厥阴者，阴尽阳生之脏，与少阳为表里者也。故其为病，阴阳错杂，寒热混淆，邪至其经，从化各异。若
其人素偏于热，则邪从阳化，故消渴，气上撞心，心中疼热，蛔厥，口烂，咽痛，喉痹，痈脓，便血等阳证见
矣。若其人素偏于寒，则邪从阴化，故手足厥冷，脉微欲绝，肤冷，脏厥，下利，除中等阴证见矣。所以少阳
不解，传变厥阴而病危，厥阴病衰，转属少阳为欲愈，阴阳消长，大伏危机。兹以阴阳从化，厥热胜复之微旨，
详发于篇中，俾临证者，延医有要道焉。
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。
【注】此条总言厥阴为病之大纲也。厥阴者，为阴尽阳生之脏，邪至其经，从阴化寒，从阳化热，故其为
病，阴阳错杂，寒热混淆也。消渴者，饮水多而小便少，乃厥阴热化而耗水也。厥阴之脉，起足大指，循股内
入阴中，环阴器抵少腹，贯心膈。其注肺热邪，循经上逆膈中，故气上撞心，心中疼热也。饥而不欲食者，非
不食也，因食则动蛔而吐，故虽饥而不欲食，食则吐蛔也。夫消渴多饮，饥不能食，则胃中所有者，但水与热
耳！若更以厥阴热气，挟蛔撞疼，误认为转属阳明之实痛而下之，则胃愈虚，必下利不止矣。
【集注】成无己曰∶邪自太阳传至太阴，则腹满而嗌干，未成渴也；至少阴则口燥舌干而渴，未成消也；
至厥阴则成消渴者，以势甚能消水故也。又张卿子云∶尝见厥阴消渴数证，舌尽红赤，厥冷脉微，渴甚，服白
虎、黄连等汤，皆不能救，盖厥阴消渴，皆寒热错杂之邪，非纯阳亢热之证可比也。
魏荔彤曰∶此申解厥阴传经热邪为患，历举其证，以禁误下也。伤寒之邪，传入少阴，为里中之里，及
自少阴传厥阴，又为三阴之极尽处矣。阴尽处受邪，无所复传，却同少阳为升降之出路。少阳无下法，厥阴阴
邪亦无下法，下之为误可知矣。首标“消渴”二字，凡热必渴，而寒湿隔阻正气，亦有渴者，然其渴虽欲饮水，
必不能多，未有渴而饮，饮而仍渴，随饮随消随渴。若是者则消渴为传经之热邪，传入厥阴无疑也。
厥阴病，渴欲饮水者，少少与之，愈。
【注】厥阴病，渴欲饮水者，乃阳回欲和，求水自滋，作解之兆，当少少与之，以和其胃，胃和汗出，
自可愈也。若多与之，则水反停渍入胃，必致厥利矣。
【集注】张璐曰∶阳气将复，故欲饮水。而少少与之者，盖阴邪方欲解散，阳气尚未归复，若恣饮不消，
反有停蓄之患矣。
汪琥曰∶厥阴有消渴一证，不言自愈者，盖热甚而津液消烁，虽饮水不能胜其燥烈，乃邪气深入未愈之
征也。而此条之渴欲饮水与之愈者，盖其热非消渴之比，乃邪气向外欲解之机也，两者自是不同。
伤寒，厥而心下悸，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。
【按】“厥而心下悸者”之下，当有“以饮水多”四字，若无此四字，乃阴盛之厥悸，
非停水之厥悸矣，何以即知是水而曰宜先治水耶？
【注】伤寒厥而心下悸者，不渴引饮，乃阴盛之厥悸也，若以饮水多，乃停水之厥悸也。故宜先治水，却
治其厥，当与茯苓甘草汤，即桂枝甘草汤、加茯苓、生姜也。桂枝、甘草补阳虚也，佐生姜外散寒邪，则厥可
回矣，君茯苓内输水道，则悸可安矣，此先水后厥之治也。盖停水者，必小便不利，若不如是治之，则所停之
水渍入胃中，必作利也。
【按】伤寒太阳篇，汗出表未和，小便不利，此条伤寒表未解，厥而心下悸，二证皆用茯苓甘草汤者，盖
因二者见证虽不同，而里无热、表未和、停水则同也。故一用之谐和荣卫以利水，一用之解表通阳以利水，无
不可也。此证虽不曰小便不利，而小便不利之意自在。若小便利则水不停，而厥悸属阴寒矣，岂宜发表利水耶！
【集注】方有执曰∶《金匮》云∶水停心下，甚则悸者，是悸为水甚，而厥则寒甚也。寒无象而水有形，
水去则寒消，而厥亦愈。入胃者，水能渗土也。
喻昌曰∶太阳篇中饮水多者，心下必悸，故此厥而心下悸者，明系饮水所致。所以乘其水未渍胃，先用茯
苓甘草汤治水，以清下利之源，后乃治厥，庶不致厥与利相因耳！
程应旄曰∶寒因水停而作厥者，其证以心下悸为验。厥阴有此，多因消渴得之。水其本也，寒其标也，不
先水而先厥，且防水渍入胃，敢下之乎？
汪琥曰∶厥而心下悸者，明系饮水多，寒饮留于心下，胸中之阳，不能四布，故见厥。此非外来之寒比也，
故法宜先治水，须与茯苓甘草汤，而治厥之法，即在其中矣。盖水去则厥自除也。不尔者，谓不治其水，则水
渍下入于胃，必作利也。
吴人驹曰∶气脉流行，不循常道，是为悖逆，名之曰厥。但厥有痰、实、寒、热、气、水之不同，此因于
水者也。水气不循故道，则水之寒气上乘于心而为悸，故治水即所以去悸，而厥亦回。设或不然，则水之甚者，
其土沮洳，因为之利矣。
伤寒脉微而厥，至七八日肤冷，其人躁无暂安时者，此为脏厥，非蛔厥也。蛔厥者，其人当吐蛔。今病
者静，而复时烦者，此为脏寒，蛔上入其膈，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，又主久利。
【按】“此为脏寒”之“此”字，当是“非”字，若是“此”字，即是脏厥，与辨蛔厥之义不属。
【注】首条总论厥阴阳邪化热，此条详辨厥阴阴邪化寒，以明脏厥、蛔厥之不同，而出其治也。伤寒脉微
而厥，厥阴脉证也。至七八日不回，手足厥冷，而更通身肤冷，躁无暂安之时者，此为厥阴阳虚阴盛之脏厥，
非阴阳错杂之蛔厥也。若蛔厥者，其人当吐蛔，今病者静而复时烦，不似脏厥之躁无暂安时，知非脏寒之躁，
乃蛔上膈之上也，故其烦须臾复止也。得食而吐又烦者，是蛔闻食臭而出，故又烦也。得食，蛔动而呕，蛔因
呕吐而出，故曰∶其人当自吐蛔也。蛔厥主以乌梅丸，又主久利者，以此药性味酸苦辛温，寒热并用，能解阴
阳错杂，寒热混淆之邪也。脏厥者，宜吴茱萸汤；兼少阴者，宜四逆、通脉、附子等汤。临证者酌而用之可也。
【集注】方有执曰∶脉微而厥，统言之也。肤冷，言不独手足，以见阳气内陷也。脏厥，言非在经也。
喻昌曰∶脉微而厥，而阳气衰微可知，然未定其为脏厥、蛔厥也。惟肤冷而躁，无暂安时，乃为脏厥。脏
厥用四逆及灸法，其厥不回者死。若蛔厥则时厥时烦，未为死候，但因此而驯至胃中，无阳则死矣。
程知曰∶言厥，有脏与蛔之别也。脏厥者，肾脏之阳不行也；蛔厥者，手足冷而吐蛔，胃腑之阳不行也。
蛔厥者，蛔动则烦而
有静时，非若脏厥之躁无暂安时也。此胃阳病而无关于肾阳，故厥虽同，而证则异也。
程应旄曰∶脉微而厥，纯阴之象，征于脉矣；七八日肤冷，无阳之象，征于形矣。阴极则发躁，无暂安时，
此自是少阴脏厥，为不治之证，厥阴中无此也。至于吐蛔，为厥阴本证，则蛔厥可与阴阳不相顺接者，连类而
明之也。用乌梅丸名曰安蛔，实是安胃，并主久利，见阴阳不相顺接，厥而下利之证，皆可以此方括之也。
林澜曰∶阳烦阴躁，烦轻躁重，于脏厥言躁，于蛔厥言烦，已具安危之异矣。脏厥者，阳气将脱，脏气欲
绝而争，故脏厥为死证；若蛔厥者，脏气虚寒，而未至于绝。脏气寒，则蛔不安其宫而动，脏气虚则蛔求食而
出，是以其证必吐蛔。
乌梅丸方
乌梅（三百枚） 细辛（六两） 干姜（十两） 黄连（十六两） 当归（四两） 附子（去皮，炮，六两）
蜀椒（出汗，四两） 桂枝（六两） 人参（六两） 黄柏（六两）
上十味，异捣筛，合治之。以苦酒渍乌梅一宿，去核，蒸之五升米下。饭熟捣成泥，和药令相得，纳臼中，
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。
【集解】柯琴曰∶六经惟厥阴为难治。其本阴，其标热，其体木，其用火，必伏其所主，而先其所因，或
收、或散、或逆、或从，随所利而行之，调其中气，使之和平，是治厥阴之法也。厥阴当两阴交尽，又名阴之
绝阳，宜无热矣。第其合晦朔之理，阴之初尽，即阳之初生，所以厥阴病热，是少阳使然也。火旺则水亏，故
消渴，气上撞心，心中疼热。气有余便是火也。木盛则生风，虫为风化。饥则胃中空虚，蛔闻食臭而出，故吐
蛔，虽饥不欲食也。仲景立方，皆以辛甘苦味为君，不用酸收之品，而此用之者，以厥阴主肝木耳！《洪范》
曰∶木曰曲直，作酸。《内经》曰∶木生酸，酸入肝。君乌梅之大酸，是伏其所主也。配黄连泻心而除疼，佐
黄柏滋肾以除渴，先其所因也。连、柏治厥阴，阳邪则有余，不足以治阴邪也。椒、附、辛、姜大辛之品并举，
不但治厥阴阴邪，且肝欲散，以辛散之也。又加桂枝、当归，是肝脏血，求其所属也。寒热杂用，则气味不和，
佐以人参，调其中气。以苦酒渍乌梅，同气相求；蒸之米下，资其谷气。加蜜为丸，少与而渐加之，缓则治其
本也。蛔，昆虫也。生冷之物与湿热之气相成，故药亦寒热互用。且胸中烦而吐蛔，则连、柏是寒因热用也。
蛔得酸则静，得辛则伏，得苦则下，信为治虫佳剂。久利则虚，调其寒热，酸以收之，下利自止。
伤寒六七日，脉微，手足厥冷，烦躁，灸厥阴。厥不还者，死。
【注】此详申厥阴脏厥之重证也。伤寒六七日，脉微，手足厥冷，烦躁者，是厥阴阴邪之重病也。若不图
之于早，为阴消阳长之计，必至于阴气寝寝而盛，厥冷日深，烦躁日甚，虽用茱萸、附子、四逆等汤，恐缓不
及事，惟当灸厥阴以通其阳。如手足厥冷，过时不还，是阳已亡也，故死。
【集注】方有执曰∶灸所以通阳，阳不回，故主死也。
程知曰∶六七日，为邪传厥阴之时。脉微而厥，未是危证，危在烦躁，为微阳外露耳！
程应旄曰∶脉微、厥冷而烦躁，是即前条中所引脏厥之证，六七日前无是也。
汪琥曰∶烦躁者，阳虚而争，乃脏中之真阳欲脱，而神气为之浮越，故作烦躁。可灸太冲穴，以太冲二穴，
为足厥阴脉之所注。穴在足大指下后二寸，或一寸半陷中，可灸三壮。
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。
【注】此详申厥阴脏厥之轻证也。手足厥寒，脉细欲绝者，厥阴阴邪寒化之脉证也，然不通身肤冷，亦不
躁无暂安时者，则非阳虚阴盛之比，故不用姜附等辈，而用当归四逆汤，和厥阴以散寒邪，调营卫以通阳气也。
若其人内有久寒者，宜当归四逆汤，加吴茱萸、生姜，以直走厥阴，温而散之也。
【集注】程知曰∶不用姜、附者，以证无下利，不属纯阴也。盖脉细欲绝之人，姜、附亦足以劫其阴，故
不惟不轻用下，且亦不轻用温也。
郑重光曰∶手足厥冷，脉细欲绝，是厥阴伤寒之外证；当归四逆，是厥阴伤寒之表药也。
当归四逆汤方
当归（三两） 桂枝（三两） 芍药（三两） 细辛（三两） 通草（二两） 甘草（炙，二两） 大枣（擘，二十五枚）
上七味，以水八升，煮取三升，去滓，温服一升，日三服。
当归四逆加吴茱萸生姜汤方
于前方内加吴茱萸半升、生姜三两。
上九味，以水六升、清酒六升和，煮取五升，去滓，温分五服。一方水酒各四升。
【方解】凡厥阴病，必脉细而厥。以厥阴为三阴之尽，阴尽阳生，若受邪则阴阳之气不相顺接，故脉细而
厥也。然相火寄居于厥阴之脏，经虽寒而脏不寒，故先厥者后必发热也。故伤寒初起，见手足厥冷，脉细欲绝
者，皆不得遽认为虚寒而用姜、附也。此方取桂枝汤。君以当归者，厥阴主肝为血室也；佐细辛味极辛，能达
三阴，外温经而内温脏；通草性极通，能利关节，内通窍而外通营；倍加大枣，即建中加饴用甘之法；减去生
姜，恐辛过甚而迅散也。肝之志苦急，肝之神欲散，甘辛并举，则志遂而神悦，未有厥阴神志遂悦，而脉细不
出，手足不温者也。不须参、苓之补，不用姜、附之峻者，厥阴厥逆与太阴、少阴不同治也。若其人内有久寒，
非辛温甘缓之品所能兼治，则加吴茱萸、生姜之辛热，非辛温甘缓之品所能兼治，则加吴茱萸、生姜之辛热，
更用酒煎，佐细辛直通厥阴之脏，迅散内外之寒，是又救厥阴内外两伤于寒之法也。
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。
【注】此申上条详出其证也。经曰∶六日厥阴受之。厥阴循阴器，络于肝，故烦满而囊缩。邪传厥阴，其
人本自有热，必从阳化，则烦渴，少腹满而囊缩，乃四逆散、承气汤证也。若其人本自有寒，必从阴化，则手
足厥冷，少腹满而囊缩，乃当归四逆加吴茱萸汤证也。今病者手足厥冷，言我不结胸，是谓大腹不满，而惟小
厥阴，是阴气终结、阳气初生的脏腑，与少阳互为表里。因此，当病邪侵犯此经时，会出现阴阳错杂、寒热混淆的情况，且病邪侵入该经后，随人体体质不同而发生不同的转化。如果患者平素体质偏热，病邪就会从阳化热，于是出现消渴（口渴多饮）、气上冲心、心中疼痛灼热、蛔厥（因蛔虫引起的四肢厥冷）、口舌生疮、咽喉肿痛、喉痹（咽喉阻塞不通）、痈脓、便血等阳证表现。如果患者平素体质偏寒，病邪就会从阴化寒，于是出现手足冰冷、脉搏微弱似有似无、全身皮肤寒冷、脏厥（内脏阳气衰竭导致的厥逆）、腹泻、除中（危重病人突然食欲亢进）等阴证表现。所以，少阳病不解，传变至厥阴则病情危重；厥阴病衰退，转属少阳则预示将要痊愈。阴阳的消长盛衰之中，潜伏着巨大的危机。现在根据阴阳随体质转化的规律，以及厥热胜复（厥冷与发热交替出现）的精微旨意，在篇中详细阐述，使临证医生有所遵循，掌握诊治的关键。
厥阴病的提纲症状是：消渴，气上冲心，心中疼痛灼热，饥饿但不想吃东西，吃东西则会吐出蛔虫，若误用攻下法会导致腹泻不止。
【注】这一条总括了厥阴病的大纲。厥阴是阴气终结、阳气初生的脏腑，病邪侵入其经脉，随体质从阴化寒或从阳化热，所以表现为阴阳错杂、寒热混淆。所谓“消渴”，是指喝水多而小便少，这是厥阴热化耗伤津液所致。厥阴经脉起于足大趾，沿大腿内侧进入阴部，环绕生殖器，抵少腹，穿过膈肌，连接心脏。若热邪循经上逆至膈中，就会出现气上冲心、心中疼痛灼热的症状。“饥饿但不想吃东西”，并非真的不想吃，而是因为进食会触动蛔虫导致呕吐，所以虽然感到饥饿却不敢吃，吃了就会吐出蛔虫。既然消渴多饮，又饥不能食，那么胃中所存的只有水和热罢了！如果再因为厥阴热气挟带蛔虫引起疼痛，误认为是转属阳明腑实的剧痛而使用攻下法，就会导致胃气更虚，必然出现腹泻不止的后果。
【集注】成无己说：邪气从太阳传入太阴，会出现腹胀、咽干，但尚未形成口渴；传到少阴，会出现口燥舌干而渴，但尚未形成消渴；传到厥阴才形成消渴，是因为邪势极盛能迅速消耗水分。张卿子又说：我曾见过厥阴消渴的几个病例，舌头完全红赤，手足厥冷，脉象微弱，极度口渴，服用白虎汤、黄连汤等清热药，都无法救治。这是因为厥阴消渴属于寒热错杂之邪，不能与纯阳亢盛的实热证相比。
魏荔彤说：这里进一步解释厥阴传经热邪为患，列举各种症状，以禁止误用攻下法。伤寒邪气传入少阴，是里中之里；再从少阴传入厥阴，又是三阴经的尽头。在阴尽之处受邪，无处再传，反而与少阳成为升降出入的出路。少阳病没有攻下法，厥阴病虽有阴邪也没有攻下法，误用攻下可知是错误的。首先标出“消渴”二字，凡是热证都会口渴，但寒湿阻隔正气也会口渴，然而那种口渴虽然想喝水，却喝不多，不会有这种喝了就消、消了又渴、随饮随消随渴的情况。像这样的就是传经的热邪，传入厥阴无疑。
厥阴病，如果口渴想喝水，只需少量给予，病即可愈。
【注】厥阴病中，口渴想喝水，是阳气回复、想要调和，寻求水源自我滋润的表现，是疾病向愈的征兆，应当少量给予饮水，以调和胃气，胃气和顺则汗出，自然痊愈。如果大量给予，水反而会停滞浸渍入胃，必然导致厥逆和腹泻。
【集注】张璐说：阳气即将恢复，所以想喝水。少量给予的原因在于，阴邪正要解散，阳气尚未完全归复，如果肆意饮水无法消化，反而会有停蓄的祸患。
汪琥说：厥阴病有消渴一证，文中未言自愈，是因为热势很盛，津液被煎熬枯竭，即使喝水也不能胜过其燥烈，这是邪气深入尚未痊愈的迹象。而本条所说的“渴欲饮水与之愈”，是因为其热势不如消渴证严重，是邪气向外欲解的机转，两者自然不同。
伤寒，出现四肢厥冷且心下悸动，应当先治疗水饮，服用茯苓甘草汤，然后再治疗厥逆。如果不这样做，水饮浸渍入胃，必然导致腹泻。
【按】在“厥而心下悸者”之下，应当有“因饮水过多”这四个字。如果没有这四个字，那就是阴盛导致的厥逆和心悸，而非停水导致的厥逆和心悸，怎么能直接知道是水饮并说宜先治水呢？
【注】伤寒出现四肢厥冷且心下悸动，如果不渴且引饮，那是阴盛导致的厥悸；如果是因饮水过多，则是停水导致的厥悸。所以应当先治水，然后再治厥，应当给予茯苓甘草汤，即桂枝甘草汤加上茯苓、生姜。桂枝、甘草补益阳气，配合生姜外散寒邪，则厥逆可回；以茯苓为主药内通水道，则心悸可安，这是先治水后治厥的方法。大概停水的人，必然小便不利，如果不这样治疗，所停之水浸渍入胃，必然导致腹泻。
【按】《伤寒论》太阳篇中，汗出表未和解，小便不利，与本条伤寒表未解、厥逆且心下悸，两个证候都使用茯苓甘草汤，是因为虽然见证不同，但里无热、表未和、有水饮停留是一致的。所以一个用于调和营卫以利水，一个用于解表通阳以利水，都是可行的。此证虽未明言小便不利，但小便不利的意思自在其中。如果小便利，则水不停留，而厥逆心悸属于阴寒，岂可用发表利水之法呢！
【集注】方有执说：《金匮要略》云：水停心下，严重的会出现心悸，这说明心悸是水邪甚盛，而厥逆是寒邪甚盛。寒无形而水有形，水去则寒消，厥逆也随之痊愈。水入胃，是水能渗湿健脾。
喻昌说：太阳篇中提到饮水多的人，心下必悸，所以此条厥逆且心下悸，明确是由饮水引起的。所以在未浸渍入胃之前，先用茯苓甘草汤治水，以清除腹泻之源，然后再治厥逆，这样才能避免厥逆与腹泻相继发生。
程应旄说：因寒与水停而致厥逆的，其证候以心下悸为验证。厥阴病有此证，多因消渴病引发。水是根本，寒是标象，不先治水而先治厥，且防止水浸渍入胃，敢用攻下法吗？
汪琥说：厥逆且心下悸，明确是由于饮水过多，寒饮留于心下，胸中阳气不能布达四周，所以出现厥逆。这不同于外来寒邪，所以治法宜先治水，须给予茯苓甘草汤，而治厥逆的方法也就包含在其中了。大概水去则厥逆自除。如果不这样，即不治水，水浸渍下行入胃，必然导致腹泻。
吴人驹说：气脉流行不循常道，称为悖逆，名为厥逆。但厥逆有痰、实、寒、热、气、水的不同，此条是因水引起的。水气不循故道，则水的寒气上乘于心导致心悸，所以治水即所以去悸，而厥逆也会回复。假如不然，水邪严重的，会使脾土潮湿，从而发生腹泻。
伤寒，脉象微弱且四肢厥冷，到了七八天，全身皮肤寒冷，其人躁动不安，片刻不得安宁的，这是脏厥，不是蛔厥。蛔厥的病人，应当吐蛔虫。现在的病人安静，却又时不时心烦，这是脏寒，蛔虫上行进入膈中，所以心烦，一会儿又停止。进食后呕吐，又心烦的，是因为蛔虫闻到食物气味而出，病人应当自行吐出蛔虫。蛔厥，用乌梅丸主治，也主治久泻久痢。
【按】“此为脏寒”的“此”字，应当是“非”字。如果是“此”字，就是脏厥，与辨别蛔厥的意义不符。
【注】首条总论厥阴阳邪化热，此条详细辨别厥阴阴邪化寒，以阐明脏厥与蛔厥的不同，并给出治疗方法。伤寒脉微而厥，是厥阴的脉证。到了七八天还不缓解，手足厥冷，且全身皮肤寒冷，躁动不安片刻不得休息的，这是厥阴阳虚阴盛导致的脏厥，不是阴阳错杂的蛔厥。如果是蛔厥，病人应当吐蛔虫。现在病人安静，却又时不时心烦，不像脏厥那样躁动不安，可知这不是脏寒导致的躁动，而是蛔虫上扰膈部，所以心烦片刻后又停止。进食后呕吐又心烦，是蛔虫闻到食物气味而出，所以又心烦。进食后蛔虫扰动而呕吐，蛔虫因呕吐而出，所以说：“病人应当自行吐出蛔虫。”蛔厥主用乌梅丸，又主治久泻久痢，是因为此药性味酸苦辛温，寒热并用，能解除阴阳错杂、寒热混淆的病邪。脏厥，宜用吴茱萸汤；兼有少阴病证的，宜用四逆汤、通脉四逆汤、附子汤等。临证时酌情选用即可。
【集注】方有执说：脉微而厥，是总体说法。肤冷，说明不仅手足冷，可见阳气内陷。脏厥，说明病不在经络而在脏腑。
喻昌说：脉微而厥，可知阳气衰微，但还不能确定为脏厥还是蛔厥。只有肤冷且躁动，片刻不得安宁，才是脏厥。脏厥用四逆汤及灸法，厥逆不回的预后不良。若蛔厥则是时而厥逆时而心烦，不属于死证，但如果因此逐渐发展至胃中无阳，则会死亡。
程知说：论厥逆，有脏厥与蛔厥的区别。脏厥，是肾脏阳气不行；蛔厥，是手足冷且吐蛔，是胃腑阳气不行。蛔厥者，蛔虫动则心烦而有静的时候，不像脏厥那样躁动不安。这是胃阳病变而与肾阳无关，所以虽然都有厥逆，但证候不同。
程应旄说：脉微而厥，是纯阴之象，体现在脉象上；七八天肤冷，是无阳之象，体现在形体上。阴极则发躁，片刻不得安宁，这本来是少阴脏厥，是不治之证，厥阴病中本无此证。至于吐蛔，是厥阴的本证，将蛔厥与阴阳不相顺接的情况连类说明。用乌梅丸名为安蛔，实际上是安胃，并主治久泻久痢，见阴阳不相顺接、厥逆伴下利的证候，都可以用此方概括。
林澜说：阳烦轻，阴躁重。在脏厥言“躁”，在蛔厥言“烦”，已经具备了安危的差异。脏厥是阳气将脱，脏气欲绝而争，所以脏厥是死证；若蛔厥，则是脏气虚寒，但未至于绝。脏气寒，则蛔不安居其位而妄动；脏气虚，则蛔求食而出，所以其证必定吐蛔。
乌梅丸方
乌梅（三百枚） 细辛（六两） 干姜（十两） 黄连（十六两） 当归（四两） 附子（去皮，炮制，六两）
蜀椒（出汗，四两） 桂枝（六两） 人参（六两） 黄柏（六两）
以上十味药，分别捣碎过筛，混合均匀。用醋浸泡乌梅一夜，去核，放在五升米下蒸熟。饭熟后捣成泥状，与药末混合均匀，放入臼中，加入蜂蜜，杵捣两千下，制成梧桐子大小的丸药。饭前用温水送服十丸，每日三次，逐渐增加至二十丸。禁忌生冷、滑腻、腐败变质等食物。
【集解】柯琴说：六经中唯独厥阴难治。其本质为阴，标象为热，体属木，用属火。必须伏其所主，先究其因，或用收敛，或用发散，或用逆治，或用从治，随其适宜而行，调和中气，使之平和，这就是治疗厥阴的方法。厥阴处于两阴交尽之时，又名阴之绝阳，按理不应有热。但其符合晦朔交替之理，阴之初尽，即阳之初生，所以厥阴病热，是少阳相火所致。火旺则水亏，所以消渴，气上冲心，心中疼痛灼热。气有余便是火。木盛则生风，虫由风化而生。饥饿时胃中空虚，蛔虫闻到食物气味而出，所以吐蛔，虽然饥饿却不想吃东西。仲景立方，多以辛甘苦味为君药，不用酸收之品，而此处用酸收，是因为厥阴主肝木的缘故！《洪范》说：木曰曲直，作酸。《内经》说：木生酸，酸入肝。以乌梅之大酸为君，是伏其所主。配伍黄连泻心火以除疼痛，佐黄柏滋肾水以除口渴，是先究其因。黄连、黄柏治疗厥阴阳邪则有余，不足以治阴邪。花椒、附子、细辛、干姜等大辛之品并举，不但治疗厥阴阴邪，而且肝喜疏散，以辛散之。又加桂枝、当归，是补肝脏之血，求其所属。寒热杂用，则气味不和，佐以人参，调其中气。用醋浸泡乌梅，同气相求；在米下蒸，资助谷气。加蜜为丸，少量开始逐渐增加，缓则治其本。蛔，是昆虫。生冷之物与湿热之气相成，所以药物也寒热互用。且胸中烦闷而吐蛔，则黄连、黄柏是寒因热用。蛔得酸则静，得辛则伏，得苦则下，确实是治虫良剂。久泻久痢则虚，调和其寒热，用酸以收敛，下利自然停止。
伤寒六七天，脉象微弱，手足厥冷，烦躁，灸治厥阴经穴位。如果厥逆不还复的，预后不良，主死。
【注】此条详细申述厥阴脏厥的重证。伤寒六七天，脉微，手足厥冷，烦躁，这是厥阴阴邪的重病。如果不尽早图谋，采取阴消阳长的策略，必然导致阴气日益强盛，厥冷日渐加深，烦躁日渐严重，即使使用吴茱萸、附子、四逆汤等，恐怕缓不济急，只当灸治厥阴经以通达阳气。如果手足厥冷，过时不回，说明阳气已亡，所以主死。
程知说：六七天，是邪气传入厥阴的时候。脉微而厥，还不是危证，危在烦躁，是微弱的阳气外露。
程应旄说：脉微、厥冷而烦躁，就是前条中所引用的脏厥证候，六七日前是没有这个证的。
汪琥说：烦躁，是阳虚而抗争，是脏中的真阳欲脱，神气为之浮越，所以故作烦躁。可以灸太冲穴，因为太冲穴是足厥阴经脉的气所注之处。穴位在足大趾后二寸或一寸半的凹陷处，可灸三壮。
手足厥寒，脉象细微似有若无的，用当归四逆汤主治。如果其人内有久寒的，宜用当归四逆加吴茱萸生姜汤。
【注】此条详细申述厥阴脏厥的轻证。手足厥寒，脉细欲绝，是厥阴阴邪寒化的脉证，然而并不像全身皮肤寒冷，也不像躁动不安片刻不得休息，这就不是阳虚阴盛的同类，所以不用干姜、附子之类，而用当归四逆汤，调和厥阴以散寒邪，调和营卫以通阳气。如果其人内有久寒的，宜用当归四逆汤，加吴茱萸、生姜，以直达厥阴，温而散之。
【集注】程知说：不用姜、附的原因，是因为证候无下利，不属于纯阴寒证。大概脉细欲绝的人，姜、附足以劫夺其阴，所以不仅不轻用攻下，也不轻用温燥。
郑重光说：手足厥冷，脉细欲绝，是厥阴伤寒的外证；当归四逆汤，是厥阴伤寒的表药。
当归四逆汤方
当归（三两） 桂枝（三两） 芍药（三两） 细辛（三两） 通草（二两） 甘草（炙，二两） 大枣（掰开，二十五枚）
以上七味药，用水八升，煮取三升，去渣，温服一升，每日三次。
当归四逆加吴茱萸生姜汤方
在前方的基础上加吴茱萸半升、生姜三两。
以上九味药，用水六升、清酒六升混合，煮取五升，去渣，分五次温服。一方用水酒各四升。
【方解】凡厥阴病，必然脉细而厥。因为厥阴是三阴之尽，阴尽阳生，若受邪则阴阳之气不相顺接，所以脉细而厥。然而相火寄居于厥阴之脏，经脉虽寒而脏不寒，所以先厥逆者后来必然发热。所以伤寒初起，见到手足厥冷，脉细欲绝者，都不可立即认为是虚寒而用干姜、附子。此方取桂枝汤之意，以当归为君药，因为厥阴主肝，肝为血室；佐以细辛，味道极辛，能通达三阴，外温经脉而内温脏腑；通草性质极通利，能利关节，内通窍道而外通营气；倍加大枣，即建中汤加饴糖用甘缓之法；减去生姜，恐辛散太过而迅疾耗散。肝的志趣苦于拘急，肝的神气欲求疏散，甘辛并举，则志遂而神悦，未有厥阴神志遂悦，而脉细不出、手足不温的。不需要人参、茯苓的补益，不用干姜、附子的峻烈，因为厥阴厥逆与太阴、少阴的治疗不同。如果其人内有久寒，非辛温甘缓之品所能兼治，则加吴茱萸、生姜的辛热，更用酒煎，佐细辛直通厥阴之脏，迅散内外之寒，这又是救治厥阴内外两伤于寒的方法。
病人手足厥冷，自称没有结胸证，小腹满，按压疼痛的，这是冷结在膀胱关元部位。
【注】此条申述上一条，详细指出其证候。经文说：第六天厥阴受邪。厥阴经脉循行经过阴器，联络于肝，所以会出现烦闷、囊缩。邪气传入厥阴，其人本来就有热，必然从阳化热，则出现烦渴、少腹满而囊缩，这是四逆散、承气汤的证候。如果其人本来就有寒，必然从阴化寒，则出现手足厥冷、少腹满而囊缩，这是当归四逆加吴茱萸汤的证候。现在病人手足厥冷，自称没有结胸证，是说大腹不满，而只是小
Jueyin is the zang organ where yin energy ends and yang energy begins, and it has a exterior-interior relationship with Shaoyang. Therefore, when pathogenic factors invade this meridian, there is a mixture of yin and yang, and a confusion of cold and heat. The transformation of the pathogen varies according to the individual's constitution. If the person's constitution is predisposed to heat, the pathogen transforms along the yang aspect, resulting in yang syndromes such as Xiao Ke (excessive thirst), Qi Shang Zhuang Xin (qi rushing up to strike the heart), Zhong Xin Teng Re (pain and burning sensation in the chest/heart region), Hui Jue (roundworm-induced cold extremities), oral ulcers, sore throat, Hou Bi (obstruction of the throat), abscesses and pus, and hematochezia. If the person's constitution is predisposed to cold, the pathogen transforms along the yin aspect, resulting in yin syndromes such as cold extremities, faint pulse nearly imperceptible, cold skin, Zang Jue (cold extremities due to internal organ failure), diarrhea, and Chu Zhong (sudden increase in appetite in critical illness). Thus, if Shaoyang disease does not resolve and transmits to Jueyin, the condition becomes critical; if Jueyin disease declines and transfers to Shaoyang, recovery is imminent. Within the waxing and waning of yin and yang lies great crisis. Here, based on the principles of yin-yang transformation and the alternating recurrence of cold and heat (Jue Re Sheng Fu), we elaborate on these subtle meanings in this chapter, so that clinicians may have essential guidelines for diagnosis and treatment.
The general outline of Jueyin disease includes: Xiao Ke (excessive thirst), Qi Shang Zhuang Xin (qi rushing up to strike the heart), Zhong Xin Teng Re (pain and burning sensation in the chest/heart region), hunger without desire to eat, vomiting roundworms after eating, and if purgatives are misused, unremitting diarrhea.
[Annotation] This clause summarizes the general outline of Jueyin disease. Jueyin is the organ where yin ends and yang begins. When pathogens enter its meridian, they transform into cold following yin or into heat following yang, resulting in a mixture of yin and yang and a confusion of cold and heat. "Xiao Ke" refers to drinking much water but producing little urine, caused by the consumption of fluids due to heat transformation in Jueyin. The Jueyin meridian originates at the big toe, runs along the inner thigh, enters the genital region, circles the genitals, reaches the lower abdomen, pierces the diaphragm, and connects to the heart. If heat pathogens follow the meridian and reverse upward to the diaphragm, qi rushes up to strike the heart, causing pain and burning in the chest. "Hunger without desire to eat" does not mean no desire to eat, but rather that eating triggers roundworms and causes vomiting, so although hungry, one does not wish to eat, and eating results in vomiting roundworms. Since Xiao Ke involves excessive drinking and hunger prevents eating, what remains in the stomach is only water and heat! If one mistakenly treats the pain caused by heat and roundworms as excess pain of Yangming transmission and uses purgatives, the stomach qi will become more deficient, inevitably leading to unremitting diarrhea.
[Collected Annotations] Cheng Wuji said: Pathogens transmitting from Taiyang to Taiyin cause abdominal fullness and dry throat, but not yet thirst; reaching Shaoyin causes dry mouth and tongue with thirst, but not yet Xiao Ke; reaching Jueyin results in Xiao Ke because the pathogenic force is strong enough to consume water. Zhang Qingzi also stated: I have seen cases of Jueyin Xiao Ke where the tongue was entirely red, extremities were cold, pulse was faint, and thirst was severe. Treatments with Baihu Tang or Huanglian Tang failed to save them. This is because Jueyin Xiao Ke involves mixed cold and heat pathogens, which cannot be compared to pure yang hyperactivity heat syndromes.
Wei Litong said: This further explains the harm of heat pathogens transmitted through meridians to Jueyin, listing symptoms to prohibit the misuse of purgatives. Cold pathogens transmitted to Shaoyin affect the interior of the interior; transmitting from Shaoyin to Jueyin reaches the extreme end of the three Yin meridians. At this point of yin exhaustion, there is nowhere else to transmit, so it shares an exit pathway with Shaoyang for ascending and descending. Shaoyang disease has no purgative method, and neither does Jueyin disease with yin pathogens; thus, using purgatives is clearly erroneous. Marking "Xiao Ke" first implies that while all heat causes thirst, cold-dampness obstructing righteous qi can also cause thirst, but such thirst involves wanting to drink but unable to drink much. It would not present as drinking, immediately consuming, and becoming thirsty again instantly. Such cases indicate heat pathogens transmitted through meridians entering Jueyin without doubt.
In Jueyin disease, if the patient desires water to drink, give it in small amounts, and the disease will resolve.
[Annotation] In Jueyin disease, the desire to drink water indicates the return of yang energy seeking harmony and self-nourishment through water, signaling recovery. One should give water in small amounts to harmonize the stomach; once the stomach is harmonized, sweating occurs, and the body recovers naturally. If given in large amounts, water will stagnate and soak into the stomach, inevitably causing cold extremities and diarrhea.
[Collected Annotations] Zhang Lu said: Yang energy is about to recover, hence the desire for water. Giving it in small amounts is because yin pathogens are just beginning to dissipate and yang energy has not fully returned; indulging in drinking without digestion leads to stagnation.
Wang Hu said: Jueyin disease features Xiao Ke, which does not mention spontaneous resolution because intense heat scorches fluids; even drinking water cannot overcome the dryness and heat, indicating deep-seated pathogens and unresolved illness. However, the "desire to drink water and resolving upon giving" in this clause differs because the heat is less severe than in Xiao Ke, representing a mechanism of pathogens moving outward to resolve. These two are distinct.
In Shanghan (Cold Damage), if there are cold extremities accompanied by palpitations in the epigastrium, one should first treat the water retention by administering Fuling Gancao Tang, and then treat the cold extremities. Otherwise, water soaking into the stomach will cause diarrhea.
[Commentary] Under "cold extremities and palpitations in the epigastrium," the phrase "due to excessive water intake" should likely exist. Without this phrase, it would be cold extremities and palpitations due to yin excess, not water retention, making it unclear why one would immediately know it is water and advise treating water first.
[Annotation] In Shanghan, cold extremities with palpitations in the epigastrium, if not accompanied by thirst, indicate cold extremities and palpitations due to yin excess. If caused by excessive water intake, it indicates cold extremities and palpitations due to water retention. Therefore, one should first treat the water, then the cold extremities, using Fuling Gancao Tang, which is Guizhi Gancao Tang plus Fuling and Shengjiang. Guizhi and Gancao tonify yang deficiency; combined with Shengjiang to disperse external cold externally, cold extremities can recover. Fuling as the sovereign herb internally regulates water passages, calming palpitations. This is the treatment of treating water before cold extremities. Generally, those with water retention have difficult urination. If not treated thus, retained water soaks into the stomach, causing diarrhea.
[Commentary] In the Taiyang chapter of Shanghan Lun, sweating with unharmonized exterior and difficult urination, and this clause with unhealed exterior, cold extremities, and epigastric palpitations, both use Fuling Gancao Tang. Although manifestations differ, the interior lacks heat, the exterior is unharmonized, and water is retained in both cases. Thus, one uses it to harmonize Ying and Wei to promote urination, and the other to release the exterior and unblock yang to promote urination; both are acceptable. Although this case does not explicitly state difficult urination, the implication is present. If urination were free, water would not retain, and cold extremities/palpitations would belong to yin-cold, making exterior-releasing and diuretic methods inappropriate.
[Collected Annotations] Fang Youzhi said: *Jingui Yaolue* states: Water stagnant under the heart causes palpitations when severe; thus, palpitations indicate severe water, and cold extremities indicate severe cold. Cold is formless, water has form; removing water removes cold, and cold extremities heal. Water entering the stomach relates to water moistening earth.
Yu Chang said: In the Taiyang chapter, excessive drinking causes epigastric palpitations. Thus, cold extremities with epigastric palpitations here are clearly caused by drinking. Before water soaks into the stomach, use Fuling Gancao Tang to treat water, clearing the source of diarrhea, then treat cold extremities, preventing cold extremities and diarrhea from occurring together.
Cheng Yingmao said: Cold extremities caused by water stagnation are verified by epigastric palpitations. Jueyin disease presenting this way often stems from Xiao Ke. Water is the root, cold is the branch. Not treating water first, nor preventing water from soaking into the stomach, how dare one use purgatives?
Wang Hu said: Cold extremities with epigastric palpitations are clearly due to excessive drinking, with cold-fluid retaining under the heart. Yang qi in the chest cannot circulate freely, causing cold extremities. This differs from external cold. The method should prioritize treating water with Fuling Gancao Tang; the method for treating cold extremities is included therein. Once water is removed, cold extremities disappear. Otherwise, failing to treat water allows it to soak down into the stomach, causing diarrhea.
Wu Renju said: Qi and pulse flowing abnormally is called rebellion, named Jue (cold extremities). Jue varies by phlegm, excess, cold, heat, qi, and water; this case is due to water. Water qi not following normal paths causes cold water qi to ascend to the heart, causing palpitations. Thus, treating water removes palpitations, and cold extremities return. If not, severe water makes the earth soggy, leading to diarrhea.
In Shanghan, if the pulse is faint and extremities are cold, and after seven or eight days the skin is cold, and the patient is restless with no moment of peace, this is Zang Jue (organ cold extremities), not Hui Jue (roundworm cold extremities). Patients with Hui Jue vomit roundworms. The current patient is quiet but occasionally irritable; this is due to cold in the organs, with roundworms moving up into the diaphragm, causing irritability, which stops after a short while. Vomiting and irritability after eating occur because roundworms emerge smelling food, and the patient will likely vomit roundworms. Hui Jue is primarily treated with Wumei Wan, which also treats chronic diarrhea.
[Commentary] The character "Ci" (this) in "This is Zang Han" (this is organ cold) should be "Fei" (not). If it is "Ci," it describes Zang Jue, which contradicts the purpose of distinguishing Hui Jue.
[Annotation] The first clause generally discusses yang pathogens transforming into heat in Jueyin; this clause details yin pathogens transforming into cold to distinguish Zang Jue from Hui Jue and provide treatment. Faint pulse and cold extremities in Shanghan are Jueyin pulse/symptoms. After seven or eight days, if not resolving, with cold hands/feet and whole-body cold skin, and restlessness with no peace, this is Zang Jue due to yang deficiency and yin excess in Jueyin, not the mixed yin-yang Hui Jue. If Hui Jue, the patient vomits roundworms. The current patient is quiet but occasionally irritable, unlike the constant restlessness of Zang Jue, indicating this is not restlessness from organ cold but roundworms disturbing the diaphragm, hence intermittent irritability. Eating causes vomiting and irritability because roundworms move due to food smell, leading to vomiting and expulsion of roundworms. Hui Jue is treated with Wumei Wan, which also treats chronic diarrhea, because the medicine's sour, bitter, pungent, and warm properties, combining cold and heat, resolve mixed yin-yang and confused cold-heat pathogens. Zang Jue is treated with Wuzhuyu Tang; if involving Shaoyin, Sini Tang, Tongmai Sini Tang, or Fuzi Tang are used. Clinicians should choose appropriately.
[Collected Annotations] Fang Youzhi said: Faint pulse and cold extremities are general statements. Cold skin indicates not just hands/feet but internal sinking of yang. Zang Jue indicates disease in organs, not meridians.
Yu Chang said: Faint pulse and cold extremities indicate declining yang, but do not confirm Zang or Hui Jue. Only cold skin with restlessness and no peace confirms Zang Jue. Zang Jue uses Sini Tang and moxibustion; if extremities do not warm, death ensues. Hui Jue presents with intermittent cold extremities and irritability, not a death sign, but if it progresses to stomach yang depletion, death occurs.
Cheng Zhi said: Discussing Jue, there is a distinction between Zang and Hui Jue. Zang Jue is kidney yang failing to function; Hui Jue is hand/foot cold with vomiting roundworms, indicating stomach yang failing to function. In Hui Jue, roundworm movement causes irritability with quiet periods, unlike Zang Jue's constant restlessness. This is a stomach yang issue unrelated to kidney yang; thus, although both have Jue, symptoms differ.
Cheng Yingmao said: Faint pulse and cold extremities are images of pure yin, evident in the pulse; cold skin after seven/eight days is an image of no yang, evident in the body. Extreme yin causes restlessness with no peace; this is originally Shaoyin Zang Jue, an untreatable syndrome, not inherent to Jueyin. Vomiting roundworms is a primary Jueyin symptom; linking Hui Jue clarifies conditions where yin and yang fail to connect smoothly. Using Wumei Wan to "calm roundworms" actually calms the stomach. Treating chronic diarrhea shows that mixed yin-yang, non-connecting jiang-yang, Jue, and diarrhea can all be covered by this formula.
Lin Lan said: Yang irritability is mild, yin restlessness is severe. Mentioning "restlessness" for Zang Jue and "irritability" for Hui Jue already indicates differences in safety and danger. Zang Jue is impending yang collapse and organ qi exhaustion with struggle, making it a fatal syndrome. Hui Jue is organ qi deficiency and cold, but not exhausted. Cold organ qi makes roundworms restless; deficient organ qi makes roundworms seek food, hence vomiting roundworms.
Wumei Wan Formula
Wumei (300 fruits) Xixin (6 liang) Ganjiang (10 liang) Huanglian (16 liang) Danggui (4 liang) Fuzi (peeled, processed, 6 liang)
Shujiao (sweating out oil, 4 liang) Guizhi (6 liang) Renshen (6 liang) Huangbai (6 liang)
These ten ingredients are separately pounded and sifted, then mixed. Soak Wumei in vinegar overnight, remove pits, steam over five sheng of rice until cooked. Pound rice into paste, mix with herbs, place in mortar, add honey, pound two thousand times, form pills like paulownia seeds. Take ten pills before meals with warm water, three times daily, gradually increasing to twenty pills. Avoid raw/cold, slippery, and foul-smelling foods.
[Collected Commentary] Ke Qin said: Among the six meridians, Jueyin is hardest to treat. Its root is yin, branch is heat, body is wood, function is fire. One must subdue its主宰 (dominance) and address its cause, using astringents, dispersants, counter-treatment, or following-treatment as appropriate, harmonizing middle qi to achieve balance. This is the method for treating Jueyin. Jueyin represents the end of two yins, also called "extreme yin of yang," theoretically lacking heat. However, following the logic of new moon/full moon, the end of yin is the beginning of yang, so Jueyin heat is caused by Shaoyang. Fire prosperity depletes water, causing Xiao Ke, Qi Shang Zhuang Xin, and Zhong Xin Teng Re. Excess qi becomes fire. Wood prosperity generates wind, and insects arise from wind transformation. Hunger empties the stomach, roundworms smell food and emerge, causing vomiting; though hungry, one does not wish to eat. Zhang Zhongjing's formulas usually use pungent, sweet, and bitter flavors as sovereigns, avoiding sour astringents. Here, sour astringents are used because Jueyin governs Liver Wood. *Hongfan* states: Wood is bending/straightening, producing sour. *Neijing* states: Wood generates sour, sour enters Liver. Using Wumei's great sourness as sovereign subdues its dominance. Pairing Huanglian clears heart heat to relieve pain; assisting Huangbai nourishes kidney water to relieve thirst addresses the cause. Lian and Bai treat Jueyang pathogens but are insufficient for yin pathogens. Shujiao, Fuzi, Xixin, Ganjiang are great pungents, treating Jueyin yin pathogens and dispersing liver qi (liver desires dispersion). Adding Guizhi and Danggui nourishes liver blood, seeking its association. Mixing cold and heat creates disharmony; assisting Renshen harmonizes middle qi. Soaking Wumei in vinegar seeks similar qi; steaming with rice provides grain qi. Adding honey for pills, starting small and increasing gradually, treats the root slowly. Roundworms are insects. Raw/cold items and damp-heat interact, so medicines combine cold and heat. Chest irritability and vomiting roundworms imply Huanglian/Huangbai are cold used for heat. Roundworms calm with sour, subside with pungent, descend with bitter; truly a good remedy for parasites. Chronic diarrhea causes deficiency; harmonizing cold/heat and astringing with sour stops diarrhea.
In Shanghan, six or seven days later, faint pulse, cold hands/feet, irritability, moxa Jueyin meridians. If cold extremities do not return, death ensues.
[Annotation] This clause elaborates on severe Zang Jue in Jueyin. Six or seven days into Shanghan, faint pulse, cold hands/feet, irritability indicate severe Jueyin yin pathology. If not addressed early to promote yin decline and yang growth, yin qi will grow stronger, cold extremities deepen, and irritability worsens. Even using Wuzhuyu, Fuzi, or Sini Tangs may be too slow. Moxa Jueyin meridians to unblock yang is necessary. If cold extremities persist beyond time, yang is lost, hence death.
[Collected Annotations] Fang Youzhi said: Moxa unblocks yang; if yang does not return, death is indicated.
Cheng Zhi said: Six or seven days is when pathogens transmit to Jueyin. Faint pulse and cold extremities are not critical; the danger lies in irritability, showing exposed weak yang.
Cheng Yingmao said: Faint pulse, cold extremities, and irritability refer to the Zang Jue syndrome mentioned earlier, which did not exist in the first six/seven days.
Wang Hu said: Irritability indicates yang deficiency struggling, true yang in organs about to escape, spirit floating, causing irritability. One may moxa Taichong acupoint, as it is the well-spring point of Foot Jueyin. Located two cun or one-and-a-half cun behind the big toe in the depression, moxa three cones.
Cold hands and feet with fine pulse nearly imperceptible are primarily treated with Danggui Sini Tang. If the person has long-standing internal cold, Danggui Sini Tang plus Wuzhuyu and Shengjiang is suitable.
[Annotation] This clause details mild Zang Jue in Jueyin. Cold hands/feet and fine pulse nearly imperceptible are Jueyin yin-pathogen cold transformation signs. However, unlike whole-body cold skin or constant restlessness, this is not yang deficiency with yin excess, so Jiang/Fu are not used. Instead, Danggui Sini Tang harmonizes Jueyin to dispel cold and regulates Ying/Wei to unblock yang. If long-standing internal cold exists, add Wuzhuyu and Shengjiang to Danggui Sini Tang to directly target Jueyin and warm/disperse.
[Collected Annotations] Cheng Zhi said: Jiang/Fu are not used because there is no diarrhea, so it is not pure yin. For those with fine pulses nearly imperceptible, Jiang/Fu could damage yin; thus, purgatives and warming agents are used cautiously.
Zheng Zhongguang said: Cold hands/feet and fine pulse nearly imperceptible are exterior signs of Jueyin Shanghan; Danggui Sini Tang is the exterior medicine for Jueyin Shanghan.
Danggui Sini Tang Formula
Danggui (3 liang) Guizhi (3 liang) Shaoyao (3 liang) Xixin (3 liang) Tongcao (2 liang) Gancao (roasted, 2 liang) Dazao (split, 25 pieces)
Seven ingredients boiled in eight sheng water to three sheng, strain, take one sheng warm, three times daily.
Danggui Sini Tang Plus Wuzhuyu and Shengjiang Formula
Add Wuzhuyu half sheng and Shengjiang three liang to the above formula.
Nine ingredients boiled in six sheng water and six sheng clear wine to five sheng, strain, divide into five warm doses. Another prescription uses four sheng each of water and wine.
[Formula Explanation] All Jueyin diseases feature fine pulse and cold extremities. Jueyin is the end of three yins, yin ending and yang beginning; pathogen invasion causes yin/yang qi to fail connecting, resulting in fine pulse and cold extremities. However, Ministerial Fire resides in Jueyin organs; although meridians are cold, organs are not, so initial cold extremities are followed by fever. Thus, early Shanghan with cold extremities and fine pulse should not be immediately diagnosed as deficiency-cold requiring Jiang/Fu. This formula takes Guizhi Tang as base, with Danggui as sovereign because Jueyin governs Liver, the house of blood; Xixin assists, extremely pungent, penetrating three yins, warming meridians externally and organs internally; Tongcao is extremely unblocking, benefiting joints, opening orifices internally and unblocking Ying externally; doubling Dazao follows the method of Jianzhong Tang adding Yitang for sweetness; reducing Shengjiang avoids excessive pungency and rapid dispersion. Liver dislikes urgency and desires dispersion; combining sweet and pungent satisfies will and pleases spirit. It is unlikely that with satisfied Jueyin spirit/will, pulse remains fine and extremities remain cold. Ginseng/Atractylodes tonification is unnecessary; Ginger/Aconite harshness is avoided because Jueyin Jue differs from Taiyin/Shaoyin treatment. If long-standing internal cold exists, mild pungent-sweet-slow agents cannot treat it alone; adding pungent-hot Wuzhuyu/Shengjiang and decocting with wine, assisting Xixin to directly penetrate Jueyin organs and rapidly disperse internal/external cold, is the method for saving Jueyin from dual cold injury.
Patients with cold extremities who state they do not have Jie Xiong (chest binding syndrome), but have lower abdominal fullness and tenderness on pressure, have cold accumulation in the Bladder Guan Yuan area.
[Annotation] This clause elaborates on the previous section's symptoms. Classic text states: On the sixth day, Jueyin receives pathogen. Jueyin meridian circles genitalia and connects to Liver, causing irritability, fullness, and testicular retraction. Transmitting to Jueyin, if the person has inherent heat, it transforms along yang, causing irritability/thirst, lower abdominal fullness, and testicular retraction, indicating Sini San or Chengqi Tang syndromes. If the person has inherent cold, it transforms along yin, causing cold extremities, lower abdominal fullness, and testicular retraction, indicating Danggui Sini Tang plus Wuzhuyu Tang syndromes. Now, the patient has cold extremities, denies Jie Xiong (meaning no upper abdominal fullness, only lower abdominal fullness... [text cuts off])