凡五十四条方六
（一）厥阴之为病。消渴。气上撞心。心中疼热。饥而不欲食。食则吐蛔。下之。利不止。
撞。陟降切。蛔。音回。厥阴。肝经也。其脉起于大趾丛毛之上。循股入阴中。环阴器。抵
小腹。消渴者。饮水多而小便少也。盖厥阴属木。邪由少阴传来。少阴属水。木为水之子。子能
令母虚。厥阴之邪热甚。则肾水为之消。肾消则引水以自救。故消而且渴。渴不为水止也。气上
撞心。心中疼热者。心属火。木火通气。肝气通于心也。饥不能食者。胃司食而属土。木
邪甚。土受制也。吐蛔者。蛔在胃中。无食则静。闻食臭则出也。下之。利不止者。邪属厥阴。
下则反虚阳明。阳明属土。土虚则木益贼其所胜也。
（二）厥阴。中风。脉浮为欲愈。不浮为未愈。
风脉当浮。以厥阴本微缓不浮。故微浮。则邪见还表。而为欲愈可诊。不浮。反不然。
（三）厥阴病。欲解时。从丑至卯上。
厥阴属木。王于丑寅卯之三时。正气得其王时。邪退而病解。在六经皆然。夫以六经各解于三
时而三阳解自寅至亥。三阴解自亥至卯。厥阴之解。至寅卯而终。少阳之解。自寅卯而始。何也。
曰。寅为阳初动。阴尚强。卯为天地辟。阴阳分。所以二经同王。其病之解。由此而终始也。然
则三阳之王时九。各不相袭。三阴之王时五。太阴与少阴同子丑。少阴与厥阴同丑寅。何也。曰。
阳行健。其道长。故不相及。阴行纯。其道促。故皆相蹑也。
（四）厥阴病。渴欲饮水者。少少与之。愈。
厥阴属木。木生于水。欲饮水。求生也。少少与。润之也。愈。木得润则生也。
（五）诸四逆厥者。不可下之。虚家亦然。
四逆见少阴篇。厥见下。盖厥为四逆之极。阴阳既不相顺接。下则必至于脱绝。故禁勿用也。
（六）伤寒脉迟。六七日而反与黄芩汤彻其热。脉迟为寒。今与黄芩汤。复除其热。腹中应
冷。当不能食。今反能食。此名除中。必死。
反。音板。应。平声。反。犹左也。言不顺于道也。黄芩汤。寒药也。彻。亦除也。应。亦
当也。反能食者。胃欲绝。引食以自救也。中。以胃言。死。谓万物无土不生也。
（七）伤寒始发热六日。厥反九日而利。凡厥利者。当不能食。今反能食者。恐为除中。食
以索饼。不发热者。知胃气尚在。必愈。恐暴热来。出而复去也。后三日。脉之。其热续在者。
期之旦日夜半愈。所以然者。本发热六日。厥反九日。复发热三日。并前六日。亦为九日。与厥
相应。故期之旦日夜半愈。后三日。脉之而脉数。其热不罢者。此为热气有余。必发痈脓也。
食以之食。与饲同。索。当作素。数。音朔。食。以饲之也。素。常也。谓以素常所食之饼
饵饲之。以颐其情也。一说无肉曰素。谓不令犯食禁也。不发热。言所食之饼化消而无患。故曰知
胃气尚在也。暴热。谓厥而猛然得热。见阳回之意也。故曰其热续在。期之旦日夜半愈也。旦日。
明日平旦。朝而阳长之时也。夜半。阴尽阳生之时也。所以然者。以下至夜半愈。乃
反复申明上文之意。数以候热。痈脓者。厥阴主血。血热持久。则壅瘀。壅瘀则腐化。故可必也。
（八）伤寒先厥。后发热而利者。必自止。见厥。复利。
先厥。起于阴也。后发热。阳胜也。见厥。谓复厥也。
（九）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。
此承上条而言。汗出。咽中痛。阳胜而热上行也。湿则痹。咽中痛而曰痹者。痰亦湿也。厥
以得湿为阳回。故发热虽无汗。而利亦必自止。便脓血。亦协热也。
（十）伤寒一二日至四五日。而厥者。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。
应。平声。厥者必发热。寒极而热复也。前热者。后必厥。阳极而内陷也。厥深热亦深。厥
微热亦微。以大概言也。厥应下之。谓邪在里也。口伤烂赤。厥阴之脉。上与督脉会于巅。其支者。
从目系下颊里。环唇内。所以误汗则热散乱。而唇口伤也。
（十一）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。以热五
日。故知自愈。
厥五日。热亦五日。阴阳胜复无偏也。当复厥不厥。阳气胜也。阳主生。故自愈可知也。
（十二）凡厥者。阴阳气不相顺接。便为厥。厥者手足逆冷是也。
此揭厥而明其义。以申其状。案脉经流注。手之三阴。从腹走至手。手之三阳。从手走至头。
足之三阳。从头下走至足。足之三阴。从足上走入腹。然则手之三阴。与手之三阳。相接于手。
足之三阴。与足之三阳。相接于足。阴主寒。阳主热。故阳气内陷。不与阴气相顺接。则手足厥
冷也。然手足为四肢。王之者脾也。脾为阴。阳不与阴相顺接。而手足逆冷。又可知也。
（十三）伤寒脉微而厥。至七八日肤冷。其人躁无暂安时者。此为脏厥。非为蛔厥也。蛔厥者。
其人当吐蛔。今病者静。而复时烦。此为脏寒。蛔上入膈。故烦。须臾复止。得食而呕。又烦者。
蛔闻食臭出。其人当自吐蛔。蛔厥者。乌梅丸主之。又主久痢方。
乌梅丸方
乌梅（三百个） 细辛（六两） 干姜（十两） 黄连（一斤） 当归（四两） 附子（六枚）
蜀椒（四两去汗） 桂枝（六两） 黄柏（六两） 人参（六两）
上十味。异捣筛。合治之。以苦酒渍乌梅一宿去核。蒸之五升米下。饭熟。捣成泥。和药令
相得。内臼中。与蜜杵二千下。丸如梧桐子大。先食。饮服十丸。日三。稍加至二十丸。禁生冷。
滑物。臭食等。
脉微而厥。统言之也。肤冷。言不独手足。以见阳气内陷。与上文互意也。躁无暂安时。言热
深且极也。脏厥。言非在经。皆互词也。寒。言尚未变热也。桂枝姜附。细辛蜀椒。胜寒而退阴也。
人参固气。当归和血。除烦而止呕也。乌梅之酸。连柏之苦。安蛔使之静也。盖蛔之为物。类有
情识。闻酸则伏。得苦则安。利本湿热。所以滞下。得苦则泄。惟酸能收。故虽曰治蛔。
而下利脓血。可通主也。
（十四）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。
热少厥微。邪浅也。所以手足不冷。而但指头寒。默默。谓无言也。不欲食。厥阴之脉挟胃
也。烦躁则内热。故以小便利。色白。为热除也。欲食。邪退而胃回也。厥而呕。胸胁烦满者。
厥阴脉。挟胃。贯膈。布胁肋也。便血。肝不纳也。
（十五）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。其后必便脓血。
邪在表则热。入里则厥。厥少则邪散。热多则正复。故病为当愈也。热不除至末。与上条末
三句互相发明。
（十六）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。
此反上条而言。进。谓加重也。
（十七）伤寒六七日。脉微。手足厥冷。烦躁。灸厥阴。厥不还者。死。
灸。所以通阳也。阳不回。故于法主死也。
（十八）伤寒发热。下利。厥逆。躁不得卧者。死。
肾主躁。不得卧。脏气绝也。
（十九）伤寒发热。下利至甚。厥不止者。死。
此与上条大意同。
（二十）发热而厥七日。下利者。为难治。
厥七日而下利。阳不复而里虚也。
（二十一）伤寒六七日。不利。便发热而利。其人汗出不止者。死。有阴无阳故也。
发热而利。里虚邪入也。故曰有阴。汗出不止。表阳外绝也。故曰无阳。
（二十二）病者手足厥冷。言我不结胸。小腹满。按之痛者。此冷结在膀胱关元也。
关元在脐下三寸。为小肠募。故小腹满。按之痛。不上结于胸。阳虚也。下结于膀胱关元者。
阴寒胜。故曰冷结也。
（二十三）伤寒五六日。不结胸。腹濡。脉虚。复厥者。不可下。此为亡血。下之。死。
濡。音软。亡。与无通。腹濡。邪在经而里阴虚也。脉者血之府。脉虚。故知无血也。血亦
阴。下之死者。重亡其阴也。
（二十四）伤寒脉促。手足厥逆者。可灸之。
促。谓短促。阳气内陷而脉不至。故厥逆也。灸。通阳也。
（二十五）伤寒脉滑而厥者。里有热也。白虎汤主之。
滑以候热。然而厥者。热本寒因。故曰里有热也。与太阳下编第十三条。文相反而意则同。
互相发明者也。故治同而方见彼。
（二十六）手足厥寒。脉细欲绝者。当归四逆汤主之。
当归四逆汤方
当归（三两） 桂枝（三两去皮） 芍药（三两） 细辛（二两） 通草（二两） 甘草
（二两炙） 大枣（二十五枚擘）
上七味。以水八升。煮取三升。去滓。温服一升。日三服。
寒。与逆同。本阳气内陷也。细则为虚。阴血不足也。当归芍药。养血而收阴。通草细辛。
行脉而通闭。桂枝辛甘。助阳而固表。甘草大枣。健脾以补胃。夫心主血。当归补其心。而芍药
以收之。肝纳血。甘草缓其肝。而细辛以润之。脾统血。大枣益其脾。而甘草以和之。然血随气
行。桂枝卫阳。气固则血和也。
若其人内有久寒者。宜当归四逆加吴茱萸生姜汤主之。
当归四逆加吴茱萸生姜汤方
于前汤方内。加吴茱萸半升。生姜三两。
上九味。以水六升。清酒六升。和煮取五升。去滓。分。温五服。（一本。水酒各四升。）
久寒。谓宿昔素常脏腑有沉寒也。吴茱萸温脏以散寒也。生姜者。佐枣以和阴阳也。
（二十七）大汗出。热不去。内拘急。四肢疼。又下利。厥逆而恶寒者。四逆汤主之。
大汗出。阳虚而表不固也。热不去。言邪不除也。内拘急四肢疼者。亡津液。而骨属不利也。
下利。厥逆。而恶寒者。亡阳。而阴寒内甚也。四逆汤。温以散寒。回阳而敛液者也。方见太阳下编。
（二十八）大汗若大下利。而厥冷者。四逆汤主之。
此与上同而较轻。故治同。
（二十九）伤寒厥而心下悸者。宜先治水。当服茯苓甘草汤。却治其厥。不尔。水渍入胃。
必作利也。
渍。资四切。金匮曰。水停心下。甚者则悸。然则悸为水甚。而厥则寒甚也。寒无象而水有
质。水去则寒消。入胃者。水能渗土也。方见太阳下编。
（三十）伤寒六七日。大下后。寸脉沉而迟。手足厥逆。下部脉不至。咽喉不利。唾脓血。泄
利不止者。为难治。麻黄升麻汤主之。
麻黄升麻汤方
麻黄（二两半去节） 升麻（一两一分） 当归（一两一分） 知母（十八铢） 黄芩
（十八铢） 葳蕤（十八铢） 石膏（六铢碎绵裹） 白术（六铢） 干姜（六铢） 芍药（六铢）
天门冬（六铢去心） 桂枝（六铢） 茯苓（六铢） 甘草（六铢）
上十四味。以水一斗。先煮麻黄一两沸。去上沫。内诸药。煮取三升。去滓。分。温。三服。
相去如炊三斗米顷。令尽。汗出。愈。
唾。吐卧切。下部脉不至者。邪乘下后。里虚深入。而阳内陷也。咽喉不利者。厥阴之脉。
贯膈。上注肺。循喉咙之后也。唾
脓血者。肺金燥而痿也。难治者。表里杂乱而不清。阴阳暌而不相顺接也。夫邪深入而阳内陷。
寸脉沉而迟也。故用麻黄升麻升举以发之。手足厥逆。而下部脉不至也。故用当归姜桂温润以达之。
然芍药敛津液。而甘草以和之。咽喉可利也。葳蕤门冬以润肺。而黄芩知母以除热。脓血可止也。
术能燥土。茯苓渗湿。泄利可愈也。石膏有彻热之功。所以为斡旋诸佐使而妙其用焉。
（三十一）伤寒四五日。腹中痛。若转气下趣少腹者。此欲自利也。
腹中痛。厥阴之脉。抵小腹挟胃也。转气下趣者。里虚不能守。而寒邪下迫也。
（三十二）下利清谷。不可攻表。汗出。必胀满。
此申上条而致戒。此条汗出。与上条汗出不同。上条以自出言。此以攻之则出言。上言已然者。
此言未然者。胀满可必者。汗法。则亡阳而阴独治也。
（三十三）下利清谷。里寒外热。汗出而厥者。通脉四逆汤主之。
下利。故曰里寒。阴不守也。外热。故汗出。阳不固也。通脉四逆。救表里。通血气。而复
阴阳也。
（三十四）下利。腹胀满。身体疼痛者。先温其里。乃攻其表。温里四逆汤。攻表桂枝汤。
此承上而申致用治之次序。腹胀满。里虚也。故温之。身体疼痛。表实也。故攻之。惟虚也。
故必先之。惟其实。故可后焉。四逆汤方。见太阳下编。上皆同。桂枝汤方。见太阳上编。
（三十五）下利。谵语者。有燥屎也。宜小承气汤。
既下利而曰有燥屎。何也。胃热则屎燥。若服汤不能和胃。则徒利津液。其燥屎固自若。所
以谵语也。宜小承气者。厥阴易于下也。方见阳明篇。
（三十六）下利后更烦。按之心下濡者。为虚烦也。宜栀子豉汤。
更烦。言本有烦。不为利除而转甚也。虚烦并方。见太阳中篇。
There are fifty-four clauses and six prescriptions in total.
(1) The manifestations of Jueyin disease include: excessive thirst (Xiao Ke), a sensation of Qi rushing up to strike the heart, pain and heat in the chest, hunger without desire to eat, and vomiting of roundworms if food is ingested. If purgatives are mistakenly used, it leads to intractable diarrhea.
"Zhuang" (strike/rush) is pronounced "zhijiang qie". "Hui" (roundworm) is pronounced "hui". Jueyin belongs to the Liver Meridian. Its vessel originates from the tufted hair on the big toe, runs along the thigh into the yin region, circles the genitalia, and reaches the lower abdomen. "Xiao Ke" refers to drinking much water but producing little urine. Generally, Jueyin belongs to Wood, and the pathogen is transmitted from Shaoyin. Shaoyin belongs to Water. Wood is the child of Water; the child can cause the mother to be deficient. When the pathogenic heat of Jueyin is severe, Kidney Water is consumed. When Kidney Water is depleted, it draws water to save itself, resulting in both consumption and thirst, which cannot be quenched by drinking. The sensation of Qi rushing up to strike the heart and pain/heat in the chest occurs because the Heart belongs to Fire, and Wood and Fire communicate via Qi; Liver Qi connects to the Heart. Hunger without desire to eat happens because the Stomach governs food intake and belongs to Earth; when Wood pathogen is excessive, it controls Earth. Vomiting roundworms occurs because roundworms reside in the Stomach; they remain quiet without food but emerge upon smelling food. Mistaken purgation leading to intractable diarrhea happens because the pathogen belongs to Jueyin; purgation reversely weakens Yangming. Yangming belongs to Earth; when Earth is weak, Wood further attacks what it overcomes.
(2) In Jueyin disease complicated by Wind invasion, a floating pulse indicates impending recovery, while a non-floating pulse indicates no recovery.
Wind pathogens typically present with a floating pulse. Since the intrinsic Jueyin pulse is slightly slow and not floating, a slight floating indicates the pathogen returning to the exterior, signifying impending recovery. A non-floating pulse indicates the opposite.
(3) Jueyin disease tends to resolve between Chou (01:00-03:00) and Mao (05:00-07:00).
Jueyin belongs to Wood and prospers during the Chou, Yin, and Mao hours. When righteous Qi gains strength during its prosperous time, the pathogen retreats and the disease resolves. This applies to all Six Channels. Among the Six Channels, each resolves during three specific hours. Taiyang, Yangming, and Shaoyang resolve from Yin to Hai hours. Taiyin, Shaoyin, and Jueyin resolve from Hai to Mao hours. Jueyin's resolution ends at Yin and Mao hours; Shaoyang's resolution begins at Yin and Mao hours. Why? Yin hour represents the initial movement of Yang, where Yin is still strong. Mao hour represents the opening of Heaven and Earth, where Yin and Yang separate. Thus, these two channels share prosperity, and the resolution of their diseases follows this beginning and end. The prosperous hours for the Three Yang are nine, distinct from one another. The prosperous hours for the Three Yin are five: Taiyin and Shaoyin share Zi and Chou hours; Shaoyin and Jueyin share Chou and Yin hours. Why? Yang moves vigorously with a long trajectory, so it does not overlap. Yin moves purely with a short trajectory, so they follow closely upon one another.
(4) In Jueyin disease, if the patient desires water, giving small amounts will lead to recovery.
Jueyin belongs to Wood, and Wood is born from Water. Desire for water signifies a drive for life. Giving small amounts moistens the system. Recovery occurs because Wood thrives when moistened.
(5) For all cases of Si Ni (Four Extremities Cold) and Jue (Cold Reversal), purgation is contraindicated. This also applies to patients with deficiency constitutions.
Si Ni is discussed in the Shaoyin chapter. Jue is detailed below. Jue is the extreme form of Si Ni. When Yin and Yang Qi fail to connect smoothly, purgation will inevitably lead to collapse and separation. Therefore, it is prohibited.
(6) In Shanghan (Cold Damage) with a slow pulse, after six or seven days, mistakenly administering Huang Qin Tang (Scutellaria Decoction) to clear heat. A slow pulse indicates cold. Administering Huang Qin Tang removes heat, causing abdominal coldness and an inability to eat. However, if the patient suddenly eats, this is called Chu Zhong (Elimination of the Middle), indicating certain death.
"Fan" (reverse/opposite) is pronounced "ban". "Ying" (should) is pronounced level tone. Fan means contrary to the Dao. Huang Qin Tang is a cold medicine. Che means to remove. Ying means should. Sudden ability to eat indicates the Stomach Qi is perishing and seeking food for self-preservation. Zhong refers to the Stomach. Death implies that all things cannot grow without Earth (Stomach Qi).
(7) In Shanghan, fever lasts six days, followed by nine days of cold extremities and diarrhea. Typically, patients with Jue and Li (diarrhea) cannot eat. If they suddenly can eat, it may indicate Chu Zhong. Feed the patient Su Bing (plain noodles). If there is no fever afterwards, it indicates Stomach Qi remains, and recovery is expected. One must fear sudden heat appearing and then disappearing. After three days, if the pulse is taken and the fever persists, recovery is expected at midnight of the next day. This is because the initial fever was six days, plus the subsequent three days of fever equals nine days, matching the nine days of cold extremities, thus balancing Yin and Yang. If, after three days, the pulse is rapid and fever persists, this indicates excess heat, likely leading to carbuncles and pus.
"Shi yi zhi shi": "Shi" is same as "Si" (to feed). "Suo" should be "Su" (plain). "Shuo" (rapid) is pronounced "shuo". "Shi" means to feed. "Su" means ordinary/common. It means feeding plain cakes familiar to the patient to soothe their condition. Another interpretation: "Su" means meatless, avoiding dietary restrictions. No fever after eating indicates the food digests safely, proving Stomach Qi exists. "Bao Re" (sudden heat) refers to sudden warmth after cold extremities, indicating Yang return. "Chi Zai" (continuing presence) confirms this expectation. Dan Ri (next day) is dawn, when Yang grows. Ye Ban (midnight) is when Yin ends and Yang is born. The reasoning reiterates the previous text. Shuo (pulse rate) monitors heat. Jueyin governs Blood; prolonged blood heat causes stagnation and putrefaction, leading to pus.
(8) In Shanghan, if cold extremities occur first, followed by fever and diarrhea, the diarrhea will stop spontaneously. If cold extremities reappear, diarrhea returns.
Initial cold extremities originate from Yin. Subsequent fever indicates Yang overcoming Yin. Reappearance of cold extremities means recurrence of Jue.
(9) In Shanghan, initial cold extremities, followed by fever and diarrhea, the diarrhea stops spontaneously. If sweating occurs with sore throat, Bi syndrome (obstruction) of the throat develops. If fever occurs without sweating and diarrhea stops spontaneously, but continues, bloody stools/pus will develop. Bloody stools/pus imply the throat will not suffer Bi syndrome.
This continues the previous clause. Sweating and sore throat indicate Yang excess and heat rising. Dampness causes Bi; sore throat termed Bi involves phlegm-damp. Jue resolving with damp indicates Yang return. Even without sweating, fever stops diarrhea. Bloody stools/pus involve heat collaboration.
(10) From one to four or five days of Shanghan, if cold extremities appear, fever must follow. Previous fever leads to subsequent cold extremities. Deeper cold extremities indicate deeper heat; milder cold extremities indicate milder heat. Jue should be treated with purgation; mistaken sweating causes mouth ulcers and redness.
"Ying" is level tone. Jue implies fever due to extreme cold reversing to heat. Previous fever leads to Jue due to extreme Yang sinking inward. Depth of Jue correlates with depth of heat generally. Jue requires purgation because the pathogen is interior. Mouth ulcers/redness occur because the Jueyin meridian connects to the Du vessel at the vertex and branches to the cheeks/lips; mistaken sweating scatters heat, damaging lips and mouth.
(11) In Shanghan, five days of cold extremities and five days of fever. If on the sixth day cold extremities do not recur, the disease heals. Cold extremities do not exceed five days; since fever lasted five days, healing is predicted.
Five days of Jue and five days of Fever indicate balanced Yin-Yang fluctuation. Absence of expected Jue indicates Yang victory. Yang governs life, hence healing.
(12) All Jue cases result from failure of Yin and Yang Qi to connect smoothly, manifesting as cold extremities.
This clarifies the meaning of Jue. According to Pulse Classic circulation: Hand Three Yin move from abdomen to hand; Hand Three Yang from hand to head; Foot Three Yang from head to foot; Foot Three Yin from foot to abdomen. Thus, Hand Yin/Yang connect at hands; Foot Yin/Yang connect at feet. Yin governs cold, Yang governs heat. If Yang Qi sinks inward and fails to connect smoothly with Yin, cold extremities result. Hands and feet are governed by Spleen. Spleen is Yin; failure of Yang to connect with Yin causes cold extremities.
(13) In Shanghan with faint pulse and cold extremities, progressing to whole-body coldness by day seven-eight, with constant restlessness, this is Zang Jue (Organ Cold Reversal), not Hui Jue (Roundworm Cold Reversal). Hui Jue patients vomit roundworms. Current patient is quiet but intermittently irritable due to Organ Cold causing roundworms to ascend to Diaphragm. Irritation stops briefly. Vomiting and irritability after eating occur because roundworms emerge at food smell; patient vomits roundworms. Hui Jue is treated with Wu Mei Wan (Mume Pill), also for chronic dysentery.
Wu Mei Wan Formula:
Wu Mei (300 fruits), Xi Xin (6 liang), Gan Jiang (10 liang), Huang Lian (1 jin), Dang Gui (4 liang), Fu Zi (6 pieces), Shu Jiao (4 liang, sweat removed), Gui Zhi (6 liang), Huang Bai (6 liang), Ren Shen (6 liang).
Ten ingredients, separately pounded and sifted, mixed. Soak Wu Mei in vinegar overnight, remove pits, steam over rice until cooked, pound to paste, mix with herbs, pound with honey 2000 times into Wutong seed-sized pills. Take 10 pills before meals with water, 3 times daily, increasing to 20. Avoid cold, slippery, and foul foods.
Faint pulse and Jue describe general state. Whole-body cold indicates Yang sinking beyond extremities. Constant restlessness indicates extreme deep heat. Zang Jue means pathology is in organs, not meridians. Cold here means heat has not yet transformed. Gui Zhi, Gan Jiang, Fu Zi, Xi Xin, Shu Jiao overcome cold and dispel Yin. Ren Shen secures Qi, Dang Gui harmonizes Blood, relieving irritability and vomiting. Sour Wu Mei and bitter Lian/Bai calm roundworms. Roundworms respond to sour and bitter tastes. Dysentery is damp-heat; bitter clears, sour astringes. Thus, Wu Mei Wan treats roundworms and dysentery with pus/blood.
(14) In Shanghan with mild heat and mild Jue, only fingertips are cold, silence, anorexia, and irritability for several days. If urination is clear and white, heat is cleared. Desire to eat indicates recovery. If Jue with vomiting and chest/hypochondriac fullness occurs, bloody stools will follow.
Mild heat/Jue indicates shallow pathogen. Fingertip cold only, not full limbs. Silence means speechlessness. Anorexia relates to Jueyin meridian surrounding Stomach. Irrability indicates internal heat. Clear white urine indicates heat clearance. Desire to eat indicates pathogen retreat and Stomach recovery. Jue with vomiting/chest fullness relates to Jueyin meridian passing through Stomach, Diaphragm, and hypochondrium. Bloody stools indicate Liver failing to store Blood.
(15) In Shanghan, fever for four days, Jue for three days, then fever for four more days. Less Jue, more Fever indicates impending recovery. If fever persists from day four to seven, bloody stools/pus will follow.
Exterior pathogen causes fever; interior entry causes Jue. Less Jue means pathogen dispersal; more Fever means righteous Qi recovery. Persistent fever indicates excess heat leading to pus/blood.
(16) In Shanghan, Jue for four days, Fever for three days, then Jue for five days. Disease progresses. More Cold, less Heat indicates Yang decline, hence progression.
Contrasts with previous clause. Progression means worsening.
(17) In Shanghan, day six-seven, faint pulse, cold extremities, irritability. Moxibustion on Jueyin points. If Jue does not reverse, death ensues.
Moxibustion promotes Yang flow. Failure of Yang return indicates fatal prognosis.
(18) In Shanghan, fever, diarrhea, cold extremities, restlessness preventing lying down: death.
Restlessness relates to Kidney; inability to lie down indicates Organ Qi exhaustion.
(19) In Shanghan, fever, severe diarrhea, unrelenting cold extremities: death.
Similar to previous clause.
(20) Fever and Jue for seven days, with diarrhea: difficult to treat.
Seven days of Jue with diarrhea indicates Yang failure to recover and interior deficiency.
(21) In Shanghan, day six-seven, initially no diarrhea, then sudden fever and diarrhea, with unremitting sweating: death. Due to Yin without Yang.
Fever and diarrhea indicate interior deficiency and pathogen entry (Yin). Unremitting sweating indicates exterior Yang collapse (Yang absence).
(22) Patient with cold extremities, stating no Chest Binding, but lower abdominal fullness and tenderness on pressure: Cold Binding at Bladder Guan Yuan point.
Guan Yuan is three cun below umbilicus, Gathering point of Small Intestine. Lower abdominal fullness/tenderness results from Yang deficiency and Cold Binding at Guan Yuan/Bladder due to Yin-Cold excess.
(23) In Shanghan, day five-six, no Chest Binding, soft abdomen, deficient pulse, recurrent Jue: do not purge. This is Blood Loss; purging causes death.
Ru (soft) indicates Exterior pathogen with Interior Yin-Blood deficiency. Pulse is mansion of Blood; deficient pulse indicates Blood loss. Purging depletes Yin further, causing death.
(24) In Shanghan, Cui (rapid/interrupted) pulse with cold extremities: moxibustion is indicated.
Cui pulse indicates Yang sinking and failure to reach vessels, causing Jue. Moxibustion promotes Yang.
(25) In Shanghan, sliding pulse with Jue indicates interior Heat. Treat with Bai Hu Tang (White Tiger Decoction).
Sliding pulse indicates Heat. Jue here is due to Heat blocking Yang (Heat constraint), indicating interior Heat. Consistent with Taiyang chapter clause 13 in principle.
(26) Cold extremities with fine, nearly imperceptible pulse: treat with Dang Gui Si Ni Tang (Angelica Decoction for Four Extremities).
Dang Gui Si Ni Tang Formula:
Dang Gui (3 liang), Gui Zhi (3 liang, peeled), Shao Yao (3 liang), Xi Xin (2 liang), Tong Cao (2 liang), Zhi Gan Cao (2 liang), Da Zao (25 pieces).
Seven ingredients, decoct in 8 sheng water to 3 sheng. Strain, take 1 sheng warm, 3 times daily.
Cold here equals reversal. Caused by Yang sinking. Fine pulse indicates deficiency and Yin-Blood insufficiency. Dang Gui/Shao Yao nourish Blood and gather Yin. Tong Cao/Xi Xin promote vessel flow and open obstruction. Gui Zhi aids Yang and secures exterior. Gan Cao/Da Zao tonify Spleen/Stomach. Heart governs Blood (Dang Gui nourishes, Shao Yao gathers). Liver stores Blood (Gan Cao moderates, Xi Xin moistens). Spleen controls Blood (Da Zao benefits Spleen, Gan Cao harmonizes). Blood follows Qi; Gui Zhi protects Yang, securing Qi harmonizes Blood.
For chronic interior Cold, use Dang Gui Si Ni Tang plus Wu Zhu Yu and Sheng Jiang.
Formula adds Wu Zhu Yu (0.5 sheng) and Sheng Jiang (3 liang) to previous formula. Nine ingredients, decoct in 6 sheng water and 6 sheng clear wine to 5 sheng. Strain, divide into 5 doses. Chronic Cold indicates deep-seated Cold in organs. Wu Zhu Yu warms organs and disperses Cold. Sheng Jiang assists Da Zao to harmonize Yin-Yang.
(27) Profuse sweating, persistent fever, interior tension, limb pain, diarrhea, cold extremities, aversion to cold: treat with Si Ni Tang (Frigid Extremities Decoction).
Profuse sweating indicates Yang deficiency and insecure exterior. Persistent fever indicates pathogen retention. Interior tension/limb pain indicates fluid depletion affecting bones/joints. Diarrhea/cold extremities/aversion to cold indicate Yang loss and severe interior Yin-Cold. Si Ni Tang warms to disperse Cold, restores Yang, and conserves fluids. Formula referenced in Taiyang chapter.
(28) Profuse sweating or severe purgation leading to cold extremities: treat with Si Ni Tang.
Same as above but milder; treatment is identical.
(29) Shanghan with Jue and palpitations under the heart: first treat Water retention with Fu Ling Gan Cao Tang (Poria and Licorice Decoction), then treat Jue. Otherwise, Water infiltrating Stomach causes diarrhea.
Zi (soak/infiltrate) pronounced "zi si qie". Jin Gui states: Water stagnating under heart causes palpitations. Palpitations indicate severe Water; Jue indicates severe Cold. Cold has no form, Water has substance. Removing Water eliminates Cold. Water infiltrating Stomach affects Earth transformation. Formula referenced in Taiyang chapter.
(30) Shanghan day six-seven, after severe purgation: Cun (inch) pulse deep and slow, cold extremities, lower pulses absent, throat obstruction, spitting pus/blood, intractable diarrhea: difficult to treat. Use Ma Huang Sheng Ma Tang (Ephedra and Cimicifuga Decoction).
Ma Huang Sheng Ma Tang Formula:
Ma Huang (2.5 liang, nodes removed), Sheng Ma (1.1 liang), Dang Gui (1.1 liang), Zhi Mu (18 zhu), Huang Qin (18 zhu), Wei Rui (18 zhu), Shi Gao (6 zhu, crushed, wrapped), Bai Zhu (6 zhu), Gan Jiang (6 zhu), Shao Yao (6 zhu), Tian Dong (6 zhu, hearts removed), Gui Zhi (6 zhu), Fu Ling (6 zhu), Gan Cao (6 zhu).
Fourteen ingredients, decoct in 1 dou water. Boil Ma Huang first, remove foam, add other herbs, boil to 3 sheng. Strain, take warm, 3 doses. Interval equivalent to cooking 3 dou rice. Sweat indicates recovery.
Tuo (spit) pronounced "tu wo qie". Absent lower pulses indicate pathogen sinking after purgation, interior deficiency, Yang sinking. Throat obstruction relates to Jueyin meridian passing through Diaphragm, Lung, and throat. Spitting pus/blood indicates Lung Dryness and flaccidity. Difficult to treat due to complex exterior-interior disorder and Yin-Yang disconnect. Ma Huang/Sheng Ma lift Yang. Dang Gui/Gan Jiang/Gui Zhi warm and reach extremities. Shao Yao/Gan Cao preserve fluids and harmonize throat. Wei Rui/Tian Dong moisten Lung; Huang Qin/Zhi Mu clear heat to stop pus/blood. Bai Zhu/Fu Ling dry Earth and drain damp to stop diarrhea. Shi Gao clears heat, coordinating the formula.
(31) Shanghan day four-five, abdominal pain, gas moving downward to lower abdomen: impending diarrhea.
Abdominal pain relates to Jueyin meridian reaching lower abdomen/Surrounding Stomach. Gas moving downward indicates interior deficiency unable to hold, with Cold pathogen pressing downward.
(32) Diarrhea with undigested food: do not attack the exterior. Sweating will cause abdominal fullness.
Warning based on previous clause. Sweating here results from mistaken exterior attack, unlike spontaneous sweating previously. Abdominal fullness is inevitable as sweating depletes Yang, leaving Yin unchecked.
(33) Diarrhea with undigested food, interior Cold with exterior Heat, sweating, and cold extremities: treat with Tong Mai Si Ni Tang (Pulse-Returning Frigid Extremities Decoction).
Diarrhea indicates interior Cold (Yin insecurity). Exterior Heat/sweating indicates Yang insecurity. Tong Mai Si Ni Tang rescues exterior-interior, promotes Blood/Qi flow, and restores Yin-Yang balance.
(34) Diarrhea, abdominal fullness, body pain: first warm the interior, then attack the exterior. Warm interior with Si Ni Tang; attack exterior with Gui Zhi Tang (Cinnamon Twig Decoction).
Clarifies treatment sequence. Abdominal fullness indicates interior deficiency (warm first). Body pain indicates exterior excess (attack later). Deficiency requires priority; excess allows delay. Formulas referenced in Taiyang chapters.
(35) Diarrhea with delirium indicates dry feces. Use Xiao Cheng Qi Tang (Minor Order the Qi Decoction).
Diarrhea with dry feces seems contradictory. Stomach Heat dries feces; if decoction fails to harmonize Stomach, it only drains fluids, leaving dry feces intact, causing delirium. Xiao Cheng Qi Tang is suitable as Jueyin responds easily to purgation. Formula referenced in Yangming chapter.
(36) Aggravated irritability after diarrhea, with soft epigastrium on palpation: Empty Irritability. Use Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction).
Aggravated irritability means pre-existing irritability worsened despite diarrhea. Empty Irritability and formula referenced in Taiyang middle chapter.