张璐曰∶躁不得卧，肾中阳气越绝之象也。大抵下利而手足厥冷者，皆为危候，以四肢为诸阳之本故也。
加以发热躁不得卧，不但虚阳发露，而真阴亦已消尽无余矣，安得不死乎？
呕而脉弱，小便复利，身有微热，见厥者，难治，四逆汤主之。
【注】厥阴呕而脉弱，大便多利，今小便复利，虽身有微热，而又见厥冷，是邪既上逆，而下焦虚寒不固，
为阴进阳退之象，故为难治。以四逆汤主之者，急壮其阳也，阳回则可望生矣。
【集注】方有执曰∶脉弱虽似邪衰，而小便复利，则是里属虚寒也。故曰∶见厥者难治。以身之有微热，
故虽厥犹可以四逆汤救其阳，使之复也。
程知曰∶言呕而厥者，宜温其下也。呕者，邪气上逆也。脉弱小便利，虚寒见于下也。身有微热，当为阳
邪在表，然见厥逆，则为阴盛于里，而微阳有不能自存之忧也。
汪琥曰∶按诸条厥利证，皆大便利。此条以呕为主病，独小便利而见厥，前后不能关锁，用四逆汤以附子
散寒，下逆气，助命门之火，上以除呕，下以止小便，外以回厥逆也。
干呕吐涎沫，头痛者，吴茱萸汤主之。
【注】太阴有吐食而无呕也；少阴有欲吐不吐，咳而呕也；厥阴之厥而呕，呕而吐蛔也。今干呕者，有声
无物之谓也；吐涎沫者，清涎冷沫随呕而出也，此由厥阴之寒，上干于胃也。三阳有头痛，必兼身热，至于太
阴、少阴二经，皆无头痛。惟厥阴与督脉会于巅，故有头痛而无身热也。此少阳不解，传入厥阴，阴邪上逆，
故呕而头痛也。以吴茱萸汤主之，从厥阴本治也。
【集注】程知曰∶此言呕而头痛者，宜温中而降逆也。
张锡驹曰∶呕者，有声有物者也；吐者，吐出其物也。故有干呕，而无干吐。今干呕吐涎沫者，涎沫随呕
而吐出也。
呕家有痈脓者，不可治呕，脓尽自愈。
【注】心烦而呕者，内热之呕也；渴而饮水呕者，停水之呕也。今呕而有脓者，此必内有痈脓，故曰不可
治，但俟呕脓尽自愈也。盖痈脓腐秽欲去而呕，故不当治。若治其呕，反逆其机，热邪内壅，阻其出路，使无
所泄，必致他变，故不可治呕，脓尽则热随脓去，而呕自止矣。
【集注】汪琥曰∶肺胃成痈，由风寒蕴于
经络，邪郁于肺，或入胃腑，变而为热，热甚则气瘀血积而为痈。痈者，壅也，言热毒壅聚而成脓也。
郑重光曰∶邪热上逆，结为内痈，肺胃之痈是也。
厥阴中风，脉微浮，为欲愈，不浮为未愈。
【注】厥阴中风，该伤寒而言也。脉微，厥阴脉也。浮，表阳脉也。厥阴之病，既得阳浮之脉，是其邪已
还于表，故为欲愈也。不浮则沉。沉，里阴脉也。是其邪仍在于里，故为未愈也。
【集注】成无己曰∶脉浮，为邪气还表作汗之兆，故云∶欲愈。不浮则邪气深入，正多变证，故云∶未愈。
方有执曰∶风脉当浮，以厥阴本微缓不浮，故微浮则邪见还表，为欲愈也。
厥阴病欲解时，从丑至卯上。
【注】丑、寅、卯三时，厥阴风木乘旺之时也。正气得其旺，则邪自退，故病解。
【集注】方有执曰∶厥阴之解，自寅卯而终；少阳之解，自寅卯而始。盖寅为阳初动，阴尚强，卯为天
地辟，阴阳分，所以二经同旺，其病之解，由此而终始也。
张璐说：烦躁不安且无法躺卧，是肾中阳气外越脱失的征象。一般来说，腹泻并伴有手足厥冷的情况，都属于危重证候，因为四肢是诸阳经的根本所在。
如果再加上发热、烦躁且无法躺卧，这不仅表明虚阳外露，而且真阴也已经消耗殆尽，怎么能不死亡呢？
呕吐且脉象微弱，小便反而清长，身体有轻微发热，出现手足厥冷的，属于难治之证，用四逆汤主治。
【注】厥阴病见呕吐且脉象微弱，通常大便多泄利，现在小便反而清长，虽然身体有轻微发热，却又出现手足厥冷，这是邪气上逆，而下焦虚寒不能固摄的表现，属于阴气进逼、阳气退却的征象，所以说是难治。使用四逆汤主治，是为了紧急温壮阳气，阳气回复则有望生存。
【集注】方有执说：脉象微弱似乎表示邪气衰退，但小便清长，说明体内属于虚寒。所以说：出现手足厥冷的属于难治。因为身体有轻微发热，所以虽然手足厥冷，还可以用四逆汤挽救其阳气，使其恢复。
程知说：这里说的是呕吐且手足厥冷的，适宜温补下焦。呕吐，是邪气上逆所致。脉象弱小且小便通利，说明虚寒表现在下部。身体有轻微发热，应当认为是阳邪在表，然而出现手足厥逆，则是阴盛于里，微弱的阳气有不能自存的忧虑。
汪琥说：考察各条关于厥逆和泄利的证候，都是大便泄利严重。这一条以呕吐为主要病症，唯独小便通利且出现手足厥冷，前后二便都不能关锁固摄，使用四逆汤，其中附子散寒，降逆气，助命门之火，向上以消除呕吐，向下以止住小便（注：此处指通过温阳固摄来改善下焦不固导致的遗溺或清长，原文语境侧重温阳固本），向外以回阳救逆纠正手足厥冷。
【注】太阴病有吐食而无呕吐的声音；少阴病有想吐又吐不出来，咳嗽且呕吐的情况；厥阴病的厥逆伴呕吐，是呕吐并吐出蛔虫。现在的干呕，是指有声音但没有实物吐出；吐涎沫，是指清稀冰冷的涎沫随着呕吐而出，这是由于厥阴的寒邪上犯胃腑所致。三阳经的头痛，必定兼有身体发热，至于太阴、少阴两经，都没有头痛。只有厥阴经与督脉会合于头顶，所以会有头痛而没有身体发热。这是少阳病未解，传入厥阴，阴邪上逆，所以呕吐且头痛。用吴茱萸汤主治，是从厥阴本经进行治疗。
【集注】程知说：这里说的是呕吐且头痛的，适宜温中焦而降逆气。
张锡驹说：呕吐，是有声音也有实物吐出；吐，是将物吐出。所以有干呕，而没有干吐。现在的干呕并吐出涎沫，是指涎沫随着呕吐的动作而吐出。
【注】心烦且呕吐的，是内热引起的呕吐；口渴且饮水后呕吐的，是水饮停聚引起的呕吐。现在呕吐且带有脓液的，这必定是体内有痈脓，所以说不可治疗呕吐，只需等待呕吐出脓液排尽后自然痊愈。大概是因为痈脓腐败秽浊之物欲排出体外而引发呕吐，所以不应当治疗呕吐。如果治疗呕吐，反而违背了机体排邪的机理，导致热邪内壅，阻碍其出路，使邪气无处宣泄，必然导致其他变证，所以不可治疗呕吐，待脓液排尽则热邪随脓液而去，呕吐自然停止。
【集注】汪琥说：肺或胃形成痈脓，是由于风寒蕴结于经络，邪气郁滞于肺，或者进入胃腑，化热而成，热势炽盛则气滞血瘀积聚而形成痈。痈，就是壅塞的意思，指热毒壅聚而成脓。
厥阴病感受风邪，脉象微微浮起，是即将痊愈的征兆，如果不浮，则是尚未痊愈。
【注】厥阴中风，这里泛指伤寒类疾病。脉象微弱，是厥阴经的脉象特征。浮，是表阳经的脉象特征。厥阴的病，既然出现了阳浮的脉象，说明邪气已经回归到体表，所以说是即将痊愈。如果不浮，则脉沉。沉，是里阴经的脉象特征。说明邪气仍然停留在体内，所以说是尚未痊愈。
【集注】成无己说：脉浮，是邪气回归体表作汗出的征兆，所以说：即将痊愈。如果不浮，则邪气深入，正气多变生他证，所以说：尚未痊愈。
方有执说：风邪致病脉象当浮，由于厥阴本脉微缓而不浮，所以脉象微微浮起，表示邪气见还于表，是即将痊愈的征兆。
厥阴病欲解除的时间，从丑时到卯时这段时间。
【注】丑、寅、卯三个时辰，是厥阴风木之气旺盛的时候。正气得到旺盛的支持，邪气自然消退，所以病愈。
【集注】方有执说：厥阴病的解除，从寅时、卯时开始直至结束；少阳病的解除，也是从寅时、卯时开始。因为寅时是阳气初动之时，阴气尚强；卯时是天地开辟、阴阳分离之时，所以这两经在此时同旺，它们的病愈过程，由此而始末相连。
Zhang Lu stated: Restlessness and inability to lie down are signs of the floating away and exhaustion of Yang Qi in the Kidney. Generally speaking, diarrhea accompanied by cold extremities indicates a critical condition, as the four limbs are the root of all Yang meridians.
If fever, restlessness, and inability to lie down are added, not only does deficient Yang expose itself, but True Yin has also been completely consumed. How can death be avoided?
Vomiting with a weak pulse, frequent clear urination, slight body heat, and the presence of cold extremities indicate a difficult-to-treat condition; Sini Tang (Four Reversal Decoction) is the primary prescription.
[Annotation] In Jueyin disease, vomiting with a weak pulse usually involves frequent loose stools. Now, with frequent clear urination, slight body heat, yet the presence of cold extremities, this signifies that pathogenic factors are reversing upward while the lower Jiao suffers from deficiency-cold and failure to secure. This represents an advance of Yin and retreat of Yang, hence it is difficult to treat. The use of Sini Tang aims to urgently strengthen Yang; once Yang returns, survival is possible.
[Collected Annotations] Fang Youzhi said: Although a weak pulse seems to indicate declining pathogens, frequent clear urination indicates interior deficiency-cold. Hence it is said: the presence of cold extremities makes it difficult to treat. Because there is slight body heat, even with cold extremities, Sini Tang can be used to rescue Yang and restore it.
Cheng Zhi said: This discusses vomiting with cold extremities, which should be treated by warming the lower Jiao. Vomiting is caused by pathogenic reversal upward. A weak pulse and free urination indicate deficiency-cold manifesting in the lower part. Slight body heat suggests Yang pathogens in the exterior; however, the presence of cold extremities indicates Yin excess in the interior, causing concern that the slight Yang cannot sustain itself.
Wang Hu said: Examining various syndromes of cold extremities and diarrhea, they all involve severe loose stools. This clause focuses on vomiting as the main pathology, with unique clear urination and cold extremities, indicating that both upper and lower orifices fail to lock and secure. Sini Tang is used; Fuzi (Aconiti Lateralis Radix Praeparata) disperses cold, directs rebellious Qi downward, and assists the Fire of the Gate of Vitality (Mingmen). It eliminates vomiting above, secures urination below, and restores Yang to reverse cold extremities outside.
Dry retching with expulsion of saliva and froth, accompanied by headache, is primarily treated with Wuzhuyu Tang (Evodiae Fructus Decoction).
[Annotation] Taiyin disease involves vomiting food without the sound of retching; Shaoyin disease involves the desire to vomit without success, coughing, and vomiting; Jueyin disease involving cold extremities and vomiting involves vomiting roundworms. Dry retching here refers to having sound but no substance expelled; expelling saliva and froth means clear, cold saliva and froth are expelled with the retching. This is caused by Cold of the Jueyin meridian invading the Stomach. Headache in the Three Yang meridians is always accompanied by fever. Neither Taiyin nor Shaoyin meridians typically present with headache. Only the Jueyin meridian meets the Du Meridian at the vertex, thus presenting with headache but without fever. This occurs when Shaoyang disease remains unresolved and transmits to Jueyin; Yin pathogens reverse upward, causing vomiting and headache. Wuzhuyu Tang is used to treat the Jueyin root directly.
[Collected Annotations] Cheng Zhi said: This discusses vomiting with headache, which should be treated by warming the Middle Jiao and descending rebellious Qi.
Zhang Xiju said: Vomiting involves both sound and substance being expelled; "Tu" (vomiting/expelling) refers to expelling the substance. Thus, there is dry retching, but no "dry vomiting." Here, dry retching with expulsion of saliva and froth means the froth is expelled along with the retching action.
In cases of vomiting accompanied by abscess pus, one should not treat the vomiting directly; once the pus is exhausted, it will heal spontaneously.
[Annotation] Vomiting with mental restlessness is due to internal heat; vomiting after drinking water due to thirst is due to retained fluids. Now, vomiting with pus indicates an internal abscess. Therefore, it is said that treating the vomiting is contraindicated; one should wait for the pus to be vomited out completely for spontaneous healing. Since the putrid and foul matter of the abscess desires to exit via vomiting, treating the vomiting would go against this mechanism, causing heat pathogens to stagnate internally, blocking the exit route, preventing discharge, and inevitably leading to other complications. Thus, treating the vomiting is contraindicated; once the pus is gone, the heat leaves with it, and vomiting stops naturally.
[Collected Annotations] Wang Hu said: Lung or stomach abscesses arise when Wind-Cold accumulates in the meridians, pathogens stagnate in the Lung, or enter the Stomach organ, transforming into heat. Excessive heat causes Qi stagnation and blood accumulation, forming an abscess. "Abscess" (Yong) means blockage, referring to the accumulation of heat toxins forming pus.
Zheng Zhongguang said: Pathogenic heat reverses upward and knots to form internal abscesses, specifically lung and stomach abscesses.
In Jueyin disease contracted from Wind, a slightly floating pulse indicates impending recovery; if not floating, recovery has not yet occurred.
[Annotation] "Jueyin Zhong Feng" (Jueyin contracting Wind) here refers generally to Shanghan (Cold Damage) diseases. A weak pulse is characteristic of the Jueyin meridian; a floating pulse is characteristic of the Exterior-Yang meridians. If a Jueyin disease presents with a Yang-floating pulse, it indicates the pathogen has returned to the exterior, signifying impending recovery. If not floating, the pulse is deep. A deep pulse is characteristic of Interior-Yin; this indicates the pathogen remains in the interior, signifying non-recovery.
[Collected Annotations] Cheng Wuji said: A floating pulse is a sign that pathogens return to the exterior to sweat out, hence "impending recovery." If not floating, pathogens have penetrated deeply, and Zheng Qi may generate many variations, hence "not recovered."
Fang Youzhi said: Wind pathogens typically present with a floating pulse. Since the Jueyin baseline pulse is slightly slow and not floating, a slightly floating pulse indicates pathogens returning to the exterior, signifying impending recovery.
The time when Jueyin disease tends to resolve is from Chou hour to Mao hour.
[Annotation] The hours of Chou, Yin, and Mao are when the Wind-Wood Qi of Jueyin is prosperous. When Zheng Qi obtains this prosperity, pathogens recede naturally, leading to resolution.
[Collected Annotations] Fang Youzhi said: The resolution of Jueyin begins from Yin and Mao hours and ends there; the resolution of Shaoyang also begins from Yin and Mao hours. Yin hour is when Yang first moves while Yin is still strong; Mao hour is when Heaven and Earth open and Yin and Yang separate. Thus, these two meridians are prosperous simultaneously, and their resolution processes begin and end during this period.