【闡釋】本條為陰虛兼水熱互結之證。由於水熱互結在裏，水滲大腸則利，犯肺則咳，犯胃則嘔，津不化則渴，陰虛陽亢則心煩不得眠。亦即鄭氏所說：“乃少陰協熱下利之的候也。”用豬苓湯育陰清熱利水，乃對症之良方。
十五、少陰病，得之二三日，（而）口燥咽幹者，急下之，宜大承氣湯。原文320
鄭論：按少陰病，而用至大承氣湯者，以少陰為水髒，宜乎口咽潤澤，今見口燥咽幹，是少陰協火而旺之的候。火盛則陰虧，恐真陰為火灼盡，而命不永，故宜急下之以存陰。但此證只憑口燥咽幹而定為急下，餘每常見口燥咽幹而不渴，舌尚潤滑，小便清長，治之不外扶陽，陽氣上升，則口燥咽幹自愈。若此證，斷為急下，務要察其口咽幹而喜飲冷，氣粗而蒸手，小便短赤痛，脈健有力，方可以主急下法，否則，斷乎不可。
【闡釋】自此以下三節，皆言急下。少陰協火之證，口燥咽幹外，必有陽明胃實諸證兼見，如喜冷惡熱，氣粗蒸手，小便短赤而痛，脈健有力，方可主以急下。若口燥咽幹而不渴，舌尚潤滑，小便清長，不能急下，治之不外扶陽。急下與扶陽兩法，不可混淆，若見證是少陰挾火之證，複轉陽明，方可用大承氣湯急下之。口燥咽幹而不見陽明胃實諸證兼見，筆者治此證，先用甘草乾薑湯加桔梗治之，如服後無不良反映，則繼用附子理中湯以扶陽，陽氣上升，則口燥咽幹自愈。
十六、少陰病，自利清水，色純青，心下必痛，口乾燥者，急下之，宜大承氣湯。原文321
鄭論：按少陰下利清水，青色，似乎虛寒，不知邪火入于少陰，火動于中，水液不藏，不待轉樞，隨氣機而下泄，兼見心痛，口乾燥者，邪火傷陰之明驗也。若不急為下之，火盛陰虧，便非佳兆。若此等證。務要細心，不可猛浪，總要求其真實火象，便不錯誤。
【闡釋】少陰下利，多稀薄清冷，或下利清穀，治宜急溫。本條自利清水，所下皆青黑色污水，且有心下痛，口乾燥，鄭氏指為“邪火傷陰之明驗也”。失此不治，真陰將隨之消亡，故用大承氣湯急下存陰，實《內經》通因通用之法。
十七、少陰病，六七日，腹脹不大便者，急下之，宜大承氣湯。原文322
鄭論：按腹脹不大便，亦有寒熱之別，寒結於下，閉其大便運行之機，為之寒閉，法宜大辛大溫，俾寒解氣通，自然脹者不脹，而不便者便矣。若熱閉下焦，阻其運行之機而作者，法宜急下，此不易之法。大約此證，是為熱結少陰者說法也。
【闡釋】此條亦見於本書卷六陽明下篇七條，可互相參看。鄭氏說：“腹脹不大便，有寒熱之別。”宜急下者，為熱閉下焦，阻其運行之機。若寒閉者，法宜大辛大溫，俾寒解氣通，則諸證自愈。臨證時務須全面分析，始不有誤。
傷寒恒論卷十
厥陰上篇
計二十一法①
①舒本厥陰篇不分上、中、下三篇，厥陰篇下有“計四十八法”一句，為照應前體例，厥陰上篇下加“計二十一法”一句。以下厥陰中篇加“計十七法”一句。厥陰下篇加“計十法”一句。
一、厥陰之為病，消渴②，氣上撞心，心中疼熱，饑而不欲食，食則吐蛔③，下之利不止。原文326
鄭論：按此乃厥陰寒熱錯雜之候也。消渴者，熱傷津液也；撞心者，熱邪上幹也；饑不欲食，食則吐蛔者，裏有寒也，吐蛔者，寒甚，則蟲不安而外出也；下之利不止者，既屬虛寒，何得以降之、利之乎？明是教人不可妄下也。
【闡釋】過去很多注解傷寒論者，認為此條是厥陰病的提綱，其實非也。
僅是厥陰病上熱下寒之證，亦即鄭氏所說：“寒熱錯雜之候也”。如消渴、氣上撞心，心中疼熱，就是上熱證狀；饑而不欲食，食則吐蛔，下之利不止，就是下寒證狀。並不包括本篇厥熱勝複，寒厥熱厥等全部疾病，所以不能稱為厥陰病的提綱。
二、厥陰中風，脈微浮（者）為欲愈，不浮（者）為未愈。原文327
鄭論：按厥陰為陰髒，陰病而見浮脈，是陰病得陽脈者生，不得陽脈者，為未愈也。
【闡釋】陰病脈不當浮，今厥陰中風脈反浮者，以厥陰與少陽為表裏，若得少陽沖和之氣，病勢有從陰出陽之機者，脈必微浮。亦即鄭氏所說：“陰病得陽脈者生，不得陽脈者為未愈也。”
三、厥陰病，欲解時，從醜至卯上。原文328
鄭論：按六經各有旺時，邪退邪進，可于旺時決之。
【闡釋】六經皆有欲解時一條。據厥陰篇：“厥少熱多，其病當愈；寒多熱少，其病為進；熱不除便膿血者不必死；下利厥不止者必死。”則本條所謂欲解，其為寒盡陽回之證。亦即鄭氏所說：“邪退邪進，可于旺時決之”之意。從時間來說，當在夜間一時至早晨五時之間。
四、厥陰病，渴欲飲水者，少少與之，愈。原文329
鄭論：按此乃厥陰挾有微熱也。學者于此，當細求陰陽實據為要。
【闡釋】本條是厥陰病邪退陽複的渴欲飲水，因陽氣乍複，津液一時不及上承，因而口渴。即鄭氏所說：“乃厥陰挾有微熱也”，故少少與飲，以滋助其津液，則病可自愈。
五、諸四逆厥者，不可下之，虛家亦然。凡厥者，陰陽氣不相順接，便為厥。厥者，手足逆冷者是也。原文330、337
鄭論：按厥證原有陽厥陰厥之別，陽厥可下，陰厥不可下，此乃一定之理。
【闡釋】本條前段指出虛寒性厥逆不可下，即凡屬虛家而不厥逆者亦不可下，法當扶陽治之。後段並賅寒熱二厥在內，致厥的原因，皆因陰陽氣不相順接所形成，證見手足逆冷。寒厥者，寒盛至極，則陰氣獨勝，而陽氣相對衰微，不能通達於四肢，故手足發生厥冷，因成寒厥。相反的熱盛至極，則陽氣被遏，亦不能通達於四肢，因成熱厥。寒厥熱厥，同樣是四肢厥冷，病因病理卻截然不同，故治法亦異。鄭氏曰：“陽厥可下，陰厥不可下，此乃一定之理”。指出治療法則，可為準繩。
六、傷寒脈遲，六七日，而反與黃芩湯徹其熱①，脈遲為寒，今與黃芩湯，複除其熱，〔腹中應冷〕，當不能食，今反能食，此名除中②，必死，原文333
①徹：除也，此處含有治療意思。
鄭論：按遲則為寒，其理明甚，而反與黃芩湯，是失其治也。失其治，病人應不能食，乃其常，今反能食，是反其常，反其常者死，此名為除中。除中者，胃陽暴露，如燈光之火，欲滅而驟明，轉瞬即滅也。
【闡釋】傷寒脈遲，脈遲屬陰主寒，胃必虛冷也。設遇此虛冷之脈證，當用理中湯以溫之，今反用黃芩湯以消其胃中僅存之陽氣，病人應不能食，反能食者，此名除中。鄭氏釋除中謂：“胃陽暴露，如燈火之光，欲滅而複明，轉瞬即滅也”，形象生動。俗稱之回光反照，必死無疑。
七、傷寒〔始〕發熱六日，厥反九日而利，凡厥利者①，當不能食，今反能食者，恐為除中，食以（素）〔索〕餅②，不發熱者，知胃氣尚在，必愈。恐暴熱來〔出〕而複去也，後（三）日脈之③，其熱續在者，期（以）〔之〕旦日夜半愈④，所以然者，（未）〔本〕發熱六日，厥反九日，復發熱三日，並前六日，亦為九日，與厥相應，故期之旦日夜半愈。後三日脈之，〔而脈〕數，其熱不（減）〔罷〕者，此為熱氣有餘，必發癰膿也。原文332
①厥利：是指手足厥冷而又患腹瀉。
②食（sì飼）以索餅：即拿東西給人吃。索餅，是以麵粉做成的條狀食物。
③脈之：即診察的意思。
④旦日夜半：是第二天的半夜。
鄭論：按厥與利，皆在不能食之例，今反能食，近似除中，當在發熱與不發熱兩字判之。若尚能發熱，則知胃氣尚存，但不可暴〔出〕也。暴是脫機，微是生機，苟無發熱，則除中決矣。期之半夜愈者，就在這一點微熱決之耳。至必發癰膿，胃陽有餘，遏鬱太甚也。又雲：以（素）〔索〕餅不發熱，既不發熱，胃氣已去，尚得雲知胃氣尚存乎？不字定是微字，方與論合。
【闡釋】本條文長義繁，總的來說，言厥與熱日數相較是相當的，其病能自愈。若厥多於熱則病利；熱多於厥則發癰膿；厥利並見，當不能食，反能食者恐為除中。是否除中，可與索餅食之。鄭氏曰：“若尚能發熱，則知胃氣尚存；不發熱則胃氣已去，尚得雲知胃氣尚存乎？不字定是微字，方與論合”。此鄭氏訂正原文之功矣。
八、傷寒先厥後發熱，（而）〔下〕利（者）必自止，而反汗出，咽中痛者，其喉為痹⑤。發熱無汗，而利必自止；若不止，必便膿血（者），〔便膿血者〕，其喉不痹。原文334
⑤其喉為痹：是指喉部痛而紅腫的疾患。
鄭論：按厥後發熱而利，發熱乃陽回之征，故可決其必自止。但利止而反汗出，咽疼為喉痹，是厥陰挾風邪而上攻，若利不止，必便膿血，是熱邪下攻故也。利止與不止間，上攻下攻之病，不問自明也。
【闡釋】本條先厥後熱，是陽進陰退之征，利必自止。如陽複太過，在上則為喉痹，在下則便膿血。治喉痹可用桔梗湯，便膿血可用白頭翁湯。至便膿血，為熱邪下利，而不復上病咽痛也。
九、傷寒（二三）〔一二〕日至四五者，（而）厥者必發熱，前熱者後必厥，（熱）〔厥〕深者（厥）〔熱〕亦深，（熱）〔厥〕微者（厥）〔熱〕亦微。〔厥〕應下之，而反發汗者，必口傷爛赤①。原文335
①口傷爛赤：口舌生瘡，紅腫糜爛。
鄭論：按熱深厥深，是為陽亢熱伏者說法，本宜破陽扶陰為主，其中有反發汗，以致口糜爛赤者。凡發藥皆上升之品，邪火得升而上浮，焉得不有此口糜赤爛之患耶？
【闡釋】熱厥形成的機轉，主要是熱邪深伏，陽氣內郁不能外達，即是鄭氏所說：“是為陽亢熱伏者說法”，法當破陽扶陰，選用承氣湯下熱存陰，自不可發汗，如誤汗之，劫奪其津，熱邪更熾，邪熱上幹，就可產生口舌生瘡，紅腫糜爛。
十、傷寒病，厥五日，熱亦五日，設六日，當複厥，不厥者，自愈。厥終不過五日，以熱五日，故知自愈。原文336
鄭論：按熱與厥，俱屬五日，乃陰陽平應之候，故斷之曰必自愈。
【闡釋】陰陽偏盛則病作，陰陽和平則病癒，一切疾病之由來皆如此。厥陰病的病勢進退生死之機，亦不外此理。故熱與厥日數相等，亦即鄭氏所說：“乃陰陽平應之候”，故知自愈也。
十一、傷寒脈微而厥，至七八日（胃）〔膚〕冷，其人煩（燥）〔躁〕無暫安時者，此為藏厥②，非蛔厥也③。蛔厥者，其人當吐蛔，（今）〔令〕病者靜，而複時煩〔者〕，此為藏寒
①，蛔上入〔其〕膈，故煩，須臾複止，得食而嘔，又煩者（蟲）〔蛔〕聞食臭（而）出，其人當自吐蛔，蛔厥者，烏梅丸主之，又主久痢。原文338
②藏厥：是指內藏真陽極虛而引起的四肢厥冷。
③蛔厥：是因蛔蟲而引起的四肢厥冷。
①藏寒：是指內臟虛寒而言。這裏所說的藏寒，可以作胃氣虛寒來解釋。
鄭論：按既稱脈微而厥，（胃）〔膚〕冷為之髒寒，即按髒寒法治之，何必另為諮議？又曰蛔厥，蛔乃厥陰風〔木〕所化，胃冷蟲必不安，胃熱蟲亦不安，胃不得食，蟲亦不安，如此推求，便得治蟲之法也。條內並未有熱象足征，不得為之寒熱錯雜。其主久痢，是亦寒泄之謂，烏梅丸，皆非正論。
【闡釋】本條前段自“傷寒脈微而厥”至“此為藏厥，非蛔厥也”，為藏寒發厥，病情已屬危候，急用四逆、白通救之。蛔厥有吐蛔證，其煩是時作時止，不是煩躁無暫安時，其厥是肢厥而非膚冷，原文烏梅丸主之，又主久痢。鄭氏認為治以烏梅丸，皆非正論。筆者對治蛔證，常用烏梅丸改作湯劑而獲效。夫久痢多屬虛寒滑脫，法當溫補收澀，常用附子理中湯加粟殼治之。
烏梅丸方（校補）
烏梅三百枚細辛六兩乾薑十兩黃連十六兩當歸四兩附子六兩（炮去皮）蜀椒四兩（出汗）桂枝六兩（去皮）人參六兩黃柏六兩上十味，異搗篩，合治之，以苦酒漬烏梅一宿，去核，蒸之五斗米下，飯熟，搗成泥，和藥令相得，內臼中，與蜜杵二千下，丸如梧桐子大，先食，飲服十丸，日三服，稍加至二十丸，禁生冷、滑物、臭食等。
【方解及其應用範圍】本方寒熱並用，攻補兼施之劑，能益胃安蛔。方中烏梅為主藥，有酸澀的作用，配川椒以殺蟲；蟲得苦則安，所以用黃連、黃柏；而附子、乾薑、細辛、桂枝，溫中散寒；人參補脾；當歸補肝；合成一個溫中祛寒，殺蟲平厥的方劑，治蛔厥有良好效果。鄭氏謂：“厥陰為陰經，陰極則生陽，故多寒熱錯雜。……仲景立烏梅丸，寒熱並投，並非專為蟲立法，凡厥陰一切症候，莫不備具。”向為治蛔厥及久痢之首選方，應用確較廣泛。鄭氏在《醫法圓通》中，用以治巔頂痛、腹痛飲冷、睾丸腫痛。筆者以此方治痢，無分新久，改丸為湯劑，功效顯著。今人以烏梅丸加減治膽道蛔蟲及多種腸道病，屢獲良效。更有人認為凡寒熱錯雜之症，本方均可施治，足見其應用之廣泛了。
十二、傷寒熱少微厥①，指頭寒，默默不欲食，煩躁，數日小便利，色白者，此熱除也。欲得食，其病為愈。若厥而嘔，胸脅煩滿者，其後必便血。原文339
[Explanation] This clause describes a syndrome of Yin deficiency combined with the intermingling of water and heat. Because water and heat are intermingled in the interior, if water seeps into the large intestine, it causes diarrhea; if it invades the lung, it causes cough; if it invades the stomach, it causes vomiting; if fluids fail to transform, it causes thirst; and if Yin is deficient with hyperactive Yang, it causes mental restlessness and insomnia. This is exactly what Mr. Zheng said: "It is the definitive manifestation of Shaoyin disease with協 (accompanying) heat and diarrhea." Zhu Ling Tang (Polyporus Decoction), which nourishes Yin, clears heat, and promotes diuresis, is an excellent formula for this condition.
Fifteen. In Shaoyin disease, if after two or three days there is dryness of the mouth and throat, immediate purgation is indicated, using Da Cheng Qi Tang (Major Order the Qi Decoction). Original text 320
Mr. Zheng's Commentary: Regarding Shaoyin disease, when Da Cheng Qi Tang (Major Order the Qi Decoction) is used, it is because Shaoyin is the Water Organ, so the mouth and throat should naturally be moist. Now that dryness of the mouth and throat is seen, this is the definitive manifestation of Shaoyin accompanying fire that is flourishing. When fire is excessive, Yin becomes deficient. One must fear that the True Yin will be scorched away by the fire, shortening life; therefore, immediate purgation is indicated to preserve Yin. However, relying solely on dryness of the mouth and throat to determine the need for immediate purgation is insufficient. I often see cases of dryness of the mouth and throat without thirst, where the tongue remains moist and slippery, and urination is clear and abundant. Treatment involves supporting Yang; as Yang Qi rises, the dryness of the mouth and throat heals spontaneously. If this case is judged to require immediate purgation, one must carefully observe whether the patient prefers cold drinks due to dryness of the mouth and throat, has coarse breathing that feels hot to the touch, has short, red, and painful urination, and has a strong and forceful pulse. Only then can the method of immediate purgation be applied; otherwise, it is absolutely contraindicated.
[Explanation] The following three clauses all discuss immediate purgation. In Shaoyin disease accompanied by fire, besides dryness of the mouth and throat, there must be concurrent symptoms of Yangming Stomach excess, such as preference for cold and aversion to heat, coarse breathing that feels hot to the touch, short, red, and painful urination, and a strong and forceful pulse. Only then can immediate purgation be the primary treatment. If there is dryness of the mouth and throat without thirst, a moist and slippery tongue, and clear, abundant urination, immediate purgation is not applicable; treatment involves supporting Yang. The methods of immediate purgation and supporting Yang must not be confused. If the signs indicate Shaoyin disease with accompanying fire that transforms into Yangming, then Da Cheng Qi Tang (Major Order the Qi Decoction) can be used for immediate purgation. If dryness of the mouth and throat is present without concurrent Yangming Stomach excess symptoms, when I treat this condition, I first use Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) plus Jie Geng (Platycodon Root). If there are no adverse reactions after taking it, I subsequently use Fu Zi Li Zhong Tang (Aconite and Magnolia Bark Decoction to Regulate the Middle) to support Yang. As Yang Qi rises, the dryness of the mouth and throat heals spontaneously.
Sixteen. In Shaoyin disease, if there is spontaneous diarrhea of clear water, purely green in color, pain in the epigastrium is certain, and the mouth and throat are dry, immediate purgation is indicated, using Da Cheng Qi Tang (Major Order the Qi Decoction). Original text 321
Mr. Zheng's Commentary: Regarding Shaoyin diarrhea of clear water, green in color, it appears to be deficiency-cold. However, unknown to many is that pathogenic fire enters Shaoyin, fire moves within, fluids fail to be stored, and without waiting for the pivot mechanism to turn, they drain downward along with the Qi mechanism. Accompanied by heart pain and dryness of the mouth and throat, this is clear evidence of pathogenic fire injuring Yin. If not purged immediately, excessive fire and deficient Yin will lead to an unfavorable prognosis. For such cases, one must be careful and not act rashly. Generally, one must seek authentic signs of fire to avoid error.
[Explanation] Shaoyin diarrhea is mostly thin, clear, and cold, or involves passing undigested food. Treatment should prioritize rapid warming. In this clause, spontaneous diarrhea of clear water consists of dark green or black foul-smelling fluid, accompanied by epigastric pain and dryness of the mouth and throat. Mr. Zheng points out that this is "clear evidence of pathogenic fire injuring Yin." If left untreated, True Yin will perish along with it. Therefore, Da Cheng Qi Tang (Major Order the Qi Decoction) is used for immediate purgation to preserve Yin, which is actually the method of "treating obstruction with unblocking agents" (Tong Yin Tong Yong) from the *Nei Jing* (Inner Canon).
Seventeen. In Shaoyin disease, after six or seven days, if there is abdominal distension and inability to pass stool, immediate purgation is indicated, using Da Cheng Qi Tang (Major Order the Qi Decoction). Original text 322
Mr. Zheng's Commentary: Abdominal distension with inability to pass stool also has distinctions between cold and heat. If cold binds below, closing the mechanism of bowel movement, it is called cold closure. The method should involve great acridity and great warmth, allowing the cold to resolve and Qi to flow freely, so that distension subsides and stool passes naturally. If heat closes the Lower Jiao, obstructing the mechanism of movement, the method should be immediate purgation, which is an unchanging principle. Approximately, this clause speaks to cases of heat binding in Shaoyin.
[Explanation] This clause also appears in Volume 6, Yangming Lower Chapter, Clause 7 of this book, and can be cross-referenced. Mr. Zheng said: "Abdominal distension with inability to pass stool has distinctions between cold and heat." Immediate purgation is indicated for heat closing the Lower Jiao and obstructing the mechanism of movement. For cold closure, the method should involve great acridity and great warmth, allowing the cold to resolve and Qi to flow freely, so that all symptoms heal spontaneously. During clinical practice, comprehensive analysis is necessary to avoid errors.
Shanghan Heng Lun, Volume 10
Jueyin Upper Chapter
Total Twenty-One Methods①
① The Shu edition does not divide the Jueyin chapter into Upper, Middle, and Lower sections. Under the Jueyin chapter, there is a sentence "Total Forty-Eight Methods." To follow the precedent, "Total Twenty-One Methods" is added under the Jueyin Upper Chapter. Below, "Total Seventeen Methods" is added under the Jueyin Middle Chapter, and "Total Ten Methods" under the Jueyin Lower Chapter.
One. The disease of Jueyin manifests as Xiao Ke (wasting-thirst), Qi rushing up to strike the heart, pain and heat in the heart, hunger without desire to eat, vomiting roundworms upon eating, and if purged, diarrhea will not cease. Original text 326
② Xiao Ke (Wasting-Thirst): Refers to drinking much water but thirst remaining unresolved.
③ Vomiting roundworms upon eating: Vomiting roundworms after consuming food.
Mr. Zheng's Commentary: This is a pattern of mixed cold and heat in Jueyin. Xiao Ke (wasting-thirst) indicates heat injuring body fluids; Qi striking the heart indicates pathogenic heat interfering upward; hunger without desire to eat, and vomiting roundworms upon eating, indicate cold in the interior. Vomiting roundworms occurs because extreme cold makes the parasites restless and drive them outward. If purged and diarrhea does not cease, since it belongs to deficiency-cold, how can descending or purging methods be used? Clearly, this teaches people not to purge recklessly.
[Explanation] Many past commentators on the *Shanghan Lun* (Treatise on Cold Damage) considered this clause the outline (Gang Mu) of Jueyin disease, which is incorrect.
It is merely a pattern of upper heat and lower cold in Jueyin disease, which Mr. Zheng described as "a pattern of mixed cold and heat." Symptoms like Xiao Ke (wasting-thirst), Qi rushing up to strike the heart, and pain and heat in the heart are signs of upper heat. Hunger without desire to eat, vomiting roundworms upon eating, and unremitting diarrhea if purged are signs of lower cold. It does not include all diseases in this chapter, such as alternating cold and heat, cold Jue, or heat Jue. Therefore, it cannot be called the outline of Jueyin disease.
Two. In Jueyin wind-strike, if the pulse is slightly floating, recovery is desired; if not floating, recovery is not yet achieved. Original text 327
Mr. Zheng's Commentary: Jueyin is a Yin organ. In Yin disease, seeing a floating pulse means that Yin disease obtaining a Yang pulse leads to survival; failing to obtain a Yang pulse means non-recovery.
[Explanation] In Yin disease, the pulse should not be floating. Now, in Jueyin wind-strike, the pulse is contrary to floating because Jueyin and Shaoyang are exterior-interior partners. If the harmonious Qi of Shaoyang is obtained, and there is a mechanism for the disease to emerge from Yin to Yang, the pulse will definitely be slightly floating. This is exactly what Mr. Zheng said: "Yin disease obtaining a Yang pulse leads to survival; failing to obtain a Yang pulse means non-recovery."
Three. In Jueyin disease, the time of resolution is from Chou to Mao hours. Original text 328
Mr. Zheng's Commentary: Each of the Six Channels has its prosperous time. The retreat or advance of pathogens can be determined during these prosperous times.
[Explanation] There is a clause regarding the time of resolution for each of the Six Channels. According to the Jueyin chapter: "If Jue is less and heat is more, the disease will heal; if cold is more and heat is less, the disease will progress; if heat is not eliminated and pus-blood appears, death is not certain; if diarrhea and Jue do not cease, death is certain." Thus, the "resolution" mentioned in this clause refers to a pattern where cold ends and Yang returns. This aligns with Mr. Zheng's statement: "The retreat or advance of pathogens can be determined during their prosperous times." In terms of time, this corresponds to between 1:00 AM and 5:00 AM.
Four. In Jueyin disease, if there is a desire to drink water, give small amounts frequently, and the patient will heal. Original text 329
Mr. Zheng's Commentary: This indicates that Jueyin is accompanied by slight heat. Scholars must carefully seek substantial evidence of Yin and Yang here.
[Explanation] This clause describes thirst and desire to drink water as pathogens recede and Yang recovers in Jueyin disease. Because Yang Qi suddenly recovers, body fluids temporarily fail to ascend to moisten the mouth, causing thirst. As Mr. Zheng said: "This is Jueyin accompanied by slight heat." Therefore, giving small amounts of water frequently nourishes and assists the body fluids, allowing the disease to heal spontaneously.
Five. All cases of Si Ni (Four Reversals/Jue) cannot be purged; this applies equally to those with deficiency constitutions. All cases of Jue occur when Yin and Yang Qi fail to connect smoothly. Jue is characterized by cold extremities reaching upwards. Original texts 330, 337
Mr. Zheng's Commentary: Regarding Jue patterns, there is originally a distinction between Yang Jue and Yin Jue. Yang Jue can be purged, while Yin Jue cannot be purged; this is an established principle.
[Explanation] The first part of this clause points out that deficiency-cold type Jue reversal cannot be purged. That is, even those with deficiency constitutions who do not have Jue reversal should not be purged; the method should be to support Yang. The second part encompasses both cold and heat Jue. The cause of Jue is formed by the failure of Yin and Yang Qi to connect smoothly, manifesting as cold extremities. In cold Jue, extreme cold causes Yin Qi to prevail exclusively, while Yang Qi relatively declines and cannot reach the four limbs, resulting in cold extremities, thus forming cold Jue. Conversely, extreme heat suppresses Yang Qi, which also fails to reach the four limbs, thus forming heat Jue. Both cold and heat Jue present with cold extremities, but their etiology and pathology are completely different, so their treatments differ. Mr. Zheng stated: "Yang Jue can be purged, Yin Jue cannot be purged; this is an established principle." This outlines therapeutic principles that serve as a standard.
Six. In Shanghan (Cold Damage), if the pulse is slow, and after six or seven days, Huang Qin Tang (Scutellaria Decoction) is wrongly given to remove heat①, since a slow pulse indicates cold, giving Huang Qin Tang (Scutellaria Decoction) again removes heat. [The abdomen should feel cold], and the patient should be unable to eat. Now, if the patient can unexpectedly eat, this is named Chu Zhong (Elimination of the Center)②, and death is certain. Original text 333
① Che (Remove): Means to eliminate; here it implies treatment.
② Chu Zhong (Elimination of the Center): A disease name referring to a paradoxical symptom appearing when Stomach Qi is about to perish.
Mr. Zheng's Commentary: A slow pulse indicates cold, which is very clear. Giving Huang Qin Tang (Scutellaria Decoction) instead is a loss of proper treatment. Losing proper treatment, the patient should be unable to eat, which is normal. Now, being able to eat is contrary to normal. Those who act contrary to normal die; this is named Chu Zhong (Elimination of the Center). Chu Zhong means Stomach Yang is exposed, like a lamp flame that is about to go out but suddenly brightens before extinguishing instantly.
[Explanation] In Shanghan (Cold Damage), a slow pulse belongs to Yin and governs cold, indicating the Stomach must be deficient and cold. If encountering this deficiency-cold pulse and syndrome, Li Zhong Tang (Regulate the Middle Decoction) should be used to warm it. Now, wrongly using Huang Qin Tang (Scutellaria Decoction) to eliminate the remaining Yang Qi in the Stomach, the patient should be unable to eat but unexpectedly can eat; this is named Chu Zhong (Elimination of the Center). Mr. Zheng explained Chu Zhong as: "Stomach Yang is exposed, like the light of a lamp, about to go out but shining brightly again before extinguishing instantly," which is vividly descriptive. Commonly known as "terminal lucidity" or "returning light reflection," death is inevitable.
Seven. In Shanghan (Cold Damage) [initially] fever for six days, Jue reverses for nine days with diarrhea. All cases of Jue and diarrhea① should be unable to eat. Now, if the patient can unexpectedly eat, one may fear Chu Zhong (Elimination of the Center). Feeding Su Bing (Noodle Cakes)②, if there is no fever, it is known that Stomach Qi still exists, and the patient will surely heal. Fearing sudden heat comes [out] and then goes away, after (three) days, palpate the pulse③. If the heat continues, expect healing at midnight of the next day④. The reason for this is: (originally) fever for six days, Jue reversed for nine days, recurring fever for three days, combined with the previous six days, totals nine days, corresponding to Jue, hence expecting healing at midnight of the next day. After three days, palpate the pulse. [And if the] pulse is rapid, and the heat does not (cease)⑤, this indicates excess heat Qi, and carbuncles and pus will certainly develop. Original text 332
① Jue Li (Jue and Diarrhea): Refers to cold extremities accompanied by diarrhea.
② Feed Su Bing (Noodle Cakes): Meaning to give food to someone. Su Bing is a strip-shaped food made of flour.
③ Mai Zhi (Pulse Palpation): Means diagnosis/palpation.
④ Dan Ye Ban Ri (Midnight of the Next Day): Is the middle of the night of the second day.
Mr. Zheng's Commentary: Jue and diarrhea both fall under the category of inability to eat. Now, unexpectedly being able to eat is similar to Chu Zhong (Elimination of the Center). Judgment depends on the words "fever" and "no fever." If still able to have fever, it is known that Stomach Qi still exists, but it must not be violent [emergence]. Violence is a sign of collapse, subtlety is a sign of life. If there is no fever, Chu Zhong (Elimination of the Center) is confirmed. Expecting healing at midnight relies on this subtle presence of fever. Regarding the certainty of developing carbuncles and pus, it is because Stomach Yang is in excess and suppression/stagnation is too severe. Also, feeding Su Bing (Noodle Cakes) results in no fever. Since there is no fever, Stomach Qi has gone, how can one say Stomach Qi still exists? The character "not" must be "subtle" to align with the commentary.
[Explanation] This clause is long and complex. Generally speaking, comparing the number of days of Jue and heat shows they are equivalent, so the disease can heal spontaneously. If Jue exceeds heat, the disease progresses; if heat exceeds Jue, carbuncles and pus develop. When Jue and diarrhea appear together, the patient should be unable to eat. If unexpectedly able to eat, one may fear Chu Zhong (Elimination of the Center). Whether it is Chu Zhong (Elimination of the Center) can be tested by feeding Su Bing (Noodle Cakes). Mr. Zheng said: "If still able to have fever, it is known that Stomach Qi still exists; if no fever, Stomach Qi has gone, how can one say Stomach Qi still exists? The character 'not' must be 'subtle' to align with the commentary." This demonstrates Mr. Zheng's contribution in correcting the original text.
Eight. In Shanghan (Cold Damage), initially Jue followed by fever, [and] diarrhea⑤ will surely stop spontaneously. But if sweating occurs contrary to expectation, and there is pain in the throat, the throat becomes Bi (Obstruction)⑥. With fever and no sweating, diarrhea will surely stop spontaneously; if it does not stop, pus-blood will certainly appear in the stool. [Those who pass pus-blood], their throats will not become Bi. Original text 334
⑤ Its Hou Wei Bi (Its Throat Becomes Bi): Refers to a disease where the throat is painful and swollen/red.
Mr. Zheng's Commentary: Regarding Jue followed by fever and diarrhea, fever is a sign of Yang returning, so it can be determined that diarrhea will surely stop spontaneously. But if diarrhea stops and sweating occurs contrary to expectation, with throat pain becoming throat Bi, this is Jueyin accompanying wind-pathogen attacking upward. If diarrhea does not stop, pus-blood will certainly appear in the stool, which is due to pathogenic heat attacking downward. Between stopping and not stopping diarrhea, the diseases of attacking upward versus attacking downward become self-evident.
[Explanation] This clause presents initial Jue followed by heat, which is a sign of Yang advancing and Yin retreating; diarrhea will surely stop spontaneously. If Yang recovery is excessive, it manifests as throat Bi (Obstruction) above, or pus-blood in stool below. Throat Bi (Obstruction) can be treated with Jie Geng Tang (Platycodon Decoction), and pus-blood in stool can be treated with Bai Tou Weng Tang (Pulsatilla Decoction). Passing pus-blood indicates pathogenic heat causing lower diarrhea, without recurring upper throat pain.
Nine. In Shanghan (Cold Damage), from the second or third day to the fourth or fifth day, [and] if there is Jue, there will surely be fever. Previous heat means subsequent Jue. The deeper the [Jue], the deeper the [heat]; the milder the [Jue], the milder the [heat]. [Jue] should be purged, but if wrongly induced to sweat, mouth injuries with rotting and redness will certainly occur⑦. Original text 335
⑦ Kou Shang Lan Chi (Mouth Injury Rotting Red): Ulcers on the tongue and mouth, red, swollen, and eroded.
Mr. Zheng's Commentary: "Heat deep, Jue deep" speaks to conditions of Yang hyperactivity and heat hiding. The main approach should be breaking Yang and supporting Yin. Among these, some wrongly induce sweating, leading to mouth erosion, rotting, and redness. All medicinal herbs tend to ascend; pathogenic fire, getting lifted, floats upward. How could one not suffer from mouth erosion, redness, and rotting?
[Explanation] The mechanism of forming heat Jue is mainly that pathogenic heat hides deeply, and Yang Qi is internally depressed and cannot reach the exterior. This is what Mr. Zheng said: "Speaks to conditions of Yang hyperactivity and heat hiding." The method should be breaking Yang and supporting Yin, selecting Cheng Qi Tang formulas to purge heat and preserve Yin. Inducing sweating is naturally contraindicated. If wrongly induced to sweat, fluids are robbed, pathogenic heat becomes more intense, and pathogenic heat interferes upward, producing ulcers on the tongue and mouth, red, swollen, and eroded.
Ten. In Shanghan (Cold Damage) disease, Jue lasts five days, heat also lasts five days. If on the sixth day, Jue recurs, but if it does not recur, the patient heals spontaneously. Jue ultimately does not exceed five days; because heat lasts five days, it is known that the patient will heal spontaneously. Original text 336
Mr. Zheng's Commentary: Heat and Jue both belong to five days, which is a pattern of balanced Yin and Yang, so it is concluded that the patient will surely heal spontaneously.
[Explanation] When Yin and Yang are imbalanced, disease arises; when Yin and Yang are peaceful, disease heals. This applies to all diseases. The progression, regression, life, and death mechanisms of Jueyin disease are no exception to this principle. Therefore, if the number of days of heat and Jue are equal, as Mr. Zheng said: "This is a pattern of balanced Yin and Yang," it is known that the patient will heal spontaneously.
Eleven. In Shanghan (Cold Damage), the pulse is faint and there is Jue. By the seventh or eighth day, (skin) is cold. If the person is vexed (restless) with no moment of peace, this is Zang Jue (Organ Jue)⑧, not Hua Jue (Roundworm Jue)⑨. The person with Hua Jue (Roundworm Jue) should vomit roundworms. (Now) let the patient be quiet, but occasionally vexed [is the case]. This is Zang Han (Organ Cold)
⑩, roundworms move up into [their] diaphragm, thus causing vexation. After a short while, it stops again. Upon eating, vomiting occurs, and if vexed again, (worms) [roundworms] smell food odor and come out. The person will naturally vomit roundworms. For Hua Jue (Roundworm Jue), Wu Mei Wan (Mume Pill) is the primary formula. It also treats chronic dysentery. Original text 338
⑧ Zang Jue (Organ Jue): Refers to cold extremities caused by extreme deficiency of True Yang in the internal organs.
⑨ Hua Jue (Roundworm Jue): Refers to cold extremities caused by roundworms.
⑩ Zang Han (Organ Cold): Refers to deficiency-cold in the internal organs. The Zang Han mentioned here can be interpreted as deficiency-cold of Stomach Qi.
Mr. Zheng's Commentary: Since it is stated that the pulse is faint and there is Jue, and (skin) cold is called Zang Han (Organ Cold), why not treat it according to the Zang Han (Organ Cold) method? Also, regarding Hua Jue (Roundworm Jue), roundworms are transformed from Jueyin Wind [Wood]. If the Stomach is cold, worms will be restless; if the Stomach is hot, worms will also be restless. If the Stomach cannot receive food, worms will be restless. Investigating thus yields the method for treating worms. There are no sufficient signs of heat in this clause to justify calling it a mixed cold-heat pattern. Its use for chronic dysentery is also referred to as cold diarrhea. Wu Mei Wan (Mume Pill) is not the correct theory.
[Explanation] The first part of this clause, from "Shanghan (Cold Damage) pulse faint and Jue" to "this is Zang Jue (Organ Jue), not Hua Jue (Roundworm Jue)," describes Zang Han (Organ Cold) causing Jue. The condition is critical, requiring urgent rescue with Si Ni Tang (Counterflow Decoction) and Bai Tong Tang (White Through Decoction). Hua Jue (Roundworm Jue) has the symptom of vomiting roundworms. Its vexation comes and goes, unlike the constant restlessness of Zang Jue (Organ Jue). Its Jue is limb cold, not skin cold. The original text states Wu Mei Wan (Mume Pill) is the primary formula, also treating chronic dysentery. Mr. Zheng believed that treating with Wu Mei Wan (Mume Pill) was not the correct theory. I often achieve efficacy in treating roundworm conditions by modifying Wu Mei Wan (Mume Pill) into a decoction. Chronic dysentery mostly belongs to deficiency-cold with slipping and loosening; the method should be warming, tonifying, and astringing. Fu Zi Li Zhong Tang (Aconite and Magnolia Bark Decoction to Regulate the Middle) plus Poppy Shell is commonly used.
Formula of Wu Mei Wan (Mume Pill) (Corrected and Supplemented)
Wu Mei (Mume Fruit) 300 pieces, Xi Xin (Asarum) 6 liang, Gan Jiang (Dried Ginger) 10 liang, Huang Lian (Coptis Rhizome) 16 liang, Dang Gui (Angelica Sinensis) 4 liang, Fu Zi (Aconite Root) 6 liang (processed, peeled), Shu Jiao (Sichuan Pepper) 4 liang (sweated), Gui Zhi (Cinnamon Twig) 6 liang (peeled), Ren Shen (Ginseng) 6 liang, Huang Bo (Phellodendron Bark) 6 liang. These ten ingredients are separately pounded and sifted, then mixed. Soak Wu Mei (Mume Fruit) in vinegar overnight, remove pits, steam over five dou of rice until cooked, pound into paste, mix with medicines until uniform, place in mortar, pound with honey two thousand times, form pills the size of paulownia seeds. Take ten pills before meals with water, three times daily, gradually increasing to twenty pills. Avoid raw/cold, slippery, and foul-smelling foods.
[Formula Analysis and Scope of Application] This formula combines cold and heat, attack and tonification, benefiting the Stomach and calming roundworms. Wu Mei (Mume Fruit) is the chief herb, having sour and astringent properties, paired with Chuan Jiao (Sichuan Pepper) to kill parasites. Worms are calmed by bitterness, hence Huang Lian (Coptis Rhizome) and Huang Bo (Phellodendron Bark) are used. Fu Zi (Aconite Root), Gan Jiang (Dried Ginger), Xi Xin (Asarum), and Gui Zhi (Cinnamon Twig) warm the middle and dispel cold. Ren Shen (Ginseng) tonifies Spleen; Dang Gui (Angelica Sinensis) tonifies Liver. Together, they form a formula that warms the middle, dispels cold, kills parasites, and pacifies Jue, yielding good effects for Hua Jue (Roundworm Jue). Mr. Zheng stated: "Jueyin is a Yin channel. At the extreme of Yin, Yang is born, so there are many mixed cold-heat patterns.... Zhang Zhongjing established Wu Mei Wan (Mume Pill), combining cold and heat therapies. It was not specifically legislated for worms; all Jueyin syndromes are fully covered." It has traditionally been the first-choice formula for treating Hua Jue (Roundworm Jue) and chronic dysentery, with broad application. Mr. Zheng used it in *Yi Fa Yuan Tong* (Circular Communication of Medical Methods) to treat vertex headache, abdominal pain preferring cold drinks, and testicular swelling/pain. I use this formula to treat dysentery, regardless of new or old, changing pills to decoctions, achieving significant efficacy. Modern practitioners use modified Wu Mei Wan (Mume Pill) to treat biliary ascariasis and various intestinal diseases, frequently obtaining good results. Some believe this formula can be applied to any mixed cold-heat syndrome, demonstrating its extensive applicability.
Twelve. In Shanghan (Cold Damage), heat is slight with mild Jue⑪, fingertips are cold, the person is silent with no desire to eat, and is vexed/restless. After several days, if urination is free and white in color, this indicates heat has resolved. Desiring to eat means the disease will heal. If there is Jue with vomiting, and fullness/vexation in the chest and hypochondrium, pus-blood will certainly appear in the stool later. Original text 339