白头翁三两 黄连（去须）三两 黄柏（去皮）三两 秦皮三两
右四味，以水七升，煮取三升，去滓，温服一升，不愈，更服一升。
【方解】
三阴俱有下利证，自利不渴者，属太阴也；自利而渴者，属少阴也。惟厥阴下利，属
于寒者，厥而不渴，下利清谷，属于热者，消渴下利，下重便脓血也。此热利下重，
乃火郁湿蒸，秽气奔逼广肠，魄门重滞而难出，即『内经』所云：暴注下迫者是也。
君白头翁，寒而苦辛；臣秦皮，寒而苦涩，寒能胜热，苦能燥湿，辛以散火之郁，涩
以收下重之利也；佐黄连清上焦之火，则渴可止；使黄柏泻下焦之热，则利自除也。
治厥阴热利有二，初利用此方之苦以泻火，以苦燥之，以辛散之，以涩固之，是谓以
寒治热之法；久利则用乌梅丸之酸以收火，佐以苦寒，杂以温补，是谓逆之从之，随
所利而行之，调其气使之平也。
@@@
伤寒下利，日十余行，脉反实者死。
【注】
伤寒下利，日十余行，正气虚也，其脉当虚，今反实者，邪气盛也。正虚邪盛，故主
死也。
【集注】
成无己曰：下利里虚也，脉当微弱，反实者，病胜藏也，故死。脉不应病，此之谓也
。
郑重光曰：脉实则胃气失和缓之状，而真藏之脉独见，邪盛正脱矣。
@@@
伤寒六、七日不利，便发热而利，其人汗出不止者死，有阴无阳故也。
【注】
伤寒六、七日，邪传厥阴之时也，厥而不利，是阴邪未盛，若便发热，尚在不死。今
六、七日不利，忽而下利，发热汗出不止者，是阴盛于中，而阳亡于外，故为有阴无
阳也，其死可知矣。
【集注】
方有执曰：发热而利，里阴内盛也，故曰有阴。汗出不止，表阳外绝也，故曰无阳。
程知曰：言暴下利汗出，为亡阳死证也，六、七日不利，忽发热而利下，至于汗出不
止，浑是外阳内阴，真阳顷刻无存矣。
汪琥曰：寒中厥阴至六、七日，当亦厥六、七日矣，不言厥者，省文也。厥则当利不
利者，阳气未败，犹能与邪相支吾也，若至发热，即利者亦当止。今则发热与利，骤
然并至，加之汗出不止，则知其热非阳回而热，乃阳脱而热，故兼下利而汗出不止也
。
张令韶曰：厥阴病发热不死，发热亦死者有三证：一在躁不得卧，一在厥不止，一在
汗出不止。
@@@
发热而厥，七日下利者，为难治。
【注】
此详申上条，发热而厥之义也。发热而厥至七日，若厥回利止，则可以自解矣。今发
热而厥至七日，下利不止者，为难治也。盖上条有阴无阳故主死，此条阴盛而阳不复
，故为难治也。
【集注】
方有执曰：厥七日而下利，阴盛而阳不复也。
张璐曰：厥利与热不两存之势也。发热而厥七日，是热者自热，厥利者自厥利，阴阳
两造其偏，漫无相协之期，故虽未见烦躁，已为难治。盖治其热则愈厥愈利，治其厥
利则愈热，不至阴阳两绝不止耳。
@@@
下利脉沉而迟，其人面少赤，身有微热，下利清谷者，必郁冒汗出而解，病人必微厥
，所以然者，其面戴阳，下虚故也。
【注】
脉沉而迟，下利清谷，是里有阴寒也，若其人面有少赤色，身有微热，又属表有阳热
也。夫内有里阴之寒，外有表阳之热，则阴得阳化而解者有之。但其未解之先，病人
必郁冒汗出而后解。所以然者，面戴之虚阳，与下利之虚阴，两相和顺，故作解也。
此非在下之阴，格在上之阳，所以病人虽冒而厥必微，必不似不解之冒厥而甚也。
【集注】
喻昌曰：下利脉沉迟，里寒也，面少赤有微热，是仍兼外邪，必从汗解。但戴阳之证
，必见微厥，此中大伏危机，其用法当迥异常法矣。六经皆有下利之证，惟少阴、厥
阴为难治。盖邪气入里，利深则必致厥，厥深亦必致利，故下利一证，经于少阴、厥
阴，皆详言之。盖以伤寒下利，则无论少阴、厥阴，其治法皆可会通也。
汪琥曰：郁冒者，头目之际，郁然昏冒，乃阳气能胜寒邪，里阳回而表和顺，故解。
汗出而解，是阳回里寒散而荣卫和，故汗出，非攻表而使之汗出也。
@@@
下利清谷，里寒外热，汗出而厥者，通脉四逆汤主之。
【注】
此承上条互详其义，以出其治也。下利清谷，里寒也；身有微热，外热也。上条有无
汗怫郁面赤之表，尚可期其冒汗而解。此条汗出而厥，则已露亡阳之变矣。故主以通
脉四逆汤，救阳以胜阴也。
【集注】
方有执曰：下利故曰里寒，阴不守也；外热故，汗出，阳不固也。通脉四逆救表里，
通血气而复阴阳者也。
喻昌曰：上条辨证，此条用药，互相发明。然不但此也，少阴病下利清谷，面色赤者
，已用此法矣。
吴人驹曰：有协热下利者，亦完谷不化，乃邪热不杀谷，其别在脉之阴阳虚实之不同
。
@@@
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。
【注】
通身大汗出，热当去矣。热仍不去，而无他证，则为邪未尽而不解也。今大汗出，热
不去，而更见拘急肢疼，且下利厥逆而恶寒，是阳亡于表，寒盛于里也，故主四逆汤
，温经以胜寒，回阳而敛汗也。
【集注】
方有执曰：大汗出，阳虚而表不固也；热不去，言邪不除也；内拘急四肢疼者，亡津
液而骨气不利也；下利厥逆，恶寒亡阳，而阴寒内甚也。
程知曰：言大汗后下利厥逆，急宜回阳也。大汗出而热不去，正恐真阳飞越，若内拘
急，四肢痛，更加下利，厥逆，恶寒，则在里，纯是阴寒矣。
程应旄曰：此证大汗出热不去，何为不在亡阳死证之列？不知亡阳由于汗不止而阳亡
，此证内拘急，四肢疼，是汗已止，阳未亡而恶寒，故可行温法也。
@@@
大汗，若大下利而厥冷者，四逆汤主之。
【注】
大汗出汗不收者，桂枝加附子汤证也。大下利，利不止者，理中加附子汤证也。今大
汗出，又大下利不止，而更见厥冷，乃阳亡于外，寒盛于中，非桂枝理中之所能治矣
，当与四逆汤急回其阳，以胜其阴，使汗利止而厥冷还，则犹可生也。以上三条，皆
厥阴少阴同病，因少阴寒甚，故俱从少阴主治也。
【集注】
喻昌曰：此证无外热相错，其为阴寒易明，然既云大汗大下，则阴津亦亡，但此际不
得不以救阳为急，阳回方可徐救其阴也。
@@@
下利，手足厥冷，无脉者，灸之不温，若脉不还，反微喘者死。下利后脉绝，手足厥
冷，晬时脉还，手足温者生，脉不还者死。
【注】
下利手足厥冷无脉者，有阴无阳也。虽用附子四逆辈，恐阳不能急回，宜急灸厥阴以
通其阳。若脉还手足温者生，脉不还手足不温，反微喘者，乃无气以续之喘，是阳气
上脱也，故主死。
【集注】
方有执曰：其喘必息短而声不续，乃阳气衰绝也。
程知曰：少阴下利，厥逆无脉，服白通汤，脉暴出者死，微续者生。厥阴下利，厥逆
脉绝，用灸法，晬时脉还者生，不还者死。可见求阳气者，非泛然求之于无何有之乡
也，必两肾之中有几微可续，然后可藉温灸为鸾胶耳！
@@@
伤寒发热，下利厥逆，躁不得卧者，死。伤寒发热，下利至甚，厥不止者，死。
【注】
伤寒发热下利而厥，反烦躁不得卧者，乃寒盛于中，孤阳扰乱也。或发热下利至甚，
厥逆不止，即不烦躁，亦为表阳外散，里阳内脱，故均死也。
【集注】
成无己曰：伤寒发热，邪在表也；下利厥逆，阳气虚也；躁不卧，病胜藏也，故死。
『金匮要略』云：六府气绝于外者，手足寒；五藏气绝于内者，下利不禁。伤寒发热
，为邪独甚，下利至甚，厥不止，为府藏气绝，故死。
程知曰：厥阴病，但发热即不死，以发热则邪出于表，而里证自除。若外发热而内厥
逆，下利不止，且至烦躁不解，则发热又为阳气外散之候，而主死矣。
张璐曰：躁不得卧，肾中阳气越绝之象也。大抵下利而手足厥冷者，皆为危候，以四
肢为诸阳之本故也。加以发热躁不得卧，不但虚阳发露，而真阴亦已消尽无余矣，安
得不死乎？
@@@
呕而脉弱，小便复利，身有微热，见厥者，难治，四逆汤主之。
【注】
厥阴呕而脉弱，大便多利，今小便复利，虽身有微热，而又见厥冷，是邪既上逆，而
下焦虚寒不固，为阴进阳退之象，故为难治。以四逆汤主之者，急壮其阳也，阳回则
可望生矣。
【集注】
方有执曰：脉弱虽似邪衰，而小便复利，则是里属虚寒也。故曰：见厥者难治。以身
之有微热，故虽厥犹可以四逆汤救其阳，使之复也。
程知曰：言呕而厥者，宜温其下也。呕者，邪气上逆也。脉弱小便利，虚寒见于下也
。身有微热，当为阳邪在表，然见厥逆，则为阴盛于里，而微阳有不能自存之忧也。
汪琥曰：按诸条厥利证，皆大便利。此条以呕为主病，独小便利而见厥，前后不能关
锁，用四逆汤以附子散寒，下逆气，助命门之火，上以除呕，下以止小便，外以回厥
逆也。
@@@
干呕吐涎沫，头痛者，吴茱萸汤主之。
【注】
太阴有吐食而无呕也；少阴有欲吐不吐，咳而呕也；厥阴之厥而呕，呕而吐蛔也。今
干呕者，有声无物之谓也；吐涎沫者，清涎冷沫随呕而出也，此由厥阴之寒，上干于
胃也。三阳有头痛，必兼身热，至于太阴、少阴二经，皆无头痛，惟厥阴与督脉会于
巅，故有头痛而无身热也。此少阳不解，传入厥阴，阴邪上逆，故呕而头痛也。以吴
茱萸汤主之，从厥阴本治也。
【集注】
程知曰：此言呕而头痛者，宜温中而降逆也。
张锡驹曰：呕者，有声有物者也；吐者，吐出其物也。故有干呕，而无干吐，今干呕
吐涎沫者，涎沫随呕而吐出也。
@@@
呕家有痈脓者，不可治呕，脓尽自愈。
【注】
心烦而呕者，内热之呕也；渴而饮水呕者，停水之呕也。今呕而有脓者，此必内有痈
脓，故曰不可治，但俟呕脓尽自愈也。盖痈脓腐秽欲去而呕，故不当治，若治其呕，
反逆其机，热邪内壅，阻其出路，使无所泄，必致他变，故不可治呕，脓尽则热随脓
去，而呕自止矣。
【集注】
汪琥曰：肺胃成痈，由风寒蕴于经络，邪郁于肺，或入胃府，变而为热，热甚则气瘀
血积而为痈。痈者，壅也，言热毒壅聚而成脓也。
郑重光曰：邪热上逆 ，结为内痈，肺胃之痈是也。
@@@
厥阴中风，脉微浮，为欲愈，不浮为未愈。
【注】
厥阴中风，该伤寒而言也。脉微，厥阴脉也。浮，表阳脉也。厥阴之病，既得阳浮之
脉，是其邪已还于表，故为欲愈也。不浮则沉，沉，里阴脉也。是其邪仍在于里，故
为未愈也。
【集注】
成无己曰：脉浮，为邪气还表作汗之兆，故云：欲愈。不浮则邪气深入，正多变证，
故云：未愈。
方有执曰：风脉当浮，以厥阴本微缓不浮，故微浮则邪见还表，为欲愈也。
@@@
厥阴病，欲解时，从丑至卯上。
【注】
丑、寅、卯三时，厥阴风木乘王之时也。正气得其王，则邪自退，故病解。
【集注】
方有执曰：厥阴之解，自寅卯而终；少阳之解，自寅卯而始。盖寅为阳初动，阴尚强
，卯为天地辟，阴阳分，所以二经同旺，其病之解，由此而终始也。
音切
撞宅江切 渍疾智切 蒂音帝 食与饲同 索当作素 瘾于容切 痹音畀 清与圊同
圊七情切 晬祖对切
白头翁三两，黄连（去须）三两，黄柏（去皮）三两，秦皮三两。
以上四味药，用水七升，煎煮至三升，滤去药渣，温服一升；若未痊愈，再服一升。
【方解】
太阴、少阴、厥阴三阴经都有下利（腹泻）的证候，自发性腹泻且不口渴的，属于太阴病；自发性腹泻且口渴的，属于少阴病。只有厥阴病的下利，属于寒证的，表现为四肢厥冷且不口渴，腹泻排出未消化的食物；属于热证的，表现为消渴（极度口渴）、下利伴有肛门重坠感及脓血便。这种热性下利伴肛门重坠，是由于火热郁结、湿气蒸腾，秽浊之气逼迫大肠，导致肛门沉重滞涩而难以排出，也就是《内经》所说的“暴注下迫”（急骤的腹泻和里急后重）。
以白头翁为君药，性寒味苦辛；以秦皮为臣药，性寒味苦涩。寒能清热，苦能燥湿，辛能发散火邪之郁结，涩能收敛止住下利重坠之症；佐以黄连清上焦之火，则口渴可止；使以黄柏泻下焦之热，则下利自然消除。
治疗厥阴热利有两种情况：初起利用此方的苦味以泻火，用苦味燥湿，用辛味散火，用涩味固脱，这叫做以寒治热的方法；久利则使用乌梅丸的酸味以收敛火邪，辅以苦寒药，杂入温补药，这叫做逆其病势或顺其病势，随其所利而行之，调和气机使其平复。
@@@
伤寒病出现下利，一天十几次，脉象反而实大有力的，主死证。
【注】
伤寒病出现下利，一天十几次，说明正气虚弱，其脉象应当虚软，现在反而实大有力，说明邪气亢盛。正气虚弱而邪气亢盛，所以主死证。
【集注】
成无己说：下利是里虚，脉象应当微弱，反而实大，是病邪胜过脏腑正气，所以死。脉象与病情不符，说的就是这种情况。
郑重光说：脉实则是胃气失去了和缓的特征，而真脏脉独现，这是邪气盛而正气脱失。
@@@
伤寒病六七天，原本没有下利，突然发热并出现下利，其人汗出不止的，主死证，这是因为有阴无阳的缘故。
【注】
伤寒病六七天，是邪气传入厥阴经的时候，如果四肢厥冷而没有下利，说明阴邪不盛，如果此时发热，尚不属于死证。现在六七天没有下利，忽然出现下利，加上发热汗出不止，这是阴寒盛于内，而阳气亡脱于外，所以称为有阴无阳，其死亡是可以预料的。
【集注】
方有执说：发热并下利，是里阴内盛，所以说有阴。汗出不止，是表阳外绝，所以说无阳。
程知说：说的是暴发性下利伴出汗，是亡阳的死证。六七天没有下利，忽然发热而下利，以至于汗出不止，完全是外阳内阴，真阳顷刻间无存了。
汪琥说：寒邪中于厥阴经到了六七天，应当也有六七天四肢厥冷，这里不说厥冷，是省略了文字。如果有厥冷却不当下利而下利，说明阳气未败，还能与邪气相持。如果到了发热阶段，即使下利也应当停止。现在是发热与下利骤然同时出现，再加上汗出不止，就知道这个热不是阳气回复的热，而是阳气脱失的热，所以兼见下利和汗出不止。
张令韶说：厥阴病发热不死，但发热也有三种死证：一是躁动不能卧，二是厥冷不止，三是汗出不止。
【注】
这条详细阐述上一条发热而厥冷的含义。发热而厥冷到了七天，如果厥冷回温、下利停止，就可以自愈了。现在发热而厥冷到了七天，下利仍不止，所以为难治。因为上一条是有阴无阳所以主死，这一条是阴盛而阳气不复返，所以为难治。
【集注】
方有执说：厥冷七天而下利，是阴盛而阳气不复。
张璐说：厥冷下利与发热是不能两存的态势。发热而厥冷七天，是热的自热，厥冷下利的自厥冷下利，阴阳各自偏向一边，没有协调的时候，所以虽然未见烦躁，也已经难治了。大概治疗发热则会加重厥冷和下利，治疗厥冷下利则会加重发热，不到阴阳两绝的地步不会停止。
@@@
下利，脉象沉而迟，其人面部微红，身体有轻微发热，下利排出未消化食物的，必定会出现头目昏冒、出汗而后病解，病人必定有轻微厥冷。之所以这样，是因为面戴阳（虚阳上浮），下部虚寒的缘故。
【注】
脉沉而迟，下利排出未消化食物，这是里有阴寒。如果其人面部有少许红色，身体有轻微发热，又属于表有阳热。体内有里阴之寒，体表有表阳之热，那么阴寒得阳气化解而病解的情况是有的。但在未解之前，病人必定先出现头目昏冒、出汗然后才病解。之所以这样，是因为面上浮越的虚阳，与下利导致的下焦虚阴，两者相互和顺，所以作解。这不是在下之阴格拒在上之阳，所以病人虽然昏冒但厥冷必轻微，一定不像病不解时那样昏冒和厥冷严重。
【集注】
喻昌说：下利脉沉迟，是里寒；面微红有微热，是仍兼外邪，必定从汗解。但戴阳证，必定见轻微厥冷，这其中潜伏着危机，其用法应当迥异于常法。六经都有下利的证候，只有少阴、厥阴为难治。大概邪气入里，下利深则必致厥冷，厥冷深也必致下利，所以下利一证，在少阴、厥阴都详细论述了。大概伤寒下利，无论少阴、厥阴，其治法都可以融会贯通。
汪琥说：郁冒，是指头目之间，郁然昏冒，这是阳气能胜寒邪，里阳回复而表和顺，所以病解。出汗而解，是阳气回复、里寒消散而营卫调和，所以出汗，不是通过发汗药强行使之出汗。
@@@
下利排出未消化食物，里寒外热，出汗且四肢厥冷的，用通脉四逆汤主治。
【注】
这条承接上一条互相详述其义，以提出治疗方法。下利排出未消化食物，是里寒；身体有轻微发热，是外热。上一条有无汗、怫郁面赤的表证，还可以期望其昏冒出汗而解。这一条汗出且厥冷，则已经显露亡阳的变证。所以用通脉四逆汤，救阳气以战胜阴寒。
【集注】
方有执说：下利所以叫里寒，是阴气不守；外热所以汗出，是阳气不固。通脉四逆汤救治表里，通行血气而复阴阳。
喻昌说：上一条辨证，这一条用药，互相发明。然而不仅如此，少阴病下利排出未消化食物，面色赤的，已经用过此法了。
吴人驹说：有协热下利的，也完谷不化，是邪热不能腐熟水谷，区别在于脉象的阴阳虚实不同。
@@@
大汗出，热不退，腹部拘急，四肢疼痛，又下利、四肢厥冷且恶寒的，用四逆汤主治。
【注】
全身大汗出，热应当退了。热仍不退，且没有其他症状，则是邪气未尽而不解。现在大汗出，热不退，而又见腹部拘急、肢体疼痛，且下利、四肢厥冷且恶寒，这是阳气亡脱于表，寒邪盛于里，所以用四逆汤，温经脉以胜寒，回阳气以敛汗。
【集注】
方有执说：大汗出，是阳虚而表不固；热不退，是说邪气未除；内拘急四肢疼，是亡津液而骨气不利；下利厥逆，恶寒亡阳，是阴寒内甚。
程知说：说的是大汗后下利厥逆，急需回阳。大汗出而热不退，正恐真阳飞越，如果内拘急，四肢痛，更加下利，厥逆，恶寒，则在里，纯是阴寒了。
程应旄说：此证大汗出热不退，为什么不在亡阳死证之列？不知道亡阳是由于汗不止而阳亡，此证内拘急，四肢疼，是汗已止，阳未亡而恶寒，所以可行温法。
【注】
大汗出而汗不收者，是桂枝加附子汤证。大下利，利不止者，是理中加附子汤证。现在大汗出，又大下利不止，而且更见厥冷，乃是阳气亡脱于外，寒邪盛于中，不是桂枝汤、理中汤所能治疗的，应当给予四逆汤急回其阳气，以胜其阴寒，使汗利止而厥冷回，则还有生机。以上三条，都是厥阴少阴同病，因少阴寒甚，所以都从少阴主治。
【集注】
喻昌说：此证无外热相错，其为阴寒容易明白，然而既说大汗大下，则阴津也亡失，但此刻不得不以救阳为急务，阳气回复方可慢慢救其阴。
@@@
下利，手足厥冷，无脉的，艾灸后若不回暖，如果脉不还复，反而轻微喘息的，主死。下利后脉绝，手足厥冷，一昼夜后脉还复，手足温暖的生，脉不还复的死。
【注】
下利手足厥冷无脉，是有阴无阳。虽然用附子四逆之类，恐怕阳气不能急回，宜急灸厥阴经以通其阳气。如果脉还手足温者生，脉不还手足不温，反而轻微喘息者，乃是无气以续之喘，是阳气上脱，所以主死。
【集注】
方有执说：其喘必定气息短促而声音不连续，是阳气衰绝。
程知说：少阴下利，厥逆无脉，服白通汤，脉暴出者死，微续者生。厥阴下利，厥逆脉绝，用灸法，一昼夜后脉还复者生，不还复者死。可见求阳气者，不是泛然在无何有之乡寻求，必须两肾之中有几微可续，然后可借温灸为鸾胶耳！
@@@
伤寒发热，下利厥逆，躁动不得卧的，死。伤寒发热，下利极甚，厥冷不止的，死。
【注】
伤寒发热下利而厥，反烦躁不得卧者，是寒盛于中，孤阳扰乱。或者发热下利极甚，厥逆不止，即使不烦躁，也是表阳外散，里阳内脱，所以均主死。
【集注】
成无己说：伤寒发热，邪在表；下利厥逆，阳气虚；躁不卧，病胜藏，所以死。《金匮要略》说：六腑气绝于外者，手足寒；五脏气绝于内者，下利不禁。伤寒发热，为邪独甚，下利至甚，厥不止，为府藏气绝，所以死。
程知说：厥阴病，但发热即不死，因为发热则邪出于表，而里证自除。若外发热而内厥逆，下利不止，且至烦躁不解，则发热又为阳气外散之候，而主死。
张璐说：躁不得卧，是肾中阳气越绝之象。大概下利而手足厥冷者，皆为危候，因为四肢为诸阳之本。加以发热躁不得卧，不但虚阳发露，而真阴亦已消尽无余，怎么能不死呢？
@@@
呕吐而脉弱，小便反而通利，身体有轻微发热，见厥冷的，难治，用四逆汤主治。
【注】
厥阴呕吐而脉弱，大便多利，现在小便反而通利，虽身体有轻微发热，而又见厥冷，是邪气既上逆，而下焦虚寒不固，为阴进阳退之象，所以为难治。用四逆汤主治的，是急壮其阳气，阳气回复则有望生。
【集注】
方有执说：脉弱虽似邪衰，而小便通利，则是里属虚寒。所以说：见厥冷者难治。因为身体有微热，所以虽厥冷犹可以用四逆汤救其阳，使之回复。
程知说：说的是呕吐而厥冷者，宜温其下。呕吐，是邪气上逆。脉弱小便利，虚寒见于下。身体有微热，当为阳邪在表，然而见厥逆，则为阴盛于里，而微阳有不能自存之忧。
汪琥说：按诸条厥利证，皆大便利。此条以呕吐为主病，独小便利而见厥冷，前后不能关锁，用四逆汤以附子散寒，降逆气，助命门之火，上以除呕，下以止小便，外以回厥逆。
【注】
太阴有吐食而无呕；少阴有欲吐不吐，咳而呕；厥阴之厥而呕，呕而吐蛔。现在干呕，是有声无物；吐涎沫，是清稀冷沫随呕而出，这是由于厥阴之寒，上干于胃。三阳经有头痛，必兼身热，至于太阴、少阴二经，皆无头痛，只有厥阴与督脉会于巅顶，所以有头痛而无身热。这是少阳不解，传入厥阴，阴邪上逆，所以呕而头痛。用吴茱萸汤主治，是从厥阴本经治疗。
【集注】
程知说：这说的是呕吐而头痛者，宜温中而降逆。
张锡驹说：呕，是有声有物；吐，是吐出其中之物。所以有干呕，而无干吐，现在干呕吐涎沫，是涎沫随呕而吐出。
【注】
心烦而呕者，是内热之呕；渴而饮水呕者，是停水之呕。现在呕吐而有脓，这必定内有痈脓，所以说不可治，只等待呕脓尽则自愈。大概痈脓腐秽欲去而呕，所以不当治，若治其呕，反逆其机，热邪内壅，阻其出路，使无所泄，必致他变，所以不可治呕，脓尽则热随脓去，而呕自止。
【集注】
汪琥说：肺胃成痈，由风寒蕴于经络，邪郁于肺，或入胃府，变而为热，热甚则气瘀血积而为痈。痈者，壅也，言热毒壅聚而成脓。
郑重光说：邪热上逆，结为内痈，肺胃之痈是也。
@@@
厥阴中风，脉微浮，为欲愈，不浮为未愈。
【注】
厥阴中风，包括伤寒而言。脉微，是厥阴脉。浮，是表阳脉。厥阴的病，既然得到阳浮之脉，是其邪气已还于表，所以为欲愈。不浮则沉，沉，是里阴脉。是其邪仍在里，所以为未愈。
【集注】
成无己说：脉浮，为邪气还表作汗之兆，所以说：欲愈。不浮则邪气深入，正多变证，所以说：未愈。
方有执说：风脉当浮，以厥阴本微缓不浮，故微浮则邪见还表，为欲愈。
@@@
厥阴病，欲解时，从丑时至卯时。
【注】
丑、寅、卯三个时辰，是厥阴风木旺盛之时。正气得其旺盛，则邪气自退，所以病解。
【集注】
方有执说：厥阴之解，自寅卯而终；少阳之解，自寅卯而始。盖寅为阳初动，阴尚强，卯为天地辟，阴阳分，所以二经同旺，其病之解，由此而终始也。
音切
撞宅江切 渍疾智切 蒂音帝 食与饲同 索当作素 瘾于容切 痹音畀 清与圊同 圊七情切 晬祖对切
Baitouweng San (Pulsatilla Decoction) consists of Baitouweng Radix (3 liang), Huanglian Rhizoma Coptidis (3 liang, remove the whiskers), Huangbai Cortex Phellodendri (3 liang, remove the bark), and Qinpi Cortex Fraxini (3 liang).
These four ingredients are decocted in seven sheng of water until three sheng remain. The dregs are strained off, and the liquid is taken warm, one sheng at a time. If not cured, administer another sheng.
[Formula Analysis]
Taiyin, Shaoyin, and Jueyin syndromes all present with diarrhea (Xiali). Spontaneous diarrhea without thirst belongs to Taiyin; spontaneous diarrhea with thirst belongs to Shaoyin. Only Jueyin diarrhea differs: cold-type presents with cold limbs, no thirst, and diarrhea of undigested food; heat-type presents with excessive thirst (Xiaoke), diarrhea with a sensation of heaviness and tenesmus in the anus, and pus and blood in the stool. This heat-type diarrhea with tenesmus is caused by fire stagnation and dampness steaming, where turbid qi forces upon the large intestine, causing the anus to feel heavy and difficult to evacuate. This corresponds to what the *Neijing* calls "sudden violent diarrhea with urgent straining" (Baozhu Xiapo).
Baitouweng Radix is the sovereign herb, cold in nature with bitter and acrid flavors; Qinpi Cortex is the minister herb, cold in nature with bitter and astringent flavors. Cold clears heat, bitterness dries dampness, acridity disperses the stagnation of fire, and astringency stops the tenesmus and diarrhea; Coptidis Rhizome assists by clearing fire in the Upper Jiao, thus stopping thirst; Phellodendri Cortex acts as the envoy by draining heat from the Lower Jiao, thus eliminating diarrhea.
There are two approaches to treating Jueyin heat diarrhea: for early-stage cases, use the bitterness of this formula to drain fire, dry dampness with bitterness, disperse fire with acridity, and consolidate with astringency; this is the method of treating heat with cold. For chronic cases, use the sourness of Wumei Wan to collect fire, assisted by bitter-cold herbs and mixed with warm-tonic herbs; this follows the principle of opposing or following the disease pathogenesis, acting according to what is beneficial, harmonizing Qi to restore balance.
@@@
In Shanghan (Cold Damage) presenting with diarrhea occurring more than ten times a day, if the pulse is unexpectedly excess-strong, it indicates a fatal prognosis.
[Annotation]
Shanghan with frequent diarrhea indicates deficiency of Zhengqi (Upright Qi); the pulse should be deficient. An unexpectedly excess pulse indicates excess of Xieqi (Pathogenic Qi). With deficient Zhengqi and excess Xieqi, death is indicated.
[Collected Notes]
Cheng Wuji states: Diarrhea indicates interior deficiency; the pulse should be weak and faint. An excess pulse means the disease overcomes the Zang organs, hence death. This is when the pulse does not match the disease.
Zheng Zhongguang states: An excess pulse indicates that the Stomach Qi has lost its gentle and moderate quality, revealing the True Zang pulse alone. This signifies excess pathogen and collapse of upright Qi.
@@@
In Shanghan, after six or seven days, if there was previously no diarrhea but suddenly fever and diarrhea appear, accompanied by incessant sweating, it indicates a fatal prognosis due to Yin being present while Yang is absent.
[Annotation]
Six or seven days into Shanghan is when pathogens transmit to the Jueyin channel. If there were cold limbs without diarrhea, the Yin pathogen was not strong; fever at this stage would not necessarily be fatal. However, sudden onset of diarrhea after six or seven days, combined with fever and incessant sweating, indicates severe Yin cold internally and collapse of Yang externally. Thus, it is described as "Yin present, Yang absent," leading to a known fatal outcome.
[Collected Notes]
Fang Youzhi states: Fever with diarrhea indicates internal abundance of Yin cold, hence "Yin present." Incessant sweating indicates external extinction of Yang, hence "Yang absent."
Cheng Zhi states: This describes acute diarrhea with sweating as a sign of Yang collapse and death. After six or seven days without diarrhea, sudden fever and diarrhea leading to incessant sweating indicate complete exterior Yang and interior Yin, with True Yang perishing instantly.
Wang Hu states: Cold invading Jueyin by the sixth or seventh day should involve six or seven days of cold limbs; omitting mention of cold limbs is an ellipsis. If cold limbs occurred without diarrhea, Yang was not yet defeated and could resist the pathogen. By the time fever appears, even if diarrhea occurs, it should stop. Here, fever and diarrhea occur simultaneously, plus incessant sweating, indicating the fever is not a return of Yang but a collapse of Yang. Hence, it accompanies diarrhea and sweating.
Zhang Lingshao states: Jueyin disease with fever is not necessarily fatal, but three types of fever lead to death: restlessness preventing lying down, unrelenting cold limbs, and incessant sweating.
@@@
Fever with cold limbs, progressing to diarrhea on the seventh day, is difficult to treat.
[Annotation]
This elaborates on the meaning of fever with cold limbs. If cold limbs resolve and diarrhea stops by the seventh day, self-recovery is possible. However, if fever and cold limbs persist for seven days with ongoing diarrhea, it is difficult to treat. The previous clause cited "Yin present, Yang absent" as fatal; this clause cites Yin excess with non-returning Yang as difficult to treat.
[Collected Notes]
Fang Youzhi states: Seven days of cold limbs followed by diarrhea indicates Yin excess and non-returning Yang.
Zhang Lu states: Cold limbs/diarrhea and fever are mutually exclusive tendencies. Persistent fever and cold limbs for seven days mean heat remains heat, and cold/diarrhea remains cold, with Yin and Yang deviating to extremes without coordination. Even without restlessness, it is difficult to treat. Treating heat worsens cold/diarrhea; treating cold/diarrhea worsens heat, potentially leading to total Yin-Yang exhaustion.
@@@
Diarrhea with a deep and slow pulse, slight facial redness, mild body heat, and diarrhea of undigested food will likely resolve after the patient experiences vertigo/dizziness (Yumao) and sweating. The patient will have mild cold limbs. This is because the facial redness represents floating deficient Yang (Daiyang) due to lower deficiency.
[Annotation]
A deep and slow pulse with diarrhea of undigested food indicates interior Yin cold. Slight facial redness and mild body heat suggest exterior Yang heat. Interior Yin cold combined with exterior Yang heat can resolve through transformation by Yang. Before resolution, the patient must experience vertigo and sweating. This occurs because the floating deficient Yang on the face and the deficient Yin from diarrhea harmonize, leading to resolution. This is not Yin rejecting Yang at the top; thus, although dizzy, the cold limbs are mild, unlike severe dizziness and cold limbs in unresolved cases.
[Collected Notes]
Yu Chang states: Deep/slow pulse and diarrhea indicate interior cold; slight redness and mild heat indicate residual exterior pathogen, resolving via sweating. Daiyang syndrome always shows mild cold limbs, hiding a critical danger requiring unusual treatment methods. Among the Six Channels, only Shaoyin and Jueyin diarrhea are difficult to treat. Pathogens entering the interior cause deep diarrhea leading to cold limbs, and deep cold limbs leading to diarrhea. Thus, these channels detail diarrhea extensively, allowing therapeutic convergence.
Wang Hu states: Yumao refers to head/eye dizziness, indicating Yang Qi overcoming Cold pathogen, returning interior Yang, and harmonizing exterior, leading to resolution. Sweating indicates returned Yang, dispersed interior cold, and harmonized Ying-Wei, not forced sweating.
@@|
Diarrhea of undigested food, interior cold with exterior heat, sweating, and cold limbs are treated with Tongmai Sini Tang (Pulse-Reviving Four Reversals Decoction).
[Annotation]
This continues the previous clause to provide treatment. Diarrhea of undigested food indicates interior cold; mild body heat indicates exterior heat. The previous clause had no-sweat, flushed face, allowing expectation of resolution via sweating. This clause has sweating and cold limbs, revealing Yang collapse. Thus, Tongmai Sini Tang is used to rescue Yang to overcome Yin.
[Collected Notes]
Fang Youzhi states: Diarrhea implies interior cold and failing Yin; exterior heat with sweating implies failing Yang. Tongmai Sini Tang rescues exterior and interior, unifies Blood-Qi, and restores Yin-Yang.
Yu Chang states: The previous clause diagnoses; this clause prescribes medication, illuminating each other. Note that Shaoyin disease with diarrhea of undigested food and red face already uses this method.
Wu Renju states: Heat-collateral diarrhea also presents with undigested food due to pathogenic heat failing to digest grains; differentiation lies in the pulse's Yin/Yang and deficiency/excess.
@@@
Profuse sweating with persistent fever, abdominal cramping, limb pain, plus diarrhea, cold limbs, and aversion to cold are treated with Sini Tang (Four Reversals Decoction).
[Annotation]
Profuse sweating should eliminate fever. Persistent fever without other symptoms indicates lingering pathogen. Here, profuse sweating with persistent fever, plus cramping, limb pain, diarrhea, cold limbs, and aversion to cold, indicates Yang collapse at the exterior and severe Cold at the interior. Sini Tang is used to warm meridians, overcome Cold, restore Yang, and arrest sweating.
[Collected Notes]
Fang Youzhi states: Profuse sweating indicates Yang deficiency and insecure exterior; persistent fever indicates unremoved pathogen; abdominal cramping and limb pain indicate fluid loss and obstructed bone-Qi; diarrhea, cold limbs, and aversion to cold indicate Yang collapse and severe interior Yin-Cold.
Cheng Zhi states: After profuse sweating, diarrhea and cold limbs require urgent Yang restoration. Persistent fever risks flight of True Yang. Cramping, pain, diarrhea, cold limbs, and aversion to cold indicate pure interior Yin-Cold.
Cheng Yingmao states: Why is this not a fatal Yang collapse? Fatal collapse requires incessant sweating. Here, cramping and pain indicate sweating has stopped, Yang is not yet collapsed, and aversion to cold allows warming methods.
@@@
Profuse sweating, or severe diarrhea with cold limbs, are treated with Sini Tang (Four Reversals Decoction).
[Annotation]
Profuse sweating with unrestrained sweat indicates Guizhi Jia Fuzi Tang syndrome. Severe unremitting diarrhea indicates Lizhong Jia Fuzi Tang syndrome. Here, profuse sweating plus severe unremitting diarrhea with cold limbs indicates Yang collapse externally and severe Cold internally, beyond the scope of Guizhi or Lizhong formulas. Sini Tang is urgently needed to restore Yang and overcome Yin, stopping sweat/diarrhea and reversing cold limbs, offering a chance of survival. These three clauses involve concurrent Jueyin and Shaoyin disease; due to severe Shaoyin Cold, they are treated primarily via Shaoyin protocols.
[Collected Notes]
Yu Chang states: Without conflicting exterior heat, interior Yin-Cold is clear. However, profuse sweating and diarrhea deplete Yin fluids. Yet, rescuing Yang is urgent here; only after Yang returns can Yin be slowly restored.
@@@
Diarrhea with cold limbs and absent pulse: if moxibustion fails to warm the limbs and the pulse does not return, but slight panting occurs, it is fatal. After diarrhea, if the pulse is absent and limbs are cold, but the pulse returns and limbs warm within one full day (Zuishi), life is preserved; if the pulse does not return, death ensues.
[Annotation]
Diarrhea with cold limbs and absent pulse indicates Yin present, Yang absent. Although Fuzi and Sini Tang may be used, Yang may not return quickly; urgent moxibustion on Jueyin channels is needed to open Yang. Pulse return and warmth indicate life; non-return with panting indicates Qi exhaustion and Yang collapsing upward, indicating death.
[Collected Notes]
Fang Youzhi states: Panting is short-breathed and discontinuous, indicating Yang depletion.
Cheng Zhi states: In Shaoyin diarrhea with cold limbs and absent pulse, Baixin Tang causes rapid pulse emergence (death) or gradual continuity (life). In Jueyin diarrhea with cold limbs and absent pulse, moxibustion leads to pulse return within a day (life) or non-return (death). Seeking Yang requires finding a trace of continuity in the Kidneys to utilize warming moxibustion effectively.
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Shanghan with fever, diarrhea, cold limbs, and restlessness preventing lying down is fatal. Shanghan with fever, severe diarrhea, and unrelenting cold limbs is fatal.
[Annotation]
Shanghan with fever, diarrhea, and cold limbs, plus restlessness, indicates severe interior Cold disturbing isolated Yang. Alternatively, severe diarrhea and unrelenting cold limbs, even without restlessness, indicate exterior Yang scattering and interior Yang collapsing, both fatal.
[Collected Notes]
Cheng Wuji states: Fever indicates exterior pathogen; diarrhea/cold limbs indicate Yang deficiency; restlessness indicates disease overcoming Zang organs, hence fatal. *Jingui Yaolue* states: Six Fu organ Qi failure externally causes cold hands/feet; Five Zang organ Qi failure internally causes uncontrollable diarrhea. Severe fever, severe diarrhea, and unrelenting cold limbs indicate Fu/Zang Qi failure, hence fatal.
Cheng Zhi states: Jueyin fever alone is not fatal as it expels pathogen outward. But exterior fever with interior cold limbs, severe diarrhea, and restlessness indicates Yang scattering outward, hence fatal.
Zhang Lu states: Restlessness indicates kidney Yang escaping. Diarrhea with cold limbs is critical as limbs are the root of Yang. Added fever and restlessness show not only deficient Yang exposure but total depletion of True Yin, hence fatal.
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Vomiting with a weak pulse, free urination, mild body heat, and cold limbs are difficult to treat and managed with Sini Tang (Four Reversals Decoction).
[Annotation]
Jueyin vomiting with weak pulse usually involves loose stools. Free urination here, despite mild heat and cold limbs, indicates pathogen rebelling upward and lower Jiao deficiency-cold failing to secure, showing Yin advancing and Yang retreating. It is difficult to treat. Sini Tang is used to urgently strengthen Yang; Yang return offers hope for survival.
[Collected Notes]
Fang Youzhi states: Weak pulse suggests declining pathogen, but free urination indicates interior deficiency-cold. Hence, cold limbs make it difficult to treat. Mild heat allows Sini Tang to rescue Yang.
Cheng Zhi states: Vomiting with cold limbs requires warming the lower Jiao. Vomiting is rebellious pathogen; weak pulse and free urination show lower deficiency-cold. Mild heat suggests exterior Yang pathogen, but cold limbs indicate interior Yin excess threatening remaining Yang.
Wang Hu states: Most cold-limb/diarrhea cases involve loose stools. This case focuses on vomiting with free urination and cold limbs, indicating failure of front/back closure. Sini Tang uses Fuzi to scatter cold, direct rebellious Qi downward, assist Mingmen Fire, stop vomiting above, control urination below, and reverse cold limbs outside.
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Dry heaving with expulsion of saliva/phlegm and headache are treated with Wuzhuyu Tang (Evodia Decoction).
[Annotation]
Taiyin has regurgitation without vomiting; Shaoyin has desire to vomit without success, coughing and vomiting; Jueyin has cold-limb vomiting or vomiting with roundworms. Dry heaving is sound without matter; expelling saliva/phlegm means cold fluid follows the heave, caused by Jueyin Cold harassing the Stomach. Three Yang channels have headaches with fever; Taiyin and Shaoyin do not. Only Jueyin connects with the Du vessel at the vertex, causing headache without fever. This results from Shaoyang unresolved transmitting to Jueyin, with Yin pathogen rebelling upward, causing vomiting and headache. Wuzhuyu Tang treats the Jueyin root.
[Collected Notes]
Cheng Zhi states: Vomiting with headache requires warming the middle and directing rebellion downward.
Zhang Xiju states: Vomiting has sound and matter; spitting expels matter. Thus, there is dry heaving but no dry spitting. Here, dry heaving expels saliva/phlegm.
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Vomiting due to abscess pus should not be treated for vomiting; once the pus is exhausted, it heals spontaneously.
[Annotation]
Heart irritability with vomiting indicates interior heat; thirst with water-induced vomiting indicates retained water. Vomiting pus indicates internal abscess. Do not treat the vomiting; wait for pus expulsion. Abscess pus is foul matter trying to exit; treating vomiting opposes this mechanism, trapping heat internally and blocking exit, causing complications. Once pus is gone, heat leaves with it, and vomiting stops.
[Collected Notes]
Wang Hu states: Lung/Stomach abscesses arise from Wind-Cold in collaterals, pathogen stagnating in Lung or entering Stomach, transforming into heat. Extreme heat causes Qi/Blood stasis forming abscess. "Abscess" means obstruction, where heat-toxin gathers into pus.
Zheng Zhongguang states: Pathogenic heat rebels upward, forming internal abscesses like Lung or Stomach abscesses.
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Jueyin Wind Strike with a slightly floating pulse indicates impending recovery; non-floating indicates no recovery.
[Annotation]
Jueyin Wind Strike includes Shanghan. A slightly weak pulse is characteristic of Jueyin; floating is an exterior Yang pulse. Obtaining a floating pulse in Jueyin disease means the pathogen has returned to the exterior, indicating recovery. Non-floating (deep) indicates the pathogen remains interior, indicating no recovery.
[Collected Notes]
Cheng Wuji states: Floating pulse signals pathogen returning to exterior for sweating, hence "recovering." Non-floating means pathogen penetrates deeper, leading to varied complications, hence "not recovering."
Fang Youzhi states: Wind pulses should be floating. Since Jueyin is naturally slightly slow/non-floating, slight floating indicates pathogen returning to exterior, hence "recovering."
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Jueyin disease resolves between Chou and Mao hours (1:00 AM – 7:00 AM).
[Annotation]
Chou, Yin, and Mao hours are when Jueyin Wind-Wood Qi is dominant. When upright Qi gains dominance, pathogens retreat, and the disease resolves.
[Collected Notes]
Fang Youzhi states: Jueyin resolves starting from Yin/Mao; Shaoyang begins resolving from Yin/Mao. Yin is initial Yang movement with strong Yin; Mao is heaven-earth opening with Yin-Yang separation. Both channels prosper here, so their resolution starts and ends here.
Phonetic Guide
Zhuang: Zhai Jiang Qie
Zi: Ji Zhi Qie
Di: Pronounced Di
Shi: Same as Si
Suo: Should be Su
Yin: Yu Rong Qie
Bi: Pronounced Bi
Qing: Same as Qing
Qing: Qi Qing Qie
Zui: Zu Dui Qie