【因】厥有二症。曰阳厥。曰阴厥。阳厥者。热厥也。必先自三阳传入阴分。故初起必因头痛发热。自浅入深。
然后及于三阴。变为四肢逆冷。或时乍温。其证由邪热内结。或伏阳失下之所致也。阴厥者。寒厥也。
初无三阳传经实热等证。仲景曰。凡厥者。阴阳气不相顺接。便为厥。厥者。手足逆冷是也。
【证】阳厥证初起。必头痛发热。然后入于三阴。变为四肢逆冷。或时乍温。其症必便结躁烦。
谵语发渴。不恶寒。反恶热。吴云峰云。阳厥者。外感六淫初起。头疼身热。口干脉数。或变乍凉乍冷。
有似阴证。但寒不过肘膝。冷不过一时。大便闭结。目红溺赤。此热邪入里。气血不得宣通。所谓阳
极发厥。火极似水也。阴厥证。畏寒厥冷。腹痛吐泻。战栗不渴。脉沉无力者。此阴寒厥逆。独阴
无阳也。故为阴厥。吴云峰云。阴厥者。素有内寒。或食凉物。或中寒邪。或因病后自汗自利。变而
身寒厥冷。倦卧不渴。面青溺白。脉沉细迟。忽然烦躁不宁。欲坐卧泥水井中。此阴极发躁。阴竭似阳
也。脏厥证。仲景曰。伤寒脉微而厥。至七八日肤冷。其人躁无暂安时者。此为脏厥。其人必心腹痛。
脏厥者死。阳气绝也。蛔厥证。其人当吐蛔。令病者静而复时烦。此为脏寒。蛔上入膈故烦。须臾复止。
得食而呕。又烦者。蛔闻食臭出。其人当自吐蛔。蛔厥者。乌梅丸主之。成无己云。蛔厥虽厥而烦。
蛔吐已则静。不若脏厥而躁无暂安时也。病患脏寒胃虚。故宜与乌梅丸。温脏安蛔。此仲景之论厥也。
至于《内经》论厥则不同。以猝然倒仆。昏冒不知人。手足冰冷。色脱口噤。状若中风。但无歪斜搐
搦之异。夫厥者。尽也。逆者。乱也。即气血败乱之谓也。景岳云。凡厥之将作。则寒热麻痹。必先
由手足而起。卒然仆倒。手足冰冷。面色不泽。昏冒不知。牙关紧闭。或六脉沉伏。状若中风。而
无痰声搐搦之异。
【脉】凡伤寒阳厥。脉沉有力。阴厥脉沉无力。李士材云。阴厥脉沉弱。指甲青而冷。阳厥脉沉滑。
指甲红而
温。脏厥脉微而厥。寸口脉沉实滑大。为痰气食厥诸有余之证。微濡而弦。为阴阳虚厥诸不足之证。
大小无常为尸厥。沉细无力为蛔厥。浮大者风。紧细者寒。芤数暑热。促急瘴湿。涩滞血逆。无脉脱元。
【治】阳厥厥微则热亦微。宜四逆散。（柴胡、芍药、枳实、甘草。）厥甚热亦甚。宜承气汤。
或三黄石膏汤。中寒阴厥。轻则理中汤。重则四逆回阳等汤。寒厥三建汤（川乌、附子、天雄、生姜
水煎。）加人参。热厥人参白虎汤。（荣斋按。《内经》的论厥。着重是在元气。所以热厥当补阴。
寒厥当补阳。《伤寒》的论厥。辨在邪气。所以寒厥宜温。热厥宜清。甚至可以攻下。这里是根据《伤寒论》
而辨证施治的。）蛔厥理中汤。加乌梅炒花椒。煎厥因于烦劳过度。阳气外张。阴精内竭者。宜六
味地黄汤加知母、黄柏、龟版。因于元气虚衰。不能收摄阴火。而昏昧卒仆发厥。脉软数者。宜黄 人
参汤（人参、黄 、生地、麦冬、五味子、天冬、黄柏、炙甘草。）薄厥因大怒则形气绝。血菀于上。
使人薄厥。宜犀角地黄汤。加消瘀降气之品。或八味顺气散（人参、白术、青皮、陈皮、茯苓、白芷、
乌药、甘草。）痰厥者。忽然气闷痰鸣。吐涎肢冷。脉见沉滑。重者不醒。为痰中。轻者渐醒为痰厥。
宜导痰汤。（制半夏、制南星、枳实、茯苓、陈皮、甘草、姜。）或四君子汤加竹沥、姜汁。尸厥因
冒犯不正之气。如登 入庙。吊死问丧。猝中恶气。忽然肢冷口噤。昏晕妄言。则为尸厥。治以苏合香丸。
姜汁调灌之。更宜醋炭薰鼻即醒。气厥之证有二。气虚气实。皆能为厥。实则形气愤然。卒倒肢冷。
口无涎沫。其脉沉弦或伏。治宜顺气调肝。四磨饮。乌药顺气汤之类。与中风身温多痰涎者大异。
虚则形气索然。色青脉弱。肢体微冷。治当大补元气。如补中益气汤。八珍汤。皆可选用。血厥之证
亦有二。血逆血脱。皆能为厥。逆则因产后适有恚怒而见者。血从气逆。必先调气。与薄厥相似。气
行则血亦行。重者、宜桃仁
承气汤。血脱如大吐大崩。或产后恶露过多不止。则气随血散。卒仆无知。宜先掐人中。或烧醋炭。
以收其气。急服独参大剂。血脱益气之法也。（荣斋按。血逆而厥。可用白薇汤。──白薇一两、
当归一两、人参、甘草各一钱。水煎服。）因醉得者为酒厥。宜葛花解酲汤。因饱得者为食厥。如
饮食醉饱之后。或感风寒。或着恼怒。食填胸中。胃气不行。须臾厥逆。名曰食厥。证必昏迷不醒。
肢不能举。气口脉形急大。或沉伏为辨。先以盐汤探吐。吐不出者危。再以和平消导治之。如二陈汤
加枳、朴、楂、曲。又有男女交接而厥脱者。多致不救。男子名脱阳。宜参附汤加鹿茸。其死后阳事
不倒。女子名脱阴。宜参附汤。合龟鹿二仙胶。或梦中遗泄而脱者。名脱元。其阳必举。精必遗泄。
形容犹带喜笑。体温者。宜参附汤。加熟地。急煎灌救之。体冷则不治矣。
【秀按】《内经》所谓阳气衰于下。则为寒厥。必肢冷脉沉微数。或虽数无力。然似热非热之证尤多。故凡手足
逆冷。而脉证无实热者。即寒厥也。宜益元汤。附子理中汤。阴气衰于下则为热厥。必先多热。脉沉滑而数。
畏热喜冷。或烦躁便闭。形证多昏冒。因乘醉入房。湿热下陷。酒气 悍。肾水日衰。阳气独盛。阴水渐涸。
令人发厥。宜壮水之主。六味地黄汤。以足三阳起于足趾之端。足三阴聚于足心之下。故热厥必从足下始。而
阴虚之病。足心多热也。寒厥必起于足五趾。而上行于膝。所以阳虚之病。四肢多不温也。故寒厥补阳。热厥
补阴。正合王太仆壮水之主。以制阳亢。益火之源。以消阴翳之法也。《经》云。血与气并走于上。则为大厥。
厥者暴死。又云。内夺而厥。则为 痱。此肾虚也。或曰肾厥。沈又彭云。厥证卒倒。是下气逆上之病。《经》
云。气复返则生。不返则死。言气复返于下。非散而复聚之谓。首章言病状。次章言病因。一由于肾。一由于
肝也。《经》言内夺。病发于肾。肾脏藏精。即真阴也。而真阳亦寓矣。肾络上挟舌本。阳喜升浮。藉阴涵吸。若
内夺其精。则阳气无根据。升浮于上。涎随气逆。填塞舌络。故舌 不能言。阳气既升而下焦存阳必微。故足
痱不能履。倘能绝欲戒怒。犹未至大厥也。《经》云。大怒病发于肝也。肝为风木之脏。性最喜升。其络循喉咙之
后。上至巅顶。精血足则肝阳有所附。虽怒亦不至大厥。惟精血衰少之人。失于涵蓄。肝阳本自易动。怒则勃
然而上。通身之气血随之。则下焦之气脱矣。故卒倒。上焦之气壅矣。故不言。是名大厥。又名暴厥。此解甚
是。吴云峰云。蛔厥者。其人素有食蛔在胃。又犯寒伤胃。或饥不得食。蛔求食而上攻。或外感证。不应发
汗。而妄发其汗。以致胃气虚寒。虫上入膈。舌干口燥。漱水不欲咽。烦躁昏乱。手足逆冷。不省人事。甚至
吐蛔。宜理中安蛔汤（人参、白术、茯苓、炒川椒、乌梅、生姜。）治之。勿用甘草。勿食甜物。盖蛔虫得甘
则动。得苦则安。得酸则静。得辛则伏故也。亦有食填太阴。脘腹痛而吐蛔者。温中化滞为宜。厥证身温汗
出。入腑者生。身冷唇青。入脏者凶。如手冷过肘。足冷过膝者死。指甲红赤者生。青黑者死。或醒或未醒。
或初病。或久病。忽吐出紫红色痰涎者死。如口开手撒。五脏绝症已见一二。惟大剂参 。兼灸气海丹田。间
有得生者。
【廉勘】厥者。从下逆上之病也。惟厥症返魂丹（方见前）可以统治诸厥。邵新甫云。大抵杂证变生之厥。
与伤寒门所载者有间。想是证气血日偏。阴阳一并而成。譬如风雷之猛烈郁极而发也。若发而渐复者。犹可转危
为安。若发而转逆者。必至直拔根 乃已。斯存亡之机。在乎命脏之盈亏耳。考方书之名目不一。致病之因由
亦繁。大抵可吐者。如痰食填塞于胸中。用瓜蒂散之类。及烧盐探引方法。可清可折者。如厥阴壮火升逆而无
制。用玉女煎。及宣明龙荟丸法。可开可降者。如气厥薄厥。而形气暴绝。五磨饮子。及菖蒲酒法。秽浊蒙
邪。而昏乱无知。有牛黄至宝丹。及苏合香丸之两法。飞尸卒厥。先宜酒醋以引导。并可按穴而施针法及灸
法。若从虚而论者。如内夺而厥。则为 痱。或谓风厥。有地黄饮子之通摄下焦法。烦劳阳张。令人煎厥。有
人参固本丸。加入金箔方。血厥而阳腾络沸。参乎从阴从阳法。色厥而精脱于下。急与大剂挽元法。肾厥宗许
学士椒附以通阳。蛔厥有仲景之安蛔法。阳极用救阴峻剂。阴极有扶阳方法。种种规模。已属全备。参考叶案
中自明。香岩于是证独重在肝。盖肝者将军之官。善于他脏者也。要知肝气一逆。则诸气皆逆。气逆则痰生。
遂火沸风旋。神迷魂荡。无所不至矣。若犯于上者。不免凌肺烁液。有麦门冬汤。及琼玉膏之补金柔制法。若
犯于中。而为呕为胀者。用六君子去术。加木瓜、姜、芍之类。及附子粳米汤。加人参。为补胃凝肝法。若
震及心脾而为悸为消者。用甘麦大枣汤。合龙牡之属。为缓急重镇法。若挟少阳之威。而乘巅摇络者。用羚
角、钩藤、玄参、连翘之剂。为熄风清络法。若本脏自病。而体用失和者。以椒梅桂芍之类。为益体宣用
法。若因母脏之虚。而扰及子脏之位者。用三才、配合龟甲、磁朱。及复脉减辛、味、复入鸡子黄之属。为安
摄其子母法。至于痿厥之法。尤觉神奇。取血肉介类。改汤为膏。谓其力味着实。填隙止厥最速。此岂非补
前人之未备。开后学之法门者乎。参阅叶案者。幸毋忽诸。朱遂生云。按吴氏所谓冷如冰。热如火。乃厥逆之
厥。若《经》所谓大厥、薄厥、阳厥、风厥、阴厥、尸厥等类。治法宜通阴纳阳。降气镇肝。开窍行血涤痰。王氏
妇、病气厥。昏不知人。腿强直。两臂忽上忽下。忽左忽右。脉不得诊。用铁落饮。和紫金锭。灌之立愈。二
年中、连发三次。如法治之皆效。乙己岁腊月十有一日三句钟。沙氏妇突患奇病。骨如播鼓。动摇不已。二三
人力不能持。言语迷离。自云头为人窃去。在九里以外。叩魂送祟者纷纷然。诊之脉如平人。因思诸风掉眩。
皆属于肝。足厥阴逆传手厥阴。则风邪上乘心包而窍闭。用铁锤烧赤淬水。煎钩藤、芍药。和紫金锭、一枚灌
之。移时神清。而形不复摇动矣。此亦厥病之类也。
【荣斋按】寒厥用四逆汤，热厥用四逆散，研究《伤寒论》者皆知之；不过二者的辨证怎样？辨证的关
键何在？则大有研究价值。前贤成无己、喻嘉言、陆定圃等，都有深湛的辨证经验，兹摘要介绍于下。成无己说∶“凡
厥若始得之，手足便厥而不温者；是阴经受邪，阳气不足，可用四逆汤。若手足自热而至温，从四逆而至厥
者，传经之邪也；四逆散主之。”喻嘉言说∶“凡伤寒病初得发热，煎熬津液，鼻干、口渴、便秘，渐至发厥
者；不问而知为热也。若阳证忽变阴厥者，万中无一。盖阴厥得之阴证，一起便直中真阴经，唇青面白，遍体
冷汗，便利不渴，身倦多睡，醒则人事了了；与伤寒传经之热邪，转入转深，人事昏惑者，万万不同。”陆定
圃说∶“厥有阴阳二症，李士材谓阴厥脉沉弱，指甲青而冷，阳厥脉沉滑，指甲红而温。余谓阴证似阳，未可
以脉沉弱指甲青冷为凭；凡证见烦躁欲裸形，或欲坐卧泥水中，舌苔淡黄，口燥齿浮，面赤如微酣，或两颧浅
红，游移不定，言语无力，纳少胸闷，渴欲饮水，或咽喉痛而索水至前，复不能饮，肌表虽大热，而重按不
热，或反觉冷，或身热反欲得衣；且两足必冷，小便清白，下利清谷；脉沉细、或浮数，按之欲散，亦有浮大
满指，而按之必无力。是宜温热之剂，药须凉服，从其类以求之也。”以上三家学说，前两家分辨阴厥与阳厥
的不同点；后一家则把阴证似阳的阴厥证，从疑似之间找出问题，同中求异，辨别得极为精审。关于色厥，
毛退之《中西医话》载∶“色厥者，其人本虚，偶因奇遇，而悉力勉为者有之；或因相慕日久，而纵竭情欲者亦有
之；故于事后，则气随精去，而暴脱不反。”但我认为这是“色脱”，由于它的原因是“气随精去”，所以证
见“暴脱不反”而不是“厥逆”现象。另有一种不即病而病此者，各家医书认为这是∶“精去于频，而脱于
渐，每多于房欲两三日之后，方见此证。但因其病不在即，故不以为此病，兼人多讳此，而不知中年之后，多
有因此而病者；是即所谓色厥也。奈时师不能察，而每以中风毙之耳！凡治此者，单以培养命门，或水或火，
当以参 峻补元气，熟地、当归、肉苁蓉、杞子填补真阴。”这与廉臣先生所说“急与大剂挽元法”是后先一
辙的。至于尸厥，古法皆以苏合香丸为治，而沈奉江有一则经验治法，载在《医验随笔》；“南门外某姓，
【病因】厥证有两种类型：一种是阳厥，另一种是阴厥。所谓阳厥，就是热厥。它必定先由三阳经传入阴分，所以初起时必然有头痛、发热的症状，病邪由浅入深，然后波及三阴经，导致四肢逆冷，有时又暂时回暖。这种病症是由于邪热内结，或者伏留的阳气未能及时攻下所致。所谓阴厥，就是寒厥。起初并没有三阳经传经实热等证候。张仲景说：“凡是厥证，都是阴阳之气不能顺接，这就叫厥。厥的表现就是手足逆冷。”
【证候】阳厥在初起时，必定有头痛发热，然后病邪进入三阴经，转变为四肢逆冷，有时又暂时回暖。其症状必定有大便干结、烦躁不安、说胡话（谵语）、口渴、不怕冷反而怕热。吴云峰说：阳厥是外感六淫之邪初起时，出现头痛身热、口干、脉数，有时突然变凉变冷，看起来像阴证。但寒冷不过过肘膝，冷的时间不过一时辰，大便闭结，眼睛发红，小便赤黄。这是热邪入里，气血不能宣通，也就是所谓的“阳极发厥”，火极似水。阴厥的症状是畏寒、四肢厥冷、腹痛、呕吐腹泻、战栗、不口渴、脉沉无力。这是阴寒导致的厥逆，只有阴气而没有阳气，所以称为阴厥。吴云峰说：阴厥的人，素来体内有寒，或者吃了凉的东西，或者感受了寒邪，或者因为病后自汗、自利，导致身体寒冷、四肢厥冷、疲倦想睡、不口渴、面色青白、小便清白、脉象沉细迟。忽然出现烦躁不宁，想要坐在泥水井中。这是阴极发躁，阴竭似阳。脏厥证，张仲景说：“伤寒脉微而厥，到了七八天皮肤也冷，其人躁动没有片刻安宁的时候，这叫脏厥。这种人必定心腹疼痛。脏厥是死证，因为阳气已经绝灭。”蛔厥证，这种人应当吐蛔虫。病人安静下来却又时不时心烦，这是因为内脏虚寒，蛔虫上行进入膈部所以心烦。过了一会儿又停止。吃东西就呕吐，又心烦，是因为蛔虫闻到食物的气味就出来。这种人应当自己吐出蛔虫。蛔厥用乌梅丸主治。成无己说：蛔厥虽然有厥逆和心烦，但蛔虫吐出后就安静了，不像脏厥那样躁动没有片刻安宁。病人内脏虚寒、胃气虚弱，所以适宜给予乌梅丸，温补脏腑、安蛔止痛。这就是张仲景关于厥证的论述。至于《内经》论述的厥则不同，是指突然跌倒昏迷，神志不清，手足冰冷，面色苍白，牙关紧闭，状如中风，只是没有口眼歪斜和抽搐的区别。所谓“厥”，是尽的意思；“逆”，是乱的意思。即指气血败乱的状态。张景岳说：凡是厥证将要发作时，寒热麻痹，必定先从手足开始，突然仆倒，手足冰冷，面色无光泽，昏沉不知人事，牙关紧闭，或者六脉沉伏，状如中风，但没有痰声和抽搐的区别。
【脉象】凡是伤寒阳厥，脉象沉而有力；阴厥脉象沉而无力。李士材说：阴厥脉象沉弱，指甲青紫而冷；阳厥脉象沉滑，指甲红润而温。脏厥脉微而厥，寸口脉沉实滑大，是痰气食厥等有余之证；脉象微濡而弦，是阴阳虚厥等不足之证。脉象大小无常是尸厥；脉象沉细无力是蛔厥；脉浮大的是风厥；脉紧细的是寒厥；脉芤数是暑热；脉促急是瘴湿；脉涩滞是血逆；无脉是元气脱失。
【治法】阳厥如果厥逆轻微，热邪也轻微，宜用四逆散。（柴胡、芍药、枳实、甘草。）如果厥逆严重，热邪也严重，宜用承气汤，或者三黄石膏汤。中寒导致的阴厥，轻症用理中汤，重症用四逆回阳等汤。寒厥用三建汤（川乌、附子、天雄，生姜水煎），加人参。（徐荣斋按：《内经》论述厥证，着重在于元气，所以热厥应当补阴，寒厥应当补阳。《伤寒论》论述厥证，辨析在于邪气，所以寒厥宜温，热厥宜清，甚至可以攻下。这里是根据《伤寒论》进行辨证施治的。）蛔厥用理中汤，加炒乌梅、花椒。煎厥是因为烦劳过度，阳气外张，阴精内竭，宜用六味地黄汤加知母、黄柏、龟版。如果是由于元气虚衰，不能收摄阴火，导致昏昧突然仆倒发厥，脉象软数，宜用人参汤（人参、黄芪、生地、麦冬、五味子、天冬、黄柏、炙甘草）。薄厥是因为大怒导致形体和气机隔绝，血液郁积于上部，使人发生薄厥，宜用犀角地黄汤，加消瘀降气的药物，或者八味顺气散（人参、白术、青皮、陈皮、茯苓、白芷、乌药、甘草）。痰厥者，忽然气闷痰鸣，吐涎沫，四肢冷，脉象见沉滑。重症不醒，称为痰中；轻症逐渐清醒，称为痰厥。宜用导痰汤。（制半夏、制南星、枳实、茯苓、陈皮、甘草、姜。）或者四君子汤加竹沥、姜汁。尸厥是因为冒犯了不正之气，如登高入庙、吊丧问疾，猝然中了恶气，忽然四肢冷、牙关紧闭、昏晕胡言，这就是尸厥。治疗用苏合香丸，用姜汁调服灌下。更宜用醋炭熏鼻即可苏醒。气厥证有两种：气虚和气实，都能导致厥证。实证是形气愤懑，突然倒下，四肢冷，口无涎沫，脉象沉弦或伏。治疗宜顺气调肝，用四磨饮、乌药顺气汤之类。这与中风身温多痰涎者大不相同。虚证是形气索然，面色青，脉弱，肢体微冷。治疗应当大补元气，如补中益气汤、八珍汤，都可以选用。血厥证也有两种：血逆和血脱，都能导致厥证。血逆多见于产后适逢愤怒而发病，血随气逆，必须先调理气机，与薄厥相似。气行则血亦行，重症宜用桃仁承气汤。血脱如大吐血、大崩漏，或者产后恶露过多不止，则气随血散，突然仆倒无知。宜先掐人中穴，或者烧醋炭，以收敛其气，急服独参大剂。这是血脱益气的治法。（徐荣斋按：血逆致厥，可用白薇汤——白薇一两、当归一两、人参、甘草各一钱，水煎服。）因醉酒得的是酒厥，宜用葛花解酲汤。因饱食得的是食厥，如在饮食醉饱之后，或者感受风寒，或者遭遇恼怒，食物填塞胸中，胃气不行，一会儿就发生厥逆，名叫食厥。症状必定昏迷不醒，肢体不能举起，气口脉象急大，或者沉伏作为辨别依据。先用盐汤探吐，吐不出来的危险。再用平和的药物消导治疗，如二陈汤加枳壳、厚朴、山楂、神曲。又有男女交接而导致厥脱的，多导致无法救治。男子名叫脱阳，宜用参附汤加鹿茸。死后阳事不倒的，女子名叫脱阴，宜用参附汤，合龟鹿二仙胶。或者梦中遗泄而脱的，名叫脱元，其阴茎必举，精液必遗泄，面容还带有喜笑之色，体温尚存的，宜用参附汤加熟地，急煎灌救。身体冷的就无法救治了。
【秀按】《内经》所说的阳气衰于下，则为寒厥，必定肢冷脉沉微数，或者虽然数但无力，然而似热非热的证候尤其多。所以凡是手足逆冷，而脉证没有实热的，就是寒厥。宜用益元汤、附子理中汤。阴气衰于下则为热厥，必定先有多热，脉沉滑而数，畏热喜冷，或者烦躁大便闭结，形证多昏沉。因为乘醉行房，湿热下陷，酒气悍烈，肾水日渐衰退，阳气独盛，阴水渐涸，令人发厥。宜壮水之主，用六味地黄汤。因为足三阳经起于足趾之端，足三阴经聚于足心之下，所以热厥必定从足下开始，而阴虚的病，足心多热。寒厥必定起于足五趾，而上行于膝，所以阳虚的病，四肢多不温暖。所以寒厥补阳，热厥补阴，正符合王太仆“壮水之主，以制阳光；益火之源，以消阴翳”的方法。《内经》说：血与气并走于上，则为大厥。厥就是暴死。又说：内夺而厥，则为痱。这是肾虚。有人说这是肾厥。沈又彭说：厥证突然跌倒，是下气逆上的病。《内经》说：气复返则生，不返则死。意思是气复返于下，不是散而复聚的意思。首章讲病状，次章讲病因，一个由于肾，一个由于肝。《内经》说内夺，病发于肾。肾脏藏精，即真阴，而真阳也寓于其中。肾络上挟舌本，阳喜升浮，藉阴涵吸。如果内夺其精，则阳气无根据，升浮于上，涎随气逆，填塞舌络，所以舌强不能言。阳气既升而下焦存阳必微，所以足痱不能履地。如果能绝欲戒怒，还不至于大厥。《内经》说：大怒病发于肝。肝为风木之脏，性最喜升，其络循喉咙之后，上至巅顶。精血足则肝阳有所依附，虽怒也不至大厥。只有精血衰少之人，失于涵蓄，肝阳本自易动，怒则勃然而上，通身之气血随之，则下焦之气脱矣。所以突然跌倒。上焦之气壅滞，所以不言语。这名叫大厥，又名暴厥。这个解释很正确。吴云峰说：蛔厥的人，素来胃中有食蛔，又犯寒伤胃，或者饥饿不得进食，蛔虫求食而上攻；或者外感证，不应发汗而妄发其汗，以致胃气虚寒，虫上入膈，舌干口燥，漱水不欲咽，烦躁昏乱，手足逆冷，不省人事，甚至吐蛔。宜用理中安蛔汤（人参、白术、茯苓、炒川椒、乌梅、生姜）治疗。不要用甘草，不要吃甜物。因为蛔虫得甘则动，得苦则安，得酸则静，得辛则伏。也有食物填塞太阴，脘腹痛而吐蛔的，温中化滞为宜。厥证身体温暖出汗，入腑者生；身体冷嘴唇青，入脏者凶。如手冷过肘，足冷过膝者死。指甲红赤者生，青黑者死。或者醒或未醒，或者初病，或者久病，忽然吐出紫红色痰涎者死。如口开手撒，五脏绝症已见一二，惟有大剂人参，兼灸气海丹田，间或有得生的。
【廉勘】厥证，是从下向上逆的病。只有厥症返魂丹（方见前）可以统管各种厥证。邵新甫说：大抵杂证变生之厥，与伤寒门所载者有所不同。猜想这个证是气血日渐偏颇，阴阳一并而成。譬如风雷猛烈，郁极而发。如果发作后逐渐恢复的，还可以转危为安；如果发作后反而逆乱的，必至根拔而死。这存亡的关键，在于命门的盈亏。考证医书名称不一，致病原因也繁杂。大抵可吐的，如痰食填塞于胸中，用瓜蒂散之类，以及烧盐探引方法；可清可折的，如厥阴壮火升逆而无制，用玉女煎，及宣明龙荟丸法；可开可降的，如气厥薄厥，而形气暴绝，用五磨饮子，及菖蒲酒法；秽浊蒙邪，而昏乱无知，有牛黄至宝丹，及苏合香丸两法；飞尸卒厥，先宜酒醋以引导，并可按穴而施针法及灸法。若从虚而论的，如内夺而厥，则为痱，或者谓之风厥，有地黄饮子的通摄下焦法；烦劳阳张，令人煎厥，有人参固本丸加入金箔方；血厥而阳腾络沸，参乎从阴从阳法；色厥而精脱于下，急与大剂挽元法；肾厥宗许学士椒附以通阳；蛔厥有仲景之安蛔法；阳极用救阴峻剂，阴极有扶阳方法。种种规模，已属全备。参考叶案自然明白。香岩对此证独重在肝。盖肝者是将军之官，善于他脏。要知肝气一逆，则诸气皆逆。气逆则痰生，遂火沸风旋，神迷魂荡，无所不至。若犯于上者，不免凌肺烁液，有麦门冬汤，及琼玉膏的补金柔制法。若犯于中，而为呕为胀的，用六君子去术，加木瓜、姜、芍之类，及附子粳米汤加人参，为补胃凝肝法。若震及心脾而为悸为消的，用甘麦大枣汤，合龙牡之属，为缓急重镇法。若挟少阳之威，而乘巅摇络的，用羚羊角、钩藤、玄参、连翘之剂，为熄风清络法。若本脏自病，而体用失和的，以椒梅桂芍之类，为益体宣用法。若因母脏之虚，而扰及子脏之位的，用三才、配合龟甲、磁朱，及复脉减辛、味、复入鸡子黄之属，为安摄其子母法。至于痿厥之法，尤觉神奇。取血肉介类，改汤为膏，谓其力味着实，填隙止厥最速。这岂不是补充前人的未备，开启后学的法门吗？参阅叶案的，希望不要忽视。朱遂生说：按吴氏所谓冷如冰，热如火，乃厥逆之厥。若《经》所谓大厥、薄厥、阳厥、风厥、阴厥、尸厥等类，治法宜通阴纳阳，降气镇肝，开窍行血涤痰。王氏妇，病气厥，昏不知人，腿强直，两臂忽上忽下，忽左忽右，脉不得诊。用铁落饮，和紫金锭，灌之立愈。两年中，连发三次，如法治之皆效。乙巳年腊月十一日三点钟，沙氏妇突患奇病，骨如播鼓，动摇不已，二三人力不能持，言语迷离，自云头为人窃去，在九里以外，叩魂送祟者纷纷然。诊之脉如平人。因思诸风掉眩，皆属于肝。足厥阴逆传手厥阴，则风邪上乘心包而窍闭。用铁锤烧赤淬水，煎钩藤、芍药，和紫金锭一枚灌之。移时神清，而形不复摇动矣。此亦厥病之类也。
【荣斋按】寒厥用四逆汤，热厥用四逆散，研究《伤寒论》的人都知道；不过二者的辨证怎样？辨证的关键何在？则大有研究价值。前贤成无己、喻嘉言、陆定圃等，都有深湛的辨证经验，兹摘要介绍如下。成无己说：“凡厥若始得之，手足便厥而不温者；是阴经受邪，阳气不足，可用四逆汤。若手足自热而至温，从四逆而至厥者，传经之邪也；四逆散主之。”喻嘉言说：“凡伤寒病初得发热，煎熬津液，鼻干、口渴、便秘，渐至发厥者；不问而知为热也。若阳证忽变阴厥者，万中无一。盖阴厥得之阴证，一起便直中真阴经，唇青面白，遍体冷汗，便利不渴，身倦多睡，醒则人事了了；与伤寒传经之热邪，转入转深，人事昏惑者，万万不同。”陆定圃说：“厥有阴阳二症，李士材谓阴厥脉沉弱，指甲青而冷，阳厥脉沉滑，指甲红而温。余谓阴证似阳，未可以脉沉弱指甲青冷为凭；凡证见烦躁欲裸形，或欲坐卧泥水中，舌苔淡黄，口燥齿浮，面赤如微酣，或两颧浅红，游移不定，言语无力，纳少胸闷，渴欲饮水，或咽喉痛而索水至前，复不能饮，肌表虽大热，而重按不热，或反觉冷，或身热反欲得衣；且两足必冷，小便清白，下利清谷；脉沉细、或浮数，按之欲散，亦有浮大满指，而按之必无力。是宜温热之剂，药须凉服，从其类以求之也。”以上三家学说，前两家分辨阴厥与阳厥的不同点；后一家则把阴证似阳的阴厥证，从疑似之间找出问题，同中求异，辨别得极为精审。关于色厥，毛退之《中西医话》载：“色厥者，其人本虚，偶因奇遇，而悉力勉为者有之；或因相慕日久，而纵竭情欲者亦有之；故于事后，则气随精去，而暴脱不反。”但我认为这是“色脱”，由于它的原因是“气随精去”，所以证见“暴脱不反”而不是“厥逆”现象。另有一种不即病而病此者，各家医书认为这是：“精去于频，而脱于渐，每多于房欲两三日之后，方见此证。但因其病不在即，故不以为此病，兼人多讳此，而不知中年之后，多有因此而病者；是即所谓色厥也。奈时师不能察，而每以中风毙之耳！凡治此者，单以培养命门，或水或火，当以参芪峻补元气，熟地、当归、肉苁蓉、杞子填补真阴。”这与廉臣先生所说“急与大剂挽元法”是后先一脉的。至于尸厥，古法皆以苏合香丸为治，而沈奉江有一则经验治法，载在《医验随笔》：“南门外某姓，
[Etiology] There are two types of Jue (syncope/cold extremities): Yang Jue and Yin Jue. Yang Jue is also known as Heat Jue. It must first transmit from the Three Yang meridians into the Yin compartments. Therefore, at the onset, there must be headache and fever. The pathogen moves from shallow to deep, then affects the Three Yin meridians, resulting in cold extremities that may temporarily warm up. This syndrome is caused by internal binding of evil heat or failure to purge latent yang. Yin Jue is also known as Cold Jue. Initially, there are no excess-heat syndromes characteristic of meridian transmission from the Three Yang meridians. Zhang Zhongjing stated: "In all cases of Jue, the yin and yang qi fail to connect smoothly, which constitutes Jue. The manifestation of Jue is cold extremities."
[Symptoms] In the initial stage of Yang Jue, there must be headache and fever, after which the pathogen enters the Three Yin meridians, transforming into cold extremities that may temporarily warm up. Symptoms must include constipation, restlessness, delirium, thirst, aversion to cold being absent but aversion to heat present. Wu Yunfeng said: Yang Jue occurs when external contraction of the Six Evils initially presents with headache, body heat, dry mouth, and rapid pulse. It may suddenly become cool and cold, resembling a Yin syndrome. However, the coldness does not extend beyond the elbows and knees, and lasts only for a short time. Stool is closed, eyes are red, and urine is dark red. This indicates heat pathogen entering the interior, where qi and blood cannot circulate freely. This is what is called "Extreme Yang leading to Jue," where extreme fire resembles water. Symptoms of Yin Jue include aversion to cold, cold extremities, abdominal pain, vomiting and diarrhea, tremors, absence of thirst, and a deep, forceless pulse. This is Jue reversal due to yin-cold, characterized by yin without yang, hence named Yin Jue. Wu Yunfeng said: Patients with Yin Jue typically have internal cold, or have consumed cold food, or contracted cold pathogen, or suffered spontaneous sweating and diarrhea after illness, leading to cold body and extremities, fatigue, desire to lie down, absence of thirst, cyanotic complexion, clear urine, and a deep, fine, slow pulse. Suddenly, they become restless and agitated, desiring to sit in mud or well water. This is "Extreme Yin leading to agitation," where yin exhaustion resembles yang. Zang Jue (Visceral Jue) syndrome: Zhang Zhongjing said, "In Shanghan, if the pulse is faint and there is Jue, and by the seventh or eighth day the skin is cold, and the patient is restless with no moment of peace, this is Zang Jue. Such patients must have heart and abdominal pain. Zang Jue is a death syndrome because yang qi has been exhausted." Hui Jue (Roundworm Jue) syndrome: The patient should vomit roundworms. The patient is quiet but occasionally becomes irritable; this is due to visceral cold, causing roundworms to move upward into the diaphragm, causing irritability. After a while, it stops again. Vomiting occurs after eating, accompanied by irritability, because the roundworms come out upon smelling food. The patient should spontaneously vomit roundworms. Hui Jue is treated with Wumei Wan (Mume Pill). Cheng Wuji said: Although Hui Jue presents with Jue and irritability, the irritability ceases once the roundworms are vomited, unlike Zang Jue where restlessness knows no pause. Since the patient's viscera are cold and stomach qi is deficient, Wumei Wan is appropriate to warm the viscera and pacify roundworms. This is Zhang Zhongjing's discussion on Jue. However, the discussion of Jue in *Neijing* differs; it refers to sudden collapse, coma, cold extremities, pale complexion, clenched jaw, resembling wind-stroke but without deviation or convulsions. "Jue" means exhaustion; "Ni" (reversal) means chaos, referring to the disorder of qi and blood. Zhang Jingyue said: When Jue is about to occur, coldness, heat, and numbness must begin in the extremities. Sudden collapse, cold extremities, lusterless complexion, coma, clenched jaw, or submerged six pulses resemble wind-stroke but lack phlegm sounds and convulsions.
[Pulse] In all cases of Yang Jue due to Shanghan, the pulse is deep and forceful; in Yin Jue, the pulse is deep and forceless. Li Shicai said: In Yin Jue, the pulse is deep and weak, nails are cyanotic and cold; in Yang Jue, the pulse is deep and slippery, nails are red and warm. In Zang Jue, the pulse is faint and Jue is present; the cunkou pulse is deep, solid, slippery, and large, indicating excess syndromes like Phlegm-Qi-Jue or Food-Jue; a faint, soft, and wiry pulse indicates deficiency syndromes like Yin-Yang Deficiency Jue. Pulse varying in size indicates Shi Jue (Corpse Jue); deep, fine, and forceless pulse indicates Hui Jue; floating and large indicates Wind Jue; tight and fine indicates Cold Jue; hollow and rapid indicates Summerheat-Heat; hurried and urgent indicates Miasma-Dampness; choppy and stagnant indicates Blood Reversal; absence of pulse indicates Yuan Qi depletion.
[Treatment] If Yang Jue is mild, the heat is also mild; use Sini San (Bupleurum, Peony, Immature Bitter Orange, Licorice). If Jue is severe, the heat is also severe; use Chengqi Tang or Sanhuang Shigao Tang. For Cold Jue due to middle-jiao cold, mild cases use Lizhong Tang; severe cases use Sini Huayang Decoction and others. For Cold Jue, use Sanjian Tang (Aconite, Prepared Aconite, Heavenly Aconite, decocted with fresh ginger), add Ginseng. (Xu Rongzhai notes: *Neijing* emphasizes Yuan Qi in discussing Jue, so Heat Jue requires nourishing yin, and Cold Jue requires tonifying yang. *Shanghan Lun* focuses on pathogenic factors, so Cold Jue requires warming, Heat Jue requires clearing, and purgation may even be used. This treatment is based on differentiation according to *Shanghan Lun*.) For Hui Jue, use Lizhong Tang added with stir-fried Mume and Sichuan Pepper. Jian Jue (Frying Jue) caused by excessive mental labor, with yang expanding outward and yin essence depleted internally, should be treated with Liuwei Dihuang Tang added with Anemarrhena, Phellodendron, and Tortoise Shell. If caused by deficiency and decline of yuan qi, failing to control ministerial fire, leading to confusion and sudden collapse with a soft and rapid pulse, use Shenren Tang (Ginseng, Astragalus, Rehmannia, Ophiopogon, Schisandra, Asparagus, Phellodendron, Honey-fried Licorice). Bo Jue (Thin Jue) caused by great anger severing form and qi, with blood stagnating in the upper jiao, leading to Bo Jue, should be treated with Xijiao Dihuang Tang added with blood-invigorating and qi-descending herbs, or Bawei Shunqi San (Ginseng, Atractylodes, Green Tangerine Peel, Tangerine Peel, Poria, Angelica Dahurica, Lindera, Licorice). Tan Jue (Phlegm Jue) presents with sudden chest oppression, phlegm rattle, salivation, cold extremities, and a deep-slippery pulse. Severe cases remain unconscious, called Phlegm Obstruction; mild cases gradually wake, called Phlegm Jue. Use Daotan Tang (Prepared Pinellia, Prepared Arisaema, Immature Bitter Orange, Poria, Tangerine Peel, Licorice, Ginger). Or Sijunzi Tang added with Bamboo Sap and Ginger Juice. Shi Jue (Corpse Jue) is caused by exposure to malignant qi, such as climbing high temples, attending funerals, or sudden exposure to foul air, leading to cold extremities, clenched jaw, fainting, and delirious speech. Treat with Suhexiang Wan, administered with Ginger Juice. Fumigation with Vinegar Charcoal can also revive the patient. Qi Jue has two types: Qi Deficiency and Qi Excess. Excess type presents with angry qi, sudden collapse, cold extremities, no salivation, and deep-wiry or submerged pulse. Treatment should soothe qi and regulate liver, using Simo Yin or Wuyao Shunqi Tang. This differs greatly from wind-stroke with warm body and abundant salivation. Deficiency type presents with exhausted qi and form, cyanotic complexion, weak pulse, and slightly cold limbs. Treatment should strongly tonify yuan qi, using Buzhong Yiqi Tang or Bazhen Tang. Xue Jue (Blood Jue) also has two types: Blood Reversal and Blood Loss. Blood Reversal often occurs postpartum after anger, where blood follows rebellious qi. Regulate qi first, similar to Bo Jue. When qi moves, blood moves. Severe cases use Tao Ren Chengqi Tang. Blood loss, such as massive hematemesis or metrorrhagia, or excessive lochia postpartum, causes qi to scatter with blood, leading to sudden collapse and unconsciousness. First pinch Renzhong or burn vinegar charcoal to gather qi, then urgently administer a large dose of Dushen Tang (Single Ginseng Decoction). This is the method of benefiting qi in blood loss. (Xu Rongzhai notes: For blood reversal causing Jue, Baiwei Tang can be used—Baiwei 1 liang, Danggui 1 liang, Renshen and Gancao 1 qian each, decocted in water.) Jiujue (Alcohol Jue) caused by drunkenness is treated with Gehua Jieying Tang. Shijue (Food Jue) caused by overeating, where after heavy meals, exposure to wind-cold, or anger, food blocks the chest, stomach qi fails to descend, leading to sudden Jue. Symptoms include coma, inability to move limbs, and rapid/large or submerged kou pulse. First induce vomiting with salt water; if unsuccessful, it is critical. Then treat with mild resolving formulas like Erchen Tang added with Zhi Ke, Hou Po, Shan Zha, and Shen Qu. Jue due to sexual intercourse often leads to untreatable collapse. In men, it is called Tuoyang (Yang Collapse), treated with Shenfu Tang added with Deer Antler. If the penis remains erect after death, it is called Tuoyin (Yin Collapse) in women, treated with Shenfu Tang combined with Guilu Erxian Jiao. Jue due to nocturnal emission is called Tuoyuan (Yuan Collapse), with erection and emission, facial expression of pleasure, and warmth; treat with Shenfu Tang added with Shu Di Huang, decocted urgently. If cold, it is untreatable.
[Xiu's Commentary] *Neijing* states that yang deficiency below leads to Cold Jue, characterized by cold limbs, deep/faint/rapid pulse, or rapid but forceless pulse, often presenting as apparent heat but not true heat. Thus, any cold extremities without excess-heat signs are Cold Jue. Use Yiyuan Tang or Fuzi Lizhong Tang. Yin deficiency below leads to Heat Jue, starting with much heat, deep/slippery/rapid pulse, aversion to heat, preference for cold, irritability, constipation, and coma-like symptoms. Caused by sex after drinking, damp-heat sinking, fierce alcohol qi, declining kidney water, dominant yang, and drying yin fluids, leading to Jue. Nourish the master of water using Liuwei Dihuang Tang. Since Foot Three Yang meridians start at toes and Foot Three Yin converge at sole, Heat Jue starts from feet, and yin-deficiency diseases often have hot soles. Cold Jue starts at five toes and rises to knees; thus, yang-deficiency diseases have cold limbs. Therefore, warming yang for Cold Jue and nourishing yin for Heat Jue aligns with Wang Bing's method: "Nourish the master of water to control hyperactive yang; benefit the source of fire to eliminate yin shadows." *Neijing* says: "When blood and qi rush upward together, it is Great Jue. Jue implies sudden death." Also: "Internal depletion leading to Jue is Fei (flaccidity). This is kidney deficiency." Some call it Kidney Jue. Shen Youpeng said: Jue is sudden collapse due to lower qi rebelling upward. *Neijing* says: "If qi returns, life; if not, death." Meaning qi returns downward, not disperses and re-aggregates. Chapter one describes symptoms; chapter two etiology—one due to kidney, one to liver. *Neijing* says internal depletion originates in kidney. Kidney stores essence (true yin), containing true yang. Kidney channels attach to tongue root. Yang likes ascending, relying on yin to anchor. If essence is depleted, yang has no basis, ascends, saliva rebels with qi, blocking tongue channels, causing aphasia. With yang ascending, lower jiao yang is weak, causing foot flaccidity. Abstaining from sex and anger prevents Great Jue. *Neijing* says great anger originates in liver. Liver is wind-wood organ, likes ascending, channels go through throat to vertex. Adequate essence/blood anchors liver yang; anger won't cause Great Jue. Only those with deficient essence/blood lack anchoring; liver yang moves easily, rising violently with anger, depleting lower jiao qi, causing collapse. Upper jiao qi congestion causes aphasia. This is Great Jue or Sudden Jue. This explanation is correct. Wu Yunfeng said: Hui Jue patients have roundworms in stomach, suffer cold/stomach injury, hunger, or improper sweating causing stomach cold, worms moving to diaphragm, dry tongue/mouth, rinsing without swallowing, irritability, coma, cold extremities, vomiting worms. Use Lizhong Anhui Tang (Ginseng, Atractylodes, Poria, Stir-fried Sichuan Pepper, Mume, Ginger). Avoid Licorice and sweet foods, as worms move with sweet, settle with bitter, calm with sour, and hide with pungent. Food blocking Taiyin causing abdominal pain and worm vomiting should be treated with warming middle and resolving stagnation. Warm body with sweat in Jue indicates entry into fu organs (survival); cold body with cyanotic lips indicates entry into zang organs (fatality). Cold hands past elbows or feet past knees is fatal. Red nails indicate survival; black/blue indicates death. Sudden vomiting of purple-red phlegm in early or late stage is fatal. Open mouth and scattered hands indicate five-viscera extinction; large doses of Ginseng and moxa on Qihai/Dantian may save some.
[Lian's Commentary] Jue is a disease reversing from below upward. Only Juozheng Fanhun Dan (formula see previous section) can govern all Jue. Shao Xinpu said: Generally, Jue arising from miscellaneous diseases differs from that in Shanghan chapters. This condition arises from daily deviation of qi and blood, forming yin and yang simultaneously, like violent wind and thunder erupting from extreme depression. If recovery is gradual after onset, danger can turn to safety; if deterioration follows, roots will be pulled out, leading to death. Survival depends on the fullness or emptiness of Mingmen. Medical books have various names and complex etiologies. Those suitable for emesis, like phlegm/food blocking chest, use Genti San or burnt salt induction. Those suitable for clearing/reducing, like Jueyin strong fire rebelling unchecked, use Yuniu Jian or Xuanming Longhui Wan. Those suitable for opening/descending, like Qi Jue or Bo Jue with sudden qi/form cessation, use Wumo Yinzi or Changpu Wine. For turbid pathogens clouding mind causing confusion, use Niuhuang Zhibao Dan or Suhexiang Wan. For Flying Corpse Sudden Jue, guide with wine/vinegar, apply acupuncture/moxibustion. For deficiency-based Jue, like internal depletion causing Fei or Wind Jue, use Dihuang Yinzi to connect lower jiao. For Jian Jue from mental labor and yang expansion, use Renshen Guben Wan with gold leaf. For Xue Jue with boiling collaterals, refer to yin/yang methods. For Se Jue with essence depletion below, urgently use large-dose Yuan-rescuing methods. For Kidney Jue, follow Xu Xueshi's Jiaofu to unblock yang. For Hui Jue, follow Zhongjing's method to pacify worms. Extreme yang uses severe yin-nourishing agents; extreme yin uses yang-supporting methods. These approaches are comprehensive. Refer to Ye Tianshi's cases for clarity. Xiangyan focused heavily on liver for this condition. Liver is the General, superior to other organs. Once liver qi rebels, all qi rebels. Qi rebellion generates phlegm, fire boils, wind spins, confusing spirit and soul. If attacking upward, it insults lung and scorches fluids; use Maidong Tang or Qiongyu Gao to tonify metal and soften restriction. If attacking middle, causing vomiting/bloating, use Liujunzi Tang minus Atractylodes, add Mu Gua, Ginger, Peony, or Fuzi Jingmi Tang plus Ginseng to tonify stomach and consolidate liver. If shaking heart/spleen causing palpitations/emaciation, use Ganmai Dazao Tang combined with Dragon Bone/Oyster Shell for calming and sedating. If involving Shaoyang attacking vertex/collaterals, use Antelope Horn, Uncaria, Scrophularia, Forsythia to extinguish wind and clear collaterals. If intrinsic organ disease with disharmony of substance/function, use Pepper, Mume, Cinnamon, Peony to benefit substance and promote function. If mother organ deficiency disturbing daughter organ, use Santian, Turtle Shell, Magnetite, Cinnabar, or Guizhi Fuling Lingzhi Tang variants to secure mother-daughter relationship. Wei Jue methods are magical, using animal/shell materials converted to paste for rapid efficacy. This supplements predecessors and opens doors for students. Do not ignore these when studying Ye's cases. Zhu Suisheng noted: Wu's description of ice-cold and fire-hot refers to Jue-Ni (Reversal Jue). *Neijing*'s Great Jue, Bo Jue, Yang Jue, Wind Jue, Yin Jue, Shi Jue require methods to unblock yin and admit yang, descend qi, calm liver, open orifices, move blood, and resolve phlegm. Mrs. Wang had Qi Jue, unconscious, stiff legs, erratic arm movements, undetectable pulse. Treated with Tieluo Yin and Zijin Ding, revived immediately. Recurred three times in two years, treated similarly with success. On the 11th day of the 12th lunar month in Yisi year, Mrs. Sha suffered strange illness, bones rattling like drums, uncontrollable shaking, requiring multiple people to hold, slurred speech, claiming head stolen nine miles away, exorcists busy. Pulse normal. Thinking "all wind/tremors/dizziness belong to liver," Foot Jueyin transmitting to Hand Jueyin allows wind pathogen to attack Heart Pericardium and close orifices. Used red-hot iron hammer quenched in water to decoct Uncaria and Peony, mixed with Zijin Ding, administered. Consciousness returned, shaking stopped. This is also a type of Jue disease.
[Rongzhai's Note] Cold Jue uses Sini Tang; Heat Jue uses Sini San. Scholars of *Shanghan Lun* know this; however, how to differentiate them and what is the key to differentiation deserves study. Predecessors Cheng Wuji, Yu Jiayan, and Lu Dingpu had profound experience. Cheng Wuji said: "If Jue begins with cold extremities not warming, it is yin meridian pathogen with insufficient yang, use Sini Tang. If extremities start hot then become cold (from Si Ni to Jue), it is transmitted pathogen, use Sini San." Yu Jiayan said: "If Shanghan starts with fever, consuming fluids, dry nose, thirst, constipation, gradually leading to Jue, it is obviously heat. If yang syndrome suddenly turns to yin Jue, one in ten thousand. Yin Jue comes from yin syndrome, directly striking true yin meridians, cyanotic lips, white face, cold sweat, loose stools without thirst, fatigue, sleepiness, clear mind upon waking; vastly different from transmitted heat in Shanghan progressing deeper with confusion." Lu Dingpu said: "Jue has yin and yang types. Li Shicai said Yin Jue pulse is deep/weak, nails cyanotic/cold; Yang Jue pulse is deep/slippery, nails red/warm. I say yin syndrome resembling yang cannot rely solely on deep/weak pulse and cyanotic/cold nails. If symptoms show irritability wanting to strip clothes or sit in mud, pale yellow tongue coating, dry mouth/swollen gums, flushed face like slight intoxication or migratory malar flush, weak speech, poor appetite/chest fullness, thirst for water or sore throat seeking water but unable to drink, surface heat but deep pressure reveals no heat or feels cold, or body heat desires clothing; plus cold feet, clear urine, pure grain diarrhea; pulse deep/fine or floating/rapid, scattering on pressure, or floating/large but forceless on pressure. Use warm agents, take medicine cool to follow its nature." The first two distinguish yin/yang Jue; the third identifies yin Jue resembling yang, finding differences amidst similarities with precision. Regarding Se Jue, Mao Tuizhi's *Zhongxiyi Hua* records: "Se Jue patients are originally deficient, exerting themselves during rare encounters or long-term lustful indulgence; afterwards, qi departs with essence, leading to sudden collapse without return." I consider this "Se Tuo" (Sexual Collapse) because the cause is "qi departing with essence," presenting as "sudden collapse" rather than "Jue reversal." Another type develops later, described in medical books as: "Essence lost frequently, collapse gradual, appearing 2-3 days after sexual desire. Because it doesn't appear immediately, it's ignored, and people hide it, unaware many get sick from this after middle age; this is Se Jue. Doctors misdiagnose as wind-stroke! Treatment should cultivate Mingmen, tonify yuan qi with Ginseng/Astragalus, fill true yin with Rehmannia, Angelica, Cistanche, Goji." This aligns with Lianchen's "urgent large-dose yuan-rescuing method." For Shi Jue, ancient methods use Suhexiang Wan. Shen Fengjiang recorded an experience in *Yiyan Suibi*: "South gate surname..."