厥阴中风。脉微浮为欲愈。不浮为未愈。
厥阴虽属至阴。然亦自有经。若为寒邪中伤。则为厥阴伤寒。风邪中之。则为厥阴中风。然入里者多。在表者少。
况邪入阴经。脉多沉迟细紧。故其邪不易出表。若得微浮。为邪气向外。仍归太阳而欲解矣。所以下文有解表用
桂枝汤者。盖脉微则为无力。浮则又为在表。微则轻细和缓而知其邪气已衰。浮则邪气还表而知其邪气将散。故为欲愈
也。若脉不浮。则邪未出表。故为未愈。
厥阴病。欲饮水者。少少与之愈。
邪在厥阴。唯恐其下利厥逆。乃为恶候。若欲饮水。是阳回气暖。胃中燥热而渴。已复归阳明矣。若热
气有余。则又有口伤烂赤。咽喉不利吐脓血之变。故可少少与之。令阴阳和平则愈也。
厥阴病。欲解时。从丑至卯上。
厥阴肝脏。乃含生土中。尚未透地之木。自子而一阳初生。木之萌芽未长。故不可言木。丑为二阳。则阳气已
长。草木之根 。已勾萌于阴土之中。至寅而三阳将及透地。阳气已旺。萌芽茁长。将出未出之时也。卯则阳气
已出。草木发生。正厥阴木旺之时。邪气至此而解矣。故曰从丑至卯上。
诸四逆厥者。不可下之。虚家亦然。
素问阴阳应象论云。清阳实四肢。阳明脉解云。四肢为诸阳之本。阳盛则四肢实。邪入阴经。则阳衰阴盛。
阳气不能充实于四肢。故四逆而厥冷。厥逆则阳气已微。急当以温经复阳为治。若以苦寒攻下。胃阳必败绝矣。
故曰不可下之。然不但诸四逆厥者不可下。即气血已虚。胃气不固。元阳衰弱者亦然也。世俗但知汗多亡阳。下多
亡阴。不知误下之亡阳尤甚也。所以太阳误下。每致胃阳虚损而成结痞。及协热下利诸证也。
辨误 尚论云。厥阴证。仲景总不欲下。无非欲邪还于表而阴从阳解也。愚窃谓三阴皆不可下。以阳气
已虚。不可更下故也。惟上文脉微浮者为还表。其余攻下之证。亦是邪气复还阳明。而成胃实之证。乃还阳。
非还表也。
凡厥者。阴阳气不相顺接。便为厥。厥者。手足逆冷者是也。
人身之阴阳。六经相为表里。营卫周贯一身。素问阴阳离合论云。少阴之上。名曰太阳。太阴之前。
名曰阳明。厥阴之表。名曰少阳。此即阴阳表里而为一合也。灵枢营卫生会篇云。人受气于谷。谷入于胃。
以传于肺。五脏六腑。皆以受气。其清者为营。浊者为卫。营在脉中。卫在脉外。营周不休。五十度而复
大会。阴阳相贯。如环无端。卫气行于阴二十五度。行于阳二十五度。分为昼夜。日入阳尽而阴受气。
平旦阴尽而阳受气。如是无已。故无病也。阴阳之气不相顺接者。二气偏盛偏虚。不相接续。故为厥。
然阳气虚。则为寒厥。阴气虚。则为热厥。故厥论云。气因于中。阳气衰。不能渗营其经络。阳气损。
阴气独在。故手足寒也。厥逆之义。见四逆散注中。
伤寒一二日至四五日。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。
此论热厥之见证。及误治之变也。一二日至四五日。言或一二日即厥。或至四五日而厥也。厥者必发热。
言邪入厥阴之经而手足厥者。厥后必发热。非若寒厥之但厥不发热也。前热者后必厥。若邪入阳经。则但发
热而不厥矣。此因邪入阴经。故虽先发热者。后亦必厥也。素问阴阳应象论云。寒极生热。热极生寒也。厥深
热深。厥微热微者。言厥冷之甚者。则发热亦甚。为证之重。厥冷之微者。则其发热亦微。为邪之轻。即至
真要大论所谓气之胜复也。岐伯曰。
胜有微甚。复有多少。此之谓也。谓之热厥者。邪气在里。阻绝阳气。不得通达流注于四肢而厥也。
与阳虚之厥冷迥异。故应下之。使热邪下泄。则阳气流通矣。然非谓厥深热深而可峻攻大下也。即下
文下利而谵语者。亦不过以小承气汤和胃而已。以其终是阴经郁热之邪。故不可大下也。前所谓诸四
逆厥者不可下。皆指阳虚之厥而言也。所以下文即云虚家亦然。盖逆厥与虚家并论。则知虚寒者不可下。
热深者为可下也。以应下之热厥而不下。反以辛温升发之药发其汗。则必助胃家之郁热而变生矣。
然胃开窍于口。热气不得下泄而上炎。故必口伤赤烂也。
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。已热五日。故知自愈。
此申上文厥者必热。热者必厥之义。言天地间阴阳对待。寒暑两停。昼夜相半。然后二气均平。
而无阴阳之患。故寒邪之入厥阴也。因寒胜而厥。其手足厥逆者五日。寒邪既胜。阳气必复。故其发热
亦五日。设五日之后。至第六日。寒气又当厥矣。若不厥者。其病自愈。何也。以其厥逆之时。自始
至终。不过五日。以其发热亦是五日。阴阳胜复之气已平。故知自愈。
伤寒发热四日。厥反三日。复热四日。厥少热多。其病当愈。四日至七日。热不除者。必便脓血。
此条较前热多于厥。为阳胜于阴。乃寒邪退而阳气已回。故其病当愈。自复热四日之后。至七日
而热犹不除。是阳气太过。亢而为害。热蓄于里。必伤阴血。腐变而便脓血矣。
伤寒厥四日。热反三日。复厥五日。其病为进。寒多热少。阳气退。故为进也。
此言厥多于热。为阴胜于阳。乃寒邪盛而阳气衰。人以阳气为生。阳衰则病。阳尽则死。故寒多
热少。为阳气退而其
病为进也。
伤寒热少厥微。指头寒。默默不欲食。烦躁数日。小便利。色白者。此热除也。欲得食。其病为愈。
若厥而呕。胸胁烦满者。其后必便血。
此申上文厥微热亦微之义也。指头寒。亦阳气不充于四末也。言其为厥也甚微。不至四肢厥逆。但
指头寒也。默默不欲食。阴静而阖也。盖阳气用则能言能食。如阳明热盛而狂言谵语。中风则能食。中寒即
不能食。乃厥阴之本证。少阳之兼证也。然两经皆有此证者。以厥阴之脉。挟胃属肝络胆。上贯膈。布胁肋。
循喉咙。与少阳之经脉。行度相同而为表里。所谓肝胆脏腑相连也。以指头寒之微厥。阴邪在里。故默默不言。
且不饮食也。烦躁者。热邪亦在里也。热虽少而不得发越。故烦躁也。烦躁数日而小便利。色白者。以热邪本少。
久则自解。故为热除也。欲得食者。热气已除。阴邪亦解。阴阳平而胃气和。故其病为愈。若厥而呕。则厥之
微者。变而为厥之甚。其厥已深。故阴气上逆而呕也。且呕而胸胁烦满。为少阳之本证。热邪内郁而烦满。则
其热亦深。故其后必伤阴而为便血也。
伤寒先厥后发热而利者。必自止。见厥复利。
此亦申上文厥者必发热。发热者必厥也。言寒邪入厥阴。先见四肢厥冷。则寒邪在里。非惟阳气不能
充于四肢而厥。且胃寒而津液不守。阴寒下注。则为下利矣。至厥后发热。则阳回气暖。脾胃营运。其利必自止。
若热后复见厥冷。则又复利矣。所以阴经受邪。必以阳回为主。故下文有云。虽发热不死也。
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。
此承上文先厥后发热。利必自止而言也。上文言见厥必复利。此言利止不复见厥。而反汗出咽中痛者。
乃后发之热太甚。郁蒸而为汗。上炎而作咽中肿痛。故曰其喉为痹。若如前厥后发热无汗出。则利必自止。
若发热而利不止者。热邪必随势下流。重伤阴分。腐化而为脓血矣。便脓血而成痢者。热已下泄。不得
上攻。故其喉不痹。
厥阴经受风邪侵袭。脉象微带浮象，是病情即将痊愈的征兆；脉象不浮，则表明尚未痊愈。
厥阴经虽然属于至阴之经，但自身也有独立的经脉。如果受到寒邪中伤，就称为厥阴伤寒；如果受到风邪侵袭，就称为厥阴中风。然而，病邪多入里，在表的较少。
况且邪气侵入阴经，脉象多表现为沉、迟、细、紧，所以邪气不容易透达出表。如果脉象出现微浮，说明邪气向外透发，仍回归太阳经而即将解除。所以下文提到解表时使用桂枝汤（Cinnamon Twig Decoction）。因为脉微表示无力，浮表示病位在表。脉微轻细和缓，可知邪气已经衰退；脉浮表示邪气还归于表，可知邪气将要消散。所以说是即将痊愈。如果脉象不浮，说明邪气未出表，所以说是尚未痊愈。
患厥阴病，想要喝水的，少量给予饮水，即可痊愈。
邪气在厥阴经，最怕出现下利和四肢逆冷，这是恶候。如果想要喝水，说明阳气回复，气温回暖，胃中燥热而口渴，病势已复归阳明经。如果热气有余，又可能出现口舌生疮溃烂、咽喉不利甚至吐脓血等变证。所以可以少量给予饮水，令阴阳平和即可痊愈。
厥阴病，欲解的时间，从丑时到卯时这段时间。
厥阴肝脏，如同含生于土中、尚未穿透地面的树木。从子时开始一阳初生，树木萌芽尚未长大，所以不能称之为木。丑时为二阳，阳气已经生长，草木的根已在阴土之中勾萌待发。到了寅时，三阳之气将及穿透地面，阳气已经旺盛，萌芽茁壮生长，正处于将出未出之时。卯时阳气已经透出，草木发生，正是厥阴木气旺盛的时候。邪气至此得以解除。所以说从丑时到卯时。
凡是出现四肢逆冷的情况，不可使用攻下法。体质虚弱的人也是如此。
《素问·阴阳应象大论》说：清阳充实于四肢。《灵枢·经脉》篇（注：原文引作阳明脉解，实指相关理论）说：四肢是诸阳之本。阳气盛则四肢充实有力。邪气侵入阴经，则阳气衰微而阴气偏盛。阳气不能充实于四肢，所以出现四肢逆冷。既然出现厥逆，说明阳气已经微弱，应当紧急采用温经复阳的方法治疗。如果使用苦寒药物攻下，胃阳必然败绝。所以说不可攻下。然而不仅凡是四肢逆冷者不可攻下，即使是气血已虚、胃气不固、元阳衰弱的人，也不可用攻下法。世俗之人只知道汗出过多亡阳，攻下过多亡阴，却不知道误用攻下导致亡阳更为严重。所以太阳病误用攻下，往往导致胃阳虚损而成结胸痞满，以及协热下利等各种证候。
辨析错误观点：尚论派说，厥阴证，张仲景总不希望使用攻下法，无非是想让邪气还归于表，使阴分随阳气而解。我私下认为，三阴经都不可攻下，因为阳气已经虚弱，不可再行攻下。只有上文提到的脉微浮，才是邪气还归于表。其余需要攻下的证候，也是邪气复还阳明，形成胃家实证的证候，这叫做还阳，而不是还表。
凡是厥证，都是阴阳之气不相顺接，就会发生厥。所谓厥，就是手足逆冷的表现。
人体的阴阳，六经互为表里，营卫之气周流贯通全身。《素问·阴阳离合论》说：少阴之上，名为太阳；太阴之前，名为阳明；厥阴之表，名为少阳。这就是阴阳表里相合为一。《灵枢·营卫生会》篇说：人受气于水谷，水谷进入胃中，传布于肺，五脏六腑都以此受气。其中清纯的部分成为营气，浑浊的部分成为卫气。营气行于脉中，卫气行于脉外。营气周流不息，运行五十周次后再次大会。阴阳之气相互贯串，如圆环般没有端点。卫气行于阴分二十五周次，行于阳分二十五周次，分为昼夜。日落时阳气尽而阴气受事，天亮时阴气尽而阳气受事。如此循环不止，所以无病。阴阳之气不相顺接，是指二气偏盛或偏虚，不能相互接续，所以发生厥证。
然而阳气虚，则为寒厥；阴气虚，则为热厥。所以《素问·厥论》说：气郁于中，阳气衰微，不能渗灌营养其经络，阳气受损，阴气独存，所以手足寒冷。厥逆的含义，见四逆散（Qu Ni San, Four Reversal Powder）注释中。
伤寒一二天到四五天，出现厥冷的一定会发热，先前发热的后来一定厥冷。厥冷严重的，内热也深重；厥冷轻微的，内热也轻微。热厥应当使用攻下法，如果反而使用发汗法，一定会出现口舌生疮溃烂。
这一段论述热厥的见证，以及误治后的变证。一二天到四五天，是说或者一二天就出现厥冷，或者到四五天才出现厥冷。出现厥冷的一定会发热，是说邪气侵入厥阴经而出现手足厥冷，厥冷之后必定发热，不像寒厥那样只厥冷而不发热。先前发热后来一定厥冷，如果邪气侵入阳经，则只发热而不厥冷。这是因为邪气侵入阴经，所以即使先前发热，后来也必定厥冷。《素问·阴阳应象大论》说：寒极生热，热极生寒。厥冷深重则内热深重，厥冷轻微则内热轻微，是说厥冷严重的，发热也严重，为证候较重；厥冷轻微的，发热也轻微，为邪气较轻。即《素问·至真要大论》所说的“气之胜复”。岐伯说：胜气有微甚，复气有多少，说的就是这个道理。称为热厥，是因为邪气在里，阻绝阳气，不得通达流注于四肢而发生厥冷。这与阳气虚弱的厥冷截然不同。所以应当使用攻下法，使热邪向下排泄，阳气就能流通了。然而并不是说厥深热深就可以峻猛攻下。即下文提到的下利且谵语的情况，也不过是用小承气汤（Xiao Cheng Qi Tang, Minor Order the Qi Decoction）调和胃气而已。因为其终究是阴经郁积的热邪，所以不可大下。前文所说的“凡四肢逆冷者不可攻下”，都是指阳气虚弱的厥冷而言。所以下文紧接着说“体质虚弱的人也是如此”。将逆厥与虚家并列讨论，就知道虚寒者不可攻下，热深者才可攻下。对于应当攻下的热厥而不攻下，反而用辛温升发的药物发汗，就会助长胃中的郁热而产生变证。然而胃开窍于口，热气不能向下排泄而上炎，所以必定出现口舌生疮溃烂。
伤寒病，厥冷五天，发热也五天。假设第六天应当再次厥冷，如果不厥冷，病就会自愈。厥冷总共不超过五天，已经发热五天，所以知道会自愈。
这一段重申上文“厥者必热，热者必厥”的道理。说天地间阴阳相对，寒暑两停，昼夜各半，然后二气均平，而没有阴阳失调的祸患。所以寒邪侵入厥阴，因寒胜而厥冷，手足逆冷五天。寒邪既已占优势，阳气必定回复，所以发热也是五天。假设五天后，到了第六天，寒气又应当导致厥冷。如果不厥冷，病就会自愈。为什么呢？因为厥冷的时间，自始至终不超过五天，发热也是五天，阴阳胜复之气已经平衡，所以知道会自愈。
伤寒发热四天，厥冷反而三天，再次发热四天。厥少热多，病应当痊愈。如果从第四天到第七天，热不退除，必定出现便脓血。
这一条比前一条热多于厥，是阳胜于阴，乃是寒邪退去而阳气已回，所以病应当痊愈。从再次发热四天后，到第七天热仍然不退除，是阳气太过，亢盛而为害。热蓄积在里，必定损伤阴血，腐化变质而便脓血。
伤寒厥冷四天，发热反而三天，再次厥冷五天。病情为进展。寒多热少，阳气退却，所以病情进展。
这一段说厥多于热，是阴胜于阳，乃是寒邪盛而阳气衰。人以阳气为生，阳衰则病，阳尽则死。所以寒多热少，是阳气退却而病情进展。
伤寒发热轻微，厥冷轻微，仅指尖寒冷，沉默不想吃东西，烦躁几天，小便通畅，颜色清白，这是热邪已除。想要吃东西，病就会痊愈。
如果出现厥冷且呕吐，胸胁烦闷胀满，其后必定便血。
这一段重申上文“厥微热亦微”的道理。指尖寒冷，也是阳气不能充养四肢末端。说其为厥冷很轻微，不至于四肢逆冷，只是指尖寒冷。沉默不想吃东西，是阴静而闭合的表现。阳气发挥作用则能言能食，如阳明热盛而狂言谵语，中风则能食，中寒则不能食，这是厥阴的本证，少阳的兼证。然而两经都有此证，是因为厥阴经脉挟胃属肝络胆，上贯膈，布胁肋，循喉咙，与少阳经脉的行度相同而互为表里，所谓肝胆脏腑相连。因为指尖寒冷的轻微厥冷，阴邪在里，所以沉默不言且不饮食。烦躁，是因为热邪也在里。热虽少但不能发散，所以烦躁。烦躁几天而小便通畅、颜色清白，是因为热邪本少，久则自行解除，所以是热邪已除。想要吃东西，是因为热气已除，阴邪也解，阴阳平和而胃气和调，所以病愈。如果出现厥冷且呕吐，则是轻微的厥冷变为严重的厥冷，其厥冷已深，所以阴气上逆而呕吐。而且呕吐伴胸胁烦满，是少阳的本证。热邪内郁而烦满，则其热也深，所以其后必定损伤阴血而便血。
伤寒先厥冷后发热而下利的，必定自行停止。见到厥冷再次出现，下利也会再次出现。
这也是重申上文“厥者必发热，发热者必厥”的道理。说寒邪侵入厥阴，先见四肢厥冷，则寒邪在里，不仅阳气不能充养四肢而厥冷，而且胃寒而津液不守，阴寒下注，就发生下利。到了厥冷后发热，则阳气回复气温回暖，脾胃运化功能恢复，下利必定自行停止。如果发热后又见厥冷，则下利又会再次出现。所以阴经受邪，必须以阳气回复为主，所以下文有说“虽然发热也不会死”。
伤寒先厥冷后发热，下利必定自行停止。如果反而出汗且咽喉疼痛，喉部会发生痹阻。发热无汗而下利必定自行停止。如果下利不止，必定便脓血。便脓血的人，喉部不会痹阻。
这一段承接上文“先厥后发热，利必自止”而言。上文说见到厥冷必定再次下利，这里说下利停止不再见厥冷，反而出汗咽喉疼痛，是后来发的热太甚，郁蒸而为汗，上炎而致咽喉肿痛，所以说喉部发生痹阻。如果像前文那样厥冷后发热而无汗出，则下利必定停止。如果发热而下利不止，热邪必定随势下行，重伤阴分，腐化而为脓血。便脓血而成痢疾，说明热邪已向下排泄，不能向上攻冲，所以喉部不会痹阻。
**Jueyin Wind-Strike. A pulse that is slightly floating indicates impending recovery; a pulse that is not floating indicates non-recovery.**
Although the Jueyin (Terminal Yin) channel belongs to the extreme Yin, it possesses its own independent meridian. If injured by Cold pathogen (Han Xie), it is termed Jueyin Cold Damage (Jueyin Shanghan); if invaded by Wind pathogen (Feng Xie), it is termed Jueyin Wind-Strike (Jueyin Zhongfeng). However, pathogens mostly enter the interior, with few remaining in the exterior.
Furthermore, when pathogens invade the Yin channels, the pulse is often deep, slow, fine, and tight, making it difficult for the pathogen to emerge to the exterior. If a slight floating sensation is obtained, it indicates the pathogen is moving outward, returning to the Taiyang (Greater Yang) channel and about to resolve. Hence, the following text mentions using Guizhi Tang (Cinnamon Twig Decoction) for resolving the exterior. A pulse that is slight indicates weakness; floating indicates the disease location is in the exterior. Slightness implies light, fine, and moderate qualities, indicating the pathogen has declined; floating implies the pathogen returns to the exterior, indicating it will dissipate. Thus, it is said to be impending recovery. If the pulse does not float, the pathogen has not exited the exterior, hence it is said to be non-recovery.
**In Jueyin disease, if the patient desires water, giving them small amounts will lead to recovery.**
When the pathogen is in the Jueyin channel, one fears diarrhea and cold reversal of the limbs, which are ominous signs. Desire for water indicates the return of Yang qi and warmth; dryness-heat in the Stomach causes thirst, and the condition has returned to the Yangming (Yang Brightness) channel. If there is excess heat, complications such as sores and ulcers in the mouth, throat obstruction, or vomiting of pus and blood may occur. Therefore, water should be given in small amounts to achieve harmony between Yin and Yang, leading to recovery.
**Jueyin disease tends to resolve from Chou hour to Mao hour.**
The Liver of Jueyin is like wood contained within the earth, not yet penetrating the surface. From Zi hour, initial Yang begins to generate; the wood sprout has not yet grown, so it cannot be called "wood." Chou hour represents two Yangs; Yang qi has grown, and the roots of grass and trees have begun to sprout within the Yin earth. By Yin hour, Three Yangs are about to penetrate the ground; Yang qi is vigorous, and the sprouts are growing robustly, at the moment of emerging but not yet fully out. At Mao hour, Yang qi has emerged, grass and trees flourish, which is precisely when Jueyin Wood qi is prosperous. Pathogens resolve at this time. Hence, it is said to resolve from Chou to Mao hours.
**For all cases of Si Ni (Four Reversals/Cold Limbs), purgation is contraindicated. This applies equally to patients with deficiency constitutions.**
*Su Wen: Yin-Yang Ying Xiang Lun* states: Clear Yang fills the four limbs. *Ling Shu: Mai Jie* states: The four limbs are the root of all Yang meridians. When Yang is abundant, the four limbs are solid. When pathogens enter Yin channels, Yang declines and Yin abounds. Yang qi cannot sufficiently fill the four limbs, resulting in cold reversal of the limbs. Since reversal indicates diminished Yang qi, treatment should urgently focus on warming the meridians and restoring Yang. If bitter-cold purgatives are used, Stomach Yang will inevitably collapse. Hence, purgation is contraindicated. Moreover, not only those with cold limbs should avoid purgation, but also those whose Qi and Blood are deficient, Stomach Qi is insecure, and Primordial Yang is weak. Laypeople only know that excessive sweating depletes Yang and excessive purgation depletes Yin, unaware that erroneous purgation depletes Yang even more severely. Thus, erroneous purgation in Taiyang disease often leads to damage of Stomach Yang, resulting in palpitations, fullness, and various syndromes like heat-collateral diarrhea.
**Clarification of Errors:** *Shang Lun* states that Zhang Zhongjing generally avoided purgation in Jueyin syndromes, intending only to return pathogens to the exterior so Yin could resolve via Yang. I privately believe that purgation is contraindicated in all three Yin channels because Yang Qi is already deficient and cannot withstand further purgation. Only the case mentioned above where the pulse is slightly floating represents the pathogen returning to the exterior. Other cases requiring purgation involve pathogens returning to Yangming, forming Stomach Excess syndromes; this is termed "returning to Yang," not "returning to the exterior."
**All cases of Jue (Reversal) occur when Yin and Yang Qi do not connect smoothly. Jue refers to cold reversal of the hands and feet.**
Yin and Yang in the human body, the six meridians are interior-exterior pairs, and Ying (Nutrient) and Wei (Defensive) Qi circulate throughout the body. *Su Wen: Yin-Yang Li He Lun* states: Above Shaoyin is named Taiyang; before Taiyin is named Yangming; the exterior of Jueyin is named Shaoyang. This is the combination of Yin-Yang and interior-exterior. *Ling Shu: Ying Wei Sheng Hui* states: Humans receive Qi from grain. Grain enters the stomach, transmits to the Lung, and nourishes the five Zang and six Fu organs. The pure part becomes Ying Qi, circulating within the vessels; the turbid part becomes Wei Qi, circulating outside the vessels. Ying Qi circulates unceasingly, meeting every fifty cycles. Yin and Yang Qi interpenetrate like a circle without end. Wei Qi travels twenty-five cycles in Yin and twenty-five in Yang, dividing day and night. Upon sunset, Yang ends and Yin receives Qi; at dawn, Yin ends and Yang receives Qi. Without interruption, there is no disease. When Yin and Yang Qi do not connect smoothly, it means the two Qi are either excessively strong or deficient and fail to接续 (connect sequentially), resulting in Jue.
However, deficiency of Yang Qi results in Cold Jue; deficiency of Yin Qi results in Heat Jue. Thus, *Jue Lun* states: Qi stagnates in the middle, Yang Qi declines, unable to nourish the meridians. With damaged Yang Qi, only Yin Qi remains, causing cold hands and feet. The meaning of Jue Ni is explained in the commentary on Si Ni San (Four Reversal Powder).
**In Cold Damage, from one-two days to four-five days, if there is Jue, there must be fever. If there was fever previously, there will be Jue subsequently. The deeper the Jue, the deeper the heat; the slighter the Jue, the slighter the heat. Jue should be treated with purgation; if sweating is induced instead, sores and ulcers in the mouth will certainly occur.**
This discusses the manifestations of Heat Jue and complications from mis-treatment. One-two to four-five days refers to Jue occurring either early or late. "If there is Jue, there must be fever" means that when pathogens enter the Jueyin channel causing cold limbs, fever will follow after Jue, unlike Cold Jue which presents with only cold limbs and no fever. "If there was fever previously, there will be Jue subsequently" means that while Yang channel pathogens cause only fever without Jue, Yin channel pathogens cause Jue even if fever preceded it. *Su Wen: Yin-Yang Ying Xiang Lun* states: Extreme cold generates heat; extreme heat generates cold. "Deeper Jue means deeper heat" means severe cold limbs correspond to severe fever, indicating a heavy syndrome; slight cold limbs correspond to slight fever, indicating mild pathogen. This corresponds to the concept of "victory and retaliation of Qi" in *Zhi Zhen Yao Da Lun*. Qibo said: Victory has degrees of severity, retaliation has quantities. This is what is meant by Heat Jue: pathogens are in the interior, obstructing Yang Qi, preventing it from flowing to the four limbs, causing Jue. This is distinctly different from Jue caused by Yang deficiency. Therefore, purgation should be used to allow heat pathogens to drain downward, allowing Yang Qi to flow freely. However, this does not mean severe Jue/heat warrants harsh purgation. As mentioned later regarding diarrhea with delirium, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is used merely to harmonize the Stomach. Since it is ultimately heat pathogens stagnant in the Yin channel, massive purgation is contraindicated. The previous statement "all cases of cold limbs should not be purged" referred specifically to Yang-deficient Jue. Hence, the text follows with "deficiency patients are also [contraindicated for purgation]." Discussing cold reversal alongside deficiency patients implies that deficiency-cold cases should not be purged, while deep-heat cases can be. Failing to purge indicated Heat Jue and instead inducing sweat with acrid-warm ascending drugs will exacerbate Stomach郁 heat and cause complications. Since the Stomach opens into the mouth, trapped heat rising upward causes sores and ulcers in the mouth.
**In Cold Damage, Jue lasts five days, fever lasts five days. If on the sixth day Jue recurs, but does not, the disease self-resolves. Jue never exceeds five days; having had five days of fever, we know it will self-resolve.**
This reiterates the principle that "Jue implies heat, heat implies Jue." It speaks of the balance of Yin and Yang in heaven and earth, equal parts of cold and heat, day and night, ensuring equilibrium and avoiding Yin-Yang imbalance. When cold pathogens enter Jueyin, cold dominance causes Jue, with cold limbs lasting five days. After cold dominance, Yang Qi must recover, so fever also lasts five days. If after five days, on the sixth day, cold should cause Jue again, but it does not, the disease resolves. Why? Because the duration of Jue from start to finish does not exceed five days, and fever is also five days. The winning and retaliating Qi of Yin and Yang has balanced, so self-resolution is known.
**Cold Damage: Fever for four days, Jue for three days, then fever for four days again. Less Jue and more heat indicates the disease should resolve. If from the fourth to seventh day, heat persists, pus and blood in stool will likely occur.**
This section describes more heat than Jue, indicating Yang surpassing Yin, cold pathogens retreating, and Yang Qi returning, so the disease should resolve. If after four days of renewed fever, by the seventh day heat persists, it indicates excessive Yang, hyperactivity causing harm. Heat accumulating in the interior damages Yin Blood, rotting and transforming into pus and blood in the stool.
**Cold Damage: Jue for four days, fever for three days, then Jue for five days again. The disease progresses. More cold and less heat indicates Yang retreat, hence progression.**
This states that more Jue than heat means Yin surpassing Yang, cold pathogens prevailing and Yang Qi declining. Humans rely on Yang Qi for life; Yang decline leads to disease, Yang exhaustion leads to death. Thus, more cold and less heat signifies Yang retreat and disease progression.
**Cold Damage: Slight heat and slight Jue, cold only at the fingertips, silence, lack of desire to eat, irritability for several days. If urination is smooth and clear white, this indicates heat removal. Desire to eat indicates recovery.**
**If there is Jue with vomiting and chest/hypochondriac fullness and irritability, blood in stool will likely occur later.**
This reiterates "slight Jue implies slight heat." Cold fingertips indicate Yang Qi failing to fill the extremities. The Jue is very slight, not extending to full limb reversal, only fingertips. Silence and anorexia reflect Yin stillness and closure. When Yang functions, one speaks and eats; e.g., Yangming excess causes delirious speech, Wind-Strike allows eating, Cold Strike prevents eating. These are primary Jueyin syndromes and secondary Shaoyang syndromes. Both meridians share these symptoms because the Jueyin meridian wraps the Stomach, connects to the Liver and Gallbladder, pierces the diaphragm, spreads over the hypochondrium, and follows the throat, sharing pathways with the Shaoyang meridian as interior-exterior pairs, reflecting the connection of Liver and Gallbladder organs. Due to slight Jue at fingertips, Yin pathogens in the interior cause silence and anorexia. Irritability indicates heat pathogens in the interior. Although heat is slight, inability to vent causes irritability. After several days of irritability, if urination is smooth and clear, it is because the slight heat naturally resolves over time, indicating heat removal. Desire to eat indicates heat removed, Yin pathogens resolved, Yin-Yang balanced, and Stomach Qi harmonized, signaling recovery. If Jue occurs with vomiting, slight Jue transforms into severe Jue, becoming deep, causing Yin Qi to rebel upward leading to vomiting. Vomiting with chest/hypochondriac fullness is a primary Shaoyang syndrome. Internal heat stagnation causing fullness indicates deep heat, which will eventually damage Yin Blood leading to hematochezia.
**Cold Damage: First Jue, then fever with diarrhea; diarrhea will surely stop. Seeing Jue again brings back diarrhea.**
This reiterates "Jue implies fever, fever implies Jue." Cold pathogens entering Jueyin first present with cold limbs, indicating pathogens in the interior. Not only does Yang fail to fill limbs causing Jue, but Stomach cold fails to secure fluids, with Yin-Cold sinking downward causing diarrhea. After Jue, fever returns, Yang recovers, warmth returns, Spleen-Stomach transport resumes, and diarrhea stops. If after fever, Jue reappears, diarrhea returns. Thus, for Yin channel pathogens, Yang recovery is paramount, hence the text says "even with fever, death is unlikely."
**Cold Damage: First Jue, then fever; diarrhea stops. If instead sweating occurs with throat pain, Bi (obstruction) of the throat ensues. Fever without sweating and diarrhea stops; if diarrhea does not stop, pus and blood in stool occur. Those with pus/blood in stool do not have throat Bi.**
This continues from "first Jue then fever, diarrhea stops." The previous text said seeing Jue brings back diarrhea; here, diarrhea stops and Jue does not recur, but sweating and throat pain occur. This is due to subsequent heat being too intense, steaming into sweat, and flaming upward causing throat swelling/pain, termed throat Bi. If, as before, Jue followed by fever without sweating, diarrhea stops. If fever accompanies persistent diarrhea, heat pathogens flow downward, severely damaging Yin, rotting into pus and blood. Pus/blood in stool (dysentery) indicates heat has drained downward and cannot attack upward, hence no throat Bi.