害非浅，犹跋扈之师矣。仲景制乌梅丸，寒热并用，攻补兼施，为平治厥阴之主方，犹总督内地之大师也。其
与之水以治消渴，茯苓甘草汤以治水，炙甘草汤以复脉，当归四逆以治厥，是间出锐师，分头以救上焦之心脏
而安神明也。用白虎、承气辈，清胃而平中焦之实热；白头翁、四逆散，清胃而止下焦之热利，是分头以救
腹中之阴，而扶胃脘之元气耳。胃为一府而分阴阳二经，少阴一经而兼阴阳两脏者，皆为根本之地故也。邪有
阴阳两途，脏分阴阳二气，御阳邪犯少阴之阳，反发热心烦，咳渴咽痛；阳邪犯少阴之阴，则腹痛自利，或便
脓血；阴邪犯少阴之阳，则身体骨节痛，手足逆冷，背恶寒而身蜷卧；阴邪犯少阴之阴，则恶寒呕吐，下利清
谷，烦躁欲死。仲景制麻黄附子细辛、黄连阿胶、甘草桔梗、猪肤、半夏苦酒等汤，御阳邪犯少阴之阳也；其
制桃花、猪苓等汤，御阳邪入少阴之阴也；附子、吴萸、四逆等汤，御阴邪犯少阴之阳也，通脉四逆、茯苓四
逆、干姜附子等汤，御阴邪入少阴之阴也。少阴为六经之根本，而外通太阳，内接阳明，故初得之而反发热，
与八、九日而一身手足尽热者，是少阴阳邪侵及太阳地面也；自利纯清水，心下痛，口燥舌干者，是少阴阳
邪侵及阳明地面也。出太阳，则用麻黄为锐师，而督以附子；入阳明，则全用大承气而不设监制，是犹用向道，
与本部不同法也。其阴邪侵入太阴，则用理中、四逆加人尿、猪胆，亦犹是矣。嗟乎！不思仲景所集，安能见
病知源哉？（柯韵伯）
太阳提纲
太阳提纲，脉浮头项强痛恶寒八字，是太阳受病之正面，读者要知三阳之脉俱浮，三阳俱有头痛证，
六经受寒，俱各恶寒，
惟头项强痛，是太阳所独也。盖太阳为诸阳主气，头为诸阳之会，项为太阳之会故也。○太阳之脉，从风则缓，
从寒则紧，从湿则细，伤上则浮，伤下则沉。○太阳以阳为主，若治不如法，阳盛则转属阳明，阳衰则转属少阳
，阳虚则转属太阴，阳亡故转属少阴耳。○《论》云∶太阳病，发热，汗出，恶风，脉缓者，为中风。又云∶太
阳中风，脉浮紧，不汗出而烦躁。又云∶阳明中风，脉浮弦大不得汗。合观之，不得以无汗为非中风矣。《论》云∶
太阳病，或未发热，或已发热，必恶寒体痛呕逆，脉阴阳俱紧者，名伤寒。而未尝言无汗。又云∶头痛发热，身
疼腰痛骨节疼痛，恶风无汗而喘者。麻黄汤主之。此不冠以伤寒，又不言恶寒。又云∶伤寒脉浮，自汗出，
微恶寒。合观之，不得以有汗为非伤寒矣。○今人但据桂枝条之中风自汗，而不究伤寒亦有自汗出者；但以麻
黄证之无汗为伤寒，而不究中风最多无汗者，谓伤寒脉浮紧，中风脉浮缓，而不知伤寒亦有浮缓，中风亦有
浮紧者；知三阳脉浮，三阴脉沉，而不知三阴亦有浮脉，三阳亦有沉脉者；总是据一条之说，不理会全书耳。
○太阳阳虚，不能主外，内伤真阴之气便露出少阴底板；少阴阴虚，不能主内，外伤太阳之气便假借太阳面目。
所以太阳病而脉反沉，用四逆以急救其里；少阴病而表反热，用麻、辛以微解其表，此表里轻重两解法也。○
发汗、利水，是治太阳两大法门，发汗分形层之次第，利水定三焦之高下，皆所以化太阳之气也。发汗有五法∶
麻黄汤，汗在皮肤，是发散外感之寒气；桂枝汤，汗在经络，是疏通血脉之精气；葛根汤，汗在肌肉，是升提
津液之清气；大青龙，汗在胸中，是解散内扰之阳气；小青龙，汗在心下，是驱逐内蓄之水气。其治水有三
法∶干呕而咳，水入即吐，是水气在上焦，在上者汗而发之，小青龙、五苓散是也；心下痞硬满而痛，是水
气在中焦，中满者泻之于内，十枣汤、陷胸汤是也；热入膀胱，小便不利，是水气在下焦，在下者引而竭之，
桂枝去桂加茯苓、白术汤是也。○凡伤
寒之病，以阳为主，故最畏亡阳。而火逆之病，则以阴为主，故最怕阴竭。小便利者，为可治。是阴不虚，津
液未亡，太阳膀胱之气化犹在也。阳盛阴虚，是火逆一证之纲领。阳盛则伤血，阴虚则亡津，又是《伤寒》
一书之大纲领也。（柯韵伯）
太阳者，巨阳也，为六经之外藩，总经络而统营卫，故外邪得而袭之，有在经、在腑之异，有风伤卫、
寒伤营、营卫俱伤之殊。不知所以为经、为腑者，汗、下因误施也；不辨所以为风、为寒者，解肌、发汗
或错用也。夫传变既非一定，乃施治专于计日，又何免于倒行逆施耶？学人能分别风寒，体认营卫，印沙画
土，经界井井，庶几表里不紊，可无临歧之惑矣。（周禹载）
凡风、寒、暑、湿、燥、热之伤，莫不始于太阳。故善治病者，治太阳而已，无余事矣。然辨证不明，辗
转错谬，而其后遂莫之救也。仲景《伤寒论》于太阳故论之详而辨之审也。○太阳以得汗而解。然有在表未尽
之邪，有在里未去之邪，有虚而当补者，有过而宜救者，仲景之法备矣。（程扶生）
汗多亡阳，人皆知之矣。然人身之阳，部分各有所主。有卫外之阳，为周身营卫之主，此阳虚，遂有汗
漏不止、恶寒身痛之证。有肾中之阳，为下焦真元之主，此阳虚，遂有发热、眩悸、 动欲擗地之证。有膻
中之阳，为上焦心气之主，此阳虚，遂有叉手冒心、耳聋、奔豚之证。有胃中之阳，中焦水谷生化之主，此阳
虚，遂有胀满、胃中不和而成心下痞之证。虽皆从发汗后所得，然救误者，须观其脉证，知犯何逆，以法治
之，不得以多汗亡阳一证混治也。（程郊倩）
阳明提纲
阳明为传化之府，当更实更虚。食入，胃实而肠虚；食下，肠实而胃虚。若但实不虚，斯阳明病根矣。
胃实不是阳明病，而阳明之为病，悉从胃家实得来，故以胃实为总纲也。然致病之由，有实于未病之先者；有
实于得病之后者；有风寒外束，热不得越
而实者；有妄吐、汗、下，重亡津液而实者；有从本经热盛而实者；有从他经热盛而实者。此只举病根在实，
勿得即以胃实为可下之证。○阳明为阖，凡里证不和者，又以阖病为主。不大便固阖也，不小便亦阖也。不
能食，食难用饱；初欲食，反不能食，皆阖也。自汗出、盗汗出，表开而里阖也。反无汗，内外皆阖也。
种种阖病，或然或否，故提纲独以胃实为正。胃实不是竟指燥屎坚硬，只对下利言，下利是胃家不实矣，故汗
出解后，胃中不和而下利者，便不称阳明病。如胃中虚而不下利者，便属阳明。即初硬后溏者，总不失为胃家
实也。所以然者，阳明、太阴同处中州，而所司各别。胃司纳，故以阳明主实；脾司输，故以太阴主利。是二
经所由分也。○太阳总纲以正面，阳明总纲以底板。其阳明之表，正面未尝不与太阳同，而病情异。如阳明病，
脉迟、汗出多、微恶寒者，是阳明之桂枝证；阳明病，脉浮，无汗而喘者，是阳明之麻黄证。○阳明之表有二∶
有外邪初伤之表，有内热达外之表。外邪之表，其证微恶寒，汗出多，或无汗而喘，只在一、二日间，此因风
寒外来，故仲景亦用麻、桂二汤汗之。内热之表，在一、二日后，其证身热汗自出，不恶寒反恶热，此因内热
外发，故仲景制栀豉汤因势吐之。后人认不出阳明表证，一、二日既不敢用麻、桂，二、三日后，又不知用
栀豉，必待热深热极，始以白虎、承气投之，不知仲景治阳明之初法，废仲景之吐法。○阳明之恶寒，二日自止，
固与他经不同。其恶寒微，又不若太阳之甚。阳明在肌肉，必蒸蒸发热，或但热无寒，与太阳翕翕发热，寒束
于皮毛之上者不同。阳明自汗，亦异于太阳中风之自汗而出之不利，有热搏之意，故其状曰 。阳明自汗，
多有波澜摇动之状，故名曰 。太阳脉浮紧，热必不解；阳明脉浮而紧，必潮热。太阳脉但浮者，必无汗；
阳明脉但浮，必盗汗出。二经表证、表脉如此。○阳明虚烦，对胃家实热而言，是空虚之虚，不是虚弱之虚。○
三阳皆看阳明之转旋。三阴之不受邪者，藉胃为之蔽
其外也，则胃不特为六经出路，而实为三阴外蔽矣。胃阳盛，则寒邪自解；胃阳虚，则寒邪深入阴经而为患，
胃阳亡，则水浆不入而死。要知三阴受邪，关系不在太阳，而全在阳明。○太阳以心胸为里，故用辛甘发散，
助心胸之阳而开元腑之表，不得用苦寒以伤上焦之阳也，所以宜汗不宜吐。阳明以心胸为表，当用酸苦涌泄，
引胃脘之阳而开胸中之表，不当用温散以伤中宫之津液也，故法当吐不当汗。盖阳明以胃实为里，不但发热、
恶寒、汗出、身重、目痛、鼻干，谓之表，一切虚烦、虚热、口苦、咽干、舌苔、喘满、不得卧、消渴、小便
不利，凡在胃之外者，悉属阳明之表，此栀豉汤为阳明解表之圣剂矣。○太阳之表，当汗而不当吐；阳明之表，
当吐而不当汗。太阳之里，当利小便而不当下；阳明之里，当下而不当利小便。○上越、中清、下夺，是治阳
明三大法；发汗、利小便，是阳明两大禁。然风寒初入阳明之表，即用麻黄、桂枝发汗者，以急于除热而存
津液，与急下之法同。若脉浮、烦渴、小便不利，用猪苓汤利小便者，亦以清火而存津液也。又曰∶汗多者，
不可与猪苓汤。要知发汗、利小便，是治阳明权巧法门。○太阳用五苓者，因寒水在心下，故有水逆之证，
桂枝以散寒，白术以培土也。阳明用猪苓者，因热邪在胃中，故有自汗之证，滑石以滋土，阿胶以生津也。散
以散寒，汤以润燥，用意微矣。○阳明之有栀豉汤，犹太阳之有桂枝汤，既可以驱邪，亦可以救误。上焦得通，
津液得下，胃气因和耳。○治阳明内热之表有三法∶热在上焦，用栀豉汤吐之，上焦得通，津液得下，胃家不实
矣；热在中焦，用白虎汤清之，胃火得清，胃家不实矣；热在下焦，用猪苓汤利之，火从下泄，胃家不实矣。
要知阳明之治表热，即是预治其里，三方皆润剂，所以存津液而不令胃实也。若因循葛根、升麻之谬，不察仲
景治阳明之表矣。○凡妄下必伤胃气。胃阳虚，则阳邪袭阴，故转属太阴；胃液涸，则两阳相搏，故转属阳明。
属太阴，则腹满时痛而不实，阴道虚也；属阳明，则腹大实而痛，
阳道实也。满而时痛，是下利之兆；大实而痛，是燥屎之征。桂枝加芍药，小试建中之剂；桂枝加大黄，微示
调胃之方。○阳明之病在胃实，当以下为正法矣。然阳明居中，诸病咸臻，故治法悉具。如多汗、无汗，分麻
黄、桂枝；在胸、在腹，分瓜蒂、栀豉；初硬、燥坚，分大、小承气。即用汗、吐、下三法，亦有轻重浅深
之不同。若大烦大渴而用白虎，瘀血发黄而用茵陈，小便不利而用猪苓，停饮不散而用五苓，食谷欲吐而用
茱萸等法，莫不各有差等。以棋喻之，发汗是先着，涌吐是要着，清火是稳着，利水是闲着，温补是急着，
攻下是末着。病至于攻下，无别着矣。故汗之得法，他着都不必用。其用吐法，虽是奇着，已是第二手矣。他
着都非正着，惟攻下为煞着，亦因从前之失着也。然诸法皆因清火而设，则清火是阳明之上着与？（柯韵伯）
凡《经》所谓阳明病，皆里实可下之证也。邪已入腑，无所复传，不下奚为？然不可下而下，与可下而不
下，其失均也，亦安得下之而恰合机宜，动中 要哉？是故有十余日不解仍宜缓下之证，有一、二日即宜急
下之证，不必计日而语。然六经皆以胃为海，阳明入腑而议下，人所知也。太阳、少阳与夫三阴，皆有入腑
而议下，人所不知。○阳明有腑证有经证，有在经之寒，亦有在经之热；有入腑之热，亦有入腑之寒。热入腑
者，胃实是也；寒入腑者，不能食是也。人知阳明有经证不得妄攻下，须知阳明有腑寒亦不得妄攻下也。（程扶生）
阳明之邪，来路则由太阳，凡阳明证见八、九，太阳证有一、二未罢，即从太阳而不从阳明，可汗而不
可下，去路则趋少阳，凡阳明证见八、九，少阳证略见一、二，即从少阳而不从阳明，汗下两不可用。惟邪已
离太阳，未接少阳，恰在阳明界内，亟为攻下。不传他经，津液元气两无亏损，何快如之？（《尚论篇》）
阳明主里，内候胃中，外候肌肉，故有病经、病腑之分。如《论》中身热、烦渴、目痛、鼻干、不得眠、不恶寒、反恶热者，
此阳明经病也；潮热、谵语、手足腋下 然汗出、腹满痛、大便硬者，此阳明腑病也。而其候各有三∶经病，
则有邪已传阳明，而太阳之表未罢，兼见头痛、恶寒、无汗之太阳证者；有太阳之邪已罢，悉传阳明，但
见壮热、有汗、心烦不眠、口渴引饮之阳明证者；有阳明之邪未已，复转少阳，兼见胸胁痛、寒热往来、
口苦而呕、目眩、耳聋之少阳证者。腑病，则有太阳阳明，谓太阳病，或发汗、或吐、或下、或利小便，亡其
津液，胃中干燥，太阳之邪乘胃燥而转属阳明，致小便反数，大便硬者，所谓脾约是也。有正阳阳明，谓阳气
The harm is not shallow, resembling an unruly army. Zhang Zhongjing formulated Wu Mei Wan (Mume Pill), combining cold and hot herbs, attacking pathogens and tonifying deficiency simultaneously, as the principal formula for pacifying Jueyin disease (disease of the Jueyin channel), akin to a grand commander leading forces within the interior. He used [Wu Ling San] (Five-Ingredient Powder with Poria) to treat thirst (Xiao Ke), Fu Ling Gan Cao Tang (Poria and Licorice Decoction) to treat water retention, Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) to restore the pulse, and Dang Gui Si Ni Tang (Angelica Four Reversals Decoction) to treat cold extremities (Jue). These are like elite troops dispatched separately to rescue the Heart in the Upper Jiao (Upper Burner) and calm the Shen (Spirit). Using formulas such as Bai Hu Tang (White Tiger Decoction) and Cheng Qi Tang (Descending the Qi Decoction) clears Stomach heat and pacifies excess heat in the Middle Jiao; Bai Tou Weng Tang (Patrinia Decoction) and Si Ni San (Four Reversals Powder) clear Stomach heat and stop lower Jiao heat-dysentery; this is dividing forces to rescue Yin fluids in the abdomen and support the Yuan Qi (Original Qi) of the Stomach. The Stomach is one Fu organ divided into two meridians of Yin and Yang, while the Shaoyin (Lesser-Yang) meridian encompasses both Yin and Yang organs; these are all grounds of fundamental importance. Thus, pathogens have two pathways of Yin and Yang, and Zang organs are divided into Yin and Yang Qi: if Yang pathogen invades the Yang aspect of Shaoyin, there is fever, irritability, cough, thirst, and sore throat; if Yang pathogen invades the Yin aspect of Shaoyin, there is abdominal pain, spontaneous diarrhea, or pus and blood in the stool; if Yin pathogen invades the Yang aspect of Shaoyin, there is body and joint pain, cold extremities, aversion to cold on the back, and curled-up posture; if Yin pathogen invades the Yin aspect of Shaoyin, there is aversion to cold, vomiting, diarrhea with undigested food, and severe irritability bordering on death. Zhang Zhongjing formulated Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction), Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction), Gan Cao Jie Geng Tang (Licorice and Platycodon Decoction), Zhu Fu Tang (Pig Skin Decoction), Ban Xia Ku Jiu Tang (Pinellia and Vinegar Decoction), etc., to resist Yang pathogen invading the Yang aspect of Shaoyin; he formulated Tao Hua Tang (Peach Blossom Decoction) and Zhu Ling Tang (Polyporus Decoction) to resist Yang pathogen entering the Yin aspect of Shaoyin; Fu Zi Li Zhong Tang (Aconite and Immature Ginger Decoction), Wu Zhu Yu Tang (Evodia Decoction), Si Ni Tang (Four Reversals Decoction), etc., to resist Yin pathogen invading the Yang aspect of Shaoyin; Tong Mai Si Ni Tang (Pulse-Recovering Four Reversals Decoction), Fu Ling Si Ni Tang (Poria Four Reversals Decoction), Gan Jiang Fu Zi Tang (Dried Ginger and Aconite Decoction), etc., to resist Yin pathogen entering the Yin aspect of Shaoyin. Shaoyin is the root of the Six Meridians, externally connecting to Taiyang (Greater-Yang) and internally connecting to Yangming (Bright-Yang); thus, upon initial contraction, there is contrary fever, or by the eighth or ninth day, fever throughout the whole body and extremities, indicating Shaoyin Yang pathogen invading Taiyang territory; spontaneous diarrhea of pure water, pain in the epigastrium, dry mouth and tongue indicate Shaoyin Yang pathogen invading Yangming territory. When exiting Taiyang, Ma Huang Tang (Ephedra Decoction) is used as an vanguard, supervised by Fu Zi (Aconite); when entering Yangming, Da Cheng Qi Tang (Major Order the Qi Decoction) is used entirely without supervising agents, akin to using a guide, differing from the main force's method. If Yin pathogen invades Taiyin (Greater-Yin), Li Zhong Tang (Regulate the Middle Decoction) or Si Ni Tang added with human urine and pig bile is used, following the same principle. Alas! Without contemplating the medical principles collected by Zhang Zhongjing, how can one see the symptoms and understand their source? (Ke Yunbo)
Taiyang Outline
The outline of Taiyang disease consists of eight characters: "floating pulse, stiffness and pain in the head and neck, and aversion to cold." This is the frontal presentation of Taiyang disease. Readers must know that pulses of the Three Yang meridians are all floating, headaches occur in all Three Yang meridians, and aversion to cold occurs in all Six Meridians upon cold invasion; only stiffness and pain in the head and neck are unique to Taiyang. This is because Taiyang governs the Qi of all Yang, the head is the meeting place of all Yang, and the neck is the gathering point of Taiyang. ○ The pulse of Taiyang becomes slow (Huan) under Wind, tight (Jin) under Cold, and fine (Xi) under Dampness; injury above results in floating pulse, injury below results in sinking pulse. ○ Taiyang is governed by Yang Qi; if treatment is improper, excessive Yang shifts to Yangming, deficient Yang shifts to Shaoyang, depleted Yang shifts to Taiyin, and lost Yang shifts to Shaoyin. ○ The Treatise states: In Taiyang disease, with fever, sweating, aversion to wind, and slow pulse, it is called Wind Strike (Zhong Feng). It also states: In Taiyang Wind Strike, with tight pulse, no sweating, and irritability. It also states: In Yangming Wind Strike, with floating, string-taut, and large pulse, and no sweating. Observing these together, one cannot conclude that absence of sweating excludes Wind Strike. The Treatise states: In Taiyang disease, whether fever has not yet appeared or has already appeared, there is invariably aversion to cold, body pain, vomiting, and reverse flow of Qi, with Yin and Yang pulses both tight; this is named Cold Damage (Shang Han). However, it does not mention absence of sweating here. It also states: Headache, fever, body pain, lower back pain, joint pain, aversion to wind, no sweating, and wheezing are treated with Ma Huang Tang. Here, "Shang Han" is not prefixed, nor is aversion to cold mentioned. It also states: Shang Han with floating pulse, spontaneous sweating, and slight aversion to cold. Observing these together, one cannot conclude that presence of sweating excludes Shang Han. ○ Modern practitioners only rely on Gui Zhi Tang (Cinnamon Twig Decoction) treating Wind Strike with spontaneous sweating, failing to investigate that Shang Han also presents with spontaneous sweating; they take the absence of sweating in Ma Huang Tang syndrome as defining Shang Han, failing to investigate that Wind Strike most often presents with no sweating; they believe Shang Han has floating-tight pulse and Wind Strike has floating-slow pulse, not knowing that Shang Han can have floating-slow pulse and Wind Strike can have floating-tight pulse; they know Three Yang pulses are floating and Three Yin pulses are sinking, not knowing that Three Yin can have floating pulse and Three Yang can have sinking pulse; they always rely on isolated statements, ignoring the entire book. ○ When Taiyang Yang Qi is deficient, it cannot govern the exterior, and internal injury to True Yin reveals the underlying Shaoyin condition; when Shaoyin Yin Qi is deficient, it cannot govern the interior, and external injury to Taiyang Qi borrows the appearance of Taiyang. Therefore, in Taiyang disease with contrary sinking pulse, Si Ni Tang is used to urgently rescue the interior; in Shaoyin disease with contrary exterior heat, Ma Huang and Xi Xin are used to slightly release the exterior; this is a method of resolving both exterior and interior with varying degrees of severity. ○ Sweating and promoting urination are the two major methods for treating Taiyang disease. Sweating distinguishes the layers of the形体 (body structure), while promoting urination determines the levels of the Three Jiao; both serve to transform Taiyang Qi. There are five methods of sweating: Ma Huang Tang releases cold qi from the exterior at the skin level; Gui Zhi Tang unblocks essence and Qi of the vessels and collaterals at the meridian level; Ge Gen Tang (Kudzu Decoction) raises clear Qi of Jin Ye (Body Fluids) at the muscle level; Da Qing Long Tang (Major Green Dragon Decoction) disperses disturbing Yang Qi in the chest; Xiao Qing Long Tang (Minor Green Dragon Decoction) expels accumulated Water Qi beneath the heart. There are three methods for treating water: Dry retching and coughing, drinking water leads to immediate vomiting, indicates Water Qi in the Upper Jiao; those above should be released via sweating, using Xiao Qing Long Tang or Wu Ling San (Five-Ingredient Powder with Poria); Epigastric fullness, hardness, distension, and pain indicate Water Qi in the Middle Jiao; fullness in the middle should be purged internally, using Shi Zao Tang (Ten Date Palm Fruit Decoction) or Xuan Fu Dai Zhe Tang (Magnolia Bark and Hematite Decoction - note: text says Xian Xiong Tang); Heat entering the Bladder with difficult urination indicates Water Qi in the Lower Jiao; those below should be drained away, using Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Tang (Cinnamon Twig Decoction minus Cinnamon plus Poria and Atractylodes Macrocephala Decoction). ○ In all Shang Han diseases, Yang Qi is primary, hence fear of Yang collapse is greatest. In Fire Injury diseases, Yin Qi is primary, hence fear of Yin exhaustion is greatest. If urination is free, the case is treatable, indicating Yin is not deficient, Jin Ye are not exhausted, and the Qi transformation of the Taiyang Bladder remains. Excess Yang and Deficient Yin is the guideline for Fire Injury. Excess Yang injures Blood, Deficient Yin exhausts Jin Ye; this is the overarching principle of the Shang Han Treatise. (Ke Yunbo)
Taiyang, also known as Ju Yang (Giant Yang), is the outer barrier of the Six Meridians, commanding the collaterals and governing Ying (Nutrient) and Wei (Defensive) Qi. Thus, external pathogens can invade it, presenting differences between being in the Meridian vs. the Fu organ, and distinctions between Wind injuring Wei, Cold injuring Ying, and simultaneous injury to both Ying and Wei. Not understanding the distinction between Meridian and Fu organ stems from erroneous application of sweating and purging methods; failing to distinguish Wind from Cold stems from incorrect use of muscle-releasing and sweating methods. Since transmission is not fixed, applying treatment strictly by days leads to counterproductive actions. If practitioners can distinguish Wind from Cold and comprehend Ying and Wei, mapping them clearly like drawing boundaries on sand or earth, they will avoid confusion between interior and exterior and hesitate less at crossroads. (Zhou Yuzai)
Injuries from Wind, Cold, Summer-heat, Dampness, Dryness, and Heat all begin at Taiyang. Therefore, a skilled healer treats Taiyang, and nothing else remains to be done. However, if differentiation is unclear, errors accumulate, making later rescue impossible. Zhang Zhongjing’s *Shang Han Lun* discusses Taiyang in detail and differentiates it carefully. ○ Taiyang disease resolves through sweating. Yet there may be residual pathogenic factors in the exterior, lingering factors in the interior, deficiency requiring tonification, or excess requiring rescue; Zhang Zhongjing’s methods are comprehensive. (Cheng Fusheng)
Profuse sweating causing Yang collapse is well known. However, Yang Qi in the body is distributed and governed in different parts. There is Exterior-Guarding Yang, master of Ying and Wei throughout the body; deficiency here leads to unceasing sweat leakage, aversion to cold, and body pain. There is Kidney Yang, master of the Lower Jiao and True Yuan; deficiency here leads to fever, vertigo, palpitations, and restlessness. There is Dan Zhong (Chest Center) Yang, master of Upper Jiao Heart Qi; deficiency here leads to crossing hands over the heart, deafness, and Ben Tun (Running Piglet) syndrome. There is Stomach Yang, master of Middle Jiao digestion and transformation; deficiency here leads to fullness, stomach disharmony, and epigastric stuffiness. Although all result from post-sweating complications, rescuers must observe pulse and symptoms, identify the error, and treat accordingly, rather than conflating all cases under "Yang collapse from profuse sweating." (Cheng Jiaoqian)
Yangming Outline
Yangming is a transmitting and transforming Fu organ, alternating between fullness and emptiness. After eating, the Stomach is full and the Intestines empty; after digestion, the Intestines are full and the Stomach empty. If there is only fullness without emptiness, this constitutes the root of Yangming disease. Stomach fullness itself is not Yangming disease, but Yangming disease arises entirely from "Stomach House Fullness" (Wei Jia Shi), so Stomach Fullness is the general outline. However, causes of this fullness vary: it may exist before illness onset, develop after onset, result from external Wind-Cold binding preventing heat dispersion, arise from reckless emesis, sweating, or purging exhausting Jin Ye, stem from excessive heat in the self-channel, or spread from other channels. This highlights the root in fullness; do not immediately assume Stomach Fullness warrants purgation. ○ Yangming governs closure (He). Any interior disharmony is primarily a closure disorder. Constipation is closure; oliguria is also closure. Inability to eat, or inability to finish a meal, or initial desire to eat followed by inability, are all closure. Spontaneous sweating and night sweats represent opening of the exterior and closure of the interior. Conversely, no sweating represents closure of both interior and exterior. Given these variable presentations of closure, the outline focuses solely on Stomach Fullness as the standard. Stomach Fullness does not exclusively mean hard dry feces; it is defined against diarrhea. Diarrhea indicates the Stomach House is not full; thus, after sweating resolves the exterior, if epigastric disharmony causes diarrhea, it is not termed Yangming disease. If the Stomach is deficient but there is no diarrhea, it belongs to Yangming. Even if stools are initially hard then loose, it still falls under Stomach House Fullness. This is because Yangming and Taiyin share the central region but have distinct functions. The Stomach governs reception, so Yangming governs fullness; the Spleen governs transportation, so Taiyin governs diarrhea. This distinguishes the two meridians. ○ The Taiyang outline emphasizes the frontal presentation, while the Yangming outline emphasizes the underlying foundation. The exterior of Yangming shares similarities with Taiyang but differs in pathology. For instance, Yangming disease with slow pulse, profuse sweating, and slight aversion to cold is the Gui Zhi syndrome of Yangming; Yangming disease with floating pulse, no sweating, and wheezing is the Ma Huang syndrome of Yangming. ○ Yangming has two types of exterior: early external pathogen invasion and internal heat reaching the exterior. Early external pathogen exterior presents with slight aversion to cold, profuse sweating, or no sweating with wheezing, occurring within one or two days due to incoming Wind-Cold, treated by Zhang Zhongjing with Ma Huang or Gui Zhi decoctions. Internal heat exterior appears after one or two days, presenting with body heat, spontaneous sweating, no aversion to cold but aversion to heat, caused by internal heat radiating outward, treated by Zhang Zhongjing with Zhi Chi Tang (Gardenia and Soybean Fermented Decoction) to induce vomiting according to the trend. Later practitioners fail to recognize Yangming exterior signs; they dare not use Ma Huang/Gui Zhi in the first two days, and fail to use Zhi Chi Tang in days two to three, waiting until heat is extreme before using Bai Hu Tang or Cheng Qi Tang, thereby ignoring Zhang Zhongjing’s initial methods and abandoning the vomiting method. ○ Yangming aversion to cold ceases spontaneously by the second day, differing from other meridians. It is mild, unlike the severe aversion in Taiyang. Yangming resides in the muscles, presenting with steaming fever or heat without cold, differing from Taiyang’s fluttering fever with cold bound to the skin. Yangming spontaneous sweating differs from Taiyang Wind Strike sweating; it involves heat struggling, described as "zhi zhi" (continuous dripping). Yangming sweating often shows rippling motion, hence named "zhi zhi". Taiyang floating-tight pulse implies unresolved heat; Yangming floating-tight pulse implies tidal fever. Taiyang floating-only pulse implies no sweating; Yangming floating-only pulse implies night sweating. The exterior signs and pulses of these two meridians are thus distinct. ○ Yangming deficiency irritability refers to emptiness relative to Stomach House excess-heat, meaning voidness, not weakness. ○ The Three Yang meridians depend on Yangming for rotation. The Three Yin meridians avoid pathogens by relying on the Stomach as an external shield; thus, the Stomach is not only the exit for the Six Meridians but the external shield for the Three Yin. Strong Stomach Yang resolves Cold pathogens; deficient Stomach Yang allows Cold pathogens to penetrate deeply into Yin meridians; lost Stomach Yang prevents intake of fluids, leading to death. One must know that involvement of Three Yin depends not on Taiyang, but entirely on Yangming. ○ Taiyang regards the Heart and Chest as interior, using acrid-sweet dispersing methods to assist Heart-Chest Yang and open the exterior of the Yuan-Fu organs, avoiding bitter-cold herbs that damage Upper Jiao Yang; thus, sweating is preferred over vomiting. Yangming regards the Heart and Chest as exterior, using sour-bitter inducing methods to draw Stomach-Wan Yang upward and open the Chest exterior, avoiding warm-dispersing herbs that damage Middle Jiao Jin Ye; thus, vomiting is preferred over sweating. Since Yangming regards Stomach Fullness as interior, symptoms like fever, aversion to cold, sweating, heaviness, eye pain, nasal dryness are considered exterior; furthermore, all deficiency irritability, deficiency heat, bitter taste, dry throat, tongue coating, wheezing/fullness, insomnia, thirst, and difficult urination, anything outside the Stomach, belong to Yangming exterior. Zhi Chi Tang is the supreme agent for releasing Yangming exterior. ○ Taiyang exterior requires sweating, not vomiting; Yangming exterior requires vomiting, not sweating. Taiyang interior requires promoting urination, not purging; Yangming interior requires purging, not promoting urination. ○ Upward evacuation, middle clearing, and downward draining are the three major methods for Yangming; sweating and promoting urination are the two major prohibitions. However, if Wind-Cold initially invades Yangming exterior, using Ma Huang or Gui Zhi to sweat is urgent to remove heat and preserve Jin Ye, similar to urgent purging. If there is floating pulse, irritability/thirst, and difficult urination, Zhu Ling Tang promotes urination to clear fire and preserve Jin Ye. Also: Do not give Zhu Ling Tang if sweating is profuse. Sweating and promoting urination are expedient methods for Yangming. ○ Taiyang uses Wu Ling San because Cold Water is beneath the heart, causing Water Counterflow; Gui Zhi disperses cold, Bai Zhu strengthens Earth. Yangming uses Zhu Ling Tang because Heat Pathogen is in the Stomach, causing spontaneous sweating; Hua Shi nourishes Earth, E Jiao generates Jin Ye. Dispersal scatters cold, decoction moistens dryness; the intent is subtle. ○ Yangming’s Zhi Chi Tang is like Taiyang’s Gui Zhi Tang; both dispel pathogens and correct errors. Once the Upper Jiao is unblocked, Jin Ye descends, and Stomach Qi harmonizes. ○ There are three methods for treating Yangming interior-heat exterior: Heat in Upper Jiao treated by Zhi Chi Tang vomiting, unblocking Upper Jiao, descending Jin Ye, preventing Stomach Fullness; Heat in Middle Jiao treated by Bai Hu Tang clearing, clearing Stomach Fire, preventing Stomach Fullness; Heat in Lower Jiao treated by Zhu Ling Tang draining, draining fire downward, preventing Stomach Fullness. Treating Yangming exterior heat is preemptive treatment of the interior; all three formulas are moistening agents preserving Jin Ye to prevent Stomach Fullness. Following Ge Gen and Sheng Ma erroneously ignores Zhang Zhongjing’s Yangming exterior treatment. ○ Reckless purging inevitably damages Stomach Qi. Stomach Yang deficiency allows Yang pathogen to invade Yin, shifting to Taiyin; Stomach fluid depletion causes Two Yangs to clash, shifting to Yangming. Shifting to Taiyin presents with abdominal fullness and intermittent pain without firmness, indicating Yin pathway deficiency; shifting to Yangming presents with severe abdominal fullness, firmness, and pain, indicating Yang pathway excess. Fullness with intermittent pain signals diarrhea; severe fullness, firmness, and pain signal dry feces. Gui Zhi Jia Shao Yao Tang (Cinnamon Twig Decoction plus Peony) tests Jian Zhong (Build the Middle) method; Gui Zhi Jia Da Huang Tang (Cinnamon Twig Decoction plus Rhubarb) hints at Tiao Wei (Regulate the Stomach) method. ○ Yangming disease involving Stomach Fullness should primarily be treated by purging. However, Yangming resides in the center, attracting all diseases, so all treatment methods are available. For profuse vs. no sweating, distinguish Ma Huang vs. Gui Zhi; for chest vs. abdomen, distinguish Gua Di (Melon Seed) vs. Zhi Chi; for initial hardness vs. dry firmness, distinguish Da vs. Xiao Cheng Qi Tang. Even using sweating, vomiting, and purging methods varies in severity and depth. For great irritability/thirst, use Bai Hu Tang; for blood stasis jaundice, use Yin Chen Hao Tang; for difficult urination, use Zhu Ling Tang; for retained fluid, use Wu Ling San; for food regurgitation, use Zhu Yu Tang, etc., each having its specific indication. Comparing to chess: sweating is the opening move, vomiting is the critical move, clearing fire is the steady move, promoting urination is the waiting move, tonifying warmth is the urgent move, and purging is the final move. When disease reaches the stage for purging, no other moves remain. If sweating is applied correctly, other moves are unnecessary. Vomiting, though a clever move, is the second hand. Other moves are not principal; only purging is the decisive move, resulting from previous mistakes. However, since all methods are established to clear fire, is clearing fire the superior move for Yangming? (Ke Yunbo)
All Shang Han texts refer to Yangming disease as interior excess warranting purging. Once pathogen enters the Fu organ, there is nowhere left to transmit; why not purge? However, purging when inappropriate and failing to purge when appropriate are equally erroneous. How can one purge precisely to hit the vital point? Thus, some cases require gentle purging after ten-plus days of unresolved illness, while others require urgent purging within one or two days; one should not rigidly count days. All Six Meridians regard the Stomach as the sea; Yangming entering Fu organ and discussing purging is commonly known. That Taiyang, Shaoyang, and the Three Yin meridians also involve Fu organ entry warranting purging is unknown to many. ○ Yangming has Fu organ syndromes and Meridian syndromes, Cold in the Meridian and Heat in the Meridian, Heat entering Fu and Cold entering Fu. Heat entering Fu manifests as Stomach Fullness; Cold entering Fu manifests as inability to eat. People know Meridian syndromes in Yangming should not be recklessly purged; one must also know that Fu organ Cold in Yangming should not be recklessly purged. (Cheng Fusheng)
Pathogens in Yangming originate from Taiyang. If Yangming signs appear on days 8-9 while Taiyang signs persist for 1-2 days, follow Taiyang, not Yangming; sweating is allowed, purging is forbidden. The exit path trends toward Shaoyang. If Yangming signs appear on days 8-9 while Shaoyang signs appear slightly for 1-2 days, follow Shaoyang, not Yangming; neither sweating nor purging is allowed. Only when pathogen has left Taiyang but not yet reached Shaoyang, residing exactly within Yangming boundaries, should urgent purging be employed. If it does not transmit to other meridians, Jin Ye and Yuan Qi remain intact; how delightful! (*Shang Lun Pian*)
Yangming governs the interior, reflecting Stomach status internally and Muscle status externally, hence distinction between Meridian and Fu organ disease. Symptoms in the Treatise such as body heat, irritability/thirst, eye pain, nasal dryness, insomnia, no aversion to cold but aversion to heat constitute Yangming Meridian disease; tidal fever, delirium, continuous sweating in hands/feet/armpits, abdominal fullness/pain, and hard stool constitute Yangming Fu organ disease. Each has three variations: Meridian disease includes: pathogen transmitted to Yangming but Taiyang exterior unresoved, with headache, aversion to cold, no sweating; Taiyang pathogen resolved, fully transmitted to Yangming, with high fever, sweating, irritability/insomnia, thirst/desire to drink; Yangming pathogen unresolved, turning to Shaoyang, with hypochondriac pain, alternating chills/fever, bitter taste/vomiting, dizziness/deafness. Fu organ disease includes: Taiyang-Yangming, where Taiyang disease treated with sweating, vomiting, purging, or diuretics exhausts Jin Ye, drying the Stomach, allowing Taiyang pathogen to shift to Yangming due to dryness, causing frequent urination and hard stool, known as Pi Yue (Splee Constriction); Zheng Yang Yangming (True Yang Yangming)...