【目】鳌按。 时脉还。非无因而自还也。乃灸之而后还也。若不还。是无根之阳。随火势
上升而脱也。亦有阴无阳之厥阴也。安望其生。
【纲】仲景曰。发热而厥。七日。下利者。为难治。伤寒发热。下利。厥逆。躁不得卧者死。
伤寒发热。下利至甚。厥不止者死。
【目】戴原礼曰。阴阳之病。皆能发厥。故有阴厥阳厥。皆病之深者。而阳厥尤易误。必初得
病头疼身热外。别有阳症。五六日方发厥。虽厥犹畏热。或饮水。或扬手掷足。烦躁不得卧。大便
秘。小便赤。乃为阳厥也。近有阳病。自腰以上极热。两脚常冷。盖三阴脉不至头。故头不疼。三
阳脉下不至足。故足冷也。
吴绶曰。有尸厥者。经言少阴脉不至。肾气微。奔气促迫。宗气反聚。血结心下。阳气退下。
热归阴股。而为尸厥也。急刺期门巨阙。
陈士铎曰。伤寒发热而能发厥。便有可生之机。以厥则邪能外出也。然厥可暂而不可久。况身
热而下利至甚。如何可久厥而不止乎。宜为死症也。盖下寒上热。郁结于中。而阴阳之气。不能彼
此相接也。必须和阴阳而通达上下。则死可变生。方用人参三两。白术五钱。附子二钱。甘草、苏
子各一钱。自然厥利俱止。倘服后厥仍不止。真不可救。
Ao's commentary: The return of the pulse is not spontaneous without cause, but occurs after moxibustion. If it does not return, it indicates rootless Yang Qi (Yang Qi lacking a foundation) which will ascend and dissipate along with the heat of the fire. There are also cases of Jueyin disease (disease of the Jueyin channel characterized by cold extremities) where Yin is excessive and Yang is absent; how can one expect survival in such cases?
[Gang] Zhang Zhongjing stated: When there is fever accompanied by cold extremities for seven days, followed by diarrhea, it is difficult to treat. In cold damage, if there is fever, diarrhea, cold extremities, and restlessness preventing lying down, death ensues. In cold damage, if there is fever, severe diarrhea, and unceasing cold extremities, death ensues.
[Dai Yuanli said: Diseases of both Yin and Yang can lead to Jue (cold extremities), hence there are Yin Jue and Yang Jue. Both indicate deep-seated disease, with Yang Jue being particularly prone to misdiagnosis. One must look for specific Yang syndrome manifestations beyond initial headache and body heat. If cold extremities appear only on the fifth or sixth day, yet the patient still fears heat, desires water, tosses hands and feet, suffers from restlessness unable to lie down, has constipation, and dark urine, this constitutes Yang Jue. Recently, there have been cases of Yang disease where the upper body above the waist is extremely hot while both legs remain cold. This is because the Three Yin channels do not reach the head, so there is no headache; the Three Yang channels do not reach the feet, so the feet are cold.]
Wu Shou said: There is a condition called Corpse Jue (a state resembling death due to sudden blockage of Qi and blood). The classics state that when the Shaoyin pulse is absent, Kidney Qi is weak, rushing Qi becomes urgent and oppressive, Zong Qi (Gathering Qi) gathers inversely, blood coagulates below the heart, Yang Qi retreats downward, and heat returns to the inner thighs, resulting in Corpse Jue. Urgently puncture Qimen (LR14) and Juxue (CV14).
Chen Shiduo said: In cold damage, if fever is accompanied by cold extremities, there is a chance for recovery, as cold extremities allow pathogenic factors to exit outward. However, cold extremities should be temporary, not prolonged. Especially when accompanied by high fever and severe diarrhea, prolonged unceasing cold extremities indicate a fatal prognosis. This is due to lower Cold and upper Heat stagnating in the middle, preventing the mutual connection of Yin and Yang Qi. One must harmonize Yin and Yang and unblock the upper and lower aspects to turn death into life. Use Ren Shen (Ginseng Radix et Rhizoma) 3 liang, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 5 qian, Fu Zi (Aconiti Lateralis Radix Praeparata) 2 qian, Gan Cao (Licorice Root) and Su Zi (Perilla Seed) each 1 qian. Naturally, both cold extremities and diarrhea will cease. If cold extremities persist after administration, it is truly incurable.
Li Gao said: In diseases caused by internal injury, overwork, and irregular diet, the palms are hot while the backs of the hands are not. In external contraction of Wind-Cold, the backs of the hands are hot while the palms are not. By distinguishing thus, the difference is clear.