（并详中寒论中）
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。（此条伤寒。乃先热后厥。亦为热厥之证。热少厥微。阳气内陷之浅者也。惟厥微故但手足指头
寒。惟热少。故虽烦躁。止默默不欲食也。条辩云。厥阴之脉挟胃。故不欲食。过数日。小便色白。欲得食。此邪热除
而胃气复。其病不治而自愈矣。若厥而呕。加之胸胁烦满者。厥阴脉不但挟胃。兼贯膈布胁肋。乃厥深而热亦深也。成
注云。厥阴属肝。主血。其后数日。内热不去。迫血下行。必从大便中出也。按此条论。仲景无治法。补亡论郭白云云。
热不除而便血。可犀角地黄汤。）
病者手足厥冷。言我不结胸小腹满。按之痛者。此冷结在膀胱关元也。（此条系真寒证。正文与注见中寒论中。）
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。其后必便脓血。（此条伤寒。
先发热。后见厥。亦热厥也。厥后复热。此为真阴气复。阳邪还表。故以厥日少。热日多。为阴阳顺接。其病当愈之征。
然热不除。为阳邪过胜。成注云。内搏厥阴之血。其后必大便脓血。按此条论。仲景。无治法。补亡论常器之云。可桃
花汤。误矣。愚以仲景黄芩汤。可借用之。）
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。（此条证。与上条相反。乃真寒厥也。
正文与注详中寒论中）
伤寒六七日。脉微手足厥冷。烦躁。灸厥阴。厥不还者。死。（此条伤寒。乃中寒也。脉微厥冷。为真寒。烦躁。是
假热。灸法详中寒论中。）
伤寒发热下利。厥逆。躁不得卧者死。（此条及下条。皆厥逆死证也。伤寒发热。则不当下利而厥逆矣。今者。既发
热又利而厥。加之躁。不得卧。为阳气扰乱。阴气亦随之而绝矣。阴阳交绝。故主死也。）
伤寒发热。下利至甚。厥不止者死（此承上文而言。伤寒发热。纵未至于躁不得卧。但利而厥不止。亦是死证。成
注引金匮云。六府气绝于外者。手足寒。五脏气绝于内者。利下不禁。脏腑气绝。故主死也。）
伤寒六七日不利。便发热而利。其人汗出不止者。死有阴无阳故也。（此条乃真阳气脱之证。正文与注详中寒论中。）
伤寒五六日。不结胸。腹濡脉虚。复厥者。不可下。此为亡血。下之死。（濡上演切与软同。此条病。系邪传厥阴。
热厥中不可下之证也。伤寒五六日。邪气传里。当作里实之时。不结胸。腹濡者。邪不实也。脉虚者。血自亏也。厥阴
之脉。挟胃贯膈。使其邪果实。则其胸必结。而其腹必不濡。厥阴藏血。使其血不亏。则其脉亦不至于虚矣。兹者。胸
不结。腹又濡。脉又虚。而其人复厥冷者。不可下。此为阴血素亏。血为阴。无阴。则阳无以附。故发厥也。若误下之。
重亡其阴。必主死也。愚按此条证。本系先发热而后发厥。故云复厥。且其厥亦不甚。故云不可下也。若热深仲景应下
之矣。又按补亡论常器之云。可当归四逆汤误矣。复云。人参汤。愚意云。汤中宜更加凉药。以清补之。）
发热而厥。七日。下利者。为难治。（发热而厥。阳邪传里也。至七日。则陷内之阳。当回复于外而厥止。在里之阴
气。亦当伸而热除矣。今则不惟不止。反加下利。则阴气消亡。故为难治。成注云。邪气胜。里气虚。愚以邪气胜者。
阳邪之气胜也。里气虚者。真阴之气虚也。诸家注认以为真阳气虚。大误之极。）
伤寒脉促。手足厥逆者可灸之。（此系真寒证。故宜火灸。正文与注见中寒论中）
（重出例）伤寒脉滑而厥者。里有热也。白虎汤主之。（注已见前第六卷阳明篇中）
手足厥寒。脉细欲绝者。当归四逆汤主之。
（此条内容在《中寒论》中有详细记载。）
伤寒病表现为热象轻微而四肢厥冷，仅手指头发凉，神情沉默不想进食，烦躁不安。过了几天，如果小便通畅且颜色清白，这说明体内的热邪已经清除，患者想要进食，这是疾病即将痊愈的征兆。如果出现四肢厥冷并伴有呕吐，胸部和胁肋部烦闷胀满的情况，随后必然会出现便血。（这一条论述的是伤寒病，属于先发热后出现四肢厥冷，也是热厥证的一种。热象轻微、厥冷程度轻，说明阳气内陷的程度较浅。正因为厥冷轻微，所以只有手指头发凉；正因为热象轻微，所以虽然烦躁，但只是神情沉默不想进食。《条辩》说：厥阴经脉挟行于胃，所以患者不想进食。过了几天，小便颜色变白，想要进食，这说明邪热已除，胃气恢复，疾病不治疗也能自愈。如果出现四肢厥冷并呕吐，加上胸部和胁肋部烦闷胀满，这是因为厥阴经脉不仅挟行于胃，还贯穿膈肌散布于胁肋，说明厥逆深重而热邪也深重。成无己注解说：厥阴属肝，主司血液，此后几天，如果内热不去，逼迫血液下行，必然从大便排出。按此条经文，张仲景没有给出治疗方法，《补亡论》中郭白云说：如果热邪未除而便血，可以使用犀角地黄汤。）
病人手足厥冷，诉说心下不硬满（结胸），小腹胀满，按压时疼痛，这是寒气凝结在膀胱关元穴部位。（这一条属于真寒证，正文与注释见《中寒论》中。）
伤寒发热四天，四肢厥冷反而三天，之后又发热四天，厥冷时间短而发热时间长，病情应当痊愈。如果从第四天到第七天，发热不退，随后必然会出现脓血便。（这一条伤寒病，先发热，后出现厥冷，也属于热厥。厥冷之后再次发热，这是真阴气恢复，阳邪回归体表的表现，所以以厥冷天数少、发热天数多，作为阴阳顺接、病情将愈的征象。然而，如果发热不退，说明阳邪过盛。成无己注解说：热邪内迫厥阴之血，随后必然导致大便脓血。按此条经文，张仲景没有给出治疗方法，《补亡论》中常器之说可以使用桃花汤，这是错误的。我认为可以借用张仲景的黄芩汤。）
伤寒四肢厥冷四天，发热反而三天，之后又厥冷五天，病情为进展。因为寒多热少，阳气衰退，所以病情加重。（这一条证候与上一条相反，属于真寒厥。正文与注释详见《中寒论》中。）
伤寒六七天，脉象微弱，手足厥冷，烦躁，艾灸厥阴经穴位，如果厥冷不缓解，预后不良（死）。（这一条伤寒病，属于中寒。脉微、厥冷是真寒，烦躁是假热。灸法详见《中寒论》中。）
伤寒发热，下利，四肢厥逆，躁动不安无法躺卧者，预后不良（死）。（这一条及下一条，都是厥逆的死证。伤寒发热，本不应同时出现下利和厥逆。现在既发热又下利且厥冷，再加上躁动不安无法躺卧，这是阳气扰乱，阴气也随之断绝。阴阳交相绝离，所以主死。）
伤寒发热，下利非常严重，四肢厥冷不止者，预后不良（死）。（这是承接上文而言。伤寒发热，即使还没有达到躁动不安无法躺卧的程度，但只要下利且厥冷不止，也是死证。成无己引用《金匮要略》说：六腑之气绝于外，则手足寒冷；五脏之气绝于内，则下利不禁。脏腑之气绝离，所以主死。）
伤寒六七天原本没有下利，突然发热并且下利，其人汗出不止者，预后不良（死），这是因为有阴无阳的缘故。（这一条属于真阳气脱的证候。正文与注释详见《中寒论》中。）
伤寒五六天，没有结胸，腹部柔软，脉象虚弱，再次出现厥冷的，不可使用攻下法。这是因为亡血。误用攻下法会导致死亡。（“濡”音同“软”。这一条病证，属于邪气传入厥阴，是热厥中不可攻下的证候。伤寒五六天，邪气传里，本应是里实的时候，但没有结胸，腹部柔软，说明邪气不实。脉象虚弱，说明血液亏虚。厥阴经脉挟行于胃贯穿膈肌，如果邪气结实，那么胸部必然结滞，腹部必然不柔软。厥阴藏血，如果血液不亏虚，脉象也不会虚弱。现在胸部不结滞，腹部柔软，脉象虚弱，而且病人再次出现厥冷，不可攻下。这是因为阴血素来亏虚，血属阴，无阴则阳无所依附，所以发生厥冷。如果误用攻下法，重伤其阴，必然导致死亡。我按语认为：这一条证候，本来是先发热而后发厥，所以说“复厥”，而且其厥冷也不严重，所以说不可攻下。如果热邪深重，张仲景应该会采用攻下法。另外按《补亡论》常器之说，可以使用当归四逆汤，这也是错误的。他又说可以用人参汤，我的意见是，汤剂中应该增加凉药，以清热补益。）
发热且四肢厥冷，到了第七天，出现下利的，属于难治。（发热且厥冷，是阳邪传入体内。到了第七天，陷入体内的阳气应当回复到体表而厥冷停止，在里的阴气也应当伸展而热邪消除。现在不仅不停止，反而加重下利，说明阴气消亡，所以为难治。成无己注解说：邪气胜，里气虚。我认为邪气胜是指阳邪之气胜，里气虚是指真阴之气虚。各家注解认为是真阳气虚，这是极大的错误。）
伤寒脉象急促，手足厥逆的，可以施以艾灸。（这一条属于真寒证，所以适宜用火灸。正文与注释见《中寒论》中。）
(The content of this clause is detailed in the *Zhong Han Lun* [Treatise on Cold Damage].)
In Shaoyang disease (Cold Damage), where heat is slight and cold extremities are present, only the tips of the fingers are cold. The patient remains silent with no desire to eat and experiences irritability. After several days, if urination is smooth and the urine is clear in color, this indicates that the pathogenic heat has been eliminated. If the patient desires food, the illness will heal. However, if there are cold extremities accompanied by vomiting, and distension and fullness with irritability in the chest and hypochondrium, hematochezia (blood in stool) will inevitably follow later. (This clause discusses Cold Damage, which presents as heat followed by cold extremities, also classified as a Heat Jue syndrome. Slight heat and mild cold extremities indicate a shallow level of internal entrapment of Yang Qi. Because the cold extremities are mild, only the finger tips are cold; because the heat is slight, although there is irritability, it manifests merely as silence and anorexia. *Tiao Bian* states: The Jueyin meridian runs alongside the stomach, hence the anorexia. After several days, clear urine and desire for food indicate that pathogenic heat has cleared and Stomach Qi has recovered, leading to spontaneous healing without treatment. If cold extremities and vomiting occur, compounded by chest and hypochondriac distension and irritability, it is because the Jueyin meridian not only runs alongside the stomach but also passes through the diaphragm and spreads into the hypochondrium, indicating deep Jue and deep heat. Cheng Wuji's commentary notes: Jueyin belongs to the Liver, which governs Blood. If internal heat persists for several days, forcing blood downward, it must exit via the large intestine. Regarding this clause, Zhang Zhongjing provides no treatment method. Guo Baiyun in *Bu Wang Lun* [Supplemental Lost Discussions] states: If heat does not subside and hematochezia occurs, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) can be used.)
The patient suffers from cold extremities, complains of no epigastric hardness (Jie Xiong), lower abdominal fullness, and pain upon pressure. This indicates cold stagnation at the Bladder Guan Yuan acupoint. (This clause pertains to a True Cold syndrome; the main text and commentary are found in *Zhong Han Lun*.)
In Cold Damage, fever lasts four days, followed by three days of cold extremities, then fever returns for four days. Since the duration of cold extremities is shorter than that of fever, the illness should heal. However, if fever persists from the fourth day to the seventh day without subsiding, pus and blood in the stool will inevitably follow later. (This Cold Damage case involves initial fever followed by cold extremities, also a Heat Jue syndrome. Fever returning after cold extremities indicates the recovery of True Yin Qi and the return of Yang pathogen to the exterior. Thus, fewer days of cold extremities and more days of fever signify the smooth connection of Yin and Yang, marking impending healing. However, persistent fever indicates excessive Yang pathogen. Cheng Wuji notes: Internal pressure on Jueyin blood leads to pus and blood in the stool later. Regarding this clause, Zhang Zhongjing provides no treatment method. Chang Qizhi in *Bu Wang Lun* suggests Taohua Tang, which is incorrect. I believe Huangqin Tang from Zhang Zhongjing can be borrowed.)
In Cold Damage, cold extremities last four days, fever lasts three days, then cold extremities return for five days. The illness progresses. Due to more cold and less heat, Yang Qi recedes, hence the progression. (This syndrome is opposite to the previous clause and constitutes a True Cold Jue. The main text and commentary are detailed in *Zhong Han Lun*.)
On the sixth or seventh day of Cold Damage, with a faint pulse, cold extremities, and irritability, moxibustion on the Jueyin channel is applied. If cold extremities do not resolve, death ensues. (This Cold Damage case involves Middle Cold. Faint pulse and cold extremities indicate True Cold; irritability indicates False Heat. Moxibustion methods are detailed in *Zhong Han Lun*.)
Cold Damage with fever, diarrhea, cold extremities, and restlessness preventing lying down indicates death. (This clause and the next describe fatal Jue syndromes. In Cold Damage with fever, diarrhea and cold extremities should not coexist. Here, fever, diarrhea, cold extremities, and restlessness indicate chaotic Yang Qi and subsequent extinction of Yin Qi. The mutual extinction of Yin and Yang leads to death.)
Cold Damage with fever, severe diarrhea, and unceasing cold extremities indicates death. (This follows the previous statement. Even without extreme restlessness, persistent diarrhea and cold extremities in Cold Damage with fever constitute a fatal syndrome. Cheng Wuji cites *Jin Gui Yao Lue*: Six Fu organs failing externally cause cold hands and feet; Five Zang organs failing internally cause uncontrollable diarrhea. Failure of both Zang and Fu Qi leads to death.)
On the sixth or seventh day of Cold Damage, if there was previously no diarrhea but suddenly fever and diarrhea appear, accompanied by incessant sweating, death ensues due to the presence of Yin without Yang. (This clause represents the collapse of True Yang Qi. The main text and commentary are detailed in *Zhong Han Lun*.)
After five or six days of Cold Damage, with no Jie Xiong, a soft abdomen, a deficient pulse, and recurring cold extremities, purgation is contraindicated. This is due to loss of Blood. Purgation will lead to death. ("Ru" sounds like "Ruan," meaning soft). This pathology involves pathogen transmission to Jueyin, representing a Heat Jue syndrome where purgation is contraindicated. At five or six days, pathogen enters the interior, typically suggesting interior excess. Absence of Jie Xiong and a soft abdomen indicate lack of pathogenic excess. A deficient pulse indicates blood deficiency. The Jueyin meridian runs alongside the stomach and through the diaphragm; if pathogen were excess, the chest would be obstructed and the abdomen hard. Jueyin stores Blood; if blood were sufficient, the pulse would not be deficient. Now, with no chest obstruction, a soft abdomen, a deficient pulse, and recurring cold extremities, purgation is forbidden. This is due to inherent Yin-Blood deficiency. Blood is Yin; without Yin, Yang has no attachment, causing Jue. Misusing purgation further depletes Yin, leading to death. My analysis: This syndrome originally involved fever preceding cold extremities, hence "recurring cold." As the cold extremities are not severe, purgation is contraindicated. If heat were deep, Zhang Zhongjing would have indicated purgation. Additionally, Chang Qizhi in *Bu Wang Lun* suggests Danggui Sini Tang, which is incorrect. He also mentions Renshen Tang; I suggest adding cooling herbs to the decoction for clearing heat and tonification.)
Fever with cold extremities persisting for seven days, accompanied by diarrhea, is difficult to treat. (Fever with cold extremities indicates Yang pathogen entering the interior. By the seventh day, trapped Yang should return to the exterior, stopping cold extremities, and interior Yin should extend, eliminating heat. Instead, diarrhea worsens, indicating exhaustion of Yin Qi, making it difficult to treat. Cheng Wuji notes: Pathogen is strong, interior Qi is weak. I interpret "Pathogen strong" as strong Yang pathogen, and "Interior Qi weak" as weak True Yin Qi. Other commentators mistakenly identify this as True Yang Qi deficiency, which is a grave error.)
In Cold Damage, with a rapid pulse and cold extremities, moxibustion may be applied. (This is a True Cold syndrome, thus suitable for fire moxibustion. Main text and commentary are found in *Zhong Han Lun*.)
(Repeated Example) In Cold Damage, a slippery pulse with cold extremities indicates interior heat, treated with Baihu Tang (White Tiger Decoction). (Commentary already appeared in Volume 6, Yangming Chapter.)
For cold hands and feet with a fine pulse nearly imperceptible, Danggui Sini Tang (Angelica Sinensis Decoction for Reversal Cold) is the primary treatment.