【纲】仲景曰。伤寒六七日。目中不了了。睛不和。无表里症。大便难。身微热者。此为实也。
急下之。宜大承气汤。
【目】朱肱曰。伤寒四五日后。以至过经。无表症。又无里症。未可下者。皆可用小柴胡随症
加减治之。以至十余日亦可用。十余日外。用小柴胡不愈者。若大便硬。看症可下。则用大柴胡下之。
以过经。其人稍虚。当下者。用大柴胡则稳。恐承气太紧。病患不禁也。如病患无表里症。发热。
七八日。脉虽浮数。可用大柴胡下之。假令已下。脉数不解。至六七
日不大便者。有瘀血也。属抵当汤。
柯琴曰。伤寒七日不愈。阳邪入阴矣。目不了了。晴不和。何以故。身微热。是表症已罢。不烦
躁。是里症未见。无表里症也。惟不大便而内实。斯必浊邪上升。阳气闭塞。下之而浊阴出下窍。
清阳走上窍矣。
【纲】仲景曰。伤寒一日。太阳受之。脉若静者。为不传。颇欲吐。若躁烦。脉数急者。为传也。
伤寒二三日。阳明少阳症不见者。为不传也。
【目】鳌按。一日。约辞。非定指一日也。脉静者。太阳伤寒脉浮紧。仍是浮紧之脉。未尝他变
也。故病仍在太阳。而亦未他传。此据脉知之。而太阳诸症自在可见。若更验之于症。胸中之阳为
在表之寒所郁。因而欲吐躁烦。脉又不静。而浮紧变为数急。太阳之邪。势必入里而传阳明。盖欲
吐躁烦。皆阳明胃症也。此又兼审脉症而知之。阳明少阳二经之症。至二三日不见。可知其脉仍浮
紧而亦不变。此又但据症而知之也。可见一日太阳。二日阳明。以次相传之日数。未可泥矣。
【纲】仲景曰。太阳病。头痛。至七日以上自愈者。以行其经尽故也。若再作经者。针足阳明。
使经不传。则愈。
【目】鳌按。上条是就太阳伤寒之传经不传经辨之。此条是就太阳伤风之传经不传经言之。其
举头痛。包太阳诸症在内。太阳经尽。不再传阳明。故愈。又言再作经云云者。必有实欲再传之势。
方可用针。不然。勿妄施也。
【纲】仲景曰。伤寒三日。三阳为尽。三阴当受邪。其人反能食不呕。此为三阴不受邪也。伤
寒三日。少阳脉小者。欲已也。
【目】鳌按。此二条。申明少阳病传不传。并愈不愈之故。盖伤寒一日太阳。二日阳明。三日少
阳。迨三日后三阳为尽。三阴当受邪。三阴必先太阴脾。脾与胃表里。今能食不呕。皆胃之握固有
力。能以卫脾。故虽脾当受邪而邪不能犯。并邪之在少阳者。亦得藉中州之力。以为驱逐三阳之邪。
且由少阳而已矣。故审其脉。少阳本弦。又邪在而更助其弦长。今变为小。故知其不传阴。而即
从少阳解也。不得以脉之小。误认为正虚脉微。
【纲】仲景曰。伤寒六七日。无大热。其人躁烦者。此为阳去入阴故也。
【目】鳌按。六七日者。由少阳误治。延至日久也。外无大热。似宜安静。忽内生烦躁。其三
阴之受邪必矣。盖三阳之热作于表。三阴之热甚于里。躁烦者。里热盛也。阳去入阴。以少阳处于
半表里。由阳入阴。其机至速。医者不可不急图于早也。
戴原礼曰。凡人伤寒。先犯太阳。以次而传。此特言其概耳。然其中变症不一。有发于阳即少
阴受之者。有夹食伤寒。食动脾。脾太阴之经。一得病即腹满痛者。亦有不循经而入。如初得病。
径犯阳明之类。不皆始于太阳也。亦有首尾止在一经。不传他经。亦有止传一二经而止者。不必尽
传诸经也。至如病之逾越。不可泥于次第。当随症施治。所以伤寒得外症为多。仲景云。日数虽多。
有表症者。尤宜汗。日数虽少。有里症者。即宜下。
吴绶曰。阳邪以日数次第而传者。由一日至七日。六经传尽。当汗出而解。七日不解。为之再
经。二七日不解。为之过经。过经不解。则为坏病。寒之伤人。初无定体。或中于阴。或中于阳。
经言。一二日发热脉沉者。少阴病也。又。一二日口中和。背恶寒者。少阴病也。此皆直中阴经之寒。
非常而为变也。活人书。凡寒邪自背而入者。或中太阳。或中少阴。自面而入者。则中阳明之类。
亦不专主于太阳也。又曰。寒邪首尾只在一经而不传者有之。有间传一二经者。有传过一经而不再传
者。亦有足经冤热而传入手经者。有误服药而致传变者多矣。故论曰。一日太阳受之。脉若静者
为不传。若脉数躁急烦欲吐者。传也。盖太阳为诸经之首。传变居多。且热邪乘虚之经则传也。
若经实则不受邪而不传也。且太阳传阳明。阳明传少阳。皆妻传夫。为微邪。少阳传太阴。太阴
传少阴。皆夫传妻。为贼邪。少阴传厥阴。太阳传少阳。皆母传子。为虚邪。太阳越经传太阴。乃误
下传。亦虚邪。太阳传少阴。乃阴阳双传。即属两感。太阳传厥阴。亦母传子。亦为虚邪。又为首
尾传。夫伤寒传至厥阴。为尾。厥者尽也。正将复而邪将解。水升火降。寒热作而大汗解也。若正
不复。邪无从解。阴气胜极。则四肢厥冷。舌卷耳聋囊缩。不知人而死矣。
陶氏云。伤寒传足不传手者。俗医之谬论也。夫人之气。自平旦会于膻中。朝行手太阴肺。以
次分布诸经。所以一脉愆和。则百脉皆病。彼云传足不传手。何据乎。盖伤寒者。冬时感寒即病之
名也。冬时则足太阳少阴正司其令。触冒之则二经受病。次则少阳厥阴。继冬而司春令。而亦受
伤。何也。盖风木之令。起于大寒。正当十二月至春分后。方行温令。故风寒亦能伤之。足阳明太
阴。中土也。土寄旺四季。则四时寒热温凉之气。皆能伤之。况表邪传里。必归脾胃而成燥屎。用
承气以除去之。胃气和矣。手之六经。主于夏秋。故不伤之。足之六经。乃受伤之方分境界也。若
言伤足不伤手。则可。谓传足不传手。不可也。况风寒中人。先入荣卫。昼夜循环。无所不到。岂
间断于手经哉。仲景云。无奇经。则无伤寒。缘奇经皆附足六经。不附手经。是以寒邪只伤足经也。
伤寒传至五六日。渐变神昏不语。或睡中独语一二句。目赤唇焦舌干。不饮水。与稀粥则咽。不
与则不思。六脉细数而不洪大。心下不痞。腹中不满。大小便如常。或传十日以来。形如醉人。医
见神昏不已。多用承气。误矣。不知此热传手少阴心经也。然又未知自何经来。答曰。本太阳伤风。
风为阳邪。阳邪伤卫。阴血自燥。热结膀胱。壬病逆传于丙。丙丁兄妹。由是传心。心火上迫而
熏肺。所以神昏也。谓肺为清虚之脏。内有火邪。致令神昏。宜栀子黄芩黄连汤。若脉在内者。导赤
散。脉在心者。泻心汤。若误用凉膈散。乃气中之血药也。如左寸沉潜有力者。则可用之。或犀角
地黄汤亦可。若脉浮沉俱有力者。是丙丁俱有热也。以导赤泻心各半服。此症膀胱传丙。
足传手经也。下传上也。丙传丁也。表传里也。壬传丁者。坎传离也。越经传也。又谓腑传脏也。
活人书。伤寒传足不传手。此言不尽意也。有从足经而传手经者。经云。伤寒或止传一经。或间
传一二经。不可拘以始太阳终厥阴也。但凭外症治之。此活法也。与食则咽者。邪不在胃也。不
与不思者。神昏故也。热邪既不在胃。误用承气。必死。
只是邪蕴日久。因足经实。手经虚。故冤热耳。有因汗下差误而传。有因七情或劳倦等而传。大抵
传于手经。必有所因。所以古人有救逆复脉等法。岂但切中病情。实启后人义例。
李 曰。表多里少为在经。宜清肌解表。里多表少为在腑。宜和肌通里。盖阳明标虽主肌。而其
本则胃也。（各经络为标各脏腑为本）然岂独阳明为十二经之长。而有经腑之异乎。仲景曰。三阳
受病。未入于腑。可汗而已。三阴受病。已入于腑。可下而已。则三阴有在经者。仍宜微汗之。盖
荣卫太阳主皮毛。胃腑主皮肤之下。肌肉之上。及肠胃也。胸胁属少阳。主血。荣百节。流行三部。
脏属三阴。主筋骨。并两足。故太阳为阳之表。阳明为阳之里。若但以脏腑分表里。则腑为表。
脏为里。若合荣卫脏腑分表里。则表者荣卫之所行。里者胃腑之所主。而脏则又深于里。但病入胃。
则亦不更传。
王氏肯堂曰。风寒客于人。使人皮肤闭而为热。故伤寒为病热也。针经曰。多热者易已。多寒
者难已。故热虽甚。不死。若两感于寒而表里俱病者。必死。经云。三阳受病。未入于腑者。可汗
而已。三阴受病。已入于腑者。可下而已。若两感于寒者死。若五脏六腑皆受病。则荣卫不行。脏
腑不通。必死。但按三阳受邪。为病在表。法当汗解。然三阳亦有便入腑者。入腑即宜下。故云。
未入腑可汗。素问腑字作脏字。理胜。盖腑阳而脏阴。且传阳明。即入腑也。三阴受邪。为病为里。
法当下。然三阴亦有在经者。在经则宜汗。故云。已入腑。可下。
经又云。其不两感于寒。更不传经。不加异气者。至七日。太阳病衰。头痛少愈也。八日。阳明
病衰。身热稍歇也。九日。少阳病衰。耳聋微闻也。十日。太阴病衰。腹减如故。则思饮食也。十一
日。少阴病衰。渴止舌干。已而嚏也。十二日。厥阴病衰。囊纵。少腹微下。大气皆去。病患精神
爽慧也。若
更感异气。变为他病者。当根据坏症治之。若脉阴阳俱盛。重感于寒者。变为温疟。阳脉浮滑。阴脉
濡弱者。更遇于风。变为风温。阳脉洪数。阴脉实大者。遇温热。变为温毒。为病最重也。温毒必
发斑。阳脉濡弱。阴脉弦紧者。更遇温气。变为温疫。以冬伤于寒。发为温病。
闵芝庆曰。伤寒传经。邪热渐入。而六经以次受之。六经传尽。无出而再传之理。欲知其传始
末。先别人身六经。足太阳为三阳。最在外。阳明为二阳。在太阳内。少阳为一阳。在阳明内。此三
阳为表也。太阴为三阴。在少阳内。少阴为二阴。在太阴内。厥阴为一阴。在少阴内。此三阴为里也。
皆由内以数至外。故一二三之次第如此。伤寒由表入里。邪气以渐深传。故一二日始于太阳。二
三日传于阳明。三四日少阳。四五日太阴。五六日少阴。六七日厥阴也。此论其常耳。变则不可拘
以日数。其传至厥阴。为传经尽。不复再传。成氏曰。六日厥阴。六日为传经尽。七日不愈者。谓之
再传。再自太阳传。至十二日再至厥阴。为传经尽。十三日当愈。十三日不愈者。谓之过经。言再
过太阳经。亦以次为传也。谬矣。马仲化云。自太阳以至厥阴。犹人由户升堂入室。厥阴复出传于
太阳。奈有少阴太阴少阳阳明以隔之。岂有遽出而传太阳之理。此斥再传之非。诚千载断案。惜乎
释七日病衰。犹有未明。使后人于传经。不能绝无障蔽耳。辨见六经七日病愈篇。（在愈解门）然
则邪气之入。果无自里而出于表者乎。无欲传之出。有欲愈之出也。太阳篇曰。欲自解者。必当先
烦。乃有汗而解。何以知之。脉浮。故知汗出解也。此以脉浮为邪气还表。知是向安之兆。不待更
用汤药。邪自外散者。散则复何传焉。须知里邪不出则已。出则欲愈。非复欲传也。或曰。太阳篇
云。太阳病头痛。七日以上自愈者。以行其经尽故也。若欲再作经者。针足阳明经。使经不传则愈。
此非一日至六日。传三阳三阴经。至七日当愈。不愈。则太阳之邪再传阳明者欤。曰。伤寒始
于太阳受病。以次而终于厥阴。为传经尽。诸经受病。凡七日自愈者。为行其经尽。太阳病至七日
头痛自愈者。以行太阳经尽故也。邪气行来。始终只在太阳一经。而尽其七日当愈之数也。论云。
发于阳者七日愈。以阳数七也。若七日以上不自愈。欲过太阳一经。再传一经。
当针足阳明迎而夺之。使不传阳明经则愈。细玩行其经尽之句。不曰传经尽。则仲景之意昭然矣。成
氏谬以行其经尽为递传六经。乃有自太阳再传之说耳。若果传遍六经。厥阴之邪。再传太阳。太阳
再传阳明。则宜厥阴未传太阳之前。预针太阳矣。何必待欲传阳明而后针阳明哉。或曰。霍乱篇有
曰。十三日愈。所以然者。经尽故也。此非伤寒六日。传遍三阳三阴。后六日再传经尽。十三日当愈者
欤。太阳篇有曰。伤寒十三日不解。过经谵语者。以有热也。当以汤下之。此非十二日再传经尽。
十三日不愈。谓之过经者欤。曰。经尽者。如太阳行其经尽之谓也。由太阳受病于一日。至七日为
行太阳经尽之例推之。则诸经皆可屈指而期矣。阳明受病于二日。至八日自愈者。为行阳明经尽。
推之少阳及三阴经。次第至十二日自愈者。为行厥阴尽。十三日当大气皆去。精神爽慧之期也。故
曰。若过十三日以上不间。尺寸陷者。大危。其曰十三日不解。过经谵语。止以当解之期不解。乃
过于经而入于里。谵语者。此为内实而结于里也。当以汤下之。此泛言过经。不专指何经者也。何
尝有再传经尽。谓之过经之旨哉。详考所谓过经者。或有言过太阳经成里症。或有专言过太阳经者。
或有泛言过经者。敢引而证之。阳明篇云。汗出谵语者。以有燥屎在胃中。此为风也。过经乃可
[General Principle] Zhang Zhongjing stated: In the course of cold damage (Shanghan) lasting six or seven days, if the patient exhibits unclear vision and unsteady eyeballs, without exterior or interior syndromes, with difficulty in defecation and slight fever, this indicates an excess syndrome. Urgent purgation is required, and Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
[Commentary] Zhu Gong stated: After four or five days of cold damage, or even after passing through the transmission cycle, if there are no exterior symptoms nor interior symptoms, purgation should not be used yet. Xiao Chai Hu Tang (Minor Order the Gallbladder Decoction) can be used for all cases, with modifications based on symptoms, even if more than ten days have passed. If more than ten days have passed and Xiao Chai Hu Tang fails to cure, and if the stool is hard and symptoms indicate purgation is suitable, then Da Chai Hu Tang (Major Order the Gallbladder Decoction) should be used for purgation. Because the transmission cycle has passed and the patient is slightly deficient, using Da Chai Hu Tang for necessary purgation is safer, as Da Cheng Qi Tang may be too harsh for the patient to tolerate. If the patient has no exterior or interior symptoms but has fever for seven or eight days, and although the pulse is floating and rapid, Da Chai Hu Tang can still be used for purgation. Suppose purgation has already been performed, but the rapid pulse persists, and if there is no bowel movement for six or seven days, this indicates blood stasis, which belongs to the Dai Dang Tang (Resist the Decoction) syndrome.
Ke Qin stated: If cold damage does not resolve after seven days, the yang pathogen has entered the yin levels. Why are vision unclear and eyeballs unsteady? Slight fever indicates that the exterior syndrome has ceased; lack of irritability indicates that the interior syndrome has not appeared; thus, there are no exterior or interior symptoms. Only when there is constipation and internal excess does it mean that turbid pathogens rise upward, blocking yang qi. After purgation, turbid yin exits through the lower orifices, and clear yang ascends to the upper orifices.
[General Principle] Zhang Zhongjing stated: On the first day of cold damage, the Taiyang (Greater Yang) channel receives the pathogen. If the pulse is calm, the disease will not transmit. If the patient desires to vomit, or is irritable, and the pulse is rapid and urgent, the disease will transmit. On the second or third day, if Yangming (Yang Brightness) and Shaoyang (Lesser Yang) symptoms do not appear, the disease will not transmit.
[Commentary] Shen Jin'ao noted: "First day" is an approximate term, not referring strictly to one day. A calm pulse refers to the Taiyang cold damage presenting with a floating-tight pulse that remains floating-tight without other changes. Thus, the disease remains in the Taiyang channel and has not transmitted elsewhere. This is known from the pulse, while Taiyang symptoms are naturally visible. Further verification by symptoms: if yang qi in the chest is constrained by exterior cold, leading to desire to vomit and irritability, and the pulse becomes restless, changing from floating-tight to rapid and urgent, the Taiyang pathogen will inevitably enter the interior and transmit to the Yangming channel. Desire to vomit and irritability are both Yangming Stomach symptoms. This is known by examining both pulse and symptoms. If Yangming and Shaoyang channel symptoms do not appear by the second or third day, it can be known that the pulse remains floating-tight and unchanged. This is known solely from symptoms. Thus, the days for transmission—"first day Taiyang, second day Yangming"—should not be rigidly adhered to.
[General Principle] Zhang Zhongjing stated: In Taiyang disease, headache, if it resolves spontaneously after seven days or more, it is because the pathogen has exhausted its course in the channel. If it begins to transmit again, needling the Foot-Yangming channel can prevent transmission and lead to recovery.
[Commentary] Shen Jin'ao noted: The previous clause analyzed transmission versus non-transmission in Taiyang cold damage; this clause discusses it in Taiyang wind strike. Mentioning headache encompasses other Taiyang symptoms. When the Taiyang channel's course is exhausted and it no longer transmits to Yangming, recovery occurs. The mention of "beginning to transmit again" implies that needling is only appropriate if there is a definite tendency to transmit further. Otherwise, one should not needle recklessly.
[General Principle] Zhang Zhongjing stated: On the third day of cold damage, the three yang channels' pathogen is exhausted, and the three yin channels should receive the pathogen. If the patient can eat and does not vomit, this indicates that the three yin channels do not receive the pathogen. On the third day of cold damage, if the Shaoyang pulse is small, the disease is about to resolve.
[Commentary] Shen Jin'ao noted: These two clauses explain why Shaoyang disease transmits or does not transmit, and resolves or does not resolve. Generally, cold damage affects Taiyang on day one, Yangming on day two, and Shaoyang on day three. After three days, the three yang channels are exhausted, and the three yin channels should receive the pathogen. The three yin channels first involve the Taiyin Spleen. Spleen and Stomach are exterior-interior pairs. Now, being able to eat and not vomiting indicates that Stomach qi is originally strong and sufficient to protect the Spleen. Thus, although the Spleen should receive the pathogen, it cannot invade. Furthermore, the pathogen in Shaoyang can also rely on the middle jiao's strength to expel the three yang pathogens, and the condition resolves from Shaoyang. Therefore, observing the pulse: Shaoyang's native pulse is wiry; with pathogen presence, it becomes more wiry and long. Now that it has become small, we know it does not transmit to yin but resolves directly from Shaoyang. Do not mistake the small pulse for deficiency pulse.
[General Principle] Zhang Zhongjing stated: On the sixth or seventh day of cold damage, if there is no significant heat on the body but the patient is restless and irritable, this is because the yang pathogen has left and entered the yin.
[Commentary] Shen Jin'ao noted: Six or seven days result from mistreatment of Shaoyang disease, prolonging the illness. Exterior absence of significant heat suggests quietness, but sudden internal restlessness and irritability indicate that the three yin channels must have received the pathogen. Heat in the three yang channels arises in the exterior, while heat in the three yin channels is intense in the interior. Restlessness and irritability indicate intense interior heat. Yang leaving to enter yin happens rapidly because Shaoyang is located at the half-exterior/half-interior level. Physicians must plan treatment early.
Dai Yuanli stated: Generally, cold damage first attacks the Taiyang channel and then transmits sequentially; this is a generalization. However, variations exist. Some attack yang channels and immediately affect Shaoyin; some involve food stagnation where food disturbs spleen qi, causing Taiyin channel abdominal fullness and pain upon onset; some do not follow the channel sequence, such as directly attacking Yangming upon onset, not always starting with Taiyang. Some remain in one channel without transmitting; some transmit to only one or two channels and stop, not necessarily transmitting to all. Regarding irregular transmission, one should not stick to chronological order but treat according to symptoms. Cold damage often presents with exterior symptoms. Zhang Zhongjing said: Even if many days have passed, if exterior symptoms exist, sweating is preferred; even if few days have passed, if interior symptoms exist, purgation is indicated.
Wu Shou stated: Yang pathogens transmit sequentially by day count. From day one to seven, after the six channels are fully transmitted, resolution occurs via sweating. If unresolved after seven days, it is called "re-transmission." If unresolved after fourteen days, it is called "passing the channel." Unresolved after passing the channel becomes a damaged disease. Cold pathogens injuring humans have no fixed form; they may strike yin or yang channels. Classics state: Fever and deep pulse on days one or two indicate Shaoyin disease. Mouth feeling normal and aversion to cold on the back on days one or two also indicate Shaoyin disease. These are direct strikes into yin channels, representing unusual variations. *Huoren Shu* states: Cold pathogens entering from the back may strike Taiyang or Shaoyin; those entering from the face strike Yangming, etc., not exclusively Taiyang. Also, cold pathogens may stay in one channel without transmitting, transmit intermittently to one or two channels, transmit past one channel and stop, or transmit from foot channels to hand channels due to mistreatment. Thus, it is said: On day one, Taiyang receives the pathogen; if the pulse is calm, it does not transmit; if the pulse is rapid, restless, with irritability and desire to vomit, it transmits. Taiyang is the head of all channels and has frequent transmission. Heat pathogens transmit when they find deficiency in a channel; if the channel is solid, it resists the pathogen and does not transmit. Transmission from Taiyang to Yangming, and Yangming to Shaoyang, is wife-to-husband transmission, considered mild evil. Shaoyang to Taiyin, and Taiyin to Shaoyin, is husband-to-wife transmission, considered thieving evil. Shaoyin to Jueyin, and Taiyang to Shaoyang, is mother-to-son transmission, considered empty evil. Taiyang skipping channels to Taiyin due to mistaken purgation is also empty evil. Taiyang to Shaoyin is simultaneous yin-yang transmission, known as double contraction. Taiyang to Jueyin is also mother-to-son, considered empty evil, also called head-to-tail transmission. When cold damage reaches Jueyin, it is the tail. Jue means exhaustion. As righteous qi recovers and pathogenic qi resolves, water rises and fire descends, chills and fever occur, followed by profuse sweating resolving the disease. If righteous qi does not recover, pathogenic qi cannot resolve. Extreme yin qi leads to cold limbs, curled tongue, deafness, retracted testicles, unconsciousness, and death.
Tao stated: The theory that cold damage transmits only to foot channels and not hand channels is a fallacy of mediocre physicians. Human qi gathers at Danzhong at dawn, flows to Hand-Taiyin Lung, and distributes to all channels. If one pulse is disordered, all pulses are diseased. What basis is there for claiming transmission only to foot channels? Cold damage is defined as illness occurring immediately after contracting cold in winter. In winter, Foot-Taiyang and Foot-Shaoyin govern. Contacting them causes disease in these two. Next are Foot-Shaoyang and Foot-Jueyin, which govern spring after winter, and are also injured. Why? Wind-wood energy begins during Great Cold, from December to after Spring Equinox, when warm energy acts. Thus, wind-cold can injure them. Foot-Yangming and Foot-Taiyin belong to Earth. Earth thrives in all four seasons, so cold, heat, warmth, and coolness in all seasons can injure them. Moreover, exterior pathogens transmitting to the interior must return to Spleen and Stomach to form dry feces, removed by Chengqi decoctions. Once Stomach qi harmonizes, recovery follows. Hand-six channels govern summer and autumn, so they are not injured. Foot-six channels are the realms of injury. Saying foot is injured but not hand is acceptable; saying foot transmits but not hand is incorrect. Wind-cold enters Ying and Wei, circulating day and night everywhere, never stopping at hand channels. Zhang Zhongjing said: Without extraordinary vessels, there is no cold damage, because extraordinary vessels attach to foot-six channels, not hand channels, so cold pathogens only injure foot channels. When cold damage progresses to five or six days, it gradually changes to coma and muteness, or speaking alone in sleep, red eyes, cracked lips, dry tongue, no desire to drink, swallowing porridge if offered but refusing if not, fine-rapid but not surging pulses throughout, no epigastric stuffiness, no abdominal fullness, normal urination and defecation. Or around ten days, appearing drunk. Physicians seeing persistent coma often use Chengqi decoctions, which is wrong. They do not realize this is heat transmitting to Hand-Shaoyin Heart channel. But from which channel did it come? Answer: Originally Taiyang wind strike. Wind is yang pathogen; yang pathogen injures Wei, causing yin blood to dry. Heat binds Bladder. Ren (Water/Kidney) disease reversely transmits to Bing (Fire/Small Intestine). Bing and Ding (Heart) are siblings; thus it transmits to Heart. Heart fire presses upward, scorching Lung, causing coma. Lung is a clear-empty organ; internal fire causes coma. Use Zhizi Huangqin Huanglian Tang (Gardenia, Scutellaria, Coptis Decoction). If pulse is interior, use Dao Chi San (Guide Out the Red Powder); if pulse is in Heart, use Xie Xin Tang (Drain the Epigastrium Decoction). Mistaken use of Liang Ge San (Cool the Diaphragm Powder), which is a blood medicine in qi layer, is inappropriate unless Left Cun pulse is deep, submerged, and forceful, in which case it can be used. Xijiao Dihuang Tang (Rhinoceros Horn, Rehmannia Decoction) is also acceptable. If floating and deep pulses are both forceful, Bing and Ding both have heat; use half doses of Dao Chi San and Xie Xin Tang. This case involves Bladder transmitting to Bing, foot to hand channel, lower to upper, Bing to Ding, exterior to interior, Ren to Ding, Kan to Li, skipping channels, and fu to zang transmission. *Huoren Shu* says cold damage transmits foot but not hand, which is incomplete. There are cases of transmission from foot to hand channels. Classics say: Cold damage may stay in one channel or skip to one or two; do not rigidly adhere to starting Taiyang ending Jueyin. Treat based on exterior symptoms; this is flexible practice. Swallowing food indicates pathogen is not in Stomach; refusing food indicates coma. Since heat is not in Stomach, mistaken use of Chengqi decoction leads to death. It is merely long-standing pathogen accumulation; foot channels are excess, hand channels are deficient, hence heat accumulation. Transmission can result from erroneous sweating/purgation, emotional factors, or fatigue. Transmission to hand channels always has a cause. Hence ancients had methods like Jiuni and Fumai to save counterflow and restore pulse, not just treating symptoms but inspiring future principles.
Li stated: Exterior excess, interior deficiency means pathogen is in channels; clear muscle and release exterior is suitable. Interior excess, exterior deficiency means pathogen is in fu organs; harmonize muscle and unblock interior is suitable. Yangming's marking governs muscle, but its root is Stomach. (Channels are markings, Zang-Fu are roots.) Is Yangming the only chief of twelve channels with channel-fu distinction? Zhang Zhongjing said: Three yang diseases not entering fu organs can be treated with sweating; three yin diseases already entering fu organs can be treated with purgation. Thus, three yin diseases in channels still require mild sweating. Ying-Wei Taiyang governs skin and hair; Stomach fu governs below skin, above muscle, and intestines. Chest and hypochondrium belong to Shaoyang, governing blood, nourishing joints, flowing through three regions. Zang belong to three yin, governing sinews and bones, and both legs. Thus Taiyang is exterior of yang, Yangming is interior of yang. If distinguishing exterior-interior only by Zang-Fu, then Fu is exterior, Zang is interior. If combining Ying-Wei and Zang-Fu, then exterior is where Ying-Wei flow, interior is where Stomach fu governs, and Zang is deeper interior. Once disease enters Stomach, it no longer transmits.
Wang Shi Kentang stated: Wind-cold lodging in humans closes skin pores, generating heat; thus cold damage manifests as heat. *Needle Classic* states: Those with much heat heal easily; those with much cold heal with difficulty. Thus, even high heat is not fatal. If double contracted by cold with exterior and interior simultaneously diseased, death ensues. Classics state: Three yang diseases not entering fu organs can be treated with sweating; three yin diseases already entering fu organs can be treated with purgation. Double contraction by cold leads to death. If all five zang and six fu organs are diseased, Ying-Wei cease to flow, Zang-Fu blockage occurs, leading to death. Observing three yang receiving pathogen means disease is in exterior, method is sweating. However, three yang may quickly enter fu organs; once in fu, purgation is needed. Hence, "not entering fu, sweat." *Suwen* uses "zang" instead of "fu," which is logically superior. Fu is yang, Zang is yin. Transmitting to Yangming means entering fu. Three yin receiving pathogen means disease is in interior, method is purgation. However, three yin may remain in channels; if in channels, sweating is needed. Hence, "already entered fu, purge."
Classics further state: For those not double-contracted by cold, not transmitting further, and not affected by different pathogens, on day seven, Taiyang disease declines, headache lessens. Day eight, Yangming disease declines, body heat subsides. Day nine, Shaoyang disease declines, hearing slightly returns. Day ten, Taiyin disease declines, abdomen reduces to normal, appetite returns. Day eleven, Shaoyin disease declines, thirst stops, tongue dries, followed by sneezing. Day twelve, Jueyin disease declines, scrotum relaxes, lower abdomen softens, great qi departs, patient spirit becomes clear. If affected by different pathogens, becoming other diseases, treat as damaged diseases. If pulse yin and yang are both surging, re-contracted by cold, it becomes Warm Malaria. Floating-slippery yang pulse, weak-rapacious yin pulse, encountering wind, becomes Wind-Warmth. Surging-rapid yang pulse, solid-large yin pulse, encountering warmth, becomes Warm-Toxin, the most severe disease. Warm-Toxin must manifest macules. Weak-rapacious yang pulse, wiry-tight yin pulse, encountering warm qi, becomes Warm-Epidemic. Winter cold injury developing into Warm Disease.
Min Zhiqing stated: Cold damage transmission involves gradual entry of pathogenic heat, affecting six channels in sequence. After six channels are fully transmitted, there is no mechanism for re-transmission outward. To understand the start and end of transmission, distinguish the six channels of the body. Foot-Taiyang is Greater Yang, most exterior; Yangming is Second Yang, inside Taiyang; Shaoyang is Lesser Yang, inside Yangming. These three yang are exterior. Taiyin is Third Yin, inside Shaoyang; Shaoyin is Second Yin, inside Taiyin; Jueyin is First Yin, inside Shaoyin. These three yin are interior. Counting from inside out explains the 1-2-3 sequence. Cold damage moves from exterior to interior, pathogen deepening gradually. Days 1-2 start in Taiyang, 2-3 in Yangming, 3-4 in Shaoyang, 4-5 in Taiyin, 5-6 in Shaoyin, 6-7 in Jueyin. This describes the norm. Variations cannot be bound by days. Reaching Jueyin marks the end of transmission, no further transmission occurs. Cheng Wuji stated: Day six Jueyin, six days mark end of transmission. Unresolved on day seven is "re-transmission." Re-starting from Taiyang, reaching Jueyin again on day twelve marks end of transmission. Healing expected on day thirteen. Unresolved on day thirteen is "passing the channel," meaning passing Taiyang channel again in sequence. This is erroneous. Ma Zhonghua stated: From Taiyang to Jueyin is like moving from door to hall to room. Jueyin transmitting back to Taiyang is impossible due to obstruction by Shaoyin, Taiyin, Shaoyang, and Yangming. This refutes re-transmission, a definitive judgment for millennia. Regrettably, explanation of day-seven decline remains unclear, hindering understanding of transmission. See discussion in Six Channels Seven-Day Recovery Chapter. Does pathogen ever exit interior to exterior? Not by desire to transmit, but by desire to heal. Taiyang chapter states: Spontaneous resolution requires prior irritability, then sweating. How do we know? Floating pulse indicates sweating resolution. Floating pulse signifies pathogen returning to exterior, a sign of approaching health, requiring no further herbs; pathogen disperses outward, so what remains to transmit? Know that interior pathogen either does not exit or, if it exits, seeks healing, not transmission. Question: Taiyang chapter says headache resolving after seven days is due to exhausting the channel course. If wanting to transmit again, needle Foot-Yangming to prevent transmission and heal. Does this mean days 1-6 transmit three yang and three yin, healing on day 7; if not, Taiyang pathogen re-transmits to Yangming? Answer: Cold damage starts in Taiyang, ends in Jueyin, marking end of transmission. All channel diseases healing in seven days are due to exhausting their respective channel courses. Taiyang headache healing on day seven is due to exhausting Taiyang channel course. Pathogen movement stays within Taiyang channel, completing its seven-day healing number. Theory states: Diseases originating in yang heal in seven days because seven is the yang number. If not healing after seven days, wanting to pass Taiyang channel and transmit to another, needle Foot-Yangming to intercept and drain, preventing transmission to Yangming heals. Carefully studying "exhausting channel course," not "transmitting channel course," reveals Zhongjing's intent clearly. Cheng Wuji erroneously interpreted "exhausting channel course" as sequential transmission of six channels, creating the theory of re-transmission from Taiyang. If truly transmitting all six channels, Jueyin pathogen re-transmitting to Taiyang, then Taiyang to Yangming, one should needle Taiyang before Jueyin transmits to it. Why wait until wanting to transmit to Yangming to needle Yangming? Question: Huoluan chapter says healing on day thirteen because "channel course exhausted." Does this mean six days transmitting all three yang and three yin, then six more days exhausting transmission, healing on day thirteen? Taiyang chapter says: Unresolved cold damage on day thirteen, passing channel with delirium indicates heat, treat with purgation. Does this mean twelve days exhausting transmission, unresolved on day thirteen called "passing channel"? Answer: "Exhausting channel course" refers to Taiyang exhausting its course. Inferring from Taiyang receiving pathogen on day one and exhausting course on day seven, all channels can be calculated similarly. Yangming receiving pathogen on day two heals on day eight, exhausting Yangming course. Inferring Shaoyang and three yin channels, sequentially healing on day twelve exhausts Jueyin course. Day thirteen is when great qi departs and spirit clears. Hence, if unresolved past day thirteen, sunken cun-chi pulse indicates great danger. "Unresolved on day thirteen, passing channel with delirium" simply means failing to resolve at the expected time, passing the channel into interior. Delirium indicates internal excess binding in interior, treat with purgation. This broadly mentions "passing channel," not specifying which channel. Where is the principle of "re-exhausting transmission called passing channel"? Detailed examination of "passing channel": some refer to passing Taiyang channel forming interior syndrome, some specifically Taiyang, some broadly. Citing proof: Yangming chapter states: Sweating and delirium indicates dry feces in Stomach, this is wind. Passing channel then can...