【纲】仲景曰。太阳病欲解时。从巳至未上。阳明病欲解时。从申至戌上。少阳病欲解时。从
寅至辰上。太阴病欲解时。从亥至丑上。少阴病欲解时。从子至寅上。厥阴病欲解时。从丑至卯
上。
【目】柯琴曰。巳午为阳中之阳。故太阳主之。至未上者。阳过其度也。申酉为阳明之时。即
日晡也。凡称欲解者。俱指表而言。如太阳头痛自止。恶寒自罢。阳明则身不热。不恶寒也。寅卯
主木。少阳始生。即少阳主时也。主气旺则邪自解矣。辰上者。卯之尽。辰之初也。经曰。合夜至鸡鸣。
天之阴。阴中之阴也。脾为阴中之至阴。故主亥子丑时。天以一生而开于子。故少阴主于子。木克
丑旺于寅时。故厥阴主丑寅卯三时。
【纲】仲景曰。凡病。欲知何时得。何时愈。答曰。假令夜半得病者。明日日中愈。日中得病者。夜半
愈。何以言之。日中得病夜半愈者。以阳得阴则解。夜半得病明日日中愈者。以阴得阳则解也。
【目】柯琴曰。发于阳者七日愈。发于阴者六日愈。以阳数七阴数六故。是论日期合阴阳之数
而愈。此论愈时于阴阳反盛时解。何也。阴盛极而阳生。阳盛极而阴生。阴阳之相生。正阴阳之相
得。即阴阳之自和也。然此指病在一二日愈者言耳。如六七日愈者。则六经各以主时解。是又阳主
昼而阴主夜矣。
【纲】仲景曰。脉病。欲知愈未愈者。何以别之。答曰。寸口关上尺中三处。大小浮沉迟数
同等。虽有寒热不解者。此脉为阴阳和平。虽剧。当愈。
【目】王肯堂曰。针经云。寸口人迎。两者相应若引绳。大小齐等者。名曰平人。言手之寸口脉。
与喉旁之人迎脉等齐。为平人。他条云。六脉阴阳俱停。必先振栗汗出而解者是也。
鳌按。脉三处同等。只是纯阴纯阳偏胜之脉。是仍为病脉。是寒热不解。病犹未愈之脉。故阴
阳和平四字。并非阴阳调和之义。曰和者。言或纯阴。或纯阳。无乖戾之象。曰平者。言纯于阴。纯
于阳。无驳杂之形也。然曰纯阴。究竟偏于阴矣。曰纯阳。究竟偏于阳矣。故非调和之义也。虽剧
当愈者。偏阴则阴剧。治其阴之剧。则阴之病当愈。偏阳则阳剧。治其阳之剧。则阳之病当愈。正
欲医者知此为阴阳偏之脉。而急早治之也。
【纲】仲景曰。欲自解者。必当先烦。乃有汗而解。何以知之。脉浮。故知汗出解也。
【目】魏荔彤曰。此与太阳病欲解时从巳至未上一条。教人于愈期愈时之际。当明辨其是传经
尽。不复再传否也。于何辨其传不传。解则不传。于何辨其解不解。汗则解。于何辨其汗不汗。先
烦则汗。于何辨其欲汗之先烦。脉浮则先烦。为欲汗之烦。而非入里之烦。伤寒原无汗。犹可以知
其汗而解。伤寒原有汗。何以知其汗为必解之汗乎。故当于脉浮二字求之。而忽浮之脉。必非入里。
伤风原脉浮有汗之症。忽添一烦。又不见入里之脉。则为欲解。然则入里之脉。数急是也。此烦
与烦躁之烦不同。脉静者为不传也。脉数急者为传也。
【纲】仲景曰。风家表解而不了了者。十二日愈。
【目】魏荔彤曰。此明太阳中风病愈后。风邪留滞之症。当听其自愈。不必妄治也。十二日愈
者。六七日推之也。七日愈者。太阳中风也。连病愈之日计之。更得六日。其实五日。除此病愈之
后。阴气复于六。而神清气爽矣。
【纲】仲景曰。阳明病。胁下硬满。不大便而呕。舌上白苔者。可与小柴胡汤。上焦得通。津
液得下。胃气因和。身 然而汗出解也。
【目】魏荔彤曰。胁下硬满。较胸胁满少甚。且不大便而呕而舌苔。是阳明病胃已成实。而邪
复转传少阳也。诸症中。惟不大便为正阳阳明。余皆少阳阳明病。是病在正阳阳明。较前已甚。即
病入少阳阳明。较前更深。但俱属未全成少阳也。仍与小柴胡和解。使正阳之邪。由少阳出。胃不
成实。阳明得罢。总无异也。上焦得通四语。又言邪之结于有形者。随津液下而由肠以泄。邪之溷
于无形者。随汗而由表以透。此所以正阳阳明之邪。由少阳阳明半表半里以和解为其出路。一同于
尽传少阳治之之法也。又何必俟传少阳而后施治哉。
鳌按。喻嘉言谓上焦得通。津液得下八字。关系病机最切。诚哉言也。其意以风寒聚膈中。必
挟津液而成喘逆呕痞诸症。故上焦风寒不解。则津液必不得下。惟和之于中。而上焦通矣。上焦通而津液亦和而
下矣。喻又推言杂病。如痰火哮喘咳嗽瘰 等症。皆火势熏蒸日久。顽痰胶结经隧。所以火不内熄。
则津液必不能下灌灵根。而清华尽化为腐浊。此旨更精。盖人之生。全赖得水谷之气以化。津
液流贯肢体。若结则病。竭则死矣。凡治病者。可不以救人之津液为急急哉。
【纲】仲景曰。凡柴胡汤病症而下之。若柴胡症不罢者。复与柴胡。必蒸蒸而振。却发热汗出
而解。凡病。若发汗。若吐。若下。若亡津液。阴阳自和者。必自愈。伤寒三日。少阳脉小者。欲已
也。
【目】魏荔彤曰。首条。言少阳误下而症不罢。是下之误未及于病也。复与柴胡何疑焉。特以
误下伤正。故见蒸蒸而振之虚象。然阳升表透。阴降里和。少阳之病亦解矣。二条。少阳为病。必
自太阳阳明递传而来。积日必久。治不合宜。顺逆之故已明之。然有治虽逆而病不为逆。则必秉质
浓。血气充。故药邪不能使病邪浸加。正气且能驱病邪渐去。故虽误于汗吐下亡津液。其人阴阳之脉和平。必当自愈。
而毋庸好事妄治也。曰凡病者。虽言少阳。实统三阳。并六经。且及百病言之。故不专曰少阳。
曰伤寒也。三条。脉不弦大而小。邪微欲解之先兆也。
【纲】仲景曰。太阴中风。四肢烦疼。阳微阴涩而长者。为欲愈。
【目】魏荔彤曰。四肢烦疼。阳微发热。阴涩汗出。纯乎太阳中风矣。然腹满时痛。下利。吐
不能食。如故。是非太阳中风宜表散者。乃太阴病而类于太阳之中风。有阴症欲还复于阳症之机也。
若脉并见长。则邪自太阴欲还少阳必矣。经邪内陷。因有腹满等症。若经邪欲出。则症见四末。
而不久于内陷可知矣。于是阳微阴涩。邪已有渐透营卫之势。兼以弦长脉见少阳之门户辟而生发之
气已动矣。更得四末之间。蠢然烦疼。汗出发热。邪纯回太阳矣。曰。为欲愈。亦见太阴之邪。必由少
阳越太阳而出也。至脉见长。在阳明篇屡言之。曰。脉弦者生。长即弦也。在阳明以少阳为出
路者。见弦长为生机。岂太阴亦以少阳为出路者。见弦长有异哉。此余言长脉之据也。
【纲】仲景曰。少阴中风。阳微阴浮者。为欲愈。
【目】魏荔彤曰。少阴病。不外直中传经寒热二邪。然于其入也。分寒热必清。于其外也。则
不必分寒热。竟言出而得愈而已。然其症脉。亦必明辨之。本少阴病也。何忽类太阳之中风。少阴
有直中之寒。无直中之风。如有直中之风。则自为风中肾脏之症。与伤寒中之传经热邪。固不相涉。
即与直中寒邪。亦不相干。今曰少阴中风。乃少阴症忽变为似乎太阳之中风也。何以见之。以其
热自发而汗自出也。少阴病。反发热。反汗出。乃内真寒。外假热。直中寒邪内所有之症。此条未
言发热汗出。而余言之。非杜撰也。乃原文中所有也。何言之。以脉见阳微阴浮。而知必发热汗出
也。在少阴直中寒邪之脉见沉紧。是阳紧而阴沉也。在少阴传经热邪之脉见沉数。是阳沉而阴数也。
今阳见微。是不紧也。原为直中之寒邪将散。故变紧为微。且不沉也。原为传经之热邪将散。故
变沉为微也。且阴见浮。是不沉也。原为直中之寒邪将散。故变沉为浮。且不数也。原为传经之热
邪将散。故变紧为浮也。此足见少阴病不论寒邪热邪。见此阳微阴浮。俱为欲愈之机矣。又何以知
其发热汗出也。太阳论曰。阳浮者热自发。阴弱者汗自出。少阴见阳微。即太阳之浮脉也。再阴脉
浮而不沉。非弱之义乎。发热则阴寒已微。况脉不见沉紧。则非内阴逼阳于外之反发热也。汗出则
里病已除。脉又不见沉细。则非阴盛逼阳出亡之汗自出也。于此知其阴病转阳。里邪透表。必发热
汗出。见欲愈之神理也。
【纲】仲景曰。厥阴中风。脉微浮。为欲愈。不浮。为未愈。
【目】魏荔彤曰。此言厥阴病得愈之脉。本厥阴病。脉应沉中见紧。或见数。俱非微脉。亦有
阳微而脉微者。则浮沉取之皆微。今沉取不见紧数。知阴分之邪已杂。浮取见微。知阳分之表欲透。
此微即太阳中风之阳浮而阴弱也。本厥
阴病。若真中风。自有口眼歪斜等症。今脉微浮。既非无根之阳外脱。亦非厥阴之阳内陷。是厥阴之邪
随阳。气由少阳达太阳。欲愈之机也。故可以厥阴中风名其病。见阳升邪脱。可识经尽得解之候也。
是全于浮之一诊决之。浮则愈。不浮则未全愈。邪透表则愈。邪未全透表则病未全已。桂枝汤。
正吃紧法矣。
【纲】仲景曰。问曰。病有战而汗出。因得解者。何也。答曰。脉浮而紧。按之反芤。此为本
虚。故当战而汗出也。其人本虚。是以发战。以脉浮。故当汗出而解。若脉浮而数。按之不芤。此
人本不虚。若欲自解。但汗出耳。不发战也。
【目】柯琴曰。治病必求其本。本者。其人平日禀气之虚实。紧者。急也。与数同而有别。盖
有虚实之分焉。又必按之芤不芤。而虚实之真伪毕见。
【纲】仲景曰。病有不战而汗出解者。何也。答曰。脉大而浮数。故知不战汗出而解也。
问曰。病有不战不汗出而解者。何也。答曰。其脉自微。此以曾经发汗。若吐。若下。若亡血。
以内无津液。待阴阳自和。必自愈。故不战不汗出而解也。
【目】王好古曰。战而后解者。太阳也。不战有汗而解者。阳明也。不战无汗而解者。少阳也。
【纲】仲景曰。问曰。伤寒三日。脉浮数而微。病患身凉和者。何也。答曰。此为欲解也。解以夜半。脉
浮而解者。 然汗出也。脉数而解者。必能食也。脉微而解者。必不汗出也。
【目】鳌按。太阳脉本浮数。三日转微。即伤寒三日。少阳脉小为欲愈之义也。盖此条微字。
与上其脉自微不同。以上是妄治后亡阳之微。此则未经妄治。故必不汗而三日自解也。
【纲】仲景曰。太阳病。未解。脉阴阳俱停。必先振栗汗出而解。但阳脉微者。先汗出而解。
但阴脉微者。下之而解。若欲下之。宜调胃承气汤。凡病。反能饮水者。为欲愈。
【目】王好古曰。太阳传阳明。其中或有下症。阳明症反退。而无热与不渴。却显少阳症。是
知可解也。太阳症知可
解者。为头不疼。项不强。肢节不痛。则知表易解也。阳明症知可解者。为无发热恶热。则知里易
解也。少阳症知可解者。寒热日不移时而作。邪未退也。若用柴胡而早晚得移其时。是邪无可容之
地。知可解也。
可解之脉。浮而虚。不可解之脉。浮而实。浮而虚者只在表。浮而实者知已在里也。汗多不解
者。转属阳明也。
闵芝庆曰。七日病愈论曰。夫六经以渐受病。其愈皆以七日为期。阳数七故也。伤寒例曰。其不
两感于寒。更不传经。不加异气者。至七日。太阳病衰。头痛可愈也。八日。阳明病衰。身热可歇
也。九日。少阳病衰。耳聋微闻也。十日。太阴病衰。腹减如故。思饮食也。十一日。少阴病衰。
渴止舌干。已而嚏也。十二日。厥阴病衰。囊纵。少腹微下。大气皆去。病患精神爽慧也。此论六经
七日病愈。本之素问热病篇。奈彼此注释者。皆不能无误。旨未明也。敢重释之。曰。其者。指伤
寒也。不两感于寒者。非日传二经之症也。更不传经者。邪在此经。更不传彼经也。不加异气者。伤
寒病热。不重感寒、感风、感温、感热、感湿。而变为他病也。夫如是。则可期六经愈日矣。太阳
篇曰。发于阳者七日愈。以是数计之。乃知六经之病。自一日受者。七日当衰。二日受者。至八
日亦是七日而当衰。故七日邪在太阳。幸而更不传阳明。更无变症。则至七日。太阳病衰。头痛少
愈。如或二日。邪传阳明。更不传变。至八日。阳明病衰。身热少歇。又或三日。邪传少阳。更不传变。至九日。少阳
病衰。
耳聋微闻。又如四日。邪传太阴。更不传变。至十日。太阴病衰。腹减如故。思饮食。又或五日。
邪传少阴。更不传变。至十一日。少阴病衰。渴止舌干。已而嚏。又或六日。邪传厥阴。经尽。
更不传变。大气皆去。精神爽慧。此二句总承六经而言。如在太阳。更不传变。当七日病衰。头痛
少愈。渐而大气皆去。头痛悉除。精神爽慧也。余经不传之例同。成氏注曰。六经传遍。则与更不传
经之句背矣。素问注证七日巨阳病衰。头痛少愈。止以初时所感之邪太甚。既于二日传之阳明矣。
而其未尽传者。尚在太阳。则至此而比之一日之际。少愈焉。果如传之阳明云云。则由此而六日
传至厥阴。为传经尽。将曰七日传何经。其未尽传者。尚在厥阴。至十二日比之六日之际。
少愈焉。又思果
【纲】张仲景说：太阳病（太阳经受邪所致的病证）想要缓解的时间，是从巳时到未时这段时间。阳明病（阳明经受邪所致的病证）想要缓解的时间，是从申时到戌时这段时间。少阳病（少阳经受邪所致的病证）想要缓解的时间，是从寅时到辰时这段时间。太阴病（太阴经受邪所致的病证）想要缓解的时间，是从亥时到丑时这段时间。少阴病（少阴经受邪所致的病证）想要缓解的时间，是从子时到寅时这段时间。厥阴病（厥阴经受邪所致的病证）想要缓解的时间，是从丑时到卯时这段时间。
【目】柯琴说：巳时和午时是阳中之阳，所以由太阳主司。到了未时之上，说明阳气超过了其正常限度。申时和酉时是阳明的时候，也就是日晡时分。凡是说“欲解”的，都是指表证而言。比如太阳病的头痛自然停止，恶寒自然消失；阳明病则是身体不发热，不恶寒。寅时和卯时主木气，少阳初生，所以少阳主司这个时辰。当主令之气旺盛时，邪气自然解除。辰时之上，是卯时的结束、辰时的开始。医经说：从黄昏到鸡鸣，是天的阴气，属于阴中之阴。脾脏为阴中之至阴，所以主司亥、子、丑三个时辰。天以一生水而开启于子时，所以少阴主司子时。木气克制丑土而旺于寅时，所以厥阴主司丑、寅、卯三个时辰。
【纲】张仲景说：大凡疾病，想知道何时得病、何时痊愈，回答说：假如在夜半得病，第二天日中就会痊愈；在日中得病，夜半就会痊愈。为什么这样说？在日中得病而在夜半痊愈的，是因为阳气得到阴气的制约而解除；在夜半得病而在第二天日中痊愈的，是因为阴气得到阳气的资助而解除。
【目】柯琴说：发于阳经的病七天痊愈，发于阴经的病六天痊愈，这是因为阳数七、阴数六的缘故。这是论述日期符合阴阳之数而痊愈。这里论述的是在阴阳反盛之时解除。为什么呢？因为阴盛极则阳生，阳盛极则阴生。阴阳的相生，正是阴阳的相得，也就是阴阳的自和。然而这指的是发病一两天就痊愈的情况。如果是六七天痊愈的，那么六经各自以其主时来解除，这又是阳主昼、阴主夜的道理了。
【纲】张仲景说：脉象与病症，想知道是否痊愈，如何辨别呢？回答说：寸口、关上、尺中三处脉象，大小、浮沉、迟数完全同等，即使有寒热症状没有解除，这种脉象称为阴阳和平，虽然病情严重，也应当痊愈。
【目】王肯堂说：《针经》说：寸口与人迎两处脉象，相互呼应如同拉紧的绳子，大小整齐相等，称为平人。意思是手部的寸口脉与喉旁的人迎脉等齐，就是平人。其他条文说：六脉阴阳俱停，必定先出现振栗出汗而后解除，说的就是这个情况。
沈金鳌按语：脉象三处同等，只是纯阴或纯阳偏胜的脉象，这仍然是病脉，是寒热不解、病犹未愈的脉象。所以“阴阳和平”这四个字，并不是阴阳调和的意思。说“和”，是指或者纯阴，或者纯阳，没有乖戾之象；说“平”，是指纯于阴，纯于阳，没有驳杂之形。然而说是纯阴，终究偏于阴；说是纯阳，终究偏于阳。所以并非调和之义。所谓“虽剧当愈”，偏阴则阴邪剧烈，治疗其阴邪之剧烈，则阴病当愈；偏阳则阳邪剧烈，治疗其阳邪之剧烈，则阳病当愈。这正是希望医生知道这是阴阳偏胜的脉象，而及早治疗。
【纲】张仲景说：想要自行解除的，必定先出现烦闷，然后才有汗出而解。怎么知道呢？因为脉象浮，所以知道会汗出而解。
【目】魏荔彤说：这与“太阳病欲解时从巳至未上”这一条一样，教导人们在预计痊愈的时期和时间，应当明辨这是传经尽而不复再传，还是仍在传变。从哪里辨别传还是不传？如果解除就不传。从哪里辨别解还是不解？如果有汗出就是解。从哪里辨别有汗还是没有汗？如果先烦闷就有汗。从哪里辨别想要出汗前的烦闷？如果脉浮就是先烦闷。这种因欲出汗而产生的烦闷，而不是邪气入里的烦闷。伤寒原本无汗，还可以知道它会通过汗出而解；伤寒原有汗出的，怎么知道这种汗出是必然能解的汗呢？所以应当在“脉浮”二字上寻求答案。忽然出现的浮脉，必定不是邪气入里。伤风原本就是脉浮有汗的症状，忽然增添一个烦闷，又不见邪气入里的脉象，那就是将要自愈。那么邪气入里的脉象，就是数急。这里的烦与烦躁的烦不同。脉静的是不传变。脉数急的是传变。
【纲】张仲景说：患风病的人，表证已解但神志尚不清爽（不了了），十二天后痊愈。
【目】魏荔彤说：这是阐明太阳中风病痊愈后，风邪留滞的症状，应当听任其自愈，不必胡乱治疗。十二天痊愈，是根据七天推算的。七天痊愈的是太阳中风。连同生病和痊愈的日子计算，再多得六天，其实是五天。除了病愈之后，阴气恢复至六，而神清气爽了。
【纲】张仲景说：阳明病，胁下硬满，不大便且呕吐，舌上有白苔的，可以给予小柴胡汤。上焦通畅，津液得以下行，胃气因而调和，身体濈然汗出而解。
【目】魏荔彤说：胁下硬满，比胸胁满胀轻微得多。而且不大便、呕吐、舌苔白，这是阳明病胃已成实，而邪气又转传入少阳。在诸症中，只有不大便是正阳阳明，其余都是少阳阳明病。既然病在正阳阳明，较之前已加重；即使病入少阳阳明，较之前更深，但都属于尚未完全形成少阳病。仍然给予小柴胡汤和解，使正阳之邪，由少阳外出，胃不成实，阳明病得以罢止，总体无异。关于“上焦得通”这四句话，又说邪气结聚在有形之处，随津液下行而从肠道排泄；邪气混杂在无形之处，随汗液从体表透出。这就是正阳阳明的邪气，由少阳阳明半表半里之地通过和解作为出路，与全部传入少阳的治疗方法相同。又何必等到传入少阳后才施治呢？
沈金鳌按语：喻嘉言认为“上焦得通，津液得下”八个字，关系病机最为切要，诚然是这样。他的意思是以风寒聚集在膈中，必定挟带津液而成喘逆、呕吐、痞满等症状。所以上焦风寒不解，津液必定不能下行。只有在中间调和，上焦才能通畅。上焦通畅而津液也就调和而下行了。喻氏又推论杂病，如痰火、哮喘、咳嗽、瘰疬等症状，都是火势熏蒸日久，顽痰胶结在经络隧道中，所以火不内熄，津液必定不能下灌灵根，而清纯之气全化为腐浊。这个宗旨更加精妙。大概人的生存，全靠水谷之气来化生，津液流贯肢体，如果凝结则生病，枯竭则死亡。大凡治病的人，能不把救护人的津液当作急务吗？
【纲】张仲景说：凡是柴胡汤证被误用下法，如果柴胡证没有罢除的，再给予柴胡汤，必定会出现蒸蒸而振栗，随后发热汗出而解。大凡疾病，如果用发汗、催吐、泻下等方法，或者导致津液亡失，只要阴阳自我调和，必定自愈。伤寒三天，少阳脉小的，是病欲愈的征兆。
【目】魏荔彤说：第一条，说的是少阳病误用下法而症状不罢，说明下法的错误没有影响到病机本身。再给予柴胡汤有什么可疑的呢？只是因为误下损伤正气，所以出现蒸蒸而振栗的虚象。然而阳气上升透表，阴气下降里和，少阳的病也就解了。第二条，少阳为病，必定是从太阳、阳明递次传变而来，积日必久，治疗不合宜，顺逆的道理已经讲明了。然而有治疗虽然逆乱而病势不为逆乱的，那一定是禀赋浓厚，血气充盛，所以药邪不能使病邪浸淫加重，正气还能驱赶病邪逐渐离去。所以虽然误用汗、吐、下法导致亡失津液，其人阴阳脉象和平，必定自愈，而无需多事胡乱治疗。说“凡病者”，虽然言及少阳，实则统括三阳，并涉及六经，以及百病而言，所以不只说少阳，也不只说伤寒。第三条，脉不弦大而小，是邪气微弱、病欲解的先兆。
【纲】张仲景说：太阴中风，四肢烦疼，脉象阳微阴涩而长的，是病欲愈。
【目】魏荔彤说：四肢烦疼，阳脉微而发热，阴脉涩而汗出，完全是太阳中风的症状。然而腹满时痛、下利、呕吐不能食等情况依旧，这不是太阳中风适宜用表散法的，而是太阴病类似太阳的中风，有阴证想要回复到阳证的机理。如果脉象并见长脉，那么邪气从太阴想要回归少阳是必然的了。经邪内陷，因为有腹满等症状；如果经邪想要外出，则症状出现在四肢末端，而不久于内陷可知了。于是阳微阴涩，邪气已有渐渐透达营卫之势，兼以弦长脉见于少阳之门户开辟而生发之气已动。再加上四肢之间，蠢然烦疼，汗出发热，邪气纯然回归太阳了。说“为欲愈”，也可见太阴之邪，必定由少阳越过太阳而出。至于脉见长脉，在阳明篇屡次提到，说：“脉弦者生”，长即弦也。在阳明以少阳为出路，见到弦长是有生机，难道太阴也以少阳为出路，见到弦长会有差异吗？这是我论述长脉的依据。
【目】魏荔彤说：少阴病，不外乎直中和传经的寒热二邪。然而在邪气入内时，必须分清寒热；在邪气外出时，则不必分寒热，竟说外出而得愈罢了。然而其症状和脉象，也必须明辨。本是少阴病，为何忽然类似太阳的中风？少阴有直中的寒邪，没有直中的风邪。如果有直中的风邪，那自然是风中肾脏的症状，与伤寒中的传经热邪本不相涉，也与直中寒邪无关。如今说少阴中风，乃是少阴症状忽然变为似乎太阳的中风。凭什么看出来？因为其热自发而汗自出。少阴病，反而发热，反而汗出，这是内真寒、外假热，是直中寒邪内部所有的症状。这条文没有说发热汗出，而我补充言之，并非杜撰，乃是原文中所有。为什么说呢？因为脉见阳微阴浮，就知道必定发热汗出。在少阴直中寒邪的脉象见沉紧，是阳紧而阴沉。在少阴传经热邪的脉象见沉数，是阳沉而阴数。如今阳见微，是不紧了，原为直中的寒邪将散，故变紧为微，且不沉了；原为传经的热邪将散，故变沉为微。且阴见浮，是不沉了，原为直中的寒邪将散，故变沉为浮，且不数了；原为传经的热邪将散，故变紧为浮。这足以见得少阴病不论寒邪热邪，见此阳微阴浮，均为欲愈的机转。又凭什么知道其发热汗出呢？《太阳篇》说：阳浮者热自发，阴弱者汗自出。少阴见阳微，即太阳的浮脉。再阴脉浮而不沉，不是弱的含义吗？发热则阴寒已微，况且脉不见沉紧，则不是内阴逼阳于外的反发热。汗出则里病已除，脉又不见沉细，则不是阴盛逼阳出亡的汗自出。由此知其阴病转阳，里邪透表，必定发热汗出，见到欲愈的神理。
【纲】张仲景说：厥阴中风，脉象微浮的，是病欲愈；不浮的，是未愈。
【目】魏荔彤说：这是说厥阴病得愈的脉象。本是厥阴病，脉应沉中见紧，或见数，都不是微脉。也有阳微而脉微的，则浮沉取之皆微。如今沉取不见紧数，知阴分之邪已杂；浮取见微，知阳分之表欲透。此微即太阳中风之阳浮而阴弱。本是厥阴病，若真中风，自有口眼歪斜等症状。如今脉微浮，既非无根之阳外脱，亦非厥阴之阳内陷，是厥阴之邪随阳气，由少阳达太阳，欲愈的机转。所以可以用厥阴中风名其病，见阳升邪脱，可识经尽得解的征候。这全凭浮这一诊决断，浮则愈，不浮则未全愈。邪透表则愈，邪未全透表则病未全已。桂枝汤，正是紧要之法。
【纲】张仲景说：问：有病战栗而后汗出，因而得解的，为什么呢？答：脉浮而紧，按之反芤，这是因为本虚，所以应当战栗而后汗出。其人本虚，所以发战，因为脉浮，所以应当汗出而解。如果脉浮而数，按之不芤，这人本不虚，如果想要自行解除，只是汗出罢了，不发战。
【目】柯琴说：治病必求其本。本，是指其人平日禀气的虚实。紧，是急的意思，与数同而有别，盖有虚实之分。又必须按之芤不芤，而虚实的真伪毕现。
【纲】张仲景说：有病不战栗而汗出解的，为什么呢？答：脉大而浮数，所以知道不战栗而汗出解。问：有病不战栗也不汗出而解的，为什么呢？答：其脉自微，这是因为曾经发汗，或者催吐，或者泻下，或者亡血，以内无津液，等待阴阳自我调和，必定自愈，所以不战栗也不汗出而解。
【目】王好古说：战栗而后解的，是太阳病。不战栗而有汗而解的，是阳明病。不战栗而无汗而解的，是少阳病。
【纲】张仲景说：问：伤寒三日，脉浮数而微，病患身体凉和的，为什么呢？答：这是欲解。在夜半解除。脉浮而解的，濈然汗出。脉数而解的，必定能进食。脉微而解的，必定不汗出。
【目】沈金鳌按语：太阳脉本浮数，三日转微，即“伤寒三日，少阳脉小为欲愈”的意义。大概此条的微字，与上文“其脉自微”不同。以上是妄治后亡阳的微，此则未经妄治，所以必不汗而三日自解。
【纲】张仲景说：太阳病，未解，脉阴阳俱停，必先振栗汗出而解。但阳脉微的，先汗出而解。但阴脉微的，下之而解。如果想要下之，宜用调胃承气汤。大凡病，反能饮水的，是欲愈。
【目】王好古说：太阳传阳明，其中或有下症，阳明症反而退去，而无热与不渴，却显现少阳症，是可知可解。太阳症可知可解的，为头不疼，项不强，肢节不痛，则知表易解。阳明症可知可解的，为无发热恶热，则知里易解。少阳症可知可解的，寒热日不移时而作，邪未退也。如果用柴胡而早晚得移其时，是邪无可容之地，可知可解。可解之脉，浮而虚；不可解之脉，浮而实。浮而虚者只在表，浮而实者知已在里。汗多不解者，转属阳明也。
闵芝庆说：七日病愈论曰：六经以渐受病，其愈皆以七日为期，阳数七的缘故。《伤寒例》说：其不两感于寒，更不传经，不加异气者，至七日，太阳病衰，头痛可愈。八日，阳明病衰，身热可歇。九日，少阳病衰，耳聋微闻。十日，太阴病衰，腹减如故，思饮食。十一日，少阴病衰，渴止舌干，已而嚏。十二日，厥阴病衰，囊纵，少腹微下，大气皆去，病患精神爽慧。此论六经七日病愈，本之《素问·热病篇》。奈彼此注释者，皆不能无误，旨未明也。敢重释之。曰：其者，指伤寒也。不两感于寒者，非日传二经之症也。更不传经者，邪在此经，更不传彼经也。不加异气者，伤寒病热，不重感寒、感风、感温、感热、感湿，而变为他病也。夫如是，则可期六经愈日矣。太阳篇曰：发于阳者七日愈。以是数计之，乃知六经之病，自一日受者，七日当衰。二日受者，至八日亦是七日而当衰。故七日邪在太阳，幸而更不传阳明，更无变症，则至七日，太阳病衰，头痛少愈。如或二日，邪传阳明，更不传变，至八日，阳明病衰，身热少歇。又或三日，邪传少阳，更不传变，至九日，少阳病衰，耳聋微闻。又如四日，邪传太阴，更不传变，至十日，太阴病衰，腹减如故，思饮食。又或五日，邪传少阴，更不传变，至十一日，少阴病衰，渴止舌干，已而嚏。又或六日，邪传厥阴，经尽，更不传变，大气皆去，精神爽慧。此二句总承六经而言。如在太阳，更不传变，当七日病衰，头痛少愈，渐而大气皆去，头痛悉除，精神爽慧也。余经不传之例同。成氏注曰：六经传遍，则与更不传经之句背矣。《素问》注证七日巨阳病衰，头痛少愈，止以初时所感之邪太甚，既于二日传之阳明矣，而其未尽传者，尚在太阳，则至此而比之一日之际，少愈焉。果如传之阳明云云，则由此而六日传至厥阴，为传经尽，将曰七日传何经？其未尽传者，尚在厥阴，至十二日比之六日之际，少愈焉。又思果
[Outline] Zhang Zhongjing said: The time when Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang channel) is likely to resolve is from Si hour to Wei hour. The time when Yangming disease (a syndrome caused by pathogenic factors invading the Yangming channel) is likely to resolve is from Shen hour to Xu hour. The time when Shaoyang disease (a syndrome caused by pathogenic factors invading the Shaoyang channel) is likely to resolve is from Yin hour to Chen hour. The time when Taiyin disease (a syndrome caused by pathogenic factors invading the Taiyin channel) is likely to resolve is from Hai hour to Chou hour. The time when Shaoyin disease (a syndrome caused by pathogenic factors invading the Shaoyin channel) is likely to resolve is from Zi hour to Yin hour. The time when Jueyin disease (a syndrome caused by pathogenic factors invading the Jueyin channel) is likely to resolve is from Chou hour to Mao hour.
[Commentary] Ke Qin said: Si and Wu hours are Yang within Yang, thus governed by Taiyang. "Up to Wei hour" means Yang energy has exceeded its normal limit. Shen and You hours are the time of Yangming, also known as Ribu (late afternoon). Whenever it says "likely to resolve," it refers to exterior syndromes. For example, in Taiyang disease, headache stops spontaneously, and aversion to cold ceases; in Yangming disease, the body is not hot, and there is no aversion to cold. Yin and Mao hours govern Wood Qi, and Shaoyang begins to generate, so Shaoyang governs this period. When the governing Qi is prosperous, pathogens resolve naturally. "Up to Chen hour" marks the end of Mao and the beginning of Chen. The Classic of Acupuncture states: From dusk to cockcrow is the Yin of Heaven, which is Yin within Yin. The Spleen is the extreme Yin within Yin, thus governing Hai, Zi, and Chou hours. Heaven generates Water at Zi hour, so Shaoyin governs Zi hour. Wood overcomes Earth at Chou and prospers at Yin hour, so Jueyin governs Chou, Yin, and Mao hours.
[Outline] Zhang Zhongjing said: Regarding general diseases, if one wishes to know when the disease was contracted and when it will heal, the answer is: If a disease is contracted at midnight, it will heal at noon the next day; if contracted at noon, it will heal at midnight. Why is this? A disease contracted at noon and healing at midnight resolves because Yang obtains Yin to balance. A disease contracted at midnight and healing at noon resolves because Yin obtains Yang to balance.
[Commentary] Ke Qin said: Diseases originating in Yang channels heal in seven days, and those originating in Yin channels heal in six days, due to the numbers Seven for Yang and Six for Yin. This discusses healing according to the numerical values of Yin and Yang. The previous discussion focused on resolution during times of reversed excess of Yin and Yang. Why? Because extreme Yin generates Yang, and extreme Yang generates Yin. The mutual generation of Yin and Yang represents their harmony, which is self-harmonization of Yin and Yang. However, this applies to cases resolving within one or two days. For cases resolving in six or seven days, the Six Channels resolve according to their respective governing times, reflecting that Yang governs the day and Yin governs the night.
[Outline] Zhang Zhongjing said: To determine if a pulse condition and disease are resolving, how does one distinguish them? The answer is: If the pulses at Cun Kou (radial artery), Guan (middle position), and Chi (cubital position) are equal in magnitude, floating/sinking, and slow/rapid, even if chills and fever persist, this pulse indicates Yin-Yang Peacefulness. Although severe, recovery is expected.
[Commentary] Wang Kentang said: The *Ling Shu* (Spiritual Pivot) states: When the Cun Kou and Ren Ying pulses correspond like a taut rope and are equal in size, it is called a healthy person. This means the Cun Kou pulse on the hand matches the Ren Ying pulse beside the throat, indicating health. Other texts state: When all six pulses show Yin and Yang cessation, the patient must first experience shivering and sweating before resolving.
Shen Jin'ao's note: Pulses being equal at three positions merely indicates an excess of pure Yin or pure Yang, which remains a pathological pulse indicating unresolved chills/fever and non-resolution. Thus, "Yin-Yang Peacefulness" does not mean harmonious balance. "He" (Harmony) implies either pure Yin or pure Yang without discordance; "Ping" (Peace) implies purity without mixture. However, pure Yin is ultimately biased toward Yin, and pure Yang toward Yang, so it is not true harmony. "Though severe, it shall heal" means if biased toward Yin, treat the severity of Yin; if biased toward Yang, treat the severity of Yang. This urges physicians to recognize these pulses of bias and treat promptly.
[Outline] Zhang Zhongjing said: Spontaneous resolution requires initial restlessness (Fan), followed by sweating and resolution. How do we know? Because the pulse is floating, indicating sweating will lead to resolution.
[Commentary] Wei Litong said: This parallels the rule "Taiyang disease resolves from Si to Wei," teaching us to distinguish between transmission completion and ongoing transmission during the expected healing window. Transmission is distinguished by whether symptoms resolve; resolution is distinguished by sweating; sweating is distinguished by initial restlessness; and initial restlessness for sweating is distinguished by a floating pulse. This restlessness is for sweating, not interior accumulation. In cold damage with no sweat, we expect sweating for resolution. In wind strike with existing sweat, how do we know it will resolve? We look to the "floating pulse." A sudden floating pulse indicates no interior transmission. Wind strike typically has floating pulse and sweat; adding restlessness without interior pulse signs suggests spontaneous resolution. Interior transmission is indicated by rapid/urgent pulses. This "restlessness" differs from agitation. Quiet pulse means no transmission; rapid/urgent pulse means transmission.
[Outline] Zhang Zhongjing said: Patients with wind strike, after exterior resolution but still feeling unwell ("liao liao bu liao"), will heal in twelve days.
[Commentary] Wei Litong said: This clarifies that after Taiyang wind strike resolves, residual wind pathogen symptoms should be allowed to heal spontaneously without rash treatment. Twelve days is derived from the seven-day cycle. Seven days heals Taiyang wind strike. Counting illness and recovery days adds six more days (effectively five post-recovery days), allowing Yin Qi to restore to six, resulting in mental clarity.
[Outline] Zhang Zhongjing said: In Yangming disease, if there is hardness/fullness under the hypochondrium, constipation, vomiting, and a white coating on the tongue, Xiao Chai Hu Tang (Minor Bupleurum Decoction) may be administered. Once the Upper Jiao (Upper Burner) is unblocked, fluids descend, Stomach Qi harmonizes, and the body sweats slightly ("ji ran") for resolution.
[Commentary] Wei Litong said: Hypochondriac hardness is milder than chest/hypochondriac fullness. Constipation, vomiting, and white coating indicate Yangming Stomach excess, yet pathogens have transferred to Shaoyang. Among these, only constipation defines Zheng Yang Yangming (True Yangming); others are Shaoyang-Yangming. Though deeper than before, it is not fully Shaoyang. Xiao Chai Hu Tang harmonizes, guiding Zheng Yang pathogens out via Shaoyang, preventing Stomach excess and resolving Yangming. The phrase "Upper Jiao unblocked..." explains that pathogens in有形 (form) exit via intestines with fluids, while formless pathogens exit via sweat. Thus, Zheng Yang Yangming pathogens exit via Shaoyang-Yangming (half-exterior/half-interior) through harmonization, similar to treating full Shaoyang transmission. Why wait for full transmission?
Shen Jin'ao's note: Yu Jiayan correctly emphasizes that "Upper Jiao unblocked, fluids descend" is crucial to pathology. Wind-cold in the Diaphragm traps fluids, causing wheezing, vomiting, and stuffiness. Without resolving Upper Jiao wind-cold, fluids cannot descend. Harmonizing internally opens the Upper Jiao, allowing fluids to descend. Yu extends this to miscellaneous diseases like phlegm-fire asthma, cough, and scrofula, where long-term fire steams phlegm into collaterals, blocking fluid nourishment to the root, turning clear essence into turbidity. Human life relies on grain/water Qi transforming into fluids circulating the body; stagnation causes disease, depletion causes death. Physicians must prioritize preserving fluids.
[Outline] Zhang Zhongjing said: If Chai Hu Tang indications are treated with purgatives and Chai Hu symptoms persist, administer Chai Hu Tang again. The patient will experience shaking chills ("zheng zheng er zhen"), followed by fever, sweating, and resolution. Generally, if sweating, vomiting, purging, or fluid loss occurs, and Yin-Yang self-harmonizes, the disease will heal spontaneously. In cold damage after three days, if the Shaoyang pulse is small, the disease is about to end.
[Commentary] Wei Litong said: The first case shows Shaoyang error with purgatives didn't affect the core pathology; Chai Hu Tang is appropriate. Shaking chills result from damaged righteous Qi, but rising Yang and descending Yin resolve Shaoyang. The second case notes Shaoyang usually transmits from Taiyang/Yangming over time. Even if treatment was improper, strong constitution allows righteous Qi to expel pathogens despite fluid loss. Yin-Yang pulse harmony ensures spontaneous healing without further intervention. "General disease" covers all Three Yang, Six Channels, and hundred diseases, not just Shaoyang. The third case: Small pulse (not string-large) indicates weak pathogens and impending resolution.
[Outline] Zhang Zhongjing said: In Taiyin wind strike, with painful limbs, if the pulse is superficially slight (Yang Wei), interiorly choppy (Yin Se), and long, the disease is about to heal.
[Commentary] Wei Litong said: Painful limbs, slight Yang pulse with fever, choppy Yin pulse with sweat resemble Taiyang wind strike. However, abdominal fullness, diarrhea, and vomiting indicate Taiyin disease mimicking Taiyang wind strike, showing Yin shifting back to Yang. A long pulse indicates pathogens returning from Taiyin to Shaoyang. Interior sinking causes abdominal symptoms; exterior emergence affects limbs. Slight Yang/choppy Yin shows pathogens penetrating Ying/Wei. String-long pulse at Shaoyang gate indicates generating Qi moving. Limb pain, sweat, and fever show pathogens returning to Taiyang. Healing occurs as Taiyin pathogens exit via Shaoyang then Taiyang. Long pulse signifies vitality (equivalent to string pulse in Yangming). Since Taiyin also uses Shaoyang as an exit, a long pulse indicates recovery.
[Outline] Zhang Zhongjing said: In Shaoyin wind strike, if the pulse is superficially slight (Yang Wei) and interiorly floating (Yin Fu), the disease is about to heal.
[Commentary] Wei Litong said: Shaoyin disease involves direct invasion or transmitted cold/heat. Upon entry, distinguish cold/heat; upon exit, simply state resolution. Symptoms mimic Taiyang wind strike, but Shaoyin has direct cold, not wind. "Shaoyin wind strike" means Shaoyin symptoms resembling Taiyang wind strike due to spontaneous heat and sweat (true cold inside, false heat outside). Although this text omits heat/sweat, they are implied by the pulse. Direct cold pulse is deep-tight (Yang tight, Yin deep); transmitted heat pulse is deep-rapid (Yang deep, Yin rapid). Here, Yang is slight (not tight/deep), indicating dispersing direct cold or transmitted heat. Yin is floating (not deep/rapid), indicating dispersing cold or heat. This pulse indicates healing regardless of cold/heat type. Heat/sweat occur because Yang floating implies heat generation, and Yin floating (weakness) implies sweat. Lack of deep-tight pulse rules out internal cold forcing Yang outward. Lack of deep-thin pulse rules out Yin excess forcing Yang collapse. Thus, Yin disease turning to Yang, interior pathogens emerging to exterior, manifests as heat and sweat, signaling healing.
[Outline] Zhang Zhongjing said: In Jueyin wind strike, if the pulse is slightly floating, the disease is about to heal; if not floating, it has not healed.
[Commentary] Wei Litong said: Jueyin disease pulses should be deep-tight or rapid, not slight. If slight everywhere, it differs. Deep absence of tight/rapid indicates mixed Yin pathogens; slight floating indicates Yang exterior desire to emerge. This slightness mirrors Taiyang wind strike's floating Yang/weak Yin. True wind stroke causes facial deviation; slight floating here is not floating Yang collapse nor Jueyin Yang sinking. It shows Jueyin pathogens following Yang Qi from Shaoyang to Taiyang, indicating healing. Naming it Jueyin wind strike highlights Yang rising and pathogen expulsion. Floating confirms healing; non-floating confirms incomplete healing. Exterior penetration cures; incomplete penetration leaves disease. Guizhi Tang (Cinnamon Twig Decoction) is the critical method.
[Outline] Zhang Zhongjing said: Question: Why does some disease resolve with shivering and sweating? Answer: If the pulse is floating and tight, but hollow (Kou) upon pressure, it is due to original deficiency, causing shivering and sweating. Deficiency causes shivering; floating pulse causes sweating for resolution. If the pulse is floating and rapid, not hollow, the patient is not deficient. Spontaneous resolution involves only sweating, no shivering.
[Commentary] Ke Qin said: Treatment seeks the root: the patient's constitutional deficiency/excess. "Tight" means urgent, distinct from "rapid," differing by deficiency/excess. Checking for "hollow" reveals true deficiency/excess.
[Outline] Zhang Zhongjing said: Question: Why does some disease resolve with sweating but no shivering? Answer: Large, floating, rapid pulse indicates resolution without shivering. Question: Why does some disease resolve without shivering or sweating? Answer: Pulse is naturally slight, due to prior sweating, vomiting, purging, or blood loss causing fluid depletion. Waiting for Yin-Yang self-harmony leads to spontaneous resolution without shivering or sweating.
[Commentary] Wang Haogu said: Shivering then resolving is Taiyang. Sweating without shivering is Yangming. No sweating without shivering is Shaoyang.
[Outline] Zhang Zhongjing said: Question: Cold damage after three days, pulse floating/rapid/slight, patient body cool and comfortable—why? Answer: This indicates impending resolution at midnight. Floating pulse resolving means slight sweating. Rapid pulse resolving means appetite returns. Slight pulse resolving means no sweating.
[Commentary] Shen Jin'ao's note: Taiyang pulse is normally floating/rapid; becoming slight on day three aligns with "Shaoyang pulse small indicates healing." This "slight" differs from "pulse naturally slight" (post-mistreatment Yang collapse). Here, no mistreatment occurred, so resolution happens in three days without sweating.
[Outline] Zhang Zhongjing said: Taiyang disease unresolved, with Yin-Yang pulses ceasing/stopping, requires shivering and sweating for resolution. If only Yang pulse is slight, sweating resolves it. If only Yin pulse is slight, purging resolves it. If purging is needed, Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction) is suitable. Generally, if a patient craves water, healing is imminent.
[Commentary] Wang Haogu said: Taiyang transmitting to Yangmay may have purgative indications. If Yangming symptoms recede (no heat/thirst) and Shaoyang symptoms appear, resolution is possible. Taiyang resolution signs: no headache, neck stiffness, or limb pain (easy exterior resolution). Yangming resolution signs: no fever/aversion to heat (easy interior resolution). Shaoyang resolution signs: chills/fever timing shifts with Chai Hu Tang, leaving no room for pathogens. Resolving pulse: floating/empty (exterior); Non-resolving pulse: floating/firm (interior). Excessive sweating without resolution indicates transmission to Yangming.
Min Zhiqing said: The theory of seven-day healing states: Six Channels are affected gradually, healing takes seven days due to Yang number seven. *Shang Han Lun Example* states: Without dual cold infection, no further transmission, or mixed pathogens, by day seven Taiyang declines (headache improves); day eight Yangming declines (fever subsides); day nine Shaoyang declines (hearing improves); day ten Taiyin declines (abdomen softens, appetite returns); day eleven Shaoyin declines (thirst/dry tongue stop, sneezing occurs); day twelve Jueyin declines (scrotum relaxes, lower abdomen softens, vital Qi departs, spirit refreshes). This derives from *Su Wen: Re Disease Chapter*. Commentators err, obscuring meaning. Clarification: "Qi" refers to cold damage. "No dual infection" means not two channels daily. "No further transmission" means pathogen stays in current channel. "No mixed pathogens" means no secondary wind/cold/heat/damp transforming the disease. Thus, healing days can be predicted. *Taiyang Chapter*: "Originating in Yang heals in seven days." Calculating from onset: Day 1 onset heals by Day 7. Day 2 onset heals by Day 8. If Day 7 Taiyang pathogen doesn't transmit to Yangming, Taiyang declines, headache improves. If Day 2 transmits to Yangming, Day 8 Yangming declines, fever subsides. If Day 3 transmits to Shaoyang, Day 9 Shaoyang declines, hearing improves. If Day 4 transmits to Taiyin, Day 10 Taiyin declines, appetite returns. If Day 5 transmits to Shaoyin, Day 11 Shaoyin declines, thirst stops. If Day 6 transmits to Jueyin, Day 12 Jueyin declines, spirit refreshes. These last two sentences summarize all Six Channels. If Taiyang doesn't transmit, Day 7 decline, headache clears, spirit refreshes. Same for other channels. Cheng Shi's commentary claims full transmission contradicts "no further transmission." *Su Wen* commentary says Day 7 Taiyang improvement is due to initial severe path lingering after Day 2 Yangming transmission. If fully transmitted to Jueyin by Day 12, Day 12 improvement compares to Day 6 status. Again, consider...