温病在脏在腑总是内热伤寒中风原无内热脏腑和平寒热不偏营卫不至内陷故六经既尽自能汗解阳盛则腑热内作从此
但热而不寒阴盛则脏寒里动从此但寒而不热入腑入脏则营卫内陷死机攸伏解无定期矣阳盛而腑热则吉其死者阳亢而失下
也阴盛而脏寒则凶其生者阴退而用温也阳生阴杀显见之理后世庸工乃至滋阴而伐阳泄火而补水一临伤寒先有传经为热之
语横塞胸中至于证脉阴阳丝毫不解人随药死枉杀多矣
肝司营血肺司卫气营行脉中卫行脉外而总统于太阳之一经者以太阳在六经之表主一身之皮毛故也风则伤卫卫秉肺金
之气其性清降而收敛得风邪之疏泄而卫气愈敛则营郁而发热里阳素旺者多传阳明之腑里阳非旺不入腑也寒则伤营营秉肝
木之气其性温升而发散得寒邪之束闭而营血愈发则卫郁而恶寒里阴素旺者多传太阴之脏里阴非旺不入脏也阴阳均平不入
脏腑营卫无内陷之路是以经尽而汗解太阴主营阳明主卫脾为生血之本胃为化气之原也营血之不陷者太阴之旺卫气之不陷
者阳明之旺太阴虚则腑热作而营气陷阳明虚则脏寒动而卫气陷卫气陷者阳复则生阴胜则死营气陷者阴复则生阳胜则死阴
阳胜复之中生死攸关不可不察也
伤寒六经分篇非皆经病也六经之病总统于太阳一经其不入脏腑而但在经脉者虽遍传六经而未经汗解则必有太阳之表
证既有太阳表证则不拘传至何经凡在六七日之内者中风俱用桂枝伤寒俱用麻黄此太阳之经病而实统六经之经病不须另立
六经之法也惟阳盛亡阴而入阳明之腑阴盛亡阳而入太阴之脏他经之里证已作而太阳之表邪未罢此在太阳则为坏病而在诸
经则为本病故于太阳立坏病之门而于太阳之外又设诸经之篇阳明篇全言腑病阳明之经病如葛根汤证乃腑病之连经非第经
病也若桂枝麻黄二证则太阳之所
统而复述于阳明者也三阴篇全言脏病太阴之桂枝少阴之麻黄细辛厥阴之麻黄升麻诸证皆脏病之连经非第经病也少阳
篇半言脏病半言腑病少阳居半表半里之中乃表里之枢机阴阳之门户阳盛则入腑阴盛则入脏少阳之经病如小柴胡汤证乃脏
病腑病之连经非第经病也盖其胸胁痞硬是阳明太阳俱有之证缘其脏腑胀满壅碍胆经降路经腑郁迫故心胁痞硬而其寒热往
来吐利并作寒多则太阴病热多则阳明病吐多则阳明病利多则太阴病若但在少阳之经而不内连于脏腑不至如柴胡诸证之剧
也若麻黄一证则太阳之所统而复述于少阳者也
温病无论是发生在脏还是腑,总是表现为内热;而伤寒中风原本就没有内热。脏腑功能平和,寒热不偏颇,营卫之气不至内陷,所以六经的病邪传变结束后,自然能够通过出汗而解表痊愈。
如果阳气偏盛,则腑中热气内生,从此只发热而不恶寒;如果阴气偏盛,则脏中寒气内生,从此只恶寒而不发热。病邪一旦进入腑或进入脏,营卫之气就会内陷,死亡的危机潜伏其中,解表的时机也就没有定期了。阳气偏盛且腑中有热,预后较好;那些死亡的案例,是因为阳亢盛而未能及时使用攻下法所致。阴气偏盛且脏中有寒,预后凶险;那些存活的案例,是因为阴邪退去而使用了温补法所致。阳生阴杀是显而易见的道理,后世的庸医竟然采用滋阴的方法来伐伤阳气,采用泄火的方法来耗损真水(肾阴/肾阳)。一遇到伤寒,心中先横亘着“伤寒会传入经络化为热证”的错误观念,以至于对证候和脉象的阴阳属性丝毫不理解,病人随着医生的用药而死,枉杀人命太多了。
肝主管营血,肺主管卫气。营气行于脉管之中,卫气行于脉管之外,而它们都由太阳经所统领,这是因为太阳经位于六经的最表层,主司一身之皮毛的缘故。风邪容易伤害卫气,卫气禀受肺金之气,其性质清肃下降且具有收敛性;受到风邪的疏泄作用影响,卫气更加收敛,导致营气郁滞而发热。体内阳气素来旺盛的人,多会传入阳明之腑,因为里阳不旺盛就不会传入腑中。寒邪容易伤害营气,营气禀受肝木之气,其性质温和上升且具有发散性;受到寒邪的束闭作用影响,营血愈发郁滞,导致卫气郁滞而恶寒。体内阴气素来旺盛的人,多会传入太阴之脏,因为里阴不旺盛就不会传入脏中。阴阳均平,病邪就不入脏腑,营卫也没有内陷的路径,因此当经气运行结束时,通过出汗而痊愈。太阴经主营血,阳明经主卫气,脾是生血的根源,胃是化生气的源头。营血之所以不内陷,是因为太阴之气旺盛;卫气之所以不内陷,是因为阳明之气旺盛。太阴虚损,则腑热发作而营气内陷;阳明虚损,则脏寒发动而卫气内陷。卫气内陷的,阳气恢复则生,阴气胜极则死;营气内陷的,阴气恢复则生,阳气胜极则死。在阴阳胜负交替的过程中,生死攸关,不可不仔细考察。
《伤寒论》六经分篇并非都是经脉本身的病变。六经的病证都统属于太阳一经。那些没有进入脏腑、仅仅停留在经脉层面的病证,虽然遍传六经,但只要还没有通过发汗解表,就一定会有太阳经的表证。既然有太阳经的表证,那么无论传变到哪一经,凡是在六七日以内的,中风证一律用桂枝汤,伤寒证一律用麻黄汤。这是太阳经的经病,实际上统摄了六经的经病,不需要另外设立六经的治疗法则。只有阳气偏盛导致亡阴而进入阳明之腑,或者阴气偏盛导致亡阳而进入太阴之脏的情况除外。其他各经的里证已经形成,但太阳经的表邪尚未罢除,这种情况在太阳经称为坏病,而在其他各经则称为本病。所以在太阳经设立坏病的门类,而在太阳经之外又设立其他各经的篇章。阳明篇全篇论述腑病,阳明经的经病如葛根汤证,乃是腑病牵连到经脉,不仅仅是经病。如果是桂枝汤或麻黄汤证,则是太阳经所统摄的病证,又在阳明篇中复述一遍。三阴篇全篇论述脏病,太阴经的桂枝汤证、少阴经的麻黄细辛附子汤证、厥阴经的麻黄升麻汤证等,都是脏病牵连到经脉,不仅仅是经病。少阳篇半篇论述脏病,半篇论述腑病。少阳位居半表半里之间,是表里的枢纽、阴阳的门户。阳气偏盛则进入腑,阴气偏盛则进入脏。少阳经的经病如小柴胡汤证,乃是脏病和腑病牵连到经脉,不仅仅是经病。大概因为胸胁部痞塞坚硬,这是阳明经和太阳经都有的证候,原因在于脏腑胀满壅塞阻碍了胆经的降路,导致经腑郁迫,所以出现心胁痞硬。而其寒热往来、呕吐腹泻并作,寒多则为太阴病,热多则为阳明病,呕吐多则为阳明病,腹泻多则为太阴病。如果仅仅在少阳经而没有内连脏腑,不至于像小柴胡汤诸证那样剧烈。如果是麻黄汤证,则是太阳经所统摄的病证,又在少阳篇中复述一遍。
Warm diseases, whether occurring in the Zang organs or Fu organs, always manifest as internal heat. In contrast, Cold Damage (Shanghan) and Wind Strike (Zhongfeng) originally lack internal heat. When the Zang and Fu organs are harmonious, with no bias towards cold or heat, and the Ying (Nutritive) and Wei (Defensive) Qi do not sink inward, the pathogenic factors of the Six Channels will naturally resolve through sweating once their transmission cycle is complete.
If Yang Qi is excessive, Fu-organ heat arises internally, leading to fever without chills from that point on. If Yin Qi is excessive, Zang-organ cold arises internally, leading to chills without fever from that point on. Once pathogens enter the Fu or Zang organs, the Ying and Wei Qi sink inward, hiding the mechanism of death, and the timing for resolution becomes unpredictable. If Yang is excessive with Fu-organ heat, the prognosis is auspicious; deaths in such cases result from Yang hyperactivity failing to be treated with purgation. If Yin is excessive with Zang-organ cold, the prognosis is ominous; survival in such cases results from Yin receding and the use of warming methods. The principle that Yang generates life while Yin leads to death is evident. Yet, incompetent physicians of later generations employed nourishing Yin to attack Yang, and draining fire to deplete Water (Kidney essence/Yang). Upon encountering Cold Damage, they were preoccupied with the notion that "Cold Damage transmits into heat," blocking their minds. Consequently, they failed to understand the Yin-Yang nature of symptoms and pulses even slightly, causing patients to die due to inappropriate medication, resulting in many wrongful deaths.
The Liver governs Ying Blood, and the Lungs govern Wei Qi. Ying Qi circulates within the vessels, while Wei Qi circulates outside the vessels, yet both are commanded by the Taiyang (Greater Yang) channel. This is because the Taiyang channel is at the exterior of the Six Channels and governs the skin and hair of the entire body. Wind pathogens injure Wei Qi. Wei Qi inherits the Qi of Lung Metal, possessing a nature of clear descent and convergence. When affected by the dispersing action of wind pathogens, Wei Qi converges excessively, causing Ying Qi to stagnate and generate fever. Individuals whose interior Yang is inherently robust often transmit to the Yangming (Yang Brightness) Fu organs, as interior Yang must be robust to enter the Fu organs. Cold pathogens injure Ying Qi. Ying Qi inherits the Qi of Liver Wood, possessing a nature of warm ascent and dispersion. When constrained by the binding action of cold pathogens, Ying Blood becomes increasingly stagnant, causing Wei Qi to stagnate and generate aversion to cold. Individuals whose interior Yin is inherently robust often transmit to the Taiyin (Lesser Yin) Zang organs, as interior Yin must be robust to enter the Zang organs. When Yin and Yang are balanced, pathogens do not enter the Zang or Fu organs, and there is no pathway for Ying and Wei Qi to sink inward; thus, upon the completion of the meridian cycle, resolution occurs through sweating. Taiyin governs Ying, and Yangming governs Wei. Spleen is the root of blood generation, and Stomach is the source of Qi transformation. Ying Blood does not sink because Taiyin Qi is robust; Wei Qi does not sink because Yangming Qi is robust. If Taiyin is deficient, Fu-heat arises and Ying Qi sinks; if Yangming is deficient, Zang-cold moves and Wei Qi sinks. For sinking Wei Qi, recovery of Yang leads to life, while dominance of Yin leads to death. For sinking Ying Qi, recovery of Yin leads to life, while dominance of Yang leads to death. Within the interplay of Yin and Yang dominance and recovery, life and death hang in the balance, requiring careful observation.
The division of Cold Damage into Six Chapters does not imply that all involve meridian diseases. Diseases of the Six Channels are primarily commanded by the Taiyang channel. For those that have not entered the Zang or Fu organs but remain only in the meridians, although they may transmit through all Six Channels, if they have not yet resolved through sweating, there must be Taiyang exterior syndromes. Given the presence of Taiyang exterior syndromes, regardless of which channel the disease has transmitted to, if it is within six or seven days, Wind Strike syndromes should uniformly use Guizhi Tang (Cinnamon Twig Decoction), and Cold Damage syndromes should uniformly use Mahuang Tang (Ephedra Decoction). These are meridian diseases of Taiyang, which actually command the meridian diseases of all Six Channels, so there is no need to establish separate treatment principles for each of the Six Channels. Exceptions exist only when Yang excess leads to Yin depletion entering the Yangming Fu organs, or Yin excess leads to Yang depletion entering the Taiyin Zang organs. When interior syndromes of other channels have formed but the exterior pathogen of Taiyang has not yet subsided, this is termed a "corrupted disease" (Huai Bing) in Taiyang, but a "primary disease" in other channels. Therefore, a section for corrupted diseases is established under Taiyang, and chapters for other channels are set up outside of Taiyang. The Yangming chapter entirely discusses Fu-organ diseases. The Yangming meridian disease, such as the Gegen Tang (Kudzu Decoction) syndrome, involves Fu-organ pathology extending to the meridian, not merely meridian pathology. If it refers to Guizhi Tang or Mahuang Tang syndromes, these are conditions commanded by Taiyang, reiterated here in the Yangming chapter. The Three Yin chapters entirely discuss Zang-organ diseases. The Guizhi Tang syndrome in Taiyin, the Mahuang Xixin Fuzi Tang (Ephedra, Asarum, and Aconite Decoction) syndrome in Shaoyin, and the Mahuang Shengma Tang (Ephedra and Cimicifuga Decoction) syndrome in Jueyin are all Zang-organ pathologies extending to the meridians, not merely meridian pathologies. The Shaoyang (Lesser Yang) chapter discusses half Zang diseases and half Fu diseases. Shaoyang resides in the semi-exterior semi-interior region, serving as the pivot of exterior and interior, and the gateway of Yin and Yang. Yang excess leads to entry into the Fu organs, while Yin excess leads to entry into the Zang organs. The Shaoyang meridian disease, such as the Xiaochaihu Tang (Minor Bupleurum Decoction) syndrome, involves Zang and Fu pathologies extending to the meridian, not merely meridian pathology. Generally, chest and hypochondriac fullness and hardness are syndromes present in both Yangming and Taiyang. This arises because Zang-Fu distension and obstruction block the descending pathway of the Gallbladder meridian, causing meridian and Fu organ stagnation and pressure, resulting in heart and hypochondriac fullness. The alternating chills and fever, along with vomiting and diarrhea, vary: more chills indicate Taiyin disease, more heat indicates Yangming disease, more vomiting indicates Yangming disease, and more diarrhea indicates Taiyin disease. If the condition remains solely in the Shaoyang meridian without connecting internally to the Zang and Fu organs, it will not be as severe as the various Xiaochaihu Tang syndromes. If it refers to the Mahuang Tang syndrome, this is a condition commanded by Taiyang, reiterated here in the Shaoyang chapter.