问曰。有犯房劳而病伤寒者。责在少阴否。答曰。不然。伤寒病适当房劳后而发。仍当
责
其本病。阳经之证。仍责阳经。阴经之证。始责阴经。仲景于汗下诸法。兢兢必顾其人之津
液。虚家患伤寒。原有不从正治之例。正不必问其曾犯房劳与否。虚象果见。即非房劳。亦
不得妄施汗下。若房劳之后。而所患仍系实证。则应汗者仍当汗。应下者仍当下。邪去而正
自安。所谓阴病者。必实见有三阴证也。房劳后之伤寒。亦有阳证。不得概从阴病论治。此
说前贤久经辨正。而近日医家。犹沿其陋。我见有误补致邪壅而死者。有误温致阴竭而死者
。既死而犹归咎于房劳。惑滋甚矣。
问曰。何以识为厥阴病。答曰。厥阴之为病。其证亦错杂不一。而仲景以消渴。气上撞
心。
心中疼热。饥而不欲食。食即吐蛔。括厥阴病之提纲。盖以厥阴当两阴交盖。其脉起足大指
。循股内。入阴中。环阴器。抵少腹。贯心膈。邪入厥阴。循经上逆。致见前证。又厥者逆
也。逆则阴阳不相顺接。故又因之致厥。厥阴乃阴尽之脏。阴尽则阳生。阴阳消长。大伏危
机。此际出表则生。入里则死。故仲景以厥多热少为病进。热多厥少为病退。然邪入既深。
寒热错杂。极难辨认。喻嘉言谓厥阴篇中。有纯阳无阴之证。有纯阴无阳之证。有阴阳差多
差少之证。有阳进欲愈。阴进未愈之证。复有阴居八九。阳居一二之证。厥而发热。热深
厥深。上攻而成喉痹。下攻而便脓血。此纯阳无阴之证也。脉微细欲绝。厥冷
。灸之不温。恶寒。大汗大利。躁不得卧。与夫冷结关元。此纯阴无阳之证也。厥三日。热
亦三日。厥五日。热亦五日。手足厥冷。而邪热在胸。水热在胃。此阴阳差多差少之证也。
渴欲饮水。饥欲得食。脉滑而数。手足自温。此阳进欲愈之证也。默默不欲食。寸脉虽浮数
。尺脉自涩。呕吐涎沫。腹胀身疼。此阴进未愈之证也。下利清谷。里寒外热。呕而脉弱。
小便复利。本自寒下。复误吐下。脉沉微厥。面反戴阳。此阴居八九。阳居一二之证也。条
分缕晰。序次最为明畅。厥阴皆里证。惟发热则有远出于表之机。大约病专属里者。亟当治
其里。由表陷入者。宜挽之出表屡寒者利在急温。属热者不宜直折。予统会仲景大法如此。
神而明之。存乎其人。
问：有人因房事劳累而患伤寒病，责任在于少阴经吗？
答：不是这样。伤寒病恰好在房事劳累后发作，仍然应当追究它的本病。阳经的证候，仍归责于阳经；阴经的证候，才开始归责于阴经。张仲景在汗法、下法等治疗方法中，必定谨慎地顾护患者的津液（人体内的正常体液）。体质虚弱的人患伤寒，原本就有不按照常规正治法的先例，正不必追问他是否曾犯房劳。如果确实见到虚象，那么即使没有犯房劳，也不得妄用汗法或下法。如果是房事劳累之后，所患的仍然是实证，那么应当发汗的仍当发汗，应当攻下的仍当攻下。邪气去除而正气自然安宁。所谓“阴病”，必须真实见到三阴经（太阴、少阴、厥阴）的证候才行。房事劳累后的伤寒，也有阳经证候，不能一概从阴病来论治。这种说法前代贤人早已辨明纠正，但近日的医家，仍然沿袭这种陋习。我见过因误用补药导致邪气壅滞而死亡的，也见过因误用温药导致阴液枯竭而死亡的。既已死亡，却还归咎于房事劳累，迷惑就更深了。
问：如何识别这是厥阴病？
答：厥阴病的证候也是错杂不一的，而张仲景以消渴（口渴多饮）、气上撞心（感觉有气向上冲击心脏）、心中疼热（胃脘部疼痛且有灼热感）、饥而不欲食（感到饥饿但不想吃东西）、食即吐蛔（吃东西就吐出蛔虫），概括了厥阴病的提纲。大概因为厥阴经处于两阴交合覆盖之处，其经脉起于足大趾，沿着大腿内侧，进入阴部，环绕生殖器，抵至小腹，贯穿心和膈膜。邪气侵入厥阴，顺着经脉向上逆行，导致出现上述证候。另外，“厥”就是逆的意思，逆则阴阳之气不能顺接，所以又因此导致四肢厥冷。厥阴是阴气尽头的脏腑，阴气尽头则阳气生发，阴阳的消长变化，潜伏着巨大的危机。此时若出表则生，入里则死。所以张仲景认为厥多热少是病情进展，热多厥少是病情退却。然而邪气深入，寒热错杂，极难辨认。喻嘉言说在《伤寒论》厥阴篇中，有纯阳无阴的证候，有纯阴无阳的证候，有阴阳偏多偏少的证候，有阳气进发欲愈的证候，有阴气进发未愈的证候，还有阴占八九、阳占一二比例的证候。四肢厥冷而发热，热越深厥越深，向上攻冲而成喉痹（咽喉肿痛闭塞），向下攻冲而便脓血，这是纯阳无阴的证候。脉象微细欲绝，四肢厥冷，艾灸后不回暖，恶寒，大汗淋漓且腹泻严重，烦躁不得卧，以及冷结关元穴等，这是纯阴无阳的证候。厥冷三天，发热也三天；厥冷五天，发热也五天，手足厥冷而邪热在胸，水热在胃，这是阴阳偏多偏少的证候。口渴想喝水，饥饿想吃东西，脉象滑数，手足自温，这是阳气进发欲愈的证候。沉默不想吃东西，寸脉虽浮数，尺脉自涩，呕吐涎沫，腹胀身疼，这是阴气进发未愈的证候。下利清谷（拉出不消化的食物），里寒外热，呕吐而脉弱，小便反而通利，本来就有寒性下利，又误用吐法和下法，脉沉微厥冷，面部反而泛红如戴阳（真寒假热），这是阴占八九、阳占一二比例的证候。条理分明，次序最为明畅。厥阴病都是里证，只有发热才有向外透达的机转。大致而言，病完全属于里的，应当急治其里；由表陷入里的，宜将其挽回到表。屡受寒邪者，利于急温；属热者，不宜直接折损。我统合张仲景的大法如此。神妙而明白它，取决于个人。
Q: If a person contracts Taiyang disease (Taiyang Disease, a syndrome caused by external pathogenic factors affecting the Taiyang channel) after sexual exertion, is the responsibility attributed to Shaoyin (Shaoyin, one of the six channels, associated with the Heart and Kidney)?
A: Not so. When Taiyang disease occurs precisely after sexual exertion, one must still attribute it to its primary disease. For syndromes of the Yang channels, the responsibility remains with the Yang channels; only for syndromes of the Yin channels does the responsibility begin to lie with the Yin channels. Zhang Zhongjing, in his methods of sweating (Sweating Method, a treatment to induce perspiration to release exterior pathogens) and purging (Purging Method, a treatment to remove internal accumulation), always carefully attends to the patient's body fluids (Jinye, normal body fluids). Patients with deficiency constitutions who contract Taiyang disease have precedents for not following standard orthodox treatments. It is unnecessary to inquire whether they engaged in sexual exertion or not. If deficiency signs are indeed present, even without sexual exertion, one must not recklessly apply sweating or purging methods. However, if after sexual exertion, the contracted disease remains an excess syndrome, then those requiring sweating should be sweated, and those requiring purging should be purged. Once the pathogen is expelled, the healthy Qi (Zhengqi, vital energy) naturally becomes secure. The term "Yin disease" strictly refers to the presence of symptoms from all three Yin channels (Taiyin, Shaoyin, Jueyin). Taiyang disease contracted after sexual exertion can also present with Yang channel symptoms and should not generally be treated as a Yin disease. This view was long ago clarified and corrected by former sages, yet modern physicians still adhere to this flawed practice. I have witnessed deaths caused by erroneous tonification leading to pathogen stagnation, and deaths caused by erroneous warming leading to exhaustion of Yin fluids. After death, they still blame sexual exertion, deepening their confusion.
Q: How can one identify Jueyin disease (Jueyin Disease, a syndrome involving the Liver and Pericardium)?
A: The symptoms of Jueyin disease are complex and varied. Zhang Zhongjing summarized the guiding principles of Jueyin disease using thirst (Xiaoke, excessive thirst), sensation of Qi rushing up to strike the heart (Qi Shang Zhuang Xin), burning pain in the epigastrium (Xin Zhong Teng Re), hunger without desire to eat (Ji Er Bu Yu Shi), and vomiting roundworms immediately after eating (Shi Ji Tu Hui). This is because Jueyin represents the convergence of two Yins. Its channel originates at the big toe, runs along the inner thigh, enters the genital region, circles the genitals, reaches the lower abdomen, penetrates the heart and diaphragm. When pathogens enter Jueyin, they follow the channel upward in rebellion, causing the aforementioned symptoms. Furthermore, "Jue" means reversal/rebellion; when there is rebellion, Yin and Yang fail to connect smoothly, thus leading to cold limbs (Jue Ni, cold extremities due to failure of Yang to reach the limbs). Jueyin is the organ where Yin ends and Yang begins. At the end of Yin, Yang arises. The waxing and waning of Yin and Yang harbor great danger. At this juncture, emergence to the exterior leads to life, while sinking into the interior leads to death. Therefore, Zhang Zhongjing considers more Jue than heat as disease progression, and more heat than Jue as disease regression. However, since the pathogen has entered deeply, with mixed cold and heat, it is extremely difficult to distinguish. Yu Jiayan stated that in the Jueyin chapter, there are syndromes of pure Yang without Yin, pure Yin without Yang, syndromes with slight differences in Yin and Yang, syndromes where Yang advances indicating recovery, syndromes where Yin advances indicating non-recovery, and syndromes where Yin occupies eight or nine parts and Yang only one or two. Cold limbs with fever, deeper heat leading to deeper cold limbs, attacking upward to cause throat obstruction (Hou Bi, sore throat/swelling), and attacking downward to cause pus and blood in stool, these are syndromes of pure Yang without Yin. A faint, thin pulse nearly imperceptible, cold limbs, lack of warmth after moxibustion, aversion to cold, profuse sweating and severe diarrhea, restlessness unable to lie down, and cold binding at Guanyuan (Guanyuan, CV4 acupoint), these are syndromes of pure Yin without Yang. Three days of Jue accompanied by three days of heat, five days of Jue accompanied by five days of heat, cold limbs with pathogenic heat in the chest and water-heat in the stomach, these are syndromes with differential amounts of Yin and Yang. Thirst desiring water, hunger desiring food, slippery and rapid pulse, warm hands and feet spontaneously, these are syndromes where Yang advances indicating recovery. Silence and lack of desire to eat, floating and rapid pulse at the Cun position but choppy pulse at the Chi position, vomiting saliva and froth, abdominal distension and body pain, these are syndromes where Yin advances indicating non-recovery. Diarrhea with undigested food, interior cold with exterior heat, vomiting with weak pulse, free urination, pre-existing cold-type diarrhea further mistreated with emesis and purging, deep and faint pulse with cold limbs, facial flushing resembling Dai Yang (Dai Yang, false heat sign with red face), these are syndromes where Yin occupies eight or nine parts and Yang one or two. These are clearly categorized and ordered most logically. Jueyin diseases are all interior syndromes, except for fever which indicates a potential shift toward the exterior. Generally, if the disease belongs exclusively to the interior, treat the interior urgently; if it sank from the exterior, attempt to draw it back to the exterior. For repeated cold invasions, urgent warming is beneficial; for heat syndromes, direct suppression is inappropriate. I have synthesized Zhang Zhongjing's major principles as follows. Understanding them profoundly depends on the individual practitioner.