鳌按。此篇非六经无归者。以并录六经之首。故亦列总论中。
【纲】仲景曰。太阳之为病。脉浮。头项强痛而恶寒。
【目】李杲曰。治不可越经。假令治太阳阳明。不可遗太阳而只用阳明药。余仿此。用三阳经
药解后。身反复重者。若烦。则是有阳明也。若不烦而反复轻者。知不传三阴也。不传三阴。则为
解也。大抵三阴之体静重。与湿相同。伤寒五日后。发热无汗。谓谷消水去形亡。故下之。三日前。
谓内有水谷。故汗之。太阳禁忌。小便不利。不可更利之。是谓犯本。则邪气入里不能解。此犯之
轻也。以是五苓散不可妄用。大便不可易动。动之是谓动血。此犯之重也。在表不可下。下之是为
犯禁。此犯之尤重也。下之而恶风恶寒头痛。待表症悉罢。方可下之也。脉浮紧者。犯之必结胸。
脉浮缓者。犯之必痞气。战而汗解者。太阳也。不战有汗而解者。阳明也。不战无汗而解者。少阳
也。若先瘥经。必不尔矣。太阳传阳明。其中或有下症。阳明症反退。而热兼不渴。却退显少阳症。
是知可解也。太阳知可解者。为头不痛。项不强。肢节不痛。则知表易解。阳明知可解者。为
不发热恶寒。知里易解也。少阳症知可解者。寒热日不移时而作。邪未退也。若用柴胡而移其时。
并气移于血。血移于气。是邪无可容之地。知可解也。病有里传表者。太阳病。反下之。因
而腹满时痛者。属太阴也。桂枝加芍药汤。至于大实痛者。胃也。桂枝加大黄汤。己传戊所以为
里传表。即名误下传也。伤寒误下。变无
定体。杂病误下。变有定体。何则。伤寒自外而入。阳也。阳主动。杂病自内而出。阴也。
阴主静。动者犯之。其变无穷。静者犯之。其变止痞与腹胁痛而已。故变无穷者为重。痞与腹胁痛
者为轻也。
李 曰。太阳经症。头疼身热脊强。此太阳正病也。以后凡言太阳症。即头疼身热脊强也。凡言表症者。
亦即太阳症也。各经仿此。阳从下起。三阳之长曰太阳。脉尺寸俱浮。浮紧伤寒。浮缓伤风。太
阳受病。当一二日发。以其脉上连风府。故头项痛腰脊强。头者诸阳之会。气病则麻。血病则痛。身热
者。寒客皮毛。郁闭其阳而后发热。虽人身正气。郁则为邪为热。热虽甚不死。盖伤寒始于寒而终
成于热也。惟不发热而但恶寒者。邪发于阴也。或热多寒少。或不大便而泉清频数。或热结膀胱而
溺涩。或汗多便难。或汗后不解。或汗漏不止。或过经不解。或蓄血发黄。或喘或吐。皆太阳所主。
鳌按。仲景立论。每经各举其主脉主症。以为一经之提纲。虽病有变迁。而苟未离此经。即不
离此主脉主症。其大较也。
【纲】仲景曰。阳明之为病。胃家实也。
【目】李杲曰。阳明症。身热目疼鼻干。不得卧。不恶风寒而自汗。或恶热。脉尺寸俱长。白
虎汤主之。阳明禁忌。不当发汗。不当利小便。以竭其津液。致生蓄血症。惟当益津液为上。以
其火就燥也。益津液者。连须葱白汤是也。汗多亡阳。下多亡阴。小便重利之。走气。三者之变
虽异。亡津液一也。汗者。本所以助阳也。若阳受阴邪。寒结无形。须当发去阴邪以复阳气。所谓益
阳而除风寒也。若阴邪已去而复汗之。反伤阳也。经曰。重阳必阴。故阳去自亡。汗多亡阳。此之
谓也。下者。本所以助阴也。若阴受阳邪。热结有形。须当除去其败坏者以致新阴。所谓益阴而除
火热也。若阳
邪已去而复下之。反亡阴也。经曰。重阴必阳。故阴气自亡。下多亡阴。此之谓也。汗不嫌早。
非预早之早。乃早晚之早也。谓当午前为阳分。当发其汗。午后阴分。不当发汗。故曰。汗无太早。
汗不嫌早。是为善攻。下不嫌晚。非待久之晚。谓当巳后为阴分。当下之。巳前阳分。不当下。故曰。
下无太晚。下不嫌晚。是为善守。汗本亡阴。以其汗多。阳亦随阴而走。下本泻阳。以其下多。阴亦
随阳而走。故曰。汗多亡阳。下多亡阴也。若犯发汗。多蓄血上焦。为衄。若犯利小便。多蓄血下
焦。为发狂。其人如狂也。伤寒有九经。何谓也。太阳、阳明、少阳。太阴、少阴、厥阴。是为六
也。有太阳阳明。有少阳阳明。有正阳阳明。是为三也。非九而何。阳明者。太阳少阳皆入于胃。
故曰正阳阳明也。前三经者。阳明自病。不入于里。谓之在经。不为正阳阳明矣。三阳从中治。
何谓也。太阳阳明。大承气汤。少阳阳明。小承气汤。正阳阳明。调胃承气汤。以汗症言之。以少
阳居其中。谓太阳症为表。当汗。阳明症为里。当下。少阳居其中。故不从汗下。以小柴胡汤从少阳
也。以下症言之。阳明居其中。谓太阳经血多气少。阳明经气血俱多。少阳经气多血少。若从太阳
下。则犯少阳。若从少阳下。则犯太阳。故止从阳明也。此三阳合病。谓之正阳阳明。不从标本。
从乎中也。缘阳明经居太少阳之中。此经气血俱多。故取居其中而不从太阳少阳也。阳明自病、调
胃承气汤。三阳并病、白虎汤。是从乎中也。如何是入阴可下。答曰。阳入于阴者可下。非入太少
厥阴之三阴。乃入三阳也。三阳亦非太少阳明之三阳。乃胃与大小肠之三阳也。三阳皆为腑。以其
受盛水谷。传导有形。故曰。入乎阴也。仲景云。已入腑者可下是也。仲景太阳阳明。大承气。少
阳阳明。小承气。正阳阳明。调胃承气。是三阳已入于脏者。泄之也。太阴。桂枝汤。少阴。麻黄
附子细辛汤。厥阴。当归四逆汤。是三阴未入于腑者。汗之也。
李 曰。阳明夹于二阳之中。阳气盛极。故曰阳明。脉尺寸俱长。长而微洪。经病。长而沉数。
腑病。太阳脉静则不传。如脉数急欲吐者。此寒邪变热传于阳明。当二三日发。以其经中客邪。
故目痛鼻干。身热者。阳明主肌肉。邪甚则身前
皆热。不眠者。烦盛津干。胃气不和也。太阳未罢者。发热恶寒。太阳已罢者。不恶寒而反恶热。
烦渴作呕。津干便硬。或即狂言。谓之正阳明。少阳阳明。胁满。不大便而呕。或瘀血发黄。或下
血谵语。或胸烦懊 。皆此经所主。然亦有里寒下利。或寒气结积而为痼瘕者。不可不知。
柯琴曰。阳明为传化之腑。当更实更虚。食入。胃实而肠虚。食下。胃虚而肠实。若但实而不虚。
斯为阳明之病根矣。胃实不是阳明病。而阳明之为病。悉从胃实上得来。故以胃家实为阳明一经之
纲领也。阳明病外症。身热汗自出。不恶寒。反恶热。
【纲】仲景曰。少阳之为病。口苦。咽干。目眩也。
【目】李杲曰。少阳症。胸胁痛。往来寒热而呕。或咳而耳聋。脉尺寸俱弦。小柴胡汤主之。
须各随仲景本条下加减用之。少阳忌发汗。忌利小便大便。故名三禁。汤乃和解之剂。若犯之。则
各随上下前后。本变及中变与诸变不可胜数。宜详之。如何是半表半里。答曰。身后为太阳。是阳
中之阳。阳分也。身前为阳明。为阳中之阴。阴分也。阳为表。阴为里。即太阳阳明二分。邪在其
中矣。治当不从标本。从乎中治。此乃治少阳之法也。太阳膀胱。水寒也。阳明胃经。燥也。邪在
其中。近后膀胱寒水。则恶寒。近前阳明燥金。则发热。故往来寒热也。此为三阳之表里。非内外
之表里也。俱不可认作宜下之里。故以此药作和解之剂。非汗非下也。邪在荣卫之间。谓之半表里
也。太阳阳明之间。少阳居身之半表里也。五苓散分阴阳。膀胱经之半表里也。理中汤治吐泻。上
下之半表里也。
李 曰。少。初也。阳气初嫩。亚于阳明。故曰少阳。脉尺寸俱弦而滑数者。阳极发厥。弦而
和者。病欲散。少阳受病。当三四日发。以其脉循胁。络于耳。故风热上壅不利。则耳聋胁痛。寒热
往来。不食。呕而口苦咽干目眩。若不呕吐而能食者。为三阴不受邪也。若身无大热躁闷者。阳去
入阴无疑矣。似疟。妇人血结。皆此经所主。
柯琴曰。太阳主表。头项强痛为提纲。阳明主里。胃家实为提纲。少阳居半表半里之位。仲景
特揭口苦咽干目眩为提纲。奇而至当也。盖口咽目三者。不可谓表。又不可谓里。是表之入里。里
之出表处。所谓半表半里也。三者能开能阖。开之可见。阖之不可见。恰合枢机之象。故两耳为少
阳经络出入之地。三症为少阳一经病机。兼风寒杂病而言。但见一症即是。不必悉具。
【纲】仲景曰。太阴之为病。腹满而吐。食不下。自利益甚。时腹自痛。若下之。必胸下结硬。
【目】李杲曰。太阴症。腹满咽干。手足自温。自利不渴。时腹痛。脉尺寸俱沉细。
太阴病。可汗。可温。可下也。脉浮可汗。桂枝汤。自利不渴。属太阴。以其脏有寒故也。可
温。四逆辈。此条虽不言脉。当知脉沉迟而弱。仲景理中汤丸。暨易老人参黄 汤。其轻重或温或
热。视人之强弱虚实所宜者选用之。太阴可下者。以本太阳症。医反下之。因而腹满时痛者。太阴
也。桂枝芍药汤。大实痛。桂枝加大黄汤。易老云。此非本有是症。以其错下。脾传于胃。故为误
下传。太阴禁忌。太阴病。腹满而吐。食不下。自利益甚。时腹自痛。若下之。则胸下结硬。太阴
病。脉弱。其人续自便利。设当行大黄芍药者。宜减之。以其人胃气弱。易动故也。伤寒而脉浮缓。
手足自温者。系在太阴。小便自利者。则不发黄。日久利甚。必止者。便硬。乃入腑传阳明也。
李 曰。阴从天降。首曰太阴。在阳为表。在阴为里。邪在表则见阳脉。邪在里则见阴脉。故
尺寸俱沉。沉实有力。当下。沉细无力。当温。太阴受病。当四五日发。以其脉布胃中。络于咽嗌。
故腹满或痛。而嗌喉下干燥。或大便不通。小便如常。或自利。手足温而渴者。为传经腑热。或
自利不渴。手足冷者。为直中阴经。或因内伤饮食。冷气入脾。必腹痛。胸膈不快。然太阴乃三阳之
终。三阴之始。阳经表气未尽。宜汗。半表里胸满多痰。宜吐。传经里热。宜下。直中阴经。宜温。
调脾胜邪。正在此关。
柯琴曰。阳明。三阳之里。故提纲属里之阳症。太阴。三阴之里。故提纲属里之阴症。太阴之上。
湿气主之。腹痛吐利。从湿化也。脾为湿土。故伤于湿。脾先受之。然寒湿伤人。入于阴经。不
能动脏。则还于腑也。
【纲】仲景曰。少阴之为病。脉微细。但欲寐也。
【目】李杲曰。少阴症。口燥舌干而渴。脉尺寸俱沉疾。大承气汤。沉迟。四逆汤。
太阴邪入于里。上接于心。与火俱化而克金。恶候或上气。死。入胃。脉沉细而疾。疾则大承
气汤下之。下入于本。与水俱化而为寒。厥逆。或见身冷静重。脉沉细而迟。迟则四逆汤温之。疾
虽可下。若疾而无力者。亦不可下。为阳将尽也。少阴症。口燥舌干而渴。身表凉。脉沉细而虚。泻
心汤。此有形无形之药也。伤寒外症。全在下症。大热而脉反细小。不可下。泻心汤。少阴受病。
身凉无汗。体沉。或体轻。脉沉。有头痛。不厥。麻黄附子泻心汤。
其人病身热而烦躁不宁。大小便自利。其脉沉洪而无力。按之全无者。附子泻心汤。其人病上
吐下泻不止。当渴而反不渴。其脉微细而弱。理中汤。渴而脉沉有力而疾者。五苓散。少阴病。发
热脉沉者。必当汗。若缓汗之。用麻黄附子细辛汤。若微汗之。用麻黄附子甘草汤。少阴下利。色
青者。当下之。色不青者。当温之。口中和者。当温之。口中不和。干燥者。当下之。少阴脉沉细
数。病为在里。忌发汗。脉微者。忌发汗。尺脉微弱涩者。忌下。麻黄附子细辛汤。体沉。加防己、
苍术。胜湿也。体轻。加石膏、知母。乃胜热也。
李 曰。少阴次于太阴。故曰少阴。脉尺寸俱沉。沉实有力。当下。沉微无力。当温。少阴受
病。当五六日发。以其脉起于足心。贯肾。络于肺系。故舌干口燥而渴。或自利清水。心痛腹胀。
或大便闭硬。不欲浓衣者。皆热入里之深也。若厥逆畏寒。欲吐未吐。腹痛自利。小便自利。或干
呕亡阳。咽痛。脉微欲寐者。乃阴毒入脏之深也。或下利体痛咳呕者。水气也。或饮食入口则吐。
脉弦迟。厥逆心下实者。不可下也。宜吐之。或脉沉。发热者。宜汗。盖有初得病。直攻少阴。不
先自太阳传次而入也。
柯琴曰。三阳以少阳为枢。三阴以少阴为枢。弦为木象。浮而弦细者。阳之少也。微为水象。
沉而微细者。阴之少也。卫气行阳则寤。行阴则寐。日行二十五度。常从足少阴之间分行脏腑。今
少阴病。则入阳分多。故欲寐。欲寐。是病患意中。非实能寐也。与少阳提纲。各臻其妙。
鳌按。仲景论。病发热头痛。脉反沉。若不瘥。身体疼痛者。当救其里。宜四逆汤。此条。
旧本俱入太阳篇。少阴病。始得之。反发热。脉沉者。麻黄附子细辛汤。此条。旧本俱入少阴篇。
前人因有少阴症似太阳。太阳脉似少阴。而反用药不同之说。窃思头疼发热。固是太阳表症。然脉
Shen Jin'ao's commentary: This section does not consist of条文 (textual passages) that do not belong to the Six Channels. Because they are recorded together with the opening statements of the Six Channels, they are also listed in the General Discussion.
[Outline] Zhang Zhongjing said: The characteristic of Taiyang disease is a floating pulse, stiffness and pain in the head and neck, and aversion to cold.
[Detail] Li Gao said: Treatment must not transcend the meridian boundaries. For example, when treating a combined Taiyang and Yangming disease, one must not omit Taiyang and use only Yangming herbs. The same applies to others. After using herbs from the Three Yang channels to resolve the exterior, if the body remains heavy and uncomfortable, and if accompanied by irritability, it indicates transmission to Yangming. If there is no irritability and the heaviness is slight, it is known that the disease has not transmitted to the Three Yin channels. If it has not transmitted to the Three Yin channels, it means the pathogen has resolved. Generally, diseases of the Three Yin channels are quiet and heavy, similar to dampness. Five days after the onset of cold damage, if there is fever without sweat, it is called "grain qi exhausted, water fluids gone, form perished," at which point purgation may be used. Within three days of onset, it is called "water and grain still inside," at which time diaphoresis should be used. The contraindication for Taiyang disease is that if urination is difficult, one must not use diuretics again; this is called violating the root, causing the pathogen to enter the interior and fail to resolve. This is a minor error. Therefore, Wuling San (Five-Ingredient Powder with Poria) must not be used recklessly. Stool must not be easily moved; moving it is called disturbing blood, which is a serious error. When the pathogen is in the exterior, purgation must not be used; doing so is called violating prohibitions, which is an especially serious error. If after purgation there is aversion to wind, aversion to cold, and headache, one must wait until all exterior symptoms have disappeared before using purgation. If the pulse is floating and tight, violating this will definitely lead to Jie Xiong (chest binding); if the pulse is floating and slow, violating this will definitely lead to Pi Qi (epigastric fullness). Resolving through chills and sweating belongs to Taiyang; resolving through sweating without chills belongs to Yangming; resolving without chills or sweating belongs to Shaoyang. If previous treatments on other channels had already cured the patient, this would not happen. When Taiyang transmits to Yangming, there may be symptoms amenable to purgation; when Yangming symptoms recede but fever persists without thirst, and Shaoyang symptoms appear, it indicates resolution. To know Taiyang is resolvable: because the head does not hurt, the neck is not stiff, and the joints do not not hurt, indicating the exterior is easily resolved. To know Yangming is resolvable: because there is no fever or aversion to cold, indicating the interior is easily resolved. To know Shaoyang is resolvable: if the alternating chills and fever no longer occur at the same time each day, the pathogen has not retreated. If Chai Hu Tang (Bupleurum Decoction) is used and the timing changes, shifting Qi into Blood and Blood into Qi, the pathogen will have nowhere to reside, indicating resolution. Diseases can transmit from interior to exterior. In Taiyang disease, if mistakenly purged, leading to abdominal fullness and occasional pain, it belongs to Taiyin, treated with Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony Root). For severe solid pain, it belongs to the Stomach (Yangming), treated with Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rhubarb). Having transmitted to Wu Earth (Stomach) thus appearing as interior transmitting to exterior is named "error-induced transmission." Errors in purgation in cold damage have no fixed pattern; errors in purgation in miscellaneous diseases have a fixed pattern. Why? Cold damage enters from outside, belonging to Yang, which is active; miscellaneous diseases emerge from inside, belonging to Yin, which is static. Mistreating the active results in infinite variations; mistreating the static results only in Pi (glomus) and abdominal/flank pain. Thus, infinite variations indicate severity, while Pi and abdominal/flank pain indicate mildness.
Li Gao said: Symptoms of the Taiyang channel include headache, body heat, and spinal stiffness; this is the correct disease of Taiyang. Henceforth, whenever "Taiyang syndrome" is mentioned, it refers to headache, body heat, and spinal stiffness. Whenever "exterior syndrome" is mentioned, it also refers to Taiyang syndrome. Other channels follow this example. Yang Qi rises from below; the chief of the Three Yang is Taiyang. Pulses at Cun, Guan, and Chi are all floating; floating-tight indicates cold damage, floating-slow indicates wind injury. Taiyang channel disease manifests within one or two days because its vessel connects to Fengfu (GV16), causing headache, neck stiffness, and lumbar/spinal rigidity. The head is the meeting place of all Yang vessels; Qi pathology causes numbness, Blood pathology causes pain. Body heat occurs because cold pathogens lodge in skin and hair, constraining Yang Qi, which then generates heat. Even if healthy Qi becomes constrained and turns into pathogenic heat, severe heat is not fatal, as cold damage begins with cold and ultimately transforms into heat. Only cases with no fever but only aversion to cold indicate pathogenesis originating in Yin. Cases may present with more heat than cold, or constipation with clear, frequent urination, or heat binding in the Bladder with dysuria, or excessive sweating with difficult defecation, or unresolved illness after sweating, or unceasing leakage of sweat, or prolonged illness beyond the expected period, or blood stasis with jaundice, or wheezing or vomiting—all are governed by the Taiyang channel.
Shen Jin'ao's commentary: Zhang Zhongjing established theories by highlighting the principal pulse and symptom for each channel as the outline for that channel. Although conditions change, as long as the disease has not left that channel, it does not leave these principal pulses and symptoms; this is the general rule.
[Outline] Zhang Zhongjing said: The characteristic of Yangming disease is Wei Jia Shi (Excess in the Stomach and Intestines).
[Detail] Li Gao said: Yangming syndrome symptoms include body heat, eye pain, nasal dryness, inability to sleep, aversion to neither wind nor cold but spontaneous sweating, or aversion to heat. Pulses at Cun, Guan, and Chi are all long; Baihu Tang (White Tiger Decoction) is the primary treatment. Contraindications for Yangming include avoiding diaphoresis and avoiding diuresis to prevent exhaustion of Jin Ye (body fluids), which could lead to Xu Xue (blood accumulation). The best approach is to replenish body fluids, as fire tends toward dryness. Replenishing fluids can be done with Lianxu Congbai Tang (Scallion White Decoction with Roots). Excessive sweating leads to loss of Yang Qi; excessive purgation leads to loss of Yin fluids; excessive diuresis depletes Qi. Although these three changes differ, they all result in fluid loss. Sweating originally aids Yang. If Yang is invaded by Yin pathogens and cold condenses formlessly, one must disperse to remove Yin pathogens and restore Yang Qi, thereby benefiting Yang and dispelling wind-cold. If Yin pathogens are removed and sweating is continued, it damages Yang. The Classics state: "Extreme Yang transforms into Yin," so when Yang departs, it vanishes naturally. Excessive sweating causing Yang loss exemplifies this. Purgation originally aids Yin. If Yin is invaded by Yang pathogens and heat condenses into form, one must remove the corrupted matter to generate new Yin, thereby benefiting Yin and clearing heat. If Yang pathogens are removed and purgation is continued, it causes Yin loss. The Classics state: "Extreme Yin transforms into Yang," so when Yin departs, it vanishes naturally. Excessive purgation causing Yin loss exemplifies this. Diaphoresis is not disliked if early—not meaning premature, but timely. It is appropriate to sweat in the morning (Yang phase) but not in the afternoon (Yin phase). Thus, "do not sweat too early." Not disliking early sweating is good attacking. Purgation is not disliked if late—not meaning delayed indefinitely, but timely. It is appropriate to purge after Si hour (Yin phase) but not before (Yang phase). Thus, "do not purge too late." Not disliking late purgation is good guarding. Sweating originally loses Yin, but because sweat is profuse, Yang follows Yin and leaves. Purgation originally drains Yang, but because purgation is profuse, Yin follows Yang and leaves. Thus, "excessive sweating causes Yang loss; excessive purgation causes Yin loss." Violating diaphoresis often causes blood accumulation in the upper Jiao, leading to epistaxis. Violating diuresis often causes blood accumulation in the lower Jiao, leading to mania, where the person acts like a madman. There are Nine Channels in cold damage. What are they? Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin—these are six. There is Taiyang-Yangming, Shaoyang-Yangming, and Zheng Yang Yangming—these are three. Are they not nine? Yangming receives pathogens from both Taiyang and Shaoyang entering the Stomach, hence called Zheng Yang Yangming (True Yang Yangming). The first three channels represent Yangming self-disease not entering the interior, called "in the channel," not Zheng Yang Yangming. Treating the Three Yang from the middle: What does this mean? Taiyang-Yangming uses Dachengqi Tang (Major Order the Qi Decoction); Shaoyang-Yangming uses Xiaochengqi Tang (Minor Order the Qi Decoction); Zheng Yang Yangming uses Tiaoweichengqi Tang (Regulate the Stomach Order the Qi Decoction). Regarding sweating symptoms: Shaoyang is in the middle. Taiyang symptoms are exterior, requiring sweating; Yangming symptoms are interior, requiring purgation; Shaoyang is in the middle, so it requires neither sweating nor purgation, but rather Xiaochaihu Tang (Minor Bupleurum Decoction) to treat Shaoyang. Regarding purgation symptoms: Yangming is in the middle. Taiyang channel has much Blood and little Qi; Yangming channel has much Qi and much Blood; Shaoyang channel has much Qi and little Blood. Purging from Taiyang would violate Shaoyang; purging from Shaoyang would violate Taiyang. Therefore, one treats only via Yangming. These combined Three Yang diseases are called Zheng Yang Yangming, following the middle rather than the root or branch. Because Yangming lies between Taiyang and Shaoyang, and this channel has abundant Qi and Blood, it is chosen as the middle, ignoring Taiyang and Shaoyang. Yangming self-disease is treated with Tiaoweichengqi Tang; combined Three Yang disease is treated with Baihu Tang, both following the middle. What does "entering Yin allows purgation" mean? It means Yang entering Yin allows purgation; this Yin does not refer to the Three Yin channels (Shaoyin, Jueyin, Taiyin), but to the Yang Fu organs. These Yangs are not just Taiyang, Shaoyang, Yangming, but specifically the Stomach, Small Intestine, and Large Intestine. All three Yangs are Fu organs because they receive and transform food and fluids and conduct有形 (form substances), hence called "entering Yin." Zhang Zhongjing said: "Once entered the Fu organ, it can be purged." Zhang Zhongjing stated: Taiyang-Yangming uses Dachengqi Tang; Shaoyang-Yangming uses Xiaochengqi Tang; Zheng Yang Yangming uses Tiaoweichengqi Tang. These are cases where the Three Yang have entered the Zang organs, requiring drainage. Taiyin is treated with Guizhi Tang; Shaoyin with Mahuang Fuzi Xixin Tang; Jueyin with Danggui Sini Tang. These are cases where the Three Yin have not yet entered the Fu organs, requiring diaphoresis.
Li Gao said: Yangming is sandwiched between the Two Yangs (Taiyang and Shaoyang), with extreme Yang Qi, hence called Yangming. Pulses at Cun, Guan, and Chi are long; long and slightly surging indicates channel disease; long and deep-rapid indicates Fu disease. If Taiyang pulse is quiet, it does not transmit. If the pulse is rapid and urgent with desire to vomit, this is cold transforming into heat and transmitting to Yangming, manifesting within two or three days due to guest pathogens in the channel. Hence eye pain and nasal dryness. Body heat occurs because Yangming governs muscles; severe pathogen causes heat throughout the front of the body. Insomnia occurs due to irritability, dry fluids, and disharmony of Stomach Qi. If Taiyang has not ceased, there is fever and aversion to cold; if Taiyang has ceased, there is no aversion to cold but aversion to heat. Irritability, thirst, vomiting, dry fluids, hard stool, or immediate delirium constitute True Yangming. Shaoyang-Yangming presents with flank fullness, constipation with vomiting, or blood stasis with jaundice, or bloody stool with delirium, or chest irritability and anguish—all governed by this channel. However, one must not ignore interior cold with diarrhea or cold qi accumulation forming masses.
Ke Qin said: Yangming is a transmitting and transforming Fu organ, alternating between excess and deficiency. When food enters, the Stomach is excess and the Intestines are deficient; when food moves down, the Stomach is deficient and the Intestines are excess. If it is only excess and never deficient, this is the root of Yangming disease. "Stomach excess" is not itself Yangming disease; rather, all Yangming disease arises from stomach excess. Therefore, "Wei Jia Shi" (Excess in the Stomach and Intestines) serves as the outline for the Yangming channel. External symptoms of Yangming disease include body heat, spontaneous sweating, no aversion to cold, and aversion to heat.
[Outline] Zhang Zhongjing said: The characteristic of Shaoyang disease is bitter taste in the mouth, dry throat, and vertigo/dizziness.
[Detail] Li Gao said: Shaoyang syndrome symptoms include chest and flank pain, alternating chills and fever with vomiting, or coughing with deafness. Pulses at Cun, Guan, and Chi are all wiry; Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary treatment. One must follow Zhang Zhongjing's modifications for each specific clause. Shaoyang prohibits diaphoresis, diuresis, and purgation, hence the name "Three Prohibitions." The decoction is a harmonizing agent. Violating these prohibitions leads to numerous variations depending on location and nature, which must be carefully studied. What is half-exterior half-interior? The back is Taiyang, Yang within Yang, the Yang aspect. The front is Yangming, Yin within Yang, the Yin aspect. Yang is exterior, Yin is interior; thus, between Taiyang and Yangming, the pathogen resides. Treatment must not follow the root or branch but the middle. This is the method for treating Shaoyang. Taiyang Bladder is Water-Cold; Yangming Stomach is Dryness-Metal. Pathogens in between, closer to posterior Bladder Cold-Water cause aversion to cold; closer to anterior Yangming Dryness-Metal cause fever. Hence alternating chills and fever. This is the relationship among the Three Yang, not internal/external exterior-interior. They must not be mistaken as interior suitable for purgation; thus, these herbs act as harmonizers, neither sweating nor purging. Pathogens between Ying (Nutrient) and Wei (Defensive) levels are called half-exterior half-interior. Between Taiyang and Yangming, Shaoyang occupies the body's half-exterior half-interior position. Wuling San separates Yin and Yang, addressing the half-exterior half-interior of the Bladder channel. Lizhong Tang treats vomiting and diarrhea, addressing the upper-lower half-exterior half-interior.
Li Gao said: "Shao" means beginning. Yang Qi is tender and inferior to Yangming, hence called Shaoyang. Pulses at Cun, Guan, and Chi are wiry, slippery, and rapid, indicating extreme Yang leading to reversal; wiry and harmonious indicates the disease will dissipate. Shaoyang disease manifests within three or four days because its vessel runs along the flanks and connects to the ears. Wind-heat congestion causes deafness, flank pain, alternating chills and fever, anorexia, vomiting, bitter taste, dry throat, and vertigo. If there is no vomiting and the patient can eat, the Three Yin channels are not affected. If there is no high fever but restlessness, Yang is leaving and entering Yin. Conditions resembling malaria or blood stagnation in women are governed by this channel.
Ke Qin said: Taiyang governs the exterior, with head/neck stiffness as the outline; Yangming governs the interior, with stomach excess as the outline; Shaoyang occupies the half-exterior half-interior position. Zhang Zhongjing uniquely highlights bitter taste, dry throat, and vertigo as the outline, which is peculiar yet appropriate. The mouth, throat, and eyes cannot be called exterior, nor interior; they are the transition from exterior to interior and interior to exterior, i.e., half-exterior half-interior. These three can open and close; openable things are visible, closed things are invisible, fitting the pivot mechanism image. Thus, the ears are the entry/exit points for Shaoyang meridians, and the three symptoms are the pathomechanism of the Shaoyang channel. Considering wind-cold and miscellaneous diseases, presence of any one symptom suffices; all need not be present.
[Outline] Zhang Zhongjing said: The characteristic of Taiyin disease is abdominal fullness with vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain. If purged, there will certainly be hardness below the chest.
[Detail] Li Gao said: Taiyin syndrome symptoms include abdominal fullness, dry throat, warm hands and feet, spontaneous diarrhea without thirst, and occasional abdominal pain. Pulses at Cun, Guan, and Chi are all deep and fine. Taiyin disease can be treated with diaphoresis, warming, or purgation. Floating pulse allows diaphoresis with Guizhi Tang. Spontaneous diarrhea without thirst belongs to Taiyin because of cold in the Zang, allowing warming with Sini Tang category. Although this clause mentions no pulse, one should know the pulse is deep, slow, and weak. Zhang Zhongjing's Lizhong Tang pills, and Yilao's Renshen Huangqi Tang (Ginseng and Astragalus Decoction), varying in warmth or heat, should be selected based on the patient's strength and deficiency. Taiyin amenable to purgation occurs when original Taiyang disease was mistakenly purged, leading to abdominal fullness and occasional pain, belonging to Taiyin, treated with Guizhi Shaoyao Tang (Guizhi Jia Shaoyao Tang). Severe solid pain is treated with Guizhi Jia Dahuang Tang. Yilao states: This is not the original symptom but results from incorrect purgation, transmitting from Spleen to Stomach, hence error-induced transmission. Taiyin contraindications: Taiyin disease with abdominal fullness, vomiting, inability to eat, worsening diarrhea, and occasional pain. If purged, hardness below the chest occurs. In Taiyin disease with weak pulse and continuous loose stools, if Dahuang or Shaoyao were indicated, doses should be reduced because the patient's Stomach Qi is weak and easily disturbed. In cold damage with floating-slow pulse and warm hands/feet, the condition relates to Taiyin. If urination is normal, jaundice will not develop. Prolonged severe diarrhea stopping indicates hard stool, transmitting to the Fu organ (Yangming).
Li Gao said: Yin descends from Heaven, starting with Taiyin. In Yang it is exterior; in Yin it is interior. Pathogen in exterior shows Yang pulse; pathogen in interior shows Yin pulse. Thus, pulses at Cun, Guan, and Chi are deep. Deep-solid-strong requires purgation; deep-fine-weak requires warming. Taiyin disease manifests within four or five days because its vessel spreads in the Stomach and connects to the throat. Hence abdominal fullness/pain and throat dryness. Constipation with normal urination, or spontaneous diarrhea, warm hands/feet with thirst indicates transmitted heat in Fu organs; spontaneous diarrhea without thirst with cold hands/feet indicates direct invasion of Yin channels. Internal injury from diet or cold qi entering the Spleen causes abdominal pain and chest discomfort. Taiyin is the end of Three Yang and start of Three Yin. Remaining exterior Qi in Yang channels warrants sweating; half-exterior/interior with chest fullness and phlegm warrants emesis; transmitted interior heat warrants purgation; direct invasion of Yin channels warrants warming. Regulating the Spleen to overcome pathogens is key here.
Ke Qin said: Yangming is the interior of the Three Yang, so its outline belongs to interior Yang syndromes. Taiyin is the interior of the Three Yin, so its outline belongs to interior Yin syndromes. Taiyin is dominated by Dampness. Abdominal pain, vomiting, and diarrhea transform from dampness. Spleen is Wet Earth, so it is first affected by dampness. However, cold-damp invading Yin channels cannot disturb the Zang directly, so it returns to the Fu organs.
[Outline] Zhang Zhongjing said: The characteristic of Shaoyin disease is a faint, fine pulse and a desire to sleep (Dan Yu Mei).
[Detail] Li Gao said: Shaoyin syndrome symptoms include dry mouth, tongue, and thirst. Pulses at Cun, Guan, and Chi are deep and rapid; Dachengqi Tang is used for rapid pulses, Sini Tang for slow pulses. If Taiyin pathogens enter the interior, connecting upward to the Heart, transforming with Fire to attack Metal, bad omens or upward Qi flow may lead to death. Entering the Stomach, pulses are deep, fine, and rapid; rapidity indicates Dachengqi Tang for purgation. Descending to the root, transforming with Water into Cold, causing reversal cold. Or cold, heavy body, deep-fine-slow pulses; slowness indicates Sini Tang for warming. Rapid pulses allow purgation, but if rapid and weak, purgation is forbidden as Yang is nearly exhausted. Shaoyin disease with dry mouth/tongue/thirst, cool body surface, deep-fine-empty pulses uses Xiexin Tang (Drain the Epigastrium Decoction), distinguishing between formless and formed pathogenic factors. External symptoms of cold damage depend entirely on internal symptoms. High fever with thin/small pulses forbids purgation; Xiexin Tang is used. Shaoyin disease with cool body, no sweat, heavy or light body, deep pulse, headache, no reversal cold uses Mahuang Fuzi Xiexin Tang. Patient with body heat, irritability, normal bowel/bladder function, deep-hollow-weak pulse (empty upon pressure) uses Fuzi Xiexin Tang. Patient with incessant vomiting/diarrhea, thirsty but not feeling thirsty, faint-fine-weak pulse uses Lizhong Tang. Thirst with deep-strong-rapid pulse uses Wuling San. Shaoyin disease with fever and deep pulse requires sweating; slow sweating uses Mahuang Fuzi Xixin Tang; mild sweating uses Mahuang Fuzi Gancao Tang. Shaoyin diarrhea with green stool requires purgation; non-green stool requires warming. Normal mouth sensation requires warming; abnormal/dry mouth requires purgation. Shaoyin deep-fine-rapid pulse indicates interior disease, prohibiting sweating. Faint pulse prohibits sweating. Weak-choppy Chi pulse prohibits purgation. Mahuang Fuzi Xixin Tang: add Fangji and Cangzhu for heavy body (to overcome damp); add Shigao and Zhimu for light body (to overcome heat).
Li Gao said: Shaoyin follows Taiyin, hence called Shaoyin. Pulses at Cun, Guan, and Chi are deep. Deep-solid-strong requires purgation; deep-micro-weak requires warming. Shaoyin disease manifests within five or six days because its vessel originates at the sole, passes through the Kidney, and connects to the Lung system. Hence dry tongue/mouth/thirst. Or spontaneous clear water diarrhea, heart pain, abdominal distension. Or constipation/hard stool, aversion to thick clothing—all indicate deep heat entering the interior. Reversal cold, fear of cold, desire to vomit but unable, abdominal pain, spontaneous diarrhea, normal urination, dry heaving with Yang loss, sore throat, faint pulse with desire to sleep indicate deep Yin toxin entering Zang organs. Diarrhea with body pain, cough, vomiting indicates Water Qi. Vomiting immediately after eating, wiry-slow pulse, reversal cold with epigastric fullness prohibits purgation; emesis is indicated. Deep pulse with fever indicates sweating. Some cases attack Shaoyin directly upon onset, without transmitting from Taiyang first.
Ke Qin said: Among the Three Yang, Shaoyang is the pivot; among the Three Yin, Shaoyin is the pivot. Wiry represents Wood; floating-wiry-fine represents lesser Yang. Faint represents Water; deep-faint-fine represents lesser Yin. Wei Qi circulates in Yang during wakefulness and in Yin during sleep. It travels 25 degrees daily, branching through organs from Foot Shaoyin. In Shaoyin disease, it enters Yang phases more, hence the desire to sleep. "Desire to sleep" means the patient feels sleepy mentally, not necessarily sleeping deeply. This matches the subtlety of the Shaoyang outline.
Shen Jin'ao's commentary: Zhang Zhongjing discusses: Fever and headache with a reverse deep pulse; if unrelieved and accompanied by body pain, rescue the interior with Sini Tang. This clause was traditionally placed in the Taiyang chapter. Shaoyin disease, initial stage with reverse fever and deep pulse, uses Mahuang Fuzi Xixin Tang. This clause was traditionally placed in the Shaoyin chapter. Predecessors noted that Shaoyin symptoms resemble Taiyang, and Taiyang pulses resemble Shaoyin, yet treatments differ. I ponder: Headache and fever are indeed Taiyang exterior symptoms, however, the pulse...