仲景六经。各有提纲一条。犹大将立旗鼓。使人知所向。故必择本经至当之脉症而标之。读者须用紧记提纲。以审
病之所在。然提纲可见者 是正面。读者又要看出底板。再细玩其四旁。参透其隐曲。则良法美意。始得了然。如太阳
总纲。提出脉浮头项强痛恶寒八字。是太阳受病之正面。读者要知三阳之脉俱浮。三阳俱有头痛症。六经受寒俱各恶寒。
惟头项强痛。是太阳所独也。故见头连项而强痛。知是太阳受病。盖太阳为诸阳主气。头为诸阳之会。项为太阳之会
故也。如脉浮恶寒发热。而头不痛。项不强。便知非太阳病。如但头痛。不及于项。亦非太阳定局矣。如头项强痛。反
不恶寒。脉反沉。不可为非太阳病。故温邪内发。或吐后内烦。或湿流关节。或病关少阴。法当救里者也。因当浮不
浮。当恶不恶。故为之反。所谓看出底板法者以此。
前辈以一日太阳。二日阳明。七日复传之说拘之。故至今不识仲景所称之太阳病。
太阳病。有身痛。身重。腰痛。骨节疼痛。鼻鸣。干呕。呕逆。烦躁。胸满。背强。咳渴。汗出。恶风。无汗而
喘等症。仲景以其或然或否。不可拘定。故散见诸节。而不入提纲。又太阳为巨阳。阳病必发热。提纲亦不言及者。以
初受病者。或未发故也。其精细如此。故诊者于头项强痛之时。必须理会此等兼症。更细审其恶寒恶风之病情。有汗无
汗之病机。已发热未发热之病势。以探其表症之虚实。是从旁细看法也。即于此处辨其有汗是桂枝症。无汗是麻黄症。
无汗烦燥。是大青龙症。干呕发热而咳。是小青龙症。项背强KT KT 。是葛根症。用之恰当。效如桴鼓。前辈以桂
枝主风
伤卫。麻黄主寒伤营。大青龙主伤寒见风。中风见寒。分三纲鼎立之势拘之。所以埋没仲景心法。又败坏仲景之正法。
脉浮。只讲得脉体之正面。诊者当浮中审其脉势之强弱。脉息之迟数。脉象之紧缓滑涩弦芤。故太阳一经。有但浮。浮
弱。浮缓。浮紧。浮迟。浮数。等症。散见于诸条。或阳浮而阴弱。或阴阳俱紧。或阴阳俱浮。或尺中迟。或尺中微。
或寸缓。关浮。尺弱。必细细体认。以消息其里之虚实。此是从中索隐法。若谓脉紧是伤寒。脉缓是中风。脉紧有汗是
中风见寒。脉缓无汗是伤寒见风。夫既有伤寒中风之别。更有伤寒中风之浑。使人无下手处矣。岂可为法乎。凡见脉浮
迟浮弱者。用桂枝。浮紧浮数者。用麻黄。不必于风寒之分。但从脉之虚实而施治。是仲景活法。是亦仲景之定法。今
伤寒
书。皆以膀胱为太阳。故有传足不传手之谬。不知仲景书。只宗阴阳之大法。不拘阴阳之经络也。夫阴阳者。散之可千。
推之可万。以心为阳中之太阳。故更称巨阳以尊之。又中身而上。名曰广明。太阴之前。名曰阳明。广明亦君主之尊
称。广明居阳明之上。故六经分位。首太阳。次阳明。又腰以上为阳。膀胱位列下焦之极底。其经名为足太阳。以手
足阴阳论。实阴中之少阳耳。以六腑为阳论。与小肠之太阳。同为受盛之器耳。不得浑膈膜之上。为父之太阳也。仲景
以心为太阳。故得外统一身之气血。内行五脏六腑之经隧。若膀胱为州都之官。所藏精液。必待上焦之气化。而后能出。
何能外司营卫。而为诸阳主气哉。岐伯圣人。南面而立。前曰广明。后曰太冲。太冲之地。名曰少阴。是心肾为一身之
大表里也。膀胱与肾为表里。第足经相络之一义耳。是表里亦何常之有。如太阳与少阳并病。刺肺俞。肝俞。岂非肝居
胆外。为少阳之表。肺居心外。为太阳之表耶。少阴病。一身手足尽热。以热在膀胱。必便血。夫热在膀胱。而仍称少
阴病。是知膀胱属腰以下之阴。得为少阴之府。不得为六经之太阳。故不称太阳病。又太阳不解。热结膀胱。其人如狂。
以太阳随经。瘀热在里。热在下焦。下血乃愈。盖太阳位最高。故太阳病。以头项强痛为提纲。此云热结在下焦。是太
阳阳邪。下陷之变也。其云随经。云在里。是知膀胱属在下焦。为太阳之根底。而非主表之太阳。为太阳之经隧。而非
太阳之都会。为太阳主血之里。非为诸阳主气之太阳也。明矣。
伤寒最多心痛。以心当太阳之位也。心为君主。寒为贼邪。君火不足。寒气得以为之。所以名为大病。今伤寒家。
乃以太阳为寒水之经。是拘于膀胱。焉水府。因有以寒召寒之说。而不审寒邪犯心。水来克火之义矣。夫人伤于寒。热
虽甚不死者。以寒所在。是邪之所留。热之所在。是心之所主也。如初服桂枝而反烦解。半日而复烦。大青龙之烦躁。
小青龙之水气。十枣泻心之心下痞硬。白虎五苓之燥渴心烦。皆心病也。若妄治后。叉手冒心。恍惚心乱。以下 逆满。
往往关心。是心病为太阳本病也。然心为一身之主。六经皆能病及。故阳明有愦愦。怵惕。懊 。等症。少阳有烦悸。
支结等症。太阴之暴烦。少阴之心中温温欲吐。厥阴之气上撞心。心中疼热。皆心病也。何前辈反有伤足不伤手之说。
夫心主营。肺主卫。风寒来伤营卫。即是手经矣。且大肠接胃。俱称阳明。小肠通膀胱。俱称太阳。伤则俱伤。何分手
足。如大便硬。是大肠病。岂专指胃言。小便不利。亦是小肠病。岂独指膀胱。且汗为心液。如汗多亡阳。岂独亡坎中
之阳。而不涉胆中之阳耶。因不明仲景之六经。故有传经之妄耳。
人皆指太阳经络行于背。而不知背为太阳之所主。竞言太阳主营卫而不究营卫之所自。 知太阳主表。而不知太阳
实
根于里。知膀胱是太阳之里。而不知心肺是为太阳之里。因不明内经之阴阳。所以不知太阳之地耳。内经以背为阳。
腹为阴。五脏以心肺为阳。而属于背。故仲景以胸下。心下。属三阳。肝脾肾为阴而属于腹。故仲景以腹中之症属三阴。
以阴阳内外相输之义也。营卫行于表。而发源于心肺。故太阳病。则营卫病。营卫病。则心肺病矣。心病则恶寒。肺病
则发热。心病则烦。肺病则喘。桂枝疗寒。芍药止烦。麻黄散热。杏仁除喘。所以和营者。正所以宁心也。所以调卫者。
正所以保肺也。麻桂二方便是调和内外。表里两解之剂矣。如大青龙。用石膏以治烦躁。小青龙。用五味干姜以除咳嗽。
皆于表剂中。即兼治里。后人妄为仲景方治表而不及里。曷不于药性一思之。太阳主表。为心君之藩篱。犹京师之有边
关也。风寒初感。先入太阳之界。惟以得汗为急务。自汗而解。犹边关之有备也。必发汗而解。是君主之令行也。若发
汗而汗不出。与发汗而汗仍不解。是君主之令不行也。夫汗为心液。本水之气。在伤寒。为天时寒水之气。在人身。为
皮肤寒湿之气。在发汗。为君主阳和之气也。君火之阳内发。寒水之邪外散矣。故治太阳伤寒。以发汗为第一义。若君
火不足。则肾液输于心下者。不能入心为汗。又不能下输膀胱。所以心下有水气也。故利水是治伤寒之二义。若君火太
盛。有烦躁消渴等症。恐不戢而自焚。故清火是太阳之反治法。若君火衰微。不足以自守。风寒内侵于脏腑。必扶阳以
御之。故温补是太阳伤寒之从治法。其他救敝诸法。种种不同。而大法不外乎此。
发汗利水。是治太阳两大法门。发汗分形层之次第。利水定三焦之高下。皆所以化太阳之气也。发汗有五法。麻黄
汤。汗在皮肤。是发散外感之寒气。桂枝汤。汗在经络。是疏通血脉之精气。葛根汤。汗在肌肉。是升提精液之清气。
大青龙。汗在胸中。是解散内扰之阳气。小青龙。汗在心下。是驱逐内蓄之水气。其治水有三法。干呕而咳。水入即吐。
是水气在上焦。在上者汗而发之。小青龙五苓散是也。心下痞硬。硬满而痛。是水气在中焦。中满者泻之于内。用十
枣汤。大陷胸汤是也。热入膀胱。小便不利。是水气在下焦。在下者引而竭之。桂枝去桂加茯苓白术汤是也。
太阳之根即是少阴。紧则为寒。本少阴脉。太阳病而脉紧者必无汗。此虽太阳能卫外而为固。令汗不出。亦赖少阴
能藏精而为守。故不得有汗也。人但知其表实。而不知其里亦实。故可用麻黄汤而无患。若脉阴阳俱紧。而反汗出者。
是阳不固而阴不守。虽称亡阳。而阴不独存。此属少阴者。是指太阳转属少阴。而非少阴本病。
太阳之虚。不能主外。内伤真阴之气。便露出少阴之底板。少阴阴虚。不能主内。外伤太阳之气。便假借太阳之面
目。所以太阳病而脉反沉。用四逆以急救其里。少阴病而反热。用麻辛以微解其表。此表里雌雄相应之机也。
伤寒一日太阳受之。即见烦躁。是阳气外发之机。六七日乃阴阳自和之际。反见烦躁。是阴阳内陷之兆。所云阳去
入阴者。指阳邪下膈言。非专指阴经也。或入太阳之府。而热结膀胱。或入阳明之府。而胃中干燥。或入少阳之府。而
胁下硬满。或入太阴而暴烦下利。或入少阴而口苦燥干。或入厥阴而心中疼热。皆入阴之谓。后人惑于传经之谬。因不
知有阴转属阳等义也。
Zhang Zhongjing's Six Meridians differentiation each has a guiding principle, just like a general setting up flags and drums to show the direction of attack. Therefore, one must select the most accurate pulse and symptoms of the respective meridian as markers. Readers must firmly memorize these guidelines to determine the location of the disease. However, what is visible in the guideline is the "frontal aspect" (main manifestation); readers must also perceive the "base plate" (internal essence or accompanying conditions), carefully ponder the surrounding details, and penetrate the hidden subtleties to fully understand the excellent methods and intentions.
For example, the general guideline for Taiyang disease presents eight characters: "pulse floating, stiffness and pain in the head and neck, aversion to cold." This is the frontal aspect of Taiyang disease. Readers should know that pulses of all three Yang meridians can be floating; headaches can occur in all three Yang meridians; aversion to cold can occur in all six meridians upon contraction of cold. Only "stiffness and pain in the head and neck" is unique to Taiyang. Thus, when seeing stiffness and pain extending from the head to the neck, one knows it is a Taiyang disease. This is because the Taiyang meridian governs the Qi of all Yang meridians, the head is the meeting place of all Yang meridians, and the neck is also where Taiyang Qi converges. If the pulse is floating, with aversion to cold and fever, but without headache or neck stiffness, it is known not to be a Taiyang disease. If there is only headache without involvement of the neck, it is also not a definitive Taiyang pattern. If there is stiffness and pain in the head and neck, yet no aversion to cold, and the pulse is instead deep, one cannot rule out Taiyang disease. It may be due to internal emergence of warm pathogenic factors, or internal irritability after vomiting, or dampness flowing into the joints, or the condition involving Shaoyin, requiring treatment to rescue the interior. Because the pulse should be floating but is not, and aversion to cold should exist but does not, it is termed "counter" (fan). This is the method of "seeing the base plate."
Predecessors were constrained by the theory of "Day 1 Taiyang, Day 2 Yangming, Day 7 recurrence," leading to a failure to recognize the Taiyang disease described by Zhang Zhongjing.
Taiyang disease presents with symptoms such as body pain, heaviness, lower back pain, joint pain, nasal congestion (bi ming), dry retching, vomiting and counterflow qi, irritability, chest fullness, back stiffness, cough and thirst, sweating, aversion to wind, absence of sweat with wheezing, etc. Zhang Zhongjing included these symptoms scattered across various chapters rather than in the guideline because they are optional and not fixed. Furthermore, although Taiyang is the Great Yang and Yang diseases must involve fever, the guideline omits this because fever may not have appeared at the initial stage. The precision is thus profound. Therefore, when encountering stiffness and pain in the head and neck, physicians must consider these accompanying symptoms, carefully distinguish between aversion to cold and aversion to wind, analyze the pathology of sweating versus non-sweating, and assess the trend of fever versus no fever to explore the deficiency or excess of exterior patterns. This is the method of detailed observation from the side. Here, one distinguishes: sweating indicates Guizhi Tang syndrome; no sweating indicates Mahuang Tang syndrome; no sweating with irritability indicates Da Qing Long Tang syndrome; dry retching, fever, and cough indicate Xiao Qing Long Tang syndrome; stiffness in the neck and back indicates Gegen Tang syndrome. Appropriate use yields rapid efficacy. Predecessors rigidly categorized Guizhi Tang as treating wind injuring Wei, Mahuang Tang as treating cold injuring Ying, and Da Qing Long Tang as treating cold injury with wind or wind injury with cold, creating a tripartite standoff. This obscured Zhang Zhongjing's core methodology and corrupted his orthodox laws.
A floating pulse only describes the frontal aspect of the pulse body. Physicians must examine the strength of the pulse momentum within the floating position, the slowness or speed of the pulse, and the tightness, relaxation, slipperiness, roughness, string-tautness, or hollow quality of the pulse image. Thus, in the Taiyang meridian, symptoms such as merely floating, floating-weak, floating-relaxed, floating-tight, floating-slow, and floating-fast appear scattered in various texts. There may be floating-yang and weak-yin, both yin and yang tight, both yin and yang floating, slow chi position, weak chi position, slow cun position, floating guan position, or weak chi position. One must carefully recognize these to infer internal deficiency or excess. This is the method of seeking hidden truths from the center. To say that tight pulse is cold injury, relaxed pulse is wind injury, tight pulse with sweating is wind injury with cold, and relaxed pulse without sweating is cold injury with wind creates confusion between distinct and mixed categories, leaving no clear approach. This cannot serve as a law. Whenever pulse is floating-slow or floating-weak, use Guizhi Tang; whenever pulse is floating-tight or floating-fast, use Mahuang Tang. One need not distinguish strictly between wind and cold but treat based on the deficiency or excess indicated by the pulse. This is Zhang Zhongjing's flexible yet definitive method. Modern Shanghan texts erroneously equate Taiyang with the Bladder, leading to the fallacy of "transmission affecting foot meridians but not hand meridians." They fail to realize that Zhang Zhongjing's work follows the great principles of Yin and Yang, not confined to specific meridian pathways.
Yin and Yang concepts can be dispersed into thousands or expanded into ten thousand variations. The Heart is referred to as the Sun-Yang within Yang, hence honored as Ju Yang (Great Yang). The upper middle body is called Guang Ming; anterior to Taiyin is Yangming. Guang Ming is also an honorific for the Sovereign. Since Guang Ming is above Yangming, the order of the Six Meridians begins with Taiyang, then Yangming. The area above the waist is Yang; the Bladder is located at the extreme bottom of the Lower Jiao, its meridian named Foot-Taiyang. In terms of hand-foot Yin-Yang, it is actually Shao-Yang within Yin. Regarding the Six Fu organs as Yang, it shares the function of receiving and storing with the Small Intestine. One cannot confuse the upper diaphragm area as the primary Taiyang. Zhang Zhongjing regards the Heart as Taiyang, enabling it to unify Qi and Blood externally and navigate the meridians of the Zang-Fu internally. If the Bladder is the official of the reservoir, storing fluids that require Upper Jiao Qi transformation for excretion, how can it govern Ying and Wei externally and act as the master of all Yang Qi?
The Sage Qibo, facing south, designated the front as Guang Ming and the back as Taichong; the land of Taichong is named Shaoyin. This shows the Heart and Kidney form the great interior-exterior relationship of the body. The Bladder and Kidney are interior-exterior pairs, representing only the connection of the foot meridians. Interior-exterior relationships are not constant. For instance, in concurrent Taiyang and Shaoyang disease, one needles Feishu and Ganshu. Is it not because the Liver is outside the Gallbladder (exterior to Shaoyang) and the Lung is outside the Heart (exterior to Taiyang)? In Shaoyin disease, heat throughout the body and limbs indicates heat in the Bladder, leading to hematochezia. Heat in the Bladder is still termed Shaoyin disease, indicating the Bladder belongs to the Yin below the waist and serves as the Fu organ of Shaoyin, not the Taiyang of the Six Meridians. Hence, it is not called Taiyang disease. When Taiyang disease persists with heat binding in the Bladder, causing manic behavior, it is due to Taiyang pathogen following the meridian, with stasis-heat in the interior and Lower Jiao; bleeding resolves it. Since Taiyang is highest, its guideline is head/neck stiffness. Heat binding in the Lower Jiao represents a deviation where Taiyang Yang pathogen sinks. "Following the meridian" and "in the interior" confirm the Bladder is the root of Taiyang in the Lower Jiao, not the exterior-governing Taiyang; it is the pathway, not the hub; it governs blood in the interior, not the Qi of all Yangs. This is clear.
Shanghan often causes heart pain because the Heart occupies the Taiyang position. The Heart is the Sovereign; Cold is the thief pathogen. If Sovereign Fire is insufficient, Cold invades, making it a major disease. Modern practitioners wrongly view Taiyang as a Cold-Water meridian, confining it to the Bladder as a water repository, leading to the idea of "summoning cold with cold," ignoring the meaning of Cold invading the Heart and Water overcoming Fire. When humans are injured by Cold, even severe heat does not cause death because Cold resides where the pathogen stays, while Heat resides where the Heart rules. For example, initial Guizhi Tang administration causing transient vexation, subsequent vexation after half a day, Da Qing Long Tang irritability, Xiao Qing Long Tang water qi, Shizao Tang epigastric hardness, Baihu Tang/Wuling San dryness-thirst-vexation—all relate to Heart disease. After mistaken treatment, crossing hands over the heart, mental confusion, or upward counterflow fullness often involve the Heart, showing Heart disease is the root of Taiyang. However, as the master of the body, all Six Meridians can affect the Heart. Yangming has confusion, fear, and remorse; Shaoyang has irritability-palpitations and flank knottiness; Taiyin has sudden irritability; Shaoyin has warm desire to vomit in the heart; Jueyin has Qi rushing to the heart and heart pain-heat. These are all Heart diseases. Why do predecessors claim "foot injured, not hand"? The Heart governs Ying, the Lung governs Wei. Wind-Cold injuring Ying-Wei involves the hand meridians. The Large Intestine connects to the Stomach, both Yangming; the Small Intestine connects to the Bladder, both Taiyang. Injury affects both; why separate hand and foot? Hard stool is Large Intestine disease, not just Stomach; difficult urination is Small Intestine disease, not just Bladder. Sweat is Heart fluid; profuse sweating losing Yang—does it only lose Kidney (Kan) Yang, excluding Gallbladder Yang? Ignorance of Zhang Zhongjing's Six Meridians leads to false transmission theories.
People point to Taiyang meridians running on the back but fail to see the back is governed by Taiyang. They discuss Taiyang governing Ying-Wei without tracing their origin. Knowing Taiyang governs the exterior but not realizing Taiyang roots in the interior. Knowing Bladder is Taiyang's interior but not knowing Heart-Lung are Taiyang's interior. Ignorance of Neijing's Yin-Yang leads to misunderstanding Taiyang's domain. Neijing states back is Yang, abdomen is Yin. Among Zang organs, Heart-Lung are Yang and belong to the back. Thus, Zhang Zhongjing places sub-xiphoid and epigastric areas under Three Yang. Liver-Spleen-Kidney are Yin and belong to the abdomen, placed under Three Yin. This reflects Yin-Yang mutual transmission. Ying-Wei circulate on the exterior but originate from Heart-Lung. Thus, Taiyang disease affects Ying-Wei; Ying-Wei disease affects Heart-Lung. Heart disease causes aversion to cold; Lung disease causes fever. Heart disease causes vexation; Lung disease causes wheezing. Guizhi treats cold, Shaoyao stops vexation, Mahuang dissipates heat, Xingren removes wheezing. Harmonizing Ying-Wei calms the Heart; regulating Wei protects the Lung. Mahuang and Guizhi formulas harmonize interior-exterior and resolve both sides. Da Qing Long uses Shigao for irritability; Xiao Qing Long uses Wuweizi and Ganjiang for cough. Both treat the interior within exterior formulas. Later authors wrongly claimed Zhang's formulas treat exterior only, neglecting the interior. One should reflect on herb properties. Taiyang governs the exterior, serving as the shield for the Heart Sovereign, like border gates for the capital. Initial Wind-Cold enters Taiyang; inducing sweat is urgent. Spontaneous resolution implies prepared borders; required sweating implies sovereign command execution. Failure to sweat or persistent sweating after treatment means command failure. Sweat is Heart fluid, originally Water Qi. In Shanghan, it is seasonal Cold-Water Qi; in the body, skin Cold-Damp Qi; during sweating, it is Sovereign Yang-Harmony Qi. Internal Sovereign Fire emission disperses external Cold-Water pathogen. Thus, inducing sweat is the primary method for Taiyang Shanghan. If Sovereign Fire is insufficient, Kidney fluids reaching the epigastrium cannot transform into Heart sweat nor flow down to the Bladder, causing epigastric water qi. Thus, promoting urination is the second method. If Sovereign Fire is excessive, causing irritability/thirst, risking self-combustion, clearing fire is the counter-treatment for Taiyang. If Sovereign Fire is weak, unable to defend against internal Wind-Cold invasion, supporting Yang is the compliant treatment. Other remedial methods vary, but the great principles remain.
Inducing sweat and promoting urination are the two major gates for treating Taiyang. Sweating differentiates layer sequences; urination determines Jiao levels. Both transform Taiyang Qi. There are five sweating methods: Mahuang Tang releases Cold from skin; Guizhi Tang unblocks Jing-Qi in collaterals; Gegen Tang raises clear Essence-Qi in muscles; Da Qing Long dissipates agitated Yang in the chest; Xiao Qing Long expels stored water Qi in the epigastrium. There are three water-draining methods: Dry retching/cough/vomiting water indicates Upper Jiao water Qi; treat by sweating (Xiao Qing Long Tang, Wuling San). Epigastric hardness/pain indicates Middle Jiao water Qi; treat by purging internally (Shizao Tang, Daxiexiong Tang). Heat entering Bladder/difficult urination indicates Lower Jiao water Qi; treat by draining downward (Guizhi Qu Guijia Fuling Baizhu Tang).
The root of Taiyang is Shaoyin. Tightness indicates Cold, originating from Shaoyin pulse. Taiyang disease with tight pulse implies no sweat. Although Taiyang guards the exterior preventing sweat, it relies on Shaoyin storing Essence to maintain closure. People see exterior excess but miss interior excess, allowing safe use of Mahuang Tang. If pulse is tight-yin-and-yang yet sweating occurs, Yang fails to secure and Yin fails to guard. Though termed Yang loss, Yin remains alone. This belongs to Shaoyin, indicating Taiyang transferring to Shaoyin, not primary Shaoyin disease.
Taiyang deficiency fails to govern the exterior; internal injury to True Yin reveals the Shaoyin base plate. Shaoyin Yin deficiency fails to govern the interior; external injury to Taiyang Qi borrows Taiyang's appearance. Thus, Taiyang disease with deep pulse requires Sini Tang to urgently rescue the interior; Shaoyin disease with fever requires Mahuang Fuzi Xixin Tang to slightly release the exterior. This is the mechanism of interior-exterior correspondence.
Shanghan on Day 1 affecting Taiyang with immediate irritability indicates Yang Qi emerging outward. By Day 6-7, when Yin-Yang naturally harmonize, irritability indicates Yin-Yang sinking inward. "Yang departing to enter Yin" refers to Yang pathogen descending past the diaphragm, not exclusively Yin meridians. It may enter Taiyang Fu with heat binding in Bladder; Yangming Fu with dry stomach; Shaoyang Fu with hard/flank fullness; Taiyin with sudden irritability/diarrhea; Shaoyin with bitter taste/dry mouth; Jueyin with Qi rushing to heart/heart pain-heat. All are entering Yin. Later generations confused by transmission fallacies ignore meanings like Yin transferring to Yang.