为什么对本条病证有时会误治？果如《金匮要略译释》所说：“本条的辨证关键在于脉迟，同时还应伴有舌淡神疲，色黄晦暗等证”，那就与属实热的阳明腑证恰恰相反。实际上，本条是因为“有燥屎在胃中”，脉证与承气汤证有相似之处，所以容易误治。但二者之间，有阴津已伤未伤之分，热邪方盛已衰之殊，故仲景特出此条，叫人明辨虚实。若谓“阳明病，脉迟”是太阴病，未免令人愕然。此证所以容易误治，正是因为有阳明腑病脉证之表现，因此仲景说：“所以然者，脉迟故也。”
三、辨清本条内容的实际意义
第一、利于合理地补出冶方，并使有关条文捐到比较确切的解释。本条当以润导行淤为大法，采用猪膏发煎较为合理。黄疸虽以湿热为常，但发热伤津之后或热病后期，邪退正虚，朋津不足，因燥致淤，因淤结而发黄者亦有之。此种黄疸是燥淤黄疸，《金匮》中论之较详，如《黄疸篇》说：“腹满，舌痿黄，躁不得睡，属黄家。”即指此种证型。但由于本条文蕴义不明，故有作湿热或寒湿的种种注释，现阐明第200条之本旨，再与此条结合看，实有互相补充，互为说明之妙，故此条·之身痿黄(舌痿是身痿)是对黄色枯燥不润泽的形容，与《湿病篇》的“熏黄”，形容黄晕如油正好相反，可对勘。腹满是胃肠燥结，干粪不去之征，燥不得睡是热罢阴虚之象，此时若饱食，则可因积食生热而产生“微烦头眩”。“诸黄，猪膏发煎主之，”一条，正是为此而出治方。此方治燥淤黄疸效果很好，古今均有喜用者，谨摘录治验二则以说明：(1)“太医校尉史脱家婢病黄，服此胃中燥粪下便瘥”(《千金方》)。(2)“予友骆天游黄疸，腹大如鼓，百药不效，用猪膏四量，发灰四量，一剂而愈”(《金匮要略译释》)。总之，《伤寒论》第200条与上述两条结合研究，则其蕴义及燥淤黄疸的证治就畅晓明通了。
第二、有益于扩大眼界，能使治黄不囿于湿热圈子。黄疸虽以湿热为常，但阳黄之治，或只强调湿热，或只强调淤热，若全然不知有燥化虚化诸证型，则不全面。有人对“黄家所得，从湿得之”和“淤热在里”等经文缺乏正确的理解，惑于疸“病虽有五，皆湿热也”等说，或认为黄疸无湿不成，或认为阳黄不外湿、热、淤，因而治疗黄疸自囿于一个“湿"字，或唯知以清热、利湿、行淤、解毒之品，杂凑威方，泛治一切阳黄，致使辨证论治之原则，降低到随症加减之水平，这就不合仲景心法。治黄疸若以“湿、热、淤”三字作茧自缚，跳不出清热、利湿、行淤之圈子，治病轻者尚可幸中藏拙，对那些治之十日以上不瘥至十八日不愈的黄疸，就束手无策，甚至忘掉“久而增气，物化之常也。气增而久，夭之由也”的告诫，反而加大苦寒、淡渗、芳化之品的剂量以冀获效，就只能徒伤阴津，绝人长命。如误人被误，俱各茫然不知，犹可慨叹！注：①此条数码采用成都中医学院主编的中医学院试用教材《伤寒论讲义》(重订本)一书。
②130页
⑥《医宗金鉴》第一分册，吴谦等著
⑧同⑥55页
⑨同⑤2003-9-1422:25:00北海散人头衔：佛门弟子等级：管理员文章：3797积分：4270注册：2002-12-24
第4楼太阳六淫病初起有六型
一般认为：太阳病初起，有二个证型，即伤寒和中风。而同时又认为：太阳为六经之首，主一身之表，外邪侵袭人体，太阳首当其冲。我们知道，所谓外邪，意指失常之六气，即六淫。但如果说六淫侵犯太阳，只有伤寒、中风两个证型，这是无论如何也说不通的，有的虽将温病亦等列为一型，但仍然遗其一半，故余谓太阳六淫病，初起有六型，现即据仲景原文条列其证治以证之，并略加讨论，以供研究仲景学说之参考。
一、太阳风淫病——中风
[脉证]“太阳病，发热、汗出、恶风、脉缓者，名为中风。”(2)。
[治例]“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，浙浙恶风，翕翕发热，鼻呜千呕者，桂枝汤主之。”(12)
[讨论]1·风邪外袭太阳，即为太阳中风。但风邪伤人并不一定先伤太阳。《伤寒论》195条说：“阳明病，若能食，名中风。”265条说：“少阳中风，两耳无所闻，目赤，胸中满而烦者，不可吐下，吐下则悸而惊。”274条说：“太阴中风，四肢烦疼，脉阳傲阴涩而长者，为欲愈。”290条说：“少朋中风，脉阳敞阴浮者，为欲愈。"327条说：“厥阴中风，脉微浮力欲愈，不浮为未愈。”六经都有中风，这是仲景原文。要说其余五者之中风，都是从太阳传来，既乏根据，又解释不通。故中风虽是太阳病初起的一个证型，但并不是太阳病独有的证型。如果只将中风列为太阳病的一个证型，对其余五者则熟视无睹，缄口不谈，这是不太好的。
2·236条说：“阳明病，脉迟，汗出多，微恶寒者，表未解也，宜桂枝汤。”，242条说：“病人烦热，汗出则解，又如疟状，日晡所发热者，属阳明也。脉实者宜下之；脉浮虚者，宜发汗。下之，与大承气汤；发汗，宜桂枝汤。”267条说：“太阴病，脉浮者，可发汗，宜桂枝汤。”准斯以观，桂枝汤仲景并不专为太阳病设。故只能说桂枝汤是太阳中风之主剂，不能说是太阳病出专药。有人因麻、桂二方可治肺经证，便说“太阳病当解释为肺经证”，这是值得商榷的。
仲景原文说明：风邪可以先侵袭太阳，也可以不先侵袭太阳。如侵袭太阳，就用桂枝汤治疗，如先侵袭阳明或太阴，也用桂枝汤治疗，这足证桂枝汤证不等于太阳中风证，倘那样认识，就不符合仲景原旨了。
二、太阳寒淫病—一伤寒
[脉证]“太阳病，或已发热，或未发热，必恶寒，体痛、呕逆，脉阴阳惧紧者，名为伤寒。”(3)
[治例]“太阳病，头痛发热，身疼腰痛，骨节疼痛，恶风，无寒而喘者，麻黄汤主之。”(35)
仁讨论]寒邪侵袭太阳，即为太阳伤寒。但寒邪也不一定先伤太阳。如237条说：“阳明病，脉浮，无汗而喘者，发汗则愈，宜麻黄汤。”这就是寒邪伤阳明的治法。这也说明麻黄汤只是太阳伤寒之主剂，并非太阳病之专药，这个道理与太阳中风同。又301条说：“少阴病，始得之，反发热，脉沉者，麻黄附子细辛汤主之。”这也是一个佐证。因为仲景明文洗是“始得之”，我们自然也不能从太阳传来作解释，否则就不是“始得之”了。究仲景治法，卫气虚弱，寒邪侵袭太阳及阳明，都用麻黄汤，肾阳虚弱，寒邪侵袭少阴，就用麻黄附子细辛汤。同样的寒邪所伤，同样的始得之，药法就有出入。风伤太阳、太阴，仲景都用桂枝汤，寒伤太阳，少阴，仲景用麻黄即加化裁，这似乎与风、寒二邪特性不同也有关。根据仲景这一药法，笔者认为肾虚患感，当忌麻黄汤之峻汗，喻嘉言关于伤风小恙亦有戴阳证的一则医案医话，宜当引起我们的重视。总之，六经皆有表证，寒邪伤人，除了直中于里(如阳明中寒证)，可伤太阳之表，也可伤阳明之表，也可伤少阴之表。故说太阳为一身藩篱，风寒伤人，必始自太阳。就个“必”字太绝对，因为与《伤寒论》原文一核对，这个“必”字就有问题了。所以，只能说外感病常从太阳开始，不能说外感病都必从太阳开始。
三、太阳火淫病——温病
[脉证]“太阳病，发热而渴，不恶寒者，为温病。若发汗已，身灼热者，名曰风温，风温为病，脉朋阳俱浮，自汗出，身重、多眠睡、息必鼾、语言难出。”(6)
[治例]“发汗后，不可更行桂枝汤，汗出而喘，无大热者，可与麻黄杏仁甘草石膏汤。”(63)
[讨论]六淫本只五气，汉时并无新感温邪之说，故所谓太阳温病，就是太阳伏火病。盖五气伤人，若伏而不即发，多从火化，伏火为病，可发自太阳，可发白阳明，也可发自少阳或他经。《难经》说：“温病之脉，行在诸经，不知何经之动也，各随其经所在而取之。”就是这个道理。第6条“为温病”三字之后，之所以尚有“若发汗已"云云，此诚如张锡纯所说：“当仲景时，人之治温病者，犹混温病于中风、伤寒之中，于病初得时，未细审其发热不恶寒，而以温热之药发之，是以汗后不解。或见其发热不恶寒，误认为病已传里，而竟以药下之，是以百六十三节，又有下后不可更行桂枝汤云云。所稍异者，一在汗后，一在下后，仲景恐人见其汗出再误认为桂枝证，故切戒其不可更行桂枝汤，而宜治以麻杏甘石汤。盖伤寒定例，凡各经病证误服他药后，其原病犹在者，仍可投以正治之原方，足以百零三节云，凡柴胡汤病证而下之，若柴胡证不罢者复与小柴胡汤。以此例彼，知麻杏甘石汤为救温病误治之方，实即治温病初得之方。”温病、中风、伤寒，《伤寒论》篇首即已并列，以前有人讨论太阳病初起时的证型，竟只讲二个，真所谓是一叶障目，不及其余了。
四、太阳燥淫病———痉病
[脉证]“太阳病，发热无汗，反恶寒者，名曰刚痉。”(一)“太阳病，发热汗出，而不恶寒，名曰柔痉。”(二)“病者身热足寒：颈项强急，恶寒，时头热，面赤目赤，独头动摇，卒口噤，背反张者，痉病也。”(七)
[治例]“太阳病，其证备，身体强，几几然，脉反沉迟，此为痉，栝蒌桂枝汤主之。”(十一)“太阳病，无汗而小便反少，气上冲胸，口噤不得语，欲作刚痉，葛根汤主之。”(十二)
[讨论]仲景曾出“太阳病，发汗太多，因致痉。”等三条，来说明误治损伤津液，病从燥化，可以病痉，但这不意味着是忽视了外感燥邪病痉。后人认为风邪偏胜则病柔痉，寒邪偏胜则病刚痉，这种认识，忽视了痉病的主要病因——燥邪，是片面的。痉是燥病，其病原主要是燥邪，燥伤太阳即为太阳痉病，致于风邪、寒邪，不过是其兼夹之气，如只讲风、寒，只讲误治，反不讲上要病原——燥邪，就本末倒置了。仲景治太阳痉病二方，一主以栝蒌根，一主以葛根，此二味均是生津药，即阳明痉病之用大承气，目的也在存阴。可见仲景治痉病，是以治燥邪为主眼的。
五、太阳湿淫病—一湿痹
[脉证]“太阳病，关节疼痛而烦，脉沉细者，此名湿痹。湿痹之候，小便不利，大便反快，但当利其小便。”(十四)
[治例]“湿家身疼烦，可与麻黄加术汤发其汗为宜。慎不可以火攻之。”(二十)
[讨论]湿邪侵犯太阳，即为太阳湿痨。《医宗金鉴》说：“太阳病，一身关节烦疼，若脉浮细者，湿在外也，当汗之，小便不利，大便反快，脉沉细者，湿在内也，当利之。”利之，宜五苓散之类；汗之，宜麻黄加术汤之类。前者属于太阳腑病治法，后者属于太阳经病治法。外湿侵犯太阳，初起经病居多，故《金匮要略》论治湿痹，于汗法独详。而麻黄加术汤之治湿痹，诚如尤怡云：“麻黄得术，虽发汗不致过汗；术得麻黄，并能行表里之湿。”，此方很符合“微微似欲汗出者，风湿俱去也”的治则。故可以作为治太阳湿淫病之代表方。因六淫伤人，每多兼夹，湿邪侵犯太阳，又常与风寒相间杂至，故《伤寒论》说与伤寒相滥。《温病明理》遂据此而谓湿痹即后世所谓之湿温，但湿温初起病位在足阳明足太阴二经，考之《金匮要略》治湿痹诸方，似不甚合，故这个问题，尚须加以研讨。
六、太阳暑淫病——中暍
[脉证]“太阳中暍，发热恶寒，身重而疼痛，其脉弦细芤迟。小便已，洒洒然毛耸，手足逆冷，小有劳，身即热，口开，前板齿燥。若发其汗，则恶寒甚；加温针，则发热甚，数下之，则淋甚。”(二十五)
[治例)“太阳中热者，暍是也，汗出，恶寒，身热而渴，白虎加人参汤主之。”
(讨论)恽铁樵说：“暍字文义，本是伤暑，伤暑伤寒相滥，非暑温而何。”仲景用白虎加人参汤治疗。由于白虎汤几乎被世所公认地认为是阳明病之方，所以叶天土说；“夏暑发自阳明，古人以白虎汤为土方。”但仲景明明是说太阳中热，足见后人见解与仲景见解不同。仲景认为六淫病都可从太阳开始，中暍也不例外，若暍病初起恶寒，即属太阳，太阳中热用白虎，这与阳明伤寒用麻黄，太阴中风用桂枝，都是同样道理。也就是说，白虎汤是阳明病之主剂，不是阳明病的专药。厥阴病篇350条“伤寒，脉滑而厥者，里有热，白虎汤主之。”说明厥阴病也有用白虎汤的，故不能因为用了白虎汤，就说太阳中热是阳明病。暑邪侵袭太阳，就是太阳中热。太阳病初起，因所伤之邪不同，故有用麻黄汤的，也有用白虎汤的，仲景于太阳病，辨因论治，原文如此，一一可以核对，后人不宜凭己见强经文本意就我说。
Why is it that this syndrome is sometimes treated incorrectly? If, as stated in *Jin Gui Yao Lue Yi Shi* (Translation and Explanation of the Golden Cabinet), "the key to differentiation for this clause lies in the slow pulse, accompanied by symptoms such as a pale tongue, mental fatigue, and dull yellowish complexion," then it would be exactly opposite to the Yangming Fu organ excess-heat syndrome. In reality, this clause is due to "dry stool in the stomach," and its pulse and symptoms are similar to those of the Chengqi Tang syndrome, making it prone to misdiagnosis. However, between the two, there is a distinction regarding whether Yin fluids have been injured and whether the heat pathogen is just flourishing or has declined. Therefore, Zhang Zhongjing specifically presented this clause to guide people to clearly distinguish between deficiency and excess. To claim that "Yangming disease with a slow pulse" belongs to Taiyin disease is bewildering. The reason this syndrome is easily misdiagnosed is precisely because it presents with the pulse and symptoms of Yangming Fu disease; thus, Zhongjing said, "The reason for this is the slow pulse."
III. Clarifying the Practical Significance of This Clause
First, it facilitates the reasonable supplementation of treatment formulas and allows related clauses to receive more precise explanations. For this clause, the primary method should be moistening the intestines to unblock bowels and promoting blood circulation to remove stasis; using Pig Fat and Hair Decoction (Zhigao Fa Jian) is more appropriate. Although jaundice is commonly caused by damp-heat, after fever injures fluids or in the late stage of febrile diseases when pathogens recede and healthy qi weakens, insufficient Yin fluids can lead to dryness-induced stasis, and jaundice resulting from stasis accumulation does occur. This type of jaundice is Dryness-Stasis Jaundice, which is discussed in detail in *Jin Gui Yao Lue*, such as in the *Jaundice Chapter*: "Abdominal fullness, flaccid yellow tongue, restlessness preventing sleep, belongs to the Yellow Family." This refers to this specific syndrome pattern. However, due to the unclear meaning of this clause's text, various annotations interpreting it as damp-heat or cold-damp have arisen. Now, by clarifying the original intent of Clause 200 and combining it with this clause, we see a wonderful mutual supplementation and explanation. Thus, the "body withered yellow" mentioned here (where "withered tongue" implies "withered body") describes a dry, lackluster yellow color, which contrasts sharply with the "smoky yellow" described in the *Dampness Disease Chapter*, depicting a yellow hue like oil; they can be cross-referenced. Abdominal fullness is a sign of gastrointestinal dryness and constipation with dry feces not passing; restlessness preventing sleep is a manifestation of post-heat Yin deficiency. At this time, if one overeats, food stagnation generating heat can cause "slight vexation and dizziness." The clause "For all types of jaundice, Pig Fat and Hair Decoction is the main formula" was provided precisely for this purpose. This formula works well for treating Dryness-Stasis Jaundice and has been favored since ancient times to the present. I briefly excerpt two clinical cases to illustrate: (1) "The maid of Ta Yi Xiao Wei Shi Tuo suffered from jaundice; after taking this formula, dry stool in the stomach was discharged, and she recovered" (*Qian Jin Fang*). (2) "My friend Luo Tianyou had jaundice, his abdomen distended like a drum, and hundreds of medicines failed; using four liang of pig fat and four liang of hair ash, he was cured in one dose" (*Jin Gui Yao Lue Yi Shi*). In summary, studying Clause 200 of *Shang Han Lun* together with the above two clauses makes its deeper meaning and the syndrome differentiation and treatment of Dryness-Stasis Jaundice clear and understandable.
Second, it helps broaden horizons, enabling the treatment of jaundice not to be confined to the circle of damp-heat. Although jaundice is commonly damp-heat, in treating Yang jaundice, some only emphasize damp-heat, while others only emphasize stasis-heat. If one is completely unaware of syndrome patterns involving dryness transformation or deficiency transformation, it is incomplete. Some people lack a correct understanding of scriptures like "What the Yellow Family obtains comes from dampness" and "Stasis-heat in the interior," being confused by statements like "although there are five types of jaundice, they are all damp-heat," or believing that jaundice cannot exist without dampness, or that Yang jaundice is nothing but dampness, heat, and stasis. Consequently, their treatment of jaundice confines itself to the character "dampness," or they only know to mix herbs for clearing heat, draining dampness, moving stasis, and detoxifying into composite formulas to treat all Yang jaundice indiscriminately. This reduces the principle of syndrome differentiation and treatment to the level of symptom-based modification, which does not conform to Zhongjing's core methodology. If treating jaundice binds oneself with the characters "dampness, heat, stasis" and cannot jump out of the circle of clearing heat, draining dampness, and moving stasis, mild cases might luckily succeed, but for jaundice lasting ten days or more up to eighteen days without cure, one would be at a loss. One might even forget the warning that "long-term increase of Qi is the norm of material transformation; prolonged increase of Qi leads to premature death," instead increasing the dosage of bitter-cold, diuretic, and aromatic-transforming herbs hoping for efficacy. This would only vainly injure Yin fluids and shorten life. It is lamentable that both the doctor and patient remain ignorant of the error! Note: ① The clause numbers used here follow the *Shang Han Lun Lecture Notes* (Revised Edition), compiled by Chengdu University of Traditional Chinese Medicine.
② Page 130
③ *Shang Han Lun Ji Zhu* (Collected Annotations on the Treatise on Cold Damage), annotated by Zhang Yinan, Volume 3
④ *Zhu Jie Shang Han Lun* (Annotated Treatise on Cold Damage), Page 130, authored by Cheng Wuji, People's Health Publishing House
⑤ *Zheng Xiao Yi Men Fa Lv · Shang Lun Pian · Volume 6 · Jaundice Gate*, authored by Yu Chang
⑥ *Yi Zong Jin Jian* (Golden Mirror of Medicine), Volume 1, authored by Wu Qian et al.
⑦ *Shang Han Lai Su Ji* (Collection of Responses on Cold Damage), Page 99, authored by Ke Qin, Shanghai Science and Technology Press.
⑧ Same as ⑥, Page 55
⑨ Same as ⑤
Floor 4: Initial Stages of Six Excess Pathogens in Taiyang Disease Have Six Patterns
It is generally believed that the initial stage of Taiyang disease has two patterns: Cold Damage (Shang Han) and Wind Strike (Zhong Feng). It is also believed that Taiyang is the head of the Six Meridians, governing the exterior of the whole body, so when external pathogens invade the human body, Taiyang bears the brunt. We know that "external pathogens" refer to abnormal Six Qi, i.e., Six Excess Pathogens. However, saying that when Six Excess Pathogens invade Taiyang, there are only two patterns—Cold Damage and Wind Strike—is unreasonable. Even if some include Warm Disease as a third pattern, half are still omitted. Therefore, I propose that the initial stage of Six Excess Pathogen diseases in Taiyang has six patterns. Here, based on Zhongjing's original text, I list their syndrome differentiation and treatments to prove this, adding brief discussions for reference in studying Zhongjing's theory.
I. Taiyang Wind Excess Disease — Wind Strike
[Pulse and Symptoms] "Taiyang disease, with fever, sweating, aversion to wind, and a moderate pulse, is named Wind Strike." (2).
[Treatment Example] "Taiyang Wind Strike, with floating yang and deficient yin; floating yang means heat spontaneously arises, deficient yin means sweat spontaneously exits. With shivering aversion to cold, chilly aversion to wind, fluttering fever, nasal congestion, and dry retching, Guizhi Tang (Cinnamon Twig Decoction) is the main formula." (12)
[Discussion] 1. When Wind Pathogen invades Taiyang externally, it is Taiyang Wind Strike. However, Wind Pathogen injuring humans does not necessarily strike Taiyang first. Clause 195 of *Shang Han Lun* says: "Yangming disease, if the patient can eat, it is named Wind Strike." Clause 265 says: "Shaoyang Wind Strike, with hearing loss in both ears, red eyes, chest fullness and vexation, vomiting and purging are contraindicated; if vomited or purged, palpitations and fright will occur." Clause 274 says: "Taiyin Wind Strike, with painful limbs, pulse that is choppy at the superficial position and slippery/long at the deep position indicates recovery is desired." Clause 290 says: "Shaoyin Wind Strike, pulse that is choppy at the superficial position and floating at the deep position indicates recovery is desired." Clause 327 says: "Jueyin Wind Strike, pulse that is slightly floating indicates recovery is desired; non-floating indicates not yet recovered." All Six Meridians have Wind Strike; this is Zhongjing's original text. To claim that Wind Strike in the other five meridians is transmitted from Taiyang lacks basis and is illogical. Thus, although Wind Strike is one pattern in the initial stage of Taiyang disease, it is not exclusive to Taiyang disease. If one only lists Wind Strike as a pattern of Taiyang disease and ignores the other five, remaining silent about them, this is undesirable.
2. Clause 236 says: "Yangming disease, with slow pulse, profuse sweating, and slight aversion to cold, the exterior is unresolved; Guizhi Tang (Cinnamon Twig Decoction) is suitable." Clause 242 says: "The patient is vexed and hot; sweating brings relief, but resembles malaria with afternoon fever, belonging to Yangming. If the pulse is solid, purging is indicated; if floating and deficient, sweating is indicated. For purging, use Dachengqi Tang (Major Order the Qi Decoction); for sweating, use Guizhi Tang (Cinnamon Twig Decoction)." Clause 267 says: "Taiyin disease, if the pulse is floating, sweating can be induced; Guizhi Tang (Cinnamon Twig Decoction) is suitable." Observing this, Zhongjing did not design Guizhi Tang (Cinnamon Twig Decoction) exclusively for Taiyang disease. Thus, one can only say Guizhi Tang (Cinnamon Twig Decoction) is the main formula for Taiyang Wind Strike, not a specific drug for Taiyang disease. Some argue that because Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) can treat Lung Meridian syndromes, "Taiyang disease should be interpreted as Lung Meridian syndrome," which is debatable.
Zhongjing's original text indicates: Wind Pathogen can invade Taiyang first, or it may not. If it invades Taiyang, Guizhi Tang (Cinnamon Twig Decoction) is used for treatment; if it invades Yangming or Taiyin first, Guizhi Tang (Cinnamon Twig Decoction) is also used. This proves that Guizhi Tang (Cinnamon Twig Decoction) syndrome is not equal to Taiyang Wind Strike syndrome. Such a recognition would not conform to Zhongjing's original intent.
II. Taiyang Cold Excess Disease — Cold Damage
[Pulse and Symptoms] "Taiyang disease, whether fever has already appeared or not, must have aversion to cold, body pain, vomiting, and a pulse that is tight at both yin and yang positions, is named Cold Damage." (3)
[Treatment Example] "Taiyang disease, with headache, fever, body ache, lower back pain, bone and joint pain, aversion to wind, no sweat, and wheezing, Mahuang Tang (Ephedra Decoction) is the main formula." (35)
[Discussion] When Cold Pathogen invades Taiyang, it is Taiyang Cold Damage. But Cold Pathogen does not necessarily strike Taiyang first. For example, Clause 237 says: "Yangming disease, with floating pulse, no sweat, and wheezing, inducing sweat will lead to recovery; Mahuang Tang (Ephedra Decoction) is suitable." This is the treatment method for Cold Pathogen injuring Yangming. This also shows that Mahuang Tang (Ephedra Decoction) is merely the main formula for Taiyang Cold Damage, not a specific drug for Taiyang disease, a logic identical to Taiyang Wind Strike. Furthermore, Clause 301 says: "Shaoyin disease, upon initial onset, with contrary fever and sinking pulse, Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite, and Asarum Decoction) is the main formula." This is another corroborating evidence. Since Zhongjing explicitly states "upon initial onset," we naturally cannot interpret it as transmission from Taiyang, otherwise it would not be "initial onset." Investigating Zhongjing's treatment methods: when Wei Qi is weak and Cold Pathogen invades Taiyang and Yangming, Mahuang Tang (Ephedra Decoction) is used; when Kidney Yang is weak and Cold Pathogen invades Shaoyin, Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite, and Asarum Decoction) is used. For the same Cold Pathogen injury and "initial onset," the medication differs. For Wind injuring Taiyang and Taiyin, Zhongjing uses Guizhi Tang (Cinnamon Twig Decoction); for Cold injuring Taiyang and Shaoyin, Zhongjing uses Mahuang Tang (Ephedra Decoction) with modifications. This seems related to the different characteristics of Wind and Cold pathogens. Based on this medication law, I believe patients with Kidney Deficiency contracting pathogens should avoid the drastic sweating of Mahuang Tang (Ephedra Decoction). Yu Jiayan's medical case record regarding a minor wind-strike illness presenting with Floating Yang Syndrome deserves our attention. In short, all Six Meridians have exterior syndromes. When Cold Pathogen injures humans, besides directly striking the interior (such as Yangming Middle Cold syndrome), it can injure the exterior of Taiyang, the exterior of Yangming, or the exterior of Shaoyin. Therefore, saying Taiyang is the fence of the body and that Wind-Cold injury must start from Taiyang is too absolute. Checking against *Shang Han Lun* original text, this "must" is problematic. Thus, one can only say exogenous diseases often start from Taiyang, not that they all must start from Taiyang.
III. Taiyang Fire Excess Disease — Warm Disease
[Pulse and Symptoms] "Taiyang disease, with fever and thirst, and no aversion to cold, is Warm Disease. If after sweating, the body becomes burning hot, it is named Wind-Warmth. Wind-Warmth disease, with pulse floating at both yin and yang positions, spontaneous sweating, heaviness of the body, excessive sleepiness, snoring breath, and difficulty speaking." (6)
[Treatment Example] "After sweating, Guizhi Tang (Cinnamon Twig Decoction) should not be used again. If there is sweating, wheezing, and no significant heat, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) can be given." (63)
[Discussion] The Six Excess Pathogens originally consisted of only Five Qi; during the Han Dynasty, there was no concept of newly acquired Warm Pathogen. Therefore, so-called Taiyang Warm Disease is actually Taiyang Latent Fire Disease. Generally, when Five Qi injure humans, if latent and not immediately manifesting, they tend to transform into Fire. Latent Fire disease can originate from Taiyang, Yangming, Shaoyang, or other meridians. *Nan Jing* states: "The pulse of Warm Disease travels through all meridians; not knowing which meridian is active, one should treat according to the location of the affected meridian." This is the principle. The reason why after the three words "is Warm Disease" in Clause 6 there follows "if after sweating..." is exactly as Zhang Xichun said: "In Zhongjing's time, those treating Warm Disease still confused Warm Disease within Wind Strike and Cold Damage. At the initial onset, failing to carefully examine fever without aversion to cold, they used warm-hot herbs to induce sweating, hence no resolution after sweating. Or seeing fever without aversion to cold, mistakenly believing the disease had transmitted to the interior, they used purgatives, hence Clause 163 mentions 'after purging, Guizhi Tang should not be used.' The slight difference is one is after sweating, the other after purging. Zhongjing feared people seeing sweating would mistake it for Guizhi Tang syndrome again, thus strictly forbidding Guizhi Tang and recommending Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction). According to the fixed rule of Cold Damage, if after mistakingly taking other drugs the original disease remains in any meridian, the original correct formula can still be administered. This is supported by Clause 103: 'For Chaihu Tang syndrome, if purged and Chaihu syndrome persists, give Xiao Chaihu Tang again.' By analogy, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) is a formula to rescue Warm Disease from mistreatment, effectively the formula for initial Warm Disease." Warm Disease, Wind Strike, and Cold Damage are listed together at the beginning of the *Shang Han Lun*. Previously, when discussing initial patterns of Taiyang disease, some only spoke of two, truly blind to the rest due to a single leaf blocking the view.
IV. Taiyang Dryness Excess Disease — Spasm Disease
[Pulse and Symptoms] "Taiyang disease, with fever and no sweat, and contrary aversion to cold, is named Gang Spasm (Rigid Spasm)." (One) "Taiyang disease, with fever and sweating, and no aversion to cold, is named Rou Spasm (Soft Spasm)." (Two) "The patient has body heat and cold feet: neck and nape stiffness, aversion to cold, occasional head heat, red face and eyes, independent head trembling, sudden jaw clenching, and opisthotonos, is Spasm Disease." (Seven)
[Treatment Example] "Taiyang disease, with complete symptoms, stiff body, stiff neck, and pulse contrary sinking and slow, this is Spasm; Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction) is the main formula." (Eleven) "Taiyang disease, with no sweat and conversely little urine, Qi rushing to the chest, jaw clenching preventing speech, intending to develop Gang Spasm, Gegen Tang (Kudzu Decoction) is the main formula." (Twelve)
[Discussion] Zhongjing presented clauses like "Taiyang disease, sweating too much, thereby causing spasm" to explain that mistreatment damages Jin-Ye (Body Fluids), the disease transforms via Dryness, and can result in Spasm. This does not mean ignoring external Dryness Pathogen causing Spasm. Later scholars believed that dominant Wind Pathogen causes Rou Spasm and dominant Cold Pathogen causes Gang Spasm. This understanding ignores the main etiology of Spasm Disease—the Dryness Pathogen—and is one-sided. Spasm is a Dryness disease; its primary pathogen is Dryness Pathogen. Dryness injuring Taiyang is Taiyang Spasm Disease. Wind and Cold pathogens are merely accompanying factors. If one only discusses Wind and Cold, or only mistreatment, while neglecting the main pathogen—Dryness Pathogen—it puts the cart before the horse. Zhongjing's two formulas for treating Taiyang Spasm Disease primarily use Trichosanthes Root (Gualou Gen) and Kudzu Root (Gegen). These two herbs generate fluids. Even in Yangming Spasm Disease where Dachengqi Tang (Major Order the Qi Decoction) is used, the purpose is also to preserve Yin. Thus, it is visible that Zhongjing's treatment of Spasm Disease focuses primarily on treating the Dryness Pathogen.
V. Taiyang Dampness Excess Disease — Damp Bi Syndrome
[Pulse and Symptoms] "Taiyang disease, with joint pain and vexation, and a sinking-thin pulse, is named Damp Bi Syndrome. The signs of Damp Bi Syndrome are difficult urination and conversely loose stools; one should only promote urination." (Fourteen)
[Treatment Example] "A person suffering from Dampness with body pain and vexation, Mahuang Jia Zhu Tang (Ephedra plus Atractylodes Macrocephala Decoction) to induce sweating is suitable. Carefully do not use fire therapy." (Twenty)
[Discussion] When Dampness Pathogen invades Taiyang, it is Taiyang Damp Bi Syndrome. *Yi Zong Jin Jian* states: "Taiyang disease, whole-body joint pain and vexation; if the pulse is floating and thin, Dampness is outside, sweating is indicated. If difficult urination and conversely loose stools occur with a sinking-thin pulse, Dampness is inside, draining is indicated." Draining is suitable with Wuling San (Five-Ingredient Powder with Poria); sweating is suitable with Mahuang Jia Zhu Tang (Ephedra plus Atractylodes Macrocephala Decoction). The former belongs to Taiyang Fu Organ disease treatment, the latter to Taiyang Jing Meridian disease treatment. External Dampness invading Taiyang mostly involves Jing Meridian disease initially, so *Jin Gui Yao Lue* details sweating methods for treating Damp Bi Syndrome. Regarding Mahuang Jia Zhu Tang (Ephedra plus Atractylodes Macrocephala Decoction) for Damp Bi Syndrome, as You Yi said: "Mahuang combined with Zhu, although inducing sweat, does not cause excessive sweating; Zhu combined with Mahuang, can drain Dampness from both exterior and interior." This formula fits the treatment principle of "slightly desiring sweat to expel both Wind and Dampness." Thus, it can serve as the representative formula for treating Taiyang Dampness Excess Disease. Because Six Excess Pathogens injuring humans often involve combinations, Dampness Pathogen invading Taiyang is often mixed with Wind and Cold, so *Shang Han Lun* says it overlaps with Cold Damage. *Wen Bing Ming Li* consequently claimed Damp Bi is what later generations call Damp-Warmth. However, the initial site of Damp-Warmth is the Foot-Yangming and Foot-Taiyin meridians. Examining the formulas for treating Damp Bi in *Jin Gui Yao Lue*, they seem not quite fitting, so this issue requires further discussion.
VI. Taiyang Summerheat Excess Disease — Heat Stroke (Ye)
[Pulse and Symptoms] "Taiyang Ye (Heat Stroke), with fever and aversion to cold, heaviness of the body and pain, pulse stringy, thin, hollow, and slow. After urination, shivering with goosebumps, cold hands and feet, slight exertion causes immediate body heat, mouth open, dry anterior teeth. If sweating is induced, aversion to cold becomes severe; if warm needles are added, fever becomes severe; frequent purging causes severe strangury." (Twenty-five)
[Treatment Example] "Taiyang Zhong Re (Middle Heat) is Ye. With sweating, aversion to cold, body heat, and thirst, Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction) is the main formula."
[Discussion] Yun Tieqiao said: "The literal meaning of Ye is Summerheat Injury. Summerheat Injury overlapping with Cold Damage, how else could it be Summerheat-Warmth?" Zhongjing used Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction) for treatment. Since Baihu Tang (White Tiger Decoction) is almost universally recognized as a formula for Yangming disease, Ye Tianshi said: "Summerheat in summer originates from Yangming; ancients used Baihu Tang as the standard formula." But Zhongjing clearly stated Taiyang Zhong Re (Middle Heat), showing later scholars' views differ from Zhongjing's. Zhongjing believed Six Excess Pathogen diseases can all start from Taiyang, and Ye is no exception. If Ye disease initially has aversion to cold, it belongs to Taiyang. Using Baihu Tang for Taiyang Zhong Re is the same logic as using Mahuang Tang for Yangming Cold Damage and Guizhi Tang for Taiyin Wind Strike. That is, Baihu Tang (White Tiger Decoction) is the main formula for Yangming disease, not a specific drug for Yangming disease. Clause 350 of the Jueyin Disease chapter states: "Cold Damage, pulse slippery and extremities cold, interior heat, Baihu Tang (White Tiger Decoction) is the main formula." This shows Jueyin disease also uses Baihu Tang (White Tiger Decoction). Thus, one cannot say Taiyang Zhong Re is Yangming disease just because Baihu Tang (White Tiger Decoction) was used. Summerheat Pathogen invading Taiyang is Taiyang Zhong Re. In the initial stage of Taiyang disease, due to different invading pathogens, Mahuang Tang (Ephedra Decoction) is used in some cases, and Baihu Tang (White Tiger Decoction) in others. Zhongjing differentiated causes and treated accordingly in Taiyang disease; the original text is thus, verifiable one by one. Later scholars should not impose their own views on the scripture's original meaning.