少阳与厥阴为表里。木火之邪。无处发泄。势必连及于肝。此表里俱病。法当从少阳治。以引阴出阳。
邵评∶木火之邪。连及厥阴。表病及里也。少阳病入厥阴。由表及里。治法当使其邪仍从少阳外出为妥。
如见舌起红刺。或黑中有红点。外症发热恶寒。如疟状。手足乍温乍冷。烦满。消渴
谵语。二便不通。脉弦而数。方用柴芩、川连、鲜地、丹皮、栀子、钩丁、薄荷等。以散风木
之郁。使邪复出少阳而解。（温病）
邵评∶少阳温病。木火郁。邪转入厥阴。表与里同病也。其邪尚轻。故用清散少阳。使邪外出。
撰伤寒书者。每于三阴或热或寒之故。都模糊过去。即有传经直中之分。亦非仲
景本旨。此处不明。何以临症。用陈鄙见。质诸高明。
一、三阴。有阳经注入之邪。有本经自感之邪。注入之邪。则传变不一。阳主动也。自
感之邪。则在本经。阴主静也。
邵评∶传经自受。是邪入三阴之两大法门。
一、三阴。世都以传经直中分两门。传经悉指为热。直中悉指为寒。此说似是而实
有未尽者。夫传经。即邪从三阳经传入。直中。即本经自受之风寒也。盖邪之传入三阴。热症固多。而寒
症亦间有。本经中寒。固无热症。而中风亦能发热。未可以此分寒热了之。其症细述于左。
邵评∶不可以传经自受。分其寒热者。以阴经寒邪。不能发热。阴经风邪。亦有发热也。
一、邪从阳经注入三阴。则或为热症。或为寒症。如邪入太阳。先作郁热。以次传入阴经。则
为热症。或邪在太阳。不及郁热。即入少阴。而现少阴形证。则为寒症。或太阳之邪。即入少阴。
而仍带太阳标病。则为先寒后热之症。或太阳之邪。不传阳明少阳。便入三阴。随其人之体质虚实。
脏腑寒热。则从阴化为寒症。从阳化为热症。或风温之邪。从三阳入阴经。则无不为热症。凡三阴篇
内。所称转属阳明。而用承气等汤。皆阳经传入之热症也。
邵评∶邪入三阴。或寒或热之故。分别详明。
一、三阴自受之邪。各有中风中寒之症。三阴中风。则能发热。以风属阳邪故也。三
阴中寒。则不能发热。以寒属阴邪故也。即少阴有反热之症。亦必带太阳标病而
然。后人但知传入三阴为伤寒。不知三阴自感。亦伤寒也。故于本经中风发热。便
误认为传经标病。以本脏中寒无热。即指为直中阴症。讵知桂枝汤为表之里药。固能兼治三阴自感之风邪。
而理中四逆等汤。本治三阴自感之寒邪也耶。盖风寒六气之伤人。或入于阳。或入于阴。原无一定。
但值何经之虚而治之。不得专以太阳为受邪之始也。故三阴固有阳经注入之症。亦有本经自感之症。均
属伤寒。不必另立名目也。兹于三阴经中无直中之条。非略也。正不敢蛇足耳。
邵评∶三阴自受寒邪。不能发热。三阴自受风邪。亦能发热。不可因其有热。误认为阳经传入之热症也。
惟三阴自受风邪。宜桂枝汤和表。自受寒邪。用理中四逆温里。
一、三阴自受之邪。论中有可历指而见者。如太阴病。脉浮者可发汗。宜桂枝汤。此太阴中风也。如
太阴病。腹满而吐。自利益甚。时腹自痛。此太阴中寒之症也。如少阴中风。脉阳微阴浮者。为欲愈。此
即少阴中风欲愈之脉也。至于少阴中寒。宜汗者。麻黄附子细辛汤。当温者。附子四逆等汤是也。如厥阴中
风。脉微浮为欲愈。此即厥阴中风欲愈之脉也。厥阴中寒。即当归四逆加吴萸生姜汤是也。阅少阴厥
阴篇内。止有中风欲愈之脉。并无未愈之证治者。必有阙文也。
邵评∶此论三阴自受风寒脉症治法。分别精细。
一、三阴篇内。惟少阴有大承气急下三症。而太阴厥阴篇内。并无承气之条。奈何
后人反称邪在厥阴。三承气选用。夫承气。本阳明胃药。少阴用承气者。盖因肾水一亏。胃土燥实。病已
转属阳明。故急下以存阴液。仲景述厥阴病云。下之利不止。此厥阴忌下之明戒也。焉有邪在厥阴。
反用承气之理。圣训具在。是非自见。
邵评∶论三阴热邪结实。可用承气攻下之法。否则切不可用之理。分别甚精。
Shaoyang (Lesser Yang) and Jueyin (Terminal Yin) have a exterior-interior relationship. When pathogenic factors of the Wood-Fire nature have no outlet for discharge, they will inevitably involve the Liver. This constitutes a simultaneous disease of both the exterior and interior. The treatment principle should focus on treating Shaoyang to guide the pathogen from the Yin meridians out to the Yang.
Shao's Commentary: Pathogenic factors of the Wood-Fire nature involving Jueyin represent an exterior condition affecting the interior. When Shaoyang disease transmits to Jueyin, it moves from exterior to interior. The treatment method should aim to allow the pathogen to exit outwardly through Shaoyang, which is appropriate.
If red prickles appear on the tongue, or black coating with red spots is seen, accompanied by external symptoms of fever and aversion to cold resembling malaria, alternating warmth and cold in the hands and feet, irritability and chest fullness, excessive thirst, delirium, and obstruction of urination and defecation, with a wiry and rapid pulse, use a formula containing Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Chuanlian (Coptidis Rhizoma), Xian Di (Rehmanniae Radix Recens), Danpi (Moutan Cortex), Zhizi (Gardeniae Fructus), Gouding (Uncariae Ramulus cum Uncis), and Bohe (Menthae Haplocalycis Herba). These herbs disperse the stagnation of Wind-Wood, allowing the pathogen to re-emerge from Shaoyang and resolve. (This falls under Warm Diseases)
Shao's Commentary: In Shaoyang Warm Disease, due to the stagnation of Wood-Fire, the pathogen transmits to Jueyin, resulting in simultaneous exterior and interior involvement. Since the pathogen is still mild, clearing and dispersing Shaoyang allows the pathogen to exit outwardly.
Authors of Shanghan texts often vaguely pass over the reasons why diseases of the Three Yin meridians are either hot or cold. Even when distinguishing between transmission via meridians and direct strike, this does not reflect Zhang Zhongjing's original intent. Without clarity here, how can one apply this clinically? I present my humble views for discussion with experts.
First, diseases of the Three Yin meridians involve pathogenic factors injected from the Yang meridians and those directly contracted by the meridian itself. Injected pathogens vary in transmission because Yang is dynamic; pathogens directly contracted remain within the meridian because Yin is static.
Shao's Commentary: Transmission via meridians and direct contraction are the two major pathways for pathogens entering the Three Yin meridians.
Second, the world generally divides Three Yin diseases into two categories: transmission via meridians and direct strike. Transmission is entirely attributed to heat, and direct strike entirely to cold. This view seems plausible but is incomplete. Transmission refers to pathogens entering from the Three Yang meridians; direct strike refers to wind-cold directly contracting the meridian. Generally, while heat syndromes are common when pathogens enter the Three Yin, cold syndromes also occur occasionally. Although cold contraction of the meridian typically lacks heat signs, wind contraction can cause fever. Thus, one cannot simply distinguish cold from heat based on this alone. Specific symptoms are detailed below.
Shao's Commentary: One cannot divide cold and heat merely by transmission or direct contraction, as Yin meridians contracting cold cannot generate fever, whereas those contracting wind may exhibit fever.
Third, when pathogens inject from Yang meridians into the Three Yin, they may present as heat or cold syndromes. For instance, if a pathogen enters Taiyang, generates stagnant heat first, and then sequentially transmits to Yin meridians, it becomes a heat syndrome. If the pathogen remains in Taiyang without forming stagnant heat and immediately enters Shaoyin, presenting Shaoyin manifestations, it becomes a cold syndrome. If Taiyang pathogen enters Shaoyin but retains Taiyang superficial symptoms, it presents as alternating cold and heat. If Taiyang pathogen bypasses Yangming and Shaoyang to enter the Three Yin directly, its transformation into cold (from Yin) or heat (from Yang) depends on the patient's constitution (deficiency or excess) and organ temperature status. Wind-Warm pathogens entering Yin meridians from Yang meridians invariably become heat syndromes. All mentions in the Three Yin chapters of transferring to Yangming and using Chengqi Decoctions refer to heat syndromes transmitted from Yang meridians.
Shao's Commentary: The reasons for cold or heat after pathogens enter the Three Yin are explained in detail.
Fourth, pathogens directly contracted by the Three Yin meridians present with wind-strike or cold-strike symptoms. Wind-strike of the Three Yin causes fever because wind is a Yang pathogen. Cold-strike of the Three Yin does not cause fever because cold is a Yin pathogen. Even atypical fever in Shaoyin must be accompanied by Taiyang superficial symptoms. Later practitioners only know that transmission to the Three Yin is called Cold Damage, failing to realize that direct contraction by the Three Yin is also Cold Damage. Therefore, they mistakenly attribute fever from meridian wind-strike to transmitted superficial symptoms, and label cold contraction without fever as direct strike to Yin. They fail to recognize that Guizhi Tang (Cinnamon Twig Decoction), a medicine for the exterior-interior, treats wind pathogens directly contracted by the Three Yin; and Lizhong Decoction (Regulate the Middle Decoction) and Sini Decoction (Frigid Extremities Decoction) treat cold pathogens directly contracted by the Three Yin. Wind, cold, and other six qi pathogens attack either Yang or Yin meridians without fixed rules. Treatment targets the deficient meridian, rather than assuming Taiyang is always the starting point. Thus, the Three Yin have both injected symptoms from Yang meridians and self-contracted symptoms, all belonging to Cold Damage, requiring no new nomenclature. The absence of specific "direct strike" clauses in the Three Yin chapters is not an omission but a refusal to add superfluous details.
Shao's Commentary: Direct cold contraction of the Three Yin does not cause fever; direct wind contraction may cause fever. Fever should not be mistaken for heat transmitted from Yang meridians. Wind contraction of the Three Yin requires Guizhi Tang to harmonize the exterior; cold contraction requires Lizhong or Sini Decoctions to warm the interior.
Fifth, direct contraction by the Three Yin has identifiable patterns in the text. For example, Taiyin disease with a floating pulse indicates sweating is indicated, suitable for Guizhi Tang; this is Taiyin wind-strike. Taiyin disease with abdominal fullness, vomiting, worsening diarrhea, and periodic abdominal pain is Taiyin cold-strike. Shaoyin wind-strike with a faint pulse at the cun position and floating pulse at the chi position indicates impending recovery. For Shaoyin cold-strike, Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) is used for sweating, while Fuzi Sini Tang (Aconite and Licorice Decoction) is used for warming. Jueyin wind-strike with a faint and floating pulse indicates impending recovery. Jueyin cold-strike is treated with Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang (Angelica Sinensis Decoction for Cold Extremities plus Evodia and Fresh Ginger). The Shaoyin and Jueyin chapters only list pulses for recovery from wind-strike, lacking treatments for unresolved cases, suggesting missing text.
Shao's Commentary: This section carefully distinguishes the pulse, symptoms, and treatments for direct wind and cold contraction of the Three Yin.
Sixth, among the Three Yin chapters, only Shaoyin lists three urgent indications for Da Chengqi Tang (Major Order the Qi Decoction), while Taiyin and Jueyin lack Chengqi references. Why do later practitioners claim Chengqi formulas can be selected for Jueyin? Chengqi formulas treat Yangming stomach excess. Shaoyin uses Chengqi only when Kidney Water is depleted, leading to dryness and excess in Stomach Earth, effectively transferring the disease to Yangming; urgent purging preserves Yin fluids. Zhang Zhongjing warned regarding Jueyin: "Purging leads to unceasing diarrhea," a clear prohibition against purging in Jueyin. There is no logic for using Chengqi when the pathogen is in Jueyin. The Master's teachings are clear; right and wrong are evident.
Shao's Commentary: This discusses the precise distinction between using Chengqi for solidified heat in the Three Yin versus the prohibition against its use otherwise.