（厥阴为风木之脏。从热化者多。从寒化者少。以木中有火故也。）
何谓厥阴症。伤寒论云。厥阴之为病。消渴。火盛。气上撞心。气逆即火逆也。心中疼热。火邪入心。饥火能消
物也。而不欲食。木克土也。食则吐蛔。虫为风化。一闻食臭。则上入于膈而吐出。下之利不止。误下伤胃气
是也。厥阴为两阴交尽。宜无热症。然厥阴主肝。而胆藏于内。则厥阴热症。皆少阳之火内发也。要知少阳
厥阴。同一相火。相火郁于内。是厥阴病。相火出于表。为少阳病。少阳咽干。即厥阴消渴之机。胸胁苦满。即
气上冲心之兆。心烦。即疼痛之初。不饮食。是饥不欲食之根。喜呕。即吐蛔之渐。故少阳不解。转属厥阴为
病危。厥阴病衰。转属少阳为欲愈。
乌梅丸为厥阴证之总方。吐蛔久利者。尤宜。
病初起手足厥冷。脉微欲绝。宜当归四逆汤。有久寒。加生姜、吴萸。酒水各半煎。以相火寄于肝。经虽寒而
脏不寒。故先厥者后必发热。手足愈冷。肝胆愈热。故云厥深热亦深也。姜附不可妄投。
脉结者。脉缓时一止曰结。活人云。阴盛则结。代者。一脏气败。其脉动而中止。不能自还。而他脏代之。心动
悸。心气不宁。炙甘草汤主之。按他经亦有此症。是阳气大虚。虚极生寒。非姜附肉桂不为功。若用此药。是
速其死也。惟厥阴症。肝中之相火。本少阳之生气。而少阳实出坎中之真阴。即经所谓阳为之正。阴为之
主是也。
按前言表证而手足厥逆。此言里证而脉结代。虽为厥阴寒化。终不用姜附大热之品。以厥阴之脏。相
火游行于其间故也。
脉微欲绝。不可下。若脉滑而厥。是内热郁闭。所谓厥应下是也。下之是下其热。非下其实。泄利下重者。四
逆散。欲饮水数升者。白虎汤。皆所以下无形之邪也。若以承气下之。则不止矣。
热利下重者。白头翁汤主之。下利欲饮水者。热也。白头翁汤主之。
以上治热化之法也。
厥者必发热。热与厥相应。热深厥亦深。热微厥亦微。此四症是厥阴伤寒之定局。先热后厥。厥热往来。厥
多热少。热多厥少。此四症是厥阴伤寒之变局。皆因其人阳气多少而然。
乘脾乘肺。二症宜辨。
曰。伤寒腹满。经云。诸腹胀大。皆属于热。此由肝火也。谵语。经云。肝气盛则多言。寸口脉浮而紧。紧即弦脉。
此肝乘脾也。名曰纵。刺期门。
曰。伤寒发热。啬啬恶寒。肺主皮毛。因无头痛项强。非属太阳病。为肺虚。渴欲饮水。无白虎证之欲饮。亦为
肺虚。腹满。无承气证。因肺虚不能通调水道。此肝乘肺也。肺金虚不能制木。肝寡于畏。侮所不胜也。名曰横。
刺期门。肝有亢火。随其实而泻之。
伤寒。阳脉涩。阴脉弦。法当腹中急痛。此亦肝乘脾也。先与小建中汤平肝以补脾。不瘥者。中气虚而不振。
邪尚流连。与小柴胡汤主之。令木邪直走少阳。使有出路。所谓阴出之阳则愈也。
伤寒。厥而心下悸者。宜先治水。当服茯苓甘草汤。却治其厥。不尔水渍入胃。必作利也。此亦肝乘肺也。虽
不发热恶寒。亦木实金虚。水气不利所致。上节腹满。是水在中焦。故刺期门以泄其实。此水在上焦。故用
茯苓甘草汤以发其汗。此方是化水为汗。发散内邪之剂。即厥阴治厥之剂也。
内经云。厥阴之上。风气治之。所谓本也。本之下。中之见也。见之下。气之标也。又曰。厥阴不从标本。而从中
见也。又曰。厥阴为阖。又热病论曰。伤寒六日。厥阴受之。厥阴脉循阴器而络于肝。故烦满而囊缩。厥阴木
气逆。火气盛。故烦满。循阴器。故囊缩。
盖厥阴以风木为本。以阴寒为标。中见少阳。厥阴为阴极。故不从标本。而从中见也。本论以厥阴自得
之病为提纲。故先曰消渴气上撞心。心中疼热。饥而不欲食。食则吐蛔。下之利不止等证。然必合之外
证。有厥热往来之气化。或呕或利。方为真厥阴。其余或厥。或利。或呕。内无气上撞心。心中疼热等症。皆
似厥阴而非厥阴也。其云消渴者。消为风消。渴为木火上熏也。其云气上撞心者。木气上凌心包也。其
云心中疼热者。是其气甚即为火。火甚即生热。阴血受灼。不足荣养筋脉。故筋脉不舒而疼。胃液受灼
故饥。其云不欲食者。是木气横逆也。其云食则吐蛔者。蛔感风木之气而生。闻食臭则出。湿热腐成。居
于胃底。无食则动。胃寒则出。胃热亦出。下之利不止者。阴寒在下也。
二章一节云。厥阴中风。脉微浮为欲愈。不浮为未愈。阴经受邪。脉当沉细。今反浮者。以风为阳邪。元气
复而邪将散。故脉见微浮。不浮则邪深入不外散。故为未愈。二节言欲愈之时。盖少阳旺于寅卯。解于
此时者。中见少阳之化。三节厥阴阴之极。渴欲饮水。水为天一所生之水。以水济火。阴阳气和而病自
愈。提纲后止此三节提出厥阴病。其余则曰伤寒。曰厥。曰下利。而不明言厥阴病。以厥阴从中见。而不
从标本也。
三章一节曰。诸四逆厥者。不可下之。虚家亦然。总起下文诸节厥逆之意。亦以承上文下之利不止。夫
四逆厥者。咸藉生阳之来复。故不可下。非特阳气大虚。寒邪直入。即热深者亦闲有之。热盛于内。内守
之真阴被烁几亡。不堪再下以竭之。故申其戒曰。气血两虚之家。即不厥逆。亦不可下也。二节言阴阳
寒热互换之理。厥阴伤寒。先厥后发热而利。必自止。厥不再作。利亦不再下。若见厥。则复利。三节言寒
热胜复之理。而归重于胃气也。凡厥利。当不能食。今反能食者。恐中气除去。求救于食。当以索饼试之。
若胃气能胜谷气而相安。则不暴然发热。恐暴热来骤而去速也。本发热六日。厥反九日。复发热三日。
热与厥无太过不及。故期旦日夜半愈。若再发热三日。兼之脉数。此中见太过。热气有余。必发痈脓也。
总之厥利转为发热。乃属愈期。仲师不是要其有热。要其发热而厥利止。厥利止而热亦随罢。方为顺
候。若热气有余。则伤血分。而化为如痈之脓。非发痈也。数脉为热气有余。迟脉为寒气不足。伤寒六七
日。阴尽出阳。可望其阳复。与黄芩汤复除其热。热除内外皆寒。腹中应冷。当不能食。今反能食。此中气
已除。必死。此节因脉数而推及脉迟。反复以明其义。五节言热化太过。火热下行。则便脓血。火热上升。
则咽痛而为喉痹。随其经气之上下而为病也。伤寒先厥后发热。下利必自止。而反汗出。阴液泄于外。
而火热炎于上。必咽中痛。其喉为痹。发热无汗。而利必自止。发热无汗而利不止。则阳热陷下。必便脓
血。火热下行。故其喉不痹。第六节遥承诸四逆厥者不可下。恐泥其说也。伤寒一二日。至四五日而厥
者。必发热也。是先厥后发热也。前热者后必厥。是先热后厥。厥之日期深者。则发热亦深。厥之日期微
者。则发热亦微。厥应下之。前不可下。指承气等方。此应下。热证轻有四逆散。重有白虎汤。寒症有乌梅
丸是也。沈尧封云。厥阴乃正邪分争。一大往来寒热。厥深热深。厥微热微。言寒热轻重。论其常理。其有
不然。亦以决病之进退矣。厥阴为三阴之尽。病及此。必阴阳错杂。厥阴肝木。于卦为震。一阳居二阴之
下。是其本象。病则阳泛于上。阴伏于下。而下寒上热之证作矣。其病藏寒。蛔上入膈。是下寒之证据也。
消渴心中疼热。是上热之症据也。况厥者逆也。下气逆。即是孤阳上泛。其病多升少降。凡吐蛔气上撞
心。皆是过升之病。治宜下降其逆上之阳。取内经高者抑之之义。其下之法。非必硝黄攻克实热方为
下剂。即乌梅丸一方已具。方中无论黄连乌梅黄柏。苦酸咸为下降药。即附子直达命门。亦莫非下降
药也。下之而阳伏于下。则阴阳之气顺。而厥可愈。倘误认为外寒所束。而反发其汗。以心中疼热之阳。
尽升于上。而口伤烂赤矣。以厥阴之脉。循颊里环唇内故也。七节言厥热相应。阴阳平。当自愈。八节云。
凡厥者。阴阳气不相顺接。便为厥。厥者。手足逆冷是也。观以凡字冠首。不独言三阴之厥。并该寒热二
厥在内矣。盖阳受气于四肢。阴受气于五脏。阴阳之气相贯。如环无端。若寒厥则阳不与阴相顺接。热
厥则阴不与阳相顺接也。或曰。阴不与阳相顺接。当四肢烦热。何反逆冷也。不知阳邪热邪深入。阳气
壅遏于里。不能外达于四肢。亦为厥。岂非阴与阳不相顺接之谓乎。九节以惟阴无阳之脏厥。托出阴
阳不和之脏寒为蛔厥。伤寒脉微而厥。至七八日肤冷。其人躁无暂安时者。此为脏厥。夫少阴水火不
交。则为烦躁。若真阳欲脱。则但躁不烦。与厥阴之但烦不躁者不同。蛔厥者。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。其人当自吐蛔。蛔厥者。乌
梅丸主之。又主久利方。吐蛔言其常。不吐蛔而呕烦。风木之动。亦可以吐蛔例也。金匮云。腹中痛。其脉
当沉而弦。今反洪大。故有蛔虫。蛔虫之病。令人吐涎心痛。发作有时。毒药不止者。甘草粉蜜汤主之。盖
腹痛脉多伏。阳气内闭。或弦。则邪气入中也。今反洪大。是蛔动而气厥也。吐涎。吐出清水。心痛。痛如咬啮。时时
上下也。蛔饱而静。其痛立止。蛔饥求食。其痛复发也。十节十一节。言厥阴必藉少阳
少阴之枢转。枢转不出逆于阴络而为便血。枢转不出逆于膀胱关元而为冷结。厥阴伤寒。热少厥微。指头寒。默
默不欲食。烦躁。数日小便利。下利色白。此热除。欲得食。其病为愈。若少阴枢转不出。故厥而呕。少阳枢
转不出。胸胁烦满者。阴阳并逆。不得外出。内伤阴络。其后必便血。热邪内陷为便
血。寒邪内陷则手足厥冷。言我不结胸。胸在上而主阳。腹在下而主阴。各从其类。故少腹满。以厥阴之脉。
过阴器抵少腹。按之则痛。此冷结在膀胱关元也。十二十三节。言阴阳胜负。可以日数之多寡验之。厥少热多。阳气太
过。
阴血受伤。其后必便血。以厥阴主包络而主血。寒多热少。阴气盛而阳气退。其病为进。人之伤于寒。则
为热病。热虽甚不死。是伤寒以热为贵。然热不及者病。太过者亦病。故此二节论寒热之多少。以明不
可太过与不及也。仲师以热多为病愈。厥多为病进者。是论病机之进退。以厥为热邪向内。热为热邪
向外。非内来客热。向外为退。向内为进也。故热多为病邪向愈之机。不是病邪便愈之候。所以纵有便
脓血之患。而热迫荣阴。与热深厥逆者。仍有轻重也。
厥阴有不治之死证。不可不知。伤寒六七日。脉微手足厥冷。虚阳在上。不得下交于阴。故烦。真阴在下。
不能上交于阳。故躁。此阴阳水火不交。宜灸厥阴以启阴中之生阳。而交会其水火。若厥不还。则阳气
不复。阴气乖离。故死。厥不还者死。则知发热为厥阴之生机。然发热亦有三种死证。伤寒发热当利止。
而反下利。身虽热而手足反见厥逆。孤阳外出。独阴不能为之守。更加躁不得卧。阴盛格阳。主死。伤寒
发热下利至甚。厥不止者。即无躁不得卧。亦主死。金匮云。六腑气绝于外者。手足寒。五脏气绝于内者。
利下不禁。脏腑气绝。故主死。伤寒六七日不利。若发热而渴。汗 而微利。是阳复之证。倘热汗下三
者。一时并见。乃真阳之气虚脱于内为利。浮散于外为热。发越于上而为汗。主死。亡阳有死证。亡阴亦
有死证。伤寒五六日。不伤于气。而伤于血。故不结胸。不结胸则腹亦不硬而濡软。伤于血则脉虚。血虚
于内。不能与阳相接于外。故手足复厥。厥不为热深而为亡血。下之愈亡其阴。故死。发热而厥。至七日
六气已周。来复于太阳则应止。今不惟不止。而反下利。阴盛虽未至于死。亦为难治。
五章凡八节。皆论厥证有寒有热有虚有实也。阳盛则促。虽手足厥逆。亦是热厥。忌用火攻。然有阴盛
之极。反假现数中一止之促。但阳盛者。重按之指下有力。阴盛者。重按之指下无力。伤寒脉促。知其阳
盛之假。手足厥冷。知其阴盛之真。可于厥阴并荣经俞等穴灸之。以启其陷下之阳。此厥阴证之寒也。
伤寒脉滑而厥者。阳气内郁。不能外达。外虽厥而里有热。白虎汤主之。脉微而厥为寒厥。脉滑而厥为
热厥。阳极似阴。全凭脉以辨之。然必烦渴引饮。不大便。乃为里有热也。经脉流行。营周不息。经血虚少。
不能流通畅达。手足厥寒。脉细欲绝者。当归四逆汤主之。若其人内有久寒。加吴萸生姜。厥阴肝脏。藏
荣血以应肝木。胆腑内寄。风火同原。苟非寒邪内犯。一阳生气欲寂者。不得用大辛大热之品。以扰动
风火。不比少阴为寒水之脏。其在经之邪。可与麻辛附子合用。是以虽有久寒。不现阴寒内犯之候者。
加生姜以宣泄。不取干姜之温中。加吴萸以苦降。不取附子之助火。分经投治。法律精严。学人所当则
效也。经脉内虚而厥。有当归四逆汤之治。而阳虚之厥。反作假热。又当何如。大汗出谓如水淋漓。热不
什么是厥阴病？《伤寒论》说：厥阴病的表现，是消渴（口渴多饮），这是火气旺盛；气向上冲撞心脏，气逆也就是火逆；心中疼痛且有灼热感，这是火邪侵入心脏；饥饿却不想吃东西，这是因为木克土（肝木克制脾土）；吃东西就会吐出蛔虫，蛔虫是由风化而生，一闻到食物的气味，就向上进入膈部而吐出来；如果误用攻下法，会导致腹泻不止，这是误下损伤了胃气。厥阴是两阴交汇的尽头，按理应该没有热证。然而厥阴主肝，胆藏于内，所以厥阴的热证，都是少阳之火在内发动。要知道少阳和厥阴，同属相火。相火郁结在体内，就是厥阴病；相火发散到体表，就是少阳病。少阳的咽干，就是厥阴消渴的征兆；胸胁苦满，就是气上冲心的预兆；心烦，就是疼痛的开始；不想饮食，是饥而不欲食的根源；喜欢呕吐，就是吐蛔的前兆。所以少阳病不解，转属为厥阴病，病情危重；厥阴病衰退，转属为少阳病，就要痊愈了。
病初起时手足冰冷，脉象微弱几乎摸不到，应当用当归四逆汤。如果有陈年旧寒，加生姜、吴茱萸，用水和酒各一半煎煮。因为相火寄居于肝，经脉虽然受寒但脏腑并不寒冷，所以先出现厥冷的，后来必定发热。手足越冷，肝胆就越热，所以说“厥深热亦深”。姜、附子不可乱用。
脉象有结代的，脉缓偶尔停跳一次叫作“结”。《活人书》说：阴气盛则脉结。“代”脉，是一脏之气败坏，脉搏跳动中途停止，不能自行恢复，由其他脏气来替代。心动悸，心气不宁，用炙甘草汤主治。按其他经络也有此症，这是阳气大虚，虚极生寒，非用姜、附、肉桂不能奏效。如果用这些药，是加速死亡。只有厥阴病，肝中的相火，本是少阳的生气，而少阳实际上出于坎卦中的真阴，这就是经文所说的“阳为之正，阴为之主”。
按前文说的是表证而手足厥逆，这里说的是里证而脉象结代。虽然属于厥阴寒化，最终也不使用姜、附等大热之品，因为厥阴之脏，相火游行在其中。
脉微欲绝，不可攻下。如果脉滑而手足厥冷，这是内热郁闭，所谓“厥应下之”就是指这个意思。攻下是下其热，不是下其实邪。泄利且肛门重坠感的，用四逆散；想喝几升水的，用白虎汤，这都是为了下无形之邪。如果用承气汤攻下，就会导致腹泻不止。
热性腹泻且肛门重坠的，用白头翁汤主治。腹泻想喝水的，是热证，用白头翁汤主治。
以上是治疗热化的方法。
厥冷必定伴随发热，热与厥相应。热深厥也深，热微厥也微。这四种情况是厥阴伤寒的定局。先发热后厥冷，厥热往来，厥多热少，热多厥少。这四种情况是厥阴伤寒的变局。这都是因为人的阳气多少不同所致。
问：伤寒腹部胀满，经书说：各种腹胀大，都属于热。这是由肝火引起的。谵语，经书说：肝气盛则多言。寸口脉浮而紧，紧即弦脉。这是肝乘脾，名叫“纵”，刺期门穴。
问：伤寒发热，啬啬恶寒。肺主皮毛，因为没有头痛项强，不属于太阳病，而是肺虚。口渴想喝水，但没有白虎汤证的剧烈口渴，也是肺虚。腹部胀满，但没有承气汤证。因为肺虚不能通调水道，这是肝乘肺。肺金虚弱不能制约肝木，肝木无所畏惧，反侮其所不胜（肺），名叫“横”，刺期门穴。肝有亢盛的火气，随其实证而泻之。
伤寒，阳脉涩，阴脉弦，按法应当腹中急痛，这也是肝乘脾。先给小建中汤以平肝补脾，如果不愈，是中气虚弱而不能振奋，邪气尚且流连，用小柴胡汤主治，使木邪直接走向少阳，使其有出路，这就是所谓的“阴出之阳则愈”。
伤寒，厥冷且心下悸动的，应当先治水，服用茯苓甘草汤，然后再治其厥冷。不然水气浸渍入胃，必定造成腹泻。这也是肝乘肺。虽然没有发热恶寒，也是木实金虚，水气不利所致。上一节说的腹满，是水在中焦，所以刺期门以泄其实。这里的水在上焦，所以用茯苓甘草汤以发汗。这个方子是化水为汗，发散内邪的药剂，也就是治疗厥阴厥冷的药剂。
《内经》说：厥阴之上，风气治之，这叫作本。本的下面，是中之见。见的下面，是气的标。又说：厥阴不从标本，而从中见。又说：厥阴为阖。又《热病论》说：伤寒六日，厥阴受之。厥阴脉循行阴器并联络肝脏，所以烦闷且囊缩。厥阴木气逆，火气盛，所以烦闷。循行阴器，所以囊缩。
大概厥阴以风木为本，以阴寒为标，中见少阳。厥阴是阴极，所以不从标本，而从中见。本篇以厥阴自得的病作为提纲，所以先说消渴、气上撞心、心中疼热、饥而不欲食、食则吐蛔、下之利不止等证。然而必须结合外证，有厥热往来的气化，或呕或利，才是真厥阴。其余或者厥，或者利，或者呕，内部没有气上撞心、心中疼热等症状，都是似厥阴而非厥阴。所谓消渴，消是风消，渴是木火上熏。所谓气上撞心，是木气上凌心包。所谓心中疼热，是其气甚即为火，火甚即生热，阴血被灼烧，不足以荣养筋脉，所以筋脉不舒展而疼痛。胃液被灼烧所以感到饥饿。所谓不欲食，是木气横逆。所谓食则吐蛔，蛔虫感受风木之气而生，闻到食物气味就出来，湿热腐化成虫，居于胃底，无食则动，胃寒则出，胃热也出。下之利不止，是因为阴寒在下。
第二章第一节说：厥阴中风，脉微浮为欲愈，不浮为未愈。阴经受邪，脉应当沉细，现在反而浮，是因为风为阳邪，元气恢复而邪气将散，所以脉见微浮。不浮则邪气深入不外散，所以为未愈。第二节讲欲愈的时候，大概少阳旺于寅卯时，解于此时的，是中见少阳的化生。第三节厥阴是阴之极，渴欲饮水，水是天一所生的水，以水济火，阴阳气和而病自愈。提纲后只这三节提出厥阴病，其余则曰伤寒，曰厥，曰下利，而不明言厥阴病，因为厥阴从中见，而不从标本。
第三章第一节说：所有四逆厥者，不可攻下，虚家亦然。总起下文诸节厥逆之意，也承接上文下之利不止。夫四逆厥者，都依赖生阳的来复，所以不可攻下。不仅是阳气大虚、寒邪直入，即使热深的也间或有之。热盛于内，内守的真阴被烁烧几乎亡失，不堪再攻下以竭尽它，所以申明告诫说：气血两虚之家，即使不厥逆，也不可攻下。第二节讲阴阳寒热互换的道理。厥阴伤寒，先厥后发热而利，必定自止，厥不再发作，利也不再下。如果见到厥，则复利。第三节讲寒热胜复的道理，而归重于胃气。凡是厥利，应当不能食，现在反而能食，恐怕是中气除去，求救于食物，应当用索饼试验。如果胃气能胜谷气而相安，则不会暴然发热，恐怕暴热来骤而去速。本来发热六日，厥反九日，又发热三日，热与厥无太过不及，所以预期在旦日夜半痊愈。如果再发热三日，兼之脉数，这是中见太过，热气有余，必定发痈脓。总之厥利转为发热，乃属愈期。仲景不是要其有热，是要其发热而厥利止，厥利止而热亦随罢，方为顺候。若热气有余，则伤血分，而化为如痈之脓，不是发痈。数脉为热气有余，迟脉为寒气不足。伤寒六七日，阴尽出阳，可望其阳复。与黄芩汤复除其热，热除内外皆寒，腹中应冷，当不能食，现在反而能食，这是中气已除，必死。这一节因脉数而推及脉迟，反复以明其义。第五节讲热化太过，火热下行，则便脓血；火热上升，则咽痛而为喉痹。随其经气之上下而为病。伤寒先厥后发热，下利必自止，而反汗出，阴液泄于外，而火热炎于上，必咽中痛，其喉为痹。发热无汗，而利必自止。发热无汗而利不止，则阳热陷下，必便脓血。火热下行，故其喉不痹。第六节遥承诸四逆厥者不可下，恐泥其说。伤寒一二日，至四五日而厥者，必发热也，是先厥后发热。前热者后必厥，是先热后厥。厥之日期深者，则发热亦深；厥之日期微者，则发热亦微。厥应下之，前不可下，指承气等方。此应下，热证轻有四逆散，重有白虎汤，寒症有乌梅丸。沈尧封说：厥阴乃正邪分争，一大往来寒热。厥深热深，厥微热微，言寒热轻重，论其常理。其有不然，亦以决病之进退矣。厥阴为三阴之尽，病及此，必阴阳错杂。厥阴肝木，于卦为震，一阳居二阴之下，是其本象。病则阳泛于上，阴伏于下，而下寒上热之证作矣。其病藏寒，蛔上入膈，是下寒之证据。消渴心中疼热，是上热之症据。况厥者逆也，下气逆，即是孤阳上泛，其病多升少降。凡吐蛔、气上撞心，皆是过升之病，治宜下降其逆上之阳，取内经高者抑之之义。其下之法，非必硝黄攻克实热方为下剂，即乌梅丸一方已具。方中无论黄连、乌梅、黄柏，苦酸咸为下降药，即附子直达命门，亦莫非下降药也。下之而阳伏于下，则阴阳之气顺，而厥可愈。倘误认为外寒所束，而反发其汗，以心中疼热之阳，尽升于上，而口伤烂赤矣，以厥阴之脉，循颊里环唇内故也。七节讲厥热相应，阴阳平，当自愈。八节说：凡厥者，阴阳气不相顺接，便为厥。厥者，手足逆冷是也。观以凡字冠首，不独言三阴之厥，并该寒热二厥在内矣。盖阳受气于四肢，阴受气于五脏，阴阳之气相贯，如环无端。若寒厥则阳不与阴相顺接，热厥则阴不与阳相顺接也。或曰：阴不与阳相顺接，当四肢烦热，何反逆冷也？不知阳邪热邪深入，阳气壅遏于里，不能外达于四肢，亦为厥，岂非阴与阳不相顺接之谓乎？九节以惟阴无阳之脏厥，托出阴阳不和之脏寒为蛔厥。伤寒脉微而厥，至七八日肤冷，其人躁无暂安时者，此为脏厥。夫少阴水火不交，则为烦躁。若真阳欲脱，则但躁不烦，与厥阴之但烦不躁者不同。蛔厥者，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，其人当自吐蛔。蛔厥者，乌梅丸主之，又主久利方。吐蛔言其常，不吐蛔而呕烦，风木之动，亦可以吐蛔例也。金匮云：腹中痛，其脉当沉而弦，今反洪大，故有蛔虫。蛔虫之病，令人吐涎心痛，发作有时，毒药不止者，甘草粉蜜汤主之。盖腹痛脉多伏，阳气内闭，或弦，则邪气入中也。今反洪大，是蛔动而气厥也。吐涎，吐出清水，心痛，痛如咬啮，时时上下也。蛔饱而静，其痛立止，蛔饥求食，其痛复发也。十节十一节，讲厥阴必藉少阳少阴之枢转。枢转不出，逆于阴络而为便血；枢转不出，逆于膀胱关元而为冷结。厥阴伤寒，热少厥微，指头寒，默默不欲食，烦躁，数日小便利，下利色白，此热除，欲得食，其病为愈。若少阴枢转不出，故厥而呕；少阳枢转不出，胸胁烦满者，阴阳并逆，不得外出，内伤阴络，其后必便血。热邪内陷为便血，寒邪内陷则手足厥冷。言我不结胸，胸在上而主阳，腹在下而主阴，各从其类，故少腹满，以厥阴之脉，过阴器抵少腹，按之则痛，此冷结在膀胱关元也。十二十三节，讲阴阳胜负，可以日数之多寡验之。厥少热多，阳气太过，阴血受伤，其后必便血，以厥阴主包络而主血。寒多热少，阴气盛而阳气退，其病为进。人之伤于寒，则为热病，热虽甚不死，是伤寒以热为贵。然热不及者病，太过者亦病，故此二节论寒热之多少，以明不可太过与不及也。仲师以热多为病愈，厥多为病进者，是论病机之进退，以厥为热邪向内，热为热邪向外，非内来客热，向外为退，向内为进也。故热多为病邪向愈之机，不是病邪便愈之候。所以纵有便脓血之患，而热迫荣阴，与热深厥逆者，仍有轻重也。
厥阴有不治之死证，不可不知。伤寒六七日，脉微手足厥冷，虚阳在上，不得下交于阴，故烦。真阴在下，不能上交于阳，故躁。此阴阳水火不交，宜灸厥阴以启阴中之生阳，而交会其水火。若厥不还，则阳气不复，阴气乖离，故死。厥不还者死，则知发热为厥阴之生机。然发热亦有三种死证。伤寒发热当利止，而反下利，身虽热而手足反见厥逆，孤阳外出，独阴不能为之守，更加躁不得卧，阴盛格阳，主死。伤寒发热下利至甚，厥不止者，即无躁不得卧，亦主死。金匮云：六腑气绝于外者，手足寒，五脏气绝于内者，利下不禁。脏腑气绝，故主死。伤寒六七日不利，若发热而渴，汗出而微利，是阳复之证。倘热汗下三者，一时并见，乃真阳之气虚脱于内为利，浮散于外为热，发越于上而为汗，主死。亡阳有死证，亡阴亦有死证。伤寒五六日，不伤于气，而伤于血，故不结胸。不结胸则腹亦不硬而濡软。伤于血则脉虚，血虚于内，不能与阳相接于外，故手足复厥。厥不为热深而为亡血，下之愈亡其阴，故死。发热而厥，至七日六气已周，来复于太阳则应止，今不惟不止，而反下利，阴盛虽未至于死，亦为难治。
第五章共八节，皆论厥证有寒有热有虚有实。阳盛则促，虽手足厥逆，亦是热厥，忌用火攻。然有阴盛之极，反假现数中一止之促。但阳盛者，重按之指下有力；阴盛者，重按之指下无力。伤寒脉促，知其阳盛之假，手足厥冷，知其阴盛之真，可于厥阴并荣经俞等穴灸之，以启其陷下之阳。此厥阴证之寒也。
伤寒脉滑而厥者，阳气内郁，不能外达，外虽厥而里有热，白虎汤主之。脉微而厥为寒厥，脉滑而厥为热厥。阳极似阴，全凭脉以辨之。然必烦渴引饮，不大便，乃为里有热也。经脉流行，营周不息，经血虚少，不能流通畅达，手足厥寒，脉细欲绝者，当归四逆汤主之。若其人内有久寒，加吴茱萸、生姜。厥阴肝脏，藏荣血以应肝木，胆腑内寄，风火同原。苟非寒邪内犯，一阳生气欲寂者，不得用大辛大热之品，以扰动风火，不比少阴为寒水之脏，其在经之邪，可与麻辛附子合用。是以虽有久寒，不现阴寒内犯之候者，加生姜以宣泄，不取干姜之温中；加吴茱萸以苦降，不取附子之助火。分经投治，法律精严，学人所当则效也。经脉内虚而厥，有当归四逆汤之治，而阳虚之厥，反作假热，又当何如？大汗出谓如水淋漓，热不
(Jueyin is the zang organ of Wind-Wood. It transforms into Heat more often than into Cold, because Fire is contained within Wood.)
What is Jueyin disease? The *Shanghan Lun* states: In Jueyin disease, there is Xiao Ke (excessive thirst and drinking), which indicates excessive Fire; Qi rushes upward to strike the heart, where Qi rebellion is also Fire rebellion; there is pain and burning sensation in the heart, indicating Fire pathogen invading the Heart; hunger without desire to eat, due to Wood overcoming Earth (Liver Wood overacting on Spleen Earth); eating leads to vomiting of roundworms, as roundworms are generated by Wind transformation, and upon smelling food odor, they move upward into the diaphragm and are vomited out; if purgatives are mistakenly used, diarrhea will persist incessantly, which is damage to Stomach Qi caused by incorrect purgation. Jueyin represents the convergence of two Yin meridians and theoretically should present no Heat symptoms. However, Jueyin governs the Liver, with the Gallbladder residing within; thus, Heat symptoms in Jueyin are all internal manifestations of Shaoyang Fire. One must understand that Shaoyang and Jueyin both belong to Ministerial Fire (Xiang Huo). When Ministerial Fire is constrained internally, it is Jueyin disease; when Ministerial Fire emerges externally, it is Shaoyang disease. Dryness of the throat in Shaoyang is the precursor to Xiao Ke in Jueyin; chest and hypochondriac fullness and distress are the signs of Qi rushing upward to strike the heart; irritability is the beginning of pain; lack of appetite is the root of hunger without desire to eat; a tendency to vomit is the gradual stage of vomiting roundworms. Therefore, if Shaoyang disease does not resolve and transfers to Jueyin, the condition becomes critical; if Jueyin disease declines and transfers to Shaoyang, recovery is imminent.
Wumei Wan (Mume Pill) is the general formula for treating Jueyin syndrome, especially suitable for cases involving vomiting of roundworms or chronic diarrhea.
At the onset of the disease, if the hands and feet are cold and the pulse is faint and nearly imperceptible, Danggui Sini Tang (Angelica Decoction for Frigid Extremities) should be used. If there is long-standing Cold, add Shengjiang (Fresh Ginger) and Wuzhuyu (Evodia Fruit), decocting with half water and half wine. Since Ministerial Fire resides in the Liver, although the meridians may be cold, the viscera are not cold; therefore, those who initially experience cold extremities will later develop fever. The colder the hands and feet, the hotter the Liver and Gallbladder become; hence it is said, "The deeper the cold, the deeper the heat." Jiang (Ginger) and Fu (Aconite) should not be administered recklessly.
A knotted pulse (Jie Mai) refers to a slow pulse that occasionally stops. The *Huoren Shu* states: Excess Yin causes a knotted pulse. A substituted pulse (Dai Mai) indicates the failure of one Zang Qi, where the pulse beats then stops and cannot recover on its own, being replaced by another Zang's Qi. Palpitations and restless Heart Qi are treated with Zhigancao Tang (Honey-Panax Decoction). Note that other meridians can also present these symptoms, indicating severe Yang deficiency leading to extreme Cold, which requires Jiang, Fu, and Rougui (Cinnamon Bark) to be effective. Using these drugs in such cases would hasten death. Only in Jueyin disease, the Ministerial Fire in the Liver originates from the vital Qi of Shaoyang, which itself arises from the True Yin of Kan (Kidney Water). This corresponds to the classic statement: "Yang provides the direction, Yin provides the governance."
As mentioned earlier regarding exterior syndromes with cold extremities, here we discuss interior syndromes with knotted and substituted pulses. Although this belongs to Jueyin Cold transformation, Jiang and Fu (large hot herbs) are ultimately not used because Ministerial Fire circulates within the Jueyin viscera.
If the pulse is faint and nearly imperceptible, purgation is contraindicated. However, if the pulse is slippery and the extremities are cold, this indicates internal heat constraint, referred to as "Jue should be purged." Here, purging targets the heat, not excess pathogens. For diarrhea with a sensation of heaviness in the anus, Sixian San (Four Reversal Powder) is used. For those desiring to drink several liters of water, Baihu Tang (White Tiger Decoction) is used. Both aim to purge formless pathogens. Using Chengqi Tang (Major/Minor Order the Qi Decoctions) for purgation would lead to incessant diarrhea.
For hot diarrhea with a sensation of heaviness in the anus, Baitouweng Tang (Pulsatilla Decoction) is indicated. Diarrhea accompanied by thirst indicates Heat, also treated with Baitouweng Tang.
These are methods for treating Heat transformation.
Cold extremities (Jue) must be accompanied by fever, corresponding to each other. Deep heat results in deep cold; slight heat results in slight cold. These four patterns constitute the fixed course of Jueyin Shanghan. Fever followed by cold, alternating cold and fever, more cold than fever, and more fever than cold constitute the variable course. All depend on the degree of the person's Yang Qi.
Differentiation is required between Liver overacting on Spleen and Liver overacting on Lung.
Question: Abdominal fullness in Shanghan. The classics state: All abdominal distensions and enlargements belong to Heat. This is caused by Liver Fire. Delirious speech occurs because excess Liver Qi leads to excessive talking. If the Cun Kou pulse is floating and tight (tight being the String-like/Xian pulse), this is Liver overacting on Spleen, named "Zong" (Vertical), treated by needling Qimen (LR14).
Question: Fever and aversion to cold in Shanghan. Lung governs skin and hair. Without headache and stiff neck, it is not a Taiyang disease but Lung deficiency. Thirst wanting water, but not the intense thirst of Baihu Tang syndrome, also indicates Lung deficiency. Abdominal fullness without Chengqi Tang syndrome occurs because Lung deficiency fails to regulate water passages. This is Liver overacting on Lung. Deficient Lung Metal cannot control Liver Wood; Liver, lacking fear, insults what it cannot overcome (Metal), named "Heng" (Horizontal), treated by needling Qimen (LR14). Excessive Fire in the Liver is drained according to its excess.
In Shanghan, if the Yang pulse is choppy and the Yin pulse is string-like, abdominal acute pain is expected by method; this is also Liver overacting on Spleen. First administer Xiaojianzhong Tang (Minor Construct the Middle Decoction) to soothe Liver and tonify Spleen. If not improved, it indicates deficient Middle Qi failing to rise and lingering pathogens; treat with Xiaochaihu Tang (Minor Bupleurum Decoction) to guide Wood pathogens directly to Shaoyang, providing an exit, known as "Yin emerging to Yang leads to healing."
In Shanghan, Jue with palpitations below the heart requires first treating water retention by administering Fuling Gancao Tang (Poria and Licorice Decoction), then treating the Jue. Otherwise, water will infiltrate the Stomach, causing diarrhea. This is also Liver overacting on Lung. Although there is no fever or aversion to cold, it is due to excess Wood and deficient Metal causing water qi stagnation. The previous section's abdominal fullness involved water in the Middle Jiao, so Qimen was needled to drain excess. Here, water is in the Upper Jiao, so Fuling Gancao Tang is used to induce sweating. This formula transforms water into sweat and disperses interior pathogens; it is a formula for treating Jue in Jueyin.
The *Neijing* states: Above Jueyin, Wind Qi governs, called the Root. Below the Root is the Manifestation of the Middle. Below the Manifestation is the Mark of Qi. It also states: Jueyin does not follow Root and Mark but follows the Middle Manifestation. It further states: Jueyin acts as the Closing. The *Treatise on Heat Diseases* says: On the sixth day of Shanghan, Jueyin is affected. The Jueyin meridian circles the genitalia and connects to the Liver, causing irritability, fullness, and retraction of the scrotum. Jueyin Wood Qi rebels and Fire Qi is excessive, causing irritability and fullness. Circulating through the genitalia causes scrotal retraction.
Generally, Jueyin has Wind-Wood as its Root and Yin-Cold as its Mark, with the Middle Manifestation being Shaoyang. As the extreme of Yin, Jueyin does not follow Root and Mark but follows the Middle Manifestation. This text uses self-generated Jueyin diseases as the outline, starting with Xiao Ke, Qi striking the heart, pain and heat in the heart, hunger without desire to eat, vomiting roundworms upon eating, and persistent diarrhea after purgation. However, true Jueyin must combine exterior signs with the Qi transformation of alternating cold and fever, or vomiting/diarrhea. Other cases presenting only Jue, diarrhea, or vomiting without internal signs like Qi striking the heart or pain/heat in the heart are similar to but not true Jueyin. "Xiao Ke": Xiao refers to Wind-induced consumption; Ke refers to Wood-Fire steaming upward. "Qi striking the heart": Wood Qi insulting the Pericardium. "Pain and heat in the heart": Extreme Qi becomes Fire; excessive Fire generates Heat, scorching Yin Blood, failing to nourish sinews and vessels, causing pain due to tension. Scorching Stomach fluids causes hunger. "No desire to eat": Horizontal rebellion of Wood Qi. "Vomiting roundworms upon eating": Roundworms are born feeling Wind-Wood Qi; they emerge upon smelling food. Damp-Heat putrefaction creates them in the stomach base; they move without food, emerge in Cold Stomach, and emerge in Hot Stomach. Persistent diarrhea after purgation is due to Yin-Cold below.
Chapter 2, Section 1 states: In Jueyin Wind-stroke, a faintly floating pulse indicates impending recovery; non-floating indicates no recovery. Yin meridians affected by pathogens should have sinking and fine pulses. Now it floats because Wind is a Yang pathogen; as Yuan Qi recovers, pathogens scatter, causing a faintly floating pulse. Non-floating means pathogens penetrate deeply and do not scatter, indicating no recovery. Section 2 discusses the time of recovery: Shaoyang prospers at Yin-Mao hours; resolving at this time reflects the transformation of Middle Manifestation Shaoyang. Section 3: Jueyin is the extreme of Yin. Thirst wanting water involves Water generated by Tianyi. Water aids Fire; when Yin and Yang Qi harmonize, the disease heals. After the outline, only these three sections explicitly mention Jueyin disease; others say Shanghan, Jue, or diarrhea without specifying Jueyin disease, because Jueyin follows the Middle Manifestation, not Root and Mark.
Chapter 3, Section 1 states: All cases of Sini (Four Reversals) and Jue should not be purged; this applies equally to deficient individuals. This summarizes the intent of subsequent sections on Jue Ni and connects to the previous warning about persistent diarrhea after purgation. Cases of Sini and Jue rely on the return of generating Yang, so they should not be purged. This applies not only to severe Yang deficiency and direct invasion of Cold pathogens but also occasionally to deep Heat. Excessive Heat inside scorches the True Yin guarding internally, nearly destroying it; further purgation to exhaust it is intolerable. Hence the warning: Even without Jue Ni, individuals with dual deficiency of Qi and Blood should not be purged. Section 2 discusses the principle of interchange between Yin/Yang and Cold/Heat. In Jueyin Shanghan, if Jue is followed by fever and diarrhea, the diarrhea must stop spontaneously, Jue will not recur, and diarrhea will not happen again. If Jue appears, diarrhea recurs. Section 3 discusses the principle of Cold/Heat victory and recurrence, emphasizing Stomach Qi. Generally, Jue and diarrhea imply inability to eat. Now, if the patient can eat, it may indicate the departure of Middle Qi seeking rescue via food. Test with Su Bing (flour cakes). If Stomach Qi can handle Grain Qi peacefully, there will be no sudden fever, fearing sudden heat coming rapidly and leaving quickly. Originally febrile for six days, Jue for nine days, then febrile for three more days; Heat and Jue are balanced, so recovery is expected at dawn or midnight. If febrile for three more days combined with a rapid pulse, this indicates excess of Middle Manifestation and surplus Heat, likely leading to carbuncles and pus. In summary, Jue and diarrhea turning into fever indicates a recovery period. Master Zhongjing does not seek fever per se, but seeks cessation of Jue and diarrhea with fever, and cessation of fever with Jue and diarrhea, which is the favorable pattern. If Heat is excessive, it damages the Blood aspect, transforming into pus like a carbuncle, not actual carbuncle formation. Rapid pulse indicates surplus Heat; slow pulse indicates insufficient Cold Qi. After six or seven days of Shanghan, Yin ends and exits to Yang, expecting Yang recovery. With Huangqin Tang to remove residual Heat, if Heat is removed, interior and exterior are cold, abdomen should be cold, and eating should be impossible. Now, if the patient can eat, Middle Qi has departed, indicating death. This section deduces from rapid pulse to slow pulse, reiterating the meaning. Section 5 discusses excessive Heat transformation: Fire-Heat descending causes bloody stools; ascending causes sore throat and Bi obstruction, depending on meridian Qi movement. In Shanghan, Jue followed by fever usually stops diarrhea spontaneously. If sweating occurs instead, Yin fluids leak outward, and Fire-Heat flares upward, causing sore throat and Bi obstruction. If no sweating and fever, diarrhea stops spontaneously. If no sweating, fever persists, and diarrhea continues, Yang-Heat sinks downward, causing bloody stools. Fire-Heat descending means no Bi obstruction. Section 6 echoes "Sini and Jue should not be purged," cautioning against rigid adherence. In Shanghan, Jue appearing from day one or two to four or five implies fever (Jue then fever). Previous fever followed by Jue implies fever then Jue. Deeper Jue duration means deeper fever; shallower Jue duration means milder fever. "Jue should be purged" refers to light Heat cases using Sixian San, heavy Heat using Baihu Tang, and Cold cases using Wumei Wan. Shen Yaofeng stated: Jueyin is the struggle between righteous Qi and pathogens, resembling alternating chills and fever. Deep Jue means deep Heat; mild Jue means mild Heat, discussing normal principles. Deviations help determine disease progression. Jueyin is the end of Three Yin; disease reaching here involves mixed Yin and Yang. Jueyin Liver Wood corresponds to the Zhen trigram, one Yang line below two Yin lines, its original image. In disease, Yang floats upward, Yin sinks downward, resulting in lower Cold and upper Heat. Visceral Cold with roundworms entering the diaphragm evidences lower Cold. Xiao Ke and pain/heat in the heart evidence upper Heat. Jue means rebellion; downward Qi rebellion is isolated Yang floating upward, characterized by more ascending than descending. Vomiting roundworms and Qi striking the heart are diseases of excessive ascent. Treatment should descend the rebellious Yang, following the Neijing principle of suppressing high things. The method of "descending" does not necessarily require Xiaoshi (Mirabilite) and Dahuang (Rhubarb) for solid Heat; Wumei Wan already embodies this. In the formula, Huanglian, Wumei, Huangbai use bitter, sour, and salty flavors as descending agents. Even Fuzi reaching the Mingmen is a descending agent. Descending allows Yang to settle below, harmonizing Yin and Yang Qi, curing Jue. Mistaking this for exterior Cold constraint and inducing sweating would cause all Yang from pain/heat in the heart to ascend, damaging the mouth and lips, as the Jueyin meridian circles the cheeks and lips. Section 7 discusses Jue and Heat correspondence; when Yin and Yang are balanced, spontaneous healing occurs. Section 8 states: All Jue results from failure of Yin and Yang Qi to connect smoothly, manifesting as cold extremities. The word "All" includes both Cold and Heat Jue, not just Three Yin Jue. Yang receives Qi in the four limbs; Yin receives Qi in the five Zang. Yin and Yang Qi interconnect like a circle. In Cold Jue, Yang does not connect smoothly with Yin; in Heat Jue, Yin does not connect smoothly with Yang. Some ask: If Yin does not connect with Yang, why not limb heat but cold? Unknown is that Yang/Heat pathogens penetrating deeply obstruct Yang Qi internally, preventing external reach to limbs, also causing Jue, fitting the description of Yin-Yang disconnection. Section 9 contrasts Zang Jue (only Yin, no Yang) with Zang Cold causing Hui Jue (roundworm Jue). In Shanghan, faint pulse and Jue, progressing to cold skin by day seven-seventy-eight, with restlessness without peace, is Zang Jue. In Shaoyin, Water-Fire non-interaction causes irritability. If True Yang is about to collapse, there is only restlessness without irritability, differing from Jueyin's irritability without restlessness. Hui Jue patients vomit roundworms. If the patient is quiet but periodically irritable, this is Zang Cold; roundworms enter the diaphragm causing irritability, stopping briefly. Eating causes vomiting and renewed irritability as roundworms smell food and emerge; the patient should vomit roundworms. Hui Jue is treated with Wumei Wan, also for chronic diarrhea. Vomiting roundworms describes the norm; vomiting and irritability without roundworms reflects Wind-Moon movement, analogous to roundworm cases. *Jingui Yaolue* states: Abdominal pain with sinking-string pulse suggests roundworms. Now, if the pulse is surging-large, roundworms are present. Roundworm disease causes salivation and heart pain, occurring intermittently. If toxic drugs fail, Gancao Fenmi Tang (Licorice, Flour, and Honey Decoction) is used. Abdominal pain pulses are often hidden (Yang constrained internally) or string-like (pathogens entering center). Surging-large pulse indicates roundworm movement and Qi Jue. Salivation is clear water; heart pain is biting pain moving up and down. Roundworms satiated are quiet, pain stops; hungry, pain recurs. Sections 10-11 state Jueyin relies on Shaoyang and Shaoyin pivot transformation. Failure of pivot leads to blood in stool via Yin collaterals or cold binding in Bladder Guanyuan. In Jueyin Shanghan, slight Heat and mild Jue, cold fingertips, silent lack of appetite, irritability, clear urine after several days, white-colored diarrhea (Heat removed), desire for food (recovery). If Shaoyin pivot fails, Jue and vomiting occur. If Shaoyang pivot fails, chest-hypochondriac irritability/fullness occurs, Yin-Yang reverse, unable to exit, injuring Yin collaterals, leading to bloody stools. Heat sinking causes bloody stools; Cold sinking causes cold extremities. "I do not have Jie Xiong": Chest is upper/Yang, Abdomen is lower/Yin, each following its kind. Thus, lower abdominal fullness, as Jueyin meridian passes genitalia to lower abdomen, painful on pressure, indicates cold binding in Bladder Guanyuan. Sections 12-13 state Yin-Yang victory/defeat can be verified by day count. Less Jue, more Heat: Yang excess injures Yin Blood, leading to bloody stools later, as Jueyin governs Pericardium and Blood. More Cold, less Heat: Yin excess, Yang retreat, disease progresses. Humans injured by Cold become Heat diseases; even severe Heat is not fatal, valuing Heat in Shanghan. However, insufficient Heat is pathological, and excessive Heat is also pathological. These two sections discuss Heat/Cold amounts to show neither excess nor deficiency is acceptable. Master Zhongjing views more Heat as recovery and more Jue as progression, discussing disease mechanism dynamics: Jue is Heat pathogen moving inward, Heat is Heat pathogen moving outward. Not external guest Heat, but outward is retreat, inward is progression. Thus, more Heat is a sign of pathogen retreating, not immediate cure. Even if bloody stools/pus occur, Heat forcing Ying-Yin differs in severity from deep Heat with Jue Ni.
Jueyin has untreatable death syndromes, unknown which is dangerous. After six-seven days of Shanghan, faint pulse and cold extremities: Deficient Yang above cannot descend to interact with Yin, causing irritability. True Yin below cannot ascend to interact with Yang, causing restlessness. This is Water-Fire non-interaction. Moxibustion on Jueyin should be used to generate Yang within Yin and reunite Water-Fire. If Jue does not return, Yang does not recover, Yin-Yang separates, leading to death. "Jue not returning leads to death" implies fever is the life force of Jueyin. However, there are three death syndromes associated with fever. In Shanghan fever, diarrhea should stop; if diarrhea persists despite fever, and extremities are cold while body is hot, isolated Yang escapes outward, lone Yin cannot guard, plus restlessness and inability to lie still, Yin excess repelling Yang, indicates death. In Shanghan fever with severe diarrhea and unrelenting Jue, even without restlessness/inability to lie still, indicates death. *Jingui* states: Six Fu Qi exhausted externally causes cold extremities; Five Zang Qi exhausted internally causes uncontrollable diarrhea. Exhaustion of Fu and Zang Qi leads to death. In Shanghan, no diarrhea for six-seven days, if fever, thirst, sweating, and slight diarrhea occur simultaneously, this is Yang recovery syndrome. If fever, sweating, and diarrhea occur together, it indicates True Yang Qi vacuity internally causing diarrhea, floating/scattering externally causing fever, and venting upward causing sweating, indicating death. Yang collapse has death syndromes; Yin collapse also has death syndromes. In Shanghan five-six days, injury to Blood rather than Qi means no Jie Xiong. No Jie Xiong means abdomen is soft, not hard. Blood injury causes empty pulse. Internal Blood deficiency cannot connect with Yang externally, causing recurrent cold extremities. Jue here is not due to deep Heat but Blood loss. Purgation further depletes Yin, leading to death. Fever with Jue, reaching day seven completes the six Qi cycle; returning to Taiyang should stop. Now, not only does it not stop, but diarrhea recurs. Yin excess is not yet fatal but is difficult to treat.
Chapter 5 has eight sections discussing Jue syndromes of Cold, Heat, Deficiency, and Excess. Yang excess causes Cu (surging) pulse; even with cold extremities, this is Heat Jue, avoiding fire therapy. However, extreme Yin excess may falsely present as Cu pulse with intermittent stops. Yang excess Cu pulse feels strong under heavy pressure; Yin excess Cu pulse feels weak under heavy pressure. In Shanghan, Cu pulse indicates false Yang excess; cold extremities indicate true Yin excess. Moxibustion on Jueyin and Ying-Shu points can be used to raise sunken Yang. This is Cold in Jueyin syndrome.
In Shanghan, slippery pulse with Jue indicates internal Yang constraint unable to reach exterior; exterior is cold but interior is hot, treated with Baihu Tang. Faint pulse with Jue is Cold Jue; slippery pulse with Jue is Heat Jue. Extreme Yang resembles Yin, distinguished entirely by pulse. Must have irritability, thirst craving drinks, and constipation to confirm interior Heat. Meridian circulation, Ying nourishment ceaseless. If Meridian Blood is deficient and flow is unsmooth, cold extremities and faint-almost-perishing pulse occur, treated with Danggui Sini Tang. If internal long-standing Cold exists, add Wuzhuyu and Shengjiang. Jueyin Liver stores Ying Blood responding to Wood; Gallbladder resides internally, Wind and Fire share origin. Unless Cold pathogens invade internally, silencing the one Yang generating Qi, large acrid-hot substances should not be used to disturb Wind-Fire, unlike Shaoyin (Cold Water organ) where exterior pathogens can be treated with Mahuang, Xixin, Fuzi. Thus, even with long-standing Cold, if no signs of internal Cold invasion, add Shengjiang to diffuse (not Ganjiang for warming middle); add Wuzhuyu for bitter descent (not Fuzi for assisting Fire). Treating by meridian, laws are precise and strict, worthy of study. For interior deficiency Jue, Danggui Sini Tang is used. What about Yang deficiency Jue presenting as false Heat? Profuse sweating described as dripping like water, heat...