厥有二证，曰阳厥，曰阴厥也。阳厥者，热厥也，必其先自三阳传入阴分，故其初起，必因头
疼发热，自
浅入深，然后及于三阴，变为四肢逆冷，或时乍温，其证必便结躁烦，谵语发渴，不恶寒，反恶热
，脉沉有力。此以传经热证所化，外虽手足厥冷，内则因于热邪，阳证发厥，故为阳厥，乃阳极似
阴也。其证由邪热内结，或伏阳失下之所致也。凡厥微则热亦微，宜四逆散之类；厥甚则热亦甚，
宜承气汤之类也。阴厥者，寒厥也，初无三阳传经实热等证，而真寒直入三阴，则畏寒厥冷，腹痛
吐泻，战栗不渴，脉沉无力者，此阴寒厥逆，独阴无阳也，故为阴厥。轻则理中汤，重则四逆、回
阳等汤主之。
成无己曰∶四逆者，四肢不温也。伤寒邪在三阳，则手足必热，传到太阴，手足自温，至少阴
则邪热渐深，故四肢逆而不温也。及至厥阴，则手足厥冷，是又甚于逆，故用四逆散，以散其传阴
之热证。
《论》曰∶诸四逆厥者，不可下之，虚家亦然。成无己注曰∶四逆者，四肢不温也；厥者，手
足冷也，甚于四逆也。皆阳气少而阴气多，故不可下，虚家亦然。《金匮玉函》曰∶虚者十补，勿
一泻之。
《论》曰∶凡厥者，阴阳气不相顺接，便为厥。厥者，手足逆冷是也。病者手足厥冷，言我不
结胸，小腹满，按之痛者，此冷结在膀胱关元也。伤寒发热四日，厥反三日，复热四日，厥少热多
，其病当愈。伤寒，厥四日，热反三日，复厥五日，其病为进。寒多热少，阳气退，故为进也。若
厥而呕，胸胁烦满者，其后必便血。
《论》曰∶少阴病，下痢清谷，里寒外热，手足厥逆，脉微欲绝，身反不恶寒，其人面赤色，
或腹痛，或干呕，或咽痛，或痢止脉不出者，通脉四逆汤主之。伤寒脉促，手足厥逆者，可灸之。
伤寒脉滑而厥者，里有热也，白虎汤主之。手足厥寒，脉细欲绝者，当归四逆汤主之。若其人内有
久寒者，宜当归四逆加吴茱萸生姜汤主之。大汗出，热不去，内拘急，四肢疼、又下痢厥逆而恶寒
者，四逆汤主之。大汗，若大下痢，而厥逆者，四逆汤主之。病患手足厥冷，脉乍紧者，邪结在胸
中，心中满而烦，饥不能食者，病在胸中，当须吐之，宜瓜蒂散。伤寒厥而心下悸者，宜先治水，
当服茯苓甘草汤，却治其厥。不尔，水渍入胃，必作痢也。下痢清谷，里寒外热，汗出而厥者，通
脉四逆汤主之。呕而脉弱，小便复痢，身有微热，见厥者难治，四逆汤主之。
按∶阳厥阴厥，其辨如前，此先哲之大法也。然愚则犹有所辨，如阴厥一证，既无阳证阳脉，
而病寒若此，明是阴证，今人但曰中寒者，即其病也。然犯此者无几，知此者无难，治宜温中，无
待辨也。惟是阳厥一证，则有不得不辨者。夫厥由三阳所传，是为阳厥，此固然矣，即以传经者
言之，又岂尽无阴证乎？故凡病真阳不足者，即阳中之阴厥也；脉弱无神者，即阳中之阴厥也；攻
伐清凉太过者，即阳中之阴厥也。四肢为诸阳之本，使非有热结、烦渴、胀实等证，而见厥逆者，
皆由阳气不足也。成无己曰∶大抵厥逆为阴所主，寒者多矣。又曰∶厥为阴之盛也。故凡属挟虚伤
寒，则虽自阳经传入者，是亦阳中之阴厥也。阴中之阴者宜温，阳中之阴者，果宜凉乎？学人勿谓
其先有头疼发热，但自三阳传至者，便为阳厥，而寒因热用之，则为害不小矣。
一、脏厥证。仲景曰∶伤寒脉微而厥，至七八日肤冷，其人躁无暂安时者，此为脏厥。脏厥者
死，阳气绝也。
一、蛔厥证。仲景曰∶蛔厥者，其人当吐蛔，今病者静，而复时烦，此为脏寒，蛔上入膈，故
烦，须臾复止，得食而呕，又烦者，蛔闻食臭出，其人当自吐蛔。蛔厥者，乌梅丸主之。成无己曰
∶脏厥者死，阳气绝也。蛔厥虽厥而烦，吐蛔已则静，不若脏厥而躁无暂安时也。病患脏寒胃虚，
故宜与乌梅九温脏安虫。
厥证有两种，分别是阳厥和阴厥。所谓阳厥，就是热厥，必定是先从三阳经传入阴分，所以在初起时，必然因为头疼发热，由浅入深，然后波及三阴经，转变为四肢逆冷，有时暂时回暖，其症状必定是大便干结、烦躁不安、说胡话、口渴，不怕冷，反而怕热，脉象沉而有力。这是由于传经的热证转化而来，虽然外部表现为手足厥冷，内部却是由于热邪所致，属于阳证引发的厥逆，所以称为阳厥，这是阳极似阴的表现。这种病症是由邪热内结，或者伏阳未能及时攻下所导致的。凡是厥逆轻微则热邪也轻微，适宜用四逆散之类的方剂；厥逆严重则热邪也严重，适宜用承气汤之类的方剂。
所谓阴厥，就是寒厥，起初并没有三阳经传经的实热等症状，而是真寒直接侵入三阴经，出现畏寒肢冷、腹痛吐泻、战栗不渴、脉象沉而无力等情况，这是阴寒厥逆，独阴无阳，所以称为阴厥。轻症用理中汤，重症用四逆汤、回阳救逆汤等主治。
成无己说：四逆，是指四肢不温暖。伤寒邪气在三阳经，手足必然发热；传到太阴经，手足自然温和；到了少阴经，邪热逐渐深入，所以四肢逆冷而不温；及至厥阴经，手足完全冰冷，这比“逆”更严重，所以用四逆散来疏散传入阴经的热证。
《内经》说：凡是出现四逆厥证的，不可使用攻下法，虚损体质的人也是如此。成无己注释说：四逆，是指四肢不温暖；厥，是指手足冰冷，比四逆更严重。这都是因为阳气少而阴气多，所以不可攻下，虚损体质的人也是如此。《金匮玉函经》说：虚证应当十次补益，不要一次泻下。
《内经》说：凡是厥证，都是阴阳之气不能顺利交接，就会发生厥逆。厥证，表现为手足逆冷。病人手足厥冷，说自己没有结胸证，小腹胀满，按压疼痛的，这是冷邪结聚在膀胱关元穴部位。伤寒发热四天，厥冷反而三天，又发热四天，厥少热多，病情应当痊愈。伤寒，厥冷四天，发热反而三天，又厥冷五天，病情为进展。寒多热少，阳气衰退，所以病情进展。如果厥逆伴有呕吐、胸胁烦闷胀满的，其后必定大便出血。
《内经》说：少阴病，下利清谷（排出未消化的食物），里寒外热，手足厥逆，脉微细几乎摸不到，身体反而不怕冷，其人面色发红，或者腹痛，或者干呕，或者咽痛，或者下利停止但脉搏不出者，用通脉四逆汤主治。伤寒脉急促，手足厥逆的，可以用灸法治疗。伤寒脉滑而厥冷的，是里有热，用白虎汤主治。手足厥寒，脉细欲绝的，用当归四逆汤主治。如果其人内有久寒的，适宜用当归四逆加吴茱萸生姜汤主治。大汗出，热不退，体内拘急，四肢疼痛，又下利厥逆且恶寒的，用四逆汤主治。大汗，或者大下利，而出现厥逆的，用四逆汤主治。病患手足厥冷，脉象突然紧实的，邪气结聚在胸中，心中胀满而烦躁，饥饿但不能进食的，病在胸中，应当使用涌吐法，适宜用瓜蒂散。伤寒厥逆且心下悸动的，适宜先治疗水饮，应当服用茯苓甘草汤，然后再治疗厥逆。不这样的话，水气浸渍入胃，必定导致下利。下利清谷，里寒外热，汗出而厥冷的，用通脉四逆汤主治。呕吐而脉弱，小便频数，身体有微热，出现厥逆的难治，用四逆汤主治。
按语：阳厥和阴厥的辨别如前所述，这是先哲的大法。然而我仍然有所辨析，比如阴厥一证，既然没有阳证阳脉，而患病如此寒冷，明明是阴证，现在的人只要说是中寒，就是此病。然而犯此病的人很少，知道此病并不难，治疗适宜温中，无需辨别。只有阳厥一证，则有不得不辨别的理由。厥由三阳经传来，这叫阳厥，这固然正确，但以传经来说，难道就没有阴证吗？所以凡是真阳不足的，就是阳中之阴厥；脉弱无神的，就是阳中之阴厥；攻伐清凉太过导致的，就是阳中之阴厥。四肢是诸阳之本，如果不是有热结、烦渴、胀实等症状，而见厥逆的，都是由阳气不足引起的。成无己说：大抵厥逆由阴所主，多为寒证。又说：厥是阴气盛的表现。所以凡是属于挟虚伤寒，即使是从阳经传入的，也是阳中之阴厥。阴中之阴者适宜温补，阳中之阴者，果真适宜凉润吗？学者不要认为先前有头疼发热，只是从三阳经传过来的，就认为是阳厥，从而采用寒因热用的方法，这样危害就不小了。
第一种，脏厥证。张仲景说：伤寒脉微而厥，到了七八天皮肤发冷，其人躁动没有片刻安宁的时候，这叫脏厥。脏厥是死证，因为阳气绝灭。
第二种，蛔厥证。张仲景说：蛔厥的病人，应当吐蛔虫，现在病人安静，却又时常心烦，这是因为脏寒，蛔虫上行进入膈部，所以心烦，一会儿又停止，吃东西后呕吐，又心烦的，是因为蛔虫闻到食物气味而出，其人应当自己吐出蛔虫。蛔厥，用乌梅丸主治。成无己说：脏厥是死证，因为阳气绝灭。蛔厥虽然厥逆且心烦，但吐蛔后就安静了，不像脏厥那样躁动没有片刻安宁。病患脏寒胃虚，所以适宜给予乌梅丸温脏安虫。
There are two types of Jue (Jue syndrome, characterized by cold extremities): Yang Jue and Yin Jue. Yang Jue refers to Heat Jue, which must initially transmit from the Three Yang meridians into the Yin compartments. Therefore, at its onset, it is necessarily accompanied by headache and fever. As the pathogen moves from superficial to deep levels, it eventually affects the Three Yin meridians, transforming into cold extremities that may occasionally become warm. The symptoms invariably include constipation, restlessness, delirium, thirst, aversion to cold being absent, but rather an aversion to heat, and a deep, forceful pulse. This condition arises from the transformation of heat syndromes transmitted through the meridians. Although the exterior presents with cold extremities, the interior is caused by heat pathogens. Since this is a Yang syndrome manifesting as Jue, it is termed Yang Jue, representing "extreme Yang resembling Yin." This syndrome results from internal accumulation of evil heat or the failure to purge latent Yang heat. When Jue is mild, the heat is also mild, and formulas similar to Sini San (Four Counterflow Powder) are appropriate; when Jue is severe, the heat is also severe, and formulas similar to Chengqi Tang (Descending the Qi Decoction) are appropriate.
Yin Jue refers to Cold Jue. Initially, there are no excess heat syndromes characteristic of transmission through the Three Yang meridians; instead, true cold directly invades the Three Yin meridians. Symptoms include fear of cold, cold extremities, abdominal pain, vomiting, diarrhea, shivering, absence of thirst, and a deep, weak pulse. This is Yin-cold Jue-ni (rebellious counterflow), characterized by exclusive Yin without Yang, hence termed Yin Jue. Mild cases are treated with Lizhong Tang (Regulate the Middle Decoction), while severe cases are managed with Sini Tang (Reverse the Five Extremities Decoction) or Hu yang (Restore Yang) decoctions.
Cheng Wuji stated: "Sini" refers to limbs that are not warm. When Shaoyang disease pathogens are in the Three Yang meridians, the hands and feet are necessarily hot; upon transmission to Taiyin, the hands and feet naturally become warm; reaching Shaoyin, the pathogenic heat deepens, causing the limbs to be cold and not warm; upon reaching Jueyin, the hands and feet become completely cold, which is more severe than "Ni," thus Sini San is used to dissipate the heat syndrome transmitted into the Yin.
The Classic states: "For all cases of Sini and Jue, purgation should not be used; this applies equally to those with deficiency constitutions." Cheng Wuji annotated: "Sini" refers to limbs that are not warm; "Jue" refers to cold hands and feet, which is more severe than Sini. Both result from scant Yang qi and abundant Yin qi, so purgation is contraindicated; this applies equally to those with deficiency constitutions. The *Jinkui Yuhan* states: "For deficiency, tonify ten times; do not purge even once."
The Classic states: "All Jue syndromes occur when Yin and Yang qi fail to connect smoothly, resulting in Jue. Jue is characterized by cold extremities. If a patient has cold extremities and states they do not have a Jie Xiong (Chest Binding) syndrome, but have fullness and tenderness upon pressure in the lower abdomen, this indicates cold binding at the Bladder's Guanyuan acupoint. In Shaoyang disease, if there is fever for four days, followed by three days of Jue, then fever for another four days, with less Jue and more heat, the disease should resolve. In Shaoyang disease, if there is Jue for four days, followed by three days of heat, then Jue for five days, the disease progresses. More cold and less heat indicate the退 (retreat) of Yang qi, hence the progression. If Jue is accompanied by vomiting and chest/hypochondriac fullness and irritability, hematochezia (blood in stool) will likely follow later."
The Classic states: "In Shaoyin disease, with dysentery passing undigested food, interior cold with exterior heat, cold extremities, and a faint pulse nearly imperceptible, yet the body feels no aversion to cold, and the person has a red complexion, or abdominal pain, dry retching, sore throat, or cessation of dysentery with non-palpable pulse, Tongmai Sini Tang (Pulse-Restoring Sini Decoction) is indicated. In Shaoyang disease with a rapid pulse and cold extremities, moxibustion may be applied. In Shaoyang disease with a slippery pulse and Jue, there is interior heat, treated with Baihu Tang (White Tiger Decoction). For cold hands and feet with a fine pulse nearly absent, Danggui Sini Tang (Angelica Sinensis Decoction to Restore the Five Extremities) is indicated. If the patient has chronic interior cold, Danggui Sini Tang plus Wuzhuyu and Shengjiang (Evodia and Fresh Ginger) is appropriate. For profuse sweating with persistent heat, interior tension, limb pain, accompanied by dysentery, Jue, and aversion to cold, Sini Tang is indicated. For profuse sweating or severe dysentery leading to Jue, Sini Tang is indicated. For patients with cold extremities and a suddenly tight pulse, the pathogen is bound in the chest, causing central fullness and irritability, hunger but inability to eat; the disease is in the chest and requires emesis, using Gouti San (Melon Seed Powder). In Shaoyang disease with Jue and epigastric palpitations, water retention should be treated first with Fuling Gancao Jiang Tang (Poria, Licorice, and Ginger Decoction), then treat the Jue. Otherwise, water will infiltrate the stomach, causing dysentery. For dysentery passing undigested food, interior cold with exterior heat, sweating, and Jue, Tongmai Sini Tang is indicated. For vomiting with a weak pulse, frequent urination, slight body heat, and appearance of Jue, the prognosis is difficult; Sini Tang is indicated."
Commentary: The differentiation between Yang Jue and Yin Jue was described above, which is the great method of the sages. However, I still have further distinctions. Regarding Yin Jue, since there are no Yang symptoms or Yang pulses, and the pathology is clearly cold, it is undoubtedly a Yin syndrome. Nowadays, people simply call it Zhong Han (Cold Strike), which is the disease itself. Few suffer from this, and recognizing it is not difficult; treatment should focus on warming the middle, requiring no further differentiation. Only Yang Jue requires necessary differentiation. Jue transmitted from the Three Yang meridians is called Yang Jue, which is correct. But even considering transmission, are there not Yin syndromes? Thus, anyone with true Yang insufficiency suffers from Yang-within-Yin Jue; those with weak, spiritless pulses suffer from Yang-within-Yin Jue; those over-treated with attacking and cooling methods suffer from Yang-within-Yin Jue. The four limbs are the root of all Yang qi. Unless there are symptoms such as heat binding, irritability/thirst, and distension/fullness/excess, Jue appearing in their absence is due to Yang qi insufficiency. Cheng Wuji said: "Generally, Jue-ni is governed by Yin and is mostly cold." He also said: "Jue represents the flourishing of Yin." Therefore, for all cases of Cold Damage complicated by deficiency, even if transmitted from Yang meridians, it is Yang-within-Yin Jue. If Yin-within-Yin requires warming, does Yang-within-Yue truly require cooling? Students should not assume that because there was initial headache and fever, and it came from the Three Yang meridians, it is Yang Jue, and thus apply cold-for-heat usage, which would cause significant harm.
1. Zang Jue (Organ Jue) Syndrome. Zhang Zhongjing said: "In Cold Damage, with a faint pulse and Jue, after seven or eight days, the skin becomes cold, and the person is restless with no moment of peace; this is Zang Jue. Zang Jue is a death syndrome, indicating the extinction of Yang qi."
2. Hui Jue (Roundworm Jue) Syndrome. Zhang Zhongjing said: "In Hui Jue, the patient should vomit roundworms. Now, the patient is quiet but periodically irritable; this is due to cold in the Zang, causing roundworms to ascend into the Diaphragm, hence the irritability. After a short while, it stops again. Upon eating, vomiting occurs, and irritability returns because the roundworms emerge smelling the food odor; the patient should spontaneously vomit roundworms. Hui Jue is treated with Wumei Wan (Mume Pill)." Cheng Wuji said: "Zang Jue is a death syndrome, indicating the extinction of Yang qi. Although Hui Jue involves Jue and irritability, it becomes quiet after vomiting roundworms, unlike Zang Jue where there is constant restlessness. Because the patient has cold in the Zang and deficiency in the Stomach, Wumei Wan should be given to warm the Zang and pacify the parasites."