若其人内有久寒者。宜当归四逆。加吴茱萸生姜汤主之。
上二条皆真寒证。（正文与注并汤见中寒论中。）
大汗出。热不去内拘急四肢疼。又下利厥逆而恶寒者。四逆汤主之。
大汗若大下利而厥冷者。四逆汤主之。上二条皆真寒证。（系误发其汗而亡阳者。正文与注并汤。俱见中寒论中）
病患手足厥冷。脉乍紧者。邪结在胸中。心下满而烦。饥不能食者。病在胸中。当须吐之。宜瓜蒂散。（此条证。乃
厥阴病用吐之法也。病患者。厥阴病之人也。言病则气上撞心痛之义。已该其中。厥冷而但云手足。乃厥之微者也。厥
则阳邪内陷。脉不当紧。今则脉乍紧者。知邪气仅结于胸。未入于胃。邪结。故脉紧也。邪在胸中。故心下满而烦。胃
无邪。故饥。不能食者。胸邪窒塞。于食有碍。故虽饥而不能食也。仲景法。邪在胸中者。宜吐之故与瓜蒂散。以吐胸
中之邪。瓜蒂散方已见前第五卷太阳下编。）
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。（此条乃厥阴病热。消渴以
后之变证也。成注引金匮云。水停心下则悸。兹则厥而心下悸者。明系消渴。饮水多。寒饮留于心下。胸中之阳。不能
四布。故见厥。此非外来之寒比也。故仲景之法。宜先治水。须与茯苓甘草汤。而治厥之法。却在其中。盖水去。则厥
自除也。不尔者。谓不治其水也。不治其水。水渍而下入于胃。必作湿热利也。诸家注。皆以阴寒为厥。谓仲景另有治
厥法。误矣。至补亡论郭白云以四逆汤治厥。大误之极。茯苓甘草汤。见前第四卷太阳篇中。或问曰吾子既云。厥阴病
热。消渴。饮水多。水停心下而厥。则是心下者。即胃脘之分也。仲景又云。不尔水渍入胃。若是乎寒挟水湿。又从外
而入。岂消渴所饮之水。不在胃以内邪。余曰不然。仲景言胃中者。即肠中也。据阳明篇云云。胃中有燥屎五六枚。则
此胃中者。非肠中邪若然。则是仲景言心下者。果系胃脘。言入胃者。即胃以下而接于肠中也。水停心下。浸渍而下入
于肠。故作利也。或又问茯苓甘草汤。仲景用以治太阳府有停水。兼主经中风邪未尽之药。与上证若不相涉。何为而借
用之也。余答云。仲景法。有一方而治两经之证者。茯苓甘草汤。兼治厥而心下悸。实防水渍入胃之药。胃土也。补土
所以胜水。故用茯苓甘草。又生姜辛温。亦能助胃。桂枝虽走太阳之药。其辛温之性。亦能借以助胃而散水。又胃。阳
也。水阴也。胃有积水。则阳气不能四布。姜桂之性。用以行胃阳。而外达于四肢之间。却治厥也。譬之热证多服寒药。
当以辛热之味纵。治同一理耳。）
伤寒六七日。大下后寸脉沉而迟。手足厥逆下部脉不至。咽喉不利。唾脓血。泄利不止者。为难治麻黄升麻汤主之。
（此条病系热厥下后之危证。成注云。伤寒六七日。邪传厥阴之时。大下后寸脉沉而迟者。肺脾阳气下陷也。下部脉不
至。则肝家之阴。亦复衰竭。阴阳不相顺接。以故手足为之厥逆也。厥阴之脉贯膈。上注肺。循喉咙之后。下后。因亡
津液。遂成肺痿。咽喉不利而唾脓血也。成注引金匮云。肺痿之病从何得之。被快药下利。重亡津液。故得之复泄利不
止者。阳气下陷于阴分。阴气衰竭。故难治也。与麻黄升麻汤。用以升阳和阴。润肺补脾调肝。而成万一之功耳。）
如果患者体内有久积的寒邪，适宜使用当归四逆加吴茱萸生姜汤来主治。
以上两条都是真寒证。（正文与注解以及方剂见《中寒论》中。）
大汗出后，发热不退，体内拘急疼痛，四肢疼痛，又出现下利、四肢厥冷且恶寒的症状，应当用四逆汤主治。
大汗出或者严重下利导致四肢厥冷的，应当用四逆汤主治。以上两条都是真寒证。（这是由于误用发汗法导致阳气亡失的情况。正文与注解以及方剂，都见于《中寒论》中。）
病患手足厥冷，脉搏突然变得紧实，这是邪气结聚在胸中。胃脘部胀满且心烦，感到饥饿却无法进食，说明病位在胸中，应当采用吐法治疗，适宜使用瓜蒂散。（这一条证候，是厥阴病使用吐法的情况。所谓病患者，即患有厥阴病的病人。说“病”字，已经包含了气上撞心、心痛的含义。只说手足厥冷，而没说全身厥冷，说明厥逆程度较轻。厥逆意味着阳邪内陷，脉搏本不应紧，如今脉搏突然变紧，可知邪气仅结聚于胸中，未进入胃腑。因为邪气结聚，所以脉紧。邪气在胸中，所以胃脘部胀满且心烦。胃中没有邪气，所以有饥饿感；不能进食，是因为胸中邪气阻滞，妨碍食物摄入，所以虽然饥饿却无法进食。张仲景的法则是：邪气在胸中的，适宜用吐法，所以给予瓜蒂散，以吐出胸中的邪气。瓜蒂散的方剂已在前面第五卷太阳篇下编中见过。）
伤寒出现厥逆且胃脘部悸动的，适宜先治疗水饮，应当服用茯苓甘草汤，然后再治疗厥逆。如果不这样处理，水气浸渍进入胃中，必然会导致下利。（这一条是厥阴病热证，消渴之后出现的变证。成无己注引用《金匮要略》说：水饮停聚在心下则会导致心悸。这里出现厥逆且心下悸动，明确是由于消渴症饮水过多，寒饮留滞于心下，胸中的阳气不能布散到四肢，所以出现厥逆。这不是外来的寒邪可比拟的。所以张仲景的法则是：适宜先治疗水饮，给予茯苓甘草汤，而治疗厥逆的方法也包含在其中。因为水饮去除，厥逆自然消除。所谓“不尔”，是指不治疗水饮。如果不治疗水饮，水气浸渍向下进入胃中，必然会导致湿热性质的下利。各家注解，都把厥逆归因于阴寒，认为张仲景另有治厥的方法，这是错误的。至于《补亡论》中郭白云用四逆汤治疗厥逆，更是错误到了极点。茯苓甘草汤，见前面第四卷太阳篇中。有人问：您既然说厥阴病热，消渴，饮水多，水停心下导致厥逆，那么心下就是胃脘的部位。张仲景又说，如果不这样，水气浸渍进入胃中。如果是这样，寒邪挟带水湿又从外部进入，难道消渴所饮入的水不在胃里面吗？我回答说：不是这样的。张仲景所说的“胃中”，实际上是指肠中。根据阳明篇的内容，如“胃中有燥屎五六枚”，那么这里的“胃中”指的就是肠中的邪气。既然如此，那么张仲景说的“心下”，确实是胃脘部位；说的“入胃”，就是指从胃以下连接到肠道的部分。水饮停聚在心下，浸渍向下进入肠道，所以导致下利。又有人问：茯苓甘草汤，张仲景原本用来治疗太阳腑证有水饮停聚，兼主经中风邪未尽的药物，与上述证候似乎不相干涉，为什么借用它呢？我回答：张仲景的法度中，有一方可以治疗两经证候的情况。茯苓甘草汤，兼治厥逆且心下悸动，实际上是防止水气浸渍进入胃中的药物。胃属土，培补脾胃土气所以能胜水，所以使用茯苓和甘草。另外生姜辛温，也能助益胃气。桂枝虽然是走太阳经的药物，但其辛温的性质，也能借以助益胃气并消散水饮。还有，胃属阳，水属阴。胃中有积水，则阳气不能布散四方，姜和桂的性味，用来运行胃阳，并向外通达于四肢之间，从而治疗厥逆。这就好比热证多服寒药，应当用辛热的味道来疏导，治疗的道理是相同的。）
伤寒六七天，经过严重的攻下治疗后，寸脉沉而迟，手足厥冷，下部脉摸不到，咽喉不利，唾吐脓血，泄利不止的，属于难治之证，应当用麻黄升麻汤主治。（这一条病证属于热厥经过攻下后的危重证候。成无己注说：伤寒六七天，是邪气传入厥阴的时候。经过严重攻下后，寸脉沉而迟，是肺脾阳气下陷的表现。下部脉摸不到，说明肝家的阴气也衰竭了。阴阳之气不能顺接，因此手足出现厥逆。厥阴经脉贯穿膈肌，向上注入肺脏，沿着喉咙后面下行。攻下之后，因为津液亡失，遂形成肺痿，导致咽喉不利且唾吐脓血。成无己引用《金匮要略》说：肺痿的病是怎么得的？被峻下药过度利下，再次亡失津液，所以得此病。再加上泄利不止，阳气下陷于阴分，阴气衰竭，所以难治。给予麻黄升麻汤，用以升发阳气、调和阴气、润肺、补脾、调肝，从而达成万一的治疗效果。）
If the patient has chronic cold accumulated internally, Danggui Sini Jia Wuzhuyu Shengjiang Tang (Astragalus and Cinnamon Twig Decoction plus Evodia and Fresh Ginger) is appropriate for treatment.
The above two clauses both describe true cold syndromes. (The main text, annotations, and prescriptions are found in *Zhonghan Lun* [Treatise on Cold Damage].)
After profuse sweating, if the fever does not subside, there is internal tension and pain, pain in the four limbs, accompanied by diarrhea, cold extremities, and aversion to cold, Sini Tang (Counterflow Decoction) should be used for treatment.
In cases of profuse sweating or severe diarrhea leading to cold extremities, Sini Tang (Counterflow Decoction) should be used for treatment. The above two clauses both describe true cold syndromes. (These result from the mistaken use of diaphoresis leading to the loss of Yang Qi. The main text, annotations, and prescriptions are all found in *Zhonghan Lun* [Treatise on Cold Damage].)
When a patient presents with cold extremities and a pulse that suddenly becomes tight, this indicates pathogenic factors knotting in the chest. If there is fullness and irritability below the heart, hunger but inability to eat, the disease is located in the chest. Emetic therapy should be employed, and Gouti San (Melon Seed Powder) is appropriate. (This clause describes the use of emetic therapy for Jueyin disease. "Patient" refers to one suffering from Jueyin disease. The term "disease" implies the sensation of Qi rushing upward causing heart pain. Mentioning only cold extremities rather than general coldness indicates a mild degree of Jue (cold reversal). Jue implies the internal entrapment of Yang pathogens; the pulse should not be tight. The sudden tightness of the pulse indicates that pathogenic factors are merely knotted in the chest and have not entered the Stomach. Due to the knotting of pathogens, the pulse is tight. Because pathogens are in the chest, there is fullness and irritability below the heart. Since there are no pathogens in the Stomach, hunger is felt. The inability to eat is due to obstruction in the chest hindering food intake; thus, although hungry, one cannot eat. Zhang Zhongjing's principle states: when pathogens are in the chest, emesis is appropriate. Therefore, Gouti San (Melon Seed Powder) is given to expel pathogens from the chest. The prescription for Gouti San (Melon Seed Powder) was previously seen in Volume 5, Taiyang Chapter, Lower Section.)
In Cold Damage presenting with Jue (cold reversal) and palpitations below the heart, water retention should be treated first. Fuling Jiangzhi Tang (Poria, Ginger, and Cinnamon Twig Decoction) should be administered, followed by treatment for Jue (cold reversal). Otherwise, if water infiltrates into the Stomach, it will inevitably cause diarrhea. (This clause describes a complication following heat syndrome in Jueyin disease and polydipsia. Cheng Wuji's annotation cites *Jin Gui Yao Lue*: Water stagnating below the heart causes palpitations. Here, Jue (cold reversal) with palpitations below the heart clearly results from excessive drinking due to polydipsia, leaving cold-fluid retention below the heart. The Yang Qi in the chest cannot circulate to the four limbs, resulting in Jue (cold reversal). This is not comparable to external cold. Thus, Zhang Zhongjing's method dictates treating the water first with Fuling Jiangzhi Tang (Poria, Ginger, and Cinnamon Twig Decoction), while the method for treating Jue (cold reversal) is contained within this approach. Once the water is removed, Jue (cold reversal) resolves naturally. "Otherwise" means failing to treat the water. If the water is not treated, it infiltrates downward into the Stomach, inevitably causing damp-heat diarrhea. Various commentators attribute Jue (cold reversal) to Yin cold, claiming Zhang Zhongjing has another method for treating Jue (cold reversal); this is erroneous. Guo Baiyun in *Bu Wang Lun* using Sini Tang (Counterflow Decoction) for Jue (cold reversal) is extremely mistaken. Fuling Jiangzhi Tang (Poria, Ginger, and Cinnamon Twig Decoction) is found in Volume 4, Taiyang Chapter. A question arises: You stated that Jueyin heat, polydipsia, excessive drinking, and water stagnation below the heart cause Jue (cold reversal). Thus, "below the heart" refers to the epigastrium. Zhang Zhongjing also says, "Otherwise, water infiltrates into the Stomach." If so, cold carries dampness entering from outside, but isn't the water drunk during polydipsia already inside the Stomach? I reply: No. When Zhang Zhongjing says "Stomach," he actually means the Intestines. According to the Yangming chapter, e.g., "five or six dry fecal masses in the Stomach," here "Stomach" refers to intestinal pathogens. Therefore, "below the heart" indeed refers to the epigastrium, while "entering the Stomach" refers to moving from the Stomach down to connect with the Intestines. Water stagnating below the heart infiltrates downward into the Intestines, causing diarrhea. Another question: Fuling Jiangzhi Tang (Poria, Ginger, and Cinnamon Twig Decoction) is originally used by Zhang Zhongjing for Taiyang Fu syndrome with water retention and residual Wind-Cold in the channels. How does it relate to the above syndrome, and why is it borrowed? I answer: Zhang Zhongjing's methodology includes formulas treating diseases of two meridians. Fuling Jiangzhi Tang (Poria, Ginger, and Cinnamon Twig Decoction) treats Jue (cold reversal) with palpitations below the heart and serves to prevent water infiltration into the Stomach. The Stomach belongs to Earth; tonifying Earth controls Water, hence Poria and Licorice are used. Ginger is acrid and warm, assisting Stomach Qi. Cinnamon Twig, though acting on the Taiyang channel, has an acrid-warm nature that assists Stomach Qi and dissipates water. Furthermore, the Stomach is Yang, and water is Yin. Water accumulation in the Stomach prevents Yang Qi from circulating. The properties of Ginger and Cinnamon Twig move Stomach Yang outward to the four limbs, thereby treating Jue (cold reversal). This is analogous to treating heat syndromes caused by excessive cold medicine with acrid-warm flavors to promote circulation; the therapeutic principle is the same.)
After seven or six days of Cold Damage, following severe purgation, if the Cun (inch) pulse is deep and slow, extremities are cold, the Chi (cubit) pulse is imperceptible, there is throat obstruction, expectoration of pus and blood, and unceasing diarrhea, this is difficult to treat. Mahuang Shengma Tang (Ephedra and Ma Huang Shen Decoction) should be used. (This clause describes a critical condition of Heat Jue (cold reversal) after purgation. Cheng Wuji notes: After seven or six days of Cold Damage, pathogens transmit to Jueyin. Severe purgation leads to a deep and slow Cun (inch) pulse, indicating sinking of Lung and Spleen Yang Qi. An imperceptible Chi (cubit) pulse indicates exhaustion of Liver Yin. The failure of Yin and Yang to connect smoothly results in cold extremities. The Jueyin meridian passes through the diaphragm, ascends to the Lung, and follows the back of the throat. Post-purgation, fluid depletion leads to Lung萎 (Lung Flaccidity), causing throat obstruction and expectoration of pus and blood. Cheng Wuji cites *Jin Gui Yao Lue*: How is Lung Flaccidity acquired? It results from harsh purgatives causing excessive fluid loss. With unceasing diarrhea, Yang Qi sinks into the Yin aspect, and Yin Qi exhausts, making it difficult to treat. Mahuang Shengma Tang (Ephedra and Ma Huang Shen Decoction) is given to raise Yang, harmonize Yin, moisten the Lung, tonify the Spleen, and regulate the Liver, achieving a slight curative effect.)