问曰。何以识为太阳病。答曰。太阳之为病脉浮。头项强痛而恶寒。凡论中所称为太阳
病者
。即指此脉此证而言。假如病家云。苦头项强痛恶寒。诊之脉浮。此即太阳病。盒饭察其身
热之微与甚。视其有汗无汗。若身热汗自出。脉浮而缓者。此太阳中风证。或未发热。或已
发热。无汗而喘。脉浮而紧者。此太阳伤寒证。又如病家云。苦头项强痛发热。问之。不恶寒
。反渴者。此属温病。若视之舌上胎。一身尽疼。身色如似熏黄者。此属湿温。又如病家云
。
苦头项强痛恶寒。视之汗出身热而渴者。此属热病。凡此五者。乃太阳病初起平脉辨证之大
纲。然又有伤风兼寒。伤寒兼风。或风兼温。或风兼湿。或寒兼湿。或风兼热。甚或寒热错
杂。皆从此定证定脉。参伍错综以观其通。太阳一经。乃伤寒家开手工夫。能从此处谛实病因。
则投剂悉中肯綮。手到病除。更无传变之足言矣。学伤寒家。首宜识此。
问曰。太阳病主头项强痛恶寒者何义。答曰。太阳之脉。起于目内 。上额交颠。从颠
入络
脑。还出别下项。连风腑。循肩膊。内侠脊。抵腰中。故头项强痛恶寒。是太阳病必有之证
。仲景特挈此为提纲。此外或已发热或未发热。或体重腰痛。或自汗。或无汗。皆太阳病中或然或不
然之证。故但散见于诸条。而不入提纲之内。至温病之不恶寒者。以温病由里而出表。虽见
太阳病。其病因本不关太阳。故微有别。按内经云。巨阳者诸阳之属。其脉连于风腑。故为
诸阳主气。夫手太阳小肠。为受盛之官。足太阳膀胱。为州都之官。小肠受盛之物。全藉膀
胱气化而始能出。此气字即巨阳为诸阳主气之气。膀胱小肠。位居腹下。当至阴之地。内经
谓太阳根起于至阴。结于命门。心与小肠。同资火化。设膻中之使道绝。而肺之治节不行。
何以下注膀胱而输津液。心主营。肺主卫。太阳一经。统司营卫。故为诸阳主气。而冠六经
之
首。谓太阳主表。义系诸此。自后世注伤寒家。专责太阳膀胱经。遂有传足不传手之谬说。又
谓太阳为寒水之气。以寒召寒。故有伤寒之名。亦未免失之穿凿。但从营卫上讨消息。则于
太阳病已思过半矣。
问：如何识别太阳病？答：太阳病的特征是脉象浮，头部和颈部僵硬疼痛，并且怕冷。凡是论述中称为“太阳病”的，就是指这种脉象和症状而言。假如病人说，苦于头部和颈部僵硬疼痛、怕冷，诊察其脉象浮，这就是太阳病。应当观察其身体发热程度的轻重，以及有汗还是无汗。如果身体发热且自然出汗，脉象浮而缓，这是太阳中风证。或者尚未发热，或者已经发热，无汗且气喘，脉象浮而紧，这是太阳伤寒证。又如病人说，苦于头部和颈部僵硬疼痛、发热，询问时，不怕冷，反而口渴，这属于温病（Wen Bing, warm disease）。如果看其舌上有苔，全身都疼痛，面色像被烟熏过的黄色，这属于湿温（Shi Wen, damp-heat warm disease）。又如病人说，苦于头部和颈部僵硬疼痛、怕冷，观察其出汗后身体发热且口渴，这属于热病（Re Bing, heat disease）。以上五种情况，是太阳病初起时平脉辨证的大纲。然而又有伤风兼寒、伤寒兼风，或者风兼温、风兼湿、寒兼湿、风兼热，甚至寒热错杂的情况，都要根据这些确定的证候和脉象，错综参互地观察其变化规律。太阳一经，是学习伤寒论入门的基本功夫，能在这里确切查明病因，那么用药就能切中要害，手到病除，更谈不上病情传变了。学习伤寒论的人，首先应该认识这一点。
问：太阳病主要表现头部和颈部僵硬疼痛、怕冷，这是什么道理？答：太阳经脉，起始于目内眦，上行至额部，交会于头顶，从头顶入络于脑，复出别下行项部，连接风府穴，沿肩膊内侧，夹脊柱而行，抵达腰部。所以头部和颈部僵硬疼痛、怕冷，是太阳病必然有的症状。张仲景特别提出这些作为提纲。此外，或者已经发热或者尚未发热，或者身体沉重腰痛，或者自汗，或者无汗，都是太阳病中或有或无的症状。所以只是散见于各个条文之中，而不列入提纲之内。至于温病不怕冷的原因，是因为温病是从体内发出到达体表，虽然见到太阳病的症状，但其病因本来与太阳经无关，所以略有区别。按《内经》所说，巨阳（Juyang, Greater Yang）是诸阳经的统领，其脉连于风府穴，所以是诸阳主气。手太阳小肠经，是受盛之官；足太阳膀胱经，是州都之官。小肠所受的盛物，全赖膀胱的气化作用才能排出。这个“气”字，就是巨阳作为诸阳主气的“气”。膀胱和小肠位居腹部下方，处于至阴之地。《内经》说太阳根起于至阴，结于命门。心与小肠，共同资借火化。如果膻中（Danzhong, Conception Vessel 14）的使道断绝，肺的治节功能不行，怎么能让津液下注膀胱并输布呢？心主营血，肺主卫气，太阳一经，统管营卫，所以是诸阳主气，而冠居六经之首。称太阳主表，意义就在这里。自从后世注释伤寒论的医家，专门指责太阳膀胱经，于是有了“只传足经不传手经”的错误说法。又说太阳是寒水之气，以寒召寒，所以有“伤寒”的名称，这也未免失之穿凿附会。只要从营卫方面探求消息，对于太阳病的理解就已经超过一半了。
Q: How to identify Taiyang disease? A: The characteristics of Taiyang disease (Taiyang Disease) are a floating pulse (Mai Fu), stiffness and pain in the head and neck (Tou Xiang Qiang Tong), and aversion to cold (E Han). Whenever "Taiyang disease" is mentioned in discussions, it refers to this specific pulse and these symptoms. If a patient complains of suffering from stiffness and pain in the head and neck, along with aversion to cold, and upon examination, the pulse is found to be floating, this constitutes Taiyang disease. One must observe the degree of body heat (Shen Re) and whether there is sweating or not. If there is body heat with spontaneous sweating (Zi Chu Han), and the pulse is floating and slow (Huan), this is Taiyang Zhong Feng syndrome (Taiyang Wind Strike Syndrome). If there is no fever yet, or if fever has already appeared, accompanied by anhidrosis (Wu Han) and wheezing (Chuan), with a floating and tight (Jin) pulse, this is Taiyang Shang Han syndrome (Taiyang Cold Damage Syndrome). Furthermore, if a patient complains of stiffness and pain in the head and neck, fever, but upon inquiry shows no aversion to cold and instead feels thirsty, this belongs to Wen Bing (Warm Disease). If one observes coating on the tongue (She Shang Tai), generalized body ache (Yi Shen Jin Teng), and a complexion resembling smoky yellow (Xun Huang), this belongs to Shi Wen (Damp-Heat Warm Disease). Again, if a patient complains of stiffness and pain in the head and neck, aversion to cold, but after observing sweating, there is body heat and thirst, this belongs to Re Bing (Heat Disease). These five categories constitute the general principles for pulse diagnosis and syndrome differentiation at the onset of Taiyang disease. However, there may also be cases where wind strike is complicated by cold, cold damage by wind, wind by warmth, wind by dampness, cold by dampness, wind by heat, or even mixed cold and heat. In all such cases, one must analyze the variations by cross-referencing these established syndromes and pulses. The Taiyang channel is the foundational step for studying Shang Han Lun (Treatise on Cold Damage Disorders). By accurately identifying the etiology here, prescriptions will hit the mark precisely, curing the disease instantly, leaving no room for further transmission. Those who study Shang Han Lun must first recognize this.
Q: What is the rationale behind Taiyang disease primarily manifesting as stiffness and pain in the head and neck, and aversion to cold? A: The Taiyang meridian originates from the inner canthus of the eye, ascends to the forehead, intersects at the vertex, enters to connect with the brain, emerges again to descend separately through the nape, connects with Fengfu (GB16), runs along the shoulder blades, passes internally alongside the spine, and reaches the waist. Therefore, stiffness and pain in the head and neck, and aversion to cold, are inevitable symptoms of Taiyang disease. Zhang Zhongjing specifically highlights these as the guiding提纲 (outline). Other symptoms, such as having already developed fever or not yet, heavy body with lower back pain, spontaneous sweating, or anhidrosis, are optional or non-optional symptoms within Taiyang disease. Hence, they appear scattered throughout various clauses but are not included in the outline. As for why Wen Bing does not present with aversion to cold, it is because Wen Bing emanates from the interior to the exterior; although Taiyang disease symptoms are seen, the etiology is originally unrelated to the Taiyang channel, hence the slight difference. According to the Nei Jing (Inner Canon), Juyang (Greater Yang) is the leader of all Yang channels, its vessels connecting to Fengfu, thus serving as the master qi of all Yang. The Hand-Taiyang Small Intestine meridian is the official of receiving and storing; the Foot-Taiyang Bladder meridian is the official of the capital. The contents received by the Small Intestine rely entirely on the Qi transformation (Qi Hua) of the Bladder to be excreted. This "Qi" refers to the Qi by which Juyang serves as the master of all Yang. The Bladder and Small Intestine reside in the lower abdomen, in the region of extreme Yin. The Nei Jing states that Taiyang roots at Zhiyin and terminates at Mingmen. The Heart and Small Intestine both utilize Fire transformation. If the pathway of Danzhong (CV17) is severed, and the regulatory function of the Lung fails, how can fluids descend to the Bladder and be distributed? The Heart governs Ying (Nutritive Qi), and the Lung governs Wei (Defensive Qi). The Taiyang channel oversees both Ying and Wei, thus being the master of all Yang, ranking first among the Six Channels. The statement that Taiyang governs the exterior derives its meaning from this. Since later commentators on Shang Han Lun focused exclusively on the Foot-Taiyang Bladder meridian, erroneous theories arose claiming that transmission occurs only in the Foot meridians and not the Hand meridians. It was also argued that Taiyang represents Cold-Water Qi, and since cold attracts cold, it is named "Shang Han" (Cold Damage). Such interpretations are somewhat forced. If one seeks understanding through the lens of Ying and Wei, one has already grasped more than half of the essence of Taiyang disease.