太阳之为病脉浮。头项强痛而恶寒。
经曰。尺寸俱浮者。太阳受病。太阳主表。为诸阳主气。脉浮。头项强痛而恶寒者。
太阳表病也。
太阳病发热。汗出恶风。脉缓者。名为中风。
风、阳也。寒、阴也。风则伤卫。发热汗出恶风者。卫中风。荣病发热无汗。不恶
风而恶寒。卫病则发热汗出。不恶寒而恶风。以卫为阳。卫外者也。病则不能卫固其外。
而皮腠疏。故汗出而恶风也。伤寒脉紧。伤风脉缓者。寒性劲急。而风性懈缓故也。
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。
经曰。凡伤于寒。则为病热。为寒气客于经中。阳经怫结而成热也。中风即发热
者。风为阳也。及伤寒。云或已发热。或未发热。以寒为阴邪。不能即热。郁而方变热
也。风则伤卫。寒则伤荣。卫虚者恶风。荣虚者恶寒。荣伤寒者。必恶寒也。气病者则
麻。血病者则痛。风令气缓。寒令气逆。体痛呕逆者。荣中寒也。经曰。脉盛身寒。得
之伤寒。脉阴阳俱紧者。知其伤寒也。
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。
太阳主表。一日。则太阳受邪。至二日。当传阳明。若脉气微而不传。阳明胃经受
邪。则喜吐。寒邪传里者则变热。如颇欲吐。若烦躁脉急数者。为太阳寒邪变热。传于
阳明也。
伤寒二三日。阳明少阳证不见者。为不传也。
伤寒二三日。无阳明少阳证。知邪不传。止在太阳经中也。
太阳病。发热而渴。不恶寒者。为温病。
发热而渴。不恶寒者。阳明也。此太阳受邪。知为温病。非伤寒也。积温成热。所
以发热而渴。不恶寒也。
若发汗已。身灼热者。名曰风温。风温为病。脉阴阳俱浮。自汗出。身重、多眠。
睡息必
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。
时螈 。若火熏之。一逆尚引日。再逆促命期。
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。而气壅不利也。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。起目内 。内经曰。瞳子高者。太阳不足。
戴眼者。太阳已绝。小便不利。直视失溲。为下后竭津液。损脏气。风温外胜。经气欲
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
时螈 也。先曾被火。为一逆。若更以火熏之。是再逆也。一逆尚犹延引时日而不愈。
其再逆者。必致危殆。故云促命期。
病有发热恶寒者。发于阳也。无热恶寒者。发于阴也。发于阳者。七日愈。发于阴
者。六日愈。以阳数七。阴数六。故也。
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。
戴元礼云。凡治伤寒。须辨阴阳二候。不可误也。阳经有三。太阳、阳明、少阳、是也。
阴经亦有三。太阴、少阴、厥阴、是也。经之阴阳。以脏腑言。腑为阳。膀胱、胃、
胆、是也。脏为阴。脾、肾、肝、是也。病之阴阳。乃是外邪之阴阳。阴气、阳气、是
也。
太阳病。头痛。至七日以上。自愈者。以行其经尽故也。若欲作再经者。针足阳明。
使经不传。则愈。
伤寒自一日至六日。传三阳三阴经尽。至七日当愈。经曰。七日太阳病衰。头痛少
愈。若七日不愈。则太阳之邪。再传阳明。针足阳明。为迎而夺之。使经不传则愈。
太阳病。欲解时。从巳至未上。
巳为正阳。则阳气得以复也。始于太阳。终于厥阴。六经各以三时为解。而太阳从
巳至未。阳明从申至戌。少阳从寅至辰。至于太阴从亥至丑。少阴从子至寅。厥阴从丑
至卯者。以阳行也速。阴行也缓。阳主于昼。阴主于夜。阳三经解时。从寅至戌。以阳
道常饶也。阴三经解时。从玄至卯。以阴道常乏也。内经曰。阳中之
太阳。通于夏气。则巳午未。太阳乘王也。
风家表解而不了了者。十二日愈。
中风家。发汗解后。未全快畅者。十二日。大邪皆去。六经悉和。则愈。
病患身大热。反欲得近衣者。热在皮肤。寒在骨髓也。身大寒。反不欲近衣者。寒
在皮肤。热在骨髓也。
皮肤言浅。骨髓言深。皮肤言外。骨髓言内。身热欲得衣者。表热里寒也。身寒不
欲衣者。表寒里热也。活人云。热在皮肤。寒在骨髓。仲景无治法。宜先与阴旦汤。寒
已。次以小柴胡加桂。以温其表。寒在皮肤。热在骨髓。仲景亦无治法。宜先与白虎加
人参汤。热除。次以桂枝麻黄各半汤。以解其外。大抵病有标本。治有先后。表热里寒
者。脉须沉迟。手或微厥。下利清谷也。所以阴证亦有发热者。四逆汤。通脉四逆汤主
之。表寒里热者。脉必滑而厥。口燥、舌干也。所以少阴恶寒而蜷。时时自烦。不欲浓
衣。用大柴胡汤下之而愈。此皆仲景之余议也。
太阳中风。阳浮而阴弱。阳浮者。热自发。阴弱者。汗自出。啬啬恶寒。淅淅恶风。
翕翕发热。鼻鸣干呕者。桂枝汤主之。
阳以候卫。阴以候荣。阳脉浮者。卫中风也。阴脉弱者。荣气弱也。风并于卫。则
卫实而荣虚。故发热汗自出也。经曰。太阳病。发热汗出者。此为荣弱卫强者是也。啬
啬者。不足也。恶寒之貌也。淅淅者。洒淅也。恶风之貌也。卫虚则恶风。荣虚则恶寒。
荣弱卫强。恶寒复恶风者。以自汗出。则皮肤缓。腠理疏。是亦恶风也。翕翕者。
然而热也。若合羽所覆。言热在表也。鼻鸣干呕者。风壅而气逆也。与桂枝汤。和荣卫
而散风邪也。
The principal pulse and symptom of Taiyang disease (Disease of the Taiyang Channel) are: a floating pulse (Pulse at the surface), headache, stiffness and pain in the neck and occiput, and aversion to cold.
The Classics state: When both the Cun (Cun position, distal) and Chi (Chi position, proximal) pulses are floating, it indicates that the Taiyang channel is affected. The Taiyang channel governs the exterior and is the master qi of all Yang channels. The presence of a floating pulse, headache, stiffness and pain in the neck and occiput, and aversion to cold constitutes an exterior syndrome of the Taiyang channel.
In Taiyang disease, if there is fever, sweating, aversion to wind, and a moderate (slow/relaxed) pulse, it is named Wind Strike (Zhong Feng).
Wind is Yang, and Cold is Yin. Wind injures the Wei Qi (Defensive Qi); fever, sweating, and aversion to wind indicate that the Wei Qi has been struck by wind. Ying Qi (Nutritive Qi) pathology presents with fever but no sweating, aversion to cold rather than aversion to wind. Wei Qi pathology presents with fever and sweating, aversion to wind rather than aversion to cold. Since Wei Qi belongs to Yang and protects the exterior, when diseased, it fails to secure the exterior, leading to loose skin and pores, thus causing sweating and aversion to wind. In Cold Damage (Shang Han), the pulse is tight; in Wind Strike, the pulse is moderate. This is because Cold nature is tense and urgent, while Wind nature is lax and relaxed.
In Taiyang disease, whether fever has already appeared or not, there is invariably aversion to cold, accompanied by body ache, vomiting, and reversal of qi flow. If the pulse is tight at all three positions (Cun, Guan, Chi), it is named Cold Damage (Shang Han).
The Classics state: All injuries from Cold result in heat diseases, because Cold Qi lodges within the channels, causing Yang channels to become blocked and generate heat. Wind Strike immediately causes fever because Wind is Yang. Regarding Cold Damage, it states that fever may or may not have appeared yet, because Cold is a Yin pathogen and cannot immediately cause heat; it must stagnate before transforming into heat. Wind injures Wei Qi, while Cold injures Ying Blood. Those with deficient Wei Qi fear wind; those with deficient Ying Qi fear cold. Those whose Ying Qi is injured by Cold will certainly fear cold. Pathology of Qi manifests as numbness; pathology of Blood manifests as pain. Wind causes Qi to relax; Cold causes Qi to rebel. Body ache and vomiting/reversal of qi flow indicate Cold in the Ying level. The Classics state: A full pulse with cold body indicates Cold Damage; a tight pulse at all three positions confirms Cold Damage.
On the first day of Cold Damage, the Taiyang channel is affected. If the pulse remains tranquil (calm without rapidity), the disease has not transmitted. If there is a strong desire to vomit, or restlessness and irritability with a rapid and urgent pulse, transmission has occurred.
The Taiyang channel governs the exterior. On the first day, evil invades Taiyang. By the second day, it should transmit to the Yangming channel. If the pulse energy is weak and does not transmit, but the Yangming Stomach channel is affected, there will be a tendency to vomit. When Cold evil transmits inward, it transforms into heat. For instance, a strong desire to vomit, restlessness, and a rapid, urgent pulse indicate that Taiyang Cold evil has transformed into heat and transmitted to Yangming.
After two or three days of Cold Damage, if Yangming and Shaoyang syndromes do not appear, the disease has not transmitted.
If after two or three days of Cold Damage, there are no Yangming or Shaoyang symptoms, it is known that the evil has not transmitted and remains solely in the Taiyang channel.
In Taiyang disease, if there is fever, thirst, and no aversion to cold, it is named Warm Disease (Wen Bing).
Fever with thirst and no aversion to cold belongs to Yangming. Although this originates from Taiyang invasion, it is identified as Warm Disease, not Cold Damage. Accumulated warmth generates heat, hence the presentation of fever, thirst, and absence of aversion to cold.
If, after inducing sweating, the body becomes burning hot, it is named Wind-Warmth (Feng Wen). In Wind-Warmth disease, the pulse is floating at all three positions, with spontaneous sweating, heavy body, excessive sleepiness, snoring during sleep, and difficulty speaking. If purgatives are incorrectly applied, it leads to difficult urination, fixed staring gaze, and loss of bowel/bladder control. If fire therapy is incorrectly applied, mild cases result in slight yellowing of the skin; severe cases resemble convulsive epilepsy with occasional spasms. If fire moxibustion is applied again after initial fire therapy, one error may prolong the illness, but a second error will hasten death.
After sweating for Cold Damage, the body should cool. If the body remains burning hot after sweating, it is not Cold Damage but Wind-Warmth. Wind attacks from above, and Yang channels are susceptible to wind. When Wind combines with Warmth, it injures Wei Qi. Floating pulse at all three positions and spontaneous sweating indicate Wei Qi invasion. Wei Qi is Qi; Wind injures Wei, Warmth injairs Qi. Heavy body and excessive sleepiness indicate that Wei Qi, invaded by Wind-Warmth, suffers from mental clouding. Snoring and difficulty speaking indicate that external Wind-Warmth is severe, causing Qi obstruction. Incorrect use of purgatives damages Zang organ Qi, specifically the Taiyang Bladder channel. The Inner Canon states: Bladder dysfunction leads to strangury (difficulty urinating); lack of restraint leads to enuresis. Strangury refers to difficult urination. The Taiyang channel begins at the inner canthus of the eye. The Inner Canon states: Eyes looking upward (pupil high) indicates Taiyang deficiency; eyes fixed upward (dai yan) indicates Taiyang exhaustion. Difficult urination, fixed gaze, and loss of control result from purgative-induced depletion of fluids and damage to Zang Qi, with external Wind-Warmth prevailing and channel Qi nearing exhaustion. This is difficult to treat. Fire therapy aids Wind-Warmth to generate heat; mild cases involve heat stasis causing jaundice; severe cases involve extreme heat generating wind, resembling epilepsy with spasms. Previous fire therapy is one error; subsequent fire moxibustion is a second error. One error may prolong the illness; two errors lead to critical danger, hence "hastening death."
Diseases presenting with fever and aversion to cold originate in Yang. Diseases presenting with aversion to cold without fever originate in Yin. Diseases originating in Yang heal in seven days; those originating in Yin heal in six days. This is due to the numerical attributes of Yang (seven) and Yin (six).
Yang represents Heat; Yin represents Cold. Fever with aversion to cold indicates Cold injuring Yang. Aversion to cold without fever indicates Cold injuring Yin. Yang corresponds to Fire; Yin corresponds to Water. The completion number of Fire is seven; the completion number of Water is six. Yang diseases heal in seven days because the Fire number is complete; Yin diseases heal in six days because the Water number is complete.
Dai Yuanli stated: In treating Cold Damage, one must distinguish between Yin and Yang patterns to avoid error. There are three Yang channels: Taiyang, Yangming, and Shaoyang. There are also three Yin channels: Taiyin, Shaoyin, and Jueyin. The Yin-Yang of channels is defined by Zang-Fu: Fu organs are Yang (Bladder, Stomach, Gallbladder); Zang organs are Yin (Spleen, Kidney, Liver). The Yin-Yang of disease refers to the Yin-Yang of external pathogens: Yin Qi and Yang Qi.
In Taiyang disease, headache persists for seven days or more and then heals spontaneously because the pathogen has exhausted its course in the channel. If it is about to transmit to the next channel, acupuncture at the Foot-Yangming channel can prevent transmission and ensure recovery.
Cold Damage transmits through the Three Yang and Three Yin channels from day one to day six. It should heal on the seventh day. The Classics state: On the seventh day, Taiyang disease declines, and headache lessens. If it does not heal by the seventh day, Taiyang evil will transmit to Yangming. Acupuncture at the Foot-Yangming channel uses the method of "meeting and seizing" to block transmission and ensure recovery.
The time when Taiyang disease tends to resolve is from Si hour to Wei hour (9:00 AM to 3:00 PM).
Si hour is the peak of Yang, allowing Yang Qi to recover. Disease begins at Taiyang and ends at Jueyin. Each of the Six Channels has a three-hour period for resolution. Taiyang resolves from Si to Wei; Yangming from Shen to Xu; Shaoyang from Yin to Chen; Taiyin from Hai to Chou; Shaoyin from Zi to Yin; Jueyin from Chou to Mao. This is because Yang moves quickly and Yin moves slowly. Yang governs the day; Yin governs the night. The resolution times for the three Yang channels (Yin to Xu) reflect that Yang Dao is abundant. The resolution times for the three Yin channels (Hai to Mao) reflect that Yin Dao is scarce. The Inner Canon states: Taiyang among Yang connects with Summer Qi; thus, Si, Wu, and Wei hours see the flourishing of Taiyang Qi.
Patients with Wind Strike who have resolved their exterior syndrome but still feel unwell will recover after twelve days.
After sweating resolves the exterior in Wind Strike patients, if they are not fully comfortable, after twelve days, the major pathogenic factors are eliminated, and the Six Channels harmonize, leading to recovery.
If a patient has a very hot body but desires to wear clothes, the heat is superficial (skin) and the cold is deep (marrow). If a patient has a very cold body but does not desire to wear clothes, the cold is superficial and the heat is deep.
"Skin" denotes shallow/exterior; "Marrow" denotes deep/interior. Body heat with desire for clothing indicates Exterior Heat and Interior Cold. Body cold without desire for clothing indicates Exterior Cold and Interior Heat. The *Huo Ren Shu* states: Heat in the skin, cold in the marrow. Zhang Zhongjing provides no specific treatment in the original text. It is appropriate to first administer Yindan Tang. After the cold resolves, use Xiaochaihu Tang plus Guizhi to warm the exterior. For cold in the skin and heat in the marrow, Zhang Zhongjing also provides no specific treatment. It is appropriate to first administer Baihu Jia Renshen Tang. After the heat clears, use Guizhi Mahuang Ban Tang to release the exterior. Generally, diseases have root and branch aspects, and treatments have sequence. Exterior Heat and Interior Cold present with a deep, slow pulse, possibly cold extremities, and diarrhea with undigested food. Thus, Yin syndromes can also present with fever, treated with Sini Tang or Tongmai Sini Tang. Exterior Cold and Interior Heat present with a slippery pulse, cold extremities, dry mouth, and dry tongue. Thus, Shaoyin disease with aversion to cold, curling up, frequent irritability, and dislike of thick clothing can be cured with Daxiehu Tang via purgation. These are supplementary discussions on Zhang Zhongjing's theories.
Taiyang Wind Strike presents with a floating pulse at the Yang position (Cun) and a weak pulse at the Yin position (Chi). Floating Yang pulse indicates spontaneous heat generation; weak Yin pulse indicates spontaneous sweating. Symptoms include shivering aversion to cold, chilly aversion to wind, mild fever (like feather coverage), nasal congestion/murmur, and dry vomiting. Guizhi Tang is indicated.
Yang pulse assesses Wei Qi; Yin pulse assesses Ying Qi. Floating Yang pulse indicates Wei Qi invaded by wind; weak Yin pulse indicates weak Ying Qi. Wind merging into Wei causes Wei excess and Ying deficiency, resulting in fever and spontaneous sweating. The Classics state: Taiyang disease with fever and sweating is Ying weakness and Wei strength. "Se se" describes insufficiency and the appearance of fearing cold. "Xi xi" describes shivering and the appearance of fearing wind. Weak Wei fears wind; weak Ying fears cold. Ying weakness and Wei strength, with both aversion to cold and wind, occur because spontaneous sweating loosens the skin and opens the pores, causing aversion to wind. "Xi xi" describes mild heat, like being covered by feathers, indicating heat in the exterior. Nasal murmur and dry vomiting indicate wind obstruction causing Qi rebellion. Guizhi Tang is given to harmonize Ying and Wei and disperse wind evil.