（仲景。）
（四逆者，四肢厥逆也。再加干姜二两，即通脉四逆汤）
治三阴伤寒（四逆汤为少阴主药，然三阴通用之。太阳证脉沉亦有用此者），身痛腹痛，
下利清谷，恶寒不渴，四肢厥冷；或反不恶寒，面赤烦躁，里寒外热；或干呕，或咽痛，脉
沉微细欲绝（腹痛自利，里寒也。三阴自利居多，身凉脉静者顺，身热脉大者逆。内寒故恶
寒不渴。四肢者，诸阳之本，寒则血脉凝涩，阳气不能散布，故一身尽痛，而手足厥冷也；
反不恶寒，面赤发躁者，阴盛格阳于外也；寒留胸中，故食入即吐；膈有寒饮，故逆而干呕；
虚火上炎，故咽痛；脉沉者，寒则伏藏也。按∶少阴脉有沉、有紧、有数，而仲景统以微细
言之，盖沉必重按始得，紧数亦在沉细中见，不似阳证浮大而紧数也。薛慎斋曰∶人知数为
热，
附子（一枚。生用） 干姜（一两） 甘草（炙。二两。）冷服。面赤者，格阳于上也，
加葱九茎以通阳（喻嘉言曰∶阳虚之人，虽有表证，其汗仍出，其手足必厥，才用表药，立
至亡阳，不用表药，外邪不服，故用前汤加葱为治）；腹痛者，真阴不足也，加芍药二两以
敛阴；咽痛，阴气上结也，加桔梗一两以利咽；利止、脉不出，加人参二两以助阳补气血；
呕吐加生姜二两，以
此足少阴药也。寒淫于内，治以甘热，故以姜附大热之剂伸发阳气，表散寒邪（附子生
用亦能发表）；甘草亦补中散寒之品，又以缓姜附之上僭也（甘草为君，干姜为臣，附子为
使）；必冷服者，寒盛于中，热饮则格拒不纳，经所谓热因寒用，又曰治寒以热，凉而行之
是也（此奇制大剂也。肝肾位远，非大剂不能达。仲景云∶伤寒，医下之，续得下利清谷，
腹满身痛者，急当救里，宜四逆汤；清便自调，身痛者，急当救表，宜桂枝汤。盖身痛尚属
表证，急则先救里而后解表也。厥阴篇曰∶大汗出，热不去，内拘急，四肢痛，又下利厥逆
而恶寒者，四逆汤主之，按∶厥阴证四肢厥冷，指甲青，脉沉疾，按之有力者为阳厥，当下
之，宜大承气汤；如脉沉迟，按之无力者，则为阴厥，宜四逆汤，更须速灸之。凡传经热邪，
则为阳厥，溺赤而四肢热；直中真寒，谓之阴厥，阴缩而四肢冷。程郊倩曰∶世言传经为热
厥，直中为寒厥，斯言甚谬。三阳之厥，多得于失下，此为热厥；少阴之厥，悉属于寒厥，
阴之热厥，仲景书仅有伤寒一二日至四五日而厥者必发热一条，果如传邪之说，则在四五日
固得矣，论中何云一二日，不知何经之邪神速若此。其曰厥应下之者，下其热，非下其厥也，
遇发热则可下，遇厥则万不可下矣。推原其故，厥阴与少阳，一腑一脏，少阳在三阳为尽，
阳尽则阴生，故有寒热之往来；厥阴在三阴为尽，阴尽则阳接，故有寒热之胜复；凡遇此证，
不必论其来自三阳，起自厥阴，只论热与厥之多少，热多厥少，知为阳厥；厥多热少，知为
阴厥；热在后而不退，则阳过胜而阴不能复，遂有喉痹、便血等证；厥在后而不退，则阴过
胜而阳不能复，遂有除中、亡阳等证。仲景所以调停二治法，须合阴阳进退之机，阳胜宜下，
小承气汤中已去芒硝之寒，而有浓朴之温；在厥阴中破阳以行阴，阴胜宜温，纵有阳邪，一
见厥利，便宜乌梅丸，聚辛热之品而加苦寒之佐；在厥阴中破阴以行阳，虽有上热，如篇首
消渴、气上冲心之证，亦不虑其为捍格也。扶阳抑阴之旨微矣。又曰∶乌梅丸于辛酸入肝药
中，微加苦寒，纳逆上之阳邪而顺之使下也，名曰安蛔，实是安胃，故并主下利，见阴阳不
相顺接而下利之证，皆可以此方括之也。经曰∶凡阴阳不相顺接，便为厥，手足逆冷是也。
方中行曰∶三阴三阳之脉，俱相接于手足，阴主寒，阳主热，阳气内陷，不与阴气相顺接，
则手足厥冷也。附∶喻嘉言论桂附丸曰∶脏为阴，可胜纯阳之药；腑为阳，必加阴药一二味
制其僭热；经
本方加白术、大枣，名术附汤（《金匮》）∶治风湿相搏，身体烦疼；及中寒发厥心痛。
本方除甘草，名干姜附子汤（仲景）∶治下后复汗，昼躁夜静，不呕不渴，无表证，脉沉微，
无大热者（昼日烦躁，虚阳扰乱，外见假热也；夜安静，不呕渴，脉沉微，无大热，阴气独
治，内系真寒也，凡阴虚之极阳必厥，阳虚之极阴必躁，姜附直从阴中回阳，不当以昼日烦
躁而疑之矣）。又治中寒厥逆、眩仆无汗，或自汗淋漓（中寒之证，身强、口噤、眩晕、无
汗或自汗者，腠理素虚而阳微也。伤寒发热，中寒不发热，以此为异。仲景于伤寒则详之，
而中寒未之及何也。曰∶阳动阴静，阴寒既郁而成热，遂从乎阳，传变不一，靡有定方，故
极推其病，不得不详也；不热者，阴邪一定而不移，则不变，故不必详也。昂按∶自汗者，
或兼风也）；及外热烦躁，阴盛格阳（阴证似阳）。姜附汤加当归、肉桂，入蜜，和服，名姜
附归桂汤（喻嘉言曰∶服姜附汤后，继服此汤。因姜附专主回阳，而卒中寒邪，先伤营血，
故加归桂逐营分之邪，始得药病相当也）。再加人参、甘草，名姜附归桂参甘汤，加姜煎（喻
氏曰∶服前汤后，继当服此，兼补气血）。本方除甘草，加葱四茎，名白通汤（复阳通脉）。
再加人尿、猪胆汁，名白通加人尿猪胆汁汤（仲景。见后）。本方加人参一两，名四逆加人
参汤（仲景）∶治恶寒，脉微，复利，利止亡血（恶寒脉微复利，阳虚阴胜也；利止则津液
内竭，故云亡血。与四逆温经复阳，加人参生津益血）。再加茯苓（六两），名茯苓四逆汤（仲
景）∶治汗下后病不解而烦躁（过汗则亡阳而表虚，误下则亡阴而里虚，阴阳表里俱虚，乃
生烦躁，故用茯苓、人参入心以除烦，附子、干姜入肾以解躁）。本方除干姜，加芍药三两，
名芍药甘草附子汤（仲景）∶治伤寒发汗不解，反恶寒者，虚故也（汗出表不解而恶寒，独
曰反，其为过汗阳弱可知。汗出为营虚，恶寒为卫虚，若重补其阴则恶寒愈甚，但回其阳则
阴愈劫矣。故用附子以回阳，而加芍药以敛阴，此营卫两虚之救法。李 曰∶汗后亡阳恶寒
者，表虚也，芍药附子甘草汤；下后恶寒者，里虚也，四逆汤；其有表邪未尽者，必兼发热，
柴胡加桂汤；又有里实热伏于内，阳彻于外而恶寒便坚者，犹须下之。《伤寒百问》曰∶汗
后恶寒人必虚，下后发热人必实是也）。本方除附子，用甘草四两、干姜二两，名甘草干姜
汤（仲景）∶治伤寒脉浮自汗，小便数，心烦，微恶寒，脚挛急，用桂枝汤误攻其表，得之
便厥，咽中干，烦躁吐逆，与此汤以复其阳（脉浮、自汗、便数、恶寒，阳不足也。攻表重
虚其阳，得汤便厥，胃之津液伤也，故与甘草益气、干姜助阳，尤虑辛热有伤其阴，随与芍
药甘草汤益其阴血，复其津液，故证虽近于少阴，而不敢用四逆也）。若厥愈足温者，更作
芍药甘草汤，以和其阴，其脚即伸∶芍药、甘草各四两（仲景。别见和解门）。本方加吴茱
萸，名茱萸四逆汤，治厥阴少阴腹痛。本方加当归、木通，名当归四逆汤∶治感寒手足厥冷，
脉细欲绝；及男妇寒疝，脐下冷，引腰胯而痛（寒伤营血，故加当归、木通，能通血脉。仲
景当归四逆汤见后）。本方加茵陈，名茵陈四逆汤∶治阴黄。本方加生脉散、陈皮，名回阳
返本汤∶治阴盛格阳。本方加官桂、良姜、半夏，名浆水散（洁古）∶治虚寒水泻，冷汗，
脉微，甚者呕吐，此为急病（浆水者，泄利浆水，澄澈清冷也。又曰∶加浆水煎之
（张仲景。）
（四逆，是指四肢厥冷。如果在原方基础上再加干姜二两，就是通脉四逆汤。）
主治三阴经伤寒（四逆汤是少阴病的主药，但三阴经疾病通用。太阳病证见脉沉的也有使用此方的），身体疼痛、腹部疼痛，腹泻且排出未消化的食物残渣，怕冷且不口渴，四肢冰冷；或者反而不怕冷，面色发红、烦躁不安，表现为体内寒盛而体表发热；或者干呕，或者咽喉疼痛，脉象沉微细弱几乎摸不到。（腹痛和自发性腹泻属于里寒证。三阴经疾病中自发性腹泻较多，如果身体凉爽、脉象平静缓和为顺证，如果身体发热、脉象洪大为逆证。因为内部有寒邪所以怕冷且不口渴。四肢是诸阳经的根本，寒邪侵袭则血脉凝滞涩阻，阳气不能布散到全身，所以全身都痛，手脚冰凉；反而不怕冷、面色发红、发躁动，这是阴寒太盛将阳气格拒于体外；寒邪停留在胸中，所以吃东西就吐；膈间有寒饮停留，所以气逆而干呕；虚火上炎，所以咽喉痛；脉象沉，是因为寒邪潜伏收藏的缘故。按语：少阴病的脉象有沉、有紧、有数，但张仲景统称为微细，大概是因为沉脉必须重按才能感觉到，紧脉和数脉也出现在沉细脉之中，不像阳证那样浮大而紧数。薛慎斋说：人们知道数脉主热，）
附子（一枚。生用） 干姜（一两） 甘草（炙。二两。） 冷服。如果面色发红，是阳气被格拒于上部，加葱九茎以通阳（喻嘉言说：阳气虚弱的人，即使有表证，汗液仍然流出，手脚必定冰冷，刚用解表药，立刻会导致亡阳；不用解表药，外邪又不除，所以用前面的汤剂加葱来治疗）；如果腹痛，是真阴不足，加芍药二两以收敛阴气；如果咽喉痛，是阴气上结，加桔梗一两以利咽；如果腹泻停止、脉搏不出，加人参二两以助阳补气血；呕吐加生姜二两，以……
这是足少阴肾经的药。寒邪淫溢于内，用甘热的药物来治疗，所以用姜、附大热的药剂来振奋阳气，发散寒邪（附子生用也能发散表邪）；甘草也是补中散寒的药物，又用来缓和姜、附药性上僭（甘草为君药，干姜为臣药，附子为使药）；必须冷服的原因，是因为寒邪盛于中焦，热饮会被格拒而不纳受，这就是《内经》所说的“热因寒用”，又说治疗寒证用热药，但要凉着服用，就是这个道理（这是奇特的制法和大剂量用药。肝肾位置深远，不是大剂量药力不能到达。张仲景说：伤寒，医生误用下法，接着出现腹泻且排出未消化食物，腹胀满身体痛，应当紧急救治里证，宜用四逆汤；如果大小便正常，身体痛的，应当紧急救治表证，宜用桂枝汤。大概身体痛尚属表证，急则先救里而后解表。厥阴篇说：大汗出后，热不退，内部拘急，四肢痛，又伴有腹泻、四肢厥冷和怕冷的，用四逆汤主治。按语：厥阴病证见四肢厥冷，指甲青紫，脉象沉疾，按之有力的是阳厥，应当用下法，宜用大承气汤；如果脉象沉迟，按之无力的是阴厥，宜用四逆汤，更需要迅速艾灸。凡是传经的热邪，导致的是阳厥，小便赤红且四肢热；直中的真寒，称为阴厥，阴器收缩且四肢冷。程郊倩说：世人传说传经为热厥，直中为寒厥，这种说法非常错误。三阳经的厥证，多因失于攻下所致，这属于热厥；少阴经的厥证，全属于寒厥，阴经的热厥，在张仲景书中仅有“伤寒一二日至四五日而厥者必发热”这一条，如果真的像传邪的说法，那么在四五日确实可能，但论述中为什么说一二日，不知道什么经的邪气神速到这种地步。他说“厥应下之”，是下其热，不是下其厥，遇到发热可以下，遇到厥逆万万不可下。推究其原因，厥阴与少阳，一腑一脏，少阳在三阳经中为尽，阳尽则阴生，所以有寒热往来的症状；厥阴在三阴经中为尽，阴尽则阳接，所以有寒热胜复的症状；凡遇到这种情况，不必论其来自三阳还是起自厥阴，只论热与厥的多少，热多厥少，知道是阳厥；厥多热少，知道是阴厥；热在后面不退，则阳过盛而阴不能恢复，于是出现喉痹、便血等证；厥在后面不退，则阴过盛而阳不能恢复，于是出现除中、亡阳等证。张仲景之所以调和这两种治法，必须结合阴阳进退的机理，阳胜适宜用下法，小承气汤中已经去掉了芒硝的寒性，而有浓朴的温性；在厥阴经中破阳以行阴，阴胜适宜用温法，纵有阳邪，一见厥逆腹泻，就适宜用乌梅丸，聚集辛热的药物加上苦寒的佐使；在厥阴经中破阴以行阳，虽然有上热，如篇首提到的消渴、气上冲心等证，也不必担心它们格格不入。扶阳抑阴的宗旨很微妙了。又说：乌梅丸在辛酸入肝的药物中，微微加入苦寒药，接纳逆上的阳邪并顺导使其下行，名叫安蛔，实际上是安胃，所以兼治腹泻，见到阴阳不相顺接而导致的腹泻证，都可以用这个方剂概括。经文说：凡是阴阳不相顺接，就会发生厥证，手足逆冷就是这样。方中行说：三阴三阳的经脉，都相接于手足，阴主寒，阳主热，阳气内陷，不与阴气顺接，就会手足厥冷。附录：喻嘉言论及桂附丸说：脏属阴，能承受纯阳的药物；腑属阳，必须加一二味阴药来制约其僭越的热性；经……
本方加白术、大枣，名叫术附汤（出自《金匮要略》）：主治风湿相搏，身体烦疼；以及中寒引起的发厥心痛。
本方去掉甘草，名叫干姜附子汤（张仲景）：主治误下后又发汗，白天烦躁晚上安静，不呕不渴，无表证，脉象沉微，没有大热的情况（白天烦躁，是虚阳扰乱，外表呈现假热；晚上安静，不呕不渴，脉象沉微，无大热，是阴气独治，内部系真寒证。凡是阴虚到了极点阳气必定厥逆，阳虚到了极点阴气必定躁动，姜、附直接从阴中回阳，不应当因为白天烦躁而怀疑）。又主治中寒厥逆、眩晕仆倒无汗，或者自汗淋漓（中寒的病证，身体僵硬、口噤、眩晕、无汗或自汗的，是因为腠理素来虚弱而阳气微弱。伤寒发热，中寒不发热，以此作为区别。张仲景对伤寒讲得很详细，而对中寒没有提及为什么呢？回答说：阳动阴静，阴寒郁积而成热，于是随阳气传变，变化不一，没有定规，所以极力推崇这种病，不得不详细论述；不发热，说明阴邪固定不移，就不会变化，所以不必详细。汪昂按语：自汗的，或许兼夹风邪）；以及外热烦躁，阴盛格阳（阴证似阳）。姜附汤加当归、肉桂，调入蜂蜜和服，名叫姜附归桂汤（喻嘉言说：服用姜附汤后，继服此汤。因为姜附专门主司回阳，而突然中受寒邪，先损伤营血，所以加当归、肉桂驱逐营分之邪，才能使药病相当）。再加人参、甘草，名叫姜附归桂参甘汤，加生姜煎煮（喻氏说：服用前汤后，继当服此汤，兼补气血）。本方去掉甘草，加葱四茎，名叫白通汤（回复阳气，通达血脉）。再加人尿、猪胆汁，名叫白通加人尿猪胆汁汤（张仲景。见后文）。本方加人参一两，名叫四逆加人参汤（张仲景）：主治怕冷，脉微，再次腹泻，腹泻停止但津液耗竭（怕冷脉微再次腹泻，是阳虚阴胜；腹泻停止则津液内竭，所以说亡血。给予四逆汤温经复阳，加人参生津益血）。再加茯苓（六两），名叫茯苓四逆汤（张仲景）：主治发汗、攻下后病不解且烦躁（过度发汗则亡阳而表虚，误用攻下则亡阴而里虚，阴阳表里俱虚，于是产生烦躁，所以用茯苓、人参入心以除烦，附子、干姜入肾以解躁）。本方去掉干姜，加芍药三两，名叫芍药甘草附子汤（张仲景）：主治伤寒发汗后病不解，反而怕冷的，是因为虚证（出汗后表不解而怕冷，唯独说“反”，可知是过汗导致阳气虚弱。出汗为营虚，怕冷为卫虚，如果重补其阴则怕冷更甚，只要回复其阳则阴液会更被劫夺。所以用附子以回阳，而加芍药以敛阴，这是营卫两虚的补救方法。李说：发汗后亡阳怕冷的，是表虚，用芍药附子甘草汤；攻下后怕冷的，是里虚，用四逆汤；如果有表邪未尽的，必定兼有发热，用柴胡加桂汤；又有里实热伏于内，阳气通达于外而怕冷且大便坚硬的，仍然需要攻下。《伤寒百问》说：发汗后怕冷的人必定虚，攻下后发热的人必定实）。本方去掉附子，用甘草四两、干姜二两，名叫甘草干姜汤（张仲景）：主治伤寒脉浮自汗，小便频数，心烦，轻微怕冷，脚部挛急，误用桂枝汤攻表，服药后出现厥逆，咽喉干燥，烦躁吐逆，给予此汤以回复阳气（脉浮、自汗、小便频数、怕冷，是阳气不足。攻表重伤其阳，得汤后便厥，胃的津液受伤，所以给甘草益气、干姜助阳，尤其担心辛热伤其阴，随即给予芍药甘草汤益其阴血，恢复其津液，所以证候虽然接近少阴，但不敢用四逆汤）。如果厥逆痊愈、脚变暖，再制作芍药甘草汤，以调和其阴，脚就能伸直：芍药、甘草各四两（张仲景。另见和解门）。本方加吴茱萸，名叫茱萸四逆汤，主治厥阴少阴腹痛。本方加当归、木通，名叫当归四逆汤：主治感受寒邪手足厥冷，脉细欲绝；以及男女寒疝，脐下冷，牵引腰胯疼痛（寒伤营血，所以加当归、木通，能通血脉。张仲景当归四逆汤见后文）。本方加茵陈，名叫茵陈四逆汤：主治阴黄。本方加生脉散、陈皮，名叫回阳返本汤：主治阴盛格阳。本方加官桂、良姜、半夏，名叫浆水散（洁古）：主治虚寒水泻，冷汗，脉微，严重的呕吐，这是急病（浆水，指泄利时排出的浆水样便，澄澈清冷。又说：加浆水煎煮……
(Zhang Zhongjing.)
(Sini refers to cold limbs. If two liang of Shengjiang (Dried Ginger) are added to the original formula, it becomes Tongmai Sini Tang (Pulse-Regulating Sini Decoction).)
Indicated for Cold Damage involving the Three Yin meridians (Sini Tang is the primary formula for Shaoyin disease, but it is commonly used for diseases of all Three Yin meridians. It may also be used in Taiyang syndrome when the pulse is deep), body pain, abdominal pain, diarrhea with undigested food, aversion to cold without thirst, and cold limbs; or conversely, no aversion to cold, red face, and irritability, presenting as internal cold with external heat; or dry retching, or sore throat, with a pulse that is deep, faint, fine, and nearly imperceptible. (Abdominal pain and spontaneous diarrhea indicate interior cold. Spontaneous diarrhea is common in Three Yin diseases; if the body is cool and the pulse calm and quiet, it is a favorable sign; if the body is hot and the pulse large, it is an unfavorable sign. Due to internal cold, there is aversion to cold and no thirst. The four limbs are the root of all Yang meridians; when cold invades, blood vessels become congealed and stagnant, and Yang Qi cannot disperse throughout the body, causing whole-body pain and cold hands and feet. Conversely, no aversion to cold, red face, and agitation indicate that excessive Yin cold repels Yang Qi to the exterior. Cold stagnating in the chest causes vomiting immediately after eating; cold-fluid retention in the diaphragm causes dry retching due to rebellious Qi; deficient Fire flaming upward causes sore throat; a deep pulse indicates that cold causes Qi to hide and store. Commentary: Shaoyin pulses can be deep, tight, or rapid, but Zhang Zhongjing generally describes them as faint and fine. This is because a deep pulse must be felt with heavy pressure, and tight or rapid qualities are found within the deep-fine context, unlike Yang syndromes which present as floating, large, tight, and rapid. Xue Shenzhai stated: People know that a rapid pulse indicates heat,)
Fuzi (Aconiti Lateralis Radix Praeparata, one piece. Raw use) Ganjiang (Zingiberis Rhizoma, one liang) Gancao (Glycyrrhizae Radix et Rhizoma, roasted, two liang). Take cold. If the face is red, indicating Yang repelled upward, add nine stalks of Congbai (Allii Fistulosum Bulbus) to unblock Yang (Yu Jiayan said: In individuals with deficient Yang, even if there are exterior signs, sweat still flows, and the hands and feet must be cold. Using exterior-releasing herbs immediately leads to collapse of Yang; not using them leaves the external pathogen unchecked. Therefore, treat with the aforementioned decoction plus Congbai). If there is abdominal pain, it indicates deficiency of True Yin; add Baishao (Paeoniae Radix Alba, two liang) to astringe Yin. If there is a sore throat, it indicates constriction of Yin Qi ascending; add Jiegeng (Platycodonis Radix, one liang) to benefit the throat. If diarrhea stops and the pulse does not emerge, add Renshen (Ginseng Radix, two liang) to assist Yang and tonify Qi and Blood. For vomiting, add Shengjiang (Zingiberis Rhizoma Recens, two liang) to...
This is a medicine for the Foot-Shaoyin Kidney meridian. When cold pathogens overflow internally, treat with sweet and hot substances. Thus, the great-hot agents Jiang (Ginger) and Fu (Aconite) are used to stimulate Yang Qi and scatter cold pathogens (Raw Fuzi can also release the exterior). Gancao (Licorice) is also a substance that tonifies the middle and scatters cold, and it serves to moderate the upward rebellion of Jiang and Fu (Gancao is the Sovereign herb, Ganjiang is the Minister herb, Fuzi is the Envoy herb). It must be taken cold because cold excess in the middle jiao would reject hot drinks. This corresponds to the Classic saying "treat heat with cold administration" (Re Yin Han Yong), and also "treat cold with hot substances, administered cool." (This is an unusual preparation and large dosage. The Liver and Kidney are distant locations; only large dosages can reach them. Zhang Zhongjing said: In Cold Damage, if the physician mistakenly uses purgatives, leading to subsequent diarrhea with undigested food, abdominal fullness, and body pain, urgently rescue the interior with Sini Tang. If bowel movements are normal and there is body pain, urgently rescue the exterior with Guizhi Tang. Generally, body pain still belongs to exterior syndrome; in emergencies, rescue the interior first, then resolve the exterior. The Jueyin chapter states: After profuse sweating, if heat persists, with internal cramping, limb pain, accompanied by diarrhea, cold limbs, and aversion to cold, Sini Tang governs. Commentary: In Jueyin syndrome, cold limbs and cyanotic nails with a deep-rapid pulse that is forceful upon pressure indicate Yang Jue (Cold Limb Syndrome due to Heat), which requires purgation, suitable for Dachengqi Tang. If the pulse is deep-slow and non-forceful upon pressure, it is Yin Jue, suitable for Sini Tang, and moxibustion should be performed urgently. Any transmitted heat pathogen causes Yang Jue, characterized by dark urine and warm limbs; direct invasion of true cold causes Yin Jue, characterized by contraction of the genitals and cold limbs. Cheng Jiaoqian said: The worldly belief that transmitted disease causes Heat Jue and direct invasion causes Cold Jue is very erroneous. Jue syndromes of the Three Yang meridians mostly result from failure to purge, constituting Heat Jue; Jue syndromes of the Shaoyin meridian all belong to Cold Jue. Regarding Heat Jue of the Yin meridians, Zhang Zhongjing's book has only one instance: "Cold damage, one to two days up to four or five days, when Jue occurs, there must be fever." If it were truly like the theory of transmitted pathogens, this would occur at four or five days, but why does the text mention one or two days? It is unknown what meridian's pathogen is so swift. When he says "Jue should be purged," it means purging the heat, not purging the Jue itself. One may purge when there is fever, but never purge when there is Jue. Tracing the cause, Jueyin and Shaoyang are one fu and one zang organ. Shaoyang is the end of the Three Yang; when Yang ends, Yin generates, hence the alternating cold and heat. Jueyin is the end of the Three Yin; when Yin ends, Yang connects, hence the winning and reversing of cold and heat. In such cases, do not discuss whether it comes from the Three Yang or originates in Jueyin; only discuss the proportion of heat versus Jue. More heat than Jue indicates Yang Jue; more Jue than heat indicates Yin Jue. If heat lingers and does not recede, Yang overcomes and Yin cannot recover, leading to throat obstruction and bloody stool. If Jue lingers and does not recede, Yin overcomes and Yang cannot recover, leading to Chu Zhong (stomach qi exhaustion) and collapse of Yang. Zhang Zhongjing harmonized these two treatments by combining the mechanism of Yin-Yang advancement and retreat. When Yang prevails, purging is suitable; Xiaochengqi Tang removes the cold Mangxiao (Mirabilitum) but retains the warm Houpo (Magnoliae Officinalis Cortex). In Jueyin, break Yang to move Yin. When Yin prevails, warming is suitable; even if there is Yang pathogen, upon seeing Jue and diarrhea, Wumei Wan (Mume Pill) is suitable, gathering pungent-hot substances with bitter-cold assistants. In Jueyin, break Yin to move Yang. Even with upper heat, such as thirst and Qi rushing to the heart mentioned at the beginning of the chapter, one need not worry about rejection. The principle of supporting Yang and suppressing Yin is subtle. Furthermore, Wumei Wan adds slight bitter-cold substances among sour-pungent liver-entering herbs to accept and guide downward the rebellious Yang pathogen. Named "Calming Ascaris," it actually calms the Stomach, thus also treating diarrhea. Seeing syndromes of diarrhea caused by Yin-Yang failing to connect smoothly, all such cases can be encompassed by this formula. The Classic states: Whenever Yin and Yang fail to connect smoothly, Jue occurs; cold reverse limbs are the manifestation. Fang Zhongxing said: The meridians of the Three Yin and Three Yang all connect at the hands and feet. Yin governs cold, Yang governs heat. If Yang Qi sinks internally and fails to connect smoothly with Yin Qi, cold reverse limbs occur. Appendix: Yu Jiayan discussed Guifu Wan, saying: Zang organs are Yin and can withstand pure Yang medicines; Fu organs are Yang and require one or two Yin substances to restrain their rebellious heat. The Classic...)
Adding Baizhu (Atractylodis Macrocephalae Rhizoma) and Dazao (Jujubae Fructus) to this formula creates Zhufu Tang (from *Jingui Yaolue*): Treats wind-dampness binding, causing bodily discomfort and pain; and cold-induced Jue with heart pain.
Removing Gancao from this formula creates Ganjiang Fuzi Tang (Zhang Zhongjing): Treats restlessness during the day and quietness at night after mistaken purgation and sweating, without vomiting or thirst, no exterior syndrome, deep-faint pulse, and no significant heat. (Daytime restlessness is false heat from disturbed deficient Yang; nighttime quietness, no vomiting/thirst, deep-faint pulse, and no significant heat indicate Yin Qi ruling alone and true interior cold. When Yin deficiency is extreme, Yang must Jue; when Yang deficiency is extreme, Yin must be restless. Jiang and Fu directly return Yang from Yin; one should not doubt this due to daytime restlessness). Also treats cold-induced Jue with dizziness and collapse, with or without sweat, or profuse spontaneous sweating. (In cold injury, stiffness, trismus, dizziness, absence of sweat or presence of spontaneous sweating indicates inherent deficiency of pores and weak Yang. Cold damage involves fever; cold injury does not. Why did Zhang Zhongjing detail Cold Damage but omit Cold Injury? Answer: Yang moves, Yin is still. When Yin cold condenses into heat, it follows Yang and transforms variably without fixed patterns, requiring detailed discussion. Non-febrile cases involve fixed Yin pathogens that do not transform, hence less detail needed. Wang Ang comments: Spontaneous sweating may imply concurrent Wind). Also treats external heat and restlessness due to Yin excess repelling Yang (Yin syndrome resembling Yang). Adding Danggui (Angelicae Sinensis Radix) and Rougui (Cinnamomi Cortex) to Jiangfu Tang, mixed with honey, creates Jiangfugui Tang (Yu Jiayan said: After taking Jiangfu Tang, take this subsequently. Since Jiangfu specifically returns Yang, and sudden cold injury first damages Ying-Blood, adding Danggui and Rougui expels Ying-pathogens, ensuring drug-disease correspondence). Adding Renshen and Gancao creates Jiangfuguishengantang, decocted with fresh ginger (Yu said: After the previous decoction, take this to tonify Qi and Blood). Removing Gancao and adding four stalks of Congbai creates Baitong Tang (Restoring Yang and unblocking Pulse). Adding human urine and pig bile creates Baitong Jia Ren Nao Zhu Dan Tang (Zhang Zhongjing. See later). Adding one liang of Renshen creates Sini Jia Renshen Tang (Zhang Zhongjing): Treats aversion to cold, faint pulse, recurrent diarrhea, and cessation of diarrhea with loss of fluids (Aversion to cold, faint pulse, and recurrent diarrhea indicate Yang deficiency and Yin excess. Cessation of diarrhea implies internal exhaustion of fluids, termed "loss of blood." Sini warms meridians and restores Yang; Renshen generates fluids and benefits blood). Adding six liang of Fuling (Poria) creates Fuling Sini Tang (Zhang Zhongjing): Treats persistent illness and irritability after sweating and purgation. (Excessive sweating collapses Yang and causes exterior deficiency; mistaken purgation collapses Yin and causes interior deficiency. Deficiency of Yin-Yang and Exterior-Interior generates irritability. Fuling and Renshen enter the Heart to remove vexation; Fuzi and Ganjiang enter the Kidney to resolve restlessness). Removing Ganjiang and adding three liang of Baishao creates Shaoyao Gancao Fuzi Tang (Zhang Zhongjing): Treats Cold Damage where sweating fails to resolve the condition, resulting in increased aversion to cold due to deficiency. (Sweating with unresolved exterior and aversion to cold, described as "increased," indicates Yang weakness from excessive sweating. Sweating indicates Ying deficiency; aversion to cold indicates Wei deficiency. Heavy tonification of Yin worsens aversion to cold; merely restoring Yang further depletes Yin. Thus, Fuzi restores Yang, while Baishao astringes Yin. This is the rescue method for dual deficiency of Ying and Wei. Li [Xue] said: Post-sweating Yang collapse with aversion to cold is exterior deficiency, treated with Shaoyao Fuzi Gancao Tang; post-purgation aversion to cold is interior deficiency, treated with Sini Tang; if exterior pathogen remains, fever accompanies it, treated with Chaihu Jia Guizhi Tang; if interior excess heat hides inside with Yang penetrating outside causing aversion to cold and hard stools, purgation is still required. *Shanghan Baiwen* states: Post-sweating aversion to cold implies deficiency; post-purgation fever implies excess). Removing Fuzi and using four liang of Gancao and two liang of Ganjiang creates Gancao Ganjiang Tang (Zhang Zhongjing): Treats Cold Damage with floating pulse, spontaneous sweating, frequent urination, mental vexation, mild aversion to cold, and cramped legs. Mistakenly attacking the exterior with Guizhi Tang leads to Jue, dry throat, irritability, and vomiting. This formula restores Yang. (Floating pulse, spontaneous sweating, frequent urination, and aversion to cold indicate insufficient Yang. Attacking the exterior severely damages Yang, leading to Jue and injury of Stomach fluids. Gancao benefits Qi, Ganjiang assists Yang. Fearing pungent-hot substances damage Yin, follow with Shaoyao Gancao Tang to benefit Yin-Blood and restore fluids. Although the syndrome approaches Shaoyin, Sini Tang is not used). If Jue resolves and feet warm, prepare Shaoyao Gancao Tang again to harmonize Yin, allowing the legs to extend: Shaoyao and Gancao, each four liang (Zhang Zhongjing. See Harmonizing Section separately). Adding Wuzhuyu (Evodiae Fructus) creates Zhuyu Sini Tang, treating abdominal pain in Jueyin and Shaoyin. Adding Danggui and Mutong creates Danggui Sini Tang: Treats cold-induced cold limbs with fine, nearly imperceptible pulse; and cold hernia in men and women, cold below the navel radiating to waist and hips. (Cold injuring Ying-Blood necessitates Danggui and Mutong to unblock blood vessels. Zhang Zhongjing's Danggui Sini Tang see later). Adding Yinchen (Artemisiae Scopariae Herba) creates Yichen Sini Tang: Treats Yin Jaundice. Adding Shengmai San and Chenpi creates Huiyang Fanben Tang: Treats Yin excess repelling Yang. Adding Guigui (Cinnamomi Ramulus), Liangjiang (Galangali Rhizoma), and Banxia (Pinelliae Tuber) creates Jiangshui San (Jiegu): Treats deficiency-cold watery diarrhea, cold sweat, faint pulse, and severe vomiting, an acute condition. (Jiangshui refers to watery stool, clear and cold. Also says: Decoct with Jiangshui...)