太阳之为病。脉浮。头项强痛。而恶寒。
〔方〕太阳者。六经之首。主皮肤。而统荣卫。所以为受病之始也。难经曰。浮。脉在肉上行也。滑氏曰。
脉在肉上行。主表也。表即皮肤荣卫丽焉。故脉见尺寸俱浮。知为病在太阳之诊也。项。颈后也。强痛者。皮
肤荣卫。一有感受。经络随感而应。邪正争扰也。恶寒者。该风而言也。风寒初袭表。而郁于表。故不胜复被
风寒外迕。而畏恶之。及其过表而入里。则不复恶。仇雠之义也。此揭太阳之总病。乃三篇之大纲。以下凡首
称太阳病者。皆指此而言之也。〔程〕凡云太阳病。便知为皮肤受邪。病在腠理荣卫之间。而未涉乎腑脏也。太
阳之见证。莫确于头痛恶寒。故首揭之。使后人一遇卒病。不问何气之交。而但兼此脉此证。便可作太阳病处
治。亦必兼此脉此证。方可作太阳病处治。虽病已多日。不问其过经已未。而尚见此脉此证。仍可作太阳病处
治。〔柯〕凡言太阳病者。必据此条脉证。如脉反沉。头不痛。项不强。不恶寒。是太阳之变局矣。仲景立六经
总纲法。与内经热论不同。太阳只重在表证表脉。不重在经络主病。看诸总纲。各立门户。其意可知。
案方云。太阳者。以太阳经所主之部属皮肤言也。皮肤为人一身之表。表之为言。外也。风寒本天之二
气。于人身为外物。故其中伤于人。必自外而内。人之中伤之。必皮肤先受起。以病方在皮肤。皮肤属太阳。
故曰太阳病。盖举大纲而言始。以见周身之皮肤具病。后人不察。以经络之一线
而讼。岂不太谬。此说出于痉书。以其论太阳之大纲。故附于此。
柯氏凡例云。太阳病脉浮头项强痛六字。当作六句读。言脉气来尺寸俱浮。头与项强而痛。若脉浮两字连
读。头项强痛而恶寒。作一句读。疏略无味。则字字读断。大义先明矣。
太阳病。发热汗出。恶风脉缓者。名为中风。（玉函。千金翼。出下有而字。脉缓者。作其脉缓。无名字。）
〔方〕太阳病。上条所揭云云者。是也。后皆仿此。发热。风邪干于肌肤。而郁蒸也。汗出。腠理疏。玄
府开。而不固也。此以风邪郁卫。故卫逆而主于恶风。缓。即下文阳浮而阴弱之谓。中。当也。凡首称太阳中
风者。则又皆指此而言也。〔喻〕中字。与伤字无别。即谓伤风亦可。〔汪〕脉缓。当作浮缓看。浮是太阳病脉。
缓是中风脉。〔钱〕缓者。紧之对称。非迟脉之谓也。风为阳邪。非劲急之性。故其脉缓也。
案中风。又称伤风。活人书。伤风之候。头痛发热。脉缓汗出恶风。三因方。叙伤风论。寒泣血。无汗
恶寒。风散气。有汗恶风。为不同。本事方。今伤风。古谓之中风。
太阳病。或已发热。或未发热。必恶寒体痛。呕逆。脉阴阳俱紧者。名为伤寒。（逆。成本作 。为。
作曰。玉函。脉上。有其字。无者名二字。）
〔方〕或。未定之词。寒为阴。阴不热。以其着人而客于人之阳经。郁而与阳争。争则蒸而为热。已发热
者。时之所至。郁争而蒸也。未发热者。始初之时。郁而未争也。必。定然之词。言发热早晚不一。而恶寒则
必定即见也。〔钱〕体痛者。寒伤营分也。营者。血中精专之气也。血在脉中。随营气而流贯滋养夫一身者也。
此因寒邪入于血脉之分。营气
涩而不快于流行。故身体骨节皆痛也。〔鉴〕胃中之气。被寒外束。不能发越。故呕逆也。寒性劲急。故脉阴
阳俱紧也。此承首条。言太阳病。又兼此脉此证者。名曰伤寒。以为伤寒病之提纲。后凡称伤寒者。皆指此脉
证而言也。〔喻〕仲景恐见恶寒体痛呕逆。又未发热。认为直中阴经之证。蚤于辨证之先。揭此一语。虑何周
耶。（一语。乃或未发热四字也。）〔柯〕阴阳。指浮沉而言。不专指尺寸也。〔魏〕伤寒中风。同一浮脉。
而彼为浮缓。此为浮紧。阳邪舒散。故缓。阴邪劲急。故紧。同为在表之浮。而一缓一紧。风寒迥异矣。
案验之病者。有其未发热。则脉沉紧。而其已发热。则浮紧者。诊视之际。宜仔细辨认也。张介宾脉神草
有说。当考。
明理论云。恶风。则比之恶寒而轻也。恶寒者。啬啬然憎寒也。虽不当风。而自然寒矣。恶风者。谓常
居密室之中。帏帐之内。则舒缓而无所畏也。一或用扇。一或当风。淅淅然而恶者。此为恶风者也。
案风寒二证。譬如人之呵与吹。呵之风属阳。吹之寒属阴。阳主泄。阴主闭。故人之感邪气。其表虚泄
而汗出者。名为中风。其表实闭而无汗者。名为伤寒。其实受邪之风寒。不知果何如。只就其表虚表实。无汗
有汗。而立其目。以为处疗之方耳。故不曰此伤寒也。此中风也。而下名为二字。其意可自知也。
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。（躁。成本。方本。作
燥。玉函。无下若字。为传也。作乃为传。）
〔钱〕伤寒一日。太阳受之者。即内经热论。所谓一日巨阳受之。二日阳明受之之义也。因太阳主表。总
统营卫。故
先受邪也。然寒伤营之证。其脉阴阳俱紧。或见浮紧之脉。若一日之后。脉安静恬退。则邪轻而自解。不至传
入他经矣。倘见证颇觉欲吐。则伤寒呕逆之证。犹未除也。况吐则邪入犯胃。乃纳入之机。若口燥而烦热。脉
数急者。为邪气已郁为热。其气正盛。势未欲解。故为传经之候也。〔方〕一日。二日。三四五六日者。犹言
第一第二第三四五六之次序也。大要譬如计程。如此立个前程的期式约模耳。非计日以限病之谓。
案燥烦。即躁烦之讹。以为口燥烦热者。误矣。诸注并以烦躁为解。
锡云。数急。对静而言。柯云。欲字。若字。是审其将然。脉之数急。是诊其已然。此因脉定证之法也。
伤寒二三日。阳明少阳证不见者。为不传也。
〔鉴〕伤寒二日。阳明受之。三日少阳受之。此其常也。若二三日。阳明证之不恶寒。反恶热。身热心
烦。口渴不眠等证。与少阳证之寒热往来。胸胁满。喜呕口苦耳聋等证。不见者。此为太阳邪轻热微。不传阳
明少阳也。〔方〕不传有二。一则不传而遂自愈。一则不传而犹或不解。若阳明少阳虽不见。太阳亦不解。则
始终太阳者有之。余经同推。要皆以脉证所见为准。若只蒙龙拘拘。数日以论经。则去道远矣。
太阳病。发热而渴。不恶寒者。为温病。（玉函。无者字。）
〔鉴〕发热不渴恶寒者。太阳证也。发热而渴。不恶寒者。阳明证也。今太阳病始得之。不俟寒邪变热。
转属阳明。而即热渴不恶寒者。知非太阳伤寒。乃太阳温病也。由于膏粱之人。冬不藏精。辛苦之人。冬伤于
寒。内阴已亏。外阳被郁。周身经络。早成温化。所以至春一遇外邪。即从内应。感寒邪者。则名曰温病。
〔程〕太阳初得之一日。即发热而渴。
不恶寒者。因邪气早已内蓄。其外感于太阳。特其发端耳。其内蓄之热。固非一朝一夕矣。盖自冬不藏精。而
伤于寒。时肾阴已亏。一交春阳发动。即病未发。而周身经络。已莫非阳盛阴虚之气所布 。所云至春发为温
病者。盖从其胚胎受之也。此证初治。可用辛凉治标。一经汗下后。芩连栀膏。只增其热。王冰云。寒之不寒。
责其无水。须大剂六味地黄汤。重加生地麦冬。救肾水为主。若干呕烦逆者。加山楂贝母。折其冲势。金水两
亏者。宜二地二冬加人参。为固本汤。滋水之上源。若见斑衄等证。此为上竭。宜四物汤。倍生地赤芍。加山
楂丹皮。复营分之亏。以生阴气。煎法俱用童便。或加金汁和服。盖病源得之冬不藏精。故滋阴可以退火。而
凉血即能清热。余以此活人多矣。因附识于此。〔钱〕其见证之初。以大青龙汤之凉解。为治温之首剂。而作
一大柱石也。然无汗者宜之耳。其有发热而渴。不恶寒。而汗自出者。不宜更汗。则有桂枝二越婢一汤之法也。
其无表证。但热渴而不恶寒者。为已入阳明。又有白虎汤可用也。
案活人书。温病渴而不恶寒者。主以竹叶石膏汤。盖其方。清凉润补相兼也。又案钱氏主用石膏。程氏专用
地黄。不知孰是。尝验温病。亦未能无虚实之分。虚者宜从程法。实者当根据钱法。学人要须参诸脉证。匆令误也。
若发汗已。身灼热者。名风温。风温为病。脉阴阳俱浮。自汗出。身重。多眠睡。鼻息必鼾。语言难出。
若被下者。小便不利。直视失溲。若被火者。微发黄色。剧则如惊痫。时 。若火熏之。一逆尚引日。再逆
促命期。（成本。名上有曰字。张卿子本无鼻字。玉函。被下者。作下之。无火者之者。及色字。 。作掣
纵。下有发作字。若以火熏之。作复以火熏之。）
〔成〕伤寒发汗已。则身凉。若发汗已。身灼热者。非伤
寒。为风温也。风伤于上。而阳受风气。风与温相合。则伤卫。脉阴阳俱浮。自汗出者。卫受邪也。卫者。气
也。风则伤卫。温则伤气。身重多眠睡者。卫受风温。而气昏也。鼻息必鼾。语言难出者。风温外甚。而气拥
不利也。若被下者。则伤脏气。太阳。膀胱经也。内经曰。膀胱不利为癃。不约为遗溺。癃者。小便不利也。
太阳之脉。起自内 。内经曰。瞳子高者。太阳不足。戴眼者。太阳以绝。小便不利。直视失溲。为下后竭津
液。损脏气。风温外胜。经曰。欲绝也。为难治。若被火者。则火助风温成热。微者热瘀而发黄。剧者热甚生
风。如惊痫。而时 也。〔方〕灼热。谓热转加甚也。风温。谓触犯于温。而有风也。〔程〕冬时伤肾。则寒
水被亏。是温病源头。误治温病。而辛温发散。是风温源头。风温。即温病之坏病。非温病外又有风温也。一
逆者。若汗若下若火也。再逆者。汗而或下。下而或火也。温乃阳盛阴虚之病。一逆已令阴竭。况再逆乎。甚
矣。温热病不同于风寒治也。〔钱〕阴阳脉俱浮。则以寸口为阳。尺中为阴。即关前为阳。关后为阴之法也。阳
脉浮。则风邪伤卫。毛孔不闭。故汗自出。阴脉浮。则热伤阴分。温邪熏灼。郁冒神昏。故身重多眠。而昏睡
中之鼻息。必 鼾也。其语言难出者。非舌强失音喑哑之病。乃神昏不语也。温病得火。内外充斥。浸淫于脏
腑肌肉筋骨之间。所以时时 也。 者。筋骨 动。十指抽掣。臂 坚劲。转侧而不自知也。
案诸家以温病风温为二证。特程注以风温为温病之坏证。今考宋版。及玉函。温病风温。连接为一条。
且据若发汗已之若字。则程注为得矣。庞安时总病论云。病患素伤于风。又复伤于热。风热相搏。则发风温。
四肢不收。头痛身热。常自汗出不解。治在少阴厥阴。不可发汗。汗出则谵语内烦。
扰不得卧。善惊。目光无精。治之复发其汗。如此者医杀之耳。风温之为病。脉阴阳俱浮。汗出体重。其息必
喘。默默但欲眠。下之则小便难。发汗则谵语。加温针则耳聋难言。但吐下之。则遗尿。宜葳蕤汤。案诸家以
风温为别证。 出于斯。
汪云。小便不利四字。当在若被下者四字之上。否则既云不利。又曰失溲。悖矣。
病有发热恶寒者。发于阳也。无热恶寒者。发于阴也。发于阳七日愈。发于阴六日愈。以阳数七。阴数六
故也。（玉函。千金翼。病上有夫字。热下并有而字。无热。作不热。六七上。并有者字。成本亦有。）
〔成〕阳为热也。阴为寒也。发热而恶寒。寒伤阳也。无热而恶寒。寒伤阴也。阳法火。阴法水。火成数
七。水成数六。阳病七日愈者。火数足也。阴病六日愈者。水数足也。〔程〕经虽有六。阴阳定之矣。阴阳之理
虽深。寒热见之矣。在发热恶寒者。阳神被郁之病。寒在表而里无寒。是从三阳经为来路也。在无热恶寒者。
阴邪独治之病。寒入里而表无热。是从三阴脏为来路也。同一证。而所发之源自异。七与六。不过奇偶二字解。
特举之为例。以配定阴阳耳。日子上宜活看。重在阳数阴数之数字上。〔张〕此条以有热无热。证阳病阴病之
大端。言阳经受病。则恶寒发热。阴经受病。则无热恶寒。尚论。以风伤卫气为阳。寒伤营血为阴。亦属偏见。
〔钱〕此一节提挚纲领。统论阴阳。当冠于六经之首。自叔和无己诸家。错简于太阳脉证之后。致喻氏以未热
注无热。悖于立言之旨矣。盖仲景以外邪之感。受本难知。发则可辨。因发知受有阴经阳经之不同。故分发热
无热之各异。以定阳奇阴耦之愈期也。发于阳者。邪入阳经而发也。发于阴者。
邪入阴经而发也。即阴阳应象论。所谓阳胜则身热。阴胜则身寒。阴阳更胜之变也。
案玉函经。及周氏钱氏张氏柯氏注本。以此条冠太阳篇首。又案以阴阳为营卫之说。 见方氏注。后喻
氏魏氏程氏及金鉴。皆从其说。周氏钱氏。驳正细辨。今不繁引。
外台秘要云。王叔和曰。夫病发热而恶寒者。发于阳。无热而恶寒者。发于阴。发于阳者。可攻其外。
发于阴者。宜温其内。发表以桂枝。温里宜四逆。庞安时总病论亦同。叶文龄医学统旨云。愚谓发于阳而发热
者。头必疼。发于阴而发热者。头不疼。
The general manifestation of Taiyang disease (Disease of the Taiyang Channel) is: a floating pulse (a pulse felt lightly on the surface), headache and stiffness/pain in the neck and occiput, accompanied by aversion to cold.
[Fang's Commentary] The Taiyang channel is the head of the six channels, governing the skin and commanding Ying (Nutritive Qi) and Wei (Defensive Qi); therefore, it is the initial site for pathogenic invasion. The *Nan Jing* states: "A floating pulse refers to the pulse qi moving above the muscle layer." Hua Shou (Hua Shi) states: "Pulse qi moving above the muscle level indicates disease in the Exterior." The Exterior refers to the skin, where Ying and Wei Qi reside. Thus, if the pulse is floating at the Cun, Guan, and Chi positions, it is known as the diagnostic sign of Taiyang disease. "Neck" refers to the back of the neck. "Stiffness and pain" occur because once the skin and Ying/Wei Qi are invaded by pathogens, the meridians respond accordingly, leading to conflict between the pathogen and healthy Qi. "Aversion to cold" here generally refers to wind pathogens. When Wind-Cold initially attacks the exterior and becomes stagnant there, the body cannot withstand further external confrontation with Wind-Cold, resulting in fear and aversion. Once the pathogen passes the exterior and enters the interior, aversion to cold ceases. This is likened to an enemy (indicating the struggle between pathogen and Zheng Qi). This clause reveals the general outline of Taiyang disease and serves as the guideline for the following three sections. Whenever "Taiyang disease" is mentioned subsequently, it refers to this condition. [Cheng's Commentary] Whenever Taiyang disease is mentioned, it indicates that the skin has been invaded by pathogens, and the disease is located between the Cou Li (interstices) and Ying/Wei Qi, without involving the Zang-Fu organs. Among the manifestations of Taiyang disease, headache and aversion to cold are the most definitive; hence, they are presented first. This allows later practitioners, upon encountering sudden illness regardless of seasonal climatic changes, to treat it as Taiyang disease if these specific pulse and symptom patterns are present; conversely, only with these patterns can it be diagnosed as Taiyang disease. Even if the illness has persisted for many days, regardless of whether it has transmitted through other channels, if these pulse and symptom patterns persist, it may still be treated as Taiyang disease. [Ke's Commentary] Whenever Taiyang disease is discussed, it must be based on the pulse and symptoms of this clause. If the pulse is instead deep, the head does not hurt, the neck is not stiff, and there is no aversion to cold, this constitutes a variant pattern of Taiyang disease. Zhang Zhongjing's method of establishing the general outlines of the Six Channels differs from that in the *Nei Jing: Re Lun*. For Taiyang disease, emphasis is placed on Exterior symptoms and Exterior pulses, rather than on the specific diseases governed by the meridians. Observing the various general outlines, each standing independently, reveals the intent.
Case Note: Fang states that Taiyang disease is defined by the area governed by the Taiyang channel, which belongs to the skin. The skin is the Exterior of the human body; "Exterior" means outside. Wind and Cold are two natural climatic factors; relative to the human body, they are external entities. Therefore, when they injure a person, they must invade from the outside inward. When injured by them, the skin is affected first. Since the disease is currently in the skin, and the skin belongs to Taiyang, it is called Taiyang disease. This likely presents the general outline to show that the skin of the whole body is diseased. Later scholars, failing to investigate, argue based solely on a single line of the meridian, which is highly erroneous. This view comes from the *Jing Shu* (Book of Spasms), as it discusses the general outline of Taiyang; thus, it is appended here.
Ke's General Rules state: The phrase "Taiyang disease, floating pulse, headache and stiffness/pain in the neck" should be read as six separate sentences. It means: the pulse qi is floating at Cun, Guan, and Chi; the head and neck are stiff and painful. If "floating pulse" is read together, and "headache, stiffness/pain in the neck, and aversion to cold" are read as one sentence, it becomes vague and lacks meaning. Reading each character separately clarifies the main principle.
In Taiyang disease, if fever, sweating, aversion to wind, and a moderate/slow pulse are present, it is named Wind Strike (Zhong Feng). (*Yu Han Jing* and *Qian Jin Yi Fang* have the character "er" (and) after "chu" (sweat). "Mai huan zhe" is written as "qi mai huan", without the words "ming wei").
[Fang's Commentary] Taiyang disease, as described in the previous clause, applies here. The subsequent cases follow this pattern. Fever results from Wind pathogen interfering with the muscles and skin, causing stagnation and steaming. Sweating occurs because the Cou Li are loose and Xuan Fu (pores) are open, lacking firmness. This is due to Wind pathogen stagnating the Wei Qi, causing Wei Qi to rebel and primarily manifest as aversion to wind. "Huan" (moderate/slow) refers to what is later described as "Yang floating and Yin weak". "Zhong" (strike) means to correspond or hit. Whenever "Taiyang Zhong Feng" is first mentioned, it refers to this condition. [Yu's Commentary] The character "Zhong" is no different from "Shang" (injure); it can also be called "Shang Feng" (Wind Injuring). [Wang's Commentary] The moderate pulse should be viewed as Floating-Moderate. Floating is the pulse of Taiyang disease; Moderate is the pulse of Zhong Feng. [Qian's Commentary] "Huan" is the opposite of "Jin" (tight); it does not mean Chi (slow) pulse. Wind is a Yang pathogen and lacks the nature of being forceful and urgent; therefore, its pulse is moderate.
Case Note: Zhong Feng is also called Shang Feng. *Huo Ren Shu* records that the syndrome of Shang Feng includes headache, fever, moderate pulse, sweating, and aversion to wind. *San Yin Fang* discusses Shang Feng, stating that Cold causes blood to congeal, leading to no sweat and aversion to cold; Wind disperses Qi, leading to sweat and aversion to wind, indicating they are different. *Ben Shi Fang* states that modern Shang Feng was called Zhong Feng in ancient times.
In Taiyang disease, whether fever has already appeared or has not yet appeared, but there is definitely aversion to cold, body pain, vomiting, and reversal, and the pulse is tight at both Yin and Yang positions, it is named Cold Damage (Shang Han). ("Ni" is written as "𠔼" in *Chen Ben*, "wei" in *Wei Ben*. *Yu Han Jing* has "qi" before "mai", and lacks "zhe ming").
[Fang's Commentary] "Huo" (or) is an indefinite term. Cold is Yin, and Yin is not hot. However, because it adheres to the person and lodges in their Yang channels, it stagnates and contends with Yang Qi. Contention leads to steaming and heat. "Already feverish" means the time has arrived, and stagnation/contention leads to steaming heat. "Not yet feverish" means at the beginning, there is stagnation but no contention yet. "Bi" (must) is a term of certainty. It means that while the timing of fever varies, aversion to cold will definitely appear immediately. [Qian's Commentary] Body pain indicates that Cold has injured the Ying division. Ying is the refined and dedicated Qi within the blood. Blood flows within the vessels, circulating with Ying Qi to nourish the whole body. Here, because Cold pathogen enters the blood vessel divisions, Ying Qi becomes sluggish and fails to circulate smoothly, causing pain throughout the body and joints. [Jian's Commentary] The Qi in the stomach is constrained externally by Cold and cannot disperse, leading to vomiting and reversal. Cold has a forceful and urgent nature, so the pulse is tight at both Yin and Yang positions. This follows the first clause, stating that Taiyang disease combined with these pulse and symptom patterns is named Shang Han, serving as the outline for Shang Han disease. Henceforth, whenever Shang Han is mentioned, it refers to these pulse and symptoms. [Yu's Commentary] Zhang Zhongjing feared that seeing aversion to cold, body pain, vomiting, and lack of fever might lead to misdiagnosis as direct transmission to the Yin channels. He raised this point before differentiation to prevent such errors. How thorough his consideration was! ("One statement" refers to the four characters "huo wei fa re" / "may not yet have fever"). [Ke's Commentary] Yin and Yang refer to Floating and Deep, not specifically to Cun and Chi. [Wei's Commentary] Both Shang Han and Zhong Feng present a floating pulse, but Zhong Feng is Floating-Moderate, while Shang Han is Floating-Tight. Yang pathogens are expansive, hence moderate; Yin pathogens are forceful and urgent, hence tight. Although both are floating (indicating Exterior location), one is moderate and the other tight, showing that Wind and Cold are distinctly different.
Case Note: Verifying patients, some have deep-tight pulses before fever appears, and floating-tight pulses after fever appears. During diagnosis, careful identification is required. Zhang Jiabin's *Mai Shen Zhang* has relevant discussions that should be consulted.
*Ming Li Lun* states: Aversion to wind is milder than aversion to cold. Aversion to cold involves shivering and hating the cold; even without wind, one naturally feels cold. Aversion to wind means that while living in a closed room or behind curtains, one feels relaxed and unafraid. But once using a fan or facing the wind, one shivers and feels aversion; this is aversion to wind.
Case Note: The two syndromes of Wind and Cold are like exhaling and blowing. Exhaled wind is Yang; blown cold is Yin. Yang governs discharge; Yin governs closure. Therefore, when humans contract pathogens, those with Exterior deficiency leading to discharge and sweating are named Zhong Feng; those with Exterior excess leading to closure and no sweating are named Shang Han. In reality, regarding the actual Wind and Cold pathogens contracted, it is unknown exactly how they differ; names are established based on Exterior deficiency/excess and presence/absence of sweat to guide treatment. Thus, it does not say "this is Shang Han, this is Zhong Feng," but uses "named," implying the meaning is self-evident.
On the first day of Shang Han, the Taiyang channel receives the pathogen. If the pulse remains quiet/stable, it indicates no transmission. If there is a strong desire to vomit, or restlessness/irritability, and the pulse is rapid and urgent, it indicates transmission. ("Zao" is written as "zao" in *Chen Ben* and *Fang Ben*. *Yu Han Jing* lacks the lower "ruo". "Wei chuan ye" is written as "nai wei chuan").
[Qian's Commentary] "First day of Shang Han, Taiyang receives it" corresponds to the *Nei Jing: Re Lun* saying "Day 1 Ju Yang receives it, Day 2 Yang Ming receives it." Because Taiyang governs the Exterior and commands Ying/Wei, it receives the pathogen first. However, in Cold injuring Ying, the pulse is tight at Yin/Yang or floating-tight. If after one day the pulse becomes quiet and retreating, the pathogen is light and resolves spontaneously, without transmitting to other channels. If symptoms include a strong desire to vomit, the vomiting/reversal of Shang Han persists. Moreover, vomiting implies the pathogen invades the Stomach, representing a mechanism of intake. If there is dry mouth and irritability/heat, and the pulse is rapid and urgent, it means the pathogen has stagnated into Heat, its Qi is flourishing, and the condition is not resolving; thus, it is a sign of transmission. [Fang's Commentary] One day, two days, three to six days refer to the sequence of First, Second, Third... Sixth. Generally, it is like calculating distance, setting a rough timeframe for progress. It does not mean limiting the disease strictly by days.
Case Note: "Zao fan" is a typo for "Zao fan" (restlessness/irritability). Interpreting it as dry mouth and irritability/heat is incorrect. All annotations explain it as Fan Zao (restlessness). Xi Yun says: "Rapid and urgent" contrasts with "quiet". Ke says: "Yu" (desire/will) and "Ruo" (if/maybe) indicate examining what is about to happen; a rapid/urgent pulse diagnoses what has already happened. This is the method of determining symptoms via pulse.
On the second or third day of Shang Han, if Yang Ming and Shao Yang symptoms do not appear, it indicates no transmission.
[Jian's Commentary] Day 2 of Shang Han, Yang Ming receives it; Day 3, Shao Yang receives it. This is the norm. If on days 2-3, Yang Ming symptoms like aversion-to-cold turning into aversion-to-heat, body heat, irritability, thirst, and insomnia, and Shao Yang symptoms like alternating chills and fever, chest/hypochondriac fullness, preference for vomiting, bitter taste, and deafness, do not appear, it means the Taiyang pathogen is light and heat is mild, not transmitting to Yang Ming or Shao Yang. [Fang's Commentary] No transmission has two meanings: one is no transmission and eventual self-healing; the other is no transmission but also non-resolution. If Yang Ming/Shao Yang are absent but Taiyang is also unresolved, the disease may remain in Taiyang throughout; the same logic applies to other channels. Ultimately, judgment must be based on observed pulse and symptoms. If one is vague and rigid, discussing channels by number of days, one is far off track.
In Taiyang disease, if there is fever and thirst, but no aversion to cold, it is named Warm Disease (Wen Bing). (*Yu Han Jing* lacks "zhe").
[Jian's Commentary] Fever, no thirst, aversion to cold is a Taiyang syndrome. Fever with thirst, no aversion to cold is a Yang Ming syndrome. Now, in early Taiyang disease, without waiting for Cold pathogen to transform into Heat and transfer to Yang Ming, immediate Heat, Thirst, and No Aversion to Cold appear. This indicates it is not Taiyang Shang Han, but Taiyang Wen Bing. This arises from those who consume rich foods, failing to store essence in winter; or hard workers, injured by Cold in winter. Internal Yin is already deficient, External Yang is constrained, and the meridians of the whole body have long since undergone warming transformation. Thus, upon encountering external pathogens in spring, they respond internally. Contracting Cold pathogens is named Wen Bing. [Cheng's Commentary] On the first day of Taiyang disease, if there is immediate fever, thirst, and no aversion to cold, it is because the pathogen had long been stored internally. The external contraction in Taiyang is merely the onset. The internal stored Heat was not accumulated overnight. Generally, since winter failure to store essence led to Cold injury, Kidney Yin was already deficient. Upon the movement of Spring Yang, even before the disease manifests, the meridians are filled with Qi of Excess Yang and Deficient Yin. The phrase "manifesting as Wen Bing in Spring" refers to its embryonic origin. Initial treatment of this syndrome can use Acrid-Cool methods to address the branch. After sweating or purging, using Huang Qin, Lian Lian, Zhi Zi, and Shi Gao will only increase Heat. Wang Bing said: "If cooling does not cool, blame Water deficiency." Large doses of Liu Wei Di Huang Tang, heavily supplemented with Sheng Di and Mai Dong, should be used to save Kidney Water. If there is dry vomiting and irritability/reversal, add Shan Zha and Bei Mu to curb the upward surge. For dual deficiency of Metal and Water, use Di Di Er Dong plus Ren Shen, forming Gu Ben Tang, to nourish the source of Water. If macules or epistaxis appear, this is upper exhaustion; use Si Wu Tang, doubling Sheng Di and Chi Shao, adding Shan Zha and Dan Pi, to restore Ying deficiency and generate Yin. Decoction should use Tong Bian (child's urine), or mix with Jin Zhi (gold juice). Since the disease source is winter failure to store essence, nourishing Yin can subdue Fire, and cooling Blood clears Heat. I have cured many people this way, so I append this note. [Qian's Commentary] At the beginning of this syndrome, the cooling resolution method of Da Qing Long Tang serves as the primary formula for treating Wen Bing, acting as a major pillar. However, it is suitable only for those without sweat. For those with fever, thirst, no aversion to cold, but spontaneous sweating, further sweating is inappropriate; the method of Gui Zhi Er Yue Bi Yi Tang applies. For those without Exterior symptoms, only Heat and Thirst without aversion to cold, indicating entry into Yang Ming, Bai Hu Tang is available.
Case Note: *Huo Ren Shu* states that for Wen Bing with thirst and no aversion to cold, Zhu Ye Shi Gao Tang is the main treatment, as the formula combines cooling, moistening, and tonifying. Another note: Qian advocates Shi Gao, Cheng advocates Di Huang exclusively; it is unclear which is correct. I have verified Wen Bing cases, finding both deficiency and excess types. Deficiency cases should follow Cheng's method; excess cases should follow Qian's method. Practitioners must integrate pulse and symptoms to avoid error.
If, after sweating, the body becomes burning hot, it is named Wind-Warmth (Feng Wen). In Wind-Warmth disease, the pulse is floating at both Yin and Yang positions, there is spontaneous sweating, body heaviness, excessive sleepiness, nasal snoring, and difficulty speaking. If mistakenly treated with purgatives, there is urinary difficulty, staring eyes, and loss of bowel/bladder control. If mistakenly treated with fire therapy, slight cases develop yellow discoloration; severe cases resemble convulsive epilepsy with occasional spasms. If burned with fire, one mistake prolongs the illness; a second mistake hastens death. (*Chen Ben* has "yue" before "ming". Zhang Qingzi's edition lacks "bi". *Yu Han Jing* writes "bei xia zhe" as "xia zhi", lacks "zhe" in "huo zhe", and lacks "se". "𠟨" is written as "che zong", with "fa zuo" below. "Ruo yi huo xun zhi" is written as "fu yi huo xun zhi").
[Cheng's Commentary] After sweating in Shang Han, the body should be cool. If the body is burning hot after sweating, it is not Shang Han, but Feng Wen. Wind injures the upper part, and Yang receives Wind Qi. When Wind combines with Warmth, it injures Wei. Pulse floating at Yin/Yang and spontaneous sweating indicate Wei pathogen invasion. Wei is Qi. Wind injures Wei; Warmth injures Qi. Body heaviness and sleepiness indicate Wei receiving Wind-Warmth, causing Qi to become dull. Nasal snoring and difficulty speaking indicate severe external Wind-Warmth causing Qi obstruction. Mistaken purgation injures Zang Qi. Taiyang is the Bladder Channel. *Nei Jing* says: "Bladder dysfunction leads to Gong (difficulty urinating); lack of restraint leads to Yi Ni (incontinence)." Gong is urinary difficulty. The Taiyang pulse starts from the inner canthus. *Nei Jing* says: "High pupils indicate Taiyang deficiency; looking up indicates Taiyang extinction." Urinary difficulty, staring eyes, and incontinence result from post-purgation depletion of fluids and damage to Zang Qi, with Wind-Warmth prevailing externally. The Classic says: "Approaching extinction," making it difficult to treat. Mistaken fire therapy aids Wind-Warmth to create Heat. Mild cases have Heat stagnation causing jaundice; severe cases have intense Heat generating Wind, resembling convulsive epilepsy with spasms. [Fang's Commentary] "Zhuo re" means heat intensifies. "Feng wen" means encountering Warmth with Wind. [Cheng's Commentary] Winter Kidney injury depletes Cold Water, the source of Wen Bing. Mistreating Wen Bing with Acrid-Warm dispersants creates Feng Wen. Feng Wen is the corrupted state of Wen Bing, not a separate entity. "One mistake" refers to sweating, purging, or fire. "Two mistakes" refers to sweating then purging, or purging then fire. Wen Bing is a disease of Excess Yang and Deficient Yin. One mistake depletes Yin; how much more so two mistakes? Alas, Warm-Heat diseases differ fundamentally from Wind-Cold treatments. [Qian's Commentary] Floating pulse at Yin/Yang uses Cun as Yang and Chi as Yin (front/back of Guan). Yang pulse floating indicates Wind injuring Wei, pores not closing, hence spontaneous sweat. Yin pulse floating indicates Heat injuring Yin, Warmth scorching, causing depression/dizziness and mental confusion, hence body heaviness, sleepiness, and snoring during sleep. Difficulty speaking is not tongue stiffness or aphasia, but mental confusion preventing speech. Warmth disease subjected to fire fills interior/exterior, infiltrating Zang-Fu, muscles, sinews, and bones, causing frequent spasms. "Che" means sinew/bone twitching, finger cramping, arm stiffness, turning over without awareness.
Case Note: Most scholars distinguish Wen Bing and Feng Wen as two syndromes; only Cheng notes Feng Wen as a corrupted state of Wen Bing. Examining Song editions and *Yu Han Jing*, Wen Bing and Feng Wen are connected in one clause. Given the word "ruo" (if) in "ruo fa han yi", Cheng's note is correct. Pang Anshi's *Zong Bing Lun* says: Patients previously injured by Wind, re-injured by Heat, Wind-Heat clashing cause Feng Wen. Limbs collapse, headache, body heat, constant spontaneous sweating without resolution. Treatment targets Shao Yin and Jue Yin; do not sweat. Sweating causes delirium, internal irritation, restlessness, poor sleep, fright, and dull eyes. Treating by sweating again kills the patient. Feng Wen disease: pulse floating at Yin/Yang, sweating, body weight,必 panting, silent desire to sleep. Purging causes urinary difficulty; sweating causes delirium; warm needles cause deafness and speech difficulty. Vomiting/purging causes enuresis. Use Wei Rui Tang. Case: Scholars distinguishing Feng Wen as a separate syndrome originate from here.
Wang states: "Urinary difficulty" should precede "mistakenly treated with purgatives"; otherwise, stating difficulty and then incontinence is contradictory.
Diseases presenting with fever and aversion to cold originate from Yang. Diseases presenting with no fever and aversion to cold originate from Yin. Those originating from Yang heal in seven days; those originating from Yin heal in six days, because Yang number is seven and Yin number is six. (*Yu Han Jing*, *Qian Jin Yi Fang* have "fu" before "bing"; "re" has "er" below; "wu re" is "bu re"; "liu qi" has "zhe" above. *Chen Ben* also has them.)
[Cheng's Commentary] Yang is Heat; Yin is Cold. Fever with aversion to cold indicates Cold injuring Yang. No fever with aversion to cold indicates Cold injuring Yin. Yang follows Fire; Yin follows Water. Fire completes number seven; Water completes number six. Yang disease healing in seven days means Fire number is sufficient. Yin disease healing in six days means Water number is sufficient. [Cheng's Commentary] Although there are six channels, they are determined by Yin/Yang. Yin/Yang principles are profound but visible through Cold/Heat. In fever/aversion to cold, Yang Spirit is depressed; Cold is in the Exterior, Interior has no Cold; the path comes from the Three Yang channels. In no fever/aversion to cold, Yin pathogen dominates alone; Cold enters Interior, Exterior has no Heat; the path comes from the Three Yin Zang. Same symptom, but different origins. Seven and six are merely odd/even numbers, used as examples to align with Yin/Yang. Days should be viewed flexibly, focusing on the numerical values of Yang/Yin. [Zhang's Commentary] This clause uses presence/absence of fever to distinguish major aspects of Yang/Yin diseases. Yang channel disease presents with aversion to cold and fever; Yin channel disease presents with no fever and aversion to cold. *Shang Lun* considers Wind injuring Wei Qi as Yang and Cold injuring Ying Blood as Yin, which is also a biased view. [Qian's Commentary] This section summarizes the guidelines, discussing Yin/Yang comprehensively, and should head the Six Channels. Since Shuhe and Wuji, misplaced after Taiyang pulse/symptoms, Yu Shi interpreted "no fever" as "not yet fever," contradicting the author's intent. Zhang Zhongjing noted that external pathogen invasion is hard to know initially, but manifestations allow differentiation. Knowing invasion from manifestation reveals differences between Yin/Yang channels, hence differing fever/no fever, determining healing periods based on Yang odd/Yin even numbers. Originating from Yang means pathogen enters Yang channel and manifests. Originating from Yin means pathogen enters Yin channel and manifests. This corresponds to *Yin Yang Ying Xiang Da Lun*: "Yang excess leads to body heat; Yin excess leads to body cold," the variation of alternating Yin/Yang excess.
Case Note: *Yu Han Jing* and Zhou, Qian, Zhang, Ke annotations place this clause at the start of the Taiyang section. Also, identifying Yin/Yang as Ying/Wei is seen in Fang's annotation. Later Yu, Wei, Cheng, and Jin Jian followed this. Zhou and Qian refuted and analyzed in detail; citations omitted here.
*Wai Tai Mi Yao* quotes Wang Shuhe: Disease with fever and aversion to cold originates from Yang. No fever and aversion to cold originates from Yin. Originating from Yang, attack the Exterior. Originating from Yin, warm the Interior. Release Exterior with Gui Zhi; warm Interior with Si Ni. Pang Anshi's *Zong Bing Lun* agrees. Ye Wenling's *Yi Xue Tong Zhi* states: I believe originating from Yang with fever necessarily involves headache; originating from Yin with fever does not involve headache.