补其母。今则补其子。何也。王曰。子不知虚劳之异乎。千金云。心劳甚者。补脾气以益之。脾王。则感之于心矣。此
与荀子所谓未有子富。而父贫者。同义（按海藏以补脾汤。佐以小柴胡。而解身热自汗。则知其虚热仍在经中。故不专
治藏也。）
（琥）据上海藏案。则知伤寒有手少阴经病可无疑矣。
心主手厥阴心包络之脉。起于胸中。出属心包络。下膈。历络三焦。（心包。一名手心主。滑氏注云。以用而言。手
厥阴相火。代君火行事。故为心之主也。以藏象而言。其藏在心漫脂之外。有细筋膜如丝。与心肺相连。故云心之包络
也。三焦注见前。此言手厥阴心包络之脉。起于胸中。出属心下之包络。由是下膈。当胃上脘。以络上焦。于中脘。以
络中焦。及脐下一寸。以络下焦。故云历络也。考上焦。当在心下膈上。其治在膻中。滑氏注云。当胃上口误。今改胃
上脘。方与下膈句无背。盖上脘在膈之下。上焦之用虽在膈上。实通乎膈之下也）其支者。循胸中。出胁。下腋三寸。
上抵腋下。循 内。行太阴少阴之间。入肘中。下臂。行两筋之间。入掌中。循中指出其端（此言支脉之行。从前属心
包之处。上循胸。横出胁下腋三寸。还上行至腋下。循 肉之内。下行以界乎太阴少阴二经之中间。入肘中。下臂行臂
两筋之间。入掌中。循中指出其端而终也。）其支者。别掌中循小指次指出其端。（此言其交经之支。即从前入掌中处。
别行循小指次指。出其端。以交于手少阳经也。）
\r手厥阴经脉之图\pt68a12.bmp\r
（琥）按手厥阴之脉。上下左右分行。共六道。其脉之本。起于胸中。出属心包。下膈历络三焦者。二道（或云此
止从中一道之脉。要其出属心包之处。必自左右而分属也）此为正经之脉也。其支者。循胸。出胁。上腋。下 肘臂掌
之中。循中指出其端者。二道。是虽支脉实接正经。而行于手者也。又其支者。从掌中别行。循小指次指出其端者。二
道。此为交经之二小支脉也。前热论中云。烦满囊缩。夫囊缩。固足厥阴经病矣。其烦与满。非手厥阴经病邪。盖手厥
阴之脉。循胸下膈。今烦满为胸膈间病。乃三焦经络受伤。医者皆昧而不及察也。
吴院判云。伤寒论中。凡泻心汤共五首。以其汤有冷热之不同。故云岐子云。非泻心火之热。泻心下之痞也。殊不
知伤寒之痞。皆胸膈热邪之气有余。仲景用泻心汤者。乃泻心包之热也。按五汤之中。热药莫过于附子。然以大黄二两
黄芩黄连各一两。纯是苦寒泻热之剂。此不过借附子之辛。以散心包之邪结。且也包络属火。附子亦属火。从治之法。
莫妙于此。
保命集云。伤寒下后。胸中结痞。过在足。少阴肾手厥阴包络。刺两经之井原。以泻胸中之气。
（琥）据上二条论。则是伤寒有手厥阴经之病可无疑矣。
（琥）总按上手经共六条。凡四时之中。人伤于寒而病热者。亦不少。热伤手经。理宜审证疗之。但今治伤寒家。
无不以手六经证。为迂阔而不切于病情者。故遇手三阳证。混于足三阳证而不知。遇手三阴证。又混于足三阴传经之证。
及混于胃腑实热之证而不觉。以至方不对证药多杀人。不亦痛夫。窃考素问中。以伤寒为热病因着热病篇。又着刺热篇。
此篇中全交。凡用针家。不可不察。其略云心热病者。刺手少阴太阳。肺热病者。刺手太阴阳明。又云。热病始手臂痛
者。刺手阳明太阴。又云。热病甚者。为五十九刺。甲乙经云所谓五十九刺者。两手外内侧各三。凡十二 。五指间各
一。凡八 。足亦如是。则是刺热病之法。岂但刺足经。而不及手经者邪。俗医不讲刺法。但求汤药。因置手经而不论。
殊不知治热病而不知手经。止用药之法。每多缺略。乌可以为医而司人之命。故孙真人习业篇云。凡欲为太医必须谙甲
乙素问。黄帝针经。明堂流注。十二经。三部九候精熟。如此方为太医。不尔犹无目夜游。动致颠殒。朱奉议亦云。凡
治伤寒先识经络。不识经络。触涂冥行。今夫业医者。欲知伤寒传变奇证。总不越手足十二经。五脏六腑。阴阳虚实之
中。盍于此卷书一究心焉。
补益其母脏。现在却说要补益其子脏，为什么呢？王冰说：你不知道虚劳病与普通疾病不同吗？《千金方》记载：心气劳损严重的，应当补益脾气来增益它。当脾气旺盛时，就能感应并滋养心脏了。这与荀子所说的“没有儿子富有而父亲贫穷的道理”是相同的（按：海藏先生用补脾汤，佐以小柴胡汤，以解除身体发热和自汗的症状，由此可知虚热仍然在经络中，所以不专门治疗脏腑。）
王琥根据上海藏先生的医案，就知道伤寒病中确实存在手少阴经的病证，这是毫无疑问的。
手厥阴心包络之脉，起始于胸中，出来归属于心包络，向下穿过膈肌，依次联络上、中、下三焦。（心包，又名手心主。滑寿注解说：从功能作用来说，手厥阴相火代替君火行使职权，所以作为心的主宰。从藏象结构来说，它位于心脏外面的脂膜之外，有细筋膜像丝一样，与心肺相连，所以称为心的包络。三焦的注解见前文。这里说的是手厥阴心包络之脉，起始于胸中，出来归属于心下的包络，由此向下穿过膈肌，经过胃的上脘部，以联络上焦；经过中脘部，以联络中焦；到达脐下一寸处，以联络下焦。所以说“依次联络”。考证上焦的位置，应当在心下膈肌之上，其治疗部位在膻中穴。滑寿注解说“在胃上口”是错误的，现在改为“胃上脘”，才与“向下穿过膈肌”一句不矛盾。因为上脘在膈肌之下，虽然上焦的功能主要在膈肌之上，但实际上贯通于膈肌之下。）它的支脉，沿着胸中，出于胁肋，下行至腋下三寸处，向上抵达腋下，沿着腋窝内侧，行走在手太阴肺经和手少阴心经之间，进入肘中，向下沿手臂，行走在两筋之间，进入掌中，沿着中指指出其末端（这里说的是支脉的走向，从前归属心包的地方，向上沿胸部，横向出于胁下腋下三寸处，再上行至腋下，沿着臂肉的内侧，下行以界于手太阴和手少阴二经的中间，进入肘中，向下沿手臂行走在两筋之间，进入掌中，沿着中指指出其末端而终止。）另一条支脉，从掌中分出，沿着无名指出其末端（这里说的是交汇经脉的支脉，即从前进入掌中的地方，另外行走沿着无名指，出其末端，以交于手少阳三焦经。）
[图片：手厥阴经脉之图]
王琥按：手厥阴之脉，上下左右分行，共有六道。其脉的根本，起始于胸中，出来归属于心包，向下穿过膈肌依次联络三焦的，是两道（有人说这仅指从中道的一脉，但考虑到其出属心包之处，必然自行左右分属）。这是正经的脉络。其支脉，沿胸部，出于胁肋，上至腋下，下行至臂、肘、臂、掌之中，沿着中指指出其末端的，是两道。这虽然是支脉，实则接续正经，而行于手部。又有一条支脉，从掌中别行，沿着无名指出其末端的，是两道。这是交汇经脉的两条小支脉。前文《热论》中说：“烦闷且囊缩”。囊缩，固然是足厥阴肝经的病证。但那烦闷的症状，难道不是手厥阴经的病证吗？盖因手厥阴之脉，循行于胸部，下穿膈肌。现在的烦闷是胸膈间的病证，乃是三焦经络受伤所致，医生们都昏昧而不加考察。
吴院判说：《伤寒论》中，凡是泻心汤共有五首，因为这些汤药有冷热的不同，所以岐伯说：这不是泻心火的火热，而是泻心下部位的痞结。殊不知伤寒病的痞结，都是胸膈间热邪之气有余造成的。张仲景使用泻心汤，其实是泻心包络的热邪。考这五首汤药中，热药没有比附子更过的了。然而其中大黄二两，黄芩、黄连各一两，纯粹是苦寒泻热的药剂。这不过是借附子的辛味，来散除心包络的邪气结聚。而且心包络属火，附子也属火，采用从治的方法，没有比这更妙的了。
《保命集》记载：伤寒攻下之后，胸中结聚痞塞，病位在足少阴肾经和手厥阴心包络经。针刺这两条经脉的井穴和原穴，以泻除胸中的邪气。
王琥根据以上两条论述，那么伤寒病中存在手厥阴经的病证，就毫无疑问了。
王琥总括上文关于手经的六条论述，大凡四季之中，人受寒邪侵袭而发热的病症，也不在少数。热邪伤害手经，按理应当审察证候进行治疗。但现在治疗伤寒的医生，无不认为手六经的证候迂腐阔远而不切合病情。所以遇到手三阳经的证候，混杂在手足三阳经证候中而不知道区分；遇到手三阴经的证候，又混杂在足三阴经传变的证候，以及混杂在胃腑实热的证候中而没有察觉。以至于方剂不对证候，药物多致人死亡，不是很令人痛心吗？我私下考证，《素问》中将伤寒列为热病因由，著录了《热病篇》，又著录了《刺热篇》。这篇内容完全相关，凡是用针的人，不可不考察。其大意说：患心热病的，针刺手少阴经和手太阳经；患肺热病的，针刺手太阴经和手阳明经。又说：热病开始表现为手臂痛的，针刺手阳明经和手太阴经。又说：热病严重的，施行五十九刺法。《甲乙经》说所谓五十九刺，是指两手内外侧各三穴，共十二穴；五指间各一穴，共八穴；足部也是这样。那么刺热病的方法，难道只是刺足经而不刺手经吗？世俗医生不讲求刺法，只求汤药，因此置手经而不讨论。殊不知治疗热病而不知手经，只用药物的方法，往往多有缺漏。怎么可以以此作为医生而掌握他人的性命呢？所以孙思邈在《习业篇》中说：凡是要成为太医，必须精通《甲乙经》、《素问》、《黄帝针经》、《明堂流注》、《十二经》、《三部九候》，做到精熟。这样才算是太医，否则就像盲人夜间行走，动不动就会跌倒摔死。朱奉议也说：凡治疗伤寒，先要认识经络。不认识经络，就是盲目乱行。如今从事医学的人，想要知道伤寒传变和奇异证候，总离不开手足十二经、五脏六腑、阴阳虚实之中。何不在这卷书中用心探究呢？
Tonify its mother organ. Now, however, it is said to tonify its child organ. Why? Wang Bing said: Do you not know that deficiency consumption (Xu Lao) differs from other diseases? The *Qian Jin Fang* records: When Heart Qi is severely exhausted, one should tonify Spleen Qi to benefit it. When Spleen Qi is prosperous, it can sense and nourish the Heart. This is consistent with the meaning of Xunzi's statement that "there is no case where the son is wealthy while the father is poor." (Note: Haizang used Pi Bu Tang (Spleen Tonifying Decoction), assisted by Xiao Chai Hu Tang (Minor Bupleurum Decoction), to resolve body heat and spontaneous sweating. From this, we know that deficiency heat remains in the meridians; therefore, treatment does not focus exclusively on the Zang organs.)
Based on Shang Haicang's medical cases, it is evident that there are indeed diseases of the Hand-Shaoyin Meridian in Shanghan (Cold Damage), which is beyond doubt.
The Pericardium Meridian of Hand-Jueyin originates in the chest, emerges to connect with the Pericardium, descends through the diaphragm, and successively connects with the Triple Burner. (The Pericardium, also known as Shou Xin Zhu (Hand Heart Master). Hua Shou noted: In terms of function, the Hand-Jueyin Ministerial Fire acts on behalf of Sovereign Fire, thus serving as the master of the Heart. In terms of zang-xiang morphology, it is located outside the fat membrane surrounding the heart, connected to the Heart and Lungs by fine fibrous membranes, hence called the Pericardium of the Heart. For the explanation of the Triple Burner, see previous notes. This passage describes the Pericardium Meridian of Hand-Jueyin originating in the chest, emerging to connect with the Pericardium below the heart, descending through the diaphragm, passing the upper epigastrium (Shang Wan) of the stomach to connect with the Upper Burner; passing the middle epigastrium (Zhong Wan) to connect with the Middle Burner; reaching one cun below the umbilicus to connect with the Lower Burner. Hence it is said to "successively connect." Examining the location of the Upper Burner, it should be above the diaphragm below the heart, with its treatment site at Danzhong (CV17). Hua Shou's note stating "at the upper opening of the stomach" is incorrect; it is now corrected to "upper epigastrium," which aligns with "descending through the diaphragm." Since the upper epigastrium is below the diaphragm, although the function of the Upper Burner is primarily above the diaphragm, it actually communicates with the area below the diaphragm.) Its branch follows the chest, emerges from the hypochondrium, descends three cun below the axilla, ascends to reach the axilla, runs along the medial aspect of the arm, travels between the Taiyin and Shaoyin meridians, enters the elbow center, descends along the forearm, runs between two tendons, enters the palm, and follows the middle finger to its tip. (This describes the course of the branch meridian: from the point connecting with the Pericardium, it ascends along the chest, transversely emerges from the hypochondrium three cun below the axilla, returns upward to the axilla, runs along the inner aspect of the arm muscle, descends to lie between the Taiyin and Shaoyin meridians, enters the elbow, descends along the forearm between the two tendons, enters the palm, and follows the middle finger to its tip to terminate.) Another branch separates from the palm, follows the ring finger to its tip. (This refers to the intersecting branch: from the point entering the palm, it separately follows the ring finger to its tip to intersect with the Hand-Sanjiao Meridian.)
[Image: Diagram of the Pericardium Meridian of Hand-Jueyin]
Wang Hu notes: The Pericardium Meridian of Hand-Jueyin divides into six pathways up, down, left, and right. The root of the meridian, originating in the chest, emerging to connect with the Pericardium, and descending through the diaphragm to successively connect with the Triple Burner, constitutes two pathways (Some say this refers only to the single central pathway, but considering where it emerges to connect with the Pericardium, it must divide to connect on both left and right sides). These are the main meridians. The branches that follow the chest, emerge from the hypochondrium, ascend to the axilla, descend to the arm, elbow, forearm, and palm, and follow the middle finger to its tip constitute two pathways. Although these are branch meridians, they essentially connect with the main meridians and run along the hand. Furthermore, the branch that separates from the palm and follows the ring finger to its tip constitutes two pathways. These are the two small branch meridians for intersection. The earlier *Re Lun* (Treatise on Heat Diseases) states: "Vexation, fullness, and retraction of the testicles." Retraction of the testicles is undoubtedly a disease of the Foot-Jueyin Meridian. However, are not vexation and fullness diseases of the Hand-Jueyin Meridian? The Pericardium Meridian of Hand-Jueyin follows the chest and descends through the diaphragm. Vexation and fullness are currently diseases of the chest and diaphragm region, caused by injury to the Sanjiao collaterals. Physicians are often ignorant and fail to examine this.
Wu Yuanpan stated: In the *Shanghan Lun*, there are five formulas of Xiexin Tang (Drain the Epigastrium Decoction). Because these decoctions differ in cold and hot properties, Qibo said: This is not draining the heat of the Heart Fire, but draining the stuffiness (Pi) in the epigastrium. Little do they know that the stuffiness in Shanghan is due to an excess of heat pathogenic qi in the chest and diaphragm. Zhang Zhongjing's use of Xiexin Tang is actually to drain the heat of the Pericardium. Among these five formulas, Fuzi (Aconite Root) is the hottest herb. Yet, the formula contains two liang of Dahuang (Rhubarb Root), and one liang each of Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome), making it purely a bitter-cold agent to drain heat. This merely borrows the acridity of Fuzi to disperse the knotting of pathogenic factors in the Pericardium. Moreover, the Pericardium belongs to Fire, and Fuzi also belongs to Fire; employing the method of following treatment (Cong Zhi), nothing is more exquisite than this.
The *Baoming Ji* records: After purgation in Shanghan, if there is knotted stuffiness in the chest, the pathology lies in the Foot-Shaoyin Kidney Meridian and the Hand-Jueyin Pericardium Meridian. One should puncture the Jing-Well and Yuan-Source points of these two meridians to drain the qi in the chest.
Based on the above two discussions, it is undeniable that there are diseases of the Hand-Jueyin Meridian in Shanghan.
Summarizing the six passages regarding the hand meridians mentioned above, among people affected by cold pathogens and developing heat in all four seasons, such cases are not few. When heat pathogens injure the hand meridians, one should theoretically examine the syndrome and treat accordingly. However, current practitioners of Shanghan treatment consider the syndromes of the hand six meridians to be pedantic and irrelevant to the actual condition. Consequently, when encountering syndromes of the hand three yang meridians, they mix them with foot three yang meridians without realizing it; when encountering syndromes of the hand three yin meridians, they mix them with transmission syndromes of the foot three yin meridians, or with excess heat syndromes of the stomach fu-organs, without noticing. This leads to prescriptions mismatched to syndromes and medicines causing death, which is truly painful. I have privately examined that the *Suwen* classifies Shanghan as a heat disease etiology, recording the *Rebing Pian* (Chapter on Heat Diseases) and the *Ci Re Pian* (Chapter on Puncturing Heat Diseases). This chapter is entirely relevant; those who use acupuncture must investigate it. It briefly states: For Heart heat disease, puncture the Hand-Shaoyin and Hand-Taiyang meridians; for Lung heat disease, puncture the Hand-Taiyin and Hand-Yangming meridians. It also states: For heat disease beginning with arm pain, puncture the Hand-Yangming and Hand-Taiyin meridians. It further states: For severe heat disease, perform the fifty-nine punctures. The *Jia Yi Jing* states that the so-called fifty-nine punctures consist of three points on each side of the hands' outer and inner aspects, totaling twelve points; one point between each of the five fingers, totaling eight points; the feet are similar. Thus, the method of puncturing heat diseases cannot be limited to the foot meridians while neglecting the hand meridians.俗医 (Common physicians) do not study acupuncture methods, seeking only herbal decoctions, thereby ignoring the hand meridians. Little do they know that treating heat diseases without understanding the hand meridians results in omissions in herbal treatment methods. How can one claim to be a physician responsible for human life? Therefore, Sun Simiao in his *Xiye Pian* (Chapter on Professional Study) states: Anyone wishing to become a Grand Physician must be proficient in the *Jia Yi Jing*, *Suwen*, *Huangdi Zhenjing*, *Mingtang Liuzhu*, *Twelve Meridians*, and *Sanbu Jiuhou*. Only then can one be considered a Grand Physician; otherwise, it is like wandering blindfolded at night, inevitably leading to falls and death. Zhu Fengyi also stated: To treat Shanghan, one must first understand the meridians. Without understanding the meridians, one wanders blindly. Those engaged in medicine who wish to understand the transmission and strange syndromes of Shanghan must look to the twelve hand and foot meridians, the five zang and six fu organs, and the concepts of yin-yang and deficiency-excess. Why not devote yourself to studying this volume?