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。
伤寒一二日至四五日。正阴阳邪正交争互胜之时。或阴受病而厥者。势必转而为热。阴胜而阳
争之也。或阳受病而热者。甚则亦变而为厥。阳胜而阴被格也。夫阳胜而阴格者。其厥非真寒也。
阳陷于中。而阴见于外也。是以热深者厥亦深。热微者厥亦微。随热之浅深。而为厥之微甚也。
夫病在阳者宜汗。
病在里者宜下。厥者热深在里。法当下之。而反发汗。则必口伤烂赤。盖以蕴隆之热。而被升浮之
气。不从下出而从上逆故耳。
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。
伤寒厥五日。热亦五日者。阴胜而阳复之也。至六日。阴当复胜而厥。设不厥。则阴退而邪解
矣。故自愈。夫厥与热。阴阳消长之兆也。兹初病至终。其厥不过五日。而厥已而热。亦得五日。
是其复之之数。当其胜之之数。所谓有阳则复。无太过亦无不及。故知其病自愈也。
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。
伤寒厥四日。热反三日。厥复五日。其病为进。寒多热少。阳气退。故为进也。
热已而厥者。邪气自表而之里也。乃厥未已。而热之日。又多于厥之日。则邪复转而之表矣。
故病当愈。其热则除。乃四日至七日而不除者。其热必侵及营中而便脓血。所谓热气有余。必发痈
脓也。厥已而热者。阳气复而阴邪退也。乃热未已而复厥。而厥又多于热之日。则其病为进。所以
然者。寒多热少。阳气不振。则阴邪复胜也。要之热已而厥者。传经之证。虑其阳邪递深也。厥已
而热者。直中之证。虑其阳气不振也。故传经之厥热。以邪气之出入言。直中之厥热。以阴阳之胜
复言。病证则同。而其故有不同如此。学人能辨乎此。则庶几矣。
伤寒先厥后发热而利者。必自止。见厥复利。
伤寒先厥者。阴先受邪也。后热者。邪从阴而出阳也。阴受邪而利。及邪出而之阳。故利必自
止。设复厥。
则邪还入而之阴。故必复利。盖邪气在阳则生热。在阴则为厥与利。自然之道也。
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。期至旦日夜半愈
。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。故期至旦
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。
伤寒始发热六日。厥反九日而又下利者。邪气从阳之阴。而盛于阴也。阴盛则当不能食。而反
能食者。恐为除中。中者。胃中之阳气也。除者。去而尽之也。言胃气为邪气所迫。尽情发露。不
留余蕴也。不发热。不字当作若。谓试以索饼食之。若果胃气无余。必不能蒸郁成热。今反热者。
知胃气尚在。非除中之谓矣。而又恐暴热暂来而复去。仍是胃阳发露之凶征也。后三日脉之。而其
热仍在。则其能食者。乃为胃阳复振无疑。故期至旦日夜半。其病当愈。所以然者。本发热六日。
厥反九日。热少厥多。其病当进。兹复发热三日。并前六日。亦为九日。适与厥日相应。故知其旦
日夜半。其病当愈。旦日犹明日也。然厥与热者。阴阳胜负之机。不可偏也。偏于厥则阴胜而碍阳
矣。偏于热则阳胜而碍阴矣。后三日脉之。而脉反加数。热复不止。则阳气偏胜。必致伤及营血。
而发为痈脓也。
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。
伤寒之邪见于阳者。不必见于阴。见于下者。不必见于上。厥已而热。下利自止者。阴邪转而
之阳也。设得汗出。其邪必解而咽中痛者。未尽之热。厥而上行也。故其喉为痹。发热无汗者。邪
气郁而在阳也。虽下利。法当自止。而反不止者。以无汗出。热仍从里行也。故必便脓血。便脓血
者。其喉不痹。邪在下者。则不复在上也。
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。指头寒。邪气自微也。默默不欲食。烦躁。邪欲传里也。里受邪而热。则其小便必
不利。虽利其色必不白。至数日。小便利色白。知其热已除也。本默默不欲食。忽欲得食。知其胃
已和也。热除胃和。其病则愈。而厥阴之脉。挟胃上膈布胁肋。若其邪不解。淫溢厥阴之位。则为
厥而呕。为胸胁烦满也。凡病上行极者。必下行主血。而病为热。血为热迫。注泄于下。则其后必
便血也。
凡厥者。阴阳气不相顺接。便为厥。厥者。手足逆冷是也。
按经脉足之三阴三阳。相接于足十趾。手之三阴三阳。相接于手十指。故阴之与阳。常相顺接
者也。若阳邪内入。阴不能与之相接。而反出于外。则厥。阴邪外盛。阳不能与之相接。而反伏于
中。亦厥。是二者。虽有阴阳之分。其为手足逆冷一也。
In cold damage (Shanghan) disease, if limb coldness (Jue) occurs from the first to the fourth or fifth day, fever must follow. If there was prior fever, limb coldness will inevitably ensue; the deeper the limb coldness, the deeper the internal heat; the slighter the limb coldness, the slighter the internal heat. This type of Jue should be treated with purgation (Xia). If sweating (Han) is used in error, it will inevitably cause oral injury and redness/ulceration.
From the first to the fourth or fifth day of cold damage disease is the period when Yin and Yang pathogens and righteous Qi contend and alternate in victory. If the Yin channel is affected causing Jue, the condition will inevitably transform into fever, representing Yin excess countered by Yang struggle. If the Yang channel is affected causing fever, severe cases may transform into Jue, representing Yang excess repelling Yin to the exterior. In cases where Yang excess repels Yin, the Jue is not true cold; rather, Yang is trapped internally while Yin manifests externally. Thus, deeper heat results in deeper Jue, and slighter heat results in slighter Jue. The degree of Jue varies according to the depth of the heat.
Generally, diseases in the Yang (exterior) are suitable for sweating therapy, while diseases in the Li (interior) are suitable for purgation. Jue is caused by deep-seated heat in the interior and legally requires purgation. If sweating is used in error, it will inevitably cause oral injury and redness/ulceration. This is because the accumulated internal heat is agitated by ascending and dispersing qi, failing to exit downward but instead counterflowing upward.
In cold damage disease, if there is Jue for five days followed by fever for five days, on the sixth day, Jue should recur. If Jue does not recur, the disease will heal spontaneously. Since Jue does not exceed five days and is followed by five days of fever, it indicates spontaneous healing.
When Jue lasts five days followed by fever for five days, it signifies Yin excess being restored by Yang. By the sixth day, Yin should regain dominance and cause Jue. If Jue does not recur, it means Yin retreats and pathogens resolve, leading to spontaneous healing. The alternation of Jue and fever represents the waxing and waning of Yin and Yang. From onset to conclusion, if Jue does not exceed five days and is followed by five days of fever, the number of Yang restoration matches the previous Yin excess. As stated, "where there is Yang, there is restoration," neither excessive nor insufficient, indicating spontaneous healing.
If cold damage presents with four days of fever followed by three days of Jue, then another four days of fever, the duration of Jue is short and fever is long (Jue shao, Re duo), indicating the disease should heal. However, if fever persists from the fourth to the seventh day without cessation, pus and blood will likely appear in the stool later.
If cold damage presents with four days of Jue followed by three days of fever, then another five days of Jue, the disease is progressing. Cold predominates over heat, Yang Qi declines, hence the progression.
Fever preceding Jue indicates pathogens moving from the exterior to the interior. However, if Jue has not ceased and the days of fever exceed the days of Jue, pathogens turn back to the exterior, so the disease should heal and heat dissipate. If heat persists from the fourth to the seventh day, it will invade the Ying (Nutritive) level, causing pus and blood in the stool. This corresponds to "excess heat inevitably causes carbuncles and abscesses."
Jue preceding fever indicates Yang recovery and Yin pathogen retreat. However, if heat ceases and Jue recurs, with Jue days exceeding fever days, the disease progresses. This is because cold exceeds heat, Yang Qi is weak, allowing Yin pathogens to regain dominance. In summary, fever-then-Jue belongs to transmitted disease patterns, worrying about progressive Yang pathogen depth; Jue-then-fever belongs to direct invasion patterns, worrying about weak Yang Qi. Thus, transmitted Jue/fever discusses pathogen entry/exit, while direct Jue/fever discusses Yin/Yang victory/restoration. Although symptoms are similar, mechanisms differ. Understanding this distinction is crucial.
In cold damage, if Jue occurs first, followed by fever and diarrhea, the diarrhea will stop spontaneously. If Jue recurs, diarrhea will resume.
Initial Jue indicates Yin receiving pathogenic influence initially. Subsequent fever indicates pathogens exiting Yin to reach Yang. Yin pathology causes diarrhea; once pathogens exit to Yang, diarrhea stops. If Jue recurs, pathogens re-enter Yin, causing diarrhea to resume. Pathogens in Yang generate heat; in Yin, they cause Jue and diarrhea. This is the natural order.
If cold damage begins with six days of fever followed by nine days of Jue and diarrhea: typically, Jue with diarrhea implies inability to eat. If the patient can eat, suspect "Chu Zhong" (stomach Qi exhaustion false sign). Feed them Suo Bing (noodles). If no fever ensues, stomach Qi remains, and healing is expected. Caution against sudden transient heat. After three days, if pulse shows sustained heat, predict healing by midnight of the next day. Reason: originally six days fever, nine days Jue, plus three more days fever equals nine days total, matching Jue duration, predicting healing at midnight. If after three days pulse is rapid and heat persists, this is excess heat, likely causing carbuncles/abscesses.
If cold damage begins with six days of fever, nine days of Jue, and diarrhea, pathogens move from Yang to Yin, flourishing in Yin. Yin excess usually prevents eating. If the patient eats, suspect "Chu Zhong." "Zhong" refers to Stomach Yang Qi; "Chu" means removal/exhaustion. It implies Stomach Qi forced by pathogens to fully expose itself without reserve. Here, "no fever" should read "if no fever," meaning testing with noodles. If Stomach Qi were exhausted, it could not generate heat through steaming/stagnation. If heat arises, Stomach Qi remains, ruling out Chu Zhong. Yet, caution against sudden transient heat as a sign of Yang collapse. After three days, if heat persists, the ability to eat confirms Stomach Yang revival, predicting healing by midnight of the next day. Originally six days fever, nine days Jue (heat less, Jue more) suggests progression. Now three more days fever makes nine days total, matching Jue days, predicting healing. "Dan Ri" means tomorrow. Jue and fever represent the mechanism of Yin/Yang victory; imbalance favors either Yin hindering Yang or Yang hindering Yin. If after three days pulse accelerates and heat continues, Yang excess injures Ying Blood, causing carbuncles/abscesses.
In cold damage, initial Jue followed by fever stops diarrhea. If sweating occurs with sore throat, Bi (obstruction) of the throat develops. Fever without sweating stops diarrhea; if diarrhea persists, pus/blood in stool occurs. Those with pus/blood in stool do not have throat Bi.
Pathogens manifesting in Yang need not manifest in Yin; those manifesting lower need not manifest upper. Jue followed by fever stopping diarrhea indicates Yin pathogens turning to Yang. If sweating occurs, pathogens resolve, but residual heat rising causes sore throat and throat Bi. Fever without sweating indicates pathogens stagnating in Yang. Even with diarrhea, it should stop; if not, lack of sweating allows heat to continue from interior, causing pus/blood in stool. Pus/blood in stool means no throat Bi, as pathogens remain lower and do not rise.
Mild heat, mild Jue, cold fingertips, silence, anorexia, irritability for several days, with clear, free urination indicates heat elimination. Desire for food indicates impending healing. If Jue with vomiting and chest/hypochondriac fullness occurs, blood in stool will follow.
Mild heat/Jue/cold fingertips indicate mild pathogens. Silence/anorexia/irritability indicate pathogens transmitting inward. Interior pathogen heat causes difficult urination and dark urine. Later, clear/free urination confirms heat elimination. Sudden desire to eat confirms Stomach harmony. Heat eliminated, Stomach harmonized, disease heals. However, Jueyin meridians flank the stomach, cross the diaphragm, and distribute to hypochondrium. Unresolved pathogens invading Jueyin cause Jue, vomiting, and chest/hypochondriac fullness. Diseases reaching extreme upward movement affect blood downward. Heat forcing blood downward causes blood in stool.
All Jue results from failure of Yin and Yang Qi to connect smoothly. Jue refers to reverse coldness of hands and feet.
Meridians: Foot Three Yin and Yang connect at toes; Hand Three Yin and Yang connect at fingers. Yin and Yang normally connect smoothly. If Yang pathogens enter internally and Yin cannot connect, reversing to exterior, Jue occurs. If Yin pathogens flourish externally and Yang cannot connect, retreating internally, Jue also occurs. Both involve Yin/Yang differentiation but present identically as reverse coldness of extremities.