问曰。太阳病不解。即传入阳明乎。答曰。此不尽然。仲景云。伤寒一日。太阳受之。
脉若
静者为不传。颇欲吐若燥烦脉数急者为传也。伤寒二三日。阳明少阳证不见者。为不传也。
可见病之轻者不传。即病之重者。治之如法。亦不必尽传。其必欲传者。亦不必尽传阳明。
有本经自传。而从太阳之经。转入太阳之腑者。此谓犯本。太阳病由经入腑。其中又有气血
之殊。热伤膀胱气分。则为蓄水。热伤膀胱血分。则为蓄血。蓄水之证。利其水则愈。蓄
血
之证。下其血则愈。盖邪既入腑。即从腑解。治仍不离乎太阳也。至于误治之后。种种变逆
。亦非一致。尤当按证分别施治。设拘于一日太阳。二日阳明之说。使当其时阳明之脉证不
见。亦可从阳明论治乎。故夫泥日数以分经者。其贻误必不少也。
问曰。凡病伤寒。其传为热。而有反寒者何也。答曰。太阳病误治致逆。救逆之法。当
分水火为
二大纲。足太阳膀胱。与足少阴肾为表里。手太阳小肠。与手少阴心为表里。脉法以左尺属
水。为元阴之根。坎象也。右尺属火。为元阳之根。离象也。太阳寒水之气。全资火化。第心
君之火。寂然不动。赖膻中为臣使之官。下合三焦。以生趺阳而伏少阴。方合坎离既济之妙
。太阳主表病。本当从表解。但解表之中。须相其人之津液。夫此所谓津液者。水火合化而
阴阳互为其根者也。太阳病治不如法。阳虚则阴盛。而水邪致逆。阴虚则阳盛。而火邪致逆
。
水邪之为病水入即吐。甚则心下支满。腹中雷鸣。又其甚者。气从少腹上冲心。或脐下悸欲作
奔豚。若此之类。皆以阳微而致水逆。火邪之为病。其人腰以下必重而痹。或圊血。或大渴
引饮。甚则谵语。又其甚者。手足躁扰。捻衣摸床。若此之类。皆以劫阴而
致火逆。水盛则火就灭。急当扶阳以制水。火盛则水立涸。急当泻火以存阴。此在太阳病误治
之后。其传变便有水火寒热之不同。正不必尽传为热。又况误汗误下之后。或大汗出。筋惕
肉。或下利不止。此亡阳之候。以大剂参附。驷马追之。犹虞不及。此尤当急温者矣。若
谓某日当在某经。而计日以定汗下。岂理也哉。
问：太阳病如果不解除，就会传入阳明经吗？答：这并不完全如此。仲景说：“伤寒第一天，邪气在太阳经受邪。如果脉象平静，说明病情没有传变；如果病人想呕吐，感到燥热烦闷，且脉搏快而急促，说明病情已经传变。”伤寒第二天或第三天，如果没有出现阳明经或少阳经的证候，就说明没有传变。由此可见，病情轻浅的不会传变；即使病情严重，只要治疗得当，也不一定都会传变。那些必然要传变的，也不一定都传入阳明经。有的会在本经内部传变，即从太阳经传入太阳腑（膀胱）。这叫做“犯本”。太阳病由经入腑，其中又有气分和血分的区别。热邪伤及膀胱气分，就形成蓄水证；热邪伤及膀胱血分，就形成蓄血证。蓄水证，通过利水的方法就可以治愈；蓄血证，通过攻下瘀血的方法就可以治愈。因为邪气既然进入腑，就从腑中解决，治疗仍然不脱离太阳病的范畴。至于误治之后出现的各种逆变证，也不尽相同，尤其应当根据具体证候分别施治。如果拘泥于“一日太阳、二日阳明”的说法，当此时并没有出现阳明经的脉证时，也可以按照阳明病来论治吗？所以，死板地按天数来划分经络的人，造成的失误一定不少。
问：凡是患伤寒病，其传变通常化为热证，但为什么反而有寒证呢？答：太阳病因误治导致逆变，救治逆变的方法，应当分为水和火两大纲领。足太阳膀胱经与足少阴肾经互为表里；手太阳小肠经与手少阴心经互为表里。脉法认为左尺部属水，是元阴的根本，对应坎卦之象；右尺部属火，是元阳的根本，对应离卦之象。太阳寒水之气，完全依赖火的化生才能发挥作用。只是心君之火寂然不动，依靠膻中作为臣使之官，向下合于三焦，以生发趺阳脉之气并潜藏于少阴，这才符合坎离既济的奥妙。太阳主表，病本当从表解，但在解表的过程中，必须观察病人的津液情况。所谓津液，就是水火合化、阴阳互为其根的物质。太阳病治疗不得法，阳气虚则阴气盛，导致水邪逆变；阴气虚则阳气盛，导致火邪逆变。水邪引起的病症，喝水即吐，甚至心下部支撑胀满，腹中雷鸣作响；更严重的，气从少腹上冲心胸，或者脐下悸动，想要发作奔豚病。像这类情况，都是因为阳气微弱而导致的水逆。火邪引起的病症，病人腰部以下必定沉重且麻木痹痛，或者便血，或者极度口渴引饮；更严重的，出现胡言乱语；再严重的，手足躁扰不安，抓空摸床。像这类情况，都是因为劫夺阴液而导致的火逆。水盛则火灭，急需扶助阳气以制约水邪；火盛则水干涸，急需泻火以保存阴液。这是在太阳病误治之后，其传变就有水火寒热的不同，正不必全都传变为热证。更何况误用汗法或下法之后，或者大汗出导致筋惕肉瞤，或者下利不止，这是亡阳的征候，需要用大剂量的参附汤，如驷马追疾般急温，还担心来不及。这更是应当紧急温阳的情况。如果说某一天应当在某一经，从而计算天数来决定使用汗法还是下法，这难道是合理的吗？
Question: If the Taiyang disease does not resolve, will it necessarily transmit to the Yangming channel? Answer: This is not entirely true. Zhongjing stated: "On the first day of cold damage, the Taiyang channel receives the pathogen. If the pulse remains calm, it indicates no transmission; if the patient desires to vomit, feels dry and restless, and the pulse is rapid and urgent, it indicates transmission." On the second or third day of cold damage, if there are no signs of Yangming or Shaoyang syndromes, it indicates no transmission. Thus, it can be seen that mild diseases do not transmit; even severe diseases, if treated correctly, do not necessarily all transmit. Those that must transmit do not necessarily all transmit to Yangming. Some may transmit within the same channel, moving from the Taiyang channel to the Taiyang fu-organ (Bladder). This is called "violating the root" (Fan Ben). When Taiyang disease moves from the channel to the fu-organ, there are distinctions between Qi level and Blood level. Heat injuring the Qi level of the Bladder results in Water Accumulation syndrome; heat injuring the Blood level of the Bladder results in Blood Accumulation syndrome. For Water Accumulation, resolving with diuretics leads to cure; for Blood Accumulation, purging blood leads to cure. Since the pathogen has entered the fu-organ, it resolves through the fu-organ, and treatment still adheres to the principles of Taiyang. As for various adverse transformations after mis-treatment, they are not uniform, and one must treat according to specific syndromes. If one rigidly adheres to the theory of "Day 1 Taiyang, Day 2 Yangming," when Yangming pulses and symptoms are absent at that time, can one still treat it as Yangming disease? Therefore, those who rigidly divide channels by days will inevitably cause significant errors.
Question: In general, cold damage transmits into heat, but why are there cases of cold instead? Answer: Adverse transformations caused by mis-treatment of Taiyang disease should be addressed by dividing them into two main categories: Water and Fire. The Foot-Taiyang Bladder channel and Foot-Shaoyin Kidney channel are exterior-interior pairs; the Hand-Taiyang Small Intestine channel and Hand-Shaoyin Heart channel are exterior-interior pairs. Pulse diagnosis holds that the left Chi position belongs to Water, the root of Primordial Yin, corresponding to the Kan trigram image; the right Chi position belongs to Fire, the root of Primordial Yang, corresponding to the Li trigram image. The Cold-Water Qi of Taiyang relies entirely on Fire transformation to function. Although the Fire of the Heart Monarch is still and unmoving, it relies on the Pericardium (Shanzhong) as the official of ministerial envoy, combining downward with the Sanjiao to generate the Du-Yang pulse and submerge into Shaoyin, thus achieving the wonder of Kan-Li mutual completion. Taiyang governs the exterior, so the disease should naturally resolve from the exterior. However, in resolving the exterior, one must observe the patient's Body Fluids (Jinye). These Body Fluids are the substance formed by the combination of Water and Fire, where Yin and Yang serve as roots for each other. If Taiyang disease is treated improperly, Yang deficiency leads to Yin excess, causing Water pathogen adverse transformation; Yin deficiency leads to Yang excess, causing Fire pathogen adverse transformation. Diseases caused by Water pathogen include vomiting immediately after drinking water, distension and fullness below the heart, borborygmus in the abdomen; more severely, Qi rushing from the lower abdomen up to the heart, or palpitations below the navel suggesting impending Ben-Tun disease. Such cases are all due to Water Reversal caused by weak Yang. Diseases caused by Fire pathogen include heaviness and numbness below the waist, hematochezia, extreme thirst with excessive drinking; more severely, delirium; even more severely, restlessness of hands and feet, picking at clothes and bed sheets. Such cases are all due to Fire Reversal caused by depletion of Yin. When Water is excessive, Fire is extinguished; urgently support Yang to control Water. When Fire is excessive, Water dries up; urgently purge Fire to preserve Yin. After mis-treatment of Taiyang disease, transmissions differ in terms of Water/Fire and Cold/Heat, and certainly do not all transmit as heat. Furthermore, after misusing sweating or purging methods, leading to profuse sweating with muscle twitching, or continuous diarrhea, these are signs of Yang Collapse. One must use large doses of Ginseng and Aconite Decoction (Shenfu Tang), pursuing urgency like four horses chasing, yet still fearing insufficiency. These are especially cases requiring urgent warming. To say that a certain day corresponds to a certain channel, thereby calculating days to decide on sweating or purging methods, is this reasonable?