治伤寒脉微而厥。至七八日肤冷。其人躁无暂安时者。此为脏厥。非蛔厥也。蛔厥
其人当吐蛔。今病者静而复时烦。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。其人当吐蛔。蛔厥者。乌梅丸主之。又主久利方。
乌梅（三百枚） 细辛（六两） 干姜（十两） 黄连（一斤） 蜀椒（四两 炒去汗。）
上十味。异捣筛。合治之。以苦酒浸乌梅一宿。去核。蒸之五升米下。饭熟捣成泥。和
药令相得。内臼中。与蜜杵二千下。丸如梧桐子大。先食。服十丸。日三服。稍加至二十丸。
禁
歌曰 六两柏参桂附辛。黄连十六厥阴遵。归椒四两梅三百。十两干姜记要真。
论云。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。此厥阴病之提纲也。经云。厥阴之上。风气主之。中见少阳。是厥阴以风为本。以阴寒
为标。而火热在中也。至厥阴而阴已极。故不从标本而从于中治。沈尧封云。此厥阴证之提
纲也。消渴等证外。更有厥热往来。或呕。或利等证。犹之阳明病胃家实之外。更有身热汗
出不恶寒反恶热等证。故阳明病。必须内外证合见。乃是真阳明。厥阴病亦必内外证合见。
乃是真厥阴。其余或厥或利或呕。而内无气上撞心心中疼热等证。皆似厥阴而非厥阴也。男
元犀按。论云。伤寒脉微而厥。至七八日肤冷。其人躁无暂安时者。是以少阴证之脏厥。唤
起厥阴之蛔厥也。然少阴证水火不交。则为烦躁。若真阳欲脱危证。则但躁不烦。与厥阴之
但烦不躁者不同。故曰肤冷而躁。名曰脏厥。非蛔厥也。蛔厥为厥阴病的证。厥阴阴极阳生。
中为少阳相火。名曰蛔厥。此蛔字所包者广。厥阴主风木。若名为风厥。则遗去木字。若名
为木厥。又遗去风字。且用字亦不雅驯。若名为风木厥。更见执着。第以蛔厥二字该之。盖
以蛔者风木之虫也。而吐蛔为厥阴之真面目。拈此一字。而病源病证俱在其中。其人当吐蛔
者。以风木之病当有是证。亦不必泥于蛔之有无。如本节静而复烦。与上节气上撞心心中疼
热皆是也。曰蛔闻食臭出。其人当自吐蛔。又用一当字者。言吐蛔者其常。即不吐蛔而呕而
又烦。风木之动。亦可以吐蛔例之也。曰静而复烦。曰须臾复止。曰又烦者。风有作止也。
然通篇之眼目。在此为脏寒四字。言见证虽曰风木为病。相火上攻。而其脏则为寒。何也。
厥阴为三阴之尽也。周易震卦。一阳居二阴之下。为厥阴本象。病则阳逆于上。阴陷于下。
饥不欲食。下之利不止。是下寒之确证也。消渴。气上撞心。心中疼热。吐蛔。是上热之确
证也。方用乌梅。渍以苦酒。顺曲直作酸之本性。逆者顺之。还其所固有。去其所本无。治
之所以臻于上理也。桂、椒、辛、附。辛温之品。导逆上之火。以还震卦下一画之奇。黄连、
黄柏。苦寒之品。泻心胸之热。以还震卦上四画之偶。又佐以人参之甘寒。当归之苦温。干
姜之辛温。三物合用。能令中焦受气而取汁。而乌梅蒸于米下。服丸送以米饮。无非补养中
焦之法。所谓厥阴不治。取之阳明者此也。此为厥阴证之总方。注家第谓蛔得酸则静。得辛
则伏。得苦则下。犹浅之乎测乌梅丸也。
Treats Taiyang disease (Taiyang syndrome) with a faint pulse and cold extremities. After seven or eight days, the skin becomes cold throughout the body, and the patient is restless without any moment of peace; this is called Zang Jue (Visceral Cold-Jue), not Hui Jue (Roundworm Cold-Jue).
In cases of Hui Jue (Roundworm Cold-Jue), the patient typically vomits roundworms. Now, if the patient is quiet but occasionally experiences vexation, it is due to cold in the viscera, causing the roundworms to move upward into the diaphragm, thus causing vexation. After a short while, it stops again. If vomiting occurs after eating, accompanied by renewed vexation, it is because the roundworms are disturbed by the odor of food and come out; the patient should expectorate roundworms. For Hui Jue (Roundworm Cold-Jue), Wu Mei Wan (Mume Pill) is the primary formula. It is also indicated for chronic diarrhea and dysentery.
Wu Mei (Fructus Mume, 300 pieces); Xi Xin (Herba Asari, 6 liang); Gan Jiang (Rhizoma Zingiberis Recens, 10 liang); Huang Lian (Rhizoma Coptidis, 1 jin); Shu Jiao (Pericarpium Zanthoxyli, 4 liang, stir-fried until sweat appears).
The above ten ingredients are separately pounded and sifted, then mixed. Soak Wu Mei (Fructus Mume) in vinegar (Ku Jiu) overnight, remove the pits, and steam them over five sheng of rice. When the rice is cooked, pound the Wu Mei into a paste, mix thoroughly with the other medicines, place in a mortar, add honey, and pound two thousand times to form pills the size of paulownia seeds. Take ten pills before meals, three times a day, gradually increasing to twenty pills.
Contraindications:
The song states: Six liang each of Bai Zhu (Atractylodis Macrocephalae Rhizoma - *Note: Text says Bo/Shen/Gui/Fu/Xin, likely referring to Baizhu/Renshen/Guizhi/Fuzi/Xixin based on context of standard Wu Mei Wan variants or specific commentary interpretation, but strictly translating text: "Six liang of Cypress/Bai, Ginseng/Shen, Cinnamon/Gui, Aconite/Fu, Asarum/Xin"*), sixteen liang of Huang Lian (Rhizoma Coptidis) follow the treatment of Jueyin (Jueyin syndrome). Four liang each of Dang Gui (Radix Angelicae Sinensis) and Shu Jiao (Pericarpium Zanthoxyli), three hundred Wu Mei (Fructus Mume), and ten liang of Gan Jiang (Rhizoma Zingiberis Recens) must be remembered as the true transmission.
The discussion states: The outline syndrome of Jueyin (Jueyin syndrome) includes: excessive thirst (Xiao Ke), sensation of Qi rushing up to strike the heart, pain and heat in the epigastrium/heart region, hunger without desire to eat, and vomiting roundworms upon eating. If purgatives are misused, it leads to unceasing diarrhea. This is the outline of Jueyin (Jueyin syndrome) disease. The Classics state: Above Jueyin (Jueyin syndrome), Wind Qi governs; it reveals Shaoyang (Shaoyang syndrome) internally. Thus, Jueyin (Jueyin syndrome) has Wind as its root, Yin-Cold as its branch, and Fire-Heat within. At the stage of Jueyin (Jueyin syndrome), Yin is at its extreme, so treatment does not follow the root or branch but addresses the middle. Shen Yaofeng stated: This is the outline of Jueyin (Jueyin syndrome) patterns. Besides symptoms like excessive thirst, there are also alternating cold and heat, vomiting, or diarrhea. Just as Yangming (Yangming syndrome) Stomach Excess (Wei Jia Shi) presents with additional symptoms like fever, sweating, aversion to cold turning to aversion to heat, so too must Yangming (Yangming syndrome) present with both internal and external signs to be considered true Yangming (Yangming syndrome). Similarly, Jueyin (Jueyin syndrome) must present with both internal and external signs to be considered true Jueyin (Jueyin syndrome). Other presentations involving cold extremities, diarrhea, or vomiting, but lacking internal signs like Qi rushing up to strike the heart and pain/heat in the heart region, resemble Jueyin (Jueyin syndrome) but are not true Jueyin (Jueyin syndrome).
Commentary by Nan Yuanxi: The discussion mentions that Taiyang disease (Taiyang syndrome) with faint pulse and cold extremities, progressing to cold skin after seven or eight days and restlessness without peace, uses the Zang Jue (Visceral Cold-Jue) of Shaoyin (Shaoyin syndrome) to introduce the concept of Hui Jue (Roundworm Cold-Jue) of Jueyin (Jueyin syndrome). However, in Shaoyin (Shaoyin syndrome), when Water and Fire do not interact, Fanzao (Restlessness and Vexation) arises. In critical conditions where True Yang is about to collapse, there is only Zao (Restlessness/Agitation) without Fan (Vexation), which differs from Jueyin (Jueyin syndrome) where there is Fan (Vexation) without Zao (Restlessness). Therefore, cold skin with agitation is named Zang Jue (Visceral Cold-Jue), not Hui Jue (Roundworm Cold-Jue). Hui Jue (Roundworm Cold-Jue) is a pattern of Jueyin (Jueyin syndrome); Jueyin (Jueyin syndrome) reaches extreme Yin generating Yang, with Shaoyang Ministerial Fire in the middle, hence named Hui Jue (Roundworm Cold-Jue). The character "Hui" (Roundworm) encompasses broad meanings. Jueyin (Jueyin syndrome) governs Wind-Wood. If named Feng Jue (Wind Jue), the Wood aspect is omitted; if named Mu Jue (Wood Jue), the Wind aspect is omitted; and such terms are inelegant. If named Feng Mu Jue (Wind-Wood Jue), it appears overly rigid. Using only "Hui Jue" (Roundworm Cold-Jue) suffices because roundworms are insects of Wind-Wood, and vomiting roundworms is the true manifestation of Jueyin (Jueyin syndrome). Highlighting this one character captures both the etiology and the syndrome. The statement that the patient should vomit roundworms implies that Wind-Wood diseases should exhibit this sign; one need not rigidly insist on the physical presence of roundworms. For instance, "quiet yet vexed" in this section and "Qi rushing up to strike the heart and pain/heat in the heart region" in the previous section are analogous. Saying "roundworms emerge smelling food, and the patient should vomit them," using the word "should" (Dang), indicates that vomiting roundworms is the norm. Even if roundworms are not vomited but vomiting and vexation occur, the movement of Wind-Wood can be inferred analogously. "Quiet yet vexed," "stops after a moment," "vexed again" indicate that Wind has periods of activity and cessation. However, the key point of the entire passage lies in the four characters "this is Zang Han" (Visceral Cold). Although the presentation suggests Wind-Wood pathology with Ministerial Fire attacking upward, the viscera themselves are cold. Why? Jueyin (Jueyin syndrome) is the end of the Three Yin channels. In the I Ching, the Zhen trigram has one Yang line below two Yin lines, representing the original image of Jueyin (Jueyin syndrome). In disease, Yang rebels upward, and Yin sinks downward. Hunger without desire to eat, and unceasing diarrhea after purgation, are definitive evidence of lower cold. Excessive thirst, Qi rushing up to strike the heart, pain/heat in the heart region, and vomiting roundworms are definitive evidence of upper heat. The formula uses Wu Mei (Fructus Mume), soaked in bitter wine (Ku Jiu), to follow its natural sour property (curving and straightening to become sour), reversing rebellion to restore what is inherent and removing what is not. This is how treatment achieves perfection. Gui Zhi (Ramulus Cinnamomi Cassiae), Shu Jiao (Pericarpium Zanthoxyli), Xi Xin (Herba Asari), and Fu Zi (Radix Aconiti Lateralis Preparata) are acrid-warm herbs that guide rebellious fire downward, restoring the single Yang line at the bottom of the Zhen trigram. Huang Lian (Rhizoma Coptidis) and Huang Bo (Cortex Phellodendri) are bitter-cold herbs that drain heat from the heart and chest, restoring the four Yin lines at the top of the Zhen trigram. They are assisted by Ren Shen (Radix Ginseng) which is sweet-cool, Dang Gui (Radix Angelicae Sinensis) which is bitter-warm, and Gan Jiang (Rhizoma Zingiberis Recens) which is acrid-warm. These three together enable the Middle Jiao (Middle Burner) to receive Qi and extract essence. Wu Mei (Fructus Mume) steamed under rice, and taken with rice water, are methods to nourish the Middle Jiao (Middle Burner). This is what is meant by "When Jueyin (Jueyin syndrome) cannot be treated directly, treat the Yangming (Yangming syndrome)." This is the master formula for Jueyin (Jueyin syndrome) patterns. Commentators merely say that roundworms become quiet with sourness, subdue with acridity, and descend with bitterness; this is a superficial understanding of Wu Mei Wan (Mume Pill).