（手弄衣被及摸床者必兼撮空此肝家之热肝将绝故见危恶之症）
太阳中风。以火发汗。邪风被火。两阳相熏其身发黄。阳盛则衄。阴盛则小便难。但头
汗出。口干咽烂。或不大便。谵语。甚者哕。捻衣摸床。小便利者。可治。吐下后不解。不大便
。日晡潮热。不恶寒。独语如见鬼状。剧则不识人。循衣摸床。惕而不安。微喘直视。脉弦者生
。涩者死。（大承气汤）
按循衣摸床。必兼见撮空。及怵惕。肝主筋。肝热甚。故动惕也。脉弦则肝木未败。故
生脉涩则金旺。而木欲绝。故死。仲景主下者。因其不大便也。若内无燥屎。而脉重按无
力者。往往以大补气血而愈。此法外之变通也。
（视物而不转睛也五脏六腑之气皆上注于目邪气壅盛冒其正气则神识不慧藏精
之气不能上荣于目则直视此邪气已极正气已坏吉少凶多者也故曰狂言直视为肾绝直视
摇头为心绝直视谵语喘满者死直视下利者死）
衄家不可汗。汗则额陷。脉紧急。直视不能 。（肝受血而能视亡血则肝虚又发汗亡阳
则阴阳俱虚此症虽逆尚可以补剂救十中之一二也）
风温被下。小便不利。直视失溲。（仲景无治法）目中不了了。睛不和。无表里症。大便
难。微热为实。（大承气汤）
（厥者四肢冷也逆者手足冷也邪在三阳则热传至太阴则温至少阴则逆至厥阴则厥故
成氏以为厥甚于逆而王履非之似亦不必 厥有阴阳之殊最当详慎）
太阳脉浮。自汗。小便数。心烦微恶寒。脚挛急。反与桂枝攻表。误也。得之便厥。咽干
。烦躁。吐逆。（甘草干姜汤）阳明脉滑而厥。里有热也。（白虎汤）三阳合病。腹满。身重。口不
仁。面垢。谵语。遗尿。发汗则谵语。下之则额汗手足逆冷。若自汗者。（白虎汤）少阴吐利
。手足厥冷。烦躁欲死。（吴茱萸汤）少阴病。下利清谷。里寒外热。厥逆脉微。反不恶寒
。面赤。或腹痛。或干呕。或咽痛。或利止脉不出。（通脉四逆汤）少阴四逆。或咳或悸。或
小便不利。或腹痛泄利。（四逆散）厥而悸者。宜先治水。却治其厥。不尔。水渍入胃。必作
利
（麻黄升麻汤）厥冷。脉细欲绝。（当归四逆汤）厥冷。脉乍紧者。邪结胸中。（瓜蒂散）一二日
至四五日厥者。必发热。厥深者热亦深。厥微者热亦微。（承气汤下之若误汗之必口伤烂赤）
少阴恶寒。身蜷而利。逆冷者。不治。少阴吐利。烦躁四逆者。死。少阴但厥无汗。强发之
。必动其血。或从口鼻。或从目出。名下厥上竭。为难治。逆厥者。不可下。发热。下
利。厥不止者死。下利厥逆。无脉。灸之不温。脉之还反微喘者死。
按厥有阴阳。辨之宜精。阴厥者。初得病。便逆冷。脉沉迟。足挛恶寒。或引衣自盖。
或不
。阳厥者。初病必身热。小便赤。大便秘。渴饮。烦躁不眠。动转不宁。至二三日后方发厥
。其脉虽沉。按之必滑。手足心温。指甲微温。法当清之。或下症悉具。而见四逆。是因失下
血气不通。承气汤下之。其曰逆冷不可下者。为真寒者言也。若夫火极似水而厥。则手足心
温。指甲亦温。非下何以救乎。
(When a patient unconsciously grasps at bedding or strokes the bed, it is usually accompanied by the symptom of "grasping at empty air." This indicates excessive heat in the Liver channel and impending exhaustion of Liver Qi, manifesting as a critical and ominous syndrome.)
In Taiyang Wind-stroke (Taiyang wind-strike), if fire therapy is used to induce sweating, the pathogenic wind combines with the fire pathogen. The mutual薰 (fuming/heating) of two Yangs causes jaundice. When Yang is excessive, epistaxis occurs; when Yin is excessive, dysuria results. There is only sweating on the head, dry mouth, ulceration of the throat, constipation, and delirium. In severe cases, hiccups occur, along with picking at clothes and stroking the bed. If urination is free, the condition is treatable. After purgative or emetic therapies fail to resolve the disease, there is constipation, tidal fever around 3-5 PM (Shen hour), aversion to cold is absent, and the patient speaks alone as if seeing ghosts. In critical stages, the patient does not recognize people, engages in stroking clothes and the bed, feels terrified and uneasy, has slight asthma/dyspnea, and fixed staring eyes. A wiry pulse indicates survival; a choppy pulse indicates death. (Use Da Cheng Qi Tang / Great Order the Qi Decoction)
Note: The symptom of stroking clothes and the bed invariably appears together with "grasping at empty air" and fearful trembling. The Liver governs the sinews; extreme Liver heat causes tremors. A wiry pulse indicates that Liver Wood Qi has not yet failed, hence survival. A choppy pulse indicates that Metal Qi is flourishing while Wood Qi is about to perish, hence death. Zhang Zhongjing advocates purgation because of the presence of constipation. If there is no dry stool in the interior and the pulse is forceless upon heavy pressure, recovery often follows large tonification of Qi and Blood. This represents flexibility beyond standard methods.
(Fixed staring without eye movement. The Qi of the Zang-Fu organs all ascend to the eyes. If pathogenic factors are abundant and obstruct the healthy Qi, mental clarity is lost, and the essence-storing Qi cannot nourish the eyes, resulting in fixed staring. This signifies that pathogenic factors have reached their peak and healthy Qi is damaged; prognosis is poor. Thus, it is said that wild speech and fixed staring indicate exhaustion of Kidney Qi; fixed staring with head shaking indicates exhaustion of Heart Qi; fixed staring with delirium, dyspnea, and fullness leads to death; fixed staring with diarrhea leads to death.)
Patients with a history of frequent epistaxis should not undergo sweating therapy. Sweating will cause depression of the forehead, urgent/tight pulse, and fixed staring inability to look around. (The Liver receives blood to enable vision; loss of blood makes the Liver deficient. Furthermore, sweating depletes Yang, leading to deficiency of both Yin and Yang. Although this is a adverse condition, it can still be saved by tonic formulas in one or two out of ten cases.)
Wind-warmth disease treated incorrectly with purgation leads to dysuria, fixed staring, and incontinence of urine and feces. (Zhang Zhongjing did not record a treatment method). Eyes see things unclearly ("muddled"), eyeballs are not flexible. With no exterior or interior syndromes, difficulty in defecation, and slight heat, this is an excess pattern. (Use Da Cheng Qi Tang / Great Order the Qi Decoction)
Jue (Cold Extremities) refers to cold limbs; Ni (Reversal) refers to cold hands and feet. Pathogens in the Three Yang channels transmit to the Taiyin channel becoming Warmth disease, to the Shaoyin channel becoming Ni, and to the Jueyin channel becoming Jue. Therefore, Cheng Wuji considered Jue more severe than Ni, while Wang Lu disagreed, suggesting such distinctions need not be overly rigid. Jue differs between Yin-Jue and Yang-Jue, requiring careful differentiation.
Taiyang disease with floating pulse, spontaneous sweating, frequent urination, vexation, slight aversion to cold, and cramped/calcaneal spasm, treated wrongly with Gui Zhi Tang to attack the exterior. This leads to cold extremities, dry throat, vexation, and vomiting/reversal of Qi. (Use Gan Cao Gan Jiang Tang / Licorice and Dried Ginger Decoction). Yangming disease with slippery pulse and cold extremities indicates internal heat. (Use Bai Hu Tang / White Tiger Decoction). Combined disease of the Three Yang with abdominal fullness, heavy body, insensitivity of the mouth/face, greasy facial appearance, delirium, and enuresis. Sweating worsens delirium; purgation causes forehead sweating and cold extremities. If there is spontaneous sweating, (Use Bai Hu Tang / White Tiger Decoction). Shaoyin disease with vomiting and diarrhea, cold extremities, and extreme vexation. (Use Wu Zhu Yu Tang / Evodia Fruit Decoction). Shaoyin disease with diarrhea passing undigested food, interior cold with exterior heat, cold extremities, faint pulse, aversion to cold is absent, red face, possibly abdominal pain, dry retching, sore throat, or cessation of diarrhea with unpalpable pulse. (Use Tong Mai Si Ni Tang / Pulse-Reverting Four Reversals Decoction). Shaoyin presenting with Si Ni (Four Reversals/Cold Extremities), possibly cough, palpitations, dysuria, abdominal pain, or diarrhea. (Use Si Ni San / Four Reversals Powder). Jue with palpitations should first be treated for water retention, then for Jue. Otherwise, water dampness entering the Stomach will cause diarrhea. (Ma Huang Sheng Ma Tang / Ephedra and Marsdenia Decoction). Cold extremities with fine pulse nearly imperceptible. (Use Dang Gui Si Ni Tang / Angelica Sinensis Four Reversals Decoction). Cold extremities with suddenly tight pulse indicate pathogen knotting in the chest. (Use Gua Di San / Melon Seed Powder). Jue occurring from day 1-2 to day 4-5 must be accompanied by fever. The deeper the Jue, the deeper the heat; the milder the Jue, the milder the heat. (Use Cheng Qi Tang / Order the Qi Decoction to purge; if sweating is mistakenly used, it will cause oral ulceration and redness).
Shaoyin disease with aversion to cold, curled-up body, diarrhea, and cold extremities is difficult to treat or untreatable. Shaoyin disease with vomiting, diarrhea, vexation, and cold extremities is a death syndrome. Shaoyin disease with only Jue and no sweat; forcing sweat will disturb the blood, causing bleeding from mouth/nose or eyes, called Lower Jue Upper Exhaustion, which is difficult to treat. For Ni-Jue, purgation is contraindicated. Fever, diarrhea, and persistent cold extremities indicate death. Diarrhea with cold extremities, absence of pulse, failure to warm after moxibustion, and subsequent slight dyspnea indicate death.
Note: Jue is divided into Yin-Jue and Yang-Jue, requiring precise differentiation. Yin-Jue presents immediately with cold extremities, deep-slow pulse, leg cramps, aversion to cold, desire to cover oneself with clothes, or refusal to uncover blankets. Yang-Jue initially presents with fever, red urine, constipation, thirst, vexation, insomnia, and restlessness. Jue appears only after 2-3 days. The pulse may be deep but slippery upon pressure; palms and soles are warm, nails slightly warm. Treatment should involve clearing heat or purging. If all purgation indications are present but cold extremities appear, it is due to failure to purge earlier, causing Qi and Blood stagnation; use Cheng Qi Tang to purge. The statement "cold extremities contraindicate purgation" applies to true cold patterns. In cases of extreme fire mimicking water (false cold), palms, soles, and nails remain warm; how else can it be saved but by purgation?