庞安时云。尺寸俱微缓者。厥阴受病也。当六七日发。以其脉循阴器。络于肝。故烦满而囊缩。微缓者。囊必不缩。
若尺寸俱沉短者。囊必缩。宜承气汤下之。
琥按上庞氏云云即仲景论例中语也。其言微缓者。囊必不缩。此以见论例中。凡言脉处。皆不可拘也。其言沉短者。
囊必缩。宜承气汤下之。愚以沉短囊缩。恐非是下证。若论脉。当沉中带弦。或带数疾。按之有力。斯为下证悉具。当
以小承气汤微利之。
王海藏云。厥阴证。烦满囊缩。大小便不通。发热引饮。腹满。脉尺寸俱微缓。又云。脉沉疾。按之有力者。为阳。
阳则当下。宜大承气汤。
琥按王氏云。厥阴证烦满囊缩。大小便不通。发热引饮。腹满。则脉不当微缓矣。其曰尺寸俱微缓者。此仲景论
例中语也。其曰脉沉疾。按之有力。是为脉证相符。决当议下。但其用大承气。亦太峻厉。盖热传厥阴。阳邪久郁。真
阴内消。若用峻厉之药。则阳邪虽得外泄。而几微之阴气。亦随之而脱矣。故余立议云。若用下药。止须以小承气汤微
利之。
活人书问手足逆冷。而大便秘。小便赤。或大便黑色。脉沉而滑。答曰。此名阳证似阴也。重阳必阴。重阴必阳。
寒暑之变也。假令前证。其脉沉而滑者。皆阳证也。轻者。白虎汤。甚者。承气汤。伤寒失下。血气不通。令四肢逆冷。
此是伏热深。故厥亦深。速用大承气。加分剂下之。汗出立瘥。（仲景所谓热厥应下之者此也。）
琥按上朱氏论。因仲景云。热厥应下。伤寒论有法无方。故采仲景之方而补之也。其言轻者。白虎汤此是仲景云。
伤寒脉滑而厥者。里有热也。宜白虎汤主之。愚以此条当是阳明篇错简。盖白虎汤。乃解肌散热之药。热病服之。有汗
出而解者。独不闻仲景云。热厥应下。不可反发汗邪。兹用白虎汤。虽非辛热发散之比。据上朱氏云。加分剂下之。汗
出立瘥。则是热厥不但应下。并宜使出汗矣。倘后学观之。更用他药。反发其汗。岂不大误。故余于仲景热厥应下之条
云。厥深者。用小承气缓下。厥微者。宜四逆散调之。
Pang Anshi stated: When both the cun (inch) and chi (foot) pulses are moderate and slow (wei huan), it indicates that the Jueyin meridian is affected. This condition typically manifests after six or seven days of onset. Since the Jueyin meridian courses through the genitalia and connects with the Liver, symptoms such as vexation, fullness in the chest and hypochondrium, and retraction of the scrotum may occur. If the pulse is moderate and slow, the scrotum will certainly not retract.
If both the cun and chi pulses are deep and short (chen duan), the scrotum will certainly retract. In this case, Chengqi Tang (Gastrointestinal Releasing Decoction) should be used to purge the interior.
Wang Hu's commentary: The above statements by Pang are actually derived from the general principles found in Zhang Zhongjing’s *Shanghan Lun* (Treatise on Cold Damage). His statement that "if the pulse is moderate and slow, the scrotum will not retract" demonstrates that one cannot rigidly adhere to pulse descriptions in the general principles of the text. His statement that "if the pulse is deep and short, the scrotum will retract, and Chengqi Tang should be used to purge" is also cited. However, I believe that a deep and short pulse accompanied by scrotal retraction does not necessarily constitute an indication for purgation. Regarding the pulse, it should present as deep with a wiry (xian) quality, or rapid and hurried (shu ji), and forceful upon palpation. Only then are all indications for purgation fully present, at which point Xiao Chengqi Tang (Minor Gastrointestinal Releasing Decoction) should be used to gently promote bowel movement.
Wang Haizang stated: Symptoms of Jueyin disease include vexation, fullness, scrotal retraction, obstruction of both large and small intestines, fever with thirst, abdominal fullness, and a moderate and slow pulse in both cun and chi positions. He further stated: If the pulse is deep and rapid (chen ji) and forceful upon palpation, it belongs to Yang patterns. Yang patterns require purgation, and Da Chengqi Tang (Major Gastrointestinal Releasing Decoction) is appropriate.
Wang Hu's commentary: Wang described Jueyin disease symptoms including vexation, fullness, scrotal retraction, obstruction of bowels and urine, fever with thirst, and abdominal fullness; therefore, the pulse should not be moderate and slow. The mention of "moderate and slow pulse in both cun and chi" refers to the general principles of Zhang Zhongjing. The mention of "deep, rapid pulse, forceful upon palpation" represents a correspondence between pulse and symptoms, definitely indicating the need for purgation. However, using Da Chengqi Tang is too harsh and severe. When heat transmits to the Jueyin, Yang pathogens stagnate for a long time, consuming true Yin internally. If harsh medications are used, although Yang pathogens may be expelled outward, the nearly depleted Yin Qi will also escape with them. Therefore, my proposal is: if purgation is necessary, only Xiao Chengqi Tang should be used to gently promote bowel movement.
The *Huoren Shu* (Book for Saving Lives) asks: What if there is cold reversal of the hands and feet, constipation, red urine, or black stools, with a deep and slippery pulse? The answer is: This is named "Yang pattern resembling Yin." Extreme Yang transforms into Yin, and extreme Yin transforms into Yang; this is the variation of cold and heat. Assuming the aforementioned symptoms, if the pulse is deep and slippery, they are all Yang patterns. For mild cases, Baihu Tang (White Tiger Decoction) is used; for severe cases, Chengqi Tang is used. If Shanghan (Cold Damage) fails to use purgation, blood and Qi become obstructed, causing cold reversal of the four limbs. This occurs because latent heat is deep, so the cold reversal is also deep. One must quickly use Da Chengqi Tang, increasing the dosage to purge, and recovery will follow immediately upon sweating. (This corresponds to what Zhang Zhongjing said: "Heat cold reversal should be treated with purgation.")
Wang Hu's commentary: Zhu’s discussion above was prompted by Zhang Zhongjing’s statement that "heat cold reversal should be treated with purgation," yet the *Shanghan Lun* provided methods without specific formulas. Thus, Zhu collected Zhang’s formulas to supplement this gap. Zhu mentioned "mild cases use Baihu Tang," citing Zhang Zhongjing: "In Shanghan, if the pulse is slippery and there is cold reversal, there is heat in the interior; Baihu Tang should be administered." I believe this clause is likely a textual error misplaced in the Yangming chapter. Baihu Tang is a formula for releasing muscle-layer heat and clearing heat; when taken for heat diseases, it induces sweating leading to resolution. Have we not heard Zhang Zhongjing say that "heat cold reversal requires purgation and should not be treated with diaphoresis"? Although Baihu Tang is not a pungent-warm diaphoretic, Zhu’s statement about "increasing the dosage to purge, with immediate recovery upon sweating" implies that heat cold reversal requires not only purgation but also induction of sweating. If later students observe this and use other drugs to induce sweating, it would be a grave error. Therefore, regarding Zhang Zhongjing’s principle that "heat cold reversal requires purgation," I propose: for severe cold reversal, use Xiao Chengqi Tang to gently purge; for mild cold reversal, use Sini San (Four Counterflow Powder) to regulate.