【纲】仲景金匮曰。阴毒之为病。面目青。身痛如被杖。咽喉痛。五日可治。七日不可治。升
麻鳖甲汤去雄黄蜀椒主之。
【目】许叔微曰。积阴感于下。则卫阳消于上。故其候四肢沉重。逆冷。腹痛。咽喉不利。或
心下胀满结硬。燥渴。虚汗不止。或时狂言。爪甲面舌青黑。六脉沉细。而一息七至。服还阳汤、
退阴散。阴毒沉困之候。六脉取之附骨方有。按之即无。一息七八至以上。甚至不可数。至此则难
治矣。宜灸脐下二三百壮。更以热药助之。手足不和缓亦不治。
朱肱曰。手足逆泠。脐腹筑痛。咽疼。呕吐下利。身如被杖。或冷汗烦渴。脉细欲绝。此名阴
毒也。阴毒之为病。初得病手足冷。背强咽痛。糜粥不下。毒瓦斯攻心。心腹痛。短气。四肢厥逆。
呕吐下利。宜服阴毒甘草汤、白术散、附子散、正阳散、肉桂散、回阳丹、返阴丹、天雄散、正元
散、退阴散。选用。大抵阴毒。本因肾气虚寒。或因冷物伤脾。外伤风寒。内既伏阴。外又感寒。
或先感外寒而内伏阴。内外皆阴。则阳气不守。遂发头疼腰重。眼睛疼。身体倦怠。四肢逆冷。额
上手背冷汗不止。或多烦渴。精神恍惚。如有所失。三二日间。或可起行。不甚觉重。脉俱沉细而
疾。尺部短小。寸口脉或大。
六脉俱浮大。或沉取之而不甚疾者。非阴症也。大抵阳毒伤寒。其脉多弦而洪数。阴毒伤寒。
其脉沉细而弦疾。不可不知也。若误服凉药。则渴转甚。躁转急。有此病者。便须急服辛热药。一
二日便安。若阴毒渐深。其候沉重。四肢逆冷。腹痛转甚。或咽喉不利。心下胀满结硬。躁渴。虚
汗不止。
阳盛则身热而无汗。阴盛则身冷而有汗。岐伯云。阳盛则身热。腠理闭。喘粗。为之俯仰。汗
不出而热。阴胜则身寒。汗出身常清。数栗而寒。寒则厥。
或时郑声。指甲面色青黑。六脉沉细而疾。一息七至以来。有此症者。速于气海及关元二穴灸
二三百壮。以手足和缓为效。仍于前诸方选而服之。内外得通。遂令阳气复而大汗解矣。阴独盛而
阳气暴绝。则为阴毒。阳独盛而阴气暴绝。则为阳毒。大凡
阴阳离绝。非大汗不能复其正气也。
若阴毒已深。病势困重。六脉附骨。取之方有。按之即无。即难治。但于脐中用葱熨法。或灼
艾三五百壮。手足不温。真不可治。如得手足温。更服前热药助之。若阴气散。阳气来。即减热药
而调治之。阳气乍复。往往烦躁。慎不可投凉药。烦躁甚者。再与返阴丹即定。当识此。勿误也。
王好古曰。考仲景书。虽有阴毒之名。然其所叙之症。不过面目青。身痛如被杖。咽喉痛而已。
并不言阴寒极甚之症。况其所治之方。亦不过升麻、甘草、鳖甲、当归而已。并不用大温大热之
药。是知仲景所谓阴毒者。非阴寒之病。乃感天地恶毒异气。入于阴经。故曰阴毒耳。后之论者。
遂以为阴寒极盛之症。称为阴毒。乃引仲景所叙面目青数语并而言之。却用附子散、正阳散等药以
治。窃谓阴寒极甚之症。固亦可名为阴毒。然非仲景所以立名之本意。观后人所叙阴毒。与仲景所
叙阴毒。自是两般。岂可混论。后人所叙阴毒。亦不过内伤冷物。或不正暴寒所中。或过服寒凉药
所变。或内外俱伤于寒而成耳。非中天地之恶毒异气也。
楼英曰。阴毒。本因肾气虚。或因欲事。或食冷物后伤风。内既伏阴。外又感寒。或先感外寒。
而后伏阴。内外皆阴。则阳气不守。遂发头痛。腰重腹痛。眼睛痛。身体倦怠而不甚热。四肢逆
冷。额上及手背冷汗不止。或多烦渴。精神恍惚。如有所失。或可起行。不甚觉重。六脉俱沉细而
疾。尺部短小。寸口或无。或六脉俱浮大。或沉取之大而不甚疾者。非阴症也。若服凉药过多则渴
转甚。躁转急。有此症者。急服还阳退阴之剂。即安。惟补虚和气而已。宜正元散、退阴散、五胜
散。阴症不宜发汗。如气盛脉大身热未瘥。用药发汗无妨。
李 曰。伤寒三阴经病深。必变为阴毒。其症四肢厥冷。吐利。不渴。静倦不卧。甚则目痛郑
声。加以头痛头汗。睛痛不欲见亮。面唇指甲青黑。手背冷汗。心下结硬。脐腹筑痛。身如被杖。
外肾冰冷。宜甘草汤、正阳散。阳气乍复。或生烦躁者。破阴丹、复阳丹。不可用凉药。
吴绶曰。或问阴毒伤寒。用附子汤冷服。何也。此盖阴极于下。阳浮于上之治法也。予曾治一
人。伤寒十余日。脉沉细。手温而足冷。大便不通。面赤。呕吐烦渴。万不能下。惟喜凉水一二口。
或西瓜一二块。食下良久复吐出。此阴寒于内。逼其浮阳。失守之火。聚于胸中。上冲咽嗌。故
为面赤呕烦也。遂用大附子一枚。以姜汁和面包煨熟。取附子去皮尖。切八片。又以人参、炮姜各
三钱。煎浸冷水中。待冷服之。即愈。内经曰。若调寒热之逆。冷热必行。则热药冷服。下嗌之后。
冷体既消。热性即发。由是病愈。近世患阴症伤寒。往往疑似参差。初便不敢用附子。直待阴极
阳竭而用之。迟矣。且夫阴症伤寒。先因欲事伏阴于内。却又着寒。内外皆阴。阴气独盛。则阳气
以衰。故脉沉而足冷也。必须急用人参、附子以益元气。温肾散寒。若舍此二味。将何以救之。许
学士论。必以真气为主。盖真气。乃人之根蒂也。若不察真气虚实。而欲攻其实。或施汗下。或用
寒凉药。攻热未愈。阴寒又生。病至危已。又方。用雄鸡血滴入无灰酒中。尽量饮之以衣被温覆取
汗。
王肯堂曰。有阴毒渐深。爪青面黑。脉七至沉细者。积阴感于下。则微阳消于上。故其候四肢
逆冷。腹痛转甚。或咽喉不利。或心下胀满结硬。躁渴。虚汗不止。或时狂言。爪甲面色青黑。
六脉沉细。一切七至。速宜灸气海关元二穴。二三百壮。以手足温暖为效。仍服五胜散、还阳散、
退阴散。有阴毒沉困之候。与前后渐染之候皆同而更加沉重。难治。有阴中伏阳者。初病四逆。脐
筑痛。身疼如被杖。盖阴症也。病虽阴症。而见阳脉。有可生之理。仍灸气海丹田百壮。手足温
温阳回。得汗而解。或问。滑沉之状。如何便有生理。予曰。仲景云。翕奄沉名曰滑。何谓也。沉
为纯阴。翕为正阳。阴阳和合。故名曰滑。古人谓脉滑。虽曰往来前后。流利旋转替替然。与数相
似。仲景三语而足也。此三字极难晓。翕。合也。言张而复合也。故曰翕为正阳。沉。言忽降而下
也。故曰。沉为正阴。方翕而合。俄降而沉。奄。为忽忽间。仲景论滑脉为谛当矣。其言皆有法。
读者难晓。宜细思之。
徐彬曰。寒邪直中阴经。久而不解。则为毒矣。故有阴毒之病。其病乃直中于肾。浸淫肝脾。寒
气凛冽。所至疼痛。面目者。肝脾之精所及也。土受寒侵。木乃乘之。故色青。寒侵肌肉。与卫气
相争。故痛如被杖。咽喉亦痛者。少阴脉上至咽。故有伏寒者。咽必痛。喉虽属阳。痛甚则气相应
也。然邪总以相传而深。深则难治。故曰。五日可治。七日不可治。药用升麻、龟甲。独去蜀椒、
雄黄。盖阴邪为毒。虽阴亦有阴躁之气。则温之无益。即攻之亦偏而鲜济。故去蜀椒之温。雄黄之
猛。而但以龟甲、当归。走肝和阴以止痛。升麻、甘草。从脾升散以化其寒。谓直折而有刚燥之患。
不若辛平而得散解之力也。
【纲】张仲景在《金匮要略》中说：阴毒这种病，症状表现为面色和目眶发青，全身疼痛如同被棍棒打过一样，咽喉疼痛。发病五天内可以治疗，七天后则难以治愈。主治方剂为升麻鳖甲汤去掉雄黄和蜀椒。
【目】许叔微说：积滞的阴寒之气感应于下部，会导致上部的卫阳之气消减。因此其候症表现为四肢沉重、逆冷（手脚冰凉），腹痛，咽喉不适。或者出现心下（胃脘部）胀满、结块坚硬，口干燥渴，虚汗不止。或者时而胡言乱语，指甲、面部和舌头发青发黑，六脉沉细，每呼吸一次脉搏跳动七次以上。服用还阳汤、退阴散。对于阴毒重症困顿的情况，六脉必须重按至骨才能触及，轻按即无；脉搏一息七八次以上，甚至无法计数，到了这种地步就难治了。适宜在脐下艾灸二三百壮，再用热性药物辅助治疗。如果手足不能恢复柔和温暖，也是不治之症。
朱肱说：手足逆冷，脐腹部像捣击一样的疼痛，咽痛，呕吐腹泻，身体疼痛如同被棍棒打过，或者冷汗、烦躁口渴，脉象细弱几乎摸不到，这叫做阴毒。阴毒这种病，刚得病时手足冰冷，背部僵硬，咽喉疼痛，连糜粥都咽不下去，毒气攻心，导致心腹疼痛，气短，四肢厥逆（手脚冰凉过肘膝），呕吐腹泻。适宜服用阴毒甘草汤、白术散、附子散、正阳散、肉桂散、回阳丹、返阴丹、天雄散、正元散、退阴散等方剂，根据情况选用。大抵阴毒，原本是因为肾气虚寒，或者因为生冷食物损伤脾胃，外部感受风寒，内部既有伏藏的阴寒，外部又感受寒邪；或者先感受外寒而后内部伏藏阴寒，内外皆属阴，那么阳气就不能固守，于是引发头痛、腰重、眼睛疼痛、身体倦怠、四肢逆冷、额头和手背冷汗不止，或者多烦躁口渴，精神恍惚，好像丢失了什么东西。两三天间，或许可以起身行走，不觉得特别沉重，脉象都是沉细而快速，尺部脉短小，寸口脉可能变大，或者六脉都浮大，或者沉取时脉象不是特别快速的，这就不是阴证了。大抵阳毒伤寒，其脉多弦而洪数；阴毒伤寒，其脉沉细而弦疾，不可不知道。如果误服凉药，那么口渴会更严重，躁动更急迫，有这种病的患者，就必须紧急服用辛热药物，一两天就能安宁。如果阴毒逐渐加深，其候症沉重，四肢逆冷，腹痛加剧，或者咽喉不利，心下胀满结硬，烦躁口渴，虚汗不止。
阳气盛则身体发热而无汗，阴气盛则身体寒冷而有汗。岐伯说：阳盛则身体发热，腠理闭塞，气喘粗重，身体俯仰不安，不出汗而发热；阴胜则身体寒冷，出汗后身体常觉清冷，频繁战栗而寒冷，寒冷则导致四肢厥逆。
或者时而出现郑声（神志不清，语言重复低微），指甲和面色青黑，六脉沉细而快速，一息七次以上，有这些症状的患者，迅速在气海穴及关元穴艾灸二三百壮，以手足变得温和舒缓为见效标准。仍然从前述诸方中选择服用。使内外通畅，从而使阳气恢复并大汗而解。如果只有阴气独盛而阳气突然断绝，就称为阴毒；只有阳气独盛而阴气突然断绝，就称为阳毒。大凡阴阳离绝，非大汗不能恢复正气。
如果阴毒已经深入，病情危重，六脉需按至骨才有的，轻按即无，这就难治了。只在脐中用葱熨法，或者艾灸三五百壮。如果手足不温，那就真的不可治了。如果得到手足温暖，再服用前述热性药物辅助。如果阴气消散，阳气来复，就减少热性药物而进行调理。阳气乍复，往往会出现烦躁，千万不可投用凉药。烦躁严重的，再给予返阴丹即可安定。应当认识这一点，不要误治。
王好古说：考证张仲景的书籍，虽然有阴毒的名称，然而他所叙述的症状，不过是面色目眶青，身体疼痛如被杖打，咽喉痛而已。并不提及阴寒极甚的症状。况且他所治疗的方剂，也不过是升麻、甘草、鳖甲、当归而已。并不使用大温大热的药物。由此可知，张仲景所说的阴毒，并非阴寒之病，而是感受天地间的恶毒异气，侵入阴经，所以叫作阴毒。后来的论述者，便认为这是阴寒极盛的症状，称之为阴毒，于是引用张仲景所叙述的面目青等几句话合并而论，却使用附子散、正阳散等药物来治疗。我私下认为，阴寒极甚的症状，固然也可以名为阴毒，但这并非张仲景立名的本意。观察后人所叙述的阴毒，与张仲景所叙述的阴毒，自然是两种不同的情况，岂可混淆讨论。后人所叙述的阴毒，也不过是内伤冷物，或者不正暴寒所中，或者过服寒凉药物所变，或者内外俱伤于寒而成罢了。并非中了天地间的恶毒异气。
楼英说：阴毒，原本是因为肾气虚弱，或者因为房事过度，或者吃冷物后感冒风邪，内部既伏藏阴寒，外部又感受寒邪；或者先感受外寒，而后内部伏藏阴寒，内外皆属阴，那么阳气就不能固守，于是引发头痛、腰重腹痛、眼睛痛、身体倦怠而不甚热、四肢逆冷、额头及手背冷汗不止，或者多烦躁口渴，精神恍惚，好像丢失了什么。或许可以起身行走，不觉得特别沉重。六脉都沉细而快速，尺部短小，寸口脉可能没有。或者六脉都浮大，或者沉取时脉大但不甚快速的，这不是阴证。如果服用凉药过多，则口渴转甚，躁动转急。有这些症状的患者，紧急服用还阳退阴的药剂，即可安宁。只是补虚和气罢了。适宜用正元散、退阴散、五胜散。阴证不宜发汗。如果气盛脉大身热未愈，用药发汗无妨。
李曰：伤寒传入三阴经，病位深，必然变为阴毒。其症状为四肢厥冷，吐利，不渴，静倦不想卧，严重时目痛、郑声，加上头痛头汗，眼睛痛不想见光亮，面唇指甲青黑，手背冷汗，心下结硬，脐腹像捣击一样的疼痛，身体疼痛如被杖打，外肾冰冷。适宜用甘草汤、正阳散。阳气乍复，如果出现烦躁的，用破阴丹、复阳丹。不可用凉药。
吴绶说：有人问，阴毒伤寒，为什么用附子汤冷服？这大概是阴极于下，阳浮于上的治疗方法。我曾经治疗一个人，患伤寒十多天，脉沉细，手温而脚冷，大便不通，面赤，呕吐烦躁口渴，万般不能进食，只喜欢凉水一二口，或者西瓜一二块，吃下去很久又吐出来。这是阴寒在内，逼迫浮阳上浮，失守之火聚于胸中，上冲咽喉，所以出现面赤呕吐烦躁。于是用大附子一枚，用姜汁和面包煨熟，取附子去皮尖，切八片，又用人参、炮姜各三钱，煎煮后浸泡在冷水中，待冷后服用，立即痊愈。《内经》说：如果要调和寒热的逆乱，冷热必须并行，所以热药冷服，药液入口之后，冷的性质既然消失，热的性质随即发作，因此病愈。近代患阴症伤寒的人，往往疑似参差，起初就不敢用附子，直到阴极阳竭时才用，就太迟了。况且阴症伤寒，先因房事使阴伏于内，却又着寒，内外皆阴，阴气独盛，则阳气衰微，所以脉沉而足冷。必须紧急用人参、附子以益元气，温肾散寒。如果舍弃这两味药，将用什么来救治呢？许学士论述，必须以真气为主。盖真气，是人的根本。如果不察真气的虚实，而想要攻其实邪，或者施以汗法下法，或者用寒凉药攻热，热未愈，阴寒又生，病势已危。另一处方，用雄鸡血滴入无灰酒中，尽量饮下，用衣被温覆取汗。
王肯堂说：有阴毒逐渐加深，爪甲青、面黑，脉象七至且沉细的，积阴感于下，则微阳消于上，所以其候症四肢逆冷，腹痛加剧，或者咽喉不利，或者心下胀满结硬，烦躁口渴，虚汗不止，或者时而胡言乱语，指甲面色青黑，六脉沉细，一息七次以上，速宜灸气海、关元二穴，二三百壮，以手足温暖为见效。仍服五胜散、还阳散、退阴散。有阴毒沉困的候症，与前后渐染的候症都相同但更加沉重，难治。有阴中伏阳的，初病四肢逆冷，脐部筑痛，身体疼痛如被杖打，这属于阴症。病虽是阴症，但出现阳脉，有可生的道理。仍灸气海、丹田百壮，手足温温阳回，得汗而解。有人问，滑脉和沉脉的状态，怎么便有生理？我说：张仲景说，翕奄沉名叫滑脉，为什么呢？沉为纯阴，翕为正阳，阴阳和合，所以名叫滑。古人说脉滑，虽然说往来前后流利旋转，与数脉相似，张仲景三句话就够了。这三个字极难理解。翕，是合的意思，说张开而后复合，所以说翕为正阳。沉，是说忽然降而下，所以说沉为正阴。方才翕而合，俄顷降而沉，奄，是忽忽之间。张仲景论滑脉是很确切的。他的话都有法度，读者难懂，应该仔细思考。
徐彬说：寒邪直中阴经，久而不解，就成为毒了。所以有阴毒的病。其病乃是直中于肾，浸淫肝脾，寒气凛冽，所到之处疼痛。面目，是肝脾之精所及的地方。土受寒侵，木乃乘之，所以色青。寒侵肌肉，与卫气相争，所以痛如被杖。咽喉也痛，是因为少阴脉上至咽，所以有伏寒者，咽必痛。喉虽属阳，痛甚则气相应。然而邪气总是通过相传而深入，深入则难治，所以说五日可治，七日不可治。药用升麻、龟甲，唯独去掉蜀椒、雄黄。因为阴邪为毒，虽然阴也有阴躁之气，那么温之无益，即攻之亦偏而鲜济，所以去掉蜀椒之温，雄黄之猛，而只用龟甲、当归，走肝和阴以止痛，升麻、甘草，从脾升散以化其寒。说是直接折损而有刚燥之患，不如辛平而得散解之力。
[Outline] Zhang Zhongjing stated in the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet): Yin Du (Yin Toxin) is a disease characterized by bluish discoloration of the face and eye sockets, generalized body pain as if beaten with a club, and sore throat. If treated within five days of onset, it is curable; if treatment is delayed until the seventh day, it becomes difficult to cure. The primary formula is Shengma Biejia Tang (Cinnamon Twig and Turtle Shell Decoction), modified by removing Xionghuang (Realgar) and Shujiao (Sichuan Pepper).
[Commentary] Xu Shuwei said: Accumulated Yin Cold pathogenic factors affecting the lower part cause the Wei Yang (Defensive Yang) in the upper part to diminish. Consequently, symptoms include heaviness and coldness of the four limbs, abdominal pain, and pharyngeal discomfort. Alternatively, there may be distension and hardness in the epigastrium (Xin Xia), dry thirst, incessant spontaneous sweating, or occasional delirious speech. The fingernails, face, and tongue may appear cyanotic and black. The six pulses are deep and fine, beating seven times per respiration or more. Treat with Huanyang Tang (Restore Yang Decoction) and Tuiyin San (Dispel Yin Powder). In cases of severe Yin Du with sinking and exhaustion, the six pulses can only be felt when pressed deeply to the bone and disappear upon light pressure. If the pulse beats seven to eight times or more per respiration, or even becomes uncountable, the prognosis is poor. Moxibustion of two to three hundred moxa cones below the umbilicus is indicated, accompanied by hot-natured herbs to assist. If the hands and feet do not recover warmth and flexibility, it is also incurable.
Zhu Gong said: Coldness of the hands and feet, pounding pain in the umbilical and abdominal region, sore throat, vomiting, and diarrhea, body pain as if beaten with a club, or cold sweat with irritability and thirst, with a thready pulse nearly imperceptible, is named Yin Du. In the initial stage of Yin Du, the hands and feet are cold, the back is stiff, the throat hurts, and even gruel cannot be swallowed. The toxin attacks the Heart, causing heart and abdominal pain, shortness of breath, and extremity coldness (Jue Ni). Vomiting and diarrhea occur. Suitable formulas include Yindu Gancao Tang (Yin Toxin Licorice Decoction), Baizhu San (Atractylodes Macrocephala Powder), Fuzi San (Aconite Powder), Zhengyang San (Correct Yang Powder), Rougui San (Cinnamon Bark Powder), Huiyang Dan (Return Yang Pill), Fanyin Dan (Reverse Yin Pill), Tianxiong San (Aconite Root Powder), Zhengyuan San (Correct Origin Powder), and Tuiyin San (Dispel Yin Powder), selected according to the condition. Generally, Yin Du originates from deficiency-cold of the Kidney Qi, or spleen injury due to cold foods, external contraction of Wind-Cold, internal latent Yin combined with external Cold invasion, or external Cold leading to internal latent Yin. When both interior and exterior are Yin, Yang Qi fails to remain secure, resulting in headache, heavy sensation in the waist, eye pain, physical fatigue, cold extremities, incessant cold sweat on the forehead and dorsum of hands, irritability and thirst, mental confusion, and a sense of loss. Within two or three days, the patient might be able to walk without feeling particularly heavy. The pulses are generally deep, fine, and rapid, with the Chi (Cun Kou) position being short and small, while the Cun (Inch) position may be large, or all six pulses floating and large. If the pulses are floating and large, or deep but not particularly rapid upon pressing, it is not a Yin syndrome. Generally, Yang Du (Yang Toxin) Shaoyang disease presents with wiry, surging, and rapid pulses; Yin Du Shaoyang disease presents with deep, fine, wiry, and rapid pulses. This must be known. If cool-natured medicines are mistakenly administered, thirst and irritability will worsen. Patients with this condition must urgently take acrid-hot medicines, and peace will return within one or two days. If Yin Du deepens, symptoms become heavier: cold extremities, worsening abdominal pain, pharyngeal obstruction, epigastric distension and hardness, irritability and thirst, and incessant cold sweat.
When Yang is excessive, the body is hot without sweat; when Yin is excessive, the body is cold with sweat. Qibo stated: Excess Yang causes body heat, closed pores, coarse breathing, restlessness, no sweat, and heat. Excess Yin causes body cold, sweating, constant chilliness, frequent shivering, coldness leading to extremity coldness, and occasionally Zheng Sheng (repetitive, low-volume speech due to mental confusion). Fingernails and complexion are cyanotic and black. Six pulses are deep, fine, and rapid, beating seven times or more per respiration. For such symptoms, quickly apply moxibustion of two to three hundred cones to Qihai (CV6) and Guanyuan (CV4) acupoints, aiming for warm and relaxed hands and feet as the sign of efficacy. Continue selecting and administering the aforementioned formulas. Once interior and exterior are unblocked, Yang Qi recovers, and resolution occurs through profuse sweating. If Yin alone is excessive and Yang Qi suddenly cuts off, it is called Yin Du; if Yang alone is excessive and Yin Qi suddenly cuts off, it is called Yang Du. Generally, when Yin and Yang separate and cut off, only profuse sweating can restore the righteous Qi.
If Yin Du has deepened significantly and the condition is critical, with six pulses only detectable at the bone level and disappearing on light pressure, it is difficult to treat. Apply the scallion-warming method to the navel, or moxibustion of three to five hundred cones. If the hands and feet remain cold, it is truly incurable. If warmth returns to the extremities, administer the aforementioned hot-natured medicines to assist. If Yin Qi dissipates and Yang Qi returns, reduce the dosage of hot medicines and regulate the condition. Upon the sudden recovery of Yang Qi, irritability often occurs; cool medicines must absolutely not be used. For severe irritability, Fanyin Dan (Reverse Yin Pill) will settle it. Recognize this point to avoid errors.
Wang Haogu stated: Examining Zhang Zhongjing’s texts, although the name "Yin Du" exists, the described symptoms are merely bluish face and eyes, body pain like being beaten, and sore throat. There is no mention of extreme Yin-Cold symptoms. Furthermore, the prescribed formulas contain only Shengma (Cimicifugae Rhizoma), Gancao (Glycyrrhizae Radix), Biejia (Testudinis Carapax et Plastrum), and Danggui (Angelicae Sinensis Radix), without using strongly warming or hot medicines. Thus, Zhang Zhongjing’s "Yin Du" refers not to an Yin-Cold disease, but to contracting evil toxic qi from heaven and earth into the Yin meridians, hence the name. Later commentators assumed it referred to extreme Yin-Cold excess, citing Zhang’s descriptions of bluish face and merging them with treatments using Fuzi San (Aconite Powder) and Zhengyang San (Correct Yang Powder). I believe that while extreme Yin-Cold can be named Yin Du, it does not align with Zhang Zhongjing’s original intent. The Yin Du described by later authors differs fundamentally from Zhang’s description. Later descriptions involve internal injury from cold food, exposure to violent cold, overconsumption of cold-cooling medicines, or simultaneous internal and external cold injury, rather than contracting evil toxic qi from heaven and earth.
Lou Ying stated: Yin Du originates from Kidney Qi deficiency, sexual excess, or wind strike after consuming cold foods. Internal latent Yin combines with external Cold invasion, or external Cold leads to internal latent Yin. When both interior and exterior are Yin, Yang Qi fails to remain secure, causing headache, heavy waist, abdominal pain, eye pain, physical fatigue without significant heat, cold extremities, incessant cold sweat on the forehead and dorsum of hands, irritability and thirst, mental confusion, and a sense of loss. The patient might walk without feeling particularly heavy. All six pulses are deep, fine, and rapid; the Chi position is short; the Cun position may be absent. Or all six pulses are floating and large, or deep and large but not rapid upon pressing—this is not a Yin syndrome. Overconsumption of cool medicines worsens thirst and irritability. Urgently administer Huanyang Tuiyin (Restore Yang and Dispel Yin) agents for relief. The principle is tonifying deficiency and harmonizing Qi. Suitable formulas include Zhengyuan San (Correct Origin Powder), Tuiyin San (Dispel Yin Powder), and Wusheng San (Five Elements Powder). Yin syndromes should not induce sweating. However, if Qi is abundant, pulses are large, and fever persists, inducing sweating with medicine is permissible.
Li stated: When Shanghan (Cold Damage) enters the Three Yin meridians, the disease is deep and inevitably transforms into Yin Du. Symptoms include cold extremities, vomiting and diarrhea, absence of thirst, lethargy and unwillingness to lie down. Severe cases present with eye pain, Zheng Sheng (repetitive speech), headache with head sweat, photophobia, cyanosis of the face, lips, and nails, cold sweat on the dorsum of hands, epigastric hardness, pounding umbilical/abdominal pain, body pain as if beaten, and cold external genitalia. Treat with Gancao Tang (Licorice Decoction) and Zhengyang San (Correct Yang Powder). If Yang Qi suddenly recovers and irritability arises, use Poyin Dan (Break Yin Pill) or Fuyang Dan (Restore Yang Pill). Do not use cool medicines.
Wu Shou stated: Someone asked why Yin Du Shanghan is treated with Fuzi Tang (Aconite Decoction) taken cold. This is a treatment method for Yin extremity at the lower part and floating Yang at the upper part. I once treated a patient with Shanghan for over ten days, presenting with deep, fine pulses, warm hands but cold feet, constipation, flushed face, vomiting, irritability, and thirst, unable to retain any intake except one or two sips of cold water or one or two pieces of watermelon. After ingestion, vomiting occurred after a long delay. This indicated internal Yin-Cold forcing floating Yang upward, with lost fire accumulating in the chest and rushing up to the throat, causing flushed face, vomiting, and irritability. I used one large Fuzi (Aconiti Lateralis Radix Praeparata), wrapped in dough with ginger juice and baked熟, removed the skin and tip, sliced into eight pieces. Then decocted Renshen (Ginseng Radix) and Paogjiang (Zingiberis Rhizoma Preparatum) each at 3 qian, soaked the mixture in cold water, and administered it cold. The patient recovered immediately. The *Neijing* states: To regulate reversed cold and heat, cold and hot must proceed together. Thus, hot medicines taken cold: after swallowing, the cold nature dissipates, and the hot nature activates, curing the disease. Modern patients with Yin syndrome Shanghan often present with ambiguous symptoms. Initially, they dare not use Aconite, waiting until Yin is extreme and Yang is exhausted before using it, which is too late. Yin syndrome Shanghan begins with latent Yin inside due to sexual activity, compounded by external cold, making both interior and exterior Yin. With Yin Qi exclusively excessive, Yang Qi declines, resulting in deep pulses and cold feet. One must urgently use Renshen (Ginseng Radix) and Fuzi (Aconiti Lateralis Radix Praeparata) to benefit Yuan Qi, warm the Kidney, and scatter Cold. Without these two herbs, how can one save the patient? Scholar Xu emphasized that Zhen Qi (True Qi) is paramount. True Qi is the root of human life. If one does not examine the deficiency or excess of True Qi, but attempts to attack excess, or applies sweating/purging methods, or uses cold-cooling medicines to attack heat, the heat may not resolve, and Yin-Cold will arise again, leading to critical illness. Another prescription involves dripping rooster blood into wine without ash, drinking it to capacity, covering with clothes and blankets to induce sweating.
Wang Kentang stated: In cases where Yin Du deepens gradually, with cyanotic nails and black face, and pulses beating seven times per respiration, deep and fine: accumulated Yin affects the lower part, causing slight Yang to diminish in the upper part. Symptoms include cold extremities, worsening abdominal pain, pharyngeal obstruction, epigastric distension and hardness, irritability and thirst, incessant cold sweat, or occasional delirium. Nails and complexion are cyanotic and black. Six pulses are deep and fine, beating seven times per respiration. Quickly moxibustion Qihai (CV6) and Guanyuan (CV4) acupoints with two to three hundred cones, aiming for warm hands and feet as efficacy. Continue administering Wusheng San (Five Elements Powder), Huanyang San (Restore Yang Powder), and Tuiyin San (Dispel Yin Powder). In cases of sinking and exhaustion of Yin Du, symptoms are similar to previous gradual stages but heavier and difficult to treat. In cases of Yang hidden within Yin, initial symptoms include cold extremities, pounding umbilical pain, and body pain as if beaten. Although it is a Yin syndrome, if Yang pulses appear, there is a possibility of survival. Moxibustion of one hundred cones to Qihai (CV6) and Dantian (CV8) warms the hands and feet, restores Yang, and resolves through sweating. Someone asked: How can sliding and deep pulse states indicate physiological potential? I replied: Zhang Zhongjing said, "Xi yan chen ming yue hua" (Xi and Yan sinking is named Hua/Sliding). Why? Chen (Deep) is pure Yin; Xi (Closing/Combining) is correct Yang. Yin and Yang harmonize, hence named Hua. Ancients described Hua pulse as flowing smoothly back and forth, resembling the Shuo (Rapid) pulse. Zhang Zhongjing explained it in three words. These three characters are hard to understand. Xi means combining; opening then closing, so Xi is correct Yang. Chen means suddenly descending, so Chen is pure Yin. Just as Xi combines, suddenly it descends to Chen. Yan means suddenly/in an instant. Zhang Zhongjing’s discussion of the Hua pulse is accurate. His words have methodology; readers find them difficult, so they should ponder carefully.
Xu Bin stated: When Cold Evil directly strikes the Yin meridians and persists unresolved, it becomes Toxin, giving rise to Yin Bing (Yin Disease). The pathogen directly invades the Kidney, infiltrating the Liver and Spleen. The Cold Qi is biting and painful wherever it goes. The face and eyes are areas where the essence of the Liver and Spleen manifests. When Earth (Spleen) is invaded by Cold, Wood (Liver) overacts, resulting in bluish color. When Cold invades muscles and contends with Wei Qi (Defensive Qi), pain resembles being beaten. The throat also hurts because the Shaoyin Meridian ascends to the throat; thus, latent Cold causes throat pain. Although the Hou (pharynx/larynx area) belongs to Yang, severe pain causes Qi resonance. However, pathogens deepen through transmission; deepening makes it difficult to treat. Hence, "curable in five days, incurable in seven." Medicines used are Shengma (Cimicifugae Rhizoma) and Guijia (Chelonis Carapax), specifically removing Shujiao (Sichuan Pepper) and Xionghuang (Realgar). Because Yin Evil as Toxin, although Yin possesses Yin-irritability, warming is ineffective, and attacking is biased and rarely successful. Therefore, Shujiao’s warmth and Xionghuang’s ferocity are removed. Instead, Guijia (Turtle Shell) and Danggui (Angelicae Sinensis Radix) are used to enter the Liver, harmonize Yin, and stop pain. Shengma (Cimicifugae Rhizoma) and Gancao (Glycyrrhizae Radix) ascend and disperse from the Spleen to transform Cold. Direct suppression risks harshness and dryness; instead, acrid-pine qualities achieve dispersion and resolution.