厥阴为阴之尽。为脏之极。阴极而尽。则必复反而之阳。故厥阴之生死。在厥热之进退也。本
篇于厥阴脉证之下。先辨厥热进退。所以明生死之机。次论生死微甚。所以明阴阳之故也。而厥阴
有热。虑其伤阴。必以法清之。厥阴有寒。虑其伤阳。必以法温之。一如少阴之例也。盖厥阴少阴
。同为阴脏。而俱属阳火。故于二者群分类聚。欲学人明辨而深思之耳。其次为厥阴汗下诸禁。
盖欲蒙其利。不可不知其害也。其次为厥阴简误。以厥阴篇中。杂入太阴少阴太阳之文。传误已久
。习焉不察。特检出之。其次为瘥后劳复等法。
则去疾者莫若尽之意也。凡六十二条。为一卷。
厥阴之为病。消渴。气上冲心。心中疼热。饥而不欲食。食则吐蛔。下之利不止。
伤寒之病。邪愈深者。其热愈甚。厥阴为阴之尽。而风木之气。又足以生阳火而铄阴津。津虚
火实。脏燥
无液。求救于水。则为消渴。消渴者。水入不足以制热。而反为热所消也。气上冲心。心中疼热
者。火生于木。肝气通心也。饥而不欲食者。木喜攻土。胃虚求食。而邪热复不能消谷也。食入即
吐蛔者。蛔无食而动。闻食臭而出也。下之利不止者。胃家重伤而邪热下注也。此厥阴在脏之的证
。病从阳经传入者也。伤寒四五日。腹中痛。若转气下趋少腹者。此欲自利也。
伤寒四五日。正邪气传里之时。若腹中痛而满者。热聚而实。将成可下之证。兹腹中痛而不满。
但时时转气。下趋少腹者。热不得聚而从下注。将成下利之候也。而下利有阴阳之分。先发热而后
下利者。传经之热邪内陷。此为热利。必有内烦脉数等证。不发热而下利者。直中之阴邪下注。此
为寒利。必有厥冷脉微等证。要在审问明白也。
下利。寸脉反浮数。尺中自涩者。必圊脓血。
此阳邪入里而作下利之证。寸浮数者。阳邪强也。尺中涩者。阴气弱也。以强阳而加弱阴。必
圊脓血。
下利脉沉而迟。其人面少赤。身有微热。下利清谷者。必郁冒汗出而解。病患必微厥。所以然
者。其面戴阳。下虚故也。
下利清谷。脉沉而迟。阴在里在下也。面少赤。身有微热。阳在上在外也。夫阴内阳外而为病
者。必得阳入阴出而后解。而面虽赤而未甚。身虽热而亦微。则其阳之发露者。仅十之三。而潜藏
者。尚十之七也。藏而能动。必当与阴相争。争而未胜则郁冒。争而既胜则汗出。汗出而内伏之阴
从外出。外出之阳从
内入。而病乃解矣。然此证下虚无气。中土不守。惟藉君主之灵。以收散亡之气。而驱沉伏之阴。
郁冒汗出。则心君震怒之候。病患所以必微厥也。设非下虚之故。何至危殆若是。然或真阳毕露。
则必不能与邪争。不争亦必无幸矣。
病者。手足厥冷。不结胸。少腹满。按之痛者。此冷结在膀胱关元也。
手足厥冷。原有阴阳虚实之别。若其人结胸。则邪结于上而阳不得通。如后所云、病患手足
厥冷。脉乍紧。邪结在胸中。当须吐之。以通其阳者也。若不结胸。但少腹满。按之痛者。则是阴
冷内结。元阳不振。病在膀胱关元之间。必以甘辛温药。如四逆白通之属。以救阳气而驱阴邪也。
Jueyin represents the extremity of Yin and the ultimate state of the Zang organs. When Yin reaches its extreme, it must revert and transform into Yang. Therefore, the life-and-death prognosis of Jueyin disease depends on the alternation between cold limbs (Jue) and fever (Re). Following the discussion of Jueyin pulse and symptoms in this chapter, the text first distinguishes the alternation of Jue and Re to clarify the mechanism of life and death; subsequently, it discusses the severity of the condition to elucidate the causes of Yin-Yang changes. If heat is present in Jueyin, there is a concern that it will damage Yin fluids, necessitating clearing methods. If cold is present in Jueyin, there is a concern that it will damage Yang Qi, necessitating warming methods. This follows the same principle as Shaoyin disease. Since both Jueyin and Shaoyin are Yin Zang organs and both contain Ministerial Fire (the fire of vital activity), these conditions are grouped together to enable students to distinguish them clearly and reflect deeply. Next, the prohibitions regarding sweating and purging methods in Jueyin disease are listed, because one cannot know the benefits without knowing the harms. Then, corrections of errors in the Jueyin chapter are provided, as texts from Taiyin, Shaoyin, and Taiyang meridians have been mixed in due to long-standing copying errors which people have become accustomed to without noticing; these are specifically extracted and corrected. Finally, methods for recovery after illness, such as relapse due to overexertion, are discussed, reflecting the intention to completely eliminate the disease. The entire volume contains sixty-two clauses and constitutes one scroll.
The typical manifestations of Jueyin disease include: excessive thirst (Xiaoke), sensation of Qi rushing up to the heart, pain and burning sensation in the epigastrium/heart region, hunger without desire to eat, vomiting of roundworms upon eating, and if purged incorrectly, unceasing diarrhea.
In Shanghan disease, the deeper the pathogen penetrates, the more severe the fever becomes. As Jueyin is the extremity of Yin, combined with the Wind-Wood qi, it is sufficient to generate Yang Fire and consume Yin Jin (body fluids). This leads to fluid deficiency and excess fire, causing dryness and lack of fluids in the Zang organs. The body seeks water, resulting in Xiaoke (excessive thirst). In Xiaoke, ingested water is insufficient to control the heat and is instead consumed by it. The sensation of Qi rushing to the heart and the burning pain in the heart region occur because Fire generates from Wood, and Liver Qi connects with Heart Qi. Hunger without desire to eat occurs because Wood attacks Earth (Liver overacting on Spleen/Stomach); the Stomach is deficient and craves food, but the pathogenic heat prevents proper digestion. Vomiting roundworms upon eating happens because the worms move when devoid of food and emerge upon smelling food odor. Diarrhea unceasing after incorrect purging results from severe injury to Stomach Qi and downward injection of pathogenic heat. These are the definitive syndromes of Jueyin affecting the Zang organs, transmitted from the Yang meridians.
After four or five days of Shanghan, if abdominal pain occurs accompanied by gas moving downward toward the lower abdomen, this indicates an impending spontaneous diarrhea.
Four or five days into Shanghan is the time when pathogenic Qi transmits inward. If abdominal pain is accompanied by fullness, it indicates heat accumulation and excess, forming a syndrome suitable for purgation. However, here there is only abdominal pain without fullness, merely occasional gas movement descending to the lower abdomen. This indicates that heat fails to accumulate and instead drains downward, heralding the onset of diarrhea. Diarrhea is divided into Yin and Yang types. Diarrhea preceded by fever indicates transmission-line heat pathogens sinking inward, constituting Heat Diarrhea, which must be accompanied by internal vexation and rapid pulse. Diarrhea without fever indicates direct invasion by Yin pathogens draining downward, constituting Cold Diarrhea, which must be accompanied by cold limbs and faint pulse. Careful inquiry is essential to distinguish them.
In cases of diarrhea, if the Cun (inch) pulse is unexpectedly floating and rapid, while the Chi (cubit) pulse is choppy, pus and blood will inevitably appear in the stool.
This describes diarrhea caused by Yang pathogens entering the interior. Floating and rapid at Cun indicates strong Yang pathogens; choppy at Chi indicates weak Yin Qi. Strong Yang attacking weak Yin inevitably leads to passage of pus and blood.
In cases of diarrhea with deep and slow pulses, where the patient's face shows slight redness, the body has mild fever, and the stool contains undigested food (Qinggu), the patient will likely experience vertigo/dizziness (Yumao) followed by sweating, after which the disease resolves. The patient will necessarily exhibit slight cold limbs. This occurs because the facial redness represents Daiyang (floating Yang due to deficiency) and the lower part is deficient.
Diarrhea with undigested food and deep, slow pulses indicates Yin/Cold in the interior and below. Slight facial redness and mild body heat indicate Yang in the exterior and above. For diseases characterized by Yin inside and Yang outside, resolution requires Yang entering and Yin exiting. Since the redness is slight and the heat is mild, only 30% of Yang is exposed, while 70% remains hidden. The hidden Yang activates and contends with Yin. If contention is unresolved, Yumao (vertigo/stuffiness) occurs; if resolved, sweating ensues. Sweating allows internal Yin to exit externally and external Yang to enter internally, resolving the disease. However, this syndrome features deficiency in the lower Jiao and instability of the Middle Earth (Spleen/Stomach). It relies on the Spirit of the Sovereign Heart (Heart Yang/Shen) to gather scattered Qi and drive away sunken Yin. Yumao and sweating represent the vigorous reaction of the Heart Sovereign against pathogens, hence the accompanying slight cold limbs. Were it not for lower deficiency, the condition would not be so critical. Conversely, if True Yang were fully exposed (rootless fire), it could not contend with pathogens, leading to certain demise.
If a patient presents with cold limbs, absence of JieXiong (Chest Binding), lower abdominal fullness, and tenderness upon pressure, this indicates Cold Binding in the Bladder and Guanyuan area.
Cold limbs can stem from various Yin/Yang and Deficiency/Excess patterns. If JieXiong is present, pathogen binds above, obstructing Yang flow (e.g., tight pulse, pathogen in chest, requiring emesis to unblock Yang). Without JieXiong, but with lower abdominal fullness and tenderness, it indicates internal binding of Yin-Cold and failure of Yuan Yang to rise. The pathology lies between the Bladder and Guanyuan. Treatment requires sweet, acrid, and warm herbs, such as Sini Tang (Four Reversal Decoction) or Baitong Tang, to rescue Yang Qi and expel Yin pathogens.