少阳与厥阴为表里。木火之邪。无处发泄。势必连及于肝。此表里俱病。法当从少阳治。以引阴出阳。
邵评∶木火之邪。连及厥阴。表病及里也。少阳病入厥阴。由表及里。治法当使其邪仍从少阳外出为妥。
如见舌起红刺。或黑中有红点。外症发热恶寒。如疟状。手足乍温乍冷。烦满。消渴
谵语。二便不通。脉弦而数。方用柴芩、川连、鲜地、丹皮、栀子、钩丁、薄荷等。以散风木
之郁。使邪复出少阳而解。（温病）
邵评∶少阳温病。木火郁。邪转入厥阴。表与里同病也。其邪尚轻。故用清散少阳。使邪外出。
撰伤寒书者。每于三阴或热或寒之故。都模糊过去。即有传经直中之分。亦非仲
景本旨。此处不明。何以临症。用陈鄙见。质诸高明。
一、三阴。有阳经注入之邪。有本经自感之邪。注入之邪。则传变不一。阳主动也。自
感之邪。则在本经。阴主静也。
邵评∶传经自受。是邪入三阴之两大法门。
一、三阴。世都以传经直中分两门。传经悉指为热。直中悉指为寒。此说似是而实
有未尽者。夫传经。即邪从三阳经传入。直中。即本经自受之风寒也。盖邪之传入三阴。热症固多。而寒
症亦间有。本经中寒。固无热症。而中风亦能发热。未可以此分寒热了之。其症细述于左。
邵评∶不可以传经自受。分其寒热者。以阴经寒邪。不能发热。阴经风邪。亦有发热也。
一、邪从阳经注入三阴。则或为热症。或为寒症。如邪入太阳。先作郁热。以次传入阴经。则
为热症。或邪在太阳。不及郁热。即入少阴。而现少阴形证。则为寒症。或太阳之邪。即入少阴。
而仍带太阳标病。则为先寒后热之症。或太阳之邪。不传阳明少阳。便入三阴。随其人之体质虚实。
脏腑寒热。则从阴化为寒症。从阳化为热症。或风温之邪。从三阳入阴经。则无不为热症。凡三阴篇
内。所称转属阳明。而用承气等汤。皆阳经传入之热症也。
邵评∶邪入三阴。或寒或热之故。分别详明。
一、三阴自受之邪。各有中风中寒之症。三阴中风。则能发热。以风属阳邪故也。三
阴中寒。则不能发热。以寒属阴邪故也。即少阴有反热之症。亦必带太阳标病而
然。后人但知传入三阴为伤寒。不知三阴自感。亦伤寒也。故于本经中风发热。便
误认为传经标病。以本脏中寒无热。即指为直中阴症。讵知桂枝汤为表之里药。固能兼治三阴自感之风邪。
而理中四逆等汤。本治三阴自感之寒邪也耶。盖风寒六气之伤人。或入于阳。或入于阴。原无一定。
但值何经之虚而治之。不得专以太阳为受邪之始也。故三阴固有阳经注入之症。亦有本经自感之症。均
属伤寒。不必另立名目也。兹于三阴经中无直中之条。非略也。正不敢蛇足耳。
邵评∶三阴自受寒邪。不能发热。三阴自受风邪。亦能发热。不可因其有热。误认为阳经传入之热症也。
惟三阴自受风邪。宜桂枝汤和表。自受寒邪。用理中四逆温里。
一、三阴自受之邪。论中有可历指而见者。如太阴病。脉浮者可发汗。宜桂枝汤。此太阴中风也。如
太阴病。腹满而吐。自利益甚。时腹自痛。此太阴中寒之症也。如少阴中风。脉阳微阴浮者。为欲愈。此
即少阴中风欲愈之脉也。至于少阴中寒。宜汗者。麻黄附子细辛汤。当温者。附子四逆等汤是也。如厥阴中
风。脉微浮为欲愈。此即厥阴中风欲愈之脉也。厥阴中寒。即当归四逆加吴萸生姜汤是也。阅少阴厥
阴篇内。止有中风欲愈之脉。并无未愈之证治者。必有阙文也。
邵评∶此论三阴自受风寒脉症治法。分别精细。
一、三阴篇内。惟少阴有大承气急下三症。而太阴厥阴篇内。并无承气之条。奈何
后人反称邪在厥阴。三承气选用。夫承气。本阳明胃药。少阴用承气者。盖因肾水一亏。胃土燥实。病已
转属阳明。故急下以存阴液。仲景述厥阴病云。下之利不止。此厥阴忌下之明戒也。焉有邪在厥阴。
反用承气之理。圣训具在。是非自见。
邵评∶论三阴热邪结实。可用承气攻下之法。否则切不可用之理。分别甚精。
少阳经与厥阴经互为表里关系。木火性质的病邪，如果无处发泄，必然会牵连到肝脏。这属于表里两经同时患病，治疗法则应当从少阳经入手治疗，以引导阴经的病邪转出到阳经而解。
邵评：木火性质的病邪，牵连到厥阴经，这是表证波及里证。少阳病传入厥阴，是由表及里的过程，治疗方法应当使病邪仍然从少阳经向外透散才妥当。
如果出现舌面上长出红色刺状物，或者舌苔黑中带有红点，外部症状表现为发热恶寒，像疟疾发作的样子，手足时而温暖时而发冷，心烦胸满，口渴多饮，胡言乱语，大小便不通畅，脉象弦且数。方剂选用柴胡、黄芩、黄连、鲜地黄、牡丹皮、栀子、钩藤、薄荷等药物。用以疏散风木之气的郁结，使病邪重新透出少阳经而解除。（此为温病范畴）
邵评：少阳温病，因木火之气郁结，病邪转入厥阴经，表证与里证同时存在。此时病邪尚轻，所以使用清解发散少阳的方法，使病邪向外透散。
撰写伤寒著作的人，对于三阴经病症或热或寒的原因，往往含糊带过。即使有传经和直中的区分，也不是张仲景的本意。这里如果不明白，怎么能在临症时应用？现提出我浅陋的见解，向高明之士请教。
第一，三阴经的病症，有来自阳经注入的病邪，也有本经直接感受的病邪。注入的病邪，传变情况不一，因为阳主动；本经直接感受的病邪，则停留在本经，因为阴主静。
第一，世人通常将三阴经病症分为传经和直中两门。传经全指为热证，直中全指为寒证。这种说法看似有理但实际上并不全面。所谓传经，即病邪从三阳经传入；所谓直中，即本经直接感受的风寒。大概病邪传入三阴经，热证固然多见，但寒证也偶尔存在。本经中寒，固然没有热证，但中风也能引起发热，不能仅凭这一点来区分寒热。具体症状详细叙述如下。
邵评：不能简单地根据传经或自受来划分寒热，因为阴经感受寒邪不能发热，但阴经感受风邪也会有发热现象。
第一，病邪从阳经注入三阴经，那么或者是热证，或者是寒证。例如病邪进入太阳经，先产生郁热，然后依次传入阴经，就成为热证。或者病邪在太阳经，来不及形成郁热，就进入少阴经，并呈现少阴经的症状，就成为寒证。或者太阳经的病邪，直接进入少阴经，但仍然带有太阳经的标病（表象），就成为先寒后热的症状。或者太阳经的病邪，不传阳明、少阳经，就直接进入三阴经，随着患者体质的虚实、脏腑的寒热不同，就会转化为寒证（从阴化）或热证（从阳化）。或者风温病邪，从三阳经进入阴经，则无不是热证。凡是在三阴篇内，所称转属阳明经，并使用承气汤等方剂的，都是阳经传入的热证。
邵评：对病邪进入三阴经后，或寒或热的原因，分别阐述得非常详细明确。
第一，三阴经直接感受的病邪，各有中风和中寒的症状。三阴经中风，就能发热，因为风属于阳邪。三阴经中寒，就不能发热，因为寒属于阴邪。即使是少阴经出现反常发热症状，也必定带有太阳经的标病才会如此。后人只知道病邪传入三阴经称为伤寒，不知道三阴经直接感受外邪也是伤寒。所以对于本经中风发热，便误认为是传经的标病；因为本脏中寒没有热象，就指为直中阴症。哪里知道桂枝汤是治表之里的药物，本来能兼治三阴经直接感受的风邪；而理中汤、四逆汤等，本来就是治疗三阴经直接感受的寒邪的。大概风寒六气伤人，有的侵入阳经，有的侵入阴经，原本没有定规。只是遇到哪条经脉虚弱就治疗哪条经脉，不能专门以太阳经作为受邪的开始。所以三阴经既有阳经注入的病症，也有本经直接感受的病症，都属于伤寒，不必另外设立名目。现在在三阴经中没有单独列出“直中”的条目，并不是遗漏，正是不敢画蛇添足罢了。
邵评：三阴经直接感受寒邪，不能发热；三阴经直接感受风邪，也能发热。不能因为有发热，就误认为是阳经传入的热证。只有三阴经直接感受风邪，宜用桂枝汤调和表邪；直接感受寒邪，用理中汤、四逆汤温补里虚。
第一，三阴经直接感受的病邪，在《伤寒论》中有可以明确指出看到的。例如太阴病，脉浮的可以发汗，宜用桂枝汤，这就是太阴中风。例如太阴病，腹部胀满且呕吐，腹泻日益严重，时常腹痛，这就是太阴中寒的症状。例如少阴中风，脉象寸微尺浮的，是快要痊愈，这就是少阴中风欲愈的脉象。至于少阴中寒，宜用汗法的，是麻黄附子细辛汤；当用温法的，是附子四逆汤等。例如厥阴中风，脉微浮是快要痊愈，这就是厥阴中风欲愈的脉象。厥阴中寒，就是当归四逆加吴茱萸生姜汤。阅读少阴、厥阴篇内，只有中风欲愈的脉象，并没有未愈的证治条文，一定有缺漏的文字。
邵评：这段论述了三阴经直接感受风寒的脉象、症状和治疗方法，分辨得非常精细。
第一，在三阴篇内，只有少阴经有大承气汤急下的三个症状，而太阴、厥阴篇内，并没有使用承气汤的条文。为什么后人反而称病邪在厥阴经，可以选用三承气汤呢？夫承气汤本是治疗阳明胃腑实热的药，少阴经使用承气汤，是因为肾水一旦亏损，胃土燥实，病已经转属阳明经，所以急下以保存阴液。张仲景论述厥阴病说：“下之利不止”，这是厥阴经禁忌攻下的明确告诫。哪有病邪在厥阴经，反而使用承气汤的道理。圣人的训诫都在那里，是非自然分明。
Shaoyang (Lesser Yang) and Jueyin (Terminal Yin) have a exterior-interior relationship. When pathogenic factors of the Wood-Fire nature have no outlet for discharge, they will inevitably involve the Liver. This constitutes a simultaneous disease of both the exterior and interior. The treatment principle should focus on treating Shaoyang to guide the pathogen from the Yin meridians out to the Yang.
Shao's Commentary: Pathogenic factors of the Wood-Fire nature involving Jueyin represent an exterior condition affecting the interior. When Shaoyang disease transmits to Jueyin, it moves from exterior to interior. The treatment method should aim to allow the pathogen to exit outwardly through Shaoyang, which is appropriate.
If red prickles appear on the tongue, or black coating with red spots is seen, accompanied by external symptoms of fever and aversion to cold resembling malaria, alternating warmth and cold in the hands and feet, irritability and chest fullness, excessive thirst, delirium, and obstruction of urination and defecation, with a wiry and rapid pulse, use a formula containing Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Chuanlian (Coptidis Rhizoma), Xian Di (Rehmanniae Radix Recens), Danpi (Moutan Cortex), Zhizi (Gardeniae Fructus), Gouding (Uncariae Ramulus cum Uncis), and Bohe (Menthae Haplocalycis Herba). These herbs disperse the stagnation of Wind-Wood, allowing the pathogen to re-emerge from Shaoyang and resolve. (This falls under Warm Diseases)
Shao's Commentary: In Shaoyang Warm Disease, due to the stagnation of Wood-Fire, the pathogen transmits to Jueyin, resulting in simultaneous exterior and interior involvement. Since the pathogen is still mild, clearing and dispersing Shaoyang allows the pathogen to exit outwardly.
Authors of Shanghan texts often vaguely pass over the reasons why diseases of the Three Yin meridians are either hot or cold. Even when distinguishing between transmission via meridians and direct strike, this does not reflect Zhang Zhongjing's original intent. Without clarity here, how can one apply this clinically? I present my humble views for discussion with experts.
First, diseases of the Three Yin meridians involve pathogenic factors injected from the Yang meridians and those directly contracted by the meridian itself. Injected pathogens vary in transmission because Yang is dynamic; pathogens directly contracted remain within the meridian because Yin is static.
Shao's Commentary: Transmission via meridians and direct contraction are the two major pathways for pathogens entering the Three Yin meridians.
Second, the world generally divides Three Yin diseases into two categories: transmission via meridians and direct strike. Transmission is entirely attributed to heat, and direct strike entirely to cold. This view seems plausible but is incomplete. Transmission refers to pathogens entering from the Three Yang meridians; direct strike refers to wind-cold directly contracting the meridian. Generally, while heat syndromes are common when pathogens enter the Three Yin, cold syndromes also occur occasionally. Although cold contraction of the meridian typically lacks heat signs, wind contraction can cause fever. Thus, one cannot simply distinguish cold from heat based on this alone. Specific symptoms are detailed below.
Shao's Commentary: One cannot divide cold and heat merely by transmission or direct contraction, as Yin meridians contracting cold cannot generate fever, whereas those contracting wind may exhibit fever.
Third, when pathogens inject from Yang meridians into the Three Yin, they may present as heat or cold syndromes. For instance, if a pathogen enters Taiyang, generates stagnant heat first, and then sequentially transmits to Yin meridians, it becomes a heat syndrome. If the pathogen remains in Taiyang without forming stagnant heat and immediately enters Shaoyin, presenting Shaoyin manifestations, it becomes a cold syndrome. If Taiyang pathogen enters Shaoyin but retains Taiyang superficial symptoms, it presents as alternating cold and heat. If Taiyang pathogen bypasses Yangming and Shaoyang to enter the Three Yin directly, its transformation into cold (from Yin) or heat (from Yang) depends on the patient's constitution (deficiency or excess) and organ temperature status. Wind-Warm pathogens entering Yin meridians from Yang meridians invariably become heat syndromes. All mentions in the Three Yin chapters of transferring to Yangming and using Chengqi Decoctions refer to heat syndromes transmitted from Yang meridians.
Shao's Commentary: The reasons for cold or heat after pathogens enter the Three Yin are explained in detail.
Fourth, pathogens directly contracted by the Three Yin meridians present with wind-strike or cold-strike symptoms. Wind-strike of the Three Yin causes fever because wind is a Yang pathogen. Cold-strike of the Three Yin does not cause fever because cold is a Yin pathogen. Even atypical fever in Shaoyin must be accompanied by Taiyang superficial symptoms. Later practitioners only know that transmission to the Three Yin is called Cold Damage, failing to realize that direct contraction by the Three Yin is also Cold Damage. Therefore, they mistakenly attribute fever from meridian wind-strike to transmitted superficial symptoms, and label cold contraction without fever as direct strike to Yin. They fail to recognize that Guizhi Tang (Cinnamon Twig Decoction), a medicine for the exterior-interior, treats wind pathogens directly contracted by the Three Yin; and Lizhong Decoction (Regulate the Middle Decoction) and Sini Decoction (Frigid Extremities Decoction) treat cold pathogens directly contracted by the Three Yin. Wind, cold, and other six qi pathogens attack either Yang or Yin meridians without fixed rules. Treatment targets the deficient meridian, rather than assuming Taiyang is always the starting point. Thus, the Three Yin have both injected symptoms from Yang meridians and self-contracted symptoms, all belonging to Cold Damage, requiring no new nomenclature. The absence of specific "direct strike" clauses in the Three Yin chapters is not an omission but a refusal to add superfluous details.
Shao's Commentary: Direct cold contraction of the Three Yin does not cause fever; direct wind contraction may cause fever. Fever should not be mistaken for heat transmitted from Yang meridians. Wind contraction of the Three Yin requires Guizhi Tang to harmonize the exterior; cold contraction requires Lizhong or Sini Decoctions to warm the interior.
Fifth, direct contraction by the Three Yin has identifiable patterns in the text. For example, Taiyin disease with a floating pulse indicates sweating is indicated, suitable for Guizhi Tang; this is Taiyin wind-strike. Taiyin disease with abdominal fullness, vomiting, worsening diarrhea, and periodic abdominal pain is Taiyin cold-strike. Shaoyin wind-strike with a faint pulse at the cun position and floating pulse at the chi position indicates impending recovery. For Shaoyin cold-strike, Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) is used for sweating, while Fuzi Sini Tang (Aconite and Licorice Decoction) is used for warming. Jueyin wind-strike with a faint and floating pulse indicates impending recovery. Jueyin cold-strike is treated with Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang (Angelica Sinensis Decoction for Cold Extremities plus Evodia and Fresh Ginger). The Shaoyin and Jueyin chapters only list pulses for recovery from wind-strike, lacking treatments for unresolved cases, suggesting missing text.
Shao's Commentary: This section carefully distinguishes the pulse, symptoms, and treatments for direct wind and cold contraction of the Three Yin.
Sixth, among the Three Yin chapters, only Shaoyin lists three urgent indications for Da Chengqi Tang (Major Order the Qi Decoction), while Taiyin and Jueyin lack Chengqi references. Why do later practitioners claim Chengqi formulas can be selected for Jueyin? Chengqi formulas treat Yangming stomach excess. Shaoyin uses Chengqi only when Kidney Water is depleted, leading to dryness and excess in Stomach Earth, effectively transferring the disease to Yangming; urgent purging preserves Yin fluids. Zhang Zhongjing warned regarding Jueyin: "Purging leads to unceasing diarrhea," a clear prohibition against purging in Jueyin. There is no logic for using Chengqi when the pathogen is in Jueyin. The Master's teachings are clear; right and wrong are evident.
Shao's Commentary: This discusses the precise distinction between using Chengqi for solidified heat in the Three Yin versus the prohibition against its use otherwise.