手足厥冷, 脉细欲绝者, 主之.
若其人内有久寒,加吴茱萸, 生姜.
当归三两 桂枝三两 芍药三两 细辛二两 通草二两 甘草 ( 炙
)二两 大枣 ( 擘 ) 二十五枚, 右七味, 以水八升 , 煮取三升,
去滓, 温服一升, 日三服.
于前汤内加吴茱萸半斤, 生姜三两., 右九味, 以水六升, 清酒六升
和煮, 取五升, 去滓, 分温五服.
【注】凡厥阴病则脉微而厥, 以厥阴为三阴之尽, 阴尽阳生, 若受其
邪,则阴阳之气不相顺接, 故脉微而厥也. 然厥阴之脏, 相火游行其
间,经虽受寒, 而脏不即寒, 故先厥者后必发热. 所以伤寒初起, 见
其手足厥冷, 脉细欲绝者, 不得遽认为虚寒而用姜, 附也. 此方取桂
枝汤 , 君以当归者, 厥阴主肝为血室也. 佐细辛味极辛, 能达三阴,
外温经而内温脏. 通草其性极通, 善开关节, 内通窍而外通营. 倍加
大枣, 即建中加饴用甘之法. 减去生姜, 恐辛过甚而迅散也. 肝之志
苦急, 肝之神欲散, 甘辛并举, 则志遂而神悦, 未有厥阴神志遂悦,
而脉微不出, 手足不温者也. 不须参, 苓之补, 不用姜, 附之峻, 此
厥阴厥逆与太少不同治也. 若其人内有久寒, 非辛温之品所能兼治,
则加吴茱萸, 生姜之辛热, 更用酒煎, 佐细辛直通厥阴之脏, 迅散内
外之寒, 是又救厥阴内外两伤于寒之法也.
Coldness of the hands and feet, with a fine pulse nearly imperceptible, is indicated for this formula.
If there is chronic cold within, add Evodiae Fructus (Wuzhuyu) and Zingiberis Rhizoma (Shengjiang).
Danggui Radix Angelicae Sinensis (3 liang), Guizhi Ramulus Cinnamomi (3 liang), Shaoyao Radix Paeoniae Alba (3 liang), Xixin Herba Asari (2 liang), Tongcao Caulis Tetrapanacis (2 liang), Ganzi Radix Glycyrrhizae Preparata (2 liang), Dazao Fructus Jujubae (25 pieces, split). The above seven ingredients are boiled in eight sheng of water to obtain three sheng. Strain and take one sheng warm, three times daily.
To the preceding decoction, add Wuzhuyu Fructus Evodiae (half jin) and Shengjiang Rhizoma Zingiberis Recens (3 liang). The above nine ingredients are boiled together with six sheng of water and six sheng of clear wine to obtain five sheng. Strain and divide into five warm doses.
[Annotation] In all cases of Jueyin disease, the pulse is faint and there is cold extremities, because Jueyin is the end of the three Yin meridians; where Yin ends, Yang generates. If affected by pathogenic factors, the Qi of Yin and Yang fails to connect smoothly, resulting in a faint pulse and cold extremities. However, in the Jueyin organ, Ministerial Fire circulates within. Although the meridians may be affected by cold, the organs do not immediately become cold; thus, those who first experience cold extremities will subsequently develop fever. Therefore, at the initial stage of Cold Damage, when cold extremities and a fine pulse nearly imperceptible are observed, one must not hastily diagnose it as deficiency-cold and use Shengjiang Rhizoma Zingiberis Recens or Fuzii Radix Aconiti Preparata. This formula selects Guizhi Tang (Cinnamon Twig Decoction) as the base, with Danggui Radix Angelicae Sinensis as the sovereign herb, because Jueyin governs the Liver, which is the repository of blood. Asari Herba (Xixin) is extremely pungent and can penetrate the three Yin meridians, warming the meridians externally and the organs internally. Tongcao Caulis Tetrapanacis is highly penetrating and good at opening joint spaces, connecting acupoints internally and nourishing Ying Qi externally. Doubling the amount of Dazao Fructus Jujubae follows the method of establishing the Middle Jiao by adding Yi Tang (Maltose) using sweet herbs. Removing Shengjiang Rhizoma Zingiberis Recens prevents excessive pungency from dispersing too rapidly. The will of the Liver suffers from tension, while the spirit of the Liver desires dispersion. Combining sweet and pungent flavors allows the will to be satisfied and the spirit to be joyful. It is impossible for the Jueyin spirit and will to be satisfied yet have a faint pulse that does not emerge and cold extremities. There is no need for tonification with Renshen Radix Ginseng or Poria Sclerotium, nor the harsh action of Shengjiang Rhizoma Zingiberis Recens and Fuzii Radix Aconiti Preparata; this distinguishes the treatment of Jueyin cold reversal from that of Taiyang and Shaoyang. If there is chronic cold within, which cannot be treated merely by pungent-warm substances, then the pungent-hot properties of Wuzhuyu Fructus Evodiae and Shengjiang Rhizoma Zingiberis Recens are added, and decocted with wine to assist Xixin Herba Asari in directly penetrating the Jueyin organ, swiftly dispersing cold inside and outside. This is another method for rescuing Jueyin from cold injury both internally and externally.