厥阴之为病。消渴。气上撞心。心中疼热。饥而不欲食。食则吐蛔。下之。利不止。
邪传厥阴。则热已深也。邪自太阳。传至太阴。则腹满而嗌干。未成渴也。邪至少
阴者。口燥舌干而渴。未成消也。至厥阴成消渴者。热甚。能消水故也。饮水多而小便
少者。谓之消渴。木生于火。肝气通心。厥阴客热。气上撞心。心中疼热。伤寒六七日。
厥阴受病之时。为传经尽。则当入腑。胃虚客热。饥不欲食。蛔在胃中。无
食则动。闻食嗅而出。得食吐蛔。此热在厥阴经也。若便下之。虚其胃气。厥阴木邪相
乘。必吐下不止。
张卿子云。素问阴证三条。皆指传邪。故云已满三日可下而已。仲景三阴首条。皆
言病气。所谓伤寒本自寒下也。太阴少阴易明。唯厥阴条。种种似热。故成氏注为热已
深。不知太阳篇中。微热消渴者五苓散则桂术也。又气上冲胸。身为振振摇。则大虚也。
厥阴寒疝。亦气上冲心。又膈中阳气微。心中饥而烦。平脉篇云。气微者心内饥。饥而
不欲食也。又胃中冷则吐蛔。脾胃论虚劳。则热气熏胸中。又杂病心中疼热。多成膈气。
宜吴茱萸汤。盖皆以不能化热成阴。玩下之利不止一句。爽然矣。成注未渴而渴消。渴
分浅深。故云渴而至消为热甚。试玩少阴渴本文云。虚故引水自救。何曾较太阴不渴为
浸热耶。尝见厥阴消渴数证。舌尽红赤。厥冷。脉微。渴甚。服白虎黄连等汤。皆不救。
厥阴中风。脉微浮。为欲愈。不浮为未愈。
经曰。阴病见阳脉而生。浮者阳也。厥阴中风。脉微浮。为邪气还表向汗之时。故
云欲愈。
厥阴病欲解时从丑至卯上。
厥阴木也。王于卯。丑寅向王。故为解时。
厥阴病。渴欲饮水者。少少与之愈。
邪至厥阴。为传经尽。欲汗之时。渴欲得水者。少少与之。胃气得润则愈。
诸四逆厥者。不可下之。虚家亦然。
四逆者。四肢不温也。厥者。手足冷也。皆阳气少而阴气多。故不可下。虚家亦然。
下之是为重虚。金匮玉函曰。虚者十补。勿一泻之。
伤寒先厥。后发热。而利者必自止。见厥复利。
阴气胜。则厥逆而利。阳气复。则发热。利必自止。见厥。则阴气还胜而复利也。
张兼善云。三阴伤寒。太阴为始。则手足温。少阴则手足清。厥阴则手足厥逆。然
病至厥阴。乃阴之极也。故反有发热之理。盖阳极则阴生。阴极则阳生。此阴阳推荡。
必然之理也。易云。穷则变。穷者。至极之谓也。阳至极而生阴。故阳病有厥冷之证。
阴至极而生阳。则厥逆者有发热之条。凡言厥深热亦深者。乃事之极而变之常。经曰。
亢则害。承乃制也。
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。期之旦日夜半愈。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。故期之旦日夜半愈。后三日脉之而脉数。其热不罢者。此为热气
有余。必发痈脓也。
始发热。邪在表也。至六日邪传厥阴。阴气胜者。作厥而利。厥反九日。阴寒气多。
当不能食。而反能食者。恐为除中。除、去也。中、胃气也。言邪气大甚。除去胃气。
胃欲引食自救。故暴能食。此欲胜也。食以索饼试之。若胃气绝。得面则必发热。若不
发热者。胃气尚在也。恐是寒极变热。因暴热来而复去。使之能食。非除中也。金匮要
略曰。病患素不能食。而反暴思之。必发热。后三日脉之。其热续在者。阳气胜也。期
之旦日夜半愈。若旦日不愈。后三日。脉数而热不罢者。为热气有余。必发痈脓。经曰。
数脉不时。则生恶疮。
伤寒脉迟。六七日。而反与黄芩汤彻其热。脉迟为寒。今与黄芩汤。复除其热。腹
中应冷。当不能食。今反能食。此名除中。必死。
伤寒脉迟。六七日。为寒气已深。反与黄芩汤寒药。两寒相搏。腹中当冷。冷不消
谷。则不能食。反能食者。除中也。四时皆以胃气为本。胃气已绝。故云必死。
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。
伤寒先厥而利。阴寒气胜也。寒极变热。后发热。下利必自止。而反汗出。咽中痛。
其喉为痹者。热气上行也。发热无汗。而利必自止。利不止。必便脓血者。热气下行者。
热气下而不上。其喉亦不痹也。
王宇泰云。厥而利。发热则利必止。反汗出者。亡阳也。咽中痛。热上冲也。亡阳。
则阴独复会于热。则阴阳结而为喉痹也。内经曰。一阴一阳。结为喉痹。
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。
前厥后发热者。寒极生热也。前热后厥者。阳气内陷也。厥深热深。厥微热微。随
阳气陷之深浅也。热之伏深。必须下去之。反发汗者。引热上行。必口伤烂赤。内经曰。
火气内发。上为口糜。
吴氏云。伤寒一二日。至四五日。而厥者。必发热。是传经之邪。前热后厥者。亦
传经之邪。当以厥之微甚。辨热之深浅。若厥热入腑而实者。须下去之。若反发汗。则
胃中津液。愈燥竭而热。故必口伤烂赤。然经云。诸四逆者不可下之。至此又云应下。
最宜详审。先贤谓热厥。手足虽厥冷而或有温时。手足虽逆冷而手足掌心必暖。戴院使又
以指甲之暖冷。别寒热二厥。临病之工慎之。
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。
阴胜则厥。阳胜则热。先厥五日。为阴胜。至六日。阳复胜。热亦五日。后复厥者。
阴复胜。若不厥。为阳全胜。故自愈。经曰。发热四日。厥反三日。复热四日。厥少热
多。其病为愈。
凡厥者。阴阳气不相顺接。便为厥。厥者。手足逆冷是也。
手之三阴三阳。相接于手十指。足之三阴三阳。相接于足十指。阳气内陷。阳不与
阴相顺接。故手足为之厥冷也。
伤寒脉微而厥。至七八日肤冷。其人躁。无暂安时者。此为脏厥。非为蛔厥也。蛔
厥
者。其人当吐蛔。令病者静。而复时烦。此为脏寒。蛔上入膈故烦。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。又主久利方。
脏厥者死。阳气绝也。蛔厥。虽厥而烦。吐蛔已。则静。不若脏厥而躁。无暂安时
也。
病患脏寒。胃虚。蛔动上膈。闻食臭出。因而吐蛔。与乌梅丸。温脏安虫。
The typical manifestations of Jueyin disease are: excessive thirst (Xiao Ke, a condition characterized by excessive drinking and urination due to heat consuming fluids), sensation of Qi rushing up to strike the heart, pain and burning sensation in the heart region, hunger without desire to eat, and vomiting of roundworms (Hui) after eating. If purgatives are mistakenly used, it will lead to unceasing diarrhea.
When pathogenic factors transmit to the Jueyin channel, the heat has already penetrated deeply. When pathogens transmit from the Taiyang channel to the Taiyin channel, symptoms include abdominal fullness and dry throat, but thirst has not yet formed. When pathogens reach the Shaoyin channel, there is dry mouth and tongue with thirst, but Xiao Ke has not yet formed. At the Jueyin stage, Xiao Ke forms because the heat is extremely severe and consumes water. The condition of drinking much water but producing little urine is called Xiao Ke. Liver belongs to Wood, Heart belongs to Fire; Wood generates Fire, so Liver Qi connects with Heart. When external heat invades the Jueyin channel, it causes Qi to rush up to strike the heart, resulting in pain and burning in the heart region. In Shanghan disease, after six or seven days, when the Jueyin channel is affected, this marks the completion of the transmission through the channels, and the pathogen should enter the Fu organs. At this time, Stomach Qi is deficient while external heat remains, causing hunger but no desire to eat. Roundworms reside in the stomach; without food, they become active, and upon smelling food, they emerge. Eating triggers the vomiting of roundworms. This indicates heat in the Jueyin channel. If purgatives are immediately used, Stomach Qi is further damaged, allowing Jueyin Wood pathogen to overact on Spleen Earth, inevitably leading to unceasing vomiting and diarrhea.
Zhang Qingzi stated that the three Yin syndrome entries in *Suwen* all refer to transmitted pathogens, hence stating that after three days, purgation can cure it. Zhang Zhongjing’s first entries in the Three Yin chapters of *Shanghan Lun* all describe the nature of the pathogenic Qi, referring to the inherent cold nature of Shanghan. Taiyin and Shaoyin syndromes are easy to understand; only the Jueyin entries present various heat-like symptoms, which Cheng Wuji annotated as "heat has penetrated deeply." However, one should not overlook that in the *Taiyang* chapter of *Shanghan Lun*, mild heat with Xiao Ke is treated with Wuling San, containing Guizhi (Cinnamon Twig) and Baizhu (Atractylodis Macrocephalae Rhizoma); also, Qi rushing up to the chest and body trembling indicate severe deficiency. Cold hernia of Jueyin also presents with Qi rushing up to the heart; slight Yang Qi in the Diaphragm causes hunger and irritability. The *Pingmai Pian* states: "Those with weak pulse feel hungry inside, but having hunger, they do not wish to eat." Furthermore, cold in the Stomach leads to vomiting roundworms. Li Dongyuan’s *Piwei Lun* mentions heat steaming the chest in deficiency consumptive diseases; miscellaneous diseases involving pain and burning in the heart often develop into Ge Qi (Diaphragmatic Qi stagnation), suitable for treatment with Wuzhuyu Tang. These cases arise because heat fails to transform into Yin. Carefully pondering the phrase "purging leads to unceasing diarrhea" brings clarity. Cheng Wuji’s annotation suggests that thirst progressing to Xiao Ke indicates varying depths, claiming that reaching Xiao Ke signifies severe heat. Studying the original text of Shaoyin regarding thirst reveals it says "due to deficiency, it draws water to save itself," never comparing Taiyin's lack of thirst to infiltrating heat. I have observed several cases of Jueyin Xiao Ke where the tongue was entirely red, limbs were cold, pulse was faint, and thirst was severe; treating with Baihu Tang (White Tiger Decoction) or Huanglian Tang (Coptis Decoction) failed to save them. In Jueyin wind-stroke, a slightly floating pulse indicates impending recovery; non-floating indicates no recovery.
Classics state: Yin diseases presenting with Yang pulses lead to survival. Floating pulse is Yang. In Jueyin wind-stroke, a slightly floating pulse indicates pathogen returning to the exterior preparing for sweating, hence "impending recovery."
Jueyin disease tends to resolve between Chou hour (01:00-03:00) and Mao hour (05:00-07:00).
Jueyin belongs to Wood, flourishing at Mao hour; Chou and Yin hours trend towards flourishing, thus constituting the resolution time.
In Jueyin disease, if the patient desires water, giving small amounts allows recovery.
Pathogen reaching Jueyin marks the end of channel transmission, a time when sweating is desired. If thirsty for water, giving small amounts moistens Stomach Qi, leading to recovery.
For all cases of Si Ni (Four Extremities Cold) and Jue (Cold Reversal), purgation is contraindicated. This applies equally to patients with deficiency constitution.
Si Ni refers to limbs not being warm. Jue refers to cold hands and feet. Both result from scant Yang Qi and abundant Yin Qi, hence purgation is contraindicated. Deficient patients are similarly treated. Purgation would cause double deficiency. *Jinkui Yufan Jing* states: "For deficiency, tonify ten times; do not purge once."
In Shanghan, initial cold reversal followed by fever implies diarrhea will stop spontaneously. If cold reversal reappears, diarrhea recurs.
Yin dominance causes cold reversal and diarrhea. Yang recovery causes fever, and diarrhea stops. Appearance of cold reversal indicates Yin dominance returns, causing diarrhea recurrence.
Zhang Jianshan said: Among Three Yin Shanghan, Taiyin starts with warm hands and feet; Shaoyin presents with cool hands and feet; Jueyin presents with cold reversal of hands and feet. However, reaching Jueyin represents the extreme of Yin, hence the possibility of fever. Extreme Yang generates Yin; extreme Yin generates Yang. This is the inevitable law of Yin-Yang interaction. *I Ching* states: "At the limit, change occurs." Limit means extremity. Extreme Yang generates Yin, so Yang diseases have cold reversal signs; extreme Yin generates Yang, so cold reversal cases have fever entries. Statements like "deeper cold reversal, deeper heat" refer to the normal change at extremes. Classics say: "Excess causes harm; control follows."
Shanghan begins with fever for six days, then cold reversal for nine days with diarrhea. Patients with cold reversal and diarrhea usually cannot eat. If they suddenly can eat, it may be Chu Zhong (Elimination of Middle, a sign of failing Stomach Qi). Feed them Suobing (noodles). If no fever ensues, Stomach Qi remains, and recovery is certain. One must fear sudden brief heat. After three days, if pulse shows sustained heat, recovery is expected at midnight of the next day. This is because initial fever was six days, cold reversal nine days, plus subsequent three days of fever equals nine days total, matching the cold reversal duration, hence recovery at midnight. If after three days pulse is rapid and heat persists, it indicates excess heat, likely leading to carbuncles and pus.
Initial fever indicates pathogen in the exterior. By day six, pathogen transmits to Jueyin. Yin dominance causes cold reversal and diarrhea. Nine days of cold reversal indicate abundant Yin-cold,理应 inability to eat. Sudden ability to eat suggests Chu Zhong. "Chu" means remove; "Zhong" means Stomach Qi. Severe pathogen eliminates Stomach Qi; Stomach seeks self-rescue by craving food, appearing as sudden appetite. This is pathogen dominance. Testing with noodles: if Stomach Qi is exhausted, eating causes fever; if no fever, Stomach Qi remains. Fear is that extreme cold transforms to heat, causing transient ability to eat, not Chu Zhong. *Jinkui Yaolue* states: "Patient unable to eat normally suddenly craves food,必定 fever. After three days, if heat persists, Yang dominates, expecting recovery at midnight. If not recovered, and after three days pulse is rapid with persistent heat, it is excess heat, leading to carbuncles. Classics say: 'Rapid pulse not stopping produces foul sores.'"
Shanghan with slow pulse for six to seven days, wrongly treated with Huangqin Tang (Scutellaria Decoction) to clear heat. Slow pulse indicates cold. Giving Huangqin Tang removes heat, causing abdominal cold and inability to eat. Sudden ability to eat is named Chu Zhong, indicating death.
Shanghan with slow pulse for six to seven days indicates deep cold. Wrongly giving cold medicine Huangqin Tang creates two colds clashing, causing abdominal cold. Cold cannot digest grain, leading to inability to eat. Sudden ability to eat is Chu Zhong. All seasons rely on Stomach Qi as root. Exhausted Stomach Qi means death.
Shanghan initial cold reversal then fever implies diarrhea stops. If sweating occurs instead, with sore throat, it becomes Hou Bi (Throat Obstruction). If fever without sweating, diarrhea stops. If diarrhea persists, pus and blood in stool occur. Those with pus/blood stool do not have throat obstruction.
Initial cold reversal and diarrhea indicate Yin-cold dominance. Extreme cold transforms to heat; subsequent fever stops diarrhea. Sweating and sore throat indicate rising heat causing Hou Bi. Fever without sweating stops diarrhea. Persistent diarrhea leads to pus/blood stool, indicating descending heat. Descending heat without ascending component spares the throat.
Wang Yutai said: Cold reversal with diarrhea stops upon fever. Sweating indicates Yang collapse. Sore throat indicates heat rushing up. Yang collapse allows Yin to gather with heat, knotting into Hou Bi. *Neijing* states: "One Yin and One Yang knot, called Hou Bi."
Shanghan days 1-2 progressing to days 4-5 with cold reversal必定 fever. Previous fever followed by cold reversal indicates Yang Qi sinking internally. Deeper cold reversal means deeper heat; shallower means shallower heat, depending on depth of Yang sinking. Deeply latent heat requires purgation. Wrongly using sweating pulls heat upward, causing oral ulceration and redness. *Neijing* states: "Fire Qi internal emission causes oral ulcers above."
Wu Shi said: Shanghan days 1-2 to 4-5 with cold reversal必定 fever indicates transmitted pathogen. Previous fever then cold reversal is also transmitted pathogen. Assess heat depth via severity of cold reversal. If cold/heat enters Fu organ becoming excess, purgation is needed. Wrong sweating dries Stomach fluids, increasing heat, causing oral ulcers. Although classics say "all Si Ni contraindicate purgation," here it says "should purge." Careful examination is vital. Ancients noted Heat Jue: hands/feet cold but occasionally warm; palms warm despite cold reversal. Dai Yuan Shi distinguished cold/heat Jue by nail temperature. Clinicians must be cautious.
Shanghan cold reversal five days, fever five days. If day six brings reversal again, no reversal means self-healing. Reversal does not exceed five days; since fever lasted five days, self-healing is known.
Yin dominance causes cold; Yang dominance causes heat. Initial five days cold indicates Yin dominance. Day six, Yang recovers dominance, fever lasts five days. Subsequent reversal indicates Yin resurgence. No reversal means Yang complete dominance, hence healing. Classics say: "Fever four days, reversal three days, fever four days more; less reversal, more fever, disease heals."
All Jue syndromes result from failure of Yin and Yang Qi to connect smoothly, causing Jue. Jue is cold reversal of hands and feet.
Hand Three Yin/Yang meridians connect at ten fingers; Foot Three Yin/Yang meridians connect at ten toes. Yang Qi sinks internally, failing to connect smoothly with Yin, causing cold hands and feet.
Shanghan with faint pulse and cold reversal, progressing to day 7-8 with cold skin, restlessness without respite, is Zang Jue (Organ Cold Reversal), not Hui Jue (Roundworm Cold Reversal).
Hui Jue patients vomit roundworms. Patient quiet but intermittently irritable indicates Cold Zang; roundworms ascend to Diaphragm causing irritation. Rest soon resumes. Vomiting and irritability after eating occur because roundworms emerge smelling food; patient vomits roundworms. Hui Jue is treated with Wumei Wan (Mume Pill), also for chronic diarrhea.
Zang Jue is fatal due to Yang Qi exhaustion. Hui Jue, though cold and irritable, quiets after vomiting roundworms, unlike Zang Jue's constant restlessness.
Patient with Cold Zang, deficient Stomach, roundworms agitated ascending to Diaphragm, emerging smelling food, vomiting roundworms. Administer Wumei Wan to warm Zang and calm worms.