不发热。惟阴盛不交于阳。阴自为阴。则厥冷也。阳亢不交于阴。阳自为阳。则发热也。盖厥热相胜则逆。逆
则病进。厥热相平则顺。顺则病愈。今厥与热日相等。气自平。故知阴阳和。而病自愈也。〔喻〕厥终不过五日
以下三句。即上句之注脚。〔程〕云自愈者。见厥热已平。其他些少之别证。举不足言矣。〔魏〕厥热各五日。
皆设以为验之辞。俱不可以日拘。如算法设为问答。以明其数。使人得较量其亏盈也。厥之本于肝。忽发热忽
厥。亦犹少阳往来寒热之义也。阳经病本于腑。病浅在表。阴经病本于脏。病深在里。此所以为时之久暂不同
也。观于疟证之一日间日三日。发之迟速不同。则少阳之往来寒热。厥阴之忽热忽厥。皆肝经脏之本然也。
凡厥者。阴阳气不相顺接。便为厥。厥者。手足逆冷者是也。（成本。玉函。冷之者。无。）
〔魏〕凡厥者。其间为寒为热不一。总由肝脏受病。而筋脉隧道。同受其患。非阴盛而阳衰。阳为寒邪
所陷。则阳盛而阴衰。阴为热邪所阻。二气之正。必不相顺接交通。寒可致厥。热亦可致厥也。言凡厥者。见
人遇厥。当详谛其热因寒因。而不可概论混施也。夫厥之为病何状。手足逆冷。是为厥也。在阴经诸证。原以
手足温冷分寒热。今凡厥俱为手
足逆冷。则是俱为寒。而非热矣。不知大寒似热。大热似寒。在少阴已然。至厥阴之厥证。阴阳凡不顺接。皆
厥也。又岂可概言寒邪。反混施也。此仲景就厥阴病中。厥之一证。令人详分寒热。便于立法以出治也。
伤寒脉微而厥。至七八日肤冷。其人躁无暂安时者。此为脏厥。非蛔厥也。蛔厥者。其人当吐蛔。令病者
静。而复时烦者。此为脏寒。蛔上入其膈。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。又主久利。（非蛔厥也。成本。作非为蛔厥也。王肯堂校本千金翼。作死字。令病者。
玉函。作今病者。成本。玉函。时烦下。无者字。上入下。无其字。又主久利四字。玉函无。千金翼。为细注。）
〔鉴〕伤寒脉微而厥。厥阴脉证也。至七八日不回。手足厥冷。而更通身肤冷。躁无暂安之时者。此为厥
阴阳虚阴盛之脏厥。非阴阳错杂之蛔厥也。若蛔厥者。其人当吐蛔。今病者静。而复时烦。不似脏厥之躁无暂
安时。知蛔上膈之上也。故其烦须臾复止也。得食而吐。又烦者。是蛔闻食臭而出。故又烦也。得食蛔动而呕。
蛔因呕吐而出。故曰其人当自吐蛔也。蛔厥。主以乌梅丸。又主久利者。以此药性味酸苦辛温。寒热并用。能
解阴阳错杂。寒热混淆之邪也。〔喻〕脉微而厥。则阳气衰微可知。然未定其为脏厥蛔厥也。惟肤冷而躁无暂
安时。乃为脏厥。用四逆汤及灸法。其厥不回者死。〔柯〕脏厥蛔厥。细辨在烦躁。脏寒则躁而不烦。内热则
烦而不躁。其人静而时烦。与躁而无暂安者。迥殊矣。此与气上撞心。心中疼热。饥不能食。食即吐蛔者。互
文以意见也。看厥阴诸证。与本方相符。下之利不止。与又主久利句合。则乌梅丸。为厥阴主方。非只为蛔厥
之剂矣。〔魏〕此为脏寒。此脏字即指胃。内经十二脏。并腑以言脏也。其蛔因
胃底虚寒。浮游于上。故有易吐之势。
案金鉴云。此为脏寒之此字。当是非字。若是此字。即是脏厥。与辨蛔厥之义不属。此说误矣。盖此证
膈热胃寒。蛔避寒就温。故上入其膈也。若果非脏寒。则乌梅丸中。宜不用附子干姜桂枝蜀椒之辛热。柯氏亦
误作非脏寒。抑何不思之甚也。
总病论。脏厥。宜四逆汤辈。极冷服之。
乌梅丸方
乌梅（三百枚○成本。枚作个。） 细辛（六两） 干姜（十两） 当归（四两） 黄连（十六两○成本。
作一斤。千金。作十两。） 附子（六两炮去皮○方周魏吴。并作六枚。成本。此与桂枝。并脱去皮字。） 蜀
椒（四两去汗） 桂枝（去皮六两） 人参（六两） 黄柏（六两○千金云。一方。用麦 ）
上十味。异捣筛。合治之。以苦酒渍乌梅一宿。去核。蒸之五斗米下。饭熟捣成泥。和药令相得。纳臼中。
与蜜杵二千下。丸如梧桐子大。先食饮服十丸。日三服。稍加至二十丸。禁生冷滑物臭食等。（成本。丸字。
并作员。渍。志聪。锡驹。作浸。千金。五斗米。作五升米。泥。作 。和药。作盘中搅三字。饭熟下。玉函。
有取字。臭食。作食臭。）
〔吴〕此方。主胃气虚。而寒热错杂之邪。积于胸中。所以蛔不安。而时时上攻。故仍用寒热错杂之味
治之。方中乌梅之酸以安胃。蜀椒之辛以泄滞。连柏之苦以降气。盖蛔闻酸则定。见辛则伏。遇苦则下也。其
他参归以补气血之虚寒。姜附以温胃中之寒饮。若无饮则不呕逆。蛔亦不上矣。辛桂以祛陷内之寒邪。若无寒
邪。虽有寒饮。亦不致呕逆。若不呕逆。则胃气纵虚。亦不致蛔厥。〔程〕名曰安蛔。实是安胃。故并主久利。
见阴阳不相顺接。厥而下利之证。皆可以此方括之也。
内台方议云。蛔厥者。乃多死也。其人阳气虚微。正元衰败。则饮食之物不化精。反化而为蛔虫也。蛔为
阴虫。故知阳微而阴胜。阴胜则四肢多厥也。若病者时烦时静。得食而呕。或口常吐苦水。时又吐蛔者。乃蛔
证也。又腹痛。脉反浮大者。亦蛔证也。有此当急治。不治杀人。故用乌梅为君。其味酸能胜蛔。以川椒细辛
为臣。辛以杀虫。以干姜桂枝附子为佐。以胜寒气。而温其中。以黄连黄柏之苦以安蛔。以人参当归之甘。而
补缓其中。各为使。且此蛔虫为患。为难比寸白等。剧用下杀之剂。故得胜制之方也。
千金方。治冷痢久下。乌梅丸。（即本方）
伤寒热少微厥。指（【原注】一作稍）头寒。嘿嘿不欲食。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。（成本玉函。微厥。作厥微。千金翼。指头。作稍头。）
〔程〕热既少厥微。而仅指头寒。虽属热厥之轻者。然热与厥并现。实与厥微热亦微者。同为热厥之例。
故阴阳胜复。难以揣摩。但以嘿嘿不欲食烦躁。定为阳胜。（不欲食似属寒以烦躁知其热）小便利色白。欲得
食。定为阴复。盖阴阳不甚在热厥上显出者。如此证。热虽少。而厥则不仅指头寒。且不但嘿嘿不欲食。而加
之呕。不但烦躁。而加之胸胁满。则自是厥深热亦深之证也。微阴当不能自复。必须下之。而以破阳行阴为事
矣。苟不知此。而议救于便血之后。不已晚乎。此条下半截曰。小便利色白。则上半截。小便短色赤。可知。
是题中二眼目。嘿嘿不欲食。欲得食。是二眼目。胸胁满烦躁。与热除。是二眼目。热字包有烦躁等证。非专
指发热之热也。
汪云。补亡论。郭白云云。热不除而便血。可犀角地黄汤。柯云。此少阳半表半里症。微者小柴胡和之。深者大柴
胡下之。○案以上二说。恐与经旨畔矣。
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。
〔鉴〕病者手足厥冷。言我不结胸。是谓大腹不满。而惟小腹满。按之痛也。论中有小腹满。按之痛。小
便自利者。是血结膀胱证。小便不利者。是水结膀胱证。手足热。小便赤涩者。是热结膀胱证。此则手足冷。
小便数而白。知是冷结膀胱证也。〔程〕发厥。虽不结胸。而小腹满。实作痛结。则似乎可下。然下焦之结多
冷。不比上焦之结多热也。况手足厥。上焦不结。惟结膀胱关元之处。故曰冷结也。〔钱〕关元者。任脉穴也。
在脐下三寸。亦穴之在小腹者。总指小腹满痛而言。故谓冷结在膀胱关元也。〔柯〕当知结胸证。有热厥者。
〔汪〕补亡论。庞安时云。宜灸关元穴。据图经云。关元一穴。系腹部中行。在脐下三寸。足三阴任脉之会。
治脐下 痛。灸之良。可百壮。愚以灸关元。而膀胱之冷结自解矣。
案总病论。删言我不结胸五字。似是。伤寒蕴要云。小腹。下焦所治。当膀胱上口。主分别清浊。或用真
武汤。
伤寒发热四日。厥反三日。复热四日。厥少热多者。其病当愈。四日至七日。热不除者。必便脓血。（玉
函。无两者字。便。作清。成本。无上者字。热不除者下。有其后二字。）
〔鉴〕伤寒邪在厥阴。阳邪则发热。阴邪则厥寒。阴阳错杂。互相胜复。故或厥或热也。伤寒发热四日。
厥亦四日。是相胜也。今厥反三日。复热四日。是热多厥少。阳胜阴退。故其病当愈也。当愈不愈。热仍不止。
则热郁于阴。其后必便脓血也。
汪云。补亡论。常器之云。可桃花汤。误矣。愚以仲景
黄芩汤。可借用之。○案未知是否。
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。（喻本。程本。魏本。金
鉴。并接前条为一条。）
〔方〕此反上条而言。进。谓加重也。〔程〕厥阴少阳。一脏一腑。少阳在三阳为尽。阳尽则阴生。故有寒
热之往来。厥阴在三阴为尽。阴尽则阳生。故有厥热之胜复。凡遇此证。不必论其来自三阳。起自三阴。只论
厥与热之多少。热多厥少。知为阳胜。阳胜病当愈。厥多热少。知为阴胜。阴胜病日进。热在后而不退。则为
阳过胜。过胜而阴不能复。遂有便血诸热证。厥在后而不退。则为阴过胜。过胜而阳不能复。遂有亡阳诸死证。
所以调停二者。治法须合乎阴阳进退之机。阳胜宜下。阴胜宜温。若不图之于早。坐令阴竭阳亡。其死必矣。
〔汪〕补亡沦。常器之云。可四逆汤。待其热退寒进。厥不复热者。始可用之。
伤寒六七日。脉微。手足厥冷。烦躁。灸厥阴。厥不还者死。（脉上。玉函。千金翼。有其字。微。千金
翼。作数。）
〔鉴〕此详申厥阴脏厥之重证也。伤寒六七日。脉微。手足厥冷烦躁者。是厥阴阴邪之重病也。若不图
之于早。为阴消阳长之计。必至于阴气 而盛。厥冷日深。烦躁日甚。虽用茱萸附子四逆等汤。恐缓不及事。
惟当灸厥阴。以通其阳。如手足厥冷。过时不还。是阳已亡也。故死。〔程〕脉微厥冷而烦躁。是即前条中所
引脏厥之证。六七日前无是也。〔汪〕烦躁者。阳虚而争。乃脏中之真阳欲脱。而神气为之浮越。故作烦躁。
常器之云。可灸太冲穴。以太冲二穴。为足厥阴脉之所注。穴在足大指下后二寸。或一寸半陷中。可灸三壮。
武陵陈氏云。灸厥阴。如关元气海之类。
宗印云。此当灸厥阴之荥穴会穴。行间章门是也。关元
百会亦可。○案今验气海关元。为得矣。
伤寒发热。下利厥逆。躁不得卧者死。
〔喻〕厥证但发热则不死。以发热则邪出于表。而里证自除。下利自止也。若反下利厥逆。烦躁有加。则
其发热。又为阳气外散之候。阴阳两绝。亦主死也。
伤寒发热。下利至甚。厥不止者死。（玉函。无此条。）
〔成〕金匮要略曰。六腑气绝于外者。手足寒。五脏气绝于内者。利下不禁。伤寒发热。为邪气独甚。
下利至甚。厥不止。为腑脏气绝。故死。〔钱〕发热则阳气已回。利当自止。而反下利至甚。厥冷不止者。是
阴气盛极于里。逼阳外出。乃虚阳浮越于外之热。非阳回之发热。故必死矣。
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。（玉函。不利。作不便利。便字。作忽。）
〔魏〕伤寒六七日不下利。此必见阳微之证于他端也。而人不反觉。遂延误其扶阳之方。其人忽而热发。
利行汗出。且不止。则孤阳为盛阴所逼。自内而出亡于外。为汗为热。自上而随阴下泄为利。顷刻之间。阳不
守其宅。阴自独于里。有阴无阳而死。倘早为图。维何致噬脐莫追乎。〔锡〕王元成曰。厥阴病发热不死。此
三节。发热亦死者。首节在躁不得卧。次节在厥不止。三节在汗出不止。
伤寒五六日。不结胸腹濡。脉虚复厥者。不可下。此亡血。下之死。（成本。玉函。亡上。有为字。千金
翼。作不可下之。下之亡血死。）
〔程〕诸四逆厥之不可下者。已条而析之矣。更得言夫虚家亦然之故。伤寒五六日。外无阳证。内无胸腹
证。脉虚复厥。则虚寒二字。人人知之。谁复下者。误在肝虚则燥而有闭证。寒能涩血故也。故曰此为亡血。
下之死。方云。亡与无
通。钱本改原文作无血。金鉴云。结胸二字。当是大便二字。不结胸腹濡。脉虚复厥。皆无可下之理。而曰不
可下。何所谓邪。○案以上数说。不可从。程注觉允当矣。
发热而厥。七日下利者。为难治。（发上。玉函。千金翼。有伤寒二字。）
〔钱〕厥多而寒盛于里。复至下利。则腔腹之内。脏腑经络。纯是阴邪。全无阳气。虽真武四逆白通等。
温经复阳之法。恐亦未能挽回阳气。故曰难治。〔志〕上文五节。言热言厥。言下利。或病五六日。或病六七日。
此节乃通承上文死证之意而言。发热而厥。至七日而犹然下利者。病虽未死。亦为难治。上文言死证之已见。
此言未死之先机。
No fever. It is solely due to Yin excess failing to interact with Yang. When Yin acts independently as Yin, cold extremities (Jue) occur. When Yang acts independently as Yang due to hyperactivity and failure to interact with Yin, fever occurs. Generally, when cold extremities and fever contend with each other, the condition becomes adverse (Ni), leading to disease progression. When cold extremities and fever are balanced, the condition is favorable (Shun), leading to recovery. Now, since the days of cold extremities and fever are equal, the Qi naturally balances; thus, we know that Yin and Yang are harmonized, and the disease will heal itself. [Yu] The three sentences following "Cold extremities do not exceed five days" serve as annotations for the preceding sentence. [Cheng] Saying "heals itself" implies that the balance between cold extremities and fever has been restored; other minor differential symptoms are negligible. [Wei] Stating that cold extremities and fever each last five days is a hypothetical scenario for verification and should not be rigidly adhered to regarding specific days. It is like setting up questions and answers in arithmetic to illustrate numerical relationships, allowing one to compare deficits and surpluses. The root of cold extremities lies in the Liver. Sudden fever alternating with cold extremities is similar in meaning to the alternating chills and fever of Shaoyang disease. Diseases of the Yang meridians originate from the Fu organs, are shallow, and located at the exterior. Diseases of the Yin meridians originate from the Zang organs, are deep, and located at the interior. This explains why the duration of illness differs. Observing malaria, which occurs daily, every other day, or every third day, with varying speeds of onset, it follows that the alternating chills and fever of Shaoyang and the sudden fever/cold extremities of Jueyin are inherent characteristics of the Liver meridian and organ.
Whenever there is cold extremities (Jue), it is because the Qi of Yin and Yang fail to connect smoothly, resulting in Jue. Jue refers to coldness extending upwards from the hands and feet. (Cheng Ben and Yu Han editions omit "wu" after "leng zhi zhe".)
[Wei] In all cases of Jue, the cause may be cold or heat, but it generally stems from disease affecting the Liver, impacting the tendons, vessels, and tunnels. It is either Yin excess with Yang deficiency, where Yang is trapped by cold pathogens; or Yang excess with Yin deficiency, where Yin is obstructed by heat pathogens. The normal Qi of both cannot connect and communicate smoothly. Cold can cause Jue, and heat can also cause Jue. By saying "whenever there is Jue," it indicates that when encountering Jue, one must carefully examine whether the cause is heat or cold, rather than applying treatments indiscriminately. What does the disease of Jue look like? Coldness extending upwards from the hands and feet constitutes Jue. In various syndromes of the Yin meridians, warmth or coldness of the hands and feet was originally used to distinguish cold from heat. Now, since all Jue syndromes present with coldness extending upwards from the hands and feet, they seem to be exclusively cold syndromes, not heat. However, one must not forget that extreme cold mimics heat, and extreme heat mimics cold, as seen in Shaoyin disease. In Jueyin Jue syndromes, any failure of Yin and Yang Qi to connect smoothly results in Jue. How can one generalize it as merely cold pathogens and apply mixed treatments? Zhang Zhongjing, within the context of Jueyin disease, details the differentiation of cold and heat in the Jue syndrome to facilitate appropriate treatment strategies.
In Shanghan, if the pulse is faint and there are cold extremities, and after seven or eight days the skin becomes cold, and the patient is restless without any moment of peace, this is Zang Jue (Organ Cold Extremities), not Hui Jue (Roundworm Cold Extremities). A patient with Hui Jue should vomit roundworms. If the patient is currently quiet but experiences intermittent irritability, this is due to cold in the Zang organs, causing roundworms to move upward into the diaphragm, hence the irritability. After a short while, it stops again. If vomiting occurs after eating, followed by irritability, it is because the roundworms emerge upon smelling food odor, and the patient will likely vomit roundworms spontaneously. Hui Jue is treated primarily with Wumei Wan. It is also indicated for chronic dysentery. (Non-Hui Jue: Cheng Ben reads "zuo fei wei hui jue ye"; Wang Kentang's edition of Qianjin Yi reads "si" character. Ling bing zhe: Yu Han reads "jin bing zhe". Cheng Ben and Yu Han omit "zhe" after "shi fan". Shang ru omits "qi". You zhu jiu li four characters are absent in Yu Han; Qianjin Yi lists them as a small note.)
[Zhang] Faint pulse and cold extremities in Shanghan are Jueyin pulse and syndrome manifestations. If after seven or eight days the condition does not improve, with cold extremities and generalized cold skin, accompanied by restlessness without any pause, this is Zang Jue caused by Yang deficiency and Yin excess in Jueyin, distinct from the Yinyang complex intermingling of Hui Jue. If it were Hui Jue, the patient would vomit roundworms. The current patient is quiet yet intermittently irritable, unlike the continuous restlessness of Zang Jue, indicating the roundworms have moved above the diaphragm. Hence, the irritability subsides after a short time. Vomiting and subsequent irritability after eating indicate the roundworms emerging due to food odor. Since roundworms move upon eating and cause vomiting, it is said "the patient will spontaneously vomit roundworms." Hui Jue is treated with Wumei Wan. Its indication for chronic dysentery arises because the medicine possesses sour, bitter, pungent, and warm properties, combining cold and heat to resolve Yinyang complexity and cold-heat confusion. [Yu] A faint pulse with cold extremities indicates severe Yang deficiency. However, it is not definitively Zang Jue or Hui Jue until skin coldness and continuous restlessness without pause confirm Zang Jue, treated with Sini Tang and moxibustion. If cold extremities do not return, death ensues. [Ke] The subtle distinction between Zang Jue and Hui Jue lies in restlessness and irritability. Zang cold causes restlessness without irritability; internal heat causes irritability without restlessness. The patient's quietness with intermittent irritability is markedly different from continuous restlessness. This corresponds mutually with "Qi rushing up to the heart, pain and heat in the heart, hunger but inability to eat, vomiting roundworms upon eating." Examining various Jueyin syndromes aligns with this formula; "purging leads to unceasing diarrhea" matches "also treats chronic dysentery," establishing Wumei Wan as the primary formula for Jueyin, not merely for Hui Jue. [Wei] "This is Zang cold": the term "Zang" here refers to the Stomach. The Neijing refers to twelve Zang, including Fu organs. Roundworms float upward due to deficiency-cold at the stomach base, creating a tendency to vomit.
Note: Jin Jian states that the character "ci" (this) in "ci wei zang han" should be "fei" (not). If it were "ci," it would imply Zang Jue, contradicting the differentiation of Hui Jue. This view is erroneous. This syndrome involves heat in the diaphragm and cold in the stomach; roundworms avoid cold and seek warmth, hence moving up to the diaphragm. If it were truly not Zang cold, Wumei Wan would not contain acrid-hot herbs like Fuzi, Ganjiang, Guizhi, and Shujiao. Ke's error in assuming non-Zang cold shows a lack of reflection.
Zong Bing Lun: For Zang Jue, use Sini Tang and similar formulas, taken very cold.
Wumei Wan Formula
Wumei (300 pieces ○ Cheng Ben reads "ge".) Xixin (6 liang) Ganjiang (10 liang) Danggui (4 liang) Huanglian (16 liang ○ Cheng Ben reads "1 jin", Qianjin reads "10 liang".) Fuzi (6 liang, prepared, peeled ○ Fang Zhou, Wei, Wu read "6 pieces"; Cheng Ben omits "peeled" for both this and Guizhi.) Shujiao (4 liang, sweat removed) Guizhi (peeled, 6 liang) Renshen (6 liang) Huangbai (6 liang ○ Qianjin says: Another prescription uses Mai...)
The above ten ingredients are separately pounded and sifted, then mixed. Soak Wumei in vinegar overnight, remove pits, steam over rice cooking in a pot containing five dou of rice. Once the rice is cooked, pound into a paste. Mix with the medicinal powder until uniform. Place in a mortar and pound with honey two thousand times. Form pills the size of wutong seeds. Take ten pills before meals with water, three times daily. Gradually increase to twenty pills. Avoid raw, cold, slippery, and foul-smelling foods. (Cheng Ben reads "yuan" for "wan". Zi Cong and Xi Ju read "jin" for "zi". Qianjin reads "5 sheng mi" for "5 dou mi". Ni reads "sen". He yao reads "pan zhong jiao" three characters. Fan shu xia: Yu Han has "qu" character. Chou shi reads "shi chou".)
[Wu] This formula treats deficiency of Stomach Qi with accumulation of complex cold-heat pathogens in the chest, causing unrest in roundworms and their upward attack. Thus, it uses complex cold-heat flavors. The sourness of Wumei stabilizes the Stomach; the pungency of Shujiao disperses stagnation; the bitterness of Lian and Bai directs Qi downward. Roundworms settle upon tasting sour, submit to pungency, and descend upon encountering bitterness. Ginseng and Angelica tonify Qi and Blood deficiency-cold; Ginger and Aconite warm cold-fluid retention in the Stomach. Without fluid retention, there is no vomiting/reversal, and roundworms do not ascend. Acrid and Cinnamon dispel cold pathogens trapped inside. Without cold pathogens, even with fluid retention, vomiting/reversal does not occur. Without vomiting/reversal, even if Stomach Qi is deficient, Hui Jue does not arise. [Cheng] Named "Peace Roundworms," it actually "Pacifies the Stomach," hence treating chronic dysentery. It demonstrates that any syndrome of failed Yinyang connection manifesting as Jue and diarrhea can be managed with this formula.
Neitai Fang Yi states: Hui Jue is often fatal. The patient's Yang Qi is weak and minute, vital energy is depleted, so food fails to transform into essence and instead transforms into roundworms. Roundworms are Yin insects; thus, Yang is weak and Yin prevails. Yin prevalence causes frequent cold extremities. If the patient is intermittently irritable/quiet, vomits after eating, or constantly spits bitter water/roundworms, it is a roundworm syndrome. Abdominal pain with a floating-large pulse also indicates roundworms. Urgent treatment is required; neglect leads to death. Therefore, Wumei is the Sovereign herb, its sourness overcoming roundworms. Sichuan Pepper and Xixin are Ministers, pungency killing parasites. Ganjiang, Guizhi, and Fuzi are Assistants, overcoming cold and warming the middle. Huanglian and Huangbai provide bitterness to pacify roundworms. Renshen and Danggui offer sweetness to tonify and soothe the middle. Each serves as an Envoy. Since roundworm infestation is more severe than tapeworms, requiring harsh purgatives, this formula achieves control through counteraction.
Qianjin Fang: Treats cold dysentery and chronic diarrhea with Wumei Wan (i.e., this formula).
In Shanghan, slight fever with minimal cold extremities, specifically cold fingers/toes, silence, loss of appetite, and irritability for several days, with clear urine and white color, indicates the heat is resolving. Desire for food signifies recovery. If there are cold extremities, vomiting, and fullness/irritability in the chest and hypochondrium, blood in stool will follow later. (Cheng Ben and Yu Han read "jue wei" for "wei jue". Qianjin Yi reads "shao tou" for "zhi tou".)
[Cheng] With slight heat and minimal cold extremities, only finger/toe coldness suggests a mild heat-Jue. However, simultaneous heat and cold, similar to "minimal Jue and minimal heat," belong to the category of heat-Jue. Thus, Yinyang victory and recovery are hard to predict. Taking silence, loss of appetite, and irritability as signs of Yang victory (loss of appetite seems cold, but irritability indicates heat). Clear urine, desire for food, indicate Yin recovery. In heat-Jue where Yinyang imbalance is not prominent, such as this case, although heat is slight, Jue extends beyond just finger/toe coldness; besides silence and anorexia, vomiting appears; besides irritability, chest/hypochondriac fullness appears. This is clearly a "deep Jue, deep heat" syndrome. Weak Yin cannot recover on its own; purging is necessary to break Yang and move Yin. Ignoring this and waiting until hematochezia occurs is too late. The lower half mentions "clear urine white," implying the upper half had short, red urine. "Silence/anorexia" vs. "desire for food" are two key points. "Chest/hypochondriac fullness/irritability" vs. "heat resolved" are two key points. "Heat" encompasses irritability etc., not just fever.
Wang Ang cites Bu Wang Lun/Guo Baiyun: If heat persists and causes hematochezia, use Xijiao Dihuang Tang. Ke Qin states: This is a Shaoyang half-exterior half-interior syndrome. Mild cases use Xiaochaihu Tang to harmonize; severe cases use Daxiehu Tang to purge. ○ Note: These two interpretations likely deviate from the classic's intent.
If the patient has cold extremities, denies chest binding (Jie Xiong), has abdominal distension in the lower abdomen, and tenderness upon pressure, this is cold binding at the Bladder and Guanyuan area.
[Zhang] Patient has cold extremities, denies chest binding, meaning the large abdomen is not distended, only the lower abdomen is distended and tender. The text mentions lower abdominal distension/tenderness with free urination indicates Blood Binding in Bladder; difficulty urinating indicates Water Binding in Bladder; hot extremities with red/scanty urination indicates Heat Binding in Bladder. Here, cold extremities with frequent white urination indicate Cold Binding in Bladder. [Cheng] Although Jue does not involve chest binding, lower abdominal distension and true pain suggest possible purgation. However, lower Jiao bindings are mostly cold, unlike upper Jiao bindings which are mostly heat. Furthermore, cold extremities indicate no upper Jiao binding, only binding at Bladder/Guanyuan, hence "cold binding." [Qian] Guanyuan is a Ren Meridian point, three cun below the umbilicus, located in the lower abdomen. It generally refers to lower abdominal distension/pain, hence "cold binding at Bladder/Guanyuan." [Ke] One should know that Jie Xiong syndromes include heat-Jue.
[Wang Ang] Bu Wang Lun/Pang Anshi: Moxibustion on Guanyuan point. Tu Jing states: Guanyuan is on the midline of the abdomen, three cun below the umbilicus, intersection of Foot Three Yin and Ren Meridians. Treats umbilical/lower abdominal pain; moxibustion is effective, up to 100 moxa cones. I believe moxibustion on Guanyuan resolves Bladder cold binding.
Note: Zong Bing Lun deletes "yan wo bu jie xiong" (says I do not have chest binding) five characters, which seems correct. Shanghan Yun Yao states: Lower abdomen is governed by the lower Jiao, corresponding to the upper opening of the Bladder, responsible for separating clear and turbid. Zhenwu Tang may be used.
In Shanghan, fever for four days, cold extremities for three days, then fever for four days again. Less cold extremities, more heat: the disease should heal. From the fourth to the seventh day, if heat does not resolve, pus and blood in stool will follow. (Yu Han lacks "liang zhe" character; "bian" reads "qing". Cheng Ben lacks "shang" character. Under "re bu chu zhe", "qi hou" two characters exist.)
[Zhang] Shanghan pathogen in Jueyin: Yang pathogen causes fever, Yin pathogen causes cold extremities. Complex Yinyang alternation causes fluctuating fever and cold extremities. Fever for four days, cold extremities for four days indicates mutual contention. Now, cold extremities are three days, fever four days: more heat, less cold extremities. Yang wins, Yin retreats; thus, healing is expected. If it does not heal and heat persists, heat stagnates in Yin, leading to pus/blood in stool later.
Wang Ang cites Bu Wang Lun/Chang Qizhi: Use Taohua Tang. Incorrect. I suggest borrowing Zhongjing's Huangqin Tang. ○ Note: Uncertain if accurate.
Shanghan cold extremities for four days, fever for three days, then cold extremities for five days. Disease progresses. More cold, less heat; Yang retreats, hence progression. (Yu Chang Ben, Cheng Ben, Wei Ben, Jin Jian merge this with the previous article.)
[Fang] This contrasts with the previous article. "Progress" means worsening. [Cheng] Jueyin and Shaoyang are one Zang and one Fu. Shaoyang is the end of Three Yang; Yang exhaustion generates Yin, hence alternating chills/fever. Jueyin is the end of Three Yin; Yin exhaustion generates Yang, hence alternating cold extremities/fever. Regardless of origin from Three Yang or Three Yin, focus on the quantity of cold extremities vs. heat. More heat, less cold extremities: Yang wins, disease heals. More cold extremities, less heat: Yin wins, disease progresses. Heat lingering afterwards indicates excessive Yang victory; Yin cannot recover, leading to bleeding/heat syndromes. Cold extremities lingering afterwards indicates excessive Yin victory; Yang cannot recover, leading to Yang collapse/death syndromes. Treatment must balance Yinyang advance/retreat. Yang excess requires purging; Yin excess requires warming. Failure to act early leads to Yin exhaustion/Yang collapse and death.
[Wang Ang] Bu Wang Lun/Chang Qizhi: Use Sini Tang. Wait for heat to recede and cold to advance, until cold extremities do not return to heat, then use it.
Shanghan six to seven days, faint pulse, cold extremities, irritability. Moxibustion on Jueyin. If cold extremities do not return, death. (Yu Han and Qianjin Yi add "qi" before "mai". Qianjin Yi reads "shu" for "wei".)
[Zhang] This elaborates on severe Zang Jue in Jueyin. Six to seven days of Shanghan, faint pulse, cold extremities, irritability: severe Yin pathogen disease in Jueyin. Without early intervention to promote Yin decline and Yang growth, Yin will become extremely prevalent, deepening cold extremities and increasing irritability. Even using Zhu Yu, Fuzi, Sini Tangs may be too slow. Moxibustion on Jueyin is needed to unblock Yang. If cold extremities persist beyond time, Yang is exhausted, hence death. [Cheng] Faint pulse, cold extremities, irritability correspond to the Zang Jue syndrome cited earlier, which did not exist in the first few days. [Wang Ang] Irritability indicates Yang deficiency struggling; true Yang in the Zang is about to escape, causing spirit/qi to float outward, resulting in irritability. Chang Qizhi suggests moxibustion on Taichong point. Taichong is the pouring point of Foot Jueyin, located two cun posterior to the big toe, or in the depression 1.5 cun back, moxibustion three cones. Wuling Chen Shi suggests moxibustion on Jueyin points like Guanyuan, Qihai.
Zong Yin states: Should moxa Jueyin Ying/Hui points, Xingjian, Zhangmen. Guanyuan, Baihui also acceptable. ○ Note: Current practice finds Qihai and Guanyuan effective.
Shanghan fever, diarrhea, cold extremities, restlessness unable to lie down: death.
[Yu] Jue syndrome with mere fever is not fatal, as fever expels pathogen to exterior, resolving interior symptoms and stopping diarrhea. If accompanied by diarrhea, cold extremities, and increased irritability, the fever indicates external dispersion of Yang Qi. Both Yin and Yang are severed, hence fatal.
Shanghan fever, severe diarrhea, unceasing cold extremities: death. (Yu Han lacks this article.)
[Cheng] Jin Gui Yao Lue states: Six Fu Qi exhaustion externally causes cold hands/feet; Five Zang Qi exhaustion internally causes uncontrolled diarrhea. Shanghan fever indicates dominant pathogenic Qi; severe diarrhea and unceasing cold extremities indicate Fu/Zang Qi exhaustion, hence death. [Qian] Fever indicates returning Yang Qi, diarrhea should stop. Severe diarrhea and unceasing cold extremities indicate extreme Yin prevalence internally forcing Yang outward. This is floating false Yang heat, not returning Yang, hence fatal.
Shanghan six to seven days without diarrhea, suddenly fever and diarrhea, with unceasing sweating: death. Due to having Yin but no Yang. (Yu Han reads "bu bian li" for "bu li", "hu" for "bian".)
[Wei] Shanghan six to seven days without diarrhea implies missed signs of Yang weakness elsewhere, delaying Yang-supporting treatment. Sudden fever, diarrhea, and unceasing sweating indicate solitary Yang forced out by abundant Yin, escaping from interior to exterior as sweat/heat, and descending with Yin as diarrhea. In moments, Yang abandons its residence, Yin dominates interior, having Yin but no Yang leads to death. Early action could have prevented this. [Xi] Wang Yuancheng says: Jueyin fever is not fatal. In these three sections, fever leads to death due to: first, restlessness/unable to lie down; second, unceasing cold extremities; third, unceasing sweating.
Shanghan five to six days, no chest binding, soft abdomen, deficient pulse with cold extremities: do not purge. This is blood depletion; purging leads to death. (Cheng Ben and Yu Han add "wei" before "wang". Qianjin Yi reads "bu ke xia zhi, xia zhi wang xue si".)
[Cheng] Cases of Si Ni/Jue unsuitable for purging are detailed. Similarly applies to deficiency cases. Shanghan five to six days, no exterior Yang signs, no interior chest/abdomen signs, deficient pulse with cold extremities: deficiency-cold is obvious, who would purge? Error lies in Liver deficiency causing dryness/closure, cold congealing blood. Thus, "blood depletion." Purging causes death. Fang notes "wang" connects to "wu". Qian Ben changes text to "wu xue". Jin Jian claims "jie xiong" should be "da bian". "No chest binding, soft abdomen, deficient pulse, cold extremities" leave no rationale for purging, yet it says "do not purge," what evil is referred to? ○ Note: Previous views are unacceptable. Cheng's annotation is reasonable.
Fever with cold extremities, diarrhea after seven days: difficult to treat. (Yu Han and Qianjin Yi add "shang han" before "fa".)
[Qian] More cold extremities and severe internal cold, plus diarrhea, means pure Yin pathogen fills the abdomen/organs/channels/vessels, lacking Yang Qi. Even Zhenwu, Sini, Baitong tonifying/warming methods may fail to restore Yang, hence "difficult to treat." [Zhang] The previous five sections discuss heat, cold extremities, diarrhea over 5-7 days. This section summarizes the fatal prognosis. Fever with cold extremities, continuing diarrhea on day seven: though not dead, it is difficult to treat. Previous sections described evident fatal signs; this describes pre-fatal signs.