太阳之为病。脉浮。头项强痛而恶寒。
人身十二经络。本相联贯。而各有畔界。是以邪气之中。必各有所见之证与可据之脉。仲景首定
太阳脉证曰脉浮头项强痛恶寒。盖太阳居三阳之表。而其脉上额交巅。入络脑。还出别下项。故
其初病。无论中风伤寒。其脉证皆如是也。后阳明篇云、阳明之为病。胃家实也。少阳篇云、少阳之为
病。口苦咽干目眩也。三阴篇云、太阴之为病。腹满而吐。食不下。自利益甚。时腹自痛。少阴之为病。
脉微细。但欲寐。厥阴之为病。消渴。气上冲心。心中疼热。饥而不欲食。食即吐蛔。
暨本文共六条。递举六经受病之脉证。故柯氏目为六经之纲领。而此则为太阳之纲领也。然阳明
条下无口干恶热之文。少阳证中无往来寒热之目。少阴欲寐。仅举一端。太阴厥阴。多言脏病。
学人当参合他条。毋徒执一可也。
太阳病。发热。汗出。恶风。脉缓者。名为中风。
此太阳中风之的脉的证也。太阳篇中。原有伤寒、中风、风温、温病、中湿、风湿、湿温、
痉等证。仲景盖以诸病皆有发热。皆能传变。与伤寒同。其实所受之邪则不同。故特列而辨之。
所以清伤寒之源也。王叔和氏分出痉、湿、 三种。以为与伤寒相似。宜应别论。其中风、风温
等病。仍汇太阳篇中。要之中风、风温、温病。虽并得称伤寒。而其病发之状。与治之之法。实与伤寒
不同。叔和汇列于此者。又以正中风、风温、温病之始也。然详仲景篇中。每多风寒互举之处。
似有不容分别而出之者。岂非以风寒之气恒相兼。与阴阳之致可互参耶。余故以中风伤寒。并列于
此。而风温、温病则隶于类病法下。遵先圣之旨也。至于汗出脉缓之理。成氏暨诸贤所谓风性解缓。
而卫不外固者韪矣。兹不复赘。
太阳病。或已发热。或未发热。必恶寒。体痛。呕逆。脉阴阳俱紧者。名曰伤寒。
此太阳伤寒之的脉的证也。与前中风条参之自别。盖风为阳邪。寒为阴邪。阳气疾。阴气徐。
故中风身
热。而伤寒不即热也。风性解缓。寒性劲切。故中风汗出脉缓。而伤寒无汗脉紧也。恶寒者。
伤于寒则恶寒。犹伤于风则恶风。伤于食则恶食也。体痛呕逆者。寒伤于形则痛。胃气得寒则逆也
。然窃尝考诸条。中湿、风湿。并兼体痛。中风中 。俱有恶寒。风邪上壅。多作干呕。湿家下早。
亦成哕逆。故论太阳伤寒者。当以脉紧无汗。身不即热为主。犹中风以脉缓多汗身热为主也。其
恶寒、体痛、呕逆。则以之合证焉可耳。不言无汗者。以脉紧该之也。此二条乃太阳病之条目也。
The guiding syndrome of Taiyang disease is: the pulse is floating (Taiyang, a channel affected by exterior pathogens), accompanied by headache and stiffness in the head and neck, along with aversion to cold.
The twelve meridians of the human body are originally interconnected and continuous, yet each has its own boundaries. Therefore, when pathogenic factors invade, specific symptoms and corresponding pulses must manifest. Zhang Zhongjing first established the pulse and syndrome of Taiyang disease as floating pulse, headache with neck stiffness, and aversion to cold. This is because the Taiyang meridian resides at the most superficial level of the three Yang meridians; its pathway ascends to the forehead, intersects at the vertex, enters to connect with the brain, emerges again, descends separately to the nape. Thus, in the initial stage of illness, whether it is Wind Strike (Zhongfeng) or Cold Damage (Shanghan), the pulse and syndrome present in this manner. Later, in the Yangming chapter, it states: "Yangming disease manifests as excess in the stomach and intestines." In the Shaoyang chapter: "Shaoyang disease manifests as bitter taste in the mouth, dry throat, and vertigo." In the Three Yin chapters: "Taiyin disease manifests as abdominal fullness and vomiting, inability to eat, worsening diarrhea, and spontaneous abdominal pain; Shaoyin disease manifests as a faint and thin pulse, and a desire to sleep; Jueyin disease manifests as excessive thirst, qi rushing upward to strike the heart, pain and heat sensation in the heart, hunger without desire to eat, and vomiting of roundworms upon eating."
Including this text, there are six clauses in total, successively listing the pulses and syndromes of diseases affecting the Six Meridians. Therefore, Ke Qin regarded them as the guidelines for the Six Meridians, and this clause specifically serves as the guideline for Taiyang. However, the Yangming clause lacks mentions of dry mouth and aversion to heat; the Shaoyang syndrome lacks the mention of alternating chills and fever; Shaoyin's "desire to sleep" cites only one aspect; Taiyin and Jueyin mostly discuss internal organ diseases. Students should refer to other clauses and not be rigidly attached to just this one.
In Taiyang disease, if there is fever, sweating, aversion to wind, and a slow pulse, it is named Wind Strike (Zhongfeng).
This describes the typical pulse and typical syndrome of Taiyang Wind Strike. In the Taiyang chapter, there were originally syndromes such as Cold Damage, Wind Strike, Wind-Warmth, Warm Disease, Dampness Strike, Wind-Dampness, Damp-Warmth, and Spasm. Zhang Zhongjing likely noted that all these diseases involve fever and can transmit/transform, similar to Cold Damage, but the actual pathogenic factors received differ. Hence, he specifically listed and differentiated them to clarify the origin of Cold Damage. Wang Shuhe separated Spasm, Dampness, and Heat Stroke (Yue), considering them similar to Cold Damage and worthy of separate discussion. The Wind Strike, Wind-Warmth, etc., were still compiled into the Taiyang chapter. In essence, although Wind Strike, Wind-Warmth, and Warm Disease can all be termed Cold Damage, their onset characteristics and treatment methods are actually different from Cold Damage. Wang Shuhe compiled them here to rectify the understanding of the origins of Wind Strike, Wind-Warmth, and Warm Disease. However, a detailed examination of Zhongjing's chapters reveals many instances where Wind and Cold are mentioned together, suggesting they might not be strictly separable. Is this not because Wind and Cold Qi often combine, and the principles of Yin and Yang pathology can be mutually referenced? Therefore, I list Wind Strike and Cold Damage side by side here, while classifying Wind-Warmth and Warm Disease under the method of similar diseases, adhering to the intent of the Sages. Regarding the logic of sweating and a slow pulse, the explanation by Cheng Wuji and other sages—that "Wind nature is relaxing, leading to the failure of Defensive Qi (Wei Qi) to secure the exterior"—is correct. This will not be elaborated further.
In Taiyang disease, whether fever has already appeared or not, there must be aversion to cold, body pain, retching/vomiting, and a tight pulse in all positions (Cun, Guan, Chi), which is named Cold Damage (Shanghan).
This describes the typical pulse and typical syndrome of Taiyang Cold Damage. Comparing it with the previous Wind Strike clause naturally distinguishes them. Wind is a Yang pathogen, Cold is a Yin pathogen; Yang Qi moves swiftly, Yin Qi moves slowly. Thus, Wind Strike involves immediate body heat, whereas Cold Damage does not immediately cause heat. Wind nature is relaxing, Cold nature is tense and cutting; thus, Wind Strike presents with sweating and a slow pulse, while Cold Damage presents with no sweating and a tight pulse. Aversion to cold occurs because injury by Cold causes aversion to cold, just as injury by Wind causes aversion to wind, and injury by food causes aversion to food. Body pain and retching occur because Cold injuring the form causes pain, and Stomach Qi injured by Cold becomes rebellious. However, I have privately examined various clauses: Dampness Strike and Wind-Dampness both accompany body pain; Wind Strike and Heat Stroke both feature aversion to cold; Wind pathogen obstructing upwards often causes dry retching; patients with Dampness who undergo premature purgation also develop hiccups. Therefore, when discussing Taiyang Cold Damage, the primary focus should be on a tight pulse, absence of sweating, and lack of immediate fever, just as Wind Strike focuses on a slow pulse, profuse sweating, and body heat. As for aversion to cold, body pain, and retching, these serve to corroborate the syndrome collectively. The absence of sweating is not explicitly stated because the tight pulse implies it. These two clauses constitute the introductory guidelines for Taiyang disease.