夫厥者。手足厥逆也。有阴厥。有阳厥。误投药则死。可不审乎。张翼云。冷厥者。四肢逆冷。脉沉微而不数。足
多挛卧恶寒。或引衣自覆也。其伏热在内而厥者。脉虽沉伏。按之至骨而来数也。其人或引饮。或扬手掷足。烦躁不得
眠。或发狂。或大小便不利。所见皆热证也。常器之云。凡厥当求得病之因。若初得病。便四肢逆冷。脉沉细而不数。
或身上粟起。下利清谷。或清便自调。谓大小便如常者。为寒厥也。若初得病。便身热头痛外。别有阳证。至二三日。
及至四五日。方发厥。为热厥也。孙兆云。阳病热深而厥。毕竟脉紧。外证须狂语。揭衣被也。阴厥。按之脉沉迟而形
静也。若证不明。未辩阴阳者。且与四顺丸试之。是阳厥。便见热证。若阴厥。便见寒证。可渐进理中四逆也。四顺丸。
即理中丸。加甘草一倍是也。高保义云。寒厥。则证多静而了了。脉虽伏若实。按之迟而弱也。热厥外证多昏塞。脉虽
伏若实。按之须挟数而有力也。
琥按上张氏云。冷厥者。四肢逆冷。脉沉微而不数。常氏亦云。脉沉细而不数。孙氏云。阴厥脉沉迟。高氏亦云。
脉虽伏若实。按之迟而弱。与前海藏阴证略例云。阴毒之候。六脉沉细而疾。或一息七至以来。八至以上。或不可数。
其论又不相符。乃知阴证之脉。亦不可执也。孙氏又云。若证不明。未便阴阳者。且与四顺丸试之。愚以仲景云。厥深
者热亦深。厥应下之。倘热厥证。反用理中丸倍甘草。恐亦不可试也。学人能于阳厥热证辩明。斯阴厥寒证自无误耳。
Jue (Cold Extremities) refers to the symptom of coldness in the hands and feet. There are Yin Jue and Yang Jue. Incorrect medication can lead to death; how can one fail to examine this carefully? Zhang Yi stated: In Cold Jue (Han Jue), there is coldness in the four limbs, the pulse is deep, faint, and not rapid. The legs are often curled up in a lying position with aversion to cold, or the patient likes to pull clothes over themselves. In cases where latent heat is internal causing Jue, although the pulse may be deep and hidden, pressing down to the bone reveals a rapid pulse. Such patients may desire drinking water, throw their hands and feet about, feel restless and unable to sleep, even go mad, or suffer from difficulty in urination and defecation; all manifestations seen are signs of Heat syndrome. Chang Qizhi said: For any Jue, one must seek the cause of the disease. If at the onset of the disease, there is immediately coldness in the four limbs, a deep and fine pulse that is not rapid, or gooseflesh on the body, diarrhea with undigested food (Xialing Qinggu), or normal urination and defecation (referred to as "Qingbian Zidiao"), this is Cold Jue. If at the onset, besides fever, headache, and other Yang syndromes, Jue develops only after two or three days, or even four or five days, this is Heat Jue. Sun Zhao said: In Yang diseases, when heat is profound leading to Jue, the pulse is ultimately tight, and external symptoms must include delirious speech and uncovering clothes and blankets. In Yin Jue, the pulse is deep and slow, and the physical form is quiet. If the syndrome is unclear and Yin/Yang cannot be distinguished, one may first administer Si Shun Wan (Four-Obedience Pill) for testing. If it is Yang Jue, Heat signs will appear; if it is Yin Jue, Cold signs will appear, and one can gradually administer Lizhong Tang (Regulate the Middle Decoction) or Sini Tang (Frigid Extremities Decoction). Si Shun Wan is essentially Lizhong Wan (Regulate the Middle Pill) with double the amount of Gancao (Licorice Root). Gao Baoyi said: In Cold Jue, symptoms are mostly quiet and the mind is clear; although the pulse may be hidden yet feel solid, pressing reveals a slow and weak pulse. In Heat Jue, external symptoms are mostly stuporous and obstructed; although the pulse may be hidden yet feel solid, pressing reveals a pulse that is necessarily accompanied by rapidity and strength.
Hu notes: Regarding the above, Zhang stated that in Cold Jue, the four limbs are cold, and the pulse is deep, faint, and not rapid; Chang also stated the pulse is deep, fine, and not rapid; Sun stated the pulse in Yin Jue is deep and slow; Gao also stated that although the pulse may be hidden yet feel solid, pressing reveals a slow and weak pulse. This contradicts Hai Zang's discussion in *Yin Zheng Lue Li* (Brief Examples of Yin Syndromes) regarding Yin Du (Yin Toxin): he stated that in Yin Toxin, the six pulses are deep, fine, and rapid, or seven beats per respiration or more, eight beats or more, or difficult to count. Their theories do not match, so it is known that the pulse of Yin syndromes should not be rigidly adhered to. Sun also stated: If the syndrome is unclear and Yin/Yang cannot be distinguished, first use Si Shun Wan for testing. I believe Zhongjing said: "The deeper the Jue, the deeper the heat; Jue should be treated with purgation." If it is a Heat Jue syndrome, using Lizhong Wan with double Gancao might not be suitable for testing. If scholars can clearly distinguish Yang Jue and Heat syndromes, then Yin Jue and Cold syndromes will naturally not be mistaken.