24. 阳邪热厥厥而热, 消渴热气撞心疼, 烦满囊缩舌焦卷, 便硬尚任
大承攻, 四逆不分四逆散, 咳加姜味下痢同, 悸加桂枝腹痛附, 下重
薤白秘尿苓.
【注】阳邪, 谓厥阴邪从阳化之热证也. 厥, 谓手足寒也. 厥而复热,
热而复厥, 是为热厥. 厥微热微, 厥深热深也. 消渴, 谓饮水多而小
便少也. 热气上撞心疼, 是火挟木邪而逆也. 烦满, 谓少腹烦满也.
囊缩, 谓外肾为热灼, 筋缩入腹也. 舌焦卷, 谓舌胎干焦而卷也. 便
硬,谓大便硬, 尚可任攻, 宜大承气汤. 四逆, 谓四肢厥冷也. 不分,
谓寒热之厥, 疑似不分也, 宜四逆散, 疏达厥阴. 其厥不回, 再审寒
热可也. 或咳加生姜, 五味子. 下痢亦加, 故曰同也. 心下悸加桂枝.
腹痛加附子. 泻痢下重加薤白. 秘尿不利加茯苓. 详少阴厥阴篇.
25. 少阴里寒外热证, 面赤身反不恶寒, 厥痢清谷脉微绝, 通脉四逆
主之先, 痢止参加脉不出, 葱入面色赤炎炎, 腹痛加芍咽桔梗, 呕加
圣药用姜鲜.
【注】少阴里寒外热之证, 面赤不恶寒, 格阳外热也. 四肢厥冷, 下
痢清谷, 脉微欲绝, 阴极里寒也, 宜通脉四逆汤主之. 服四逆汤下痢
止, 脉仍不出加人参, 面色赤者加葱, 腹痛加芍药, 咽痛加桔梗, 呕
加生姜. 详少阴篇.
24. 阳邪热厥：出现手足厥冷且伴有发热，口渴多饮，自觉有热气上冲导致心胸疼痛，心烦胀满，阴囊收缩，舌苔焦干卷缩，大便坚硬。此时若患者体质尚能耐受攻下法，可使用大承气汤进行攻下治疗。若将四逆散误认为四逆汤而混淆不清，则需根据兼症加减：咳嗽者加入生姜、五味子；下痢者用药原则相同；心悸者加入桂枝；腹痛者加入附子；里急后重者加入薤白；小便不利者加入茯苓。
【注】所谓“阳邪”，是指厥阴病的邪气从阳化热所形成的热证。“厥”，是指手足寒冷。先出现厥冷随后发热，或发热随后又出现厥冷，这称为热厥。厥冷轻微则发热轻微，厥冷深重则发热深重。“消渴”，是指饮水很多但小便量少。“热气上撞心疼”，是火邪挟带肝木之邪气上逆所致。“烦满”，是指少腹部感到烦闷胀满。“囊缩”，是指外生殖器因热邪灼烧，筋脉拘挛收缩进入腹中。“舌焦卷”，是指舌苔干燥焦黑且舌头卷缩。“便硬”，是指大便坚硬，如果患者身体尚可承受攻下疗法，适宜使用大承气汤。“四逆”，是指四肢厥冷。“不分”，是指寒证与热证引起的厥冷疑似难辨，此时适宜使用四逆散，以疏达厥阴经气。服用后若厥冷不回，再仔细辨别寒热属性即可。若有咳嗽症状，加入生姜、五味子；下痢也加入这两味药，所以说用药原则相同。心下部悸动不安，加入桂枝；腹痛，加入附子；泻痢伴有里急后重，加入薤白；小便闭塞不通，加入茯苓。详细情况请参阅少阴病和厥阴病篇。
25. 少阴病里寒外热证：面部发红，身体反而不觉得怕冷，手足厥冷，下痢排出未消化的食物，脉搏微弱甚至摸不到，应当先用通脉四逆汤治疗。若服药后下痢停止但脉搏仍不出，加入人参；面色赤红如火焰般，加入葱白；腹痛加入芍药；咽痛加入桔梗；呕吐加入生姜。
【注】少阴病里寒外热的证候，表现为面部发红且不恶寒，这是虚阳被格拒于外的假热现象（格阳）。四肢厥冷，下痢排出完谷不化的食物，脉搏微弱欲绝，这是阴寒极盛于里的真寒表现，适宜用通脉四逆汤主治。服用四逆汤类方剂后，若下痢停止但脉搏仍然无法触及，应加入人参；若面色赤红，应加入葱白；若腹痛，加入芍药；若咽痛，加入桔梗；若呕吐，加入生姜。详细情况请参阅少阴病篇。
24. Yang Pathogen Heat Jue: The patient presents with cold extremities accompanied by fever, excessive thirst (Xiao Ke), a sensation of hot qi rushing upward causing heart/chest pain, irritability and abdominal fullness, retraction of the scrotum, and a dry, scorched, curled tongue. If the stool is hard and the patient's constitution can still tolerate purgation, Da Cheng Qi Tang (Major Order the Qi Decoction) may be used for purging. If Si Ni San (Frigid Extremities Powder) is confused with Si Ni Tang (Frigid Extremities Decoction), modifications should be made based on accompanying symptoms: add Sheng Jiang (Zingiberis Rhizoma Recens, Fresh Ginger) and Wu Wei Zi (Schisandrae Chinensis Fructus, Schisandra Berry) for cough; the principle is the same for dysentery; add Gui Zhi (Cinnamomi Ramulus, Cinnamon Twig) for palpitations; add Fu Zi (Aconiti Lateralis Radix Praeparata, Prepared Aconite Root) for abdominal pain; add Xie Bai (Allii Macrostemonis Bulbus, Garlic Bulb) for tenesmus; add Fu Ling (Poria, Poria Cocos) for difficult urination.
[Annotation] "Yang pathogen" refers to a heat syndrome where the pathogen in the Jueyin stage transforms into heat following the Yang aspect. "Jue" refers to cold extremities. When cold extremities are followed by fever, or fever by cold extremities, it is termed Heat Jue. Mild cold extremities indicate mild heat; deep cold extremities indicate deep heat. "Xiao Ke" (excessive thirst) refers to drinking much water but producing little urine. The sensation of hot qi rushing up to cause heart pain indicates fire pathogen carrying Liver Wood pathogen rebelling upward. "Irritability and fullness" refers to irritability and fullness in the lower abdomen. "Scrotal retraction" refers to the external genitalia shrinking into the abdomen due to heat burning the sinews. "Scorched and curled tongue" refers to a dry, scorched tongue coating with a curled tongue body. "Hard stool" refers to hard feces; if the patient can endure purgation, Da Cheng Qi Tang is appropriate. "Si Ni" refers to cold extremities. "Indistinguishable" implies that cold and heat-induced Jue are difficult to differentiate; in such cases, Si Ni San is suitable to soothe and unblock the Jueyin channel. If cold extremities do not resolve after administration, re-evaluate the cold-heat nature. Add Sheng Jiang and Wu Wei Zi for cough; these are also added for dysentery, hence "the same." Add Gui Zhi for epigastric palpitations; add Fu Zi for abdominal pain; add Xie Bai for dysentery with tenesmus; add Fu Ling for urinary retention. Refer to the Shaoyin and Jueyin chapters for details.
25. Shaoyin Syndrome of Interior Cold and Exterior Heat: The face is red, the body does not feel aversion to cold despite the interior cold, there are cold extremities, dysentery with undigested food in the stool, and a faint or imperceptible pulse. Tong Mai Si Ni Tang (Unblocking the Vessels Frigid Extremities Decoction) should be administered first. If dysentery stops but the pulse remains absent after taking Si Ni Tang, add Ren Shen (Ginseng Radix et Rhizoma, Ginseng Root); if the face is intensely red, add Cong Bai (Allii Fistulosi Bulbus, Green Onion Stem); add Shao Yao (Paeoniae Radix Alba, White Peony Root) for abdominal pain; add Jie Geng (Platycodonis Radix, Balloon Flower Root) for sore throat; add Sheng Jiang for vomiting.
[Annotation] In the Shaoyin syndrome of interior cold and exterior heat, facial redness without aversion to cold indicates floating Yang repelled outward (Ge Yang). Cold extremities, dysentery with undigested food, and a faint, nearly absent pulse indicate extreme Yin cold in the interior (Ji Han). Tong Mai Si Ni Tang is indicated. After administering Si Ni Tang, if dysentery ceases but the pulse does not return, add Ren Shen; if the face is red, add Cong Bai; add Shao Yao for abdominal pain; add Jie Geng for sore throat; add Sheng Jiang for vomiting. Refer to the Shaoyin chapter for details.