海藏云∶霍乱头痛发热，其邪自风寒而来。中焦为寒热相半之分，邪稍高者居阳分，则为
热，热多饮水者，五苓散以散之；邪稍下者居阴分，则为寒，寒多不饮水者，理中丸以温之。所以
同少阴入里，与手经接为热，大承气汤下之；与足经接为寒，四逆汤温之。
海藏云∶仲景阴脉，皆叔和次之，药俱见仲景本经条下。
按之似有举还无，气满三焦脏腑虚，冷气不调三部壅，通肠建胃始能除。右沉脉。
涩脉关前胃气并，当关血散不能停，尺部如斯逢逆冷，体寒脐下作雷鸣。右涩脉。
关前弱脉阳道虚，关中有此气多疏，若在尺中阴气绝，酸疼引变上皮肤，右弱脉。
寸口脉紧一条弦，胸中急痛状绳牵，关中有弦寒在胃，下焦停水满丹田。右弦脉。
微脉关前气上侵，当关郁结气排心，尺部见之脐下积，身寒饮水即呻吟。右微脉。
阴毒伤寒身体重，背强眼痛不堪任，小腹痛急口青黑，毒瓦斯冲心转不禁，四肢逆冷唯思
吐，咽喉不利脉细沉，若能速灸脐轮下，六日看过见喜深。
脐下五穴，并见宜灸条下。
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。入六腑则身热不时卧，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。经云∶一二日少阴病
者，何也？谓国中病时，腠理寒，使入阴经，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，亦不必先自巨阳次传而
至。
盖寒气入太阳，即发热而恶塞；入阴经，只恶寒而不发热也。三阴中寒，微则理中汤，
稍厥或中寒下利，即干姜甘草汤。
手足指头微冷盖谓之清（音去声，）此未消吃四逆，盖疾轻故也，只可服理中干姜之类。
大假重者用四逆汤，无脉者用通脉四逆汤也。
何谓厥阴？厥阴肝之经，主消渴，气上冲心中疼热，饥不欲食，食则吐蛔，下之则
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，
或吐利，当急救，可灸脐下，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。微则用辛甘，甚则用辛苦热。阴极发躁
，阴证似阳也。学人当以脉别之。
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，脉细欲绝者
，何也？
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、白术散、附子散、正阳散、肉桂散、
回阳丹、返阴丹、天雄散、正元散、退阴散之类，可选用之。大抵阴毒本因肾气虚寒，或因
冷物伤脾，外伤风寒，内既伏阴，外又感寒，或先
外寒而内伏阴，内外皆阴，则阳气不守，遂发头痛腰重，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，寸口或大。
阳证六脉俱浮大，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，更须急服辛热之药，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。
上此一条服凉药躁渴转甚，当服热药可也。
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，数躁而寒，寒则厥。（清即冷也。）
上此岐伯说阴躁之原。
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，以手足温和为效，仍兼服正阳散、回阳丹、天雄散、白术散，内外通，遂令阳
气复而大汗解矣。
阴毒盛而阳气暴绝，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
汗不能复正气也。
阴阳则夫妇也，各得中则和，若偏胜则各专以权，至于极，继之以离矣！药石以攻邪，
邪去正复，是犹鞭挞以教而欲并生也。
若阴毒已深，疾势困重，六脉附骨取之方有，按之既无，一息八至以上，或不可数，至
此则
药饵难为攻矣！但于脐中用葱慰法，或灼艾三五百壮已来，手足不温者，不可治也。如手足
得温，更服热药以助之。若阴气阳气来，即渐减热药而调治之。
若阳气乍复，往往却见烦躁，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。
问胸膈不快， 满闭塞，唇青手足冷，脉沉细，少情绪，或腹痛者，何也？
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，满面色及唇皆无色泽，手足逆冷，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，盖不知寒中太阴脾之经也。
右膈不快，不可用食药，下之则成痞。
海藏云∶阴证胸膈不快，此无病形也，若投巴豆之药，即取有形也病，故轻则转痞，重
则成劳，尤重则一二日遂成不救也。故《活人》本经云∶丸子巴豆，乃攻食积耳！
问∶万一饮食不节，胸膈不快，寒中阴经，何法以治？
答曰∶急则理中汤加青陈皮，锉如麻豆小，服一二剂，胸膈即快。枳实理中丸、五积散
尤良。
五积散一句，是兼表也，或无有表证，或自内而之外，传至极高之分，则宜是药。若无
表则不宜用此也，用理中法足矣！
问脉微细，欲吐不吐，心烦但欲寐，六七日自利而渴者，何也？
此名少阴也。少阴之为病，欲吐不吐，心烦但欲寐，六七日自利而渴者，虚也，故引水自救
。若小便色白者，少阴病形悉具矣。小便色白者，以下焦虚有寒，不能制水，故令色白也。
四逆汤主之。
举阳证 少阴证，口燥舌干而渴者，须急下之，不可缓也，宜大承气汤主之。若
脉沉而迟者，须温之，四逆汤主之。盖以口燥舌干而渴者知其热，脉沉而迟者别其寒也。
少阴病属肾，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
，但若烦愦默而极，不欲见光明，有时腹痛，其脉沉细，旧用四逆汤。古人恐其热不敢遽用
，云肾病而体犹有热者，可服黄连龙骨汤。若已十余日，下利水止，手足微冷，乃无热候
，可服增损四顺散。
上此一条，虽有肾病，而体犹有热一句，亦当以久暂察之，不可乍见便以为身热也。
不用四逆用黄连，及手足冷却用四顺，亦不甚的当。
举阳证 少阴病，若恶寒而倦，时时自烦，不欲浓衣者，大柴胡下之。少阴病
，始
得之，反发热，脉沉者，麻黄附子细辛汤微汗之。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。此学人不可不知也。
问身微热，烦躁，面赤，脉沉而微者，何也？
此名阴证似阳也。阴发躁，热发厥，物极则反也。大率以脉别之为准，诸数为热，诸迟
为寒，无如此最为验也。
上此一句，可以为世法。
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。治者不看脉，以虚阳烦躁，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，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。
上外热内寒，烦躁，不可用凉热。
问∶身冷，脉细沉疾，烦躁而不饮水者，何也？
此名阴盛格阳也。伤寒阴盛格阳者，病患身冷，脉细沉疾，烦躁而不饮者是也。若欲引
饮者
，非也。不欲饮水者，宜服霹雳散，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、丹砂丸并主之。
问身体重少气，阴肿入里，腹内绞痛，热上冲胸，头重不欲举，眼中生花，妇人则里
急，腰胯连腹内痛者，何也？
此名阴阳易也。伤寒病新瘥，阴阳气未和，因合房室，则令人阴肿，入腹绞痛，妇人则
里急
，腰胯连腹痛，名为阴阳易也。其男子病新瘥，未平复，而妇人与之交接得病，名曰阳易；其
妇人病新瘥，未平复，男子与之交接得病，名曰阴易。若二男二女，并不相易。所以呼为易
者，阴阳相感动甚，毒疫着人，如换易然。其病状身体热冲胸，头重不能举，眼中生花，四
肢拘急，小腹绞痛，手足拳则皆死。其亦有不即死者。病若小腹里急，热上冲胸，头重不欲
举，百节解离，经脉缓弱，血气虚，骨髓竭，便翕翕气力转小，着床而不若摇动，起止仰人
。或引岁月不死，烧 散、 鼠粪汤、竹皮汤、干姜汤、青竹茹汤、当归白术汤，可选用之
《孙兆口诀》，治阴盛隔阳，伤寒其人必躁热，不欲饮水者，宜服霹雳散。
附子一枚，烧灰存性，为末，蜜水调下，为一服而愈。此逼散寒气，然后热气上行，而
汗出乃愈。
海藏说：霍乱伴有头痛、发热，其病邪来源于风寒。中焦是寒热各占一半的分界线，病邪位置稍高的居于阳分，表现为热证，若饮水较多者，用五苓散来发散；病邪位置稍低的居于阴分，表现为寒证，若不欲饮水者，用理中丸来温中。所以（霍乱）与少阴病入里相似，若与手经相接化为热证，用大承气汤攻下；若与足经相接化为寒证，用四逆汤温补。
海藏说：仲景书中的阴脉条文，都是按照叔和（王叔和）的次序排列的，药物都见于仲景的本经条文中。
按之似有若无，举指即无，气满三焦脏腑虚损，冷气不调导致三部壅滞，通肠建胃才能消除。这是右手的沉脉。
涩脉在关前反映胃气并见，当关部则血散不能停留，尺部出现这种情况逢到逆冷，身体寒冷脐下如雷鸣作响。这是右手的涩脉。
关前弱脉表示阳道虚损，关中出现此脉则气多疏泄，若在尺中则阴气绝灭，酸痛牵引变化至上部皮肤。这是右手的弱脉。
寸口脉紧且一条弦直，胸中急痛状如绳索牵拉，关中有弦脉则寒在胃，下焦停水满溢丹田。这是右手的弦脉。
微脉在关前表示气上侵，当关部郁结气排心，尺部见到则脐下有积滞，身体寒冷饮水后即呻吟。这是右手的微脉。
阴毒伤寒身体沉重，背部僵硬眼痛不堪忍受，小腹痛急口唇青黑，毒瓦斯冲心转而不能禁受，四肢逆冷只想呕吐，咽喉不利脉象细沉，若能迅速灸脐轮下方，六日过后看到喜悦的景象。
脐下五个穴位，并见宜灸条目之下。
太阴、少阴、厥阴，都属于阴证。太阴，就是脾；少阴，就是肾；厥阴，就是肝。
什么是太阴证？太阴脾经，主治胸膈胀闷。《甲乙经》说：邪气生于阳分，得之于风雨寒暑；邪气中于阴分，得之于饮食居处、阴阳喜怒。又说：贼风虚邪属于阳分所受；饮食不节、起居不时属于阴分所受。阳分所受则入腑，阴分所受则入脏。入六腑则身热不时卧，气喘呼叫；入五脏则痞满闭塞，下部为完谷不化的泄泻，久则成肠澼。
什么是少阴证？少阴肾经，主治脉微细，心烦但想睡觉，或者自利而口渴。经文说：发病一二天就出现少阴病的，为什么呢？是说国家中患病时，腠理寒冷，使邪气进入阴经，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，是肝胆之经，又更加少见。凡是病一日至十二三日，太阳证未罢的，只治太阳。有初得病就见到少阴证的，直接攻治少阴，也不必先从巨阳（太阳）次传而至。
寒气侵入太阳，就发热而恶寒；侵入阴经，只恶寒而不发热。三阴中寒，轻微的用理中汤，稍微厥逆或中寒下利的，就用干姜甘草汤。
手足指头微微发冷称为“清”（音去声），这尚未达到吃四逆汤的程度，因为疾病轻浅，只可服用理中、干姜之类的药。
假如病情重者用四逆汤，无脉者用通脉四逆汤。
什么是厥阴？厥阴肝经，主治消渴，气上冲心中疼热，饥饿但不欲食，食则吐蛔虫，误用下法则利不止。若阴气独盛，阳气暴绝，则为阴毒，其证四肢逆冷，脐腹筑痛，身体像被杖打一样，脉沉疾，或者吐利，应当急救，可灸脐下，服用辛热药物，令阳气恢复而大汗解。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，严重的用辛苦热。阴极发躁，是阴证似阳。学者应当以脉象辨别。
问：手足逆冷，脐腹筑痛，咽喉疼，呕吐下利，身体像被杖打，或者冷汗烦渴，脉细欲绝的，是什么病？
这叫阴毒。阴毒这个病，初得病时手足冷，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，适宜服用阴毒甘草汤、白术散、附子散、正阳散、肉桂散、回阳丹、返阴丹、天雄散、正元散、退阴散之类，可选用。大体阴毒本因肾气虚寒，或因冷物伤脾，外伤风寒，内既伏阴，外又感寒，或先外寒而内伏阴，内外皆阴，则阳气不守，遂发头痛腰重，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，三两天间或许可以起行，不觉得特别重。诊察则六脉俱沉细而疾，尺部短小，寸口或大。
阳证六脉俱浮大，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，更须急服辛热药物，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。
上一条提到服凉药后躁渴转甚，应当服热药。
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，数躁而寒，寒则厥。（清即冷也。）
上面这段是岐伯论述阴躁的原因。
有时郑声，指甲面色青黑，六脉沉细而疾，一息七至以上。有此证者，速于气海或关元二穴，灸三二百壮，以手足温和为效，仍兼服正阳散、回阳丹、天雄散、白术散，内外通，遂令阳气复而大汗解。
阴毒盛而阳气暴绝，则为阴毒；若阳独盛而阴气暴绝，则为阳毒。大凡阴阳离绝，非大汗不能复正气。
阴阳就像夫妇，各得中和则和谐，若偏胜则各自专权，至于极端，继之以分离！药石用来攻邪，邪去正复，这就像鞭挞来教导却想共生一样。
如果阴毒已深，病势困重，六脉附骨取之方有，按之既无，一息八至以上，或者不可计数，至此则药饵难以为攻了！只在脐中用葱熨法，或者灼艾三五百壮以来，手足不温的，不可治。如手足得温，再服热药以助之。若阴气阳气来，就渐减热药而调治。
如果阳气乍复，往往却见烦躁，慎不可投凉药，烦躁甚重的，再给返阴丹即定。常须识此，勿令误。
问胸膈不快，痞满闭塞，唇青手足冷，脉沉细，少情绪，或者腹痛的，是什么？
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，是由冷物伤脾胃，阴经受之，主胸膈痞满，满面色及唇皆无色泽，手足逆冷，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，盖不知寒中太阴脾经。
右边胸膈不快，不可用食药，下之则成痞。
海藏说：阴证胸膈不快，这是无病形，若投巴豆之药，即取有形之病，故轻则转痞，重则成劳，尤重则一二日遂成不救。故《活人书》本经说：丸子巴豆，乃攻食积耳！
问：万一饮食不节，胸膈不快，寒中阴经，何法以治？
答曰：急则理中汤加青陈皮，锉如麻豆小，服一二剂，胸膈即快。枳实理中丸、五积散尤其好。
五积散一句，是兼表证，或者无有表证，或者自内而之外，传至极高之分，则宜是药。若无表则不宜用此，用理中法足矣！
问脉微细，欲吐不吐，心烦但欲寐，六七日自利而渴的，是什么？
这叫少阴。少阴之为病，欲吐不吐，心烦但欲寐，六七日自利而渴者，是虚证，故引水自救。若小便色白的，少阴病形悉具矣。小便色白的，以下焦虚有寒，不能制水，故令色白。四逆汤主之。
举阳证和少阴证，口燥舌干而渴的，须急下之，不可缓，宜大承气汤主之。若脉沉而迟的，须温之，四逆汤主之。盖以口燥舌干而渴知其热，脉沉而迟别其寒。
少阴病属肾，古人谓之肾伤寒。肾伤寒口燥舌干而渴，固当急下，大体肾伤寒亦多表里无热，但若烦愦默而极，不欲见光明，有时腹痛，其脉沉细，旧用四逆汤。古人恐其热不敢遽用，云肾病而体犹有热者，可服黄连龙骨汤。若已十余日，下利水止，手足微冷，乃无热候，可服增损四顺散。
上面这一条，虽有肾病而体犹有热一句，亦当以久暂察之，不可乍见便以为身热。不用四逆用黄连，及手足冷却用四顺，亦不甚的当。
举阳证和少阴病，若恶寒而倦，时时自烦，不欲浓衣的，大柴胡下之。少阴病，始得之，反发热，脉沉的，麻黄附子细辛汤微汗之。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。此学人不可不知。
问身微热，烦躁，面赤，脉沉而微的，是什么？
这叫阴证似阳。阴发躁，热发厥，物极则反。大率以脉别之为准，诸数为热，诸迟为寒，无如此最为验。
上面这一句，可以为世法。
假令身体微热，烦躁面赤，其脉沉而微的，皆阴证。身微热者，里寒故也；烦躁者，阴盛故也；面戴阳者，下虚故也。治者不看脉，以虚阳烦躁，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，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。
上面外热内寒，烦躁，不可用凉热。
问：身冷，脉细沉疾，烦躁而不饮水的，是什么？
这叫阴盛格阳。伤寒阴盛格阳者，病患身冷，脉细沉疾，烦躁而不饮者是也。若欲引饮者，非也。不欲饮水者，宜服霹雳散，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、丹砂丸并主之。
问身体重少气，阴肿入里，腹内绞痛，热上冲胸，头重不欲举，眼中生花，妇人则里急，腰胯连腹内痛的，是什么？
这叫阴阳易。伤寒病新瘥，阴阳气未和，因合房室，则令人阴肿，入腹绞痛，妇人则里急，腰胯连腹痛，名为阴阳易。其男子病新瘥，未平复，而妇人与之交接得病，名曰阳易；其妇人病新瘥，未平复，男子与之交接得病，名曰阴易。若二男二女，并不相易。所以呼为易者，阴阳相感动甚，毒疫着人，如换易然。其病状身体热冲胸，头重不能举，眼中生花，四肢拘急，小腹绞痛，手足拳则皆死。其亦有不即死者。病若小腹里急，热上冲胸，头重不欲举，百节解离，经脉缓弱，血气虚，骨髓竭，便翕翕气力转小，着床而不若摇动，起止仰人。或引岁月不死，烧裈散、鼠粪汤、竹皮汤、干姜汤、青竹茹汤、当归白术汤，可选用。《孙兆口诀》，治阴盛隔阳，伤寒其人必躁热，不欲饮水者，宜服霹雳散。
附子一枚，烧灰存性，为末，蜜水调下，为一服而愈。此逼散寒气，然后热气上行，而汗出乃愈。
Haizang said: Cholera accompanied by headache and fever, the pathogenic factor originates from wind-cold. The middle jiao is the dividing line where cold and heat are equally divided; if the pathogen resides slightly higher in the yang aspect, it manifests as a heat syndrome. If there is excessive drinking of water, Wuling San (Five-Ingredient Powder with Poria) is used to dissipate it. If the pathogen resides slightly lower in the yin aspect, it manifests as a cold syndrome. If there is no desire for water, Lizhong Wan (Regulate the Middle Pill) is used to warm the interior. Thus, similar to Shaoyin disease entering the interior, if it connects with the hand meridians transforming into heat, Dachengqi Tang (Major Order the Qi Decoction) is used to purge; if it connects with the foot meridians transforming into cold, Sini Tang (Frigid Extremities Decoction) is used to warm.
Haizang said: The Yin pulse chapters in Zhang Zhongjing's work were arranged according to Wang Shuhe's order, and the herbs are all found under the relevant clauses in Zhang Zhongjing's original classic.
Pressing feels present but vanishes upon lifting, Qi fills the three jiao while zang organs are deficient, cold qi fails to regulate causing stagnation in the three positions, only by unblocking the intestines and establishing the stomach can it be eliminated. This is the deep pulse on the right side.
The choppy pulse at the guan position indicates concurrent stomach Qi deficiency; at the middle position, blood scatters and cannot stay; if seen at the chi position, it meets with counter-cold, body coldness, and rumbling below the navel. This is the choppy pulse on the right side.
The weak pulse at the cun position indicates deficiency of the Yang pathway; if present at the guan position, Qi is often dispersed; if in the chi position, Yin Qi is exhausted, leading to soreness and pain radiating to the upper skin. This is the weak pulse on the right side.
The cun position pulse is tight and wiry like a single string, chest urgency and pain feel like rope pulling; if wiry at the guan position, cold is in the stomach, stagnant water fills the lower jiao and Dantian. This is the wiry pulse on the right side.
The faint pulse at the cun position indicates Qi invading upwards; at the middle position, depression and stagnation of Qi affect the heart; if seen at the chi position, accumulation occurs below the navel, body coldness leads to groaning after drinking water. This is the faint pulse on the right side.
Yin Toxic Cold Damage causes heavy body, stiff back, unbearable eye pain, urgent lower abdominal pain, blue-black lips, toxic vapors rushing to the heart making it uncontrollable, cold extremities with desire to vomit, throat discomfort, fine and deep pulse. If moxa is applied quickly below the navel ring, joy may be seen after six days.
The five acupoints below the navel are detailed under the section on indications for moxibustion.
Taiyin, Shaoyin, and Jueyin all belong to Yin syndromes. Taiyin is the spleen; Shaoyin is the kidney; Jueyin is the liver.
What is the Taiyin syndrome? The Taiyin spleen meridian governs chest and diaphragm distension. The *Jiayi Jing* states: Pathogens arising from Yang are contracted from wind, rain, cold, and summer heat; pathogens striking Yin are contracted from diet, dwelling, and emotions. It also says: Rogue winds and empty pathogens are received by Yang; irregular diet and improper living habits are received by Yin. Received by Yang enters the fu organs; received by Yin enters the zang organs. Entering the six fu organs causes fever, inability to lie down regularly, and wheezing/calling out; entering the five zang organs causes fullness and obstruction, lower part presents as undigested diarrhea, prolonged becomes intestinal dysentery.
What is the Shaoyin syndrome? The Shaoyin kidney meridian governs fine and minute pulse, vexation but desire to sleep, or spontaneous diarrhea with thirst. The classic asks: Why does Shaoyin disease appear on day one or two? It means that during an epidemic, when pores are cold, pathogens enter the Yin meridians without passing through the Three Yang meridians.
Although Cold Damage involves Three Yin and Three Yang, generally manifesting in Yang is Taiyang disease, manifesting in Yin is Shaoyin disease. These two meridians are exterior-interior pairs and are most commonly affected. Yangming and Taiyin are less frequently affected. Shaoyang and Jueyin, being liver and gallbladder meridians, are even rarer. For any illness from one to twelve or thirteen days, if Taiyang syndrome persists, treat only Taiyang. If Shaoyin syndrome appears immediately upon onset, attack Shaoyin directly, without needing to transmit sequentially from Juyang (Taiyang).
Cold qi entering Taiyang causes fever and aversion to cold; entering Yin meridians causes only aversion to cold without fever. In Three Yin cold damage, mild cases use Lizhong Tang; slightly cold extremities or cold-damage diarrhea use Ganjiang Gancao Tang (Dried Ginger and Licorice Decoction).
Slight coldness of finger and toe tips is called "Qing" (cold), which has not yet reached the severity for Sini Tang because the disease is light; only Lizhong or Dried Ginger type medicines should be taken.
For severe cases, use Sini Tang; for absent pulse, use Tongmai Sini Tang (Pulse-Recovering Frigid Extremities Decoction).
What is Jueyin? The Jueyin liver meridian governs excessive thirst, Qi rushing up to the heart causing pain and heat, hunger but no desire to eat, vomiting roundworms after eating, and unremitting diarrhea if purged. If Yin Qi alone is excessive and Yang Qi suddenly perishes, it becomes Yin Toxic. Symptoms include cold extremities, pounding pain in umbilical/abdominal region, body feeling like beaten by a staff, deep and rapid pulse, or vomiting/diarrhea. Emergency treatment is required: moxa below the navel and administer pungent-hot medicines to restore Yang Qi, resolving via profuse sweating. Ancients said: Pungent and sweet disperse and are Yang, referring to Guizhi Tang (Cinnamon Twig Decoction), Gancao, Ganjiang, Fuzi, etc., which can restore Yang Qi. Mild cases use pungent-sweet; severe cases use pungent-bitter-hot. Extreme Yin causes restlessness, a Yin syndrome resembling Yang. Scholars must distinguish by pulse.
Question: Cold extremities, pounding abdominal pain, sore throat, vomiting/diarrhea, body like beaten, or cold sweat/vexation/thirst, fine pulse nearly vanished—what is this?
This is named Yin Toxic. Yin Toxic disease begins with cold extremities, stiff back, sore throat, inability to swallow porridge, toxic vapors attacking the heart, heart/abdominal pain, shortness of breath, cold extremities, vomiting/diarrhea, body like beaten. Suitable formulas include Yindu Gancao Tang (Yin Toxic Licorice Decoction), Baizhu San (Atractylodes Powder), Fuzi San (Aconite Powder), Zhengyang San (Correct Yang Powder), Rougui San (Cinnamon Bark Powder), Huiyang Dan (Return Yang Pill), Fanyin Dan (Reverse Yin Pill), Tianxiong San (Heavenly Male Aconite Powder), Zhengyuan San (Correct Origin Powder), Tuiyin San (Push Away Yin Powder), etc., select as appropriate. Generally, Yin Toxic stems from kidney Qi deficiency and cold, or cold food injuring spleen, external wind-cold, internal latent Yin plus external cold, or external cold first then internal latent Yin. Both interior and exterior are Yin, so Yang Qi cannot guard, leading to headache, heavy waist, abdominal pain, eye pain, body fatigue, cold extremities, cold sweat on forehead/back of hands, or vexation/thirst, mental confusion as if lost. Within 2-3 days, one might walk, not feeling very heavy. Diagnosis shows six pulses all deep, fine, and rapid, chi position short/small, cun position possibly large.
Yang syndrome pulses are all floating and large, or deep-palpated large but not very rapid; this is not Yin syndrome. Generally, Yang Toxic Cold Damage pulses are wiry, surging, and rapid; Yin Toxic Cold Damage pulses are deep, fine, wiry, and rapid; this must be known.
If cool medicines are mistakenly taken, thirst increases, restlessness intensifies. For such symptoms, urgently take pungent-hot medicines; peace returns in one or two days.
If Yin Toxic deepens, symptoms become heavy, cold extremities, worsening abdominal pain, throat discomfort, epigastric fullness/hardness, vexation/thirst, continuous cold sweat.
Regarding the previous point where cool medicines caused increased vexation/thirst, hot medicines should be administered.
Yang excess causes hot body without sweat; Yin excess causes cold body with sweat. Qibo said: Yang excess causes hot body, closed pores, rough breathing, tossing about, no sweat but heat; Yin excess causes cold body, sweating, constant chilliness, frequent restlessness and cold, cold leads to cold extremities. (Chill means cold.)
The above passage explains the origin of Yin restlessness according to Qibo.
Occasional confused speech, blue-black nails and complexion, six pulses deep, fine, and rapid, seven beats per respiration or more. For such symptoms, quickly moxa Qihai or Guanyuan acupoints 300-200 times, aiming for warm extremities, concurrently take Zhengyang San, Huiyang Dan, Tianxiong San, Baizhu San. Interior-exterior connect, Yang Qi restores, resolving via profuse sweating.
Excessive Yin Toxic and sudden Yang Qi perishing constitutes Yin Toxic; excessive Yang and sudden Yin Qi perishing constitutes Yang Toxic. Generally, separation of Yin and Yang cannot restore righteous Qi without profuse sweating.
Yin and Yang are like husband and wife; each attaining balance brings harmony. If biased, each takes power to the extreme, leading to separation! Medicines attack pathogens; once pathogens leave, righteous Qi returns. This is like whipping to teach while wanting to coexist.
If Yin Toxic is deep, disease is critical, six pulses felt only pressing to bone, vanish upon lifting, eight beats per respiration or more, or uncountable. At this stage, medicines are difficult to use! Use onion-warming method on the navel, or moxa 300-500 times. If extremities do not warm, it is incurable. If extremities warm, take more hot medicines to assist. If Yin/Yang Qi returns, gradually reduce hot medicines and regulate.
If Yang Qi temporarily recovers, restlessness often appears. Do not administer cool medicines. For severe restlessness, give Fanyin Dan again to settle. Always remember this, do not err.
Question: Chest/diaphragm discomfort, fullness/obstruction, blue lips, cold extremities, deep/fine pulse, low mood, or abdominal pain—what is this?
This is Taiyin. Modern people often do not 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, governing chest/diaphragm fullness. Face and lips lack luster, cold extremities, 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 Seed (Baidu) again worsens chest discomfort, causes vomiting/diarrhea, leading to death within 1-2 days, due to ignorance of cold invading Taiyin spleen meridian.
Right-side chest discomfort: Do not use digestive aids; purging leads to glomus.
Haizang said: Yin syndrome chest discomfort has no pathological form; administering Radix Crotonis Seed creates pathological form. Mildly turns to glomus, severely to consumptive disease, critically leads to death in 1-2 days. Thus, *Qin Ren Shu* states: Pills containing Radix Crotonis Seed only attack food stagnation!
Question: What if irregular diet causes chest discomfort, cold invading Yin meridians, how to treat?
Answer: Urgently use Lizhong Tang added with Qingpi and Chenpi, cut small like hemp seeds, take 1-2 doses, chest discomfort resolves. Zhishi Lizhong Wan (Immature Bitter Orange Regulate the Middle Pill) and Wuji San (Five Accumulations Powder) are especially good.
Wuji San addresses exterior syndrome simultaneously. If no exterior syndrome, or transmission from interior to highest exterior, this medicine is suitable. Without exterior, this is inappropriate; using Lizhong method is sufficient.
Question: Fine/minute pulse, desire to vomit but unable, vexation but desire to sleep, spontaneous diarrhea with thirst after 6-7 days—what is this?
This is Shaoyin. Shaoyin disease features desire to vomit but unable, vexation but desire to sleep, spontaneous diarrhea with thirst after 6-7 days. This is deficiency, hence drawing water to save oneself. If urine is white, Shaoyin disease signs are complete. White urine indicates lower jiao deficiency with cold, inability to control water, hence color is white. Sini Tang is primary.
Comparing Yang syndrome and Shaoyin syndrome: Dry mouth/tongue with thirst requires urgent purging, do not delay, use Dachengqi Tang. If pulse is deep and slow, require warming, use Sini Tang. Dry mouth/tongue/thirst indicates heat; deep/slow pulse distinguishes cold.
Shaoyin disease belongs to kidney, ancients called it Kidney Cold Damage. Kidney Cold Damage with dry mouth/tongue/thirst should be purged urgently. Generally, Kidney Cold Damage often lacks interior/exterior heat. If extremely vexed/silent, avoiding light, occasional abdominal pain, deep/fine pulse, traditionally use Sini Tang. Ancients feared heat and did not use it hastily, saying if kidney disease with residual heat, Huanglian Longgu Tang (Coptis and Dragon Bone Decoction) can be taken. If over 10 days, diarrhea stops, slight cold extremities, no heat signs, Zengsun Sishun San (Modified Four-Gentle Smooth Powder) can be taken.
Regarding the previous point "kidney disease with residual heat," observe duration; do not assume heat just because it appears. Not using Sini Tang but Huanglian, or using Sishun when extremities are cold, is not entirely accurate.
Comparing Yang syndrome and Shaoyin disease: If aversion to cold, fatigue, frequent self-vexation, dislike thick clothing, Da Chaihu Tang purges. Shaoyin disease, initially presenting with fever and deep pulse, Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) induces slight sweating. Shaoyin disease, 2-3 days in, usually lacking Yang syndrome signs, still requires slight sweating, use Ma Huang Fu Zi Gan Cao Tang (Ephedra, Aconite, and Licorice Decoction). Scholars must know this.
Question: Slight body heat, restlessness, red face, deep/micro pulse—what is this?
This is Yin syndrome resembling Yang. Yin causes restlessness, heat causes cold extremities, extremes reverse. Generally, distinguish by pulse: rapid numbers indicate heat, slow numbers indicate cold; this is most reliable.
The above sentence serves as a standard for the world.
Suppose slight body heat, restlessness, red face, deep/micro pulse—all are Yin syndromes. Slight heat is due to interior cold; restlessness is due to Yin excess; red face (floating Yang) is due to lower deficiency. Treators ignoring pulse mistake vacuous Yang restlessness for excess heat, giving cool medicines, depleting Qi and causing major disease. *Waitai Miyao* says: Yin excess causing restlessness, desiring to sit in wells, treat with hot medicines. Zhang Zhongjing's Shaoyin syndrome with red face uses Sini Tang adding Congbai (Green Onion Bulb).
Above: Exterior heat, interior cold, restlessness, do not use cool/hot indiscriminately.
Question: Cold body, fine/deep/rapid pulse, restlessness without desire to drink—what is this?
This is Yin Excess Repelling Yang. Cold Damage Yin Excess Repelling Yang: patient cold body, fine/deep/rapid pulse, restlessness without desire to drink. If desiring to drink, it is not this. Without desire to drink, use Pili San (Thunderbolt Powder). Restlessness stops shortly, sleep follows, sweating ensues, recovery occurs. This medicine disperses cold Qi, then hot Qi rises, sweating resolves disease. Huoyan San (Flame Powder), Dansha Wan (Cinnabar Pill) also treat it.
Question: Heavy body, shortness of Qi, Yin swelling entering interior, abdominal cramping pain, heat rushing to chest, heavy head unwilling to lift, flowers before eyes, women have urgency in interior, waist/hips connecting to abdominal pain—what is this?
This is Yin-Yang Exchange. After recovery from Cold Damage, Yin-Yang Qi not harmonized, sexual intercourse causes Yin swelling, abdominal cramping pain, women have urgency, waist/hip/abdominal pain, named Yin-Yang Exchange. If man newly recovered, not fully restored, woman joins him and gets sick, it is Yang Exchange; if woman newly recovered, not fully restored, man joins her and gets sick, it is Yin Exchange. Two men or two women do not exchange. Called Exchange because Yin-Yang move each other intensely, pestilential toxin attaches to person like swapping. Symptoms: heat rushing to chest, heavy head unable to lift, flowers before eyes, limb spasms, lower abdominal cramping, clenched fists lead to death. Some do not die immediately. If lower abdominal urgency, heat rushing to chest, heavy head, joints separating, meridians slack, Qi/Blood deficient, marrow exhausted, strength diminishes, lying in bed unable to move, needs assistance to rise. If surviving months/years, Shao Kun San (Burnt Underwear Powder), Shu Fen Tang (Mouse Dropping Decoction), Zhupi Tang (Bamboo Peel Decoction), Ganjiang Tang (Dried Ginger Decoction), Qingzhuru Tang (Green Bamboo Sap Decoction), Danggui Baizhu Tang (Angelica and Atractylodes Decoction) can be selected. *Sun Zhao Koujue* treats Yin Excess Repelling Yang: Cold Damage patient restless/hot, no desire to drink, use Pili San.
One piece of Fuzi (Prepared Aconite Root), burned to ash retaining nature, ground to powder, mixed with honey water, taken as one dose for cure. This forces dispersion of cold Qi, then hot Qi rises, sweating resolves disease.