河间刘氏宣明论云。伤寒传足经。不传手经。内经及仲景论中。未详言耳。且自人身十二经络。分布上下。手足各
有三阴三阳。禀天地之气。天枢之上。同天之阳。天枢之下。同地之阴。至真大论云。身半以上。其气三矣。天之分也。
天气主之。身半以下。其气三矣。地之分也。地气主之。注云。当阴之分。冷病归之。当阳之分。热病归之。有八节邪
气所中于人。阳邪为病。传手经。阴邪为病。传足经。其邪自何而入。自风池而入。为脊骨两旁一寸五分。是十二经之
俞穴。春夏应阳。秋冬应阴。又云。寒暑温凉。盛衰之用。其在四维。故阳之动。始于温。盛于暑。阴之动。始于凉。
盛于寒。春夏秋冬。各差其分。易云。水流湿。火就燥。太阴阳明论云。阳受风气。阴受湿气。又云。伤于风者。上先
受之。伤于湿者。下先受之。注云。阳气炎上。故受风。阴气润下。故受湿。盖同气相合耳。故风热火为阳。寒湿燥为
阴。热论云。热病者。伤寒之类也。人之伤于寒。则为病热。刺热论云。五脏俱有热病。肝热病。左颊先赤。心热病。
颜先赤。脾热病。鼻先赤。肺热病。右颊先赤。肾热病。腮先赤。甲乙热论云。有手足太阴热病。有手足少阴热病。有
手足厥阴热病。热论又云。三阴三阳。五脏六腑皆受病。营卫不行。五脏不通。则死矣。未尝止传足经。不传手经。
云岐子保命集云。伤寒三阳头痛。何法刺之。答曰。手之三阳。足之三阳。皆会于头者。谓诸阳之会。其受邪伏留
而不去。故曰三阳头痛。视其色脉。知在何经。如脉浮而头痛。过在手足太阳。刺腕骨。京骨。如脉浮而长。过在手足
阳明。刺合骨。冲阳。如脉浮而弦。过在手足少阳。刺阳池。丘墟。风府。风池。刺头痛之法也。伤寒邪在三阴。内不
得交通。故为腹痛。手足之经。皆会于腹。如脉弦而腹痛。过在足厥阴肝。手太阴肺。刺太冲。太渊。如脉沉而腹痛。
过在足少阴肾。手厥阴心包。刺太溪。大陵。如脉沉细而腹痛。过在足太阴脾。手少阴心刺太白。神门。三阴交。刺腹
痛之法也。
海藏老人此事难知云。伤寒传至五六日间。渐变神昏不语。或睡中独语一二句。目赤。唇焦舌干。不饮水。稀粥与
之。则咽。终日不与。则不思。六脉细数。而不洪大。心下不痞。腹中不满。大小便如常。或传至十日以来。形貌如醉
人。医见神昏不已。多用承气汤下之。则误矣。盖不知此热传手少阴心经也。本太阳经伤风。谓风为阳邪。阳邪伤卫。
阴血自燥。热蓄膀胱。壬病逆传于丙。丙丁兄妹。由是传心。火上迫而熏肺。所以神昏也。宜栀子黄芩黄连汤。若脉在
丙者。导赤散。脉在丁者。泻心汤。（朱奉议解云。与食则咽者。邪不在胃也。不与则不思者。以其神昏故也。热邪既不
在胃。误与承气汤下之。其死必矣。）
陶节庵琐言云。伤寒传足。不传手经者。俗医之谬论也。夫人身之气。自平旦会于膻中。朝行手太阴肺经。以次分
布诸经。所以一脉愆和。则百脉皆病。理固然也。彼云传足不传手者。何所据乎。盖伤寒者。乃冬时感寒即病之名也。
冬乃坎水用事。其气严寒凛冽。在时则足太阳少阴。正司其令。触冒之者。则二经受病。其次则足少阳厥阴。继冬而司
春令。而亦受伤。何也。盖风木之令。起于大寒节正当十二月中。至春分后方行温令。故风寒亦能伤之。足阳明太阴。
中土也。与冬时无预。而亦伤之。何也。紫阳朱子曰。土无定位。无成名。无专气。寄王于四季。能终始万物。则四时
寒热温凉之气。皆能伤之也。况表邪传里。必归于脾胃。而成燥粪。用承气汤以除去之。胃气和矣。手之六经。主于夏
秋。故不伤之。足之六经。盖受伤之方。分境界也。若言伤足不伤手则可。以为传足不传手。则不可也。况风寒之中人。
先入营卫。昼夜循环。无所不至。岂间断于手经哉。设或不传。气逆作喘。何经而来。如谓不然。何仲景桂枝麻黄二汤。
乃心肺药也。请试思之。
张景岳类经注云。伤寒传变。止言足经。不言手经其义本出素问热论篇中。夫人之血气。营运周身。流注不息。岂
传遇手经。而邪有不入者哉。且寒之中。人必先皮毛。皮毛者。肺之合。故在外则有寒栗鼻塞等证。谓不传于肺乎。其
入手少阴厥阴也。则有舌苔。拂郁。神昏。错乱等证。谓不传于心主包络乎。其入手阳明也。则有泄泻秘结等证。谓不
传于大肠乎。其入手太阳也。则有癃闭不化等证。谓不传于小肠乎。其入手少阳也。则有上下不通。五官失职。痞满燥
实俱全等证。谓不传于三焦乎。然本经之不言手者。何也。盖伤寒者。表邪也。欲求外证。但当察于周身。而周身上下
脉络。惟足六经则尽之矣。手经不能遍也。且手经所至。足经无不至者。故但言足经。则其左右前后阴阳诸证。无不可
按而得。而手经亦在其中。不必言矣。
（琥）总按上诸贤名论。大抵人在四时之中。六气所伤。则手足十二经皆受病。其正伤寒。则但足六经受病耳。至
其郁热流传。则手经亦在所不免。若夏秋暑热燥病。其邪宜止伤手经。然亦不免有伤足经者。何也。以其初必受风寒之
气而病故也。所以今医总谓之伤寒。然分而言之。在冬月。既名为正伤寒。则在三时。当名为类伤寒也。其类伤寒。如
手之六经。或伤或传。其证每多。故其经络之起止。循行。交会。连属之处。学人所当究心焉。
刘河间在《宣明论》中说：伤寒只传足经，不传手经。《内经》和仲景的论述中，并没有详细阐明这一点。况且从人身十二经络来看，分布上下，手足各有三阴三阳，禀受天地之气。天枢穴以上，与天之阳气相应；天枢穴以下，与地之阴气相应。《至真要大论》说：身半以上，其气分为三，属于天的分野，由天气所主；身半以下，其气分为三，属于地的分野，由地气所主。注解说：当阴的分野，冷病归于此处；当阳的分野，热病归于此处。有八节邪气中人，阳邪致病，传入手经；阴邪致病，传入足经。邪气从哪里进入？从风池穴进入，位于脊骨两旁一寸五分处，这是十二经的俞穴。春夏应合于阳，秋冬应合于阴。又说：寒暑温凉，盛衰的作用，在于四维（四季之交）。所以阳气的发动，始于温和，盛于暑热；阴气的发动，始于清凉，盛于寒冷。春夏秋冬，各有其时差。《易经》说：水往湿处流，火向燥处燃。《太阴阳明论》说：阳经受风气，阴经受湿气。又说：伤于风者，上部先受之；伤于湿者，下部先受之。注解说：阳气炎上，所以受风；阴气润下，所以受湿。这是因为同气相求的缘故。所以风、热、火为阳，寒、湿、燥为阴。《热论》说：热病，是伤寒的一类。人伤于寒，就会得病发热。《刺热论》说：五脏都有热病。肝热病，左颊先发红；心热病，颜面先发红；脾热病，鼻头先发红；肺热病，右颊先发红；肾热病，腮部先发红。《甲乙经·热论》说：有手足太阴热病，有手足少阴热病，有手足厥阴热病。《热论》又说：三阴三阳，五脏六腑都受病，营卫不通，五脏闭塞，就会死亡。这里从未说过只传足经而不传手经。
云岐子在《保命集》中说：伤寒三阳头痛，用什么方法针刺？回答说：手之三阳经、足之三阳经，都会合于头部，称为诸阳之会。邪气潜伏停留不去，所以叫三阳头痛。观察面色脉象，就知道在哪条经。如果脉浮且头痛，病在手足太阳经，针刺腕骨穴、京骨穴。如果脉浮而长，病在手足阳明经，针刺合谷穴、冲阳穴。如果脉浮而弦，病在手足少阳经，针刺阳池穴、丘墟穴、风府穴、风池穴。这是治疗头痛的方法。伤寒邪气在三阴经，内部不能交通，所以出现腹痛。手足之经都会合于腹部。如果脉弦且腹痛，病在足厥阴肝经、手太阴肺经，针刺太冲穴、太渊穴。如果脉沉且腹痛，病在足少阴肾经、手厥阴心包经，针刺太溪穴、大陵穴。如果脉沉细且腹痛，病在足太阴脾经、手少阴心经，针刺太白穴、神门穴、三阴交穴。这是治疗腹痛的方法。
海藏老人张元素在《此事难知》中说：伤寒传到五六天，逐渐变为神志昏迷不说话，或者睡梦中独自说一两句梦话，眼睛红，嘴唇焦，舌头干，不想喝水，给稀粥喝则吞咽，整天不给则不想吃。六脉细数，但不洪大。心下不痞满，腹中不胀满，大小便正常。或者传到十天左右，神态像醉酒的人。医生见神志昏迷不止，多用承气汤攻下，这就错了。大概是因为不知道这是热邪传入手少阴心经。原本是太阳经伤风，说风为阳邪，阳邪伤卫气，阴血自然干燥。热蓄积在膀胱，壬水之病逆传于丙火（小肠），丙丁为兄妹关系，由此传于心。火上迫熏肺，所以神志昏迷。宜用栀子黄芩黄连汤。如果脉象显示病在丙（小肠），用导赤散；脉象显示病在丁（心），用泻心汤。（朱奉议解解释说：给食物则吞咽，说明邪气不在胃里。不给则不想吃，是因为神志昏迷的缘故。热邪既然不在胃里，误用承气汤攻下，必死无疑。）
陶节庵在《琐言》中说：伤寒只传足经，不传手经，这是俗医的错误言论。人身之气，自平旦时会聚于膻中，早晨运行于手太阴肺经，依次分布于各经。所以一脉不和，百脉皆病，道理本来如此。他们说只传足不传手，有什么依据呢？所谓伤寒，是冬季感受寒邪立即发病的名称。冬季是坎水当令，气候严寒凛冽，在时令上足太阳、足少阴正当其令，触犯它，这两经就受病。其次是足少阳、足厥阴，继冬季之后主管春季时令，也受到伤害。为什么呢？因为风木之令，起于大寒节气，正当十二月之中，到春分后才行温令，所以风寒也能伤害它们。足阳明、足太阴属中土，与冬季无关，但也受伤，为什么呢？紫阳朱子说：土无固定位置，无特定名称，无专一之气，寄旺于四季，能终始万物，所以四时寒热温凉之气，都能伤害它。况且表邪传里，必然归于脾胃，形成燥屎，用承气汤除去它，胃气调和了。手之六经，主宰夏秋季节，所以不受伤害。足之六经，大概是受伤的主要部位，划分了境界。如果说伤足不伤手还可以，如果说传足不传手，就不对了。况且风寒中人，先进入营卫，昼夜循环，无所不到，难道会在手经间断吗？假设如果不传，气逆作喘，是从哪条经来的？如果说不是这样，为什么仲景的桂枝汤、麻黄汤，是治心肺的药？请仔细思考。
张景岳在《类经注》中说：伤寒传变，只说足经，不说手经，其义本出自《素问·热论篇》。人的血气，营运周身，流注不息，难道遇到手经，邪气就不进入吗？而且寒邪中人，必先侵犯皮毛，皮毛是肺的合部，所以在外则有恶寒战栗、鼻塞等症状，能说没有传给肺吗？邪气入手少阴、手厥阴经，则有舌苔、烦郁、神志昏迷、错乱等症状，能说没有传给心和心包络吗？邪气入手阳明经，则有泄泻、便秘等症状，能说没有传给大肠吗？邪气入手太阳经，则有小便癃闭、气化不利等症状，能说没有传给小肠吗？邪气入手少阳经，则有上下不通、五官失职、痞满燥实俱全等症状，能说没有传给三焦吗？然而本经之所以不言手经，为什么呢？大概伤寒是表邪，想要了解外证，只需观察周身，而周身上下脉络，只有足六经能涵盖尽。手经不能遍及全身。而且手经所到的地方，足经没有不到的，所以只说足经，那么左右前后阴阳各种症状，没有不可以按此得出的，手经也就包含在其中，不必再说了。
（琥）总括上述各位贤达的名论，大致是人在四时之中，被六气所伤，则手足十二经都会受病。如果是正伤寒，则只是足六经受病。至于郁热流传，则手经也在所难免。如果是夏秋的暑热燥病，邪气应该只伤手经，然而也不免有伤足经的情况，为什么呢？因为起初必定受风寒之气而发病。所以现在医生总称之为伤寒。然而分别来说，在冬季，既然名为正伤寒，那么在其余三个季节，应当名为类伤寒。所谓类伤寒，如手之六经，或受邪或传变，其症状往往较多。所以对于这些经络的起止、循行、交会、连属之处，是学者应当深入研究的。
Liu Hejian, in *Xuanming Lun* (Treatise on the Manifestation of Disease), stated: Taiyang cold damage (Shanghan) transmits only through the Foot meridians and does not transmit through the Hand meridians. Neither the *Neijing* (Inner Canon) nor Zhang Zhongjing's treatises elaborate on this point. Furthermore, regarding the twelve meridians of the human body, they are distributed above and below, with three Yin and three Yang meridians for both the hands and feet, inheriting the Qi of Heaven and Earth. Above the Tianshu point (Shu-32), the Qi corresponds to the Yang of Heaven; below the Tianshu point, it corresponds to the Yin of Earth. The *Zhiyun Yao Lun* (Discourse on the Supreme Truth) states: The upper half of the body has its Qi divided into three, belonging to the domain of Heaven, governed by Heavenly Qi; the lower half of the body has its Qi divided into three, belonging to the domain of Earth, governed by Earthly Qi. The commentary notes: In the Yin domain, cold diseases reside; in the Yang domain, heat diseases reside. When pathogenic factors from the eight seasonal changes enter the human body, Yang pathogens causing disease transmit to the Hand meridians, while Yin pathogens transmitting to the Foot meridians. From where do these pathogens enter? They enter via the Fengchi point (GB-20), located 1.5 cun lateral to the spine, which is the Shu point of the twelve meridians. Spring and Summer correspond to Yang, Autumn and Winter correspond to Yin. It is also said that the use of cold, heat, warmth, and coolness, in their waxing and waning, lies in the four cardinal directions (seasonal transitions). Thus, the movement of Yang begins with warmth and peaks with summer heat; the movement of Yin begins with coolness and peaks with winter cold. Spring, Summer, Autumn, and Winter each have their specific temporal distinctions. The *I Ching* (Book of Changes) states: Water flows to wetness, fire moves towards dryness. The *Taiyin Yangming Lun* (Discourse on Taiyin and Yangming) states: Yang meridians receive wind patterns, Yin meridians receive dampness patterns. It further states: Those injured by wind suffer first in the upper part; those injured by dampness suffer first in the lower part. The commentary explains: Yang Qi flares upward, thus receiving wind; Yin Qi moistens downward, thus receiving dampness. This is due to the affinity of similar Qi. Therefore, wind, heat, and fire are Yang, while cold, dampness, and dryness are Yin. The *Re Lun* (Discourse on Heat) states: Heat diseases are a category of cold damage. When humans are injured by cold, they develop febrile diseases. The *Ci Re Lun* (Discourse on Acupuncture for Heat) states: All five Zang organs have heat diseases. Liver heat disease manifests first as redness on the left cheek; Heart heat disease manifests first as redness on the face; Spleen heat disease manifests first as redness on the nose tip; Lung heat disease manifests first as redness on the right cheek; Kidney heat disease manifests first as redness on the cheeks/jaw area. The *Jia Yi Jing* (Jia Yi Classic) states: There are Hand and Foot Taiyin heat diseases, Hand and Foot Shaoyin heat diseases, and Hand and Foot Jueyin heat diseases. The *Re Lun* further states: When San Yin and San Yang, along with the five Zang and six Fu organs, are all diseased, and Ying and Wei Qi fail to circulate, and the five Zang organs become blocked, death ensues. It never stated that transmission occurs only in Foot meridians and not Hand meridians.
Yun Qizi, in *Baoming Ji* (Collection for Preserving Life), asked: What acupuncture method treats headache caused by San Yang cold damage? The answer was: The three Hand Yang meridians and the three Foot Yang meridians all converge at the head, known as the meeting place of all Yang meridians. Pathogens lurking and remaining there cause what is called San Yang headache. By observing complexion and pulse, one can determine which meridian is affected. If the pulse is floating and there is headache, the pathology involves the Hand and Foot Taiyang meridians; acupoints Wan Gu (SI-4) and Jing Gu (BL-64) should be needled. If the pulse is floating and long, the pathology involves the Hand and Foot Yangming meridians; Hegu (LI-4) and Chongyang (ST-42) should be needled. If the pulse is floating and wiry, the pathology involves the Hand and Foot Shaoyang meridians; Yangchi (TE-4), Qiuxu (GB-40), Fengfu (DU-16), and Fengchi (GB-20) should be needled. These are the methods for treating headache. When cold damage pathogens reside in the San Yin meridians, internal communication fails, resulting in abdominal pain. The meridians of the hands and feet all converge in the abdomen. If the pulse is wiry and there is abdominal pain, the pathology involves the Foot Jueyin Liver meridian and the Hand Taiyin Lung meridian; Taichong (LR-3) and Taiyuan (LU-9) should be needled. If the pulse is deep and there is abdominal pain, the pathology involves the Foot Shaoyin Kidney meridian and the Hand Jueyin Pericardium meridian; Taixi (KI-3) and Daling (PC-7) should be needled. If the pulse is deep and fine and there is abdominal pain, the pathology involves the Foot Taiyin Spleen meridian and the Hand Shaoyin Heart meridian;太白 (SP-3), Shenmen (HT-7), and Sanyinjiao (SP-6) should be needled. These are the methods for treating abdominal pain.
H aizang Laoren (Zhang Yuansu), in *Cishi Nan Zhi* (Difficulties of This Matter), stated: When cold damage progresses to the fifth or sixth day, it gradually changes into unconsciousness and muteness, or speaking alone in sleep for one or two sentences, with red eyes, scorched lips, and a dry tongue. The patient does not desire water; if given thin porridge, they swallow, but if not offered throughout the day, they show no desire to eat. The six pulses are fine and rapid, but not surging and large. There is no epigastric fullness or abdominal distension, and urination and defecation are normal. Or, after ten days, the appearance resembles that of a drunken person. Physicians seeing persistent unconsciousness often mistakenly use Chengqi Tang (Gastrointestinal Purge Decoction) to purge downwards. This is an error because they fail to realize that the heat has transmitted to the Hand Shaoyin Heart meridian. Originally, it was Wind injuring the Taiyang meridian. Wind is a Yang pathogen; Yang pathogens injure Wei Qi, causing Yin blood to naturally dry up. Heat accumulates in the Bladder. The disease of Ren (Water) reversely transmits to Bing (Small Intestine Fire). Bing and Ding (Heart Fire) are like siblings, thus transmitting to the Heart. Fire presses upward and steams the Lungs, causing unconsciousness. One should use Zhizi Huangqin Huanglian Tang (Gardenia, Scutellaria, and Coptis Decoction). If the pulse indicates pathology in Bing (Small Intestine), use Dao Chi San (Guide Out Red Powder); if the pulse indicates pathology in Ding (Heart), use Xiexin Tang (Drain the Epigastrium Decoction). (Zhu Fengyi explained: Swallowing when food is offered indicates the pathogen is not in the Stomach. Not desiring food when not offered is due to unconsciousness. Since the heat pathogen is not in the Stomach, mistakenly purging with Chengqi Tang will surely lead to death.)
Tao Jian'an, in *Suoyan* (Trivial Words), stated: The claim that cold damage transmits only to Foot meridians and not Hand meridians is a fallacy of vulgar physicians. The Qi of the human body converges at Danzhong (CV-17) at dawn, circulates through the Hand Taiyin Lung meridian in the morning, and distributes sequentially to other meridians. Therefore, if one pulse is discordant, all pulses become diseased; this is the natural principle. On what basis do they claim transmission is only to Foot meridians and not Hand meridians? Cold damage is defined as illness occurring immediately upon contracting cold in winter. Winter is governed by Kan Water, with severe cold. In terms of timing, Foot Taiyang and Foot Shaoyin are in command. Contracting cold injures these two meridians. Next are Foot Shaoyang and Foot Jueyin, which succeed winter to govern spring, and are also injured. Why? Because the command of Wind-Wood begins at the Great Cold solar term, mid-December, and only brings warm commands after the Spring Equinox; thus, wind and cold can also injure them. Foot Yangming and Foot Taiyin belong to Central Earth, unrelated to winter, yet they are also injured. Why? Zhu Xi (Purple Emperor) stated: Earth has no fixed position, no specific name, and no exclusive Qi; it resides in power during the four seasons and can terminate and initiate all things. Therefore, the Qi of cold, heat, warmth, and coolness of the four seasons can all injure it. Moreover, when exterior pathogens transmit inward, they must return to the Spleen and Stomach to form dry feces, which are removed using Chengqi Tang to harmonize Stomach Qi. The six Hand meridians govern Summer and Autumn, so they are not injured. The six Foot meridians are the primary sites of injury, defining boundaries. It is acceptable to say Foot meridians are injured and Hand meridians are not, but unacceptable to say transmission occurs only in Foot meridians and not Hand meridians. Furthermore, when wind and cold invade humans, they first enter Ying and Wei Qi, circulating day and night without exception. How could there be interruption in the Hand meridians? If transmission did not occur, and Qi reversed causing wheezing, from which meridian would it come? If one argues otherwise, why are Zhongjing's Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang (Ephedra Decoction) medicines for the Heart and Lungs? Please consider this carefully.
Zhang Jingyue, in *Leijing Zhu* (Commentary on the Inner Canon), stated: Regarding cold damage transmission, mentioning only Foot meridians and not Hand meridians originates from the *Re Lun* chapter of the *Suwen*. Human Blood and Qi circulate throughout the body without ceasing; how could pathogens fail to enter when encountering Hand meridians? Cold invading humans first affects the skin and hair, which are the external associations of the Lungs. Thus, externally there are symptoms like aversion to cold, shivering, and nasal congestion; how can one say it does not transmit to the Lungs? When entering the Hand Shaoyin and Hand Jueyin meridians, there are symptoms like tongue coating, irritability, unconsciousness, and confusion; how can one say it does not transmit to the Heart and Pericardium? When entering the Hand Yangming meridian, there are symptoms like diarrhea and constipation; how can one say it does not transmit to the Large Intestine? When entering the Hand Taiyang meridian, there are symptoms like urinary retention and failure of transformation; how can one say it does not transmit to the Small Intestine? When entering the Hand Shaoyang meridian, there are symptoms of blockage above and below, dysfunction of the five orifices, and complete presentation of fullness, stagnation, dryness, and excess; how can one say it does not transmit to the Sanjiao? However, why does the original text not mention Hand meridians? Cold damage is an exterior pathogen. To seek exterior signs, one should observe the whole body. The meridians and collaterals above and below the body are fully covered by the six Foot meridians, whereas Hand meridians cannot cover the entire body. Moreover, wherever Hand meridians reach, Foot meridians also reach. Therefore, stating only Foot meridians allows one to deduce all Yin-Yang syndromes on the left, right, front, and back, including the Hand meridians within them, making explicit mention unnecessary.
(Hu) Summarizing the famous theories of the aforementioned sages: Generally, when humans are injured by the Six Qi in the four seasons, both Hand and Foot twelve meridians suffer disease. In true cold damage (Zheng Shanghan), only the six Foot meridians are diseased. However, when stagnant heat spreads, Hand meridians are inevitably involved. In summer and autumn, heat and dryness diseases should theoretically only injure Hand meridians, yet Foot meridians are also sometimes injured. Why? Because initially, the disease is contracted from Wind-Cold Qi. Hence, modern physicians generally call it cold damage. However, distinguishing specifically, in winter, since it is named True Cold Damage, in the other three seasons, it should be named Category Cold Damage (Lei Shanghan). In Category Cold Damage, such as when Hand meridians are injured or transmit, symptoms are often numerous. Therefore, scholars must study the origin, termination, course, intersection, and connection of these meridians.