当归四逆汤。桂枝汤。白头翁汤。乌梅丸。干姜黄连黄芩人参汤。
刺期门 四逆散 白虎汤
气上冲心。吐蛔。厥。下利。少腹满。囊缩。
仲景述厥阴病。消渴。气上撞心。心中疼热。饥而不欲食。食则吐蛔。下之。利不止。此
皆厥阴自病之热症。并非伤寒传经之热邪。盖厥阴内藏相火。其消渴。火盛水亏
也。气上撞心。心中疼热。肝火乘心也。饥不欲食。食即吐蛔。风木克土。胃中空虚也。
下之即利。土受木贼。不禁再利也。不得以伤寒正病视之。
邵评∶此厥阴病之总纲。总而言之。太阴厥阴。皆以里症为提纲。太阴主寒。厥阴主热。太阴
为阴中之至阴。厥阴为阴中之阳。两阴交尽。名曰厥阴。其脉络于少阳。厥阴热症。皆少阳相火化合耳。
凡伤寒手足厥冷。脉细欲绝者。此寒伤厥阴之经。但当温散其表。不可遽温其里。
当归四逆汤主之。盖厥阴相火所寄。脏气本热。寒邪止得外伤于经。而不内伤于
脏。故止用桂枝以解外邪。当归以和肝血。细辛以散寒。大枣以和营。通草以通阴阳。则表邪
散而营卫行。手足温而脉自不绝矣。若其人素有寒邪。加吴茱萸以温本脏之寒。
邵评∶以伤寒邪伤厥阴之经。未伤于脏。阳虚血弱。用此方行营卫而散表邪。最效。
论曰。厥阴中风。脉微浮为欲愈。脉不浮为未愈。按此止有欲愈未愈之脉。并无未
愈之证治。不能无阙文之憾。要不出乎桂枝汤为主治。
邵评∶厥阴中风。以脉辨病之欲愈未愈。亦是诊病之一法。
风中厥阴本经。脉微浮。风邪外出。故欲愈也。不浮而沉。则风邪入里。木郁不舒。则
下克脾土。必变热利下重。渴欲饮水之症。宜白头翁汤主之。白头翁、秦皮以平风。
黄柏、黄连以清火。是苦以坚之也。若厥阴久痢不止。当用乌梅丸酸以收之。
邵评∶此厥阴阳邪下陷。协热下利之正法 。
厥阴寒格。医复吐下之。食入口即吐。干姜黄连黄芩人参汤主之。此寒格于下。拒
热于上。故格拒不纳。芩连以清上热。干姜以开寒格。因误治以虚中气。故用人参
助干姜。以壮胃阳而开阴格。
邵评∶寒热相阻。则为格症。用此汤开其寒热之格拒。而兼补里虚也。
伤寒腹满谵语。寸口脉浮而紧。此肝乘脾也。名曰纵。刺期门。
邵评∶腹满谵语。由于肝火木旺。脾家有热。脉浮紧者为弦。弦乃肝脉。脉症是肝
邪乘脾之候。肝木侮土。理尚顺直。故曰纵。刺期门者。泻肝邪也。
按腹满谵语。为太阴阳明里症。脉浮而紧。为太阳阳明表脉。何以辨其为厥阴。脉
法曰。脉浮而紧者。名曰弦也。内经谓诸腹胀大。皆属于热。又曰肝气甚则多言。是
腹满由于肝火。而谵语乃肝旺所发也。肝木侮脾。故曰纵。厥阴忌汗下。故刺期门以泄之。
伤寒发汗。啬啬恶寒。大渴欲饮水。其腹必满。此肝乘肺也。名曰横。刺期门。自汗出。
小便利。其病欲解。
邵评∶肝邪挟火而刑肺金。肺气不得宣布。故渴饮而腹满。木反乘金。侮所不胜。
寡于畏也。于理不顺。故曰横。横者曲也。刺期门。亦泻肝邪也。
按其腹因饮多而满。则非太阴之满。饮水不消。亦非厥阴之消渴。此肝邪挟火而
刑肺金。故大渴。肺气不能通调水道。故腹满。侮其所胜曰纵。侮所不胜曰横。自汗
出。小便利。其病欲解者。得汗。则发热恶寒之表症自解。得小便利。则腹满之里症自除。
邵评∶前第一条消渴气上撞心。是肝邪乘心。上条腹满谵语。是肝邪乘脾。此条
恶寒饮水。是肝反乘肺。肝寄相火。有泻无补者。此类是也。
厥阴有脏厥。有蛔厥。脏厥至七八日。脉微肤冷。不烦而躁。无暂安时。此属脏冷。纯阴无阳。故不治。
邵评∶此是脏厥主症。与蛔厥不同。分辨在此。其但躁而无暂安时者。浮阳外越。
不久即散，阴气寒结于肠中。乃纯阴无阳。故不治也。
蛔厥亦有脉微肤冷。此内热外冷。故时烦而躁。其显症在吐蛔。宜乌梅丸主之。
邵评∶此与脏厥之躁无暂安时者不同。况有吐蛔见症。是蛔厥而非脏厥矣。盖
外寒遏热于内。蛔不安而动。则其人时烦。蛔静则烦躁亦止。非若脏厥之无暂安时也。用乌
梅丸以温脏安蛔。最合。
凡厥者。必发热。前热者。后必厥。厥深热亦深。厥微热亦微。厥少热多。其病当退。厥
多热少。其病当进。
邵评∶伤寒以阳气为重。此以厥热之微甚。即觇其人阳气之多寡。热多则阳气
未伤。故病当退。厥多则阳气衰少。故病当进。
厥微者。四逆散。厥深者。白虎汤。此肝火乘胃也。
邵评∶此是阳邪热厥。由邪火乘胃也。加左金丸尤效。
脉滑而厥为热厥。宜白虎汤。若反发其汗。必口伤赤烂。
邵评∶脉滑而厥者。里有热也。阳邪入里。阴气被格。阳内阴外。故热深则厥甚。热
微则厥亦微。此为热厥。与寒厥之脉微欲绝者。大相迳庭矣。此当有口燥舌干之症。
用白虎汤清里除热。其厥自已。
Danggui Sini Decoction (Cinnamon Twig and Angelica Decoction), Guizhi Tang (Cinnamon Twig Decoction), Baitouweng Tang (Pulsatilla Decoction), Wumei Wan (Mume Pill), Ganjiang Huanglian Huangqin Renshen Tang (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction).
Acupuncture at Qimen (LR14), Six-Ingredient Pinellia Decoction (Sini San), Baihu Tang (White Tiger Decoction).
Qi rushing upward to strike the heart, vomiting roundworms, cold extremities (Jue), diarrhea, fullness in the lower abdomen, contraction of the scrotum.
Zhang Zhongjing discussed Jueyin disease: excessive thirst, Qi rushing upward to strike the heart, pain and burning sensation in the heart region, hunger without desire to eat, and vomiting roundworms after eating. If purgatives are misused, it leads to unceasing diarrhea. These are all heat syndromes originating from the Jueyin channel itself, not heat pathogens transmitted via the meridians in Shanghan (Cold Damage). This is because the Jueyin organ harbors Ministerial Fire (Sanjiao Fire); its manifestation of excessive thirst is due to fire excess and water deficiency. The Qi rushing upward to strike the heart and the pain/burning in the heart region result from Liver Fire invading the Heart. Hunger without desire to eat, and vomiting roundworms upon eating, occur because Wind-Wood overacts on Earth, leaving the Stomach empty. Misuse of purgatives leading to diarrhea happens because the Spleen Earth is attacked by Liver Wood and cannot withstand further draining. Therefore, this should not be viewed as the primary disease of Shanghan.
Shao’s Commentary: This is the general outline for Jueyin disease. In summary, both Taiyin and Jueyin use interior syndromes as their guiding principles. Taiyin governs Cold, while Jueyin governs Heat. Taiyin is the Ultimate Yin within Yin, whereas Jueyin is Yang within Yin. When two Yins meet and exhaust themselves, it is named Jueyin. Its meridians connect with Shaoyang. All heat syndromes of Jueyin are combinations of Shaoyang Ministerial Fire.
In cases where Shanghan causes cold extremities and a pulse that is fine and nearly imperceptible, this indicates Cold pathogen damaging the Jueyin meridian. One should only warm and disperse the exterior; one must not hastily warm the interior.
Danggui Sini Decoction is the primary treatment. Since Jueyin hosts Ministerial Fire, its organ qi is inherently warm. Cold pathogens can only damage the exterior meridians, not the interior organs. Thus, Guizhi (Cinnamon Twig) is used to resolve exterior pathogens, Danggui (Angelicae Sinensis Radix) to harmonize Liver blood, Xixin (Asari Radix et Rhizoma) to dispel Cold, Dazao (Jujubae Fructus) to harmonize Ying (Nutritive Qi), and Tongcao (Tetrapanacis Medulla) to unblock the interaction between Yin and Yang. This allows exterior pathogens to scatter, Ying and Wei (Defensive Qi) to circulate, extremities to warm, and the pulse to resume naturally. If the patient has pre-existing internal Cold, add Wuzhuyu (Evodiae Fructus) to warm the Cold of the home organ.
Shao’s Commentary: Since the Shanghan pathogen damages the Jueyin meridian without injuring the organ, resulting in Yang deficiency and Blood weakness, using this formula to promote Ying and Wei circulation and disperse exterior pathogens is most effective.
The Treatise states: In Jueyin Wind Strike, a slightly floating pulse indicates impending recovery, while a non-floating pulse indicates no recovery. According to this, there are only descriptions of pulses indicating recovery or non-recovery, but no treatments for non-recovery, which leaves a regrettable gap in the text. However, the treatment essentially revolves around Guizhi Tang as the main prescription.
Shao’s Commentary: Using the pulse to distinguish between impending recovery and non-recovery in Jueyin Wind Strike is also a method of diagnosis.
When Wind pathogen strikes the Jueyin proper meridian, a slightly floating pulse indicates Wind pathogen exiting outward, hence impending recovery. If the pulse is not floating but deep, the Wind pathogen enters the interior. Liver Wood becomes stagnant and fails to diffuse, thereby downwardly attacking Spleen Earth. This inevitably transforms into symptoms of heat dysentery with a feeling of heaviness in the anus and thirst with desire to drink water. Baitouweng Tang (Pulsatilla Decoction) is indicated. Baitouweng (Pulsatillae Radix) and Qinpi (Ailanthi Cortex) pacify Wind; Huangbai (Phellodendri Cortex) and Huanglian (Coptidis Rhizoma) clear Fire. This utilizes the bitter flavor to firm and preserve Yin. For chronic dysentery of Jueyin origin that does not cease, Wumei Wan (Mume Pill) should be used, employing sour flavors to astringe.
Shao’s Commentary: This is the correct method for treating Jueyin Yang pathogen sinking inward and協热 (cooperating heat) dysentery.
In Jueyin Cold Gridlock, if the physician mistakenly uses emesis and purgation, food is vomited immediately upon entering the mouth. Ganjiang Huanglian Huangqin Renshen Tang (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction) is indicated. This is because Cold blocks below and rejects Heat above, causing gridlock and refusal to accept intake. Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) clear upper Heat; Ganjiang (Zingiberis Rhizoma) opens the Cold gridlock. Because mistreatment has depleted Middle Qi, Renshen (Ginseng Radix) is added to assist Ganjiang, strengthening Stomach Yang to open the Yin Cold gridlock.
Shao’s Commentary: When Cold and Heat obstruct each other, a Gridlock syndrome forms. This decoction opens the Cold-Heat gridlock while simultaneously tonifying interior deficiency.
In Shanghan, abdominal fullness and delirious speech, accompanied by a floating and tight pulse at the Cun position, indicate Liver Qi overacting on Spleen Earth, termed "Zong" (Vertical/Unrestrained). Acupuncture at Qimen (LR14).
Shao’s Commentary: Abdominal fullness and delirium arise from exuberant Liver Fire (Wood) and Heat in the Spleen. A floating-tight pulse manifests as a String-taut (Xian) pulse, which is the Liver pulse. The pulse and symptoms indicate Liver Pathogen overacting on Spleen. Liver Wood insulting Spleen Earth follows the normal order of control (Wood controls Earth), hence it is called "Zong" (Vertical/Unrestrained). Acupuncture at Qimen (LR14) drains Liver Pathogen.
Abdominal fullness and delirium belong to Taiyin and Yangming interior syndromes; a floating and tight pulse belongs to Taiyang and Yangming exterior pulses. How do we distinguish this as Jueyin? Pulse methodology states: A floating and tight pulse is named String-taut (Xian). The Neijing states: All abdominal distensions and enlargements belong to Heat. It also states: Excessive Liver Qi leads to excessive talking. Thus, abdominal fullness stems from Liver Fire, and delirium arises from Liver exuberance. Liver Wood insulting Spleen Earth is termed "Zong". Jueyin contraindicates sweating and purging methods; therefore, acupuncture at Qimen (LR14) is used to drain the pathogen.
After Shanghan sweating therapy, if the patient experiences shivering aversion to cold, extreme thirst with desire to drink, and abdominal fullness, this indicates Liver Qi overacting on Lung Metal, termed "Heng" (Horizontal/Rebellious). Acupuncture at Qimen (LR14). If spontaneous sweating occurs and urination is free, the disease will resolve.
Shao’s Commentary: Liver Pathogen carrying Fire insults Lung Metal. Lung Qi cannot disseminate and descend, causing thirst, drinking, and abdominal fullness. Wood overacting on Metal insults the element that normally controls it (Metal controls Wood), showing a lack of fear/restraint. This violates the normal order, hence termed "Heng" (Horizontal/Rebellious). "Heng" implies deviation or bending. Acupuncture at Qimen (LR14) also drains Liver Pathogen.
The abdominal fullness due to excessive drinking is not Taiyin fullness; the inability to metabolize water is not Jueyin excessive thirst. This is Liver Pathogen carrying Fire insulting Lung Metal, causing extreme thirst. Lung Qi fails to regulate water passages, causing abdominal fullness. Insulting the controlled element is "Zong"; insulting the controlling element is "Heng". Spontaneous sweating resolves the exterior symptoms of fever and aversion to cold. Free urination eliminates the interior symptom of abdominal fullness.
Shao’s Commentary: The first case of excessive thirst and Qi striking the heart involves Liver Pathogen overacting on the Heart. The previous case of abdominal fullness and delirium involves Liver Pathogen overacting on the Spleen. This case of aversion to cold and drinking involves Liver counter-overacting on the Lung. The Liver hosts Ministerial Fire and is suited for draining rather than tonifying; these cases exemplify this principle.
Jueyin disease includes Zang Jue (Organ Cold Reversal) and Hui Jue (Roundworm Cold Reversal). In Zang Jue, after seven to eight days, the pulse is faint, skin is cold, there is no restlessness but only agitation without any moment of peace. This belongs to Cold Organs, Pure Yin without Yang, and is considered untreatable.
Shao’s Commentary: These are the main symptoms of Zang Jue, distinct from Hui Jue. The distinction lies here. Agitation without any moment of peace indicates Floating Yang escaping outward, which will dissipate shortly. Yin Cold congeals in the intestines, representing Pure Yin without Yang, hence untreatable.
Hui Jue also presents with a faint pulse and cold skin, but this is Internal Heat with External Cold, causing intermittent restlessness and agitation. The prominent symptom is vomiting roundworms. Wumei Wan (Mume Pill) is indicated.
Shao’s Commentary: This differs from Zang Jue, which features constant agitation without peace. Moreover, the presence of vomiting roundworms confirms Hui Jue rather than Zang Jue. External Cold traps Heat inside, disturbing the roundworms, causing intermittent restlessness; when roundworms settle, agitation ceases. This is unlike Zang Jue, which has no moments of peace. Wumei Wan (Mume Pill) warms the organs and calms roundworms, making it highly appropriate.
In all cases of Jue (Cold Reversal), there must be fever. If fever preceded, Jue will follow. Deep Jue corresponds to deep Heat; slight Jue corresponds to slight Heat. If Jue is less and Heat is more, the disease should recede. If Jue is more and Heat is less, the disease should progress.
Shao’s Commentary: In Shanghan, Yang Qi is paramount. Here, the degree of Jue and Heat reveals the amount of Yang Qi. More Heat means Yang Qi is undamaged, so the disease should recede. More Jue means Yang Qi is deficient, so the disease should progress.
For slight Jue, use Six-Ingredient Pinellia Decoction (Sini San). For deep Jue, use Baihu Tang (White Tiger Decoction). This is caused by Liver Fire overacting on the Stomach.
Shao’s Commentary: This is Yang Pathogen Heat Jue, caused by Evil Fire overacting on the Stomach. Adding Zuojin Wan (Left Metal Pill) is particularly effective.
A slippery pulse with Jue indicates Heat Jue, treated with Baihu Tang (White Tiger Decoction). If sweating is mistakenly induced, it will certainly cause oral lesions and red, rotting lips.
Shao’s Commentary: A slippery pulse with Jue indicates Interior Heat. Yang Pathogen enters the interior, repelling Yin Qi. Yang is inside, Yin is outside; thus, deep Heat causes severe Jue, and slight Heat causes slight Jue. This is Heat Jue, vastly different from Cold Jue with a faint, nearly imperceptible pulse. Symptoms should include dry mouth and tongue. Baihu Tang (White Tiger Decoction) clears Interior Heat, and the Jue will resolve spontaneously.