterflowing upward symptoms belong to Fire; all Jue symptoms belong to the Lower Jiao. However, when Kidney Yin and Yang are harmonious, the Lower Jiao is governed well; when unharmonious, it is not governed well, leading to Cold or Hot Jue. This is the way the Kidney governs Jue. Regarding the Chong Mai and Stomach, both named "Sea," the twelve meridians receiving Qi result in identical Jue diseases. Other chapters discuss Jue caused by Yang Qi overexertion leading to expansion, essence exhaustion accumulating in summer, causing Jian Jue (Frying Jue); or Er Yang (Stomach/Large Intestine) and Yi Yin (Liver) pathology causing Feng Jue; or insufficient Zhi (Will) causing Jue; or Zang Jue; or sudden unconsciousness Jue; or Shi Jue (Corpse Jue) due to exhaustion of five collaterals. All these counterflowing pathogens are stirred up by Xiang Huo (Ministerial Fire) interacting with the Five Fires. Once stirred, they disrupt meridian Qi, causing the Five Qi (Wind, Cold, Dryness, Dampness, Heat) to arise. These Five Qi often transform together: Wind and Dryness transform with Heat, Dampness transforms with Cold. Severe cases result in extremity meridians undergoing Jue according to the transformed Cold or Heat. Presumably, Qi counterflowing from below to above requires the momentum of Fire. Sanjiao, Foot Shaoyang Gallbladder, Chong, Ren, and Du meridians all govern Ministerial Fire in the lower body, yet are unified under the Kidney. Why? Because Foot Shaoyin Kidney (Zi) and Hand Shaoyin Heart (Wu) correspond and transform, residing therein, allowing Kidney Yuan Qi to govern the lower body properly. If Ministerial Fire moves recklessly, one must first rescue the Kidney, distinguishing direct and indirect treatments, checking the counterflow, and identifying the prevalence of the Five Qi for tonification or sedation. Although there are cases of sudden coldness not due to Qi counterflow, such as in *Yuan Bing Shi*, which states that Yin Water governs tranquility, so cold illness causes cold limbs. This is due to Yang deficiency with Yin predominance causing cold, i.e., Zhongjing's concept of initial Jue followed by heat, where external Cold pathogens overwhelm Yang, causing initial Jue. Although pathogens have internal and external distinctions, warming treatment remains the same.
[Cold and Hot Jue] *Suwen*: Huangdi asked: What is the mechanism behind cold and hot Jue? Qibo answered: Yang Qi deficiency in the lower part causes Cold Jue; Yin Qi deficiency in the lower part causes Hot Jue. Di asked: Why does Hot Jue heat always start from the soles of the feet? Qibo said: Yang Qi originates from the lateral aspect of the five toes of the foot, while Yin meridians gather at the sole and converge at the heel. Thus, when Yang Qi prevails, the sole becomes hot. Di asked: Why does Cold Jue coldness always rise from the five toes to the knees? Qibo said: Yin Qi originates from the medial aspect of the five toes, gathers below the knee, and converges above the knee. Thus, when Yin Qi prevails, coldness spreads from the toes to above the knee. This coldness does not come from the exterior but arises from within. Di asked: How does Cold Jue occur? Qibo said: The anterior yin is the gathering place of the Zongjin, the meeting point of Taiyin and Yangming. In spring and summer, Yang Qi is abundant and Yin Qi is scarce; in autumn and winter, Yin Qi is abundant and Yang Qi is scarce. A robust person who overexerts themselves during autumn and winter causes lower Qi to contend upward without recovery, essence spills out, and pathogenic factors follow upward. Qi stagnates in the middle, Yang Qi declines and cannot moisten the meridians, Yang Qi diminishes daily, Yin Qi remains alone, causing cold hands and feet. Di asked: How does Hot Jue occur? Qibo said: Alcohol enters the stomach, filling the Luo vessels while emptying the Jing meridians. The Spleen transports fluids for the Stomach. When Yin Qi is deficient, Yang Qi enters; when Yang Qi enters, the Stomach becomes disharmonious; when the Stomach is disharmonious, essence is exhausted; when essence is exhausted, the four limbs are not nourished. Such persons often drink heavily or engage in sex after full meals, causing Qi to accumulate in the Spleen without dispersing. Alcohol Qi and Grain Qi struggle, generating intense heat in the center, spreading heat throughout the body, causing internal heat and red urine. Alcohol Qi is strong and pungent, daily depleting Kidney Qi, leading to predominant Yang Qi, causing hot hands and feet. The *Lingshu·Dian Kuang* chapter states that Jue Ni presents with sudden cold feet, chest feeling like splitting, intestines feeling like being cut by a knife, irritability, inability to eat, and choppy pulses of all sizes. Warmth should be applied to Foot Shaoyin points, coolness to Foot Yangming points. Cold conditions require tonification, heat conditions require sedation. *Rumen Shiqin* states: Li Zhengzhi from Xihua suffered from Cold Jue, and his wife from Hot Jue, for over ten years. His wife took Xiaoyao San for over ten doses with no effect. One day, I diagnosed them; both had floating, large, and forceless pulses. Zhengzhi said: "My hands and feet are cold, soaking in hot water doesn't stop it; my wife's hands and feet are hot, pouring cold water doesn't stop it. Why?" I said: "This is Cold and Hot Jue. Both resulted from gluttony and indulgence in desires." I cited the *Neijing·Jue Lun* to verify. Zhengzhi joyfully said: "Ten years of doubt is now resolved. Even without medicine, I am half cured." I said: "Hot Jue has cold in the Upper Jiao; Cold Jue has heat in the Upper Jiao. For cold in the Upper Jiao, use warm agents to tonify Lung Metal. For heat in the Upper Jiao, use cool agents to clear Heart Fire. Take these two medicines continuously. Within ten days, Zhengzhi thanked me, saying both Cold and Hot Jue were cured." *Yuan Bing Shi* states that Jue has Yin and Yang distinctions. Yin Jue presents with Yin signs: cool body, no thirst, slow, fine, and minute pulse. Yang Jue presents with Yang signs: irritability, thirst, delirium, fever, and rapid pulse. If Yang Jue is extreme or untreated, leading to cold body and Yin signs with a faint, nearly imperceptible pulse leading to death, this is due to extreme heat. Wang Andao said: Extreme heat causing Jue is Yang extreme resembling Yin; extreme cold causing Jue is pure Yin without Yang. Yang extreme resembling Yin uses cold herbs; pure Yin without Yang uses hot herbs. This must be distinguished. Ye Shi said: The Cold and Hot Jue in *Neijing* refers to Yin and Yang Qi counterflow causing deficiency syndromes. Cold Jue tonifies Yang; Hot Jue tonifies Yin. This aligns with Wang Taipu's statement: "Strengthen the master of Water to suppress excessive Yang; benefit the source of Fire to eliminate Yin shadows." This tonifies the deficiency of True Water and True Fire. Zhongjing, Hejian, and Andao discussed Jue as cold extremities due to Shanghan. Since the syndromes differ, treatments differ. Cold Jue: Exterior heat, interior cold, diarrhea with undigested food, vomiting immediately after eating, deep and hidden pulse, cold extremities; treated with Sini Tang. Hot Jue: Abdominal fullness, heaviness, difficulty turning, greasy face, delirium, urinary incontinence, cold extremities with spontaneous sweating, deep and slippery pulse; treated with Baihu Tang. Hot Jue with hot extremities and wandering redness: Shengyang Xiehuo Tang. If stool is hard: Dachaihu Tang. Cold Jue with cold extremities: Fuzi Lizhong Tang. Cold fingertips (Qing): Lizhong Tang.
[Cold Jue with Cold Extremities] Deep, rapid, and full pulse indicates Heat. Li Dongyuan treated Zhongshu Tiehe Gong with coldness in feet, knees, buttocks, waist, and back, with a deep, rapid, and forceful pulse, using Huangbai Zishen Wan, cured after two doses. He also treated Zhongshu Zuocheng Yao Gongmao with upper heat and lower cold, cured with Jiji Jiedu Tang. Danxi treated Lv Zongxin with abdominal masses and cold feet up to the knees, cured with modified Dachengqi Tang. These are Cold Jue with Heat. Deep, fine, and minute pulse indicates Cold. Luo Qianfu treated Zhengnan Fuyuanshuai Datemu'er, aged 60, who campaigned in July and fell ill in mid-winter with spontaneous diarrhea of undigested food, cold pain in the umbilical and abdominal region, cold shanks, insensitivity to scratching, requiring heated stones for warmth without relief. Pulse was deep, fine, and minute. This was due to advanced age, weak Qi, deep penetration into enemy territory, complex military duties, morning and evening exposure to cold, irregular diet, excessive consumption of milk and cheese, living in damp lowlands, Yang failing to secure the exterior, allowing cold-dampness to invade deficiency, causing disease from below, hence cold and counterflow in the shanks. *Neijing* states: Contracting cold causes disease; mild cases cause cough, severe cases cause diarrhea and pain. This is cold-dampness combining to cause disease. Treatment should urgently dispel cold-dampness and strongly tonify Yang; only moxibustion can cure. First, moxa Qihai with large cones, 100 moxa units, to tonify Lower Jiao Yang deficiency. Second, moxiate Zusanli 21 units each, treating cold and counterflow in shanks, guiding Yang Qi downward. Third, moxiate Sanyinjiao to dispel cold-dampness in the feet. Prescription: For overwhelming cold, treat with acrid-hot; for external dampness, level with bitter-hot, dissipate with bitter. Fuzi, greatly acrid-hot, assists Yang, retreats Yin, warms meridians, and disperses cold as Sovereign herb. Ganjiang and Guizhi, greatly hot, acrid-sweet, also dispel cold-dampness; Baizhu and Banxia, bitter-acid-warm, dry Spleen dampness, as Ministers. Renshen, Caodoukou, and Gancao, greatly warm, tonify Middle and boost Qi; Shengjiang, greatly acrid-warm, dispels cold-dampness; Congbai, acrid-warm, unblocks Upper Jiao Yang Qi, as Assistants. Also: Tonifying lower and treating lower requires urgent preparation with strong flavor, hence large dosage. After a few doses, diarrhea stopped, pain reduced, shanks warmed, diet regulated, recovered in ten days. Next autumn, passing Xiangyang in rain, symptoms recurred after ten days. Re-moxa as before, adding Yangfu 14 units each, administering previous medicine, cured after a few doses. *Neijing* Cold Jue belongs to Kidney deficiency. Kidney governs Zhi (Will); insufficient Zhi causes Jue. Kidney deficiency causes Qing Jue and unhappiness. Lower deficiency causes Jue. All Jue, retention, and incontinence belong to the Lower Jiao. *Lingshu·Nishun Feishou*: Huangdi asked: Why does Shaoyin channel descend alone? Qibo said: No. Chong Mai is the Sea of Five Zang and Six Fu, receiving from all. Upper branch exits at Kangsang, seeps into Yang meridians, irrigates essence. Lower branch injects into Shaoyin's great Luo, exits at Qichong, follows inner thigh, enters yin, runs deep in bone, descends behind medial malleolus, then branches. Lower branch joins Shaoyin, seeps into Three Yin. Anterior branch runs deep, exits at Fusuo, follows dorsum, enters big toe, seeps into collaterals, warms muscles. If collateral knots, dorsum is immobile; immobile leads to Jue; Jue leads to cold. (Classics: Hard and tight meridians are treated with fire, i.e., moxibustion or herbal wine soak.) Yunqi Cold Jue has two types: One is Cold. Classics: Water qi is Jing Shun. Jing Shun cycle, disease is Jue. Year of excessive Water, cold qi spreads, evil harms Heart Fire, restlessness, palpitations, Yin Jue. Year of deficient Metal, flame fire acts, retaliation causes Yin Jue and obstruction. Two is Cold-Damp. Classics: Taiyin rules heaven, heaven qi descends, earth qi rises, people suffer Cold Jue. *Qianjin Fang* treats men with cold, immobile waist and feet: 3 dou good wine, 3 dou water, mix in urn, warm soak to knees, 3 days. Keep fire under urn to prevent cooling. Li Dongyuan: Classics say Jue in feet, Zong Qi does not descend, blood in meridians coagulates and stops; only fire can resolve it. Jiegu: Body hot as fire, feet cold as ice; moxa Yangfu. Leg acid-cold; moxa Jiegu.
[Hot Jue with Hot Extremities] Danxi said: Sicheng Shu always felt heat from ankles down since birth, could not add cotton in winter, claimed robust constitution不怕cold. I said: This is Foot Three Yin deficiency. Should abstain from sex, tonify and nourish Yin blood, perhaps avoidable. He laughed and refused. At 17, developed Wei syndrome, died in half a year. *Qianjin Fang* for hot hands and feet: 3 sheng urine, warm soak in basin. *Suwen* Hot Jue: Select Foot Taiyin and Shaoyang, retain needle.
Sudden unconsciousness Jue: Previously seen in Stroke/Jue Men. Here are mild cases not falling suddenly, not classified as stroke. Jue with phlegm tide, sawing sound in throat, is Phlegm Jue. First use Genti San, or Xixian San, or Ginseng Lu decoction to induce vomiting, then Daotan Tang with much Zhuli and little Jiangzhi. Sudden anger causing Qi counterflow and fainting is Qi Jue. Use Bawei Shunqi San, or Tiaoqi San, or Siqi Tang. Hand and foot spasms are Feng Jue. Use Xiao Xuming Tang. Alcohol-induced is Jiu Jue. Use Erchen Tang plus Gan Ge and Qing Pi, or Gehua Jieying Tang. Bone withering and claw pain is Gu Jue. Body straight as a rafter is Jue. Panting and distress is Yangming Jue. All due to Qi counterflow. Jue with abdominal fullness and unconsciousness, or recovering slightly after 1-2 days, all sudden confusion, due to pathogen chaos and Yang Qi counterflow, Shaoyin Kidney pulse absent. Kidney Qi weak, essence and blood rush, Qi急促, enters chest and hypochondrium, Zong Qi knots below heart, Yang Qi retreats, heat returns to thighs and abdomen, assisting Yin, causing insensitivity. Five collaterals meet at ears. Exhaustion of five collaterals causes whole body pulse movement but form insensible, like corpse, hence Shi Jue. Due to Zang Qi conflict or external pathogen clash, Qi stagnates, blocked in meridians, pulses hide, unconscious. Treat by opening Zang Qi: Cold with Heat, Heat with Cold, Blockage with Opening. Zhongjing: Shi Jue pulse moves but no Qi, Qi blocked, hence still and dead. Blow Schisandra powder into nostrils, place Cinnamon on tongue. Cut left corner hair square inch, burn to ash, mix with wine,灌, wake immediately. Blow air into ears with bamboo tube. Huanhun Tang. Sudden death, cold extremities, unconscious, abdominal Qi rumbling like thunder, is Shi Jue. Yanxiao 5 qian, Liuhuang 2 qian, grind fine, divide into 3 doses. Each dose decoct in 1 large cup good aged wine. When Yanxiao fumes rise, pour into basin, cover, warm drink. After walking 5 li, take next dose. Not more than 3 doses to wake. Moxa Baihui 49 units, Qihai and Dantian 300 units. Stop moxa when body warms. If no previous medicine, use 1 prepared black Fuzi, 1 liang Renshen, divide into 2 doses, decoct in 3 cups wine, or with Ginger juice and wine. Moxa Baihui, moxa cone size of mung bean, coarse hurts person.
[Diagnosis] Deep, minute, not rapid pulse is Cold Jue. Deep, hidden, rapid pulse is Hot Jue. Fine pulse is Qi deficiency. Large like scallion tube is Blood deficiency. Floating, rapid is Phlegm. String-taut, rapid is Heat. Floating is External Contraction. Pulse like panting is Qi Jue. Cun position deep, large, and slippery: Deep is Excess, Slippery is Qi,