太阳经九法 太阴经一法 少阴经七法 少阴死证五法 厥阴经五法厥阴死证五法《卒病论》虽亡，《伤寒论》固
存也。仲景于伤寒阳微阴盛恶寒之证，尚不俟其彰着，早用附子、干姜治之，并灸之矣。况于卒病乎？况于卒
病彰着之极者乎？兹特重加剖绎，非但治卒病有据，即遇伤寒危证，毫发奠遁耳。
仲景治伤寒传经热病，邪在太阳之初，便有用附子治阳虚九法。
其一因误用发汗药，致汗漏不止者，用桂枝汤加附子为救法。其证恶风，小便难，四肢微急，难以屈伸。
风伤卫之证原恶风，加以误汗，则腠理尽开，而恶风愈甚。小便难者，诸阳主气，阳亡于外，膀胱之气化自不行也，
四肢微急，难以屈伸者，四肢为诸阳之本，亡阳脱液，斯骨属不利也。阳虚之人，误发其汗，既可用此方以救其阳，未
汗之先，宁不可用此方以解肌得汗乎？仲景于桂枝汤中加人参加附子，不一而足，其旨微矣。
其一因误汗，致心悸头眩身 动，无可奈何者，用真武汤为救法。其证发汗不解，仍发热心下悸，头眩身 动，振
振欲擗地。
汗虽出而热不退，则邪未尽，而正已大伤。况里虚为悸，上虚为眩，经虚为 ，身振振摇，无往而非亡阳之象，所
以行真武把守关口坐镇之法也。
其一为发汗不解，反恶寒者，用芍药甘草附子汤为救法。其证发汗不解，反恶寒者，虚故也。
未汗而恶寒，邪盛而表实；已汗而恶寒，邪退而表虚；阳虚则恶寒，宜用附
子固矣。然既发汗不解，可知其热犹在也，热在而别无他证，自是阴虚之热，又当用芍药以收阴，此荣卫两虚之救法也。
其一发汗若下之，病仍不解烦躁者，用茯苓四逆汤为救法。
误汗则亡阳而表虚，误下则亡阴而里虚，阴阳俱虚，邪独不解，故生烦躁，用此汤以救之。前一证荣卫两虚，此一
证表里两虚，制方之妙，又非表里一言可尽。盖烦为心烦，躁为肾躁，故用干姜、附子入肾以解躁，茯苓、人参入心以
解烦也。
其一误下而致脉促胸满，复微恶寒者，用桂枝汤去芍药加附子为救逆。
脉促虽表邪未尽，然胸但满而不结，则以误下而损其胸中之阳也。加以微恶寒，则并肾中之真阳亦损，而浊阴用事
矣。故去芍药之阴，加附子以回阳也。
其一下之后复发汗，脉沉微，身无大热者，用干姜附子汤为救法。其证昼日烦躁不得眠，夜而安静，不呕不渴，无
表证，脉沉微，身无大热。
此证前一条云∶下之后复发汗，必振寒脉微细，所以然者，以内外俱虚故也。误汗亡阳，误下亡阴，故云内外俱虚。
然不出方，以用附子回阳，人参益阴，已有成法，不必赘也。此复教人以精微之蕴，见亡阳一证，较亡阴倍多，然阳用
事于昼者也，热烦躁扰不得眠，见于昼者若此。阴用事于夜者也，安静不呕不渴，见于夜者若彼，岂附子、人参，阴阳
两平之可施乎？必干姜、附子，偏于辛热，乃足回其阳，以协于偏胜之阴也。
其一风湿两邪，搏聚一家，用甘草附子汤分解之法。其证骨节烦疼掣痛，不得屈伸，近之则痛剧，汗出短气，小便
不利，恶风不欲去衣，或身微肿。
风则上先受之，湿则下先受之。逮至两相搏聚，注经络，流关节，渗骨体，躯壳之间，无处不到，则无处不痛也。
于中短气一证，乃汗多亡阳，阳气大伤之征，故用甘草、附子、白术、桂枝为剂，以复阳而分解外内之邪也。又寒伤
荣而无汗之证，用桂枝附子汤，即本方去术加姜枣之制也。其寒伤荣无汗，而大便硬小便自利者，知其邪不在表，则本
方去桂枝仍用术，借其益土燥湿之用也。三方原三法，今并为一，见治风湿相搏，不出以回阳为急务耳。
其一心下痞而恶寒汗出。用附子泻心汤，复阳泻痞，兼而行之之法。
泻心汤有五∶曰甘草、曰半夏、曰生姜、曰黄连、曰附子。以恶寒汗出，阳虚之证，较阴痞更急。故用麻沸汤渍去
痞之药，而浸入浓煎之附子汁，虽曰一举两得，其所重从可识矣。
其一误用阳旦汤致逆，用四逆汤救逆一法。
阳旦汤者，桂枝汤加黄芩之制也。其人阳气素衰者，虽当夏月，阳外阴内，桂枝汤中可加附子，不可加黄芩，所以
其人得汤便厥也。若重发汗，或烧针者，误上加误，非四逆汤不能回其阳矣。阳明、少阳二经，绝无用附子法，惟太阳
一经，独有不得不用之证。盖太阳膀胱为肾之府，肾中阳虚阴盛，势必传出于府，以故才见脉微恶寒，漏汗恶风，心悸
头眩，肉 筋惕，躁扰等证。纵是传经热病，不得不用姜附以消阴复阳也。而暴病不由传经发热，卒然而至，尚何等待
而不用附子、干姜乎？
太阴经一法
伤寒传太阴经，有自利不渴一证，乃其人平素湿土之藏有寒也，故用四逆汤为温土之法。
太阴湿土之藏有寒，不用理中而用四逆者，此亦可见仲景之精义。盖水土同出一源，冬月水暖，则土亦暖；夏月水
寒，则土亦寒，所以土寒即阴内阳外，非细故也。用四逆以温土，抑何神耶？
少阴经七法
少阴病得之一二日，口中和，其背恶寒者，用灸及附子汤，外内相攻之法。
口中和而不燥不渴，其无里证可知。况背为督脉，统督诸阳上行之地，他处不寒，独觉背间寒者，其为阳虚而阴邪
上凑又可知。故外灸内温，两法并施，必求阴消阳复而后已也。不知者，谓伤寒才一二日，外证且轻，何反张皇若此。
讵识仲景正以一二日即显阳虚阴盛之证，蚤从暴病施治，所谓见微知着也。若待至三四日，势必极盛难返，不可救药矣。
况于三四日以后，其非暴病明矣，又何用张皇也哉！
少阴病得之二三日，麻黄附子甘草汤微发汗，以二三日无里证，故微发汗之法。
得病才二三日，无吐利躁烦呕渴里证，其当从外解无疑。然少阴绝无发汗之法，汗之必至亡阳。惟此一证，其外发
热无汗，其内不吐利躁烦呕渴，乃可温经散寒，取其微似之汗，此义甚微。在太阳经但有桂枝加附子之法，并无麻黄加
附子之法。盖太阳病无脉微恶寒之证，即不当用附子。及见脉微恶寒吐利躁烦等证，亡阳已在顷刻，又不当用麻黄。即
此推之，凡治暴病而用麻黄者，其杀人不转睫矣。
少阴病，身体痛，手足寒，骨节痛，脉沉者，有用附子汤一法。
一身骨节俱痛者，伤寒太阳经病也，手足寒而脉沉，则肾中真阳之虚审矣。可见身体骨节之痛，皆阳虚所致，而与
外感不相涉矣，故用附子汤以助阳而胜肾寒，斯骨节之痛尽除也。若以其痛为外感之痛，宁不杀人乎？
少阴下利脉微者，有用白通汤一法。
利不止厥逆无脉，干呕烦者，有白通加猪胆汁一法，服汤脉暴出者死，微续者生。
少阴下利，其人肾藏虚，寒邪盛也。脉微者，与白通汤，驱寒助阳，斯利止脉健矣。服之利不止，转至无脉，呕烦
有加，此因以热药治寒，寒甚而格药不入，徒增其逆乱之势也。加猪胆汁为响导，斯药入而寒不为拒，阳可回，脉可
出矣。然脉必微续乃生，暴出反死，甚哉虚阳之易出难回也。
少阴下利有水气，或咳或呕者，有用真武汤加减一法。
阴寒甚而水气泛滥，由阳虚不能摄水，复不能生土以制水。以故腹痛，小便不利，四肢沉重疼痛，自下利，或小便
亦利，或咳或呕，水性泛滥，则无所不之也。因其见证不一，故有加减法，余见《尚论篇》。
少阴下利，里寒外热，手足厥逆，脉微欲绝，有用白通四逆汤加减一法。
面色赤者，加葱九茎。腹中痛者，去葱加芍药二两。呕者加生姜二两。咽痛者，去芍药加桔梗一两。利止脉不出者，
去桔梗加人参二两。
少阴死证五条
少阴病，恶寒身蜷而利，手足逆冷者不治。
阴盛无阳也。
少阴病，下利止而头眩，时时自冒者死。
阳回利止则生，若利止更加眩冒，则其止也，乃阴已先亡。故阳无根据附，浮越于上，而神气散乱，时时自冒也。
少阴病，四逆恶寒而身蜷，脉不至，不烦而躁者死。
脉不至，阳已先绝，不烦而躁，孤阴顷刻自尽矣。
少阴病，六七日息高者死。
息高则真阳上越，其下无根，绵绵若存之地，神机化灭，故主死也。
少阴病，脉微沉细，但欲卧，汗出不烦，自欲吐，至五六日自利，复烦躁不得卧寐者死。
伤寒忌见阴脉，故仲景谓少阴病脉沉者，急温之。今脉之微沉细，具见外证，嗜卧汗出不烦，阳不为用矣。自欲吐，
阴邪上干矣。更加自利，则藏气必至尽绝矣。况始先不烦，今更烦躁，始先欲寐，今更不得卧寐。所存一线之阳，扰乱
若此，可复收乎？
厥阴经五法
病者手足厥冷，言我不结胸，少腹满，按之痛者，此冷结在膀胱关元一法。
阳邪当结于阳，不结胸，则阳虚可知。阴邪当结于阴，冷结在膀胱关元，则阴盛可知。
伤寒脉促，手足厥逆者，有灸之之法。
脉见喘促，阳气内陷，急遽不舒之状也。加以手足厥逆，阳微阴盛，必罹灭顶之凶，故当灸之以通其阳也。
大汗出热不去，内拘急，四肢疼，又下利厥逆而恶寒，用四逆汤一法。
大汗出而邪不除，阳则反虚矣。内拘急，四肢疼，下利厥逆恶寒，则阳之虚者，已造于亡。而阴之盛者，尚未有极，
故用四逆汤，以胜阴复阳也。
下利清谷，里寒外热，汗出而厥者，用通脉四逆汤一法。
下利里寒，加以外热，是有里复有表也。然在阳虚之人，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，终是外邪不服，故于四逆汤中，加葱为治，丝丝必贯，为万世法程。
呕而脉弱，小便复利，身有微热，见厥者难治，用四逆汤一法。
呕与微热，似有表也。脉弱则表邪必不盛，小便利则里邪必不盛，可见其呕为阴邪上干之呕，热为阳气外散之热。
见厥则阳遭阴掩，其势侵危，非用四逆汤，莫可救药矣。难治二字，回互上条，多少叮咛。见呕而微热，与里寒外热，
毫厘千里，用四逆汤，即不可加葱，以速其阳之飞越，学人可不深研乎？
厥阴死证四条
伤寒六七日，脉微，手足厥冷，烦躁，灸厥阴，厥不还者死。
灸所以通阳也，厥不还，则阳不回可知矣。
伤寒发热，下利厥逆，躁不得卧者死。
肾主躁，躁不得卧，肾中阳气越绝之象也。
发热而厥七日，下利者为难治。
先热后厥，病邪已为加进。其厥复至七日之久，所望者，阳回厥返耳。若更加下利，是其虚寒深锢，阳固无回驭之
机，阴亦有立尽之势，故难治也。
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。
发热而利，里虚而外邪内入也，故曰有阴。汗出不止，表虚而内阳外出也，故曰无阳。再按∶少阴肾中，内藏真阳，
其死证，舍真阳外亡，别无他故矣。乃厥阴之死证，亦因厥逆不返，下利不止，致肾脏真阳，久出不返，乃成死候。然
则肾脏之真阳，岂非生身立命之根乎？观此而《卒病论》之旨，全现全彰矣。
太阳经治法九种，太阴经治法一种，少阴经治法七种，少阴死证五种，厥阴经治法五种，厥阴死证五种。《卒病论》虽然失传，《伤寒论》确实保存下来了。张仲景对于伤寒中阳气微弱、阴寒内盛且伴有恶寒的病症，尚且不等到症状明显显露，就及早使用附子、干姜进行治疗，并配合艾灸。何况是突发疾病呢？何况是突发疾病症状极其明显的情况呢？这里特意重新深入剖析研究，不仅治疗突发疾病有依据，即使遇到伤寒危重病症，也丝毫无法隐藏。
张仲景治疗伤寒传经热病，邪气在太阳经初期，就有使用附子治疗阳虚的九种方法。
第一种是因为误用发汗药，导致汗出不止，用桂枝汤加附子作为补救方法。其症状表现为怕风，小便困难，四肢轻微拘急，难以屈伸。
风邪伤及卫分原本就会怕风，加上误用发汗，导致腠理完全开放，所以怕风更加严重。小便困难，是因为诸阳主司气化，阳气在外亡失，膀胱的气化功能自然不能运行。四肢轻微拘急，难以屈伸，是因为四肢是诸阳的根本，阳气亡失、津液脱失，骨骼关节就不利了。阳虚的人，误用发汗法，既然可以用这个方剂来挽救阳气，那么在未发汗之前，难道不可以用这个方剂来解肌表之邪而得汗吗？张仲景在桂枝汤中加入人参和附子的情况不止一次，其中的旨意是很微妙的。
第二种是因为误用发汗，导致心悸、头晕、身体震颤动摇，无可奈何，用真武汤作为补救方法。其症状表现为发汗后病不解，仍然发热，心下悸动，头晕，身体震颤动摇，颤抖得好像要跌倒在地。
汗虽然出了但热不退，说明邪气未尽，而正气已经大伤。况且里虚导致心悸，上虚导致头晕，经络虚弱导致震颤，身体振摇不定，无处不是阳气亡失的迹象，所以采用真武汤把守关口、坐镇全局的方法。
第三种是发汗后病不解，反而更加怕冷，用芍药甘草附子汤作为补救方法。其症状表现为发汗后病不解，反而怕冷，这是因为虚的缘故。
未发汗时怕冷，是邪气盛而表实；已发汗后还怕冷，是邪气退而表虚；阳虚就会怕冷，适宜用附子固然是对的。然而既然发汗后病不解，可知热邪还在，热邪存在而没有其他症状，自然是阴虚之热，又应当用芍药来收敛阴液，这是营卫两虚的补救方法。
第四种是发汗或攻下后，病仍不解且出现烦躁，用茯苓四逆汤作为补救方法。
误用发汗则亡阳而表虚，误用攻下则亡阴而里虚，阴阳俱虚，邪气独自不解，所以产生烦躁，用这个汤剂来救治。前一种证候是营卫两虚，这一种证候是表里两虚，制方的精妙之处，不仅仅是一句“表里”可以概括的。大概烦是心烦，躁是肾躁，所以用干姜、附子入肾以解除躁，茯苓、人参入心以解除烦。
第五种是误用攻下导致脉促、胸满，又轻微怕冷，用桂枝汤去芍药加附子作为救逆方法。
脉促虽然表示表邪未尽，但如果只是胸满而不结聚，那是因为误用攻下损伤了胸中的阳气。加上轻微怕冷，那么连肾中的真阳也受损，浊阴之气就要逞势作乱了。所以去掉芍药的阴柔，加入附子以回阳。
第六种是攻下之后再次发汗，脉象沉微，身体没有大热的，用干姜附子汤作为补救方法。其症状表现为白天烦躁不得睡眠，夜间安静，不呕吐不口渴，没有表证，脉象沉微，身体没有大热。
这个证候在前一条中说：攻下之后再次发汗，必定会出现畏寒、脉微细，之所以这样，是因为内外都虚的缘故。误用发汗亡阳，误用攻下亡阴，所以说内外俱虚。然而这里没有给出方剂，因为用附子回阳、用人参益阴，已有成法，不必赘述。这里再次教导人们精微的蕴义，见到亡阳一证，比亡阴多出一倍，然而阳气在白天发挥作用，热烦躁扰不得睡眠，出现在白天的情况就是这样。阴气在夜晚发挥作用，安静不呕不渴，出现在夜晚的情况就是那样，难道是附子、人参这种阴阳两平的药可以施用的吗？必须用干姜、附子，偏于辛热，才足以回复阳气，以协调偏胜的阴气。
第七种是风湿两种邪气，搏结在一起，用甘草附子汤分解的方法。其症状表现为骨节烦痛掣痛，不能屈伸，靠近就疼痛剧烈，出汗短气，小便不利，怕风不想脱衣，或者身体轻微浮肿。
风邪先从上受，湿邪先从下受。等到两者搏结，注入经络，流注关节，渗透骨体，躯壳之间，无处不到，所以无处不痛。其中短气一证，是汗多亡阳，阳气大伤的征象，所以用甘草、附子、白术、桂枝为药剂，以恢复阳气并分解内外之邪。另外，寒邪伤及营分而无汗的证候，用桂枝附子汤，就是本方去掉白术加上生姜大枣的制法。如果是寒邪伤及营分无汗，而大便硬、小便自利的，知道邪气不在表，就本方去掉桂枝仍用白术，借其补益脾胃、燥湿的作用。这三个方子原本有三种方法，现在合并为一，可见治疗风湿相搏，不出以回复阳气为紧急任务之外。
第八种是心下痞塞且怕冷出汗，用附子泻心汤，回复阳气、消除痞塞，兼而行之的方法。
泻心汤有五种：甘草泻心汤、半夏泻心汤、生姜泻心汤、黄连泻心汤、附子泻心汤。因为怕冷出汗，是阳虚的证候，比阴痞更紧急。所以用滚开水浸泡去除痞塞的药物，而浸入浓煎的附子汁，虽然说一举两得，但其侧重点可以从这里认识。
第九种是误用阳旦汤导致变证，用四逆汤救逆的一种方法。
阳旦汤，是桂枝汤加黄芩的制法。如果其人阳气素来衰弱，即使在夏天，也是外阳内阴，桂枝汤中可以加附子，不可加黄芩，所以其人喝了汤后就出现四肢厥冷。如果再重度发汗，或者用烧针，误上加误，非四逆汤不能回复其阳气。阳明经、少阳经这两条经脉，绝对没有使用附子的方法，只有太阳经这一条经脉，独有不得不用的证候。大概太阳膀胱经是肾的府库，肾中阳虚阴盛，势必传导出到府，所以才见到脉微恶寒、漏汗恶风、心悸头晕、肌肉跳动筋惕、躁扰等症状。即使是传经热病，也不得不使用姜、附来消除阴寒、回复阳气。而突发疾病不由传经发热，突然到来，还等待什么而不使用附子、干姜呢？
太阴经一种方法
伤寒传到太阴经，有一种自利（腹泻）不口渴的证候，这是其人平素脾脏（湿土之藏）有寒的缘故，所以用四逆汤作为温补脾土的方法。
太阴湿土之脏有寒，不用理中汤而用四逆汤，这也可见张仲景的精义。大概水土同出一源，冬天水暖，则土也暖；夏天水寒，则土也寒，所以土寒就是阴在内阳在外，不是小事。用四逆汤来温补脾土，多么神奇啊！
少阴经七种方法
少阴病得之一二日，口中平和（不燥不渴），背部怕冷的，用艾灸及附子汤，内外同时攻治的方法。
口中平和而不燥不渴，可知没有里证。况且背部是督脉统摄诸阳上行之地，其他地方不冷，唯独觉得背部寒冷，可知这是阳虚而阴邪上凑。所以外用艾灸内服温药，两法并用，必须求得阴消阳复才停止。不知道的人，认为伤寒才一二天，外证还轻，为什么反而如此慌张。岂不知张仲景正是因为在一二天就显现出阳虚阴盛的证候，尽早从突发疾病施治，这就是所谓见微知著。如果等到三四天，势必极盛难返，不可救药了。何况在三四天以后，显然不是突发疾病了，又何必慌张呢！
少阴病得之二三日，用麻黄附子甘草汤微发汗，因为二三天没有里证，所以用微发汗的方法。
得病才二三天，没有呕吐腹泻、烦躁、呕吐口渴等里证，其应当从外表解除无疑。然而少阴经绝无发汗的方法，发汗必至亡阳。只有这一种证候，其外发热无汗，其内不吐利烦躁口渴，才可以温经散寒，取其微微似汗的效果，这个意义很微妙。在太阳经只有桂枝加附子之法，并没有麻黄加附子之法。大概太阳病没有脉微恶寒的证候，就不当用附子。等到见到脉微恶寒、吐利烦躁等证候，亡阳已在顷刻之间，又不当用麻黄。由此推断，凡是治疗突发疾病而用麻黄的，其杀人就在眨眼之间了。
少阴病，身体痛，手足寒，骨节痛，脉沉的，有用附子汤一种方法。
一身骨节都痛的，是伤寒太阳经病，但手足寒而脉沉，则肾中真阳之虚就很明确了。可见身体骨节的痛，都是阳虚所致，而与外感不相涉，所以用附子汤以助阳而战胜肾寒，这样骨节的痛就全部消除了。如果认为这痛是外感的痛，岂不是会害死人吗？
少阴病下利脉微的，有用白通汤一种方法。
下利不止、四肢厥冷、无脉、干呕烦躁的，有白通加猪胆汁汤一种方法，服药后脉象突然暴出的死，脉象微微续接的活。
少阴病下利，其人肾脏虚，寒邪盛。脉微的，与白通汤，驱寒助阳，这样利止脉健了。服用后利不止，转至无脉，呕吐烦躁加重，这是因为用热药治寒，寒邪太甚而格拒药物不入，徒增其逆乱之势。加猪胆汁作为向导，这样药入而寒不为拒，阳可回，脉可出矣。然而脉必须微微续接才生，突然暴出反而死，虚阳易出难回啊！
少阴病下利有水气，或者咳嗽或者呕吐的，有用真武汤加减一种方法。
阴寒太甚而水气泛滥，由于阳虚不能摄水，又不能生土以制水。所以腹痛，小便不利，四肢沉重疼痛，自行下利，或者小便也利，或者咳嗽或者呕吐，水性泛滥，就无所不到。因为其见证不一，所以有加减法，其余见于《尚论篇》。
少阴病下利，里寒外热，手足厥冷，脉微欲绝的，有用白通四逆汤加减一种方法。
面色赤的，加葱九根。腹中痛的，去葱加芍药二两。呕吐的加生姜二两。咽痛的，去芍药加桔梗一两。利止脉不出去的，去桔梗加人参二两。
少阴死证五条
少阴病，怕冷身体蜷缩而下利，手足逆冷的不治。
阴盛无阳。
少阴病，下利停止而头晕，时常自觉头目昏蒙的死亡。
阳气回复利止则生，如果利止更加眩晕昏蒙，那么这个停止，乃是阴气已先亡失。所以阳气无所依附，浮越于上，而神气散乱，时常自己感到昏蒙。
少阴病，四肢厥冷、怕冷而身体蜷缩，脉摸不到，不烦躁而躁动的死亡。
脉摸不到，阳气已先绝，不烦躁而躁动，孤阴顷刻间就要尽绝了。
少阴病，六七天呼吸高远的死亡。
呼吸高远则真阳上越，其下无根，绵绵若存的地方，神机化灭，所以主死。
少阴病，脉微沉细，只想睡觉，出汗不烦躁，自己想吐，到了五六天自行下利，又烦躁不得卧睡的死亡。
伤寒忌讳见到阴脉，所以张仲景说少阴病脉沉的，急温之。现在脉象微沉细，具备外证，嗜睡出汗不烦躁，阳气不为用了。自己想吐，阴邪上干了。再加上自行下利，则脏气必至尽绝了。况且开始不烦躁，现在更烦躁，开始想睡，现在更不得卧睡。所存的一线阳气，扰乱成这样，还能收回来吗？
厥阴经五种方法
病人手足厥冷，说我不结胸，小腹胀满，按之痛的，这是冷结在膀胱关元穴的一种方法。
阳邪应当结于阳，不结胸，则阳虚可知。阴邪应当结于阴，冷结在膀胱关元，则阴盛可知。
伤寒脉促，手足厥冷的，有艾灸的方法。
脉象见喘促，是阳气内陷，急遽不舒的状态。加上手足厥冷，阳微阴盛，必然遭受灭顶之灾，所以应当艾灸以通其阳。
大汗出热不去，内部拘急，四肢疼，又下利厥冷而怕冷，用四逆汤一种方法。
大汗出而邪气不除，阳气则反虚了。内部拘急，四肢疼，下利厥冷恶寒，则阳气的虚者，已达到亡失的地步。而阴气的盛者，还没有到极点，所以用四逆汤，以战胜阴寒回复阳气。
下利清谷（完谷不化），里寒外热，出汗而厥冷的，用通脉四逆汤一种方法。
下利里寒，加上外热，是有里又有表。然而在阳虚之人，虽有表证，其汗仍出，其手足必厥，才用表药，立即至亡阳。不用表药，终归是外邪不服，所以在四逆汤中，加葱为治，丝丝必贯，成为万世的法度。
呕吐而脉弱，小便又利，身体有微热，见到厥冷的难治，用四逆汤一种方法。
呕吐与微热，似乎有表证。脉弱则表邪必不盛，小便利则里邪必不盛，可见其呕吐为阴邪上干的呕吐，热为阳气外散的热。见到厥冷则阳气遭阴邪掩盖，其形势危急，非用四逆汤，无可救药了。“难治”二字，呼应上一条，多少叮咛。见到呕吐而微热，与里寒外热，毫厘千里之差，用四逆汤，就不可加葱，以免加速阳气的飞越，学医的人可不深入研究吗？
厥阴死证四条
伤寒六七天，脉微，手足厥冷，烦躁，灸厥阴经穴位，厥冷不还的死亡。
艾灸是用来通阳的，厥冷不还，则阳气不回可知了。
伤寒发热，下利厥冷，躁动不得卧睡的死亡。
肾主躁，躁动不得卧睡，是肾中阳气越绝的景象。
发热而厥冷七天，下利的难治。
先热后厥，病邪已为加深。其厥冷又持续七天之久，所希望的，是阳气回复厥冷返回。如果再加上下利，是其虚寒深锢，阳气固然无回复驾驭之机，阴气也有立即尽绝之势，所以难治。
伤寒六七天不下利，便发热而利，其人汗出不止的死亡，有阴无阳的缘故。
发热而利，里虚而外邪内入，所以曰有阴。汗出不止，表虚而内阳外出，所以曰无阳。再按：少阴肾中，内藏真阳，其死证，除了真阳外亡，别无他故了。乃厥阴的死证，也因厥逆不返，下利不止，致使肾脏真阳，久出不返，乃成死候。然而肾脏的真阳，岂不是立身立命的根本乎？看此而《卒病论》的宗旨，完全显现完全彰明了。
Nine methods for the Taiyang (Greater Yang) channel, one method for the Taiyin (Lesser Yin) channel, seven methods for the Shaoyin (Lesser Yin) channel, five methods for Shaoyin death syndromes, five methods for the Jueyin (Terminal Yin) channel, and five methods for Jueyin death syndromes. Although the *Zubing Lun* (Treatise on Acute Diseases) has been lost, the *Shanghan Lun* (Treatise on Cold Damage) is indeed preserved. Zhang Zhongjing, regarding cold damage syndromes characterized by faint Yang and abundant Yin with aversion to cold, did not wait for symptoms to become manifest; instead, he employed Aconite (*Fuzi*) and Dried Ginger (*Ganjiang*) early in treatment, combined with moxibustion. How much more so for acute diseases? And how much more so for acute diseases where symptoms are extremely manifest? Here, I have specially re-analyzed and elaborated these principles, providing not only a basis for treating acute diseases but also ensuring that critical cold damage syndromes cannot escape detection or proper management.
Zhang Zhongjing employed nine methods using Aconite (*Fuzi*) to treat Yang deficiency during the initial stage of cold damage transmitting heat pathogens in the Taiyang channel.
The first method addresses cases where improper use of diaphoretic agents caused sweating that would not stop. The remedy is Guizhi Tang (Cinnamon Twig Decoction) with added Aconite (*Fuzi*). Symptoms include aversion to wind, difficulty urinating, slight stiffness in the four limbs making flexion and extension difficult. Wind damaging the Wei (Defensive) level originally causes aversion to wind; combined with improper sweating, the interstices (*Couli*) open completely, worsening the aversion to wind. Difficulty urinating occurs because Yang governs Qi transformation; when Yang collapses externally, the Qi transformation of the Bladder naturally fails. Slight stiffness in the limbs results from the fact that the limbs are the root of all Yang; collapse of Yang and depletion of fluids lead to dysfunction of the bone structures. For patients with Yang deficiency who were improperly induced to sweat, if this formula can rescue Yang, could it not have been used beforehand to release the muscle layer and induce appropriate sweating? Zhang Zhongjing’s frequent addition of Ginseng (*Renshen*) and Aconite (*Fuzi*) to Guizhi Tang reveals profound intent.
The second method addresses cases where improper sweating led to palpitations, dizziness, and body tremors, leaving no other recourse. The remedy is Zhenwu Tang (True Warrior Decoction). Symptoms include persistence of fever after sweating, epigastric palpitations, dizziness, body tremors, and a sensation of trembling as if about to fall to the ground. If fever persists despite sweating, the pathogen remains while the healthy Qi is severely damaged. Interior deficiency causes palpitations; upper deficiency causes dizziness; meridian deficiency causes tremors; whole-body shaking indicates signs of Yang collapse everywhere. Thus, Zhenwu Tang is used to guard the passes and stabilize the condition.
The third method addresses cases where sweating failed to resolve the disease, resulting in increased aversion to cold. The remedy is Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction). Symptoms include unresolved disease after sweating and increased aversion to cold due to deficiency. Aversion to cold before sweating indicates excess pathogen and exterior excess; aversion to cold after sweating indicates retreat of the pathogen and exterior deficiency. Yang deficiency causes aversion to cold, justifying the use of Aconite (*Fuzi*). However, since the disease remains unresolved after sweating, heat likely persists. With heat present and no other symptoms, this represents Yin deficiency heat, requiring Peony (*Shaoyao*) to consolidate Yin. This is a remedy for simultaneous Ying (Nutritive) and Wei (Defensive) deficiency.
The fourth method addresses cases where sweating or purgation failed to resolve the disease, accompanied by restlessness (*Fan*) and agitation (*Zao*). The remedy is Fuling Sini Tang (Poria, Four Reversal Decoction). Improper sweating causes Yang collapse and exterior deficiency; improper purgation causes Yin collapse and interior deficiency. With both Yin and Yang deficient and the pathogen unresolved, restlessness and agitation arise. This decoction rescues the condition. The previous case involved Ying and Wei deficiency; this case involves both exterior and interior deficiency. The sophistication of formula formulation extends beyond simple exterior-interior distinctions. Generally, *Fan* (restlessness) refers to heart restlessness, while *Zao* (agitation) refers to kidney agitation. Thus, Dried Ginger (*Ganjiang*) and Aconite (*Fuzi*) enter the Kidney to resolve agitation, while Poria (*Fuling*) and Ginseng (*Renshen*) enter the Heart to resolve restlessness.
The fifth method addresses cases where improper purgation led to a rapid pulse (*Cu*), chest fullness, and mild aversion to cold. The remedy is Guizhi Tang without Peony (*Shaoyao*) plus Aconite (*Fuzi*) to reverse the adverse effect. Although a rapid pulse suggests residual exterior pathogen, chest fullness without knotting indicates damage to Yang Qi in the chest due to improper purgation. Combined with mild aversion to cold, even the True Yang of the Kidney is damaged, allowing turbid Yin to dominate. Therefore, the yin-nourishing Peony (*Shaoyao*) is removed, and Aconite (*Fuzi*) is added to restore Yang.
The sixth method addresses cases where purgation was followed by sweating, resulting in a deep and faint pulse (*Chenwei*), absence of significant fever, daytime irritability preventing sleep, nighttime quietness, absence of vomiting or thirst, no exterior syndrome, deep faint pulse, and no significant body heat. The remedy is Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction). As noted previously, purgation followed by sweating causes chills and fine/faint pulses due to internal and external deficiency. Improper sweating collapses Yang; improper purgation collapses Yin. No formula was given here because methods for restoring Yang with Aconite (*Fuzi*) and benefiting Yin with Ginseng (*Renshen*) are already established. This section teaches subtle principles: Yang collapse syndromes are twice as common as Yin collapse. Yang operates during the day; thus, heat and irritability preventing sleep appear during the day. Yin operates at night; thus, quietness without vomiting or thirst appears at night. Can balanced Yin-Yang tonics like Aconite and Ginseng suffice? Only the pungent-heat nature of Dried Ginger (*Ganjiang*) and Aconite (*Fuzi*) can sufficiently restore Yang to counterbalance the predominant Yin.
The seventh method addresses the binding of Wind-Damp pathogens. The remedy is Gancao Fuzi Tang (Licorice and Aconite Decoction) to separate and resolve them. Symptoms include severe joint pain, inability to flex or extend, extreme pain upon touch, sweating, shortness of breath, difficulty urinating, aversion to wind with desire to keep clothes on, or slight bodily swelling. Wind affects the upper body first; Dampness affects the lower body first. When they bind together, they enter meridians, flow into joints, permeate bones, and reach every part of the body, causing pain everywhere. Shortness of breath indicates excessive sweating leading to Yang collapse and severe Yang injury. Thus, Licorice (*Gancao*), Aconite (*Fuzi*), Atractylodes (*Baizhu*), and Cinnamon Twig (*Guizhi*) are used to restore Yang and resolve internal/external pathogens. Additionally, for Cold damaging the Ying level without sweating, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) is used, which is this formula minus Atractylodes (*Baizhu*) plus Fresh Ginger (*Shengjiang*) and Jujube (*Dazao*). If Cold damages the Ying level without sweating, but stool is hard and urination is normal, the pathogen is not in the exterior; thus, Cinnamon Twig (*Guizhi*) is removed while retaining Atractylodes (*Baizhu*) to benefit Earth and dry Dampness. These three formulas represent three methods merged into one, showing that treating Wind-Damp binding prioritizes restoring Yang.
The eighth method addresses epigastric stuffiness (*Pi*) with aversion to cold and sweating. The remedy is Fuzi Xixin Tang (Aconite and Artemisia Decoction), which restores Yang and resolves stuffiness simultaneously. There are five Xixin Tang variants: Gancao Xixin Tang, Banxia Xixin Tang, Shengjiang Xixin Tang, Huanglian Xixin Tang, and Fuzi Xixin Tang. Due to aversion to cold and sweating indicating Yang deficiency, this is more urgent than Yin-type stuffiness. Boiling water is used to steep the stuffiness-resolving herbs, while concentrated decocted Aconite juice is added separately. Though achieving two goals in one, the emphasis on restoring Yang is clear.
The ninth method addresses adverse effects from improper use of Yangdan Tang. The remedy is Sini Tang (Four Reversal Decoction) to reverse the adverse effect. Yangdan Tang is Guizhi Tang with added Scutellaria (*Huangqin*). In patients with inherently weak Yang, even in summer, Yang is outside and Yin inside; adding Aconite (*Fuzi*) to Guizhi Tang is acceptable, but adding Scutellaria (*Huangqin*) is not, leading to limb reversal (*Jue*). If compounded by heavy sweating or burning needle therapy, the error increases, and only Sini Tang can restore Yang. The Yangming and Shaoyang channels absolutely do not use Aconite (*Fuzi*); only the Taiyang channel has indications necessitating its use. The Taiyang Bladder is the residence of the Kidney; when Kidney Yang is deficient and Yin abundant, it transmits to the Bladder. Thus, symptoms like faint pulse, aversion to cold, leaking sweat, aversion to wind, palpitations, dizziness, muscle twitching, and agitation appear. Even in transmitting heat syndromes, Ginger and Aconite are indispensable to eliminate Yin and restore Yang. For acute diseases not arising from transmission but appearing suddenly, why delay using Aconite (*Fuzi*) and Dried Ginger (*Ganjiang*)?
One Method for the Taiyin Channel
Cold damage transmitting to the Taiyin channel presents with spontaneous diarrhea and lack of thirst, indicating inherent Cold in the Spleen (Earth organ). Thus, Sini Tang (Four Reversal Decoction) is used to warm the Earth. Using Sini Tang instead of Lizhong Tang for Taiyin Cold demonstrates Zhang Zhongjing’s profound insight. Water and Earth share a source; warm water in winter warms Earth, while cold water in summer cools Earth. Earth Cold implies Yin inside and Yang outside, a serious matter. Using Sini Tang to warm Earth is miraculous.
Seven Methods for the Shaoyin Channel
In Shaoyin disease presenting on days 1-2 with a neutral mouth (no dryness/thirst) and aversion to cold in the back, Moxibustion combined with Fuzi Tang (Aconite Decoction) is used for simultaneous internal and external treatment. A neutral mouth indicates no interior syndrome. The back is the pathway of the Du Meridian, governing ascending Yang; localized back cold indicates Yang deficiency with Yin pathogen rising. External moxibustion and internal warming are applied until Yin dissipates and Yang recovers. Ignorant people might think such urgency is unnecessary for mild early symptoms, but Zhang Zhongjing acts early because early manifestation of Yang deficiency/Yin abundance allows timely intervention ("seeing the small to know the significant"). Waiting until days 3-4 makes recovery impossible. After day 4, it is clearly not an acute onset, so urgency is less relevant.
In Shaoyin disease presenting on days 2-3 without interior syndromes, Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction) is used for mild diaphoresis. Absence of vomiting, diarrhea, restlessness, or thirst confirms the need to resolve from the exterior. However, Shaoyin generally prohibits sweating as it risks Yang collapse. This specific case involves external fever/no sweating and internal absence of interior symptoms, allowing warming of meridians and dispersal of Cold to achieve mild sweating. This principle is subtle. In Taiyang, there is Guizhi plus Aconite, but no Mahuang plus Aconite. Taiyang lacks faint pulse/aversion to cold; if such symptoms appear, Aconite is needed. If vomiting/diarrhea/restlessness appear, Yang collapse is imminent, and Mahuang is contraindicated. Using Mahuang in acute diseases can be fatal instantly.
For Shaoyin disease with body pain, cold hands/feet, joint pain, and deep pulse, Fuzi Tang (Aconite Decoction) is used. Generalized joint pain suggests Taiyang cold damage, but cold extremities and deep pulse confirm Kidney True Yang deficiency. Body/joint pain here stems from Yang deficiency, unrelated to external pathogens. Fuzi Tang assists Yang to overcome Kidney Cold, resolving pain. Misidentifying this as external pathogenic pain could be fatal.
For Shaoyin diarrhea with a faint pulse, Baitong Tang (White Through Decoction) is used. If diarrhea persists with reversal cold, absent pulse, dry retching, and agitation, Baitong Tang plus Pig Bile (*Zhudanhui*) is used. Sudden emergence of pulse after administration indicates death; gradual continuation indicates survival. Shaoyin diarrhea with Kidney deficiency and盛 Cold requires Baitong Tang to drive out Cold and assist Yang. If diarrhea persists and pulse vanishes with worsening vomiting/agitation, it is due to Cold rejecting hot medicine. Pig Bile acts as a guide to prevent rejection, allowing Yang restoration and pulse return. Gradual pulse return ensures life; sudden pulse emergence signals death, highlighting the difficulty of retaining floating Yang.
For Shaoyin diarrhea with fluid retention, cough, or vomiting, modified Zhenwu Tang (True Warrior Decoction) is used. Severe Yin Cold and flooding fluids result from Yang deficiency failing to control water and generate Earth to restrain water. Symptoms include abdominal pain, difficulty urinating, heavy/painful limbs, spontaneous diarrhea, or variable urination/cough/vomiting due to fluid flooding. Modifications depend on specific presentations (see *Shanglun Pian*).
For Shaoyin diarrhea with interior Cold and exterior Heat, cold extremities, and faint/nearly absent pulse, modified Baitong Sini Tang (White Through Four Reversal Decoction) is used. Add 9 stalks of Scallion (*Cong*) for red face; remove Scallion, add 2 liang Peony (*Shaoyao*) for abdominal pain; add 2 liang Fresh Ginger (*Shengjiang*) for vomiting; remove Peony, add 1 liang Platycodon (*Jiegeng*) for sore throat; remove Platycodon, add 2 liang Ginseng (*Renshen*) if diarrhea stops but pulse does not return.
Five Death Syndromes of Shaoyin
Shaoyin disease with aversion to cold, curled posture, diarrhea, and cold extremities is untreatable (Yin abundance, no Yang).
Shaoyin disease with cessation of diarrhea accompanied by dizziness and periodic vertigo/death indicates death. While Yang recovery stops diarrhea, cessation with worsening vertigo indicates prior Yin exhaustion. Yang floats upward without foundation, scattering Shen Qi.
Shaoyin disease with reversal cold, aversion to cold, curled posture, absent pulse, and agitation without restlessness indicates death. Absent pulse means Yang has perished; agitation without restlessness means solitary Yin will perish instantly.
Shaoyin disease with high-pitched breathing on days 6-7 indicates death. High breathing signifies True Yang floating upward without root; Shen Ji (spirit mechanism) perishes.
Shaoyin disease with faint/deep/thin pulse, desire to sleep, sweating without restlessness, urge to vomit, progressing to spontaneous diarrhea, agitation, and insomnia on days 5-6 indicates death. Cold damage forbids Yin pulses; Zhang Zhongjing advises urgent warming for deep pulses. Faint/deep/thin pulse with lethargy/sweating/non-restlessness shows Yang failure. Urge to vomit shows Yin pathogen attacking upward. Spontaneous diarrhea indicates organ Qi exhaustion. Initial non-restlessness turning to agitation, and initial sleepiness turning to insomnia, shows the last thread of Yang is chaotic and irrecoverable.
Five Methods for the Jueyin Channel
Patients with cold extremities stating "I do not have Jie Xiong (chest knotting)," lower abdominal fullness, and tenderness upon pressure suffer from Cold binding at the Bladder Guan Yuan point. Yang pathogens bind in Yang (chest); absence of chest knotting indicates Yang deficiency. Yin pathogens bind in Yin; Cold binding at Guan Yuan indicates Yin abundance.
For cold damage with rapid pulse and cold extremities, moxibustion is used. Rapid pulse indicates internal sinking of Yang Qi and distress. Combined with cold extremities (Yang faint, Yin abundant), death is likely unless moxibustion opens Yang.
For excessive sweating with persistent fever, internal cramping, limb pain, diarrhea, reversal cold, and aversion to cold, Sini Tang (Four Reversal Decoction) is used. Excessive sweating without pathogen resolution indicates Yang deficiency. Internal cramping, limb pain, diarrhea, and cold indicate Yang has reached collapse, though Yin abundance may not yet be extreme. Sini Tang overcomes Yin and restores Yang.
For diarrhea with undigested food, interior Cold with exterior Heat, sweating, and cold extremities, Tongmai Sini Tang (Pulse-Restoring Four Reversal Decoction) is used. Diarrhea with interior Cold plus exterior heat suggests simultaneous interior/exterior involvement. In Yang-deficient patients, exterior symptoms still cause sweating and cold extremities; using exterior-releasing drugs immediately causes Yang collapse. Not using them leaves exterior pathogens unresolved. Adding Scallion (*Cong*) to Sini Tang treats this meticulously, setting a standard for eternity.
For vomiting with weak pulse, free urination, slight body heat, and cold extremities, the prognosis is poor, treated with Sini Tang (Four Reversal Decoction). Vomiting and slight heat suggest exterior syndrome, but weak pulse rules out strong exterior pathogen; free urination rules out strong interior pathogen. Thus, vomiting is due to Yin pathogen attacking upward, and heat is Yang dissipating externally. Cold extremities show Yang covered by Yin, a critical state requiring Sini Tang. "Poor prognosis" echoes the previous case, emphasizing caution. Vomiting with slight heat differs significantly from interior Cold/exterior Heat; using Sini Tang without Scallion (*Cong*) prevents accelerating Yang flight. Students must study this deeply.
Four Death Syndromes of Jueyin
Cold damage on days 6-7 with faint pulse, cold extremities, and restlessness, treated with Jueyin moxibustion, results in death if reversal cold does not improve. Moxibustion opens Yang; failure to improve indicates Yang will not return.
Cold damage with fever, diarrhea, reversal cold, and agitation preventing sleep indicates death. Kidney governs agitation; inability to sleep due to agitation shows Kidney Yang escaping/perishing.
Fever with reversal cold lasting seven days, accompanied by diarrhea, is difficult to treat. Fever then cold indicates pathogen progression. Seven days of cold suggests hope for Yang recovery. Added diarrhea indicates deep-seated deficiency-Cold; Yang cannot recover, and Yin faces immediate extinction.
Cold damage without diarrhea for 6-7 days, suddenly developing fever, diarrhea, and unceasing sweating indicates death due to "Yin present, Yang absent." Fever with diarrhea shows interior deficiency allowing exterior pathogen inward ("Yin present"). Unceasing sweating shows exterior deficiency allowing internal Yang to escape ("Yang absent"). In Shaoyin, Kidney stores True Yang; death results solely from True Yang loss. In Jueyin, death results from unreversed reversal cold and persistent diarrhea causing prolonged escape of Kidney True Yang. Is Kidney True Yang not the root of life? This clarifies the intent of the *Zubing Lun*.