丹溪治一妇。病不知人。稍苏即号叫数四而复昏。朱诊之。肝脉弦数且滑。曰。此怒火
所为。盖得之怒而饮酒也。诘之。以不得于夫。每夜必引满自酌解其怀。朱治之以流痰降火
之剂。而加香附以散肝分之郁。立愈。
戴原礼治方氏子妇。疟后多汗。呼媵人易衣不至。怒形于色。遂昏厥若死状。灌以苏合
香丸而苏。自后闻人步之重。鸡犬之声。辄厥逆如初。原礼曰。脉虚甚。重取则散。是谓汗
多亡阳。以参、 日补之。其惊渐减。至浃旬而安。
汪石山治一人年逾七十。忽病瞀昧。但其目系渐急。即合眼昏懵。如瞌睡者。头面有
触。皆不避。少顷而苏。问之。曰不知也。一日或发二三次。医作风治。病转剧。汪诊其脉
结止。苏则如常。但浮虚耳。曰。此虚病也。盖病发而脉结者。血少气劣耳。苏则气血流通
心志皆得所养。故脉又如常也。遂以十全大补汤去桂。加麦冬、陈皮而安。三子皆庠生。
时欲应试而惧。注曰。三年之内。可保无恙。越此非予之所知也。果验。
江篁南治一妇。忽如人将冰水泼之。则手足厥冷。不知人。少顷发热则渐省。一日二三
次。江诊六脉俱微。若有若无。欲绝非绝。此气虚极之证也。用人参三钱。陈皮一钱。枳壳
二分。人参渐加。服至六两。而愈。
孙东宿治徐中宇之妇。汗出如雨。昏昏愦愦。两手无所着落。胸要人足 之不少放。少
放即昏愦益甚。气促不能以息。少近风则呕恶晕厥。与九龙镇心丹一丸。服下即稍定。少间
则又发。始知胸喉中有物作梗而痛。汤水难入。即药仅能吞一口。多则弗能咽下。乃以苏合
香丸与之。晕厥寻止。心痛始萌。昨日六脉俱伏。今早六部俱见。惟左寸短涩。知其痛为瘀
血也。用延胡、桃仁、丹参、丹皮、青皮、当归、香附。其夜仍晕厥一次。由其痛极而然。
再与前方加乌梅、桂枝、赤芍、贝母、人参。而痛减大半。乃自云心虚有热。头眩。加山栀
仁。居常多梦交之证。近更甚。以其心虚故也。人参、丹参、归、芍、枣仁、酒连、香附、
贝母、石斛。调理全安。
李士材治吴门周复庵。年近五旬。荒于酒色。忽然头痛发热。医以羌活汤散之。汗出不
止。昏晕不苏。李灸关元十壮而醒。四君子加姜、桂。日服三剂。至三日少康。分晰家产。
劳而且怒。复发厥。李用好参一两。熟附二钱。煨姜十片煎服。稍醒。但一转侧即厥。一日
之间。计厥七次。服参三两。至明日。以羊肉羹糯米粥与之。尚厥二三次。至五日而厥定。
李曰。今虽痊。但元气虚极。非三载调摄。不能康也。两月之间。服参四斤。三年之内。进
剂六百帖。丸药七十余斤。方得步履如初。
喻嘉言治黄我兼令正。痰厥。频发不痊。有欲用涌剂及下法者。喻曰。惊痰堵塞窍隧。
昏迷不过片向耳。设以涌药投之。痰才一动。人即晕去。探之指不能入。咽之气不能下。药
势与病势相扼。转致连日不苏。将若之何。丹溪云。惧吐者。宜消息下之。是或一道也。但
窍隧之痰。岂能搜导下行。徒伤脾气。痰愈窒塞。此法亦不可用。今三部脉象虚软无力。邪
盛正衰。不易开散。用药贵有节次矩 。盖惊痰之来始于肝胆。冬月木气归根。不敢攻治。
但当理脾清肺。使脾能健运。肺能肃降。痰乃下行耳。今四末肿麻。气壅已甚。须药饵与饮
食相参。白饭香蔬苦茗。便为佳珍。不但浓味当禁。即粥亦不宜食。以粥饮之。结为痰饮。
易易耳。不但杂食当禁。即饮食亦宜少减。以脾气不用以消谷。转用之消痰。较药力更捷耳
其辛辣酒脯及煎爆日曝之物。俱能伤肺。并不宜食。根据此调理。至春月木旺。才用四君子
汤加龙胆草、芦荟、代赭石、黄连、青黛等药。为丸服之。痰迷之症。果获全瘳。后遂不发
震按内经仲景所谓厥者。手足逆冷耳。故有寒厥热厥之辨。今人所谓厥者。乃晕厥耳。
亦兼手足逆冷。而其重在神昏若死也。向来混于一处。最误后学。今只选晕厥。不选厥逆。
庶几头绪稍清。故丹溪案是怒厥也。又名肝厥。戴汪江三案是虚厥也。孙案是血厥也。又名
薄厥。李案是虚厥之极。即脱厥也。喻案是痰厥。亦兼怒厥。法已略备矣。
朱丹溪治疗一位妇女，患者昏迷不省人事，稍一苏醒便大声呼叫几次后又陷入昏厥。朱丹溪诊察发现其肝脉弦、数且滑，说道：“这是由怒火引起的。大概是因为愤怒后饮酒所致。”经追问得知，她因在丈夫那里得不到宠爱，每晚必自斟自饮以排解愁怀。朱丹溪用清热化痰降火的方剂治疗，并加入香附以疏解肝经的郁结，患者立刻痊愈。
戴原礼治疗方家的儿媳，患疟疾后出汗过多，呼唤丫鬟更换衣服，丫鬟未及时赶到，她怒形于色，随即昏厥，状如死亡。灌服苏合香丸后苏醒。此后，只要听到人脚步沉重或鸡犬叫声，就会像当初一样发生昏厥。戴原礼说：“脉象非常虚弱，重按则散乱无根，这是汗出过多导致亡阳的表现。”用人参、白术补益元气，患者的惊恐症状逐渐减轻，经过十天便安稳下来。
汪石山治疗一位年过七十的男子，忽然出现神志昏蒙不明，只是他的目系（连接眼球与脑部的脉络）逐渐变得紧张，一旦闭眼就感到昏沉懵懂，像要睡着的样子。头面部受到触碰，他都不躲避，过了一会儿才苏醒。询问他，他说什么都不知道。一天发作两三次。医生误作风证治疗，病情反而加重。汪石山诊察其脉搏有间歇（结脉），苏醒后脉象如常，只是浮而虚软。他说：“这是虚证。发病时脉搏出现间歇，是因为血少气弱。苏醒后气血流通，心志得到滋养，所以脉象又恢复正常。”于是用十全大补汤去掉桂枝，加入麦冬、陈皮，患者得以安宁。汪石山的三个儿子都是秀才，当时正想参加科举考试而心存恐惧。汪石山预言：“三年内可以保平安，过了这个期限就不是我所知道的了。”果然应验。
江篁南治疗一位妇女，忽然感觉像有人将冰水泼在身上，导致手足冰冷，昏迷不省人事，过了一会儿发热后才渐渐清醒。一天发作两三次。江篁南诊察六脉都微弱，若有若无，欲绝而未绝，这是气虚到了极点的证候。使用人参三钱，陈皮一钱，枳壳二分，人参逐渐增加剂量，服用至六两，病愈。
孙东宿治疗徐中宇的妻子，出汗如雨，昏昏沉沉，双手不知该放在哪里，胸部需要人踩踏才能稍微缓解，稍微松开就昏沉更加严重，气促无法呼吸，稍微靠近风就会呕吐、恶心、晕厥。给予九龙镇心丹一丸，服下后症状稍定，但不久又发作。这才知道胸喉中有异物梗阻且疼痛，汤药难以入口，即使是药物也只能吞下一口，多了就无法咽下。于是给她苏合香丸，晕厥随即停止，心痛开始萌生。昨天六脉全部伏匿，今早六部脉象都显现出来，只有左寸脉短而涩，知道疼痛是由瘀血引起的。使用延胡索、桃仁、丹参、牡丹皮、青皮、当归、香附。当晚仍然晕厥一次，是由于疼痛剧烈所致。再次给前方加入乌梅、桂枝、赤芍、贝母、人参，疼痛减轻了大半。患者自称心虚有热，头晕目眩，加入栀子仁。平时有多梦遗精的症状，最近更严重，这是因为心虚的缘故。用人参、丹参、当归、白芍、酸枣仁、酒黄连、香附、贝母、石斛调理，完全康复。
李士材治疗苏州周复庵，年龄近五十岁，荒废于酒色，忽然头痛发热。医生用羌活汤发散，导致汗出不止，昏晕不醒。李士材灸关元穴十壮使其苏醒，用四君子汤加生姜、肉桂，每天服用三剂，到第三天稍微好转。此时他分晰家产，既劳累又愤怒，再次复发厥证。李士材用好人参一两，熟附子二钱，煨姜十片煎服，患者稍醒，但只要一转侧就会昏厥。一天之内，共计昏厥七次。服用人参三两，到第二天，给他吃羊肉羹和糯米粥，仍然昏厥两三次，到第五天昏厥才停止。李士材说：“现在虽然痊愈，但元气极度虚弱，如果不调养三年，不能恢复健康。”两个月之间，服用人参四斤，三年内进药六百帖，丸药七十多斤，才得以前行如常。
喻嘉言治疗黄我兼的夫人，痰厥，频繁发作久治不愈。有人想用涌吐法和泻下法治疗。喻嘉言说：“惊恐导致的痰浊堵塞窍道隧道，昏迷不过片刻。如果用涌吐药投之，痰浊刚一动摇，人就会晕倒，探喉取痰手指无法进入，吞咽气息无法下行。药势与病势相互遏制，反而导致连续几天不苏醒，该怎么办呢？朱丹溪说：‘害怕呕吐的人，适宜斟酌后用下法。’这或许是一条途径。但是窍道中的痰浊，怎么能搜刮引导下行呢？只会损伤脾气，使痰浊更加窒塞，这种方法也不可用。现在三部脉象虚软无力，邪气盛正气衰，不容易开散。用药贵在有序有节。惊恐痰浊的产生始于肝胆，冬季木气归根，不敢攻治，只应当调理脾胃、清肃肺气，使脾能健运，肺能肃降，痰浊自然下行。现在四肢肿胀麻木，气机壅滞已经很严重，必须让药物与饮食配合。白米饭、清香蔬菜、苦茶，便是佳珍。不但浓味应当禁止，就是粥也不宜食用，因为喝粥会凝结成痰饮，非常容易。不但杂食应当禁止，就是饮食也应当减少，因为脾气不用来消化谷物，转而用来消除痰浊，比药力更快捷。辛辣、酒类、肉干以及煎炸日晒的食物，都能伤肺，都不宜食用。根据此法调理，到春季木气旺盛时，才用四君子汤加龙胆草、芦荟、代赭石、黄连、青黛等药，制成丸药服用。痰迷心窍的症状，果然获得全愈，后来不再发作。
按语：《内经》和《伤寒论》所说的“厥”，是指手足逆冷，所以有寒厥、热厥的区别。现在人所称的“厥”，其实是晕厥，也兼有手足逆冷，但其重点在于神志昏迷如同死亡一样。向来将这些混为一谈，最误导后学。现在只选取晕厥的案例，不选取单纯的厥逆，这样头绪稍微清晰一些。所以朱丹溪的医案是怒厥，又名肝厥；戴原礼、汪石山、江篁南的三个医案是虚厥；孙东宿的医案是血厥，又名薄厥；李士材的医案是虚厥的极致，即脱厥；喻嘉言的医案是痰厥，也兼有怒厥。治疗方法已经大致完备了。
Zhu Danxi treated a woman who was unconscious. Upon regaining consciousness briefly, she would scream several times before falling back into a coma. Zhu examined her and found the Liver pulse to be Wiry (Xian), Rapid (Shu), and Slippery (Hua). He said, "This is caused by furious anger. It likely resulted from drinking alcohol after becoming angry." Upon inquiry, it was revealed that because she felt unloved by her husband, she drank heavily every night to relieve her sorrow. Zhu treated her with a formula to clear heat, resolve phlegm, and descend fire, adding Cyperi Rhizoma (Xiangfu) to dissipate depression in the Liver channel. She recovered immediately.
Dai Yuanli treated the daughter-in-law of the Fang family. After suffering from malaria, she sweated excessively. When she called for her maid to change her clothes and the maid did not arrive promptly, she showed signs of anger, then fainted and appeared dead. She revived after being administered Suhexiang Wan (Styrax Pill). Afterwards, whenever she heard heavy footsteps or the sound of chickens and dogs, she would faint as before. Dai said, "The pulse is extremely deficient; when pressed heavily, it scatters. This is defined as Yang collapse due to excessive sweating." He used Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu) to tonify Qi. Her惊 (fright/anxiety) gradually decreased, and she stabilized after ten days.
Wang Shishan treated a man over seventy years old who suddenly suffered from mental confusion and dimness. His eye tendons became tense, causing dizziness and sleepiness whenever he closed his eyes. He did not avoid touch on his head and face, but recovered after a short while. When asked, he claimed ignorance. The episodes occurred two or three times a day. Physicians treated it as Wind disease, worsening the condition. Wang diagnosed a Knotted pulse (Jie Mai) with interruptions; upon recovery, the pulse returned to normal, merely Floating (Fu) and Deficient (Xu). He said, "This is a Deficiency syndrome. The knotted pulse during onset indicates insufficient Blood and weak Qi. Upon recovery, Qi and Blood flow smoothly, nourishing the Heart and Mind, so the pulse returns to normal." He prescribed Shiquan Dabu Tang (Ten Great Tonifying Decoction) without Cinnamomi Ramulus (Guizhi), adding Ophiopogonis Radix (Maidong) and Citri Reticulatae Pericarpium (Chenpi). The patient recovered. Wang’s three sons were Xiangsheng (students in the local school) preparing for imperial examinations and feared failure. Wang predicted, "You will be safe within three years; beyond that is unknown to me." This proved accurate.
Jiang Huangnan treated a woman who suddenly felt as if ice water had been poured on her, resulting in cold extremities and unconsciousness. She gradually regained consciousness after fever set in. This happened two or three times a day. Jiang examined six pulses, all Micro (Wei), seemingly present yet absent, on the verge of disappearing. This is a syndrome of extreme Qi deficiency. He used San Qian (three mace) of Ginseng Radix et Rhizoma (Renshen), one mace of Citri Reticulatae Pericarpium (Chenpi), and two fen of Aurantii Fructus Immaturus (Zhike). The dosage of Ginseng was gradually increased until six liang were consumed, leading to recovery.
Sun Dongsu treated the wife of Xu Zhongyu. She sweated profusely like rain, feeling dizzy and confused, unable to rest her hands anywhere. Her chest required someone to step on it for relief; slight relaxation worsened her dizziness and confusion. She suffered from shortness of breath and could not breathe comfortably. Slight exposure to wind induced vomiting, nausea, and fainting. One pill of Jiulong Zhenxin Dan (Nine-Dragon Heart-Calming Pill) was given, which provided temporary relief, but symptoms recurred shortly after. It was then discovered that there was an obstruction and pain in the chest and throat, making it difficult to swallow even medicine; only one mouthful could be swallowed at a time. Suhexiang Wan (Styrax Pill) was administered, stopping the fainting. Heart pain began to emerge. Yesterday, all six pulses were Hidden (Fu); this morning, they were visible in all positions, except the Left Cun position which was Short (Duan) and Choppy (Se). This indicated pain due to Blood Stasis. Yanhusuo (Corydalis Rhizoma), Tao Ren (Persicae Semen), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Mudanpi (Moutan Cortex), Qingpi (Citri Reticulatae Pericarpium Viride), Danggui (Angelicae Sinensis Radix), and Xiangfu (Cyperi Rhizoma) were used. She fainted once that night due to severe pain. The previous formula was repeated with added Wumei (Mume Fructus), Guizhi (Cinnamomi Ramulus), Chishao (Paeoniae Radix Rubra), Beimu (Fritillariae Thunbergii Bulbus), and Renshen (Ginseng Radix et Rhizoma). Pain reduced significantly. The patient reported Heart deficiency with Heat, causing dizziness; Zhizi Ren (Gardeniae Semen) was added. She often experienced nocturnal emissions and vivid dreams, recently worsened due to Heart deficiency. A regimen of Renshen, Danshen, Danggui, Baishao (Paeoniae Radix Alba), Suanzaoren (Ziziphi Spinosae Semen), Jiu Lian (Coptidis Rhizoma processed with wine), Xiangfu, Beimu, and Shihu (Dendrobii Caulis) was used for conditioning, leading to full recovery.
Li Shicai treated Zhou Fu'an from Suzhou, nearly fifty years old, who indulged in alcohol and sex. He suddenly suffered headache and fever. Physicians used Qianghuo Tang (Notopterygii Decoction) to disperse, causing continuous sweating, dizziness, and unconsciousness. Li moxaed Guan Yuan (CV4) ten moxibustions to revive him. Four Junzi Tang (Four Gentlemen Decoction) with Shengjiang (Zingiberis Rhizoma Recens) and Rougui (Cinnamomi Cortex) was taken three times daily. By the third day, he slightly recovered. However, while dividing family assets, he became tired and angry, triggering another syncope. Li used one liang of high-quality Renshen, two qian of Shufu (Aconiti Lateralis Radix Praeparata), and ten slices of Wei Jiang (Zingiberis Rhizoma Preparatum) decocted and administered. He slightly revived but fainted again with any movement. Within one day, he fainted seven times. Three liang of Renshen were consumed. The next day, he was given mutton soup and glutinous rice porridge, still fainting two or three times. By the fifth day, the syncope stopped. Li stated, "Although cured now, his Yuan Qi is extremely deficient. Without three years of regulation, he cannot recover." In two months, he consumed four jin of Renshen. Over three years, he took 600 prescriptions and over 70 jin of pills before walking normally again.
Yu Jiayan treated the lady of Huang Wojian, who suffered from frequent Phlegm Syncope (Tan Jue) resistant to treatment. Some suggested using emetics (Yong Ji) and purgatives (Xia Fa). Yu said, "Phlegm caused by fright blocks the orifices and tunnels. The coma lasts only a moment. If emetics are used, the phlegm moves, causing immediate fainting. Probing the throat becomes impossible, and swallowing fails. The drug action conflicts with the disease state, potentially causing days of unconsciousness. What should be done? Zhu Danxi said, 'For those afraid of vomiting, it is suitable to consider purgation.' This might be one path. However, phlegm in the orifices cannot be easily guided downward. It only damages Spleen Qi, making phlegm more obstructed. This method is also unusable. Currently, the pulses in all three positions are deficient, soft, and powerless. Pathogen is strong, Zheng Qi is weak, making dispersion difficult. Medication must follow order and rules. Phlegm from fright originates in the Liver and Gallbladder. In winter, Wood Qi returns to its root; aggressive treatment is inadvisable. One should regulate the Spleen and clear the Lung, enabling Spleen transportation and Lung descending, allowing phlegm to move downward. Currently, the four limbs are swollen and numb, indicating severe Qi stagnation. Medicine and diet must be combined. White rice, fragrant vegetables, and bitter tea are best. Rich flavors are forbidden, and even porridge is unsuitable as it easily transforms into Phlegm-Fluids. Mixed foods are forbidden, and general food intake should be reduced because Spleen Qi is diverted from digesting grain to eliminating phlegm, which is faster than medication. Spicy foods, alcohol, dried meats, and fried/sun-dried items damage the Lung and are unsuitable. Following this regulation, in spring when Wood Qi is vigorous, Sijunzi Tang (Four Gentlemen Decoction) plus Longdancao (Gentianae Radix), Lushen (Aloe), Daizheshi (Haematitum), Huanglian (Coptidis Rhizoma), and Qingdai (Indigo Naturalis) were made into pills. The Phlegm-misting syndrome fully resolved and did not recur.
Commentary: Nei Jing and Shanghan Lun define "Jue" as cold extremities, distinguishing between Cold Jue and Hot Jue. Modern usage of "Jue" refers to syncope/fainting, often accompanied by cold extremities, but primarily characterized by coma resembling death. Historically, these were conflated, misleading students. Here, only syncope cases are selected, excluding simple extremity coldness, to clarify distinctions. Thus, Zhu Danxi’s case is Anger Jue (Liver Jue); Dai, Wang, and Jiang’s cases are Deficiency Jue; Sun’s case is Blood Jue (also known as Bo Jue); Li’s case is extreme Deficiency Jue, i.e., Collapse Jue; Yu’s case is Phlegm Jue, also involving Anger Jue. The therapeutic methods are thus comprehensively covered.