伤寒三日少阳脉小者欲已也
伤寒一日太阳二日阳明三日少阳阳明篇伤寒三日阳明脉大若三日而见少阳之小脉不见阳明之大脉是不传阳明之腑而
病欲已也此与太阳经伤寒一日太阳受之脉若静者为不传义同言六经俱遍邪不里传自能汗解也
伤寒三日三阳为尽三阴当受邪其人反能食不呕此为三阴不受邪也
伤寒一日一经六日六经俱遍则正复邪退汗出而解其不应期而解者阳盛而入阳明之腑阴盛而入三阴之脏者也少阳居阳
明太阴之介阳盛则入于腑阴盛则入于脏于伤寒三日病在少阳之时候之少阳脉小不传阳明之腑是阳不偏盛使阴气偏盛当入
三阴之脏是时三阳既尽三阴当受邪矣若其人反能食不呕此为三阴之脏不受外邪再俟三日但传三阴之经自能应当汗解也
太阴为病腹满而吐食不下是脏病而非经病也故仲景曰以其脏有寒故也阳明篇皆言腑病(其经病皆有腑证也)三阴篇
皆言脏病并非经病也阴阳和平脏腑可以不传经无不传之理所谓发于阳者七日愈发于阴者六日愈必然之数也六经经证总统
于太阳一经凡中风在六日之内不拘何经皆宜桂枝伤寒在六日之内不拘何经皆宜麻黄惟入脏入腑则阴阳偏胜愈期不齐而法
亦百变不穷矣盖入脏入腑而后太阳证罢不入脏腑而在经络万无太阳遽罢但有别经表证者所谓表者止有皮毛一层皮毛即开
太阳已罢则经如何不罢若皮毛未开太阳何缘遽罢太阳不罢是以六经俱尽总宜麻桂也程氏谓伤寒一日太阳受之脉若静者为
不传
伤寒三日少阳脉小者欲已也伤寒三日三阴当受邪其人反能食不呕此为三阴不受邪也为经亦不传悖谬之至
伤寒病经过三天,如果少阳脉象表现为细小,说明病情即将痊愈。
在《阳明篇》中提到:“伤寒第一天太阳受邪,第二天阳明受邪,第三天少阳受邪。”又说:“伤寒三天后,若出现阳明脉大。”如果到了第三天,见到的是少阳的细脉,而没有出现阳明的洪大脉,这说明病邪没有传入阳明的腑,而是疾病将要自愈。这与《太阳篇》中“伤寒第一天,太阳经受邪,如果脉象平静不变,说明病邪不传变”的道理是相同的。这是说六经的病邪都遍历了一遍,但邪气没有向体内深层传变,身体自然可以通过出汗而解表痊愈。
伤寒病经过三天,三阳经的病邪已经走完,接下来应该是三阴经受邪。如果病人反而能够进食,并且没有呕吐,这说明三阴经没有受到邪气侵袭。
伤寒病第一天,病邪在一经;到第六天,六经的病邪都遍历一遍,此时正气恢复,邪气退却,通过出汗而痊愈。那些没有在预期时间内痊愈的,是因为阳气偏盛,病邪就传入阳明的腑;阴气偏盛,病邪就传入三阴的脏。少阳位于阳明和三阴(此处指太阴等)之间。如果阳气偏盛,病邪就传入腑;如果阴气偏盛,病邪就传入脏。在伤寒第三天的时候,病位在少阳,此时如果少阳脉象细小,说明病邪没有传入阳明的腑,这意味着阳气没有偏盛。如果导致阴气偏盛,病邪本应传入三阴的脏。此时三阳经的病邪既已尽,三阴经本该受邪。但如果病人反而能进食且不呕吐,这说明三阴的脏没有接受外邪。再等待三天,病邪只传入三阴的经,身体自然应当通过出汗而痊愈。
太阴病表现为腹部胀满、呕吐、饮食不下,这是脏病而不是经病。所以张仲景说:“因为脏里有寒的缘故。”《阳明篇》所说的都是腑病(其经病都有相应的腑证),《三阴篇》所说的都是脏病,并非单纯的经病。阴阳平和,脏腑功能正常,病邪可以不传经,这是必然的道理。所谓“发于阳者七日愈,发于阴者六日愈”,这是必然的定数。六经的经证总纲都在太阳一经之中。凡是中风病,在六天之内,不论在哪一经,都适宜用桂枝汤;伤寒病在六天之内,不论在哪一经,都适宜用麻黄汤。只有当病邪入脏入腑时,阴阳偏胜,痊愈的时间就不一致,治疗方法也变化无穷了。大概是因为病邪入脏入腑之后,太阳表的证候才罢休;如果不入脏腑而在经络,太阳表的证候绝不会突然罢休,只是表现为其他经络的表证而已。所谓的“表”,仅仅指皮毛这一层。皮毛腠理一旦开通,太阳经的病邪就罢休了,那么其他经络的病邪怎么会不罢休呢?如果皮毛未开,太阳经的病邪凭什么会突然罢休?正因为太阳经的病邪未罢,所以当六经病邪都结束时,总宜使用麻黄汤或桂枝汤。程氏认为:“伤寒第一天,太阳经受邪,如果脉象平静,说明不传变;伤寒第三天,少阳脉小,说明病欲愈;伤寒第三天,三阴本该受邪,如果病人反而能食不呕,说明三阴不受邪。如果是这样,连经病都不传变,这真是荒谬至极。”
If, after three days of Taiyang cold damage (Shanghan), the Shaoyang pulse is small, it indicates that the disease is about to resolve.
In the Yangming Chapter, it states: "On the first day of cold damage, the Taiyang channel is affected; on the second day, the Yangming channel; on the third day, the Shaoyang channel." It also says: "After three days of cold damage, if the Yangming pulse is large." If, on the third day, a small Shaoyang pulse is observed instead of a large Yangming pulse, it signifies that the pathogenic factor has not transmitted into the Yangming fu-organ, and the illness is likely to heal spontaneously. This aligns with the principle in the Taiyang Chapter: "On the first day of cold damage, when the Taiyang channel is affected, if the pulse remains quiet/stable, it indicates no transmission." This implies that although the pathogenic factors have traversed all six channels, they have not transmitted inward to the interior, allowing the body to resolve the condition naturally through sweating.
After three days of cold damage, the diseases of the three yang channels are exhausted, and the three yin channels should theoretically be affected. However, if the patient can eat and does not vomit, this indicates that the three yin channels are not affected by the pathogen.
On the first day of cold damage, the pathogen affects one channel; by the sixth day, it has traversed all six channels. At this point, healthy qi recovers, pathogenic factors retreat, and resolution occurs through sweating. Those who do not resolve within the expected timeframe do so because excess yang causes transmission into the Yangming fu-organs, while excess yin causes transmission into the zang-organs of the three yin. Shaoyang lies between Yangming and the three yin (specifically Taiyin). Excess yang leads to transmission into the fu; excess yin leads to transmission into the zang. On the third day of cold damage, when the pathology is in Shaoyang, a small Shaoyang pulse indicates that the pathogen has not transmitted into the Yangming fu-organ, suggesting that yang is not in excess. If yin were in excess, the pathogen would enter the zang-organs of the three yin. Since the three yang channels are exhausted, the three yin should be affected. Yet, if the patient can eat and does not vomit, it shows that the zang-organs of the three yin have not accepted the external pathogen. After waiting another three days, if the pathogen only transmits to the meridians of the three yin, the body should naturally resolve through sweating.
Taiyin disease manifests as abdominal fullness, vomiting, and inability to eat, which constitutes a zang-organ disease rather than a meridian disease. Therefore, Zhang Zhongjing stated: "This is due to cold in the zang-organs." The Yangming Chapter discusses fu-organ diseases (meridian diseases have corresponding fu-organ manifestations), while the Three Yin Chapters discuss zang-organ diseases, not merely meridian diseases. When yin and yang are balanced and the zang-fu organs function harmoniously, the pathogen may fail to transmit, which is an inevitable principle. It is said: "Diseases originating from yang heal in seven days; diseases originating from yin heal in six days." This is a fixed numerical rule. The general principles of meridian diseases in the six channels are summarized under the Taiyang channel. For wind-strike (Zhongfeng) occurring within six days, regardless of the affected channel, Guizhi Tang (Cinnamon Twig Decoction) is appropriate. For cold damage occurring within six days, regardless of the channel, Mahuang Tang (Ephedra Decoction) is appropriate. Only when the pathogen enters the zang or fu organs do yin and yang become imbalanced, leading to variable healing times and infinitely changing treatment methods. Generally, once the pathogen enters the zang or fu, the Taiyang exterior syndrome ceases. If the pathogen remains in the meridians without entering the zang or fu, the Taiyang syndrome will not suddenly cease; rather, it presents as exterior syndromes of other meridians. The term "exterior" refers solely to the skin and hair follicles. Once the pores open, the Taiyang pathogen resolves, and consequently, the pathogen in other meridians also resolves. If the pores remain closed, how could the Taiyang pathogen suddenly cease? Because the Taiyang pathogen has not ceased, when the diseases of all six channels are exhausted, Mahuang Tang or Guizhi Tang should generally be used. Cheng Shi argued: "On the first day of cold damage, Taiyang is affected; if the pulse is quiet, there is no transmission. On the third day, a small Shaoyang pulse indicates impending resolution. On the third day, the three yin should be affected; if the patient eats well and does not vomit, the three yin are unaffected. If this were true, even meridian transmission would cease, which is utterly absurd."