伤寒一二日至四五日而厥者。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。
伤寒一二日至四五日。正阴阳邪正交争互胜之时。或阴受病而厥者。势必转而为热。阴胜而阳
争之也。或阳受病而热者。甚则亦变而为厥。阳胜而阴被格也。夫阳胜而阴格者。其厥非真寒也。
阳陷于中。而阴见于外也。是以热深者厥亦深。热微者厥亦微。随热之浅深。而为厥之微甚也。
夫病在阳者宜汗。
病在里者宜下。厥者热深在里。法当下之。而反发汗。则必口伤烂赤。盖以蕴隆之热。而被升浮之
气。不从下出而从上逆故耳。
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。以热五日。故知
自愈。
伤寒厥五日。热亦五日者。阴胜而阳复之也。至六日。阴当复胜而厥。设不厥。则阴退而邪解
矣。故自愈。夫厥与热。阴阳消长之兆也。兹初病至终。其厥不过五日。而厥已而热。亦得五日。
是其复之之数。当其胜之之数。所谓有阳则复。无太过亦无不及。故知其病自愈也。
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。
伤寒厥四日。热反三日。厥复五日。其病为进。寒多热少。阳气退。故为进也。
热已而厥者。邪气自表而之里也。乃厥未已。而热之日。又多于厥之日。则邪复转而之表矣。
故病当愈。其热则除。乃四日至七日而不除者。其热必侵及营中而便脓血。所谓热气有余。必发痈
脓也。厥已而热者。阳气复而阴邪退也。乃热未已而复厥。而厥又多于热之日。则其病为进。所以
然者。寒多热少。阳气不振。则阴邪复胜也。要之热已而厥者。传经之证。虑其阳邪递深也。厥已
而热者。直中之证。虑其阳气不振也。故传经之厥热。以邪气之出入言。直中之厥热。以阴阳之胜
复言。病证则同。而其故有不同如此。学人能辨乎此。则庶几矣。
伤寒先厥后发热而利者。必自止。见厥复利。
伤寒先厥者。阴先受邪也。后热者。邪从阴而出阳也。阴受邪而利。及邪出而之阳。故利必自
止。设复厥。
则邪还入而之阴。故必复利。盖邪气在阳则生热。在阴则为厥与利。自然之道也。
伤寒始发热六日。厥反九日而利。凡厥利者。当不能食。今反能食者。恐为除中。食以索饼。
不发热者。知胃气尚在。必愈。恐暴热来出而复去也。后三日脉之。其热续在者。期至旦日夜半愈
。所以然者。本发热六日。厥反九日。复发热三日。并前六日。亦为九日。与厥相应。故期至旦
日夜半愈。后三日脉之。而脉数。其热不罢者。此为热气有余。必发痈脓也。
伤寒始发热六日。厥反九日而又下利者。邪气从阳之阴。而盛于阴也。阴盛则当不能食。而反
能食者。恐为除中。中者。胃中之阳气也。除者。去而尽之也。言胃气为邪气所迫。尽情发露。不
留余蕴也。不发热。不字当作若。谓试以索饼食之。若果胃气无余。必不能蒸郁成热。今反热者。
知胃气尚在。非除中之谓矣。而又恐暴热暂来而复去。仍是胃阳发露之凶征也。后三日脉之。而其
热仍在。则其能食者。乃为胃阳复振无疑。故期至旦日夜半。其病当愈。所以然者。本发热六日。
厥反九日。热少厥多。其病当进。兹复发热三日。并前六日。亦为九日。适与厥日相应。故知其旦
日夜半。其病当愈。旦日犹明日也。然厥与热者。阴阳胜负之机。不可偏也。偏于厥则阴胜而碍阳
矣。偏于热则阳胜而碍阴矣。后三日脉之。而脉反加数。热复不止。则阳气偏胜。必致伤及营血。
而发为痈脓也。
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。
伤寒之邪见于阳者。不必见于阴。见于下者。不必见于上。厥已而热。下利自止者。阴邪转而
之阳也。设得汗出。其邪必解而咽中痛者。未尽之热。厥而上行也。故其喉为痹。发热无汗者。邪
气郁而在阳也。虽下利。法当自止。而反不止者。以无汗出。热仍从里行也。故必便脓血。便脓血
者。其喉不痹。邪在下者。则不复在上也。
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。
热少厥微。指头寒。邪气自微也。默默不欲食。烦躁。邪欲传里也。里受邪而热。则其小便必
不利。虽利其色必不白。至数日。小便利色白。知其热已除也。本默默不欲食。忽欲得食。知其胃
已和也。热除胃和。其病则愈。而厥阴之脉。挟胃上膈布胁肋。若其邪不解。淫溢厥阴之位。则为
厥而呕。为胸胁烦满也。凡病上行极者。必下行主血。而病为热。血为热迫。注泄于下。则其后必
便血也。
凡厥者。阴阳气不相顺接。便为厥。厥者。手足逆冷是也。
按经脉足之三阴三阳。相接于足十趾。手之三阴三阳。相接于手十指。故阴之与阳。常相顺接
者也。若阳邪内入。阴不能与之相接。而反出于外。则厥。阴邪外盛。阳不能与之相接。而反伏于
中。亦厥。是二者。虽有阴阳之分。其为手足逆冷一也。
伤寒病一二天到四五天出现四肢厥冷的，必定伴有发热。先前发热的，后来必然出现厥冷；厥冷严重的，内热也严重；厥冷轻微的，内热也轻微。这种厥证应当用攻下法治疗，如果反而使用发汗法，必然导致口腔损伤、糜烂红肿。
伤寒病一二天到四五天，正是阴阳邪正相互交争、胜负交替的时期。如果是阴经受邪而致厥的，病情势必会转化为发热，这是阴气胜而阳气与之抗争的表现。如果是阳经受邪而致热的，严重时也会转变为厥冷，这是阳气胜而阴气被格拒于外的表现。所谓阳气胜而阴气被格拒的情况，其厥冷并非真正的寒证，而是阳气郁陷于体内，阴气显现于体表所致。因此，内热越深，厥冷也越深；内热越微，厥冷也越微。随着热邪深浅的变化，厥冷的程度也随之轻重变化。
一般来说，病在表（阳）适宜用汗法，病在里（阴）适宜用下法。厥证是因为热邪深伏于里，依法应当用下法。如果反而使用发汗法，必然导致口腔损伤、糜烂红肿。这是因为体内的蕴积之热，被升浮的发散之气所激扰，热气不从下面排出，反而向上逆冲的缘故。
伤寒病，先厥冷五天，随后发热五天。如果到了第六天，应当再次出现厥冷。如果没有出现厥冷，说明病自愈了。厥冷的时间不超过五天，因为后面跟着五天的发热，所以知道病会自愈。
伤寒先厥冷五天，随后发热五天，这是阴气胜而阳气来复的表现。到了第六天，阴气应当再次占优势而出现厥冷。假设没有再出现厥冷，说明阴邪已退，病邪已解，所以病会自愈。厥与热的交替，是阴阳消长的征兆。从初病到终病，厥冷不超过五天，厥冷过后发热也是五天，这说明阳气回复的数量与之前阴气胜时的数量相当，即所谓“有阳则复”，既不过分亢盛，也不虚弱不足，所以知道病会自愈。
伤寒发热四天，随后厥冷三天，接着又发热四天。厥冷时间短而发热时间长（厥少热多），病应当痊愈。如果从第四天到第七天发热仍然不退，那么之后必然会出现大便带脓血。
伤寒先厥冷四天，随后发热三天，接着又厥冷五天。这是病情进展的表现。寒多热少，阳气衰退，所以病情加重。
先发热后出现厥冷的，是邪气从体表传入体内的表现。但如果厥冷尚未结束，而发热的天数又多于厥冷的天数，说明邪气又转而返回体表，所以病应当痊愈，热邪随之消除。如果从第四天到第七天热邪仍不消除，热邪必然会侵入营分而导致大便脓血。这就是所谓的“热气有余，必发痈脓”。
先厥冷后发热的，是阳气恢复而阴邪消退的表现。但如果热邪未止又出现厥冷，且厥冷的天数多于发热的天数，那么病情就是进展。之所以这样，是因为寒多热少，阳气不振，导致阴邪再次占优势。总之，先热后厥的，属于传经的证候，担心的是阳邪逐渐深入；先厥后热的，属于直中的证候，担心的是阳气不振。所以，传经的厥热，是从邪气的出入角度而言；直中的厥热，是从阴阳的胜负往复角度而言。病证虽然相同，但机理却不同如此。医者若能辨别这一点，就差不多掌握要领了。
伤寒先出现厥冷，随后发热，并且伴有下利的，下利必然自行停止。如果再次出现厥冷，下利又会复发。
伤寒先出现厥冷的，是阴气先受邪气侵袭。随后发热的，是邪气从阴分出透达于阳分。阴经受邪导致下利，等到邪气转出阳分，所以下利必然自行停止。假如再次出现厥冷，说明邪气又回转入阴分，所以必然再次出现下利。大概邪气在阳分则生热，在阴分则表现为厥冷和下利，这是自然的规律。
伤寒开始发热六天，随后厥冷反而九天并伴有下利。凡是厥冷伴下利的，通常应当不能进食。现在反而能进食，要担心是“除中”（胃气将绝前的假象）。给病人吃面条（索饼），如果不发热，说明胃气还在，病必愈。但要担心是暴热突然来去。过了三天诊察脉象，如果热度持续存在，预测到第二天半夜病会痊愈。之所以这样，是因为原本发热六天，厥冷九天，后来又发热三天，加上之前的六天，总共也是九天，这与厥冷的天数相应，所以预测到第二天半夜病会痊愈。过了三天诊察脉象，如果脉搏数疾，热度不退，这是热气有余，必然会发生痈脓。
伤寒开始发热六天，厥冷反而九天并伴有下利的，是邪气从阳分进入阴分，并在阴分盛行的表现。阴气盛时应当不能进食，现在反而能进食，要担心是“除中”。“中”指胃中的阳气，“除”指去除、耗尽。意思是胃气被邪气逼迫，尽情暴露，不留余蕴。这里的“不发热”的“不”字应作“若”解，意为试着给病人吃面条。如果胃气真的耗竭，必然不能蒸腾郁结产生热量。现在反而产生热量，说明胃气尚在，不是“除中”。但又担心是暴热暂时来临随即消失，这仍是胃阳外脱的凶险征象。过了三天诊察脉象，如果热度仍在，那么这种能进食的情况，无疑是胃阳重新振奋的表现，所以预测到第二天半夜病会痊愈。之所以这样，是因为原本发热六天，厥冷九天，热少厥多，病情本应进展。现在又发热三天，加上之前的六天，总共也是九天，恰好与厥冷的天数相应，所以知道第二天半夜病会痊愈。“旦日”就是明天。然而，厥与热是阴阳胜负的关键，不可偏颇。偏于厥冷，则阴胜而阻碍阳气；偏于发热，则阳胜而阻碍阴气。过了三天诊察脉象，如果脉搏反而加快，热势不止，则是阳气偏胜，必然会导致伤及营血，从而发生痈脓。
伤寒先厥冷后发热，下利必然自行停止。如果反而出汗，咽喉疼痛的，喉部会发生痹阻。如果发热无汗，下利必然自行停止。如果下利不止，必然大便带脓血。
大便带脓血的，喉部不会痹阻。
伤寒的邪气表现在阳分，不一定表现在阴分；表现在下部，不一定表现在上部。厥冷过后发热，下利自止的，是阴邪转而向阳分转化。假如出现汗出，邪气必然解除，但若咽喉疼痛，说明未尽的热邪向上逆行，所以喉部发生痹阻。发热无汗的，是邪气郁滞在阳分。即使有下利，依法应当自止，如果反而不止，是因为没有汗出，热邪仍然从内部下行，所以必然大便带脓血。大便带脓血的，喉部就不会痹阻。邪气在下部的，就不会再出现在上部。
伤寒热势轻微，厥冷轻微，仅指尖发凉，沉默不想吃东西，烦躁几天，小便通畅且颜色清白，这是热邪已除的表现。想要吃东西，说明病将要痊愈。如果出现厥冷并呕吐，胸胁烦闷胀满的，之后必然便血。
热势轻微，厥冷轻微，仅指尖发凉，说明邪气轻微。沉默不想吃东西，烦躁，说明邪气欲传入里。里部受邪而生热，小便必然不利，即使有利，颜色也不会清白。到了几天后，小便通畅且颜色清白，可知热邪已除。本来沉默不想吃东西，忽然想吃东西，可知胃气已调和。热除胃和，病就会痊愈。但是厥阴经脉，挟胃上行穿过膈肌，散布于胁肋。如果邪气不解，淫溢侵犯厥阴经的部位，就会出现厥冷呕吐、胸胁烦满的症状。凡是病势向上发展到极致的，必然向下影响主血的脏腑，且病因为热，血液被热邪逼迫，注泄于下部，所以之后必然便血。
凡是厥冷，都是由于阴阳之气不能顺接所致。厥冷，是指手足逆冷。
按经脉循行，足部的三阴三阳经，交接于足十趾；手部的三阴三阳经，交接于手十指。所以阴与阳，通常是顺相接通的。如果阳邪内入，阴气不能与之相接，反而出于体表，就会发生厥冷；如果阴邪外盛，阳气不能与之相接，反而伏藏于体内，也会发生厥冷。这两种情况，虽然有阴阳之分，但都表现为手足逆冷。
In cold damage (Shanghan) disease, if limb coldness (Jue) occurs from the first to the fourth or fifth day, fever must follow. If there was prior fever, limb coldness will inevitably ensue; the deeper the limb coldness, the deeper the internal heat; the slighter the limb coldness, the slighter the internal heat. This type of Jue should be treated with purgation (Xia). If sweating (Han) is used in error, it will inevitably cause oral injury and redness/ulceration.
From the first to the fourth or fifth day of cold damage disease is the period when Yin and Yang pathogens and righteous Qi contend and alternate in victory. If the Yin channel is affected causing Jue, the condition will inevitably transform into fever, representing Yin excess countered by Yang struggle. If the Yang channel is affected causing fever, severe cases may transform into Jue, representing Yang excess repelling Yin to the exterior. In cases where Yang excess repels Yin, the Jue is not true cold; rather, Yang is trapped internally while Yin manifests externally. Thus, deeper heat results in deeper Jue, and slighter heat results in slighter Jue. The degree of Jue varies according to the depth of the heat.
Generally, diseases in the Yang (exterior) are suitable for sweating therapy, while diseases in the Li (interior) are suitable for purgation. Jue is caused by deep-seated heat in the interior and legally requires purgation. If sweating is used in error, it will inevitably cause oral injury and redness/ulceration. This is because the accumulated internal heat is agitated by ascending and dispersing qi, failing to exit downward but instead counterflowing upward.
In cold damage disease, if there is Jue for five days followed by fever for five days, on the sixth day, Jue should recur. If Jue does not recur, the disease will heal spontaneously. Since Jue does not exceed five days and is followed by five days of fever, it indicates spontaneous healing.
When Jue lasts five days followed by fever for five days, it signifies Yin excess being restored by Yang. By the sixth day, Yin should regain dominance and cause Jue. If Jue does not recur, it means Yin retreats and pathogens resolve, leading to spontaneous healing. The alternation of Jue and fever represents the waxing and waning of Yin and Yang. From onset to conclusion, if Jue does not exceed five days and is followed by five days of fever, the number of Yang restoration matches the previous Yin excess. As stated, "where there is Yang, there is restoration," neither excessive nor insufficient, indicating spontaneous healing.
If cold damage presents with four days of fever followed by three days of Jue, then another four days of fever, the duration of Jue is short and fever is long (Jue shao, Re duo), indicating the disease should heal. However, if fever persists from the fourth to the seventh day without cessation, pus and blood will likely appear in the stool later.
If cold damage presents with four days of Jue followed by three days of fever, then another five days of Jue, the disease is progressing. Cold predominates over heat, Yang Qi declines, hence the progression.
Fever preceding Jue indicates pathogens moving from the exterior to the interior. However, if Jue has not ceased and the days of fever exceed the days of Jue, pathogens turn back to the exterior, so the disease should heal and heat dissipate. If heat persists from the fourth to the seventh day, it will invade the Ying (Nutritive) level, causing pus and blood in the stool. This corresponds to "excess heat inevitably causes carbuncles and abscesses."
Jue preceding fever indicates Yang recovery and Yin pathogen retreat. However, if heat ceases and Jue recurs, with Jue days exceeding fever days, the disease progresses. This is because cold exceeds heat, Yang Qi is weak, allowing Yin pathogens to regain dominance. In summary, fever-then-Jue belongs to transmitted disease patterns, worrying about progressive Yang pathogen depth; Jue-then-fever belongs to direct invasion patterns, worrying about weak Yang Qi. Thus, transmitted Jue/fever discusses pathogen entry/exit, while direct Jue/fever discusses Yin/Yang victory/restoration. Although symptoms are similar, mechanisms differ. Understanding this distinction is crucial.
In cold damage, if Jue occurs first, followed by fever and diarrhea, the diarrhea will stop spontaneously. If Jue recurs, diarrhea will resume.
Initial Jue indicates Yin receiving pathogenic influence initially. Subsequent fever indicates pathogens exiting Yin to reach Yang. Yin pathology causes diarrhea; once pathogens exit to Yang, diarrhea stops. If Jue recurs, pathogens re-enter Yin, causing diarrhea to resume. Pathogens in Yang generate heat; in Yin, they cause Jue and diarrhea. This is the natural order.
If cold damage begins with six days of fever followed by nine days of Jue and diarrhea: typically, Jue with diarrhea implies inability to eat. If the patient can eat, suspect "Chu Zhong" (stomach Qi exhaustion false sign). Feed them Suo Bing (noodles). If no fever ensues, stomach Qi remains, and healing is expected. Caution against sudden transient heat. After three days, if pulse shows sustained heat, predict healing by midnight of the next day. Reason: originally six days fever, nine days Jue, plus three more days fever equals nine days total, matching Jue duration, predicting healing at midnight. If after three days pulse is rapid and heat persists, this is excess heat, likely causing carbuncles/abscesses.
If cold damage begins with six days of fever, nine days of Jue, and diarrhea, pathogens move from Yang to Yin, flourishing in Yin. Yin excess usually prevents eating. If the patient eats, suspect "Chu Zhong." "Zhong" refers to Stomach Yang Qi; "Chu" means removal/exhaustion. It implies Stomach Qi forced by pathogens to fully expose itself without reserve. Here, "no fever" should read "if no fever," meaning testing with noodles. If Stomach Qi were exhausted, it could not generate heat through steaming/stagnation. If heat arises, Stomach Qi remains, ruling out Chu Zhong. Yet, caution against sudden transient heat as a sign of Yang collapse. After three days, if heat persists, the ability to eat confirms Stomach Yang revival, predicting healing by midnight of the next day. Originally six days fever, nine days Jue (heat less, Jue more) suggests progression. Now three more days fever makes nine days total, matching Jue days, predicting healing. "Dan Ri" means tomorrow. Jue and fever represent the mechanism of Yin/Yang victory; imbalance favors either Yin hindering Yang or Yang hindering Yin. If after three days pulse accelerates and heat continues, Yang excess injures Ying Blood, causing carbuncles/abscesses.
In cold damage, initial Jue followed by fever stops diarrhea. If sweating occurs with sore throat, Bi (obstruction) of the throat develops. Fever without sweating stops diarrhea; if diarrhea persists, pus/blood in stool occurs. Those with pus/blood in stool do not have throat Bi.
Pathogens manifesting in Yang need not manifest in Yin; those manifesting lower need not manifest upper. Jue followed by fever stopping diarrhea indicates Yin pathogens turning to Yang. If sweating occurs, pathogens resolve, but residual heat rising causes sore throat and throat Bi. Fever without sweating indicates pathogens stagnating in Yang. Even with diarrhea, it should stop; if not, lack of sweating allows heat to continue from interior, causing pus/blood in stool. Pus/blood in stool means no throat Bi, as pathogens remain lower and do not rise.
Mild heat, mild Jue, cold fingertips, silence, anorexia, irritability for several days, with clear, free urination indicates heat elimination. Desire for food indicates impending healing. If Jue with vomiting and chest/hypochondriac fullness occurs, blood in stool will follow.
Mild heat/Jue/cold fingertips indicate mild pathogens. Silence/anorexia/irritability indicate pathogens transmitting inward. Interior pathogen heat causes difficult urination and dark urine. Later, clear/free urination confirms heat elimination. Sudden desire to eat confirms Stomach harmony. Heat eliminated, Stomach harmonized, disease heals. However, Jueyin meridians flank the stomach, cross the diaphragm, and distribute to hypochondrium. Unresolved pathogens invading Jueyin cause Jue, vomiting, and chest/hypochondriac fullness. Diseases reaching extreme upward movement affect blood downward. Heat forcing blood downward causes blood in stool.
All Jue results from failure of Yin and Yang Qi to connect smoothly. Jue refers to reverse coldness of hands and feet.
Meridians: Foot Three Yin and Yang connect at toes; Hand Three Yin and Yang connect at fingers. Yin and Yang normally connect smoothly. If Yang pathogens enter internally and Yin cannot connect, reversing to exterior, Jue occurs. If Yin pathogens flourish externally and Yang cannot connect, retreating internally, Jue also occurs. Both involve Yin/Yang differentiation but present identically as reverse coldness of extremities.