杂病四肢厥冷。为脾肾阳虚。不能达于四末。四逆汤主之。若失血之人。而亦间有发厥者。则多是热邪内
陷。伏匿在里。外见假寒。身如冷水。目昏神暗。脉伏不见。或冷一阵。反而发热。或厥数日。反发热数日。其厥
多热少者。是阳极似阴。热之至也。厥少热深者。是伏热犹得发泄。热尚浅也。此即伤寒论厥阴篇。所谓热
深厥亦深。热微厥亦微是矣。盖厥阴肝经。内寄胆火。病则火伏阴中。而为厥。火出阳分则反热。发热固是
火甚。发厥则火伏于内。而更盛矣。先宜治其伏火。使火得发。转厥为热。次乃更清其热。斯可愈耳。若误认
为杂病发厥。而用热药。是促其命也。其辨法。杂病之厥。吐利不止。脉脱气微。有寒无热。伏火之厥。则厥后
微露热形。口不和。便不溏。小便不清。心中疼热。烦躁不宁。恶明喜暗。渴欲得饮。吐衄随厥而发。皆现真热
假寒之象。先以清化汤。合升降散。攻其伏热。或当归芦荟丸攻之。次以五蒸汤清之。厥止热不退者。再用
大补阴丸。地黄汤。以滋阴。发厥之证。又有寒闭于外。而火不得发者。用仲景四逆散。加荆芥黄连枯芩。审
其阳陷于内。而不出者。白头翁汤。以清达之。升阳散火汤。以温发之。二方酌宜而行。
血家发热。固多是真热假寒。然亦有真寒者。去血太多。气随血泄。以致中气虚而不旺。元气损而不足。四
肢厥冷。不思饮食。大便溏泻。此乃虚则生寒之证。法宜温补。十全大补汤。参附汤。养荣汤。随宜用之。
杂病中出现的四肢厥冷，是由于脾肾阳气虚弱，无法温煦到达四肢末端所致。治疗应以四逆汤为主方。如果是失血的患者，偶尔也会出现发厥的情况，这大多是因为热邪内陷，潜伏在体内，体表呈现出假寒的症状，身体感觉像冷水一样冰冷，眼睛昏花、精神暗淡，脉搏伏匿难以触及。或者出现一阵发冷，随后反而发热；或者厥冷持续数日，随后反而发热数日。如果厥冷的时间多于发热的时间，这是阳极似阴的表现，说明热邪极盛；如果厥冷时间短而热象深重，说明潜伏的热邪尚能发泄，热邪还比较浅表。这正是《伤寒论·厥阴篇》中所说的“热深厥亦深，热微厥亦微”的道理。因为厥阴肝经内部寄居着胆火，患病时火气潜伏在阴分之中，从而导致厥冷；当火气透出阳分时，反而会出现发热。发热固然说明火势旺盛，但发厥则说明火气潜伏在内，且更加炽盛。治疗上应先处理潜伏的火邪，使火气得以发散，将厥冷转化为发热，然后再清除余热，这样才可以痊愈。如果误认为是杂病引起的发厥，而使用温热药物，那就是加速病人的死亡。辨别的方法在于：杂病引起的厥冷，伴有呕吐腹泻不止，脉象微弱甚至摸不到，气息微弱，只有寒象没有热象；而伏火引起的厥冷，则在厥冷之后微微显露出热象，口不干和不渴，大便不稀溏，小便浑浊不清，心中疼痛且有灼热感，烦躁不安，厌恶光亮喜欢昏暗，口渴想要饮水，吐血或鼻衄随着厥冷而发作，这些都呈现出真热假寒的征象。治疗时先用清化汤合升降散，攻逐体内的伏热；或者用当归芦荟丸来攻逐。随后再用五蒸汤来清热。如果厥冷停止但发热不退，再使用大补阴丸和地黄汤来滋阴。发厥的证候中，还有因寒邪闭塞于体表，导致火气不得发散的情况，应使用张仲景的四逆散，加入荆芥、黄连、枯芩（黄芩）。如果审察到阳气下陷于体内而不能外达，应使用白头翁汤来清解透达，或使用升阳散火汤来温通发散。这两个方剂应根据具体情况斟酌选用。
失血患者发热，固然是多表现为真热假寒，但也有属于真寒的情况。如果失血过多，气随血泄，导致中气虚弱而不旺盛，元气受损而不足，出现四肢厥冷，不想吃东西，大便稀溏，这是虚证产生的寒象。治疗方法应当采用温补法，可根据情况酌情使用十全大补汤、参附汤或养荣汤。
In miscellaneous diseases, coldness of the four limbs is caused by deficiency of Spleen and Kidney Yang Qi, which fails to reach the extremities. Si Ni Tang (Four Reversal Decoction) is the primary formula. In patients who have suffered blood loss, occasional reversal coldness may also occur; this is mostly due to pathogenic heat sinking inward and hiding within, presenting with false cold on the exterior. The body feels as cold as water, vision is blurred, spirit is dull, and the pulse is hidden and difficult to palpate. Alternatively, there may be episodes of coldness followed by fever, or reversal coldness lasting several days followed by fever for several days. When reversal coldness predominates over fever, it indicates extreme Yang transforming into Yin-like symptoms, signifying extreme heat. When reversal coldness is slight but heat is profound, it indicates that latent heat can still vent, meaning the heat is relatively superficial. This corresponds to the statement in the *Shanghan Lun* (Treatise on Cold Damage), Jueyin Chapter: "The deeper the heat, the deeper the reversal coldness; the milder the heat, the milder the reversal coldness." This is because the Jueyin Liver Meridian harbors Gallbladder Fire internally. When diseased, the fire hides within the Yin, causing reversal coldness; when the fire emerges into the Yang aspect, fever occurs. Fever indeed indicates strong fire, but reversal coldness indicates fire hiding internally and becoming even more intense. Treatment should first address the latent fire, allowing it to vent, transforming reversal coldness into fever, and then clear the remaining heat for recovery. Misidentifying this as reversal coldness from miscellaneous diseases and using warming herbs would hasten death. Differentiation: Reversal coldness from miscellaneous diseases presents with continuous vomiting and diarrhea, absent or faint pulse, weak Qi, and only cold without heat. Reversal coldness from latent fire reveals slight heat signs after the cold episode, dry mouth without thirst, normal stool consistency, turbid urine, heart pain with burning sensation, restlessness, aversion to light preferring darkness, thirst with desire to drink, and hematemesis or epistaxis occurring with reversal coldness, all showing true heat and false cold signs. Initially use Qing Hua Tang (Clearing Transformation Decoction) combined with Sheng Jiang San (Ascending-Descending Powder) to attack latent heat, or Dang Gui Lu Hui Wan (Aloes Pill with Angelica). Subsequently use Wu Zheng Tang (Five Steaming Decoction) to clear heat. If reversal coldness stops but fever persists, use Da Bu Yin Wan (Great Tonify Yin Pill) and Di Huang Tang (Rehmannia Decoction) to nourish Yin. Another type of reversal coldness involves external cold blocking the exterior, preventing fire from venting; treat with Zhang Zhongjing's Si Ni San (Four Reversal Powder) added with Jingjie (Schizonepeta), Huanglian (Coptis), and Ku Qin (Scutellaria). If Yang Qi is determined to be sunken internally and unable to emerge, use Bai Tou Weng Tang (Pulsatilla Decoction) to clear and unblock, or Sheng Yang San Huo Tang (Raise Yang Scatter Fire Decoction) to warm and vent. Choose between these two formulas based on the situation.
Patients with blood disorders experiencing fever often present true heat and false cold, but true cold cases also exist. Excessive blood loss causes Qi to escape with the blood, leading to deficient and weak Middle Qi, and damaged insufficient Yuan Qi. Symptoms include coldness of the four limbs, anorexia, and loose stools. This is a cold syndrome generated by deficiency. The treatment method should be warming and tonifying. Use Shi Quan Da Bu Tang (Comprehensive Great Tonification Decoction), Shen Fu Tang (Ginseng and Aconite Decoction), or Yang Rong Tang (Nourish Blood Decoction) as appropriate.