【秀按】传经热邪。一到少阴。经中之阴液先伤。往往邪未除而阴已竭。故死者多。生者少。况加以各经兼
证。其人尚有生理乎。惟辨证之际。却有二种要诀。一辨其人真阳素虚者。阴寒为本。邪多挟水而动。其证为
呕为咳。为魄汗淋漓。为腹痛下利。此少阴阴胜而胃阳亏负也。法当补火培土以御其水。固不待言。即在太阳
中见证。发表药中。早宜加干姜附子等品。以助阳御阴。庶免逼汗亡阳之患。一辨其人真阴素虚者。阳亢为
本。邪多挟火而动。其证口燥咽干。心烦不寐。腹满便闭。肌肤 燥。此胃阳过胜而少阴阴涸也。法当急夺其
土以救肾水。如或不宜伐阳。亦当养阴退阳。即治太阳发表药中。亦早宜加阿胶、生地等药。以回护真阴。方
可得汗而解。否则阴精被劫。汗无所酿。用纯表药全然无汗者以此。
厥阴标证。手足厥冷。一身筋挛。寒热类疟。头痛吐涎。面青目赤。耳聋颊肿。胸满呕逆。甚或男子睾丸疝疼。
女人少腹肿痛。
【秀按】凡阴阳气不相顺接。便为厥。厥者手足逆冷是也。有寒厥。有热厥。厥阴热厥多而寒厥少。少阴寒
厥多而热厥少。盖厥阴与少阳相表里。厥阴厥热之胜复。犹少阳寒热之往来。少阳之寒因乎热。厥阴之厥亦因
乎热。热为阳邪向外。厥为阳邪陷内。厥与热总属阳邪出入阴分。热多厥少。而热胜于厥者。其伤阴也犹缓。
厥多热少。而厥胜于热者。其伤阴也更急。故厥深者热亦深。厥微者热亦微。总之厥阴以厥热为眼目。凡有
厥而复有热者。其厥也定为热厥。更于脉滑而喉痹便脓血。脉沉短而囊缩。脉沉疾而爪甲青。不大便而腹满硬
痛。诸见厥证。所用四逆散及白虎承气辈互推之。自可决定热厥矣。惟有厥无热。甚则一厥不复热。及大汗大
下利。厥逆而恶寒者。呕而小便利。身无热而见厥者。其厥也方是寒厥。方可用当归四逆汤以温经。而藏厥吐
沫之用吴茱萸汤。蛔厥吐蛔之用乌梅丸。胥准此耳。
厥阴本证。口渴消水。气上冲心。心中痛热。饥不欲食。食则吐蛔。泄利下重。误下则利不止。或便脓血。甚
则晕厥如尸。手足螈 。体厥脉厥。舌卷囊缩。妇人乳缩。冲任脉动 震手。
【秀按】厥阴一经。最多寒热错杂。阴阳疑似之候。必先分际清析。庶有头绪。如热而发厥。热深厥深。上
攻而为喉痹。下攻而便脓血。此纯阳无阴之证也。脉微细欲绝。手足厥冷。灸之不温。凛凛恶寒。大汗大利。
躁不得卧。与夫冷结关元。此纯阴无阳之证也。渴欲饮水。饥欲得食。脉滑而数。手足自温。此阳进欲愈之证
也。默默不欲食。呕吐涎沫。腹胀身疼。此阴进未愈之证也。厥三日。热亦三日。厥五日。热亦五日。手足厥
冷。而邪热在膈。水热在胃。此阴少阳多之证也。下利清谷。里寒外热。呕而脉弱。本自寒下。复误吐下。面
反戴阳。此阴多阳少之证也。大抵阳脉阳证。当取少阳阳明经治法。阴脉阴证。当用少阴经治法。厥阴病见阳
为易愈。见阴为难痊。其表里错杂不分。又必先治其里。后解其表。若见咽喉不利。咳唾脓血。切忌温药。仍
宜分解其热。清滋其枯。尝见有周身冰冷。而一衣不着。半被不盖者。有令两人各用扇扇之者。有欲畅饮冰水
者。此非伏火在内。热极恶热而何。盖肝为藏血之脏。中多络脉。邪热入络。其血必郁而化火。其气亦钝而不
灵。故厥阴病以血热、络郁为眼目。观热厥之四逆散。寒厥之当归四逆汤。并以辛润通络为君。可知刚燥之非
宜矣。又可知厥阴门之姜附。实为兼少阴病虚寒而设。凡少阴病之宜清滋者。皆属厥阴。而厥阴病之宜温热
者。则皆少阴也。以厥阴风化。内藏少阳相火。而少阴虽属君火。实主太阳寒水也。
厥阴中见证。头晕目眩。口苦耳聋。乍寒乍热。寒则四肢厥冷。热则干呕渴饮。呕黄绿水。或吐黑臭浊阴。
或兼吐蛔。甚则蛔厥。两胁串痛。或痉或厥。
【秀按】六经惟厥阴最难调治。盖厥阴内寄相火。本属有热无寒。纵使直受寒邪。证现四逆脉细。仲景只用
当归四逆。而不用姜附可悟也。而乌梅丸中乃桂附辛姜并进者何也。因厥阴火郁。必犯阳明。阳明气实。则肝
火自由少阳而散。苟胃阳不支。则木邪乘土。必撤阳明之阖。而为太阴之开。以致吐利交作。亡阳可畏。故必
重用温脾。俾以就阳明之实。而不陷太阴之虚。此转绝阴为生阳。即藉生阳以破绝阴之法也。否则酸苦等味。
虽有清泄厥阴之长。能无害胃伤阳之弊乎。总之厥阴证。全以胃阳为用神。胃阳胜。则转出少阳而病退。胃阳
负。则转入太阴而病进。亦以胃阴为后盾。胃阴胜。则能制相火而邪热外达。胃阴衰。则反竭肾水而虚阳上
越。观仲景一用理中以治霍乱。一用复脉以治阴竭。其主义尤易见也。昔赵养葵高鼓峰辈。用逍遥散加生地、
疏肝益肾汤等。以治伤寒化火烁阴。暗合仲景厥阴病正法。厥后叶天士乃溯源于复脉及黄连阿胶等方。前哲成
法。其揆一也。
厥阴兼证。兼肺经证。气咳痰粘。胸痛串胁。甚则咯血。或痰带血丝血珠。兼心经证。舌卷焦短。鸦口
嘬嘴。昏不知人。醒作睡声。撮空上视。面青目紫。兼脾经证。脘满而吐。腹痛自利。四肢厥逆。渴不喜饮。面色
痿黄。神气倦怠。兼胃经证。胸脘满闷。格食不下。两胁抽痛。胃疼呕酸。饥不欲食。胃中嘈杂。兼肾
经证。面色憔悴。两颧嫩红。喘息短促。气不接续。手足厥冷。腰膝 软。男子足冷精泄。女子带下如注。
【秀按】六经感证。兼带厥阴者。尚可救疗。若由三阳经传至厥阴。入里极深。风木与相火。两相煽灼。伤
阴最速。阴液消耗。邪热内陷包络。则神昏谵语。甚则不语如尸。内陷肝络。则四肢厥逆。甚则手足发痉。热
极生风。九窍随闭。所形皆败证矣。故厥阴最多死证。惟兼肺兼胃两经。治之得法。尚可转危为安。若兼心脾
肾三经。则死者多。生者少矣。
【廉勘】一切感证。邪传厥阴。当辨手足两经。手厥阴为包络。主血亦主脉。横通四布。如渴欲饮水。气上
冲心。心中疼热。此由包络挟心火之热。发动于上。甚则发厥。不语如尸。此由包络粘涎瘀血。阻塞心与脑神
气出入之清窍。当以涤涎祛瘀。通络开窍为君。参以散火透热。庶可救疗。足厥阴为肝。主藏血亦主回血。气
化属风。内含胆火。或寒热互相进退。为厥热往来。或外寒内热。为厥深者热亦深。或下寒上热。为饥不欲
食。食则吐蛔。或阴搏阳回。为左旋右转之抽风。或阳回阴复。为厥热停匀而自愈。至于风之生虫。必先积
湿。故虫从风化。亦从湿化。其证多寒热错杂。当以苦降辛通酸泄为君。或佐熄风。或佐存阴可也。
【荣斋按】本节各条。分析六经的本证、标证、中见证、兼证等，详细得近于繁复了。陆渊雷先生在《伤寒今
释》里曾指出执简驭繁之法，他说∶“发热而恶寒，不论有汗无汗，皆为太阳病；寒热往来如疟者，为少阳病；
发热汗出，不恶寒反恶热者，为阳明病；见机能衰弱之症，或误治而虚其正气者，为少阴病；吐利属于虚寒
者，为太阴病；发热若干日，热退若干日，或消渴，或吐蛔，或下利，或舌卷囊缩者，为厥阴病。”可称清爽
明白。他在《伤寒论概要》里，更扼要地说∶“三阳为热病之正型，视其抗病力之趋势，分为三种综合症，施以三
种治疗方法；少阴为热病之变型，心脏衰弱，不但不能发生抗病力，生命且岌岌不保，急须用强心药；太阴是
杂病，非伤寒；厥阴则为散列。”陆先生对《伤寒论》六经病证的看法，是精当而深入的；他这样的指出，可作我
们研究方面“由博反约”的实践。概括的说∶“六经病症”是根据急性发热病的经过而分做六个阶段。每个阶
段更就不同的症状，分做若干亚类，每类各有若干大同小异的综合症；这就衍化了六经本证、标证、中见证和
兼证。本节文本，我们只应领会其精神，其实质可不必拘泥。
【秀按】传经的热邪，一旦传入少阴经，经络中的阴液首先受损，往往邪气尚未清除而阴液已经枯竭，所以死亡的多，存活的少。何况再加上各经的兼夹证候，这人还有生机吗？只是在辨证的时候，却有两种关键要领。一是辨别其人真阳素来虚弱者，以阴寒为本，邪气多挟带水湿而动，其症状表现为呕吐、咳嗽、大汗淋漓如珠（魄汗）、腹痛下利，这是少阴阴盛而胃阳亏虚的表现。治法应当补火培土以抵御水湿，这不用多说。即使在太阳病中见到这些证候，在发表药中也应尽早加入干姜、附子等药物，以助阳气抵御阴寒，这样才可能避免逼迫出汗导致亡阳的祸患。二是辨别其人真阴素来虚弱者，以阳亢为本，邪气多挟带火热而动，其症状表现为口燥咽干、心烦失眠、腹部胀满、大便闭塞、肌肤干燥，这是胃阳过盛而少阴阴液枯竭的表现。治法应当急夺其土（脾胃）以救肾水。如果不宜攻伐阳气，也应当滋养阴液、退抑阳热。即在治疗太阳病的发表药中，也应尽早加入阿胶、生地等药物，以回护真阴，这样才能通过发汗而解表。否则阴精被劫夺，汗液没有化源，使用纯表药完全无汗的原因就在这里。
厥阴经的标证：手足厥冷，全身筋脉拘挛，寒热往来类似疟疾，头痛吐涎沫，面色青、眼睛红，耳聋脸颊肿胀，胸满呕逆，甚至男子睾丸疝痛，女人小腹肿痛。
【秀按】凡是阴阳之气不能顺接，就称为“厥”，厥就是手足逆冷。有寒厥，有热厥。厥阴经的热厥多而寒厥少，少阴经的寒厥多而热厥少。大概厥阴与少阳相表里，厥阴经厥与热的胜复交替，就像少阳经寒热的往来一样。少阳的寒是因为热引起的，厥阴的厥也是因为热引起的。热是阳邪向外，厥是阳邪陷入内部。厥与热总属于阳邪出入于阴分。热多厥少，且热胜于厥的，其损伤阴液还比较缓慢；厥多热少，且厥胜于热的，其损伤阴液就更急迫。所以说，厥越深重，热邪也越深重；厥轻微，热邪也轻微。总之，厥阴经以厥和热为辨证的关键。凡是有厥而又出现热的，其厥定然是热厥。再结合脉滑且喉痹便脓血，脉沉短且囊缩，脉沉疾且指甲青紫，不大便且腹部胀满硬痛，诸如此类见到厥证的情况，运用四逆散及白虎汤、承气汤等方剂互相推演，自然可以决定是热厥了。只有厥而没有热，甚至一次厥冷后不再发热，以及大汗、大下利，厥逆且恶寒的，呕吐且小便清长，身体无热而见厥冷的，这种厥才是寒厥。这时才可以运用当归四逆汤来温通经脉，而脏厥吐沫的用吴茱萸汤，蛔厥吐蛔的用乌梅丸，都依据这个原则。
厥阴经的本证：口渴饮水，气上冲心，心中疼痛且有热感，饥饿但不想进食，进食则吐蛔虫，泄泻痢疾伴有肛门重坠感。误用下法则腹泻不止，或者便脓血，甚至晕厥像死人一样，手足抽搐，身体厥冷脉象亦厥，舌卷缩，阴囊收缩，妇女乳房收缩，冲任脉跳动震手。
【秀按】厥阴这一经，最多见寒热错杂、阴阳疑似的证候，必须先分辨清楚界限，才有头绪。比如热而发厥，热深厥深，向上攻冲则为喉痹，向下攻冲则便脓血，这是纯阳无阴的证候。脉微细欲绝，手足厥冷，艾灸也不温热，凛凛恶寒，大汗大利，烦躁不得卧，以及冷结关元，这是纯阴无阳的证候。渴欲饮水，饥欲得食，脉滑而数，手足自温，这是阳气进逼、病情欲愈的证候。默默不欲食，呕吐涎沫，腹胀身疼，这是阴气进逼、病情未愈的证候。厥三日，热也三日；厥五日，热也五日，手足厥冷，而邪热在膈，水热在胃，这是阴少阳多的证候。下利清谷，里寒外热，呕吐而脉弱，本自寒下，又误用吐下法，面部反而戴阳，这是阴多阳少的证候。大抵阳脉阳证，应当取少阳、阳明经的治法；阴脉阴证，应当用少阴经的治法。厥阴病见到阳证为易愈，见到阴证为难痊。其表里错杂不分时，又必须先治其里，后解其表。如果见到咽喉不利，咳唾脓血，切忌使用温药，仍宜分解其热，清滋其枯。曾见过周身冰冷，却一件衣服不穿，半床被子不盖的；有让人两人各用扇子扇他的；有想要畅饮冰水的。这不是伏火在内，热极恶热而是什么呢？大概肝是藏血的脏器，中间多有络脉，邪热入络，血液必然郁滞而化火，气机也会迟钝而不灵。所以厥阴病以血热、络郁为关键。看治疗热厥的四逆散，治疗寒厥的当归四逆汤，都以辛润通络为君药，可知刚燥之药是不适宜的。又可知厥阴门中的姜、附，实在是为了兼有少阴病虚寒而设的。凡少阴病适宜清滋的，都属于厥阴范畴；而厥阴病适宜温热的，则都属于少阴范畴。因为厥阴风化，内藏少阳相火，而少阴虽属君火，实则主司太阳寒水。
厥阴经的中见证：头晕目眩，口苦耳聋，乍寒乍热，寒则四肢厥冷，热则干呕渴饮，呕吐黄绿水，或吐出黑臭浊阴之物，或兼吐蛔虫，甚至蛔厥，两胁串痛，或痉挛或厥冷。
【秀按】六经之中，唯独厥阴最难调治。大概厥阴内寄相火，本性属有热无寒。纵使直接感受寒邪，证现四逆脉细，仲景只用当归四逆汤，而不用姜、附，由此可悟。那么乌梅丸中为何桂枝、附子、辛夷、干姜并进呢？因为厥阴火郁，必定侵犯阳明，阳明气实，则肝火自由少阳而散。倘若胃阳不支，则木邪乘土，必定撤去阳明之阖，而为太阴之开，以致吐利交作，亡阳可畏。所以必须重用温脾之法，使其顺应阳明之实，而不陷于太阴之虚。这就是转绝阴为生阳，即借助生阳以破绝阴的方法。否则酸苦等味，虽然有清泄厥阴之长，能没有伤害胃气、损伤阳气的弊端吗？总之厥阴证，全以胃阳为用神。胃阳胜，则转出少阳而病退；胃阳负，则转入太阴而病进。也以胃阴为后盾。胃阴胜，则能制约相火而邪热外达；胃阴衰，则反竭肾水而虚阳上越。看仲景一用理中汤治疗霍乱，一用复脉汤治疗阴竭，其主旨尤其容易看见。昔日赵养葵、高鼓峰等人，用逍遥散加生地、疏肝益肾汤等，来治疗伤寒化火烁阴，暗合仲景治疗厥阴病的正法。后来叶天士乃溯源于复脉汤及黄连阿胶汤等方，前贤成法，其道理是一样的。
厥阴经的兼证：兼肺经证，气咳痰粘，胸痛串胁，甚至咯血，或痰中带血丝血珠。兼心经证，舌卷焦短，鸦口嘬嘴，昏不知人，醒时发出睡声，撮空摸物，眼球上视，面青目紫。兼脾经证，脘腹满闷而呕吐，腹痛自利，四肢厥逆，渴但不喜饮水，面色萎黄，神气倦怠。兼胃经证，胸脘满闷，格拒饮食不下，两胁抽痛，胃痛呕酸，饥饿但不想进食，胃中嘈杂。兼肾经证，面色憔悴，两颧嫩红，喘息短促，气不接续，手足厥冷，腰膝酸软，男子足冷精泄，女子带下如注。
【秀按】六经感证，兼带厥阴的，尚可救疗。若由三阳经传至厥阴，入里极深，风木与相火，两相煽灼，伤阴最快，阴液消耗，邪热内陷包络，则神昏谵语，甚至不语如尸；内陷肝络，则四肢厥逆，甚至手足发痉，热极生风，九窍随之闭塞，所形成的都是败证。所以厥阴最多死证，唯有兼肺、兼胃两经，治之得法，尚可转危为安。若兼心、脾、肾三经，则死者多，生者少矣。
【廉勘】一切感证，邪传厥阴，当辨手足两经。手厥阴为心包络，主血亦主脉，横通四布。如渴欲饮水，气上冲心，心中疼热，这是由包络挟带心火之热，发动于上，甚则发厥，不语如尸，这是由包络粘涎瘀血，阻塞心与脑神气出入的清窍，应当以涤涎祛瘀、通络开窍为君药，参以散火透热，才可救疗。足厥阴为肝，主藏血亦主回血，气化属风，内含胆火。或寒热互相进退，为厥热往来；或外寒内热，为厥深者热亦深；或下寒上热，为饥不欲食，食则吐蛔；或阴搏阳回，为左旋右转之抽风；或阳回阴复，为厥热停匀而自愈。至于风之生虫，必先积湿，故虫从风化，亦从湿化。其证多寒热错杂，当以苦降辛通、酸泄为君，或佐熄风，或佐存阴即可。
【荣斋按】本节各条，分析六经的本证、标证、中见证、兼证等，详细得近于繁复了。陆渊雷先生在《伤寒今释》里曾指出执简驭繁之法，他说：“发热而恶寒，不论有汗无汗，皆为太阳病；寒热往来如疟者，为少阳病；发热汗出，不恶寒反恶热者，为阳明病；见机能衰弱之症，或误治而虚其正气者，为少阴病；吐利属于虚寒者，为太阴病；发热若干日，热退若干日，或消渴，或吐蛔，或下利，或舌卷囊缩者，为厥阴病。”可称清爽明白。他在《伤寒论概要》里，更扼要地说：“三阳为热病之正型，视其抗病力之趋势，分为三种综合症，施以三种治疗方法；少阴为热病之变型，心脏衰弱，不但不能发生抗病力，生命且岌岌不保，急须用强心药；太阴是杂病，非伤寒；厥阴则为散列。”陆先生对《伤寒论》六经病证的看法，是精当而深入的；他这样的指出，可作为我们研究方面“由博反约”的实践。概括的说：“六经病症”是根据急性发热病的经过而分做六个阶段。每个阶段更就不同的症状，分做若干亚类，每类各有若干大同小异的综合症；这就衍化了六经本证、标证、中见证和兼证。本节文本，我们只应领会其精神，其实质可不必拘泥。
[Commentary by Xiu] The heat pathogen transmitted through the meridians, once it enters the Shaoyin (Lesser Yin) meridian, first injures the yin fluids within the meridian. Often, the pathogen is not yet eliminated while the yin is already exhausted; thus, many die and few survive. How much more so when complicated by syndromes of other meridians—can such a person still have vitality? However, during differentiation, there are two key principles. First, differentiate whether the person's true yang has been deficient since constitution. If yin-cold is the root, the pathogen often moves with water-dampness. Symptoms include vomiting, coughing, profuse sweating like pearls (Pohan), abdominal pain, and diarrhea. This indicates Shaoyin yin excess and deficiency of Stomach yang. The treatment method should be to tonify fire and cultivate earth to control water, which goes without saying. Even if these symptoms appear in Taiyang disease, early addition of dried ginger (Ganjiang) and prepared aconite (Fuzi) to the exterior-releasing formulas is necessary to assist yang and resist yin, thereby avoiding the danger of forced sweating leading to collapse of yang. Second, differentiate whether the person's true yin has been deficient since constitution. If yang hyperactivity is the root, the pathogen often moves with fire. Symptoms include dry mouth and throat, mental restlessness and insomnia, abdominal fullness, constipation, and dry skin. This indicates excessive Stomach yang and exhaustion of Shaoyin yin. The treatment method should urgently drain earth (Spleen/Stomach) to save Kidney water. If attacking yang is not suitable, one should nourish yin and retreat yang. Even in Taiyang exterior-releasing formulas, early addition of donkey-hide gelatin (Ejiao) and rehmannia root (Shengdi) is needed to protect the true yin, so that sweating can occur to resolve the exterior. Otherwise, if yin essence is robbed, there will be no source for sweat, and pure exterior-releasing drugs will fail to produce sweat for this reason.
Biao (Mark/Manifestation) syndromes of Jueyin (Terminal Yin): Cold hands and feet, general spasm of tendons, alternating chills and fever resembling malaria, headache with salivation, blue complexion and red eyes, deafness, swollen cheeks, chest fullness and reverse flow of qi (vomiting), or even testicular hernia pain in men, and lower abdominal swelling and pain in women.
[Commentary by Xiu] Whenever yin and yang qi do not connect smoothly, it is called "Jue" (Cold Extremities). Jue refers to cold hands and feet. There is cold Jue and hot Jue. In Jueyin, hot Jue is common and cold Jue is rare; in Shaoyin, cold Jue is common and hot Jue is rare. Jueyin and Shaoyang are interior-exteriorly related. The alternation of Jue and heat in Jueyin is similar to the alternation of chills and fever in Shaoyang. The chills in Shaoyang are caused by heat; the Jue in Jueyin is also caused by heat. Heat is a yang pathogen moving outward; Jue is a yang pathogen sinking inward. Both Jue and heat belong to yang pathogens entering and exiting the yin divisions. When heat is abundant and Jue is scarce, and heat exceeds Jue, the injury to yin is relatively slow. When Jue is abundant and heat is scarce, and Jue exceeds heat, the injury to yin is more urgent. Therefore, the deeper the Jue, the deeper the heat; the milder the Jue, the milder the heat. In summary, Jueyin focuses on Jue and heat as the key indicators. Whenever there is Jue accompanied by heat, the Jue is definitely hot Jue. Combined with slippery pulse and sore throat with pus/blood in stool, or deep-short pulse and retracted scrotum, or deep-rapid pulse and cyanotic nails, or constipation with abdominal fullness, hardness, and pain, among other manifestations of Jue, applying Si Ni San (Frigid Extremities Powder) and comparing it with Bai Hu Tang (White Tiger Decoction) and Cheng Qi Tang (Order the Qi Decoctions) allows one to determine it is hot Jue. Only when there is Jue without heat, or even a single episode of Jue without subsequent heat, or massive sweating and severe diarrhea with Jue and aversion to cold, or vomiting with clear urination and body without heat but with Jue, is this truly cold Jue. At this point, Dang Gui Si Ni Tang (Tangkuei Decoction for Frigid Extremities) can be used to warm the meridians. For Zang Jue (Viscera Jue) with salivation, Wu Zhu Yu Tang (Evodia Decoction) is used. For Hui Jue (Roundworm Jue) with expulsion of roundworms, Wu Mei Wan (Mume Pill) is used. All follow this principle.
Ben (Root/Essence) syndromes of Jueyin: Thirst requiring water intake, sensation of qi rushing up to the heart, painful heat in the epigastrium, hunger without desire to eat, expulsion of roundworms after eating, dysentery with a feeling of heaviness in the anus. Misapplication of purgatives leads to unceasing diarrhea, or pus and blood in stool, or even syncope resembling death, twitching of hands and feet, body coldness with absent pulse, curled tongue, and retracted scrotum. In women, breast retraction and pulsating Chong and Ren vessels felt under the hand.
[Commentary by Xiu] The Jueyin meridian features the most complex mixtures of cold and heat, and ambiguous yin-yang presentations. One must clearly distinguish boundaries to find a thread. For example, heat with Jue, where deep heat causes deep Jue, attacking upward causing sore throat, or attacking downward causing pus and blood in stool, is a syndrome of pure yang without yin. Pulse is faint and thin, nearly imperceptible; hands and feet are cold; warming with moxibustion does not restore warmth; shivering aversion to cold; massive sweating and severe diarrhea; restlessness unable to lie down; and cold accumulation at Guanyuan point—all indicate pure yin without yang. Desire to drink water, hunger with desire to eat, slippery and rapid pulse, and naturally warm hands and feet indicate yang advancing and the condition about to heal. Silent demeanor, lack of appetite, vomiting of saliva/phlegm, abdominal distension, and body ache indicate yin advancing and the condition not healing. Three days of Jue corresponds to three days of heat; five days of Jue corresponds to five days of heat. With cold hands and feet, but pathogenic heat in the diaphragm and water-heat in the stomach, this is less yin and more yang. Diarrhea with undigested food, interior cold with exterior heat, vomiting with weak pulse, originally cold below, further mistreated with vomiting and purging, with facial flushing (floating yang), this is more yin and less yang. Generally, yang pulses and yang syndromes should be treated using Shaoyang and Yangming methods. Yin pulses and yin syndromes should use Shaoyin methods. Jueyin disease presenting with yang signs is easier to cure; presenting with yin signs is difficult to cure. When interior and exterior are mixed and indistinct, one must first treat the interior, then release the exterior. If there is throat obstruction, coughing up pus and blood, warm drugs must be strictly avoided; instead, one should resolve heat and clear/nourish dryness. I have seen cases where the whole body was ice cold, yet the patient wore no clothes and refused blankets; patients ordered to be fanned by two people; patients desiring to drink ice water freely. Is this not latent fire inside, extreme heat causing aversion to heat? The Liver stores blood and contains many collaterals. When pathogenic heat enters the collaterals, blood stagnates and transforms into fire, and qi becomes sluggish and dull. Thus, Jueyin disease focuses on blood heat and collateral stagnation. Observing Si Ni San for hot Jue and Dang Gui Si Ni Tang for cold Jue, both using pungent-moistening methods to unblock collaterals as the chief action, shows that rigid-drying drugs are inappropriate. It also shows that ginger and aconite in the Jueyin chapter are specifically set for concurrent Shaoyin deficiency-cold. Cases of Shaoyin disease suitable for clearing and nourishing belong to Jueyin; cases of Jueyin disease suitable for warming and heating belong to Shaoyin. Jueyin wind transformation internally houses Shaoyang ministerial fire, while Shaoyin, though belonging to sovereign fire, actually governs Taiyang cold-water.
Zhong (Middle/Intermediate) syndromes of Jueyin: Dizziness and blurred vision, bitter taste and deafness, alternating chills and fever. Chills cause cold extremities; heat causes dry retching and thirst for drinks, vomiting yellow-green water, or black foul-smelling turbid yin fluids, or expelling roundworms, even leading to roundworm Jue. Pain radiating through the hypochondrium, spasms or Jue.
[Commentary by Xiu] Among the six meridians, Jueyin is the most difficult to regulate. Jueyin internally harbors ministerial fire and essentially possesses heat without cold. Even if directly affected by cold pathogen, presenting with cold extremities and fine pulse, Zhang Zhongjing uses only Dang Gui Si Ni Tang and avoids ginger and aconite, from which we can understand. So why do Gui Zhi, Fu Zi, Xin Yi, and Gan Jiang all appear in Wu Mei Wan? Because Jueyin fire stagnation must invade Yangming. If Yangming qi is substantial, liver fire disperses freely through Shaoyang. If Stomach yang cannot support, wood pathogen attacks earth, collapsing Yangming closure and opening Taiyin, resulting in simultaneous vomiting and diarrhea, with fear of yang collapse. Therefore, heavy use of spleen-warming methods is required to align with Yangming substance and avoid Taiyin deficiency. This is the method of turning absolute yin into generating yang, using generating yang to break absolute yin. Otherwise, sour and bitter flavors, while having the strength to clear and drain Jueyin, would inevitably harm stomach qi and damage yang. In summary, Jueyin syndromes rely entirely on Stomach yang as the vital spirit. If Stomach yang prevails, the disease turns to Shaoyang and recedes; if Stomach yang fails, it turns to Taiyin and progresses. Stomach yin serves as the rear guard. If Stomach yin prevails, it controls ministerial fire and allows pathogenic heat to exit externally; if Stomach yin declines, it exhausts Kidney water and causes deficient yang to float upward. Observing Zhang Zhongjing using Li Zhong Tang for cholera and Mai Mai Wen Jing Tang (or Fu Mai Tang) for yin exhaustion reveals his main intent clearly. Zhao Yangkui and Gao Gufeng previously used Xiao Yao San plus Sheng Di, and Shu Gan Yi Shen Tang, to treat typhoid transforming into fire and consuming yin, coincidentally matching Zhang Zhongjing's correct method for Jueyin disease. Later, Ye Tianshi traced back to Fu Mai Tang and Huang Lian E Jiao Tang. The methods of former sages share the same principle.
Jian (Concurrent) syndromes of Jueyin: Concurrent Lung meridian syndrome: Cough with sticky phlegm, chest pain radiating to hypochondrium, even hemoptysis, or blood-streaked sputum. Concurrent Heart meridian syndrome: Curled, scorched, short tongue, beaked mouth, unconsciousness, snoring while awake, grasping at empty air, eyes rolling up, blue face and purple eyes. Concurrent Spleen meridian syndrome: Epigastric fullness with vomiting, abdominal pain with spontaneous diarrhea, cold extremities, thirst without desire to drink, sallow complexion, mental fatigue. Concurrent Stomach meridian syndrome: Chest and epigastric fullness, food rejection, drawing pain in hypochondrium, stomach pain with acid regurgitation, hunger without desire to eat, gastric discomfort. Concurrent Kidney meridian syndrome: Haggard complexion, tender red malar flush, panting and shortness of breath, disconnected qi, cold hands and feet, soreness and weakness of waist and knees, cold feet and seminal emission in men, profuse leukorrhea in women.
[Commentary by Xiu] Six-meridian infectious syndromes concurrent with Jueyin can still be treated. However, if transmitted from the Three Yang meridians to Jueyin, penetrating deeply into the interior, wind-wood and ministerial fire fan each other, injuring yin rapidly. Consumption of yin fluids allows pathogenic heat to sink into the Pericardium, causing delirium and unconsciousness, or mutism resembling death; sinking into Liver collaterals causes cold extremities, even spasms of hands and feet. Extreme heat generates wind, closing the nine orifices, forming defeat syndromes. Thus, Jueyin has the most fatal syndromes. Only concurrent Lung and Stomach meridians, if treated correctly, can turn danger into safety. Concurrent Heart, Spleen, and Kidney meridians result in many deaths and few survivals.
[Commentary by Lian] For all infectious syndromes transmitting to Jueyin, differentiate Hand and Foot meridians. Hand Jueyin is the Pericardium, governing blood and vessels, spreading horizontally. Symptoms like thirst, qi rushing to heart, painful heat in epigastrium arise from Pericardium carrying Heart fire heat activating upward, potentially leading to Jue and mutism resembling death due to sticky phlegm and stasis blocking the clear orifices of Heart and Brain. Treatment should prioritize clearing phlegm and removing stasis, unblocking collaterals and opening orifices, supplemented by dissipating fire and venting heat. Foot Jueyin is the Liver, storing blood and returning blood, qi transformation belongs to wind, containing Gallbladder fire. Alternating chills and fever represent Jue-heat alternation; exterior cold interior heat represents deep Jue meaning deep heat; lower cold upper heat represents hunger without desire to eat and expelling roundworms; yin surging and yang returning represents convulsions rotating left and right; yang returning and yin recovering represents balanced Jue and heat leading to self-healing. Regarding worms generated by wind, dampness must accumulate first; thus worms transform via wind and dampness. Syndromes are mostly mixed cold and heat. Treatment should prioritize bitter descending, pungent unblocking, and sour draining, possibly assisting with extinguishing wind or preserving yin.
[Commentary by Rongzhai] The items in this section analyze Ben, Biao, Zhong, and Jian syndromes of the six meridians in detail, bordering on complexity. Mr. Lu Yuanlei, in *Shanghan Jinshi* (Modern Interpretation of Treatise on Cold Damage), pointed out the method of mastering simplicity to control complexity, stating: "Fever with aversion to cold, regardless of sweating, is Taiyang disease; alternating chills and fever like malaria is Shaoyang disease; fever with sweating, no aversion to cold but aversion to heat is Yangming disease; symptoms of functional decline or deficiency of righteous qi due to mis-treatment is Shaoyin disease; vomiting and diarrhea belonging to deficiency-cold is Taiyin disease; fever for several days followed by absence of fever for several days, or thirst, or expelling roundworms, or diarrhea, or curled tongue and retracted scrotum is Jueyin disease." This is refreshingly clear. In *Shanghan Lun Gaoyao* (Outline of Treatise on Cold Damage), he more concisely stated: "The Three Yang are the standard types of febrile diseases; based on the trend of resistance, they are divided into three complex syndromes treated with three methods; Shaoyin is the variant type of febrile disease, with cardiac weakness, unable to generate resistance, life in peril, requiring urgent cardiotonics; Taiyin is miscellaneous disease, not cold damage; Jueyin is scattered." Mr. Lu's view on the six-meridian syndromes in *Shanghan Lun* is precise and profound; his indication serves as practice for our research to "return from extensive to simple." Broadly speaking, "Six-Meridian Syndromes" divide the course of acute febrile diseases into six stages. Each stage is subdivided into several sub-types based on different symptoms, each containing several similar but slightly different complex syndromes; this evolves the Ben, Biao, Zhong, and Jian syndromes of the six meridians. For this text, we should grasp its spirit, but need not be rigid about its details.