厥阴中风。脉微浮为欲愈。不浮为未愈。
厥阴虽属至阴。然亦自有经。若为寒邪中伤。则为厥阴伤寒。风邪中之。则为厥阴中风。然入里者多。在表者少。
况邪入阴经。脉多沉迟细紧。故其邪不易出表。若得微浮。为邪气向外。仍归太阳而欲解矣。所以下文有解表用
桂枝汤者。盖脉微则为无力。浮则又为在表。微则轻细和缓而知其邪气已衰。浮则邪气还表而知其邪气将散。故为欲愈
也。若脉不浮。则邪未出表。故为未愈。
厥阴病。欲饮水者。少少与之愈。
邪在厥阴。唯恐其下利厥逆。乃为恶候。若欲饮水。是阳回气暖。胃中燥热而渴。已复归阳明矣。若热
气有余。则又有口伤烂赤。咽喉不利吐脓血之变。故可少少与之。令阴阳和平则愈也。
厥阴病。欲解时。从丑至卯上。
厥阴肝脏。乃含生土中。尚未透地之木。自子而一阳初生。木之萌芽未长。故不可言木。丑为二阳。则阳气已
长。草木之根 。已勾萌于阴土之中。至寅而三阳将及透地。阳气已旺。萌芽茁长。将出未出之时也。卯则阳气
已出。草木发生。正厥阴木旺之时。邪气至此而解矣。故曰从丑至卯上。
诸四逆厥者。不可下之。虚家亦然。
素问阴阳应象论云。清阳实四肢。阳明脉解云。四肢为诸阳之本。阳盛则四肢实。邪入阴经。则阳衰阴盛。
阳气不能充实于四肢。故四逆而厥冷。厥逆则阳气已微。急当以温经复阳为治。若以苦寒攻下。胃阳必败绝矣。
故曰不可下之。然不但诸四逆厥者不可下。即气血已虚。胃气不固。元阳衰弱者亦然也。世俗但知汗多亡阳。下多
亡阴。不知误下之亡阳尤甚也。所以太阳误下。每致胃阳虚损而成结痞。及协热下利诸证也。
辨误 尚论云。厥阴证。仲景总不欲下。无非欲邪还于表而阴从阳解也。愚窃谓三阴皆不可下。以阳气
已虚。不可更下故也。惟上文脉微浮者为还表。其余攻下之证。亦是邪气复还阳明。而成胃实之证。乃还阳。
非还表也。
凡厥者。阴阳气不相顺接。便为厥。厥者。手足逆冷者是也。
人身之阴阳。六经相为表里。营卫周贯一身。素问阴阳离合论云。少阴之上。名曰太阳。太阴之前。
名曰阳明。厥阴之表。名曰少阳。此即阴阳表里而为一合也。灵枢营卫生会篇云。人受气于谷。谷入于胃。
以传于肺。五脏六腑。皆以受气。其清者为营。浊者为卫。营在脉中。卫在脉外。营周不休。五十度而复
大会。阴阳相贯。如环无端。卫气行于阴二十五度。行于阳二十五度。分为昼夜。日入阳尽而阴受气。
平旦阴尽而阳受气。如是无已。故无病也。阴阳之气不相顺接者。二气偏盛偏虚。不相接续。故为厥。
然阳气虚。则为寒厥。阴气虚。则为热厥。故厥论云。气因于中。阳气衰。不能渗营其经络。阳气损。
阴气独在。故手足寒也。厥逆之义。见四逆散注中。
伤寒一二日至四五日。厥者必发热。前热者后必厥。厥深者热亦深。厥微者热亦微。厥应下之。而反发
汗者。必口伤烂赤。
此论热厥之见证。及误治之变也。一二日至四五日。言或一二日即厥。或至四五日而厥也。厥者必发热。
言邪入厥阴之经而手足厥者。厥后必发热。非若寒厥之但厥不发热也。前热者后必厥。若邪入阳经。则但发
热而不厥矣。此因邪入阴经。故虽先发热者。后亦必厥也。素问阴阳应象论云。寒极生热。热极生寒也。厥深
热深。厥微热微者。言厥冷之甚者。则发热亦甚。为证之重。厥冷之微者。则其发热亦微。为邪之轻。即至
真要大论所谓气之胜复也。岐伯曰。
胜有微甚。复有多少。此之谓也。谓之热厥者。邪气在里。阻绝阳气。不得通达流注于四肢而厥也。
与阳虚之厥冷迥异。故应下之。使热邪下泄。则阳气流通矣。然非谓厥深热深而可峻攻大下也。即下
文下利而谵语者。亦不过以小承气汤和胃而已。以其终是阴经郁热之邪。故不可大下也。前所谓诸四
逆厥者不可下。皆指阳虚之厥而言也。所以下文即云虚家亦然。盖逆厥与虚家并论。则知虚寒者不可下。
热深者为可下也。以应下之热厥而不下。反以辛温升发之药发其汗。则必助胃家之郁热而变生矣。
然胃开窍于口。热气不得下泄而上炎。故必口伤赤烂也。
伤寒病。厥五日。热亦五日。设六日当复厥。不厥者自愈。厥终不过五日。已热五日。故知自愈。
此申上文厥者必热。热者必厥之义。言天地间阴阳对待。寒暑两停。昼夜相半。然后二气均平。
而无阴阳之患。故寒邪之入厥阴也。因寒胜而厥。其手足厥逆者五日。寒邪既胜。阳气必复。故其发热
亦五日。设五日之后。至第六日。寒气又当厥矣。若不厥者。其病自愈。何也。以其厥逆之时。自始
至终。不过五日。以其发热亦是五日。阴阳胜复之气已平。故知自愈。
伤寒发热四日。厥反三日。复热四日。厥少热多。其病当愈。四日至七日。热不除者。必便脓血。
此条较前热多于厥。为阳胜于阴。乃寒邪退而阳气已回。故其病当愈。自复热四日之后。至七日
而热犹不除。是阳气太过。亢而为害。热蓄于里。必伤阴血。腐变而便脓血矣。
伤寒厥四日。热反三日。复厥五日。其病为进。寒多热少。阳气退。故为进也。
此言厥多于热。为阴胜于阳。乃寒邪盛而阳气衰。人以阳气为生。阳衰则病。阳尽则死。故寒多
热少。为阳气退而其
病为进也。
伤寒热少厥微。指头寒。默默不欲食。烦躁数日。小便利。色白者。此热除也。欲得食。其病为愈。
若厥而呕。胸胁烦满者。其后必便血。
此申上文厥微热亦微之义也。指头寒。亦阳气不充于四末也。言其为厥也甚微。不至四肢厥逆。但
指头寒也。默默不欲食。阴静而阖也。盖阳气用则能言能食。如阳明热盛而狂言谵语。中风则能食。中寒即
不能食。乃厥阴之本证。少阳之兼证也。然两经皆有此证者。以厥阴之脉。挟胃属肝络胆。上贯膈。布胁肋。
循喉咙。与少阳之经脉。行度相同而为表里。所谓肝胆脏腑相连也。以指头寒之微厥。阴邪在里。故默默不言。
且不饮食也。烦躁者。热邪亦在里也。热虽少而不得发越。故烦躁也。烦躁数日而小便利。色白者。以热邪本少。
久则自解。故为热除也。欲得食者。热气已除。阴邪亦解。阴阳平而胃气和。故其病为愈。若厥而呕。则厥之
微者。变而为厥之甚。其厥已深。故阴气上逆而呕也。且呕而胸胁烦满。为少阳之本证。热邪内郁而烦满。则
其热亦深。故其后必伤阴而为便血也。
伤寒先厥后发热而利者。必自止。见厥复利。
此亦申上文厥者必发热。发热者必厥也。言寒邪入厥阴。先见四肢厥冷。则寒邪在里。非惟阳气不能
充于四肢而厥。且胃寒而津液不守。阴寒下注。则为下利矣。至厥后发热。则阳回气暖。脾胃营运。其利必自止。
若热后复见厥冷。则又复利矣。所以阴经受邪。必以阳回为主。故下文有云。虽发热不死也。
伤寒先厥后发热。下利必自止。而反汗出咽中痛者。其喉为痹。发热无汗而利必自止。若不止。必便脓
血。便脓血者其喉不痹。
此承上文先厥后发热。利必自止而言也。上文言见厥必复利。此言利止不复见厥。而反汗出咽中痛者。
乃后发之热太甚。郁蒸而为汗。上炎而作咽中肿痛。故曰其喉为痹。若如前厥后发热无汗出。则利必自止。
若发热而利不止者。热邪必随势下流。重伤阴分。腐化而为脓血矣。便脓血而成痢者。热已下泄。不得
上攻。故其喉不痹。
**Jueyin Wind-Strike. A pulse that is slightly floating indicates impending recovery; a pulse that is not floating indicates non-recovery.**
Although the Jueyin (Terminal Yin) channel belongs to the extreme Yin, it possesses its own independent meridian. If injured by Cold pathogen (Han Xie), it is termed Jueyin Cold Damage (Jueyin Shanghan); if invaded by Wind pathogen (Feng Xie), it is termed Jueyin Wind-Strike (Jueyin Zhongfeng). However, pathogens mostly enter the interior, with few remaining in the exterior.
Furthermore, when pathogens invade the Yin channels, the pulse is often deep, slow, fine, and tight, making it difficult for the pathogen to emerge to the exterior. If a slight floating sensation is obtained, it indicates the pathogen is moving outward, returning to the Taiyang (Greater Yang) channel and about to resolve. Hence, the following text mentions using Guizhi Tang (Cinnamon Twig Decoction) for resolving the exterior. A pulse that is slight indicates weakness; floating indicates the disease location is in the exterior. Slightness implies light, fine, and moderate qualities, indicating the pathogen has declined; floating implies the pathogen returns to the exterior, indicating it will dissipate. Thus, it is said to be impending recovery. If the pulse does not float, the pathogen has not exited the exterior, hence it is said to be non-recovery.
**In Jueyin disease, if the patient desires water, giving them small amounts will lead to recovery.**
When the pathogen is in the Jueyin channel, one fears diarrhea and cold reversal of the limbs, which are ominous signs. Desire for water indicates the return of Yang qi and warmth; dryness-heat in the Stomach causes thirst, and the condition has returned to the Yangming (Yang Brightness) channel. If there is excess heat, complications such as sores and ulcers in the mouth, throat obstruction, or vomiting of pus and blood may occur. Therefore, water should be given in small amounts to achieve harmony between Yin and Yang, leading to recovery.
**Jueyin disease tends to resolve from Chou hour to Mao hour.**
The Liver of Jueyin is like wood contained within the earth, not yet penetrating the surface. From Zi hour, initial Yang begins to generate; the wood sprout has not yet grown, so it cannot be called "wood." Chou hour represents two Yangs; Yang qi has grown, and the roots of grass and trees have begun to sprout within the Yin earth. By Yin hour, Three Yangs are about to penetrate the ground; Yang qi is vigorous, and the sprouts are growing robustly, at the moment of emerging but not yet fully out. At Mao hour, Yang qi has emerged, grass and trees flourish, which is precisely when Jueyin Wood qi is prosperous. Pathogens resolve at this time. Hence, it is said to resolve from Chou to Mao hours.
**For all cases of Si Ni (Four Reversals/Cold Limbs), purgation is contraindicated. This applies equally to patients with deficiency constitutions.**
*Su Wen: Yin-Yang Ying Xiang Lun* states: Clear Yang fills the four limbs. *Ling Shu: Mai Jie* states: The four limbs are the root of all Yang meridians. When Yang is abundant, the four limbs are solid. When pathogens enter Yin channels, Yang declines and Yin abounds. Yang qi cannot sufficiently fill the four limbs, resulting in cold reversal of the limbs. Since reversal indicates diminished Yang qi, treatment should urgently focus on warming the meridians and restoring Yang. If bitter-cold purgatives are used, Stomach Yang will inevitably collapse. Hence, purgation is contraindicated. Moreover, not only those with cold limbs should avoid purgation, but also those whose Qi and Blood are deficient, Stomach Qi is insecure, and Primordial Yang is weak. Laypeople only know that excessive sweating depletes Yang and excessive purgation depletes Yin, unaware that erroneous purgation depletes Yang even more severely. Thus, erroneous purgation in Taiyang disease often leads to damage of Stomach Yang, resulting in palpitations, fullness, and various syndromes like heat-collateral diarrhea.
**Clarification of Errors:** *Shang Lun* states that Zhang Zhongjing generally avoided purgation in Jueyin syndromes, intending only to return pathogens to the exterior so Yin could resolve via Yang. I privately believe that purgation is contraindicated in all three Yin channels because Yang Qi is already deficient and cannot withstand further purgation. Only the case mentioned above where the pulse is slightly floating represents the pathogen returning to the exterior. Other cases requiring purgation involve pathogens returning to Yangming, forming Stomach Excess syndromes; this is termed "returning to Yang," not "returning to the exterior."
**All cases of Jue (Reversal) occur when Yin and Yang Qi do not connect smoothly. Jue refers to cold reversal of the hands and feet.**
Yin and Yang in the human body, the six meridians are interior-exterior pairs, and Ying (Nutrient) and Wei (Defensive) Qi circulate throughout the body. *Su Wen: Yin-Yang Li He Lun* states: Above Shaoyin is named Taiyang; before Taiyin is named Yangming; the exterior of Jueyin is named Shaoyang. This is the combination of Yin-Yang and interior-exterior. *Ling Shu: Ying Wei Sheng Hui* states: Humans receive Qi from grain. Grain enters the stomach, transmits to the Lung, and nourishes the five Zang and six Fu organs. The pure part becomes Ying Qi, circulating within the vessels; the turbid part becomes Wei Qi, circulating outside the vessels. Ying Qi circulates unceasingly, meeting every fifty cycles. Yin and Yang Qi interpenetrate like a circle without end. Wei Qi travels twenty-five cycles in Yin and twenty-five in Yang, dividing day and night. Upon sunset, Yang ends and Yin receives Qi; at dawn, Yin ends and Yang receives Qi. Without interruption, there is no disease. When Yin and Yang Qi do not connect smoothly, it means the two Qi are either excessively strong or deficient and fail to接续 (connect sequentially), resulting in Jue.
However, deficiency of Yang Qi results in Cold Jue; deficiency of Yin Qi results in Heat Jue. Thus, *Jue Lun* states: Qi stagnates in the middle, Yang Qi declines, unable to nourish the meridians. With damaged Yang Qi, only Yin Qi remains, causing cold hands and feet. The meaning of Jue Ni is explained in the commentary on Si Ni San (Four Reversal Powder).
**In Cold Damage, from one-two days to four-five days, if there is Jue, there must be fever. If there was fever previously, there will be Jue subsequently. The deeper the Jue, the deeper the heat; the slighter the Jue, the slighter the heat. Jue should be treated with purgation; if sweating is induced instead, sores and ulcers in the mouth will certainly occur.**
This discusses the manifestations of Heat Jue and complications from mis-treatment. One-two to four-five days refers to Jue occurring either early or late. "If there is Jue, there must be fever" means that when pathogens enter the Jueyin channel causing cold limbs, fever will follow after Jue, unlike Cold Jue which presents with only cold limbs and no fever. "If there was fever previously, there will be Jue subsequently" means that while Yang channel pathogens cause only fever without Jue, Yin channel pathogens cause Jue even if fever preceded it. *Su Wen: Yin-Yang Ying Xiang Lun* states: Extreme cold generates heat; extreme heat generates cold. "Deeper Jue means deeper heat" means severe cold limbs correspond to severe fever, indicating a heavy syndrome; slight cold limbs correspond to slight fever, indicating mild pathogen. This corresponds to the concept of "victory and retaliation of Qi" in *Zhi Zhen Yao Da Lun*. Qibo said: Victory has degrees of severity, retaliation has quantities. This is what is meant by Heat Jue: pathogens are in the interior, obstructing Yang Qi, preventing it from flowing to the four limbs, causing Jue. This is distinctly different from Jue caused by Yang deficiency. Therefore, purgation should be used to allow heat pathogens to drain downward, allowing Yang Qi to flow freely. However, this does not mean severe Jue/heat warrants harsh purgation. As mentioned later regarding diarrhea with delirium, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is used merely to harmonize the Stomach. Since it is ultimately heat pathogens stagnant in the Yin channel, massive purgation is contraindicated. The previous statement "all cases of cold limbs should not be purged" referred specifically to Yang-deficient Jue. Hence, the text follows with "deficiency patients are also [contraindicated for purgation]." Discussing cold reversal alongside deficiency patients implies that deficiency-cold cases should not be purged, while deep-heat cases can be. Failing to purge indicated Heat Jue and instead inducing sweat with acrid-warm ascending drugs will exacerbate Stomach郁 heat and cause complications. Since the Stomach opens into the mouth, trapped heat rising upward causes sores and ulcers in the mouth.
**In Cold Damage, Jue lasts five days, fever lasts five days. If on the sixth day Jue recurs, but does not, the disease self-resolves. Jue never exceeds five days; having had five days of fever, we know it will self-resolve.**
This reiterates the principle that "Jue implies heat, heat implies Jue." It speaks of the balance of Yin and Yang in heaven and earth, equal parts of cold and heat, day and night, ensuring equilibrium and avoiding Yin-Yang imbalance. When cold pathogens enter Jueyin, cold dominance causes Jue, with cold limbs lasting five days. After cold dominance, Yang Qi must recover, so fever also lasts five days. If after five days, on the sixth day, cold should cause Jue again, but it does not, the disease resolves. Why? Because the duration of Jue from start to finish does not exceed five days, and fever is also five days. The winning and retaliating Qi of Yin and Yang has balanced, so self-resolution is known.
**Cold Damage: Fever for four days, Jue for three days, then fever for four days again. Less Jue and more heat indicates the disease should resolve. If from the fourth to seventh day, heat persists, pus and blood in stool will likely occur.**
This section describes more heat than Jue, indicating Yang surpassing Yin, cold pathogens retreating, and Yang Qi returning, so the disease should resolve. If after four days of renewed fever, by the seventh day heat persists, it indicates excessive Yang, hyperactivity causing harm. Heat accumulating in the interior damages Yin Blood, rotting and transforming into pus and blood in the stool.
**Cold Damage: Jue for four days, fever for three days, then Jue for five days again. The disease progresses. More cold and less heat indicates Yang retreat, hence progression.**
This states that more Jue than heat means Yin surpassing Yang, cold pathogens prevailing and Yang Qi declining. Humans rely on Yang Qi for life; Yang decline leads to disease, Yang exhaustion leads to death. Thus, more cold and less heat signifies Yang retreat and disease progression.
**Cold Damage: Slight heat and slight Jue, cold only at the fingertips, silence, lack of desire to eat, irritability for several days. If urination is smooth and clear white, this indicates heat removal. Desire to eat indicates recovery.**
**If there is Jue with vomiting and chest/hypochondriac fullness and irritability, blood in stool will likely occur later.**
This reiterates "slight Jue implies slight heat." Cold fingertips indicate Yang Qi failing to fill the extremities. The Jue is very slight, not extending to full limb reversal, only fingertips. Silence and anorexia reflect Yin stillness and closure. When Yang functions, one speaks and eats; e.g., Yangming excess causes delirious speech, Wind-Strike allows eating, Cold Strike prevents eating. These are primary Jueyin syndromes and secondary Shaoyang syndromes. Both meridians share these symptoms because the Jueyin meridian wraps the Stomach, connects to the Liver and Gallbladder, pierces the diaphragm, spreads over the hypochondrium, and follows the throat, sharing pathways with the Shaoyang meridian as interior-exterior pairs, reflecting the connection of Liver and Gallbladder organs. Due to slight Jue at fingertips, Yin pathogens in the interior cause silence and anorexia. Irritability indicates heat pathogens in the interior. Although heat is slight, inability to vent causes irritability. After several days of irritability, if urination is smooth and clear, it is because the slight heat naturally resolves over time, indicating heat removal. Desire to eat indicates heat removed, Yin pathogens resolved, Yin-Yang balanced, and Stomach Qi harmonized, signaling recovery. If Jue occurs with vomiting, slight Jue transforms into severe Jue, becoming deep, causing Yin Qi to rebel upward leading to vomiting. Vomiting with chest/hypochondriac fullness is a primary Shaoyang syndrome. Internal heat stagnation causing fullness indicates deep heat, which will eventually damage Yin Blood leading to hematochezia.
**Cold Damage: First Jue, then fever with diarrhea; diarrhea will surely stop. Seeing Jue again brings back diarrhea.**
This reiterates "Jue implies fever, fever implies Jue." Cold pathogens entering Jueyin first present with cold limbs, indicating pathogens in the interior. Not only does Yang fail to fill limbs causing Jue, but Stomach cold fails to secure fluids, with Yin-Cold sinking downward causing diarrhea. After Jue, fever returns, Yang recovers, warmth returns, Spleen-Stomach transport resumes, and diarrhea stops. If after fever, Jue reappears, diarrhea returns. Thus, for Yin channel pathogens, Yang recovery is paramount, hence the text says "even with fever, death is unlikely."
**Cold Damage: First Jue, then fever; diarrhea stops. If instead sweating occurs with throat pain, Bi (obstruction) of the throat ensues. Fever without sweating and diarrhea stops; if diarrhea does not stop, pus and blood in stool occur. Those with pus/blood in stool do not have throat Bi.**
This continues from "first Jue then fever, diarrhea stops." The previous text said seeing Jue brings back diarrhea; here, diarrhea stops and Jue does not recur, but sweating and throat pain occur. This is due to subsequent heat being too intense, steaming into sweat, and flaming upward causing throat swelling/pain, termed throat Bi. If, as before, Jue followed by fever without sweating, diarrhea stops. If fever accompanies persistent diarrhea, heat pathogens flow downward, severely damaging Yin, rotting into pus and blood. Pus/blood in stool (dysentery) indicates heat has drained downward and cannot attack upward, hence no throat Bi.