汤主之。（正八十一）表寒里热者。脉必滑而厥。口燥舌干也。所以少阴恶寒而 。时时自烦。不欲浓衣。用大
柴胡下之（正三十）而愈。此皆仲景之余议也。
此一卷论阴阳。治伤寒须识阴阳二证。手足各有三阴三阳。合为十二经。在手背者为阳属表为
腑。在手掌里者为阴属里为脏。足经仿此。伤寒只传足经不传手经。素问热论。亦只说足三阴三阳
受病。巢氏言。一曰太阳属小肠误矣。足之阳者。阴中之少阳。足之阴者。阴中之太阴。足之三阳
从头走足。足之三阴从足走腹。阳务于上。阴务于下。阳行也速。阴行也缓。阳之体轻。阴之体重。
阴家脉重。阳家脉轻。阳候多语。阴证无声。阳病则旦静。阴病则夜宁。阳虚则暮乱。阴虚则夜争。
阴阳消息。证状各异。然而物极则反。寒暑之变。重阳必阴。重阴必阳。阴证似阳。阳证似阴。阴盛
隔阳。似是而非。若同而异。明当消息以法治之。
（十八）问阴证
太阴少阴厥阴。皆属阴证也。太阴者。脾也。少阴者。肾也。厥阴者。肝也。○何谓太阴证。
太阴脾之经。主胸膈 胀。甲乙经云。邪生于阳者。得之风雨寒暑。邪中于阴者。得之饮食居处。
阴阳喜怒。又曰。贼风虚邪者。阳受之。饮食不节。起居不时者。阴受之。阳受之则入腑。阴受之
则入脏。入六腑则身热。不时上为喘呼。入五脏则 满闭塞。下为飧泄。久为肠 。○何谓少阴证。
少阴肾之经。主脉微细心烦。但欲寐。或自利而渴。又问经云。一二日少阴病者何也。谓国中病时。
腠理寒。便入阴经。不经三阳也。伤寒虽是三阴三阳。大抵发于阳则太阳也。发于阴则少阴也。
此
二经为表里。其受病最为多。阳明太阴受病颇稀。至于少阳厥阴肝胆之经。又加少焉。凡病一日至
十二三日。太阳证不罢者。但治太阳。有初得病便见。（去声）少阴证者。直攻少阴。亦不必先自太阳次传
而至。盖寒气入太阳。即发热而恶寒。入少阴经。只恶寒而不发热也。三阴中寒。微则理中汤。（正七十四）
稍厥或中寒下利。即干姜甘草汤。（正五十五）手足指头微寒冷谓之清。（音去声）此未消吃四逆。盖疾轻故也。只可服
理中干姜之类。大段重者。用四逆汤。（正七十五）无脉者用通脉四逆汤也。（正八一）○何谓厥阴证。厥阴肝之经主消
渴。气上冲。心中疼。热饥不欲食。食则吐蛔。下之利不止也。若阴气独盛。阳气暴绝。则为阴
毒。其证四肢逆冷。脐腹筑痛。身如被杖。脉沉疾。或吐或利。当急灸脐下。服以辛热之药。令阳气
复而大汗解矣。古人云。辛甘发散为阳。谓桂枝甘草干姜附子之类。能复其阳气也。微用辛甘。甚
则用辛苦。阴极发躁。阴证似阳。学人当以脉别之。
（十九）问阳证
太阳阳明少阳。皆属阳证也。太阳者。膀胱也。发热恶寒头疼腰痛而脉浮也。阳明者。胃也。不
恶寒反恶热。 汗出。大便秘。潮热而脉长也。少阳者。胆也。口苦咽干胁下满。发热而呕。或往
来寒热而脉弦也。麻黄汤（正二十）、大青龙汤（正三十五）、桂枝汤、治太阳经伤风寒也。大柴胡汤（正三十）、调胃承
气汤（正四十三）、小承气汤（正四十二）、大承气汤（正四一）、治阳明伤寒也。小柴胡汤（正二十九）、治少阳伤寒也。
其他药皆发汗吐下后证也。○若阳气独
盛。阴气暴绝。即为阳毒。必发躁狂走妄言。面赤咽痛。身斑斑如锦纹。或下利赤黄。脉洪实。
或滑促。当以酸苦之药。令阴气复而大汗解矣。古人云。酸苦涌泄为阴。谓苦参大青葶苈苦酒之类。（杂十六）
能复其阴气也。微用苦。甚则兼用酸苦。折热复阴。若热极发厥。阳证似阴。学人当以脉别之。
（二十）问手足逆冷。脐腹筑痛。咽喉疼。呕吐下利。身体如被杖。或冷汗。烦渴。脉细欲绝。
此名阴毒也。阴毒之为病。初得病手足冷。背强咽痛。糜粥不下。毒瓦斯攻心。心腹痛。短气。
四肢厥逆。呕吐下利。体如被杖。宜服阴毒甘草汤（杂七）、白术散（杂八）、附子散（杂九）、正阳散（杂十）、肉桂散
（杂十一）、回阳丹（杂十二）、返阴丹（杂十三）、天雄散、正元散、退阴散（并杂十四）之类。可选用之。○大抵阴毒。
本因肾气虚寒。或因冷物伤脾。
外感风寒。内既伏阴。外又感寒。或先感外寒而内伏阴。内外皆阴。则阳气不守。遂发头疼腰重腹
痛。眼睛疼。身体倦怠。四肢逆冷。额上手背冷汗不止。或多烦渴。精神恍惚。如有所失。三二日
间。或可起行。不甚觉重。诊之则六脉俱沉细而疾。尺部短小。寸口脉或大。（六脉俱浮大。或沉
取之大而不甚疾者。非阴证也。大抵阳毒伤寒。其脉多弦而洪数。阴毒伤寒。其脉沉细而弦疾。不
可不知也）若误服凉药。则渴转甚。躁转急。有此病证者。便须急服辛热之药。一日或二日便安。
○若阴毒渐深。其候沉重。四肢逆冷。腹痛转甚。或咽喉不利。心下胀满结硬。躁渴。虚汗不止。
（阳盛则身热而无汗。阴盛则身冷而有汗。岐伯云。阳胜则身热。腠理闭。喘粗。为之。俯仰。汗
不出而热。阴胜则身寒汗出。身常清。数栗而寒。寒则厥）或时郑声。指甲面色青黑。六脉沉细
而疾。一息七至已来。有此证者。速于气海或关元二穴灸三二百壮。以手足和暖为效。仍兼服正阳
散、肉桂散、回阳丹、返阴丹、天雄散、白术散。内外通逐。令阳气复而大汗解矣。（阴独盛而阳
气暴绝。则为阴毒。若阳独盛而阴气暴绝。则为阳毒。大凡阴阳离绝。非大汗不能复其正气也）
○若阴毒已深。疾势困重。六脉附骨。取之方有。按之即无。一息八至以上。或不可数至。此则药
耳难为攻矣。但于脐中用葱熨法（杂十五）、或灼艾三五百以来。手足不温者。不可治也。如得手足温。更服
前热药以助之。若阴气散。阳气来。即渐减热药而调治之。（阳气乍复。往往却烦躁。慎不可投凉
药。烦躁甚者。再与返阴丹即定。常须识此。勿令误也）
（二十一）问发躁狂走。妄言面赤。咽痛。身斑。斑若锦文。或下利赤黄。而脉洪实。
此名阳毒也。伤寒病。若阳气独盛。阴气暴绝。必发躁狂走。妄言面赤。咽痛身斑。斑若锦文。
或下利赤黄。脉洪实。或滑促。宜用酸苦之药。令阴气复而大汗解矣。葶苈苦酒汤（杂十六）、阳毒升麻汤（杂十七）、
大黄散（杂十八）、栀子仁汤（杂十九）、黑奴丸（杂二十）、可选而用之。○近人治伤寒脉洪大。内外结热。舌卷焦黑。
鼻中如烟
煤。则宜以水渍布薄之。叠布数重。新水渍之。稍捩去水。搭于胸上。须臾蒸热。又渍令冷如前薄
之。仍数换新水。日数十易。热甚者。置病患于水中。热势才退则已。亦良法也。
（二十二）问病患潮热独语。如见鬼状。发则不识人。寻衣撮空。直视微喘。
仲景云。伤寒若吐若下后不解。不大便。五六日。上至十余日。日晡所发潮热。不恶寒独语。
如见鬼状。若剧者发则不识人。循衣摸床。惕而不安。微喘直视。但发热谵语者。大承气汤主之（正四一）。
若一服利则止后服。脉弦者生。涩者死。（弦者阳也。涩者阴也。阳证见阴脉者死。病患有阳证而
脉涩者。慎不可下）
（二十三）问胸膈不快。 满闭塞。唇青手足冷。脉沉细。少情绪。或腹痛。
此名太阴也。近人多不识阴证。才见胸膈不快。便投食药。非其治也。大抵阴证者。由冷物伤
脾胃。阴经受之也。主胸膈 满。面色及唇皆无色泽。手足冷。脉沉细。少情绪。亦不因嗜欲。但
内伤冷物。或损动胃气。遂成阴证。复投巴豆之类。胸膈愈不快。或吐而利。经一二日遂致不救。
盖不知寒中太阴也。太阴者。脾之经也。○又问万一饮食不节、胸膈不快、寒中阴经、何法以治之。
答云。急作理中汤、加青橘陈橘锉如麻豆大。
服一二剂。胸膈即快。枳实理中丸（杂八一）、五积散、（杂二十一）尤良。
（二十四）问脉微细。欲吐不吐。心烦。但欲寐。五六日自利而渴。
此名少阴也。少阴之为病。欲吐不吐。心烦但欲寐。五六日自利而渴者虚。故引水自救。若小
便色白者。少阴病形悉具。小便白者。以下焦虚有寒。不能制水。故令色白也。四逆汤主之（正七五）。○少
阴病。若口燥舌干而渴者。须急下之。不可缓也。大承气汤主之。（正四一）若脉沉而迟者。须温之。四逆汤主
之。盖以口燥而渴者。知其热。脉沉而迟者。别其寒也。少阴属肾。古人谓之肾伤寒也。肾伤寒。
口燥舌干而渴。固当急下。大抵肾伤寒。亦多表里无热。但苦烦愦。默默而极。不欲见光明。有时腹
痛。其脉沉细。旧用四顺汤。古人恨其热不堪用云。肾病而体犹有热者。可服仲景四逆散（正七六）。若已十余
日。下利不止。手足彻冷。乃无热候。可增损四顺汤。（杂百十九）○少阴病若恶寒而 。时时自烦。不欲浓衣
者。用去大黄大柴胡汤（正三十）。○少阴病始得之。反发热。脉沉者。麻黄细辛附子汤（正二十三）微汗之。○少阴病
得
之二三日。常见少阴无阳证者。亦须微发汗。宜麻黄附子甘草汤（正二十二）。此学人不可不知也。
（二十五）问身微热烦躁。面赤脉沉而微。
此名阴证似阳也。阴发躁热发厥。物极则反也。大率以脉为主。诸数为热。诸迟为寒。无如此最
验也。假令身体微热。烦躁面赤。其脉沉而微者。皆阴证也。身微热者。里寒故也。烦躁者。阴盛故
也。面戴阳者。下虚故也。若医者不看脉。以虚阳上膈躁。误以为实热。反与凉药。则气消成大病
矣。外台秘要云。阴盛发躁。名曰阴躁。欲坐井中。宜以热药治之。仲景少阴证面赤者。四逆加葱白
主之。
（二十六）问手足逆冷。而大便秘。小便赤。或大便黑色。脉沉而滑。
此名阳证似阴也。重阳必阴。重阴必阳。寒暑之变也。假令手足逆冷而大便秘。小便赤。或大
便黑色。其脉沉而滑者。皆阳证也。轻者白虎汤（正六四）。甚者承气汤（正四二）。伤寒失下。血气不通。令四肢逆冷。
此是伏热深。故厥亦深。速用大承气（正四一）加分剂下之。汗出立瘥。（仲景所谓厥应下之者此也）○兼热
厥与阴厥自不同。热厥者。微厥即发热。若阴厥即不发热。四肢逆冷。恶寒脉沉而细。大小便滑泄
矣。
（二十七）问身冷脉细沉疾。烦躁而不饮水。
此名阴盛隔阳也。伤寒阴盛隔阳者。病患身冷。脉细沉疾。烦躁而不饮水者是也。若欲引饮者
非也。不欲饮水者。宜服霹雳散（杂二十二）。须臾躁止。得睡汗出即瘥。此药通散寒气。然后热气上行。汗出
乃愈。火焰散（杂二十二）、丹砂丸（杂二十四）、并主之。
（二十八）问手足逆冷
此名厥也。厥者。逆也。阴阳不相顺接。手足逆冷也。阳气衰。阴气盛。阴胜于阳。故阳脉为之
逆。不通于手足。所以逆冷也。伤寒热多厥少者。其病当愈。厥多热少者。其病为进。○然有冷厥。
有热厥。当仔细辩认。○冷厥者。初得病日。便四肢逆冷。脉沉微而不数。足多挛卧而恶寒。或自引
衣覆盖。不饮水。或下利清谷。或清便自调。（清便自调。即是大便如常）或小便数。外证多惺
惺而静。脉虽沉实。按之迟而弱者。知其冷厥也。四逆汤（正七五）理中汤（正七四）。通脉四逆汤。（正八一）当归
四逆汤。（正七八）当归
四逆加茱萸生姜汤（正八十）。白通加猪胆汤（正九八）。皆可选用也。○热厥者。国中病。必身热头痛外。别有阳证。
至
二三日乃至四五日。方发厥兼热厥者。厥至半日却身热。盖热气深。则方能发厥。须在二三日后也。
若微厥即发热者。热微故也。其脉虽沉伏。按之而滑。为里有热。其人或畏热。或饮水。或扬手掷足。
烦躁不得眠。大便秘。小便赤。外证多昏愦者。知其热厥也。白虎汤（正六四）。承气汤（正四二）。随证用之。仲景
云。伤寒一二日至四五日厥者。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。（热厥当下。故云厥应下之者。若反发汗。必口伤烂赤也）又有下证悉
具而见四逆者。是失下后。血气不通。四肢便厥。医人不识。却疑是阴厥。复进热药祸如反掌。大
抵热厥须脉沉伏而滑。头上有汗。其手虽冷。时复指爪温。须便用承气汤下之。不可拘忌也。（诸手
足逆冷。皆属厥阴。不可下。不可汗。然有须下、有须汗证者。谓手足虽逆冷。时有温时。手足掌
心必暖。非正厥逆也。当消息之）○若病患寒热而厥。面色不泽。冒昧而两手忽无脉。或一手无
脉者。必是有正汗也。多用绵衣包手足令温暖。急服五味子汤（杂二十五）。或兼与麻黄细辛甘草汤之类。服之
时。必大汗而解矣。○或伤寒厥逆而心下怔忪者。宜先治水。当服茯苓甘草汤（正五三）。却治厥。不尔。水
渍入胃必下利也。○又有病患手足厥冷。脉乍结者。邪气结在胸也。心下满而烦。饥不能食者。病在
（接上文）用汤剂主治。（正八十一）表寒里热者，脉象必然滑利且四肢厥冷，口燥舌干。所以少阴病出现恶寒而身热，时时自烦，不想穿厚衣服，用大柴胡汤攻下（正三十）而痊愈。这都是张仲景的补充论述。
这一卷论述阴阳。治疗伤寒必须识别阴阳两种证候。手和脚各有三条阴经和三条阳经，合起来为十二经脉。在手背侧的为阳，属表，属腑；在手掌内侧的为阴，属里，属脏。足部经脉仿照此理。伤寒只传变足经，不传变手经。《素问·热论》也只说足三阴三阳受病。巢元方说“太阳属小肠”是错误的。足部的阳经，是阴中的少阳；足部的阴经，是阴中的太阴。足的三条阳经从头走向足，足的三条阴经从足走向腹部。阳气务求向上，阴气务求向下。阳行速度迅速，阴行速度缓慢。阳的体质轻清，阴的体质重浊。阴家脉象重，阳家脉象轻。阳证患者多言语，阴证患者无声响。阳病则早晨安静，阴病则夜晚安宁。阳虚则傍晚混乱，阴虚则夜间争斗。阴阳消长，症状各异。然而物极必反，寒暑变化，重阳必转化为阴，重阴必转化为阳。阴证似阳，阳证似阴，阴盛格拒阳气，似是而非，若同而异。应当仔细审察以法治之。
（十八）问阴证
太阴、少阴、厥阴，都属于阴证。太阴，指脾经；少阴，指肾经；厥阴，指肝经。○什么是太阴证？
太阴是脾经，主管胸膈胀满。《甲乙经》说：邪气生于阳，得之于风雨寒暑；邪气中于阴，得之于饮食居处、阴阳喜怒。又说：贼风虚邪，阳先受之；饮食不节，起居不时，阴先受之。阳受邪则入腑，阴受邪则入脏。入六腑则身体发热，不时上逆导致喘呼；入五脏则腹满闭塞，下泄为完谷不化的腹泻，久则成为肠澼。○什么是少阴证？
少阴是肾经，主管脉微细、心烦、只想睡觉。或者自利而口渴。又问经文说：发病一两天就出现少阴病是怎么回事？说是国家流行疾病时，腠理寒冷，病邪便直接侵入阴经，不经过三阳经。伤寒虽然涉及三阴三阳，大体发于阳则是太阳病，发于阴则是少阴病。这两经互为表里，受病最多。阳明、太阴受病较少。至于少阳、厥阴肝胆之经，受病更少。凡病一日至十二三日，太阳证未罢的，只治太阳。有初得病就见到（去声）少阴证的，直接攻治少阴，也不必先从太阳次传而至。因为寒气入太阳，即发热而恶寒；入少阴经，只恶寒而不发热。三阴中寒，轻微的用理中汤（正七十四）。稍见厥冷或中寒下利的，就用干姜甘草汤（正五十五）。手足指头微冷称为“清”（音去声）。这还未到需要吃四逆汤的程度，因为病情轻。只可服用理中、干姜之类。大段严重的，用四逆汤（正七十五）。无脉的用通脉四逆汤（正八一）。○什么是厥阴证？
厥阴是肝经，主管消渴，气上冲心，心中疼痛，感觉饥饿但不想吃东西，吃东西则吐蛔虫，误用攻下法则腹泻不止。如果阴气独盛，阳气暴绝，则为阴毒。其证候四肢逆冷，脐腹剧烈疼痛，身体像被棍棒打过一样痛，脉沉疾，或者呕吐或者下利，应当紧急灸脐下，服用辛热的药物，使阳气恢复而大汗解。古人说：辛甘发散为阳，指桂枝、甘草、干姜、附子之类，能恢复其阳气。轻微的用辛甘，严重的用辛苦。阴极发躁，阴证似阳，学者应当通过脉象来辨别。
（十九）问阳证
太阳、阳明、少阳，都属于阳证。太阳，指膀胱经，发热恶寒，头痛腰痛，脉浮。阳明，指胃经，不恶寒反恶热，汗出，大便秘结，潮热，脉长。少阳，指胆经，口苦咽干，胁下满闷，发热而呕，或者往来寒热，脉弦。麻黄汤（正二十）、大青龙汤（正三十五）、桂枝汤，治疗太阳经受风寒。大柴胡汤（正三十）、调胃承气汤（正四十三）、小承气汤（正四十二）、大承气汤（正四一），治疗阳明伤寒。小柴胡汤（正二十九），治疗少阳伤寒。其他药物都是发汗、催吐、攻下后的证候。○如果阳气独盛，阴气暴绝，即为阳毒。必定发躁狂走，妄言，面赤，咽喉痛，身上斑纹如锦缎花纹，或者下利赤黄色，脉洪实，或者滑促。应当用酸苦的药物，使阴气恢复而大汗解。古人说：酸苦涌泄为阴，指苦参、大青、葶苈、苦酒之类（杂十六），能恢复其阴气。轻微的用苦，严重的兼用酸苦，折热复阴。如果热极发厥，阳证似阴，学者应当通过脉象来辨别。
（二十）问手足逆冷，脐腹筑痛，咽喉疼，呕吐下利，身体像被棍棒打过，或者冷汗，烦渴，脉细欲绝。
这叫阴毒。阴毒这个病，初得病时手足冷，背强，咽喉痛，连糜粥都难以下咽，毒瓦斯攻心，心腹痛，短气，四肢厥逆，呕吐下利，身体像被棍棒打过。宜服用阴毒甘草汤（杂七）、白术散（杂八）、附子散（杂九）、正阳散（杂十）、肉桂散（杂十一）、回阳丹（杂十二）、返阴丹（杂十三）、天雄散、正元散、退阴散（并杂十四）之类。可选用。○大体阴毒，本因肾气虚寒，或因冷物伤脾，外感风寒，内既伏阴，外又感寒，或者先感外寒而内伏阴，内外皆阴，则阳气不守，于是发头疼腰重，腹痛，眼睛疼，身体倦怠，四肢逆冷，额上手背冷汗不止，或多烦渴，精神恍惚，如有所失。两三天间，或许可以起行，不觉得太重。诊察则六脉俱沉细而疾，尺部短小，寸口脉或大。（六脉俱浮大，或者沉取之大而不甚疾的，不是阴证。大体阳毒伤寒，其脉多弦而洪数；阴毒伤寒，其脉沉细而弦疾，不可不知道。）如果误服凉药，则渴更甚，躁更急。有此病证的，便须急服辛热的药物，一天或两天便安。○如果阴毒渐深，其候沉重，四肢逆冷，腹痛转甚，或者咽喉不利，心下胀满结硬，躁渴，虚汗不止。（阳盛则身热而无汗，阴盛则身冷而有汗。岐伯说：阳胜则身热，腠理闭，喘粗，为之俯仰，汗不出而热；阴胜则身寒汗出，身常清，数栗而寒，寒则厥。）或者时而郑声，指甲面色青黑，六脉沉细而疾，一息七至以上。有此证的，速于气海或关元二穴灸三二百壮，以手足和暖为效。仍兼服正阳散、肉桂散、回阳丹、返阴丹、天雄散、白术散，内外通逐，令阳气复而大汗解。（阴独盛而阳气暴绝，则为阴毒；若阳独盛而阴气暴绝，则为阳毒。大凡阴阳离绝，非大汗不能复其正气也。）○如果阴毒已深，疾势困重，六脉附骨，取之方有，按之即无，一息八至以上，或者不可数至，这则药石难为攻治了。只在脐中用葱熨法（杂十五），或者灼艾三五百壮以来。手足不温的，不可治。如得手足温，更服前热药以助之。如果阴气散，阳气来，即渐减热药而调治之。（阳气乍复，往往却烦躁，慎不可投凉药。烦躁甚重的，再与返阴丹即定。常须识此，勿令误也。）
（二十一）问发躁狂走，妄言面赤，咽痛，身斑，斑若锦文，或者下利赤黄，而脉洪实。
这叫阳毒。伤寒病，如果阳气独盛，阴气暴绝，必定发躁狂走，妄言面赤，咽痛身斑，斑若锦文，或者下利赤黄，脉洪实，或者滑促。宜用酸苦的药物，使阴气恢复而大汗解。葶苈苦酒汤（杂十六）、阳毒升麻汤（杂十七）、大黄散（杂十八）、栀子仁汤（杂十九）、黑奴丸（杂二十），可选而用之。○近人治疗伤寒脉洪大，内外结热，舌卷焦黑，鼻中如烟煤，则宜以水浸湿布薄贴之。叠布数重，新水浸之，稍拧去水，搭于胸上。须臾蒸热，又浸令冷如前薄之。仍数换新水，日数十易。热甚重的，置病患于水中，热势才退则已。也是良法。
（二十二）问病患潮热独语，如见鬼状，发作则不识人，寻衣撮空，直视微喘。
张仲景说：伤寒如果吐如果下后不解，不大便，五六日，上至十余日，日晡所发潮热，不恶寒独语，如见鬼状。如果严重的话，发作则不识人，循衣摸床，惕而不安，微喘直视。但发热谵语的，大承气汤主之（正四一）。如果一服利则止后服。脉弦者生，涩者死。（弦者阳也，涩者阴也。阳证见阴脉者死。患有阳证而脉涩的，慎不可下。）
（二十三）问胸膈不快，腹满闭塞，唇青手足冷，脉沉细，少情绪，或者腹痛。
这叫太阴。近人多不识阴证，才见胸膈不快，便投食药，这不是正确的治法。大体阴证，由冷物伤脾胃，阴经受之也。主胸膈腹满，面色及唇皆无色泽，手足冷，脉沉细，少情绪，也不因嗜欲，只是内伤冷物，或者损动胃气，遂成阴证。再投巴豆之类，胸膈愈不快，或者吐而利，经一二日遂致不救。盖不知寒中太阴也。太阴，是脾经。○又问万一饮食不节、胸膈不快、寒中阴经，何法以治之？答云：急作理中汤，加青橘陈橘锉如麻豆大，服一二剂，胸膈即快。枳实理中丸（杂八一）、五积散（杂二十一），尤良。
（二十四）问脉微细，欲吐不吐，心烦，但欲寐，五六日自利而渴。
这叫少阴。少阴之为病，欲吐不吐，心烦但欲寐，五六日自利而渴者虚，故引水自救。如果小便色白的，少阴病形悉具。小便白者，以下焦虚有寒，不能制水，故令色白也。四逆汤主之（正七五）。○少阴病，如果口燥舌干而渴的，须急下之，不可缓也。大承气汤主之（正四一）。如果脉沉而迟的，须温之，四逆汤主之。盖以口燥而渴者，知其热；脉沉而迟者，别其寒也。少阴属肾，古人谓之肾伤寒也。肾伤寒，口燥舌干而渴，固当急下。大体肾伤寒，亦多表里无热，但苦烦愦，默默而极，不欲见光明，有时腹痛，其脉沉细。旧用四顺汤，古人恨其热不堪用云。肾病而体犹有热的，可服仲景四逆散（正七六）。如果已十余日，下利不止，手足彻冷，乃无热候，可增损四顺汤（杂百十九）。○少阴病如果恶寒而身热，时时自烦，不欲浓衣的，用去大黄大柴胡汤（正三十）。○少阴病始得之，反发热，脉沉的，麻黄细辛附子汤（正二十三）微汗之。○少阴病得之二三日，常见少阴无阳证的，亦须微发汗，宜麻黄附子甘草汤（正二十二）。这是学者不可不知道的。
（二十五）问身微热烦躁，面赤脉沉而微。
这叫阴证似阳。阴发躁热发厥，物极则反也。大体以脉为主，诸数为热，诸迟为寒，没有比这最验的。假令身体微热，烦躁面赤，其脉沉而微的，都是阴证。身微热者，里寒故也。烦躁者，阴盛故也。面戴阳者，下虚故也。如果医生不看脉，以虚阳上膈躁，误以为实热，反与凉药，则气消成大病矣。《外台秘要》说：阴盛发躁，名曰阴躁，欲坐井中，宜以热药治之。仲景少阴证面赤的，四逆加葱白主之。
（二十六）问手足逆冷，而大便秘，小便赤，或者大便黑色，脉沉而滑。
这叫阳证似阴。重阳必阴，重阴必阳，寒暑之变也。假令手足逆冷而大便秘，小便赤，或者大便黑色，其脉沉而滑的，都是阳证。轻者白虎汤（正六四）。甚者承气汤（正四二）。伤寒失下，血气不通，令四肢逆冷，这是伏热深，故厥亦深，速用大承气（正四一）加分剂下之，汗出立瘥。（张仲景所谓“厥应下之”者此也。）○兼热厥与阴厥自不同。热厥者，微厥即发热；若阴厥即不发热，四肢逆冷，恶寒脉沉而细，大小便滑泄矣。
（二十七）问身冷脉细沉疾，烦躁而不饮水。
这叫阴盛隔阳。伤寒阴盛隔阳者，病患身冷，脉细沉疾，烦躁而不饮水者是也。如果想引饮的，非也。不欲饮水的，宜服霹雳散（杂二十二）。须臾躁止，得睡汗出即瘥。此药通散寒气，然后热气上行，汗出乃愈。火焰散（杂二十二）、丹砂丸（杂二十四），并主之。
（二十八）问手足逆冷
这叫厥。厥者，逆也。阴阳不相顺接，手足逆冷也。阳气衰，阴气盛，阴胜于阳，故阳脉为之逆，不通于手足，所以逆冷也。伤寒热多厥少的，其病当愈；厥多热少的，其病为进。○然有冷厥，有热厥，当仔细辨认。○冷厥者，初得病日，便四肢逆冷，脉沉微而不数，足多挛卧而恶寒，或者自引衣覆盖，不饮水，或者下利清谷，或者清便自调（清便自调，即是大便如常），或者小便数，外证多惺惺而静，脉虽沉实，按之迟而弱的，知其冷厥也。四逆汤（正七五）、理中汤（正七四）、通脉四逆汤（正八一）、当归四逆汤（正七八）、当归四逆加茱萸生姜汤（正八十）、白通加猪胆汤（正九八），皆可选用也。○热厥者，国家流行疾病时，必身热头痛外，别有阳证，至二三日乃至四五日，方发厥兼热厥者，厥至半日却身热，盖热气深，则方能发厥，须在二三日后也。如果微厥即发热的，热微故也。其脉虽沉伏，按之而滑，为里有热，其人或者畏热，或者饮水，或者扬手掷足，烦躁不得眠，大便秘，小便赤，外证多昏愦的，知其热厥也。白虎汤（正六四）、承气汤（正四二），随证用之。张仲景说：伤寒一二日至四五日厥的，必发热，前热者后必厥，厥深者热亦深，厥微者热亦微，厥应下之而反发汗的，必口伤烂赤。（热厥当下，故云“厥应下之”者，若反发汗，必口伤烂赤也。）又有下证悉具而见四逆的，是失下后，血气不通，四肢便厥，医人不识，却疑是阴厥，复进热药祸如反掌。大体热厥须脉沉伏而滑，头上有汗，其手虽冷，时复指爪温，须便用承气汤下之，不可拘忌也。（诸手足逆冷，皆属厥阴，不可下，不可汗，然有须下、有须汗证的，谓手足虽逆冷，时有温时，手足掌心必暖，非正厥逆也，当消息之。）○如果病患寒热而厥，面色不泽，冒昧而两手忽无脉，或者一手无脉的，必是有正汗也。多用绵衣包手足令温暖，急服五味子汤（杂二十五），或者兼与麻黄细辛甘草汤之类，服之时，必大汗而解矣。○或者伤寒厥逆而心下怔忪的，宜先治水，当服茯苓甘草汤（正五三），却治厥，不尔，水渍入胃必下利也。○又有病患手足厥冷，脉乍结的，邪气结在胸也，心下满而烦，饥不能食者，病在
(Principal Formula) Governs it. (Zheng 81) In cases of exterior cold and interior heat, the pulse must be slippery with cold limbs, dry mouth and tongue. Thus, Shaoyin disease involves aversion to cold accompanied by [body heat], frequent restlessness, and a dislike for heavy clothing. Use Dachaihu Tang (Cinnamon Twig and Rhubarb Decoction) (Zheng 30) to purge, resulting in recovery. These are all supplementary discussions from Zhang Zhongjing.
This volume discusses Yin and Yang. Treating Shanghan (Cold Damage) requires recognizing both Yin and Yang syndromes. The hands and feet each have three Yin and three Yang meridians, totaling twelve meridians. Those on the back of the hand are Yang, belonging to the Exterior and Fu organs; those on the palm are Yin, belonging to the Interior and Zang organs. The foot meridians follow this pattern. Shanghan transmits only through the foot meridians, not the hand meridians. Suwen Re Lun also states that only the foot three Yin and three Yang meridians are affected. Chao Shi claims Taiyang belongs to the Small Intestine, which is incorrect. The Yang of the feet is Shao Yang within Yin; the Yin of the feet is Tai Yin within Yin. The three Yang meridians of the feet run from head to foot; the three Yin meridians of the feet run from foot to abdomen. Yang strives upward; Yin strives downward. Yang moves quickly; Yin moves slowly. Yang's nature is light; Yin's nature is heavy. Yin family pulses are heavy; Yang family pulses are light. Yang syndromes involve much speech; Yin syndromes are silent. Yang illness is quiet in the morning; Yin illness is peaceful at night. Yang deficiency leads to confusion in the evening; Yin deficiency leads to contention at night. Yin and Yang wax and wane, presenting different symptoms. However, when things reach an extreme, they reverse: changes in cold and heat mean excessive Yang transforms into Yin, and excessive Yin transforms into Yang. Yin syndromes resemble Yang; Yang syndromes resemble Yin. Excessive Yin blocks Yang, appearing similar yet distinct. One must clearly observe these changes and treat accordingly.
(Question 18) On Yin Syndromes
Taiyin, Shaoyin, and Jueyin all belong to Yin syndromes. Taiyin refers to the Spleen meridian; Shaoyin refers to the Kidney meridian; Jueyin refers to the Liver meridian. ○ What is a Taiyin syndrome?
Taiyin is the Spleen meridian, primarily governing chest and diaphragm distension. Jiayi Jing states: Pathogens arising from Yang are contracted from wind, rain, cold, and heat; pathogens striking Yin are contracted from diet, dwelling, and emotional fluctuations. It further says: Rogue winds and empty evils affect Yang first; irregular diet and improper living habits affect Yin first. Affecting Yang enters the Fu organs; affecting Yin enters the Zang organs. Entering the six Fu organs causes body heat and occasional upward rebellion manifesting as wheezing; entering the five Zang organs causes fullness and obstruction, leading downward to undigested diarrhea, and over time to intestinal dysentery. ○ What is a Shaoyin syndrome?
Shaoyin is the Kidney meridian, primarily governing a faint and fine pulse, vexation, and a desire to sleep. Or spontaneous diarrhea with thirst. Another question asks: Why does Shaoyin disease appear on days one or two? It is said that during epidemics, if the interstices are cold, pathogens enter the Yin meridians directly without passing through the Three Yang meridians. Although Shanghan involves Three Yin and Three Yang, generally originating in Yang manifests as Taiyang disease, and originating in Yin manifests as Shaoyin disease. These two meridians are interior-exterior pairs and are most frequently affected. Yangming and Taiyin are less frequently affected. Shaoyang and Jueyin (Liver and Gallbladder meridians) are even rarer. For any illness lasting one to twelve or thirteen days, if Taiyang symptoms persist, treat only Taiyang. If Shaoyin symptoms appear immediately upon onset, attack Shaoyin directly; there is no need to wait for transmission from Taiyang. Cold pathogen entering Taiyang causes fever and aversion to cold; entering Shaoyin causes only aversion to cold without fever. For Cold damaging the Three Yin meridians, if mild, use Lizhong Tang (Regulate the Middle Decoction) (Zheng 74). If slightly cold or with cold-induced diarrhea, use Ganjiang Gancao Tang (Dried Ginger and Licorice Decoction) (Zheng 55). Mild coldness in the fingertips is called "Qing" (pure/cold). This has not yet reached the severity for Sini Tang (Reverse the Extremities Decoction) because the disease is light; only Lizhong or Dried Ginger types should be taken. For severe cases, use Sini Tang (Zheng 75). For absent pulse, use Tongmai Sini Tang (Unblock the Vessels Sini Decoction) (Zheng 81). ○ What is a Jueyin syndrome?
Jueyin is the Liver meridian, primarily governing excessive thirst, Qi rushing upward, heart pain, hunger without desire to eat, vomiting roundworms after eating, and uncontrollable diarrhea if purged. If Yin qi alone is excessive and Yang qi suddenly perishes, it becomes Yin Du (Yin Toxin). Symptoms include cold limbs, pounding abdominal pain, body feeling like being beaten by a club, deep and rapid pulse, vomiting or diarrhea. Moxibustion below the umbilicus should be performed urgently, followed by acrid-hot medicines to restore Yang qi, resolving through profuse sweating. Ancients said: Acrid and sweet disperse and ascend as Yang, referring to Guizhi Tang (Cinnamon Twig Decoction), Gancao, Ganjiang, Fuzi, etc., which can restore Yang qi. Mildly use acrid-sweet; severely use acrid-bitter. Extreme Yin causes restlessness; Yin syndromes resemble Yang. Students must distinguish them by pulse.
(Question 19) On Yang Syndromes
Taiyang, Yangming, and Shaoyang all belong to Yang syndromes. Taiyang refers to the Bladder meridian: fever, aversion to cold, headache, lower back pain, and floating pulse. Yangming refers to the Stomach meridian: no aversion to cold but aversion to heat, sweating, constipation, tidal fever, and long pulse. Shaoyang refers to the Gallbladder meridian: bitter taste, dry throat, hypochondriac fullness, fever with vomiting, or alternating chills and fever with wiry pulse. Mahuang Tang (Ephedra Decoction) (Zheng 20), Da Qinglong Tang (Major Green Dragon Decoction) (Zheng 35), Guizhi Tang (Cinnamon Twig Decoction) treat Taiyang meridian Wind-Cold damage. Dachaihu Tang (Zheng 30), Xiaochengqi Tang (Minor Order the Qi Decoction) (Zheng 42), Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) (Zheng 43), Dachengqi Tang (Major Order the Qi Decoction) (Zheng 41) treat Yangming Shanghan. Xiao Chaihu Tang (Minor Bupleurum Decoction) (Zheng 29) treats Shaoyang Shanghan. Other medicines address post-emesis, purgation, or sweating conditions. ○ If Yang qi alone is excessive and Yin qi suddenly perishes, it becomes Yang Du (Yang Toxin). There will be restlessness, manic running, delirious speech, red face, sore throat, mottled skin rash like brocade, or bloody-yellow diarrhea, with surging-solid or slippery-rapid pulse. Sour-bitter medicines should be used to restore Yin qi, resolving through profuse sweating. Ancients said: Sour and bitter induce vomiting and purging as Yin, referring to Kushen (Sophora Root), Daqing Ye (Isatis Leaf), Tingli Zi (Semen Lepidii), Kujiu (Vinegar), etc. (Za 16), which can restore Yin qi. Mildly use bitter; severely combine sour and bitter to reduce heat and restore Yin. If extreme heat causes Jue (reversal cold), Yang syndromes resemble Yin. Students must distinguish them by pulse.
(Question 20) On cold limbs, pounding abdominal pain, sore throat, vomiting and diarrhea, body feeling like being beaten, cold sweat, vexation/thirst, and fine-almost-absent pulse.
This is named Yin Du (Yin Toxin). In Yin Du disease, initially the hands and feet are cold, the back is stiff, the throat hurts, porridge cannot be swallowed, toxin attacks the heart causing heart/abdominal pain, shortness of breath, limb reversal cold, vomiting/diarrhea, body feeling like beaten. Suitable to take Yindu Gancao Tang (Yin Toxin Licorice Decoction) (Za 7), Baizhu San (Atractylodes Powder) (Za 8), Fuzi San (Aconite Powder) (Za 9), Zhengyang San (Upright Yang Powder) (Za 10), Rougui San (Cinnamon Bark Powder) (Za 11), Huiyang Dan (Return Yang Pill) (Za 12), Fanyin Dan (Reverse Yin Pill) (Za 13), Tianxiong San, Zhengyuan San, Tuiyin San (all Za 14), etc. Selectively use. ○ Generally, Yin Du originates from Kidney Qi deficiency and cold, or spleen injury from cold foods, combined with external Wind-Cold. Internally latent Yin, externally contracted Cold, or external Cold first then internal latent Yin, making both interior and exterior Yin, causing Yang Qi to fail to hold. This leads to headache, heavy waist/abdomen, eye pain, body fatigue, cold limbs, continuous cold sweat on forehead/back of hands, or vexation/thirst, mental trance, feeling lost. Within two to three days, one might walk, feeling not too heavy. Diagnosis shows all six pulses deep, fine, and rapid; Chi position is short/small; Cun position pulse may be large. (If all six pulses are floating-large, or deep-palpated large but not very rapid, it is not a Yin syndrome. Generally, Yang Du Shanghan pulses are wiry and surging-numerous; Yin Du Shanghan pulses are deep-fine and wiry-rapid; this must be known.) If cool medicines are mistakenly taken, thirst increases, restlessness intensifies. With these symptoms, urgent administration of acrid-hot medicine is required; peace returns in one or two days. ○ If Yin Du deepens, symptoms become heavy: cold limbs, worsening abdominal pain, throat obstruction, epigastric fullness/hardness, vexation/thirst, continuous false sweat. (Excess Yang causes body heat without sweat; Excess Yin causes body cold with sweat. Qibo said: Yang excess causes body heat, closed pores, rough breathing, difficulty lying flat, no sweat but heat; Yin excess causes body cold, sweating, constant chilliness, frequent shivering/chills, cold leading to reversal cold) Or muttering delirium, blue-black nails/face, six pulses deep-fine-rapid, seven beats per respiration or more. With these signs, urgently moxa Qihai or Guanyuan points 300-200 units until hands/feet warm. Continue taking Zhengyang San, Rougui San, Huiyang Dan, Fanyin Dan, Tianxiong San, Baizhu San. Internal and external expulsion restores Yang qi, resolving through profuse sweating. (When Yin alone is excessive and Yang qi suddenly perishes, it is Yin Du; if Yang alone is excessive and Yin qi suddenly perishes, it is Yang Du. Generally, separation of Yin and Yang cannot be restored without profuse sweating.) ○ If Yin Du is already deep, disease is critical, six pulses require deep pressure to feel, disappearing on light touch, eight beats per respiration or more, or uncountable. Medicine is difficult to apply here. But use Congyi method (Scallion Ironing) (Za 15) on the umbilicus, or moxa 300-500 units. If hands/feet remain cold, it is incurable. If hands/feet warm, continue previous hot medicines. If Yin disperses and Yang returns, gradually reduce hot medicines and regulate. (When Yang temporarily returns, restlessness often occurs; strictly avoid cool medicines. For severe restlessness, give Fanyin Dan again to settle. Always remember this to avoid error.)
(Question 21) On restlessness, manic running, delirious speech, red face, sore throat, body rash like brocade patterns, or bloody-yellow diarrhea, with surging-solid pulse.
This is named Yang Du (Yang Toxin). In Shanghan, if Yang qi alone is excessive and Yin qi suddenly perishes, there will be restlessness, manic running, delirious speech, red face, sore throat, body rash like brocade, or bloody-yellow diarrhea, surging-solid or slippery-rapid pulse. Use sour-bitter medicines to restore Yin qi, resolving through profuse sweating. Tingli Kujiu Tang (Lepidium Vinegar Decoction) (Za 16), Yangdu Shengma Tang (Yang Toxin Cimicifuga Decoction) (Za 17), Dahuang San (Rhubarb Powder) (Za 18), Zhizi Ren Tang (Gardenia Seed Decoction) (Za 19), Heinu Wan (Black Slave Pill) (Za 20) are selectable. ○ Recently, treating Shanghan with surging-large pulse, internal/external knotted heat, curled/scorched black tongue, nose smelling like soot: soak cloth in water, layer several times, soak in fresh water, wring slightly, place on chest. When heated, soak again in cold water as before. Change fresh water many times daily, dozens of changes. For severe heat, place patient in water until heat subsides. Also a good method.
(Question 22) On patient with tidal fever, talking alone, seeing ghosts, unrecognized during episodes, picking at clothes/air, staring straight, slight panting.
Zhongjing said: After Shanghan emesis or purgation, unresolved, no bowel movement for five-six days up to ten-plus days, tidal fever at dusk, no aversion to cold, talking alone, seeing ghosts. If severe, unrecognized during episodes, picking at clothes/bed, fearful/restless, slight panting, staring straight. Only fever and delirium: Dachengqi Tang (Major Order the Qi Decoction) (Zheng 41) governs. If one dose yields relief, stop subsequent doses. Wiry pulse indicates life; choppy pulse indicates death. (Wiry is Yang; Choppy is Yin. Yang syndrome with Yin pulse is death. Patient with Yang syndrome and choppy pulse must not be purged.)
(Question 23) On chest/diaphragm discomfort,痞满 (fullness/obstruction), blue lips, cold hands/feet, deep-fine pulse, low mood, or abdominal pain.
This is named Taiyin. Recently, few recognize Yin syndromes; seeing chest discomfort, they administer digestive aids, which is incorrect treatment. Generally, Yin syndrome results from cold food injuring Spleen/Stomach, affecting Yin meridians. It governs chest/diaphragm fullness, lack of luster in face/lips, cold hands/feet, deep-fine pulse, low mood, not due to desires, but internal injury from cold food or damaging Stomach Qi, forming Yin syndrome. Administering Radix Crotonis (Badou) type drugs worsens chest discomfort, causing vomiting/diarrhea, leading to death in one-two days. Because they do not know Cold attacking Taiyin. Taiyin is the Spleen meridian. ○ Question: If dietary irregularity causes chest discomfort, Cold damaging Yin meridians, how to treat? Answer: Urgently make Lizhong Tang, add Qingju/Chenju (Green/Aged Tangerine Peel) chopped like hemp seeds. Take one-two doses, chest discomfort resolves. Zhishi Lizhong Wan (Immature Bitter Orange Regulate Middle Pill) (Za 81), Wuji San (Five Accumulations Powder) (Za 21) are especially good.
(Question 24) On faint-fine pulse, desire to vomit but nothing comes out, vexation, desire to sleep, spontaneous diarrhea with thirst after five-six days.
This is named Shaoyin. Shaoyin disease presents as desire to vomit but nothing comes out, vexation, desire to sleep. Spontaneous diarrhea with thirst after five-six days indicates deficiency, hence drawing water to save oneself. If urine is white, Shaoyin syndrome characteristics are complete. White urine indicates lower Jiao deficiency-cold, inability to control water, hence white color. Sini Tang (Reverse the Extremities Decoction) (Zheng 75) governs. ○ Shaoyin disease, if dry mouth/tongue with thirst, requires urgent purging, do not delay. Dachengqi Tang (Major Order the Qi Decoction) (Zheng 41) governs. If pulse is deep-slow, requires warming; Sini Tang governs. Dry mouth/thirst indicates Heat; deep-slow pulse distinguishes Cold. Shaoyin belongs to Kidney, ancients called it Kidney Shanghan. Kidney Shanghan, dry mouth/tongue/thirst, definitely requires urgent purging. Generally, Kidney Shanghan also lacks interior/exterior heat, only suffering from vexation/depression, silence, extreme exhaustion, dislike for light, occasional abdominal pain, deep-fine pulse. Old usage of Sishun Tang was criticized by ancients as too hot. For Kidney disease with residual heat, Zhongjing's Sini San (Reverse the Extremities Powder) (Zheng 76) can be taken. If over ten days, continuous diarrhea, cold limbs throughout, no heat signs, modify Sishun Tang (Za 119). ○ Shaoyin disease with aversion to cold and [body heat], frequent restlessness, dislike for heavy clothing: use Dachaihu Tang minus Dahuang (Zheng 30). ○ Shaoyin disease at onset, contrary fever, deep pulse: Mahuang Xixin Fuzi Tang (Ephedra, Asarum, and Aconite Decoction) (Zheng 23) induces slight sweating. ○ Shaoyin disease after two-three days, commonly lacking Yang syndrome signs, still requires slight sweating; Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction) (Zheng 22) is suitable. Students must know this.
(Question 25) On slight body heat, vexation, red face, deep-micro pulse.
This is named Yin syndrome resembling Yang. Yin causes restlessness/heat/reversal cold; things reverse at extremes. Generally, rely on pulse: numerous indicates Heat, slow indicates Cold, nothing more reliable. Suppose slight body heat, vexation, red face, deep-micro pulse: all are Yin syndromes. Slight heat is due to interior cold. Vexation is due to Yin excess. Face wearing Yang (red face) is due to lower deficiency. If doctor ignores pulse, mistaking floating Yang upper-chest restlessness for Excess Heat, giving cool medicines consumes Qi causing major illness. Waitai Mi Yao says: Yin excess causing restlessness is named Yin Zao (Yin Restlessness), wanting to sit in well, treat with hot medicine. Zhongjing's Shaoyin syndrome with red face: Sini Tang plus Congbai (Scallion White) governs.
(Question 26) On cold limbs, constipation, red urine, or black stool, deep-slippery pulse.
This is named Yang syndrome resembling Yin. Excessive Yang becomes Yin, excessive Yin becomes Yang, change of cold/heat. Suppose cold limbs, constipation, red urine, or black stool, deep-slippery pulse: all are Yang syndromes. Mild case: Baihu Tang (White Tiger Decoction) (Zheng 64). Severe case: Chengqi Tang (Order the Qi Decoction) (Zheng 42). Shanghan missed purgation, blood/qi blocked, causing cold limbs: this is deep latent heat, thus deep reversal cold. Quickly use Dachengqi Tang (Major Order the Qi Decoction) (Zheng 41) with increased dosage to purge; sweating brings immediate recovery. (This is what Zhongjing meant by "Reversal cold should be purged.") ○ Heat Jue differs from Yin Jue. Heat Jue: slight reversal cold then fever. Yin Jue: no fever, cold limbs, aversion to cold, deep-fine pulse, loose stools/urine.
(Question 27) On cold body, fine-deep-rapid pulse, vexation without desire to drink.
This is named Yin excess blocking Yang. Shanghan Yin excess blocking Yang: patient cold body, fine-deep-rapid pulse, vexation without desire to drink. Desire to drink is incorrect. No desire to drink: use Pili San (Thunderbolt Powder) (Za 22). Soon restlessness stops, sleep and sweating bring recovery. This medicine disperses cold qi, then hot qi rises, sweating heals. Huoyan San (Flame Powder) (Za 22), Dansha Wan (Cinnabar Pill) (Za 24) also govern.
(Question 28) On cold limbs
This is named Jue (Reversal). Jue means reversal. Yin and Yang do not connect smoothly, causing cold limbs. Yang qi declines, Yin qi exceeds, Yin surpasses Yang, so Yang pulse reverses, not reaching hands/feet, hence cold. Shanghan with more Heat than Jue: disease should heal. More Jue than Heat: disease progresses. ○ However, there is Cold Jue and Heat Jue, must distinguish carefully. ○ Cold Jue: from onset day, limbs cold, deep-micro non-rapid pulse, legs curled/wanting warmth, pulling clothes to cover, no desire to drink, or clear grain diarrhea, or normal stool (normal stool means stool like usual), or frequent urination, exterior signs mostly alert and quiet, pulse deep-solid but slow-weak on pressure indicates Cold Jue. Sini Tang (Zheng 75), Lizhong Tang (Zheng 74), Tongmai Sini Tang (Zheng 81), Danggui Sini Tang (Angelica Reverse Extremities Decoction) (Zheng 78), Danggui Sini Jia Zhuyu Shengjiang Tang (Angelica Reverse Extremities plus Dogwood and Ginger Decoction) (Zheng 80), Botong Zhu Dan Tang (Clear Connect Pig Bile Decoction) (Zheng 98) are selectable. ○ Heat Jue: during epidemic, besides body heat/headache, other Yang signs exist. By day two-three to four-five, Jue appears. Combined Heat Jue: Jue lasts half day then body heats up, because heat is deep, requiring two-three days to cause Jue. If slight Jue then fever, heat is mild. Pulse deep-hidden but slippery on pressure indicates interior Heat. Patient may fear heat, drink water, throw hands/feet, vexation insomnia, constipation, red urine, exterior signs mostly confused: knows as Heat Jue. Baihu Tang (Zheng 64), Chengqi Tang (Zheng 42) used according to syndrome. Zhongjing said: Shanghan day one-four-five Jue, must have fever, previous heat follows with Jue, deep Jue means deep heat, slight Jue means slight heat, Jue should be purged; if wrongly sweated, mouth injuries/redness occur. (Heat Jue should be purged, hence "Jue should be purged"; if wrongly sweated, mouth injuries/redness occur.) Also, full purgation signs with Sini (cold limbs): missed purgation, blood/qi blocked, limbs Jue. Doctor doesn't recognize, suspects Yin Jue, gives hot medicine, disaster follows instantly. Generally Heat Jue requires deep-hidden slippery pulse, sweat on head, hands cold but fingers occasionally warm, must use Chengqi Tang to purge, do not hesitate. (All cold limbs belong to Jueyin, cannot purge/sweat, but some need purge/sweat: if limbs cold but sometimes warm, palms warm, not true Jue reversal, observe carefully.) ○ If patient has cold/heat and Jue, dull complexion, dizziness, sudden absence of pulse in both or one hand: must be correct sweating. Wrap hands/feet in cotton to keep warm, urgently take Wuwei Zi Tang (Schisandra Decoction) (Za 25), or combine Mahuang Xixin Gancao Tang. Upon taking, profuse sweating resolves. ○ Or Shanghan Jue with epigastric palpitations: treat water first, take Fuling Gancao Tang (Poria and Licorice Decoction) (Zheng 53), then treat Jue; otherwise water enters stomach causing diarrhea. ○ Also patient with cold limbs, intermittent knotted pulse: pathogen knotted in chest, epigastric fullness/vexation, hunger unable to eat: disease is in