同理。而各有义。乌梅丸意在缓以收功。治胃厥以安蛔。麻黄升麻汤意在急于奏捷。理肺热以发汗。
【纲】仲景曰。手足厥寒。脉细欲绝者。当归四逆汤主之。若其人内有久寒者。宜当归四逆加
吴茱萸生姜汤主之。
【目】魏荔彤曰。厥寒脉细。似四逆症。然直中之厥阴。宜四逆。若传经之邪。先盛后衰。渐
至不振。则此时之寒。固宜急理。而当日之热。尤宜回顾也。病在阴厥。一热一厥。互争日久。厥
阴血脏。血未有不亏者。故厥阴病之末。不惟阳气衰而阴血亦亡。法当于救阳之中顾阴也。不然。
阴亡而阳亦终归于亡。何救之有。所以主当归四逆。救阳兼补其血也。设或阴盛于阳。阳衰于阴。
内有久寒。则加姜萸。虽扶阳之力较多。而养阴之意不失。所以救肝血于热邪既伤之后。扶阳气于
厥多热少之时。此方内第一适用者也。
【纲】仲景曰。下利后。脉绝。手足厥冷。 时脉还。手足温者生。脉不还者死。
The principles are the same, yet each contains distinct meanings. Wu Mei Wan (Mume Pill) aims to achieve results through a缓 (gentle/moderating) approach, treating Wei Jue (Stomach Cold-Reversal) to pacify roundworms. Ma Huang Sheng Ma Tang (Ephedra and Corydalis Decoction) aims for rapid efficacy, clearing Lung Heat to induce sweating.
[Gang] Zhang Zhongjing stated: In cases where the hands and feet are cold and the pulse is fine and nearly imperceptible, Dang Gui Si Ni Tang (Angelica Sinensis Decoction for Reversal of Extremities) should be administered. If the patient has chronic cold retained internally, Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang (Dang Gui Si Ni Decoction with Evodia and Fresh Ginger) is appropriate.
[Mu] Wei Litong stated: Cold reversal accompanied by a fine pulse resembles Si Ni syndrome (Shao Yin disease critical stage). However, if it is cold pathogen directly invading the Jue Yin channel, Si Ni Tang is indicated. If it is pathogenic factors transmitted from other channels, initially excessive but subsequently declining, gradually leading to weakness, then the current cold must indeed be treated urgently, while the heat present on that day requires retrospective consideration. The disease involves Yin reversal; heat and cold alternate in struggle for a long time. Since Jue Yin is the blood organ, its blood is invariably deficient. Therefore, at the end stage of Jue Yin disease, not only is Yang Qi deficient, but Yin Blood is also exhausted. The treatment method should conserve Yin Blood while rescuing Yang Qi. Otherwise, if Yin Blood is exhausted, Yang Qi will ultimately perish as well, rendering rescue futile. Hence, Dang Gui Si Ni Tang is prescribed to rescue Yang Qi while simultaneously tonifying Blood. If Yin Excess overwhelms Yang Qi, and Yang Qi declines due to Yin, with chronic cold retained internally, add Sheng Jiang (Fresh Ginger) and Wu Zhu Yu (Evodia Fruit). Although the force of assisting Yang is greater, the intent of nourishing Yin remains intact. This is most applicable for rescuing Liver Blood after injury by heat pathogens and supporting Yang Qi when cold reversal predominates over heat.
[Gang] Zhang Zhongjing stated: After diarrhea ceases, if the pulse is absent and the hands and feet are cold, life is possible if the pulse returns and the hands and feet become warm; death ensues if the pulse does not return.