2f. 六经辩证-厥阴病

2f. Six Jing diagnosis –Jueyin stage

厥阴病是伤寒病最后的厥证阶段。因为厥阴是人体阴阳之气交替转换的阶段，厥阴病则是人体阴阳之气不能正常交替，即所谓“阴阳气不相顺接”，阴阳气不相顺接的临床特征就是“厥”，“阴阳气不相顺接”的再发展就是“阴阳离决”，“阴阳离决”就是死亡。所以从伤寒的过程来看，厥阴病是伤寒的最后阶段。这时，寒气极盛就会逼阳外出，形成里寒外热的寒热错杂，或戴阳证等等。

If a patient has both cold hands and feet, his/her condition will belong to the Jueyin stage. The Jue condition means that the body Yang Qi is much depleted through the course against the disease, so that there is no enough Yang Qi moving from the Yin side of the body into the Yang side of the body (the end of the hands and feet).

Normally the Yin meridian and the Yang meridian connects at the end of the hand and feet – the fingers and the toes, so the hands and the feet feel cold.

Along with the progress of the disease, the cold feeling in the hands and feet moves up to the elbow or to the knee direction. This is what we call it here “Jue condition”. Due to the disconnection of the Yang Qi from the Yin side of the body and the Yang side of the body, the Yang Qi could float on the face or head, forming the “Floating Yang” condition. If the disconnection condition further develops, the Yin Qi and the Yang Qi would separate, to cause death.

(1). 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。

因消渴, 只能让病人少量多次饮水. 饮水多则导致心下悸, 手足厥冷. 此时当治水, 用茯苓甘草汤. 不可治厥, 否则水入胃致下利.

(1). Thirsty syndrome: The patient feels very thirsty, feels a gas rushing up to pouch the heart, feels pain and hot in the chest, and feels hungry but no desire to eat. If eat, there would vomit out roundworm. Use Fuling Gancao Tang for the treatment. In such condition, the patient should be allowed to drink the water more times but less volume each time. If drink too much water, there would be palpitation in the upper stomach and it causes cold hands and feet. The accumulated water should be treated first, not the Jue condition (as by the use of warm herbs). Otherwise, water drink would cause diarrhea. Colon-cleansing therapy should not be used either. It will cause continuous diarrhea.

(2). 伤寒脉微而厥，至七、八日肤冷，其人躁无暂安时者，此为藏厥，乌梅丸主之，又主久利。

(2). Organ Jue syndrome: The pulse is tiny. The patient feels cold in hands and feet. After several days, the skin is cold. The person behaves continuous jumping of arms and legs (irritated feeling). This is a condition called Organ Jue Condition. Use Wumei Pill for the treatment.

(3). 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.

(3). Meridian Jue syndrome: The patient feels cold in hands and feet; the pulse is very tiny and weak. Use Danggui Sini Tang for the treatment. If the patient has also a long term cold condition inside the body (easy to have diarrhea when eat cold food), use Danggui Sini plus Wu Sheng Tang.

(4). 手足厥冷，小腹满，按之痛者，此冷结在膀胱关元. 宜温, 宜灸关元穴.

(4). Cold-entangled in urine bladder: The patient feels cold hands and feet, feels bloating in lower stomach, feels pain in the lower stomach when touch. This condition is called cold-entangled in the urinary bladder. Use moxibustion on the Guanyuan point (in the middle of the lower stomach).

(5). 手足厥冷，脉乍紧, 心下满而烦，饥不能食者，病在胸中，当须吐之，宜瓜蒂散。此为寒实结在胸中导致的四逆。

(5). Cold-entangled in the chest: The patient feels cold in hands and feet, feels bloating in the upper stomach, irritated, hungry but cannot eat. The pulse is tight from time to time. The problem is in the chest. Use Guadi San for the treatment (to stimulate vomit for the treatment).

(6). 伤寒脉促而厥者，可灸之。

(6). If the pulse feels as urgent and hurry and the hands and feet feel cold (the Jue condition) in Shanghan disease, moxibustion can be used for the treatment.

(7). 下利脉沉而迟，其人面少赤，身有微热，厥而下利清谷者，为戴阳证, 用通脉四逆汤.

(7). Dai Yang syndrome: The patient feels cold hands and feet. The pulse is deep and slow. The face is slightly in red and the body feels slightly hot. The patient has diarrhea with non-digested food in stool. Use Tong Mai Si Ni Tang.

(8). 下利清谷，汗出而厥, 里寒外热者，通脉四逆汤主之。

(8). Diarrhea with non-digested food in the stool, sweat and the cold hands and feet. For such inside cold but outside hot syndrome, use Tong Mai Si Ni Tang for the treatment.

(9). 大汗出，热不去，内拘急，四肢疼，又下利厥逆而恶寒者，四逆汤主之。

(9): The patient has heavy sweat, continuous fever, spasm in stomach, pain in the arms and legs, diarrhea, chilly, and cold hands and feet. This is the co-exist of Yangming and Jueyin. Use Si Ni Tang for the treatment.

(10). 大汗，若大下利而厥冷者，四逆汤主之。

(10). The patient has heavy sweat and heavy diarrhea, feels cold hands and feet. Use Si Ni Tang for the treatment. This is also the co-exist of Yangming and Jueyin stages. 

(11). 厥阴病,  干呕吐涎沫，头痛者，吴茱萸汤主之。

(11). In the Jueyin stage, if the patient feels nausea and vomit saliva and headache, use Wuzhuyu Tang for the treatment.

注意事项和解释：

Notice and explanations:

1. 手足厥逆称为厥. 厥有寒厥热厥之分

1. There are Cold Jue and Hot Jue conditions. The Jue condition in the Jueyin stage here is the Cold Jue condition.

厥阴之厥有热厥和寒厥之分. 伤寒一、二日热, 至四、五日而厥者，厥深者热亦深，厥微者热亦微，热厥应下之，而反发汗者，必口伤烂赤. 若为寒厥, 伤寒一, 二日即厥, 至四, 五日厥不已. 热厥者, 手掌心应暖, 脉为滑脉。 寒厥者，手掌冷，脉沉细微。

In the Shanghan disease, if in the first and second day, the patient has fever, but upon the fourth day or fifty day, the patient has the Jue condition, it is Hot Jue condition. If the Jue is severe (e.g. severer cold in hands and feet), it means the Fire inside the body is also severer. If the Jue is mild, it means the Fire condition inside the body is also not severer. For the treatment of the Hot Jue condition, colon-cleansing therapy should be used. If sweat therapy is mis-used, the patient would have ulcer in mouth.

For Cold Jue condition, the Jue Condition occurs on the first or the second day of the Shanghan disease. It can last to the fourth and fifty day of the disease without disappear. For the Hot Jue condition, the palm is warm and the pulse is slippery pulse. For the Cold Jue Condition, the palm is also cold and the pulse is deep, thin, and tiny.

热厥多见于伤寒阳明中风经证，相当于急性传染病高热期。热厥者，用白虎汤治疗。寒厥者，用当归四逆汤。

Hot Jue condition is commonly seen in the Wind-attack Yangming stage of the Shanghan disease. It is almost as in the peak stage of an infectious disease. For the treatment of the Hot Jue condition, use Baihu Tang; for Cold Jue condition, use Danggui Si Ni Tang. 

2. 寒厥有经寒和脏寒之分

2. There are the meridian Cold Jue condition and the organ Cold Jue condition

经寒者, 四肢厥逆, 用当归四逆汤; 脏寒者, 心下痞满, 食谷欲吐, 或寒气上逆致干呕吐涎沫, 头痛, 用吴茱萸汤；躁无暂安时，用乌梅丸；消渴者，用茯苓甘草汤. 如果经寒, 脏也寒, 用当归四逆加吴茱萸生姜汤.

For the meridian Cold Jue condition, the patient has the cold hands and feet but no any other problem inside the body. For this use Danggui Sini Tang for the treatment. For the organ Cold Jue condition, the patient has bloating in upper stomach area, has desire to vomit after eat, or has nausea, spits saliva, has headache, beside the cold hands and feet. In this case, use Quzhuyu Tang for the treatment. If the Cold Jue condition is with no-end restless in arms and legs, use Wumei Wan. If the Jue condition is with heavy thirsty, use Fuling Gancao Tang. If there are both the meridian and the organ Cold Jue, use Danggui Sini Tang plus Wuzhuyu and Shengjinag.

3. 厥阴病的四肢厥逆要和四逆散之阳气不达肢末; 附子泻心汤阳虚为本的上热下寒 (阳虚表现为腹泻阴冷); 及黄连阿胶汤阴虚为本的上热下寒证相区别 (阴虚表现为口干咽干)。其上热多表现为上半身汗出而心烦，下寒多为下肢冷。

There are several conditions that need to be distinguished with the Jue condition: the Si Ni San condition, the Fuzi Xiexin Tang condition, and the Huanglian Ajiao Tang conditions, etc.

(3.1). 四逆散证：四逆散证本质为阳气郁滞在内而不达四末。病人也有手脚冰，腹胀，微热，或咳，或悸，或尿不利，或腹痛等。四逆散证者脉不沉不微细。厥阴病厥症者脉沉细微。

(3.1). Si Ni San syndrome: The patient feel also cold hands and feet, bloating in the upper side of the stomach. The patient can also have slight hot, or cough, or palpitation, or difficult in urination, or stomach pain, or diarrhea. The cold hands and feet are due to the stagnation of Yang Qi inside of the body. The Yang Qi is sufficient but is blocked to reach the hands and feet. It is not the same reason as the cold hands and feet in the Jue condition of the Jueyin stage, where the Yang Qi is insufficient in the body. For the Si Ni San syndrome, the pulse is not deep-thin-tiny, but the Jueyin stage, the pulse should be deep, or thin or tiny.

(3.2). 附子泻心汤证：上半身身热汗出，上腹胀满，下半身至脚冷。也可以是恶寒汗出，上腹胀满。

(3.2). Fuzi Xie Xin Tang syndrome: The patient feels hot and sweat in the upper part of the  body, but cold feeling in the lower part of the body, with bloating feeling in the upper stomach. It can also be used with chilly and sweat, bloating in upper stomach area.

(3.3). 黄连阿胶汤证：后世总结黄连阿胶汤证为上半身身热，口燥眼干，心烦，脚冰。

(3.3). The Huanglian Ajiao Tang syndrome: The patient feels sweat in the upper part of the body, dry mouth and throat, irritated, and cold feet.

厥症指的是手脚皆冷或冰。而类似与这里的附子泻心汤和黄连阿胶汤的脚冰为主而手基本上不甚冰的方证很多，如苏子降气汤，桃核承气汤等等。

Jue condition means that both hands and feet are cold, though it has to be distinguished with Sini San syndrome. The clinic conditions that are cold mostly in feet but not in hands, similar to the Fuzi Xiexin Tang and Huanglina Ajiao Tang here, are many. For example, in the Suzi Jiang Qi Tang and Taohe Chengqi Tang conditions, the patient feels mostly cold in feet but may not so cold in hands.

4. 厥阴病的冷结膀胱证需要与血结膀胱，水结膀胱，热结膀胱，和相鉴别。诸证都为小腹满，压之痛。如果压之不痛，也许得考虑为金匮肾气丸证。

4. The Cold-entangle in urinary bladder condition should be distinguished with Water-, Blood-, and Fire-entangle in urinary bladder conditions. All the entangle conditions show bloating feeling in lower stomach area, which feels pain when press. If no pain when press, it might be the Shen Qi Wang condition.  

(4.1). 冷结膀胱者，手足厥冷，小便白而数。

(4.1). For the Cold-entangle condition, the patient has cold feet and hands, and the urine is frequent and pure as water.

(4.2). 若小便自利者, 为血结膀胱; 该证已经在太阳病章介绍过了 （膀胱积血证）

(4.2). For the Blood-entangle condition, the urination is easy, no problem. This condition has been introduced in Taiyang stage.

(4.3). 若小便不利者, 为水结膀胱;

(4.3). For the Water-entangle condition, the urination is difficult.

(4.4). 若手足热, 小便赤涩者, 为热结膀胱; 该证也已经在太阳病章介绍过了 （膀胱蓄热证）

(4.4). For the Fire-entangle condition, the urine is red in color, and the urination is also in sluggish. This condition has also been introduced in the Taiyang stage.

5. 厥阴之厥证需要和蛔虫导致的迴厥区别

5. The Jue condition in the Jueyin stage should be distinguished with the Jue condition due to roundworm

厥阴病和蛔厥都会有吐蛔虫的现象。厥阴之厥为持续性，有消渴，气上撞心，心中疼热，饥而不欲食，食则吐蛔。而蛔厥者，有发作性腹痛，腹痛剧烈时方有手脚冰冷，发作后如常人。

The Jueyin stage or the roundworm both could have roundworm vomit. The cold hands and feet in the Jueyin stage is continuous condition, and have no paroxysmal stomach pain. While the cold hands and feet in roundworm disease is paroxysmal when the stomach is very painful. After the episode of the stomach pain, the person behaviors as normal. 

6. 厥阴病主方

6.. About the main formula for the Jueyin stage

关于厥阴病的主方, 也就是说厥阴病的主证到底是什么方子, 向来诸说不一. 有说就是这里书面上的乌梅汤, 有说是当归四逆汤, 也有的认为吴茱萸汤应该是厥阴病的主方.

There are large conflicting ideas about which herbal formula is the main formula for the Jueyin stage. Someone believes that the herbal formula Wumei Tang should be the main formula. Some others insist that the Danggui Si Ni Tang should be the one, or the Wuzhuyu Tang should be.

首先, 这里要明白的一点是厥阴病, 病位在厥阴肝. 病至厥阴, 阳气极弱, 阴气极重. 阴阳之气不相顺接, 故有肢厥; 重阴逼迫阳气外散而有浮阳加阴寒综合征. 所以, 凡是治疗这些征候的方子都可以看作是厥阴病主方. 故而, 当归四逆汤, 吴茱萸汤, 乌梅汤, 都可以看作是厥阴病主方. 实际上, 在少阴病的时候, 就有除了四逆汤基本方以外，黄连阿胶汤为少阴心火为病的主方和真武汤为少阴肾水寒的主方之分. 并不是说每一个病就只有一个所谓的主方. 在太阳病, 不就有麻黄汤和桂枝汤两个主方吗.

We should understand that, for the Jueyin stage, the location of the disease is in the Jueyin meridian or the Jueyin phase of the energy circle. In this stage or this phase, the Yin Qi is very strong and the Yang Qi is weak. The Yang Qi fails to connect or fail to go into the next circle (through the hands and feet), so there is the cold hands and feet. The strong Yin Qi presses the Yang Qi away, so there is the Yang Qi floating phenomenon. Therefore, any herbal formula that can work for either of these conditions can be regarded as the main formula of the Jueyin stage. In fact, each stage may have several formula as the main formula. For instance, in the Shaoyin stage, the Huanglian A Jiao Tang, which works for the syndrome caused by Heart Fire burning, and the Zhen Wu Tang, which works for the syndrome caused by Kidney Water flooding, can both be regarded as the main formula, beside the basic formula Si Ni Tang. You may remember that, in the Taiyang stage, we have both Mahuang Tang and the Guizhi Tang as the main formulae.

7. 厥阴下利要和白头翁汤相鉴别

7. Jueyin diarrhear needs to be distinguished with Baitouwen Tang

原文: 下利欲饮水者，以有热故也，白头翁汤主之。热利下重者，白头翁汤主之。

The original text in the book is: That diarrhea is with thirsty feeling is because there is hotness inside the body. Use Baitouwen Tang for the treatment. If the hot diarrhea is with retention feeling in side the anus, also use the Baitouwen Tang for the treatment.

在此, 将白头翁汤列在厥阴病一章, 应该为鉴别诊断之目的, 因为厥阴下利, 剧者有可能有里寒逼阳 (经肛门) 外泄, 故而也会有肛门烁热及里急后重感, 但是病人有肢厥及下利不渴. 白头翁汤证应该属于温病范畴.

We believe that, Master Zhang Zhongjing listed the Baitouwen Tang here is for distinguish. For the diarrhea in the Jueyin stage, the strong Yin Qi could press or push the Yang Qi. Yang Qi may escape from the anus (it can also escape from mouth, from nose, form eyes, or ears) to cause burning sensation that feels similar to the Baitouwen Tang condition. But in the Baitouwen Tang condition, there is no cold hands and feet. If indeed it has, the Jue condition should belong to Hot Jue condition, similar to the Bai Hu Tang condition (see above).  

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