〔《活》〕李根汤 治气上冲，正在心端。
半夏 当归 芍药 生姜 茯苓 桂枝 黄芩 甘草 甘李根白皮（各等分）
上 咀，每服五钱，水煎温服。
饥不欲食，食则吐蛔者，厥阴病。（论见气上冲心。）手足厥冷，脉乍紧，心烦，饥不能食者，邪
在胸中，宜瓜蒂散吐之。（论见厥。）
太阳病吐，发汗出，发热不恶寒，关脉细数，腹中饥，口不能食，朝暮吐者，此为小逆。（论见发热。）
阳明病，下后心下懊 ，饥不欲食，但头汗出者，宜栀子豉汤。（论见烦。）
气上冲，心疼，饥不欲食，吐蛔者，厥阴病。（论见气上冲。）静而复烦，须臾复止，得食而呕，又烦，
吐蛔虫者，为蛔厥，宜乌梅丸。（方论见厥。）
病患有寒，复发汗，胃中冷，必吐蛔。（《活人》云∶先服理中丸，次服乌梅丸。）
两感于寒者，三日少阳与厥阴俱病，则耳聋囊缩而厥。（论见太阴。注云∶耳聋者，少阳病；囊缩而厥者，
厥阴病。）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。成无己云∶若始得之，手足便厥而不温者，是阴经受邪，阳气不足，可用四逆汤温
之。若手足自热而至温，从四逆而至厥者，传经之邪也，四逆散主之。必须识此，勿令误也。（四逆汤方见下
利。四逆散方见欲寐。）又当外症别之。予尝治一中年妇人，恶热身热而渴，脉数细弱，先厥后热，用温药反
剧，后以四逆散兼参、术各半服之，厥愈，脉出洪大而痊。
手足厥寒，脉细欲绝者，宜当归四逆汤。
甘草 通草（各六钱） 当归 桂枝 细辛 芍药（各一两）
上 咀，每服五钱，入枣子一枚，同煎温服。
若其人内有久寒者，宜当归四逆加茱萸生姜汤主之。于原方内加吴茱萸二两，生姜二两半。呕而脉弱，小
便复利，身有微热见厥者难治，四逆汤主之。
伤寒脉滑而厥者，里有热也，白虎汤主之。
伤寒脉促，手足厥逆者，可灸之。（《脉经》云∶可灸，少阴厥阴主逆。）伤寒六七日，脉微，手足厥冷，
烦躁，灸厥阴，灸而不止者死。
病患手足厥冷，脉乍紧者，邪结在胸中，心中满而烦，饥不能食者，病在胸中，当吐之，宜瓜蒂散。（“脉紧”
一作“脉结”者，有理。）脉来数，时一止复来曰促；脉来缓，时一止复来曰结。结促二脉者，脉为邪碍而歇止
也，灸之吐之，所以逐去其邪也。
少阴病，身痛，手足寒，脉沉者，宜附子汤。（论见欲寐。）伤寒五六日，头汗出，微恶寒，手足冷，
心下满，口不欲食，大便硬，脉细者，此为阳微结，必有表复有里也。脉沉，亦在里也。汗出为阳微，假
令纯阴结，不得复有外症，悉入在里，此为半在里半在表也。脉虽沉紧，不为少阴病，所以然者，阴不得
有汗，今头汗出，故知非少阴也，可与小柴胡汤，设不了了者，得屎而解。
〔《本》〕有人患伤寒五六日，头汗自出，自颈以下无汗，手足冷，心下痞闷，大便秘结，或者见四肢冷，
又汗出满闷，以为阴症。予诊其脉沉而紧。予曰∶此症诚可疑，然大便结，非虚结也，安得为阴？脉虽沉而紧，
为少阴症多是自利，未有秘结者。此症半在里半在表，投以小柴胡汤得愈。仲景称伤寒五六日头汗出云云至得
屎而解，正此之谓也。有人难曰∶脉阴阳俱紧，反汗出者，亡阳也。此属少阴不得有汗，何也？今头汗出者，
故知非少阴。何以头汗出便知非少阴症？予曰∶此一段正是仲景议议处，谓四肢冷，脉沉紧，腹满，全似少阴，
然大便硬，头汗出，不得为少阴。盖头者，三阳同聚，若三阴，止胸而还，有头汗出，自是阳虚，故曰汗出为
阳微，是阴不得有汗也。若少阴头有汗，则死矣。故仲景《平脉法》云∶心者，火也，明少阴则无头汗者可治，
有汗者死。心为手少阴，肾为足少阴，相与为上下，惟以意逆志者，斯可得之。
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。
茯苓甘草汤
茯苓 桂枝（各二钱） 生姜（三钱） 甘草（炙，一钱）
上 咀，水煎温服。
少阴病，四逆或悸者，四逆散加桂枝主之。（方论见欲寐。）伤寒脉浮，自汗出，小便数，心烦，微恶寒，
脚挛急，反与桂枝汤欲攻其表，此误也，得之便厥，咽中干，烦躁吐逆者，作甘草干姜汤与之，以复其阳。
若厥愈足温者，更作芍药甘草汤与之，其脚即伸。若胃气不和谵语者，少与调胃承气汤。若重发汗，复加烧
针者，四逆汤主之。
甘草干姜汤
甘草（四两） 干姜（二两）
上 咀，每服五钱，水煎温服。
芍药甘草汤
白芍药 甘草（各二两）
上 咀，每服五钱，水煎温服。
调胃承气汤（方见发热。） 四逆汤（方见下利。）
问曰∶症象阳旦，按法治之而增剧，厥逆，咽中干，两胫拘急而谵语。师曰∶言夜半手足当温，两脚当伸，
后如师言。何以知此？答曰∶尺寸浮而大，浮则为风，大则为虚，风则生微热，虚则两胫挛急。症象桂枝，因
加附子参其间，增桂令汗出，附子温经回阳故也。厥逆，咽中干，烦躁，阳明内结，谵语烦乱，更饮甘草干姜
汤。夜半阳气还，两足当热，胫尚微拘急，重与芍药甘草汤，乃胫伸。以承气汤微溏，则止其谵语，故知病可
愈。少阴病，食入则吐，复不能吐，手足寒，脉弦迟者，宜吐之。（论见吐。）
下利而厥，下重者，四逆加薤白。脉微者，通脉四逆汤、白通汤。温后无脉者，白通加猪胆汁汤。汗后拘
急者，四逆汤。下后咽不利者，麻黄升麻汤。（方论见下利。）
吐利，发热恶寒，汗出而厥者，属霍乱，宜四逆汤。吐利，烦躁欲死而厥者，属少阴，宜吴茱萸汤。吐利
止，脉微欲绝而厥者，通脉四逆加猪胆汁汤。（方论见吐利。）
中暑口干而渴，治法见中暑门。
伤寒脉微而厥，至七八日，肤冷，其人躁无暂安时者，此为脏厥，非为蛔厥也。蛔厥者，其人当吐蛔，
令病者静而复时烦，此为脏寒，蛔上入膈故烦，须臾复止，得食而呕，又烦者，蛔闻食臭出，其人当自吐蛔。
蛔厥者，宜乌梅丸主之。
乌梅（七十五个） 细辛 附子（炮，去皮） 人参 黄柏 桂枝（各一两） 干姜（二两）
黄连（四两） 蜀椒（炒，去汗，一两） 当归
上十味，共为细末，以苦酒渍乌梅一宿，去核，蒸熟，杵成泥，和药令相得，纳臼中，加炼蜜，杵三千下，
丸如桐子大。食前服十丸，日三服，稍加至二十丸。忌生冷滑物等。
凡厥者，阴阳气不相顺接，便为厥，厥者手足逆冷是也。
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。伤寒发热四日，厥反三日，
厥少热多，其病当自愈，四日至七日热不除者，其后必便脓也。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，恐为除中。食以索饼，不发热者，知胃气尚在，必愈。恐胃热来而复去也，后三日脉之，
其热续在者，期之旦日夜半愈。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，故期之旦日夜半愈。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。苦厥而呕，胸膈烦满者，其后必便血。少
腹满痛而厥，为冷结关元。（论见少腹痛。）少阴四逆，恶寒身蜷，无脉，不烦而躁，死。（论见欲寐。）
少阴病，但厥无汗，而强发之，必动其血。（论见欲寐。）诸四逆厥者，不可汗之，诸虚家亦然。伤寒
五六日，不结胸，腹濡，脉虚复厥者，不可下，此为亡血，下之者死。
上厥逆皆忌下，惟前条先热者必厥，厥应下之，而反发汗者，一法，宜下，忌汗之。
【《活人书》】李根汤：治疗气上冲心，症状位于心口正上方。
药材：半夏、当归、芍药、生姜、茯苓、桂枝、黄芩、甘草、甘李根白皮（以上各等分）。
制法与用法：将药材切碎，每次服用五钱，加水煎煮后温服。
感到饥饿但不想进食，进食后则呕吐蛔虫的，属于厥阴病。（相关论述见“气上冲心”一节。）手足冰冷，脉搏突然变得紧实，心中烦躁，感到饥饿却无法进食的，是邪气停留在胸中，适宜用瓜蒂散进行催吐治疗。（相关论述见“厥”一节。）
太阳病经过吐法治疗后，出现出汗、发热且不恶寒的症状，关脉细数，腹中感觉饥饿但口中无法进食，早晚都呕吐的，这称为小逆证。（相关论述见“发热”一节。）
阳明病经过泻下法治疗后，出现心下部懊恼不适，饥饿但不想进食，仅头部出汗的，适宜用栀子豉汤治疗。（相关论述见“烦”一节。）
气上冲心，心痛，饥饿但不想进食，呕吐蛔虫的，属于厥阴病。（相关论述见“气上冲”一节。）患者安静片刻后又感到烦躁，过了一会儿又停止，进食后发生呕吐并再次烦躁，吐出蛔虫的，这是蛔厥，适宜用乌梅丸治疗。（方剂论述见“厥”一节。）
患有寒证的病人，如果再次发汗，导致胃中寒冷，必定会呕吐蛔虫。（《活人书》说：先服用理中丸，再服用乌梅丸。）
两感于寒邪的病人，到了第三天，少阳经和厥阴经同时发病，就会出现耳聋、睾丸收缩以及手足厥冷。（相关论述见太阴病。注解说：耳聋是少阳病的表现；睾丸收缩且手足厥冷是厥阴病的表现。）伤寒一二天到四五天出现手足厥冷的，必定伴有发热。先前有发热的，后来必然会出现厥冷，厥冷严重的，热邪也深重；厥冷轻微的，热邪也轻微。厥冷证应当使用泻下法，如果反而使用发汗法，必定会导致口腔损伤、红肿溃烂。成无己说：如果是刚得病，手脚就厥冷且不温暖的，这是阴经受邪，阳气不足，可以使用四逆汤来温补。如果是手脚从发热逐渐转为温暖，或者从四肢厥逆转变为厥冷的，这是传经之邪，主治方剂为四逆散。必须认清这一点，不要弄错。（四逆汤方剂见下文“下利”部分。四逆散方剂见“欲寐”部分。）另外还应当结合外在症状加以辨别。我曾治疗一位中年妇女，她怕冷但身体发热且口渴，脉搏数而细弱，先出现厥冷后出现发热，使用温热药物后病情反而加重，后来改用四逆散与人参、白术各半剂量合服，厥冷痊愈，脉搏变为洪大，疾病治愈。
手足厥冷，脉搏细微几乎摸不到的，适宜用当归四逆汤。
药材：甘草、通草（各六钱）、当归、桂枝、细辛、芍药（各一两）。
制法与用法：将药材切碎，每次服用五钱，加入一枚大枣，共同煎煮后温服。
如果患者体内有久治不愈的寒邪，适宜用当归四逆加吴茱萸生姜汤主治。在原方基础上加入吴茱萸二两，生姜二两半。
呕吐且脉搏微弱，小便清长，身体有轻微发热却出现厥冷的，属于难治之症，主治方剂为四逆汤。
伤寒脉象滑利却出现手足厥冷的，是里有热邪，主治方剂为白虎汤。
伤寒脉象急促，手足厥逆的，可以采用灸法治疗。（《脉经》说：可以灸治，少阴经和厥阴经主司逆证。）伤寒六七天，脉搏微弱，手足厥冷，烦躁不安，应灸治厥阴经穴位，如果灸治后症状不止者，预后不良致死。
病患手足厥冷，脉搏突然紧实的，邪气结聚在胸中，心中胀满且烦躁，感到饥饿却无法进食的，病位在胸中，应当采用吐法，适宜用瓜蒂散。（“脉紧”一作“脉结”，是有道理的。）脉搏跳动快，偶尔停歇一下又继续跳动的叫促脉；脉搏跳动慢，偶尔停歇一下又继续跳动的叫结脉。结脉和促脉，是因为脉气被邪气阻碍而出现间歇，灸法和吐法都是为了驱除邪气。
少阴病，身体疼痛，手足寒冷，脉搏沉伏的，适宜用附子汤治疗。（相关论述见“欲寐”一节。）伤寒五六天，头部出汗，轻微怕冷，手足冷，心下部胀满，口中不想进食，大便干硬，脉搏细微的，这叫做阳微结，既有表证又有里证。脉搏沉，说明病也在里。出汗是因为阳气微弱，假如是纯阴结，就不会再有外在症状，全部病邪都在里，这叫做半在里半在表。脉搏虽然沉紧，但不是少阴病，之所以这样判断，是因为阴证不应该有汗，现在头部出汗，所以知道不是少阴病，可以给予小柴胡汤治疗，如果服药后仍不舒服的，通过排便即可解除。
【《本草衍义》或其他医家言论】有人患伤寒五六天，头部自然出汗，从颈部以下没有汗，手足冷，心下部痞闷，大便秘结，有的人看到四肢冷，又出汗且满闷，误认为是阴证。我诊察他的脉搏沉而紧。我说：这个症状确实可疑，但是大便干结，不是虚性的结滞，怎么能说是阴证呢？脉搏虽然沉而紧，但少阴病大多表现为自发性腹泻，没有便秘的情况。这个症状半在里半在表，投用小柴胡汤后痊愈。仲景称伤寒五六天头汗出云云直到得屎而解，正是说的这种情况。有人质疑说：脉象寸关尺俱紧，反而出汗的，是亡阳证。这属于少阴病，不应该有汗，为什么呢？现在头部出汗，所以知道不是少阴病。为什么头部出汗就知道不是少阴病呢？我说：这一段正是仲景议论精妙之处，谓四肢冷，脉沉紧，腹部胀满，完全像少阴病，但是大便硬，头部出汗，不能诊断为少阴病。因为头部是三阳经汇聚的地方，如果是三阴经，只到胸部就返回了，如果有头部出汗，自然是阳虚所致，所以说出汗是阳气微弱，阴证不应该有汗。如果少阴病头部有汗，就会死亡。所以仲景《平脉法》说：心属火，明了少阴经的道理，那么没有头部出汗的可以治愈，有头部出汗的会死亡。心为手少阴经，肾为足少阴经，上下相互关联，只有用心意去推测其旨意，才能明白其中的道理。
伤寒出现厥冷且心下部悸动的，适宜先治疗水饮，应当服用茯苓甘草汤，然后再治疗厥冷。如果不这样做，水气浸渍入胃，必定会导致腹泻。
茯苓甘草汤
药材：茯苓、桂枝（各二钱）、生姜（三钱）、甘草（炙，一钱）。
制法与用法：将药材切碎，加水煎煮后温服。
少阴病，出现四肢厥逆或心悸的，用四逆散加桂枝主治。（方剂论述见“欲寐”一节。）伤寒脉浮，自汗出，小便频数，心烦，轻微怕冷，脚部抽筋拘急，反而给予桂枝汤想要攻表，这是错误的。患病后立即出现厥冷，咽喉干燥，烦躁呕吐逆气的，制作甘草干姜汤给予服用，以恢复其阳气。
如果厥冷痊愈、脚部变温暖的，再制作芍药甘草汤给予服用，其脚部就能伸直。如果胃气不和出现谵语的，少量给予调胃承气汤。如果再次发汗，又加上烧针治疗的，主治方剂为四逆汤。
甘草干姜汤
药材：甘草（四两）、干姜（二两）。
制法与用法：将药材切碎，每次服用五钱，加水煎煮后温服。
芍药甘草汤
药材：白芍药、甘草（各二两）。
制法与用法：将药材切碎，每次服用五钱，加水煎煮后温服。
调胃承气汤（方剂见“发热”部分）。四逆汤（方剂见“下利”部分）。
问曰：症状像阳旦证，按照常规方法治疗却病情加重，出现厥逆，咽喉干燥，两小腿拘挛紧急且谵语。老师说：预计半夜时手脚会变温暖，双脚能伸直，后来果然如老师所言。怎么知道会这样呢？回答说：尺寸脉浮而大，浮则代表风邪，大则代表虚损，风邪会产生轻微发热，虚损会导致两小腿拘挛紧急。症状像桂枝证，因此加入附子在其中，增加桂枝令其出汗，附子温经回阳的缘故。出现厥逆，咽喉干燥，烦躁，阳明内结，谵语烦乱，再饮用甘草干姜汤。夜半阳气回归，两脚应当发热，小腿尚且轻微拘挛紧急，再次给予芍药甘草汤，于是小腿伸直。用承气汤轻微通便，就能停止谵语，所以知道病可痊愈。
少阴病，食物入口即吐，又想吐却吐不出来，手足寒冷，脉搏弦迟的，适宜采用吐法。（相关论述见“吐”一节。）
腹泻且厥冷，伴有肛门重坠感的，用四逆加薤白汤。脉搏微弱的，用通脉四逆汤、白通汤。温补后无脉搏的，用白通加猪胆汁汤。发汗后出现拘挛急迫的，用四逆汤。泻下后咽喉不利的，用麻黄升麻汤。（方剂论述见“下利”部分。）
呕吐腹泻，发热恶寒，出汗且厥冷的，属于霍乱，适宜用四逆汤。呕吐腹泻，烦躁欲死且厥冷的，属于少阴病，适宜用吴茱萸汤。呕吐腹泻停止，脉搏微弱几乎摸不到且厥冷的，用通脉四逆加猪胆汁汤。（方剂论述见“吐利”部分。）
中暑口干且口渴，治疗方法见“中暑”门。
伤寒脉微且厥冷，到了七八天，皮肤冰冷，其人躁动没有片刻安宁的，这是脏厥，不是蛔厥。蛔厥的患者，应当呕吐蛔虫，现在病人安静片刻后又时常烦躁，这是因为内脏寒冷，蛔虫上行进入膈部所以烦躁，一会儿又停止，进食后发生呕吐并再次烦躁，这是因为蛔虫闻到食物的气味而出动，病人应当自行吐出蛔虫。蛔厥的患者，适宜用乌梅丸主治。
乌梅（七十五个）、细辛、附子（炮制，去皮）、人参、黄柏、桂枝（各一两）、干姜（二两）、黄连（四两）、蜀椒（炒制，去汗，一两）、当归。
以上十味药，共研为细末，用醋浸泡乌梅一夜，去掉核，蒸熟，捣成泥状，与药粉混合均匀，放入臼中，加入炼蜜，捣三千下，制成梧桐子大小的丸药。饭前服用十丸，每日三次，逐渐增加到二十丸。忌食生冷滑腻之物等。
凡是厥证，都是阴阳之气不相顺接，就称为厥，厥的表现就是手足逆冷。
伤寒厥冷四天，发热反而三天，又厥冷五天，病情为进展，寒多热少，是因为阳气衰退所以病情进展。伤寒发热四天，厥冷反而三天，厥少热多，病情应当自愈，如果从第四天到第七天热势不退，其后必定大便脓血。伤寒开始发热六天，厥冷反而九天且腹泻，凡是厥冷腹泻的，应当不能进食，现在反而能进食，恐怕是除中证（胃气将绝的假象）。给吃索饼（面条），如果不发热，知道胃气尚在，必定痊愈。担心是胃热暂时来而复去，三天后诊察脉搏，如果热势持续存在，预计在第二天半夜痊愈。之所以这样，本来发热六天，厥冷反而九天，又发热三天，加上之前的六天，也是九天，与厥冷天数相应，所以预计在第二天半夜痊愈。三天后诊察脉搏如果脉数，热势不消退的，这是热气有余，必定会发生痈脓。伤寒病厥冷五天，发热也五天，假设第六天应当再次厥冷，如果不厥冷则自愈。厥冷终不过五天，因为发热五天，所以知道会自愈。伤寒热少厥微，指尖寒冷，沉默不想进食，烦躁几天，小便通畅，颜色白的，这是热邪已除，想要进食，病情将愈。如果厥冷且呕吐，胸膈烦闷胀满的，其后必定便血。小腹满痛且厥冷的，是冷结关元穴。（相关论述见“少腹痛”。）少阴病出现四肢厥逆，怕冷身体蜷缩，无脉搏，不烦躁而是躁动，预后不良致死。（相关论述见“欲寐”一节。）
少阴病，只是厥冷无汗，如果强行发汗，必定扰动血液导致出血。（相关论述见“欲寐”一节。）凡是四肢厥逆的，不可发汗，凡是虚损体质的病人也是如此。伤寒五六天，没有结胸，腹部柔软，脉搏虚弱且厥冷的，不可泻下，这是亡血证，泻下的会死亡。
上述厥逆证都忌讳使用泻下法，只有前面提到的先发热后必厥冷，厥冷应当使用泻下法，如果反而发汗的，这是一种特殊情况，适宜泻下，忌讳发汗。
[From *Huoren Shu*] Li Gen Tang: Treats Qi rushing upward to the heart, with symptoms located directly at the epigastrium.
Herbs: Banxia (Pinelliae Rhizoma), Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), Shengjiang (Zingiberis Rhizoma Recens), Fuling (Poria), Guizhi (Cinnamomi Ramulus), Huangqin (Scutellariae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Ganli Gen Baipi (Pruni Radicis Cortex Albus) (all in equal parts).
Preparation and Administration: Cut the herbs into small pieces. Take 5 qian per dose, decoct with water, and take warm.
Feeling hunger but having no desire to eat, and vomiting roundworms after eating, belongs to Jueyin Disease. (See discussion under "Qi Rushing Upward to the Heart".) Cold hands and feet, pulse suddenly becoming tight, mental restlessness, feeling hungry but unable to eat, indicates pathogenic factors lodged in the chest; Dou Chi San (Cucurbita Seed Powder) is suitable for inducing vomiting. (See discussion under "Jue".)
After purgation in Taiyang Disease, if sweating occurs, accompanied by fever without aversion to cold, fine and rapid Guan pulse, hunger in the abdomen but inability to eat from the mouth, and vomiting morning and evening, this is called Minor Reversal. (See discussion under "Fever".)
After purgation in Yangming Disease, if epigastric restlessness occurs, hunger without desire to eat, and only head sweating, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is suitable. (See discussion under "Restlessness".)
Qi rushing upward to the heart, heart pain, hunger without desire to eat, and vomiting roundworms belong to Jueyin Disease. (See discussion under "Qi Rushing Upward".) If the patient is quiet then becomes restless again, stops after a moment, vomits after eating, becomes restless again, and vomits roundworms, this is Roundworm Jue; Wumei Wan (Mume Pill) is suitable. (Formula discussion see "Jue".)
A patient with cold syndrome who undergoes diaphoresis again will have a cold stomach and must vomit roundworms. (*Huoren Shu* states: First administer Lizhong Wan, then administer Wumei Wan.)
In cases of contracting cold on two channels simultaneously, on the third day, Shaoyang and Jueyin are both diseased, resulting in deafness, retraction of the testicles, and Jue. (See discussion under Taiyin. Note: Deafness is a Shaoyang disease symptom; retraction of testicles and Jue are Jueyin disease symptoms.) In Shanghan, if Jue occurs between one or two days and four or five days, there must be fever. If there was prior fever, Jue will follow; deep Jue corresponds to deep heat, slight Jue corresponds to slight heat. Jue should be treated with purgation; if diaphoresis is used instead, oral lesions and redness will certainly occur. Cheng Wuji said: If Jue and cold extremities occur immediately upon onset, it is pathogenic invasion of Yin channels with insufficient Yang Qi; Sini Tang (Frigid Extremities Decoction) can be used to warm. If hands and feet go from hot to warm, or from Si Ni (Four Reversals) to Jue, it is transmitted channel pathogen; Sini San (Frigid Extremities Powder) is the main formula. This must be recognized to avoid error. (Sini Tang formula see "Diarrhea" below. Sini San formula see "Desire to Sleep".) Additionally, external symptoms must be distinguished. I once treated a middle-aged woman with aversion to cold but body heat and thirst, with a rapid, fine, and weak pulse, presenting first Jue then fever. Treatment with warming medicines aggravated the condition. Later, using half doses of Sini San combined with Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma), her Jue resolved, pulse became surging and large, and she recovered.
Cold hands and feet with a fine pulse nearly imperceptible indicate Danggui Sini Tang (Angelica Decoctio Frigidorum Extremorum).
Herbs: Gancao (Licorice Root), Tongcao (Tetrapanacis Medulla) (each 6 qian); Danggui (Angelicae Sinensis Radix), Guizhi (Cinnamomi Ramulus), Xixin (Asari Radix et Rhizoma), Shaoyao (Paeoniae Radix) (each 1 liang).
Preparation and Administration: Cut herbs. Take 5 qian per dose, add one jujube, decoct together, and take warm.
If the patient has chronic internal cold, Danggui Sini Tang plus Wuzhuyu and Shengjiang (Angelica Decoctio Frigidorum Extremorum plus Evodia and Fresh Ginger) is the main treatment. Add 2 liang of Wuzhuyu and 2.5 liang of Shengjiang to the original formula.
Vomiting with weak pulse, frequent clear urination, slight body heat with Jue is difficult to treat; Sini Tang (Frigid Extremities Decoction) is the main formula.
Shanghan with slippery pulse and Jue indicates internal heat; Baihu Tang (White Tiger Decoction) is the main formula.
Shanghan with hurried pulse and cold hands and feet can be treated with moxibustion. (*Mai Jing* states: Moxibustion is permissible; Shaoyin and Jueyin govern reversal.) In Shanghan lasting six or seven days, with faint pulse, cold hands and feet, and irritability, moxa the Jueyin points. If symptoms persist after moxibustion, death ensues.
Patients with cold hands and feet and sudden tight pulse have pathogenic factors knotted in the chest, fullness and irritability in the heart, hunger but inability to eat; the pathology is in the chest, vomiting is indicated; Gou Ti San (Melon Spine Powder) is suitable. ("Tight pulse" as "knotted pulse" is reasonable.) A pulse that beats fast but occasionally stops and resumes is called Cu (Hurried); a pulse that beats slowly but occasionally stops and resumes is called Jie (Knotted). In Jie and Cu pulses, the pulse pauses due to obstruction by pathogenic factors; moxibustion and vomiting are used to expel these pathogens.
Shaoyin Disease with body pain, cold hands and feet, and sinking pulse indicates Fuzi Tang (Aconite Decoction). (See discussion under "Desire to Sleep".) In Shanghan lasting five or six days, with head sweating, slight aversion to cold, cold hands and feet, epigastric fullness, lack of desire to eat, hard stool, and fine pulse, this is Yang Wei Jie (Minor Yang Knotting), involving both exterior and interior. Sinking pulse also indicates interior involvement. Sweating indicates minor Yang deficiency. If it were pure Yin knotting, there would be no exterior symptoms, all entering the interior; this is half-interior, half-exterior. Although the pulse is sinking and tight, it is not Shaoyin Disease, because Yin syndromes should not have sweating. Since there is head sweating, it is known not to be Shaoyin. Xiao Chai Hu Tang (Minor Bupleurum Decoction) may be given; if discomfort persists, resolution comes with bowel movement.
[From *Ben Cao Yan Yi*] A person suffered from Shanghan for five or six days, with spontaneous head sweating, no sweat from the neck down, cold hands and feet, epigastric stuffiness, and constipation. Some saw cold limbs and sweating with stuffiness and mistook it for Yin Syndrome. I palpated his pulse as sinking and tight. I said: This symptom is indeed suspicious, but hard stool indicates it is not a deficiency knot; how can it be Yin? Although the pulse is sinking and tight, Shaoyin Disease mostly presents with spontaneous diarrhea, rarely constipation. This case is half-interior, half-exterior; administering Xiao Chai Hu Tang (Minor Bupleurum Decoction) resulted in recovery. Zhang Zhongjing's statement about Shanghan for five or six days with head sweating... until resolution with stool, refers precisely to this. Someone questioned: When pulse is tight in all positions with sweating, it is Yang collapse. This belongs to Shaoyin, which should not have sweat. Why? Because there is head sweating, we know it is not Shaoyin. How does head sweating indicate it is not Shaoyin? I said: This passage is where Zhang Zhongjing's reasoning is profound. Cold limbs, sinking-tight pulse, abdominal fullness look exactly like Shaoyin, but hard stool and head sweating rule out Shaoyin. The head is the convergence of the Three Yang channels; the Three Yin channels stop at the chest. Head sweating indicates Yang deficiency, hence "sweating is minor Yang," meaning Yin should not have sweat. If Shaoyin had head sweating, it would be fatal. Thus, Zhang Zhongjing's *Ping Mai Fa* states: The Heart is Fire. Understanding Shaoyin, those without head sweating can be cured; those with head sweating die. The Heart is Hand Shaoyin, the Kidney is Foot Shaoyin; they relate upper and lower. Only by interpreting the intent can one understand this.
In Shanghan, Jue with epigastric palpitations requires treating water retention first; Fu Ling Gan Jiang Tang (Poria and Ginger Decoction) should be taken, then treat the Jue. Otherwise, water will infiltrate the stomach and cause diarrhea.
Fu Ling Gan Jiang Tang
Herbs: Fuling (Poria), Guizhi (Cinnamomi Ramulus) (each 2 qian); Shengjiang (Zingiberis Rhizoma Recens) (3 qian); Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) (1 qian).
Preparation and Administration: Cut herbs, decoct with water, and take warm.
Shaoyin Disease with Si Ni (Four Reversals) or palpitations is treated with Sini San (Frigid Extremities Powder) plus Guizhi (Cinnamomi Ramulus). (Formula discussion see "Desire to Sleep".) In Shanghan with floating pulse, spontaneous sweating, frequent urination, irritability, slight aversion to cold, and leg cramps, giving Guizhi Tang (Cinnamon Twig Decoction) to attack the exterior is an error. This leads immediately to Jue, dry throat, irritability, and vomiting/reversal. Prepare Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) to restore Yang.
If Jue resolves and feet become warm, prepare Shaoyao Gancao Tang (Peony and Licorice Decoction) to extend the legs. If stomach disharmony causes delirium, give a small amount of Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction). If excessive sweating and burning needles were used, Sini Tang (Frigid Extremities Decoction) is the main formula.
Gancao Ganjiang Tang
Herbs: Gancao (Licorice Root) (4 liang), Ganjiang (Zingiberis Rhizoma) (2 liang).
Preparation and Administration: Cut herbs. Take 5 qian per dose, decoct with water, and take warm.
Shaoyao Gancao Tang
Herbs: Baishaoyao (White Paeonia Root), Gancao (Licorice Root) (each 2 liang).
Preparation and Administration: Cut herbs. Take 5 qian per dose, decoct with water, and take warm.
Tiaowei Chengqi Tang (Formula see "Fever"). Sini Tang (Formula see "Diarrhea").
Question: Symptoms resemble Yang Dan syndrome, but treatment worsened it, causing Jue, dry throat, calf cramps, and delirium. Master said: Hands and feet will warm at midnight, legs will extend, which happened. How do you know? Answer: Cun and Chi pulses are floating and large. Floating indicates Wind, Large indicates Deficiency. Wind generates mild heat; Deficiency causes calf cramps. Symptoms resemble Guizhi Tang pattern, so Fuzi (Aconite Root Lateralis Preparata) was added, and Guizhi increased to induce sweating; Fuzi warms meridians and restores Yang. For Jue, dry throat, irritability, Yangming internal knotting, and delirium, drink Gancao Ganjiang Tang again. At midnight, Yang returns, feet warm. If calves remain slightly cramped, give Shaoyao Gancao Tang again to extend them. Use Chengqi Tang to mildly loosen bowels to stop delirium; thus, recovery is known.
Shaoyin Disease with regurgitation after eating, inability to vomit, cold hands and feet, and string-taut slow pulse indicates vomiting is appropriate. (See discussion under "Vomiting".)
Diarrhea with Jue and tenesmus is treated with Sini Tang plus Xiebai (Allii Macrostemonis Bulbus). With faint pulse, Tongmai Sini Tang (Pulse-Resuscitating Frigid Extremities Decoction) or Baitong Tang (Opening the Yang Decoction). After warming, if pulse is absent, Baitong Tang plus Zhu Danzhi (Pig Gallbladder Bile). After sweating, if cramping occurs, Sini Tang. After purgation, if throat is uncomfortable, Mahuang Shengma Tang (Ephedra and Corydalis Decoction). (Formula discussion see "Diarrhea".)
Vomiting and diarrhea with fever, aversion to cold, sweating, and Jue belong to Huoluan (Cholera-like disorder); Sini Tang (Frigid Extremities Decoction) is suitable. Vomiting and diarrhea with extreme irritability and Jue belong to Shaoyin; Wuzhuyu Tang (Evodia Decoction) is suitable. If vomiting and diarrhea stop, pulse is faint and nearly absent with Jue, Tongmai Sini Tang plus Zhu Danzhi (Pig Gallbladder Bile) is used. (Formula discussion see "Vomiting and Diarrhea".)
Heatstroke with dry mouth and thirst: See Heatstroke section.
Shanghan with faint pulse and Jue, progressing to skin cold and constant restlessness after seven or eight days, is Zang Jue (Visceral Jue), not Hui Jue (Roundworm Jue). Hui Jue patients vomit roundworms; they are quiet then intermittently restless due to visceral cold causing roundworms to ascend to the diaphragm. Restlessness stops after a moment. Vomiting and restlessness after eating occur because roundworms smell food and emerge, leading to self-vomiting of roundworms. Hui Jue is treated with Wumei Wan (Mume Pill).
Wumei (Mume Fructus) (75 fruits), Xixin (Asari Radix et Rhizoma), Fuzi (Aconiti Lateralis Radix Preparata, processed, peeled), Renshen (Ginseng Radix et Rhizoma), Huangbai (Phellodendri Cortex), Guizhi (Cinnamomi Ramulus) (each 1 liang), Ganjiang (Zingiberis Rhizoma) (2 liang), Huanglian (Coptidis Rhizoma) (4 liang), Shujiao (Zanthoxyli Pericarpium, stir-fried, sweat removed) (1 liang), Danggui (Angelicae Sinensis Radix).
Grind the ten herbs into fine powder. Soak Wumei in vinegar overnight, remove pits, steam until cooked, pound into paste, mix with powder, place in mortar, add refined honey, pound three thousand times, form pills the size of paulownia seeds. Take ten pills before meals, three times daily, gradually increasing to twenty pills. Avoid raw, cold, and slippery foods.
All Jue syndromes occur when Yin and Yang Qi fail to connect smoothly, resulting in cold extremities.
In Shanghan, if Jue lasts four days and fever three days, then Jue five days, the disease progresses due to excess cold and deficient Yang. If fever lasts four days and Jue three days, with less Jue and more heat, the disease should resolve spontaneously. If heat persists from day four to seven, pus and blood will appear in stool later. If Shanghan starts with six days of fever and nine days of Jue with diarrhea, the patient should not eat. If they can eat now, fear Chu Zhong (Middle Elimination/False Appetite). Feed Suobing (noodles); if no fever follows, stomach Qi remains, and recovery is certain. Fear that stomach heat came and went. Check pulse in three days; if heat continues, recovery is expected at midnight of the next day. Originally fever six days, Jue nine days, plus three more days of fever equals nine days, matching the Jue duration, hence recovery at midnight. If pulse is rapid and heat persists after three days, excess heat will cause abscesses/pus. If Jue and fever each last five days, and Jue does not recur on the sixth day, it resolves spontaneously. Jue does not exceed five days; since heat lasted five days, recovery is known. In Shanghan with slight heat and mild Jue (cold fingertips), silence, lack of desire to eat, irritability for several days, clear urine, and white color, heat is eliminated, desire to eat returns, and disease resolves. If Jue with vomiting and chest/diaphragm fullness occurs, blood in stool will follow later. Fullness and pain in the lower abdomen with Jue indicates Cold Knotting at Guanyuan point. (See discussion under "Lower Abdominal Pain".) Shaoyin Si Ni with aversion to cold, curled posture, absent pulse, irritability without restlessness, is fatal. (See discussion under "Desire to Sleep".)
Shaoyin Disease with only Jue and no sweat: forcing sweating will disturb blood. (See discussion under "Desire to Sleep".) All Si Ni and Jue syndromes contraindicate diaphoresis; so do all deficiency syndromes. In Shanghan lasting five or six days, without Chest Binding, soft abdomen, weak pulse, and Jue, purgation is contraindicated; this is Blood Loss, and purgation leads to death.
All the above Jue reversals contraindicate purgation, except the previously mentioned case of prior fever leading to Jue, where Jue requires purgation; if sweating was used instead, that is the exception: purgation is suitable, sweating is contraindicated.