厥之寒热者，何也？（厥者逆也，气逆则乱，故忽为眩仆脱绝，是名为厥。厥证之起于足者，厥发之始
也，甚至猝倒暴厥，忽不知人，轻则渐苏，重则即死，最为急候。后世以手足寒热为厥，又有以香港脚为厥者，
谬之甚也。虽仲景有寒厥、热厥之分，亦以手足为言，盖以辨伤寒之寒热耳，非谓厥也。暴厥者，不知与
人言；血之与气，并走于上，则为大厥，厥则暴死，气复反则生，不反则死；手足少阴、太阴、足阳明五络
俱竭，令人身脉皆重而形无知也；其状若尸曰“尸厥”，若此者岂止于手足寒热及香港脚之谓耶？今人多不知
厥症，而皆指为中风也。夫中风者，病多经络之受伤；厥逆者，直因精气之内夺，表里虚实，病情当辨。名
义不正，以风治厥，医中之害，莫此为甚，今将风、厥并列便观，学人识之。）阳气衰于下，则为寒厥；阴
气衰于下，则为热厥。（凡物之生气，必自下而升，故阴阳之气衰于下，则寒厥、热厥由此而生也。）
热厥之为热也，必起
于足下者，阳气起于足五趾之表，阴脉者，集于足下聚于而足心，故阳气胜则足下热也。（足趾之端曰表，
三阳之所起也。足下、足心，三阴之所聚也。若阳气胜则阴气虚，阳乘阴位，故热厥必从足下始。
凡人病阴虚者，所以足心多热也。）寒厥之为寒也，必从五趾而上于膝者，阴气起于五趾之里，集于膝下而
聚于膝上，故阴气胜则从五趾至膝上寒。其寒也，不从外，皆从内也。（里，言内也。亦足下也。若阴气胜
则阳气虚，阳不胜阴，故寒。厥必起于五趾而上寒至膝，然其寒也，非从外入，皆由内而生也。故凡病阳虚
者，必手足多寒，皆从趾端始。）寒厥何失而然也？（厥上将发，手足先寒者，是为寒厥。）
前阴者，宗筋之所聚，太阴、阳明之所合也。（前阴者，阴器也。宗筋者，众筋之所聚也，如足之三阴、阳
明、少阳、及冲、任、督、跷筋脉皆聚于此，故曰“宗筋”。此独言太阴、阳明之合者，重水谷之脏也。盖胃
为水谷气血之海，主润宗筋，又阴阳总宗筋之会，会于气街，而阳明为之长，故特言之，以发明下文之义。）
春夏则阳气多而阴气少，秋冬则阴气盛而阳气衰。（天人之道皆然也。）此人者质壮，以秋冬夺
于所用，下气上争不能复，精气溢下，邪气因从之而上也。（质壮者有所恃，当秋冬阴胜之时，必多情欲之用，
以夺肾中之精气。精虚于下，则取足于上，故下气上争也。去者太过，生者不及，故不能复也。
精溢则气去，气去则阳虚，阳虚则阴胜为邪，故寒气因而上逆矣。）气因于中。（气，即上文之精气。邪
气也。精气之原，本于水谷，水谷之化，出于脾胃，故凡病为寒厥，为下气上争，为精气溢下，皆气因于中
也。然水谷在胃，命门在肾。以精气言，则肾精之化因于胃；以火土言，则土中阳气根于命门。阴阳颠倒，
互有所关，故上文云“厥起于下”，此云“气因于中”，正以明上下相因之义。）阳气衰，不能渗营其经络，
阳气日损，阴气独在，故手足为之寒也。（阳气者，即阳明胃气也。四肢皆禀气于胃，故阳虚于中，则
不能渗营经络而手足寒也。）热厥何如而然
也？（厥之将发，手足皆热者，是为热厥。）酒入于胃，则络脉满而经脉虚。（酒为熟谷之液，其气悍而疾，
故先充络脉。络满而经虚者，酒能伤阴，阳盛则阴衰也。）脾主为胃行其津液者也，阴气虚则阳气入，
阳气入则胃不和，胃不和则精气竭，精气竭则不营其四肢也。（脾主为胃行其津液，故酒入于胃，必归于脾，
湿热在脾，则脾阴虚，阳独亢而胃不和矣。脾胃俱病，则精气竭，故不能营其经络四肢也。）此人心
数醉若饱以入房，气聚于脾中不得散，酒气与谷气相搏，热盛于中，故热遍于身，内热而溺赤也。夫酒气盛
而悍，肾气日衰，阳气独胜，故手足为之热也。（数醉若饱入房者，既伤其脾，复伤其肾，皆阴虚也，故
手足为热。寒、热二厥，一由恃壮，以秋冬夺于所用，故阳气衰而为寒厥，一由数醉若饱入房，故精气竭而
为热厥。二者皆因于酒色，致伤真元，乃为是病。首言其所由然，则厥之轻重，于兹可见矣。）厥或令
人腹满，或令人暴不知人，或至半日、远至一日乃知人者，阴气盛于上则下虚，下虚则腹胀满；（阴气盛于
上则不守于下，故下虚。阴虚于下，则脾肾之气不化，故腹为胀满。）阳气盛于上则下气重上而邪气逆，逆
则阳气乱，阳气乱则不知人也。（重，并也。邪气，气失常也。阳气盛于上，则下气并而上行，
并则逆，逆则乱，阳气乱则神明失守，故暴不知人也。）
其六经脉之厥状病能，（能，犹形也。前言病厥之本，此明各经之状。）巨阳之厥，则肿首头重，
足不能行，发为眩仆；（眩，目眩乱也。仆，猝倒也。足太阳之脉起于目内 ，上额交巅，入络脑，故为
肿首头重、眩仆，其下行之支者，合 中，贯 内，故为足不能行。）阳明之厥，则癫疾欲走呼，腹满，不
得卧，面赤而热，妄见而妄言；（阳明，胃脉也，为多气多血之经。气逆于胃，则阳明邪实，故为癫狂之疾
而欲走且呼也。其脉循腹里，故为腹满。胃不和则卧不安，故为不得卧。阳明之脉行于面，故为面赤
而热。阳邪盛则神明乱，故为妄见妄言。）少阳
之厥，则暴聋，颊肿而热，胁痛， 不可以运；（厥在足少阳者，其脉入耳中，故暴聋；下加颊车，故颊肿
而热∶下腋循胸，过季胁；故胁痛；下出膝外廉，下外辅骨之前，故 不可以运。 ，音杭。）太阴之厥，
则腹满 胀，后不利，不欲食，食则呕，不得卧；（足太阴之脉，入腹属脾络胃，故厥则腹满 胀。逆气
在脾，故后便不利，且令不欲食，而食则呕。脾与胃为表里，胃不和者卧不安，脾亦然也。）少阴之厥，则
口干，溺赤，腹满，心痛；（厥逆在足少阴者，其脉循喉咙，挟舌本，故口干；肾脉络膀胱，故溺赤；其直
者从肾上贯肝膈，其支者从肺出络心，注胸中，故腹满心痛。）厥阴之厥，则少腹肿痛，腹胀，泾溲不利，
好卧，屈膝，阴缩肿， 内热。（足厥阴之脉，抵少腹，挟胃，故厥则少腹肿痛而腹胀。其脉环阴器，故泾溲
不利，阴缩而肿。肝主筋，为罢极之本，故足软好卧而屈膝。其下者行足胫内侧，故 内为热。）盛则泻
之，虚则补之，不盛不虚，取经调之。（不盛不虚者，惟逆气在经，而无阙于虚盛也，故但取其经而调之。）
太阴厥逆， 急挛，心痛引腹；（此重申前义，以明足六经之厥逆也。）少阴厥逆，虚满呕变，下
泻清；厥阴厥逆，挛，腰痛，虚满，前闭，谵言。三阴俱逆，不得前后，使人手足寒，
三日死。（不得前后者，或闭结不通，或遗失不禁，不得其常之谓也，三阴俱逆，则脏气绝，所谓“厥逆连
经则生，连脏则死”也。）太阳厥逆，僵仆，呕血，善衄；少阳厥逆，机关不利，机关不利者，腰不
可以行，项不可以顾，发肠痈，不可治，惊者死；（肠痈发于少阳厥逆者，相火之结毒也，故不可治。若
有惊者；其毒连脏，故当死。）阳明厥逆，喘咳身热，善惊，衄，呕血。
手太阴厥逆，虚满而咳，善呕沫；（此下言手六经之厥逆也。手太阴之脉起于中焦，循胃口，上膈属
肺，故其为病如此。）手心主、少阴厥逆，心痛引喉，身热，死不可治；（手心主厥阴之脉起于胸中，
出属心胞络，手少阴心脉从心系上挟嗌，皆令人心痛引喉。二经属火，其主血脉，故为身热。心为五脏六腑之
大主，故逆之则死，不可治。）手太阳厥逆，耳聋泣出，项不可以顾，腰不可以俯仰；（手太阳小肠
之脉，至目之内外 ，入耳中，故厥则耳聋泣出；其支者从缺盆循颈，故项不可以顾。邪在小肠者，连睾
系属于脊，故腰不可以俯仰也。）手阳明、少阳厥逆，发喉痹嗌肿，痉。（手阳明小肠之脉，从缺盆上颈贯颊，
手少阳三焦之脉，上出缺盆上项，故皆发喉痹嗌肿；痉，谓手臂肩项强直也。以上不言死者，可视其虚实，治
其主病者也。）
人有病头痛数岁不已，当有所犯大寒，内至骨髓，髓者以脑为主，脑逆故令头痛，齿亦痛，病亦名曰“厥
逆”。（髓以脑为主，诸髓皆属于脑也，故大寒至髓则上入头脑而为痛。其邪深，故数岁不已。髓为骨之充，
故头痛齿亦痛。是因邪逆于上，故亦名曰“厥逆”。）有癃者，一日数十溲，此不足也；身热如炭，颈膺如
格，人迎躁盛，喘息，气逆，此有余也。太阴脉细微如发者，此不足也。（癃，小水不利也，一日数十溲。数
欲便而所出不多也。如炭者，热之甚也。颈言咽喉，膺言胸臆。如格者，上下不通，若有所格也。人迎
躁盛者，足阳明动脉在结喉两旁，所以候阳也。喘息者，呼吸急促也。气逆者，治节不行也。大阴脉微细者，
即两手寸口之脉，所以候阴也。）病在太阴，（脾、肺二脏，皆属太阴。下文“颇在肺”，此则专言脾阴也。
太阴之脉细微者，正以气口亦太阴也。脏气不足，则脉见于此。又中气不足，溲便为之变。今其癃而数十溲者，
亦由中气之不足耳，故病在脾阴。）其盛在胃，（上云身热如炭者，胃主肌肉也，颈膺如格者，胃脉循喉咙，
入缺盆，下膈也。人迎躁盛者，一盛、二盛、三盛、四盛，且大且数，名曰“溢阳”也。凡上三者，皆属
阳明，故曰“其盛在胃”。）颇在肺，（即喘息气逆也。）病亦名曰“厥”，死不治。（阴不入阳，故其盛
在胃；阳不入阴，故太阴细微。病亦名曰“厥”者，阴阳皆逆也，故死不可治。）此所谓得
“五有余”、“二不足”也。所谓“五有余”者，五病之气有余也；“二不足”者，亦病气之不足也。今
外得“五有余”，内得“二不足”，此其身不表不里，亦正死明矣。（外得五有余者，一身热如
炭，二颈膺如格，三人迎躁盛，四喘息，五气逆也；内得二不足者，一癃而一日数十溲，二太阴脉细微如发
也。若此五病者，邪气有余也；二病者，正气不足也。欲泻其邪，则阴虚于里；欲补其虚，则阳实于外。
救里不可，治表亦不可，此不表不里之病，即阳证阴脉之类，有死而已，不能为也。）
有病厥者，诊右脉沉而紧，左脉浮而迟，不知病主安在？（此言厥逆而为腰痛者，其病在肾也。右脉、
左脉，皆以两尺为言。）然冬诊之，右脉固当沉紧，此应四时；左脉浮而迟，此逆四时。（冬气伏藏，故沉紧
者为应时，浮迟者为逆，逆则为厥矣。）在左当主病在肾，颇关在肺，当腰痛也。（在左者，当主病在肾，
此正以尺为言也。然浮者为肺脉，故云“颇关在肺”。）何以言之？少阴脉贯肾络肺，今
得肺脉，肾为之病，故肾为腰痛之病也。（肾脉本络于肺，今以冬月而肺脉见于肾位，乃肾气不足，故脉不能
沉而见浮迟。此非肺病，病在肾也。腰为肾之府，故肾气逆者，当病为腰痛。）
有病膺肿颈痛，胸满腹胀，亦名厥逆。（膺肿颈痛，胸满腹胀，皆在上、中二焦，此以阴并于阳，
下逆于上，故病亦名“厥逆”。）灸之则喑，石之则狂，须其气并，乃可治也。（喑，失音也。石，总针
石而言。）何以然？阳气重上，有余于上，灸之则阳气入阴，入则喑；（阳气有余于上而复灸之，是以火济
火也。阳极乘阴则阴不能支，故失声为喑。）石之则阳气虚，虚则狂。（阳并于上，其下必虚，以石
泄之，则阳气随刺而去，气去则上下俱虚而神失其守，故为狂也。）须其气并而治之，可使全也。（气并者，
谓阴阳既逆之后，必渐通也。盖上下不交，因而厥逆，当其乖离而强治之，恐致偏绝，故必须其气并，则
或阴或阳，随其盛衰，察而调之，可使保全也。）
厥证中的寒热表现，是怎么回事呢？（所谓“厥”，就是逆乱的意思。气机逆乱就会紊乱，所以突然发生眩晕、跌倒甚至昏厥脱绝，这就叫做厥。起源于足部的厥证，是厥发作的开始，严重的会突然倒地暴厥，忽然不省人事，轻的逐渐苏醒，重的立即死亡，是最为急重的病候。后世将手足寒冷或发热称为厥，又有将香港脚（一种下肢疾病）称为厥的，这是非常错误的。虽然张仲景有寒厥和热厥的区分，也是针对手足而言的，大概是为了辨别伤寒病的寒热罢了，并不是指真正的厥证。暴厥的人，不能与人言语；血与气一起向上冲逆，就形成大厥，大厥会导致突然假死，如果气机能回复则生，不能回复则死；手足少阴、太阴以及足阳明这五条经络的气血都衰竭时，会让人全身经脉沉重且形体无知觉；这种状态像尸体一样，叫做“尸厥”，像这样的情况，哪里仅仅是手足寒热及香港脚所能概括的呢？现在的人大多不知道什么是厥症，而都将其指认为中风。中风这个病，多是经络受到损伤；厥逆这个病，直接是因为精气在内被剥夺，表里虚实的情况应当加以辨别。名分义理不正确，用治疗风邪的方法来治疗厥证，医学中的危害，没有比这更严重的了。现在将风病和厥病并列以便观察，学习的人要认清这一点。）
阳气在下部衰微，就会形成寒厥；阴气在下部衰微，就会形成热厥。（凡是万物的生机，必定是从下往上升发的，所以阴阳之气在下部衰微，寒厥和热厥便由此产生。）
热厥之所以表现为热，必定从脚底开始，因为阳气起于足五趾的表面，阴脉汇聚于脚底并聚集在足心，所以阳气胜则脚底发热。（足趾的末端叫作“表”，是三阳经起始的地方。脚底、足心，是三阴经汇聚的地方。如果阳气胜则阴气虚，阳乘占了阴的位置，所以热厥必定从脚底开始。凡是患有阴虚病的人，所以足心多发热。）
寒厥之所以表现为寒，必定从五个脚趾向上蔓延到膝盖，因为阴气起于五趾的内侧，汇聚于膝下并聚集在膝上，所以阴气胜则从五趾到膝盖以上感到寒冷。这种寒冷，不是从外部侵入的，都是从内部产生的。（“里”指的是内部，也就是足下。如果阴气胜则阳气虚，阳不胜阴，所以寒冷。厥必定起于五趾并向上寒冷至膝盖，然而这种寒冷，并非从外而入，全是由内而生。所以凡是患阳虚病的人，必定手足多寒冷，都是从脚趾端开始的。）
寒厥是因为什么失误才这样的呢？（厥即将发作时，手足先感到寒冷，这就是寒厥。）
前阴部位，是宗筋汇聚的地方，也是太阴经和阳明经会合的地方。（前阴是指阴器。宗筋是指众多筋脉的汇聚，如足的三阴经、阳明经、少阳经，以及冲脉、任脉、督脉、跷脉的筋脉都汇聚于此，所以叫“宗筋”。这里单独提到太阴、阳明的会合，是重视水谷之脏的原因。胃是水谷气血的海，主要滋润宗筋，又是阴阳总汇宗筋的交会处，交会于气街穴，而阳明经在其中起主导作用，所以特别提及，以阐明下文的意义。）
春夏时节阳气多而阴气少，秋冬时节阴气盛而阳气衰。（天地自然的规律都是这样的。）这种人身体强壮，却在秋冬季节过度使用精力（指房事等），导致下部的精气向上争竞而不能恢复，精气从下部溢出，邪气便趁机随之而上逆。（身体强壮的人有所依仗，应当在秋冬阴气胜的时候节制情欲，否则会掠夺肾中的精气。精虚于下，就会向上索取，所以下气向上争竞。耗损太过，生成不及，所以不能恢复。精溢则气去，气去则阳虚，阳虚则阴胜成为邪气，所以寒气因此上逆。）
气被困阻在中焦。（气，即上文所说的精气、邪气。精气的本源，在于水谷，水谷的转化，出于脾胃，所以凡是病发为寒厥、下气上争、精气溢下的情况，都是因为气困阻在中焦。然而水谷在胃，命门在肾。从精气来说，肾精的化生依赖于胃；从火土来说，土中的阳气根源于命门。阴阳颠倒，互相关联，所以上文说“厥起于下”，这里说“气因于中”，正是为了阐明上下相互关联的意义。）
阳气衰微，不能渗透滋养其经络，阳气日渐损耗，阴气独存，所以手足为之寒冷。（阳气，即阳明胃气。四肢都禀受胃气，所以中焦阳虚，就不能渗透滋养经络而导致手足寒冷。）
热厥是怎么样的呢？（厥即将发作时，手足都发热，这就是热厥。）
酒进入胃中，则络脉充满而经脉空虚。（酒是熟谷的液体，其气悍烈而疾速，所以先充盈络脉。络满而经虚，是因为酒能伤阴，阳盛则阴衰。）
脾主为胃传输津液，阴气虚则阳气内入，阳气内入则胃不和，胃不和则精气竭绝，精气竭绝则不能营养四肢。（脾主为胃传输津液，所以酒入于胃，必归于脾，湿热在脾，则脾阴虚，阳独亢而胃不和。脾胃俱病，则精气竭绝，所以不能营养经络四肢。）
这种人常常醉酒或饱食后行房事，气聚积在脾中不得散开，酒气与谷气相互搏结，热盛于中，所以热遍于全身，体内发热且小便赤黄。酒的性质盛大而悍烈，肾气日渐衰微，阳气独胜，所以手足为之发热。（多次醉酒或饱食后行房事，既伤了脾，又伤了肾，都是阴虚，所以手足发热。寒、热两种厥证，一种是倚仗身体强壮，在秋冬季节过度使用精力，导致阳气衰微而为寒厥；一种是多次醉酒或饱食后行房事，导致精气竭绝而为热厥。两者都是因为酒色，致使真元受伤，才得此病。首先说明它们的原因，那么厥证的轻重，从这里就可以看出来了。）
厥证有时让人腹部胀满，有时让人突然不省人事，有的半天、远的一天后才醒过来，这是因为阴气盛于上部则下部虚弱，下部虚弱则腹胀满；（阴气盛于上部则不能固守于下部，所以下部虚弱。下部阴虚，则脾肾之气不能运化，所以腹部胀满。）阳气盛于上部则下部之气重并于上而邪气逆乱，逆乱则阳气混乱，阳气混乱则神志不清而不省人事。（“重”，通“并”，合并之意。邪气，指气失常。阳气盛于上部，则下部之气并合而上行，并合则逆乱，逆乱则混乱，阳气混乱则神明失守，所以突然不省人事。）
六经脉厥的症状和病态，（“能”，通“形”，形状。前言厥证的根本原因，这里阐明各经的具体症状。）
太阳经厥逆，则头部肿胀头重，脚不能行走，引发眩晕跌倒；（眩，眼睛眩晕混乱。仆，突然跌倒。足太阳经脉起于目内眦，上额交巅，入络脑，所以出现头部肿胀头重、眩晕跌倒，其向下运行的分支，合于腘中，贯穿腓肠肌内侧，所以脚不能行走。）
阳明经厥逆，则患癫狂病想奔跑呼喊，腹部胀满，不能躺卧，面色红赤而发热，胡言乱语看见不存在的东西；（阳明，是胃脉，是多气多血的经脉。气逆于胃，则阳明邪气实，所以患癫狂病而想跑且喊叫。其脉循行于腹里，所以腹部胀满。胃不和则睡不安稳，所以不能躺卧。阳明经脉行于面部，所以面色红赤而发热。阳邪盛则神明混乱，所以胡言乱语看见不存在的东西。）
少阳经厥逆，则突然耳聋，脸颊肿胀发热，胁肋疼痛，膝关节活动不利；（足少阳经厥逆，其脉入耳中，所以突然耳聋；下行加于颊车穴，所以脸颊肿胀发热；下行经过腋下沿胸部，过季胁；所以胁肋疼痛；下行出膝外侧，下于外辅骨之前，所以膝关节活动不利。“杭”音háng，指膝关节。）
太阴经厥逆，则腹部胀满，大便不通，不想吃东西，吃了就呕吐，不能躺卧；（足太阴经脉，入腹属脾络胃，所以厥逆时腹部胀满。逆气在脾，所以大便不通，并且让人不想吃东西，吃了就呕吐。脾与胃互为表里，胃不和则睡不安稳，脾也是如此。）
少阴经厥逆，则口干，小便赤黄，腹部胀满，心痛；（足少阴经厥逆，其脉循喉咙，挟舌本，所以口干；肾脉络膀胱，所以小便赤黄；其直行者从肾上贯肝膈，其分支从肺出络心，注入胸中，所以腹部胀满心痛。）
厥阴经厥逆，则小腹部肿痛，腹部胀满，大小便不利，喜欢躺着，弯曲膝盖，生殖器收缩肿胀，大腿内侧发热。（足厥阴经脉，抵小腹部，挟胃，所以厥逆时小腹部肿痛而腹部胀满。其脉环绕阴器，所以大小便不利，生殖器收缩而肿。肝主筋，是疲劳的本源，所以脚软喜欢躺着而弯曲膝盖。其下行者行于小腿内侧，所以大腿内侧发热。）
实证用泻法，虚证用补法，不虚不实，取本经调理。（不虚不实的情况，只有逆气在经脉，而没有明显的虚盛偏差，所以只取本经来调理。）
太阴经厥逆，腨部拘急挛缩，心痛牵引腹部；（这是重申前面的意思，以阐明足六经的厥逆。）
少阴经厥逆，腹部虚满，呕吐变易，下利清谷；厥阴经厥逆，肢体拘挛，腰痛，腹部虚满，前阴闭塞，胡言乱语。三阴经都厥逆，大小便不通，使人手足寒冷，三天死亡。（大小便不通，或者闭结不通，或者遗失不禁，是不符合正常状态的。三阴经都厥逆，则脏气断绝，所谓“厥逆连经则生，连脏则死”。）
太阳经厥逆，僵直仆倒，呕血，容易鼻出血；少阳经厥逆，关节活动不利，关节活动不利的人，腰不能行走，颈不能回顾，引发肠痈，不可治愈，如果有惊悸症状的则死亡；（肠痈发于少阳厥逆，是相火结聚的毒邪，所以不可治愈。如果有惊悸症状，则毒邪连及内脏，所以应当死亡。）
手太阴经厥逆，腹部虚满而咳嗽，容易呕吐涎沫；（这里下面讲手六经的厥逆。手太阴经脉起于中焦，循胃口，上膈属肺，所以它的病症如此。）
手心主、少阴经厥逆，心痛牵引咽喉，身体发热，死亡不可治愈；（手心主厥阴经脉起于胸中，出属心包络，手少阴心脉从心系上挟咽喉，都让人心痛牵引咽喉。这两经属火，主血脉，所以身体发热。心是五脏六腑的大主，所以逆乱则死亡，不可治愈。）
手太阳经厥逆，耳聋流泪，颈不能回顾，腰不能俯仰；（手太阳小肠经脉，至眼的内外眦，入耳中，所以厥逆时耳聋流泪；其分支从缺盆循颈，所以颈不能回顾。邪在小肠的，连睾系属于脊，所以腰不能俯仰。）
手阳明、少阳经厥逆，引发喉痹咽喉肿胀，痉挛。（手阳明大肠经脉，从缺盆上颈贯颊，手少阳三焦经脉，上出缺盆上项，所以都引发喉痹咽喉肿胀；痉挛，指手臂肩项强直。以上没有说死亡的，可以根据虚实，治疗其主要病症。）
有人患头痛多年不愈，一定是遭受了大寒，寒气深入骨髓，髓以脑为主，脑气逆乱所以令头痛，牙齿也痛，这种病也叫做“厥逆”。（髓以脑为主，诸髓都属于脑，所以大寒至髓则上入头脑而为痛。邪气深重，所以多年不愈。髓是骨的充养物，所以头痛牙齿也痛。这是因为邪气逆乱于上，所以也叫做“厥逆”。）
有人患癃闭，一天几十次排尿，这是正气不足；身体发热像炭火一样，颈部和胸膺像被格挡一样不通畅，人迎脉搏动躁盛，喘息，气逆，这是邪气有余。太阴脉细微如头发一样，这是正气不足。（癃，小便不利，一天几十次排尿。频繁想解小便但排出很少。像炭火，形容热得很厉害。颈指咽喉，膺指胸臆。像格挡，形容上下不通，好像有什么阻挡。人迎脉搏动躁盛，足阳明动脉在结喉两旁，用来候阳气。喘息，呼吸急促。气逆，治节不行。太阴脉细微，即两手寸口之脉，用来候阴气。）
病在太阴，（脾、肺二脏，皆属太阴。下文“颇在肺”，这里专指脾阴。太阴脉细微，正是因为气口也属太阴。脏气不足，脉象显现在这里。另外中气不足，小便和大便就会发生变化。现在他癃闭而一天几十次排尿，也是因为中气不足的缘故，所以病在脾阴。）
其盛在胃，（上文说身体发热像炭火，胃主肌肉，颈部和胸膺像被格挡，胃脉循喉咙，入缺盆，下膈。人迎脉搏动躁盛，一盛、二盛、三盛、四盛，而且大而且数，名叫“溢阳”。以上三种情况，都属阳明，所以说“其盛在胃”。）
这种病也叫做“厥”，死亡不可治愈。（阴不入阳，所以其盛在胃；阳不入阴，所以太阴脉细微。这种病也叫做“厥”，是因为阴阳都逆乱，所以死亡不可治愈。）
这就是所谓的“五有余”、“二不足”。所谓“五有余”，是五种病气有余；“二不足”，也是病气的不足。现在外面得到“五有余”，里面得到“二不足”，这人的病既不表也不里，也是明确的死证了。（外面得到五有余，是一身热如炭，二是颈部胸膺像被格挡，三是人迎脉搏动躁盛，四是喘息，五是气逆。里面得到二不足，一是癃闭而一天几十次排尿，二是太阴脉细微如头发。像这五种病，是邪气有余；两种病，是正气不足。想要泻除邪气，则里阴虚；想要补益虚损，则外阳实。救里不可以，治表也不可以，这是不表不里的病，就像阳证阴脉之类，只有死而已，不能救治了。）
有病厥的人，诊察右脉沉而紧，左脉浮而迟，不知道病的主因在哪里？（这里说厥逆而伴有腰痛的人，病在肾。右脉、左脉，都是以两尺脉而言。）
然而冬天诊察，右脉本来应当沉紧，这是顺应四时；左脉浮而迟，这是违背四时。（冬气伏藏，所以沉紧的是应时，浮迟的是逆，逆则为厥了。）
左脉浮迟应当主病在肾，但也关系到肺，应当是腰痛。（左脉浮迟，应当主病在肾，这里正是以尺脉而言。然而浮脉是肺脉，所以说“颇关在肺”。）
为什么这么说？少阴脉贯通肾络肺，现在得到肺脉，肾为之病，所以肾是腰痛病的根源。（肾脉本络于肺，现在以冬季而肺脉见于肾位，乃是肾气不足，所以脉不能沉而见浮迟。这不是肺病，病在肾。腰为肾之府，所以肾气逆乱，应当病为腰痛。）
有病胸部肿胀颈部疼痛，胸满腹胀，也叫做厥逆。（胸部肿胀颈部疼痛，胸满腹胀，都在上、中二焦，这是因为阴并于阳，下逆于上，所以病也叫做“厥逆”。）
艾灸则会失音，砭石刺破则会发狂，必须等待气机调和，才可以治疗。（喑，失音。石，总称针石。）
为什么会这样？阳气重聚于上，有余于上，艾灸则阳气入阴，入阴则失音；（阳气有余于上而又艾灸，是以火济火。阳极乘阴则阴不能支撑，所以失声为喑。）
砭石泄之则阳气虚，虚则发狂。（阳并于上，其下必虚，用砭石泄之，则阳气随刺而去，气去则上下俱虚而神失其守，所以发狂。）
必须等待气机并合而治疗它，可以使痊愈。（气并，是说阴阳既逆乱之后，必然逐渐通达。盖上下不交通，因而厥逆，当它们乖离分离时强行治疗，恐怕导致偏绝，所以必须等待气机并合，则或阴或阳，随其盛衰，观察而调理，可以使保全。）
What is the reason for cold and heat in Jue syndrome? (The term "Jue" refers to reversal or counterflow. When Qi flows reversely, it causes chaos, leading suddenly to dizziness, collapse, or loss of consciousness, which is named Jue. Jue originating from the feet marks the beginning of the attack; severe cases involve sudden collapse and unconsciousness, while mild cases recover gradually, and severe ones may result in immediate death, making it a critical condition. Later generations incorrectly referred to cold or hot extremities as Jue, and some even misidentified Hong Kong foot (a lower limb disease) as Jue, which is highly erroneous. Although Zhang Zhongjing distinguished between Cold Jue and Heat Jue, he was referring specifically to the extremities to differentiate cold and heat patterns in Shanghan (Cold Damage), not defining Jue itself. In sudden Jue, the patient cannot speak; when Blood and Qi rush upward together, it forms Great Jue, causing sudden apparent death. If Qi returns, the patient lives; if not, they die. When the meridians of Foot Shaoyin, Taiyin, and Foot Yangming are all exhausted, the body feels heavy and the form becomes insensate; this state resembling a corpse is called "Corpse Jue." Such conditions far exceed mere cold/hot extremities or Hong Kong foot. Nowadays, people often fail to recognize Jue syndrome and mistakenly diagnose it as Stroke. Stroke typically involves injury to the meridians, whereas Jue directly results from the depletion of Essence and Qi internally. The exterior-interior and deficiency-excess aspects must be differentiated. Incorrect terminology and treating Jue with wind-dispelling methods cause significant harm to medicine. By comparing Wind and Jue side by side, students should clearly understand this.)
When Yang Qi declines at the lower part, Cold Jue occurs; when Yin Qi declines at the lower part, Heat Jue occurs. (The vital energy of all things rises from below; thus, the decline of Yin and Yang Qi at the lower level gives rise to Cold and Heat Jue.)
Heat Jue manifests as heat starting from the soles of the feet because Yang Qi originates from the dorsal aspect of the five toes, while Yin meridians converge at the soles and gather in the sole center. Therefore, when Yang Qi prevails, the soles become hot. (The distal ends of the toes are termed "biao" (exterior/surface), where the three Yang meridians originate. The soles and centers of the feet are where the three Yin meridians gather. If Yang Qi prevails, Yin Qi becomes deficient, allowing Yang to invade Yin territories, so Heat Jue always begins at the soles. This is why patients with Yin deficiency often experience heat in the soles.)
Cold Jue manifests as cold starting from the five toes and extending up to the knees because Yin Qi originates from the plantar aspect of the five toes, gathers below the knees, and accumulates above them. Thus, when Yin Qi prevails, coldness spreads from the toes to above the knees. This coldness does not come from outside but arises from within. ("Li" refers to the interior, i.e., the soles. If Yin Qi prevails, Yang Qi becomes deficient and cannot overcome Yin, resulting in cold. Jue always starts at the toes and ascends with coldness. However, this cold is not exogenous but endogenous. Hence, patients with Yang deficiency invariably have cold extremities starting from the toe tips.)
Why does Cold Jue occur due to such imbalance? (When Cold Jue is about to manifest, the hands and feet feel cold first.)
The anterior yin region is the gathering place of the Zongjin (major sinews), where the Taiyin and Yangming meridians intersect. (The anterior yin refers to the genitalia. Zongjin denotes the convergence of numerous sinews, including those of the three Yin meridians, Yangming, Shaoyang, Chong, Ren, Du, and Qiao meridians. Here, only Taiyin and Yangming are mentioned because they emphasize the organs of water and grain. The Stomach is the sea of water and grain and blood/qi, moistening the Zongjin, serving as the meeting point of Yin and Yang sinews at the Qichu acupoint, with Yangming acting as the leader. This is highlighted to explain the following text.)
In spring and summer, Yang Qi is abundant and Yin Qi is scarce; in autumn and winter, Yin Qi is prosperous and Yang Qi declines. (This follows the natural laws of heaven and earth.) A robust person who overexerts themselves during autumn and winter depletes their lower Qi, causing it to struggle upward without recovery. Essence overflows downward, and pathogenic Qi follows it upward. (Robust individuals rely on their strength but may indulge in sexual activity during Yin-dominant seasons, depleting Kidney essence. Deficiency of essence below leads to an upward struggle of lower Qi. Excessive consumption outpaces generation, preventing recovery. Essence overflow leads to Qi loss; Qi loss leads to Yang deficiency; Yang deficiency allows Yin excess to become pathogenic, causing cold Qi to rebel upward.)
Qi becomes constrained in the middle jiao. (Qi here refers to the essence and pathogenic Qi mentioned earlier. Essence originates from water and grain, transformed by the Spleen and Stomach. Thus, Cold Jue, upward struggle of lower Qi, and essence overflow are all caused by Qi constrained in the middle. While water and grain reside in the Stomach and Mingmen is in the Kidney, essence transformation depends on the Stomach, and Earth's Yang root lies in Mingmen. Yin and Yang are interlinked; hence, "Jue starts from below" and "Qi is constrained in the middle" illustrate their mutual dependence.)
When Yang Qi declines, it cannot nourish the meridians. As Yang Qi diminishes daily, Yin Qi remains alone, causing coldness in the hands and feet. (Yang Qi here refers to Yangming Stomach Qi. The four limbs receive Qi from the Stomach. Middle-jiao Yang deficiency fails to nourish the meridians, resulting in cold extremities.)
How does Heat Jue occur? (When Heat Jue is imminent, the hands and feet are hot.)
Wine enters the Stomach, filling the Luo (collateral) vessels while leaving the Jing (main) vessels empty. (Wine is a liquid of cooked grains with fierce and rapid Qi, filling the collaterals first. Full collaterals and empty meridians indicate that wine damages Yin, leading to Yang excess and Yin deficiency.)
The Spleen transports fluids for the Stomach. When Yin Qi is deficient, Yang Qi enters inwardly. Internal Yang Qi disrupts Stomach harmony, leading to exhaustion of essential Qi, which then fails to nourish the four limbs. (Since the Spleen transports fluids, wine entering the Stomach affects the Spleen. Damp-heat in the Spleen causes Spleen Yin deficiency and isolated Yang hyperactivity, disrupting Stomach harmony. Spleen-Stomach dysfunction exhausts essential Qi, failing to nourish the limbs.)
Such individuals often engage in sexual activity after heavy drinking or full meals. Qi aggregates in the Spleen and cannot disperse. Wine Qi and Grain Qi contend, generating intense heat in the center, spreading throughout the body, causing internal heat and dark urine. Wine Qi is fierce and dominant, causing daily decline of Kidney Qi and isolated Yang excess, leading to hot extremities. (Frequent drunkenness and sexual activity damage both Spleen and Kidney, causing Yin deficiency and hot extremities. Cold Jue arises from overexertion in winter depleting Yang Qi; Heat Jue arises from drunkenness/sexual activity exhausting Essence Qi. Both stem from alcohol and lust damaging true Yuan Qi, explaining the severity of Jue.)
Jue may cause abdominal fullness, sudden unconsciousness, or recovery after half a day to a day. This is because excessive Yin Qi above leads to lower deficiency, causing abdominal distension. (Yin Qi prevailing above fails to secure the lower part, causing lower deficiency. Lower Yin deficiency impairs Spleen-Kidney transformation, leading to abdominal fullness.) Excessive Yang Qi above causes lower Qi to merge and ascend rebelliously, creating chaotic Yang Qi and unconsciousness. ("Zhong" means merging. Pathogenic Qi refers to abnormal Qi flow. Yang excess above forces lower Qi upward, causing rebellion and chaos, leading to loss of Shen spirit and sudden unconsciousness.)
Regarding the manifestations of Jue in the six meridian systems:
Taiyang Jue causes head swelling, heaviness, inability to walk, dizziness, and collapse. (Taiyang Meridian starts at the inner canthus, crosses the vertex, and enters the brain, causing head symptoms. Its descending branch passes through the popliteal fossa and calf, causing walking difficulties.)
Yangming Jue causes manic epilepsy, running and shouting, abdominal fullness, inability to lie down, red and hot face, hallucinations, and delirious speech. (Yangming is the Stomach meridian, rich in Qi and Blood. Qi rebellion in the Stomach creates excess pathogens, causing mania. The meridian runs along the abdomen, causing fullness. Disharmony prevents sleep. The meridian traverses the face, causing redness and heat. Yang pathogen chaos causes mental disturbances.)
Shaoyang Jue causes sudden deafness, swollen and hot cheeks, hypochondriac pain, and knee stiffness. (Shaoyang meridian enters the ear, causing deafness. It descends to the jaw, causing cheek swelling. It passes the chest and ribs, causing pain. It exits the lateral knee, causing joint stiffness.)
Taiyin Jue causes abdominal fullness, constipation, anorexia, vomiting upon eating, and insomnia. (Taiyin meridian enters the abdomen and connects to the Spleen and Stomach. Qi rebellion in the Spleen causes constipation and digestive issues. Spleen-Stomach disharmony causes insomnia.)
Shaoyin Jue causes dry mouth, dark urine, abdominal fullness, and heart pain. (Shaoyin meridian circulates around the throat and tongue base, causing dry mouth. It connects to the Bladder, causing dark urine. Its branches connect to the Heart, causing abdominal fullness and heart pain.)
Jueyin Jue causes lower abdominal swelling and pain, abdominal distension, difficulty urinating and defecating, preference for lying down with bent knees, genital retraction and swelling, and heat in the medial thigh. (Jueyin meridian reaches the lower abdomen and stomach, causing swelling. It circles the genitals, causing urinary/reproductive issues. The Liver governs sinews; weakness causes preference for lying down. The meridian runs along the medial leg, causing heat.)
Excess patterns are treated with draining methods; deficiency patterns with tonifying methods. For neither excess nor deficiency, regulate the affected meridian.
Taiyin Jue causes calf cramping, heart pain radiating to the abdomen.
Shaoyin Jue causes false fullness, vomiting, and clear diarrhea. Jueyin Jue causes cramping, lower back pain, false fullness, urinary retention, and delirium. When all three Yin meridians rebel, causing inability to pass stool or urine and cold extremities, death occurs within three days. (Failure to pass stool or urine indicates organ failure. "Jue connecting to meridians allows life; connecting to organs causes death.")
Taiyang Jue causes rigidity, collapse, hematemesis, and frequent epistaxis. Shaoyang Jue causes joint dysfunction, inability to walk or turn the neck, intestinal abscess (incurable), and death if accompanied by fright. (Intestinal abscess in Shaoyang Jue is due to Fire-toxin accumulation. Fright indicates toxin affecting organs.) Yangming Jue causes wheezing, coughing, fever, fright, epistaxis, and hematemesis.
Hand Taiyin Jue causes false fullness, coughing, and vomiting of saliva. (Hand Taiyin meridian originates in the middle jiao, connects to the Lung.)
Hand Jueyin (Pericardium) and Hand Shaoyin (Heart) Jue cause heart pain radiating to the throat, fever, and death (incurable). (These Fire meridians govern blood vessels. Heart is the master of organs; rebellion leads to death.)
Hand Taiyang Jue causes deafness, tearing, neck stiffness, and inability to bend or extend the waist. (Hand Taiyang Small Intestine meridian connects to the ear and neck. Pathogens in the Small Intestine affect the spine and waist.)
Hand Yangming and Hand Shaoyang Jue cause sore throat, pharyngeal swelling, and spasms. (Meridians traverse the neck and throat. Spasms refer to rigidity of arms, shoulders, and neck. These are treatable based on excess/deficiency.)
Chronic headache lasting years is caused by severe cold penetrating to the bone marrow and brain, named "Jue Ni" (Reversal Jue). (Marrow belongs to the brain. Cold invading marrow causes head and tooth pain due to rebellious Qi.)
A patient with strangury (frequent small-volume urination) has deficiency. Fever like charcoal, blocked neck/chest, hyperactive Renying pulse, wheezing, and Qi rebellion indicate excess. Fine Hair-like Taiyin pulse indicates deficiency. (Strangury is frequent urination with little output. Charcoal-like heat is severe. Blocked neck/chest implies obstruction. Renying pulse reflects Yang. Taiyin pulse reflects Yin.)
The disease is in Taiyin (Spleen Yin), with excess in the Stomach (Yangming), and slightly involving the Lung. This is named "Jue," incurable death. (Yin fails to enter Yang; Yang fails to enter Yin. Both Yin and Yang are rebellious. This is "Five Excesses and Two Deficiencies." Five excesses: fever, blockage, hyperactive pulse, wheezing, Qi rebellion. Two deficiencies: strangury, fine pulse. Treating excess worsens deficiency; tonifying deficiency worsens excess. This mixed pattern is fatal.)
For Jue with right pulse deep/tight and left pulse floating/slow in winter: Right pulse matches seasons (Winter = Deep/Tight); Left pulse contradicts seasons (Floating/Slow = Rebellious). Left pulse suggests Kidney disease affecting the Lung, manifesting as lower back pain. (Kidney meridian connects to Lung. Winter Lung pulse at Kidney position indicates Kidney Qi deficiency failing to sink, causing Floating/Slow pulse. Waist is the mansion of the Kidney.)
Chest swelling, neck pain, chest fullness, and abdominal distension are also named "Jue Ni." (Yin merges with Yang, rebelling upward. Moxibustion causes aphonia; stone therapy causes madness. Treatment requires waiting for Qi harmonization.) (Moxibustion adds fire to existing upper Yang excess, damaging Yin and causing aphonia. Stone therapy drains Qi, causing emptiness and madness. Harmonizing Qi allows recovery.)