问曰∶四肢厥冷，何以是直中寒证？答曰∶四肢为阳，寒邪属阴，今中寒邪，则阳衰不
能温其四肢，故厥冷。其甚者，过乎肘膝，肘膝为人之四关，今冷过之，则阴寒极矣。宜大
温之。又问曰∶阳证亦厥逆，何也？答曰∶此物极则反，热极而反见厥也。别之，凡病初起即厥者
寒厥也，初起发热日久变厥者热厥也。且热厥必烦躁口渴，恶热，小便短赤，大便或闭，或
下利肠垢，脉必沉实有力。寒厥则不渴，必恶寒身痛，小便清长，或下利清谷，脉必沉细无
力。安危之机，祸如反掌，不可不辨。
问曰∶身痛如被杖，何以是直中寒证？答曰∶寒邪客于人，则身痛。痛如被杖，寒之极
甚者也。又问曰∶表证亦身痛，何也？答曰∶表证身痛，痛如绳缚也；里证身痛，痛如被杖
也。虽为表里之殊，而为寒则一也，宜急温之。表寒则温散，里寒则温中，寒气散，痛自除
问曰∶囊缩何以是直中寒证？答曰∶热主舒，寒主敛，定理也。春夏则万物发舒，秋冬
则万物敛藏，即此观之，可见囊缩为寒矣。又问曰∶《指掌》用承气治囊缩，何也？答曰∶
此传经厥阴证也。伤寒传至厥阴，六经已尽，厥阴者，肝也，肝主周身之筋，又厥阴之脉络
阴器，因热邪烁其津液，筋脉不荣，故舌卷而囊缩。其证必口渴烦满，唇焦舌燥，与直中阴
寒之证，迥然不同尔。
问：四肢厥冷，为什么属于直中寒证？答：四肢属阳，寒邪属阴，如今寒邪直中人体，导致阳气衰微，不能温煦四肢，所以出现厥冷。病情严重的，寒冷超过肘部和膝部。肘和膝是人体的“四关”，现在寒冷超过了这个部位，说明阴寒已经极盛了。应当用大温之法治疗。又问：阳证也会出现厥逆，这是为什么呢？答：这是因为物极必反，热邪极盛反而出现厥冷的症状。辨别的方法在于：凡是病初起就出现厥冷的，是寒厥；初起发热，日久之后才转变为厥冷的，是热厥。而且热厥必定伴有烦躁、口渴、怕热、小便短赤、大便或闭塞不通，或下利肠垢（黏液脓血便），脉象必定沉实有力。寒厥则不口渴，必定怕冷、身体疼痛、小便清长，或下利清谷（完谷不化），脉象必定沉细无力。安危的关键，祸福只在顷刻之间，不可不仔细辨别。
问：身体疼痛如同被棍棒打过一样，为什么属于直中寒证？答：寒邪客居在人体内，就会导致身体疼痛。疼痛剧烈如同被杖击打，这是寒邪极盛的表现。又问：表证也会出现身体疼痛，这是为什么呢？答：表证的身体疼痛，感觉像被绳子捆绑一样；里证的身体疼痛，感觉像被棍棒打过一样。虽然表证和里证有所不同，但致病因素都是寒邪，应当紧急温治。如果是表寒，就用温散的方法；如果是里寒，就用温中的方法。寒气散去，疼痛自然消除。
问：阴囊收缩（囊缩）为什么属于直中寒证？答：热性主舒展，寒性主收敛，这是确定的道理。春夏季节万物发散舒展，秋冬季节万物收敛闭藏，由此可以推断，阴囊收缩是由寒邪引起的。又问：《指掌》书中用承气汤来治疗囊缩，这是为什么呢？答：那是传经至厥阴的证候。伤寒传变到厥阴经，六经的病邪已尽。厥阴经对应肝脏，肝主管全身的筋脉，且厥阴经的脉络连接阴器。因为热邪灼烧津液，导致筋脉失养，所以出现舌头卷曲和阴囊收缩的症状。这种证候必定伴有口渴、烦闷胀满、嘴唇焦裂、舌面干燥，与直中阴寒的证候截然不同。
Q: Why is cold extremities (Jue Leng) considered a direct invasion of cold syndrome? A: The four limbs belong to Yang, while cold pathogenic factors belong to Yin. When cold pathogens directly invade the body, Yang Qi becomes deficient and fails to warm the four limbs, resulting in cold extremities. In severe cases, the cold extends beyond the elbows and knees. The elbows and knees are known as the "Four Passes" of the human body; if the cold surpasses these points, it indicates an extreme accumulation of Yin-Cold. Treatment should employ strong warming methods.
Q: Why do Yang syndromes also present with inverted cold (Ni Jue)? A: This occurs due to the principle that things reverse when they reach an extreme; excessive heat can paradoxically manifest as cold extremities. To differentiate: Cold Jue (Han Jue) presents with cold extremities from the onset of the disease. Heat Jue (Re Jue) begins with fever and develops into cold extremities after a prolonged period. Furthermore, Heat Jue is invariably accompanied by restlessness, thirst, aversion to heat, scanty dark urine, constipation, or dysentery-like diarrhea with mucus and pus, and the pulse is deep, full, and forceful. In contrast, Cold Jue features no thirst, marked aversion to cold, body pain, clear and profuse urine, or diarrhea with undigested food, and the pulse is deep, thin, and weak. The distinction between safety and danger is critical and must not be overlooked.
Q: Why is body pain resembling blows from a staff considered a direct invasion of cold syndrome? A: When cold pathogens lodge in the body, they cause body pain. Pain described as feeling like being beaten with a staff indicates extreme severity of cold.
Q: Why does exterior syndrome also present with body pain? A: Body pain in exterior syndrome feels like being bound by ropes, whereas body pain in interior syndrome feels like being struck by a staff. Although there is a distinction between exterior and interior locations, the pathogenic factor is cold in both cases, requiring urgent warming treatment. For exterior cold, use warming and dispersing methods; for interior cold, use warming the middle methods. Once the cold pathogen dissipates, the pain will naturally cease.
Q: Why is penile retraction (Nang Suo) considered a direct invasion of cold syndrome? A: Heat tends to cause expansion and relaxation, while cold causes contraction and gathering; this is a fundamental principle. In spring and summer, all things expand and flourish; in autumn and winter, all things contract and store. From this observation, we can deduce that penile retraction is caused by cold.
Q: Why does the text *Zhi Zhang* use Chengqi Tang to treat penile retraction? A: That refers to a syndrome transmitted to the Jueyin stage. When Shaoyin disease transmits to the Jueyin meridian, the pathogenic factors of the six meridians have exhausted their progression. Jueyin corresponds to the Liver, which governs the tendons of the entire body. Additionally, the Jueyin meridian connects to the genitalia. Due to heat pathogens scorching body fluids, the tendons and vessels lose nourishment, resulting in tongue curling and penile retraction. Such cases invariably present with thirst, irritability, fullness, cracked lips, and a dry tongue, which are distinctly different from direct invasion of Yin-Cold syndromes.