厥阴之为病，消渴，气上撞心，心中疼热，饥而不欲食，食则吐蛔，下之利不止。
邪传厥阴，则热已深也。邪自太阳传至太阴，则腹满而嗌干，未成渴也；邪至少阴者，口燥舌干而渴，未
成消也；至厥阴成消渴者，热甚能消水故也。饮水多而小便少者，谓之消渴。
木生于火，肝气通心，厥阴客热，气上撞心，心中疼热。伤寒六七日，厥阴受病之时，为传经尽，则当入腑，
胃虚客热，饥不欲食，蛔在胃中，无食则动，闻食嗅（医统本作“臭”）而出，得食吐蛔，此
热在厥阴经也。若便下之，虚其胃气，厥阴木邪相乘，必吐下不止。
厥阴中风，脉微浮，为欲愈；不浮，为未愈。
经曰∶阴病见阳脉而生，浮者阳也。厥阴中风，脉微浮，为邪气还表，向汗之时，故云欲愈。
厥阴病，欲解时，从寅（赵本医统本并作“丑”）至卯上。
厥阴，木也，王于卯丑寅，向王，故为解时。
厥阴病，渴欲饮水者，少少与之，愈。
邪至厥阴，为传经尽，欲汗之时，渴欲得水者，少少与之，胃气得润则愈。
诸四逆厥者，不可下之，虚家亦然。
四逆者，四肢不温也。厥者，手足冷也。皆阳气少而阴气多，故不可下，虚家亦然。下之是为重虚，
《金匮玉函》曰∶虚者十补，勿一泻之。
伤寒先厥，后发热而利者，必自止。见厥复利。
阴气胜，则厥逆而利；阳气复，则发热，利必自止。见厥，则阴气还胜而复利也。
伤寒始发热，六日，厥反九日而利。凡厥利者，当不能食，今反能食者，恐为除中，（赵本注∶“
一云消中”）食以索饼，不发热者，知胃气尚在，必愈，恐暴热来出而复去也。后三（赵本无“三”字）日脉之，
其热续在者，期之旦日夜半愈。所以然者，本发热六日，厥反九日，复发热三日，并前六日，亦为九日，与厥
相应，故期之旦日夜半愈。后三日脉之而脉数，其热不罢者，此为热气有余，必发痈脓也。
始发热，邪在表也。至六日，邪传厥阴，阴气胜者，作厥而利，厥反九日，阴寒气多，当不能食，而
反能食者，恐为除中。除，去也；中，胃气也。言邪气太甚，除去胃气，胃欲引食自救，故暴能食，此欲胜
也。食以索饼试之，若胃气绝，得面则必发热；若不发热者，胃气尚在也。恐是寒极变热，因暴热来而复
去，使之能食，非除中也。《金匮要略》曰∶病患素不能食，而反暴思之，必发热。后三日脉之，其热续在
者，阳气胜也，期之旦日夜半愈；若旦日不愈，后三日脉数而热不罢者，为热气有
余，必发痈脓。经曰∶数脉不时，则生恶疮。
伤寒脉迟，六七日，而反与黄芩汤彻其热。脉迟为寒，今与黄芩汤，复除其热，腹中应冷，当不能食；今
反能食，此名除中，必死。
伤寒脉迟，六七日，为寒气已深，反与黄芩汤寒药，两寒相搏，腹中当冷，冷不消谷，则不能食；反能
食者，除中也。四时皆以胃气为本，胃气已绝，故云必死。
伤寒先厥后发热，下利必自止，而反汗出，咽中痛
者，其喉为痹。发热无汗而利必自止，若不止，必便脓血。便脓血者，其喉不痹。
伤寒先厥而利，阴寒气胜也。寒极变热后发热，下利必自止，而反汗出，咽中痛，其喉为痹者，热气上行
也。发热无汗而利必自止，利不止，必便脓血者，热气下行也。热气下而不上，其喉亦不痹也。
伤寒一二日，至四五日而（赵本无“而”字）厥者，必发热，前热者，后必厥，厥深者，热亦深，厥微
者，热亦微，厥应下之，而反发汗者，必口伤烂赤。
前厥后发热者，寒极生热也；前热后厥者，阳气内陷也；厥深热深，厥微热微，随阳气陷之深浅也。热
之伏深，必须下去之，反发汗者，引热上行，必口伤烂赤。《内经》曰∶火气内发，上为口糜。
伤寒病，厥五日，热亦五日，设六日当复厥，不厥者，自愈。厥终不过五日，以热五日，故知自愈。
阴胜则厥，阳胜则热。先厥五日为阴胜，至六日阳复胜，热亦五日，后复厥者，阴复胜；若不厥为
阳全胜，故自愈。经曰∶发热四日，厥反三日，复热四日，厥少热多，其病为愈。
凡厥者，阴阳气不相顺接，便为厥。厥者，手足逆冷（赵本有“者”字）是也。
手之三阴三阳，相接于手十指；足之三阴三阳，相接于足十趾。阳气内陷，阳不与阴相顺接，故手足为
之厥冷也。
伤寒，脉微而厥，至七八日，肤冷，其人躁，无暂安时者，此为脏厥，非为（赵本无“为”字）蛔厥也。
蛔厥者，其人当吐蛔。令（《玉函经》作今）病者静，而复时烦，（赵本有“者”字）此为脏寒。蛔上
入（赵本有“其”字）膈，故烦，须臾复止，得
食而呕，又烦者，蛔闻食臭出，其人当（赵本作“常”）自吐蛔。蛔厥者，乌梅丸主之。又主久利方。（赵本
无“方”字）
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，蛔动
上膈，闻食臭出，因而吐蛔，与乌梅丸，温脏安虫。
乌梅丸方∶
乌梅（三百个。赵本作“枚”。味酸温） 细辛（六两。辛热） 干姜（十两。辛热） 黄连（一斤。
赵本作“十六两”。苦寒） 当归（四两。辛温） 附子（六两，炮。赵本有“去皮”二字。辛热） 蜀椒
（四两，去子。赵本作“出汗”。医统本作“去汗”。辛热） 桂枝（六两。赵本有“去皮”二字。辛热）
人参（六两。甘温） 黄柏（六两。苦寒）
肺主气，肺欲收，急食酸以收之，乌梅之酸，以收肺气；脾欲缓，急食甘以缓之，人参之甘，以缓
脾气；寒淫于内，以辛润之，以苦坚之，当归、桂、椒、细辛之辛，以润内寒；寒淫所胜，平以辛热，姜、
附之辛热，以胜寒；蛔得甘则动，得苦则安，黄连、黄柏之苦，以安蛔。
上十味，异捣筛，合治之，以苦酒渍乌梅一宿，去核，蒸之五升（赵本作“斗”）米下，饭熟，捣成泥，
和药令相得，内臼中，与蜜，杵二千下，丸如梧桐子大，先食饮，服十丸，日三服，稍加至二十丸。禁
生冷、滑物、臭食等。
伤寒，热少厥微，指（赵本注∶“一作稍”）头寒，默默（赵本作“嘿嘿”）不欲食，烦躁数日，小便
利，色白者，此热除也，欲得食，其病为愈；若厥而呕，胸胁烦满者，其后必便血。
指头寒者，是厥微热少也；默默不欲食烦躁者，邪热初传
里也；数日之后，小便色白，里热去，欲得食，为胃气已和，其病为愈。厥阴之脉，挟胃贯膈，布胁肋。厥
而呕，胸胁烦满者，传邪之热，甚于里也。厥阴肝主血，后数日热不去，又不得外泄，迫血下行，必致便血。
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。
手足厥不结胸者，无热也；小腹满，按之痛，下焦冷结也。
伤寒发热四日，厥反三日，复热四日，厥少热多，（赵本有“者”字）其病当愈。四日至七日，热不
除者，其后（赵本无“其后”二字）必便脓血。
先热后厥者，阳气邪传里也。发热为邪气在表。至四日后厥者，传之阴也。后三日复传阳经，则复热。
厥少则邪微，热多为阳胜，其病为愈。至七日传经尽，热除则愈；热不除者，
为热气有余，内搏厥阴之血，其后必大便脓血。
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。
伤寒阴胜者先厥，至四日邪传里，重阴必阳却，热三日，七日传经尽，当愈。若不愈而复厥者，传作
再经，至四日则当复热；若不复热，至五日厥不除者，阴胜于阳，其病进也。
伤寒六七日，脉微，手足厥冷，烦躁，灸厥阴，厥不还者，死。
伤寒六七日，则正气当复，邪气当罢，脉浮身热为欲解；若反脉微而厥，则阴胜阳也。烦躁者，阳虚
而争也。灸厥阴，以复其阳；厥不还，则阳气已绝，不能复正而死。
伤寒发热，下利，厥逆，躁不得卧者，死。
伤寒发热，邪在表也；下利厥逆，阳气虚也；躁不得卧者，
病胜脏也。故死。
伤寒发热，下利至甚，厥不止者，死。
《金匮要略》曰∶六腑气绝于外者，手足寒；五脏气绝于内者，利下不禁。伤寒发热，为邪气独甚，
下利至甚，厥不止，为腑脏气绝，故死。
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。
伤寒至七日，为邪正争之时，正胜则生，邪胜则死。始不下利，而暴忽发热，下利汗出不止者，
邪气胜，正阳气脱也，故死。
伤寒五六日，不结胸，腹濡，脉虚，复厥者，不可下，此为（赵本无“为”字）亡血，下之死。
伤寒五六日，邪气当作里实之时。若不结胸，而腹濡者，里无热也；脉虚者，亡血也；复厥者，阳气
少也。不可下，下之为重虚，故死。《金匮玉函》曰∶虚者重泻，真气乃绝。
发热而厥，七日，下利者，为难治。
发热而厥，邪传里也。至七日传经尽，则正气胜邪，当汗出而解，反下利，则邪气胜，里气虚，则为难治。
伤寒脉促，（赵本注∶“一作纵”）手足厥逆者，（赵本无“者”字）可灸之。
脉促，则为阳虚不相续；厥逆，则为阳虚不相接。灸之，以助阳气。
伤寒脉滑而厥者，里有热也，（赵本无“也”字）白虎汤主之。（赵本有“白虎汤方”详见卷四）
滑为阳厥，气内陷，是里热也，与白虎汤以散里热也。
手足厥寒，脉细欲绝者，当归四逆汤主之。
手足厥寒者，阳气外虚，不温四末；脉细欲绝者，阴血内弱，脉行不利。与当归四逆汤，助阳生阴也。
当归四逆汤方∶
当归（三两。辛温） 桂枝（三两。赵本有“去皮”二字。辛热） 芍药（三两。酸寒） 细辛（三两。
辛热） 大枣（二十五个。赵本作“枚，擘，一法十二枚”。甘温） 甘草（二两，炙。甘平） 通草（二两。甘平）
《内经》曰∶脉者，血之府也。诸血者，皆属心。通脉者，必先补心益血。苦先入（医统本有“于”字）心，
当归之苦，以助心血；心苦缓，急食酸以收之，芍药之酸，以收心气；肝苦急，急食甘
以缓之，大枣、甘草、通草之甘，以缓阴血。
上七味，以水八升，煮取三升，去滓，温服一升，日三服。
若其人内有久寒者，宜当归四逆加吴茱萸生姜汤主之。（赵本无“主之”二字。赵本有“当归四逆
加吴茱萸生姜汤方”详见卷十）
茱萸辛温，以散久寒；生姜辛温，以行阳气。
大汗出，热不去，内拘急，四肢疼，又下利，厥逆而恶寒者，四逆汤主之。（赵本有“四逆汤方”详见卷二）
大汗出，则热当去；热反不去者，亡阳也。内拘急下利者，寒甚于里。四肢疼，厥逆而恶寒者，寒甚
于表。与四逆汤，复阳散寒。
大汗，若大下利而厥冷者，四逆汤主之。
大汗，若大下利，内外虽殊，其亡津液、损阳气则一也。阳虚阴胜，故生厥逆，与四逆汤，固阳退阴。
病患手足厥冷，脉乍紧者，邪结在胸中。心中（赵本
医统本并作“下”）满而烦，饥不能食者，病在胸中，当须吐之，宜瓜蒂散。（赵本有“瓜蒂散方”详见卷四）
手足厥冷者，邪气内陷也。脉紧牢者，为实；邪气入腑，则脉沉。今脉乍紧，知邪结在胸中为实，故心
下满而烦，胃中无邪则喜饥，以病在胸中，虽饥而不能食，与瓜蒂散，以吐胸中之邪。
伤寒厥而心下悸者，（赵本无“者”字）宜先治水，当服茯苓甘草汤，却治其厥；不尔，水渍入胃，必
作利也。（赵本有“茯苓甘草汤方”详见卷三）
《金匮要略》曰∶水停心下，甚者则悸。厥虽寒胜，然以心下悸，为水饮内甚，先与茯苓甘草汤，治
其水，而后治其厥；若先治厥，则水饮浸流入胃，必作下利。
伤寒六七日，大下后，寸脉沉而迟，手足厥逆，下部脉不至，咽喉不利，唾脓血，泄利不止者，为难治。
麻黄升麻汤主之。
伤寒六七日，邪传厥阴之时。大下之后，下焦气虚，阳气内陷，寸脉迟而手足厥逆，下部脉不至。厥阴
之脉，贯膈上注肺，循喉咙。在厥阴随经射肺，因亡津液，遂成肺痿，咽喉不利而唾脓血也。《金匮要略》曰∶
肺痿之病，从何得之，被快药下利，重亡津液，故得之。若泄利不止者，为里气大虚，故云难
治。与麻黄升麻汤，以调肝肺之气。
麻黄升麻汤方∶
麻黄（二两半，去节。甘温） 升麻（一两一分。甘平） 当归（一两一分。辛温） 知母（苦寒 赵本作
“十八铢”） 黄芩（苦寒 赵本作“十八铢”） 葳蕤（各十八铢。赵本一作菖蒲。甘平） 石膏（碎，绵裹。
甘寒。赵本作“六铢”） 白术（甘温） 干姜（辛热 赵本作“六铢”） 芍
药（酸平 赵本作“六铢”） 天门冬（去心。甘平 赵本作“六铢”） 桂枝（辛热。赵本有“六铢，去
皮”四字） 茯苓（甘平 赵本作“六铢”） 甘草（炙 各六铢 甘平 赵本无“各”字）
《玉函》曰∶大热之气，寒以取之；甚热之气，以汗发之。麻黄、升麻之甘，以发浮热；正气虚者，
厥阴病的典型症状是：口渴多饮，气向上冲撞心脏，心中感觉疼痛且有灼热感，虽然感到饥饿但不想吃东西，如果吃了东西就会吐出蛔虫，若误用泻下法治疗，会导致腹泻不止。
邪气传入厥阴经，说明热邪已经深入。邪气从太阳经传到太阴经时，会出现腹部胀满和咽喉干燥，但尚未形成口渴；邪气传到少阴经时，会出现口燥舌干而渴，但尚未形成消渴（饮水多且小便少的病症）；到了厥阴经形成消渴，是因为热邪极盛，能够消耗津液所致。饮水多而小便少的情况，称为消渴。
肝属木，心属火，木能生火，故肝气通于心。厥阴经受客热之邪，导致气上冲撞心脏，心中疼痛且有灼热感。伤寒病经过六七天，正值厥阴经受病的时候，这是传经的最后一环，邪气应当传入腑中。此时胃气虚弱而有客热停留，患者感到饥饿但不欲进食。蛔虫在胃中，没有食物时就会躁动，闻到食物的气味就会出来，所以进食后会吐出蛔虫，这是热邪停留在厥阴经的表现。如果此时立即使用泻下法，会进一步损伤胃气，导致厥阴木邪乘虚克制脾胃，必然出现呕吐和腹泻不止的症状。
厥阴病感受风邪，脉象微浮，是病情将要痊愈的征兆；脉不浮，则是病情未愈。
经典记载：阴病见到阳脉则生机旺盛，浮脉属于阳脉。厥阴病中风，脉象微浮，说明邪气由里出表，正处于应当发汗解表的时机，所以说病情将愈。
厥阴病欲解除的时间，是在寅时到卯时之间。
厥阴属木，旺于丑、寅、卯这三个时辰，向旺之时，所以是疾病缓解的时间。
厥阴病患者，如果感到口渴想喝水，只需少量给予饮水，病即可痊愈。
邪气到达厥阴经，是传经的尽头，也是正气驱邪外出、即将发汗的时候。此时患者口渴想喝水，只需少量给予饮水，使胃气得到滋润，病就能痊愈。
凡是出现四肢逆冷的厥证，不可使用泻下法，体质虚弱的人也是如此。
四逆，是指四肢不温暖。厥，是指手足冰冷。这都是因为阳气不足而阴气偏盛，所以不可使用泻下法，体质虚弱的人也同样禁忌。如果使用泻下法，会造成严重的虚损。《金匮玉函经》说：对于虚证，应当采用十次补益的方法，切勿使用一次泻下的方法。
伤寒病先出现四肢厥冷，后来发热并且伴有腹泻的，腹泻必定会自行停止。如果再次出现厥冷，腹泻也会再次发作。
阴气偏胜，就会出现四肢厥逆和腹泻；阳气恢复，就会出现发热，腹泻必定自行停止。如果再次出现厥冷，说明阴气重新偏胜，腹泻也会再次发作。
伤寒病开始发热六天，后来反而厥冷九天并伴有腹泻。凡是厥冷和腹泻的患者，通常不能进食，但现在反而能进食，这恐怕是“除中”证（胃气将绝前的假性食欲亢进）。给患者吃面条类食物测试，如果不发热，说明胃气尚存，病必痊愈；但要警惕是否是暴热来去匆匆造成的假象。三天后诊察脉象，如果发热持续存在，预计第二天半夜痊愈。之所以这样判断，是因为原本发热六天，反而厥冷九天，后来又发热三天，加上之前的六天，总共也是九天，与厥冷的天数相应，所以预计第二天半夜痊愈。如果三天后诊察脉象，脉搏数疾，发热不退，这是热气有余，必然会引发痈脓。
起初发热，说明邪气在体表。到了第六天，邪气传入厥阴，如果阴气偏胜，就会发生厥冷和腹泻。厥冷长达九天，说明阴寒气重，按理说应该不能进食，现在反而能进食，恐怕是“除中”。除，就是去除的意思；中，指胃气。意思是邪气太盛，耗尽了胃气，胃为了自救想要引食，所以突然能进食，这是邪气欲胜的表现。给患者吃面条测试，如果胃气已绝，吃到面食必然发热；如果不发热，说明胃气尚存。要警惕这是否是因为寒极生热，因暴热来袭又迅速消退，导致患者能进食，并非真正的除中。《金匮要略》说：病人平时不能进食，却突然想吃东西，一定会发热。三天后诊察脉象，如果发热持续存在，说明阳气胜，预计第二天半夜痊愈；如果第二天未愈，三天后脉数且热不退，说明热气有余，必然会引发痈脓。经典说：脉数而不止息，就会产生恶疮。
伤寒病脉迟，过了六七天，反而给予黄芩汤来清除其热。脉迟代表寒证，现在给予黄芩汤这种寒凉药，进一步清除其热，腹中应当寒冷，应当不能进食；现在反而能进食，这叫做“除中”，必定死亡。
伤寒病脉迟，六七天时，说明寒气已经深入，反而给予黄芩汤这种寒药，两寒相搏，腹中应当寒冷，寒冷则无法消化谷物，所以不能进食；现在反而能进食，这就是“除中”。四季养生都以胃气为本，胃气已经断绝，所以说必定死亡。
伤寒病先厥冷后发热，腹泻必定自行停止，但如果反而出汗，咽喉疼痛的，喉部会发生痹阻。如果发热无汗且腹泻必定自行停止，如果腹泻不止，必定排出脓血。排出脓血的患者，喉部不会发生痹阻。
伤寒先厥冷且腹泻，是阴寒气偏胜。寒极变热后发热，腹泻必定停止，但如果反而出汗，咽喉疼痛，喉部发生痹阻，这是因为热气上行。发热无汗且腹泻必定停止，如果腹泻不止，必定排出脓血，这是因为热气下行。热气下行而不上行，喉部也不会发生痹阻。
伤寒一二天，到四五天出现厥冷的，必定会发热。先前发热的，后来必定厥冷。厥冷严重的，热邪也深重；厥冷轻微的，热邪也轻微。厥证应当使用泻下法，如果反而使用发汗法，必定导致口腔受伤溃烂发红。
先前厥冷后来发热的，是寒极生热；先前发热后来厥冷的，是阳气内陷。厥深热深，厥微热微，随着阳气内陷的深浅而变化。热邪伏藏深重，必须用泻下法祛除，如果反而发汗，会引导热邪上行，必定导致口腔受伤溃烂发红。《内经》说：火气在内发散，向上会导致口腔糜烂。
伤寒病，厥冷五天，发热也五天，假设第六天应当再次厥冷，如果没有再次厥冷，病就会自愈。厥冷的时间不超过五天，因为发热也有五天，所以知道病会自愈。
阴气偏胜则厥冷，阳气偏胜则发热。先厥冷五日是阴气偏胜，到第六天阳气恢复偏胜，发热也是五天，之后如果再次厥冷，是阴气重新偏胜；如果不厥冷，就是阳气全胜，所以病会自愈。经典说：发热四天，反而厥冷三天，后来又发热四天，厥冷少而发热多，病就会痊愈。
大凡厥证，都是阴阳之气不相顺接，从而导致厥冷。所谓厥，就是手足逆冷。
手部的三阴经和三阳经，交接于手指十个末端；足部的三阴经和三阳经，交接于脚趾十个末端。阳气内陷，阳不与阴顺接，所以手足因此厥冷。
伤寒病，脉象微细且手足厥冷，到了七八天，皮肤也冷，患者烦躁，没有片刻安宁的时候，这是脏厥，不是蛔厥。
蛔厥的患者，应当会吐出蛔虫。现在的病人安静时，却时不时心烦，这是因为内脏寒冷。蛔虫向上进入膈部，所以心烦，过了一会儿又停止，进食后呕吐，又心烦的，是因为蛔虫闻到食物的气味而出，这类患者通常会吐出蛔虫。蛔厥证，用乌梅丸主治。乌梅丸也主治久痢。
脏厥证预后不良，因为阳气绝灭。蛔厥证，虽然厥冷且心烦，但吐出蛔虫后就安静了，不像脏厥那样烦躁没有片刻安宁。病患内脏寒冷、胃气虚弱，蛔虫扰动上行至膈，闻到食物气味而出，因而吐出蛔虫。给予乌梅丸，可以温补脏腑、安顿蛔虫。
乌梅丸方剂组成：
乌梅（三百个。赵本作“枚”。味酸温） 细辛（六两。辛热） 干姜（十两。辛热） 黄连（一斤。赵本作“十六两”。苦寒） 当归（四两。辛温） 附子（六两，炮制。赵本有“去皮”二字。辛热） 蜀椒（四两，去籽。赵本作“出汗”。医统本作“去汗”。辛热） 桂枝（六两。赵本有“去皮”二字。辛热） 人参（六两。甘温） 黄柏（六两。苦寒）
肺主气，肺喜欢收敛，急需食用酸味药物来收敛它，乌梅的酸味，可以收敛肺气；脾喜欢缓和，急需食用甘味药物来缓和它，人参的甘味，可以缓和脾气；寒邪淫溢于体内，用辛味润泽它，用苦味坚固它，当归、桂枝、蜀椒、细辛的辛味，可以润泽体内的寒邪；寒邪偏胜，用辛热药平抑它，干姜、附子的辛热，可以战胜寒邪；蛔虫遇到甘味就会躁动，遇到苦味就会安定，黄连、黄柏的苦味，可以安顿蛔虫。
以上十味药，分别捣碎过筛，混合处理。用醋浸泡乌梅一夜，去核，放在五升（赵本作“斗”）米下面蒸，饭熟后，将乌梅捣成泥，与药粉混合均匀，放入臼中，加入蜂蜜，杵击两千下，制成梧桐子大小的丸药。饭前服用，每次十丸，每日三次，逐渐增加到二十丸。禁止食用生冷、滑腻、腐败变质等食物。
伤寒病，热邪轻微，厥冷轻微，仅指尖发凉，神情沉默不想吃东西，烦躁几天，小便通畅，颜色白的，这说明热邪已除，想要吃东西，病就会痊愈；如果出现厥冷且呕吐，胸胁部烦闷胀满的，其后必定便血。
指尖发凉，说明厥冷轻微、热邪少；神情沉默不想吃东西且烦躁，是邪热刚刚传入里部；几天之后，小便颜色变白，说明里热已去，想要吃东西，说明胃气已调和，病就会痊愈。厥阴经脉，挟胃贯穿膈肌，分布于胁肋。出现厥冷且呕吐，胸胁烦闷胀满，说明传变的邪热在里部加重。厥阴肝主血，几天后热邪不去，又不能向外宣泄，逼迫血液下行，必定导致便血。
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。
手足厥冷且没有结胸证，说明没有热邪；小腹胀满，按压疼痛，是下焦冷邪结聚。
伤寒发热四天，反而厥冷三天，后来又发热四天，厥冷少而发热多，病应当痊愈。从第四天到第七天，如果热邪不消除，其后必定便脓血。
先发热后厥冷，是阳气邪气传入里部。发热表示邪气在表。到了第四天后出现厥冷，是邪气传入阴经。后又过三天传回阳经，所以再次发热。厥冷少说明邪气微弱，发热多说明阳气胜，病会痊愈。到了第七天传经结束，热邪消除则痊愈；如果热邪不消除，说明热气有余，内迫厥阴之血，其后必定大便脓血。
伤寒厥冷四天，发热反而只有三天，后来又厥冷五天，病情为进展，寒多热少，阳气衰退，所以病情进展。
伤寒阴气偏胜者先出现厥冷，到第四天邪气传入里部，重阴必转化为阳，发热三天，第七天传经结束，应当痊愈。如果未愈又出现厥冷，是邪气传入再一经，到第四天应当再次发热；如果不再次发热，到第五天厥冷不消除，说明阴胜于阳，病情进展。
伤寒六七天，脉象微细，手足厥冷，烦躁，灸治厥阴经穴位，如果厥冷不还复，预后不良。
伤寒六七天，正气应当恢复，邪气应当罢退，脉浮身热是欲解的迹象；如果反而脉微而厥冷，则是阴胜阳衰。烦躁，是阳虚而与邪争的表现。灸治厥阴经，以恢复阳气；如果厥冷不还，说明阳气已绝，不能恢复正气而死。
伤寒发热，腹泻，厥逆，躁动不得卧倒的，预后不良。
伤寒发热，邪气在表；腹泻厥逆，阳气虚；躁动不得卧倒，是病邪胜过脏气。所以预后不良。
伤寒发热，腹泻严重，厥冷不止的，预后不良。
《金匮要略》说：六腑之气绝于外，手足寒冷；五脏之气绝于内，腹泻不禁。伤寒发热，是邪气独盛；腹泻严重，厥冷不止，是腑脏之气绝灭，所以预后不良。
伤寒六七天，原本没有腹泻，突然发热且腹泻，病人汗出不止的，预后不良。这是因为有阴无阳。
伤寒到第七天，是邪正相争的时候，正气胜则生，邪气胜则死。开始没有腹泻，却突然发热、腹泻且汗出不止，是邪气胜，正气阳气脱失，所以预后不良。
伤寒五六天，没有结胸，腹部柔软，脉象虚弱，又出现厥冷的，不可使用泻下法，这是因为亡血，使用泻下法会导致死亡。
伤寒五六天，邪气应当形成里实证的时期。如果不结胸，且腹部柔软，说明里没有热邪；脉象虚弱，是亡血；又出现厥冷，是阳气少。不可使用泻下法，泻下会造成严重的虚损，所以死亡。《金匮玉函经》说：虚证如果再被泻下，真气就会绝灭。
发热且厥冷，到了第七天，出现腹泻的，难以治疗。
发热且厥冷，是邪气传入里部。到了第七天传经结束，应当正气胜邪，通过出汗而解，反而出现腹泻，说明邪气胜，里气虚，所以难以治疗。
伤寒脉促，（赵本注：“一作纵”）手足厥逆的，（赵本无“者”字）可以用灸法治疗。
脉促，说明阳气虚而不相续；厥逆，说明阳气虚而不相接。灸治可以辅助阳气。
伤寒脉滑而厥冷的，里有热邪，用白虎汤主治。（赵本有“白虎汤方”详见卷四）
滑脉为阳厥，气机内陷，是里热证，给予白虎汤以疏散里热。
手足厥寒，脉象细弱几乎摸不到的，用当归四逆汤主治。
手足厥寒，是阳气在外虚弱，不能温煦四肢末端；脉细欲绝，是阴血在内虚弱，脉道运行不利。给予当归四逆汤，助阳生阴。
当归四逆汤方剂组成：
当归（三两。辛温） 桂枝（三两。赵本有“去皮”二字。辛热） 芍药（三两。酸寒） 细辛（三两。辛热） 大枣（二十五个。赵本作“枚，擘，一法十二枚”。甘温） 甘草（二两，炙。甘平） 通草（二两。甘平）
《内经》说：脉是血的府库。所有的血，都归属于心。通利血脉，必须先补心益血。苦味先入心，当归的苦味，可以助心血；心苦缓，急需食用酸味来收敛它，芍药的酸味，可以收敛心气；肝苦急，急需食用甘味来缓和它，大枣、甘草、通草的甘味，可以缓和阴血。
以上七味药，用水八升，煮取三升，去渣，温服一升，每日三次。
如果病人内有久寒的，适宜用当归四逆加吴茱萸生姜汤主治。（赵本无“主之”二字。赵本有“当归四逆加吴茱萸生姜汤方”详见卷十）
吴茱萸辛温，可以散久寒；生姜辛温，可以行阳气。
大汗出，热邪不去，内部拘急，四肢疼痛，又腹泻，厥逆且恶寒的，用四逆汤主治。（赵本有“四逆汤方”详见卷二）
大汗出，热邪应当去除；热邪反而不去，是亡阳。内部拘急且腹泻，是寒邪甚于里部。四肢疼痛，厥逆且恶寒，是寒邪甚于表部。给予四逆汤，恢复阳气，驱散寒邪。
大汗，或者大腹泻且厥冷的，用四逆汤主治。
大汗，或者大腹泻，内外虽然不同，但损耗津液、损伤阳气是一样的。阳虚阴胜，所以产生厥逆，给予四逆汤，固护阳气，退却阴邪。
病人手足厥冷，脉象突然紧实的，邪气结聚在胸中。心中（赵本、医统本并作“下”）胀满且心烦，饥饿但不能进食的，病在胸中，应当使用吐法，适宜用瓜蒂散。（赵本有“瓜蒂散方”详见卷四）
手足厥冷，是邪气内陷。脉紧牢，属实证；邪气入腑，脉象应沉。现在脉象突然紧实，知道邪气结聚在胸中为实证，所以心下胀满且心烦，胃中没有邪气所以喜饥，但因为病在胸中，虽然饥饿但不能进食，给予瓜蒂散，以吐出胸中之邪。
伤寒厥冷且心下悸动的，（赵本无“者”字）适宜先治水饮，应当服用茯苓甘草汤，然后再治疗厥冷；否则，水气浸渍入胃，必定导致腹泻。（赵本有“茯苓甘草汤方”详见卷三）
《金匮要略》说：水停心下，严重时则心悸。厥冷虽然是寒胜，但因为心下悸动，是水饮内盛，先给予茯苓甘草汤，治疗水饮，然后治疗厥冷；如果先治疗厥冷，则水饮浸流入胃，必定导致腹泻。
伤寒六七天，经过大泻下后，寸脉沉而迟，手足厥逆，下部脉摸不到，咽喉不利，唾吐脓血，腹泻不止的，难以治疗。
用麻黄升麻汤主治。
伤寒六七天，邪气传入厥阴的时候。大泻下之后，下焦气虚，阳气内陷，寸脉迟且手足厥逆，下部脉摸不到。厥阴经脉，贯穿膈肌上注于肺，循行喉咙。在厥阴随经射肺，因为亡失津液，遂成肺痿，咽喉不利而唾吐脓血。《金匮要略》说：肺痿病，是怎么得的？被峻下药泻利，重伤津液，所以得此病。如果腹泻不止，说明里气大虚，所以说难治。给予麻黄升麻汤，以调理肝肺之气。
麻黄升麻汤方剂组成：
麻黄（二两半，去节。甘温） 升麻（一两一分。甘平） 当归（一两一分。辛温） 知母（苦寒 赵本作“十八铢”） 黄芩（苦寒 赵本作“十八铢”） 葳蕤（各十八铢。赵本一作菖蒲。甘平） 石膏（碎，绵裹。甘寒。赵本作“六铢”） 白术（甘温） 干姜（辛热 赵本作“六铢”） 芍药（酸平 赵本作“六铢”） 天门冬（去心。甘平 赵本作“六铢”） 桂枝（辛热。赵本有“六铢，去皮”四字） 茯苓（甘平 赵本作“六铢”） 甘草（炙 各六铢 甘平 赵本无“各”字）
The typical manifestations of Jueyin disease include: excessive thirst with copious drinking, a sensation of Qi rushing upward to strike the heart, pain and burning heat in the epigastrium, hunger without desire to eat, vomiting of Ascaris (roundworms) if food is ingested, and intractable diarrhea if purgatives are misused.
When pathogenic factors transmit to the Jueyin channel, the heat pathogen has already penetrated deeply. When pathogens transmit from the Taiyang channel to the Taiyin channel, abdominal fullness and dry throat occur, but thirst has not yet formed; when pathogens reach the Shaoyin channel, dry mouth and tongue with thirst occur, but Xiao Ke (Wasting-Thirst syndrome characterized by polydipsia and oliguria) has not yet formed; upon reaching the Jueyin channel and forming Xiao Ke, it is because extreme heat consumes body fluids. The condition of drinking much water while producing little urine is called Xiao Ke.
Liver belongs to Wood, Heart belongs to Fire; Wood generates Fire, thus Liver Qi connects with the Heart. Guest heat in the Jueyin channel causes Qi to rush upward to strike the heart, resulting in pain and burning heat in the epigastrium. In Cold Damage diseases, after six or seven days, when the Jueyin channel is affected, this marks the completion of the transmission sequence, and pathogens should enter the Fu organs. At this time, Stomach Qi is deficient with guest heat lingering; the patient feels hungry but does not wish to eat. Ascaris reside in the stomach; without food, they become active, and upon smelling food odor, they emerge. Thus, eating leads to vomiting of Ascaris. This indicates heat residing in the Jueyin channel. If purgatives are immediately administered, Stomach Qi is further depleted, allowing Jueyin Wood pathogen to overact on the Spleen and Stomach, inevitably causing intractable vomiting and diarrhea.
In Jueyin disease complicated by Wind, a slightly floating pulse indicates impending recovery; a non-floating pulse indicates no recovery.
The Classics state: Yin diseases presenting with Yang pulses indicate vitality. Floating pulse belongs to Yang. In Jueyin disease with Wind, a slightly floating pulse signifies pathogenic factors returning to the exterior, approaching the time for sweating, hence it is said that recovery is imminent.
Jueyin disease tends to resolve during the hours of Yin (03:00–05:00) to Mao (05:00–07:00).
Jueyin corresponds to Wood, which prospers during Chou, Yin, and Mao hours. Approaching its time of prosperity, these are the times of resolution.
In Jueyin disease, if the patient desires water due to thirst, giving small amounts of water will lead to recovery.
When pathogens reach the Jueyin channel, marking the end of transmission and the approach of sweating, thirst indicates a need for fluids. Giving small amounts of water moistens Stomach Qi, leading to recovery.
For all cases of Si Ni (Four Coldness/Reversal Cold), purgation is contraindicated; this also applies to patients with deficiency constitutions.
Si Ni refers to limbs that are not warm. Jue refers to cold hands and feet. Both result from insufficient Yang Qi and excess Yin Qi, so purgation is contraindicated, as is the case for deficient patients. Purgation would cause severe depletion. The *Jingui Yufan* states: "For deficiency, use tonification ten times; do not use purgation even once."
In Cold Damage, if initial Jue (cold extremities) is followed by fever and diarrhea, the diarrhea must stop spontaneously. If Jue reappears, diarrhea recurs.
Excess Yin Qi causes Jue and diarrhea; restoration of Yang Qi causes fever, and diarrhea stops spontaneously. Appearance of Jue indicates Yin Qi has regained dominance, causing diarrhea to recur.
In Cold Damage, initial fever lasts six days, followed by nine days of Jue and diarrhea. Generally, patients with Jue and diarrhea cannot eat. However, if the patient can now eat, one must suspect Chu Zhong (Elimination of the Middle, a false sign of appetite indicating impending gastric Qi exhaustion). Feed the patient Suo Bing (noodles/wheat cakes); if no fever ensues, it indicates Stomach Qi remains, and recovery is certain. Caution is needed to distinguish this from sudden heat coming and going quickly. Three days later, if the pulse is taken and fever persists, recovery is expected at midnight of the following day. This is because the initial six days of fever plus three days of subsequent fever equals nine days, matching the nine days of Jue, thus balancing Yin and Yang. If three days later the pulse is rapid and fever persists, this indicates excess heat, which will likely manifest as carbuncles and pus.
Initial fever indicates pathogen in the exterior. By the sixth day, pathogen transmits to Jueyin. If Yin Qi dominates, Jue and diarrhea occur. Nine days of Jue indicate abundant Yin-Cold Qi; theoretically, eating should be impossible. The ability to eat suggests Chu Zhong. Chu means elimination; Zhong refers to Stomach Qi. Extreme pathogenic factors deplete Stomach Qi; the Stomach attempts self-rescue by seeking food, causing sudden appetite, signaling pathogen dominance. Testing with noodles: if Stomach Qi is exhausted, ingestion causes fever; if no fever, Stomach Qi remains. One must consider if extreme cold transformed into heat, causing transient heat and appetite, rather than true Chu Zhong. The *Jingui Yaolue* states: "If a patient who usually cannot eat suddenly craves food, fever will surely follow." Three days later, if fever persists, Yang Qi dominates, predicting recovery at midnight. If not recovered by then, and three days later pulse is rapid with persistent fever, heat is excessive, leading to carbuncles. The Classics state: "Rapid pulse unceasing produces foul sores."
In Cold Damage with a slow pulse, after six or seven days, administering Huang Qin Tang (Scutellaria Decoction) to clear heat is erroneous. Slow pulse indicates cold. Administering cold herbs like Huang Qin Tang removes heat further, causing abdominal coldness and inability to eat. If the patient can now eat, this is Chu Zhong, indicating certain death.
With a slow pulse at six or seven days, cold pathogen is deep. Administering cold Huang Qin Tang creates a clash of two colds, causing abdominal coldness and indigestion. Inability to eat is normal; sudden ability to eat is Chu Zhong. Since all seasons rely on Stomach Qi as the root, exhaustion of Stomach Qi implies certain death.
In Cold Damage, initial Jue followed by fever stops diarrhea spontaneously. However, if sweating occurs instead, with throat pain, Bi obstruction (impediment) of the throat develops. If fever occurs without sweating and diarrhea stops, but diarrhea persists, dysentery (pus and blood in stool) develops. Patients with dysentery do not have throat Bi.
Initial Jue and diarrhea indicate excess Yin-Cold Qi. Transformation from extreme cold to heat brings fever, stopping diarrhea. Sweating with throat pain indicates heat rising. Fever without sweating stopping diarrhea, but persisting diarrhea leading to dysentery, indicates heat descending. Heat descending without ascending spares the throat from Bi.
From one or two days to four or five days in Cold Damage, appearance of Jue is followed by fever. Previous fever leads to subsequent Jue. Deep Jue indicates deep heat; slight Jue indicates slight heat. Jue should be treated with purgation; if sweating is used erroneously, oral ulcers and redness will occur.
Previous Jue followed by fever indicates extreme cold generating heat; previous fever followed by Jue indicates internal sinking of Yang Qi. Depth of Jue correlates with depth of heat. Deeply latent heat requires purgation. Erroneous sweating guides heat upward, causing oral lesions. The *Neijing* states: "Fire Qi erupting internally manifests as oral erosion."
In Cold Damage, five days of Jue followed by five days of fever. If on the sixth day Jue does not recur, the disease resolves spontaneously. Jue does not exceed five days; since fever also lasted five days, recovery is anticipated.
Yin excess causes Jue; Yang excess causes fever. Five days of Jue indicates Yin excess. On the sixth day, Yang recovers and dominates, causing five days of fever. Subsequent Jue indicates Yin resurgence. No Jue indicates complete Yang dominance, hence spontaneous recovery. The Classics state: "Four days of fever, three days of Jue, then four days of fever; less Jue and more fever indicates recovery."
All Jue syndromes result from failure of Yin and Yang Qi to connect smoothly, causing reversal cold. Jue is defined as cold extremities.
Hand Yin and Yang meridians connect at the fingertips; Foot Yin and Yang meridians connect at the toes. Internal sinking of Yang Qi prevents smooth connection between Yang and Yin, causing cold extremities.
In Cold Damage, with faint pulse and Jue, progressing to skin coldness and restlessness without respite by the seventh or eighth day, this is Zang Jue (Organ Reversal Cold), not Wei Jue (Ascaris Reversal Cold).
Wei Jue patients vomit Ascaris. Current patient is quiet but intermittently irritable due to cold Zang. Ascaris move up to the Diaphragm, causing irritability, which ceases momentarily. Vomiting and irritability after eating occur because Ascaris respond to food odor, leading to vomiting of worms. Wei Jue is treated with Wu Mei Wan (Mume Pill). It also treats chronic dysentery.
Zang Jue is fatal due to exhaustion of Yang Qi. In Wei Jue, although there is Jue and irritability, symptoms cease after vomiting Ascaris, unlike Zang Jue where restlessness is constant. For patients with cold Zang and deficient Stomach Qi, where Ascaris move up due to food odor, Wu Mei Warms the Zang and calms the parasites.
Formula: Wu Mei Wan
Wu Mei (Mume Fructus, 300 pieces, sour, warm) Xi Xin (Asari Radix, 6 liang, acrid, hot) Gan Jiang (Dried Ginger Rhizome, 10 liang, acrid, hot) Huang Lian (Coptidis Rhizome, 1 jin, bitter, cold) Dang Gui (Angelicae Sinensis Radix, 4 liang, acrid, warm) Fu Zi (Aconiti Lateralis Radix Praeparata, 6 liang, processed, acrid, hot) Shu Jiao (Sichuan Pepper Fruit, 4 liang, de-seeded, acrid, hot) Gui Zhi (Cinnamomi Ramulus, 6 liang, acrid, hot) Ren Shen (Ginseng Radix, 6 liang, sweet, warm) Huang Bo (Phellodendri Cortex, 6 liang, bitter, cold)
Lung governs Qi and prefers astringency; sour taste astringes Lung Qi. Wu Mei's sourness astringes Lung Qi. Spleen prefers relaxation; sweet taste relaxes Spleen Qi. Ren Shen's sweetness relaxes Spleen Qi. Cold invading interior is moistened by acrid and fortified by bitter. Acrid herbs like Dang Gui, Gui Zhi, Shu Jiao, and Xi Xin moisten internal cold. To counteract excess cold, acrid-hot herbs like Gan Jiang and Fu Zi overcome cold. Ascaris become active with sweet taste and calm with bitter taste. Bitter herbs Huang Lian and Huang Bo calm Ascaris.
Process the ten ingredients separately, sift, and mix. Soak Wu Mei in vinegar overnight, remove pits, steam over rice, mash into paste, mix with herbs, add honey, pound 2,000 times, form pills size of Sophora seeds. Take 10 pills before meals, three times daily, increasing gradually to 20 pills. Avoid raw, cold, slippery, and spoiled foods.
In Cold Damage, slight heat and mild Jue with cold fingertips, silent demeanor, anorexia, and irritability for several days, with clear urination, indicates heat clearance. Desire for food signals recovery. If Jue is accompanied by vomiting and chest/hypochondriac fullness, hematochezia (blood in stool) will follow later.
Cold fingertips indicate mild Jue and slight heat. Silence, anorexia, and irritability indicate initial transmission of pathogenic heat to the interior. Clear urine days later indicates interior heat removal. Desire for food indicates harmonized Stomach Qi and recovery. Jueyin meridian passes through Stomach, pierces Diaphragm, and distributes to hypochondrium. Jue with vomiting and chest/hypochondriac fullness indicates intense transmitted heat in the interior. Jueyin Liver governs Blood. Persistent heat unable to vent externally forces blood downward, causing hematochezia.
Patients with cold extremities stating no Chest Binding, with lower abdominal fullness and tenderness on pressure, have Cold Binding at the Bladder Guan Yuan point.
Cold extremities without Chest Binding indicate absence of heat. Lower abdominal fullness and tenderness indicate Cold Binding in the Lower Jiao.
In Cold Damage, four days of fever followed by three days of Jue, then four days of fever again. Less Jue and more fever indicates impending recovery. If heat persists from day four to seven, hematochezia with pus will follow.
Initial fever then Jue indicates Yang pathogen transmitting to interior. Fever indicates exterior pathogen. Jue after four days indicates transmission to Yin channels. Subsequent fever indicates return to Yang channels. Less Jue means weak pathogen; more fever means Yang dominance, indicating recovery. By day seven, transmission completes; heat clearance brings recovery. Persistent heat indicates excess heat forcing Jueyin blood, leading to pus and blood in stool.
In Cold Damage, four days of Jue followed by only three days of fever, then five days of Jue again, indicates disease progression. More cold and less heat signifies Yang decline, hence progression.
Cold Damage with Yin excess starts with Jue. By day four, pathogen transmits to interior; heavy Yin transforms to Yang, causing three days of fever. By day seven, transmission completes, expecting recovery. If unresolved and Jue returns, pathogen enters another cycle; fever should return by day four. Absence of fever and persistent Jue by day five indicates Yin exceeding Yang, signifying progression.
In Cold Damage, six or seven days with faint pulse, cold extremities, and irritability. Moxibustion on Jueyin channel is indicated. If Jue does not reverse, prognosis is fatal.
By six or seven days, healthy Qi should recover, and pathogen should subside. Floating pulse and fever indicate resolution. Faint pulse and Jue indicate Yin excess and Yang deficiency. Irritability indicates Yang deficiency struggling against pathogen. Moxibustion on Jueyin restores Yang. Failure of Jue to reverse indicates absolute Yang exhaustion and death.
In Cold Damage, fever with diarrhea, Jue, and restlessness preventing lying down, prognosis is fatal.
Fever indicates exterior pathogen; diarrhea and Jue indicate Yang deficiency. Restlessness indicates pathogen overcoming Zang Qi. Hence, fatal.
In Cold Damage, fever with severe diarrhea and persistent Jue, prognosis is fatal.
The *Jingui Yaolue* states: Exhaustion of Six Fu organs externally causes cold hands and feet; exhaustion of Five Zang organs internally causes intractable diarrhea. Fever indicates dominant pathogen; severe diarrhea and persistent Jue indicate exhaustion of Fu and Zang Qi. Hence, fatal.
In Cold Damage, six or seven days, initially no diarrhea, but sudden fever, diarrhea, and inextinguishable sweating, prognosis is fatal. This is due to presence of Yin without Yang.
By day seven, struggle between healthy Qi and pathogen occurs. Healthy Qi victory brings life; pathogen victory brings death. Initial absence of diarrhea followed by sudden fever, diarrhea, and inextinguishable sweating indicates pathogen victory and collapse of healthy Yang Qi. Hence, fatal.
In Cold Damage, five or six days, no Chest Binding, soft abdomen, deficient pulse, and recurrence of Jue. Purgation is contraindicated; this indicates Blood Loss. Purgation will cause death.
At five or six days, pathogen should form interior excess. No Chest Binding and soft abdomen indicate no interior heat. Deficient pulse indicates Blood Loss. Recurrence of Jue indicates scant Yang Qi. Purgation causes severe depletion, leading to death. The *Jingui Yufan* states: "Severe purgation of deficiency exhausts True Qi."
Fever with Jue, progressing to diarrhea by day seven, is difficult to treat.
Fever and Jue indicate interior transmission. By day seven, transmission completes; healthy Qi should overcome pathogen via sweating. Recurrence of diarrhea indicates pathogen victory and interior deficiency, making treatment difficult.
In Cold Damage, rapid pulse (Cu Mai) with cold extremities. Moxibustion is indicated.
Rapid pulse indicates discontinuous Yang Qi deficiency; Jue indicates disconnected Yang Qi deficiency. Moxibustion assists Yang Qi.
In Cold Damage, slippery pulse with Jue indicates interior heat. Bai Hu Tang (White Tiger Decoction) is indicated.
Slippery pulse indicates Yang Jue with internal sinking of Qi, signifying interior heat. Bai Hu Tang disperses interior heat.
Cold extremities with thready, nearly imperceptible pulse. Dang Gui Si Ni Tang (Angelica Four-Reversal Decoction) is indicated.
Cold extremities indicate external Yang deficiency failing to warm the extremities. Thready, near-absent pulse indicates internal Yin-Blood deficiency causing poor vessel flow. Dang Gui Si Ni Tang assists Yang generation and Yin nourishment.
Formula: Dang Gui Si Ni Tang
Dang Gui (Angelicae Sinensis Radix, 3 liang, acrid, warm) Gui Zhi (Cinnamomi Ramulus, 3 liang, acrid, hot) Shao Yao (Paeoniae Radix Alba, 3 liang, sour, cold) Xi Xin (Asari Radix, 3 liang, acrid, hot) Da Zao (Jujubae Fructus, 25 pieces, sweet, warm) Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 liang, roasted, sweet, neutral) Tong Cao (Tetrapanacis Medulla, 2 liang, sweet, neutral)
The *Neijing* states: Vessels are the residence of Blood. All Blood belongs to the Heart. To unblock vessels, one must first tonify Heart and nourish Blood. Bitter taste enters Heart; Dang Gui's bitterness assists Heart Blood. Heart suffers from laxity; sour taste astringes. Shao Yao's sourness astringes Heart Qi. Liver suffers from tension; sweet taste relieves. Sweet herbs Da Zao, Gan Cao, and Tong Cao relieve Yin-Blood tension.
Decoct the seven ingredients in eight sheng of water, reduce to three sheng, strain, and take one sheng warm, three times daily.
If the patient has chronic interior cold, Dang Gui Si Ni Tang plus Wu Zhu Yu and Sheng Jiang (Angelica Four-Reversal Decoction plus Evodia and Fresh Ginger) is indicated.
Wu Zhu Yu is acrid and warm, dispersing chronic cold; Sheng Jiang is acrid and warm, promoting Yang Qi circulation.
Profuse sweating with persistent fever, internal spasms, limb pain, diarrhea, Jue, and aversion to cold. Si Ni Tang (Four-Reversal Decoction) is indicated.
Profuse sweating should dissipate fever; persistence indicates Yang collapse. Internal spasms and diarrhea indicate severe interior cold. Limb pain, Jue, and aversion to cold indicate severe exterior cold. Si Ni Tang restores Yang and dispels cold.
Profuse sweating or severe diarrhea with cold extremities. Si Ni Tang (Four-Reversal Decoction) is indicated.
Profuse sweating or severe diarrhea, though differing externally, both deplete fluids and damage Yang Qi. Yang deficiency with Yin excess causes Jue. Si Ni Tang secures Yang and retreats Yin.
Patient with cold extremities and sudden tight pulse. Pathogen binds in the Chest. Epigastric fullness and irritability, hunger but inability to eat. Disease is in the Chest; emesis is required. Gua Di San (Melon Seed Powder) is indicated.
Cold extremities indicate internal sinking of pathogen. Tight pulse indicates excess. Pathogen entering Fu organs presents with deep pulse. Sudden tight pulse indicates excess binding in Chest. Epigastric fullness and irritability occur; Stomach is free of pathogen, causing hunger, but Chest pathology prevents eating. Gua Di San induces emesis to expel Chest pathogen.
In Cold Damage, Jue with epigastric palpitations. Treat water retention first with Fu Ling Gan Cao Tang (Poria and Licorice Decoction), then treat Jue. Otherwise, water infiltrates Stomach, causing diarrhea.
The *Jingui Yaolue* states: Water stagnating below the Heart causes palpitations. Although Jue results from cold excess, epigastric palpitation indicates severe internal fluid retention. Treat water first with Fu Ling Gan Cao Tang, then Jue. Treating Jue first allows water to flood Stomach, causing diarrhea.
In Cold Damage, six or seven days, after severe purgation, Cun (Cun position) pulse is deep and slow, cold extremities, lower pulses absent, throat obstruction, expectoration of pus and blood, and intractable diarrhea. Difficult to treat. Ma Huang Sheng Ma Tang (Ephedra and Cimicifuga Decoction) is indicated.
At six or seven days, pathogen transmits to Jueyin. Severe purgation depletes Lower Jiao Qi, causing Yang sinking. Cun pulse is slow, extremities cold, lower pulses absent. Jueyin meridian pierces Diaphragm, ascends to Lung, follows throat. Transmission to Lung with fluid depletion leads to Fei Wei (Flaccid Lung), causing throat obstruction and expectoration of pus/blood. The *Jingui Yaolue* states: Fei Wei results from harsh purgation severely depleting fluids. Intractable diarrhea indicates severe interior deficiency, hence difficult to treat. Ma Huang Sheng Ma Tang regulates Liver and Lung Qi.
Formula: Ma Huang Sheng Ma Tang
Ma Huang (Ephedrae Herba, 2.5 liang, de-stemmed, sweet, warm) Sheng Ma (Cimicifugae Rhizoma, 1 liang 1 fen, sweet, neutral) Dang Gui (Angelicae Sinensis Radix, 1 liang 1 fen, acrid, warm) Zhi Mu (Anemarrhenae Rhizoma, bitter, cold) Huang Qin (Scutellariae Radix, bitter, cold) Wei Yu (Polygonati Odorati Rhizoma, each 18 zhu, sweet, neutral) Shi Gao (Gypsum Fibrosum, crushed, wrapped in cloth, sweet, cold) Bai Zhu (Atractylodis Macrocephalae Rhizoma, sweet, warm) Gan Jiang (Dried Ginger Rhizome, acrid, hot) Shao Yao (Paeoniae Radix Alba, sour, neutral) Tian Dong (Asparagi Radix, de-heart, sweet, neutral) Gui Zhi (Cinnamomi Ramulus, acrid, hot) Fu Ling (Poria, sweet, neutral) Gan Cao (Glycyrrhizae Radix et Rhizoma, roasted, each 6 zhu, sweet, neutral)
The *Yufan* states: Great heat is countered with cold; severe heat is dispersed with sweating. Sweet properties of Ma Huang and Sheng Ma disperse floating heat. For deficient healthy Qi,