仲景所谓厥逆，与《内经》所言不同。盖仲景单就伤寒言，以阴邪直中，寒入
三阴而手足冷者为寒厥；阳邪传经，热入三阴而手足冷者（热深入，阳内陷，不达于四肢，故
冷也）为热厥。盖主外邪言，不论寒热证皆手足冷者也。《内经》则指内伤言，以上盛
下虚，气血逆冲而上，暴仆卒倒者为厥逆。（厥者尽也，逆者上冲也，言正气虚竭，上冲而欲脱也。）
又分热厥者手足热，寒厥者手足寒，其不同如此。仲景所谓寒厥、热厥，及蛔厥、
脏厥等，已详《伤寒论》，此篇止就《内经》所论言之。
《经》云∶内夺而厥，则为喑痱，此肾虚也。（详中风门。）又云∶气血并走于上，则
为厥，暴死，气复反（反于下也）则生，不反则死。又云∶脉至如喘，（急促之意。）曰暴厥，
不知与人言。（即中风不识人证。）又云∶阳并于上则火独光，阴并于下则足寒。又云∶阳
气者，烦劳则张，（气高喘也。）精绝，（热耗水虚。）辟积于夏，使人煎厥。（辟积，即襞
积，衣褶也，有
叠积意。叠积至夏令，则益热而如煎如熬矣。即中暑证。）又云∶大怒则血菀于上，（血随气
上壅也。）使人
薄厥。（薄者，相迫之谓。言气血乱于胸中，相迫而厥。即中气证也。）又云∶偏枯痿厥，
肥贵人则膏粱
之疾也。（即中食证。）又云∶冲脉者，脏腑之海。其上者，出于颃颡，渗诸阳，灌诸精，
其下者，并于少阴之经，渗三阴，下循跗，故别络结则跗上不动，不动则厥，厥则
寒。（详《灵枢·逆顺肥瘦篇》。愚按∶冲脉实通身经络之所会归，故又称血海，
与任督二脉并起胞中。胞中即丹
田，在女子谓之胞，在男子为精室，乃性命之根本也，根本一败，诸经皆败。然则卒厥暴仆，
岂止一经一脏之所致
哉？）又云∶邪客于手足少阴、太阴，足阳明之络，此五络皆会于耳中，上络左角。（左
额角也。）五络俱竭，（谓脉为邪阻，不至也。）令人身脉皆动而形无知也，（所谓形如死
人。）其状若
尸，曰尸厥。 （即 ）其左角之发方一寸燔治，（即烧灰存性也。）饮以美酒一杯，（血余通
血，酒通气，气血通则苏。）不能饮者（口噤也）灌之，立已。（此即中恶证也。）
以上经文与《诸中篇》中所言无异，是《经》所谓厥逆者，明以暴仆卒倒为言，
初不系于手足之为寒为热也。此其与《伤寒论》所称固大异矣，然《经》亦有以手
足寒热为言者，详下文。
《厥论》谓∶阳气衰于下则为寒厥，以阴气起于五趾之里而聚于膝，阴气胜则从
趾至膝上寒，由此人质壮，以秋冬夺于所用，（于秋冬阳气收藏之时，妄行耗散，其阳
如被夺去也。）
阳气衰损，阴气独在，故手足寒也。阴气衰于下则为热厥，以阳气起于足五趾之表，
阴脉者集于足下而聚于足心，故阳气胜则足下热，由其人数醉，若饱以入房，气聚
于脾中不得散，（酒食在胃，因房事伤其精气，不能营运也。）酒气与谷食相搏，热盛于中，遍于
身，内热则溺赤，肾气日衰，（水受火耗。）阳气独胜，故手足为之热也。
详此经文，热厥则手足热，寒厥则手足寒，亦与仲景不论寒热厥皆手足寒者，
异矣。
治法∶煎厥，人参固本丸。薄厥，蒲黄汤。尸厥，二十四味流气饮、苏合香丸，
（见诸中。）菖蒲末吹鼻。寒厥，四逆汤、六味附子汤，灸阳辅、绝骨，或酒水各半温渍
至膝。热厥，六味地黄丸，（见虚损。）小便三升温渍手足。另有痰厥，即《中风篇》丹
溪所云因于湿热生痰者也。若是寒痰迷闷，四肢逆冷而卒倒，姜附汤。（见中寒。）又气
厥分气虚、气实。虚者，即《中风篇》东垣所谓因于气虚者也；实者，即《中气篇》
所言者是也。又有血脱之厥，（大吐大崩，多致卒倒。）宜先掐人中，或烧炭沃醋熏鼻，以收
其气，急用人参一二两煎汤灌之，然后根据血证门用药。有色脱之厥，淫欲过度立即
脱死者，急掐人中，令阴人搂定，用口相对嘘暖气通接之，切勿放脱，随灸气海数
十壮，饮以独参汤。如迟至三两日乃脱者，（精去于先，而气脱于后也。）亦灸气海，饮参汤。
酒厥，葛花解酲汤。（见伤饮食。大醉则上盛下虚，故卒厥。）食厥，过饱适有感
触，胃气不行，
阳并于上，上半身热，下半身冷，（即中食上部有脉下部无脉证。）拥炉不暖。误行温补则死，
此阳明气逆，故两手不冷，平胃、加减保和丸。（并见伤食。）
张仲景所说的“厥逆”，与《黄帝内经》中的说法不同。张仲景仅从伤寒角度论述，认为阴邪直接侵入，寒气进入三阴经导致手足冰冷的，称为寒厥；阳邪传变入里，热邪深入三阴经导致手足冰冷的（因热邪深入，阳气内陷，不能通达四肢，所以发冷），称为热厥。这是主要就外感邪气而言，无论寒证还是热证，都表现为手足冰冷。而《黄帝内经》则是针对内伤杂病而言，指上实下虚，气血逆乱冲向上部，突然昏倒仆地的，称为厥逆。（“厥”意为尽，“逆”意为上冲，指正气虚竭，向上冲逆欲脱。）此外，《内经》又区分了热厥表现为手足发热，寒厥表现为手足寒冷，其区别如此之大。张仲景所说的寒厥、热厥，以及蛔厥、脏厥等，已在《伤寒论》中详细论述，本篇仅就《黄帝内经》的论述进行说明。
《内经》说：“精气内夺而致厥，就会出现失音和足废不用，这是肾虚所致。”（详见中风门）又说：“气血同时并走于上部，就会发生厥证，甚至暴死，如果气机能回复下行则生，不能回复则死。”又说：“脉象急促如喘息状，称为暴厥，患者神志昏迷，不能与人言语。”（即中风不识人的证候）又说：“阳气偏并于上部，则火气独盛发光；阴气偏并于下部，则足部寒冷。”又说：“人体的阳气，若因烦劳过度则亢张（气高喘促），精液枯竭（热耗伤肾水），若在夏季这种叠积的热邪作用下，会导致煎厥（‘辟积’即‘襞积’，像衣服褶皱一样，有叠积之意。叠积至夏令，则热势更盛，如同煎熬一般。即中暑证）。”又说：“大怒则血液郁结于上部（血随气上壅），导致薄厥（‘薄’意为相迫。指气血在胸中紊乱，相互逼迫而致厥。即中气证）。”又说：“偏枯、痿证、厥证，是富贵之人食用膏粱厚味所致的疾病。”（即中食证）又说：“冲脉是脏腑之海。其上行的一支，出于颃颡，渗入诸阳经，灌注精气；其下行的一支，并入少阴经，渗入三阴经，向下沿足背而行，所以别络结滞则足背脉搏不动，不动则发生厥逆，厥逆则寒冷。”（详见《灵枢·逆顺肥瘦篇》。我认为：冲脉实际上是全身经络的会归之处，所以又称血海，与任脉、督脉同起于胞中。胞中即丹田，在女子称为胞，在男子称为精室，是性命的根本。根本一旦败坏，各条经脉都会败坏。那么突然发生的厥逆暴仆，岂止是一经一脏造成的呢？）又说：“邪气侵犯手足少阴、太阴及足阳明经的络脉，这五条络脉都汇聚于耳中，上行联络左额角。如果这五条络脉都衰竭（指脉道被邪气阻滞，气血不至），使人周身脉搏跳动但形体无知觉（所谓形如死人），其状态像尸体一样，称为尸厥。（即……）取左侧额角头发一寸长烧成灰存性，用一杯美酒送服（血余能通血，酒能通气，气血通畅则苏醒）。不能吞咽的患者（因口噤不开），灌服亦可立即痊愈。（此即中恶证）。”
以上经文与《诸中篇》中所说的没有差异，可见《内经》所说的厥逆，明确是以突然昏倒仆地为特征，起初并不取决于手足是寒还是热。这与《伤寒论》所称的确实大不相同，然而《内经》也有以手足寒热来论述的情况，详见下文。
《厥论》说：“阳气在下部衰微则为寒厥，因为阴气起于五趾内侧并聚集于膝部，阴气胜则从脚趾到膝盖以上发冷，因此人虽然体质强壮，但在秋冬阳气收藏之时妄行耗散（在秋冬阳气潜藏之时，妄为消耗发散，其阳气如同被剥夺一样），导致阳气衰损，阴气独盛，所以手足寒冷。阴气在下部衰微则为热厥，因为阳气起于足五趾外侧，阴脉汇聚于足下并聚集于足心，所以阳气胜则足下发热，由于此人多次醉酒或饱食后行房事，气聚于脾中不得疏散（酒食在胃，因房事损伤精气，不能正常运化），酒气与谷食相互搏结，热盛于中焦，遍布全身，内热则小便赤黄，肾气日渐衰微（肾水受火热耗伤），阳气独盛，所以手足发热。”
详查这段经文，热厥表现为手足发热，寒厥表现为手足寒冷，这也与张仲景不论寒热厥皆表现为手足寒冷的观点不同。
治疗方法：煎厥，用人参固本丸。薄厥，用蒲黄汤。尸厥，用二十四味流气饮、苏合香丸（见诸中篇），并用菖蒲末吹鼻。寒厥，用四逆汤、六味附子汤，灸阳辅穴、绝骨穴，或用酒和水各半温浸至膝部。热厥，用六味地黄丸（见虚损篇），将药汁分三次温热浸渍手足。另有痰厥，即《中风篇》朱丹溪所说的因湿热生痰所致者。如果是寒痰迷闷，四肢逆冷而突然昏倒，用姜附汤（见中寒篇）。另外，气厥分为气虚和气实两种。虚证，即《中风篇》李东垣所说的因气虚所致者；实证，即《中气篇》所说的是也。又有血脱之厥（大吐大崩，多导致突然昏倒），宜先掐人中穴，或烧炭泼醋熏鼻，以收敛其气，急用人参一两至二两煎汤灌服，然后根据血证门的方药治疗。有色脱之厥，因淫欲过度立即脱死的，急掐人中穴，令女性抱住固定，用口对口嘘暖气连通接引，切勿松脱，随即灸气海穴数十壮，饮用独参汤。如果是延迟三两日才出现脱证（精气先失，而后气脱），也灸气海穴，饮用人参汤。酒厥，用葛花解酲汤（见伤饮食篇。大醉则上盛下虚，故致卒厥）。食厥，因过饱且受到感触，胃气不行，阳气并于上部，上半身热，下半身冷（即中食证，上部有脉下部无脉），靠近火炉也不觉暖。误用温补则会致死，此为阳明气逆，所以两手不冷，用平胃散、加减保和丸（均见伤食篇）。
Zhang Zhongjing's concept of "Jue Ni" (Jue and Ni) differs from that stated in the *Huangdi Neijing* (Yellow Emperor's Inner Canon). Zhang Zhongjing discusses it solely in the context of Shanghan (Cold Damage), stating that when Yin pathogens directly invade and cold enters the Three Yin meridians causing cold hands and feet, it is called Cold Jue; when Yang pathogens transmit through the meridians and heat enters the Three Yin meridians causing cold hands and feet (due to deep-seated heat causing Yang Qi to sink internally and fail to reach the four limbs, resulting in coldness), it is called Heat Jue. This primarily refers to external pathogens, where both cold and heat syndromes manifest as cold hands and feet. In contrast, the *Neijing* refers to internal injuries, describing Jue Ni as a condition of upper excess and lower deficiency, where Qi and Blood rebel upward, causing sudden collapse and fainting ("Jue" means exhaustion, "Ni" means upward rebellion, indicating the depletion of Zheng Qi with upward rushing and impending collapse). Furthermore, the *Neijing* distinguishes between Heat Jue, which presents with hot hands and feet, and Cold Jue, which presents with cold hands and feet, highlighting such significant differences. The Cold Jue, Heat Jue, Hui Jue (Ascaris Jue), and Zang Jue (Viscera Jue) mentioned by Zhang Zhongjing are detailed in the *Shanghan Lun* (Treatise on Cold Damage); this chapter only elaborates on the discussions found in the *Neijing*.
The *Classic* states: "When essence is depleted internally leading to Jue, aphasia and flaccid paralysis occur, which is due to Kidney deficiency." (See Stroke Section.) It also states: "When Qi and Blood rush together to the upper part, Jue occurs, potentially leading to sudden death; if Qi returns downward, life is preserved; if it does not return, death ensues." It further states: "When the pulse is rapid like panting, it is called Bao Jue (Sudden Jue), characterized by unconsciousness and inability to speak." (This corresponds to stroke with loss of consciousness.) It states: "When Yang Qi rebels to the upper part, Fire shines alone; when Yin Qi rebels to the lower part, the feet become cold." It states: "Human Yang Qi, when subjected to excessive mental or physical labor, becomes hyperactive (manifesting as high-pitched breathing and panting). If Essence is exhausted (Heat consumes Kidney Water), and this accumulates over time into summer, it leads to Jian Jue (Frying Jue). 'Pi Ji' implies accumulation like folds in clothing. Accumulated heat reaching summer makes one feel as if being fried or boiled, corresponding to heatstroke." It states: "Great anger causes Blood to stagnate in the upper part (Blood follows Qi upward and congests), leading to Bo Jue (Pressing Jue). 'Bo' means pressure. This indicates chaotic Qi and Blood in the chest pressing against each other, causing Jue, corresponding to Qi stagnation syndrome." It states: "Hemiplegia, flaccidity, and Jue are diseases of wealthy individuals caused by rich and greasy food." (Corresponding to Food Stagnation Syndrome.) It states: "The Chong Mai (Penetrating Vessel) is the Sea of the Five Zang-Fu Organs. Its ascending branch emerges from the Kangsang (pharynx/nasopharynx region), permeates the Yang meridians, and irrigates the Jing (Essence); its descending branch joins the Shaoyin Meridian, permeates the Three Yin meridians, and descends along the dorsum of the foot. Therefore, if collateral vessels are obstructed, the pulse at the dorsum of the foot ceases; if the pulse ceases, Jue occurs, and Jue leads to coldness." (See *Lingshu: Ni Shun Fei Shou Chapter*. Note: The Chong Mai is the convergence point of all meridians throughout the body, hence also called the Sea of Blood. It originates from the Baozhong (Uterus/Essence Chamber) along with the Ren and Du meridians. Baozhong is the Dantian; in women, it is called Bao, and in men, Jing Shi. It is the root of life and nature. Once the root fails, all meridians fail. Thus, sudden Jue and collapse are not merely caused by a single meridian or organ.) It states: "Pathogens invading the collaterals of the Hand and Foot Shaoyin, Taiyin, and Foot Yangming meridians—these five collaterals converge in the ear and ascend to connect with the left corner of the head (left frontal angle). If these five collaterals are exhausted (meaning pulses are blocked by pathogens and do not reach), the person's body pulses may move but the form is unconscious (described as resembling a corpse). This state resembles a dead body and is called Shi Jue (Corpse Jue). [Treatment:] Burn one square cun of hair from the left frontal angle to ash (preserving its properties), drink with a cup of fine wine (Blood remainder promotes blood circulation, wine promotes Qi flow; when Qi and Blood circulate, consciousness returns). For those who cannot swallow (due to lockjaw), force-feed the mixture, and recovery will be immediate." (This corresponds to Evil Invasion Syndrome.)
The above scriptural passages are consistent with those in the *Zhu Zhong Pian* (Chapter on Various Collapses). Thus, the Jue Ni mentioned in the *Classic* clearly refers to sudden collapse and fainting, initially unrelated to whether the hands and feet are cold or hot. This is fundamentally different from the descriptions in the *Shanghan Lun*. However, the *Classic* also discusses Jue based on hand and foot temperature, as detailed below.
The *Jue Lun* (Treatise on Jue) states: "When Yang Qi declines in the lower part, it results in Cold Jue. Since Yin Qi originates from the interior of the five toes and gathers at the knees, when Yin Qi prevails, coldness spreads from the toes up to the knees. Even if a person is physically strong, if they overexert themselves during autumn and winter (times when Yang Qi should be stored, but wasteful consumption depletes it, as if stolen), Yang Qi is damaged and Yin Qi remains dominant, causing cold hands and feet. When Yin Qi declines in the lower part, it results in Heat Jue. Since Yang Qi originates from the exterior of the five toes, and Yin meridians gather at the soles and arches of the feet, when Yang Qi prevails, the soles become hot. This often happens when a person drinks heavily or engages in sexual activity after a full meal. Qi gathers in the Spleen and cannot disperse (food and alcohol remain in the Stomach, while sexual activity damages Essence and Jing, impairing transportation and transformation). The Qi of alcohol and grain food struggle within, generating intense heat in the center that spreads throughout the body. Internal heat causes dark urine. As Kidney Qi declines daily (Kidney Water is consumed by Fire), Yang Qi becomes dominant, causing hot hands and feet."
Examining this scripture, Heat Jue presents with hot hands and feet, and Cold Jue presents with cold hands and feet. This differs from Zhang Zhongjing's view that both cold and heat Jue present with cold hands and feet.
Treatment Methods: For Jian Jue (Frying Jue), use Renshen Guben Wan (Ginseng Root-Solidifying Pill). For Bo Jue (Pressing Jue), use Puhuang Tang (Pollen Typhae Decoction). For Shi Jue (Corpse Jue), use Ershisi Wei Liqi Yin (Twenty-Four-Ingredient Qi-Circulating Decoction) or Suhexiang Wan (Styrax Pill) (see Zhu Zhong Pian), and blow Changpu Mo (Acorus Rhizome Powder) into the nose. For Cold Jue, use Sini Tang (Four Reversal Decoction) or Liuwei Fuzi Tang (Six-Ingredient Aconite Decoction), moxa Yangfu and Juegu acupoints, or warm compress the legs to the knees with a half-wine, half-water mixture. For Heat Jue, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) (see Deficiency Damage Section), and soak hands and feet three times daily in warm medicinal liquid. There is also Tan Jue (Phlegm Jue), which Zhu Danxi in the *Stroke Section* attributes to Phlegm generated by Damp-Heat. If Cold Phlegm confuses the mind, causing cold extremities and sudden collapse, use Jiangfu Tang (Ginger and Aconite Decoction) (see Cold Damage Section). Additionally, Qi Jue is divided into Qi Deficiency and Qi Excess types. The deficiency type corresponds to Li Dongyuan's description in the *Stroke Section* of being caused by Qi deficiency; the excess type corresponds to the discussion in the *Qi Section*. There is also Xue Tuo Zhi Jue (Jue due to Blood Collapse) (caused by severe vomiting or uterine bleeding, often leading to sudden collapse). Pinch the Renzhong acupoint first, or burn charcoal and pour vinegar to fumigate the nose to consolidate Qi, then urgently administer a decoction of 1–2 liang of Renshen (Ginseng). Subsequently, treat according to the Blood Syndrome section. There is also Se Tuo Zhi Jue (Jue due to Essence/Libido Collapse), occurring immediately after excessive sexual activity leading to collapse and death. Urgently pinch Renzhong, have a woman hold the patient firmly, and perform mouth-to-mouth resuscitation to transfer warm air; do not release. Immediately moxa Qihai for dozens of moxibustion units, and drink Dushen Tang (Single Ginseng Decoction). If collapse occurs after two to three days (Essence lost first, then Qi collapses), also moxa Qihai and drink Ginseng Decoction. For Jiu Jue (Alcohol Jue), use Gegua Jie Cheng Tang (Kadsura Flower Decoction for Relieving Hangover) (see Food and Drink Injury Section. Heavy drinking causes upper excess and lower deficiency, leading to sudden collapse). For Shi Jue (Food Jue), caused by overeating combined with emotional disturbance, leading to stagnant Stomach Qi and Yang Qi rebelling upward. The upper body is hot, the lower body is cold (corresponding to Food Stagnation Syndrome with pulses present in the upper body but absent in the lower body), and the patient feels cold even near a stove. Misapplication of warming tonics will cause death. This is Yangming Qi rebellion, hence the hands are not cold. Use Pingwei San (Calm the Stomach Powder) or Jiajian Baohe Wan (Modified Harmonize the Stomach Pill) (see Food Injury Section).